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Chelsea's Advan Patho & Pharm 2018 > pharm 2 test > Flashcards

pharm 2 test Flashcards

drugs of ANS, CNS brain disorders mental health endocrine - DM and thyroid Anemias and anticoags

1
Q

What type of drugs stimulate the Sympathetic nervous system?

A

Adrenergics aka

Alpha or Beta agonists

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2
Q

what kind of drugs inhibit the SNS?

A

Alpha or beta blockers

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3
Q

what kind of drugs stimulate the Parasympathetic nervous system?

A

Cholinergics

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4
Q

what drugs Inhibit the parasympathetic nervous system?

A

Anticholinergics

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5
Q

Cholinergic Crisis symptoms

A

Lacrimation, salivation, urination, defecation
Muscle weakness to the point of required ventilatory support

(think about the opposite of PNS)

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6
Q

how do Cholinergics work?

A

directing binding to ACh receptors
or
by inhibiting acecylcholinesterase

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7
Q

examples of adrenergic drugs

A 
Epinephrine
Dopamine 
Phenylephrine 
Dobutamine 
Albuterol

norepinephrine is a catecholemine

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8
Q

alpha 2 agonist drugs can used to treat?

A

PTSD

an example drug is - Guanfacine

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9
Q

Acetylcholinesterase Inhibitor can be used to….

A

strengthen muscle
in Myasthenia gravis

for Alzheimer’s treatment

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10
Q

Cholinergics can be used in the treatment of what diseases?

A

urinary retention
glaucoma
Myasthenia gravis
improve memory - Alzheimer’s

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11
Q

what two drug classes of the ANS have similar effects?

A

sympathetic agonists
and
anti-cholinergics

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12
Q

Cholinergic crisis treatment

A

atropine

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13
Q

constricted pupils may be a side effect of?

A

sympathetic agonists (adrenergic agonist)
and
anti-cholinergics

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14
Q

adrenergic agonist is a drug that stimulates a response from the…

A

adrenergic receptors are: α₁, α₂, β₁, β₂, and β₃

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15
Q

Adrenergic Agonists are also known as

A

Catecholamines or noncatecholamines

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16
Q

can you take Catecholamines orally?

A

NO!

you can’t swallow a cat

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17
Q

Catecholamines examples

A

Epinephrine, norepinephrine, and dopamine

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18
Q

Adrenergic Agonists used for respiratory treatment

A

albuterol

bronchodilation
Primarily Beta 2 activity

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19
Q

Ipratropium (Atrovent) mechanism of action

A

Anticholinergic

(Muscarinic) – blocks bronchoconstriction

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20
Q

Visine and afrin are both what class of drugs?

A

Adrenergic Agonist

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21
Q

Propranolol and Metoprolol are what class of drugs

A

Adrenergic Antagonists

beta blockers!

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22
Q

Propranolol should not be given to patients with what disease?

A

Asthma

it is a beta non-selective

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23
Q

A drug to treat urinary retention would most likely be a?

A

Cholinergic

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24
Q

When giving an anticholinergic, what cardiac side effect might you see?

