Pharm Final 6 Flashcards
serotonin receptor agonist used for migraines
sumatriptan
phenobarbital
barbiturate (sedative/hypnotic/anxiolytic)
diazepam
benzodiazepines (sedative/hypnotic/anxiolytic)
zolpidem
benzodiazepines (sedative/hypnotic/anxiolytic)
eszopiclone
“other anxiolytic and hypnotic drugs” (this one is Lunesta)
general CNS depressants that inhibit neuronal impulse conduction
barbiturates
Although the mechanism of barbiturates is unclear, it might have to do with activating
GABA
the major inhibitory transmitter of the CNS
GABA
the 2 major groups of sedative/hypnotic/anxiolytics
barbiturates and benzodiazepines
facilitate activity of GABA at it’s receptors
benzodiazepines (and possibly barbiturates)
the suffix “ital” means
barbiturate
the suffix “pam” means
benzodiazepine
benzodiazepines are less likely to causes this than barbiturates
respiratory depression, coma, death
clinical pharmacology: sedation hypnosis anesthesia anticonvulsant muscle relaxant respiratory depression anxiety disorders
barbiturates and benzodiazepines (sedative/hypnotic/anxiolytic)
used to induce anesthesia
barbiturates
reduces the amount of anesthesia needed
barbiturates
used for epilepsy
barbiturates and benzodiazepines (sedative/hypnotic/anxiolytic)
barbiturates and benzodiazepines (sedative/hypnotic/anxiolytic) control epilepsy by
reducing the number of neurons firing
toxic/undesirable effects: tolerance physical dependence anterograde amnesia drowsiness respiratory depression, coma, death
barbiturates and benzodiazepines (sedative/hypnotic/anxiolytic)
tolerance develops for anti-seizure effects
benzodiazepines
tolerance does not develop for anxiolytic effects
benzodiazepines
tolerance develops to the sedative and hypnotic effects
barbiturates
withdrawal symptoms include anxiety and insomnia
barbiturates and benzodiazepines (sedative/hypnotic/anxiolytic)
toxic/undesirable effects: anterograde amnesia
barbiturates and benzodiazepines (sedative/hypnotic/anxiolytic)
toxic/undesirable effects: respiratory depression, coma, death
barbiturates and benzodiazepines (sedative/hypnotic/anxiolytic)
poor memory during the drug use, memory returns after
anterograde amnesia
inducers of the P450 system
barbiturates
drug interactions occur with other CNS sedatives like alcohol, narcotics, and anticonvulsants
barbiturates and benzodiazepines (sedative/hypnotic/anxiolytic)
clinical uses: anxiety sleep disorders anesthesia epilepsy alcohol withdrawal
barbiturates and benzodiazepines (sedative/hypnotic/anxiolytic)
nursing implications for barbiturates and benzodiazepines (sedative/hypnotic/anxiolytic) (4)
vitals
assess sleep patterns
day time drowsiness (don’t drive etc)
avoid alcohol and other CNS depressants (like benedryl)
nursing implications: vitals assess sleep patterns day time drowsiness (don't drive etc) avoid alcohol and other CNS depressants
barbiturates and benzodiazepines (sedative/hypnotic/anxiolytic)
nursing implications: day time drowsiness (don’t drive etc)
barbiturates and benzodiazepines (sedative/hypnotic/anxiolytic)
2 drugs we learned that are best for insomnia
zolpidem and eszopiclone
haloperidol
antipsychotic
clozapine
antipsychotic
prochlorperazine
antipsychotic
in addition to being an antipsychotic, it’s also used for antiemetic
prochlorperazine
the glaring/obvious symptoms of schizophrenia are called
positive symptoms
are antipsychotics better at controlling positive symptoms or negative symptoms?
positive
In schizophrenia, speech pattern and lack of emotion are __ symptoms
negative
although the pathogenesis of schizophrenia is uncertain, the best theory is the ___ hypothesis
dopamine hypothesis
hyperdopaminergic means
too much DA
the dopamine hypothesis of schizophrenia is that there’s an imbalance of DA. hyperdopaminergia causes __ symptoms and hypodopaminergic causes __ symptoms
positive
negative
2 examples of a conventional antipsychotic
haloperidol
prochlorperazine
example of atypical antipsychotic
clozapine
Both conventional and atypical drugs are good at treating positive symptoms, but ___ can also treat negative symptoms
atypical
has side effects r/t muscle activity
conventional antipsychotic (haloperidol prochlorperazine)
class of drug that works by blocking receptors for DA, ACH, histamine, and NE
antipsychotics
class of drug has emotional quieting and reduced physical movement
antipsychotics
class of drug, antiemetic
antipsychotics
class of drug, increases prolactin
antipsychotics
antipsychotics side effects (4)
dry mouth, urinary retention, constipation, sedation, orthostatic hypotension
class of drug, has antihistamine effect (causes sedation)
antipsychotics
which group of antipsychotic causes less extrapyramidal side effects
atypical
which group of antipsychotic can relieve positive and negative symptoms
atypical
__ is used to treat some of the extrapyramidal side effects of antipsychotics
benedryl
name of side effect: spasms of face, neck, mouth, back
acute dystonia
name of side effect: tremor, bradykinesia, mask-like face, altered posture
Parkinson’s
name of side effect: catatonia, rigidity, fever
malignant syndrome
name of side effect: involuntary movements of mouth, face, trunk and extremities; sucking and smacking lips
tardive dyskinesia
treatment of acute dystonia
anti-cholinergic (parkinson’s drug?)
treatment of Parkinsons
anti-cholinergic (parkinson’s drug?)
