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Pharm Exam 3 > Neuropharm > Flashcards

Neuropharm Flashcards

1
Q

Levodopa MOA

A

Dopamine replacement

Levodopa is converted to dopamine which then activates dopamine receptors

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2
Q

Levodopa Use

A

Reduce movement disorders
1st line drug
Always combined with carbidopa
May also supplement to a dopamine agonist

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3
Q

Levodopa A/E

A 
Dyskinesia 
Dark urine/sweat
Insomnia
Nightmares
Dysrhythmias 
Hallucinations/psychosis
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4
Q

Levodopa A/E early in treatment

A

N/V

Postural hypotension

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5
Q

Levodopa Drug interactions

A

Carbidopa, Entacapone: Increase effects
1st gen Antipsychotics: Decrease effects
MAOIs: increase risk for HTN crisis

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6
Q

Levodopa Contraindications

A

W/O carbidopa
Caution in renal failure
Narrow angle glaucoma

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7
Q

Levodopa Pt edu

A

Avoid high protein food
↳keep protein intake consistent throughout the day (decreases absorption)
May wear off between doses
Noticeable difference may take weeks - months
Take with food

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8
Q

Levodopa Nursing considerations

A

Treatment may seem effective initially, but becomes less effective as disease progresses

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9
Q

Carbidopa MOA

A

Dopamine agonist
Inhibits decarboxylation of levodopa in the intestines and peripheral tissue
Decreases A/E of Levodopa

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10
Q

Carbidopa Max dose

A

8 tabs/day no matter the strength

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11
Q

Carbidopa A/E

A

Only from increased absorption of levodopa

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12
Q

Carbidopa Pt edu

A

Avoid high protein foods
↳ eat consistent amount of protein throughout the day
May wear off between doses

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13
Q

Levodopa Monitoring

A

Dyskinesia

Other A/E

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14
Q

Carbidopa Monitoring

A

Dyskinesia

Other A/E

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15
Q

Carbidopa Nursing considerations

A

Treatment may seem effective initially, but becomes less effective as disease progresses

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16
Q

Carbidopa Drug interactions

A

Levodopa: decrease A/E of levodopa

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17
Q

Pramipexole MOA

A

Selectively binds to dopamine D2 and D3 receptors, Activating dopamine receptors, mildly blocks serotonergic and alpha adrenergic receptors
Non ergot dopamine receptor agonist

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18
Q

Pramipexole Use

A 
Monotherapy (only early on)
Produces significant motor performance improvement 
RLS w/ levodopa 
Reduces motor control fluctuations 
May reduce levodopa doses
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19
Q

Pramipexole Dose time

A

2-3 hr before bed

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20
Q

Pramipexole A/E

A 
Nausea
Dizziness
Daytime somnolence 
Insomnia
Constipation
Weakness
Hallucinations 
❊Sleep attacks
❊Impulse control issues
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21
Q

Pramipexole A/E when Combo with Levodopa

A

Hallucinations
Daytime sleepiness
Postural hypotension

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22
Q

Pramipexole Contraindications

A

Compulsive behavior

Decrease dose with significant renal impairment

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23
Q

Pramipexole Drug interactions

A

Cimetidine

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24
Q

Pramipexole Pt edu

A

May take weeks to see max benefits

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25
Q

Pramipexole Nursing implementations

A

Screen for compulsive behavior

Monitor BUN, Cr

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26
Q

Entacapone MOA

A

Catechol-O-Methyltransferase

Selectively inhibits enzyme COMT, resulting in decreased metabolism of levodopa in intestines and peripheral tissue

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27
Q

Entacapone Use

A

Prolong half life of levodopa

Prevent wearing off effect of levodopa

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28
Q

Entacapone Max Dose

A

1600mg /day

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29
Q

Entacapone A/E

A

Vomiting
Diarrhea
Constipation
Yellow/Orange urine

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30
Q

Entacapone A/E with Levodopa

A 
Dyskinesia
Orthostatic hypotension
Nausea 
Hallucinations 
Sleep disturbances 
Impulse control disorder
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31
Q

Entacapone Drug interactions

A

Increase level of other drugs metabolized by COMT
Methyldopa
Dobutamine
Isoproterenol

