Exam 4 Flashcards
Anticholinergic Medications
Tolterodine tartrate [Detrol]: Increases bladder capacity and decreases desire/urge to go. They also increase the frequency of bladder contractions.
Side Effects: Dry mouth, constipation, vision impairment, confusion, cognitive dysfunction, tachycardia, decreased sweating, and heat prostration.
Urinary Analgesics
Phenazopyridine (Pyridium): Relieve pain, burning sensation, frequency, urgency
Side effects/adverse reactions: Headache, dizziness, GI distress, Contact lens, urine discoloration (Orange and stains), Skin pigmentation.
Urinary Stimulants
Bethanechol (Urecholine): Increases bladder tone of the detrusor muscle usually producing a contraction sufficiently strong to urinate
Side effects/adverse reactions: GI distress, abdominal cramps, Headache, dizziness.
Crystalloids
Solutions that contain fluids & electrolytes. They freely cross capillary walls
Treats: Dehydration, Electrolyte imbalances, Short-term maintenance fluids, and Early plasma expansion (Shorter duration of action).
Colloids
Solutions that contain proteins or other large molecules. Increase osmolarity without dissolving in the solution. Plasma expanders which pull fluids from the interstitial space into the plasma. Used with patients in Dematos, or pt in fluid overload
Potassium Blood Levels
Extracellular K+ levels 3.5 to 5 mEq/L
Treatment for Hypokalemia
K+ replacement PO or IV (NEVER push K+)
Treatment for Hyperkalemia
Stop all K+ sources, food, meds & lower extracellular K+ levels
Calcium salts (calcium gluconate), insulin & glucose, oral or rectal sodium polystyrene sulfonate (Kayexalate), or dialysis.
Benzodiazepines
Lorazepam (Ativan), Diazepam (Valium), Midazolam (Versed):
Inhibits GABA neurotransmission by binding to specific benzodiazepine receptors. Treat anxiety, insomnia, seizures, status epilepticus, alcohol withdrawal, muscle spasms, preoperatively.
Side Effects: Drowsiness, dizziness, ataxia, confusion, amnesia, blurred vision, bradycardia, hypotension
Antipsychotics
Block dopamine receptors in the brain.
Typical groups of antipsychotics: Phenothiazines (Block norepinephrine), Nonphenothiazines (Block only the neurotransmitter dopamine)
Atypical antipsychotics: Treats schizophrenia and other psychotic disorders (Block dopamine and serotonin receptors)
Typical Antipsychotics
Phenothiazines: Chlorpromazine (Thorazine)
Nonphenothizaines: Haloperidol (Haldol)
Adverse Reactions: Extrapyramidal syndrome, Acute dystonia, Akathisia, Tardive dyskinesia, Neuroleptic malignant syndrome
Atypical Antipsychotics
Quetiapine (Seroquel), Aripiprazole (Abilify): Block serotonin and dopaminergic D4 receptors.
Adverse Reactions: Drowsiness, headache, unsteady gait, insomnia, depression, weight gain, dyslipidemia, diabetes mellitus
Mood Stabilizers Basic Info.
Used for bipolar, manic episodes, schizophrenia, and psychosis
Side Effects: Memory impairment, Hypotension, dysrhythmias, GI distress
Mood Stabilizers #1
Lithium: Alteration of ion transport in muscle and nerve cells; Increased receptor sensitivity to serotonin
Mood Stabilizers #2
Quetiapine (Seroquel): Combination of dopamine and serotonin type antagonism.
MAO Inhibitors
Block monoamine oxidase enzyme. Monoamine oxidase enzyme inactivates norepi, dopamine, epi, and serotonin.
Side Effects: Anticholinergic effects, hypertensive crisis from tyramine interaction.
Interactions: CNS stimulants such as vasoconstrictors, phenylephrine, pseudoephedrine, and foods containing tyramine.
