Pharm test 1 Flashcards
1
Q
What is the involuntary contraction of muscles or muscle groups?
A
Spasms
2
Q
What are three causes of muscle spasms?
A
Epilepsy
Hypocalcemia
Pain Syndromes
3
Q
What is a group of movement disorders in the CNS characterized by increased muscle tone, spasms, and a loss of dexterity?
A
Spasticity
4
Q
What are two disorders that have spasticity?
A
Sclerosis and Cerebral Palsy
5
Q
What are two drugs that are used to relieve spasms and decrease local pain and increase range of motion?
A
Diazepan and Tizanidine
6
Q
What medication is a benzodiazepine that works through GABA in the spinal cord and the brain but can cause sedation?
A
Diazepam (Think IZZY)
7
Q
What drug is used for muscle spasms and it’s moa is that it mimics the actions of GABA on the spinal nerves? but has no effect of skeletal muscles?
A
Baclofen
8
Q
What are the AE of Baclofen?
A
Nausea
Constipation
Urinary retention
9
Q
What medication acts on skeletal muscle to lower the release of calcium
A
Dantrolene
10
Q
What is Dantrolene used for?
A
Spasticity and Malignant Hyperthermia
11
Q
What are the AE of Dantrolene?
Used for spasticity so it causes the opposite….
A
Hepatotoxicity
Muscle Weakness
12
Q
What is a disease that is characterized by progressive memory loss and the inability to perform daily tasks?
A
Alzheimer’s disease
13
Q
What is the cholinesterase inhibitor that causes IRREVERIBLE inhibition of cholinesterase to treat AD?
A
Rivastigmine
14
Q
What are possible AE of Rivastigmine
A
Abdominal Pain— PUD
Lung disease
Bradycardia
Sick sinus syndrome
Urinary Obstruction
Fainting and falls
15
Q
What is the cholinesterase inhibitor that causes REVERSIBLE inhibition of cholinesterase in MILD, MODERATE, AND SEVERE AD?
A
Donepezil
16
Q
What are possible AE with Donezepil?
(this is given for AD)
A
N/V/D
Bradycardia
Fainting, Falls, and Fractures
17
Q
What is the drug class that blocks the cholinergic receptors and can reduce the individual’s response to cholinesterase used in AD?
A
Cholinesterase Inhibitors
18
Q
What are cholinesterase inhibitors used in?
A
AD
19
Q
Cholinesterase Inhibitors prevent the breakdown of _________________
A
Acetylcholine
20
Q
Overall cholinesterase inhibitors _______ the progression of the disease?
A
SLOW
21
Q
What are the possible AE of cholinesterase inhibitors?
A
Cholinergic Side Effects
GI
Dizziness
HA
Bronchoconstriction
22
Q
What is the disorder where there is a rapid degeneration of neurons in the hippocampus and later in the cerebral cortex?
A
Alzheimer’s
23
Q
What are the primary drug classes used in AD?
A
Cholinesterase Inhibitors
24
Q
What are the three main cholinesterase inhibitors used in AD?
A
Donepezil
Galantamine
Rivastigmine
25
What is the cholinesterase inhibitor that causes reversible cholinesterase inhibitor and used in mild to moderate AD?
Galantamine
26
What are possible AE of Galantamine?
Bradycardia
Fainting, falls, fractures (this is all AD meds)
Bronchoconstriction
27
What is the drug that falls in the category of N-methyl-D-asparate receptor antagonist
Memantine
28
What drug is used in moderate to severe AD and is better tolerated that cholinesterase inhibitors
Memantine
29
What are possible AE with Memantine
*** They are all pretty typical.
Dizziness
HA
Confusion
Constipation`
30
What are possible AE with Memantine
Dizziness
HA
Confusion
Constipation`
31
What are the antidepressants discussed?
Used in patients with ADHD
hint**If you use antidepressants you may be in a BIND**
Bupropion
Imipramine
Nortriptyline
Desipramine
32
Antidepressants are paired with patient's who already have what conditions?
PSYCH
33
What are possible AE of antidepressants
Arrythmias
Anticholinergic effects
AND THESE DRUGS LOWER THE SEIZURE THRESHOLD
34
What drugs are used in ADHD and are LESS effective that stimulants?
