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PRNU 228 > Module Neuro 1 > Flashcards

Module Neuro 1 Flashcards

1
Q

baclofen (Lioresal) class

A

centrally acting muscle relaxant

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2
Q

baclofen (Lioresal) expected pharmacologic action

A

enhance inhibitory effects of GABA on receptors in the spinal cord, results in suppression of hyperactive reflexes

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3
Q

baclofen (Lioresal) adverse drug reactions

A

drowsiness, dizziness, weakness, fatigue

nausea, vomiting, constipation, urinary retention rare but possible

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4
Q

baclofen (Lioresal) nursing considerations

A

take oral doses with food to decrease gastric irritation

encourage fluids and dietary fiber to avoid constipation

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5
Q

centrally acting muscle relaxants - name prototype and others

A

baclofen (Lioresal)

carisoprodol (Soma)
chlorzoxazone (Parafon Forte)
cyclobenzaprine (Flexeril)

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6
Q

baclofen (Lioresal) contraindications

A

known hypersensitivity
use of MAOI antidepressants

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7
Q

centrally acting muscle relaxant interactions

A

avoid alcohol or other CNS depressants

serotonin syndrome can occur if cyclobanzaprine is given to patient on SSRIs, SSNRIs, or tricyclic antidepressants

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8
Q

baclofen (Lioresal) therapeutic use

A

spinal cord injury
multiple sclerosis
cerebral palsy

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9
Q

peripherally acting muscle relaxants prototype

A

dantrolene (Dantrium)

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10
Q

dantrolene (Dantrium) class

A

peripherally acting muscle relaxant

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11
Q

dantrolene (Dantrium) therapeutic use

A

prevent muscle spasms in CVA, stroke, spinal cord injury, MS, CP

prevent malignant hyperthermia

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12
Q

dantrolene (Dantrium) adverse drug reactions

A

weakness
drowsiness
dizziness
diarrhea
liver toxicity

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13
Q

dantrolene (Dantrium) nursing considerations

A

assess muscle strength during treatment
monitor for CNS effects
monitor for diarrhea
monitor liver function

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14
Q

dantrolene (Dantrium) contraindications

A

liver disease

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15
Q

dantrolene (Dantrium) precautions

A

cardiac disease
pulmonary disease
neuromuscular disorders
age over 35 years - increased risk for liver damage

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16
Q

dantrolene (Dantrium) interactions

A

age over 35 and use of estrogen can lead to liver toxicity

avoid use with alcohol or CNS depressants

can cause cardiac dysrhythmias if taken with calcium channel blockers

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17
Q

baclofen (Lioresal) precautions

A

patients with:
severe mental illness
seizure disorders
stroke

older adults and children under 2 years

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18
Q

AEDs

A

anti-epileptic drugs

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19
Q

what are hydantoins?

A

help control tonic-clonic seizures and partial seizures

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20
Q

hydantoins - name prototype and others

A

phenytoin (Dilantin)

fosphenytoin (Cerebyx)

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21
Q

expected pharmacologic action of hydantoins

A

decrease neuronal activity by inhibiting influx of sodium through sodium channels

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22
Q

hydantoins - adverse drug reactions

A

drowsiness
CNS depression
gingival hyperplasia - abnormal tissue growth around gums
skin rash

abrupt discontinuation can lead to recurrence of seizures

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23
Q

hydantoins - nursing actions

A

monitor for drowsiness and CNS effects
observe gums for hyperplasia
monitor for rashes

phenytoin should be given with meals to prevent GI distress

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24
Q

what precautions should be taken when administering phenytoin IV?

A

no more than 50 mg per minute, no more than 25 mg per minute for older adults

injecting drug too quickly can cause cardiac collapse

monitor vital signs to identify dysrhythmias or hypotension

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25
Q

hydantoins contraindications

A

pregnancy - teratogenic
skin rash
bradycardia
heart block
hydantoin allergy
seizures caused my low blood sugar

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26
Q

hydantoins precautions

A

liver or kidney disease
cardiac dysfunction
diabetes mellitus
respiratory dysfunction
history of alcoholism = high risk of toxicity

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27
Q

phenytoin (Dilantin) interactions

A

diazepam, isoniazid, cimetidine, valproic acid increase levels of phenytoin

alcohol use can increase or decrease phenytoin levels

phenobarbital and carbamazepine decrease phenytoin levels

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28
Q

carbamazepine (Tegretol) class

A

anticonvulsant

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29
Q

carbamazepine (Tegretol) therapeutic use

A

partial seizures
tonic-clonic seizures
mood stabilizer for bipolar
reduces trigeminal neuralgia pain

