Pharma Exam 1 Flashcards

Question

Benzodiazepines

Answer 1

* poteintate the effects An inhibitory neurotransmitter(GABA); causes the cells to relax and go to sleep night night. Inhibits nervous system response causing more CNS depression * A high margin of safety. Can still cause respiratory depression.

Answer 2

* Benzodiazepine + GABA effect * Alchy widrawal, anticonvulsant, muscle relaxer, Anxiety relief, sleep promotion, * Pre-op sedation & conscious sedation(conscious = cardioversion or wisdom teeth removal) * Induction of general anesthesia(allows for less general sedation) * Dont give to pts with Psychoses (worsens condition) * SE= Long-term physical dependence(Can have seizure and/or die from withdrawal) * Nursing Considerations: CNS assessments, Avoid abrupt cessation, Antidote = Flumanezil, and Highly abusable

Answer 3

* Used primarily for sleep/ sleep anxiety * Affects the GABA receptors

Answer 4

* Nonbenzo/Nonbarbituate + GABA effect * Short-term insomnia (7-10 days) * RAPIDLY induces sleep & should be taken immediately before bed * Cautin= Elderly population(Monitor for paradoxical effect) * Nursing Considerations: Monitor for unusual sleep behaviors, Flumanezil may help with overdose(BC this med affects GABA), and No bueno for long term

Answer 5

Cerebral Cortex shaking

Answer 6

Hypothalamus Blank stare

Answer 7

* Treats seizures by increasing GABA * Benzo

Answer 8

* Sodium channel blocker * Seizures * Monitor pts who are malnourinshed bc the drug is 90-95% protein bound * Doesnt allow absorption of Vitamin K in the gut * Dont give to pts with bradycardia or heart block * If you give it in Hand IV can cause purple glove syndrome(necrose) * Nursing Intervetions: Monitor CBC, monitor drug levels(thereputic= 10-20 mcg), push in a deciated line with saline bc its very irritaing, will crystalize if you admin with dextrose, push med slowly(50mcg/min) can cause arrhthmias so push even slower in elderly.

Answer 9

* Absence (petit-mal) seizures(Works by inhibiting Ca+ flow rate into cell) * SE= blood dyscrasias and Known to interact with other antiepileptic drugs * Nursing Considerations: Monitor drug levels at initiation + dose changes, taper dose if discontinuing bc if not can cause seizures

Answer 10

* CNS depressant through stimulation of GABA receptor. * Increases sensitivity to pain. * Has street value(ppl love to snort it)

Answer 11

* Promotes natural GABA neurotransmitter production, also used for nerve pain * Diabetic neuropathy-> relaxes/sedates the nerve * Mood Stablizer(anxiety and bipolar

Answer 12

* Monitoring drug levels is essential for valproic acid, phenytoin, and phenobarbital * Labs: CBC + Electrolyte (CA, Na) bc most of these causes blood dyscrasia(aplastic anemia) * Monitor CNS function and for bruising or bleeding * Caution with CNS depressants * Encourage foods high in: K, D, B, folic acid

Answer 13

* Vit D Deficiency * Early Alzheimer’s * Thyroid Disorders

Answer 14

* SSRI such as fluoxetine (Prozac) & *paroxetine (Paxil)

Answer 15

* enhance the activity of norepinephrine and serotonin by blocking neuronal reuptake of these neurotransmitters. * Tricyclics have a very narrow therapeutic index * Prototype drug: amitriptyline (Elavil)

Answer 16

*Tricyclic + norepi+ serotonin * Depression, chronic pain, migraines * NO for pts with Cardio diseases(increase HR) or seizure disorders(increases risk by increasing norepi) * SE= weight gain(4lb) , tremors, urinary retention

Answer 17

* metabolizing amines such as dopamine, epinephrine, norepinephrine, and serotonin in the synapse. * Prototype drug: phenelzine (Nardil)

Answer 18

* MAOI, Dopamine, Epi, Norepi, Serotonin * No for pts with Decreased liver function & CHF * SE= Anticholinergic effects, Agranulocytosis, leukopenia, Thrombocytopenia * Drug to Drug Interactions: SSRI, Insulin, Antihypertensive, Tyramine Rich foods(can lead to HTN crisis due to increased norepi), TCA, oral anti-diabetics,

Answer 19

* May lead to a stroke * Severe headache,N/V, Sweating, * severe anxiety, nose bleeds, confusion * SOB, Vision Changes, Chest pain, Tachycardia

