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Pharm Exam 4 - Class Review > knowledge deck > Flashcards

knowledge deck Flashcards

1
Q

what is unique about Sucralfate (Carafate) MOA

A

Protective barrier

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2
Q

Disadvantages of Sulcrafate?

A

QID use
GI effects
Decreases drug absorption

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3
Q

When do you take Sucralfate?

A

Before meals and at bedtime

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4
Q

How do you recognize PPIs by their generic name

A

-prazole

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5
Q

Are PPIs more or less powerful than H2RAs

A

More powerful due to irreversible pump shutdown

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6
Q

are PPIs a single drug therapy for Peptic ulcers?

A

First line treatment but but not single drug therapy for ulcers plus H.Pylori
PPI used for bleeding or NSAID ulcers; Antacids and H2RB are not

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7
Q

How well tolerated are PPIS

A

very well tolerated

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8
Q

Potential disadvantages to chronic PPI therapy?

A

increased risk for food poisoning, HAI (esp c-diff), pneumonia,

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9
Q

How to take PPIs in relation to meals

A

take before meals to keep the acid production from coming

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10
Q

For H2 receptor antagonists…

use with caution with ______ or _____ disease

A

kidney or liver

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11
Q

which H2RA has the most drug interactions and why

A

most drug interactions are from cimetidine (Tagamet) due to CP450 effects

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12
Q

which drug interactions are a problem and why (H2RA)

A

ETOH and CNS depressants for safety reasons

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13
Q

what population group is at risk for CNS adverse effects for H2RA

A

elderly

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14
Q

what are the protective factors of the stomach

A

mucous
bicarb
prostaglandin

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15
Q

The stomach also secretes intrinsic factor which helps with?

A

B12 absorption

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16
Q

A deficiency in B12 absorption leads to

A

macrocytic anemia

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17
Q

causative bacteria for peptic ulcer disease

A

H.Pylori

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18
Q

Treatment for H.Pylori

A

PPI plus a combo of 2 antibiotics for 1-2 weeks then continue with PPI for 4-8 weeks for healing to occur

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19
Q

Which acid controlling drug neutralizes acid

A

antacids

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20
Q

What is an example of an antacid

A

Calcium Carbonate

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21
Q

which acid controlling drug blocks stimulation of production

A

H2 receptor antagonist

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22
Q

What is an example of a H2 receptor antagonist

A

Ranitidine

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23
Q

Which acid controlling drug stops the production of acid

A

Proton pump inhibitors

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24
Q

What is an example of a PPI

A

Omeprazole

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25
Q

what does sucralfate (Carafate) do

A

Protects the lining of the stomach

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26
Q

What does simethicone (Mylicon) do?

A

breaks up gas

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27
Q

who gets stress ulcers and why

A

after major trauma

due to endogenous and exogenous steroids production (anti-prostaglandins)

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28
Q

what classes of drugs are used to prevent stress ulcers

A

H2RBs and PPIs

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29
Q

mucous protects against

A

autodigestion

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30
Q

bicarbonate

A

helps buffer HCL

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31
Q

prostaglandins

A

prevent activation of proton pump and increase blood flow, bicarb and mucous production

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32
Q

which antacid has the worst rebound reaction

A

Calcium carbonate

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33
Q

indications for antacids

A 
Hyperacidity
GERD
Gastritis
Ulcer prevention
Calcium and magnesium replacement
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34
Q

How does the pt prevent drug interactions when using antacids

A

Take 2 hours before or after other meds

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35
Q

cautions for pts using chronic or excessive use of antacids

A

avoid unsupervised use for greater than 2 weeks, may need a workup

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36
Q

which antacids are more risky if you have diarrhea or renal disease

A

magnesium

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37
Q

which antacids are more risky if you have constipation

A

calcium

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38
Q

which antacids are more risky if you have heart failure

A

sodium

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39
Q

What are the types of laxatives?

A 
Bulk forming
Emollient
Hyperosmotic
Saline
Stimulant
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40
Q

Bulk forming MOA

A

High fiber
Prebiotic effect
absorb water to increase bulk
distends bowel to initiate reflex bowel activity

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41
Q

Metamucil and citrucel are examples of what type of laxative

A

Bulk forming

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42
Q

foods high in fiber

A 
stems
seeds
skins of plants
whole grains
prunes
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43
Q

Emollient MOA

A

stool softeners and lubricants
promote more water and fat in stools
lubricate the fecal material and intestinal wall

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44
Q

colace and surfak are examples of what type of laxitive

A

emollient

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45
Q

Examples of lubricants

A

mineral oil - not absorbed

olive oil - nutritional value (folk remedy)

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46
Q

Hyperosmotics MOA

A

increase fecal water content

result in bowel distension, increase peristalsis and evacuation

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47
Q

examples of hyperosmotics

A

Miralax
glycerin (very mild)
Lactulose

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48
Q

what is lactulose also use for

A

to bring down serum ammonia levels

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49
Q

saline laxative MOA

A

increases osmotic pressure drawing more water into the intestines
results in bowel distension, increase peristalsis and evacuation

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50
Q

examples of saline laxatives

A

milk of magnesia

mag citrate

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51
Q

stimulant laxative MOA

A

Increase peristalsis via intestinal nerve stimulation which is effective higher in the colon

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52
Q

examples of stimulant laxatives

A

Senna (Senekot)

bisacodyl (Dulcolax)

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53
Q

adverse effects bulk forming laxatives

A

impaction if the pt is not taking in adequate water

esophageal blockage - need to drink it right away or it starts to thicken

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54
Q

adverse effects of emollient laxatives

A

skin rashes
decreased absorption of lipid soluble vitamins
risk of aspiration pneumonia esp in a bed ridden pt

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55
Q

adverse effects of hyperosmotic laxatives

A

abd bloating
cramping
rectal irritation

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56
Q

saline laxative adverse effect

A

increased thirst, cramping, diarrhea
electrolyte imbalance
for renal insufficiency patients - mag toxicity

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57
Q

stimulant laxative adverse effects

A 
nutrient malabsorption
skin rashes
gastric, rectal irritation
discolored urine
dependency
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58
Q

pt education on laxatives

A

do not use if suspect appendicitis - can lead to rupture

-n/v and severe abd pain

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59
Q

laxative dependency

A

from an atonic colon, depends on the laxative

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60
Q

laxative abuse

A

Chronic exposure to laxatives can diminish defecatory reflexes leading to further reliance on laxatives. Laxatives can purge the bowel. Reflex wont return until bowel refills but often time someone thinks they are constipated again because they aren’t having a bm daily. Can lead to electrolyte imbalance, dehydration and colitis

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61
Q

which of the laxatives is best suited for children

A

glycerin suppository

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62
Q

which of the laxatives is best suited for elderly

A

stool softeners

Bulk

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63
Q

which of the laxatives is best suited for long term, chronic use

A

stool softeners

bulk

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64
Q

which of the laxative classes is slowest on onset

A

stool softeners

Bulk

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65
Q

which of the laxatives is fastest to onset

A

osmotics

saline

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66
Q

which of the laxative classes is most likely to cause fluid/electrolyte imbalances

A

saline

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67
Q

which laxative is also used as an antacid

A

Milk of Magnesia

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68
Q

which laxative is most likely to cause aspiration pneumonia or deficiency of lipid soluble vitamins with prolonged use

A

Mineral oil

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69
Q

esophageal/Intestinal blockage, which laxatives put you most at risk/ what group is at highest risk