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30
Q

carbamazepine (Tegretol) adverse drug reactions

A

visual disturbances
ataxia
headache
skin rash
photosensitivity

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31
Q

carbamazepine (Tegretol) considerations

A

give before bed to avoid side effects during daytime
give with meals
monitor WBC and CBC counts
monitor for skin rash
Asian patients may have genetic predisposition to severe skin reaction
protect from sun exposure

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32
Q

carbamazepine (Tegretol) contraindications

A

pregnancy - teratogenic
absence or myoclonic seizures
hematologic disorders
heart failure
MAOI use in last two weeks
concurrent use of nefazodone or NNRTIs

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33
Q

carbamazepine (Tegretol) precautions

A

cardiac or hepatic disease
alcoholism

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34
Q

carbamazepine (Tegretol) interactions

A

grapefruit juice increases levels
false negative pregnancy test
decrease efficacy of oral contraceptives
some antifungals and antiretrovirals can increase levels
phenytoin and others decrease plasma levels

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35
Q

valproic acid class

A

anticonvulsant

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36
Q

valproic acid brand names

A

Depakote, Depacon, Depakene

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37
Q

valproiic acid therapeutic use

A

all seizure types
controls mania in bipolar
prevents migraines

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38
Q

valproic acid adverse drug reactions

A

brusing, bleeding, decreased platelets
GI symptoms
skin rash
neural tube defect in pregnancy
hyperammonemia
pancreatitis
liver toxicity

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39
Q

valproic acid considerations

A

monitor bleeding, bruising, platelet count
give with food
use ER form
monitor for rash
folic acid supplementation in pregnancy
assess for vomiting, confuson
liver function tests

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40
Q

valproic acid contraindications

A

pregnancy and lactation
liver disorders
concurrent use of other anticonvulsants

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41
Q

valproic acid precautions

A

kidney disease
older adults
children younger than 2 years

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42
Q

valproic acid expected pharmacologic action

A

inhibiting influx of sodium through sodium channels

may enhance inhibitory effects of GABA

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43
Q

local anesthetics - prototype and others

A

lidocaine (Xylocaine)

procaine (Novocain)
benzocaine (Americaine)

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44
Q

local anesthetic expected pharmacologic action

A

blocks influx of sodium through sodium channels
prevents depolarization
prevents action potentials from being activated

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45
Q

local anesthetics adverse drug reactions

A

CNS stimulation - restlessness, irritability, tremors, confusion, convulsions

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46
Q

local anesthetics nursing considerations

A

monitor vital signs
do not place in eyes or broken skin
ask patient to report paresthesias - tingling or pain
ask patient to report breathing difficulties

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47
Q

lidocaine contraindications

A

previous allergy
viscous lidocaine should not be used in children under 3

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48
Q

lidocaine interactions

A

beta blockers, quinidine, cimetidine increase level in blood

concurrent administration of procainamide increases risk of CNS and cardiac effects

phenytoin increases risk of cardiac effects

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49
Q

Barbituates - General Anesthetics - Intravenous anesthetics
name the prototype drug and others

A

methohexital sodium (Brevital) is the prototype

propofol (Diprivan) most widely used

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50
Q

therapeutic use of general anesthesia barbiturates

A

rapid induction of anesthesia and hypnosis for brief procedures

adjunct anesthesia with other anesthetic agents if procedure is longer than 15 minutes

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51
Q

general anesthesia barbiturate adverse drug reactions

A

respiratory depression
cardiovascular toxicity - tachycardia or hypotension
suicide or abuse

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52
Q

general anesthesia barbiturate nursing considerations

A

monitor vitals
IV injection should be slow
resuscitation equipment should be kept on hand

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53
Q

contraindications for general anesthesia barbiturates

A

known sensitivity

use precaution with hepatic and renal disease because they can prolong the effects of the drug

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54
Q

general anesthesia barbiturate interactions

A

potentiates CNS effects of other CNS depressants

giving with general benzodiazepine anesthetics will prolong anesthesia

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55
Q

general anesthesia benzodiazepines - name prototype and others

A

midazolam (Versed) is prototype

diazepam (Valium)

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56
Q

therapeutic use of general anesthetic benzodiazepines

A

sedation before general anesthesia
conscious sedations with induction of amnesia
supplement to inhalation anesthesia for surgeries

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57
Q

general anesthetic benzodiazepine adverse drug reactions

A

amnesia from time prior to injection
cardiac or respiratory arrest

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58
Q

general anesthetic benzodiazepine nursing considerations

A

monitor vitals
inject IV bolus slowly and wait at least 2 minutes between doses
resuscitation equipment on hand

