2820 Pharmacology Exam Four Flashcards
1
Q
haloperidol: therapeutic use
A
acute and chronic psychotic disorders
2
Q
why is haloperidol often used at the end of life?
A
because some patients develop agitation and delirium as they near death
3
Q
lorazepam: action
A
potentiates the effect of GABA to reduce neuronal excitability
4
Q
why might lorazepam be administered as patients approach death?
A
because patients nearing death may become anxious and restless due to dyspnea, pain, etc.
5
Q
lorazepam: class
A
sedative hypnotic
6
Q
ondansetron/zofran: action
A
blocks serotonin receptors in GI tract and the chemoreceptor trigger zone in the brain
7
Q
why might zofran be given in the end of life process?
A
to help with nausea and vomiting (often due to pain, fear, or the side effects of other drugs)
8
Q
what are adverse effects associated with zofran?
A
headache dizziness drowsiness constipation diarrhea
9
Q
why is constipation often an issue at the end of life?
A
not eating well
lack of mobility
side effect of other medications
10
Q
action of bulk forming laxatives
A
contain fiber to absorb water and increase the size of the fecal mass
11
Q
why must patients drink plenty of water with bulk forming laxatives?
A
because there has to be enough water in the system for the drugs to pull it into the colon
12
Q
saline cathartics are also known as
A
osmotic laxatives
13
Q
how do saline cathartics work?
A
they pull water into the fecal matter to create more watery stool
14
Q
why should saline cathartics not be used on a regular basis?
A
they can produce very rapid bowel movements, leading to dehydration and electrolyte imbalance
15
Q
how do stimulant laxatives work?
A
they promote peristalsis by irritating bowel mucosa
16
Q
surfactant laxatives are also known as
A
stool softeners
17
Q
how do surfactant laxatives work?
A
they cause more water and fat to be absorbed into the stool to make it softer
18
Q
what are surfactant laxatives most often used for?
A
preventing constipation in patients who recently had surgery or are at higher risk for constipation
19
Q
how do herbal agents such as senna work in managing constipation?
A
they irritate the bowel to increase peristalsis
20
Q
when is morphine often given to help with dyspnea?
A
when dyspnea is due to heart failure, pulmonary edema, or during the end of life process
21
Q
why is it theorized that morphine helps with dyspnea?
A
not fully understood, but might be due to it vasodilating pulmonary vasculature
22
Q
why is secretion control important during end of life processes?
A
because patients have increased secretions and decreased coughing and swallowing to deal with them
23
Q
scopolamine: class
A
anticholinergic
24
Q
why is scopolamine effective in controlling secretions?
A
it blocks cholinergic responses (such as salivation and bronchial secretions) allowing sympathetic responses to dominate
25
What happens when penicillin weakens the bacterial cell wall?
It allows water to enter, killing the organism
26
What type of bacteria are most commonly affected by penicillins?
Gram positive (streptococcus and staphylococcus)
27
What are some infections for which penicillin is indicated?
Pneumonia
Meningitis
Skin, bone, joint, stomach, blood, and heart valve infections
28
What are two broad spectrum antibiotics?
Ampicillin and amoxicillin
29
What is the primary advantage of extended-spectrum antibiotics like piperacillin?
Activity against Pseudomonas auruginosa, which causes many HAIs and can be hard to treat
30
Why is penicillin G only given IV or IM?
It is poorly absorbed (only 15%) if given orally
31
What is the most serious adverse effect of penicillin G?
Anaphylaxis
32
What effect does penicillin G have on oral contraceptives?
Decreases effectiveness
33
What is the primary use of cephalosporins?
Gram negative bacteria or for use in patients who cannot tolerate less expensive penicillins
34
How are cephalosporins classified?
By generations (first through fifth generation)
35
Examplar cephalosporin
Cefazolin (ancef)
36
What cases or infections call for the use of cefazolin?
Respiratory, urinary, skin, biliary tract, bone, or joint infections
Also commonly used prophylactically before surgery
37
Why is cefazolin one of the most frequently prescribed parenteral antibiotics?
Longer half life, so less frequent dosing is necessary
38
What is a primary contraindication for cefazolin?
Previous severe allergic reaction to penicillin
39
What do carbapenems do?
Inhibit bacterial cell wall construction
40
Carbapenem exemplar drug
Imipenem
41
Why is imipenem the most widely prescribed carbapenem?
It has the broadest antimicrobial spectrum of any antibiotic
42
What is imipenem always combined with and why?
Cilastatin to increase serum levels of the dose
43
What types of infection is vancomycin reserved for?
Severe gram positive infections
44
Which bacterial infection is vancomycin most effective in treating?
MRSA
45
What is a serious adverse effect of vancomycin?
Ototoxicity
46
What lab work is done after three doses of vancomycin?
Peak and trough doses
47
What reaction can occur with rapid IV administration of vancomycin?
Red man syndrome (large amounts of histamine released)
48
What are common signs and symptoms of red man syndrome?
