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Pharm 2 > Final Exam > Flashcards

Final Exam Flashcards

1
Q

Inflammation

A

a vascular reaction in which fluids, WBC, chemical mediators accumulate at injured tissue or infection site (increases permeability)

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2
Q

two phases of inflammation

A

vascular phase
delayed phase

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3
Q

vascular phase

A

occurs 10-15 mins post injury
Vasodilation, ↑capillary permeability, blood substance move from plasma to injury

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4
Q

delayed phase

A

leukocytes infiltrate the tissue

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5
Q

chemical mediators released during inflammation

A

prostaglandins (vasodilate, relax smooth muscle, increase permeability and pain)
Cyclooxygenase (COX-1 and 2, needed for synthesis of prostaglandins)

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6
Q

COX-1

A

protects stomach lining and regulates PLTs

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7
Q

COX-2

A

triggers inflammation and pain
BLACK BOX WARNING FOR CARDIOVASCULAR DISEASE OR HISTORY OF CVA

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8
Q

SE of COX-1 and 2

A

ulcers, gastritis, stomach irritation

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9
Q

1st gen salicylates

A

ASA and diflunisal (dolobid)

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10
Q

salicylate derivatives

A

Dipentum, sulfasalazine

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11
Q

Para Chlorobenzoic Acids (Indoles)

A

NSAIDS
Indomethacin(Indocin), Clinoril, Tolectin

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12
Q

Phenylacetic Acid

A

NSAIDS

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13
Q

Phenylacetic Acid

A

NSAIDS
Voltaren, Voltaren XR, Toradol

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14
Q

propionic acid

A

NSAIDS

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15
Q

propionic acid

A

NSAIDS
Nalfon, Ansaid, Motrin, Advil, Naprosyn, Daypro

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16
Q

Anthranilic acids (Fenemates)

A

NSAIDS

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17
Q

Anthranilic acids (Fenemates)

A

NSAIDS
Meclomen, ponstel

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18
Q

oxicams

A

NSAIDS
feldene, mobic

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19
Q

naphthyl alkanes

A

relafen

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20
Q

COX-2 example

A

celebrex

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21
Q

salicylates prototype (aspirin, bayer, ecotrin, astrin) contra

A

flu or virus symptoms in children
3rd trimester in pregnancy

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22
Q

salicylates prototype (aspirin, bayer, ecotrin, astrin) caution

A

renal failure

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23
Q

salicylates prototype (aspirin, bayer, ecotrin, astrin) dose important fact

A

per rectum: double dose

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24
Q

salicylates prototype (aspirin, bayer, ecotrin, astrin) use

A

reduce pain and inflammation, body temp, inhibit platelet aggregation

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25
Q

salicylates prototype (aspirin, bayer, ecotrin, astrin) SE

A

Anorexia (check H&H), N/V/D, dizziness, confusion, hearing loss, heartburn, rash, stomach pains, drowsiness

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26
Q

salicylates prototype (aspirin, bayer, ecotrin, astrin) AR and LT

A

Adverse reactions: Tinnitus, urticarial (rash), ulceration
Life threatening: agranulocytosis, hemolytic anemia, bronchospasm, anaphylaxis, thrombocytopenia, hepatotoxicity, leukopenia

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27
Q

salicylates prototype (aspirin, bayer, ecotrin, astrin) nursing considerations

A

don’t take with ETOH or 5-7 days before surgery esp if CNS
not for children or flu-like symptoms
take with food
report SE

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28
Q

advil dose

A

200-800 mg tid/qid, max 3200mg

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29
Q

advil contra

A

severe renal or hepatic disease
asthma
peptic ulcer
NOT PRN FOR PAIN OR INFLAMMATION
DON’T TAKE ALEVE WITH ASPIRIN ALLERGY

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30
Q

advil drug side effects

A

anorexia, N/V/D, rash, purpura, tinnitus, fatigue, dizziness, lightheadedness, anxiety, confusion, fluid retention with edema

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31
Q

advil AR and LT

A

Adverse reaction: GI bleeding
Life-threatening: blood dyscrasias, cardiac dysrhythmias, nephrotoxicity, anaphylaxis

