Exam 2 Big Picture Flashcards
Alzheimer’s Medication Prototypes
donepezil (Aricept)
memantine (Namendal)
donezepil (Aricept) interactions and symptoms of interaction
NSAIDS increase risk of GI bleeding leading to:
coffee ground or bloody stools and emesis
dizziness
donepezil (Aricept) patient education
Take at bedtime due to drowsy side effects
Monitor for bradycardia, if HR < 60 contact provider
memantine (Namendal) interactions
Foods that alkalinize urine
e.g. citrus, vegetables
memantine (Namendal) adverse and side effects
Hepatic Impairment
Renal Impairment
Heart Failure
Migraine prototype
sumatriptan (Imitrex)
sumatriptan (Imitrex) contraindications
History of MI or Stroke
Risk for CAD/PAD (menopausal women or men over 40)
sumatriptan (Imitrex) interactions
Serotonin-supporting drugs
e.g. St. John’s Wort, SSRI, MAOI
sumatriptan (Imitrex) toxicity name and effects
Serotonin syndrome
Neuromuscular Excitation (tremors, hyperreflexia)
Autonomic Nervous System dysfunction (Elevated BP/HR, fever, flushing, headache)
Altered Mental Status (confusion)
Seizure Disorder Prototypes
phenytoin (Dilantin)
carbamazepine (Tegretol)
valporic acid (Depakote)
gabapentin (Neurontin)
Seizure Medication adverse and side effects
Hepatic Impairment Renal Impairment Pancreatits Depression Blood Dyscrasia
phenytoin (Dilantin) patient education and considerations
IV Slowly
No tylenol/alcohol
Don’t stop suddenly
phenytoin (Dilantin) therapeutic range
10-20 mcg/mL
carbamazepine (Tegretol) thereputic range
4-12 mcg/mL
valproic acid (Depakote) therapeutic range
50-100 mcg/mL
carbamazepin (Tegretol) patient education/considerations
Use different BC
XR Coating can appear in stool
Report signs of fever/infection
Do not take if pregnant
valproic acid (Depakote) patient education/considerations
Report signs of fever/infection
Use other forms of BC
No Alcohol (CNS Depression)
gabapentin (Neurontin) summary
Adjunct drug with others can cause depression no alcohol take at bedtime ALSO USED FOR DIABETES/NEUROPATHY
Centrally Acting Depressant/Relaxant Prototype
baclofen (Lioresal)
baclofen (Lioresal) indication/contraindications
Muscle Spasms
Renal Impairment
baclofen (Lioresal) patient education/considerations
Fast onset, slow half-life Taper off Fall risk/side effects taper with use IV Via baclofen pump Monitor for CNS depression
Peripherally Acting Depressant/Relaxant Prototype
dantrolene (Dantrium)
dantrolene (Dantrium) indications/contraindications
Muscle Spasms, -Malignant Hyperthermia-
Liver Impairment
dantrolene (Dantrium) patient education/considerations
Oral for spasms, injectible for Malignant Hyperthermia
Monitor for hepatotoxicity, diarrhea
CNS Depression
Sedative/Hypnotic Prototype
zolpidem (Ambien)
zolpidem (Ambien) patient education/considerations
Black Box Warning: Complex sleep-behaviours
Binds to same receptor as Benzos
Must set aside 7-8 hours for sleep
Short-Acting Anesthesia Prototype
propofol (Diprivan)
propofol (Diprivan) overview
Fast acting used to induce and during procedures
Fast onset, renal and liver tolerable
Overdose reduces bp
Burns when injected
Benzodiazepine Anesthesia Prototype
midazolam (Versed)
midazolam (Versed) overview
Primary sedation
Education must be in writing due to amnesia effect
Opioid anesthesia prototype
fentanyl (Duragesic & Actiq)
fentanyl (Duragesic & Actiq) overview
Very fast onset (30s - 1m)
High potential for abuse
Risk of nausea
Anesthetic Overview
Contraindicated by pregnancy
Interacts with CNS Depressants (ETOH, Opioids, Benzos) sometimes for benefit
Airway is primary importance
Risk of Resp. Dep
Neuromuscular Blocker Prototype
succinylcholine (Anectine & Quelicin)
succinylcholine (Anectine & Quelicin) overview
Paralyzes smooth & skeletal muscles for induction and intubation
Risk of malignant hyperthermia
Extended use can cause spasms
Can cause Hyperkalemia
Local Anesthesia Prototype
lidocaine (Xylocaine)
lidocaine (Xylocaine) overview
Blocks nerve conudction in peripheral nervous system
Can cause “spinal headache”
Stimulant Prototypes
amphetamine/dextroamphetamine (Adderall)
methylphenidate (Ritalin/Concerta)
amphetamine/dextroamphetamine (Adderall) Administration Overview
Increases effectes of norepinephrine and dopamine in CNS
Treats ADHD & Narcolepsy
Do not use in uncontrolled hypertension
amphetamine/dextroamphetamine (Adderall) patient education/considerations
AE/SE: Inc. HR/BP, anxiety, insomnia, dry mouth, wt loss, dysrhythminas
Must taper off
Take in the morning
Take drug holiday (M-F, off weekends) to reduce AE and lower tolerance
methylphenidate (Ritalin/Concerta) considerations
Transdermal 9 hour patch
High potential for abuse
Non-amphetamine stimulant prototype
modafinil (Provigil)
modafinil (Provigil) considerations
For drowsiness/daytime sleepiness (night shift)
Interacts with contraceptives, warfarin, phenytoin
Antiparkinson Drug Prototypes
levodopa/carbidopa (Sinemet)
selegiline (eldepryl)
levodopa/carbidopa (Sinemet) contraindications
glaucoma
undiagnosed skin conditions (can activate malignant melanoma)
levodopa/carbidopa (Sinemet) adverse/side effects and interactions
reduced bp orthostatic hypotension constipation dyskenesia darkened sweat and urine B6 reduces effectiveness
levodopa/carbidopa (Sinemet) patient education/considerations
change positions slowly, take on empty stomach, avoid high protein, monitor for constip.
watch for “on/off” phenomenon, “wearing off” phenomenon, fall precautions, monitor bp
selegiline (Eldepryl) overview
contraindications for everything
caution for orthostatic hypotension
interacts with tyramine in Chun foods
take as early in day as possible
pramipexole (Mirapex) overview
indicates for RLS
start low and slow
watch for orthostatic BP, GI Upset
avoid CNS depressants
Glucocorticoid Prototypes
methylpredislone (Solu-medrol)
prednisone (Deltasone)
Glucocorticoid contraindications
Diabetics (increased glucose)
Osteoperosis (bone demineralization)
Transplant patients/Active Infections/Autoimmune (Immunosuppressant)
Petpic Ulder/Gastritis (GI Distress from inhibited prostiglandin)
Glaucoma (increases intraocular pressure/causes cateract)
Glucocorticoid Education/Consideration
Monitor for contraindications, high cortisol = moon face
Avoid Non-K+ Sparing Diuretics, NSAIDs, anti-diabetic drugs live vaccines
Must taper due to adrenal crisis
Antigout/Antihyperuricemic Prototype
allopurinol (Zyloprim)
allopurinol (Zyloprim) overview
Reduces production of uric acid
Monitor WBC, Anemia
Interacts with warfarin - too much blood thinning
Metallic taste is normal
