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pharm quiz 2 Flashcards

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1
Q

3 types of sedative-hypnotics

A
  1. Benzodiazepines
  2. Barbiturates
  3. Nonbarbiturate Hypnotics
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2
Q 
Alprazolam (Xanax)
Lorazepam (Ativan)
Midazolam (Versed)
Temazepam (Restoril)
Triazolam (Halcion)
A

benzodiazepines used as anxiolytic hypnotics

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3
Q

Mechanism of Action: enhance the action of gamma-aminobutyric acid (GABA) in the CNS

Pharmacokinetics
Absorbed from GI track with peak levels in 30 minutes to 2 hours
Distributed throughout body; lipid soluble
Metabolized in liver
Excreted in urine
Cross placenta and enter breast milk

A

benzodiazepines used as anxiolytic hypnotics

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4
Q

CNS depression—lightheaded, drowsiness
Anterograde amnesia
Paradoxical responses—insomnia, excitation, rage
Respiratory depression with IV administration
Physical dependence and withdrawal symptoms if rapid discontinuation
Acute toxicity if overdose—drowsy, lethargic, confused, respiratory depression; Note that Flumazenil (Romazicon) is administered to counteract sedation and reverse effects of overdose

A

S/S of Benzodiazepines Used as Anxiolytic-Hypnotics

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5
Q

Known allergy
Pregnant/lactating
Sleep apnea, respiratory depression, presence of organic brain disease
Avoid alcohol and other CNS depressants such as Barbiturates and Opioids
Use cautiously if history of substance use disorder, liver dysfunction, kidney failure, and in elderly

A

contraindications of Benzodiazepines Used as Anxiolytic-Hypnotics

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6
Q

depress the sensory cortex, decrease motor activity, and alter cerebellar function; produce sedation, hypnosis, and anesthesia

A

Barbiturates Used as Anxiolytics-Hypnotics

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7
Q 
Amobarbital (Amytal Sodium)
Butabarbital (Butisol)
Pentobarbital (Nembutal)
Phenobarbital (Luminal)
Secobarbital (Seconal)
A

Barbiturates Used as

Anxiolytics-Hypnotics

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8
Q

Absorbed in GI track with peak levels in 20-60 minutes
Metabolized in liver; lipid soluble
Excreted in urine
Readily cross the placenta and enter breast milk

A

Barbiturates Used as

Anxiolytics-Hypnotics

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9
Q

CNS depression—drowsiness, lethargy, vertigo, ataxia, feeling “hung-over”, paradoxical excitement, anxiety
GI—nausea, vomiting, constipation, diarrhea, epigastric pain
Cardiovascular—bradycardia, hypotension, syncope
Serious hypoventilation and respiratory depression can occur
Rash, serum sickness, Stevens-Johnson Syndrome

A

Barbiturates Used as

Anxiolytics-Hypnotics

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10
Q

Known allergy
Severe hepatic, renal, cardiac, or respiratory disease
History of drug abuse or dependence
Porphyria; uncontrolled pain
Lactation
Use cautiously with children, elderly or debilitated individuals; hepatic, renal, cardiac, or respiratory impairment; depressed/suicidal individuals; pregnancy
Note: Several drug to drug interactions and additive CNS depression with alcohol

A

contraindications Barbiturates Used as Anxiolytics-Hypnotics

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11
Q

Eszopiclone (Lunesta)
Zalepton (Sonata)
Zolpidem (Ambien)

A

nonbarbiturate hypnotics

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12
Q

Mechanism of Action: enhance the action of GABA in the CNS

Absorbed by GI track
Metabolized in liver
Excreted in urine
Can cross the placenta and enter breast milk

A

nonbarbiturate hypnotics

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13
Q

Daytime sleepiness and lightheadedness—so advise to take med just before bedtime and allow for at least 8 hours of sleep

use in caution in elderly, impaired kidney, liver or respiratory function

A

nonbarbituate hypnotics

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14
Q

CNS stimulation is mediated by release of norepinephrine from central noradrenergic neurons in the cerebral cortex, reticular activating system (RAS), and brainstem. However, the action in the treatment of ADHD is unclear.

A

CNS stimulants used to treat ADHD

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15
Q

calming hyperexcitability through CNS stimulation that is seen in ADHD is believed to be related to increased stimulation of the immature RAS, which leads to the ability to be more selective in response to incoming stimuli

A

paradoxical effect

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16
Q 
Methylphenidate (Ritalin, Concerta)
Dexmethylphenidate (Focalin)
Dextroamphetamine (Dexedrine)
Amphetamine Mixture (Adderall)
Lisdexamfetamine dimesylate (Vyvanse)
A

controlled substances of CNS stimulants used to treat ADHD

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17
Q

CNS stimulation (insomnia, restlessness)
Weight loss, anorexia, nausea
Cardiovascular effects
Hallucinations; paranoia
Withdrawal reaction if abruptly discontinued
Hypersensitive skin reaction to transdermal Methylphenidate