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32
Q

Entacapone Pt edu

A

Importance of taking with levodopa/Carbidopa

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33
Q

Entacapone Monitoring

A

A/E

↳determine if levodopa needs to be adjusted

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34
Q

Selegiline MOA

A

MAO-B inhibitor

Selectively and irreversibly inhibits MAO-B, which is the enzyme that inactivates dopamine

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35
Q

Selegiline Use

A 
Improves motor function 
May delay neurodegeneration 
Can prolong effects of levodopa 
Recommended in newly diagnosed
Mild symptoms
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36
Q

Selegiline Dose time

A

Right before breakfast or lunch

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37
Q

Selegiline A/E

A 
Insomnia
Orthostatic hypotension
Dizziness
GI symptoms 
HTN crisis 
Buccal mucosa irritation with ODT
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38
Q

Selegiline Drug interactions

A

Tyramine
Sympathomimetics
Meperidine
SSRI

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39
Q

Selegiline Pt edu

A

Benefits may decline after 12-24 mo
Administer last dose before noon to avoid insomnia
Avoid foods containing tyramine and sympathomimetics
Avoid liquids with ODTs

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40
Q

Selegiline Monitoring

A

BP

Effectiveness of drug

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41
Q

Donepezil MOA

A

Cholinesterase inhibitor
Inhibits the breakdown of acetylcholine by acetylcholinesterase, increasing acetylcholine available at the cholinergic synapses

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42
Q

Donepezil Use

A

Mild, Moderate and Severe AD

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43
Q

Donepezil Drug interactions

A

1st gen Antihistamines (bronchoconstriction)
TCA
1st gen Antipsychotics
Other anticholinergics

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44
Q

Donepezil A/E Most common

A 
HA
Dizziness
Vertigo
Insomnia
N/V/D
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45
Q

Donepezil A/E Most severe

A

Bronchoconstriction
Bradycardia (r/f falls and syncope)
Sick sinus syndrome

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46
Q

Donepezil Contraindications

A

Asthma
COPD
Liver and heart disease

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47
Q

Donepezil Pt edu

A

Not a cure, will slow progression
A/E risk increase with higher doses
Takes about 1-3 mo to see effects
Take with food

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48
Q

Donepezil Monitoring

A 
Effectiveness
Bronchoconstriction
HR
Titrate carefully 
Start low go slow
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49
Q

Memantine MOA

A

NMDA receptor antagonist

Regulates Ca uptake into cells, preventing toxic levels of Ca from blocking memory formation

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50
Q

Memantine Use

A

Moderate to severe AD

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51
Q

Memantine A/E

A 
Dizziness
HA
Confusion
Constipation
Diarrhea
HTN
Hypotension
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52
Q

Memantine Drug interactions

A

Other NMDA antagonist
Sodium bicarbonate
❊Caution with drugs that alkalinize urine (kidney problems)

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53
Q

Memantine Caution

A

Renal/ hepatic impairment due to alkaline urine

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54
Q

Memantine Pt edu

A

May see improvement of Sx

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55
Q

Memantine Monitoring

A

BUN

Cr

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56
Q

Phenytoin MOA

A

Blocking sodium entry into neurons decreases activity of neurons that produce seizures

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57
Q

Phenytoin Use

A

Partial seizure
Generalized tonic-clonic seizures
Dysrhythmias

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58
Q

Phenytoin A/E

A 
Nystagmus
Sedation
Ataxia
Diplopia
Cognitive impairment 
Gingival hyperplasia
Measles like rash
Bleeding tendencies in newborns
Dysrhythmias IV admin
Hypotension IV admin
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59
Q

Phenytoin Contraindication

A

HLA-B*1502 genetic mutation

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60
Q

Phenytoin Pregnancy Cat.

