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Practice Assessment > Pharmacology 2 > Flashcards

Pharmacology 2 Flashcards

1
Q

Phenytoin (Dilantin)

A

Hydantoins prototype–Drugs for Treating Generalized Seizures
Indications:
-control of tonic-clonic and psychomotor seizures
-prevention of seizures during neurosurgery
-control of status epilepticus
Actions:
-stabilizes neuronal membranes and prevents prevents hyperexcitability caused by excessive stimulation
Adverse effects:
-most common r/t CNS depression and its effects on body function: depression, confusion, drowsiness, lethargy, fatigue, constipation, dry mouth, anorexia, cardiac arrhythmias and changes in BP, urinary retention, and loss of libido.
-hydantoins may cause severe liver toxicity, bone marrow suppression, gingival hyperplasia, and Steven-Johnson syndrome

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2
Q

Oxybutynin (Ditropan, Oxytrol)

A

Urinary Tract Antispasmodic
Indications:
-relief of symptoms of bladder instability associated with uninhibited neurogenic and reflex neurogenic bladder
-treatment of S&S of overactive bladder
Actions:
-acts directly to relax smooth muscle in the bladder
-inhibits effects of acetylcholine at muscarinic receptors
Adverse effects:
-r/t blocking of the parasympathetic system and include:
nausea, vomiting, dry mouth, nervousness, tachycardia, and vision changes
-anticholinergic effects of: decreased sweating, urinary retention, and changes in GI activity

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3
Q

Acetazolamide (Diamox)

A

Carbonic Anhydrase Inhibitor prototype–Diuretics
Indications:
-adjunctive treatment of open-angle glaucoma, secondary to glaucoma
-preoperative use in acute angle-closure glaucoma when delay of surgery is indicated
-edema caused by HF
-drug-induced edema
Actions:
-inhibits carbonic anydrase (which decreases aqueous humor formation in the eye, intraocular pressure, and hydrogen secretion by the renal tubules
Adverse effects:
-r/t disturbances in acid-base and electrolyte balances
-weakness, fatigue, rash, anorexia, nausea, urinary frequency, renal calculi, bone marrow suppression, weight loss
-hypokalemia
-paresthesias (tingling) of extremities, confusion, drowsiness

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4
Q

Amoxicillin and Clavulanate Potassium (Augmentin)

A

-clavulanic acid protects certain beta-lactam antibiotics from breakdown in presence of penicillinase enzymes.
-combination of amoxicillin and clavulanic acid (Augmentin) commonly used to allow amoxicillin to remain effective against certain strains of resistant bacteria.
-usual dosage:
250-500 mg PO q8h for adults or 20-40 mg/kg/d PO in divided doses for children

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5
Q

Neostigmine (Prostigmin)

A

Agents for Myasthenia Gravis–Indirect-Acting Cholinergic Agonists
Indications:
-diagnosis and management of myasthenia gravis
-reversal of toxicity from nondepolarizing neuromuscular junction-blocking drugs, which are used to paralyze muscles during surgery.
Adverse effects:
-r/t stimulation of the parasympathetic nervous system
-GI effects: nausea, vomiting, cramps, diarrhea, increased salivation
-CV effects: bradycardia, heart block, hypotension, and even cardiac arrest
-urinary tract effects: sense of urgency r/t stimulation of bladder muscles and sphincter relaxation

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6
Q

Myasthenia Gravis

A
  • chronic muscular disease caused by a defect in neuromuscular transmission.
  • an auto-immune disease characterized by antibodies to the ACh receptors. Results in loss of ACh receptors and eventual loss of response at the neuromuscular junction.
  • *ACh is the neurotransmitter used at the nerve-muscle synapse. If these receptors are blocked and cannot be stimulated, muscle activity is decreased.
  • *Marked by progressive weakness and lack of muscle control, with periodic acute episodes.
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7
Q

Valproic Acid (Depakene)

A

Drugs that Modulate the Inhibitory Neurotransmitter Gamma-aminobutyric Acid prototype–Drugs for Treating Generalized Seizures
Indications:
-drug of choice for myoclonic seizures
-second-choice for treatment of absence seizures
-also effective in mania, migraine headaches, and complex partial seizures
Actions:
-reduces abnormal electrical activity in the brain and may increase GABA activity at inhibitory receptors.
Adverse effects:
-liver toxicity
-CNS effects r/t CNS suppression: weakness, fatigue, drowsiness, dizziness, and paresthesias.