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59
Q

general anesthetic benzodiazepine administration considerations

A

do not give IV bolus to neonate
can be given orally to children
can administer IM for conscious sedation
can combine with opioid for conscious sedation

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60
Q

general anesthetic benzodiazepine contraindications

A

pregnancy and lactation risk
benzo sensitivity
acute angle-closure glaucoma

use caution for neuromuscular, cardiac, pulmonary, or renal disorders

61
Q

general anesthetic benzodiazepine interactions

A

enhances effects of anticonvulsants
herbal products can increase or decrease effects of midazolam

62
Q

name the prototype drug for the general anesthesia neuroleptic-opioid combination class

A

fentanyl (Duragesic or Actiq)

63
Q

fentanyl (Duragesic) therapeutic use

A

supplemental to general anesthesia
used with droperidol and nitrous oxide for neurolepanalgesia
used with skeletal muscle relaxant as anesthesia for high-risk patients

64
Q

fentanyl (Duragesic) adverse reactions

A

sedation
nausea
respiratory or circulatory depression

65
Q

fentanyl nursing consiiderations

A

monitor LOC
monitor for nausea
monitor vitals
resuscitation equipment on hand
naloxone (Narcan) on hand

66
Q

fentanyl contraindications

A

substance abuse
childbirth

67
Q

fentanyl precautions

A

patients who have increased ICP
older adults and young children
patients with cardiac or respiratory disorders
patients with liver or kidney disorders

68
Q

fentanyl interactions

A

MAOI antidepressants can cause hypertensive crisis
other CNS depressants increase risk for sedation and respiratory depression

69
Q

what kind of drugs are used to treat ADHD and narcolepsy?

A

CNS stimulants

amphetamines, methylphenidate, non-amphetamines

70
Q

amphetamines prototype and others

A

amphetamine/dextroamphetamine sulfate (Adderall)

methamphetamine hydrochloride (Desoxyn)

71
Q

expected pharmacological action of amphetamines

A

increase release of norepinephrine and dopamine
increase alertness and energy
can inhibit appetite

72
Q

amphetamine/dextroamphetamine sulfate (Adderall) adverse reactions

A

insomnia and nervousness
weight loss
hypertension, tachycardia, heart palpitations
toxicity can cause psychosis
dependence and abuse
withdrawal - depression

73
Q

considerations for Adderall

A

time doses to allow for nighttime sleep
monitor weight
children need breaks to prevent growth suppression
taper dose if discontinuing
treat symptoms with antipsychotics or antihypertensives
monitor for fatigue and depression

74
Q

Adderall client instructions

A

avoid caffeine
take as early in day as possible
time large meals when appetite is greatest
do not stop abruptly

75
Q

Adderall contraindications

A

amphetamine allergy
hypertension
heart disease
structural cardiac defects in children
drug abuse history
MAOI use in last 14 days
glaucoma

76
Q

Adderall precautions

A

mild hypertension

77
Q

Adderall interactions

A

use within 2 weeks of MAOI causes hypertension
increased chance of cardiac effects if taken with other stimulants
vitamin C and ammonium chloride decrease elimination

78
Q

CNS stimulant category prototype drug and others

A

methylphenidate (Ritalin or Concerta)

dexmethylphenidate (Focalin)

79
Q

expected pharmacologic action of methylphenidate (Ritalin)

A

increasing norepinephrine and dopamine release
increases energy and alertness

80
Q

methylphenidate (Ritalin) adverse drug reactions

A

insomnia, nervousness
weight loss
hypertension and heart palpitations
dependence and abuse
withdrawal depression

81
Q

methylphenidate (Ritalin) considerations

A

time doses to allow for nighttime sleep
monitor weight
children need breaks to prevent growth suppression
taper dose if discontinuing
monitor for fatigue and depression

82
Q

methylphenidate (Ritalin) client instructions

A

avoid caffeine
take as early in day as possible
report weight loss or cardio symptoms
time large meals when appetite is greatest
do not stop abruptly

83
Q

methylphenidate (Ritalin) contraindications

A

amphetamine allergy
cardiac arrhythmia or structural defects
psychosis, depression, mania
drug abuse history
children younger than 6
MAOI use within 2 weeks
glaucoma
tics or Tourette’s syndrome

84
Q

methylphenidate (Ritalin) precautions

A

hypertension
hyperthyroidism

85
Q

methylphenidate (Ritalin) innteractions

A

hypertension if used within 2 weeks of MAOI
increase chance of cardiac effects if taken with other stimulants

