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Pharmocology > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

T3

A

stimulates metabolism

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2
Q

T4

A

inactive until converted into T3 by the tissues

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3
Q

Iodine and tyrosine

A

needed to make TH

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4
Q

hypothalamus anterior pituitary and the thyroid

A

can all lead to thyroid problems

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5
Q

primary thyroid dysfunction

A

problem with thyroid

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6
Q

primary hyperthyroid

A

TSH is low and TH is high

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7
Q

primary hypothyroid

A

TSH is high and TH is low

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8
Q

secondary thyroid dysfunction

A

problem due to pituitary gland

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9
Q

secondary hyperthyroid

A

TSH is high and TH is high

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10
Q

secondary hypothyroid

A

TSH is low and TH is low

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11
Q

tertiary thyroid dysfunction

A

due to hypothalamus

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12
Q

increase TRH —->

A

TSH ——> TH

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13
Q

Increase metabolic rate

A

decrease TH —- TRH —– TSH

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14
Q

women are ____ times more likely then men to have thyroid imbalance

A

5-10

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15
Q

hypothyroidism

A

can be congenital (cretinism) or acquired (hashimoto thyroiditis or thyroidectomy)

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16
Q

hyperthyroidism

A

can be graves disease or thyroid tumors, can cause a goiter, everything becomes excited

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17
Q

hashimoto thyroiditis

A

autoimmune disease, destruction of thyroid, 20’s or 50s-60s

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18
Q

graves disease

A

bug eyes, can be in 20s or 40s

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19
Q

causes of hypothyroidism

A

absence of the thyroid gland, lack of insufficient iodine in diet, autoimmune disorder, lack of TSH (pituitary gland disease), lack of TRH ( tumor or disorder of hypothalamus)

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20
Q

signs of hypothyroidism

A

lethargy hypotension hypoventilation slow GI intolerance to cold

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21
Q

cretinism

A

child with hypothyroidism, untreated leads to poor growth and development, preventable with hormone replacement

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22
Q

myxedema

A

life threatening, severe adult hypothyroidism

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23
Q

myxedema coma

A

end stage of hypothyroidism, life-threatening, most often in elderly women, 30% mortality rate

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24
Q

levothyroxine (synthroid, levonoxyl)

A

synthetic T4, given PO unless myxedema (given IV), can cause symptoms of hyperthyroidism, BLACK BOX- use for weight loss is contraindicated, take the same time each day with a full glass of water on empty stomach 30 minutes prior to eating

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25
Q

contraindications of TH

A

known allergy thyrotoxicosis (thyroid storm) hyperthyroidism acute MI, caution with lactation (still can give)

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26
Q

Thyroid storm or crisis

A

extreme manifestation of hyperthyroidism, caused by untreated hyperthyroidism precipitated by stress, manifested by high fever (NO aspirin) tachycardia MI coma delirium, 80-90% mortality if not treated

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27
Q

thyroidectomy

A

take out thyroid, increased TH right after surgery, airway issues, can save parathyroid (if not watch serum calcium, can drop), increased potential to bleed (watch for frequent swallowing)

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28
Q

anti-thyroid agent

A

prevent iodine from getting into the thyroid and partially inhibits conversion of T4 to T3, used for hyperthyroidism. if needed during pregnancy use PTU, can cause thyroid suppression development of goiter, iodine drugs can cause metallic taste and staining of teeth

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29
Q

propylthiouracil PTU

A

drug of choice for children used for hyperthyroidism, inhibits synthesis of TH and conversion of T4 to T3, therapeutic effect can be delayed for 3 weeks, can cause leukopenia or hepatotoxicity, given 3-4 times daily

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30
Q

methimazole (Tapazole)

A

used to treat hyperthyroidism by inhibiting production of TH, more bone marrow suppression, used in management of thyroid storm (bc can be given PO or IV), less likely to cause GI effects, less likely to induce hypothyroidism

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31
Q

sodium Iodine 131

A

radioactive, given for hyperthyroid, used in adults over 30, NOT in pregnancy may have adverse effects on fertility, used for thyroid destruction, limited contact with patient for only 1 hr per day, no contact with pregnant women or children

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32
Q

potassium iodide (lugol’s solution)

