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My Pharm > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

What are the CNS stimulant drugs?

A
  • amphetamines
  • analeptics, caffeine
  • anorexiants
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2
Q

What is the mechanism of action for amphetamines?

A
  • stimulate the release of the neurotransmitters norepinephrine and dopamine
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3
Q

What are the uses of amphetamines?

A
  • they increase wakefulness in narcolepsy
  • they increase attention span, cognition
  • they decrease hyperactivity, impulsiveness, restlessness of ADHD
  • they cause euphoria (leading to misuse)
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4
Q

Amphetamine drugs are …

A
  • amphetamine (Adderall)
  • dextroamphetamine (Dexedrine)
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5
Q

What are the side effects of amphetamines?

A
  • increased P, BP and palpitations
  • Tachycardia
  • palpations
  • dysrhythmias
  • hypotension
  • anorexia
  • dry mouth
  • weight loss
  • diarrhea
  • constipation
  • impotence
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6
Q

When should amphetamines be given?

A
  • At least 6-8 hours before bed
  • Typically given before morning and noon meals
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7
Q

What is the use of modafinil (Provigil)?

A

It is used for narcolepsy

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8
Q

What is the therapeutic effect of modafinil (Provigil)?

A

It increases the time the patient feels awake. (daytime wakefullness)

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9
Q

What is the use of methylphenidate (Ritalin)?

A
  • Used for ADHD, fatigue, and narcolepsy
  • Increases the effects of dopamine and norepinephrine
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10
Q

What are the interactions of methylphenidate (Ritalin)?

A
  • Caffeine may increase effects
  • Decreased effects of decongestants, antihypertensives, and barbituates
  • may alter insulin effects
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11
Q

What are the adverse reactions of methylphenidate (Ritalin)

A
  • Tachycardia
  • palpitations
  • hypertension
  • weight loss
  • growth suppression
  • thrombocytopenia
  • hepatotoxicity
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12
Q

What are the side effects of modafinil (Provigil)?

A
  • headache
  • nausea
  • diarrhea
  • nervousness
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13
Q

What is are the uses of lidocaine?

A
  • general anesthesia - in conjunction with other anesthesia (propofol) in order to decrease pain associated with injection.
  • local anesthesia - to block pain at the administration site
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14
Q

What is the therapeutic effect of lidocaine?

A

blockage of pain at the site of administration.

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15
Q

What is the therapeutic range of phenytoin (Dilantin)?

What is the level where it becomes toxic?

What are some important nursing interventions?

A
  • 10-20mcg/mL
  • 30-50mcg/mL
  • Monitor CBC’s for early detection of blood dyscrasias
  • May cause anorexia, NV
  • use seizure precautions
  • monitor drug serum levels
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16
Q

What are the side effects of phenytoin?

A
  • HA
  • diplopia
  • dizziness
  • slurred speech
  • decreased coordination
  • alopecia
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17
Q

What are the adverse effects of phenytoin?

A
  • Gingivitis
  • gingival hyperplasia
  • nystagmus
  • Thrombocytopenia
  • Stevens-Johnson syndrome
  • Long-term: hyperglycemia
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18
Q

What should be covered during patient teaching for phenytoin?

A
  • Urine may have a pink or reddish-brown color
  • primrose and borage lower the seizure threshold
  • gingko may decrease phenytoin effectiveness
  • shake solution well
  • may have teratogenic effects - consult before/with pregnancy
  • avoid alcohol and other CNS depressants
  • monitor blood glucose if diabetic
  • DONT STOP ABRUPTLY
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19
Q

For what is phenytoin used?

A

anticonvulsant

prevention of grand mal and partial seizures

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20
Q

What are the uses of Benzodiazepines?

A
  • anxiety
  • insomnia (short-term use)
  • seizures
  • sedation
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21
Q

What is the therapeutic effect of benzodiazepines related to insomnia?

A
  • It is a minor tranquilizer and anxiolytic.
  • Therefore, it induces sleep and reduces anxiety
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22
Q

Which benzodiazepine(s) are used to treat status epilepticus?

A
  • Diazepam**
  • midazolam
  • lorazepam
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23
Q

What are the side effects of benzodiazepines?

A
  • drowsiness
  • loss of muscle coordination
  • behavioral changes
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24
Q

What are the signs of an overdose of benzodiazepines

and what is the antidote?

A
  • Dizziness
  • confusion
  • drowsiness
  • blurred vision
  • unresponsiveness
  • anxiety
  • agitation
  • Antidote is flumazenil (romazicon)
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25
Q

What is the use of valproic acid?

A
  • petit mal
  • grand mal
  • mixed types of seizures
  • bipolar
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26
Q

What are the adverse effects of valproic acid?

A
  • hepatotoxicity
  • Stevens-Johnson syndrome
  • pancreatitis
  • birth defects
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27
Q

What are the side effects of valproic acid?

