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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
Q

Irritable bowel might be treated with ?

A

anticholinergic

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26
Q

In order to enhance the amount of Ach in the CNS, you might give

A

An acetylcholinesterase inhibitor

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27
Q

What drugs may help in the management Alzheimer’s disease?

A

Acetylcholinesterase Inhibitor

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28
Q

Nasal decongestants rely on what mechanism?

A

Enhancing alpha 1 receptors

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29
Q

Preterm labor can be slowed through the use of?

A

Beta 2 agonists

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30
Q

Side effect of Beta 1 antagonists

A

exercise intolerance

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31
Q

patient education considerations for Cholinergics

A

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

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32
Q

cholenergic effects look like which system?

A

parasympathetic

pleasure, pee, poo

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33
Q

anticholinergics side effect “can’t see” is caused by

A

Increased intraocular pressure
Blurred vision
Slightly dilated pupils

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34
Q

Beta blockers can hide symptoms of

A

hypoglycemia

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35
Q

side effect of beta blocker includes

A

dependent edema

can exacerbate vascular insufficiency

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36
Q

Your patient is taking doxazosin, an α1 blocker, for BPH. What teaching is important to include?

A

rise slowly from supine to sitting to standing

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37
Q

A beta 2 agonist may cause

A

tachycardia

ex: Albuterol

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38
Q

Beta blockers are encouraged for post MI patients because they

A

reduce cardiac O2 demand and decrease workload

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39
Q

Which condition may contraindicate use of hycoscymine for drying excess secretions?

A

possible bowel obstruction

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40
Q

An alpha 2 agonist is prescribed for

A

PTSD
sedation
Side effect = HoTN

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41
Q

Muscarinic antagonists are similar to

A

beta agonist

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42
Q

Norepinephrine causes the release of

A

renin

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43
Q

alpha 2 agonist such as clonidine is used for

A

HTN

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44
Q

alpha 2 agonist such as clonidine side effects include

A

Xerostomia
agitation, anxiety
Asthma, dry nose

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45
Q

what drugs will cause sialorrhea (drooling)?

A

cholenergics

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46
Q

how do anti-seizure medications work?

A

limiting influx of sodium ions across cell membrane

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47
Q

urinary retention would most likely caused by which drugs?

A

Anticholinergics

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48
Q

Oxybutyn - Antispasmodic - over active bladder tx is what kind of drug?

A

alpha 1 agonist

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49
Q

D//t the mechanism of action of anti-seizure what side effects must we monitor for?

A

Cardiac is the most concerning – bradycardia, heart block - (blocking Na+ ions)
Skin rashes - SJS
cognitive impairment and lethargy

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50
Q

prescriber considerations for anti-seizure Hydantoins

A

monitor drug levels
small therapeutic window
monitor ekg

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51
Q

Anti-seizure med Carbamazepine (Tegretol) black box warnings

A

Serious dermatological reactions
Aplastic anemia/agranulocytosis

monitor CBC

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52
Q

Valproic Acid black box warnings

A

Hepatotoxicity
Pancreatitis
Major teratogen

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53
Q

valporic acid monitoring considerations

A

AFTs ALTs
Hcg
amylase and lipase levels

54
Q

Gabapentin side effect to monitor for

A

depression

55
Q

Pregabalin (Lyrica) how is it helpful as adjudicative anticonvulsant therapy

A

inhibits glutamate

56
Q

Classes of Antidepressants

A

Tricyclic Antidepressants (TCAs)

Selective Serotonin Reuptake Inhibitors (SSRIs)

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

Norepineprine Dopamine Reuptake Inhibitor (NDRI)

Noradrenergic and Selective Serotonin Antidepressant

57
Q

biggest concern with anti-depressants

A

adherence d/t side effects
weight gain
low libido

58
Q

black box warning on all antidepressants

A

increased risk for suicide

59
Q

serotonin syndrome symptoms

A

clonus tremor

confusion

60
Q

first line antidepressant

A

SSRI

61
Q

Important to monitor for what with patients on antipyschotics?

