Pharm test 2 Flashcards
1
Q
People with type I DM, they have a complete lack of ________
A
Insulin
2
Q
If a patient has type II DM, the patient has _______ resistance and decreased ________ insulin output
A
Insulin resistance; decreased pancreatic insulin output
3
Q
A fasting glucose of greater than ______ is Diabetic
A
126 mg/dL
4
Q
A random plasma glucose greater than ____ and symptomatic is Diabetic
A
200 mg/dL
5
Q
An elevated plasma glucose Post-OGTT and level of greater than ____ is Diabetic
A
200 mg/dL
6
Q
A Hemoglobin A1C greater than ______ is Diabetic
A
6.5%
7
Q
Prediabetic level for A1C is what?
A
5.7-6.4
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.
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.
10
Q
What are the goals for DM?
A
Prevent acute and chronic complications
11
Q
What are acute complications for DM?
A
Hypoglycemia
DKA
HHNS
12
Q
What are microvascular chronic complications of DM?
A
Retinopathy, Neuropathy, Nephropathy
13
Q
What are macrovascular chronic complications of DM?
A
Cardiovascular, cerebrovascular, peripheral vascular disease
14
Q
The goal fasting plasma glucose for a diabetic is what value?
A
80-130 mg/dL
15
Q
The goal A1c for a diabetic patient should be what value?
A
< 7.0 %
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
17
Q
How often should you look at A1c for a patient who has uncontrolled DM?
A
3 months
18
Q
How often should you look at A1c for a patient who has controlled DM?
A
6 months
19
Q
What should a patient’s blood sugar be after eating a meal?
A
less than 180 mg/dL
20
Q
What is the ADA’s goal for a blood pressure of a patient with DM?
A
< 140/90
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.
22
Q
Which medication reduces the risk for both macro and microvascular complications?
A
BP meds like lisinopril
23
Q
Prediabetes is when the fasting plasma glucose is between ___ and ___?
A
100-125 mg/dL
24
Q
What medication is a high alert medication?
A
Insulin; There are a lot of medication errors with this med.
25
What are the rapid acting insulins?
Inhaled Insulin
Fast Aspart
Lispor aabc
Glulisine
Aspart
Lispro
26
What is the onset of Inhaled Insulin, Fast Aspart, Lispro aabc?
2-3 minutes
27
What is the onset of Glulisine, Aspart, Lispro?
5-15 minutes
28
What is the duration of rapid acting insulin?
2-5 hours
29
What is the duration of short acting insulin?
4-6 hours
30
What is the peak of short acting insulin?
2-3 hours
31
When is the peak of Rapid acting insulins?
1-2 hours
32
What is the short acting insulin?
Regular
33
What is the intermediate acting insulin?
NPH
34
What is the Intermed/Long Acting Insulin?
Detemir
35
What are the two long acting insulin?
Glargine and Degludec
36
What is the onset of short acting insulin like Regular?
0.5-1 hours
37
What is the onset of NPH?
1-2 hours
38
What is the onset of Detemir?
2-4 hours
39
What is the peak of intermediate acting insulin?
4-8 hours; duration 10-20 hours
40
What is the only insulin that is given IV?
regular
41
What is the peak of long acting insulin?
No peak (Flat); lasts 24 hours.
42
What is the onset of Glargine and Degludec?
1-2 hours
43
What is the only insulin in the US that is cloudy?
NPH
44
The patient complains that his Lispro looks cloudy in its container, you should educate the patient to do what?
Discard the medication, this medication should not be cloudy. Only NPH insulin is cloudy (in the U.S)
45
What is Lipodystrophy and Liphohypertrophy
A condition that occurs when a patient injects the insulin in the same spot all the time.
46
Places that a patient can use to inject insulin
Upper arm, thigh, abdomen
47
A patient is newly diabetic and needs education about how to store his insulin. What would you teach him?
