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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
Pramipexole Nursing implementations
Screen for compulsive behavior | Monitor BUN, Cr
26
Entacapone MOA
Catechol-O-Methyltransferase | Selectively inhibits enzyme COMT, resulting in decreased metabolism of levodopa in intestines and peripheral tissue
27
Entacapone Use
Prolong half life of levodopa | Prevent wearing off effect of levodopa
28
Entacapone Max Dose
1600mg /day
29
Entacapone A/E
Vomiting Diarrhea Constipation Yellow/Orange urine
30
Entacapone A/E with Levodopa
``` Dyskinesia Orthostatic hypotension Nausea Hallucinations Sleep disturbances Impulse control disorder ```
31
Entacapone Drug interactions
Increase level of other drugs metabolized by COMT Methyldopa Dobutamine Isoproterenol
32
Entacapone Pt edu
Importance of taking with levodopa/Carbidopa
33
Entacapone Monitoring
A/E | ↳determine if levodopa needs to be adjusted
34
Selegiline MOA
MAO-B inhibitor | Selectively and irreversibly inhibits MAO-B, which is the enzyme that inactivates dopamine
35
Selegiline Use
``` Improves motor function May delay neurodegeneration Can prolong effects of levodopa Recommended in newly diagnosed Mild symptoms ```
36
Selegiline Dose time
Right before breakfast or lunch
37
Selegiline A/E
``` Insomnia Orthostatic hypotension Dizziness GI symptoms HTN crisis Buccal mucosa irritation with ODT ```
38
Selegiline Drug interactions
Tyramine Sympathomimetics Meperidine SSRI
39
Selegiline Pt edu
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
40
Selegiline Monitoring
BP | Effectiveness of drug
41
Donepezil MOA
Cholinesterase inhibitor Inhibits the breakdown of acetylcholine by acetylcholinesterase, increasing acetylcholine available at the cholinergic synapses
42
Donepezil Use
Mild, Moderate and Severe AD
43
Donepezil Drug interactions
1st gen Antihistamines (bronchoconstriction) TCA 1st gen Antipsychotics Other anticholinergics
44
Donepezil A/E Most common
``` HA Dizziness Vertigo Insomnia N/V/D ```
45
Donepezil A/E Most severe
Bronchoconstriction Bradycardia (r/f falls and syncope) Sick sinus syndrome
46
Donepezil Contraindications
Asthma COPD Liver and heart disease
47
Donepezil Pt edu
Not a cure, will slow progression A/E risk increase with higher doses Takes about 1-3 mo to see effects Take with food
48
Donepezil Monitoring
``` Effectiveness Bronchoconstriction HR Titrate carefully Start low go slow ```
49
Memantine MOA
NMDA receptor antagonist | Regulates Ca uptake into cells, preventing toxic levels of Ca from blocking memory formation
50
Memantine Use
Moderate to severe AD
51
Memantine A/E
``` Dizziness HA Confusion Constipation Diarrhea HTN Hypotension ```
52
Memantine Drug interactions
Other NMDA antagonist Sodium bicarbonate ❊Caution with drugs that alkalinize urine (kidney problems)
53
Memantine Caution
Renal/ hepatic impairment due to alkaline urine
54
Memantine Pt edu
May see improvement of Sx
55
Memantine Monitoring
BUN | Cr
56
Phenytoin MOA
Blocking sodium entry into neurons decreases activity of neurons that produce seizures
57
Phenytoin Use
Partial seizure Generalized tonic-clonic seizures Dysrhythmias
58
Phenytoin A/E
``` Nystagmus Sedation Ataxia Diplopia Cognitive impairment Gingival hyperplasia Measles like rash Bleeding tendencies in newborns Dysrhythmias IV admin Hypotension IV admin ```
59
Phenytoin Contraindication
HLA-B*1502 genetic mutation
60
Phenytoin Pregnancy Cat.