86
Q

non-amphetamine prototype and others

A

modafinil (Provigil)

armodafinil (Nuvigil)

remember vigil like vigilant = alert

87
Q

expected pharmacologic action of non-amphetamines

A

unknown, may block reuptake up norepinephrine

88
Q

modafinil (Provigil) adverse reactions

A

nausea and diarrhea
headache
tachycardia and hypertension
rash - stevens-johnson syndrome

89
Q

modafinil (Provigil) considerations

A

take with food
monitor vitals for cardiac effects
discontinue if rash develops

90
Q

modafinil (Provigil) interactions

A

decrease levels of oral contraceptives
methylphenidate can cause delayed absorption

91
Q

modafinil (Provigil) contraindications

A

valvular heart disease
pregnancy

92
Q

modafinil (Provigil) precautions

A

heart disease
hypertension
hepatic or renal impairment
substance abuse history
mania or psychosis
older adults or children younger than 16

93
Q

dopamine replacement drugs prototype

A

levodopa/carbidopa (Sinemet)

94
Q

therapeutic use of levodopa/carbidopa (Sinemet)

A

relieves parkinson’s symptoms

95
Q

expected pharmacologic action of levodopa/carbidopa (Sinemet)

A

drug converts to dopamine and is used

96
Q

levodopa/carbidopa (Sinemet) adverse reactions

A

nausea
vomiting
postural hypotension
dyskinesias

97
Q

levodopa/carbidopa (Sinemet) considerations

A

fall prevention measures
gradually increase dose to reduce adverse effects
take with food
avoid high-protein foods

98
Q

levodopa/carbidopa (Sinemet) contraindications

A

glaucoma
melanoma
psychosis
suicidal ideation

99
Q

levodopa/carbidopa (Sinemet) precautions

A

renal, hepatic, endocrine, respiratory disorders
wide-angle glaucoma
peptic ulcers
depression or bipolar

100
Q

levodopa/carbidopa (Sinemet) interactions

A

first gen antipsychotics and B6 decrease action
MAOI within 2 weeks causes hypertensive crisis
anticholinergic drugs increase response

101
Q

Direct-acting dopamine receptor agonist prototype and others

A

pramipexole (Mirapex)

ropinirole (Requip)

102
Q

therapeutic use of pramipexole (Mirapex)

A

restless leg syndrome
parkinson’s symptoms

103
Q

pramipexole (Mirapex) adverse reactions

A

nausea
drowsiness
muscle weakness
orthostatic hypotension
dyskinesias

104
Q

pramipexole (Mirapex) expected pharmacologic action

A

bind to dopamine receptors and mimic dopamine

105
Q

pramipexole (Mirapex) considerations

A

monitor LOC
monitor nausea
monitor muscle weakness and prevent falls
monitor cardiac status
wait 5 to 7 days between dosage increases

106
Q

pramipexole (Mirapex) contraindications

A

allergy
pregnancy and lactation

107
Q

pramipexole (Mirapex) precautions

A

renal dysfunction
compulsive behavior
older adults
psychotic disorder

108
Q

pramipexole (Mirapex) interactions

A

alcohol increases risk of adverse effects
antipsychotics decrease therapeutic effect
cimetidine increases levels

109
Q

Antiparkinson Agent/MAOB inhibitors prototype and others

A

selegiliine (Eldepryl or Zelapar ODT)

rasagiline (Azilect)

110
Q

therapeutic use of MAOB inhibitors

A

parkinson’s symptoms
major depression

111
Q

MAOB inhibitors expected pharmacologic action

A

inhibits monoamine oxidase enzyme, which prevents it from inactivating dopamine

112
Q

MAOB inhibitors adverse drug reactions

A

insomnia
hypertension if interacting with other drugs
irritation of oral mucous membranes if given in orally disintegrating form

113
Q

MAOB inhibitors considerations

A

monitor for adverse effects
monitor BP
inspect tongue and mouth for irritation
levodopa dosage can be reduced if given with MAOB inhibitors
no food or drink within 5 minutes of ODT administration

114
Q

MAOB inhibitors contraindications

A

hypersensitivity
concurrent meperidine

115
Q

MAOB inhibitors precautions

A

peptic ulcers

116
Q

MAOB inhibitors interactions

A

opioids, MAOIIs, SSRIs can cause fever and hypertension
herbals can cause hypertension

117
Q

cholinesterase inhibitor prototype and others

A

donepezil (Aricept)

rivastigmine (Exelon)
galantamine (Razadyne)