A

used for acute thyrotoxicosis, immediately blocks release of TH, can be used to make meth

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33
Q

Iodine solutions

A

contraindicated with pregnancy and Pulmonary edma/TB, adverse effects can stain teeth (drink through straw behind teeth) toxicity/ iodism

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34
Q

Calcium

A

found in bones, reciprocal relationship with phosphate, normal level 8.6- 10.2 total, transmission of nerve impulses, blood clotting

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35
Q

if PTH is taken out _____ type symptoms

A

hypocalcemia

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36
Q

functional tumor

A

secretes hormones

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37
Q

non-functional tumor

A

grows and presses on gland = hypo___

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38
Q

hypoparathyroidism

A

decreased PTH, decreased serum calcium, can be related to thyroidectomy parathyroidectomy or radical neck dissection, can be autoimmune, can manifest as hypocalcaemia

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39
Q

hyperparathyroidism

A

increased PTH, can be related to PTH tumor, can be secondary to renal failure or malabsorption of calcium, more common in women, more common over 50, patient will have hypercalcemia, demineralization of bone

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40
Q

Vitamin D therapy

A

increase absorption of calcium, indicated for hypocalcemia renal failure hypoparathyroidism, teach pt to increase weight bearing and the decrease consumption of alcohol and smoking

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41
Q

calcitrol (rocaltrol)

A

active form of vitamin D, need 400-600 units of vitamin D per day, decreased bone reabsorption , promotes calcium absorption in the gut and renal reabsorption of calcium

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42
Q

other forms of vitamin D

A

ergocalciferol, calcifediol, dihydrotachysterol

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43
Q

biphosphonates

A

act on calcium levels, lower serum calcium, can cause paget disease (demineralizes bone) or osteoporosis, contraindicated with pregnancy renal dysfunction or upper GI disease, can cause esophageal erosion (take in the morning sitting up with glass of water, don’t eat or drink for 30 minutes after

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44
Q

list of biphosphonates

A

etidronate (didronel), ibandronate (Boniva) taken monthly, pamidronate (Aredia) taken weekly, risedronate (Actonel) taken weekly, alendronate (Fosamax) taken weekly

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45
Q

raloxifene (Evista)

A

selective estrogen receptor modulator, prevents osteoporosis by increasing estrogen receptors on bone and increasing bone density, PO can cause hot flashes,

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46
Q

Denosumab (prolia)

A

monoclonal antibody prevents bone reabsorption, given subQ every 6 months

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47
Q

Teriparatide

A

stimulates bone formation, derivative of PTH

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48
Q

Calcitonin

A

hormones secreted by the thyroid gland to balance effects of PHT, inhibits bone reabsorption, increased secretion of calcium, emergency treatment of hypercalcemia, calcitonin -salmon nasal spray no used a lot linked to cancer

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49
Q

Calcitonin is released when

A

Serum Calcium levels are high

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50
Q

androgens

A

Male and female sex hormones (estrogen and testosteron)

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51
Q

Glucocorticoids (cortisol)

A

Stimulate an increase in glucose levels for energy, Increased breakdown of fat, Increase protein breakdown, decrease protein synthesis, Stress hormones, Suppression of inflammatory and immune responses

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52
Q

Mineralocorticoids (aldosterone)

A

Affect fluid and electrolyte levels, Causes the reabsorption of sodium and water and the elimination of potassium

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53
Q

CRH —> ——->

A

ACTH, cortisol

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54
Q

increase cortisol =

A

decrease CRH and ACTH which shuts down loop (why we tapper doses)

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55
Q

anti-inflammatory corticosteroids

A

supresses the leukocytes and chemical mediators in the inflammatory responce

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56
Q

immunosuppressive corticosteroids

A

supresses humoral and cell mediated immunity

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57
Q

maintenance of normal BP with corticosteroids

A 
Enhance vasoconstriction (norepinephrine)
Cause reabsorption of sodium and water and elimination of potassium (aldosterone-mineralocorticoid)
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58
Q

carbohydrates and metabolism with corticosteroids

A

Increased glycogenolysis and insulin resistance
Increase breakdown of protein (for gluconeogenesis)
Mobilize free fatty acids and redistribute fat