A

bulk forming

Those with eating disorders are most at risk

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70
Q

duration of acute diarrhea

A

up to 2 weeks

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71
Q

duration of chronic diarrhea

A

greater than 3 weeks

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72
Q

other symptoms of chronic diarrhea

A 
recurring diarrheal stools
fever
poor appetite
n/v
weight loss
weakness
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73
Q

causes of acute diarrhea

A 
bacterial
viral
drug induced
food related
protozoa
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74
Q

causes of chronic diarrhea

A 
tumors
diabetes mellitus
Addisons disease
Hyperthyroidism
IBS
AIDS
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75
Q

example of probiotics

A

L.acidophilus ( Lactinex)

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76
Q

does probiotics treat or prevent diarrhea

A

both

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77
Q

example of probiotics

A

L.acidophilus ( Lactinex)

Yogurt

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78
Q

examples of adsorbents

A

Pepto-bismol

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79
Q

danger of giving Pepto bismol to children or teenagers with virus

A

Risk of Reye’s syndrome

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80
Q

examples of adsorbents

A

Pepto-bismol (Bismuth subsalicylates)

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81
Q

Examples of opiates

A 
Immodium -AD
Lomotil
paregoric
opium tincture
codeine
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82
Q

Examples of opiates

A 
Imodium -AD
Lomotil
paregoric
opium tincture
codeine
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83
Q

anticholinergics moa

A

antimotility

slows the movement of fecal matter through GI tract

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84
Q

examples of anticholinergics

A

atropine - which is in Lomotil

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85
Q

cholinergic effects

A 
Acronym "SLUDGE"
Salivation
Lacrimation
urination
Diarrhea
GI distress
Emesis
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86
Q

anticholinergic toxicity

A 
Blind as a bat
mad as a hatter
dry as a bone
Hot as a dessert
red as a beet
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87
Q

Adverse Effects

Adsorbents- Salicylates:

A

Increased bleeding time
• Decrease absorption of many other drugs
• Constipation, dark stools/ tongue
• Confusion, twitching
• Hearing loss, tinnitus, metallic taste, blue
gums

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88
Q

Adverse Effects

Opiates

A
  • Drowsiness, sedation, dizziness, lethargy
  • Nausea, vomiting, anorexia, constipation
  • Respiratory depression
  • Hypotension
  • Urinary retention
  • Flushing
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89
Q

Adverse Effects

Anticholinergics

A 
• Urinary retention (esp who?),
hesitancy, impotence
• CNS effects: Headache, dizziness,
confusion, anxiety, drowsiness
• Dry skin, flushing
• Blurred vision (why?)
• Hypotension, bradycardia
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90
Q

Anticholinergic Agents MOA

A

Blockade of muscarinic receptors in the

striatum

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91
Q

example of an anticholinergic agent

A

atropine

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92
Q

side effect of anticholinergic agents

A

Urinary retention, hesitancy, acute glaucoma,

orthostatic BP, decreased sweating

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93
Q

adverse effect anticholinergic agent

A

Dysrhythmias, risk hyperthermia (esp for ____),

____ glaucoma» _____crisis

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94
Q

adverse effect anticholinergic agent

A

Dysrhythmias, risk hyperthermia (esp for elderly),

narrow angle glaucoma» angle closure crisis

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95
Q

Anti-diarrheals:

Monitoring/ Pt Education

A

Teach patients about fluid intake and
dietary changes
• Use salicylates carefully in elderly or those
with bleeding/ clotting disorders, confusion
• Assess hydration/ fluid volume status
• Needs evaluation if bloody stools, with
fever, severe pain, risk dehydration,
prolonged

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96
Q

On what basis is diarrhea defined?

A

Loose or watery, usually

frequent stools

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97
Q

Which is used in MILD diarrhea?

A

Adsorbents or probiotics

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98
Q

Why does Lomotil contain atropine?

A

To

prevent abuse

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99
Q

anti-diarrheal CI (contraindicated) in children?

A

Bismuth

subsalicylates to prevent Reyes syndrome

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100
Q

Lomotil (and all anti-peristaltics) is CI in what

kind of diarrhea and why?

A

AAPMC/ C diff as
antibiotics are needed and antimotilty agents
allow more (fatal) toxins to be absorbed

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101
Q

example of an Anticholinergic drugs (ACh blockers)

A

Scopolamine

• Also used for motion sickness (transdermal patch)

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102
Q 
Antihistamine drugs (H1
receptor blockers) examples
A

dimenhydrinate (Dramamine),
diphenhydramine (Benadryl), meclizine
(Antivert)- specifically for vertigo

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103
Q

Antidopaminergic drugs- phenothiazides examples

A

prochlorperazine (Compazine), promethazine

Phenergan

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104
Q

Antidopaminergic/ Prokinetic drugs

A

if the problem is the food is sitting too long and not moving forward so causes the vomiting

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105
Q

Antidopaminergic/ Prokinetic drugs examples

A

metoclopramide (Reglan)
• Long-term use may cause irreversible tardive dyskinesia&raquo_space;
“Litogenic” - law suit generating

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106
Q

Serotonin blockers examples

A

ondansetron (Zofran), dolasetron (Anzemet)

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107
Q

NK (neurokinin)1 Receptor antagonist - the only one

A

• Only one ex: aprepitant (Emend) - expensive

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108
Q 
phosphorated
carbohydrate solution (Emetrol) MOA
A 
decrease peristalsis and delay gastric
emptying
• No drug interactions, no serious reactions
• Avoid with diabetes
great for pregnancy
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109
Q

Taking antiemetics with _______ may cause

severe CNS depression

A

alcohol

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110
Q

Teach patients to ______ to avoid

hypotensive effects

A

rise and change positions

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111
Q

diet teaching for n/v

A

bland diet

wet/dry diet

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112
Q

what is a wet dry diet

A

eat meal dry with no drink, wait and hour to drink

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113
Q

antiemetics : Many of these drugs cause severe drowsiness;

warn patients ________

A

about driving/operating heavy machinery

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114
Q

Anticholinergics block

A

cholinergic receptors ie) Scopolamine

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115
Q

Antihistamines block

A

Block H1 receptors ie) meclizine

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116
Q

Antidopaminergic block

A

Block dopamine receptors,

promethazine

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117
Q

Prokinetics block

A
  • Block dopamine receptors and stimulate

stomach emptying ie) metaclopramide

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118
Q

• Serotinin blockers block

A
  • Block 5-HT3 receptors- odansetron
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119
Q

antiemetics Most likely to cause drowsiness?

A

Anticholinergics,

Antihistamines & Antidopaminergic

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120
Q

antiemetics Most likely to cause dry mouth, blurred vision and
urinary retention?

A

Anticholinergics, Antihistamines &

Antidopaminergic

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121
Q

Which of the antiemetics is most likely to
cause Parkinsonian SE and tardive dyskinesia
with long term use

A

Metoclopramide

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122
Q

Which of the antiemetics is indicated for

motion sickness AND vertigo?

A

Meclizine (Antivert)

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123
Q

Indicated for nausea/ vomiting secondary to

chemotherapy?

A

Serotonin blockers or NK1

blockers

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124
Q

What pt population(s) are most likely to have

paradoxical reactions from antihistamines?

A

Kids and elderly

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125
Q

What are alternative modes of administration

besides orally?

A

Suppositories, IV or patch (scopolamine)

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126
Q

How does you monitor the therapeutic effect

of antinausea/ antiemetic drugs?

