Pharm Exam 2 Flashcards
What is the function of the Blood Brain Barrier?
Acts as a selective filter and protects CNS by limiting substances that enter the brain and spinal cord
The Blood Brain Barrier is crucial for maintaining the homeostasis of the central nervous system.
What causes the barrier effect of the Blood Brain Barrier?
The tight junctions that occur between capillary endothelial cells
These tight junctions prevent the free passage of substances and help maintain the integrity of the barrier.
What is the primary function of sedative hypnotic drugs?
Promote sleep
What calming effect do sedative hypnotic drugs have on patients?
Helps relax the patient
What are the two general categories of sedative hypnotic drugs?
Benzodiazepines and Nonbenzodiazepines
What do Benzodiazepines do?
Boost the effect on the brain on the brain’s endogenous inhibitory neurotranmitters (GABA);
- This also increases inhibation in spinal cord, producing skeletal muscle relaxation
Usually the PRIMARY drug used to treat anxiety due to their safety
What do Non-Benzodiazepines do?
Potentiate the inhibitory effects of GABA by binding to GABA a (alpha) receptors
Sedative-Hypnotic Drugs
What the Adverse Effects with the use of benzodiazepines and nonbenzodiazepines?
- Hangover effect
–This can include drowsiness, confusion, or impaired motor function - Cardiovascular and Respiratory Depression
- Dependence (Withdraw may effect sleep)
Refers to residual effects after the drug’s active effects have worn off
Where are benzodiazepines and nonbenzodiazepines excreted from the body?
Kidneys
The kidneys play a vital role in the elimination of these drugs
What are the Considerations for PTs with Sedative-Hypnotic Drugs?
Patients experiencing drowsiness or decreased motor performances are at a greater risk of falls due to the slowed reaction time, therefore utiliziing a gait-belt is important.
- Assess vitals is important before starting exercise to ensure vitals are within normal limits
What are the primary types of antianxiety drugs?
Benzodiazepines, Azapirones (Buspirone), Antidepressants, Beta adrenergic antagonist
This categorization includes various classes of medications used to treat anxiety.
What is the mechanism of action for Azapirones (Buspirone)?
Increases 5-HT (serotonin) effects in the brain. This is safer for long-term use
What is the efficacy level of Buspirone?
Moderate efficacy
This indicates that Buspirone is effective but not as potent as some other antianxiety medications.
How long does it typically take for medications to begin to work for depression?
2 to 4 weeks
This delay is due to the time needed for compensatory changes in the CNS.
Anti-Anxiety Drugs
What are the Adverse Effects for Benzodiazepine?
- Sedation
- Psychomotor Impairments
- Rebound Anxiety
What are the Adverse Effects for Azapirones?
- Dizziness
- Headache
- Nausa
- Restlessness
What are the PT considerations for Antianxiety Drugs?
Pt. experiencing drowsiness, dizziness, or decreased motor performance are at greater risk for falls, therefore a gaitbelt is important.
- Considerations must be taken when completing assessments with individuals under the sedative effects of these drugs
What are the primary classes of antidepressants?
- Selective Serotonin Reuptake Inhibitors (SSRI)
- Selective Serotonin-Norepinephrine Reuptake Inhibitors (SNRI)
- Monoamine Oxidase Inhibitors (MAOi)
- Tricyclic Antidepressants (TCA)
These classes of antidepressants differ in their mechanisms of action and side effects.
Anti-depressive Drugs
What do Selective Serotonin Re-Uptakes Inhibitors (SRRI) do?
SSRIs work by blocking the re-uptake of serotonin into the presynaptic terminal at key locations within the brain
Anti-depressive Drugs
What does Serotonin-Nonepinephrine
Re-uptake Inhibitors (SNRI) do?
Decrease Serotonin and norepinephrin uptake
Anti-depressive Drugs
What do Tricyclics do?
Blocks re-uptakes of amine neurotranmitters (Such as: Serotonin and norepinephrine reuptake)
Anti-depressive Drugs
What is the Role of Monamine Oxidase Inhibitors (MAO) for Bipolar Disorder Drugs?