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59
Q

therapeutic uses of corticosteroids

A

Hormone replacement for adrenocortical insufficiency, Suppression of allergic reactions (Anaphylaxis and Drug reaction), Suppression of inflammatory disorders (RA, SLE, Inflammatory bowel disease, OA), Autoimmune disorders (Hashimoto’s thyroiditis), pulmonary disorders, prevention of transplant rejection, can decrease pain from inflammation

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60
Q

Adverse effects of corticosteroids

A

Hypokalemia, GI distress (prone to PUD), Muscle atrophy and weakness, Mood changes, insomnia, fatigue, Hyperglycemia, Fat redistribution to trunk and face, immunosupressive, suppress the release of ACTH, hypocalcemia, hypertension, weight gain, inhibit antibody responce to vaccines, protein depletion (osteoporosis), frail skin

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61
Q

contraindications of corticosteroids

A

acute infections, allergy and lactation, Caution in pregnancy (unless benefit to mother clearly outweighs risk to baby), diabetes (increase BG), peptic ulcer disease (increase irratation to the stomach)

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62
Q

name corticosteroids

A

betamethasone (Celestone), budesonide (Rhinocort) – rhinitis (intranasal), dexamethasone (Decadron) – inflammatory disorders (long acting), triamcinolone (Aristospan) – asthma, methylprednisolone (Medrol), prednisone (Deltasone), hydrocortisone (Cortef, Solu-Cortef) (has mineralocorticoid activity), prednisolone (Delta-Cortef), cortisone (has some mineralocorticoid activity)

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63
Q

nursing care with corticosteroids

A

use as low of dose as possible, take in the morning with food, may need vitamin D and calcium replacement, wean from drug, high protein calcium and potassium low sodium diet

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64
Q

mineralocorticoids

A

cortisone (Cortisone Acetate) (has some glucocorticoid activity as well) short acting (orally and parenterally), hydrocortisone (has some glucocorticoid activity as well) short acting, Fludrocortisone (Florinef)- small doses produce sodium retention, increased excretion of potassium and elevate BP. May be combined with glucocorticoid. given for fainting problem

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65
Q

mineralocorticoids contraindications and adverse reactions

A

Contraindications- Hypersensitivity, Heart failure, hypertension
Adverse Reactions- Increase fluid volumes, Allergic reactions, Hypokalemia

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66
Q

calcium is needed to

A

initiate the release of neurotransmitters into the synaptic space

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67
Q

three main types of neurotransmitters

A

Aminoacides (ex. Gamma aminobutyric acid [GABA}*** inhibits the CNS )
Peptides (endorphins, enkephalins, substance P- pain responce)
Monoamines (serotonin, dopamine, norepinephrine

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68
Q

sympathetic nervous systems

A

fight or flight, neurotransmitters: norepinephrine dopamine and epinephrine, have adrenergic receptors (Alpha and Beta)

69
Q

parasympathetic nervous system

A

rest and digest, cholinergic nervous system, neurotransmitter is acetlycholine, has cholinergic receptors

70
Q

effects of PSNS stimulation

A

increase in secretions urinary frequency and sweating (nicotinic receptors), constriction of pupil and bronchi, decrease heart rate

71
Q

adrenergic stimulation (SNS)

A

inhibits digestion secretions except sweat and ejaculation, causes piloerection, increase muscle strength, stimulation of RAAS

72
Q

alpha 1 stimulation

A

vasoconstriction, mydriasis (pupil dilation), ejaculation, CNS stimulation, uterus contraction

73
Q

Alpha 2 stimulation

A

shut off vavle for SNS, Receptors are located on the presynaptic nerve terminals, Control the release of neurotransmitters, Inhibit the release of norepinephrine

74
Q

beta 1 receptors

A

primarily in the heart, increase HR BP contractility and conduction, also increase renin secretion and angiotensin

75
Q

Positive Inotropic effect
Positive Chronotropic Effect
Positive Dromotropic Effect

A

increase myocardial contractility
increase HR
increase conduction through heart

76
Q

beta 2 receptors

A

primarily in the lungs, bronchioles dialate, Arterioles (some dilation), GI tract- decreased motility and tone, Uterus- relaxation of uterine smooth muscle, Liver- activation of glycogenolysis (increase BG)