Selective Serotonin Reuptake Inhibitors (SSRIs)
Fluoxetine (Prozac), Sertraline (Zoloft): Block uptake of the neurotransmitter serotonin.
Side Effects: Dry mouth, GI distress, Erectile dysfunction
Side effects often decrease over 1 to 4 weeks.
Serotonin syndrome: anxiety, agitation, delirium, diaphoresis, tachycardia, hypertension, hyperthermia, gastrointestinal distress, tremor, muscle rigidity, myoclonus, and hyperreflexia
Uses for SSRIs
Major depression
Anxiety disorders
Obsessive-compulsive disorder
Panic disorders, phobias
Posttraumatic stress disorder
Prevention of migraine headaches
Decrease premenstrual tension syndrome
Eating disorders
Substance use disorder
Tricyclic Antidepressants
Amitriptyline (Elavil): Blocks uptake of norepinephrine and serotonin in the brain. Blocks histamine receptors. Blocks cholinergic receptors
Side Effects: Drowsiness, dizziness, blurred vision (Anticholinergic). Dry mouth and eyes, GI distress (Anticholinergic). Urinary retention, sexual dysfunction (Anticholinergic) cardiotoxicity. Extrapyramidal Side Effects (EPS). Neuroleptic Malignant Syndrome (NMS)
TCAS Interactions
MAOIs may lead to toxic psychosis, cardiotoxicity
Antithyroid drugs may increase dysrhythmias
General Seizure Medication
Phenytoin (Dilantin): Most widely used AED. Selectively inhibits sodium channels. Used for Epilepsy, partial, and tonic-colonic seizures.
Adverse Effects: Confusion, Nystagmus, Sedation, Gingival Hyperplasia, Teratogen, Dysrhythmias, Hematopoietic complications, and Skin Rash.
Keppra
Levetiracetam: Used to treat complex partial seizures. Less drug interactions were noted with this medication than with other anticonvulsants.
Adverse Effects: Drowsiness/dizziness, Depression, Rash
Metabolism of Phenytoin
The capacity of the liver to metabolize phenytoin is limited. Relationship between dosing and plasma levels is unusual…..difficult to maintain safe & effective dosing
Antiseizure Drug
Stabilize nerve cell membranes. Suppress abnormal electric impulses in the cerebral cortex
Specific types of action: Suppress sodium influx. Suppress calcium influx. Enhance the action of GABA.
Parkinson Disease Treatment
Dopamine Replacement
Dopamine Agonists
MAO-B Inhibitors
COMT Inhibitors
Dopamine Replacement Med
Levodopa (Dopar) [Carvidopa/Levodopa (Sinemet)]: Converts to dopamine in the brain
Causes the “On-off” phenomenon, which means any time during dosing interval there is an off period
Adverse Effects: Nausea & Vomiting, Dyskinesias, Head bobbing, Tics, Grimacing, Ballismus, Chorea, Postural hypotension, Drowsiness, Impulsiveness, Psychosis, Severe depression with suicidal ideation
Dopamine Agonists Medication
Pramipexole (Mirapex): Dopamine receptor agonist. Binds selectively to D2 and D3 receptors
Early Stage Parkinson’s: Mirapex used alone
Advanced Parkinson’s: Mirapex + levodopa
Adverse Effects: Sleep Attacks, Nausea, Dizziness, Daytime somnolence, Insomnia, Hallucinations
MAO-B Inhibitor Medication
Selegiline (Eldepryl): Inhibits MAO-B from inactivating dopamine. High doses can inhibit MAO-A and increase the risk for hypertensive crisis as can foods high in tyramine (aged cheese, red wine, bananas)
Adverse Effects: Insomnia, Orthostatic hypotension, Dizziness, Suicidal ideations.
COMT Inhibitors
Entacapone (Comtan): Inhibits the COMT enzyme which inactivates dopamine. Prevent peripheral degradation of levodopa, allowing a higher concentration to cross the blood-brain barrier.