```
Hypotension
Flushing
Red rash
Increased heart rate
N/V
Dizziness
Fainting
Muscle weakness
```
49
What is the mechanism of action for tetracyclines?
Binding to bacterial ribosomes to slow microbe growth and exert a bacteriostatic effect
50
Why is therapeutic utility of tetracyclines limited?
Many bacterial strains are now resistant to it because it used to be very widely prescribed
51
Why should PO tetracyclines not be taken with milk or iron supplements?
They bind metals like calcium and iron, which can decrease absorption by up to 50%
52
What dermatological manifestation can occur with tetracyclines?
Severe photosensitivity
53
Why should patients younger than eight not be given tetracyclines unless absolutely necessary?
May cause permanent yellow-brown discoloration of teeth
54
What is the first macrolide antibiotic?
Erythromycin
55
For what illnesses is a macrolide indicated?
Whooping cough
Legionnaires disease
H. Influenza
M. Pneumoniae
56
For which infection is fidaxomicin specifically approved?
C. Diff
57
What types of infections are aminoglycosides reserved for? Give an example
Serious systemic gram negative infections like e. Coli
58
Why are aminoglycosides given parenterally?
They are poorly absorbed from the GI tract
59
For what types of infections are gentamicin given?
Serious urinary, respiratory, nervous, or GI infections
60
What are four serious adverse effects that gentamycin can cause?
Neurotoxicity
Neuromuscular blockade
Respiratory paralysis
Nephrotoxicity
61
Why must patients take antitubercular drugs for 6-12 months?
Because the microorganisms are very slow growing and it takes that long for the meds to reach the microorganisms isolated in the tubercules
62
What is the most effective way to ensure adherence to antitubercular drugs?
Directly observed therapy
63
Why is multiple drug therapy necessary for mycobacterium infections?
Resistance is common and mycobacterium grow slowly
64
When is chemoprophylaxis for TB indicated?
Close contact with actively infected patients or for susceptible immunocompromised patients
65
What is an example of an antitubercular drug?
Isoniazid (INH)
66
Why is isoniazid a first line drug to treat TB?
High safety profile and very effective
67
When should isoniazid be administered?
On an empty stomach (either one hour before or two hours after a meal)
68
What serious adverse issue can isoniazid cause?
Hepatotoxicity
69
What are some signs of hepatotoxicity?
Jaundice
Fatigue
Increased liver enzymes
Appetite loss
70
What is amphotericin B?
An anti fungal drug
71
What types of infections is amphotericin used for?
Serious systemic fungal infections
72
By what route is amphotericin given?
IV
73
Why must amphotericin be given slowly?
Risk of cardiovascular collapse if infused slowly
74
What adverse effects may patients experience at the beginning of treatment with amphotericin B?
Fever, chills, vomiting, and headache, but will go away as treatment is continued
75
In what areas do protozoal/non-malarial infections occur most frequently?
Those with poor public sanitation and high population density
76
What is a common antiprotozoal drug?
Metronidazole (flagyl)
77
What are indications of use for metronidazole?
Nonmalarial protozoal infections (amebiasis, giardiasis, trichomoniasis)
Respiratory, bone, skin, and CNS infections (also has antibiotic properties)
78
What adverse effects of metronidazole could impact a patients nutrition?
Dry mouth and metallic taste in mouth
79
What is the black box warning for metronidazole?
It is carcinogenic in lab animals
80
What infections make up the herpesvirus family?
```
HSV 1
HSV 2
CMV
Varicella-zoster virus
Epstein Barr
Herpesvirus type 6
```
81
What occurs following initial entrance of a herpesvirus into the body?
It may remain latent for many years
82
What conditions can promote replication of a herpesvirus?
Immunosuppression
Physical challenges
Emotional stress
83
What is an exemplar drug in the antiviral family?
Acyclovir
84
Against which infections is acyclovir most effective?
HSV 1 and 2
| In larger doses, CMV and varicella-zoster
85
How does acyclovir decrease duration and severity of acute herpes episodes?
It prevents viral DNA synthesis (but does not cure the patient)
86
what is the general action of psychotropic medications?
either increasing or decreasing the activity of certain neurotransmitters
87
what are the four levels of anxiety?
mild
moderate
severe
panic
88
alprazolam and clonazepam: class
benzodiazapines
89
alprazolam/clonazepam: action
enhances the effects of GABA in the CNS (inhibits CNS)
90
alprazolam/clonazepam: use
rapid relief of anxiety in anxiety disorders
91
alprazolam/clonazepam: adverse effects
```
amnesia
sedation/drowsiness/lethargy
paradoxical effect
dependence
toxicity
```
92
what should patients be advised to not use with alprazolam or clonazepam?
alcohol
opioids
grapefruit juice
CNS depressants
93
nursing considerations for alprazolam/clonazepam?
for short term use only due to dependence risk
monitor for toxicity and paradoxical response
initiate fall precautions
94
paroxetine: class
SSRI
95
paroxetine: action
selectively inhibits serotonin receptors to increase serotonin levels
96
paroxetine: use
```
long term treatment of anxiety disorder
OCD
panic disorder
depression
PTSD
```
97
how long does it take for paroxetine to reach full therapeutic effects? why?