77
Q

adrenergic agonists

A

Direct acting-bind to the adrenergic receptors and cause the fight or flight response, Indirect acting-increase the amount of norepinephrine at the synapse

78
Q

indications and examples of adrenergic agonist

A

indications= Cardiac arrest, Heart failure, AV block, Shock

examples=Epinephrine, Norepinephrine, Dopamine, Dobutamine, Phenylephrine

79
Q

Epinephrine (Adrenalin)

A

Therapeutic uses= Shock, cardiac arrest, Anaphylaxis, Bronchodilator, Mydriatic (pupil dilation), Reduce nasal congestion, Non-selective adrenergic agonist (catecholamine), Receptors stimulated, alpha one, beta one, beta two, Administer IV, Subcutaneous, IM, inhalation, topical, ophthalmic, intracardiac (in emergencies)

80
Q

adverse effecs of epinephrine

A

CNS – headache, restlessness, excitement, insomnia, tremors, dizziness
Cardiovascular – chest pain, vasoconstriction, hypertension, tachycardia, palpitations, dysrhythmias
Other body systems – dry mouth, anorexia, nausea, vomiting
Can cause tissue necrosis at site of infusion if extravasatio

81
Q

alpha adrenergic agonist

A

given to relieve nasal congestion, treat hypotension or orthostatic hypotension, Contraindicated in patient with hypertension, Pregnancy Category C
Not recommended for use in infants and children
Do not use nasal sprays for longer than 3 days
Use sunglasses to prevent photosensitivity
Safety precautions due to blurred vision

82
Q

phenylephrine (neo-synephrine)

A

ALPHA ADRENERGIC AGONIST
Oral and intranasal to relieve nasal congestion
Parenteral for hypotension
IV, IM, subcutaneously, PO, intranasal, ophthalmic
Can cause stinging of the nasal mucosa and rebound congestion, Photophobia if administered ophthalmic

83
Q

Midodrine (Proamatine)

A

ALPHA ADRENERGIC AGONIST, used to treat orthostatic hypotension

84
Q

intra-nasal decongestants

A

ALPHA ADRENERGIC AGONIST
Oxymetazoline (Afrin)
Psuedoephedrine (Sudafed)
Potential for misuse in the development of methamphetamine= Limited in the amount that can be purchased
Limit use to 3-5 days
Can cause rebound congestion if abrupt withdrawal

85
Q

ol=

A

beta something

86
Q

isoproterenol (isuprel)

A

NON SELECTIVE BETA AGONIST
Bronchodilator, Increases HR, myocardial contractility, conduction through the heart, Pregnancy category C
Eliminate caffeine due to stimulatory effect and increase in insomnia, anxiety and tremors
May increase blood glucose

87
Q

beta 2 adrenergic agonist

A

bronchodilators
Selective= Albuterol (Proventil), Formoterol (Foridil), Levalbuterol (Xopenex), Salmeterol (Serevent), Pirbuterol (Maxair)
Non Selective= epinephrine

88
Q

Alpha Blocker indications (osin)

A

Hypertension
-doxazosin (Cardura), prazosin (Minipress), terazosin (Hytrin),
Raynaud’s disease
-Vasospasms of vessels to the extremities
Benign Prostatic Hypertrophy
-tamsulosin (Flomax), alfuzosin (Uroxatral)

89
Q

Beta Blockers (lol)

A

Non-selective= propranolol (Inderal), nebivolol (Bystolic), nadolol (Corgard), sotalol (Betapace), timolol (Timoptic)
Selective beta 1= atenolol (Tenormin), metoprolol (Lopressor), esmolol (Brevibloc), bisoprolol (Zebeta), acebutalol (Brevibloc)

90
Q

beta blocker information

A

slows HR, do not suddenly stop, hold drug if BP less than 100

91
Q

Alpha- and Beta-Adrenergic Blocking Agents and Their Indications

A

Carvedilol (Coreg): Hypertension, congestive heart failure (adult)
Given orally
Labetalol (Normodyne, Trandate): Hypertension, pheochromocytoma, clonidine withdrawal
Can be given IV and oral

92
Q

cholinergic agonist

A

Stimulate the acetylcholine receptors, Stimulate the parasympathetic nervous system, Are called: Cholinergics, Parasympathomimetics, Response is similar to adrenergic antagonist which inhibit the Sympathetic Nervous system