A
  • NV
  • sedation
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28
Q

What is the therapeutic range for valproic acid?

A

50-100mcg/mL

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29
Q

What labs must be monitored with valproic acid?

A
  • AST
  • ALT
  • Billirubin
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30
Q

For what is carbamazepine (Tegretol) used?

A
  • Grand mal
  • parital seizures
  • trigeminal neuralgia
  • bipolar disorder
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31
Q

What dietary alerts must be communicated to the patient for carbamazepine (Tegretol)?

A
  • Do not take with grapefruit juice
    • it increases drug blood levels by inhibiting enzymes responsible for its breakdown
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32
Q

What are the side effects of carbamazepine (Tegretol)?

A
  • dizziness
  • drowsiness
  • unsteadiness
  • nausea
  • vomiting
33
Q

What are the adverse reactions with carbamazepine (Tegretol)?

A
  • agranulocytosis
  • aplastic anemia
  • thrombocytopenia
  • SJS
34
Q

What is the therapeutic range for carbamazepine (Tegretol)?

A

5-12mcg/mL

35
Q

For what are barbiturates used?

A
  • general anesthesia
  • partial mal
  • grand mal
  • acute episodes of status epilepticus
  • meningitis
  • toxic reactions
  • eclampsia
36
Q

For what is phenobarbital used?

A
  • to prevent grand mal and complex partial seizures
37
Q

What are the side effects of phenobarbital?

A
  • drowsiness
  • dizzyness
  • HA
  • nausea
  • loss of appetite
  • Hangover effect
  • Respiratory depression
38
Q

What are some things to cover during pt teaching for phenobarbital?

A
  • Phenobarbital should be gradually reduced
  • There are risks of sedation so the pt should not drive or operate heavy equipment
  • There is a risk of tolerance and dependency
  • high doses for adults may lead to coma or respiratory depression
  • high doses for older adults and children may cause confusion, depression, irritability.
  • Adverse effects include suicidal ideation.. seek Dr. help!
39
Q

For what is auranofin (Ridaura) used?

A
  • gold therapy for rheumatoid arthritis.
  • slows disease progression and prevents deformities
40
Q

What are the adverse effects of auranofin (Ridaura)?

A
  • diarrhea
  • urticaria
  • dermatitis
41
Q

What are the contraindications for auranofin (Ridaura)?

A
  • hemorrhagic conditions
  • eczema
  • urticaria
  • colitis
  • SLE
42
Q

What are some teaching goals for auranofin (Ridaura)?

A
  • good oral care
  • schedule and monitor lab tests (CBC) for thrombocytopenia
  • report bleeding gums/ blood in stool
  • avoid direct sunlight
43
Q

For what is methadone used?

A
  • Used for weaning program for meth
  • also can be used to decrease severity of pain
44
Q

What is the therapeutic effect of methadone?

A

It suppresses withdrawal symptoms

45
Q

What is drug tolerance?

A

a diminished response to a drug as a result of repeated use and the bodies adaptation to continued presence of the drug.

46
Q

What is dependence?

A

an adaptive state that develops from repeated drug administration, and which results in withdrawal upon cessation of drug use.

47
Q

What is the hangover effect?

A

it is residual drowsiness caused by some CNS depressants (barbiturates, benzodiazepates)

48
Q

What are extrapyramidal symptoms?

A

–Tremors, masklike facies, rigidity, shuffling gait may develop.

49
Q

What is serotonin syndrome?

A

hallucinations, inc HR, inc. temp., loss of coordination, muscle spasms, NVD, and rapid changes in blood pressure

50
Q

What is agranulocytosis?

What are the signs of the condition?

A

failure of bone marrow to make enough WBCs

  • sudden fever
  • chills
  • sore throat
  • weakness in your limbs
  • sore mouth and gums
  • mouth ulcers
  • bleeding gums
51
Q

What is thrombocytopenia?

What are the signs of the condition?

A

is a deficiency of platelets in the blood. This causes bleeding into tissues, bruising, and slow blood clotting after injury.

  • Easy or excessive bruising
  • (petechiae), usually on the lower legs.
  • Prolonged bleeding from cuts.
  • Bleeding from your gums or nose.
  • Blood in urine or stools.
52
Q

What is neutropenia?

A

a count of 1,700 or fewer neutrophils per microliter of blood (adult)

  • asymptomatic beyond increased susceptibility to infection
53
Q

What are the uses for NSAIDS?

A
  • Reduce inflammation and pain
    • rheumatoid and osteoarthritis
  • Not recommended for fever or headaches
    • except aspirin, ibuprofen
54
Q

What are the types of NSAIDs

A
  • First generation
    • Salicylates
    • propionic acid derivatives
    • phenylacetic acid derivatives
  • second generation
    • cox-2 inhibitors
55
Q

What are the side effects of salicylates?