A

Tachycardia

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25
Irritable bowel might be treated with ?
anticholinergic
26
In order to enhance the amount of Ach in the CNS, you might give
An acetylcholinesterase inhibitor
27
What drugs may help in the management Alzheimer’s disease?
Acetylcholinesterase Inhibitor
28
Nasal decongestants rely on what mechanism?
Enhancing alpha 1 receptors
29
Preterm labor can be slowed through the use of?
Beta 2 agonists
30
Side effect of Beta 1 antagonists
exercise intolerance
31
patient education considerations for Cholinergics
do not abruptly stopped Doses should be spread evenly apart to optimize the effects Overdosing can cause life-threatening problems Therapeutic effects of anti-Alzheimer's are temporary and may take up to 6 weeks
32
cholenergic effects look like which system?
parasympathetic pleasure, pee, poo
33
anticholinergics side effect "can't see" is caused by
Increased intraocular pressure Blurred vision Slightly dilated pupils
34
Beta blockers can hide symptoms of
hypoglycemia
35
side effect of beta blocker includes
dependent edema | can exacerbate vascular insufficiency
36
Your patient is taking doxazosin, an α1 blocker, for BPH. What teaching is important to include?
rise slowly from supine to sitting to standing
37
A beta 2 agonist may cause
tachycardia ex: Albuterol
38
Beta blockers are encouraged for post MI patients because they
reduce cardiac O2 demand and decrease workload
39
Which condition may contraindicate use of hycoscymine for drying excess secretions?
possible bowel obstruction
40
An alpha 2 agonist is prescribed for
PTSD sedation Side effect = HoTN
41
Muscarinic antagonists are similar to
beta agonist
42
Norepinephrine causes the release of
renin
43
alpha 2 agonist such as clonidine is used for
HTN
44
alpha 2 agonist such as clonidine side effects include
Xerostomia agitation, anxiety Asthma, dry nose
45
what drugs will cause sialorrhea (drooling)?
cholenergics
46
how do anti-seizure medications work?
limiting influx of sodium ions across cell membrane
47
urinary retention would most likely caused by which drugs?
Anticholinergics
48
Oxybutyn - Antispasmodic - over active bladder tx is what kind of drug?
alpha 1 agonist
49
D//t the mechanism of action of anti-seizure what side effects must we monitor for?
Cardiac is the most concerning – bradycardia, heart block - (blocking Na+ ions) Skin rashes - SJS cognitive impairment and lethargy
50
prescriber considerations for anti-seizure Hydantoins
monitor drug levels small therapeutic window monitor ekg
51
Anti-seizure med Carbamazepine (Tegretol) black box warnings
Serious dermatological reactions Aplastic anemia/agranulocytosis monitor CBC
52
Valproic Acid black box warnings
Hepatotoxicity Pancreatitis Major teratogen
53
valporic acid monitoring considerations
AFTs ALTs Hcg amylase and lipase levels
54
Gabapentin side effect to monitor for
depression
55
Pregabalin (Lyrica) how is it helpful as adjudicative anticonvulsant therapy
inhibits glutamate
56
Classes of Antidepressants
Tricyclic Antidepressants (TCAs) Selective Serotonin Reuptake Inhibitors (SSRIs) Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) Norepineprine Dopamine Reuptake Inhibitor (NDRI) Noradrenergic and Selective Serotonin Antidepressant
57
biggest concern with anti-depressants
adherence d/t side effects weight gain low libido
58
black box warning on all antidepressants
increased risk for suicide
59
serotonin syndrome symptoms
clonus tremor | confusion
60
first line antidepressant
SSRI
61
Important to monitor for what with patients on antipyschotics?
tardive dyskinesia
62
Antidepressant considerations/ pt ed
``` 4 weeks for full affect cont 4 to 6 weeks after recovery - helps decrease relapse side effects are immediate may experience withdrawl some GI side effects ```
63
pt at increased risk for serotonin syndrome when...
on multiple drugs that increase serotonin | eg Amitriptyline and imitrex with an SSRI
64
some SSRIs cause _____ | but all SSRIs cause __________
``` QT prolongation (celexa but not lexpro) low libido ```
65
which drug has increased effectiveness with increased dose? | SSRI or SNRI
SNRI
66
with increased norepinephrine SNRIs may also increase
anxiety SNS!
67
why are SNRIs second line tx?
More side effects more drug interactions with great power comes great responsibility and crappier side effects
68
Tricyclic side effects
Anticholinergic: (dry mouth, constipation, blurred vision, metallic taste, urine retention) Orthostatic hypotension Drowsiness/ sedation cardiac arrythmia and cardiotoxicity
69
Tricyclic can useful what specific populations?
``` Panic disorder Bulimia Chronic pain (*neuropathic pain) Chronic itching Premenstrual symptoms ```
70
NDRI (atypical antidepressant) side effects
``` increased anxiety Lowers the seizure threshold (at very high doses) Insomnia anorexia agitation ``` increases dopamine - SNS!
71
NDRI side effects
``` increased anxiety Lowers the seizure threshold (at very high doses) Insomnia anorexia agitation ``` increases dopamine - SNS!
72
NaSSA side effects
sedating | remeron is an NaSSA
73
MAOI side effects
Hepatocellular jaundice Hyperthermia Hypertension 3 Hs
74
when taking MAOI inform pt to avoid what kinds of food?
``` Tyramine containing chocolate cheese cured meats ETOH fermented foods soy ```
75
“Discontinuation Syndrome” | symptoms
occurs with abrupt cessation withdrawal flu-like fatiue, nasuea, muscle weakness, chills, anxiety
76
Anxiety Disorder first line treatment option
SSRI
77
another good option for anxiety disorder
Second-line therapy | Buspirone
78
Mood Stabilizing Agents
Lithium Anticonvulsants Antipsychotics
79
Lithium acts to _____
block the serotonin “transporter” protein | - increases serotonin