ALPHA 2 ADRENERGIC
35
What are possible AE of Alpha 2 Adrenergics
(Everything opposite of Fight or Flight)
Sedation
Fatigue
HA
low HR and BP
Depression
36
What general anesthetic is used primarily in kiddos?
Ketamine
37
What anesthetic is associated with hallucinations, bad dreams and delirum
Ketamine
38
What are the drugs that can be used as an epidural?
Lidocaine and Bupivacaine
39
What is a key point when giving an epidural?
HAVEA GOOD IV LINE!
40
What is is called when the patient is unconscious and there is a lack of responsiveness to all painful stimuli including loss of all sensations?
General Anesthetics
41
What is is called when there is a combo of drugs to achieve what we cannot achieve with inhalation anesthetics alone?
Balanced anesthesia
42
What are the components of Balanced anesthesia?
Short acting barbiturate for INDUCTION
Neuromuscular blocking agent for muscle relaxation
Opioids and NO for analgesia
43
What is the minimum alveolar concentration?
The lower the MAC value the higher the potency
44
What are the possible AE of General Anesthetics
Resp. and cardiac depression
Sensitization of the heart to catecholamines
Malignant hyperthermia
Aspiration of gastric contents
Hepatic toxicity
45
What meds are given before anesthesia to decrease anxiety, promote perioperative amnesia and relieve pre-op pain?
Benzo
Opiods
Clonidine
Anticholinergic drugs
46
What drug class decreases the amount of anesthesia needed to prevent contraction of all skeletal muscle including the diaphragm?
Neuromuscular blocking agents.
47
What are the three meds given post-anesthetically?
Analgesia- pain control depending on severity
Antiemetics- General anesthesia makes you nauseous
Muscarinic agents- enable PNS
48
What is the inhaled anesthetic that has a quick action and a weak analgesic?
Halothane
49
What inhaled anesthetic has weak muscle relaxation so you give it with NMBA?
Halothane
50
What are the AE of Halothane?
HALLMARK AE IS H_____________
Hypotension
RR depression
Sensation of the heart to catecholamines
Malignant hypertethermia
Hepatic toxicity
51
What is the potent anesthetic that has a low MAC value but is an effective muscle relaxant?
Isoflurone
52
What is the anesthetic that does not have any effect on renal or hepatic toxicity?
Isoflurone
53
What are the AE of Isoflurone?
Resp. depression
Hypotension
54
What anesthetic is AKA laughing gas?
Nitrous Oxide
55
Nitrous Oxide is a _____ anesthetic and a ______ analgesic but will never be used as a primary anesthetic?
WEAK anesthetic
STRONG analgesic
56
20% NO= the pain relief of ________
Morphine
57
Are there serious side effects of NO?
NO ;)
58
What is the IV sedative used for induction and maintentnce of anesthesia?
Propofol
59
Propofol's onset is ____ seconds
Duration is ______ minutes
60 seconds
3-5 minutes
60
What are the AE of Propofol?
Requires close monitoring in the RESP. system
Resp. depression
Low BP
Bacterial infection
Monitor triglycerides (if on this long term)
61
Propofol needs to be discarded after ______ hours
6
62
What are the two benzodiazepines that can be used in balanced analgesia?
(END IN AM)
Diazepam
Midazolam
63
People taking Diazepam are unconscious within __ minute
1
64
Pancurionium is used for what?
General anesthesia, intubation, and mechanical ventilation
65
What is the antidote for Pancurionium?
Neostigamine
66
Use caution giving pancurionium to patient's with _______
Liver disease
67
What is the drug that competes with ACH at the nicotinic receptors?
Succinylcholine
68
Succinylcholine peaks at ____ minute
1
69
What is Succinylcholine's use?
Muscle relaxation during Intubation
70
What are AE of Succinylcholine?
Apnea
Malignant hyperthermia
Post-op muscle spasms
71
What are drugs that suppress pain by blocking the impulse?
Local anesthetics
72
Give local anesthetics with __________________ like Ephedrine?
Vasoconstrictors.
73
Amides (Lidocaine) can be given ____________ or ____________
Topical or Injection
74
The onset of amides is rapid and intense and have more __________________ effects
Prolonged
75
Esthers (Procaine) there is an increased risk of __________ rxn.
Allergic
76
Procaine can give _______ only!
Injection
77
What is the first line therapy for ADHD?
