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Nurs 306 / Pharm 2 > Pharm test 2 > Flashcards

Pharm test 2 Flashcards

1
Q

People with type I DM, they have a complete lack of ________

A

Insulin

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2
Q

If a patient has type II DM, the patient has _______ resistance and decreased ________ insulin output

A

Insulin resistance; decreased pancreatic insulin output

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3
Q

A fasting glucose of greater than ______ is Diabetic

A

126 mg/dL

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4
Q

A random plasma glucose greater than ____ and symptomatic is Diabetic

A

200 mg/dL

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5
Q

An elevated plasma glucose Post-OGTT and level of greater than ____ is Diabetic

A

200 mg/dL

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6
Q

A Hemoglobin A1C greater than ______ is Diabetic

A

6.5%

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7
Q

Prediabetic level for A1C is what?

A

5.7-6.4

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8
Q

A patient comes into the physician’s office and has his A1c tested and comes back with a level of 6.0. What would the nurse tell the patient and recommend?

A

He falls within a prediabetic category; She should recommend that he makes some lifestyle and diet changes.

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9
Q

A prediabetic patient asks for a recommendation on things he could do to decrease the risk of getting diabetes, what should the nurse tell him as far as diet and exercise

A

Lose 7% of initial body weight
Walk for 30 minutes for five days a week.

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10
Q

What are the goals for DM?

A

Prevent acute and chronic complications

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11
Q

What are acute complications for DM?

A

Hypoglycemia
DKA
HHNS

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12
Q

What are microvascular chronic complications of DM?

A

Retinopathy, Neuropathy, Nephropathy

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13
Q

What are macrovascular chronic complications of DM?

A

Cardiovascular, cerebrovascular, peripheral vascular disease

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14
Q

The goal fasting plasma glucose for a diabetic is what value?

A

80-130 mg/dL

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15
Q

The goal A1c for a diabetic patient should be what value?

A

< 7.0 %

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16
Q

What is more accurate blood glucose or A1c?

A

A1c; It shows a more long term snapshot of how their blood glucose has been managed

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17
Q

How often should you look at A1c for a patient who has uncontrolled DM?

A

3 months

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18
Q

How often should you look at A1c for a patient who has controlled DM?

A

6 months

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19
Q

What should a patient’s blood sugar be after eating a meal?

A

less than 180 mg/dL

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20
Q

What is the ADA’s goal for a blood pressure of a patient with DM?

A

< 140/90

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21
Q

Why do we need to control DM?

A

Blood sugar control = Reduce microvascular complications
Cholesterol control = Reduce macrovascular complications
Blood Pressure control= Reduce bother macrovascular and microvascular risks.

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22
Q

Which medication reduces the risk for both macro and microvascular complications?

A

BP meds like lisinopril

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23
Q

Prediabetes is when the fasting plasma glucose is between ___ and ___?

A

100-125 mg/dL

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24
Q

What medication is a high alert medication?

A

Insulin; There are a lot of medication errors with this med.

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25
Q

What are the rapid acting insulins?

A

Inhaled Insulin
Fast Aspart
Lispor aabc
Glulisine
Aspart
Lispro

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26
Q

What is the onset of Inhaled Insulin, Fast Aspart, Lispro aabc?

A

2-3 minutes

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27
Q

What is the onset of Glulisine, Aspart, Lispro?

A

5-15 minutes

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28
Q

What is the duration of rapid acting insulin?

A

2-5 hours

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29
Q

What is the duration of short acting insulin?

A

4-6 hours

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30
Q

What is the peak of short acting insulin?

A

2-3 hours

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31
Q

When is the peak of Rapid acting insulins?

A

1-2 hours

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32
Q

What is the short acting insulin?

A

Regular

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33
Q

What is the intermediate acting insulin?

A

NPH

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34
Q

What is the Intermed/Long Acting Insulin?

A

Detemir

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35
Q

What are the two long acting insulin?

A

Glargine and Degludec

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36
Q

What is the onset of short acting insulin like Regular?

A

0.5-1 hours

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37
Q

What is the onset of NPH?

A

1-2 hours

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38
Q

What is the onset of Detemir?

A

2-4 hours

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39
Q

What is the peak of intermediate acting insulin?

A

4-8 hours; duration 10-20 hours

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40
Q

What is the only insulin that is given IV?

A

regular

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41
Q

What is the peak of long acting insulin?

A

No peak (Flat); lasts 24 hours.

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42
Q

What is the onset of Glargine and Degludec?

A

1-2 hours

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43
Q

What is the only insulin in the US that is cloudy?

A

NPH

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44
Q

The patient complains that his Lispro looks cloudy in its container, you should educate the patient to do what?