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
48
Possible Complications of Insulin Treatment
Hypoglycemia
Lipohypertrophy
Allergic Rxn
Hypokalemia
Drug interactions
49
A DMI patient should be on a _______/______ insulin regimen
basal/bolus
50
What are meds given "basal" to prevent ketosis and control fasting BG?
***longer acting***
Detemir (intermed-long)
Glargine (long)
Degludec (long)
NPH (intermed)
51
What are insulins you could give "bolus" to control post prandial glucose excursions?
Glulisine
Aspart
Lispro
Inhaled
Regular
52
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?
The Basal Insulin
53
Target goals for a DM II patient before meals?
70- 130 mg/dL before meals
54
Target goal for a DM II patient at bedtime?
100-140 mg/dL at bedtime
55
A Hemoglobin A1c of less than ___% is good for more patients
7%
56
A Hemoglobin A1c of below ___% may be okay for patients with a limited life expectancy and other complications?
8%
57
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?
Metformin.
58
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?
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?
59
What are the preferred options to add to metformin?
SU'z
TZDs
Basal insulin
DPP-4 inhibitors
GLP-1 agonist
SGLT-2 inhibitors
60
What other meds would you anticipate a diabetic to be on?
Insulin
ACE/ARB for HTN
Statins for dyslipidemia
61
What drug has the MOA that inhibits glucose prod. in liver, reduces absorption in gut, and sensitizes insulin receptors in target tissues.
Metformin (Biguinides)
62
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
two
63
What are some Pros of Metformin?
Good A1C reduction
Cheap
Well tolerated
Weight loss
Some lipid benefits
Possible CV benefit
64
What is a contraindication for metformin?
eGFR less than 45- dose reduce
less than 30- can't give the med
65
Does metformin make you gain weight?
No; it may promote weight loss but NO weight gain! Some lipid and CV benefits
66
If a patient is going in for surgery you are to ____ Metformin
HOLD
67
What are some possible SE of Metformin?
GI- cramping diarrhea nausea and vomiting
Lactic acidosis- diarrhea, dizziness, low HR
B12 deficiency- neuropathic pain
68
What are some unique SE of Metformin?
Lactic Acidosis
Vitamin B12 deficiency
69
What are contraindications for Metformin?
eGFR that tanks
(below 30)
70
Exenatide falls under which drug class added to metformin?
GLP-1 receptor agonists
71
GLP-1 receptor agonists end in....
"atide"
72
What are possible SE of Exenatide?
GI effects
***Pancreatitis***
Drug interactions
2x daily or biweekly
73
What is the oral version of a GLP-1 that is also good for weight loss?
Semaglutide
(Ozempic)
74
What is the GLP-1 may cause thyroid cancer but protects CVD protection?
Liraglutide
75
What are some benefits for GLP-1 agonists?
A1c reduction
Weight loss
Dosing flexability
CVD risk reduction
76
What are some risks for GLP-1 Agonists
***Warning for thyroid cancer***
Weight loss (this could be a good thing)
GI SE (Should dissipate after 2 weeks)
Injection site discomfort
***Pancreatitis risk***
77
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?
GLP-1 agonists
78
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...?
She does not "qualify" to take these because she has a history of thyroid cancer, but there are other medications that may help her!
79
What is the MOA of SGLT-2 inhibotors?
Block reabsorption of filtered glucose in the kidney, leading to glucosura
80
What are the two classes of drugs that can added to metformin for patients that have CVD risks?
SGLT2 inhibitors (canagliflozin) and GLP-1 agonists (exenatide)
81
What is the class of drug that can be added to Metformin that are ***cost effective*** and promote insulin release?
Sulfonylureas
82
What are the major side effects of Sulfonylureas?
Hypoglycemia and weight gain
83
What are some second generation Sulfonylureas?
*** All start with G***
Glipizide
Glyburide
Glimepiride
84
What are benefits of Sulfonylureas?
Cheap and decreases A1C
85
What are some cons of Sulfonylureas?
