Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

semester 4 > pharmacology 1 > Flashcards

pharmacology 1 Flashcards

1
Q

Antidepressant Administration Notes

A

can be taken with food to avoid GI distress
will need to be tapered to avoid withdrawals
– someone switching from a TCA to an MAOI will need two weeks washout (no TCA for two weeks), SSRIs have a low potential for overdose so can be prescribed in normal quantities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the usual first line antidepressant?

A

SSRIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Antidepressant Assessment

A

blood pressure (hypotension), 1-2 weeks to start taking effect, 4-6 weeks for full effect (educate patient to be patient), usually sedating so be careful with driving and alcohol until you know how you handle it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

SSRI suicide risk

A

lowest risk for suicide so they are dispensed in normal quantities
can cause an increased suicide risk in some patients, often they will be happy about it
slight increase in teens and young adults however its not statistically significant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Examples of SSRIs

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

SSRI adverse effects that affect compliance

A

sexual dysfunction and weight gain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

SSRI adverse effects to monitor

A

withdrawal can occur, must taper drug to avoid syndrome
hyponatremia risk with thiazide diuretics
can alter bleeding avoid NSAIDs and aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

SNRI (serotonin norepinephrine reuptake inhibitors) Examples

A

Duloxetine (Cymbalta)
Venlafaxine (Effexor)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

NASSAs Mechanism and Example

A

Increase norepinephrine and serotonin neurotransmission by blocking presynaptic alpha-2 adrenergic receptors & minimizing serotonin related side-effects by blocking certain serotonin receptors.

Mirtazapine (Remeron)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

NDRIs

A

Inhibit the re-uptake of dopamine and norepinephrine
Bupropion (Wellbutrin, Zyban)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Bupropion (Wellbutrin, Zyban) Considerations and Other Uses

A

Hx of seizures - don’t exceed 300 mg
Seizure risk greatly increases if dose execeds 450 mg day
Also used for: smoking cessation, ADHD, alternative to stimulants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

SARIs

A

Serotonin receptor antagonists and reuptake inhibitors:
Trazodone (Desyrel)

Higher does to treat depression (watch for hypotension) and lower doses for insomnia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Auvelity

A

Dextromethorphan/bupropion(DXM/BUP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

TCA Examples

A

Increases norepinephrine and serotonin levels but have more side effects than SSRI’s

Amitriptyline (Elavil)
Clomipramine (Anafranil)
Desipramine (Norpramin)
Imipramine (Tofranil)
Nortriptyline (Pamelor, Aventyl)
Trimipramine (Surmontil)
Doxepin (Sinequan)
Protriptyline (Vivactil)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

TCA Side Effects

A

Orthostatic hypotension, cardiac dysrhythmias, contraindicated in recovery of MI
Anticholinergic effects not as severe as antipsychotics
Decreased seizure threshold
Tapered withdrawal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

TCA Withdrawal Symptoms

A

nightmares, N&V, cold sweats, anxiety, akathisia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

TCA Interactions

A

Do not use with MAOI: hypertensive crisis
Do not use with SSRIs: ↑ Serotonin syndrome
Take at night - sedating effect, best for insomnia/agitation
Generally not used for older adults due to increased fall risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

MAOIs Examples

A

Inhibit monoamine oxidase breakdown of serotonin and norepinephrine

Phenelzine (Nardil)
Tranylcypromine (Parnate)
Isocarboxazid (Marplan)
Selegiline (EMSAM0) transdermal patch

Generally reserved for non-responders to other antidepressants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

MAOI Side Effects

A

Risk for hypertensive crises with TCA’s (2 week washout)
food containing tyramine cheese
Risk for serotonin syndrome with SSRIs
Hypotension
Taper dose to prevent withdrawal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Foods Containing Tyramine

A

to avoid cheese effect
Dairy: aged cheese and cultured products
Fruit & Veg: avocado, banana, fava
Meat: lunch meat, pickled or potted meat, dried fish
Any high-protein food that has been aged, fermented, pickled or smoked
Other: chocolate, licorice, sauerkraut, soy, yeast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Hypertensive Crisis S/S