D
61
Phenytoin Drug interactions
``` PO contraceptives Warfarin Glucocorticoids Diazepam Isoniazid Cimetidine ETOH Valproic acid Carbamazepine Phenobarbital Barbiturates CNS depressants ```
62
Phenytoin Pt edu
Good oral hygiene Take 0.5 folic acid daily Birth control Avoid ETOH and other CNS depressants
63
Phenytoin Screening
Suicide risk
64
Phenytoin Monitoring
LFT A/E Drug level (10-20)
65
Carbamazepine MOA
Suppresses high frequency neuronal discharge in and around seizure focus
66
Carbamazepine Use
Partial seizures (1st choice) Tonic-Clonic seizures Symptomatic control of BPD Trigeminal and glossopharyngeal neuralgias
67
Carbamazepine A/E
``` 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 ```
68
Carbamazepine Drug interactions
``` BC Warfarin Phenytoin Phenobarbital Grapefruit juice ```
69
Carbamazepine Contraindications
Pre-existing hematologic abnormalities | HLA-B*1502 gene mutation
70
Carbamazepine Pregnancy cat.
D
71
Carbamazepine Pt edu
Tolerance will decrease A/E after a few wk Take biggest dose at bedtime Avoid grapefruit juice Take with meals
72
Carbamazepine Screening
Suicide | HLA-B*1502 in Asians
73
Carbamazepine Monitoring
LFT CBC BMP
74
Valproic Acid MOA
Suppresses high frequency neurons targeting sodium channels, preventing Ca from entering Ca channels, may enhance inhibitory influence of GABA
75
Valproic Acid Use
Seizures (ALL) BPD Migraine HA
76
Valproic Acid A/E
``` N/V Indigestion Hyperammonemia Rash Wt gain Hair loss Tremor Blood dyscrasia ```
77
Valproic Acid Toxicity
Hepatotoxic | Pancreatitis
78
Valproic Acid Drug interactions
``` Phenobarbital Phenytoin Topiramate (hyperammonemia) Carbapenem Meropenem and Imipenem/Cilastatin ETOH ```
79
Valproic Acid Pregnancy Cat.
D
80
Valproic Acid Contraindications
Combination with other drugs under the age of 2 because of fatal liver injury Pre-existing liver dysfunction
81
Valproic Acid Pt edu
``` Take with food S/S of liver failure and pancreatitis BC Women of childbearing age should take folic acid Swallow whole ```
82
Valproic Acid Screening
Suicide
83
Valproic Acid Monitoring
LFT Lipase Amylase Therapeutic effect
84
Phenobarbital MOA
Binds to GABA receptors, leading to receptors to respond to GABA more
85
Phenobarbital Use
``` Partial seizures Tonic- Clonic seizures IV for generalized convulsive status epilepticus Sedation Sleep aid Last resort due to A/E ```
86
Phenobarbital A/E
``` 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 ```
87
Phenobarbital Drug interactions
BC Warfarin Other CNS depressants (ETOH, Valproic Acid)
88
Phenobarbital Contraindications
History of intermittent porphyria | Suicidal tendencies
89
Phenobarbital Pregnancy cat.
D
90
Phenobarbital Pt edu
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
91
Phenobarbital Screening
Suicide
92
Phenobarbital Monitoring
``` Nystagmus Ataxia CNS depressants Plasma Drug level (15-40) LFT BUN Cr ```
93
Gabapentin MOA
May enhance GABA release, precise MOA is unknown
94
Gabapentin Use
``` Adjunct therapy for partial seizures Posthepatic neuralgia Monotherapy of partial seizures Neuropathic pain Migraine prophylaxis Fibromyalgia Postmenopausal hot flashes ```
95
Gabapentin A/E
``` Somnolence Dizziness Ataxia Fatigue Nystagmus Peripheral edema ```
96
Gabapentin Contraindications
Decrease dose with renal impairment
97
Gabapentin Pregnancy cat
C | Caution with breastfeeding
98
Gabapentin Pt edu
A/E diminish with prolonged use | Avoid driving until effects are known
99
Gabapentin Screening
Suicide
100
Gabapentin Monitoring
BUN | Cr
101
Levetiracetam MOA
Chemically and pharmacologically different than other AEDs | MOA is unknown