This helps keep more transmitters in the synaptic cleft
Anti-depressive Drugs
What are the Adverse Effects for SSRI and SNRI?
- Arrhythmias and orthostatic hypotension (low risk)
- Anticholinergic effects (dry mouth, confusion, etc.)
- Serotonin Syndrome (Sweating, Agitation, Tachycardia, Tremors, rigidity, fasciculations, clonus)
Anti-depressive Drugs
What are the Adverse Effects of Tricyclics?
- Sedation
- Anticholinergic Effects (dry mouth, constipation, urinary retention, confusion)
- Arrhythmia and Orthostatic hypotension
Anti-depressive Drugs
What are the Adverse Effects of MAO (Monamine Oxidase) Inhibators?
- Tremors, confusion
- Hypertensive Crises
- Heart attack and Stroke (Cheese effect), when combined with fermented foods such as wine and some types of cheese
What central nervous system effects can MAO inhibitors produce?
CNS excitation, restlessness, irritability, agitation, sleep loss
These effects can significantly impact a patient’s daily functioning.
What neurotransmitters do antidepressants modulate?
Serotonin, norepinephrine, and dopamine
Antidepressants can influence mood and pain perception by affecting these neurotransmitters.
Which neurotransmitter is considered a key inhibitory transmitter?
Noradrenaline
Noradrenaline is important for regulating various functions, including mood and attention.
What role does serotonin (5-HT) play in neurotransmission?
Serotonin acts as both an inhibitory and stimulatory transmitter
Serotonin is involved in many functions, including mood regulation and the sleep-wake cycle.
What is Bipolar Disorder?
A mental health condition associated with mood swings from mania to depression
Mood swings can range from extreme euphoria to deep sadness.
What characterizes manic episodes in Bipolar Disorder?
Euphoria, hyperactivity, and talkativeness
These episodes are marked by heightened energy and mood.
What is the focus of treatment for Bipolar Disorder?
Preventing the start of mood swings by preventing manic-depressive disorder
Treatment often involves the use of mood stabilizers.
With Bipolar disorder, what are mood stabilizers also known as?
Antimanic drugs
These medications help to control manic and depressive episodes.
What is the primary drug used to treat bipolar disorder?
Lithium
Lithium is the most commonly prescribed medication for managing bipolar disorder.
How is Lithium administered?
Orally
Where is Lithium absorbed?
From the GI tract
How is Lithium distributed in the body?
Throughout all the tissues in the body
Is Lithium metabolized in the body?
No, Lithium is not metabolized
How is Lithium eliminated from the body?
Almost exclusively through excretion in the urine
What can frequently occur during the administration of lithium?
Toxic levels can be reached
This is a significant concern for patient safety.
What Mild Toxicity Symptom can result from the use of Lithium?
- Tremors, fatigue, weakness
- Loss of appetite, dry mouth
- Polyuria, Polydispsia
What Mild-Severe toxicity symptoms can result from the progressive accumulation of lithium?
- Seizures
- Coma
- Kidney Damage
- Syncope
- Death
These complications highlight the need for careful monitoring.
What should clinicians be aware of in patients taking lithium?
Any changes in behavior
Behavioral changes may indicate lithium toxicity.
What are the considerations PT should take with BiPolar Disorder Drugs?
Being aware of the S/S of lithium toxicity is important to prevent further life-threatneing complications
What role does cholinergic activity play in Parkinson’s Disease?
It compensates for dopamine under secretion, causing rigidity in movement.
What are the two key neurotransmitters involved in controlling balance, posture, tone, and involuntary muscle movement?
- Dopamine
- Acetylcholine (Ach)
What is the therapeutic goal when dopamine is absent in Parkinson’s Disease?
Restore dopamine and block Ach
What is the primary pharmacokinetic property of dopamine in relation to the blood-brain barrier (BBB)?
Dopamine does not cross the BBB.
What is the primary pharmacokinetic property of levodopa (dopa) in relation to the blood-brain barrier (BBB)?