A

tardive dyskinesia

62
Q

Antidepressant considerations/ pt ed

A 
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
Q

pt at increased risk for serotonin syndrome when…

A

on multiple drugs that increase serotonin

eg Amitriptyline and imitrex with an SSRI

64
Q

some SSRIs cause _____

but all SSRIs cause __________

A 
QT prolongation (celexa but not lexpro)
low libido
65
Q

which drug has increased effectiveness with increased dose?

SSRI or SNRI

A

SNRI

66
Q

with increased norepinephrine SNRIs may also increase

A

anxiety

SNS!

67
Q

why are SNRIs second line tx?

A

More side effects
more drug interactions

with great power comes great responsibility and crappier side effects

68
Q

Tricyclic side effects

A

Anticholinergic: (dry mouth, constipation, blurred vision, metallic taste, urine retention)
Orthostatic hypotension
Drowsiness/ sedation
cardiac arrythmia and cardiotoxicity

69
Q

Tricyclic can useful what specific populations?

A 
Panic disorder
Bulimia
Chronic pain (*neuropathic pain)
Chronic itching
Premenstrual symptoms
70
Q

NDRI (atypical antidepressant) side effects

A 
increased anxiety
Lowers the seizure threshold (at very high doses)
Insomnia
anorexia
agitation

increases dopamine - SNS!

71
Q

NDRI side effects

A 
increased anxiety
Lowers the seizure threshold (at very high doses)
Insomnia
anorexia
agitation

increases dopamine - SNS!

72
Q

NaSSA side effects

A

sedating

remeron is an NaSSA

73
Q

MAOI side effects

A

Hepatocellular jaundice
Hyperthermia
Hypertension

3 Hs

74
Q

when taking MAOI inform pt to avoid what kinds of food?

A 
Tyramine containing
chocolate
cheese
cured meats
ETOH
fermented foods
soy
75
Q

“Discontinuation Syndrome”

symptoms

A

occurs with abrupt cessation
withdrawal
flu-like
fatiue, nasuea, muscle weakness, chills, anxiety

76
Q

Anxiety Disorder first line treatment option

A

SSRI

77
Q

another good option for anxiety disorder

A

Second-line therapy

Buspirone

78
Q

Mood Stabilizing Agents

A

Lithium
Anticonvulsants
Antipsychotics

79
Q

Lithium acts to _____

A

block the serotonin “transporter” protein

- increases serotonin

80
Q

Lithium side effects

A

GI distress

polydipsia, polyuria - ADH

81
Q

lithium monitoring

A 
get baseline labs!
    Renal function**
    BMP
   CBC
   creatinine
   GFR
   HcG* - category X
monitor lithium level
82
Q

valporic acid considerations

A

LFT’s
CBC
HCG

83
Q

considerations for patient’s taking stimulants

A

Arrhythmias, tachycardia,

Monitor for:
anxiety, weight loss, abuse, growth suppression

Baselie EKG, LFT, CBC

84
Q

1st line therapy for ADHD

A

Behavioral therapy

85
Q

1st gen anti-psychotics benefit

A

less sedating

86
Q

2nd gen anti-psychotic benefits

A

treats both positive and negative sx

milder EPS

87
Q

extrapyramidal symptoms

A 
dyskinesias and dystoni
 tardive dyskinesia, 
Parkinsonism, 
akinesia, 
akathisia
neuroleptic malignant syndrome.
88
Q

1st gen anti-psychotic side effects

A

Reduce inhibition of prolactin

lactation

89
Q

2nd gen anti-psychotics

A 
weight gain
increased lipids
hyperglycemia - increased risk of DKA
Hepatic dysfunction
prolonged QT interval
sexual dysfunction - priaprism
Metabolic syndrome!
90
Q

Clozapine side effects

A

all of them times a million!
wght gain, hyperglycemia, seizures, sedation, coma

Agranulocytosis** - strict monitoring

91
Q

monitoring of patients on anti-psychotics includes…

A

moonitor lipids annualy
gget fasting glucose
measure waist circumfrence

92
Q

side effect of Alzheimer’s meds

A

incontinence

anticholenergic causes retention

93
Q

MAOI more likely used in ____ than in depression

A

parkinson’s

94
Q

levels to watch in thyroid disease

A

T4

TSH

95
Q

high TSH =

A

Hypothyroid

96
Q

Thyroid Monitoring and Dosing

A

titrate titrate titrate!

with screening Q4 to 8 weeks

97
Q

Thyroid medication is based on what lab?