102
Levetiracetam Use
``` Adjunct therapy of myoclonic seizures Partial onset seizures Primary generalized tonic-clonic seizures Migraines BPD Pedi epilepsy ```
103
Levetiracetam A/E
Drowsiness Weakness Suicidal ideations
104
Levetiracetam Contraindications
Reduce dose for renal impairment
105
Levetiracetam Pregnancy cat
C | Avoid in breastfeeding
106
Levetiracetam Screening
Suicidal
107
Levetiracetam Monitoring
BUN | Cr
108
Status epilepticus
Continuous tonic-clonic seizure lasting at least 5 minutes
109
Status epilepticus Treatment
Lorazepam | Diazepam
110
Status epilepticus Long term control
Phenytoin | Fosphenytoin
111
Lidocaine MOA
Amide type local anesthetic | Blocks conduction by preventing sodium from entering sodium channels
112
Lidocaine Use
Suppesses locally and topically or by injection | IV for dysrhythmias
113
Lidocaine A/E
``` CNS excitation followed by depression Seizure Respiratory depression Bradycardia Heart block decreased contractility Cardiac arresst Hypersensitivity reaction Burning at site HA N/V ```
114
Lidocaine Contraindication
Avoid EPI with tachycardia | Caution with bradycardia
115
Lidocaine Pregnancy cat
B
116
Lidocaine Drug interaction
Epi increase local effects
117
Lidocaine Pt edu
``` 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
Lidocaine Monitoring
Vital signs S/S of tox (heart probs) LFTs
119
Propofol MOA
Release GABA, the major inhibitory neurotransmitter, resulting in CNS depression
120
Propofol Use
Induction/Maintenance of general anesthesia in balanced anesthesia Sedation
121
Propofol Max dose
4mg/kg/hr
122
Propofol A/E
Respiratory depression Hypotension Bacterial infection Propofol infusion syndrome (long term use)
123
Propofol infusion syndrome
Metabolic acidosis Cardiac failure/Arrest Renal failure Rhabdomyolysis
124
Propofol Drug interactions
Analgesics CNS depressants CNS stimulants Opioids
125
Propofol Cautions
Older adults Hypovolemia Cardiac dysrhythmias Breastfeeding
126
Propofol Pregnancy cat
B
127
Propofol Nursing considerations
Requires intubation | Change vial Q6hr due to bacterial growth
128
Propofol Monitoring
``` Vital signs CPK Pain BUN Cr ```
129
Isoflurane MOA
Theory is they selectively alter synaptic transmission
130
Isoflurane Use
General anesthesia for surgery Usually in combo with other agents Only in those who are intubated
131
Isoflurane Route
Inhaled
132
Isoflurane A/E
``` Hypotension Respiratory depression N/V Decreased urinary output Malignant hypothermia ```
133
Isoflurane Toxicity
Hepatotoxic
134
Isoflurane Drug interactions
Analgesic CNS depressants/stimulants Opioids Succinylcholine
135
Isoflurane Caution
pregnancy and breastfeeding
136
Isoflurane Nursing considerations
Requires intubation
137
Isoflurane Monitoring
``` Vitals LFTs A/E BUN Cr Urine output ```
138
Morphine MOA
Mimics action of opioid peptides at mu receptors | Standard that everything is measured against
139
Morphine Use
Reduction in pain | Sedation
140
Morphine Drug interaction
``` ETOH Benzodiazepines Barbiturates Anesthesia Other CNS depressants Anticholinergics Antihypertensives MAOIs Pentazocine Buprenorphine Naloxone Phenothiazine Amphetamines Clonidine Dextromethorphan ```
141
Morphine A/E
``` 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
Morphine Toxicity
Neurotoxicity
143
Morphine Contraindication
Hypotension | Decreased dose for liver impairment
144
Morphine Caution
``` Asthma Emphysema Kyphoscoliosis Chronic Cor pulmonale Head injury Infants/Elderly Inflammatory bowel disease ```
145
Morphine Pregnancy cat
C
146
Morphine Pt edu
