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Pharmacology Test 4 > New Drugs > Flashcards

New Drugs Flashcards

1
Q

carbamazepine: class

A

anti-epileptic

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2
Q

carbamezepine: MOA

A
  • suppresses high frequency neuronal discharge in and around seizure foci
    • mechanism: delayed recovery of socium channels from their inactivated state
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3
Q

carbamezepine: indication

A
  • epilepsy: tonic clonic, simple partial, complex partial
    • first drug of choice of partial seizures
  • bipolar disorder
  • trigeminal and glossopharyngeal neuralgias
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4
Q

carbamezepine: SE

A
  • CNS effects: visual disturbance, ataxia, vertigo, HA
  • photosensitivity rxns
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5
Q

carbamezepine: ADRs

A
  • leukopenia
  • thrombocytopenia
  • aplastic anemia
  • birth defects: spina bifida
  • hypo-osmolarity: so inhibits excretion of water and promotes secretion of ADH
    • problem for patients with HF
  • suicidal thoughts
  • Stevens Johnson Syndrome
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6
Q

carbamezepine: nursing implications

A
  • contraindications: pregnancy (only use if the benefits of seizure control outweight the risks to the fetus); bone marrow suppression
  • causes fewer ADRs than other anti-epileptics (phenytoin and phenobarbital)
  • minimize CNS effects by start therapy at low doses and give largest dose at bedtime
  • d/c if experience hematologic effects but only if WBC is below 3000
  • do CBC
  • administer with meals to prevent GI upset
  • monitor Na levels
  • can tx mild dermatologic effects with prednisone or an antihistamine
  • do not drink alcohol, grapefruit juice
  • do not d/c abruptly
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7
Q

phenytoin: class

A
  • anti-epileptic
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8
Q

phenytoin: MOA

A
  • causes selective inhibition of Na channels
    • slows recovery of Na channels from the inactive state back to the active state, so entry of Na into neuron is inhibited, so APs are suppressed
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9
Q

phenytoin: Indication

A
  • seizures: partial seizures, tonic clonic seizures
  • cardiac dysrhythmias
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10
Q

phenytoin: SEs

A
  • CNS effects: sedation, nystagmus, diplopia
  • gingival hyperplasia
  • hypotension
  • cardiac dysrhythmias
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11
Q

phenytoin: ADRs

A
  • toxic epidermal necrolysis
  • stevens johnson syndrome
  • fetus: cleft palate, heart malformations, fetal hydantoin syndrome, bleeding tendency
  • suicidal thoughts
  • acute hepatic failure
  • agranulocytosis
  • aplastic anemia
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12
Q

phenytoin: nursing implications

A
  • contraindications: alcohol intolerance, heart block, bradycardia
    • caution in pregnant women: only use if safer alternatives are not effective
  • give folic acid; good oral hygiene to prevent gingival hyperplasia
  • to prevent neonatal bleeding, give prophylactic vitamin K to mom 1 month before/during delivery and to baby after
  • inject slowly by IV to prevent dysrhythmias
  • do not take w/in 2-3 hours of antacids
  • take at same time daily
  • give with food to prevent GI upset
  • do not d/c abruptly
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13
Q

valproic acid: indication

A
  • anti-epileptic
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14
Q

valproic acid: MOA

A
  • suppression of high frequency neuronal firing thru blockade of Na channels
  • suppress Ca influex
  • augment inhibitory effects of GABA
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15
Q

valproic acid: indication

A
  • seizure: first line for partial and generalized seizure
  • bipolar disorder
  • migraine
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16
Q

valproic acid: SE

A
  • GI effects: n/v
  • rash
  • weight gain
  • tremor
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17
Q

valproic acid: ADRs

A
  • hepatotoxicity
  • pancreatitis
  • teratogen: spina bifida, impairment of cognitive fcn
  • hyperammonemia
  • suicidal thoughts
  • hypothermia
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18
Q

valproic acid: nursing implications

A
  • contraindications: hepatic impairment, mitochondrial disorders, pregnancy
  • take with food to minimize GI upset
  • evaluate liver fcn at baseline and during therapy
  • use at lowest effective dosage
  • MUST use effective contraception and should take folic acid supplements
  • inform pt about S/S of liver toxicity and pancreatitis
  • do not d/c abruptly
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19
Q