93
Q

Cholinergic antagonist

A

Block or inhibit the acetylcholine receptors, Inhibit the parasympathetic nervous system, Are called: Anticholinergic s, Cholinergic blockers, Parasympatholytics
Response is similar to adrenergic agonist which stimulate the Sympathetic Nervous system

94
Q

direct acting cholinergic agonists

A

Occupy receptor sites for ACh on the membranes of the effector cells of the postganglionic cholinergic nerves
Cause increased stimulation of the cholinergic receptor

95
Q

indirect acting cholinergic agonists

A

React with the enzyme acetylcholinesterase and prevent it from breaking down the ACh that was released from the nerve

96
Q

cholinergic drug indications PNS

A 
Eye drops (topical)= Reduce IOP – glaucoma (contracts ciliary muscle allowing fluid to drain from the eye)
Bladder= increases bladder tone (relaxes the urinary spinchter) Given to patients with urinary retention 
Stimulate exocrine glands (lacrimation, sweat, saliva)
GI= Increase GI motility Increase GI secretion
97
Q

cevimeline (evoxac)

A

direct acting cholinergic used to treat dry mouth

98
Q

bethanechol (urecholine)

A

cholinergic used to treat non-obstructive urinary retention

99
Q

pilocarpine (pilocar)

A

direct acting cholinergic used to decrease IOP

100
Q

Acetylcholinesterase Inhibitors Used to Treat Myasthenia Gravis

A

Neostigmine (Prostigmine): Has a strong influence at the neuromuscular junction, 2nd line to pyridostigmine
Pyridostigmine (Regonol, Mestinon): Has a longer duration of action than neostigmine, first line drug
Ambenonium (Mytelase): Available only in oral form; cannot be used if patient is unable to swallow tablets, not first line drug
Edrophonium (Tensilon, Enlon): Diagnostic agent for myasthenia gravis

101
Q

Drugs Used to Treat Alzheimer’s Disease

A 
Tacrine (Cognex)
First drug to treat Alzheimer’s dementia
Galantamine (Reminyl)
Used to stop progression of Alzheimer’s dementia
Rivastigmine (Exelon)
Available in solution for swallowing ease
Donepezil (Aricept)
Has once-a-day dosing
102
Q

Cholinergic crisis

A

Overdose with cholinergic agents or exposure to nerve gas (Sarin) or organophosphate insecticides(Malathion)
Manifested as miosis, nausea, vomiting, urinary incontinence, increased secretions, abdominal cramping, diarrhea, blurred vision
Treat with atropine (anticholinergic)

103
Q

DONT GIVE CHOLINERGICs TO A PT WITH

A

active asthma, chronic obstructive pulmonary disease (COPD), bradycardia, hypotension, Parkinson’s disease, PUD, GI or urinary obstruction

104
Q

side effects of anticholinergics

A

fever, dry secretions, blurred vision, confusion

105
Q

Parkinson’s Disease

A

Progressive degenerative disorder of the basal ganglia caused by a dopamine depletion in the substantia nigra, Results in an imbalance between dopamine and acetylcholine, seen more in man over the age of 60

106
Q

TRAP parkinson’s disease

A

Tremor Rigidity Akinesia (bradykinesia) Postural instability

107
Q

drug types for parkinson’s

A

Do not cure just alleviate symptoms, Dopaminergic Agents Anticholinergic Agents MAOI’s Anti-virals COMT inhibitors

108
Q

Dopaminergic agents

A

Levadopa(Dopar), carbidopa-levodopa(Sinemet)

Precursor of dopamine that crosses the blood–brain barrier, where it is converted to dopamine
The dosage of levodopa can be decreased, reducing adverse side effects

109
Q

Dopamine agonists

A

Prototype Drug= Pramipexole (Mirapex)
Apomorphine (Apokyn)- Used as single dose, subcu injection, Used to treat “off” episodes, not routine management
Bromocriptine (Parlodel)
Ropinirole (Requip)- Monotherapy early and with levodopa in advanced disease; less dyskinesias than levodopa; also used for restless leg syndrome

110
Q

Amantadine (Symmetrel)