Bowel regimen S/S of OD Narcan use at home
147
Morphine Monitoring
Vitals signs Before Respiratory assessment LFTs
148
Fentanyl MOA
Mimics action of opioid peptides at mu receptors | Strong opioid
149
Fentanyl Use
Breakthrough pain- not first DOC Chronic pain (cancer) Surgical procedures
150
Fentanyl Drug interactions
``` ETOH Benzodiazepines Barbiturates Anesthesia Other CNS depressants Anticholinergics Antihypertensives MAOIs Pentazocine Buprenorphine Naloxone Phenothiazine Amphetamines Clonidine Dextromethorphan CYP3A4 inhibitors Droperidol ```
151
Fentanyl A/E
``` Respiratory depression ❊Constipation Hypotension Rigidity Anxiety HA Confusion Weakness Urinary retention Cough suppression N/V Euphoria Sedation Miosis ```
152
Fentanyl Contraindications
Hypotension
153
Fentanyl Caution
``` Asthma Emphysema Kyphoscoliosis Chronic Cor pulmonale Head injury Infants/Elderly Inflammatory bowel disease ```
154
Fentanyl Pregnancy cat
C
155
Fentanyl Pt edu
``` ❊Bowel regimen S/S of OD Narcan home use Importance of adjunct therapy How to administer ```
156
Fentanyl Monitoring
Vital signs | Respiratory assessment
157
Hydromorphone MOA
Mimics action of opioid peptides at mu receptors | Strong opioid
158
Hydromorphone Use
Reduction in pain Sedation 2nd line NO histamine effects
159
Hydromorphone A/E
``` Respiratory depression Constipation Urinary retention Cough suppression N/V Sedation ```
160
Hydromorphone Drug interactions
``` ETOH Benzodiazepines Barbiturates Anesthesia Other CNS depressants Anticholinergics Antihypertensives MAOIs Pentazocine Buprenorphine Naloxone Phenothiazine Amphetamines Clonidine Dextromethorphan ```
161
Hydromorphone Monitoring
Vitals | Respiratory assessment
162
Hydromorphone Caution
``` Asthma Emphysema Kyphoscoliosis Chronic Cor pulmonale Head injury Infants/Elderly Inflammatory bowel disease ```
163
Methadone Use
Relieving pain | Addiction to heroin and opioids (weaning off)
164
Hydromorphone Pt edu
Bowel regimen S/S of OD Narcan home use Importance of adjunct therapy
165
Methadone Monitoring
Vitals Respiratory assessment Effectiveness EKG
166
Methadone MOA
Mimics action of opioid peptides at mu receptors | Strong opioid
167
Codeine Use
Pain | Cough suppression
168
Methadone A/E
``` Respiratory depression Constipation Prolonged OT interval Fatal dysrhythmias Increased sweating Tachycardia Bradycardia Urinary retention N/V Euphoria Miosis ```
169
Methadone Drug interactions
``` ETOH Benzodiazepines Barbiturates Anesthesia Other CNS depressants CYP3A4 inhibitors TCAs ```
170
Codeine Caution
Infants/Elderly Breastfeeding CYP2D6 deficiency
171
Methadone Pt edu
Bowel regimen S/S of OD Less potential for abuse EKG before treatment, 30 days later, then annually
172
Codeine Monitoring
Vitals Respiratory assessment LFTs Effectiveness
173
Codeine MOA
Mimics action of opioid peptides at mu receptors | ❊Moderate to strong opioid
174
Codeine Drug interaction
``` ETOH Benzodiazepines Barbiturates Anesthesia Other CNS depressants Anticholinergics Antihypertensives MAOIs Pentazocine Buprenorphine Naloxone Phenothiazine Amphetamines Clonidine Dextromethorphan ```
175
Codeine Pt edu
``` Bowel regimen S/S of OD Narcan home use Importance of adjunct therapy Lower potential for abuse ```
176
Hydrocodone MOA
Mimics action of opioid peptides at mu receptors | Moderate to strong opioid
177
Hydrocodone Use
Reduction of pain | Cough suppression
178
Hydrocodone A/E
``` Respiratory depression Constipation Urinary retention Cough suppression Miosis Euphoria N/V ```
179
Hydrocodone Toxicity
Neurotoxicity
180
Hydrocodone Drug interactions
