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NU 308 Pharmacology > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

What are indications for Central Nervous System Stimulants and Amphetamines?

A

ADHD
* Conduct disorder
* Narcolepsy
* Obesity
* Shift Work

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2
Q

What are examples of amphetamines?

A

dextroamphetamine (adderall)
methamphetamine
lisdexamfetamine (vyvanse)

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3
Q

What is the action of Central Nervous System
Stimulants and Amphetamines

A

Raise the levels of norepinephrine
and dopamine in the central
nervous system

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4
Q

What is abstinence syndrome?

A

clients abruptly withdraw from a substance they are physically dependen

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5
Q

What major substances are associated with substance abuse disorder?

A

Alcohol
Hypnotics
Caffeine
Anxiolytics
Cannabis
Stimulants
Hallucinogens
Tobacco
Inhalants
Anabolic
Steroids
Opioids
Sedatives

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6
Q

What are s/s of alcohol withdrawal?

A

N/V;
tremors;
restlessness insomnia;
depressed mood or irritability; tachycardia,
HTN,
tachypnea, and
fever;
diaphoresis;
tonic-clonic seizures;
and illusions.

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7
Q

What is the first line treatment for alcohol withdrawal?

A

benzodiasepines like, Chlordiazepoxide, diazepam, lorazepam

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8
Q

What is the antidote for benzos?

A

fumazenil

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9
Q

What meds help with alcohol abstienence? (after withdrawal)

A

disfuliram

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10
Q

What are contraindications for amphetamines?

A

caffiene
MAOIS

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11
Q

What do we teach patients about amphetamines?

A

Do not stop taking medication suddenly.
* Avoid use of OTC medications
* Avoid Caffeine
* Do not use w/in 14 days of MAOIs

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12
Q

What do we educate clients about disulfiram?

A

Be aware of the dangers and potentially fatal reactions of drinking
any alcohol.

Avoid ingesting or applying any products that contain alcohol (cough
syrups, sauces, mouthwash, after-shave lotion, colognes, and hand
sanitizer).

Wear a medical alert bracelet.

Participate in a 12-step self-help program.

Medication effects (potential for acetaldehyde syndrome with alcohol
ingestion) persist for 2 weeks following discontinuation of disulfiram

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13
Q

What is naltrexone?

A

a pure opioid antagonist that suppresses the
craving and pleasurable effects of alcohol (also
used for opioid withdrawal)

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14
Q

What does opioid withdrawal syndrome look like?

mimics other conditions, not happy to be withdrawing

A

agitation,
insomnia,
flu-like manifestations,
rhinorrhea,
yawning,
sweating,
piloerection,
abdominal cramping, and diarrhea.
Manifestations are non-life-threatening, although suicidal ideation can
occur

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15
Q

What is the antidote for opioids?

A

naloxone

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16
Q

What is methadone and what is it used for?

A

an oral opioid agonist that replaces the opioid to which the
client has a physical dependence

It is used for withdrawal and long-term maintenance
 Dependence will be transferred from the illegal opioid to
methadone

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17
Q

Where do clients get methadone?

A

Medication must be administered from an approved treatment
center.

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18
Q

What is bupropion used for?

A

decreases nicotine craving and s/s of withdrawal

also depression

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19
Q

What is varenicline used for?

A

a nicotinic receptor agonist that promotes the release of
dopamine to simulate the pleasurable effects of nicotine.
 Reduces cravings for nicotine as well as the severity of
withdrawal

(nicotine cravings and withdrawal)

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20
Q

What are side effects of varenciline?

A

Can cause neuropsychiatric effects (unpredictable
behavior, mood changes, and thoughts of suicide). Due
to potential adverse effects, varenicline is banned for use
in clients who are commercial truck or bus drivers, air
traffic controllers, or airplane pilots

Unpredictable behavior, mood changes, thoughts of suicide

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21
Q

What is the only indication for irreversable cholinesterase inhibitors?

A

glaucoma

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22
Q

What is an example of irreversable cholinesterase inhibitors?

A

echothiophate

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23
Q

What is the difference in reversable and irreversable cholinesterase inhibitors?

A

rreversible inhibitors (such as echothiophate): The therapeutic effect is long-acting and is highly toxic

Reversible inhibitors: Therapeutic effect lasts for a moderate duration (2 to 4 hours) and is used to treat Alzheimer’s
and Parkinson’s disease and reverse the effects of nondepolarizing neuromuscular blocking agents following surgery

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24
Q

What are s/s of carbidopa/levodopa?