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32
Q

nursing considerations of advil

A

Observe for signs of bleeding especially with anticoag use
Take with food to reduce GI discomfort
Avoid concomitant use with ASA and acetaminophen (an hour apart is fine)
Avoid ETOH to reduce ulcer risk
Inform dentist or surgeon of use prior or procedures
Do not take if pregnant or breastfeeding

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33
Q

celebrex preg warning

A

not for 3rd trimester

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34
Q

celebrex indications

A

to treat osteoarthritis, Rheumatoid arthritis, relieve dysmenorrhea

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35
Q

celebrex and COX

A

inhibits COX-2 (inflammation), not COX-1 (good for stomach issue pts)

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36
Q

dose for celebrex

A

100-200mg daily

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37
Q

contra of celebrex

A

hypersensitivity, advanced renal disease, severe hepatic disease, anemia, concurrent use of diuretics, and ACE inhibitors

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38
Q

caution of celebrex

A

renal or hepatic dysfunction, HTN, fluid retention, HF, infection, H/O GI bleeding or ulcer, concurrent AC/steroid or ETOH

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39
Q

SE and AR of celebrex

A

Side effects: HA, dizziness, sinusitis, Nausea, flatulence, diarrhea, rash
Adverse Reactions: peripheral edema

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40
Q

para-chlorobenzoid acid

A

anti-inflammatory
Class may increase BP, sodium and water retention
Example Indomethacin (Indocin)
Indications: treat RA, Gouty arthritis, OA
Highly protein bound can result in toxicity
Irritating to stomach take with food
Other examples with less side effects
Sulindac (clinoril), tolmetin (Tolection)

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41
Q

Phenylacetic acid derivatives

A

antiinflammatory
Example : diclofenac sodium (Voltaren)
Indications: decrease inflammation RA, OA, ankylosing spondylitis
POTENTIALLY safe for cardiac pts bc maybe less systemic effects
Has codeine, not for abuse pts
Ketorolac Acid (Toradol), IM/IV/PO
Inhibits prostaglandin synthesis, greater anti-inflammatory effects
Indicated for post-surgical pain

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42
Q

oxicams

A

antiinflammatory and corticosteroid
Example Piroxicam (Feldene)
Indications: Long-term arthritic conditions such as RA, OA
Lower incidence of GI distress than other NSAIDs
Full clinical response may take 1-2 weeks
Worried abt hyperglycemia, immunosuppression, and ulcers

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43
Q

immunomodulator

A

tumor necrosis factor blocker

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44
Q

immunomodulator

A

tumor necrosis factor blocker
FOR AUTOIMMUNE DISORDERS
Prototype: infliximab (Remicade)

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45
Q

Infliximab (Remicade)

A

immunomodulator
for RA and crohn’s

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46
Q

SE of infliximab (Remicade)

A

HA, dizziness, coughing, fatigue, hot flashes, anxiety, insomnia, D/V/C, rash, alopecia, urinary frequency

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47
Q

AR, contra, and caution of infliximab (Remicade)

A

Adverse reaction: severe infections!!, chest pain, hypotension, HTN, ↑ LFT’s
Contraindications: hypersensitivity, heart failure
Caution: renal or hepatic dysfunction, immunosuppression, MS, elderly

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48
Q

nocioreceptors

A

sensory receptors activated by noxious stimuli in the peripheral tissues (mechanical, thermal, chemical)

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49
Q

somatic

A

structural pain from tissue injuries

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50
Q

neuropathic pain

A

sensory disturbance involving neural hypersensitivity

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51
Q

cortisone

A

decreases phospholipase (reduces production of prostaglandins and leukotrienes)

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52
Q

tylenol and alcohol and pregnancy

A

don’t take if you’ve had 3 drinks
avoid in pregnancy if you can

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53
Q

SE off tylenol

A

anorexia, N/V, rash

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54
Q

AR and LT of tylenol

A

Adverse reaction: severe hypoglycemia, oliguria, urticaria
Life-threatening: hemorrhage, hepatotoxicity (can occur in 1-4 days), hemolytic anemia, leukopenia, thrombocytopenia