``` ETOH Benzodiazepines Barbiturates Anesthesia Other CNS depressants Anticholinergics Antihypertensives MAOIs Pentazocine Buprenorphine Naloxone Phenothiazine Amphetamines Clonidine Dextromethorphan ```
181
Hydrocodone Caution
Hypotension Infants/Elderly Breastfeeding
182
Hydrocodone Pregnancy cat
C
183
Hydrocodone Pt edu
``` Bowel regimen S/S of OD Narcan home use Importance of adjunct therapy Lower potential for abuse ```
184
Hydrocodone Monitoring
Vitals Respiratory assessment Effectiveness
185
Hydrocodone Monitoring
Vitals Respiratory assessment Effectiveness
186
Naloxone MOA
Blocks opioid receptors, preventing opioids from being effective
187
Naloxone Use
Antidote to opioids | Reversing respiratory depression, sedation, euphoria, analgesia
188
Naloxone Pregnancy cat
B
189
Naloxone Pt edu
S/S of OD | How to use
190
Naloxone Monitoring
Response | S/S of withdrawal
191
Tramadol MOA
❊Non opioid centrally acting analgesic | Weak activity at the Mu receptors, blocks norepinephrine and serotonin uptake which results in spinal inhibition of pain
192
Tramadol Use
❊Moderate to moderately severe pain Similar effects as opioids ❊Better for elderly
193
Tramadol A/E
``` Sedation Dizziness Constipation HA Dry mouth Rarely respiratory depression Seizures ```
194
Tramadol Drug interactions
``` CNS depressants MAOI SSRI SNRI TCA Triptans ```
195
Tramadol Contraindication
Epilepsy Neurologic disorders History of abuse Suicidal ideations
196
Tramadol Pregnancy cat
C
197
Tramadol Pt edu
Avoid ETOH and other CNS depressants
198
Tramadol Monitoring
``` LFTs BUN Cr Effectiveness A/E ```
199
Sumatriptan MOA
Serotonin receptor agonist activation 5HT Vasoconstriction results after an intracranial blood vessels which leads to decreased inflammatory neuropeptides and diminished perivascular inflammation
200
Sumatriptan Use
Abortive Migraine relief (cluster)
201
Sumatriptan A/E
Symptomatic coronary vasospasm Heavy arm feeling Chest pressure Angina
202
Sumatriptan Drug interactions
``` Ergot alkaloids other triptans MAOI SSRI SNRI ```
203
Sumatriptan Contraindication
``` CAD History of heart disease Uncontrolled HTN MI Vertigo Malaise Fatigue Tingling sensation ```
204
Sumatriptan Caution
Hepatic/renal impairment
205
Sumatriptan Pregnancy cat
C
206
Sumatriptan Pt edu
BC | Avoid other triptans and ergot alkaloids
207
Sumatriptan Monitoring
LFTs Effectiveness Frequency of use
208
Sumatriptan Monitoring
LFTs Effectiveness Frequency of use
209
Ergotamine MOA
Ergot alkaloid | Complex actions that are not fully understood
210
Ergotamine Use
2nd line abortive therapy for migraines
211
Ergotamine A/E
``` N/V Weakness in legs Myalgia Numbness and tingling in fingers and toes Angina like pain Tachycardia Bradycardia OD (peripheral and cerebral ischemia) ```
212
Ergotamine Drug interactions
Triptans | CYP3A4 inhibitors: increase ergotamine levels
213
Ergotamine Contraindications
``` Daily use Hepatic/Renal impairment Sepsis CAD PVD Uncontrolled HTN ```
214
Ergotamine Caution
Children | Elderly
215
Ergotamine Pregnancy Cat
X
216
Ergotamine Pt edu
S/S of OD Withdrawal symptoms BC Risk to potential fetus
217
Ergotamine Monitoring
``` LFTs BUN Cr Pregnancy Vitals Effectiveness ```
218
Depakote ER MOA
AED (Valproic acid) Suppresses high frequency neurons targeting sodium channels, preventing Ca from entering Ca channels, may enhance inhibitory influence of GABA
219
Depakote ER Use
Prophylactic treatment of migraines, for those with 3+ attacks / mo, or attacks that dont respond to abortive agents
220
Depakote ER A/E
``` Nausea Fatigue Wt gain Tremor Bone loss Reversible hair loss Suicidal ideation ```