A

Hydration,
weight, urine ketones, tolerance of triggers,
intake/retention of fluids, food

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127
Q

definition of drug abuse

A

using a drug in a fashion inconsistent with medical or social norms

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128
Q

a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems

A

substance use disorder

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129
Q

results from regular drug use and can be defined as a state in which a particular dose elicits a smaller response than it did with initial use.

A

tolerance

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130
Q

a state in which tolerance to one drug confers tolerance to another. (generally in the same class)

A

cross-tolerance - example is heroin and morphine

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131
Q

an intense subjective need for a particular psychoactive drug

A

psychological dependence

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132
Q

a state in which an abstinence syndrome will occur if drug use is discontinued. if drug is stopped there is a visible physical symptom

A

physical dependence

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133
Q

the ability of one drug to support physical dependence on another drug

A

cross-dependence

ie) a alcoholic who needs ativan to go to work without alcohol

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134
Q

a constellation of signs and symptoms that occurs in physically dependent individuals when they discontinue drug use

A

withdrawal syndrome

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135
Q

being physically dependent on a drug is/is not the same as having a substance use disorder

A

is not

ie) someone who has seizures needs to be on a medication to stay seizure free. This is not SUD

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136
Q

explain reinforcement in drugs

A

a drug can give the individual an experience that is pleasurable
lets say you have someone who is anxious so they take barbituates. This makes them feel better

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137
Q

factors that contribute to substance use disorder

A 
reinforcement of drugs
physical dependence
psychological dependence 
social factors
drug availability
vulnerability of the individual
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138
Q

repeated use of a drug contributes to the transition from voluntary use to compulsive use by causing

A

molecular changes in the brain

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139
Q

The Comprehensive Drug Abuse Prevention and Control Act of 1970, known informally as the Controlled Substances Act (CSA) objective is to

A

reduce the chances that drugs originating from legitimate sources will be diverted to abusers

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140
Q

You can only prescribe controlled substances if you have

A

a DEA licence

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141
Q

what schedule class carry the highest risk for abuse

A

Schedule II

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142
Q

oral prescriptions for schedule II meds can be called in for an emergency but you must have a written prescription within ____ hours

A

72

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143
Q

what is the most common used and abused psychoactive agent in the US

A

alcohol

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144
Q

2 of the biggest negative effects of alcohol

A

depression of the CNS

activation of the reward system - perpetuates the abuse of this substance

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145
Q

if alcohol is chronically used in excess

A

injury to CNS
significant nutritional deficiencies
cardiac depressant

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146
Q

alcohol and sleep

A

commonly used as a sleep aid but it actually
disrupts sleep. alters sleep cycles, decrease total sleeping time, reduces the quality of sleep
can intensify snoring and exacerbate sleep apnea

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147
Q

alcohol and cardiac

A

dilation of cutaneous blood vessels - increased blood flow to skin (flushing, warm sensation)

direct damage to myocardium - increases risk for heart failure (alcohol induced cardiac myopathy)

dose dependent elevation of BP - deeper tissues you see vasoconstriction

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148
Q

moderate alcohol use

A

2 drinks a day or less for men
one drink a day or less for women

3-4 days per week
protection is greater than someone who drinks 1-2 days per week

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149
Q

heart benefits of moderate alcohol use

A 
less ischemic stroke
less CAD
less MI
less heart failure
as opposed to abstainers
raises HDL cholesterol which protects against CAD
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150
Q

the degree of protection with type of alcohol

A

nearly equal for beer, wine, and distilled spirits

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151
Q

Cardioprotection in regard to drinking is greatest for those

A

with an unhealthy lifestyle -
for those who exercise, eat fruits and vegetables and do not smoke - alcohol has little or no effect on the incidence of coronary events

conversely - for those who lack these behaviors, moderate alcohol intake is associated with a 50% reduction in coronary risk

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152
Q

alcohol and diabetics

A

has several effects on glucose metabolism that may decrease the risk for type 2 diabetes.

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153
Q

alcohol and bone health

A

increases bone mineral density, by increasing levels of sex hormones

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154
Q

alcohol and liver

A

can sustain large amounts of alcohol use

for chronic drinkers - nonviral hepatitis develops in approximately 90% of heavy users which can evolve into cirrhosis

alcohol abuse is unquestionably the major cause of fatal cirrhosis

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155
Q

alcohol and stomach

A

excessive use can cause erosive gastritis

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156
Q

alcohol and kidney

A

alcohol is a diuretic. it can eventually cause renal damage

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157
Q

alcohol and pancrease

A

can cause pancreatitis (2nd most common cause of this)

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158
Q

alcohol and cancer

A

alcohol (even in moderate amounts) is associated with increased risk for several common cancers - breast, liver, rectum, aerodigestive tract (lips, tongue, mouth, nose, throat, vocal cords, portions of the esophagus and trachea)

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159
Q

Fetal alcohol spectrum disorder

A

craniofacial malformations
growth restrictions
neurodevelopmental abnormalities

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160
Q

the concentration of alcohol in breastmilk parallels ____

A

the concentration of alcohol in blood. Recent data indicates that drinking while breastfeeding can adversely affect the infants feeding and behavior

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161
Q

alcohol is primarily absorbed through

A

the stomach and small intestines

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162
Q

alcohol is metabolized by

A

liver and stomach

primarily in the liver

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163
Q

male and female metabolism of alcohol

A

females have lower activity of alcohol dehydrogenase so gastric metabolism is significantly less in women who metabolize alcohol slower than men

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164
Q

cross tolerance with alcohol

A

general anesthetics
barbiturates
other general CNS depressants

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165
Q

very little tolerance develops to

A

resp depression

alcoholics may tolerate blood alcohol levels as high as 0.4% (five times the amount defined by law as intoxicating) with no marked reduction in consciousness. However if blood levels rise only slightly above this level, death may ensue.

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166
Q

drug interactions for alcohol

A

CNS depression
benzodiazepines
opioids
barbituates

NSAIDS - increase chance of GI bleeding

Acetaminophen - potentially fatal liver injury when taking normal dosing with large amounts of alcohol

Antihypertensive drugs
tends to counteract the effects of antihypertensive medications
monitor BP closely

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167
Q

alcohol poisoning treatment

A

alcohol lavage

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168
Q

drugs to facilitate alcohol withdrawal

A

Benzodiazepines in inpatient or outpatient settings

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169
Q

What does benzodiazepines do in alcohol withdrawal

A

stabilize vital signs
reduce symptom intensity
decrease risk for seizures and delirium tremens

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170
Q

Benzodiazepines used in alcohol withdrawal

A

chlordiazepoxide
clorazepate (Tranxene)
Oxazepam
Lorazepam (Ativan)

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171
Q

adjunct therapy with benzodiazepines for alcohol withdrawal

A

B blockers

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172
Q

drugs used to maintain alcohol abstinence

A

Naltrexone (Vivitrol) - reduces craving for alcohol
blocks the pleasurable effect of alcohol
decreases their high

Acamprosate - not used as much
reduces unpleasant feelings - anxiety, tremors
should be used with counseling

Disulfiram (antabuse) - violent physical reaction
must be careful - risk of death from the physical reaction