Dopa crosses the BBB.
What type of drug is used to inhibit the premature breakdown of levodopa?
A peripheral de-carboxylase inhibitor, such as carbidopa.
What is the combination of levodopa and a decarboxylase inhibitor called?
Sinemet.
What is the Role of the Dopamine Agonist for Parkinson’s Disease?
Stimulate dopamine receptors in the basal ganglia
What is the Role of Anticoholinergic Drugs for PD?
Limit acetylcholine transmission, which can help alleviate the Sx of PD, Especially tremors and rigidity by blocking acetylcholine recptors in the basal ganglia
What is the Role of Amantadine for PD?
Inhibits the effects of excitatory amino acids such as glutamate in the basal gangia
What is the Role of Monoamine Oxidase B Inhibitors for PD?
Inhibits the monoamine oxidase type B (MOA-B) enzyme. This enzyme is responsible for breaking down dopamine in the basal ganglia. This enables dopamine to remain active for longer periods of time
What is the role of Catechol-O-Methyltransferase Inhibitors in PD?
Helps prevent breakdown of dopamine in peripheral tissue, allows more levadopa to reach the brain
PD Med.
What are the Adverse Effects of Levodopa?
- Cardiac Arrythmia
- Orhtostacic Hypotension
- Dyskinesia
- Inpulsiveness (Behavior changes)
- End of dose akinesia
- On-off phenomenon
PD Med.
What are the Adverse Effects of Dopamine Agonist?
- Confusion
- Orthostatic Hypotension
PD Med.
What are Adverse Effects for Anticholinergic Drugs?
- Mood changes, confusion, decreased congnition, drowsiness
- Cardiac Irregulation
- Blurred Vision
PD Meds.
What are the Adverse Effects of Amantadine?
- Orthostatic Hypotension
- CNS disturbance (Depression, confusion, hallucinations)
PD Meds.
What are the Adverse Effects of MAO-B?
- Dizziness and Sedation
- GI distress
PD Meds.
What are the Adverse Effects for
Catechol-O-Methyltransferase?
- Initial increase in dyskinesia
- Dizziness
- Muscle pain and cramps
What are the Physical Therapy Considerations for PD Medications?
- Orthostatic Hypotension is commonly seen during the first few days of treatment Levodopa and Dopamine-Agonist, so special attension should be paid to maximize safety.
- PT should pay attension to changes in cognition, alertness, vision and dyskinesia as they place the pt at an increase risk for falls
- Vitals should be taken due to potential cardiac irregularities
What do General Anestegtics do?
They make the patient unconscious, still, and pain-free during surgery
What are the 4 Induction stages for General Anestheisa?
- Analgesia
- Excitement (Delirium)
- Surgical Anesthesia
- Medullary Paralysis
The goal of the anesthesia provider is to bring the patient to stage 3 as rapidly as possible and to maintian the patient at this stage for the duration of the surgical procedure
General Anesthetics Meds
What is the Role of Inhaled Anesthetics?
Provide via gas or volatile liquids. They decrease activity of neurons in the reticular activiating system in the brain, producing sedation, hypnosis, and amnesia during surgery
What are the Adverse Effects for Anesthetics?
- Muscle weakness
- Delirium
- Lethargy
Delirium is a sudden state of confusion and mental dysfunction
What are the Pre-Operative Medications?
- Barbituates
- Opioids
- Benzodiazepines
- Antihistamines
- Anticholinergics
- H2 receptor blockers
- Serotonin receptor antagonist
General Anesthetics Meds.
What do Neuromuscular Blockers Do?
What are the 2 different blockers?
They allow for muscle paralysis during surgery and mechanical ventilation
- Depolarizing Blockers
- Nondepolarizing Blockers
What are the Adverse Effects for General Anesthetics?
- Tachycardia
- Muscle Pain and weakness
- Nausa and vomiting
- confusion
What are the Physical Therapy Considerations for General Anesthetics?