Stimulants
78
Atomoxetine has a black box warning for _______!
Suicide
79
What are adverse effects for stimulants in the treatment of ADHD?
Decreased appetite
Poor growth
Dizziness
Insomnia
Mood lability
Rebound
Tics
Psychosis
MISUSE??
80
What is the most effective drug for Parkinson's?
Levodopa
81
What is the MOA of levodopa?
Decrease s/sx of PD by increasing the synthesis of Dopamine
82
T/x for a wearing off effect?
Give the dose more frequently
Add COMT inhibitor
Add dopamine agonist
Controlled release form
83
T/x for the on off effect in PD?
Add COMT inhibitor
Redistribute dietary proteins
84
AE of levodopa?
Dyskinesias- with all PD drugs
CV- orthostatics
Psychosis- Hallucinations
Darkens sweat
85
What is the most notable AE for Levodopa?
MALIGNANT MELANOMA
86
Carbidopa is given with levodopa to ________ the effects?
ENHANCE
87
Carbidopa has ____ effect on it's own?
NO
88
What is the MOA of Pramipexole?
Dopamine receptor agonist
89
Pramipexole is typically used with _______
Levodopa
90
What are the AE for Levodopa
Daytime somnelence
insomnia
Hallucinations
91
What is the MOA of Bromocriptine?
Direct acting dopamine agonist
92
AE of Bromocriptine?
USED FOR PD
Nightmares
Agitation
Hallucinations
Paranoid Delusions
93
Bromocriptine is used with ________
Levodopa
94
What is the COMT inhibitor that inhibits the metabolism of levodopa in the periphery.
Tolcapone and Entacapone
95
The use of Tolcapone is with levodopa and allows for ____ dosage and ____ function of levodopa
Decrease dosage
Increase function
96
What is the primary AE for Tolcapone?
Liver failure
97
What are the AE for Entacapone?
Hallucination
Yellow and orange urine
98
What is the drug that increases dopamine levels and us used with levodopa..... CAN CHANGE INTO AN AMPHETAMINE
Selegiline
99
What is the medication that inhibits MAO-B and increased dopamine and is used with levodopa? DOES NOT CHANGE INTO AN AMPHETAMINE
Rasagiline
100
What are the AE of Rasagiline (used in PD)?
Arthralgia
Flu like s/sx
101
What is the med that promotes Dopamine release and is used in early PD?
Amantadine
102
What are the AE of Amantadine?
Urinary retention
Livedo reticularis- skin discoloration that occurs when the patient has been on this for 1 mo.
103
_________ are given for PD and can be used alone or with levodopa?
Anticholinergic drugs
104
What are the AE of anticholinergic drugs?
These dry everything out
Dry mouth
Blurred vision
Photophobia
Urinary retention
Constipation and increased HR
105
Dopaminergic drugs in PD address?
Tremor
Bradykinesia
Rigidty
106
Anticholinergic drugs only address
Tremor
107
What are the three steps for the initial treatment for PD?
1. Dopamine agonsit less effective than levodopa
2. Levodopa
3. COMT inhibitor added ot levodopa
108
What is the neurodegenerative disease that is associated with an imbalance of ACH and Dopamine
Parkinson's Disease
109
What is the drug that addresses PARTIAL seizures and lessens Ca++ currents?
Zonisamine
110
What is the drug that is good for partial seizures and decreases NA+ Currents
Topiramate
111
What drug could be useful in Absence seizures?
Zonisamide
112
What are the AE of Topiaramate?
Somnolence
Nervousness
Ataxia
113
What is the schedule 5 drug that can be used for neuropathic pain
Pregabalin
114
What are the AE of Pregabalin?
Drowsiness
Weight Gain
Angioedema
115
What is the drug that prevents hypersychronization and is not metabolized extensively?
Levetiracetam (KEPPA)
116
What are the AE of Levetiracetam?
**this is the drug that the man had to stop taking because it changed his behavior so much
Drowsiness
Behavioral Changes
117
What drug can be used for status epillepticus?
Levetiracetam
118
What is the drug that moa is noncompetitive antagonist of AMPA glucamate receptor?
Perampanel
119
What are the AE of PErampanel?
Neuropsychiatric effects
dizziness
gait disturbances
Weight gain
120
What is the barbiturate that is effective against clonic/tonic seizures but may WORSEN absent seizures?