gabapentin: class

A
  • anti-epileptic
  • mood stabilizer
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20
Q

gabapentin: MOA

A
  • unknown
  • analog of GABA but does not directly affect GABA receptors, but may enhance the release of GABA
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21
Q

gabapentin: indication

A
  • adjunctive therapy for partial seizures
  • postherpetic neuralgia
  • off label: neuropathic pain, migraine, fibromyalgia, hot flashes
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22
Q

gabapentin: SE

A
  • CNS: somnolence, dizziness, ataxia, fatigue
  • peripheral edema
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23
Q

gabapentin: ADRs

A
  • suicidal thoughts
  • rhabdomyolysis
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24
Q

gabapentin: nursing implications

A
  • use w/ caution in pregnant women, b/c the effects have not been determined
  • do not take w/in 2 hours of an antacid
  • can be administered w/o regard to meals
  • do not d/c abruptly
25
Q

levetiracetam: class

A
  • anti-epileptic
26
Q

levetiracetam: indications

A
  • myoclonic seizures (if over 12 yo)
  • partial onset seizures (in those over 4 yo)
  • primary generalized tonic clonic seizures (in those over 6 yo)
  • unlabeled: migraine, bipolar
27
Q

levetiracetam: SEs

A
  • drowsiness
  • asthenia
  • CNS: agitation, anxiety, depression, hallucinations, depersonalization
28
Q

levetiracetam: ADRs

A
  • suicidal thoughts
  • agranulocytosis
  • Stevens johnson syndrome
  • toxic epidermal necrolysis
29
Q

levetiracetam: nursing implications

A
  • contraindicated: breast feeding
    • safety has not been established in pregnancy
  • max dose is 3000 mg/day
  • do not d/c abruptly
30
Q

ethosuximide: class

A
  • anti-epileptic
31
Q

ethosuximide: MOA

A
  • suppresses neurons in the thalamus that are responsible for generating absence seizures
32
Q

ethosuximide: indications

A
  • absence seizures (first line)
    • (Better tolerated than valproic acid, but works to the same effectiveness)
33
Q

ethosuximide: SE

A
  • CNS: drowsiness, dizziness, lethargy
  • n/v
34
Q

ethosuximide: ADRs

A
  • SLE
  • leukopenia
  • aplastic anemia
  • Stevens Johnson syndrome
  • inc freq of seizures
  • suicidal thoughts
35
Q

ethosuximide: nursing implications

A
  • contraindications: children under 3 yo
  • administer with food to prevent GI upset
  • vry long half life, so can take 1x or 2x per day
  • do not d/c abruptly
  • avoid alcohol
  • avoid during pregnancy
36
Q

lithium: class

A
  • mood stabilizer
37
Q

lithium: indications

A
  • bipolar disorder (for manic episodes)
    • prophylaxis against manic and depressive disorders
38
Q

lithium: SEs

A
  • when lithium is above therapeutic range:
    • hand tremor
    • GI upset
    • thirst
    • muscle weakness
  • when lithium at therapeutic range:
    • fatigue
    • muscle weakness
    • HA
    • confusion
    • tremor
    • polyuria
    • hypothyroidism/goiter
39
Q

lithium: ADRs

A
  • teratogenesis
  • renal toxicity
  • seizures
40
Q

lithium: nursing implications

A
  • contraindicated: severe CV/renal dz, dehydrated pts, breast feeding
  • DO NOT use during 1st trimester of pregnancy
  • should have a negative pregnancy test before work
  • NARROW THERAPEUTIC RANGE: 0.5-1.5
  • kidney fcn tests, thyroid fcn tests
  • can take a beta blocker to reduce tremor
  • maintain adequate hydration
  • administer w/ food to prevent GI upset
41
Q

haloperidol: class

A
  • 1st gen anti psychotic
42
Q

haloperidol: MOA

A
  • Alters the effects of dopamine in the CNS.
  • Also has anticholinergic and alpha-adrenergic blocking activity.
43
Q

haloperidol: indications

A
  • schizophrenia
  • acute psychosis
  • Tourette’s Syndrome
44
Q

haloperidol: SEs

A
  • anticholinergic effects
  • sedation
  • hypoTN
  • extrapyramidal rxns (acute dystonia, parkinsonism, akathisia)
  • neuroendocrine effects: galactorrhea, gynecomastia, menstrual irregularities
45
Q

