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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
Q

What are side effects of barbituates like phenobarbital and primidone?

A

CNS effects
 Toxicity: Nystagmus,
ataxia,
respiratory depression,
coma,
pinpoint pupils,
hypotension,
death

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26
Q

Are barbituates safe for pregnancy?

A

no

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27
Q

What are major fetal risks with phenytoin?

A

Pregnancy Cat D
 Cleft Palate and heart defects in newborns

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28
Q

What is the indication for cyclosporine?

A

organ transplant

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29
Q

What are side effects of phenytoin?

A

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

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30
Q

What are side effects of lamotrigine?

A

double/blurred vision
n/v
dizziness
headache
skin rash
stevens-johnson syndrome
cleft lip/palate in fetus

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31
Q

What education do we provide a client taking hyxdroychloroquine?

A

Baseline eye examination and then q 6 mo. w/ophthalmologist

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32
Q

What is the side effect of hydroxychloroquine?

A

Retinal damage (blindness)

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33
Q

What are side effects of glucocorticoids like prednisone?

A

risk of infection
osteoperosis
adrenal suppression
fluid retention
GI discomfort
GI ulceraiton
hyperglycemia
hypokalemia

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34
Q

What medication is for acute gout attacks?

A

colchicine

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35
Q

What are side effects of colchicine?

lots of tummy problems

A

Mild GI distress which can progress to GI
toxicity:
Abdominal pain,
diarrhea,
nausea,
vomiting
Thrombocytopenia, suppressed bone
marrow
Rhabdomyolysis

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36
Q

What patient teaching to we provide for colchicine?

related to gout

A

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)

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37
Q

What medication is used for chronic gout?

A

allopurinol

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38
Q

What are side effects of allopurinol?

A

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

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39
Q

What education do we provide about allopurinol?

A

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)

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40
Q

What are anxiolytics used for?

A

antianxiety

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41
Q

What is the benzo outlier?

A

chlorodiazepoxide (it isn’t like the rest)

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42
Q

What is an example of a sedative (hypnotic)?

A

zolpidem (ambian)

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43
Q

What can cause death, and respiratory depression when combined with benzos?

A

opioids

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44
Q

What is an example of an atypical anxiolytic?

A

buspirone

45
Q

What are side effects of buspirone?

A

constipation
SI

46
Q

What are indications for buspirone?

What mental health conditions?

A

GAD
PTSD
OCD

47
Q

What pregnancy cat is buspirone?

A

B

48
Q

What is the benefit of buspirone?

A

meant for short term, but useful for up to a year

49
Q

What category drug is amitryptiline?

A

tryciclic antidepressent

50
Q

What category drug is escitalopram and citalopram?

A

SSRI

51
Q

What category drug is duloxetine?

A

SSNRI

52
Q

What category drug is bupropion?

A

atypical antidepressants

53
Q

What category drug is lithium?

A

mood stabilizer

54
Q

What are early AE of SSRIs?

no dumb donkeys fight tractors (mneomnic)

A

nausea
diaphoresis
drowsiness
fatigue
tremors

55
Q

What are late AE of SSRIs?

A

insomnia
headache
sexual dysfunction

56
Q

what are s/s of serotonin syndrome?

A

agitation,
anxiety,
restlessness,
disorientation,
diaphoresis,
hyperthermia,
tachycardia,
nausea,
vomiting,
tremor,
muscle rigidity,
hyperreflexia, myoclonus

57
Q

How do you treat serotonin syndrome?

A

stop the medication
serotonin blockade
cooling blankets
anticonvulsants
artificial ventilation

58
Q

How long can it take TCAs like amytriptyiline to work?

A

10-14 days
Max effects may take 4 to 6 weeks

59
Q

What should you avoid eating with MAOIs?

A

caffiene
chocolate
fava beans
ginseng
(avoid the tyramine stuff)

60
Q

What do we teach patients on lithium?

A

any exercise or sweating can increase risk of toxicity
report tremors

61
Q

What are side effects of lithium?

A

fine hand tremors
lithium toxicity
hypothyroidism
goiter

62
Q

What class drug are carbamazepin, valproic acid, and lamotrigine?

A

mood stabilizing antiepileptics

63
Q

What are side effects of carbamazepine?

mean to your blood and babies

A

blood dyscrasias
teratogenesis
Dermatitis, rash, and Stevens-Johnson

64
Q

What are side effects of valrpic acid?

harsh on some organs

A

hepatotoxicity
pancreatitis

65
Q

What is carbamazepin contraindicated with?

specific organ disorder

A

liver disorders

66
Q

Which mood stabilizing antiepileptics are pregnancy cat D?

A

carbamazepie and valproic acid

67
Q

What is the theraputic range for carbamazepine?

A

4-12mcg/mL

68
Q

What is the therapeutic range for valproic acid?

A

50-120mcg/mL

69
Q

What would we teach a patient regarding lamotrigine?