Weight Gain and hypoglycemia
86
What are the two drugs that fall under the Meglitinides?
***End in Glinide***
Repaglinide
Nateglinide
87
What are some risks for Meglitinides?
Weight gain
Cost
***Hypoglycemia*** take with meals
Mealtime dosing
88
What are the two drugs that are under the drug class Thiazolidinediones?
(AKA Glitazone)
Rosiglitazone and Pioglitazone
89
What are the MOA for Glitazones (TZD)?
Reduce glucose levels by decreasing insulin resistance
90
What is the Glitazone drug that can cause renal retention of fluid and raises plasma lipids?
***(Rosi think Renal)***
Rosiglitazone
91
Rosiglitazone can increase risk of what?
Heart failure; too much fluid retention
92
What are the two D/D interactions for Rosiglitazone?
Insulin
Gemfibrozil
93
What is the newest Glintazone that can cause hepatoxicity?
Pioglitazone
94
What are some AE of Pioglitazone?
URI
HA
Sinusitis
Myalgia
Promotes water gain
95
What are some drug interactions for Pioglitazone?
Gemfibrozil
96
What are benefits of TZDs?
A1c reduction
insulin sensitivity
Cost
97
Risks for TZDs?
Weight gain
Edema
***Avoid in CHF- fluid retention***
***Risk for bladder cancer***
Proximal bone fracture risk
98
What is the DPP-4 Inhibit that enhances the actions of incretin hormones?
***(End in -gliptins)***
Sitagliptin
99
What is the peak of long acting insulin?
No peak (Flat); lasts 24 hours.
100
What is the drug that inhibits glucose production in the liver and reduces glucose absorption in the gut?
Metformin
101
What medication has good A1C reduction, is cheap, well tolerated, and causes no weight gain?
Metformin
102
What are common SE of Metformin caused by lactic acidosis?
Diarrhea, dizziness, bradycardia
103
What are common SE of metformin due to B12 deficiency?
Neuropathic Pain
104
If a patient is taking Metformin and the eGFR is less than 45, you should....
Reduce the dose
105
If a patient is taking metformin and the eGFR is less than 30 you should.....
DO NOT GIVE IT (lactic acidosis risk)
106
If a patient is undergoing a study with iodine contrast dye, you should hold metformin for how long?
48 hours
107
Hold metformin if the patient is about to have what?
Surgery
108
What is the GLP-1 Receptor Agonist that was talked about?
Exanatide
109
How is Exanatide given?
SQ injection once or twice a week or BID
110
What are the AE of Exantidie?
GI, weight loss and ***pancreatitits***
111
What are the benefits of Exanatide?
Good A1C reduction
Weight loss
CVD risk reduction
112
What is the black box warning for Exanatide?
Risk for thyroid cancer
113
When giving Exanatide, use caution when giving to patients with what three conditions?
Gastroparesis
Pancreatitis
Renal impairment
114
What are the two contraindications for Exnantide?
CrCl of less than 30
Medullary thyroid cancer
115
What do SGLT-2 inhibitors end in?
(-flozin)
116
What is the MOA of Canagilflozin?
Blocks the reabsoprtopn of filtered glucose in kidneys
117
What are AE of Cenagliflozin?
***(Flozin think FUNGAL)***
Genital fungal infections
UTIs
Increased urination
118
How often is Canagliflozin given?
Once a day
119
What are the benefits of Canagliflozin?
Moderate A1C improvement
Weight loss
Minimal hypoglycemia
Slow CKD progression
120
What are the risks of Canagliflozin?
New, expensive and urinary AE
121
What is the black box warning with Canagliflozin?
Amputation risk
122
What is the MOA for SUlfonylureas?
Promote insulin release
123
Sulfonylureas are old meds but they are ___________!
Inexpensive
124
What are the AE of Sulfonylureas?
Severe hypoglycemia
Weight gain
125
What are the benefits for sulfonylureas?