80
Lithium side effects
GI distress | polydipsia, polyuria - ADH
81
lithium monitoring
``` get baseline labs! Renal function** BMP CBC creatinine GFR HcG* - category X monitor lithium level ```
82
valporic acid considerations
LFT’s CBC HCG
83
considerations for patient's taking stimulants
Arrhythmias, tachycardia, Monitor for: anxiety, weight loss, abuse, growth suppression Baselie EKG, LFT, CBC
84
1st line therapy for ADHD
Behavioral therapy
85
1st gen anti-psychotics benefit
less sedating
86
2nd gen anti-psychotic benefits
treats both positive and negative sx | milder EPS
87
extrapyramidal symptoms
``` dyskinesias and dystoni tardive dyskinesia, Parkinsonism, akinesia, akathisia neuroleptic malignant syndrome. ```
88
1st gen anti-psychotic side effects
Reduce inhibition of prolactin | lactation
89
2nd gen anti-psychotics
``` weight gain increased lipids hyperglycemia - increased risk of DKA Hepatic dysfunction prolonged QT interval sexual dysfunction - priaprism Metabolic syndrome! ```
90
Clozapine side effects
all of them times a million! wght gain, hyperglycemia, seizures, sedation, coma Agranulocytosis** - strict monitoring
91
monitoring of patients on anti-psychotics includes...
moonitor lipids annualy gget fasting glucose measure waist circumfrence
92
side effect of Alzheimer's meds
incontinence anticholenergic causes retention
93
MAOI more likely used in ____ than in depression
parkinson's
94
levels to watch in thyroid disease
T4 | TSH
95
high TSH =
Hypothyroid
96
Thyroid Monitoring and Dosing
titrate titrate titrate! | with screening Q4 to 8 weeks
97
Thyroid medication is based on what lab?
TSH only | t4 too variable
98
levothyroxine therapy initiated when TSH is ___
> 10 | or close to 10 with symptoms
99
levothyroxine caution with what populations?
elderly hx of CV dx pregnancy!! tight control needed
100
Bisphosphanates used for
osteoporosis and Paget’s disease
101
HgA1C goal
< 7%
102
Postprandial goal
< 140 - 180 DM I | < 180 DM II
103
1st line in DM 2
Metformin
104
Metformin pros
``` rare hypoglycemia weight loss decrease in LDL increase in HDL can be used in prediabetes ```
105
Metformin cons
GI side effects **contraindicated in renal insufficiency ≥ Cr 1.5
106
Metformin considerations
``` hold with contrast 48 hrs before and after baseline CMP hepatic and renal function* monitor Q 3 to 6 months HgA1C no ETOH ```
107
Sulfonylureas pros
can be mono-therapy or used with metformin renal dosing capable - only safe one for renal impairment
108
SU cons
large Risk of hypoglycemia (esp w/ETOH ) weight gain Fatigues functioning β cells, lose 50% over 10 years increased CV disease and mortality Cross hypersensitivity with sulfonamides and thiazide diuretics Teratogenic except for glyburide
109
GLP-1 agonist pros
Weight loss Most effective adjunct therapy to basal insulin May mildly reduce BP, no increased CV risk Lower risk of hypoglycemia
110
GLP-1 agonist cons
Injectable only Only works with glucose in the system Monitor for pancreatitis Caution in gastroparesis - delays stomach emptying Black box warning for thyroid or endocrine tumors
111
DPP4 Inhibitors
very similar to GLP-1 Once a week dosing available caution in Renal impairment
112
Sodium Glucose Transport Inhibitors (SGLTs) pros
``` Greater reduction in HbA1c than metf, SUs or GLP1s lower CV mortality Associated with weight loss decreased SBP monotherapy Low risk of hypoglycemia ```
113
SGLTs inhibitors cons
``` Genital mycotic infections, Candida UTI pyelonephritis and urosepsis Osmotic diuresis and hypotension w ace or arb renal function baseline renal function studies ``` bone fractures? increased LDL and HDL Higher than expected incidence of ketoacidosis
114
Thiazolinediones (TZDs) considerations
can be used profilacticly with pre-DM black box warning for heart failure! monitor liver function Q2 months
115
Meglitinides considerations
similar to SUs but more specific less hypoglycemia must take with each meal
116
Alpha-glucosidase Inhibitors considerations
``` TID dosing w/ meals only good with high starch diet can be used with SUs not used in pt's w/ GI disease monitor liver function ``` only oral dextrose or glucose for hypoglycemia
117
Orlistat Considerations
low fat diet good for those with multiple co morbidities works well but only when taken long term therapy
118
antithrombin III (ATIII) is ....
our natural regulatory (inactivation) mechanism for coagulation
119
Indications for Heparin
rapid onset needed possible quick withdrawal pregnancy PE *unpredictable and lots of monitoring needed
120
low molecular weight heparin considerations
less monitoring renal excretion - care w//kidney disease
121
Warfarin works on what coagulation factors?
10-9-7-2
122
warfarin
``` Teratogenic Warfarin-induce skin necrosis Many food interactions Many drug interactions some decrease effect some increase effect (ibuprofren, anti-fugals, protonix) ```
123
INR goal for patients on warfarin
2 - 3 below 5 is ok
124
Direct Thrombin Inhibitors - Pradaxa pros
no need for lab monitoring no known drug-drug/food-drug interactions does not utilize CYP pathway
125
pradaxa cons
``` no reversal agent safety not established for renal impairment, BID dosing Increased risk of GI bleeds GI side effect ```
126
Xarelto pros
renal dosing fast onset Reversible
127
Xarelto and Eliquis cons
no antidote, higher cost limited information on side effects
128
Aspirin works by...
inhibiting cyclooxygenase | *arachidonic acid pathway
129
ASA side effects
irreversible renal disease increased GI bleed
130
Plavix (Clopidogrel) used for ____ but not ____
prevention of MI but NOT stroke

Chelsea's Advan Patho & Pharm 2018 (7 decks)

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