A

D

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61
Q

Phenytoin Drug interactions

A 
PO contraceptives
Warfarin
Glucocorticoids
Diazepam
Isoniazid
Cimetidine 
ETOH
Valproic acid 
Carbamazepine 
Phenobarbital 
Barbiturates 
CNS depressants
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62
Q

Phenytoin Pt edu

A

Good oral hygiene
Take 0.5 folic acid daily
Birth control
Avoid ETOH and other CNS depressants

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63
Q

Phenytoin Screening

A

Suicide risk

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64
Q

Phenytoin Monitoring

A

LFT
A/E
Drug level (10-20)

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65
Q

Carbamazepine MOA

A

Suppresses high frequency neuronal discharge in and around seizure focus

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66
Q

Carbamazepine Use

A

Partial seizures (1st choice)
Tonic-Clonic seizures
Symptomatic control of BPD
Trigeminal and glossopharyngeal neuralgias

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67
Q

Carbamazepine A/E

A 
Nystagmus
Blurred vision
Diplopia
Ataxia
Vertigo
Unsteadiness
HA
Bone marrow suppression (fever, sore throat, infection)
Leukopenia
Anemia
Thrombocytopenia (bruising)
Hypo-osmolarity 
Measles like rash
SJS, TENS (dermatologic) in Asians 
Hyponatremia
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68
Q

Carbamazepine Drug interactions

A 
BC
Warfarin
Phenytoin
Phenobarbital
Grapefruit juice
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69
Q

Carbamazepine Contraindications

A

Pre-existing hematologic abnormalities

HLA-B*1502 gene mutation

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70
Q

Carbamazepine Pregnancy cat.

A

D

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71
Q

Carbamazepine Pt edu

A

Tolerance will decrease A/E after a few wk
Take biggest dose at bedtime
Avoid grapefruit juice
Take with meals

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72
Q

Carbamazepine Screening

A

Suicide

HLA-B*1502 in Asians

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73
Q

Carbamazepine Monitoring

A

LFT
CBC
BMP

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74
Q

Valproic Acid MOA

A

Suppresses high frequency neurons targeting sodium channels, preventing Ca from entering Ca channels, may enhance inhibitory influence of GABA

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75
Q

Valproic Acid Use

A

Seizures (ALL)
BPD
Migraine HA

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76
Q

Valproic Acid A/E

A 
N/V
Indigestion
Hyperammonemia
Rash
Wt gain
Hair loss
Tremor 
Blood dyscrasia
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77
Q

Valproic Acid Toxicity

A

Hepatotoxic

Pancreatitis

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78
Q

Valproic Acid Drug interactions

A 
Phenobarbital 
Phenytoin
Topiramate (hyperammonemia)
Carbapenem 
Meropenem and Imipenem/Cilastatin 
ETOH
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79
Q

Valproic Acid Pregnancy Cat.

A

D

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80
Q

Valproic Acid Contraindications

A

Combination with other drugs under the age of 2 because of fatal liver injury
Pre-existing liver dysfunction

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81
Q

Valproic Acid Pt edu

A 
Take with food 
S/S of liver failure and pancreatitis 
BC
Women of childbearing age should take folic acid 
Swallow whole
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82
Q

Valproic Acid Screening

A

Suicide

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83
Q

Valproic Acid Monitoring

A

LFT
Lipase
Amylase
Therapeutic effect

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84
Q

Phenobarbital MOA

A

Binds to GABA receptors, leading to receptors to respond to GABA more

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85
Q

Phenobarbital Use

A 
Partial seizures
Tonic- Clonic seizures 
IV for generalized convulsive status epilepticus 
Sedation 
Sleep aid 
Last resort due to A/E
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86
Q

Phenobarbital A/E

A 
Lethargy/ drowsiness (MC)
Depression
Learning impairment 
Paradoxical response in children 
Agitation and confusion in elderly 
Dependance 
Acute intermittent porphyria 
Bleeding tendencies in newborns 
Rickets 
Osteomalacia 
Nystagmus
Respiratory depression leading to death
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87
Q

Phenobarbital Drug interactions

A

BC
Warfarin
Other CNS depressants (ETOH, Valproic Acid)

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88
Q

Phenobarbital Contraindications

A

History of intermittent porphyria

Suicidal tendencies

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89
Q

Phenobarbital Pregnancy cat.