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55
Q

drug interactions of tylenol

A

increased effect with caffeine, diflunisal
decreased effect with contraceptives, anticholinergics, cholestyramine, charcoal (absorbent)

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56
Q

how long to take tylenol and antidote

A

10 days in adults, 5 in children
antidote: acetylcysteine

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57
Q

roxanol

A

controlled substance, needs a DEA number

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58
Q

roxanol indications

A

for severe pain (opioid)

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59
Q

roxanol SE

A

anorexia, N/V/C drowsiness, dizziness, sedation, confusion, urinary retention, constipation, bradycardia, flushing, euphoria

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60
Q

roxanol AR and LT

A

Adverse reactions: hypotension, urticaria (rash), seizures
Life threatening: respiratory depression, increased intracranial pressure

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61
Q

caution in roxanol

A

respiratory renal or hepatic disease, myocardial infarction (used bc it decreased preload, but make sure they don’t have cardiovascular collapse), older adults and young children
Crosses the placenta and excreted in breast milk

62
Q

meperidine (demerol)

A

opioid
pain relief, beneficial for GI procedures
less constipation and urinary retention
not for liver pts
monitor for hypotension
don’t use >48-72h

63
Q

dilaudid

A

synthetic opioid
more potent than morphine
less hypnotic effects and GI distress

64
Q

dilaudid

A

synthetic opioid
more potent than morphine
less hypnotic effects and GI distress
faster onset and duration
tolerance! Don’t take >72h

65
Q

dilaudid dosage

A

2mg or less

66
Q

nalbuphine (nubain) indications

A

opioid
not for late trimesters
to relieve mod-sev pain

67
Q

SE of nalbuphine (nubain)

A

dizziness, confusion, hallucinations, blurred vision, HA, flushing, sedation, nervousness, bitter, hypotension, dyspnea

68
Q

AR and LT of nalbuphine (nubain)

A

Adverse reactions: bradycardia, tachycardia (when pts have hypotension), respiratory depression
Life-threatening: respiratory depression

69
Q

caution of nalbuphine (nubain)

A

h/o drug abuse, emotional instability, impaired respirations, ↑ ICP, biliary tract surgery, renal or hepatic dysfunction
CNS depression w ETOH

70
Q

what to keep nearby with fentanyl

A

saline bc hypotension
also itching is normal

71
Q

transdermal fentanyl

A

change patch every 24h

72
Q

migraine

A

unilateral throbbing head pain with N/V and photophobia, lasting 2-24 hours
Caused by inflammation of blood vessels in cranium
Thought to be a serotonin imbalance
2/3 women 20-30, decrease during pregnancy and menopause (hormonally related)
Triggers: red wine, cheese and chocolate

73
Q

cluster headache

A

Severe unilateral non-throbbing pain usually around eye
Occur in clusters of severe attack one or more attacks for several days over several weeks
Occurs in men more commonly than women
Related to stress

74
Q

preventative meds for migraines

A

Beta-adrenergic blockers (inderal, tenormin)
Anticonvulsants (valproic acid), neurontin
TCA (elavil, tofranil)

75
Q

treatment or cessation of migraines

A

Analgesics, opioid analgesics, ergot alkaloids, SSRA (triptans)

76
Q

5-HT 1 receptor agonist: sumatripan (imitrex) indication

A

to TREAT (not prevent) cluster headaches and migraines
take med when they feel the aura

77
Q

sumatriptan (imitrex) SE

A

dizziness, fainting, tingling, numbness, drowsiness, muscle cramps, N/V/D, abdominal cramps

78
Q

sumatriptan (imitrex) AR and LT

A

Adverse effects: hypotension, HTN (more common than hypotension), heart block, angina, dysrhythmias, thromboembolism (from vasoconstriction), seizures
Life threatening: coronary artery vasospasm, MI, cardiac arrest

79
Q

sumatriptan (imitrex) contra and caution

A

Contraindicated: hypersensitivity, CAD, HTN, obesity, DM, smoking, CVA
Caution: liver or renal dysfunction