Affect fasting and post-prandial glucose, cheap, good A1C decrease
126
What are the two meglitinides?
***(end in glinide)***
Repaglinide
Nateglinide
127
What is the MOA of Repaglinide and nateglinide?
Promote insulin release
128
What are the AE of Meglitinides?
Severe hypoglycemia (take with meals) and weight gain
129
What are the benefits of Meglitinides?
BEtter focus on post prandial glucose control
130
What is the CON of Meglitinides?
They are more expensive than sulfonylureas
131
What are the MOA of thiazolidinediones?
Reduce glucose levels by DECREASING INSULIN RESISTANCE
132
What are the Thiazolidinediones?
***(End in Glitazone)***
Pioglitazone
Rosiglitazone
133
What are the AE of Rosiglitazone?
Renal retention of fluid and high plasma lipid levels
134
What are the AE of Pioglitazone?
Hepatotoxicity and water retention
135
What are the CI of Pioglitazone?
Bladder cancer in your history and family history
136
What is a consideration for Pioglitazone for menopausal women?
IT can cause ovulation
137
What are the contraindications for Thiazolidineodiones?
CHF- too much water retention
Osteopenia- breaks down bones
Osteoporosis- breaks down bones
138
What are the benefits of Thiazolidinediones?
Good A1C reduction, improves beta cell function and they are inexpensive
139
What are the risks for Thiazolidinediones?
Weight gain and edema
Blackbox warning for CHF
140
What are the DPP-4 inhibitors? (-gliptins)
Sitagliptin
141
What is the MOA of Sitagliptin?
Enhances the action of incretin hormones, stimulates insulin releases and supresses glucagon release?
142
What are the AE of Sitagliptin?
(The AE are like the flu or a cold)
URI
HA
Throat and nasal inflammation and joint pain
143
What are drug that relieve anxiety?
Anxiolytic drugs
144
What are drugs that help you sleep?
Hypnotics
145
What are the benefits of Sitagliptin?
Focus on post prandial glucose, once daily, well tolerated, and weight neutral
146
What are the risk for sitagliptin?
Modest A1C reduction
Expensive
Renal dose adjustment needed
CHF risk
147
What do you need to do first if someone has DKA?
CHECK POTASSIUM
148
What other things need done if a patient has DKA?
Fluid replacement
Check Potassium
IV insulin
Fix glucose
149
What is the DOC for treating insomnia and anxiety?
Benzodiazepines
150
What are the two most prescribed BEnzo?
Lorazepam and alprazolam
151
A patient with DKA should have what labs?
Glucose < 200
pH > 7.3
Bicarb > 15
Anion gap < 12
152
What is a state where there is dehydration and sluggish blood with a change in pH and ketoacid levels?
Hyperosmolar Hyperglycemic state
153
What are the three things that need fixed with HHS?
Correct dehydration
Correct high BG
Correct electrolyte abnormalities
154
What drug has the MOA of potentiating GABA?
Benzodiazepines
155
What is the treatment for Hypoglycemia?
GLucogon
IV glucose
156
What are the primary uses for Benzo?
Anxiety
Insomnia
Seizure
Sedation
157
If a diabetic has nephrotoxicity give what?
ACE or ARBS
158
What benzo should be given to elderly patients of people with liver impairments
(These ones are okay for LIVER.... Monitor Liver with ***L***F***T***)
Ativan/***L***orazepam
***T***amezapam/Restoril
159
If a diabetic patient has neuropathy, give what?
B12 (if on metformin)
160
If a diabetic patient has BP issues, you can give what?
CCB, thiazide diuretics or ACE/ARBs
161
What med should every diabetic patient be on
A statin. Always a statin
162
A diabetic patient should be on what for CVD prevention?
ASA
Clopedigrol
163
What is Graves disease?
Hyperthyroidism; too much T3 and T4 release
164
What lab findings will you see in a patient with Graves?
low TSH high T4
165
What is Hashimotos?
