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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
levetiracetam: class
* anti-epileptic
26
levetiracetam: indications
* 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
levetiracetam: SEs
* drowsiness * asthenia * CNS: agitation, anxiety, depression, hallucinations, depersonalization
28
levetiracetam: ADRs
* suicidal thoughts * agranulocytosis * Stevens johnson syndrome * toxic epidermal necrolysis
29
levetiracetam: nursing implications
* contraindicated: breast feeding * safety has not been established in pregnancy * max dose is 3000 mg/day * do not d/c abruptly
30
ethosuximide: class
* anti-epileptic
31
ethosuximide: MOA
* suppresses neurons in the thalamus that are responsible for generating absence seizures
32
ethosuximide: indications
* absence seizures (first line) * (Better tolerated than valproic acid, but works to the same effectiveness)
33
ethosuximide: SE
* CNS: drowsiness, dizziness, lethargy * n/v
34
ethosuximide: ADRs
* SLE * leukopenia * aplastic anemia * Stevens Johnson syndrome * inc freq of seizures * suicidal thoughts
35
ethosuximide: nursing implications
* 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
lithium: class
* mood stabilizer
37
lithium: indications
* bipolar disorder (for manic episodes) * prophylaxis against manic and depressive disorders
38
lithium: SEs
* 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
lithium: ADRs
* teratogenesis * renal toxicity * seizures
40
lithium: nursing implications
* 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
haloperidol: class
* 1st gen anti psychotic
42
haloperidol: MOA
* Alters the effects of dopamine in the CNS. * Also has anticholinergic and alpha-adrenergic blocking activity.
43
haloperidol: indications
* schizophrenia * acute psychosis * Tourette's Syndrome
44
haloperidol: SEs
* anticholinergic effects * sedation * hypoTN * extrapyramidal rxns (acute dystonia, parkinsonism, akathisia) * neuroendocrine effects: galactorrhea, gynecomastia, menstrual irregularities
45
haloperidol: ADRs
* serious dysrhythmias * esp long QT * seizures * agranulocytosis * neuroleptic malignant syndrome
46
haloperidol: nursing implications
* 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
Levodopa/Carbidopa: class
* anti-parkinsonian
48
Levodopa/Carbidopa: MOA
* 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
Levodopa/Carbidopa: Indications
* Parkinson's Dz
50
Levodopa/Carbidopa: SEs
* 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
Levodopa/Carbidopa: ADRs
* malignant melanoma * hemorrhage * GI perforation * pancreatitis
52
Levodopa/Carbidopa: nursing implications
* 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
disulfiram: class
* alcohol abuse therapy
54
disulfiram: MOA
* 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
disulfiram: indications
* helps alcoholics avoid drinking by causing unpleasant effects if alcohol is ingested
56
disulfiram: SEs
* drowsiness * skin rxn
57
disulfiram: ADRs
* 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
disulfiram: nursing implications
* 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
Lithium Toxicity S/S
* polydipsia * slurred speech * fine hand tremors * + oliguria, * N/V, * hypotension, * muscle weakness, * diarrheas

Pharmacology Test 4 (10 decks)

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