A

Discard the medication, this medication should not be cloudy. Only NPH insulin is cloudy (in the U.S)

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45
Q

What is Lipodystrophy and Liphohypertrophy

A

A condition that occurs when a patient injects the insulin in the same spot all the time.

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46
Q

Places that a patient can use to inject insulin

A

Upper arm, thigh, abdomen

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47
Q

A patient is newly diabetic and needs education about how to store his insulin. What would you teach him?

A

Stores in fridge when unopened
Never frozen
Can be used until expiration date if kept in fridge.
After opening, it can be kept for 1 month without significant loss of activity
Keep it out of the sun and extreme heat

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48
Q

Possible Complications of Insulin Treatment

A

Hypoglycemia
Lipohypertrophy
Allergic Rxn
Hypokalemia
Drug interactions

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49
Q

A DMI patient should be on a _______/______ insulin regimen

A

basal/bolus

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50
Q

What are meds given “basal” to prevent ketosis and control fasting BG?
longer acting

A

Detemir (intermed-long)
Glargine (long)
Degludec (long)
NPH (intermed)

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51
Q

What are insulins you could give “bolus” to control post prandial glucose excursions?

A

Glulisine
Aspart
Lispro
Inhaled
Regular

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52
Q

A patient comes into the clinic and says that he was up at 3 AM and his blood sugar was very high. He reports that he did not eat anything prior. What insulin would you likely need to adjust?

A

The Basal Insulin

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53
Q

Target goals for a DM II patient before meals?

A

70- 130 mg/dL before meals

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54
Q

Target goal for a DM II patient at bedtime?

A

100-140 mg/dL at bedtime

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55
Q

A Hemoglobin A1c of less than ___% is good for more patients

A

7%

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56
Q

A Hemoglobin A1c of below ___% may be okay for patients with a limited life expectancy and other complications?

A

8%

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57
Q

A middle aged patient came into the physician’s office and was given a diagnosis of Type 2 Diabetes. What would you anticipate the initial drug of choice be?

A

Metformin.

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58
Q

The doctor mentions that there may be a need to add another med to the patient’s metformin. What things would need to be considered?

A

How high is their A1c?
Is the problem fasting or after meals?
Are there contraindications?
Is there a risk for hypoglycemia?
Is weight an issue?
Cost issues?
Oral or injection preferences?

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59
Q

What are the preferred options to add to metformin?

A

SU’z
TZDs
Basal insulin
DPP-4 inhibitors
GLP-1 agonist
SGLT-2 inhibitors

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60
Q

What other meds would you anticipate a diabetic to be on?

A

Insulin
ACE/ARB for HTN
Statins for dyslipidemia

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61
Q

What drug has the MOA that inhibits glucose prod. in liver, reduces absorption in gut, and sensitizes insulin receptors in target tissues.

A

Metformin (Biguinides)

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62
Q

If the patient is having gut issues after starting Metformin, encourage the patient to keep taking it and the gut issues should get better after ______ weeks

A

two

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63
Q

What are some Pros of Metformin?

A

Good A1C reduction
Cheap
Well tolerated
Weight loss
Some lipid benefits
Possible CV benefit

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64
Q

What is a contraindication for metformin?

A

eGFR less than 45- dose reduce
less than 30- can’t give the med

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65
Q

Does metformin make you gain weight?

A

No; it may promote weight loss but NO weight gain! Some lipid and CV benefits

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66
Q

If a patient is going in for surgery you are to ____ Metformin

A

HOLD

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67
Q

What are some possible SE of Metformin?

A

GI- cramping diarrhea nausea and vomiting
Lactic acidosis- diarrhea, dizziness, low HR
B12 deficiency- neuropathic pain

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68
Q

What are some unique SE of Metformin?

A

Lactic Acidosis
Vitamin B12 deficiency

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69
Q

What are contraindications for Metformin?

A

eGFR that tanks
(below 30)

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70
Q

Exenatide falls under which drug class added to metformin?

A

GLP-1 receptor agonists

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71
Q

GLP-1 receptor agonists end in….

A

“atide”

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72
Q

What are possible SE of Exenatide?

A

GI effects
Pancreatitis
Drug interactions
2x daily or biweekly

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73
Q

What is the oral version of a GLP-1 that is also good for weight loss?

A

Semaglutide
(Ozempic)

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74
Q

What is the GLP-1 may cause thyroid cancer but protects CVD protection?

A

Liraglutide

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75
Q

What are some benefits for GLP-1 agonists?

A

A1c reduction
Weight loss
Dosing flexability
CVD risk reduction

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76
Q

What are some risks for GLP-1 Agonists

A

Warning for thyroid cancer
Weight loss (this could be a good thing)
GI SE (Should dissipate after 2 weeks)
Injection site discomfort
Pancreatitis risk

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77
Q

If a patient comes into the clinic and has a history of pancreatitis, the nurse would advocate that the patient would not be put on what class of drug?