Answer 20

* High risk overdose bc They have more energy to care out their suicidial plans. * Start low, with divided doses and taper up * Bedtime dosing if possible, for MOST antidepressants (sedative effects) except the SSRI’s: sertraline (Zoloft)

Answer 21

* Excessive excitement * Delusions of grandeur * Flight of ideas (not ADHD) * Elevation of mood * Sx: insomnia, constant movement, risk taking behaviors, incessant talking

Answer 22

* CNS stimulant and schedule 2 drug * Tx: ADHD, Obesity, Nacrolepsy * Releases norepi and dopamine in the brain * NO MAOIs, antileptics, HTN drug * Nusing Consideration: Use with family therapy or CBT since its a lifelong drug, Last dose before 4pm, Monitor Height and Weight, Highly abusable(street valu2 20 dollars a pill)

Answer 23

* blocks dopamine and serotoning at the receptor sites there by diminishing neurological excitement * Sedates the nerves and settles down the hallucinations

Answer 24

* Conventional Antipsychotics(Phenothiazines) * Tx: schizophrenic delusions and hallucinations * First pass effect(T 1/2 30 hrs) great for schizo bc they don’t have to take multiple doses * No pts with Demetia(increase risk of death) brain injury * SE: EPS, Sedation side effects * Nursing Considerdations: EPS(5 hrs to 5 days from first dose; muscle spasms of face, neck, back, and tongue), May take up to 7 weeks to be effective, Monitor WBC, K, ECG, liver function, Orthostatic BP, NMS

Answer 25

* High life threating temp Unstable fluctuating BP, Changes in LOC, Muscle rigidity, dysrhythmias * Tx: cooling blanket, dantrolene, frequent vs, hydration, benzodiazepines for muscle spams * Can have temp so high they stroke out and die

Answer 26

* 1st antipsychotic drugs * Ex: Haloperidol (Haldol)

Answer 27

* Typical antipsychotic drugs * Blocks dopaminergic receptors -> Effective decrease in movement disorders, relief of hallucinations, delusions, and psychosis-> sleep * Dont give to pts with Parkinson's(lack of dopamine) or dementia * SE: EPS(more likely to occur if the patient repeatedly stops and restarts therapy) * Nursing Considerations: Same as chlorpromazine but haloperidol has a higher potentcy

Answer 28

* Differ from typical antipsychotics bc they only target specific dopamine receptors. * Eliminates most of side effects and only affects D2 receptors * Prototype drug: 2nd generation risperidone (Risperdal)

Answer 29

* Tx: psychotic symptoms in schizophrenia and for short-term treatment of acute bipolar disorder * Highly protein bound(some clear it quickly and need a higher dose, some dont) * SE: Tardive dyskinesa, gynecomastia(increased prolactin), Agitation * Nursing Considerations: Liver enzymes increased, May cause blood dyscrasias (thrombocytopenia, agranular anemia, Increased blood glucose and prolactin levels, and NO CNS Depressants, Monitor for orthostatic BP

Answer 30

* Schedule 2 drug * Blocks release of substance ”P” and receptors Mu & Kappa * CNS depressant on respiration and cough reflex center * SE: respiratory depression, Drops BP * Nursing Considerations: Monitor RR, B/P, HR, Fall risk, GI Motility is slowed down

Answer 31

* IV preferred for reversal of opioid effects (onset w/n 2 minutes) * May need repeated doses if action of narcotic longer than naloxone ½ life of 1-1 ½ hrs. * Will cause return of pain and withdrawal symptoms * Caution with liver disease

Answer 32

* Inhibits both COX-1 and COX-2 * Enzymes COX-1 and COX-2-> produce prostaglandins-> promote inflammation, pain, and fever. * COX-1increases blood flow to kidneys, and mucus/bicarb production in stomach.(Keeps the stomach acid from eating the stomach leading to ulcers ) * COX-2 produces prostaglandins at injury site activated by injury (Promotes vasconstriction at the point of injury) * Ibuprofen, naproxen, indomethacin, ketorolac, meloxicam, diclofenac, and Aspirin

Answer 33

* 1st generation NSAID * If they have GI issues-> enteric coated aspirin and its digest in the small intestine * Tx: Inflammation(inhibit prostagladin), antiplatelet(Pts have to be off aspirin for 5-7 days so their platelets can clot properly), Fever( Dont use unless its a high fever) * SE: Abnormal bleeding, GI upset, Reye's syndrome in kids(life threatning and No baby aspirin to babies or peds patients) * Give with milk or food to coat the stomach anddecrease GI upset and Taking with a empty stomach does not cause stomach ulcers. * Nursing Considerations: Monitor platelets and renal function, Must be off NSAID's for 1 week for surgery, ASA is only for cardiac conditions, ASA should not be taken with ibuprofen

Answer 34

* hemodialysis, IV bicarb admin., activated charcoal * Bicarb= bc aspirin is an acidic and bicarbonate helps to alkaline the urine.