A

Obviously – high BP
Sudden onset
Stiff neck, headache
Palpitations
Dilated pupils, photophobia
N & V
Diaphoresis
Chest pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Drugs for Hypertensive Crisis

A

Phentolamine IV
Nifedipine S/L in ER

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Trazadone (Desyrel)

A

is classified as an antidepressant but is commonly used to treat insomnia (18 and older)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Escitalopram (Lexapro) Off Label Use

A

generalized anxiety disorder

25
Q

Fluoxetine (Prozac) Off Label Use

A

Obsessive-Compulsive Disorder (OCD)

26
Q

Venlafaxine (Effexor) Is Approved For

A

FDA approved to treat GAD, Panic Disorder, and Social Anxiety Disorder

27
Q

Serotonin Syndrome - Why Though

A

Caused by increased serotonin when things are combined, particularly with an SSRI

Other antidepressants
Lithium
Opioids
Other: copious caffeine, St. John’s Wort, migraine medication

28
Q

Serotonin Syndrome - What Do

A

s/s: sudden onset of confusion, agitation, myoclonus muscle spasms, rigidity, diarrhea, increased HR, hyperthermia, changes in BP

Untreated – seizures, apnea, death

Interventions: inform PCP and stop meds
Treat symptoms: i.e., propranolol, anticonvulsants, induce paralysis
Cooling blankets

29
Q

Anticholinergic Side Effects

A

Dry mouth
Blurred vision, photophobia
Tachycardia
Constipation: may need immediate medical attention
Urinary retention: may need immediate medical attention

30
Q

Benzodiazepines administration

A

sublingual, PO or IV are used to prevent severe withdrawal, elevated VS, seizures, or DTs.
Often ordered on a ‘sliding scale’ based on CIWA scores/VS
benzodiazepines and opioids at the same time – high risk of respiratory depression
must be tapered to avoid withdrawals

31
Q

antidote for benzodiazepine overdose

A

Flumazenil IV

32
Q

Alcohol Withdrawal Medications

A

decreased ICU admissions phenobarbital used with benzodiazpines

phenobarbital use decreased readmissionin the first 3 days after discharged

phenobarbital instead of benzodiazepines shortened LOS length of stay on inpatient services

33
Q

Carbamazepine (Tegretol)

A

(alcohol withdrawal) decrease risk for seizures

34
Q

Clonidine (Catapres)

A

(alcohol withdrawal) reduces high HR and BP
Sedative and Hypotensive used to manage opioid withdrawal symptoms
Also used for chronic pain
DOES NOT REDUCE CRAVINGS
Taper dose at end of treatment to prevent withdrawal

35
Q

Propranolol (Inderal)

A

(alcohol withdrawal) reduces high HR and BP and decreases cravings

36
Q

Atenolol (Tenormin)

A

(alcohol withdrawal) reduces high HR and BP and decreases cravings

37
Q

Acamprosate (Campral)

A

“relief cravers” (minimize withdrawal discomfort first few months), FDA approved specifically for alcohol use disorder treatment; alternative to off label use of Gabapentin (Neurontin)

38
Q

Naltrexone(Revia)

A

Reduces effects and craving for alcohol
Used for Alcohol and Opioid Use Disorders

39
Q

Disulfiram (Antabuse)

A

cause AcetaldehydeSyndrome when combined with alcohol use (aversion therapy), check liver function to avoid hepatotoxicity, effects can linger for 2 weeks after last dose

40
Q

AcetaldehydeSyndrome

A

can cause death - wear a medical alert bracelet
Cardinal - facial flushing
nausea & severe vomiting (and thirst)
headache (throbbing)
tachycardia and cardiac palpations
Diaphoresis
Weakness and Vertigo
Can occur in people (Asian) who lack aldehyde dehydrogenase (breaks down alcohol)

