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Pharmacology II > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Mechanism of Action: Levodopa

A

reduces symptoms by increasing dopamine synthesis in the striatum

Has no direct effects on its own, converted to dopamine (active form)

as dopamine, levodopa restores a proper balance between dopamine and acetylcholine.

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2
Q

Adverse effects: Levodopa

A

dyskinesias, nausea & vomiting, postural hypotension, dysrhythmias, psychosis, CNS effects (anxiety, agitation, etc.), dark urine and sweat.

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3
Q

Facts about absorption: Levodopa

A
  • undergoes rapid absorption form small intestine
  • Food delays absorption by slowing gastric emptying
  • High protein foods will reduce therapeutic effects
  • Most is metabolized in the periphery which only lets a small fraction go to the brain.
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4
Q

Mechanism of Action: Carbidopa

A

inhibits decarboxylation of levodopa in the intestine and peripheral tissues which allows levodopa to be more available to the CNS.

Does not prevent the conversion of levodopa to dopamine by decarboxylases in the brain because carbidopa is unable to cross the blood brain barrier.

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5
Q

Therapeutic uses: Benztropine

A

Parkinson’s disease to decrease tremors and muscle rigidity

***NOT bradykinesia

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6
Q

Mechanism of Action: Donepezil

A

Increases ACh (by inhibiting cholinesterase), which may improve memory and cognition

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7
Q

Therapeutic benefits: Donepezil

A
  • Mild - severe Alzheimer’s symptoms
  • improves quality of life of cognitive function

Also approved for severe symptoms

Improvements are modest and last a short time & only benefits half of patients.

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8
Q

Dosing Specifics: Donepezil

A
  • Should be carefully titrated and treatment should continue as long as clinically indicated
  • Highest doses produces greatest benefits, but the most intense side effects.
  • Dosages should be **low intitially **and gradually increased
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9
Q

Mechanism of Action: Interferon Beta

A
  • Inhibits the migration of proinflammatory leukocytes across the blood brain barrier, preventing these cells from reaching neurons of the CNS
  • Suppresses T-helper cell activity
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10
Q

Therapeutic uses: Interferon Beta

A
  • Relapsing forms of MS
  • Decrease the frequency and severity of attacks redice the number and size of MRI detectable lesions, and delay the progression of disability
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11
Q

Side effects/Adverse effects of Interferon beta

A

* Flu- like reactions (Headache, fever, chills, malaise, muscle aches, and stiffness)
* **Hepatotoxicity* *(liver damage)
* **Myelosuppression **(suppresses bone marrow fx)
* **Injection site reactions **
* Depression
* Neutralizing antibodies

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12
Q

Nursing Management of SE: Inteferon Beta

A
  • Apply ice packs for 2-3 min at injection site
  • rotate injection site
  • use benadryl or topical hydrocortisone sparingly to reduce erythema and itching
  • give acetaminophen or ibuprofen if flu like symptoms occur.
  • begin with low dose then titrate up
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13
Q

Mechanism of Action: Mitoxantrone

A

Suppresses the production of immune system cells (B lymphocytes, T lymphocytes, and macrophages) and thereby decreases autoimmune destruction of myelin.

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14
Q

Nursing assessments: Mitoxantrone

A
  • Liver function test baseline and a pregnancy test before each dose
  • perform complete blood counts at baseline and before each dose
  • Determine left ventricular ejection fraction
    -before the first dose
    -before all doses after cumulative dose has been reached
  • whenever signs of congestive heart failure develop
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15
Q

Dosing: Mitoxantrone

A

IV solution: 2mg/ml (12mg every 3 months)
Hazardous agent: check for leaking at IV site
Do not mix with other drugs

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16
Q

Mechanism of Action: Phenytoin

A

Selective inhibition of sodium channels— as a result the drug suppresses activity of seizure-generating neurons but leaves healthy neurons unaffected

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17
Q

Teaching about taking/stopping: Phenytoin

A
  • Take with or immediately after a meal to reduce gastric upset
  • oral suspension mix: mix well before dispensing to avoid uneven dosing
  • enteral feedings: withhold feddings an hour before and after administration
  • give prophylactic vitamin K to mother for 1 month before and during delivery
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18
Q

Side effects/Adverse effects and Teaching: phenytoin

A
  • CNS: vision issues, ataxia, etc.
    * gingival hyperplasia
  • Dertmatologic effects: measles-like rash
  • effects in pregnancy
  • cardiac dysrhythmias
  • hypotension
    * purple glove syndrome
19
Q

Drug interactions: Phenytoin

A
  • Hepatic drug metabolizing enzymes
  • drugs that increase plasma levels of phenytoin (diazepam, cimetidine, alcohol)
  • drugs that decrease plasma levels (carbamazepine, phenobarbital, and alcohol)
  • CNS depressants
  • decreases effects of warfarin, glucose, oral contraceptives
20
Q