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173
Q

types of anxiety disorders

A 
Generalized anxiety disorder (GAD)
Panic Disorder (PD)
Obsessive Compulsive Disorder (OCD)
Social Anxiety Disorder (SAD)
Posttraumatic Stress Disorder (PTSD)
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174
Q

for most patients a combination of drug therapy and psychotherapy is

A

more effective together than either alone

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175
Q

2 drugs used most for anxiety

A

SSRIs

SNRIs

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176
Q

med used for anxiety with long onset of action

A

Buspar

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177
Q

first line choices for anxiety disorders

A

SRIs
SSRIS
SNRIs
Buspar

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178
Q

2nd line for anxiety disorders

A

Benzos

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179
Q

only 4 antidepressants approved for GAD

A

Venlafaxine (Effexor)
Duloxetine (Cymbalta)
Paroxetine (Paxil)
Escitalopram (Lexapro)

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180
Q

compared with Benzodiazepines the antidepressants do a better job of decreasing cognitive and psychiatric symptoms of anxiety but they are not as good at decreasing

A

somatic symptoms

so antidepressants do not carry risk for abuse like benzos do

181
Q

What was the first antidepressant approved for GAD

A

Venlafaxine (Effexor)

182
Q

NEVER combine Venlafaxine (Effexor) with a

A

MAOI inhibitor (rule is to never combine an antidepressant with one)

183
Q

Buspar is a

A

anxiolytic - no abuse potential - takes a month to see results. they will need something else while they are waiting for this drug to take effect

184
Q

Buspar adverse effects

A

dizziness, nausea, headache, nervousness, sedation, lightheadedness

185
Q

Drug and food interactions for Buspar

A

levels greatly increased by erythromycin and ketoconazole and grapefruit juice

186
Q

panic disorder typically respond to

A

all 4 classes of antidepressants

187
Q

what is first line for panic disorders

A

SSRIS

188
Q

only 3 SSRIs are approved for panic disorders

A

fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)

189
Q

first line drugs for OCD

A

Fluoxetine (Prozac)
Fluvoxamine (Luvox)
Sertraline (Zoloft)
Paroxetine (Paxil)

190
Q

____ therapy is most important in OCD than any other disorder

A

Behavioral

191
Q

what TCA is used to treat OCD

A

Clomipramine (Anafranil)

192
Q

social anxiety disorder - 2 drugs approved

A

Paroxetine (Paxil)

Sertraline (Zoloft)

193
Q

Beta blocker beneficial for social anxiety disorder

A

Propranolol - musicians and actors use this frequently - also good for test anxiety
off label use

194
Q

when you prescribe a drug off label, what must you do

A

inform the patient that it its not approved for this use

195
Q

PTSD should be treated with ____ in addition to drugs

A

psychotherapy

196
Q

drugs for PTSD

A 
beneficial
fluoxetine (Prozac)
paroxetine (Paxil) - approved
Sertraline (Zoloft) - approved
Venlafaxine (Effexor)
197
Q

Sertraline (Zoloft) is used very commonly and more problematic for

A

GI side effects - so if they have IBS, zoloft wont be your DOG

198
Q

how long do patients have to have signs of depression before it can be considered major depression?

A

2 weeks

199
Q

SSRI MOA is to

A

increase serotonin available at the presnyeptic cleft

200
Q

SSRI effects

A

HEAD
decrease anxiety, decrease impulsivity, decrease sex drive

RED
interfere with plt and bleeding

FED
GI motility
Nausea

201
Q

What is the number one reason people want to stop taking SSRI

A

decrease sex drive

202
Q

How long do SSRI take to work?

A

4 to 6 weeks

203
Q

Fluoxetine (Prozac)

A

SSRI

longest 1/2 life
-1 week

“flu” worst week of your life

if you switch too fast to another SSRI/ MAOIs you can cause Serotonin syndrome

204
Q

Sertraline (Zoloft)

A

SSRI

Harsher GI side effects….”Squirt-aline”

take with meal to decrease GI SE

safer for BFing and pregnant women

205
Q

Paroxetine (Paxil)

A

SSRI

rapidly absorbed worst SE

inital SE, before clinical improvement

Withdrawal will happen much faster if stopped abruptly

NOT safe during pregnancy d/t withdrawal syndrome

206
Q

Citalopram (Celexa)

A

SSRI

effect on QT interval if given >40mg/day >20mg/day in elderly get yearly EKG

207
Q

Escitalopram (Lexapro)

A

Cleanest SSRI

208
Q

Fluvoxamine (Luvox)

A

SSRI

only approved for OCD

209
Q

Venlafaxine (Effexor)

A

SNRI

may be better for patients with lack of energy, decreased concentration

Can cause HTN, don’t use with someone with hx of HTN

210
Q

Duloxetine (Cymbalta)

A

SNRI

also helps with chronic pain “dull” for dulls the pain

211
Q

Mirtazapine (Remeron)

A

a-2 adrenergic receptor antagonist

  • nursing homes cancner clinics
  • because it helps increase appetite
  • may decrease nausea
212
Q

Mirtazapine (Remeron)

A

a-2 adrenergic receptor antagonist

  • nursing homes cancner clinics
  • because it helps increase appetite
  • may decrease nausea
213
Q

Tricyclic Antidepressants MOA

A

inhibit the reuptake of SE and NE

antagonizing Ach and histamine

inhibiting Na and calcium channels

214
Q

TCA overdose can cause

A

severe cardiac issues

widen QRS complex

215
Q

what TCA do you give if patient has insomnia

A

Doxapin

216
Q

What TCA do you give if you don’t want more sedation

A

desipramine

217
Q

If someone has ACH issues (glaucoma, constipation, BPH) what TCA do you give them?

A

Give notriptyline due to weak ACH effects

218
Q

Imipramine (Tofranil)

A

TCA

sometimes used for bed wettting in children

219
Q

Clomipraimine (anafranil)

A

TCA

gold standard for OCD but d/t high SE use SSRI first line

220
Q

use of benzodiazepines in pregnancy and lactation

A

use during first trimester is associated with increased risk for congenital malformations

use near term can cause CNS depression in the neonate

contraindicated

221
Q

drug given to promote sleep

A

hypnotics

222
Q

what are the 4 major groups of sedative-hypnotics

A

Barbiturates
Benzodiazepines
Benzodiazepine-like
new agents with unique MOA

223
Q

When treating anxiety and insomnia which is more preferred out of Barbiturates and Benzodiazepines?

A

Benzodiazepines

224
Q

When taken ____, Benzodiazepines have no affect on the heart, but when given ____ can produce profound hypotension and cardiac arrest

A

PO

IV

225
Q

What is the drug of choice for acute anxiety

A

Benzodiazepines

226
Q

anterograde amnesia

A

benzodiazepines can cause anterograde amnesia (impaired recall of events that take place after dosing).

227
Q

anterograde amnesia is especially bad with what drug

A

triazolam (Halcion)

228
Q

benzodiazepines and sleep related

A

taking benzodiazepines in sleep inducing doses may carry out complex behaviors and then have no memory of their actions. include sleep driving, preparing and eating meals, phone calls, ect

229
Q

benzodiazepines and breastfeeding

A

can pass through milk easily and can reach toxic levels in the infant. do not use

230
Q

are drugs for insomnia meant for long term or short term use

A

short term

231
Q

Zolpidem (Ambien) is approved only for

A

short term management of insomnia

232
Q

Ambien vs Ambien CR

A

Ambien is good for those who have difficulty falling asleep

Ambien CR is good for those who have difficulty staying asleep

233
Q

rebound insomnia

A

When a pt is on long term insomnia therapy when they discontinue the med they are more likely to have rebound insomnia enforcing the behavior that they feel like they need the medication

234
Q

Zaleplon (Sonata) is approved only for the short-term management of

A

insomnia

235
Q

Zaleplon (Sonata) is good for what sleep problem

A

falling asleep but not staying asleep

236
Q

Common side effects of Zaleplon (Sonata)

A 
headache
nausea
drowsiness
dizziness
myalgia
abd pain
rare cases of sleep driving
237
Q

Eszopiclone (Lunesta) is approved for

A

treating insomnia with no limitation on how it can be used

however there are no studies on use for greater than 6 mos

238
Q

Eszopiclone (Lunesta) reduced sleep ____

A

latency and nighttime awakening, increased total sleep time and sleep quality

239
Q

other common side effects are

A 
headache
somnolence
dizziness
dry mouth
sleep driving
anaphylaxis or angioedema
240
Q

Ramelteon (Rozerem) moa

A

melatonin agonist

approved for insomnia characterized by difficulty with sleep onset but not with staying asleep

241
Q

what is the only drug for insomnia that is not regulated as a controlled substance

A

Ramelteon (Rozerem)

242
Q

did the FDA put a limit on how long Ramelteon (Rozerem) can be used?