A

D

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90
Q

Phenobarbital Pt edu

A

Doses for seizures are not normally high enough for addiction
As tolerance builds, drowsiness with decrease, take at night
Limit or avoid Alcohol
Dont D/C abruptly
May take wks to reach therapeutic level
Can supplement Vit D/Ca
Take at night due to drowsiness

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91
Q

Phenobarbital Screening

A

Suicide

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92
Q

Phenobarbital Monitoring

A 
Nystagmus
Ataxia
CNS depressants 
Plasma Drug level (15-40)
LFT
BUN
Cr
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93
Q

Gabapentin MOA

A

May enhance GABA release, precise MOA is unknown

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94
Q

Gabapentin Use

A 
Adjunct therapy for partial seizures 
Posthepatic neuralgia 
Monotherapy of partial seizures 
Neuropathic pain 
Migraine prophylaxis 
Fibromyalgia
Postmenopausal hot flashes
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95
Q

Gabapentin A/E

A 
Somnolence 
Dizziness
Ataxia
Fatigue
Nystagmus 
Peripheral edema
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96
Q

Gabapentin Contraindications

A

Decrease dose with renal impairment

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97
Q

Gabapentin Pregnancy cat

A

C

Caution with breastfeeding

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98
Q

Gabapentin Pt edu

A

A/E diminish with prolonged use

Avoid driving until effects are known

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99
Q

Gabapentin Screening

A

Suicide

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100
Q

Gabapentin Monitoring

A

BUN

Cr

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101
Q

Levetiracetam MOA

A

Chemically and pharmacologically different than other AEDs

MOA is unknown

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102
Q

Levetiracetam Use

A 
Adjunct therapy of myoclonic seizures
Partial onset seizures 
Primary generalized tonic-clonic seizures 
Migraines
BPD
Pedi epilepsy
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103
Q

Levetiracetam A/E

A

Drowsiness
Weakness
Suicidal ideations

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104
Q

Levetiracetam Contraindications

A

Reduce dose for renal impairment

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105
Q

Levetiracetam Pregnancy cat

A

C

Avoid in breastfeeding

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106
Q

Levetiracetam Screening

A

Suicidal

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107
Q

Levetiracetam Monitoring

A

BUN

Cr

108
Q

Status epilepticus

A

Continuous tonic-clonic seizure lasting at least 5 minutes

109
Q

Status epilepticus Treatment

A

Lorazepam

Diazepam

110
Q

Status epilepticus Long term control

A

Phenytoin

Fosphenytoin

111
Q

Lidocaine MOA

A

Amide type local anesthetic

Blocks conduction by preventing sodium from entering sodium channels

112
Q

Lidocaine Use

A

Suppesses locally and topically or by injection

IV for dysrhythmias

113
Q

Lidocaine A/E

A 
CNS excitation followed by depression 
Seizure
Respiratory depression
Bradycardia
Heart block
decreased contractility 
Cardiac arresst 
Hypersensitivity reaction
Burning at site 
HA
N/V
114
Q

Lidocaine Contraindication

A

Avoid EPI with tachycardia

Caution with bradycardia

115
Q

Lidocaine Pregnancy cat

A

B

116
Q

Lidocaine Drug interaction

A

Epi increase local effects

117
Q

Lidocaine Pt edu

A 
Use smallest amount possible 
Do not apply to broken skin
Avoid strenuous activity
Avoid wrapping/ heating site
Remove patch before applying another 
Wash hands after application
118
Q

Lidocaine Monitoring

A

Vital signs
S/S of tox (heart probs)
LFTs

119
Q

Propofol MOA

A

Release GABA, the major inhibitory neurotransmitter, resulting in CNS depression

120
Q

Propofol Use

A

Induction/Maintenance of general anesthesia in balanced anesthesia
Sedation

121
Q

Propofol Max dose

A

4mg/kg/hr

122
Q

Propofol A/E

A

Respiratory depression
Hypotension
Bacterial infection
Propofol infusion syndrome (long term use)

123
Q

Propofol infusion syndrome

A

Metabolic acidosis
Cardiac failure/Arrest
Renal failure
Rhabdomyolysis

124
Q

Propofol Drug interactions

A

Analgesics
CNS depressants
CNS stimulants
Opioids

125
Q

Propofol Cautions

A

Older adults
Hypovolemia
Cardiac dysrhythmias
Breastfeeding

126
Q

Propofol Pregnancy cat

A

B

127
Q

Propofol Nursing considerations

A

Requires intubation

Change vial Q6hr due to bacterial growth

128
Q

Propofol Monitoring

A 
Vital signs 
CPK
Pain
BUN
Cr
129
Q

Isoflurane MOA

A

Theory is they selectively alter synaptic transmission

130
Q

Isoflurane Use

A

General anesthesia for surgery
Usually in combo with other agents
Only in those who are intubated