A

N, V, drowsy
Dyskinesias (head bobbing, ticking, grimacing, tremors): decrease dose but PD
Orthostatic hypotension
CV effects from B1 stimulation (tachycardia, palpitations, irregular heartbeat)
Psychosis (visual hallucinations, nightmares, paranoid ideation): with second-gen antipsychotics as they do not
block dopamine. Do not use within 2 weeks of MAOI use.
Discoloration of sweat and urine (harmless)
Activation of malignant melanoma

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25
What are side effects of barbituates like phenobarbital and primidone?
CNS effects  Toxicity: Nystagmus, ataxia, respiratory depression, coma, pinpoint pupils, hypotension, death
26
Are barbituates safe for pregnancy?
no
27
What are major fetal risks with phenytoin?
Pregnancy Cat D  Cleft Palate and heart defects in newborns
28
What is the indication for cyclosporine?
organ transplant
29
What are side effects of phenytoin?
CNS effects  Gingival hyperplasia: Softening and overgrowth of gum tissue, tenderness, and bleeding gums  Cardiovascular effects: dysrhythmias, hypotension Endocrine and other effects: Coarsening of facial features, hirsutism, and interference with vitamin D metabolism
30
What are side effects of lamotrigine?
double/blurred vision n/v dizziness headache skin rash stevens-johnson syndrome cleft lip/palate in fetus
31
What education do we provide a client taking hyxdroychloroquine?
Baseline eye examination and then q 6 mo. w/ophthalmologist
32
What is the side effect of hydroxychloroquine?
Retinal damage (blindness)
33
What are side effects of glucocorticoids like prednisone?
risk of infection osteoperosis adrenal suppression fluid retention GI discomfort GI ulceraiton hyperglycemia hypokalemia
34
What medication is for acute gout attacks?
colchicine
35
What are side effects of colchicine? | lots of tummy problems
Mild GI distress which can progress to GI toxicity: Abdominal pain, diarrhea, nausea, vomiting Thrombocytopenia, suppressed bone marrow Rhabdomyolysis
36
What patient teaching to we provide for colchicine? | related to gout
Prevent gout attacks (avoiding alcohol and foods high in purine [red meat and other foods that seem to precipitate attacks], ensuring adequate water intake, exercising regularly, and maintaining a healthy BMI)
37
What medication is used for chronic gout?
allopurinol
38
What are side effects of allopurinol?
Kidney injury * Hepatitis * GI distress (nausea and vomiting) * Increase in gout attacks during the first months of treatment * Colchicine or an NSAID can be prescribed with allopurinol to prevent this
39
What education do we provide about allopurinol?
Prevent gout attacks (avoiding alcohol and foods high in purine [red meat, and other foods that seem to precipitate attacks], ensuring adequate water intake, exercising regularly, and maintaining a healthy BMI)
40
What are anxiolytics used for?
antianxiety
41
What is the benzo outlier?
chlorodiazepoxide (it isn't like the rest)
42
What is an example of a sedative (hypnotic)?
zolpidem (ambian)
43
What can cause death, and respiratory depression when combined with benzos?
opioids
44
What is an example of an atypical anxiolytic?
buspirone
45
What are side effects of buspirone?
constipation SI
46
What are indications for buspirone? | What mental health conditions?
GAD PTSD OCD
47
What pregnancy cat is buspirone?
B
48
What is the benefit of buspirone?
meant for short term, but useful for up to a year
49
What category drug is amitryptiline?
tryciclic antidepressent
50
What category drug is escitalopram and citalopram?
SSRI
51
What category drug is duloxetine?
SSNRI
52
What category drug is bupropion?
atypical antidepressants
53
What category drug is lithium?
mood stabilizer
54
What are early AE of SSRIs? | no dumb donkeys fight tractors (mneomnic)
nausea diaphoresis drowsiness fatigue tremors
55
What are late AE of SSRIs?
insomnia headache sexual dysfunction
56
what are s/s of serotonin syndrome?
agitation, anxiety, restlessness, disorientation, diaphoresis, hyperthermia, tachycardia, nausea, vomiting, tremor, muscle rigidity, hyperreflexia, myoclonus
57
How do you treat serotonin syndrome?
stop the medication serotonin blockade cooling blankets anticonvulsants artificial ventilation
58
How long can it take TCAs like amytriptyiline to work?
10-14 days Max effects may take 4 to 6 weeks
59
What should you avoid eating with MAOIs?
caffiene chocolate fava beans ginseng (avoid the tyramine stuff)
60
What do we teach patients on lithium?
any exercise or sweating can increase risk of toxicity report tremors
61
What are side effects of lithium?
fine hand tremors lithium toxicity hypothyroidism goiter
62
What class drug are carbamazepin, valproic acid, and lamotrigine?
mood stabilizing antiepileptics
63
What are side effects of carbamazepine? | mean to your blood and babies
blood dyscrasias teratogenesis Dermatitis, rash, and Stevens-Johnson
64
What are side effects of valrpic acid? | harsh on some organs
hepatotoxicity pancreatitis
65
What is carbamazepin contraindicated with? | specific organ disorder
liver disorders
66
Which mood stabilizing antiepileptics are pregnancy cat D?
carbamazepie and valproic acid
67
What is the theraputic range for carbamazepine?
4-12mcg/mL
68
What is the therapeutic range for valproic acid?
50-120mcg/mL