80
Q

symptoms of psychosis

A

Difficulty processing information/conclusion
Delusions
Hallucinations
Incoherence
Catatonia (no facial expression)
Aggressive behavior

81
Q

positive symptoms of schizo

A

(exaggeration of normal function)
Incoherent speech
Hallucinations
Delusions
Paranoia

82
Q

negative symptoms of schizo

A

(decrease/loss of function or motivation)
Loss of speech
Poor self-care
Social withdrawal

83
Q

phenothiazines/nonphenothiazine

A

Blocks norepinephrine causing sedative hypotensive effects when started
Ex: chlorpromazine HCL (thorazine)
Fluphenazine HCL (prolixin)
Trilafon, mellaril

84
Q

atypical antipsychotics

A

Ex. Clozapine
1st line treatment for schizophrenia due to decreased SE
Good for use in other psychotic disorders that don’t respond to typical antipsychotics
Ex: clozaril, zyprexa, risperdal, abilify, seroquel

85
Q

dopaminergic antagonists

A

D1-5

86
Q

extrapyramidal syndrome

A

pseudoparkinsonism
MARCHING MOVEMENT

87
Q

adverse effects of antipsychotics

A

Acute dystonia: muscle spasms of face, tongue, back and neck, facial grimacing, abnormal upward eye movement, laryngeal spasms that can impair respiration
Akathisia: difficulty standing still, restless, paces floor
Tardive dyskinesia: protrusion and rolling of tongue, sucking and smacking movements of lips, chewing motion, involuntary movement
Neuroleptic malignant syndrome: rare, potentially fatal condition associated with antipsychotic drugs

88
Q

typical antipsychotic ending

A

-azine

89
Q

fluphenazine (prolixin)

A

typical antipsychotic

90
Q

fluphenazine (prolixin)

A

typical antipsychotic
to manage psychosis/schizo

91
Q

contra of fluphenazine (prolixin)

A

subcortical brain damage, blood dyscrasia, renal/liver damage, coma

92
Q

SE of fluphenazine (prolixin)

A

sedation, dizziness, HA, dry mouth, nasal congestion, blurred vision, photosensitivity, N/C, urinary retention

93
Q

AR and LT of fluphenazine (prolixin)

A

Adverse reactions: HTN, hypotension, tachycardia, extrapyramidal symptoms (tardive dyskinesia), impaired thermoregulation, convulsions
Life threatening: agranulocytosis

94
Q

kava kava with fluphenazine (prolixin)

A

may increase dystonia

95
Q

haldol

A

typical antipsychotic
to treat acute and chronic psychoses, children with severe behavior problems who are combative, suppress narcotic withdrawal symptoms, schizophrenia resistant to other drugs, tourette syndrome, symptoms of dementia in older adults

96
Q

SE of haldol

A

sedation, extrapyramidal symptoms, orthostatic hypotension, HA, photosensitivity, dry mouth and eyes, blurred vision (anticholinergic side effects)

97
Q

AR and LT of haldol

A

Adverse reactions: tachycardia, seizures, urinary retention
Life threatening: laryngospasm, resp depression (especially in the elderly), cardiac dysrhythmias, neuromalignant syndrome, agranulocytosis

98
Q

risperidone (risperdal)

A

atypical antipsychotic
to manage psychosis/schizo
for elderly pts with dementia

99
Q

risperidone (risperdal) SE

A

sedation (a lot, goes away in about a week or so), weight gain, HA, fatigue, photosensitivity, blurred vision, sexual dysfunction, alopecia, amenorrea, agitation

100
Q

AR and LT of risperidone (risperdal)

A

Adverse reactions: orthostatic hypotension, HTN, bradycardia, tachycardia, EPS, convulsions
Life threatening: suicidal ideation, neuroleptic malignant syndrome

101
Q

contraindications and drug effects of risperidone (risperdal)

A

Contraindicated: hypersensitivity, dehydration, ETOH, intoxication, suicidal ideation
Drug interactions: increased effects of hypertensives