A

GLP-1 agonists

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78
Q

A patient who just entered remission for thyroid cancer asks if she can take a GLP-1 agonist because she heard they help you lose weight, the nurse should educate the patient that…?

A

She does not “qualify” to take these because she has a history of thyroid cancer, but there are other medications that may help her!

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79
Q

What is the MOA of SGLT-2 inhibotors?

A

Block reabsorption of filtered glucose in the kidney, leading to glucosura

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80
Q

What are the two classes of drugs that can added to metformin for patients that have CVD risks?

A

SGLT2 inhibitors (canagliflozin) and GLP-1 agonists (exenatide)

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81
Q

What is the class of drug that can be added to Metformin that are cost effective and promote insulin release?

A

Sulfonylureas

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82
Q

What are the major side effects of Sulfonylureas?

A

Hypoglycemia and weight gain

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83
Q

What are some second generation Sulfonylureas?
* All start with G*

A

Glipizide
Glyburide
Glimepiride

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84
Q

What are benefits of Sulfonylureas?

A

Cheap and decreases A1C

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85
Q

What are some cons of Sulfonylureas?

A

Weight Gain and hypoglycemia

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86
Q

What are the two drugs that fall under the Meglitinides?
End in Glinide

A

Repaglinide
Nateglinide

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87
Q

What are some risks for Meglitinides?

A

Weight gain
Cost
Hypoglycemia take with meals
Mealtime dosing

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88
Q

What are the two drugs that are under the drug class Thiazolidinediones?
(AKA Glitazone)

A

Rosiglitazone and Pioglitazone

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89
Q

What are the MOA for Glitazones (TZD)?

A

Reduce glucose levels by decreasing insulin resistance

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90
Q

What is the Glitazone drug that can cause renal retention of fluid and raises plasma lipids?
(Rosi think Renal)

A

Rosiglitazone

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91
Q

Rosiglitazone can increase risk of what?

A

Heart failure; too much fluid retention

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92
Q

What are the two D/D interactions for Rosiglitazone?

A

Insulin
Gemfibrozil

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93
Q

What is the newest Glintazone that can cause hepatoxicity?

A

Pioglitazone

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94
Q

What are some AE of Pioglitazone?

A

URI
HA
Sinusitis
Myalgia
Promotes water gain

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95
Q

What are some drug interactions for Pioglitazone?

A

Gemfibrozil

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96
Q

What are benefits of TZDs?

A

A1c reduction
insulin sensitivity
Cost

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97
Q

Risks for TZDs?

A

Weight gain
Edema
Avoid in CHF- fluid retention
Risk for bladder cancer
Proximal bone fracture risk

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98
Q

What is the DPP-4 Inhibit that enhances the actions of incretin hormones?
(End in -gliptins)

A

Sitagliptin

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99
Q

What is the peak of long acting insulin?

A

No peak (Flat); lasts 24 hours.

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100
Q

What is the drug that inhibits glucose production in the liver and reduces glucose absorption in the gut?

A

Metformin

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101
Q

What medication has good A1C reduction, is cheap, well tolerated, and causes no weight gain?

A

Metformin

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102
Q

What are common SE of Metformin caused by lactic acidosis?

A

Diarrhea, dizziness, bradycardia

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103
Q

What are common SE of metformin due to B12 deficiency?

A

Neuropathic Pain

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104
Q

If a patient is taking Metformin and the eGFR is less than 45, you should….

A

Reduce the dose

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105
Q

If a patient is taking metformin and the eGFR is less than 30 you should…..

A

DO NOT GIVE IT (lactic acidosis risk)

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106
Q

If a patient is undergoing a study with iodine contrast dye, you should hold metformin for how long?

A

48 hours

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107
Q

Hold metformin if the patient is about to have what?

A

Surgery

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108
Q

What is the GLP-1 Receptor Agonist that was talked about?

A

Exanatide

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109
Q

How is Exanatide given?

A

SQ injection once or twice a week or BID

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110
Q

What are the AE of Exantidie?

A

GI, weight loss and pancreatitits

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111
Q

What are the benefits of Exanatide?

A

Good A1C reduction
Weight loss
CVD risk reduction

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112
Q

What is the black box warning for Exanatide?

A

Risk for thyroid cancer

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113
Q

When giving Exanatide, use caution when giving to patients with what three conditions?

A

Gastroparesis
Pancreatitis
Renal impairment

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114
Q

What are the two contraindications for Exnantide?

A

CrCl of less than 30
Medullary thyroid cancer

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115
Q

What do SGLT-2 inhibitors end in?

A

(-flozin)

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116
Q

What is the MOA of Canagilflozin?