Hypothyroidism; iatrogenic cause poor functioning of the thyroid?
166
What lab findings with be seen in Hashimotos?
High TSH and low T4
167
What are AE for Benzodiazepines?
CNS depression
Antreograde amnesia
Paradoxial effects
168
What are CNS depressant SE for benzo?
Drowsness, incoordination, and difficulty concentraing
169
What are more SE for Benzos?
RR depression
Abuse
Fetal harm
Hypotension
170
What is the preferred treatment for Graves disease?
Ablataive therapy with radioactive iodine
171
What are drug interactions with Benzos?
Do not use with another CNS depressant
(Too much RR depression)
172
If the cause of hyperthyroidism is because of an adenoma, you should do what?
Surgical resection
173
If a patient is waiting for a procedure and cannot have the normal thyroid ablative therapy, you should do what?
Move to pharmacological therapy
174
What thyroid drug inhibits iodination and synthesis of thyroid hormones?
Thiourea
175
What is the preferred thioureas?
Methimazole
176
If a patient abruptly stops a benzo, they will have what?
Physical dependence so withdrawl
177
Methimazole is the preferred drug for hyperthyroidism, but it cannot be used in __________
Pregnancy
178
If a patient has hyperthyroidism, and becomes pregnant they need put on what?
Propylthiouracil
(PTU)
179
What are the AE for thioureas?
(CHECK CBC)
Arthraliga
Fever
Rash
Transiet Leukopenia
180
What Thiourea has a risk of liver toxicity?
Propylthiouracil
PTU
181
What Thiourea has a risk for pancreatitis?
Methimazole
182
Both Thioureas have a risk for agranulocytosis, so monitor what?
CBC
183
What are the three ***benzo like*** drugs?
Zolpidem- onset and maintanence
Zaleplon- onset
Eszopiclone- onset and maintanence
184
What benzo like drug is used as short term treatment of insomnia?
Zolpidem
185
what benzo like drug helps people fall asleep and is only for short term managment?
Zaleplon
186
What is the benzo like drug that can be used in long term insomnia treatment?
Esxopiclone
187
What other drugs can help with hyperthyroidism?
BBlockers
Iodine
188
What do you do if a patient has thyroid storm?
Potassium iodine
PTU
Betablocker
189
What are soem actions to take if a patient has thyroid storm?
Sedate
Cool
Glucocorticoids
IV fluids
190
What is the drug that kills the thyroid?
Radioactive Iodine 131
191
What is the DOC for hypothyroidism?
Synthetic T4 (Levothyroxine)
192
When should a pt. take levothyroxine?
Before food in the AM and 3-4 hours after food at night
193
T4 is __________ to a patient's need
TIRTRATED
194
What is a melatonin agonist?
Rozerem
195
What are the AE of levothyroxine?
Hyperthyroidism, MI, bone fracture risk
196
When a patient is levothyroxine, do not give _________ within 4 hours?
Calcium
197
____________ increases the body's response to catecholamines, so you need to be aware of the s/sx of cardiac arrest?
Levothyroxine
198
What hormone is released from the anterior pituatary?
Growth Hormone
199
What are the GH biologic effects
Promote growth
Promote protein synthesis
Carbohydrate metabolism
200
What drug has the MOA that bind to GABA receptors and enhance actions of GABA
Barbituates
201
What are the uses for GH?
GH deficiency
Prader Willis syndrome
202
What are the AE of GH?
Hyperglycemia
Neutrolize ABX
Carpal tunnel
Some fatality
HTN
203
GH supresses the function of what drugs?
Glucocorticoids
204
BArbituates can cause what?
CNS depression
LOWER BP AND HR
Inducer of hepatic enzymes
205
Acromegaly is what?
too muhc GH
206
How is ACromegaly treated?
If caused by a pituitary adenoma, SURGERY
207
How are barbituates used?
Insomnia (not anymore)
Seizures
Anestesia
Mania
208
AE of barbituates?