A

sites and blocks reuptake of dopamine, Rapid reduction in symptoms followed by diminished effects after several months, Adverse effects: confusion, dizziness, irritability, headache, sedation
Can exacerbate hallucinations and suicidal ideations
Anti-viral agent

111
Q

Catechol-O-methyltransferase (COMT) inhibitors

A

Adjunct to levodopa, Prevent the destruction of levodopa in the peripheral tissues, Not used as monotherapy (just with levodopa to prolong its half life)
Decrease “off” time during levodopa therapy
Entacapone (Comtan)
Tolcapone (Tasmar)

112
Q

MAO-B Inhibitors

A

Selegiline (Eldepryl), rasagiline (Azilect)
May slow progression of PD, Available as an oral tablet, an orally disintegrating tablet and a patch, Inhibiting MAO allows more dopamine to be present in the CNS
Can be used as monotherapy or with levodopa
Used early in PD, may delay the need for levodopa

113
Q

Anticholinergic drugs

A

effective at reducing tremor, Restore balance between acetylcholine and dopamine by blocking muscarinic receptors in the striatum, inhibiting the effects of acetylcholine
Benzotropine (Cogentin) Trihexyphenidyl (Artane)

114
Q

nociceptors are

A

pain receptors

115
Q

natural pain modifiers

A

Endogenous Opioids- Endorphins Enkephalins

116
Q

drugs that target pain transmission

A

Opioids analgesics – bind to opioid receptors and mimic the inhibitory effects of endogenous opioids.
Baclofen (Lioresal) inhibits transmission by binding to GABA receptors thus mimicking the inhibitory effects (CNS) of GABA. (Centrally acting muscle relaxer)

117
Q

intense acute pain

A

is top priority

118
Q

types of headaches

A

Migraine, Cluster, Tension-type, Temporomandibular joint pain

119
Q

Migraine headache

A

Neuronal hypersensitivity in the cerebral cortex and occipital cortex. Serotonin appears to be a key factor
Usually recurring, unilateral, throbbing (pulsing) pain, pounding, intense.
Prodrome and aura may precede the headache, Last 4-72 hours

120
Q

cluster headache

A

Dysfunction of intracranial blood vessels, sympathetic nervous system and pain modulation systems.Repeated headaches that can occur for weeks to months followed by a remission. Sharp stabbing, penetrating, burning, severe, intense pain. Last a few minutes to 3 hours.
Associated with tearing periorbital swelling facial flushing nasal congestion and constriction of the pupil.
Focused around one eye

121
Q

tension headache

A

Usually occur at times of stress; dull band of pain around the entire head, squeezing the head, Bilateral, Palpable neck and shoulder muscles, Stiff neck ( but not nuchal rigidity), given OTC analgesics (Aspirin, Acetaminophen, ibuprofen)

122
Q

opioids

A

moderate to serve pain, narcotic analgesic, Prototype: morphine sulfate

123
Q

narcotic agonists list

A

codeine, fentanyl(Actiq, Duragesic), hydrocodone(Hycodan), hydromorphone(Dilaudid), meperidine(Demerol), Methadone(Dolophine), opium(Paregoric), oxycodone(Oxycontin)

124
Q

combination drugs narcotic agonists

A

Vicodin(Hydrocodone bitartrate 5mg & acetaminophen 500mg) Schedule II
Percocet(Oxycodone Hcl 2.5mg &acetaminophen 325 mg) Schedule III

125
Q

narcotic antagonists

A

Nalmefene (Revex)
Reverses the effects of narcotics; manages known or suspected narcotic overdose
Naloxone (Narcan)
Reverses adverse effects of narcotics; diagnoses suspected acute narcotic overdose

126
Q

medications given for migraine headaches

A

Mild – NSAIDS, Acetaminophen and Caffeine combinations, triptans or ergot derivatives.
acetaminophen combination with butalbital (barbiturate), caffeine (Fioricet) Fiorinal has ASA instead of acetaminophen
Moderate – oral, intranasal or subcutaneous serotonin agonist
Severe – IM, subcutaneous or IV serotonin agonist, or narcotic analgesics

127
Q

ergot derivatives

A

Causes constriction of cranial vessels, Decreases the pulsations of a migraine, Prevention migraine or vascular headaches
EX: Ergotamine (Ergostat)- prototype, Dihydroergotamine mesylate (D.H.E. 45), Ergotamine tartrate with caffeine (Cafergot)