131
Q

Isoflurane Route

A

Inhaled

132
Q

Isoflurane A/E

A 
Hypotension
Respiratory depression
N/V
Decreased urinary output
Malignant hypothermia
133
Q

Isoflurane Toxicity

A

Hepatotoxic

134
Q

Isoflurane Drug interactions

A

Analgesic
CNS depressants/stimulants
Opioids
Succinylcholine

135
Q

Isoflurane Caution

A

pregnancy and breastfeeding

136
Q

Isoflurane Nursing considerations

A

Requires intubation

137
Q

Isoflurane Monitoring

A 
Vitals
LFTs
A/E
BUN
Cr
Urine output
138
Q

Morphine MOA

A

Mimics action of opioid peptides at mu receptors

Standard that everything is measured against

139
Q

Morphine Use

A

Reduction in pain

Sedation

140
Q

Morphine Drug interaction

A 
ETOH
Benzodiazepines
Barbiturates
Anesthesia
Other CNS depressants 
Anticholinergics 
Antihypertensives 
MAOIs
Pentazocine
Buprenorphine
Naloxone 
Phenothiazine 
Amphetamines
Clonidine 
Dextromethorphan
141
Q

Morphine A/E

A 
Respiratory depression
Constipation
Hypotension
Urinary retention
❊Cough suppression
❊Biliary colic (spasms of bile duct)
N/V
❊Increase ICP
Euphoria 
Sedation
Miosis
Delirium
Agitation
Hyperalgesia
Coma
❊Itching
142
Q

Morphine Toxicity

A

Neurotoxicity

143
Q

Morphine Contraindication

A

Hypotension

Decreased dose for liver impairment

144
Q

Morphine Caution

A 
Asthma
Emphysema
Kyphoscoliosis
Chronic Cor pulmonale
Head injury
Infants/Elderly 
Inflammatory bowel disease
145
Q

Morphine Pregnancy cat

A

C

146
Q

Morphine Pt edu

A

Bowel regimen
S/S of OD
Narcan use at home

147
Q

Morphine Monitoring

A

Vitals signs Before
Respiratory assessment
LFTs

148
Q

Fentanyl MOA

A

Mimics action of opioid peptides at mu receptors

Strong opioid

149
Q

Fentanyl Use

A

Breakthrough pain- not first DOC
Chronic pain (cancer)
Surgical procedures

150
Q

Fentanyl Drug interactions

A 
ETOH
Benzodiazepines
Barbiturates
Anesthesia
Other CNS depressants 
Anticholinergics 
Antihypertensives 
MAOIs
Pentazocine
Buprenorphine
Naloxone 
Phenothiazine 
Amphetamines
Clonidine 
Dextromethorphan 
CYP3A4 inhibitors 
Droperidol
151
Q

Fentanyl A/E

A 
Respiratory depression
❊Constipation
Hypotension
Rigidity 
Anxiety
HA
Confusion
Weakness
Urinary retention
Cough suppression 
N/V
Euphoria 
Sedation
Miosis
152
Q

Fentanyl Contraindications

A

Hypotension

153
Q

Fentanyl Caution

A 
Asthma
Emphysema
Kyphoscoliosis
Chronic Cor pulmonale
Head injury
Infants/Elderly 
Inflammatory bowel disease
154
Q

Fentanyl Pregnancy cat

A

C

155
Q

Fentanyl Pt edu

A 
❊Bowel regimen 
S/S of OD
Narcan home use
Importance of adjunct therapy 
How to administer
156
Q

Fentanyl Monitoring

A

Vital signs

Respiratory assessment

157
Q

Hydromorphone MOA

A

Mimics action of opioid peptides at mu receptors

Strong opioid

158
Q

Hydromorphone Use

A

Reduction in pain
Sedation
2nd line
NO histamine effects

159
Q

Hydromorphone A/E

A 
Respiratory depression
Constipation
Urinary retention
Cough suppression
N/V
Sedation
160
Q

Hydromorphone Drug interactions

A 
ETOH
Benzodiazepines
Barbiturates
Anesthesia
Other CNS depressants 
Anticholinergics 
Antihypertensives 
MAOIs
Pentazocine
Buprenorphine
Naloxone 
Phenothiazine 
Amphetamines
Clonidine 
Dextromethorphan
161
Q