A

Blocks the reabsoprtopn of filtered glucose in kidneys

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117
Q

What are AE of Cenagliflozin?
(Flozin think FUNGAL)

A

Genital fungal infections
UTIs
Increased urination

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118
Q

How often is Canagliflozin given?

A

Once a day

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119
Q

What are the benefits of Canagliflozin?

A

Moderate A1C improvement
Weight loss
Minimal hypoglycemia
Slow CKD progression

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120
Q

What are the risks of Canagliflozin?

A

New, expensive and urinary AE

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121
Q

What is the black box warning with Canagliflozin?

A

Amputation risk

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122
Q

What is the MOA for SUlfonylureas?

A

Promote insulin release

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123
Q

Sulfonylureas are old meds but they are ___________!

A

Inexpensive

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124
Q

What are the AE of Sulfonylureas?

A

Severe hypoglycemia
Weight gain

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125
Q

What are the benefits for sulfonylureas?

A

Affect fasting and post-prandial glucose, cheap, good A1C decrease

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126
Q

What are the two meglitinides?
(end in glinide)

A

Repaglinide
Nateglinide

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127
Q

What is the MOA of Repaglinide and nateglinide?

A

Promote insulin release

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128
Q

What are the AE of Meglitinides?

A

Severe hypoglycemia (take with meals) and weight gain

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129
Q

What are the benefits of Meglitinides?

A

BEtter focus on post prandial glucose control

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130
Q

What is the CON of Meglitinides?

A

They are more expensive than sulfonylureas

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131
Q

What are the MOA of thiazolidinediones?

A

Reduce glucose levels by DECREASING INSULIN RESISTANCE

132
Q

What are the Thiazolidinediones?
(End in Glitazone)

A

Pioglitazone
Rosiglitazone

133
Q

What are the AE of Rosiglitazone?

A

Renal retention of fluid and high plasma lipid levels

134
Q

What are the AE of Pioglitazone?

A

Hepatotoxicity and water retention

135
Q

What are the CI of Pioglitazone?

A

Bladder cancer in your history and family history

136
Q

What is a consideration for Pioglitazone for menopausal women?

A

IT can cause ovulation

137
Q

What are the contraindications for Thiazolidineodiones?

A

CHF- too much water retention
Osteopenia- breaks down bones
Osteoporosis- breaks down bones

138
Q

What are the benefits of Thiazolidinediones?

A

Good A1C reduction, improves beta cell function and they are inexpensive

139
Q

What are the risks for Thiazolidinediones?

A

Weight gain and edema
Blackbox warning for CHF

140
Q

What are the DPP-4 inhibitors? (-gliptins)

A

Sitagliptin

141
Q

What is the MOA of Sitagliptin?

A

Enhances the action of incretin hormones, stimulates insulin releases and supresses glucagon release?

142
Q

What are the AE of Sitagliptin?
(The AE are like the flu or a cold)

A

URI
HA
Throat and nasal inflammation and joint pain

143
Q

What are drug that relieve anxiety?

A

Anxiolytic drugs

144
Q

What are drugs that help you sleep?

A

Hypnotics

145
Q

What are the benefits of Sitagliptin?

A

Focus on post prandial glucose, once daily, well tolerated, and weight neutral

146
Q

What are the risk for sitagliptin?

A

Modest A1C reduction
Expensive
Renal dose adjustment needed
CHF risk

147
Q

What do you need to do first if someone has DKA?

A

CHECK POTASSIUM

148
Q

What other things need done if a patient has DKA?

A

Fluid replacement
Check Potassium
IV insulin
Fix glucose

149
Q

What is the DOC for treating insomnia and anxiety?

A

Benzodiazepines

150
Q

What are the two most prescribed BEnzo?

A

Lorazepam and alprazolam

151
Q

A patient with DKA should have what labs?

A

Glucose < 200
pH > 7.3
Bicarb > 15
Anion gap < 12

152
Q

What is a state where there is dehydration and sluggish blood with a change in pH and ketoacid levels?

A

Hyperosmolar Hyperglycemic state

153
Q

What are the three things that need fixed with HHS?

A

Correct dehydration
Correct high BG
Correct electrolyte abnormalities

154
Q

What drug has the MOA of potentiating GABA?

A

Benzodiazepines

155
Q

What is the treatment for Hypoglycemia?

A

GLucogon
IV glucose

156
Q

What are the primary uses for Benzo?

A

Anxiety
Insomnia
Seizure
Sedation

157
Q

If a diabetic has nephrotoxicity give what?

A

ACE or ARBS

158
Q

What benzo should be given to elderly patients of people with liver impairments
(These ones are okay for LIVER…. Monitor Liver with LFT)

A

Ativan/Lorazepam
Tamezapam/Restoril

159
Q

If a diabetic patient has neuropathy, give what?