treatment of malignant syndrome
stop meds immediately
treatment of tardive dyskinesia
minimize doses initially
side effect that’s irreversible and therefore the causative drug should be started at low dose
tardive dyskinesia
time of onset, tardive dyskinesia
months to years
time of onset, malignant syndrome
weeks
time of onset, Parkinson’s
5-30 days
time of onset, acute dystonia
1-5 days
clinical use can include tourettes syndrome
antipsychotic
antipsychotic nursing implications (3)
vitals
monitor extrapyramidal side effects
avoid alcohol
which antipsychotic is good for antiemetic
prochlorperazine
what’s the best side effect to identify malignant syndrome
fever
depression in response to an event
reactive
depression not in response to an event
no reason
no reason depression is aka
endogenous depression
no reason depression includes __ disorder
bipolar disorder
symptoms: increase or decrease weight, can’t sleep or sleep too much
depression
depression involves an imbalance between __ and __ neurotransmitters
inhibitory and excitatory
most significant neurotransmitters in depression
serotonin and NE
Major classes of antidepressants (4)
MAO inhibitors
TCA
SSRI
Other
Not an antidepressant, a mood stimulator
lithium
TCA prototype
amitryptyline
SSRI prototype
sertraline
MAO prototype
phenelzine
prototype of “other” antidepressants
bupropion
antidepressant that works by blocking of NE and/or serotonin reuptake
amitryptyline
antidepressant takes 2-3 weeks to work
amitryptyline
antidepressant,
anti-cholinergic effects (dry mouth, constipation, urinary retention)
anti-histamine effects (sedation)
orthostatic hypotension
amitryptyline
TCA has SEVERE reaction with
MAO inhibitors (coma)
TCA (amitryptyline) contraindications
heart conditions
side effects,
drowsy, dizzy, orthostatic hypotension, sedation, constipation
TCA (amitryptyline)
toxic effects,
cardiac conduction defects, coma CV collapse, seizures, delerium
TCA (amitryptyline)
used for endogenous depression
TCA (amitryptyline)
used for OCD
TCA (amitryptyline)
antidepressant, blocks reuptake of 5HT by presynaptic terminal
(SSRI) sertraline
increases level of 5HT
(SSRI) sertraline
antidepressant with no anticholinergic action
(SSRI) sertraline
side effects,
insomnia, nervousness, akathesia, tinnitus, headache, sexual problems, weight loss followed by weight gain
(SSRI) sertraline
drug that irreversibly inactivates MAO
phenelzine
increases levels of amines such as norepinephrine, epinephrine, DA, serotonin, and tyramine
phenelzine
suppress REM and causes orthostatic hypotension
phenelzine
has interactions with foods high in tyramine (such as beer, cheese, chicken liver)
MAO inhibitors (phenelzine)
phenelzine interaction with tyramine
hypertension
antidepressant that enhances the action of general anesthetics, sedatives, narcotics, and TCAs
phenelzine
antidepressant contraindicated with st johns wort
phenelzine (both are MAO inhibitors)
toxic effects,
liver toxicity
2-3 drug-free period before taking a tri/hetero-cyclic antidepressant
phenelzine
overdose can result in agitation, headache, convulsions, hypo/hypertension
phenelzine
weakly blocks reuptake of NE, serotonin, and DA
bupropion (“other”)
at lower doses, can be used for smoking cessation
bupropion (“other”)
antidepressant with side effects: CNS stimulation, weight change, dry mouth, headaches, GI effects
bupropion (“other”)
used in treatment of mania and manic parts of bipolar disorder
lithium
lithium route of administration
oral
drug with very narrow TI
lithium
side effects:
polyuria, excessive thirst, epileptic seizures, thyroid enlargement
lithium
contraindicated in pregnancy
lithium
the main receptor for opioid is
Mu
extrapyramidal side effects refer to ___ issues
muscle
extrapyramidal side effects are treated with ___ or ___
benedryl or benztropine
insulin increases uptake or
glucose
insulin increases storage of glucose as __ in the ___
glycogen in the liver
insulin inhibits (3)
gluconeogenesis, glycogenolysis, lipolysis (which makes sense because the point of insulin is to decrease the excess energy in the blood)
insulin promotes uptake of AAs and __ synthesis in muscle
protein
insulin decreases free __ acids and promotes triglyceride storage in
free fatty acids
adipocytes
increases uptake of potassium
insulin
diabetes is characterized by either having no __ or the body not responding to insulin
insulin
kind of diabetes thats an autoimmune disorder
type 1
type of diabetes where there’s no circulating insulin in the plasma
type 1
type of diabetes where patient is prone to hyperglycemia and ketoacidosis
type 1
kind of diabetes “absolute deficiency”
type 1
kind of diabetes “relative deficiency”
type 2
kind of diabetes where the body isn’t responding to insuln
type 2
kind of diabetes that happens with obesity
type 2
kind of diabetes occurs due to a defect in the receptor on the pancreatic B cell
type 2
in type 1 diabetes, what causes glycosuria, osmotic diuresis, thirst, dehydration
kidneys overloaded with glucose
without insulin, a child with IDDM wastes away and dies from DKA which is
diabetic ketoacidosis
kind of diabetes, hyperglycemia
type 1
kind of diabetes, glycosuria
type 1
kind of diabetes, polydipsia
type 1
kind of diabetes, weight loss
type 1
kind of diabetes, malaise
type 1
kind of diabetes, ketoacidosis
type 1
increased level or circulating fatty acids, leads to renal failure and circulatory collapse
ketoacidosis
kind of diabetes, decreased glucose transport in muscle, elevated hepatic glucose production, and increased breakdown of fat
type 2
kind of diabetes, impaired insulin secretion; may lead to beta cell “burn out”
type 2
kind of diabetes, increased glucose secretion by the liver (in response to increase insulin)
type 2
disease includes: nephropathy neuropathy retinopathy atherosclerosis
diabetes