RR depression
Suicide
Abuse
Harmful for fetus
Porphyria
Hangover
Paradoxial excitement
Hyperalgesia
209
What is a hormone that inhibits the release of GH?
SomatoSTATIN
210
If a patient has OD caused by barbituates, the nurse should?
Remove barbituate and maintain O2 to the brian
211
ADH causes water retention and THUS
LESS URINATION
212
What is the most common psych disorder?
Depression
213
The use of synthetic ADH
DI
Cardiac arrest
Postop
Abdominal distention
Hemophilia A and VOn Wilebrans
214
What is the deficiency of ADH with excretion of lots of dilute urine?
Diabetes Insipidus
215
What is the treatment of DI?
Replace ADH with desmopresson or vasopressin (nasal)
216
What are the AE of ADH
Water intoxication and excessive vasoconstrition
217
If a patient has water intoxication, the nurse should
Eduacte about less water consumption
218
What are some common s/sx depression
Depressed mood
Loss if interest
Insomnia
Anorexia
219
What two neurotransmitters are decreased in patients with depression?
Norepinephrine and Serotonin
220
What are important education points for depression meds
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
There is an increase of what with antidepressants?
Suicide
222
All antidepressants are equally ________
Efficacious
223
What are the first antidepressants available?
Tricylic antidepressants (TCAs)
224
What is the MOA of TCAS
blocking the reuptake of 5-HT and norepinepherine
225
What are the SE of TCAs
Antihistamine= sedation
Anticholinergic= anticholinergic (dry out)
Cardiac conduction= orthostatic hypotension
Sedation
Lethal in OD
226
What TCA can be used in neuropathy?
Amitriptyline
227
AMitriptyline can also be used as prophylaxis for what?
Migranes
228
What are the drugs that block the enzyme responsible for the breakdown of catecholamines?
Monoamine oxidase inhibitors (MAOIs)
229
What are the two MAOIs that were discussed?
(ine)
Phenelzine
Tranylcypromine
230
When taking a MAOI, avoid foods high in what?
Tyramine
231
What can foods high in tyramine do while taking a MAOI?
HTN crisis
232
If taking a MAOI, avoid what other drugs?
OTC sympathomimetics
Antidepressants
Let the other antidepressants get out of your system before starting this
233
What foods are high in tyramine
Avocado, soybeans
Figs and bananas
Fermented and smoked meats
Cheese and foods with yeast
Beer and wine
234
What is a transdermal MAOI?
Selegiline
235
Selegiline decreases the risk of HTN crisis and thus you can eat some
Tyramines
236
Selegiline still affects other sympathomimetic drugs and what other drugs?
Carbamazepines
Oxcarbazepine
237
What is the drug that inhibit the reuptake serotinin
SSRIs
238
What SSRIS are okayed for depression
(SSRIs end if pram and ine)
Fluoxetine (Prozac®)
Sertraline (Zoloft®)
Paroxetine (Paxil®)
Citalopram (Celexa®)
Escitalopram (Lexapro®)
Fluvoxamine (Luvox®)
Vilazodone
239
Flouxetine has a _____ half life
LONG
240
Paroxetine needs to be given at night because it is big at _______
SEDATING
241
What two drugs are inhibitors of the 2D6 pathway
Fluoxetine and paroxetine
242
What SSRI can increase QTc prolongation risk in doses about 40 mg?
Citalopram
243
A lot of psych drugs are metabolized though what pathway
2D6
244
What SSRI is category D in pregnancy
Pareoxetine
245
What are some SE of SSRIs
***They key one starts with a S***
GI- nausea
CNS- anxiety
HA
Sexual dysfunction
246
SSRIs are not lethal in a __
OD
247
What is a serotonin syndrome
When two drugs that increase serotonin are given at the same time.
248
SSRIs should not be stopped abruptly because it can lead to
Withdrawal
249
What are the serotonin/norepinephrine reuptake inhibitor?