Hydromorphone Monitoring

A

Vitals

Respiratory assessment

162
Q

Hydromorphone Caution

A 
Asthma
Emphysema
Kyphoscoliosis
Chronic Cor pulmonale
Head injury
Infants/Elderly 
Inflammatory bowel disease
163
Q

Methadone Use

A

Relieving pain

Addiction to heroin and opioids (weaning off)

164
Q

Hydromorphone Pt edu

A

Bowel regimen
S/S of OD
Narcan home use
Importance of adjunct therapy

165
Q

Methadone Monitoring

A

Vitals
Respiratory assessment
Effectiveness
EKG

166
Q

Methadone MOA

A

Mimics action of opioid peptides at mu receptors

Strong opioid

167
Q

Codeine Use

A

Pain

Cough suppression

168
Q

Methadone A/E

A 
Respiratory depression
Constipation
Prolonged OT interval 
Fatal dysrhythmias
Increased sweating 
Tachycardia
Bradycardia
Urinary retention
N/V
Euphoria 
Miosis
169
Q

Methadone Drug interactions

A 
ETOH
Benzodiazepines
Barbiturates
Anesthesia
Other CNS depressants 
CYP3A4 inhibitors 
TCAs
170
Q

Codeine Caution

A

Infants/Elderly
Breastfeeding
CYP2D6 deficiency

171
Q

Methadone Pt edu

A

Bowel regimen
S/S of OD
Less potential for abuse
EKG before treatment, 30 days later, then annually

172
Q

Codeine Monitoring

A

Vitals
Respiratory assessment
LFTs
Effectiveness

173
Q

Codeine MOA

A

Mimics action of opioid peptides at mu receptors

❊Moderate to strong opioid

174
Q

Codeine Drug interaction

A 
ETOH
Benzodiazepines
Barbiturates
Anesthesia
Other CNS depressants 
Anticholinergics 
Antihypertensives 
MAOIs
Pentazocine
Buprenorphine
Naloxone 
Phenothiazine 
Amphetamines
Clonidine 
Dextromethorphan
175
Q

Codeine Pt edu

A 
Bowel regimen 
S/S of OD
Narcan home use
Importance of adjunct therapy 
Lower potential for abuse
176
Q

Hydrocodone MOA

A

Mimics action of opioid peptides at mu receptors

Moderate to strong opioid

177
Q

Hydrocodone Use

A

Reduction of pain

Cough suppression

178
Q

Hydrocodone A/E

A 
Respiratory depression
Constipation
Urinary retention
Cough suppression
Miosis
Euphoria 
N/V
179
Q

Hydrocodone Toxicity

A

Neurotoxicity

180
Q

Hydrocodone Drug interactions

A 
ETOH
Benzodiazepines
Barbiturates
Anesthesia
Other CNS depressants 
Anticholinergics 
Antihypertensives 
MAOIs
Pentazocine
Buprenorphine
Naloxone 
Phenothiazine 
Amphetamines
Clonidine 
Dextromethorphan
181
Q

Hydrocodone Caution

A

Hypotension
Infants/Elderly
Breastfeeding

182
Q

Hydrocodone Pregnancy cat

A

C

183
Q

Hydrocodone Pt edu

A 
Bowel regimen 
S/S of OD
Narcan home use
Importance of adjunct therapy 
Lower potential for abuse
184
Q

Hydrocodone Monitoring

A

Vitals
Respiratory assessment
Effectiveness

185
Q

Hydrocodone Monitoring

A

Vitals
Respiratory assessment
Effectiveness

186
Q

Naloxone MOA

A

Blocks opioid receptors, preventing opioids from being effective

187
Q

Naloxone Use

A

Antidote to opioids

Reversing respiratory depression, sedation, euphoria, analgesia

188
Q

Naloxone Pregnancy cat

A

B

189
Q

Naloxone Pt edu

A

S/S of OD

How to use

190
Q

Naloxone Monitoring

A

Response

S/S of withdrawal

191
Q

Tramadol MOA

A

❊Non opioid centrally acting analgesic

Weak activity at the Mu receptors, blocks norepinephrine and serotonin uptake which results in spinal inhibition of pain