A

no because there was no rebound insomnia

243
Q

side effects of Ramelteon (Rozerem)

A 
SOMNOLENCE
dizziness
fatigue
may also cause sleep driving 
hallucinations
agitation
mania
can increase the levels of prolactin causing
amenorrhea
galactorrhea
reduced libido
fertility problems

anyphylaxis
angioedema

244
Q

drug interactions for Ramelteon (Rozerem)

A

Fluvoxamine (Luvox) can increase levels more than 50 fold

alcohol can intensify symptoms

245
Q

what drug may be given during abstinence syndrome to facilitate the withdrawal process

A

phenobarbital - a long acting barbiturate - dosage should be reduced gradually over 10 days to 3 weeks

246
Q

Ramelteon (Rozerem) and pregnancy

A

avoid

247
Q

Suvorexant (Belsomra)

A

orexin antagonist

treats insomnia for going to sleep and maintaining sleep

248
Q

does Suvorexant (Belsomra) have abuse potential

A

yes

249
Q

drug interactions for Suvorexant (Belsomra)

A

Use with strong inhibitors of CYP3A can increase the effects

Can also increase digoxin levels requiring close monitoring

250
Q

Pregnancy and lactation for Suvorexant (Belsomra)

A

studies are lacking

251
Q

Prolonged use of Barbiturates results in ____ ____, a state in which continued use is required to avoid an ____ _____.

A

physical dependence

abstinence syndrome

252
Q

symptoms of withdrawal from general CNS depressants

abstinence syndrome

A 
weakness
confusion
restlessness
insomnia
hyperthermia
orthostatic hypotension
disorientation
by 3rd day seizures may develop
then psychotic delirium (similar to alcoholic delirium tremens)
in extreme cases followed by exhaustion cardiovascular collapse and death

progresses over 8 days

253
Q

what drug may be given during abstinence syndrome to facilitate the withdrawal process

A

phenobarbital - a long acting barbituate - dosage should be reduced gradually over 10 days to 3 weeks

254
Q

overdose of barbiturates

A

apnea and death

255
Q

what is a heavily abused barbiturate

A

Xanax

256
Q

to minimize drug-dependency insomnia, hypnotics should be employed judiciously. That is, they should be

A

used in the lowest effective dosage for the shortest time required.

257
Q

Trazodone (oleptro) can decrease

A

sleep latency and prolong sleep duration

258
Q

major adverse affect of Trazodone

A

Can cause Priapism, a medical emergency

259
Q

Doxepin is an

A

TCA with strong sedative and also is really good for appetite. used for sleep maintenance in low doses

260
Q

Doxepin is contraindicated in

A

pts with severe narrow angle glaucoma and severe urinary retention

261
Q

another TCA that will help with sleep

A

Elavil

262
Q

antihistamines used for sleep aid

A

Diphenhydramine (Nytol, sominex)

263
Q

passage across the blood brain barrier is limited to

A

lipid soluble agents ant to drugs that cross by way of specific transport systems. Protein-bound drugs and highly ionized drugs cannot cross

264
Q

Can you use a drug that treats muscle spasms to relieve spasticity?

A

no, these groups are not interchangeable

As a rule, the drugs used to treat spasticity do not relieve acute muscle spasm and the drugs used to treat acute muscle spasm do not relieve spasticity.

265
Q

A group of movement disorders of CNS origin. characterized by heightened muscle tone, spasm and loss of dexterity.

A

Spasticity

266
Q

Spasticity is most commonly caused by

A

sclerosis
cerebral palsy

other causes - traumatic spinal cord injury
stroke

267
Q

what are the 4 drugs used to treat spasticity

A

Baclofen
Diazepam
Tizanidine
Dantrolene

268
Q

Which is the drug approved for spasticity that instead of working on the CNS, it works on the skeletal muscle

A

Dantrolene

269
Q

What is the drug that is approved to relieve spasticity r/t MS and some spinal cord injuries but not approved for spasticity r/t Cerebral Palsy, stroke, Parkinson disease or Huntington chorea

A

Baclofen

270
Q

Does Baclofen decrease muscle strength?

A

no
Because baclofen has no direct muscle relaxant action, it does not decrease muscle strength. For this reason Baclofen is preferred over Dantrolene

271
Q

Baclofen and CNS

A 
drowsiness
dizziness
weakness
fatigue
most intense during early phase of therapy and diminishes with continued drug use

avoid alcohol

272
Q

Antidote for Baclofen overdose

A

There is none.
can produce coma and resp depression
supportive therapy should be started immediately

273
Q

symptoms of abrupt withdrawal of oral Baclofen

A

visual hallucinations
paranoid ideation
seizures

274
Q

adverse effects of Baclofen

A

n/v
constipation
urinary retention
hypotension

275
Q

Pt education for Baclofen

A
  • possible depressant effects such as drowsiness, lightheadedness, and fatigue
  • Avoid driving and operating heavy machinery
  • Avoid other CNS depressants
  • Frequently causes hypotension, nausea, constipation, urinary retention
  • Abrupt discontinuation can cause psychiatric symptoms such as hallucinations, paranoia and seizures
276
Q

What is the only benzodiazepine labeled for treating spasticity

A

Diazepam (Diastat, Valium)

277
Q

Patient education for Dantrolene

A
  • possible depressant effects such as drowsiness, lightheadedness, and fatigue
  • Avoid driving and operating heavy machinery
  • signs of liver dysfunction are jaundice, abd pain, malaise
  • Avoid CNS depressants
278
Q

Dantrolene can relieve spasticity associated with

A

multiple sclerosis
cerebral palsy
spinal cord injury

279
Q

What drug that is approved to relieve spasticity may be associated with a significant reduction in strength

A

Dantrolene

280
Q

What should you do if you do not see benefit from Dantrolene within 45 days

A

discontinue the drug

281
Q

Black Box Warning for Dantrolene

A

fatal hepatotoxicity has occurred . The lowest effective dose should be used. Because patients may be asymptomatic, baseline liver function tests should be obtained followed by frequent monitoring of these levels throughout therapy.