Phenobarbital
121
What are the AE of phenobarbital
Neuropsychiatic
Rickets
Pophyria
Nystagmus and ataxia
122
Phenobarbital is really effected (levels skyrocket) when used with ________ ____
Valproic Acid
123
Avoid food with tyramine in people taking
Rasagiline
124
Drug interactions with Rasagiline
Meperidine
SSRIs
Phenylephrine
125
What is the moa for Valproic Acid?
Decrease Ca, decrease neuron firing
126
Valproic acid is used in _______, _________ disorders, and _______
Seizures
Bipolar disorders
Migrianes (not the best med for this)
127
What are the AE of Valproc Acid?
Liver failure
Pancreatitis
Hyperamonemia
Hypersalivation
128
What are Drug drug interactions with Valproic Acid
Phenobarbital- levels rise by 40%
Phenytoin
Topiramate
Menopenem and Imipenem
129
What is the MOA for carbamazepine?
Effects Na+ channels and inhibits voltage sensitive channels
130
Carbamazepines work on all seizures BUT ________
Absent seizures
131
What are the theraputic index for Carbamazepines
4-12
132
What are the AE for Carbamazepine
Visual disturbances
Ataxia
Vertigo
Leukopenia
Pregnancy category D
Promotes ADH
Rash and SJS
133
What lab needs to be monitored on patient's with Carbamazepine
CBC bc it can cause anemia
134
What drug has the moa that inhibits the influx of Na
Phenytoin
135
What is the DOC for tonic-clonic seizures and partial seizures but ineffective in absent seizures?
Phenytoin
136
What are the normal TI for Phenytoin?
10-20
137
Phenytoin is _______ protein bound?
Hightly
138
What levels need to be monitored on a patient with phenytoin?
Albumin
139
What are the AE for phenytoin
** associated with TI levels
Nystagmus
Ataxia and seizing (levels above 30)
Stupor and coma (levels above 40)
140
If a patient on Phenytoin has gingiva hyperplasmia what should you give them to help?
Folic Acid
141
What are inducers of metabolism?
Phenytoin
Carbamazepine
Phenobarbital
142
What is the inhibitor of metabolism?
Valproic ACid
143
What is a med that is used broad spectrum for seizures activity and bipolar disorders
Lamotrigine
144
What are AE of lamotrigine?
Severe skin rxn
Aseptic meningitis
SUICIDE risk
145
Gabapenttin is used for what?
Neuropathic pain
146
What is used for monotherapy for partial seizures?
Oxacarbazepine
147
What is the hallmark AE for oxacarbazepine?
Clinically significant hyponatremia
148
What drug decreases the threshold for Ca++ currents and is used in ABSENT seizures?
Ethosuximide
149
What are the normal serum levels for valproic acid?
50-100
150
When giving Phenytoin IV it can cause _________
Cardiac dysrhythmias and hypotension
151
When giving Phenytoin IV give it _______ and _______
slowly and DILUTED
152
What is the pro-drug of phenytoin?
Fosphenytoin
153
Phenytoin is an _______ of metabolism
Inducer
154
What can increase the CNS effects of Phenytoin?
CNS depressants
155
What is the DOC for partial seizures?
Carbamazepine
156
Carbamazepine is an ________ of metabolism and it is so strong it ________ itself!
Inducer; Induces itself!
157
Never allow a patient to drink what with Carbamazepine?
Grapefruit juice
158
What med is used for absent seizures but is not effective for T/C?
Ethosuximide
159
What is another medication that can be used in patients with AHDH
Methylphenidate
160
What is a non-stimulant used in patients with AHDH
Amoxetine
161
Can Neuromusclular Blocking Agents cross the BBB?
No
162
Do neuromuscular blocking agents have analgesic properties?
No; Patients who have this are fully awake, but paralyzed
163
Generally speaking, neuromuscular blocking agents end in what?
"IUM"
164
Patients who are on neuromuscular blockers need what because of the severe resp. depression?
Mechanical Ventilation
165
What to do if a patient has malignant hyperthermia?
Chilled Saline and Dantrolene
166
Use caution when giving patients with Alzheimer's what other class of drugs?
Depolarizing Neuromuscular Blocker
167
Using a vasoconstrictor with local anesthetics serve what purpose?
prolong anesthesia and decrease the risk of toxicity