221
Depakote ER Toxicity
Hepatitis | Pancreatitis
222
Depakote ER Drug interactions
Phenobarbital Phenytoin Topiramate Carbapenem
223
Depakote ER Contraindications
Combo with other drugs under 2 yr old due to liver injury | Pre-existing liver dysfunction
224
Depakote ER Pregnancy cat
D
225
Depakote ER Pt edu
``` Take with food S/S of liver failure/Pancreatitis BC Women should take folic acid Swallow whole ```
226
Depakote ER Monitoring
``` Screen for Suicide LFTs Lipase Amylase Therapeutic effect ```
227
Lorazepam MOA
Benzo | Enhance the effects of GABA
228
Lorazepam Use
``` Decrease anxiety Promote sleep Seizure disorders ETOH withdrawal Pre anesthesia Breakthrough nausea in cancer ```
229
Lorazepam Drug interactions
Other CNS depressants
230
Lorazepam A/E
``` Confusion Amnesia Hypotension Cardiac arrest Drowsiness Light headedness Incoordination Trouble focusing Paradoxical reaction Abuse ```
231
Lorazepam Caution
Respiratory disorders | Reduce dose in hepatic impairment
232
Lorazepam Pregnancy Cat
D
233
Lorazepam Pt edu
Avoid ETOH, opioids, barbiturates Some people have reported sleep driving Caution with heavy machinery
234
Lorazepam Monitoring
``` LFTs Vital signs effectiveness A/E Tolerance Wean slowly ```
235
Diazepam MOA
Benzo | Enhance the effects of GABA
236
Diazepam Use
``` Initiation of sedation Anxiety Seizures Muscle spasms Anxiety ETOH withdrawal ```
237
Diazepam Drug interactions
Other CNS depressants
238
Diazepam A/E
``` Confusion Amnesia Hypotension Cardiac arrest Drowsiness Light headedness Incoordination Trouble focusing Paradoxical reaction Abuse Respiratory depression with IV ```
239
Diazepam Caution
Respiratory disorders | Reduce dose in hepatic impairment
240
Diazepam Pregnancy Cat
D
241
Diazepam Pt edu
Avoid ETOH, opioids, barbiturates Some people have reported sleep driving Caution with heavy machinery
242
Diazepam Monitoring
Vital signs Have respiratory support available if not intubated LFTs
243
Midazolam MOA
Benzo | Enhance the effects of GABA
244
Midazolam Use
Initiation of sedation Conscious sedation Amnesia effect
245
Midazolam A/E
Respiratory depression Respiratory / Cardiac arrest Hypotension
246
Midazolam Drug interactions
Other CNS depressants
247
Benzo Antidote
Flumazenil
248
Midazolam Caution
Respiratory disorders | Reduce dose in hepatic impairment and age
249
Midazolam Pregnancy cat
D
250
Midazolam Pt edu
Avoid ETOH, opioids, barbiturates Some people have reported sleep driving Caution with heavy machinery
251
MIdazolam Monitoring
Vital signs Continuous monitoring during conscious sedation, have respiratory support available if not intubated LFTs
252
Zolpidem MOA
Z-hypnotic | Binds to benzodiazepine receptor sites on GABA receptors
253
Zolpidem Use
Insomnia | Amnesia effect
254
Zolpidem Dose
Regular: Rapid acting, helps fall asleep ER: long acting, helps stay asleep
255
Zolpidem Drug interactions
Other CNS depressants
256
Zolpidem A/E
``` Day time drowsiness Dizziness Sleep driving Sleep related complex behaviors Confusion Paradoxical reaction Amnesia ```
257
Zolpidem Pregnancy cat
c
258
Zolpidem Pt edu
Avoid operating heavy machinery
259
Zolpidem Monitoring
A/E BUN Cr
260
Migraines Prophylaxis Tx
Beta blockers TCA Antiepileptic Drugs
261
Migraine Abortive Tx
Non specific analgesics | Opioids
262
Cluster HA Prophylaxis Tx
Glucocorticoids Verapamil Lithium
263
Cluster HA Abortive Tx
Sumatriptan | Oxygen
264
Tension HA Prophylaxis Tx
Amitriptyline QHS
265
Tension HA Abortive Tx
Acetaminophen NSAIDS Analgesic-sedative combo

Pharm Exam 3 (4 decks)

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