282
Q

involuntary contraction of a muscle or muscle group

A

muscle spasm

283
Q

what causes muscle spasm

A

epilepsy
hypocalcemia
acute and chronic pain syndromes
localized muscle injury

284
Q

treatment of acute muscle spasm involves

A

physical measures

drug therapy

285
Q

What are some examples of adjunct therapy for muscle spasms

A

physical therapy
specific exercises
whirlpool baths
heat application

286
Q

application of a cold compress following a musculoskeletal injury

A

used initially to relieve pain and reduce swelling not to relieve muscle spasm

287
Q

drug therapy for localized muscle spasms

A

analgesics (acetaminophen or NSAIDS)

Centrally acting muscle relaxants

288
Q

What are the centrally acting muscle relaxants used to relieve muscle spasm

A 
carisoprodol
chlorzoxazone
cyclobenzaprine
diazepam
metaxalone
methocarbamol
orphenadrine
289
Q

what is the drug of choice for acute muscle spasm

A

Cyclobenzaprine

290
Q

CNS adverse effects of Cyclobenzaprine

A

It is a CNS depressant so
drowsiness
dizziness
fatigue

291
Q

anticholinergic effects of Cyclobenzaprine

A 
dry mouth
blurred vision
photophobia
urinary retention
constipation
292
Q

Cardiac effects of Cyclobenzaprine

A

cardiac rhythm disturbances- sinus tachycardia and significant conduction delays

293
Q

Cyclobenzaprine is contraindicated for patients taking

A 
Monoamine Oxidase (MAO) Inhibitors (-ine)
make sure there as been at least a 2 week dry out period before starting

SSRI
SNRI
Tricyclic antidepressants

294
Q

Taking Cyclobenzaprine with an MAO Inhibitor could lead to

A

potentially fatal serotonin syndrome

  • high fevers
  • Seizures
  • rhabdomyolysis
295
Q

Tizanidine is indicated for _____ and has been used off label to treat _____

A

spasticity

acute back pain

296
Q

What drug is approved for treatment of both spasticity and muscle spasm

A

Diazepam

297
Q

what two centrally acting muscle relaxants can cause liver damage and liver function should be assessed before starting treatment

A

Tizanidine (Zanaflex)

Metaxalone (Skelaxin)

298
Q

what centrally acting skeletal muscle relaxant can cause hepatitis and potentially fatal hepatic necrosis

A

Chlorzoxazone (Lorzone)

299
Q

what centrally acting skeletal muscle relaxant may turn urine brown, black, dark green (harmless)

A

Methocarbamol

300
Q

What centrally acting skeletal muscle relaxant may turn urine orange to purple-red (harmless)

A

Chlorzoxazone

301
Q

What centrally acting skeletal muscle relaxant can cause dry mouth, hypotension, hallucinations and psychotic symptoms

A

Tizanidine

302
Q

What needs to happen when discontinuing Tizanidine and why

A

The dose needs to be tapered to avoid rebound hypertension

303
Q

Which antidepressants can be taken safely while breastfeeding?

A

Sertraline

304
Q

what are the 2 indications for CNS stimulants

A

ADHD

narcolepsy

305
Q

what are the three most widely used CNS stimulants

A

amphetamines
methylphenidate (Ritalin)
methylxanthines (caffeine)

306
Q

what drugs are in the amphetamine family

A

-amphetamine

lisdexamfetamine (Vyvance)
amphetamine
dextroamphetamine
methamphetamine

307
Q

amphetamines and CNS

A 
prominent affects on mood and arousal
increase wakefulness and alertness
reduce fatigue 
elevate mood
augment self confidence and initiative
308
Q

Amphetamines and cardiac

A

increase HR, atrioventricular conduction, force of contraction

can cause dysrhythmias
can cause HTN

309
Q

Do amphetamines have a high or low potential for abuse? withdrawal syndrome

A

chronic use will produce physical dependence

if abruptly stopped withdrawal syndrome will ensue

310
Q

adverse effects of amphetamines

A

insomnia
restlessness
weight loss

311
Q

antiseizure for pregnancy

A

Lamictal

312
Q

a disorder characterized by daytime somnolence and uncontrollable attacks of sleep

A

Narcolepsy

313
Q

Caffeine and other methylxanthines with neonatal apnea

A

used to reduce the number and duration of apnea episodes and can promote a more regular pattern of breathing

314
Q

Modafinil (Provigil) - what is it, what is it used for

A

non-amphetamine stimulant
approved for wakefulness in patients with narcolepsy, shift-work sleep disorder (SWSD) and obstructive sleep apnea-hypopnea syndrome (OSAHS)

315
Q

can you use Modafinil during pregnancy

A

no

316
Q

what to look for in Modafinil (adverse reactions)

A 
headache
nausea
nervousness
Steven Johnson syndrome
erythema multiforme
toxic epidermal necrolysis

report - swelling, rash esp with fever
or changes in oral mucosa

317
Q

does Modafinil affect nighttime sleep

A

no

318
Q

drug interactions for Modafinil

A

Cytochrome P450

accelerates the metabolism of oral contraceptives, cyclosporine and certain other drugs

319
Q

What is the typical drug of choice for children with ADHD

A

Methylphenidate (Ritalin, Concerta)

320
Q

ADHD is characterized by

A

Inattention
hyperactivity
impulsivity

321
Q

To make a diagnosis for ADHD…

A

symptoms must appear before age 7 and be present for at least 6 months

322
Q

subclassifications of ADHD

A

predominantly inattentive type
predominantly hyperactive-impulsive type
combined type

323
Q

In addition to drugs, what can be used for the management of ADHD

A

family therapy
parent training
cognitive therapy for child

324
Q

second choice drugs for ADHD in kids

A

nonstimulants
atomoxetine
guanfacine
clonidine

325
Q

first line treatment for ADHD in adults

A

methylphenidate (Ritalin, Concerta)
dexmethylphenidate (Focalin)
dextroamphetamine-amphetamine mixture (Adderall)
lisdexamfetamine (Vyvanse)

326
Q

For ADHD with stimulants they do not create _____behavior; they only reduce ____ behavior

A

positive; negative

327
Q

principle adverse affects of stimulants are

A

insomnia and growth suppression (secondary to appetite suppression)

328
Q

what is a “drug holiday” with stimulants

A

some physicians recommend drug holidays on weekends and summers which creates opportunity for the growth to catch up. However, other clinicians argue against this because this can be hard on the kids. a rebound increase in growth will take place - as a result adult height may not be affected

329
Q

Atomoxetine (Strattera)

A

approved for ADHD in adults and kids
first non-stimulant approved for ADHD
not regulated as a controlled substance
taken once a day

330
Q

Adverse effects of Atomoxetine (Strattera)

A 
GI (dyspepsia, n/v)
reduced appetite
dizziness
somnolence
mood swings
trouble sleeping
sexual dysfunction and urinary retention in adults
angioneurotic edema - d/c drug and contact dr
SI in children and adolescence
weight loss and growth delay
severe liver injury
raise or lower bp
hypotension 
syncope
331
Q

what bowel cleaners are used for colonoscopy prep

A

sodium phosphate
a combination of sodium picosulfate, magnesium oxide and citric acid
PEG plus electrolytes

332
Q

Polyethylene glycol-electrolyte solutions

(CoLyte, GoLYTELY) adverse effects

A

dehydration does not occur and electrolyte balance is preserved

nausea, bloating, abd discomfort

333
Q

Are CoLyte and GoLYTELY safe for patients with electrolyte imbalances, heart failure, kidney disease or advanced liver disease

A

yes because they do not alter water and electrolyte status

334
Q

what bowel prep laxative is not safe for heart failure, kidney disease, advanced liver disease or patients with electrolyte imbalances

A

sodium phosphate products. This is an osmotic laxative

335
Q

What type of therapy is Phenytoin (Dilantin)?

What type of seizures is it approved for

A

monotherapy

partial seizures
primary generalized tonic clonic seizures

NOT absent seizures

336
Q

Can you use Phenytoin (Dilantin) in pregnancy?