4 weeks because it has a very long half life
98
paroxetine: adverse effects
```
sexual dysfunction
insomnia
somnolence
headache
nervousness
serotonin syndrome
suicidal ideation
drowsiness
```
99
nursing considerations for paroxetine
```
give with food
monitor for suicidal thoughts or actions, especially at start of treatment
take in morning to prevent insomnia
monitor for serotonin syndrome
do not discontinue suddenly
```
100
what is a benefit of SSRI's over TCAs?
less anticholinergic and cardiac effects
101
citalopram: class
SSRI
102
how long can citalopram take to reach full effectiveness? why?
1-3 weeks due to long half life
103
citalopram: use
```
generalized anxiety disorder
major depressive disorder/other depressive disorders
PTSD
OCD
bulimia
panic and social anxiety disorder
```
104
citalopram: adverse effects
```
sexual dysfunction
serotonin syndrome
insomnia
headache
nervousness
suicidal ideation
drowsiness
```
105
citalopram: nursing considerations
don't discontinue suddenly (taper dose slowly)
monitor for serotonin syndrome and suicidal ideation
give in the morning
avoid caffeine
106
how soon after dosing can serotonin syndrome occur?
between 2-72 hours, but usually occurs at around 24 hours
107
what are some signs and symptoms of serotonin syndrome?
```
agitation/restlessness
confusion
increased HR and BP
dilated pupils
muscle twitching or lack of muscle control
muscle rigidity
fever
sweating
diarrhea
fever
seizures
shivering
```
108
venlafaxine: class
SNRI
109
venlafaxine: action
blocks the reuptake of serotonin and norepinephrine at the synaptic space, leaving more at the neuron junction
110
venlafaxine: use
major depressive disorder (primary)
| also panic disorders and can be used as adjuvant pain medication
111
venlafaxine: adverse effects
```
bizarre dreams
sweating
loss of appetite and weight loss
serotonin syndrome
dry mouth
n/v
```
112
venlafaxine: nursing considerations
taper slowly when discontinuing
administer in the morning
avoid caffeinated beverages
monitor for serotonin syndrome and other side effects
113
trazadone: class
atypical antidepressant
114
trazadone: action
alters effect of serotonin in CNS
115
trazadone: use
major depression
alternative for patients who cannot tolerate SSRIs/SNRIs
smoking cessation
116
trazadone: adverse effects
```
headache
dry mouth
drowsiness
serotonin syndrome
GI distress/constipation
insomnia
BP changes
```
117
trazadone: nursing considerations
taper slowly
monitor for serotonin syndrome
do not take with alcohol
118
amitriptyline: class
tricyclic antidepressant
119
amitripyline: action
blocking reuptake of serotonin and norepinephrine
120
amitriptyline: use
major depression
depressive episodes of bipolar
fibromyalgia and neuropathic pain
anxiety and OCD
121
amitriptyline: adverse effects
anticholinergic effects
hypertension
toxicity
decreased seizure threshold
122
amitriptyline: contraindications
past history of MI, asthma, GI disorders, or alcoholism
123
amitriptyline: nursing considerations
monitor BP and HR
| tell client to avoid alcohol and other CNS depressants
124
lithium: class
mood stabilizer
125
lithium: action
producing neurochemical changes in the brain, including serotonin receptor blockade
126
lithium: use
control of acute manic episodes in bipolar
| prevention of return of mania or depression in bipolar
127
lithium: adverse effects
```
GI distress
fine hand tremors
polyuria
thirst
weight gain
renal toxicity
hypothyroidism
hypotension
hyponatremia
lithium toxicity
```
128
what does lithium act like in the body?
a salt
129
lithium: nursing considerations
administer with milk or food
limit caffeine
maintain adequate fluid and sodium intake
monitor thyroid hormone levels
monitor lithium levels (narrow therapeutic index)
healthy diet/weight control
130
valproic acid: class
mood stabilizer/antiepileptic
131
valproic acid: action
slows entrance of sodium and calcium back into cell
potentiates effects of GABA
inhibits glutamate to suppress CNS
132
valproic acid: use
treats and prevents relapse of mania and depression in bipolar disorder
133
valproic acid: adverse effects
```
dizziness
ataxia
somnolence
headache
blurred vision
drowsiness
prolonged bleeding
hepatotoxicity
pancreatitis
```
134
valproic acid: nursing considerations
```
monitor amylase
monitor liver enzymes
monitor platelet counts
watch for weight gain
administer at bedtime
should not be taken in pregnancy
```
135
definition of physical dependence
a state in which abstinence syndrome will occur if use is discontinued
136
tolerance
particular dose of a drug eliciting less of a response due to repeated use of a drug
137
addiction
a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.
138
psychological dependence
intense subjective need for a particular psychoactive drug