128
Q

Triptans

A

Bind to selective serotonin receptors sites to cause vasoconstriction of cranial vessels, Treatment of acute migraine, Abortive therapy (stops a migraine that has already started)

129
Q

triptans cannot be taken within _____ of ergots

A

24hrs

130
Q

list of Triptans (triptan)

A

sumatriptan (Imitrex), sumatriptan/naproxen (Treximet), almotriptan (Axert), eletriptan (Relpax), naratriptan (Amerge), rizatriptan (Maxalt), zolmitriptan (Zomig), frovatriptan (Frova)

131
Q

beta blockers for migraines

A

Used preventatively in the treatment of chronic migraines, The beta-blockers used in preventing migraine headaches include propranolol (Inderal), atenolol (Tenormin), metoprolol (Lopressor, Lopressor LA, Toprol XL), nadolol (Corgard), and timolol (Blocadren).

132
Q

other drugs for migraines

A

Antidepressants (migraine prophylaxis)= Amitriptyline (Elavil) (TCA) Fluoxetine (Prozac) (SSRI)
Anti-seizure (migraine prophylaxis)= Divalproex sodium (Depakote) topiramate (Topamax)
Anti-emetics= metoclopramide (Reglan)
Sedatives

133
Q

muscle spasms

A

Involuntary contraction, Usually localized to specific muscle group, Caused by injury or overuse of muscles, Diminishes in a few minutes, Can produce pain, Can impair joint mobility, Pain may be related to decreased blood flow leading to ischemia and lactic acid production, Can be from hypokelemia or hypocalcimia

134
Q

herbal therapy for muscle spasms

A

Kava (oral, also has anti-anxiety effects), Black cohosh (topical application to relax muscles), Castor oil packs (topical application), Capsaicin (topical application)

135
Q

drug therapy for muscle spasms

A

NSAIDS (aspirin, naproxen, ibuprofen), muscle relaxants

136
Q

what is the drug of choice for treating muscle spasms

A

Centrally acting skeletal muscle relaxants

137
Q

Centrally acting skeletal muscle relaxants

A

inhibit CNS (safety), cause a sedative effect

138
Q

Cyclobenzaprine (Amrix, Flexeril)

A

Skeletal muscle relaxant
Mechanism of action-Thought to occur at brainstem and spinal cord Increases norepinephrine activity by blocking its synaptic reuptake to produce anticholinergic effect
Acts centrally, no direct action on skeletal muscle

139
Q

Baclofen (Lioresal)

A

can cause dependence, resembles GABA (safety)

140
Q

Metaxalone (Skelaxin)

A

Ineffective in treatment of spasticity-related neurologic disorders
Can cause liver toxicity; monitor liver function tests, contraindicated in patients with liver dysfunction

141
Q

Tizanidine (Zanaflex)

A

Spasticity related to brain or spinal cord injury of MS
Centrally acting alpha 2 adrenergic agonist
Can cause hypotension
First line drug in the management of spasticity (along with baclofen)
Has to be dosed every 6-8 hours
Can cause liver impairment

142
Q

Benzodiazepines

A

Adjunct to relieve skeletal muscle spasm associated with cerebral palsy, paraplegia and tetanus
Used only if other medications fail to produce adequate muscle relaxation
Scheduled IV drug and can cause dependence.
Diazepam (Valium)

143
Q

muscle spasticity

A 
in bigger muscle groups, comes from brain
Result is increased muscle tone and pain
Pain more intense than muscle spasm
Greater mobility impairment than spasm
Longer term
144
Q

hypertonia

A

Continuous state of contraction, Irritable deep tendon reflexes, Muscle spasms, Involuntary jerking, Scissoring movements lower extremities, Fixed joint movement

145
Q

management of muscle spasticity

A

Direct-acting skeletal muscle relaxants, Physical therapy= Increases movement Prevents contractures, CNS muscle relaxants= Baclofen (Lioresal) Tizanidine (Zanafle)

146
Q

Dantrolene Sodium (Dantrium)

A

Direct-acting skeletal muscle relaxant, antispasticity agent, Calcium release blocker (muscle cells), Pregnancy category C, contraindicated with hepatic disease (hepatotoxicity)