A

no

337
Q

What precautions do you need to take when you give Phenytoin (Dilantin) IV

A

can cause severe hypotension and cardiac dysrhythmias. Cardiac monitoring should be used

338
Q

What type of dosing considerations do you need for Phenytoin (Dilantin)?

A

Narrow therapeutic range

Non-linear relationship between dosing

339
Q

What population do you need to avoid prescribing Phenytoin (Dilantin) to without specific testing

A

Asian population

340
Q

CYP interactions may decrease effectiveness of what drugs when taking Phenytoin (Dilantin)?

A

oral contraceptives
warfarin
glucocorticoids (ie) prednisone, dexamethasone, hydrocortisone

341
Q

what are some adverse effects for Phenytoin (Dilantin)

A

gingival hyperplasia

Dress syndrome

342
Q

when is Fosphenytoin (Cerebyx) used

A

when PO Phenytoin is contraindicated. This is the IV formulation

343
Q

What type of seizures is Carbamazepine (Tegretol) used for?

A

Tonic-clonic
simple partial
complex partial

344
Q

When you compare Carbamazepine (Tegretol) to Phenytoin, which drug is preferred and why?

A

Carbamazepine (Tegretol) - less side effects

345
Q

What is important to know about the pharm of Carbamazepine (Tegretol)

A

The half life decreases as the therapy progresses

initial treatment 40 hours
continued treatment 15 hours

346
Q

what is the blackbox warning for Carbamazepine (Tegretol)

A

may cause serious skin reactions such as SJS and TEN

Aplastic anemia and agranulocytosis can occur

347
Q

What population of people do you have to be cautious when giving Carbamazepine (Tegretol)

A

Asian population (test for HLA-B 1502

348
Q

What adverse effects are important to know for Carbamazepine (Tegretol)

A 
Bone marrow suppression
aplastic anemia
Water retention - caution with patients who have HF
Hyponatremia
monitor for DRESS
Hepatic and renal failure
349
Q

what do you need to tell your patient to watch for with Carbamazepine (Tegretol)

A

fever, sore throat, pallor, weakness, infection, easy bruising, petechiae - notify provider if these occur

350
Q

What food should they avoid while taking Carbamazepine (Tegretol)

A

Grapefruit juice

351
Q

What labs need to be monitored for Carbamazepine (Tegretol)

A

Na+
Hepatic
Renal
Blood counts

352
Q

Avoid prescribing Valproic Acid (Depakene, Depakote) in children less than

A

2 years old

353
Q

Can you give Valproic Acid (Depakene, Depakote) to someone who is pregnant?

A

no

354
Q

What type of seizures can you prescribe Valproic Acid (Depakene, Depakote) for?

A

all of them

355
Q

what is the blackbox warning for Valproic Acid (Depakene, Depakote)

A

Fatal hepatic failure has occurred. Young children and patients with mitochondrial disease are at increased risk. Fatal and rapidly progressing pancreatitis has occurred. Highly teratogenic

356
Q

what are the symptoms for pancreatitis?

A

n/v
anorexia
abd pain

357
Q

tell me about the therapeutic window for Valproic Acid (Depakene, Depakote)

A

wide

358
Q

what are the most common side effects for Valproic Acid (Depakene, Depakote)

A

GI side effects - give enteric coated and take with food

359
Q

what patient population can you not give Valproic Acid (Depakene, Depakote)

A

with decreased liver function - evaluate liver function at baseline and periodically

360
Q

signs and symptoms of liver injury

A 
reduced appetite
malaise
nausea
abd pain 
jaundice
361
Q

are CNS effects common for Valproic Acid (Depakene, Depakote)

A

no

362
Q

what are the drug interactions for Valproic Acid (Depakene, Depakote)

A

combined with Topiramate = increased risk for hyperammonemia

Do not take with Carbapenem ABX -mero and imipenem can reduce plasma levels of valproic acid

363
Q

signs and symptoms of hyperammonemia

A

vomiting
lethargy
altered LOC
altered cognitive function

364
Q

what is Ethosuximide used for?

A

drug of choice for absence seizures

365
Q

how many times per day do you take Ethosuximide

A

once per day but twice per day is better tolerated

366
Q

how is Ethosuximide dosed

A

This is by monitoring clinical response. The balance is high enough to control the symptoms or the adverse effects become too great

367
Q

adverse effects of Ethosuximide

A

systemic lupus erythematosus
leukopenia
aplastic anemia
SJS

368
Q

Phenobarbital falls under what class of drugs?

A

Barbituates

369
Q

What schedule class is Phenobarbital

A

Schedule IV

370
Q

what type of seizures does Phenobarbital treat

A

partial and generalized tonic clonic

NOT absence

371
Q

what is the metabolism of Phenobarbital

A

long half life - about 4 days

372
Q

how long does it take to reach the plateau of Phenobarbital and why is that important?

A

2-3 weeks, loading doses are often given to increase serum levels

373
Q

What problem should you avoid prescribing Phenobarbital having to do with familial history

A

avoid in pt with personal or familial history of porphyria

374
Q

Don’t give Phenobarbital to patients with

A

resp compromise as it can cause resp depression

375
Q

What vitamin deficiency is Phenobarbital linked to and what problems does this cause

A

Vit D, Vit K and calcium causing rickets and osteomalacia. eat foods high in vitamin D, K and calcium

376
Q

symptoms of Phenobarbital tox

A

nystagmus
ataxia
generalized CNS depression
Death from resp depression

377
Q

Drug interactions for Phenobarbital

A

CYP interactions decrease the effects of oral contraceptives and warfarin

Avoid other CNS depressants

When used with valproic acid can cause Phenobarbital levels to increase which could worsen adverse effects - decrease dose of Phenobarbital

378
Q

Primidone is very similar to what drug?

A

Phenobarbital

379
Q

what type of seizures is Primidone used for

A

tonic clonic
simple partial
complex partial

NOT absence

380
Q

Primidone - monotherapy or adjunct?

A

adjunct therapy used usually with phenytoin or carbamazepine. NEVER use with phenobarbital

381
Q

CNS effects Primidone

A

confusion in older adults
hyperactivity in children

sense of acute intoxication can occur after dosing

382
Q

Primidone is contraindicated in

A

patients or family history of porphyria

383
Q

adverse effects Primidone

A

acute psychosis
leukopenia
thrombocytopenia
systemic lupus

384
Q

drug interactions Primidone

A

reduce the effects of oral contraceptives and warfarin

385
Q

Risk with Zofran

A

prolongs QT interval

386
Q

What should you monitor when giving zofran long term?

A

QT level and electrolytes

387
Q

what two steroids are used to treat nausea but not FDA approved?

A

methylprednisonlone

and

dexamthasone

388
Q

Aprepitant (Emend) pairs with what drugs when treating chemo induced n/v

A

dexamthasone and zofran

389
Q

Aprepitant (Emend) Drug Interactions

A

rifampoin and phenytoin can decrease levels of emend

emend can raise levels of docetaxel, paclitaxel, etop, irinotecan, ifosfamide, imatinib, vinorelbine, vinblastine, and VCR, steroids (So reduce doses of steroids)

emend can decrease warfarin oral contraceptives

390
Q

black box warning with phenergan

A

contraindicated in children below 2 years old

391
Q

first line nausea in pregnancy

A

doxylamine and vitamin B6

392
Q

n/v meds safe for bfing

A

phenergan

393
Q

n/v meds to avoid in bfing

A

reglan, marinol,

394
Q

n/v meds to avoid in older adults

A

benzo, scopolamine, reglan

395
Q

when can you use methylpredisone in preg.