102
Q

abilify

A

for psychosis

103
Q

abilify drug interactions

A

antidiabetic agents; can cause hypoglycemia
Hypotension with antihypertensives, other antipsychotics increases risk of NMS and EPS syndrome
Anticholinergic effects, CNS depressants
Grapefruit juice may increase blood levels
St. john’s wort may decrease blood levels

104
Q

nursing considerations of abilify

A

Monitor for orthostatic hypotension
Make sure pt has swallowed pill
Observe for EPS
May take 6 weeks or longer for full clinical effect
Do not d/c abruptly
Avoid CNS depressants, ETOH
May be excreted in breast milk
Wear med-alert bracelet
Tolerance to sedative effect develops over a few weeks

105
Q

benzos

A

for anxiety
Ex: alprazolam (xanax), clorazepate HCL (librium), diazepam (valium)
Ativan
Azapirones
Ex: buspar

106
Q

lorazepam (ativan)

A

STRONG
to control anxiety, status epilepticus, preop sedation

107
Q

contra and caution of ativan

A

Contraindications: hypersensitivity, CNS depression, shock, coma, narrow-angle glaucoma, pregnancy, lactation
Caution: hepatic or renal dysfunction, suicidal (used to off themselves)

108
Q

drug interactions of ativan

A

Cimetidine increases lorazepam plasma levels, increases dilantin levels, smoking decrease anti anxiety effects
Kava: may potentiate sedation

109
Q

reversal agent for ativan

A

flumazenil (mazicon)

110
Q

ending for benzos

A

-am

111
Q

buspirone HCL (buspar)

A

less sedating
1-2 weeks to be effective
grapefruit juice only 8oz

112
Q

nursing considerations of ativan

A

2-4 months max to avoid dependence
lower doses in children and elderly
orthostatic hypotension
no driving or ETOH
do not abruptly d/c

113
Q

reactive depression

A

Sudden onset after an event (death of a loved one)
Client knows why depressed
Lasts for months
Treatment: benzodiazepine

114
Q

major depression

A

Primary
Not r/t health problem

Secondary
R/t health problem (drugs/psychiatric)
Loss of interest in work
Inability to complete tasks
Deep depression (dysphoria)

115
Q

bipolar affective depression

A

Manic depressive
Swings between moods
Euphoria/dysphoria
Treatment of choice: depakote

116
Q

herbal supplement for depression

A

st. john’s wort and gingko biloba
d/c 1-2 weeks before surgery bc increased bleeding

117
Q

tricyclic antidepressants examples

A

Amitriptyline (elavil), clomipramine (anafranil), imipramine (tofranil)
-INE
d/c gradually

118
Q

SSRIs for depression examples

A

Citalopram (celexa), fluoxetine (prozac), fluvoxamine (luvox), paxil, zoloft

119
Q

atypical antidepressants examples

A

Amoxapine (asendin), bupropion (wellbutrin), venlafaxine (effexor), MAOIs

120
Q

amitriptyline HCL

A

for depression, BPD, alcoholism, migraines, anxiety, and urinary incontinence

121
Q

amitriptyline HCL SE

A

sedation, drowsiness, nervousness, blurred vision, metallic taste, dry mouth and eyes, urinary retention, constipation, weight gain, N/A increased intraocular pressure

122
Q

amitriptyline HCL AR and LT

A

Adverse reactions: orthostatic hypotension, cardiac dysrhythmias, extrapyramidal symptoms
Life-threatening: agranulocytosis, thrombocytopenia, leukopenia, seizures
Contraindications: acute MI, taking MAOIs, cardiac dysrhythmias

123
Q

amitriptyline HCL AR and LT

A

Adverse reactions: orthostatic hypotension, cardiac dysrhythmias, extrapyramidal symptoms
Life-threatening: agranulocytosis, thrombocytopenia, leukopenia, seizures
Contraindications: acute MI, taking MAOIs, cardiac dysrhythmias

124
Q

amitriptyline HCL contra and caution

A

Contraindications: acute MI, taking MAOIs, cardiac dysrhythmias
Caution: severe depression with suicidal tendency (when we make them feel better, they feel more willing to kill themselves so be careful!!), cardiovascular, liver or kidney dysfunction, narrow angle glaucoma, seizures, prostatic hypertrophy, DM, hyperthyroidism