Significant Side effects: Oxcarbazepine

A

Most common: Dizziness, drowsiness, double vision, nystagmus, headache, and ataxia.
* Hyponatremia
* hypothyroidism
* hematologic abnormalities
* skin reactions
* hypersensitivity reactions
* decreased bone mineral density

21
Q

Indications for diazepam

A

anxiety, seizures, muscle spasms, alcohol withdrawal, induction/maintenance of anesthesia, spasticity

CNS Muscle relaxant

22
Q

Mechanism of Action: Dantrolene

A

prevents release of calcium in skeletal muscles (inhibiting muscle contraction) to decrease muscle spasticity

23
Q

Side Effects: dantrolene

A
  • reduction in strength (**muscle weakness) **
  • Hepatic toxicity (life threatening)
  • drowsiness
  • diarrhea **(GI upset) **
24
Q

Monitoring: dantrolene

A

Baseline liver function tests and periodically minimize dosage

25
Q

Mechanism of Action: Chloroprocaine

A

Suppress pain by blocking sodium and by blocking impulse conduction along axons

26
Q

Serious adverse effects: Lidocaine

A
  • Excitation (Seizures) followed by depression (drowsiness, unconsciousness, to coma)
  • bradycardia, heart block, reduced contractile force, cardiac arrest, hypotension
  • Allergic reactions
  • decreased uterine contractility and maternal effort
  • bradycardia and CNS depression in neonate
27
Q

Properties of Nitrous oxide

A

Unique in 2 ways:
1. has very low anesthetic potency
2. has very high analgesic potency

Not a primary anesthetic
Frequently combined with other inhalational agents to enhance analgesia

28
Q

Mechanism of Action: Propofol

A

Potentiates the effects of GABA

Promotes release of GABA

results is generalized CNS depression

29
Q

Therapeutic Uses: Propofol

A

Induction and maintenance of general anesthesia. Sedation of intubated patients

30
Q

Nursing interventions in relation to drug stability: propofol

A
  • Unconsciousness in less than 60 seconds after IV injection
  • lasts 3-5 minutes
  • For extended sedation, a continuous low dose infusion is not to exceed 4 mg/kg/hr
  • Monitor VS continuously
  • Discard unused portions of propofol after 6 hours due to risk of bacterial contamination
31
Q

Side effects/Adverse effects: propofol

A

Amnesia, bradycardia, hypotension, respiratory depression
*high risk for bacterial infection
*prolonged high doses can lead to infusion syndrome

32
Q

Mechanism of Action: Ketamine

A

Blocks stimulatory NMDA receptors

33
Q

Type of Amnesia/anesthesia it produces: Ketamine

A

-dissociative anesthesia makes patients feel disassociated from the environment
-sedation
-immobility
-analgesia
-amnesia
-can cause hallucinations, disturbing dreams, and delirium

34
Q

Opioid definition

A

Any drug, natural, or synthetic that has actions similar to those of morphine

35
Q

Opiate definition

A

Term that applies only to compounds present in opium

36
Q

Mechanism of Action: Morphine

A

Binds to opioid receptors in the CNS

Relieve pain by mimicking the actions of endogenous opioid peptides

primarily at mu receptors and partly at kappa receptors.

37
Q

Side effects/Adverse effects: Morphine

A

Sedation, GI upset (especially constipation), hypotension, urinary retention, respiratory depression, increased ICP, risk for tolerance and dependence

R: Respiratory depression
U: Urinary Retention
S: Sedation
H: Hypotension

38
Q

Nursing assessments: Morphine

A

Monitor pain level, vital signs, respiratory status. Monitor signs of overdose

Used cautiously in those w/ decreased respiratory rates and impaired pulmonary fx

39
Q

S/S of toxicity: Morphine

A

*Coma, cannot be aroused
*Respiratory depression as low as 2-4 breaths/min
*pinpoint pupils initially but may dilate as hypoxia sets in
*treat with vent support and narcan (naloxone)

40
Q

Mechanism of Action: Naloxone

A

-Act as a competitive antagonist at opioid receptors, thereby blocking opioid actions
*naloxone can reverse most effects of the opioid agonists, including respiratory depression, coma, and analgesia.

41
Q

Mechanism of Action: Sumatriptan

A

Intracranial vasoconstriction

42
Q

Therapeutic effects: Sumatriptan

A

Migraine headaches, cluster headaches

43
Q

Risks for taking ergotamine

A

*Risk for dependence even with moderate daily doses
*withdrawal that resembles a migrain attack
*overdose

Pharmacology II (4 decks)

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