Pharm Exam 4 Flashcards
When is the best time to take a triptan medication?
When a headache starts!
When taking aspirin to prevent an MI, what should a patient report to a provider in fear of possible toxicity?
Tinnitus
think ototoxicity
How many grams of acetaminophen is the max to be taken per day by a healthy adult?
4g / day (for purposes of the exam)
COX2 inhibitors are best known for decreasing inflammation
True.
COX2 enzyme causes inflammation.
COX2 inhibitor does opposite
When is the best time of day for a patient to take levothyroxine?
1 hour before meals
How long does it take to achieve a therapeutic effect of levothyroxine (Synthroid)?
Several weeks
What are the signs of overdose of thyroid replacement hormone?
Tachycardia, chest pain, anxiety, nervousness
Why should hypothyroidism be treated during pregnancy?
A child could have neuropsychological defects
What are the clinical symptoms (physical assessment) of hypothyroidism?
Brittle hair, pale skin, low temperature
How do levothyroxine (Synthroid) and warfarin (Coumadin) interact?
Synthroid requires a decrease in warfarin
What is a side effect of low-dose radioactive iodine when used to treat Graves’ disease?
Nausea, dry mouth, dry eyes, swollen salivary glands
When is the best time to take sumitriptan (Imitrex - serotonin-selective agonist) for the management of symptoms?
Take as soon as headache starts
What are the signs of acute salicylates (aspirin) poisoning?
Headache, tinnitus, GI distress
Why is acetaminophen (Tylenol) not effective for the treatment of rheumatoid arthritis?
Not meant for inflammation
Think of examples of physical conditions that would be appropriate for a nonsteroidal anti-inflammatory agent.
RA, osteoarthritis, tendonitis, muscle aches, backaches, dental pain, gout, bursitis, menstrual cramps, fever, aches, ankle sprain
When should high-dose aspirin be discontinued prior to surgery?
7 to 14 days
Which medication may cause Reye’s syndrome?
Aspirin
Understand early sign of salicylate toxicity (aspirin overdose).
Headache, tinnitus, GI distress
Acetaminophen (Tylenol) should not exceed what max daily dose
4 g
What do COX-2 inhibitors do?
Decrease inflammation, pain, fever
What is the reversal agent for morphine?
Narcan (naloxone)
What are constipation treatment options for someone on chronic morphine treatment?
Laxative or stool softener
What are life threatening symptoms of an opioid overdose?
Respiratory depression
What are serious side effects of long-term opioid use?
Potential medical risks include serious fractures, breathing problems during sleep, hyperalgesia, immunosuppression, chronic constipation, bowel obstruction, myocardial infarction, and tooth decay secondary to xerostomia.
What are considerations when converting a morphine dose from the intravenous to the oral route?
Increased dose due to digestion
What are the risks of giving a mixed opioid agonist-antagonist with a opioid agonists?
Withdrawal
What needs to be assessed prior to administering morphine?
RR and BP
What is the reversal agent for Tylenol toxicity?
Acetylcysteine (NAC)
What are symptoms of normeperidine toxicity?
Tremor
meperidine= tramadol (narcotic analgesic)
What is the reversal agent for aspirin?
None
What is the ideal way for someone to wean off anti-seizure medications?
Eradicating all seizure activity then weaning off medication once patient is seizure-free for 3 months
When is the best time to take trazodone (Desyrel)?
Bed time
Which drugs are appropriate to treat inflammation?
COX 2 inhibitors
What are the contraindications for acetaminophen (Tylenol)?
Cirrhosis d/t alcohol use
A common drug ending for a Serotonin-receptor agonist?
Triptans
What labs must be monitored for Valproic Acid (Depakote)?
Liver and platelets
What is a common, non-serious side effect of imipramine (Toframil)?
Sedation
imipramine is a tricyclic antidepressant (TCA)
How long will it take to achieve a therapeutic response from imipramine (Tofranil)?
1-3 weeks
What is a common, non-serious side effect of tricyclic antidepressant that would most likely diminish over time?
Drowsiness
Between bupropion (Wellbutrin) and serotonin selective reuptake inhibitors (SSRIs) which would have less adverse sexual side effects?
Wellbutrin
What is the interaction between an SSRI, fluoxetine (Prozac) and St. John’s Wort?
Serotonin syndrome
After symptoms are controlled, how long does one continue antidepressant medications?
One year
What is the interaction of monoamine oxidase inhibitors (MAOIs) and foods containing tyramine?
Hypertensive crisis
What are the anticholinergic effects associated with antidepressant agents?
Constipation, dry mouth, urinary retention
What symptoms should a patient seek emergency care for when taking a monoamine oxidase inhibitor (antidepressant)?
Chest pain, dizziness, headache
What is general patient education regarding lithium and fluids and salt intake?
Drink 2-3L of fluid
What drug counteracts benzodiazepine, chlordiazepoxide (Librium)?
Flumazenil/Romazicon
What are common contraindications for benzodiazepines?
COPD, bronchitis, sleep apnea, myasthenia gravis
When is the best time to take trazodone (Desyrel)?
Bedtime
What are common side effects of the benzodiazepine, diazepam (Valium)?
Drowsiness, dizziness, fatigue, constipation
What is the effect of buspirone (BuSpar) on the central nervous system?
No effect
Drug endings to indicate a benzodiazepine
-pam
clonazepam (klonopin)
What side effects are classified as anticholinergic effects?
Constipation, dry mouth, urinary retention
What antidepressant medication is contraindicated for those with a history of seizures?
Bupropion/wellbutrin
What are signs of Steven Johnson Syndrome?
Rash, fever, coughing, redness, itching, sore throat, swelling, mouth blisters
What are the effects of an Amitriptyline overdose?
Cardiac arrest, dangerously low blood pressure, seizures
At what dose of amitriptyline could a patient experience adverse side effects?
Initiating with high doses (low initial doses minimize adverse reactions and help promote adherence), 150 mg/day is max dose
What are dietary considerations for those taking MAOI medication?
Foods high in tyramine: aged cheese, chicken, beef, avocado, beer, figs, fava beans
What is the black box warning for SSRIs?
Suicidality in ages 15-24