125
Q

drug interactions with amitriptyline HCL

A

increased CNS respiratory depression, hypotension with ETOH
Increased sedation and anticholinergic effects with phenothiazines and haldol
HTN crisis and death may occur with MAOIs, NEVER take together

126
Q

TCAs

A

for agitated depressed ppl
Amitriptyline (elavil), doxepin (sinequan), trimipramine (surmontil) have highly sedative effects

127
Q

prozac use

A

SSRI for depression
for calm pts, NOT agitated

128
Q

prozac SE

A

headache, nervousness, restlessness, insomnia, blurred vision, tremors, GI distress, sexual dysfunction

129
Q

AR of prozac

A

seizures, hyponatremia, palpitations, chest pain

130
Q

SSRI ending

A

oxetine

131
Q

SSRI 3 major SE

A

confusion
slurred speech
altered LOC

132
Q

contra, caution, and drug interactions of prozac

A

Contraindications: AMI, taking MAOIs
Caution: severe depression with suicidal tendency, severe liver or kidney disease
Drug interactions: increased effect of CNS, respiratory depression, hypotension with ETOH

133
Q

effexor and MAOIs

A

DON’T TAKE TG
14 days after you d/c MAOIs

134
Q

SE and AR of effexor

A

Side effects: drowsiness, dizziness, nervousness, insomnia, HA, N/V/D, weight loss
Adverse effects: bradycardia, tachycardia, hyponatremia, seizures

135
Q

MAOIs use

A

to relieve symptoms of depression

136
Q

examples of MAOIs

A

isocarboxazid (marplan), phenelzine sulfate (nardil), tranylcypromine sulfate (parnate), selegiline HCL (eldepryl)

137
Q

SE of MAOIs

A

agitation, restlessness, insomnia, and orthostatic hypotension

138
Q

adverse effects of MAOIs

A

HTN crisis from food and drug interactions

139
Q

drug interactions of MAOIs

A

DO NOT TAKE W TCAS
NOT MIXED WITH SYMPATHOMIMETICS OR CNS STIMULANTS
decreased effectiveness of anticonvulsants

140
Q

foods to avoid with MAOIs

A

Cheese
Bananas, raisins
Pickled foods
Red wine, beer
Cream, yogurt
Chocolate, coffee
Italian green beans
Liver
Yeast
Soy sauce

141
Q

mood stabilizers

A

used for BPD
for this and manic depression, it makes them tired so compliance is low

142
Q

lithium use as a mood stabilizer

A

Calming effect without impairing intellectual activity
Controls evidence of flight of ideas and hyperactivity
Manic behavior often returns when a person stops taking lithium

143
Q

lithium and fluid intake

A

Increase water intake to 2-3L per day in the first week then 1L per day

144
Q

drug range of lithium

A

0.5-1.5

145
Q

SE of lithium

A

HA, lethargy, drowsiness, dizziness, tremors, slurred speech, dry mouth, anorexia, D/V, polyuria, hypotension, abdominal pain, muscle weakness, restlessness

146
Q

adverse reactions of lithium

A

urinary incontinence, hyponatremia, clonic movements, stupor, azotemia, leukocytosis, nephrotoxicity

147
Q

LT reactions of lithium

A

dysrhythmia and circulatory collapse

148
Q

contra and caution of lithium

A

Contraindications: liver and renal disease, pregnancy, lactation, severe cardiac disease, severe dehydration, brain tumor or brain damage, sodium depletion, children <12
caution: thyroid disease

149
Q

drug interactions of lithium

A

increased sodium levels with thiazide diuretics, methyldopa, haldol, NSAIDs, antidepressants, carbamazepine
Lithium may cause sodium depletion

150
Q

nursing considerations of lithium

A

When drawing blood levels check immediately before next dose (8-12 hours after last dose)
Monitor and maintain weight and urine output
Maintain adequate fluid intake (2-3L/day initially, then 1-2L maintenance)
Take with meals to decrease GI distress

Pharm 2 (5 decks)

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