A

B12 (if on metformin)

160
Q

If a diabetic patient has BP issues, you can give what?

A

CCB, thiazide diuretics or ACE/ARBs

161
Q

What med should every diabetic patient be on

A

A statin. Always a statin

162
Q

A diabetic patient should be on what for CVD prevention?

A

ASA
Clopedigrol

163
Q

What is Graves disease?

A

Hyperthyroidism; too much T3 and T4 release

164
Q

What lab findings will you see in a patient with Graves?

A

low TSH high T4

165
Q

What is Hashimotos?

A

Hypothyroidism; iatrogenic cause poor functioning of the thyroid?

166
Q

What lab findings with be seen in Hashimotos?

A

High TSH and low T4

167
Q

What are AE for Benzodiazepines?

A

CNS depression
Antreograde amnesia
Paradoxial effects

168
Q

What are CNS depressant SE for benzo?

A

Drowsness, incoordination, and difficulty concentraing

169
Q

What are more SE for Benzos?

A

RR depression
Abuse
Fetal harm
Hypotension

170
Q

What is the preferred treatment for Graves disease?

A

Ablataive therapy with radioactive iodine

171
Q

What are drug interactions with Benzos?

A

Do not use with another CNS depressant
(Too much RR depression)

172
Q

If the cause of hyperthyroidism is because of an adenoma, you should do what?

A

Surgical resection

173
Q

If a patient is waiting for a procedure and cannot have the normal thyroid ablative therapy, you should do what?

A

Move to pharmacological therapy

174
Q

What thyroid drug inhibits iodination and synthesis of thyroid hormones?

A

Thiourea

175
Q

What is the preferred thioureas?

A

Methimazole

176
Q

If a patient abruptly stops a benzo, they will have what?

A

Physical dependence so withdrawl

177
Q

Methimazole is the preferred drug for hyperthyroidism, but it cannot be used in __________

A

Pregnancy

178
Q

If a patient has hyperthyroidism, and becomes pregnant they need put on what?

A

Propylthiouracil
(PTU)

179
Q

What are the AE for thioureas?
(CHECK CBC)

A

Arthraliga
Fever
Rash
Transiet Leukopenia

180
Q

What Thiourea has a risk of liver toxicity?

A

Propylthiouracil
PTU

181
Q

What Thiourea has a risk for pancreatitis?

A

Methimazole

182
Q

Both Thioureas have a risk for agranulocytosis, so monitor what?

A

CBC

183
Q

What are the three benzo like drugs?

A

Zolpidem- onset and maintanence
Zaleplon- onset
Eszopiclone- onset and maintanence

184
Q

What benzo like drug is used as short term treatment of insomnia?

A

Zolpidem

185
Q

what benzo like drug helps people fall asleep and is only for short term managment?

A

Zaleplon

186
Q

What is the benzo like drug that can be used in long term insomnia treatment?

A

Esxopiclone

187
Q

What other drugs can help with hyperthyroidism?

A

BBlockers
Iodine

188
Q

What do you do if a patient has thyroid storm?

A

Potassium iodine
PTU
Betablocker

189
Q

What are soem actions to take if a patient has thyroid storm?

A

Sedate
Cool
Glucocorticoids
IV fluids

190
Q

What is the drug that kills the thyroid?

A

Radioactive Iodine 131

191
Q

What is the DOC for hypothyroidism?

A

Synthetic T4 (Levothyroxine)

192
Q

When should a pt. take levothyroxine?

A

Before food in the AM and 3-4 hours after food at night

193
Q

T4 is __________ to a patient’s need

A

TIRTRATED

194
Q

What is a melatonin agonist?

A

Rozerem

195
Q

What are the AE of levothyroxine?

A

Hyperthyroidism, MI, bone fracture risk

196
Q

When a patient is levothyroxine, do not give _________ within 4 hours?

A

Calcium

197
Q

____________ increases the body’s response to catecholamines, so you need to be aware of the s/sx of cardiac arrest?

A

Levothyroxine

198
Q

What hormone is released from the anterior pituatary?

A

Growth Hormone

199
Q

What are the GH biologic effects

A

Promote growth
Promote protein synthesis
Carbohydrate metabolism

200
Q

What drug has the MOA that bind to GABA receptors and enhance actions of GABA

A

Barbituates

201
Q

What are the uses for GH?

A

GH deficiency
Prader Willis syndrome

202
Q

What are the AE of GH?

A

Hyperglycemia
Neutrolize ABX
Carpal tunnel
Some fatality
HTN

203
Q

GH supresses the function of what drugs?

A

Glucocorticoids

204
Q

BArbituates can cause what?

A

CNS depression
LOWER BP AND HR
Inducer of hepatic enzymes

205
Q

Acromegaly is what?