A

TSH only

t4 too variable

98
Q

levothyroxine therapy initiated when TSH is ___

A

> 10

or close to 10 with symptoms

99
Q

levothyroxine caution with what populations?

A

elderly
hx of CV dx
pregnancy!! tight control needed

100
Q

Bisphosphanates used for

A

osteoporosis and Paget’s disease

101
Q

HgA1C goal

A

< 7%

102
Q

Postprandial goal

A

< 140 - 180 DM I

< 180 DM II

103
Q

1st line in DM 2

A

Metformin

104
Q

Metformin pros

A 
rare hypoglycemia
weight loss
decrease in LDL
increase in HDL 
can be used in prediabetes
105
Q

Metformin cons

A

GI side effects
**contraindicated in renal insufficiency
≥ Cr 1.5

106
Q

Metformin considerations

A 
hold with contrast 48 hrs before and after
baseline CMP
   hepatic and renal function*
    monitor Q 3 to 6 months
HgA1C 
no ETOH
107
Q

Sulfonylureas pros

A

can be mono-therapy or used with metformin
renal dosing capable
- only safe one for renal impairment

108
Q

SU cons

A

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
Q

GLP-1 agonist pros

A

Weight loss
Most effective adjunct therapy to basal insulin
May mildly reduce BP, no increased CV risk
Lower risk of hypoglycemia

110
Q

GLP-1 agonist cons

A

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
Q

DPP4 Inhibitors

A

very similar to GLP-1
Once a week dosing available
caution in Renal impairment

112
Q

Sodium Glucose Transport Inhibitors (SGLTs) pros

A 
Greater reduction in HbA1c than metf, SUs or GLP1s
lower CV mortality
Associated with weight loss
decreased SBP
monotherapy
Low risk of hypoglycemia
113
Q

SGLTs inhibitors cons

A 
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
Q

Thiazolinediones (TZDs) considerations

A

can be used profilacticly with pre-DM

black box warning for heart failure!
monitor liver function Q2 months

115
Q

Meglitinides considerations

A

similar to SUs but more specific
less hypoglycemia

must take with each meal

116
Q

Alpha-glucosidase Inhibitors considerations

A 
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
Q

Orlistat Considerations

A

low fat diet
good for those with multiple co morbidities
works well but only when taken
long term therapy

118
Q

antithrombin III (ATIII) is ….

A

our natural regulatory (inactivation) mechanism for coagulation

119
Q

Indications for Heparin

A

rapid onset needed
possible quick withdrawal
pregnancy
PE

*unpredictable and lots of monitoring needed

120
Q

low molecular weight heparin considerations

A

less monitoring

renal excretion - care w//kidney disease

121
Q

Warfarin works on what coagulation factors?

A

10-9-7-2

122
Q

warfarin

A 
Teratogenic
Warfarin-induce skin necrosis
Many food interactions
Many drug interactions
   some decrease effect
   some increase effect (ibuprofren, anti-fugals, protonix)
123
Q

INR goal for patients on warfarin

A

2 - 3

below 5 is ok

124
Q

Direct Thrombin Inhibitors - Pradaxa pros

A

no need for lab monitoring
no known drug-drug/food-drug interactions
does not utilize CYP pathway

125
Q

pradaxa cons

A 
no reversal agent
safety not established for renal impairment,
BID dosing
Increased risk of GI bleeds
GI side effect
126
Q

Xarelto pros

A

renal dosing
fast onset
Reversible

127
Q

Xarelto and Eliquis cons

A

no antidote,
higher cost
limited information on side effects

128
Q

Aspirin works by…

A

inhibiting cyclooxygenase

*arachidonic acid pathway

129
Q

ASA side effects

A

irreversible
renal disease
increased GI bleed

130
Q

Plavix (Clopidogrel) used for ____ but not ____

A

prevention of MI but NOT stroke

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

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