PTs working in acute care hospitals would likely see patients shortly after surgery. Special care must be taken to ensure safety as the adverse effects of anesthetics and some adjunct medications can place the patient at an increased risk for falls
What are the indications for Local Anesthetics?
These are used to reduce sensation to a specific body part or region by inhibiting sodium ion channels
What are the Clinical uses of Local Anesthetics?
- Topical
- Transdermal
- Infiltration
- Peripheal N. Block
- Central neural block
- Sympathetic
- Intravenous Regional Anesthesia
What are the Adverse Effects for Local Anesthetics?
- Localized pain and necrosis
- Local Anesthtic Systemic toxicity (LAST)
What are the Physical Therapy Considerations for Local Anesthetics?
PTs should take extra caution to protect the limb after a nerve block.
- Physical therapists should be aware of symptoms of anesthetic toxicity because if left untreated, it can be fatal.
Heating modalities should never be applied on or near the patch because the heat will accelerate absorption of the drug, which could result in systemic absorption and toxic effects. Individuals who use local anesthetics will experience numbness in the area, so physical therapists need to be very careful when utilizing heat, cold, or electrical modalities due to risk of skin burns.
What is a drug commonly used to treat Skeletal Muscle Spasms?
- Diazepam
What is a Second Category for Antispamic Drugs?
Centally Acting Antispasm Drugs
- Cyclobenzprine (Flexeril)
This attempts to enhance muscle relaxation and decrease muscle spasm
What are 5 examples of Antispasticity Drugs?
- Baclofen
- Dantrolene sodium (Inhibits calcium release from the sarcoplasmic reticulum)
- Diazepam
- Gabapentin
- Tizanidine
What are 2 benzodiazepines that are used as antispasticity drugs?
- Diazepam
- Clonazepam
What is the use of Local Injection of Botulinum Toxin?
This can be used to treat focal dystonias and spasticity, in specific muscles or muscle groups
What is the Role of Opiod Analgesic Agents?
What are examples of this Med?
This changes the way the brain perceives pain
Oxycodone, Hydrocodone, Morphine
What is the Role of Non-Opoid Analgesic Agents?
What are examples of this Med?
Relieve different types of pain
- Acetaminophen, Asprine, Ibuprofen, and similar agents (NSAIDs)
When should Opiods be used?
- For Moderate to Severe Pain (post-surgery, trauma, chronic pain)
- Alter the perception of pain rather than eliminating the painful sensation entirely
With Opioids, is physical dependance at a high or low risk?
Physical Dependence is a High Risk, so Opioids are considered a controlled substance
What Medications are Strong Agonist Opioid Agents used for Severe Pain?
- Morphine
- Alfentanil (Alfenta, Rapifen)
What Medications are Mild to Moderate Agonist Opioid Agents used for Moderate Pain?
- Codeine (Paveral)
- Oxycondone (OxyCodontine, Roxicodone)
What Medications are Antagonist Opoid Agents used for Opioid Overdose and Addiction?
- Naloxone (Narcan)
- Naltrexone (ReVia, Vivitrol) + Behavioral Therapy
WIth Opioids, what are the Adverse Effects with the CNS?
- Impaired cognitive abilities
- Drowsiness
- Opioid abuse and addiction
WIth Opioids, what are the Adverse Effects with the Cardiovascular System?
Orthostatic Hypotension
WIth Opioids, what are the Adverse Effects with the GI?
- Nausea and Vomiting
- Constipation
What is the Clinical Application of NSAIDs?
- Decrease inflammation
- Analgesia
- Antipyresis (Fever reduction)
- Anticoagulants
WIth Opioids, what are the Adverse Effects with the Pulmonary System?
Respiratory Depression
What is a common application with NSAIDs?
Acute and chronic MSK conditions
What are Common NSAIDs?
Get General idea
- Aspirin
- Celecoxib/celebrex
- Ibuprofen/Moltrin/Advil/Nuprin
- Ketorolac/Toradol
What are Common NSAIDs that are Relatively selective for COX-2 Enzyme?
