PHARM 1 EXAM #2 Flashcards

Question

What are the contraindications for taking *Methylphenidate (Ritalin)*

Answer 1

Patients who have a history of heart disease, hypertension, hyperthyroidism, parkinsonism, or glaucoma.

Answer 2

— Tachycardia, palpitations, hypertension Sleeplessness, restlessness — Irritability — Anorexia, dry mouth, weight loss, diarrhea, constipation — Impotence (no el sexo)

Answer 3

*MOA* — Modulates serotonergic pathways by affecting changes in dopamine transport *USES* — ADHD, fatigue, narcolepsy *INTERACTIONS* — Caffeine may increase effects (decrease or eliminate, plsss) — Decreased effects when using with decongestants, anti-HTN’ves, barbiturates — May alter insulin effects

Answer 4

*Methylphenidate (Ritalin)* *Modafinil (Provigil)* — don’t fully understand the MOA Uses: _increases_ the amount of time patients with narcolepsy feel awake

Answer 5

Amphetamines MOA: stimulate release of norepinephrine + dopamine **high abuse potential due to euphoria-feeling** Amphetamine-Like drugs: *Methylphenidate (Ritalin)*, *Dexmethylphenidate (Focalin)*

Answer 6

Amphetamines & Amphetamine-Like Drugs — MOA: stimulate release of norepinephrine + dopamine; has a paradoxical effect to be able to increase attention span and cognitive performance *Runs potential for abuse/addiction* ___________________ For Narcolepsy — MOA:

Answer 7

Drug — Doxapram (Dopram) Uses — Respiratory depression caused by overdose, pre/post-anesthetic respiratory depression, and hx of COPD; trying to get off ventilators and need a little push to help you become more awake **Onset of action — 20-40 seconds, peak within 2 minutes** Side Effects — HTN, Tachycardia, trembling, convulsions

Answer 8

*Drugs* — Caffeine, Theophylline *Uses* — Stimulate respiratory effort in **newborns** *Side Effects* — Restlessness, tremors, twitching, palpitations, insomnia — Diuresis, tinnitus, nausea, diarrhea — Psychological dependence

Answer 9

— Benzphetamine HCl (Didrex) — Diethylpropion HCl (Tenuate) — Phentermine HCl (Suprenza) — Phentermine-topiramate (Qsymia) — Phendimetrazine (Bontril) — Lorcaserin (Belviq) **Side effects** Nervousness, restlessness, irritability, insomnia, heart palpitations, and hypertension ___________________ *NOTE: tolerance and abusive tendencies may arise if on the drug long enough therefore not chosen often*

Answer 10

MOA — stimulates the medullary respiratory centre both by a direct action and by peripheral stimulation of the carotid body Uses — Respiratory depression caused by overdose, pre/post-anesthetic respiratory depression, and hx of COPD; trying to get off ventilators and need a little push to help you become more awake **Onset of action — 20-40 seconds, peak within 2 minutes** Side Effects — HTN, Tachycardia, trembling, convulsions

Answer 11

— Rapid eye movement (REM) — Nonrapid eye movement (NREM) ________________________________ *NOTE:* It is difficult to arouse someone who is in REM sleep)* therefore interrupting a person’s sleep (before reaching REM cycle), results in the person having to go through these stages from the **beginning** in order to reach REM** **COHORT YOUR CARE TO PREVENT THIS**

Answer 12

— No daytime naps — Warm fluids to drink — Caffeine avoided 6 hr before bedtime — Heavy meals and exercise avoided before bedtime — Warm bath, reading, listening to music

Answer 13

**Hangover** — residual drowsiness **Dependence** — results in withdrawal symptoms **Tolerance** — need to increase dosage to get desired effect **Withdrawal symptoms** — due to being dependent on a drug **Rapid eye movements (REM) rebound** — vivid dreams and nightmares **Respiratory depression** — suppression of respiratory center in the medulla; CNS depressants/EtOH/opioids = need ambubag **Hypersensitivity** — skin rashes

Answer 14

**Dose** ________ Sedative = give a smaller dose Hypnotic = give a larger dose

Answer 15

*Sedatives produce mildest form of CNS depression* _Drugs_ — Barbiturates, Benzodiazepines, Nonbenzodiazepines

Answer 16

— Sominex — Tylenol PM — Diphenhydramine (Benadryl)

Answer 17

1st generation — crosses the BBB —> drowsiness — *e.g. Diphenhydramine (Benadryl)* 2nd generation — does **NOT** cross the BBB —> no drowsiness/non-sedating — *e.g. Claritin, Zyrtec, Xyzal, Allegra*