***XINE***
Venlafaxine
Desvenlafaxine
Duloxetine
250
SNRIs are better for depression than
SSRIs
251
SNRIs can lead to what?
Weight loss, increase BP and GI issues
252
SNRIs cannot be stopped all of a sudden because it can lead to?
Withdrawl
253
What psych drug is a serotonin reuptake inhibitor that blcosk serotonin receptors?
Trazodone
254
What are the SE of Trazodone?
Sedating
Ortho hypotension
Dry mouth
255
Trazodone is used in ____ more than in depression
SLEEP
256
Bupropion lower the _______ threshold
Seizure
257
Buproprion should be taken in the _______
Morning
258
What are some SE for Buproprion
***Lowers seizure threshold***
Agitation
Wt. loss
Constipation
Tremor
HA, insomnia
Increase sexual function
259
Mirtazapine is very sedating and needs to be taken when?
At night
260
SE of Mirtazapine
Sedation and Weight gain
261
What drugs are at highest risk for serotonin syndrome?
MOAI
262
What drugs area at high risk for serotonin syndrome?
SSRI
SNRI
Clomipramine
263
What drugs are at adjunctive risk for Serotonin syndrome?
Buspirone
Dextromethorphan
Lithium
Fentanyl
Merperidine
Linezolid
Stimulants
Tramadol
264
What symptoms are under the autonomic instability for serotonin syndrome?
Diaphoresis
Hyperthermia
265
What are symptoms under the neuromuscular hyperactivity in serotonin syndrome
Myoclonus
Rigidity
Tremors
Incoordination
266
What are symptoms under the altered mental status category of serotonin syndrome
Agitation
Confusion
Hypomanic
267
What are the components of Bipolar disorder?
Depression and Mani
268
What are the components of Bipolar disorder?
Depression and Mania
269
What is the treatment standard for Bipolar disorders?
Mood Stabilizers such as lithium and valproic acid
270
Bipolar Disorder is _____ in nature and there are recurrent _________
Cyclic; fluctuations in mood
271
What are the two treatment priorities for bipolar disorder
Drugs and psychotherapy
272
What are the key mood stabilizers used in bipolar disorders
Lithium
Valproic Acid
Carbamazepine
273
What drugs are added in the manic period of Bipolar disorder?
Antipsychotics
274
What drugs are given during a depressive episode in bipolar disorder?
Antidepressants
275
What meds are given in a manic episode?
Lithium
Valproic Acid
(+ antipsychotic and benzo)
276
Lithium is used in both phases of bipolar disorder. BUT it is a low TI drug and needs to be _______
Monitored
277
How long does it take lithium to work?
Antimanic takes 5-7 days
2-3 weeks for full effects
278
Lithium is secreted by the _______
Kidneys
279
AE of Lithium
GI- nausea, diarrhea, and abdominal bloating
Tremor
Polyuria
Renal toxicity
Goiter and hypothyroidism
Tetratogenic
INCREASE WBC
280
What are the safe levels for lithium
0.6-1.2 mEq/L
281
Mild toxcity range for lithium?
1.3-1.4 (hold lithium)
282
Moderate toxicity range for lithium?
1.5-2.5 (Hold; supportive care)
283
Severe toxicity range for lithium?
GREATER than 2.5(need hemodialysis)
284
What are some education points for lithium?
Encourage fluid intake (2000-3000 mL/day)
Renal function
Thyroid function
UA every 6-12 months
285
When do through levels for lithium need to be taken
12 hours after the evening dose
286
Meds than increase lithium concentrations
NSAIDS
Thiazide diuretics
287
Things that decrease lithium concentrations
Caffeine
Increase GFR
Sodium intake
288
What is a anticonvulsant that can be used in bipolar disorder?
Valproic Acid
289
AE of Valproic Acid?
Think blood and liver
Thrombocytopenia
Liver failure
290
Target plasma levels for Valproic Acid?