haloperidol: ADRs

A
  • serious dysrhythmias
    • esp long QT
  • seizures
  • agranulocytosis
  • neuroleptic malignant syndrome
46
Q

haloperidol: nursing implications

A
  • contraindications: pts who are comatose, severely depressed, pts w/ Parkinson’s, bone marrow depression, severe hypoTN and HTN
    • also avoid in pts with risk factors for torsades de pointes (like hypokalemia, hypomagnesemia, bradycardia, long QT, history of dysrhythmias, MI) or those taking drugs that cause long QT
  • report any signs of EPS
  • to prevent anticholinergic effects: void before using, drink water and eat sugarfree candy, inc fluids/fibers, do not exercise outside in hot temps
  • inform pts about possible orthostatic hypoTN
    • take at night at 1st to prevent this
  • watch for sore throat/fever (early signs of agranulocytosis)
  • do not use alcohol
  • do not d/c abruptly
47
Q

Levodopa/Carbidopa: class

A
  • anti-parkinsonian
48
Q

Levodopa/Carbidopa: MOA

A
  • carbidopa enhances effects of levodopa
    • carbidopa has no therapeutic effects on its own, but it inhibits decarboxylation of levodopa in the intestine and peripheral tissues, so makes more levodopa available in the CNS
    • does not prevent conversion of levodopa to dopamine in the brain, b/c carbidopa does not cross BBB
  • levodopa is converted to dopamine in the brain and used as a NT
49
Q

Levodopa/Carbidopa: Indications

A
  • Parkinson’s Dz
50
Q

Levodopa/Carbidopa: SEs

A
  • n/v (but admin w/ carbidopa helps with this)
  • involuntary movements
  • postural hypoTN
  • dysrhythmias
  • psychosis: hallucinations, vivid dreams, paranoid ideation
  • CNS: anxiety, agitation, insomnia, nightmares, impulse control (alcohol, sex, gambling)
  • darker colored sweat/urine
51
Q

Levodopa/Carbidopa: ADRs

A
  • malignant melanoma
  • hemorrhage
  • GI perforation
  • pancreatitis
52
Q

Levodopa/Carbidopa: nursing implications

A
  • contraindications: glaucoma, MAOIs, melanoma, undiagnosed skin lesions
  • can take w/ food to reduce n/v, but this also dec the amt of levodopa that will be absorbed, so avoid if possible
    • avoid high protein meals
  • if pt experiences involuntary mvmts, then can administer amantidine
  • sit/stand up slowly to prevent orthostatic hypoTN
  • watch for any changes in skin lesions and report
  • Inform patient that harmless darkening of saliva, urine, or sweat may occur.
53
Q

disulfiram: class

A
  • alcohol abuse therapy
54
Q

disulfiram: MOA

A
  • disrupts alcohol metabolism by causing irreversible inhibition of aldehyde dehydrogenase
    • so if alcohol is ingested, acetaldehyde will accumulate to toxic levels, producing unpleasant and potentially harmful effects
55
Q

disulfiram: indications

A
  • helps alcoholics avoid drinking by causing unpleasant effects if alcohol is ingested
56
Q

disulfiram: SEs

A
  • drowsiness
  • skin rxn
57
Q

disulfiram: ADRs

A
  • hepatotoxicity
  • acetaldehyde syndrome–dangerous
    • mild: n/v, flushing, constipation, HA, sweating, thirst, chest pain, hypoTN, blurred vision
    • severe: respiratory depression, CV collapse, dysrhythmias, MI, CHF, convulsions, death
58
Q

disulfiram: nursing implications

A
  • contraindications: CV dz, psychosis, use of alcohol, lactation
  • make sure to educate pts that consuming any amount of alcohol (as little as 7 mL) can cause a severe, possibly fatal, rxn
  • minimum duration of tx is 3 mos
  • administer at bedtime to reduce drowsiness
  • immediately report any signs of hepatotoxicity
59
Q

Lithium Toxicity S/S

A
  • polydipsia
  • slurred speech
  • fine hand tremors
    • oliguria,
  • N/V,
  • hypotension,
  • muscle weakness,
  • diarrheas

Pharmacology Test 4 (10 decks)

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