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8
Q

Generalized Seizure

A
  • seizure that begins in one area of the brain and rapidly spreads throughout both hemispheres
    1) tonic-clonic (grand mal)
    2) absence (petit mal)
    3) myoclonic
    4) febrile
    5) rapidly recurrent (status epilepticus)
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9
Q

Tonic-clonic Seizure

A
  • type of generalized seizure
  • characterized by serious clonic-tonic muscular reactions and LOC, with exhaustion and little memory of the event on wakening
  • formerly known as grand mal
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10
Q

Absence Seizure

A
  • type of generalized seizure
  • characterized by sudden, temporary LOC
  • sometimes with staring or blinking for 3-5 sec
  • formerly known as petit mal
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11
Q

Myoclonic Seizures

A
  • type of generalized seizure
  • involves short, sporadic periods of muscle contractions that last for several minutes
  • relatively rare and often secondary seizures
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12
Q

Febrile Seizures

A
  • type of generalized seizure
  • r/t very high fevers and usually involve tonic-clonic seizures
  • most frequently occur in children
  • usually self-limited and do not reappear.
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13
Q

Status Epilepticus

A
  • type of generalized seizure
  • most dangerous of seizure conditions
  • seizures rapidly recur again and again with no recovery between seizures
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14
Q

Partial Seizures

A

(also called focal seizures)

  • involving one area of the brain that do not spread throughout the entire organ
    1) simple
    2) complex
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15
Q

Simple Seizures

A
  • type of partial seizure
  • occur in a single area of the brain
  • may involve a single muscle movement or sensory alteration
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16
Q

Complex Seizures

A
  • type of partial seizure
  • involve a series of reactions or emotional changes and complex sensory changes such as hallucinations, mental distortion, changes in personality, LOC, and loss of social inhibitions
  • motor changes may include: involuntary urination, chewing motions, diarrhea, etc.
  • onset usually occurs by the late teens
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17
Q

Benztropine (Cogentin)

A

Anticholinergic Agent–Antiparkinsonism Agents
Indications:
-adjunctive treatment of parkinsonism, and drug-induced parkinsonism resulting from drug effects of phenothiazines
Adverse effects:
-CNS effects r/t blocking of central acetylcholine receptors: disorientation, confusion, memory loss, agitation, nervousness, delirium, dizziness, light-headedness, and weakness
Anticipated peripheral anticholinergic effects:
-dry mouth, nausea, vomiting, paralytic ileus, and constipation r/t decreased GI secretions and motility

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18
Q

Anticholinergics

A

-drugs that oppose the effects of acetylcholine at receptor sites in the substantia nigra and the corpus striatum, thus helping to restore chemical balance in the area

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19
Q

Parkinson disease

A

-debilitating disease, characterized by progressive loss of coordination and function, which results from the degeneration of dopamine-producing cells in the substantia nigra

20
Q

Parkinsonism

A

-Parkinson disease-like extrapyramidal symptoms that are adverse effects associated with particular drugs or brain injuries

21
Q

Substantia Nigra

A
  • part of the brain rich in dopamine and dopamine receptors

- site of degenerating neurons in Parkinson disease

22
Q

Corpus Striatum

A

-part of the brain that reacts with the substantia nigra to maintain a balance of suppression and stimulation

23
Q

Mannitol (Osmitrol)

A

Osmotic Diuretic prototype–Diuretics (Drugs Acting on the Renal System)
Indications:
-treatment of elevated ICP, acute renal failure, acute glaucoma
-also used to decrease ICP, prevent oliguric phase of renal failure, and promote movement of toxic substances through the kidneys
Actions
-elevates osmolarity of glomerular filtrate, leading to a loss of water, sodium, and chloride
-creates and osmotic gradient in the eye, reducing intraocular pressure
-creates and osmotic effect that decreases swelling after transurethral surgery
Adverse effects:
**closely monitor for fluid and electrolyte imbalance
-dizziness, headache, hypotension, rash, nausea, anorexia, dry mouth, thirst, diuresis, fluid and electrolyte imbalance

24
Q

Carbamazepine (Tegretol, Atretol)

A

Drugs for Treating Partial Seizures prototype
Indication:
-drug of choice for treatment of partial seizures and tonic-clonic seizures
-treatment of trigeminal neuralgia, bipolar disorder
Action:
-is chemically r/t the tricyclic antidepressants.
-has the ability to inhibit polysynaptic responses and to block sodium channels to prevent the formation of repetitive action potentials in the abnormal focus.
Adverse effects:
-r/t CNS depression that results:
drowsiness, fatigue, weakness, confusion, headache, insomnia; GI depression, with nausea, vomiting, and anorexia; and upper respiratory infections.