A

CNS stimulants for ADHD

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18
Q

Caution parents and the patient regarding physical and psychological dependence; need to taper dose under MD supervision if meds discontinued; and safe storage of these controlled substances
Big teaching point – can’t just give it when it’s due. Needs to be locked up/monitored to prevent complications with children

A

CNS stimulants for ADHD

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19
Q

Avoid concurrent use of MAOIs; caffeine; over the counter (OTC) cold medications and decongestants
OTC: increase BP and heart rate and the stimulant itself already increases this
Use caution if concurrent use of Methylphenidate with Phenytoin (Dilantin), Warfarin (Coumadin), and Phenobarbital—as Methylphenidate inhibits metabolism of these meds leading to increased serum levels

*As with all medications, inform MD about current meds so an informed decision can be made prior to prescribing additional meds/using OTC meds

A

interactions with CNS stimulants for ADHD

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20
Q

Atomoxetine (Strattera)—not a controlled substance

A

Other meds to treat ADHD

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21
Q

blocks reuptake of norepinephrine at synapse in the CNS. Action in the treatment of ADHD is unclear. (May take 1-3 weeks for therapeutic effect.)

A

other meds for ADHD

Strattera

22
Q

is usually well tolerated with minimal side effects
Anticholinergic –dry mouth, urinary hesitancy, constipation, nausea
Adverse effects—undesirable effects that are not anticipated may include appetite suppression; nausea and vomiting; suicide ideation; hepatotoxicity

A

Strattera

23
Q

Known allergy
Current or prior history of pheochromocytoma
-Tumor: headache, hypertension, palpitation, increase heart rate
Use cautiously if cardiovascular disorder
Narrow angle glaucoma
Avoid use if pregnant or lactating
Avoid concurrent use with MAOIs

A

contraindications for Strattera

24
Q

Benzodiazepines
Atypical Anxiolytic Medications
Other Medications used to treat anxiety

A

antianxiety meds

25
Q

Potentiate the effects of gamma-aminobutyric acid (GABA) which is a powerful inhibitory neurotransmitter

A

antianxiety meds: benzodiazepines

26
Q 
Alprazolam (Xanax)
Chlordiazepoxide (Librium)
Clonazepam (Klonopin)
Chlorazepate (Tranxene)
Diazepam (Valium)
Lorazepam (Ativan)
A

antianxiety meds: benzodiazepines

27
Q

Absorbed from GI track with peak levels achieved within 30 minutes to 2 hours
Distributed throughout body; lipid soluble
Metabolized in liver
Excreted in urine
Cross the placenta and enter breast milk

A

antianxiety meds: benzodiazepines

28
Q

CNS depression
Anterograde amnesia
Acute toxicity if overdose—drowsiness, lethargy, confusion; respiratory depression, severe hypotension, cardiac arrest (Note: Flumazenil (Romazicon) administered to counteract sedation and reverse the adverse effects)
Paradoxical response—insomnia, rage, euphoria
Withdrawal effects if abruptly discontinued

WITHDRAWAL EFFECTS: Can be life threatening – depression, insomnia, increase anxiety, abdominal and muscle cramps, tremors, vomiting, sweating, convulsions and delirium

A

antianxiety meds: benzodiazepines

29
Q

Known allergy
Shock
Coma
Pregnancy or lactating
Use cautiously if substance use disorder history; liver disease
Use short-term due to risk for dependence

A

antianxiety meds: benzodiazepines

30
Q

Abuse and dependency concerns, so carefully evaluate drug/alcohol history before benzodiazepines prescribed on a long-term basis
Benzodiazepines are used on short-term basis in alcohol withdrawal situations

A

special considerations for antianxiety benzodiazepines

31
Q

Buspirone HCl (BuSpar)—may take 3-6 weeks to reach full therapeutic effect

A

NOT a benzodiazepine

Atypical anxiolytic meds

32
Q

is unknown; binds to serotonin and dopamine recepto

A

atypical anxiolytic meds

33
Q

CNS—dizziness, nausea, headache, light headedness, agitation

A

atypical anxiolytic meds Buspar

34
Q

Known allergy
Concurrent use with MAOIs or 14 days after MAOIs are discontinued (could result in hypertensive crisis)
Not recommended for use if breast feeding
Used cautiously in elderly; if liver or renal dysfunction

A

atypical anxiolytic meds Buspar

35
Q

Avoid grapefruit juice
Avoid herbal preparations that contain St. John’s wort
Avoid the use of Erythromycin and Ketoconazole

A

atypical anxiolytic meds Buspar

36
Q

Beta-adrenergic blockers such as Propranolol HCl (Inderal)
Some SSRIs approved to treat specific anxiety disorders, for example
Paroxetine (Paxil) used to treat Generalized Anxiety Disorder (GAD), Panic Disorder, Obsessive Compulsive Disorder (OCD), Social Anxiety Disorder, PTSD
Sertraline (Zoloft) used for Panic Disorder, OCD, PTSD, Social Anxiety Disorder
Escitalopram (Lexapro) used for GAD and OCD
Fluoxetine (Prozac) used for Panic Disorder and GAD
Flovoxamine (Luvox) used for OCD and Social Anxiety q