- Diclofenac/Voltaren
- Etodolac/Lodine
- Meloxicam/Mobic
What are common conditions treated by Aspirin and Aspirin-like drugs?
- Inflammation, mild to moderate pain and fever associated with it:
–MSK disorders
–Post-operative pain - Prevention of thrombus formation associated with thrombeomboic condition
–Inhibits platelet-induced thrombus formation
What is Aspirin contraindiacted for children?
Because its association with Reye Syndrome, a liver dysfunction
Children should take ibuprofen
What is the Pharmokinetics for Aspirin?
- Absorption: Stomach and small intestin
- Biotransformation: Bloodstream; oxidation or conjugation in the liver
- Excertion: Kidneys
What are potential side affects of NSAIDs?
- GI damage
- Cardiovascular disease
- Hepatotoxicity
- May aggravate renal disease
What is the Role of COX-2 Selective Drugs (COX-2 Inhibitors/COXIBS)?
- This mediates pain and other aspects of the inflammatory response
What are the concers of COX-2 Selective Drugs (COX-2 Inhibitors/COXIBS)?
MI and CVA
What is the main difference between Acetaminophen and Aspirin?
Acetaminophen lacks anti-inflammatory and anti-coagulant properties
What are the goals for Rheumatoid Arthritis Drug Therapy?
To decrease joint inflammation and arrest the progression of RA
What are 3 general categories of drugs for RA therapy?
- NSAIDs: decrease joint inflammation
- Glucocorticoids: decrease joint inflammation
- Disease-Modifying antirheumatic drugs (DMARDs): Alters immune response
RA Med.
What is the Role of Glucocorticoids?
This binds to receptors in cytoplasm of cells to inhibit proinflammatory substances and increasing anit-inflammatory proteins
RA Meds.
What is the Role of DMARDs?
“Disease-Modifying antirheumatic drugs”
This halts the progression of rheumatoid disease
- In general it inhibits immune responses the underlie RA
The main categories of this are: Traditional Non-Biologic and Biologics
What drugs are used to treat OA?
- Acetaminophen and NSIADs: often the first choice for controlling pain
- Viscosupplemation: An injection of hyaluronan (Hyaluronic acid), this can assist with synovial fluid viscosity
-Glucosamine and Chondroitin Sulfate: This is a diatary supplements (These are key ingredients needed for the production of articular cartilage and synovial fluid0
What are Patient-Controlled Analgesia (PCA)?
This is when patients administer small doses of drug (usually opioids) at relative frequent intervals for optimal pain relief
What are the advantages of Patient-Controlled Analgesia?
- Allows the patient to better control pain
- As pain fluctuates the patient can self deliver more or less medication
- This improves patient satisfaction
What type of patients use Patient-Controlled Analgesia?
- Patients following surgery
- Cancer Patients
Patient-Controlled Analgeisa
With PCA, what is the difference between Loading and Demand Dose and Lockout Interval?
Loading Dose: The use of a single large dose given initially to establish analgesia prior to PCA
Demand Dose: The amount of drug that is self administered by the patient each time they activate the PCA pump
Lockout Interval: The minimal amount of time allowed between each demand dose (the system will not deliver
Patient-Controlled Analgesia
With PCA frequency, what does 1 and 4 hour limit mean?
This limits the total drug tht can be delivered
Patient-Controlled Analgesia
With PCA, what is background infusion?
In some patients a small continuous delivered background level of analgesia
Patient-Controlled Analgesia
With PCA, what are Successful versus total demands?
Successful demands are when patient activates PCA and receives dose. A large number of unsuccessful demands may signals changes need to be made
Patient-Controlled Analgesia
What Opioids are used with PCA?
Morphine, Meperidine, Tramadole and Fentanyl
Patient-Controlled Analgesia
What are Non-Opioids that can be combined with Opioids?
- NSAIDs such as Toradol (this inhibits prostaglandins)
- General Anesthesia such as Ketamine
- An Antipsychotic such as Droperidol
- Low dose of opioid blocker (Nalozone) to block certain side effects (Nausa, Pruritus) while allowing Analgesia