A

too muhc GH

206
Q

How is ACromegaly treated?

A

If caused by a pituitary adenoma, SURGERY

207
Q

How are barbituates used?

A

Insomnia (not anymore)
Seizures
Anestesia
Mania

208
Q

AE of barbituates?

A

RR depression
Suicide
Abuse
Harmful for fetus
Porphyria
Hangover
Paradoxial excitement
Hyperalgesia

209
Q

What is a hormone that inhibits the release of GH?

A

SomatoSTATIN

210
Q

If a patient has OD caused by barbituates, the nurse should?

A

Remove barbituate and maintain O2 to the brian

211
Q

ADH causes water retention and THUS

A

LESS URINATION

212
Q

What is the most common psych disorder?

A

Depression

213
Q

The use of synthetic ADH

A

DI
Cardiac arrest
Postop
Abdominal distention
Hemophilia A and VOn Wilebrans

214
Q

What is the deficiency of ADH with excretion of lots of dilute urine?

A

Diabetes Insipidus

215
Q

What is the treatment of DI?

A

Replace ADH with desmopresson or vasopressin (nasal)

216
Q

What are the AE of ADH

A

Water intoxication and excessive vasoconstrition

217
Q

If a patient has water intoxication, the nurse should

A

Eduacte about less water consumption

218
Q

What are some common s/sx depression

A

Depressed mood
Loss if interest
Insomnia
Anorexia

219
Q

What two neurotransmitters are decreased in patients with depression?

A

Norepinephrine and Serotonin

220
Q

What are important education points for depression meds

A

Symptoms resolve slowly
Responses may develop 1-3 weeks
Maximal responses may not be seen for 12 weeks
Failure is 1 month without success

221
Q

There is an increase of what with antidepressants?

A

Suicide

222
Q

All antidepressants are equally ________

A

Efficacious

223
Q

What are the first antidepressants available?

A

Tricylic antidepressants (TCAs)

224
Q

What is the MOA of TCAS

A

blocking the reuptake of 5-HT and norepinepherine

225
Q

What are the SE of TCAs

A

Antihistamine= sedation
Anticholinergic= anticholinergic (dry out)
Cardiac conduction= orthostatic hypotension
Sedation
Lethal in OD

226
Q

What TCA can be used in neuropathy?

A

Amitriptyline

227
Q

AMitriptyline can also be used as prophylaxis for what?

A

Migranes

228
Q

What are the drugs that block the enzyme responsible for the breakdown of catecholamines?

A

Monoamine oxidase inhibitors (MAOIs)

229
Q

What are the two MAOIs that were discussed?
(ine)

A

Phenelzine
Tranylcypromine

230
Q

When taking a MAOI, avoid foods high in what?

A

Tyramine

231
Q

What can foods high in tyramine do while taking a MAOI?

A

HTN crisis

232
Q

If taking a MAOI, avoid what other drugs?

A

OTC sympathomimetics
Antidepressants
Let the other antidepressants get out of your system before starting this

233
Q

What foods are high in tyramine

A

Avocado, soybeans
Figs and bananas
Fermented and smoked meats
Cheese and foods with yeast
Beer and wine

234
Q

What is a transdermal MAOI?

A

Selegiline

235
Q

Selegiline decreases the risk of HTN crisis and thus you can eat some

A

Tyramines

236
Q

Selegiline still affects other sympathomimetic drugs and what other drugs?

A

Carbamazepines
Oxcarbazepine

237
Q

What is the drug that inhibit the reuptake serotinin

A

SSRIs

238
Q

What SSRIS are okayed for depression
(SSRIs end if pram and ine)

A

Fluoxetine (Prozac®)
Sertraline (Zoloft®)
Paroxetine (Paxil®)
Citalopram (Celexa®)
Escitalopram (Lexapro®)
Fluvoxamine (Luvox®)
Vilazodone

239
Q

Flouxetine has a _____ half life

A

LONG

240
Q

Paroxetine needs to be given at night because it is big at _______

A

SEDATING

241
Q

What two drugs are inhibitors of the 2D6 pathway

A

Fluoxetine and paroxetine

242
Q

What SSRI can increase QTc prolongation risk in doses about 40 mg?

A

Citalopram

243
Q

A lot of psych drugs are metabolized though what pathway

A

2D6

244
Q

What SSRI is category D in pregnancy

A

Pareoxetine

245
Q

What are some SE of SSRIs
They key one starts with a S

A

GI- nausea
CNS- anxiety
HA
Sexual dysfunction

246
Q

SSRIs are not lethal in a __

A

OD

247
Q

What is a serotonin syndrome

A

When two drugs that increase serotonin are given at the same time.