118
Q

expected pharmacologic action of cholinesterase inhibitors

A

prevents acetylcholinesterase enzyme from inactivating acetylcholine

119
Q

therapeutic use of cholinesterase inhibitors

A

improve cognitive function in Alzheimer’s patients

120
Q

cholinesterase inhibitor adverse drug reactions

A

nausea
CNS - insomnia, dizziness, headache
bradycardia

121
Q

cholinesterase inhibitor cosiderations

A

give with food
monitor weight
monitor for signs of GI bleed
fall prevention for dizziness
give at bedtime

122
Q

cholinesterase inhibitor contraindications

A

GI bleeding
donepezil allergy
being a child

123
Q

cholinesterase inhibitor precautions

A

liver, renal, cardiac, GI, pulmonary disorders
hyperthyroidism
seizures

124
Q

cholinesterase inhibitor interactions

A

use with NSAIDs can cause GI bleed
anticholinergic drugs such as antihistamines decrease effects

125
Q

NMDA receptor antagonist prototype

A

there is currently only one NMDA receptor antagonist

memantine (Namenda)

126
Q

NMDA receptor antagonist therapeutic use

A

slow the decline of cognitive and physical functioning in Alzheimer’s

127
Q

memantine (Namenda) expected pharmacologic action

A

block excess glutamate from stimulating NMDA receptors

decrease influx of calcium into neurons

prevent neuronal damage from high levels of calcium

128
Q

memantine (Namenda) adverse drug reactions

A

dizziness, headache
confusion
constipation

129
Q

memantine (Namenda) considerations

A

monitor for CNS effects
maintain safety if dizziness or confusion occurs
provide fiber supplements and stool softener for constipation

130
Q

memantine (Namenda) contraindications

A

renal failure
allergy

131
Q

memantine (Namenda) precautions

A

liver or kidney disorders
seizure disorders
older adults

132
Q

memantine (Namenda) interactions

A

antacids increase levels, possible toxicity

133
Q

what kind of drugs treat multiple sclerosis?

A

immunomodulators and immunosuppressants

134
Q

immunomodulators expected pharmacologic action

A

inhibits movements of leukocytes across blood-brain barrier to prevent them from damaging myelin sheath

135
Q

immunomodulator prototype and others

A

TWO PROTOTYPE DRUGS

interferon beta 1a (Avonex or Rebif)
interferon beta 1b (Betaseron)

glatiramer acetate (Copaxone)
natalizumab (Tysabri)

136
Q

immunomodulator adverse drug reactions

A

headache, fever, chills, myalgia
decreased blood cell production
liver toxicity
subQ injection site irritation

137
Q

immunomodulator considerations

A

start low dose
acetaminophen for flu-like symptoms
liver function tests

138
Q

immunomodulator administration schedule

A

Avonex administered IM once a week
Rebif administered subQ 3x a week
Betaseron subQ every other day

139
Q

immunomodulator contraindications

A

allergic reaction to interferon beta, albumin, mannitol

140
Q

immunomodulator precautions

A

suicidal ideation
liver disorder
alcohol abuse
age under 18 years
seizures
mental health disorders

141
Q

immunomodulator interactions

A

immunosuppressants

142
Q

serotonin agonist therapeutic use

A

relieve symptoms of migraine or cluster headache

143
Q

serotonin agonist prototype and others

A

sumatriptan (Imitrex)

zolmitriptan (Zomig)

144
Q

serotonin agonist expected pharmacologic action

A

promote vasoconstriction and suppress release of CGRP that causes inflammatory response

145
Q

serotonin agonist adverse drug reactions

A

chest pressure - vasoconstriction in lungs and esophagus
anginal pain
CNS - tingling and vertigo

146
Q

serotonin agonist considerations

A

monitor vitals after first dose in case of vasospasm
maximum daily dose of nasal spray sumatriptan is 40 mg
do not give more than 2 subQ doses in 24 hours
do not give more than 200 mg orally in 24 hours

147
Q

serotonin agonist contraindications

A

coronary artery disease, angina, MI, hypertension
peripheral vascular disease
older adults
stroke
MAOI in last 2 weeks
use of another triptan in 24 hours

148
Q

serotonin agonist precautions

A

liver or kidney insufficiency
seizure disorders
high blood pressure
serotonin syndrome
fertility impairment

149
Q

serotonin agonist interactions

A

St John’s wort can cause toxicity
MAO inhibitors within 2 weeks can cause sumatriptan toxicity
can cause serotonin syndrome if taken with another serotonin agonist

PRNU 228 (19 decks)

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