Adverse Effects: Affects liver function (Tasmar). Dark yellow-orange urine. Can intensify the effects of levodopa.
Alzheimer’s Medication
Individual Cholinesterase Inhibitors
Donepezil (Aricept): Blocks the breakdown of acetylcholine by acetylcholinesterase.
Adverse Effects: Nausea, Vomiting
Diarrhea, Dizziness, Headache. Overall, it was pretty well-totaled by patients.
Musculoskeletal Medication
Acetylcholinesterase Inhibitors
Skeletal Muscle Relaxants
Acetylcholinesterase Inhibitors
Neostigmine (Short-acting), Pyridostigmine (Intermediate-acting): Blocks the action of acetylcholinesterase to increase available acetylcholine
Side Effects: Miosis, Blurred vision, Bradycardia, Hypotension, GI distress, Nausea, vomiting
Skeletal Muscle Relaxants
Cyclobenzaprine (Flexeril), Baclofen (Lioresal): Relax skeletal muscles. Used for muscle pain and fracture pain.
Side Effects: Anticholinergic effects (blurred vision, dry mouth, tachycardia, urine retention, constipation). Drowsiness, dizziness, Headache, nervousness, confusion, GI distress, unpleasant taste, Dysrhythmias
Prostaglandin Analogs
Latanoprost (Xalatan): First-line medications for glaucoma. Facilitate aqueous humor outflow (relax the ciliary muscle)
Adverse Effects: Harmless heightened brown pigmentation of the iris, Hypertrichosis, Blurred vision, Burning/stinging
Cholinergic Agonist (Senses)
Pilocarpine: similar action as parasympathetic neurotransmitter acetylcholine. Can cause systemic parasympathomimetic effects: cardiac irregularities, diarrhea, respiratory depression
Adverse Effects: Sweating
Beta Blockers (Senses)
Timolol (Timoptic): First-line medication for glaucoma. Decrease production of aqueous humor by the ciliary body.
Adverse Effects: Blurred vision, Stinging, Photophobia, Conjunctivitis
Alpha2-Adrenergice Agonists (Senses)
Brimonidine (Alphagan): Reduces aqueous humor production. May delay optic nerve degeneration.
Adverse Effects: Dry mouth, Ocular hyperemia (engorgement of ocular blood vessels), Burning/stinging, Foreign body sensation
Anticholinergic Agents (Senses)
Isopto Atropine: Allows for observation of the interior of the eye. Eye examination or surgery.
Adverse Effects: Blurred vision, Photophobia, Increased risk of angle-closure glaucoma, Dry mouth, Constipation, Fever, Tachycardia
General Side Effects/Adverse Reactions of all Anticancer Meds
Bone marrow suppression/myelosuppression: Low RBC (anemia), Low WBC (leukopenia), Low platelet count (thrombocytopenia)
AND
Fatigue, Infertility, Stomatitis, Alopecia, GI Disturbances, Anorexia, Nausea /vomiting, Diarrhea
Vaccines
Attenuated virus
Toxoids
Conjugate vaccines
Recombinant subunit vaccines
Adjuvant
mRNA
Attenuated Virus
Live, weakened microorganisms.
EX: MMR, Varicella
Toxoids
Inactivated toxins that stimulate antitoxin formation but can’t produce disease.
EX: Tetanus
Conjugate Vaccines
require a protein or toxoid from an unrelated substance that can then be recognized by the immune system.
EX: Meningists
Recombinant Subunit Vaccines
DNA is injected into another cell or organism where it then replicates.
EX: Hep B
Adjuvant
substance added to the vaccine to increase the immune response. Often an aluminum salt. Rigorously tested for safety. Require less antigen to produce a dose of the vaccine.
EX: Influenza, polio
mRNA
Works by introducing a piece of mRNA that corresponds to a viral protein, usually a small piece of a protein found on the virus’s outer membrane.
EX: Covid-19 vaccince