248
Q

SSRIs should not be stopped abruptly because it can lead to

A

Withdrawal

249
Q

What are the serotonin/norepinephrine reuptake inhibitor?
XINE

A

Venlafaxine
Desvenlafaxine
Duloxetine

250
Q

SNRIs are better for depression than

A

SSRIs

251
Q

SNRIs can lead to what?

A

Weight loss, increase BP and GI issues

252
Q

SNRIs cannot be stopped all of a sudden because it can lead to?

A

Withdrawl

253
Q

What psych drug is a serotonin reuptake inhibitor that blcosk serotonin receptors?

A

Trazodone

254
Q

What are the SE of Trazodone?

A

Sedating
Ortho hypotension
Dry mouth

255
Q

Trazodone is used in ____ more than in depression

A

SLEEP

256
Q

Bupropion lower the _______ threshold

A

Seizure

257
Q

Buproprion should be taken in the _______

A

Morning

258
Q

What are some SE for Buproprion

A

Lowers seizure threshold
Agitation
Wt. loss
Constipation
Tremor
HA, insomnia
Increase sexual function

259
Q

Mirtazapine is very sedating and needs to be taken when?

A

At night

260
Q

SE of Mirtazapine

A

Sedation and Weight gain

261
Q

What drugs are at highest risk for serotonin syndrome?

A

MOAI

262
Q

What drugs area at high risk for serotonin syndrome?

A

SSRI
SNRI
Clomipramine

263
Q

What drugs are at adjunctive risk for Serotonin syndrome?

A

Buspirone
Dextromethorphan
Lithium
Fentanyl
Merperidine
Linezolid
Stimulants
Tramadol

264
Q

What symptoms are under the autonomic instability for serotonin syndrome?

A

Diaphoresis
Hyperthermia

265
Q

What are symptoms under the neuromuscular hyperactivity in serotonin syndrome

A

Myoclonus
Rigidity
Tremors
Incoordination

266
Q

What are symptoms under the altered mental status category of serotonin syndrome

A

Agitation
Confusion
Hypomanic

267
Q

What are the components of Bipolar disorder?

A

Depression and Mani

268
Q

What are the components of Bipolar disorder?

A

Depression and Mania

269
Q

What is the treatment standard for Bipolar disorders?

A

Mood Stabilizers such as lithium and valproic acid

270
Q

Bipolar Disorder is _____ in nature and there are recurrent _________

A

Cyclic; fluctuations in mood

271
Q

What are the two treatment priorities for bipolar disorder

A

Drugs and psychotherapy

272
Q

What are the key mood stabilizers used in bipolar disorders

A

Lithium
Valproic Acid
Carbamazepine

273
Q

What drugs are added in the manic period of Bipolar disorder?

A

Antipsychotics

274
Q

What drugs are given during a depressive episode in bipolar disorder?

A

Antidepressants

275
Q

What meds are given in a manic episode?

A

Lithium
Valproic Acid
(+ antipsychotic and benzo)

276
Q

Lithium is used in both phases of bipolar disorder. BUT it is a low TI drug and needs to be _______

A

Monitored

277
Q

How long does it take lithium to work?

A

Antimanic takes 5-7 days
2-3 weeks for full effects

278
Q

Lithium is secreted by the _______

A

Kidneys

279
Q

AE of Lithium

A

GI- nausea, diarrhea, and abdominal bloating
Tremor
Polyuria
Renal toxicity
Goiter and hypothyroidism
Tetratogenic
INCREASE WBC

280
Q

What are the safe levels for lithium

A

0.6-1.2 mEq/L

281
Q

Mild toxcity range for lithium?

A

1.3-1.4 (hold lithium)

282
Q

Moderate toxicity range for lithium?

A

1.5-2.5 (Hold; supportive care)

283
Q

Severe toxicity range for lithium?

A

GREATER than 2.5(need hemodialysis)

284
Q

What are some education points for lithium?

A

Encourage fluid intake (2000-3000 mL/day)
Renal function
Thyroid function
UA every 6-12 months

285
Q

When do through levels for lithium need to be taken

A

12 hours after the evening dose

286
Q

Meds than increase lithium concentrations

A

NSAIDS
Thiazide diuretics

287
Q

Things that decrease lithium concentrations

A

Caffeine
Increase GFR
Sodium intake

288
Q

What is a anticonvulsant that can be used in bipolar disorder?

A

Valproic Acid

289
Q

AE of Valproic Acid?
Think blood and liver

A

Thrombocytopenia
Liver failure

290
Q

Target plasma levels for Valproic Acid?

A

50-125

291
Q

What is a anticonvulsant that can be used in bipolar disorder when it is given with lithium?

A

Carbamazepines

292
Q

Target trough plasma levels for carbamazepine?