Answer 18

*Drugs used as hypnotics* — — Flurazepam (Dalmane) — Alprazolam (Xanax) — Temazepam (Restoril) — Triazolam (Halcion) — Estazolam (ProSom) — Quazepam (Doral) *Drugs used for anxiety* — Lorazepam (Ativan); can give higher dose to abort seizures — Diazepam (Valium) ________ **NOTE: high doses = hypnotic-sedatives vs. low doses = anxiolytic

Answer 19

— When using as a sedative — anxiolytic to reduce anxiety — When using as a hypnotic — Tx insomnia (increasing dose) *Side Effects* — Respiratory depression (very old/young, outside normal BMI)

Answer 20

Retrograde: “Oh, I forgot what I did yesterday.” Anterograde: Forget what’s happening coming up/what’s going to happen Why? Forget what’s happening _presurgery, pre-chemo, preprocedure therapy_ b/c don’t want patient to feel miserable during the incoming process

Answer 21

**Benzodiazepines** _Enhance_ patient’s own GABA to quiet the brain, and increase efficacy of own GABA neurotransmitters Barbiturates = _mimic_ GABA so adding more towards brain = increase in abuse potential

Answer 22

**These drugs directly mimic GABA, the principal inhibitory neurotransmitter, in the CNS** = “putting brain to sleep” Scheduled II & III = highly addictive/abusive potential ____________ — Long-acting — Intermediate-acting — Short-acting — Ultrashort-acting — Restricted to short-term use (2 weeks or less) because of side effects, including drug tolerance Interactions — alcohol, opioids, other sedative-hypnotics

Answer 23

— Identify cause. — Use nonpharmacologic methods first. — Use short- to intermediate-acting benzodiazepines such as estazolam (ProSom), temazepam (Restoril), and triazolam (Halcion). — Avoid benzodiazepines such as flurazepam, quazepam (Doral), and diazepam (Valium). — Eszopiclone (Lunesta) – benzo-like drug **These drugs will INCREASE fall risk**

Answer 24

*Drug interactions* — Alcohol, CNS depressants *Nursing interventions* — First use nonpharmacologic methods. — Be attentive to safety. — Avoid alcohol, other CNS depressants. — Take 15 to 45 minutes before bedtime. — Report hangover effect. — Monitor BP, RR. **— Withdraw gradually**

Answer 25

— Ramelteon (Rozerem) — First FDA-approved hypnotic not classified as a controlled substance — Selectively targets melatonin receptors to regulate circadian rhythm in the treatment of insomnia — Not been shown to decrease REM sleep *Adverse effects:* drowsiness, dizziness, fatigue, headache, nausea, and suicidal ideation Also used as an antianxiety (anxiolytic) drug — great for older adult population to reduce abuse potential with other drugs

Answer 26

Inhalation Intravenous (IV) Topical Local Spinal

Answer 27

— Go through menengial covering — injected medication into the cerebral spinal fluid and may circulate/drift upward Interventions — Have HOB slightly raised (medication may move up higher into the spinal cord and don’t want to happen); DO NOT WANT TO HAVE A NUMB DIAPHRAGM!

Answer 28

Stage 1: Analgesia (don’t sense pain) Stage 2: Excitement or delirium (acute loss of sensorium; don’t know what’s going on around you) Stage 3: Surgical Stage 4: Medullary paralysis — **(TOXIC)** *In order to perform surgery, **must** past stages 2 + 3 (pain perception)*

Answer 29

*Several drugs used to ensure smooth induction and adequate muscle relaxation in your patient (prior/during procedure) to make it as pleasant as possible for the patient* May include — A hypnotic given the night before to ensure adequate rest — Premedication with an opioid analgesic or benzodiazepine (e.g., midazolam [Versed]) plus an anticholinergic (e.g., atropine) given about _1 hour before surgery_ to decrease secretions — A short-acting barbiturate such as thiopental sodium (Pentothal) — An inhaled gas—often a combination of nitrous oxide and oxygen; for anxious children to start an IV — A muscle relaxant given as needed

Answer 30

— Methoxyflurane, enflurane (Ethrane), isoflurane (Forane), desflurane (Suprane), and sevoflurane (Ultane) — Usually combined with a barbiturate (e.g., thiopental), a strong analgesic (e.g., morphine), and a muscle relaxant (e.g., pancuronium) — Adverse effects: respiratory depression, hypotension, dysrhythmias, and hepatic dysfunction — Malignant hyperthermia *(genetic)*