41
Q

Opioid Notes

A

Heroin is made from Morphine but is 3x stronger and is faster
Oxycodone (Percocet, Oxycontin) much stronger than hydrocodone (Vicodin, Norco)
Fentanyl is 50x more potent than heroin, cheaper to manufacture for illegal drug trade

42
Q

Reverse opioid overdose

A

Naloxone(Narcan)

43
Q

Methadone

A

Opioid Agonist, synthetic similar to morphine – long half life
Heroin/Opioid Replacement - has less euphoria and sedation, used in approved rehabilitation centers for manage opioid withdrawal symptoms and decrease cravings
taper at the end of treatment to avoid withdrawals
some people are methadone lifers

44
Q

Buprenorphine (Buprenex)

A

Opioid partial agonist
Higher doses for detox, then maintenance dose of 4-24mg/day, prevents withdrawal and decreases cravings
Lower respiratory depression than methadone
Be aware of sound alike/look alike: Bupropion (Wellbutrin, Zyban) – different med

45
Q

Suboxone

A

combines naloxone (Narcan) and buprenorphine

46
Q

Naltrexone(Revia)

A

Blocks euphoria
Suppresses cravings
Used for Alcohol and Opioid Use Disorders

47
Q

Bupropion (Wellbutrin, Zyban)

A

An antidepressant used to decrease S/S withdrawal
Decreases seizure threshold, avoid use in pts with seizure Dos

48
Q

Varenicline (Chantix)

A

Increases dopamine (reword neurotransmitter)
Reduces cravings
Blocks nicotine effects
Decreases S&S withdrawal

49
Q

Lithium effective for

A

Effective for symptoms of hypomania and mania: elation, grandiosity, flight of ideas, irritability, manipulation, anxiety – may take 7-14 days for full effect

50
Q

lithium acts like

A

Acts like sodium – dehydration, diaphoresis, diuretics (hydrochlorothiazide), low sodium, and NSAIDS can cause lithium toxicity

51
Q

lithium dosage

A

Dosage 300-600mg. BID-TID
Narrow therapeutic Index 0.6-1.5 mEq/L (some say 0.8 to 1.2)
Ideally – medication nurse documents daily on presence or absence of side effects and toxic effects (story geri-psych unit)
Titrate up to blood, higher end to control mania, lower end for maintenance
Need to obtain trough level (before AM dose)
maintain water intake

52
Q

Lithium side effects

A

Reassure pts that these side effects usually resolve in time
Fine hand tremor
Polyuria
Mild thirst
Mild nausea – TAKE WITH FOOD to minimize GI irritation
Weight gain - because its acts like a salt

53
Q

early lithium toxicity

A

Nausea
Vomiting
Diarrhea
Increased thirst
Increased polyuria
Lethargy
Slurred speech
Muscle weakness

54
Q

advanced lithium toxicity (time to admit)

A

Coarse hand tremor
Persistent GI, Nausea and Vomiting
Confusion
Muscle irritability
EEG changes
Sedation
Poor coordination

55
Q

severe lithium toxicity

A

“drunk sailor”
Worsening lack of coordination – ataxia, clonic movements
Increased EEG changes - seizures
Blurred vision
Giddiness and or stupor
Increased polyuria – dilute urine
Hypotension
Death secondary to pulmonary complications

56
Q

lithium toxicity so bad you need dialysis

A

Oliguria (opposite of polyuria)
Seizures
Death

57
Q

Anticonvulsants as Mood Stabilizers

A

Valproic acid (Depakene) & Valproate semisodium (Depakote)
Carbamazepine (Tegretol)
Lamotrigine (Lamictal)

58
Q

Valproic acid (Depakene) & Valproate semisodium (Depakote) administration

A

BBW liver damage
regularly do ammonia level and valproic acid levels

59
Q

Lamotrigine (Lamictal)
administration

A

Report rashes - usually benign - BUT Black Box Warning for Stevens-Johnson and other rash reactions that can cause death

semester 4 (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions