PHARM 1 EXAM #4 Flashcards

Question

Monoamine Oxidase Inhibitors (MAOIs) Use + Action + Drug Examples

Answer 1

*Make the NTs more available in the brain because will inhibit breakdown by inhibiting MAO* **Big problem with these drug are the interactions therefore NEVER a 1st line option** _Examples:_ tranylcypromine sulfate (Parnate), isocarboxazid (Marplan), selegiline (Emsam), phenelzine sulfate (Nardil) _Action:_ monamine oxidase enzyme inactivates norepinephrine, dopamine, epinephrine, and serotonin. _Use:_ depression not controlled by TCAs and second-generation antidepressants *The go drug IF suffering refractory depression, not being controlled with other medications*

Answer 2

_Drug interactions:_ Vasoconstrictors and cold medications containing phenylephrine and pseudoephedrine can cause a hypertensive crisis when taken with an MAOI. _Food interactions:_ **Foods that contain tyramine** Some cheeses, cream, bananas, avocados, raisins, Italian green beans, liver, pickled foods, sausage, soy sauce, yeast, beer, and red wines, can cause a hypertensive crisis. ________________ Coffee (caffeine) does not contain tyramine, but intake should be limited to 2- 8 oz. beverages, because it can increase BP significantly when combined with MAO-Is. Overripe fruits are higher in tyramine.

Answer 3

— Agitation, restlessness, insomnia — Anticholinergic effects — Orthostatic hypotension **Hypertensive crisis from fatal tyramine or drug interaction**

Answer 4

— Monitor vital signs. — Monitor mood for drug effectiveness. — Monitor for suicidal tendencies, seizures. — Warn that foods that contain tyramine can cause a hypertensive crisis with MAOIs. — Encourage taking drug as prescribed. — Encourage avoiding alcohol, CNS depressants, and cold medicines. — Teach to take drug with food if GI distress occurs. — Warn patient against driving or using dangerous mechanical equipment until drug effect is known. **— Warn patient against abruptly stopping drug** — **Instruct patient to take drug at bedtime (may make you drowsy)** — Advise patient that a therapeutic response usually occurs in 2 to 4 weeks (but chemistry changes are effected immediately) — Inform patient that herbs (e.g., St. John’s wort, ginseng) may interact with antidepressants.

Answer 5

Used to tx bipolar d/o for the switching of euphoria —> dysphoria, making it difficult to treat *Lithium (Lithibid) Carbamazepine (Tegretol) Divalproex (Depakote, Valproate) Lamotrigine (Lamictal) Olanzapine (Zyprexa) Ziprasidone (Geodon) Aripiprazole (Abilify)* **Normally used in conjunction with an antidepressant**

Answer 6

Bipolar affective disorder was formerly known as manic-depressive illness. Definition of bipolar disorder (BPD) — Cyclic disorder — Recurrent fluctuations in mood — Episodes of mania and depression persist for months without treatment In patients with bipolar depression, using an antidepressant alone may induce mania—although the risk appears lower than previously believed. Nonetheless, to minimize any risk mania, antidepressants should not be used alone; rather, they should be combined with a mood-stabilizing drug.

Answer 7

LITHIUM (ESKALITH) *also known as an antimania drug, was the first drug used to manage bipolar affective disorder* **Therapeutic serum range: 0.5 to 1.5 mEq/L** — Serum lithium levels greater than 1.5 to 2 mEq/L are toxic. — Changes in fluid balance will alter these levels, making it hard to manage; Li+ follows Na+ _Action_ — Alteration of ion transport in muscle and nerve cells — Increased receptor sensitivity to serotonin _Use_ — Treat manic episodes in bipolar psychosis **Overhydrated = Lithium will be flushed = below therapeutic range = drug failure Dehydrated = Lithium will be saved = will enter toxic ranges**

Answer 8

_Interactions_ — Increased lithium level with thiazides, methyldopa, haloperidol, NSAIDs, antidepressants, theophylline, phenothiazines _Side effects/adverse reactions_ — Headache, drowsiness, dizziness — Hypotension, dysrhythmias — Restlessness, slurred speech — Dry mouth, metallic taste, GI distress — Tremors, muscle weakness — Edema of hands and ankles — Increased urination, blood dyscrasias, nephrotoxicity

Answer 9

— Monitor vital signs, sodium levels. — Monitor for drug effectiveness, suicidal tendencies. — Monitor urine output, renal function tests. — Encourage adequate fluid intake (1 to 2 L daily) — *Take with food to decrease GI irritation* — **Monitor lithium levels every 1 to 2 months (0.8 to 1.5 mEq/L); toxic range is greater than 2 mEq/L** **— _Toxic side effects:_ persistent nausea, vomiting, severe diarrhea, blurred vision, tinnitus, ataxia, increasing tremors, confusion, dysrhythmias, seizures** — Teach patient to wear medical alert identification. — Teach patient to take drug as prescribed and keep medical appointments. — Warn against driving motor vehicles or operating dangerous equipment until drug effect is known. — Advise patient that drug effect may take 1 to 2 weeks. — Encourage patient to avoid caffeine, crash diets, NSAIDs, diuretics. — **Advise patient against getting pregnant because of teratogenic effects**

Answer 10

_SS:_ — EXCESS of neurotransmitters (NTs) _NMS:_ LACK of NTs…we inhibited too much..yikes *Side Effects look very similar to one another* —INCREASE (temp, BP), diaphoretic, twitchy, muscle cramps, nauseous So how do you tell? By what they’re taking: — Antipsychotic = NMS — Antidepressants = SS **For both drugs, a couple doses WILL be held**

Answer 11

In _psychosis/mania,_ we try to inhibit neurotransmitters (NTs) In _depression,_ we try to ENHANCE NTs

Answer 12

— Losing contact with reality — Manifested in a variety of mental or psychiatric disorders — Usually characterized by more than one symptom: difficulty in processing information and coming to a conclusion, delusions, hallucinations, incoherence, catatonia, and aggressive or violent behavior

Answer 13

Barbiturates ADD to the cup (GABA) Benzodiazepines IMPROVE your GABA; takes the “edge” off

Answer 14

—Chronic psychotic d/o; usually occurs in adolescence or early adulthood _(+) Sx’s:_ —agitation —delusion —paranoia —hallucinations —incoherent speech _(-) Sx’s:_ —poor self-care —poverty of speech —social withdrawal

Answer 15

— _Positive symptoms:_ characterized by exaggeration of normal function — _Negative symptoms:_ characterized by decrease or loss of function and motivation — Negative symptoms tend to be more chronic, persistent and refractory to treatment. — FGAs don’t treat negative symptoms effectively, only SGAs seem to help.

Answer 16

*FGAs* — Block receptors for dopamine in CNS (D2 receptors) — Cause serious movement disorders (extrapyramidal symptoms [EPS]) *(SGAs)* — Produce moderate blockade of dopamine receptors Strong blockade for serotonin (5-HT2 receptors) Fewer EPS

Answer 17

— haloperidol (Haldol) — fluphenazine (Prolixin) — thiothixene (Navane) — pimozide (Orap) — loxapine (Loxitane) — chlorpromazine (Thorazine) — thioridazine (Mellaril)

Answer 18

— clozapine (Clozaril) — risperidone (Risperdal) — paliperidone (Invega) — olanzapine (Zyprexa) — zipradisone (Geodon) — quetiapine (Seroquel) — aripiprazole (Abilify) — asenapine (Saphris) — lurasidone (Latuda)

Answer 19

Disorganized thinking, memory difficulty Decreased ability to focus attention

Answer 20

— Monitor vital signs + mood for drug effectiveness; suicidal tendencies, seizures. **— Warn that foods that contain _tyramine_ can cause a hypertensive crisis with MAOIs.** — Encourage taking drug as prescribed. — Encourage avoiding alcohol, CNS depressants, and cold medicines. — Teach to take drug with food if GI distress occurs — Warn patient against driving or using dangerous mechanical equipment until drug effect is known. — Warn patient against abruptly stopping drug. — Instruct patient to take drug at bedtime. — Advise patient that a therapeutic response usually occurs in 2 to 4 weeks. — Inform patient that herbs (e.g., St. John’s wort, ginseng) may interact with antidepressants.

Answer 21

*Thiazide action:* *Loop action:* *Potassium-sparing diuretic action:* *Calcium channel action:* *Drugs that suppress RAAS:* — ACE-I = prevents angiotensin I from becoming angiotensin II — ARBs (targets BVs & adrenal medulla) = angiotensin II receptors BLOCK receptors in vasculature and adrenal gland —> “-sartan” — Aldosterone antagonist = K+ sparing diuretics; antagonists aldosterone (save Na+) — Direct renin inhibitors = stops system at the very beginning (Renin); may not have the efficacy that other meds [above] have

Answer 22

— Thiazide diuretics: HCTZ = used for BP — High-ceiling (loop) diuretics: furosemide (Lasix) = heart failure — Potassium-sparing: spironolactone (Aldactone) = w/ combination in effort to INCREASE urine output w/o depleting K+ further

Answer 23

Proximal tubule — Descending loop — Loop of Henle (high-ceiling) — Loop diuretics, e.g. furosemide (Lasix) —> will lose MORE electrolytes Distal (ascending) tubule — Thiazides, e.g. HCTZ Collecting tubule — K+ sparing, e.g. triamterene

Answer 24

**Nonselective beta blockers** — *Propranolol & Carvedilol* stop all sympathetic input to the heart (d/t bleed over from heart disease) — **WATCH lungs b/c can be impacted** **Selective beta blockers** — Contraindications: patients w/ DM when taking BBers b/c MASK S/Sx of HYPOglycemia _Purpose:_ HTN, angina and dysrhythmias + SLOW heart down (allow for vasodilation) + DECREASE HR

Answer 25

K+ wasting: watching for HYPOkalemia K+ sparing: watching for HYPERkalemia

Answer 26

**MUST know BP + HR BEFORE ADMINISTRATION** — Marked decrease in blood pressure — Insomnia — Depression — Nightmares — Sexual dysfunction (impotence)

Answer 27

**Do not abruptly stop taking beta blockers: rebound hypertension may result** — Monitor vital signs — Blood glucose — Renal and liver laboratory results (especially BUN, serum creatinine, AST, and LDH) — Suggest that patient wear a MedicAlert bracelet — Advise patients to avoid over-the-counter drugs without first checking with a health care provider.

Answer 28

*Turning ON alpha 2 receptors, stopping Sympatholytics input leading to vasodilation; WANT to agonize this one* — Methyldopa (Aldomet) = drug of choice for pregnant woman — Clonidine (Cadapres) = affect alpha 2 agonists, leading to vasodilation; fluid retention possible, so used with diuretic to avoid this — Guanabenz = — Guanfacine =

Answer 29

**_ Pheochromocytoma:_** is a rare tumor of adrenal gland tissue. It results in the release of too much epinephrine and norepinephrine, hormones that control heart rate, metabolism, and blood pressure

Answer 30

**Primary = essential HTN** — No identifiable cause — Chronic, progressive disorder — Population: older adults, African Americans, Mexican Americans, postmenopausal women — Treated but not cured (lifelong condition) — Referred to as _“essential hypertension”_ _______________ **Secondary** — Identifiable primary cause — Possible to treat the cause directly — Some individuals can actually be cured

Answer 31

— A very high blood pressure that comes on suddenly and quickly —The lower (diastolic) blood pressure reading, which is normally less than 80 mmHg, is often above 130 mmHg.

Answer 32

— Seat quietly for 5 minutes in chair — Feet on floor, arm supported at heart level — No caffeine, exercise or smoking for 30 minutes prior — Cuff bladder encircle at least 80% arm circulation — At least 2 measurement and average — Inflate 20-30mmHg above pulse extinction — Deflate at rate of 2mmHg/sec — Cuff size: too narrow = false high BP (extra pressure to compress artery); too wide/loose =

Answer 33

BP is the force of the blood pushing against the side of its container, the vessel wall. The strength of the push changes with the event in t he cardiac cycle. Systolic BP = SBP: maximum pressure felt on the artery during left ventricular contraction, or systole = **onset of 1st Karotkoff sound** Diastolic = DBP: the elastic recoil, or resting, pressure that the blood exerts constantly b/w each contraction = **disappearance of Karotkoff sounds**

Answer 34

*Baroreceptors:* sensitive to pressure changes in the vasculature, will stimulate vasoconstriction and tachycardia when B/P drops in effort to maintain perfusion *ADH:* hormone produced in the hypothalamus stimulates the kidneys to conserve and retain water when there is a fluid volume deficit; in fluid overload ADH secretion is inhibited and the kidney then excrete more water *ANP* (hormone secreted from atria in response to fluid overload/atria stretching) and *BNP* (hormone secreted from ventricles in response to fluid overload/ventricle stretching) both work to increase urine output and lower vascular volume.

Answer 35

— Diurese you = make you pee — Lowers BP *BNP serum is used to quantify heart failure b/c peptides are released when the heart is stretched; the more volume of blood/stretch to ventricles, the MORE the peptides will be released* secreted by ventricles of heart; Normal = <100

Answer 36

_Physiologic:_ — Excessive intake of saturated fat and simple carbohydrates — Alcohol: increases renin secretions _Cultural responses to antihypertensive agents:_ — African Americans, Asian Americans, Mexican-Americans Hypertension in older adult _Cultural_ African Americans – who are more likely to develop HTN earlier do not respond well to beta blockers, ACE inhibitors, or diuretics (as monotherapy); usually treated with alpha1 blockers and calcium channel blockers, can use diuretic in combination with these. Asian Americans – twice as sensitive to antihypertensives, doses may need to be reduced Older Adults – aging increases HTN risk; more at risk of side effect of orthostatic (postural) hypotension….think safety!

Answer 37

_Category_ *_Systolic_* *_Diastolic_* **NORMAL** <120mmHg <80mmHg **PREHTN** 120 to 139mmHg 80 to 89mmHg **STAGE 1 HTN** 140 to 159mmHg 90 to 99mmHg **STAGE 2 HTN** >160mmHg >100mmHg

Answer 38

end organ damage. — Can have heart failure, a stroke, kidney failure, poor circulation to limbs (amputation) if continued pressure builds up _Consequences of Hypertension_ Heart disease Myocardial infarction (MI) Heart failure Angina pectoris Kidney disease-end organ damage Stroke end organ damage

Answer 39

**turning OFF fight-or-flight in order to VASODILATE + DECREASE BP** ________________ Beta-adrenergic blockers – end in olol Central acting alpha2 agonists – methyldopa, clonidine Alpha1 blockers – doxazosin (Cardura), terzosin (Hytrin) Alpha & beta blockers – carvedilol (Coreg) and labetalol Adrenergic neuron blockers – only 1 – reserpine

Answer 40

**work directly on the blood vessels to dilate them**

Answer 41

*calcium are in seashells + pine trees (-ipines) are found outside* promote dilation of arteries.