Pharm final- old stuff Flashcards
What is the MOA of phenytoin?
-selective inhibition of sodium channels
-slows recovery of Na channels from the inactive state
What are some ADRs r/t phenytoin?
-SJS/ toxic epidermal necrolysis> associated with genetic mutation
-gingival hypertrophy
-hyperplasia>excessive growth of gum tisue
-reduced with folic acid
- regularly brush teeth, floss gently
-interferes with metabolism of vitamin D (Do not give to an older adult who already has osteoporosis)
-hirsutism
What are some ADRs r/t phenytoin?
-SJS/ toxic epidermal necrolysis> associated with genetic mutation
-gingival hypertrophy
-hyperplasia>excessive growth of gum tissue
-reduced with folic acid
- regularly brush teeth, floss gently
-interferes with metabolism of vitamin D
-hirsutism
MOA of valproic acid?
- suppresses neuronal firing by blocking sodium channels
-suppresses calcium influx by blocking calcium channels
-potentiates the inhibitory influence of GABA
What is a drug interaction of valproic acid?
-topiramate (hyperammonemia)
-excessive ammonia in body when these drugs are combined
How may a patient appear if valproic acid and topiramate are combined?
-confusion
-vomiting
- altered LOC
What is the drug of choice for absence seizures?
Ethosuximide
What are some ADRs of lamotrigine?
-life-threatening rashes (SJS and TEN)
-Aseptic meningitis
(confusion, photophobia, n/v, Nuchal rigity (main sign), inflammation of the meninges)
What is the MOA of vigabatrin?
-inhibits GABA transaminase
- Prevents GABA inactivation, so it enhances GABA mediated inhibition of neuronal activity
What is the MOA of Ezogabin?
Promotes potassium efflux in the neuronal membrane
(nonselective)
It activates potassium channels in the bladder which can cause urinary retention
What are some therapeutic uses of Gabapentin?
-Neuropathic pain
-migraine prophylaxis
-fibromyalgia
-Postmenopausal hot flashes
Endogenous opioids work on..
Mu, Kappa, delta
Exogenous opioids work on…
MU and Kappa
Mu side effects include?
-respiratory depression
-euphoria
Kappa side effects include?
- no euphoric effects
-decreased potential for addiction
What is the prototype for a pure opioid agonist? (STRONG)
Morphine
-activates Mu and Kappa receptors
-most effective against constant, dull pain
Prototype for moderately strong opioid agonist?
Codeine
-used to control mild/moderate pain
What is the prototype for agonist-antagonist opioid (partial agonist)
Pentazocine
-no euphoric effects
-less abuse potential
Pentazocine acts as an _____ at kappa receptors and an _______ at Mu receptors.
agonist
antagonist
What is the prototype for a pure opioid antagonist?
Naloxone
-used to diagnose and treat overdose
What are some adverse effects of morphine?
-Resp. depression
-orthostatic hypotension
-Neurologic effects (sedation, euphoria, elevation of ICP, miosis)
-Cough suppression
-constipation
-Promotes N/V/ emesis
-Urinary retention
How do you monitor the effectiveness of furosemide?
-daily weight, urine output ( OUTPUT SHOULD EXCEED INTAKE), decreased edema, clear lung sounds
What are some ADRs of furosemide?
-hypovolemia, hypokalmeia, hypochloremia, hyponatremia
-hyperglycemia, hyperuricemia, high LDL, high triglycerides
-ototoxicity
-hypotension
-Arrythmias (low potassium)
-metabolic alkalosis
What are some drug interactions with furosemide?
-Antihypertensives- lowers BP
-Digoxin- Toxicity
-Aminoglycosides- ototoxicity
-Lithium- low sodium level
-NSAIDS
-Potassium-sparing diuretics (POSITIVE)
What can you teach your patient that is taking furosemide?
-They will pee ALOT
-stand up slowly
-increase potassium intake for potassium eliminating diuretics
- take in the morning if QDAY and morning afternoon if BID
-hypokalemia s/s= muscle weakness
- Call provider if they gain more than 2 llbs in a day, experiencing SOB, changes in hearing, or pain in joints= GOUT
What is the difference between ADRs of hydrochlorothiazide compared to furosemide?
Same ADRs as furosemide EXCEPT ototoxicity and hypocalcemia
What are some advantages of using hydrochlorothiazide compared to furosemide?
-Protects against post-menopausal osteoporosis
-prevents calcium-induced renal calculi
-Enhances actions of ADH- can be used for diabetes insipidus
MOA of spironolactone?
- Acts at late distal tubule to decrease both sodium reabsorption and potassium secretion
What are some ADRs of spironolactone?
-Androgenic effects
-impotence
-hirsutism
-gynecomastia/amenorrhea