50-125
291
What is a anticonvulsant that can be used in bipolar disorder when it is given with lithium?
Carbamazepines
292
Target trough plasma levels for carbamazepine?
6-12 ug/ml
293
AE of Carbamazepine?
Blood gets super wonky
Leukopenia
Anemia
Thrombocytopenia
294
________ is another anticonvulsant that can be used in bipolar disorder?
Lamotrigine (Can cause SJS)
295
Why cant you use a classic antidepressant in a patient with bipolar disorder?
Can lead them right into a manic episode
296
What is the disordered thinking and the reduced ability to comprehend reality
Schizophrenia
297
What are + symptoms of Schizophrenia (easier to address)
Exaggeration or distortion of normal function
Hallucinations
Delusions
Agitation
Tension
Paranoia
298
What are - symptoms of Schizophrenia (very hard to address)
Loss or diminution of normal function
Lack of motivation
Poverty of speech
Blunted affect
Poor self-care
Social withdrawal
299
What are cognitive symptoms of schizophrenia
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
When discussing schizophrenia, what are acute episodes?
Delusions
Hallucinations
301
When discussing schizophrenia, residual symptoms are?
Suspiciousness; poor anxiety management; and diminished judgment, insight, motivation, and capacity for self-care
302
What is the term that refers to these are erroneous beliefs involving misinterpretations of reality and are relatively resistant to evidence that refutes them.
Delusions
303
What is the term that refers to perceptual abnormalities that can involve any sensory system.
Hallucinations
304
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.
Thought disorder
305
What two classes are used in the treatment of schizophrenia
Conventional antipsychotics
Atypical antipsychotics
306
FGAs are used in what disorders?
Movement disorders
307
SE for FGAs
Anticholinergic
Histaminergic- sedative
Orthostasis- alpha blockade
308
What is Spasms of muscle groups. Ex: torticollis, laryngospasm, and oculogyric crisis
Dyskinesia
309
What is Bradykinesia, tremor, rigidity, akinesia, etc. Can give anticholinergic agents: Benadryl® or Cogentin®
Parkinsonism (can give amantadine)
310
What is restlessness and the inability to stay calm?
Akathisia
311
What is a neuro effect that results from long term therapy with FGAs?
Tardive dyskinesia
312
Where do tardive dyskinesias normally occur?
The mouth
313
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***
Neuroleptic Malignant Syndrome (happens with FGAs)
314
How is neuroleptic malignant syndrome treated?
Similar to malignant hyperthermia
Stop the offending agent
Supportive therapy
Fluids and cooling
Can give dantrolene
315
What are some endocrine effects that stem from FGAS?
Galactorrhea
Menstrual changes
Hyperprolactinemia
316
What are AE of FGAs?
Weight gain
Sexual dysfunction
Corneal opacity
QT prolongation (esp. with thioridazine)
Lower seizure threshold
317
SGAs have more _________ SE
METABOLIC (weight gain and DM)
318
What are the two FGAs that we need to know
Haloperidol and Chlorpromazine
319
What do you do if a patient ODs on a FGA?
Intravenous fluids, alpha-adrenergic agonists, and gastric lavage
Emetics not effective: Neuroleptics block the antiemetic action
(They likely won't die)
320
What is the preferred agent for Tourette's syndrome?
Haloperidol
321
Haloperidol can be used in what other orders?
Schizophrenia
Acute psychosis
322
AE of Haloperidol
Extrapyramidal reactions
Neuroendocrine effects
Can prolong the QT interval and cause dysrhythmias
323
Therapeutic uses for Chlorpromazine?
Schizophrenia, schizoaffective disorder, and the manic phase of bipolar disorder
324
AE of Chlorpromazine?
Sedation
orthostatic hypotension
anticholinergic effects
325
What antipsychotics increase the risk of extra pyramidal side effects is much lower compared to typical antipsychotics at usual clinical doses?
Atypical Antipsychotics