A

other meds for anxiety

37
Q

Two categories:
Typical/First Generation/ Conventional Neuroleptic Medications
Atypical/ Second Generation Medications
Both categories of medications take 2-4 weeks before signs of significant improvement; effects can be seen within a few days

A

antipsychotic meds

38
Q

Absorbed from the GI track
IM doses provide 4-5 times the active dose as oral
Distributed widely in the tissues and stored there- can be released up to 6 months after medication is discontinued
Cross the placenta and enter breast milk

A

antipsychotic meds

39
Q

Legal-right to refuse treatment includingmeds;except inemergency situations when patient’s thoughts/behaviors posedangertoself orother
Ethical-principle ofautonomy; however needtobalance freedom of choice andthe individual’s autonomy with personal/public safetyconcerns

A

antipsychotic meds

40
Q

Used to control positive symptoms of psychotic disorders

Block dopamine receptors, histamine, acetylcholine, and norepinephrine

A

typical and first generation

41
Q 
Chlorpromazine (formerly as Thorazine)
Fluphenazine (formerly as Prolixin)**
Haloperidol (Haldol)**
Loxapine (Loxitane)
Perphenazine (Trilafon)
Thiothixene (Navane)
**Available in the decanoate form- a long lasting injectabl
A

typical and first generation

42
Q

Anticholinergic (dry mouth, blurred vision, urinary retention, constipation, tachycardia, photophobia)

A

s/e of typical first generation

43
Q

Neuroendocrine- gynecomastia, galactorrhea, menstrual irregularities
Orthostatic hypotension, sedation, seizures, dysrhythmias, sexual dysfunction, photosensitivity
NEUROLEPTIC MALIGNANT SYNDROME- medical emergency
Severely high fever (102+), tachycardia, tachypnea, fluctuations in blood pressure (labile BP), severe parkinsonian muscle rigidity, diaphoresis, and rapid deterioration of mental status to stupor and coma

A

Typical first generation

44
Q

Coma; CNS depression; Parkinson’s disease; prolactin-dependent breast cancer; prolonged QT waves; severe hypotension
Use cautiously if glaucoma; paralytic ileus; prostate enlargement; heart disorders; liver or kidney disease; seizure disorders; pregnant or lactating
Avoid alcohol and other CNS depressants; Levodopa

A

typical and first generatoin

45
Q

Used to relieve both positive and negative symptoms of psychotic disorders
Blocking serotonin, dopamine receptors, histamine, acetylcholine, and norepinephrine
Medications of choice for initial treatment
-Decrease depression, anxiety and suicidal behaviors
-Improve neurocognitive deficits- memory
-Fewer EPS
-Less relapse
Some Atypical Antipsychotics approved for treatment of:
-Major Depressive Disorder
-Bipolar Disorder

A

atypical second generation

46
Q

Clozapine (Clozaril)
Risperidone (Risperdal)—and Risperdal Consta
Aripiprazole (Abilify)—and Abilify Maintena
Olanzapine (Zyprexa)—and Zyprexa Relprevv
Paliperidone (Invega)—and Invega Sustenna
Asenapine (Saphris)
Ziprasidone (Geodon)
Quetiapine (Seroquel)
Iloperidone (Fanapt)
Lurasidone (Latuda)

A

atypical second generation

47
Q 
New onset diabetes mellitus
Weight gain, lots of weight gain
Hypercholesterolemia
Orthostatic hypotension
Anticholinergic effects
Agitation, dizziness, sedation, sleep disruption
Mild EPS, such as tremor
A

atypical second generatoin

48
Q

potentially fatal adverse effect associated with Clozapine (Clozaril) so close monitoring of neutrophils (a type of WBC that helps fight off infections

A

agranulocytosis

S/E of atypical 2nd generation

49
Q

Black box warning for individuals with Dementia
Avoid concurrent use of alcohol; Levodopa; meds that prolong QT intervals
Use cautiously with cardiovascular or cerebrovascular disease; seizures; diabetes mellitus; pregnant and breast-feeding

A

atypical second generation

50
Q

Anticholinergic medications are used to relieve some of the EPS associated with Antipsychotic Medications
Mechanism of Action: blocks acetylcholine receptors; and Diphenhydramine (Benedryl) also blocks histamine release
Select Antiparkinson Medications include:
Benztropine (Cogentin)
Trihexyphenidyl (Artane)
Diphenhydramine (Benadryl)
Pharmacokinetics
Absorbed in GI tract
Cross the placenta and enter breast milk

A

antiparkinson meds

51
Q 
CNS effects (disorientation, confusion, memory loss)
Agitation; nervousness; delirium; dizziness; weakness
Anticholinergic effects (dry mouth, blurred vision, urinary retention, constipation, paralytic ileus, nausea and vomiting)
Cardiovascular (tachycardia, palpitations, hypotension)
A

antiparkinson meds

psych pharm (4 decks)

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