Answer 31

Malignant hyperthermia (MH) is a rare, _genetically determined,_ life-threatening reaction to general anesthetics. Coadministration of **succinylcholine,** a neuromuscular blocker, increases the risk of the reaction. **ANTIDOTE:** dantrolene (Dantrium) – muscle relaxant; comes in po & IV – IV used to treat MH ___________________ Dantrolene = generic (Dantrium), (Ryanodex) = brand/trade name

Answer 32

Use — Mucous membranes, broken or unbroken skin surfaces, and burns Forms — Solution, liquid spray, ointment, cream, gel, and powder — Decrease the sensitivity of nerve endings of the affected area *Cocaine often used for anesthesia of the ear, nose & throat – causes vasoconstriction also…good for epistaxis*

Answer 33

General anesthetics: — Purpose: depress the CNS, alleviate pain, and cause a loss of consciousness __________________________ Local anesthetics — Purpose: analgesia in limited area *Dose related r/t effects:* lose sensation order first pain, then temperature, touch, and finally motor sensation

Answer 34

Perception of pain is lost first, followed in order by perception of cold (temperature), warmth, touch and deep pressure. *NOTE: Blocks not only sensory but also motor neurons, which is why you can’t smile when you leave the dentist*

Answer 35

1. Focal onset 2. Generalized onset

Answer 36

GENERALIZED = grand-mal & petit mal Tonic-clonic — aka *grand mal* — **most common;** tonic = rigidity & clonic =spasms w/ jerkiness Tonic seizure = “drop attack” losing muscle tone Absence (petit mal): — aka *petit mal* — a brief LOC (for 10 seconds or less) — usually occurs in children ______________________________ PARTIAL (Focal Onset Seizure) —Psychomotor = repetitive behavior (e.g. chewing/swallowing motions) — Behavioral changes — Motor seizures *Simple Partial* = remains conscious *Complex Partial* = lose consciousness w/ potential of 2ndary results leading to—> Generalized

Answer 37

**Pharmacokinetics:** **Side Effects:** **Adverse Rxns:** **Therapeutic plasma:** **Contraindications:** **Drug Interactions**

Answer 38

**Pharmacokinetics:** **Side Effects:** _gingival hyperplasia_ (gum will grow upward) **Adverse Rxns:** **Therapeutic plasma: 10-20 mcg/mL** must keep blood level within range in order for the drug to remain effective and not toxic for patient **Contraindications:** **DO NOT USE** during pregnancy (teratogenic) **Drug Interactions:** **TEACHING:** brush teeth with soft toothbrush and brush downward

Answer 39

— Seizures associated with fever usually occur in children between the ages of 3 months and 5 years. — Temperature = >102.2 ºF (39ºC) for when seizures may occur

Answer 40

**FALSE** — Epilepsy develops in approximately 2.5% of children who have had one or more febrile seizures. — Febrile common from 6 months to 5 years; does not really increase risk of developing epilepsy

Answer 41

Prophylactic anticonvulsant treatment such as *phenobarbital* or *diazepam* may be indicated for high-risk patients.

Answer 42

Valproic acid should not be given to children younger than 2 years because of its possible *hepatotoxicity*

Answer 43

— Shake suspension well for 5 minutes — Monitor serum drug levels — _Safety:_ Protect env’tal hazards, driving — Warn female patient taking oral contraceptives to use additional contraception — Warn patient to avoid certain herbs, EtOH, and other CNS depressants **— Warn patient not to discontinue abruptly** —Patient will need to frequent oral hygiene and dental check-ups; brush with soft toothbrush, brush downward to prevent gingival hyperplasia — Diabetics **must** monitor glucose levels — Tell each patient to take drug at _same time every day_ — Warn of harmless pinkish/red or brown urine — Teach patient to report sore throat, bruising, nosebleeds — Encourage patient to wear medical-alert identification __________________ *Note* GENERIC NAME: PHENYTOIN BRAND/TRADE NAME: DILANTIN

Answer 44

— Clonazepam — Clorazepate dipotassium — Diazepam (Valium)

Answer 45

Phenobarbital

Answer 46

— Shake suspension well for 5 minutes. — Treats partial seizures, grand mal seizures, acute episodes of status epilepticus seizures, meningitis, toxic reactions, and eclampsia — Therapeutic serum range of phenobarbital is 20 to 40 mcg/mL. — Risks–sedation and patient tolerance to the drug — Discontinuance of phenobarbital should be gradual to avoid recurrence of seizures.