A

after 10 weeks gestation

396
Q

why do they put atropine with lomotil?

A

to reduce the chance of abusing the drug

397
Q

treating e.coli diarrhrea

A

cipro

398
Q

treating e.coli in children and pregnant women

A

azithromycin

399
Q

alosetron bbw

A

ischemic colitits

400
Q

alosetron is contraindicated in pts with

A

severe constipation

intestinal obstruction

ischemic colitis

crohns disease

ulcerative colitis

diverticulitis

401
Q

drug therapy for IBS

A 
5-aminosalicylates 
glucocorticoids
immunosuppressants
immunomodulators
abx
402
Q

sulfasalazine use

A

5-aminosalicylates used for IBS reduces inflammation by reducing prostoglandin

403
Q

sulfasalazine baseline labs

A

cbc

404
Q

How is oxcarbazepine (Oxtellar XR, Trileptal) used?

A

monotherapy and adjunctive therapy for management of partial seizures

405
Q

Is oxcarbazepine (Oxtellar XR, Trileptal) safe for kids?

A

yes used in adults in children
4 years and older for monotherapy
2 years and older for adjunctive therapy

406
Q

adverse effect for oxcarbazepine (Oxtellar XR, Trileptal)

A

hyponatremia if combined with other drugs that reduce NA then you should monitor NA levels

407
Q

If you are allergic to _______, you should not take oxcarbazepine (Oxtellar XR, Trileptal)

A

Carbamazepine

408
Q

drug interactions for oxcarbazepine (Oxtellar XR, Trileptal)

A

If you combine with Perampanel or
phenobarbital and valproic acid
It can decrease your oxcarbazepine (Oxtellar XR, Trileptal) levels. Monitor levels closely

not recommended with Eslicarbazepine - can increase levels of Eslicarbazepine

birth control

409
Q

oxcarbazepine (Oxtellar XR, Trileptal) and bone

A

decreased bone mineral density - osteopenia and osteoporosis with increased risk of fractures

410
Q

Lamotrigine (lamictal) black box warning

A

may cause skin reactions such as SJS and TEN

411
Q

what is Lamotrigine (lamictal) approved for

A

Adj therapy in adults and children older than 2

                - generalized seizures associated with lennox-gastaut syndrome in adults and children
               - primary generalized tonic clonic sizures in adults and children older than 2

monotherapy
- partial seizures in patients at least 16

412
Q

Lamotrigine (lamictal) and psych

A

risk of SI is greater compared to other anti-seizure drugs

413
Q

Gabapentin (Neurontin) is approved for

A

adjunctive therapy of partial seizures

414
Q

is the absorption of Gabapentin (Neurontin) affected by food?

A

no

415
Q

Gabapentin (Neurontin) and driving

A

avoid driving until tolerance develops

416
Q

Gabapentin (Neurontin) drug interactions

A

it has none. Well combined with other drugs

417
Q

Pregabalin (Lyrica) is used for

A

adjunct therapy of partial seizures

418
Q

Pregabalin (Lyrica) has similar effects to _____ and is a schedule ____

A

Diazepam

Schedule V

419
Q

Can you give Pregabalin (Lyrica) in pregancy

A

no

420
Q

CNS effects of Pregabalin (Lyrica) and does it improve with time

A

Dizziness, somnolence - does not improve with time

421
Q

Vision and Pregabalin (Lyrica)

A

Blurred vision, typically improves with time

422
Q

other side effects of Pregabalin (Lyrica)

A

weight gain, concentration issues, headache, peripheral edema, dry mouth

423
Q

Adverse effects Pregabalin (Lyrica)

A

Angioedema - d/c at the start of reaction

Rhabdomyolysis - d/c med

424
Q

symptoms of rhabdomyolysis

A

muscle injury pain
tenderness
weakness

425
Q

Abrupt d/c of Pregabalin (Lyrica)

A

insomnia
nausea
headache
diarrhea

withdraw slowly over one week

426
Q

drug interactions for Pregabalin (Lyrica)

A

alcohol, opioids, benzodiazepines, and other CNS depressants may intensify the depressant effects of Pregabalin (Lyrica), so you should avoid

427
Q

Levetiracetam (Keppra) approved for

A

myoclonic seizures in adults and adolescents 12 years and older
partial onset seizures in adults and children 4 and older
Primarily generalized tonic-clonic seizures 6 years old and older

428
Q

side effects of Levetiracetam (Keppra)

A

possible like between keppra and renal injury

otherwise mild to moderate SE

most common: drowsiness and asthenia (lack of strength or weakness)

does not affect speech, cognition or other cognitive fx

429
Q

drug interactions for Levetiracetam (Keppra)

A

There are none

430
Q

can you use keppra in pregnancy

A

yes

431
Q

Topiramate (Topamax) is approved for

A

Adj therapy of adults and children 2 years old and older with partial seizures, primary generalized tonic clonic seizures, and seizures associated with lennox gastaut syndrome

Monotherapy of adults and kids 10 yo and older with partial seizures or primary generalized tonic-clonic seizures

432
Q

Topiramate (Topamax) adverse affects

A

can cause metabolic acidosis (hyperventilation develops)

prolonged use can lead to kidney stones, fractures, growth delay

angle closure glaucoma

433
Q

what are the risk factors for Topiramate (Topamax)

A

pt with renal dx
severe resp disorders
diarrhea
ketogenic diet

434
Q

What should the pt taking Topiramate (Topamax) do if they notice hyperventilation

A

notify the provider

their dose should be tapered slowly so you dont have rebound effects

435
Q

What labs should be monitored periodically for Topiramate (Topamax)

A

Serum bicarb

436
Q

signs of angle closure glaucoma

A

ocular pain, redness, vision changes

437
Q

can you take Topiramate (Topamax) with pregancy

A

no

438
Q

drug interactions for Topiramate (Topamax)

A

Phenytoin and carbamazepine can decrease levels of Topiramate (Topamax) by 45%

Increased risk for hyperamonia if given with valproic acid (encephalopathy)

439
Q

Tiagabine (Gabitril) indications

A

partial seizures in pt at least 12yo

440
Q

Tiagabine (Gabitril) drug interactions

A

levels of Tiagabine (Gabitril) can be decreased by Phenytoin, phenobarbital and carbamazepine

441
Q

Zonisamide (Zonegran) indications

A

adjunct therapy of partial seizures in adults

442
Q

Zonisamide (Zonegran) and driving

A

avoid driving

443
Q

Zonisamide (Zonegran) and kidney patients

A

may effect kidneys, use in caution with patients that have kidney issues

444
Q

Zonisamide (Zonegran) and fluids

A

drink 6-8 glasses of water per day

avoid grapefruit juice

445
Q

labs for Zonisamide (Zonegran)

A

bicarb at baseline and periodically there after

446
Q

drug interactions for Zonisamide (Zonegran)

A

st johns wort
phenytoin
phenobarbital
carbamazepine can all accelerate the metabolism of Zonisamide (Zonegran) which would reduce its half life

447
Q

Felbamate (Felbatol) indications

A

adjuctive or monotherapy in adults with partial seizures

adjuctive therapy in children with lennox gastaut syndrome

448
Q

Felbamate (Felbatol) black box warning

A

increased risk for aplastic anemia

may cause acute liver failure

Pharm Exam 4 - Class Review (14 decks)

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