A

wear sunscreen
dosage change may occur if stopping or starting oral contraceptive
notifty provider about rashes (could be Stevens Johnson)

70
Q

What are side effects of first gen antipsychotics (chlorpromazine)

Brings you down and impairs some functions

A

orthostatic hypotension
sedation
sexual dysfunciton
agranulocytosis
severe dehydration
liver impairment

71
Q

What are drug interactions for antipsychotics (chlorpromazine)

A

anticholingeric agents- increase anticholingeric effects
CNS depressants- additivine CNS effects
levodopa- counteracts effects of antipsychotic agents

72
Q

How long does it take antipsychotics to have their effects?

A

2-4 weeks

73
Q

What are EPS effects of antipsychotics?

A

acute dystonia
tardive dyskinesia
parkinsonism

74
Q

What is tardive dyskenesia?

A

late EPS
involuntary movement of tongue

75
Q

What do we do for NMS?

A

stop antipsychotic med
apply cooling blanket
administer antipyretic

76
Q

What is the first line treatment for schizophrenia? (for positive and negative symptoms)

A

2nd gen antipsychotics like risperidone

77
Q

What drugs do we use to treat insomnia?

A

benzodiazepines
typically diazepam

78
Q

What are major uses for benzos?

A

antianxiety
hypnotic
anticonulsant
pre op sedation
acute alcohol withdrawal

79
Q

What non benzos do we use for insomnia?

A

zolpidem

80
Q

What is a drug holiday?

A

Martin’s example: Children not taking their medicine when school is out

81
Q

What do we monitor for with barbiturates?

A

Monitor and report manifestations of
depression and thoughts of suicide

82
Q

What do we teach patients taking MAOIs?

A

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
Q

What is the therapeutic range of lithium?

A

0.6-1.2

84
Q

What happens at lithium levels below 1.5?

A

diarrhea
nausea
polyuria
fine hand tremors
slurred speech
lethargy
muscle weakness

85
Q

What are adverse effects of lithium levels between 1.5-2.0?

really messes with your mind

A

GI distress
n/v/d
mental confusion
poor coordination
coarse tremors sedation

86
Q

What happens at lithium levels between 2.0-2.5?

A

extreme polyuria
tinnitus
involuntary extremity movements
blurred vision
ataxia
seizures
coma
death

87
Q

What happenes at a lithium level greater then 2.5?

A

oligura
seizures
manifestations that lead to coma and death

88
Q

Is phenobarbitol recommended during pregnany?

A

no

89
Q

What is buprenorphine and what is it used for?

A

An agonist-antagonist opioid used for
withdrawal and maintenance

Decreases craving and can be effective in
maintaining adherence

90
Q

What are anticholingergic effects?

A

can’t pee, can’t poop, can’t see,
can’t spit

91
Q

What are contraindications for sedative hypnotics?

A

sleep apnea, respiratory depression, or glaucoma

92
Q

What are s/s of oral toxicity for benzos?

slows your mind down

A

drowsiness, lethargy, confusion

93
Q

What are s/s of IV toxicity for benzos?

benzos bring you down so theyll do…..

A

can lead to respiratory depression, severe
hypotension, or cardiac/respiratory arrest

94
Q

Where are benzos on the controlled substance scheduling?

A

IV

95
Q

What are tyramine rich foods?

A

aged cheese, pepperoni,
salami, avocados, figs, bananas, smoked fish, protein dietary supplements, soups, soy sauce, some beers,
and red wine

96
Q

What are indications for zolpidem?

A

insomnia

97
Q

What are side effects of methotrexate?

A

risk of infection
bone marrow suppression
oral/stomach ulcers
kidney/liver toxicity

98
Q

What pregnancy category is methotrexate?

A

X

99
Q

What do patients take to help with side effects of methotrexate?

A

Folic acid/folate/vitamin B9

100
Q

What is a cholinergic crisis?

A

excessive muscarinica stimulation and respiratory depression from a neuromuscular blockade

101
Q

What can anxiolytics be used for?
Other then anxiety

A

Seizures
insomnia
muscle spasms
alcohol withdrawal
induction of anesthesia
amnesiac prior to surgery

102
Q

What are side effects of anxiolytics?

A

CNS depression
toxicity
withdrawal symptoms
anterograde amnesia

103
Q

What are extrapyramidal symptoms?

A

abnormal body movements that include:
involuntary fine motor tremors
rigidity
uncontrollable restlesness
acute dystonias

104
Q

How can you treat EPSs?

A

anticholinergic meds

105
Q

What are s/s of neuroleptic malignant syndrome?

A

sudden high grade fever
BP changes
dysrythmias
muscle rigidity
diaphoreses
tachycardia

106
Q

How do we treat neuroleptic malignant syndrome?

A

stop antipsychotic meds
apply cooling blankets
administer antipyretics
incrase fluid intake
diazepam to control anxiety

107
Q

What is flumazenil used for?

A

benzo antidote

108
Q

What are s/s of malignant hyperthermia?

A

muscle rigidity
Temp as high as 43C (109.4F)

109
Q

How do we treat malignant hyperthermia?

A

monitor vitals
100% O2
cooling blanket and ice bags
administer dantrolene

NU 308 Pharmacology (23 decks)

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