Answer 47

— Carbamazepine: 5 to 12 mcg/mL — Hydantoins: 10 to 20 mcg/mL — Phenobarbital: 20 to 40 mcg/mL — Ethosuximide (Zarontin): 40-100 mcg/mL — Valproic acid: 50 to 150 mcg/mL

Answer 48

To suppress abnormal neuron firing

Answer 49

— Diazepam (Valium) *OR* Lorazepam (Ativan) administered IV — Followed by IV administration of phenytoin (Dilantin) = **essential**

Answer 50

A pharmaceutical agent that has been developed specifically to treat a rare medical condition, the condition itself being referred to as an orphan disease.

Answer 51

Midazolam (Versed) or propofol (Diprivan) _________ *Goals:* — Maintain ventilation — Terminate seizures — Correct hypoglycemia — Initiate or continue long term suppression medication

Answer 52

Short-acting: Diazepam Long-acting: Lorazepam w/ effects lasting up to 72 hours — generally preferred ______________________ *Note: If diazepam is used follow up treatment with a long acting drug is essential (i.e. Dilantin or fosphenytoin/Cerebyx)*

Answer 53

It is a diazepam rectal gel that has a unique locking mechanism that ensures that your patients receive the correct dose _________________ *NOTE: Remind your patients and their caregivers to inspect each DIASTAT AcuDial syringe BEFORE leaving the pharmacy.*

Answer 54

— _Mechanism of Action:_ Enhances GABA activity — _Use:_ Tonic–clonic, partial, myoclonic seizures, status epilepticus — _Therapeutic serum range:_ 20 to 40 mcg/mL — _Side effects:_ Sedation, tolerance — _Discontinuation:_ Should be gradual

Answer 55

— Phenytoin (Dilantin) — Fosphenytoin — Carbamazepine — Oxcarbazepine — Valproic acid — Topiramate — Zonisamide — Lamotrigine

Answer 56

— _Carbamazepine:_ effective in Tx’ing refractory seizure d/o’s that have not responded to *other* anticonvulsant therapies *A derivative of Iminostilbene* _________________________ — Used to control *grand-mal + partial seizures* and a combination of these seizures — Also used for psychiatric d/o (e.g. bipolar d/o), trigeminal neuralgia (as an analgesic), and alcohol withdrawal **— Therapeutic serum range of carbamazepine: 5-12mcg/mL** **— An interaction may occur when _grapefruit juice_ is taken with _Carbamazepine (Tegretol)_ causing possible toxicity**

Answer 57

Nystagmus, ataxia, diplopia, drowsiness, dizziness, headache

Answer 58

— Water retention can be dangerous in those with heart failure — *Periodic CBC* should be done due to risk (though rare) of hematologic side effects which can include aplastic anemia

Answer 59

— Valproic acid (Depakane) — Ethosuximide

Answer 60

*Brand/Trade names:* Dyzantil, Epilim, Episenta, Epival _MOAction:_ *_Valproic acid:_* Used to treat petit mal, grand mal, and mixed types of seizures — Safety and efficacy of this drug has not been established for children younger than 2 years of age. — Caution in patients with liver disorders, because hepatotoxicity is one of the possible adverse reactions. — Liver enzymes should be monitored. **—Therapeutic serum range is 50 to 150 mcg/mL**

Answer 61

— Stabilizes neuronal membranes by decreasing sodium and calcium ion influx into the neurons — Also decreases post-tetanic potentiation and repetitive discharge.

Answer 62

Enhances GABA activity

Answer 63

Decreases calcium influx

Answer 64

Binding P site, inhibition of initiation complex and also translocation of peptidyl-tRNA from A site to P site

Answer 65

— They act by facilitating the binding of the inhibitory neurotransmitter GABA at various GABA receptors throughout the CNS — Results in the sedative, hypnotic (sleep-inducing), anxiolytic (anti-anxiety), anticonvulsant, and muscle relaxant properties for which the drugs are prescribed.

Answer 66

— Enhancement of sodium channel inactivation by reducing high-frequency repetitive firing of action potentials — Action on synaptic transmission.

Answer 67

— Inhibit succinic semialdehyde dehydrogenase — This inhibition results in an increase in succinic semialdehyde which acts as an inhibitor of GABA transaminase ultimately reducing GABA metabolism and increasing GABAergic neurotransmission.