147
Q

Botulinum toxin (Botox, Botox Cosmetic, Dysport, Myobloc, Xeomin)

A

Obtained from Clostridium botulinum, Inhibits release of acetylcholine= Paralysis of muscle
Treatment for Cervical dystonia, migraines (if other treatments fail), glabellar lines (wrinkles), upper limb spasticity

148
Q

black box warning with botulinum toxin

A

May spread to distant muscles, leading to risk for:
Asthenia, generalized muscle weakness, diplopia, blurred vision, dysphagia, dysphonia, urinary incontinence, swallowing and breathing difficulties

149
Q

seizures

A

electric storm in the brain, can be provoked or unprovoked, CNS problem= safety

150
Q

epilepsy

A

recurrent seizures, unprovoked

151
Q

convulsions

A

involuntary, violent spasms of the large skeletal muscles of the face, neck arms and legs.
characteristic sign of a tonic-clonic seizure.
All convulsions are seizures, but all seizures are not convulsions

152
Q

generalized seizure

A

wide spread, entire brain, can be absence (just disconnected) atonic (stiffening- drop attack) myoclonic (jerking- can be small muscles) or tonic-clonic (grand mal, stiffening and jerking)

153
Q

partial seizure

A

focused area of brain, can be simple (have memory, are aware and conscious) or complex (missing one of the three)

154
Q

treatment of seizures does not

A

cure just helps patients

155
Q

antiseizure drugs

A

Barbiturates – not first line, Benzodiazepines, Hydantoins, Iminostilbenes, Succinimides

156
Q

nursing care for seizures

A

Prevent aspiration, don’t limit movement, time it, do not put anything in the mouth, give O2, check VS and BG after, put bed as low as possible

157
Q

Barbiturates and barbiturate like drugs

A

Phenobarbital(Luminal), Produces fewer adverse effects, May take several weeks to see desired outcome
Adverse effects: CNS depression Sedation, hypnosis, anesthesia, coma Can cause dependence
Emergency treatment of status epilepticus (long seizure)

158
Q

Benzodiazepines

A

Mechanism of Action: Binding of BZ to GABA Receptors
Common BZ’s for seizures
EX: diazepam(Valium) clonazepam(Klonopin) Lorazepam(Ativan)

159
Q

Hydantoins

A

Phenytoin (Dilantin), Generally less sedating, May be the drugs of choice for patients who are not willing to tolerate sedation and drowsiness, Adverse Effects: CNS depression, Liver toxicity, BM suppression, Gingival hyperplasia, SJS (call MD at first sign of rash)

160
Q

Iminostilbene

A

Carbamazepine (Tegretol)
for Parital seizures, Tonic clonic seizures, Trigeminal neuralgia
Mechanism of action: similar to phenytoin in regard to suppression of sodium across the cell membrane

161
Q

succinimides

A

Work by delaying the influx of calcium into the cell, Work best for absence seizures
Drug example: ethosuximide(Zarontin) suximide(Celontin)
Adverse Effects: Suicidal intent Severe metal depression Stevens-Johnson Syndrome Skin reactions-pruritis, urticaria, alopecia

162
Q

Gabapentin (Neurontin)

A

partial seizures with or without generalization.

Does not induce CYP450 enzymes

163
Q

Ezogabine (Potiga)

A

adjunctive treatment for partial seizures in adults

164
Q

Lamotrigine (Lamictal)

A

adjunctive therapy of partial, absence and tonic-clonic seizures, dose must be reduced if used with Valproic Acid.

165
Q

Levetiracetam (Keppra)

A

adjunctive treatment of partial seizures in adults

166
Q

Pregabalin (Lyrica)

A

partial seizures.

dizziness and drowsiness in 20-40% of patients treated. May cause dependence (Schedule V)

167
Q

Zonisamide (Zonegran)

A
  • for partial seizures.
    avoid in patients allergic to sulfa.
    Long ½ life. May take 2 weeks to be optimally therapeutic
168
Q

Valproic acid (Depakene)

A

decreases electrical activity in the brain and increases GABA activity, Give orally and intravenously, Can be used in the management of absence seizures, Can be used to treat bipolar disorder
Causes CNS depression
Potentiates GABA
Liver toxic

Pharmocology (8 decks)

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