192
Q

Tramadol Use

A

❊Moderate to moderately severe pain
Similar effects as opioids
❊Better for elderly

193
Q

Tramadol A/E

A 
Sedation 
Dizziness
Constipation
HA
Dry mouth 
Rarely respiratory depression 
Seizures
194
Q

Tramadol Drug interactions

A 
CNS depressants
MAOI
SSRI
SNRI
TCA
Triptans
195
Q

Tramadol Contraindication

A

Epilepsy
Neurologic disorders
History of abuse
Suicidal ideations

196
Q

Tramadol Pregnancy cat

A

C

197
Q

Tramadol Pt edu

A

Avoid ETOH and other CNS depressants

198
Q

Tramadol Monitoring

A 
LFTs
BUN
Cr
Effectiveness
A/E
199
Q

Sumatriptan MOA

A

Serotonin receptor agonist activation 5HT
Vasoconstriction results after an intracranial blood vessels which leads to decreased inflammatory neuropeptides and diminished perivascular inflammation

200
Q

Sumatriptan Use

A

Abortive Migraine relief (cluster)

201
Q

Sumatriptan A/E

A

Symptomatic coronary vasospasm
Heavy arm feeling
Chest pressure
Angina

202
Q

Sumatriptan Drug interactions

A 
Ergot alkaloids
other triptans 
MAOI
SSRI
SNRI
203
Q

Sumatriptan Contraindication

A 
CAD
History of heart disease
Uncontrolled HTN
MI
Vertigo
Malaise
Fatigue
Tingling sensation
204
Q

Sumatriptan Caution

A

Hepatic/renal impairment

205
Q

Sumatriptan Pregnancy cat

A

C

206
Q

Sumatriptan Pt edu

A

BC

Avoid other triptans and ergot alkaloids

207
Q

Sumatriptan Monitoring

A

LFTs
Effectiveness
Frequency of use

208
Q

Sumatriptan Monitoring

A

LFTs
Effectiveness
Frequency of use

209
Q

Ergotamine MOA

A

Ergot alkaloid

Complex actions that are not fully understood

210
Q

Ergotamine Use

A

2nd line abortive therapy for migraines

211
Q

Ergotamine A/E

A 
N/V
Weakness in legs
Myalgia
Numbness and tingling in fingers and toes
Angina like pain
Tachycardia
Bradycardia
OD (peripheral and cerebral ischemia)
212
Q

Ergotamine Drug interactions

A

Triptans

CYP3A4 inhibitors: increase ergotamine levels

213
Q

Ergotamine Contraindications

A 
Daily use
Hepatic/Renal impairment 
Sepsis
CAD
PVD
Uncontrolled HTN
214
Q

Ergotamine Caution

A

Children

Elderly

215
Q

Ergotamine Pregnancy Cat

A

X

216
Q

Ergotamine Pt edu

A

S/S of OD
Withdrawal symptoms
BC
Risk to potential fetus

217
Q

Ergotamine Monitoring

A 
LFTs
BUN
Cr
Pregnancy
Vitals 
Effectiveness
218
Q

Depakote ER MOA

A

AED (Valproic acid)
Suppresses high frequency neurons targeting sodium channels, preventing Ca from entering Ca channels, may enhance inhibitory influence of GABA

219
Q

Depakote ER Use

A

Prophylactic treatment of migraines, for those with 3+ attacks / mo, or attacks that dont respond to abortive agents

220
Q

Depakote ER A/E

A 
Nausea
Fatigue 
Wt gain
Tremor
Bone loss
Reversible hair loss
Suicidal ideation
221
Q

Depakote ER Toxicity

A

Hepatitis

Pancreatitis

222
Q

Depakote ER Drug interactions

A

Phenobarbital
Phenytoin
Topiramate
Carbapenem

223
Q

Depakote ER Contraindications

A

Combo with other drugs under 2 yr old due to liver injury

Pre-existing liver dysfunction

224
Q

Depakote ER Pregnancy cat

A

D

225
Q

Depakote ER Pt edu

A 
Take with food
S/S of liver failure/Pancreatitis 
BC
Women should take folic acid
Swallow whole
226
Q

