EXAM 2 meds

Question 1

A-fib treatment

Answer 1

diltiazem, amiodarone, digoxin, metoprolol, esmolol

Question 2

clot prevention

Answer 2

warfarin, dabigatran, rivaroxaban, apixaban

Question 3

PVC’s tx

Answer 3

lidocaine, amiodarone

Question 4

lidocaine

Answer 4

antiarrhythmic
used in urgent treatment
assess for lidocain toxicity: confusion, blurred vision, tremors, n/v, ringing in ears
monitor lidocaine levels via bloodwork

Question 5

diltiazem

Answer 5

CCB, antiarrhythmic
acute care: continuous infusion, maybe bolus before starting infusion
non acute: oral

Question 6

amiodarone

Answer 6

antiarrhythmic
acute: bolus medication, and continuous infusion
non acute- PO
SE: QT prolongation, bradycardia, hypotension

Question 7

digoxin

Answer 7

antiarrhythmic, digitalis glycoside, inotrop
a-fib and heart failure
IVP or PO
toxicity*** bradycardia, hypotension, halos

Question 8

metoprolol

Answer 8

beta blocker
IVP or PO

Question 9

esmolol

Answer 9

beta blocker
IV

Question 10

lithium carbonate

Answer 10

effective for acute mania
blood levels: 0.4-0.8 mEq/L (toxic if >1.5)
contra: renal funcion and thyroid, also liver
decrease NA= toxicity
increased Na= subtheraputic
toxicity: large amount dilute urine, then oliguria, EKG changes, uncoordinated, ataxia, seizures, death, course tremor
Maintenance therapy- 9-12mo/ lifelong

Question 11

anticonvulsant mood stabalizers

Answer 11

valproate (acute phase, prevention from mania)
carbamazepine (druge interactions)
lamotrigine (pregnant, risk SJS)

monitor platlets and liver function

Question 12

second generation antipsychotics

Answer 12

olanzapine
risperidone
aripiprazole
asenaprine
cariprazine
lurasidone
quetiapine
ziprasidone

Question 13

dopamine

Answer 13

inotrope, vasopressor, titrate keep MAP >65
increase CO, SV, HR and contractility (low dose)
increase afterload and BP (high dose)
SE: tachycardia, ectopy, increased SVR, peripheral vasoconstriction, low urine ouptut

Question 14

Norepinephrine

Answer 14

vassopressor, titrate
increase contractility and HR, vasoconstriciton, increase BP, coronary blood flow, increase afterload
SE: tachycardia, increased myocardial oxygen demands, renal/cutaneous/visceral/internal organs vasoconstriction

Question 15

Vasopressin

Answer 15

ADH, set dose infusion
vasoconstriction, increase BP, decreased blood flow to visceral/internal organs, coronary GI, skin, and muscular systems
SE: abdominal cramps, diarrhea, peripheral vasoconstriction
consider: risk of tissue necrosis if extravasation occurs; central line

Question 16

epinephrine

Answer 16

adrenaline, vasopressor, titrate
increased HR, SV< cardiac stimulation icnreaseing myocardial oxygen consumption, increase SVR, vasoconstriction at high doses
SE: arrhythmias, peripheral vasoconstriciton, lower doses can increase cardiac output
consider: necrosis with extravasation, central line, monitor bP and ECG

Question 17

symptoms of serotonin syndrome

Answer 17

delirium
agitation
tachycardia
sweating
myoclonus
hyperreflexia
shivering
coarse tremors
hyperthermia
rhabdomyolysis
renal failure
cardiac dysrhythmias
DIC

Question 18

Tricyclic antidepressants

Answer 18

second line
block reuptake of neurotransmitters serotonin and norepinephrin causing accumulation at the nerve ending- increased neurotransmitters

amitriptaline, nortriptalyne

Question 19

TCA adverse effects

Answer 19

sedation, anticholinergic, impotence, orthostatic hypotension, ataxia
Overdose lethal- may use activated charcoal

Question 20

TCA indications

Answer 20

depression
childhood enuresis
ocd
adjunctive analgesics for chronic pain conditions

Question 21

MAOIs

Answer 21

phenelzine and tranylcypromine
moa: inhibits MAO enzyme
rarely for depression, more Parkinsons
potential cause hypertensive crisis if taken with tyramine (charcuterie board items)

Question 22

second generation antidepressants

Answer 22

SSRI, SNRI, bupropion, NDRI, SDNI
fewer effects then MAOI or TCA
4-6wks to reach maximum clinical effectivnes
highly protein bound

Question 23

second gen antidepressant adverse effects

Answer 23

insomnia, weight gain, anxiety, dizziness, drowsiness, sexual dysfunction, discontinuation syndrome, increased risk bleeding, serotonin syndrom

Question 24

second gen antidepressant indications

Answer 24

depression, BPD, obesity, eating disorders, OCD, pani attacks, social anxiety, PTSD, premenstrual dysphoric disorder, neurologic disorder myoclonus, substance abuse