Answer 35

* Should only be used short term(5 days at the most) * Only given IV; Very Potent * Can cause GI ulcers and perforation(can kill patients)

Answer 36

* migraine begins when intracranial blood vessels dilate-> dilation stimulates trigeminovascular system-> abnormal excitable neurons that send pain impulses to brain pain receptors

Answer 37

* First-line drugs for the treatment of acute migraine headache. * They are not useful for other types of headache or inflammation that occur elsewhere in the body. * Prototype drug: sumatriptan (Imitrex) or any "triptans"

Answer 38

* acts on receptors of dilated cranial blood vessels to cause vasoconstriction * Effects on trigeminal nerve-> blocks inflammatory peptides and decreases pain nerve transmission * No pts with CAD or ischemic diseases * SE: Dysrhythmias, MI, HTN * Nursing Considerations: Monitor pain before and after, Monitor B/P and HR, Monitor for LOC changes,and Pt with circulatory impairment (CVA, CVD, PVD) should not use or use with caution and monitoring

Answer 39

* produce local or regional anesthesia by blocking nerve conduction and abolishing sensations in a limited and well-defined area of the body without loss of consciousness. * Ex: Cocaine, Lidocaine or any caine

Answer 40

* Local anesthetic by diminishing nerve membrane’s permeability to sodium.(Na+ blocker) * IV use control ventricular tachycardia(Numbs the excessive electrical activity in the heart) * Causes Fetal bradycardia bc blocks the sodium channels in the babys heart. * SE: IV use can cause neurotoxicity, dysesthesia (unpleasant sensations, pains, tingling burning of the skin) * Nursing Considerations: Monitor for safety of the affected area to prevent injury, Monitor LOC, HR, and the site

Answer 41

* Induction agents as (good to give prior to deep anesthesia to get the body ready for deep anesthesia) * Non-barbiturate hypnotic prototype drug: propofol (Diprivan) * Benzodiazepines, ketamine, fentanyl, opioids

Answer 42

* Used for induction and maintenance of anesthesia and maintenance of sedation in ICU. * Onset 40 secs if given IV and Duration 3-5 min * Dont give to prego/lactation and allergy to soy bean or eggs * No with benzo, CNS depressant(additive effect) * Nursing Conisderation: LOC, short half life, dont use if no advanced airway or ampu bag, Safety for falls and position injuries. If pt is position wrong in the OR they can get nerve damage), BM and UO(sedates gut)

Answer 43

* The prototype drug is isoflurane (Forane) C. * "ane” (halothane, desflurane)

Answer 44

* Used to induce and maintain anesthesia. * Excreted in lungs unchanged(hangs out in dead spaces in lungs.. This is why we ask patients to deep breathe right after surgery…. To get rid of that dead space and help them wake up better) * Dont give with pts that have predisposition to NMS(very genetic, watch for sudden spike in temp right after surgery bc it takes 72 hrs after surgery to get an infection) * SE: NMS, resp. depression * Nursing Considerations: History of NMS in family, Breathing/Airway, Cardiac monitoring, Encourage deep breathing in postop period to excrete drug

Answer 45

* work by causing the muscle cell membrane to depolarize or become excited, which causes muscle contraction ->leads to paralysis of the muscle after repeated excitation. * This mechanism differs from that of nondepolarizing NMJ blockers, which prevent excitation. * Not an anesthetic ! Only paralyzes. * succinylcholine (Anectine)

Answer 46

* Parlzytic/NMJ * Used primarily for rapid endotracheal intubation and endoscopic procedures. * NO patient/family history of malignant hyperthermia * SE: NMS and muscle paralysis * Nursing Considerations: Continuous ECG and respiratory monitoring, Monitor K(Damaged muscles release potassium which could cause a spike), Fall risk, Give pain meds, Watch for NMS

Answer 47

* Low Dopamine * Dopamine is a neurotransmitter that sends information to the parts of the brain that control movement and coordination. * As the disease progresses, messages from the brain telling the body how and when to move are delivered more slowly.