A
  • Tinnitus, hearing loss
  • Dizziness, confusion, drowsiness
  • GI distress, peptic ulcer
  • thirst
  • diarrhea
  • vomiting
56
Q

What are the adverse reactions to salicylates

A
  • Reye’s syndrome (children)
  • Thrombocytopenia
  • leukopenia
  • agranulocytosis
  • hepatotoxicity
  • convulsions
  • cardiovascular collapse
  • coma
  • gastric bleeding
  • bronchospasm
57
Q

What are some nursing interventions for salicylates?

A
  • Check for signs of bleeding or toxicity (tinnitus, visual changes, HA, GI)
  • Don’t take with anticoagulants (coumadin)
  • Discontinue 3-7 days prior to surgery
  • Inform dentist if taking before procedure
  • Do not give to children
  • Take with food
58
Q

What are the side effects of propionic acid derivatives?

A
  • Gastric distress
  • tinnitus
  • ness, confusion
  • edema
  • blood dyscrasias
  • dysrhythmias
  • nephrotoxicity (monitor creatinine clearance)
59
Q

What are the Cox-2 inhibitors and how are they different from non-selective cox inhibitors?

A
  • Celebrex
  • Only affect Cox-2 which decreases inflammation and pain
  • lacks the regulation of blood platelets and GI disturbance from Cox-1
60
Q

What are the therapeutic effects of opioids?

A

pain relief and antitussive (cough suppressant)

61
Q

What are the side effects of opioids?

A
  • Hypotension
  • Sedation
  • Constipation
  • Urinary retention
  • Respiratory depression
  • tolerance and withdrawal symptoms
62
Q

Which opioids are used for moderate vs. severe pain?

A
  • Codeine is for mild to moderate pain
  • Dilaudid and Demerol are used for moderate to severe pain
  • Morphine is for severe pain
63
Q

How long do they take to elicit a therapeutic response (IV vs PO)

A
  • Exact time ??
  • IV almost immediately, PO slower
64
Q

What is the antidote for opioid overdose?

A

naloxone (Narcan)

65
Q

What is the maximum 24 hour dose of acetaminophen?

A

4 grams

66
Q

What are the adverse reactions of clozapine?

A
  • agranulocytosis
  • extrapyramidal symptoms
    • pseudoparkinsonism (seizures, tremors, uncontrolled movements)
67
Q

Which antidepressants do not cause sedation and can be taken before bed?

A

SSRIs and SNRIs

68
Q

Patients taking MAOIs must avoid what foods?

A
  • Those containing tyramine such as
    • cheese
    • cream
    • yogurt
    • coffee
    • chocolate
    • bananas
    • raisins
    • Italian green beans
    • liver
    • pickled foods
    • sausage
    • soy sauce
    • yeast
    • beer
    • red wines
69
Q

The therapeutic range for lithium is

A

0.5-1.5mEq/L

Levels greater than 1.5-2mE/L

70
Q

The normal range for Na in the body is

A

135-145mEq/L

71
Q

What are the side effects of lithium?

A
  • dry mouth
  • thirst
  • increased urination
  • weight gain
  • bloated feeling
  • metallic taste
  • edema of the hands and ankles
72
Q

What lab values must be monitored for a patient taking lithium?

A
  • creatinine
  • AST
  • ALT
  • BUN
  • drug serum levels
  • urine output must be greater than 600ml/day
73
Q

For what is allopurinol used?

A

it is an anti-gout medication

74
Q

What is the mechanism of allopurinol?

A

It inhibits the final steps of uric acid biosynthesis and therefore lowers the serum uric acid levels.

75
Q

What are some teaching goals r/t allopurinol?

A
  • have regular lab tests for renal, liver and CBC fx
  • Increase fluid intake
  • report side effects of anorexia, NV, diarrhea, stomatitis, dizziness, rash, pruritis and metallic taste
  • Have a yearly eye exam
  • avoid alcohol and caffeine
  • Do not take large doses of Vitamin C
  • avoid foods high in purine
  • Report gastric distress
76
Q

What herbal contraindications should be avoided with antidepressants

A
  • St. Johns Wart
  • feverfew
  • MAOIs
    • ginseng
    • ephedra
    • ma-huang
    • anise
    • brewer’s yeast
77
Q

What are the side effects of TCAs (antidepressants)?

A
  • orthostatic hypertension
  • sedation
  • anticholinergic effects (tachycardia, urinary rtn, constipation, dry mouth, blurred vision)
  • cardiotoxicity
  • seizures
  • Amitriptyline - EPS
  • Clomipramine - neuroleptic malignant syndrome
78
Q

What are the side effects of SSRIs

A
  • dry mouth
  • blurred vision
  • insomnia
  • HA
  • nervousness
  • anorexia
  • N
  • Diarrhea
  • suicidal ideation
  • sexual dysfunction
79
Q

What are the side effects of MAOIs

A
  • CNS stimulation
  • orthostatic hypotension
  • anticholinergic effects

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