Answer 68

ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION EVALUATION

Answer 69

Enhances GABA activity

Answer 70

It is a diazepam rectal gel that has a unique locking mechanism that ensures that your patients receive the correct dose _________________ *NOTE: Remind your patients and their caregivers to inspect each DIASTAT AcuDial syringe BEFORE leaving the pharmacy.*

Answer 71

**FALSE** — — Febrile common from 6 months to 5 years; does not really increase risk of developing epilepsy

Answer 72

**FALSE** — — Febrile common from 6 months to 5 years; does not really increase risk of developing epilepsy

Answer 73

Methylphenidate (Ritalin) is contraindicated in patients who have a history of heart disease, hypertension, hyperthyroidism, parkinsonism, or glaucoma.

Answer 74

*Several drugs used to ensure smooth induction and adequate muscle relaxation in your patient (prior/during procedure) to make it as pleasant as possible for the patient* May include — A hypnotic given the night before — Premedication with an opioid analgesic or benzodiazepine (e.g., midazolam [Versed]) plus an anticholinergic (e.g., atropine) given about 1 hour before surgery to decrease secretions — A short-acting barbiturate such as thiopental sodium (Pentothal) — An inhaled gas—often a combination of nitrous oxide and oxygen; for anxious children to start an IV — A muscle relaxant given as needed

Answer 75

Methoxyflurane, enflurane (Ethrane), isoflurane (Forane), desflurane (Suprane), and sevoflurane (Ultane), Nitrous Oxide

Answer 76

— Also known as “laughing gas” — Very low anesthetic potency — Very high analgesic potency — Never used as primary anesthetic — Frequently combined with other inhalation agents to enhance analgesia — 20% nitrous oxide = Pain relief of morphine — No serious side effects (nausea and vomiting) ___________ *NOTE: Because of its low anesthetic action, cannot produce surgical anesthesia alone – even if administered at 100% (not enough to cause respiratory depression)*

Answer 77

*Trying to consciously sedate person for a procedure; do not want them anxious or in pain* — Droperidol (Innovar), etomidate (Amidate), ketamine hydrochloride (Ketalar) — Rapid onsets and short durations of action — Midazolam (Versed) and propofol (Diprivan) — Induction and maintenance of anesthesia or conscious sedation for minor surgery or procedures like mechanical ventilation or intubation — Patients are sedated and relaxed but responsive to commands.

Answer 78

— Short-acting, lipophilic intravenous general anesthetic. The drug is unrelated to any of the currently used barbiturate, opioid, benzodiazepine, arylcyclohexylamine, or imidazole intravenous anesthetic agents. — With propofol - unconsciousness develops within 60 seconds and lasts 3–5 minutes; can cause profound respiratory depression *Risks for propofol abuse:* — Schedule 4 drug — Supplies are not closely monitored — Widely available in operating rooms and other areas of hospitals and clinics — No “high” — Instantaneous but brief sleep period — Patients awaken “refreshed” and talkative; many report feeling elated and even euphoric

Answer 79

Block pain at the site where the drug is administered Consciousness is maintained. Use: — Dental procedures, suturing skin lacerations, short-term (minor) surgery at a localized area, blocking nerve impulses (nerve block) below the insertion of a spinal anesthetic, and diagnostic procedures such as lumbar puncture and thoracentesis

Answer 80

Location — Local anesthetic injected in the subarachnoid space at the third or fourth lumbar space Side effects/adverse reactions —Respiratory distress, headache, hypotension (hence the IV is **needed**)

Answer 81

**_Esters_** — **higher** percentage of allergic rxns *e.g.* — Procaine (Novocain) – since 1905 — Cocaine – since 1884 — Benzocaine **_Amides_** — have a **very low** incidence of allergic reaction (MUCH safer) *e.g.* Procaine hydrochloride (Novocain) Lidocaine hydrochloride (Xylocaine) — 1948 Bupivacaine (Marcaine) Dibucaine

Answer 82

— _Spinal block:_ penetration of the anesthetic into the subarachnoid membrane, the second layer of the spinal cord —_Epidural block:_ placement of the local anesthetic in the outer covering of the spinal cord, or the dura mater — _Caudal block:_ placed near the sacrum — _Saddle block:_ administered at the lower end of the spinal column to block the perineal area

Answer 83

Monitor patient’s level of consciousness. **Monitor vital signs (respirations, HR, BP)** Respiratory status Cardiovascular status (check for HoTN) Monitor pre-and post-operative urine output. Administer analgesics cautiously until patient fully recovers. Dosage may need to be decreased.