Answer 48

* Lack of Dopamine and excess acetylcholine causes symp * Goal is to restore the balance between dopamine and acetylcholine. * Parkinson drugs increase dopamine levels, stimulate dopamine receptors, extend the action of dopamine in the brain, or prevent the activation of cholinergic receptors. * Dopamine cant cross BBB

Answer 49

* Parkinsons * levodopa is coverted into dopamine and carbidopa prevents levopdopa from being broken down in periperhal circulation so it can cross BBB * Reduces Levodopa dose by 25% * Protein can interfere with absorption(Monitor diet for high protein) * Drug "Holiday" will reach a point where the drug does not work so taper off for a week then back on * Nusring Considerations: Must taper off for discontinuation, Monitor for skin cancers bc it causes photosensivity, Eat carbs before med

Answer 50

* Movement disorders are due to the excessive stimulation of acetylcholine in the brain. Use of anticholinergics decreases ACh activity in the nerve synapses. * Prototype: bentropine (Cogentin)

Answer 51

* Anticholinergic * Centrally acting in the brain * Drives heart rate up * Cant see, cant pee, cant spit

Answer 52

* Language skills (Communication) * Higher-level skills, such as judgment, comprehension, and problem solving (ADLs) * Ability to recognize or identify objects despite intact sensory function (Cognition) * Ability to perform motor skills * Mood and behavior may also be affected in dementia. * Agitation or withdrawal, hallucinations, delusions, insomnia, emotional apathy, and loss of inhibitions are also common.

Answer 53

* Most common cause of dementia among people 65 years of age and older. * Causes a gross, diffuse atrophy of the cerebral cortex. * Extracellular plaques with beta-amyloid protein deposits and neurofibrillary tangles in the cortical neurons.

Answer 54

* AIDS, Parkinson disease, Huntington chorea

Answer 55

* By inhibiting the action of AChE, acetylcholinesterase inhibitors (AChEIs) prolong the activity of acetylcholine on the brain * Increase concentrations of the memory-regulating and cognition-regulating neurotransmitter acetylcholineby reversibly inhibiting the enzyme cholinesterase. * Prototype drug: donepezil (Aricept)

Answer 56

* Treating mild-to-moderate dementia. * SE: GI(N/V, anorexia, weight loss), joint pain, * Atropine is antidote * Nursing Considerations: temp prevents decline of cognitive function, Takes 1-6 months to see effect

Answer 57

*Myelin sheath around nerve fibers is damaged-> Causes muscle weakness and spasms. * Meds: Immune modulating drugs

Answer 58

* Interferon beta (Avonex, Betaseron) * Glatiramer (Copaxone) * These drugs are Synthetic protein that simulates myelin basic protein to repair itself

Answer 59

* Immunosupressant * MS patients who have not responded to immune-modulating therapy * SE: blue-green tint to urine, hair loss, toxicity * Nursing Considerations: CBC, Liver enzymes

Answer 60

*Excessive use or local injury to skeletal muscle * Overmedication with antipsychotics * Epilepsy * Hypocalcemia * Dehydration * Neurologic disorders

Answer 61

* Benzos such as Diazepam (Valium), lorazepam (Ativan), clonazepam (Klonopin) * cyclobenzaprine (Flexeril) and Dantrolene

Answer 62

Depress the _CNS_ in the brainstem, basal ganglia, and neurons of the spinal cord

Answer 63

* Muscle spasms, cerebral palsy, strains * No pts with hyperthyrodism and increaed risk of (arrhythmias) within 14 days of using MAOIs * SE: CNS depression and anticholinergic activity

Answer 64

*Pheripheral Acting * Blocks CA release from skeletal muscles-> less responsive. * Used to prevent/manage spasticity from Malignant Hyperthermia, MS, Cerebral Palsy, Spinal cord injuries, CVA * SE: fatal hepatitis, Ataxia * Dont give to pts with Cerebral palsy if advanced bc it will worsen condition * NC: High Fall Risk, NO liver disease/pulmonary/cardiac dysfunctions , NO alchy or CNS depressants, Abrupt DC can lead to seizures, Liver labs, Baclofen lower seizure threashold

Answer 65

A painful muscle biopys before surgery to see if a patient has a predisoption to Dantrolene