A

6-12 ug/ml

293
Q

AE of Carbamazepine?
Blood gets super wonky

A

Leukopenia
Anemia
Thrombocytopenia

294
Q

________ is another anticonvulsant that can be used in bipolar disorder?

A

Lamotrigine (Can cause SJS)

295
Q

Why cant you use a classic antidepressant in a patient with bipolar disorder?

A

Can lead them right into a manic episode

296
Q

What is the disordered thinking and the reduced ability to comprehend reality

A

Schizophrenia

297
Q

What are + symptoms of Schizophrenia (easier to address)

A

Exaggeration or distortion of normal function
Hallucinations
Delusions
Agitation
Tension
Paranoia

298
Q

What are - symptoms of Schizophrenia (very hard to address)

A

Loss or diminution of normal function
Lack of motivation
Poverty of speech
Blunted affect
Poor self-care
Social withdrawal

299
Q

What are cognitive symptoms of schizophrenia

A

Disordered thinking
Reduced ability to focus attention
Prominent learning and memory difficulties
Subtle changes may appear years before symptoms become florid
Florid changes: Thinking and speech may be completely incomprehensible to others

300
Q

When discussing schizophrenia, what are acute episodes?

A

Delusions
Hallucinations

301
Q

When discussing schizophrenia, residual symptoms are?

A

Suspiciousness; poor anxiety management; and diminished judgment, insight, motivation, and capacity for self-care

302
Q

What is the term that refers to these are erroneous beliefs involving misinterpretations of reality and are relatively resistant to evidence that refutes them.

A

Delusions

303
Q

What is the term that refers to perceptual abnormalities that can involve any sensory system.

A

Hallucinations

304
Q

What is the term that refers to “Loose associations” refers to the person going from one topic to another as though connected. “Tangential” speech refers to answers to questions that are only slightly related or totally unrelated to the question. “Word salad” refers to speech that is almost incomprehensible and is very much like receptive aphasia.

A

Thought disorder

305
Q

What two classes are used in the treatment of schizophrenia

A

Conventional antipsychotics
Atypical antipsychotics

306
Q

FGAs are used in what disorders?

A

Movement disorders

307
Q

SE for FGAs

A

Anticholinergic
Histaminergic- sedative
Orthostasis- alpha blockade

308
Q

What is Spasms of muscle groups. Ex: torticollis, laryngospasm, and oculogyric crisis

A

Dyskinesia

309
Q

What is Bradykinesia, tremor, rigidity, akinesia, etc. Can give anticholinergic agents: Benadryl® or Cogentin®

A

Parkinsonism (can give amantadine)

310
Q

What is restlessness and the inability to stay calm?

A

Akathisia

311
Q

What is a neuro effect that results from long term therapy with FGAs?

A

Tardive dyskinesia

312
Q

Where do tardive dyskinesias normally occur?

A

The mouth

313
Q

What is a rare but serious rxn that casues ” rigidity, sudden high fever, sweating, autonomic instability, dysrhythmias, fluctuations in blood pressure, altered level of consciousness, and seizures or coma may develop

A

Neuroleptic Malignant Syndrome (happens with FGAs)

314
Q

How is neuroleptic malignant syndrome treated?
Similar to malignant hyperthermia

A

Stop the offending agent
Supportive therapy
Fluids and cooling
Can give dantrolene

315
Q

What are some endocrine effects that stem from FGAS?

A

Galactorrhea
Menstrual changes
Hyperprolactinemia

316
Q

What are AE of FGAs?

A

Weight gain
Sexual dysfunction
Corneal opacity
QT prolongation (esp. with thioridazine)
Lower seizure threshold

317
Q

SGAs have more _________ SE

A

METABOLIC (weight gain and DM)

318
Q

What are the two FGAs that we need to know

A

Haloperidol and Chlorpromazine

319
Q

What do you do if a patient ODs on a FGA?

A

Intravenous fluids, alpha-adrenergic agonists, and gastric lavage
Emetics not effective: Neuroleptics block the antiemetic action
(They likely won’t die)

320
Q

What is the preferred agent for Tourette’s syndrome?

A

Haloperidol

321
Q

Haloperidol can be used in what other orders?

A

Schizophrenia
Acute psychosis

322
Q

AE of Haloperidol

A

Extrapyramidal reactions
Neuroendocrine effects
Can prolong the QT interval and cause dysrhythmias

323
Q

Therapeutic uses for Chlorpromazine?

A

Schizophrenia, schizoaffective disorder, and the manic phase of bipolar disorder

324
Q

AE of Chlorpromazine?

A

Sedation
orthostatic hypotension
anticholinergic effects

325
Q

What antipsychotics increase the risk of extra pyramidal side effects is much lower compared to typical antipsychotics at usual clinical doses?

A

Atypical Antipsychotics

Nurs 306 / Pharm 2 (4 decks)

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