Depakote ER Monitoring

A 
Screen for Suicide
LFTs
Lipase
Amylase
Therapeutic effect
227
Q

Lorazepam MOA

A

Benzo

Enhance the effects of GABA

228
Q

Lorazepam Use

A 
Decrease anxiety 
Promote sleep
Seizure disorders
ETOH withdrawal 
Pre anesthesia
Breakthrough nausea in cancer
229
Q

Lorazepam Drug interactions

A

Other CNS depressants

230
Q

Lorazepam A/E

A 
Confusion
Amnesia
Hypotension
Cardiac arrest
Drowsiness
Light headedness
Incoordination
Trouble focusing
Paradoxical reaction
Abuse
231
Q

Lorazepam Caution

A

Respiratory disorders

Reduce dose in hepatic impairment

232
Q

Lorazepam Pregnancy Cat

A

D

233
Q

Lorazepam Pt edu

A

Avoid ETOH, opioids, barbiturates
Some people have reported sleep driving
Caution with heavy machinery

234
Q

Lorazepam Monitoring

A 
LFTs
Vital signs
effectiveness
A/E
Tolerance
Wean slowly
235
Q

Diazepam MOA

A

Benzo

Enhance the effects of GABA

236
Q

Diazepam Use

A 
Initiation of sedation
Anxiety 
Seizures
Muscle spasms
Anxiety
ETOH withdrawal
237
Q

Diazepam Drug interactions

A

Other CNS depressants

238
Q

Diazepam A/E

A 
Confusion
Amnesia
Hypotension
Cardiac arrest
Drowsiness
Light headedness
Incoordination
Trouble focusing
Paradoxical reaction
Abuse
Respiratory depression with IV
239
Q

Diazepam Caution

A

Respiratory disorders

Reduce dose in hepatic impairment

240
Q

Diazepam Pregnancy Cat

A

D

241
Q

Diazepam Pt edu

A

Avoid ETOH, opioids, barbiturates
Some people have reported sleep driving
Caution with heavy machinery

242
Q

Diazepam Monitoring

A

Vital signs
Have respiratory support available if not intubated
LFTs

243
Q

Midazolam MOA

A

Benzo

Enhance the effects of GABA

244
Q

Midazolam Use

A

Initiation of sedation
Conscious sedation
Amnesia effect

245
Q

Midazolam A/E

A

Respiratory depression
Respiratory / Cardiac arrest
Hypotension

246
Q

Midazolam Drug interactions

A

Other CNS depressants

247
Q

Benzo Antidote

A

Flumazenil

248
Q

Midazolam Caution

A

Respiratory disorders

Reduce dose in hepatic impairment and age

249
Q

Midazolam Pregnancy cat

A

D

250
Q

Midazolam Pt edu

A

Avoid ETOH, opioids, barbiturates
Some people have reported sleep driving
Caution with heavy machinery

251
Q

MIdazolam Monitoring

A

Vital signs
Continuous monitoring during conscious sedation, have respiratory support available if not intubated
LFTs

252
Q

Zolpidem MOA

A

Z-hypnotic

Binds to benzodiazepine receptor sites on GABA receptors

253
Q

Zolpidem Use

A

Insomnia

Amnesia effect

254
Q

Zolpidem Dose

A

Regular: Rapid acting, helps fall asleep
ER: long acting, helps stay asleep

255
Q

Zolpidem Drug interactions

A

Other CNS depressants

256
Q

Zolpidem A/E

A 
Day time drowsiness
Dizziness
Sleep driving
Sleep related complex behaviors 
Confusion
Paradoxical reaction 
Amnesia
257
Q

Zolpidem Pregnancy cat

A

c

258
Q

Zolpidem Pt edu

A

Avoid operating heavy machinery

259
Q

Zolpidem Monitoring

A

A/E
BUN
Cr

260
Q

Migraines Prophylaxis Tx

A

Beta blockers
TCA
Antiepileptic Drugs

261
Q

Migraine Abortive Tx

A

Non specific analgesics

Opioids

262
Q

Cluster HA Prophylaxis Tx

A

Glucocorticoids
Verapamil
Lithium

263
Q

Cluster HA Abortive Tx

A

Sumatriptan

Oxygen

264
Q

Tension HA Prophylaxis Tx

A

Amitriptyline QHS

265
Q

Tension HA Abortive Tx

A

Acetaminophen
NSAIDS
Analgesic-sedative combo

Pharm Exam 3 (4 decks)

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