69
What would we teach a patient regarding lamotrigine?
wear sunscreen dosage change may occur if stopping or starting oral contraceptive notifty provider about rashes (could be Stevens Johnson)
70
What are side effects of first gen antipsychotics (chlorpromazine) | Brings you down and impairs some functions
orthostatic hypotension sedation sexual dysfunciton agranulocytosis severe dehydration liver impairment
71
What are drug interactions for antipsychotics (chlorpromazine)
anticholingeric agents- increase anticholingeric effects CNS depressants- additivine CNS effects levodopa- counteracts effects of antipsychotic agents
72
How long does it take antipsychotics to have their effects?
2-4 weeks
73
What are EPS effects of antipsychotics?
acute dystonia tardive dyskinesia parkinsonism
74
What is tardive dyskenesia?
late EPS involuntary movement of tongue
75
What do we do for NMS?
stop antipsychotic med apply cooling blanket administer antipyretic
76
What is the first line treatment for schizophrenia? (for positive and negative symptoms)
2nd gen antipsychotics like risperidone
77
What drugs do we use to treat insomnia?
benzodiazepines typically diazepam
78
What are major uses for benzos?
antianxiety hypnotic anticonulsant pre op sedation acute alcohol withdrawal
79
What non benzos do we use for insomnia?
zolpidem
80
What is a drug holiday?
Martin's example: Children not taking their medicine when school is out
81
What do we monitor for with barbiturates?
Monitor and report manifestations of depression and thoughts of suicide
82
What do we teach patients taking MAOIs?
Avoid taking any medications without the approval of the provider. Dietary and medication restrictions should be continued for 2 weeks after the MAOI has been discontinued Avoid foods that contain these agents (caffeinated beverages, chocolate, fava beans, ginseng) to avoid hypertensive reaction f taking bupropion for seasonal pattern depression, take it beginning in the autumn each year and gradually taper the dose and discontinue by spring. If taking bupropion for seasonal pattern depression, take it beginning in the autumn each year and gradually taper the dose and discontinue by spring.
83
What is the therapeutic range of lithium?
0.6-1.2
84
What happens at lithium levels below 1.5?
diarrhea nausea polyuria fine hand tremors slurred speech lethargy muscle weakness
85
What are adverse effects of lithium levels between 1.5-2.0? | really messes with your mind
GI distress n/v/d mental confusion poor coordination coarse tremors sedation
86
What happens at lithium levels between 2.0-2.5?
extreme polyuria tinnitus involuntary extremity movements blurred vision ataxia seizures coma death
87
What happenes at a lithium level greater then 2.5?
oligura seizures manifestations that lead to coma and death
88
Is phenobarbitol recommended during pregnany?
no
89
What is buprenorphine and what is it used for?
An agonist-antagonist opioid used for withdrawal and maintenance Decreases craving and can be effective in maintaining adherence
90
What are anticholingergic effects?
can’t pee, can’t poop, can’t see, can’t spit
91
What are contraindications for sedative hypnotics?
sleep apnea, respiratory depression, or glaucoma
92
What are s/s of oral toxicity for benzos? | slows your mind down
drowsiness, lethargy, confusion
93
What are s/s of IV toxicity for benzos? | benzos bring you down so theyll do.....
can lead to respiratory depression, severe hypotension, or cardiac/respiratory arrest
94
Where are benzos on the controlled substance scheduling?
IV
95
What are tyramine rich foods?
aged cheese, pepperoni, salami, avocados, figs, bananas, smoked fish, protein dietary supplements, soups, soy sauce, some beers, and red wine
96
What are indications for zolpidem?
insomnia
97
What are side effects of methotrexate?
risk of infection bone marrow suppression oral/stomach ulcers kidney/liver toxicity
98
What pregnancy category is methotrexate?
X
99
What do patients take to help with side effects of methotrexate?
Folic acid/folate/vitamin B9
100
What is a cholinergic crisis?
excessive muscarinica stimulation and respiratory depression from a neuromuscular blockade
101
What can anxiolytics be used for? Other then anxiety
Seizures insomnia muscle spasms alcohol withdrawal induction of anesthesia amnesiac prior to surgery
102
What are side effects of anxiolytics?
CNS depression toxicity withdrawal symptoms anterograde amnesia
103
What are extrapyramidal symptoms?
abnormal body movements that include: involuntary fine motor tremors rigidity uncontrollable restlesness acute dystonias
104
How can you treat EPSs?
anticholinergic meds
105
What are s/s of neuroleptic malignant syndrome?
sudden high grade fever BP changes dysrythmias muscle rigidity diaphoreses tachycardia
106
How do we treat neuroleptic malignant syndrome?
stop antipsychotic meds apply cooling blankets administer antipyretics incrase fluid intake diazepam to control anxiety
107
What is flumazenil used for?
benzo antidote
108
What are s/s of malignant hyperthermia?
muscle rigidity Temp as high as 43C (109.4F)
109
How do we treat malignant hyperthermia?
monitor vitals 100% O2 cooling blanket and ice bags administer dantrolene

NU 308 Pharmacology (23 decks)

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