25
Q

Tamoxifen (Nolvadex, Soltamox)

A

Hormone/Hormone Modulator–prototype–Antineoplastic Agents
Indications:
-in combination therapy with surgery to treat breast cancer
-treatment of advanced breast cancer in men and women
-first drug approved for prevention of breast cancer in women at high risk for breast cancer
Actions:
-competes with estrogen for binding sites in target tissues, such as the breast
-a potent antiestrogenic agent
Special considerations:
-S&S of menopause are common effects (hot flashes, vaginal spotting, vaginal dryness, moodiness, and depression)
-CNS depression, bone marrow depression, and GI toxicity are common
-can change visual acuity and cause corneal opacities and retinopathy–pretherapy and periodic ophthalmic examinations are indicated

26
Q

Epoetin Alfa (Epogen)

A

Erythropoiesis-Stimulating Agents-prototype–Drugs Used to Treat Anemias
Indications:
-treatment of anemia associated with renal failure and patients on dialysis
-reduction in need for transfusions in surgical patients
-treatment of anemia associated with AIDS therapy
-treatment of anemia associated with cancer chemotherapy
Actions:
-natural glycoprotein that stimulates RBC production in the bone marrow
Adverse effects:
-headache, arthralgias (painful joints), fatigue, asthenia (weakness), dizziness, hypertension, edema, chest pain, nausea, vomiting, diarrhea

27
Q

Glargine (Lantus)

A

Insulin–Agents to Control Blood Glucose Levels
ONSET = 60-70 min
PEAK = none
DURATION = 24 hr

28
Q

Hyperglycemia

A

-high blood sugar
S&S:
-decreased LOC, sluggishness progressing to coma; hypoactive reflexes
-weakness, lethargy
-tachycardia, hypotension
-rapid, deep respirations (Kussmaul); acetone-like fruity breath
-nausea; vomiting; polydipsia (excessive thirst)
-dry, warm, flushed skin; soft eyeballs
-glycosuria;
-clinical S&S = fatigue, lethargy, irritation, glycosuria, polyphagia, polydipsia, and itchy skin (from accumulation of wastes that the liver cannot clear).
ONSET =
-gradual
-patient is slow and sluggish
-associated with lack of insulin, increased stress

29
Q

Signs of impending dangerous complications of hyperglycemia

A

1) fruity breath as the ketones build up in the system and are excreted through the lungs
2) dehydration as fluid and important electrolytes are lost through the kidneys
3) slow, deep respirations (Kussmaul respirations) as the body tries to rid itself of high acid levels
4) loss of orientation and coma
* *needs to be treated immediately with insulin

30
Q

Hypoglycemia

A

-blood glucose concentration < 40 mg/dL
S&S:
-headache, blurred vision, diplopia (double vision); drowsiness progressing to coma; ataxia (abnormal, uncoordinated movements); hyperactive reflexes
-paresthesias; weakness; muscle spasms; twitching progressing to seizures
-tachycardia; palpitations; normal-high BP
-rapid, shallow respirations
-hunger, nausea
-diaphoresis (excessive sweating); cool and clammy skin; normal eyeballs
-urine glucose negative; blood glucose low
ONSET =
-sudden
-patient appears anxious, drunk
-associated with overdose of insulin, missing a meal, increased stress

31
Q

Haloperidol (Haldol)

A

Typical Antipsychotics–Antipsychotic/Neuroleptic Drugs
Indications:
-schizophrenia and manifestations of other psychotic disorders: hyperactivity, combative behavior, and severe behavioral problems in children (short-term control)
-frequently used to treat acute psychiatric situations and is available for IV use when prolonged parenteral therapy is required.
Actions:
-block dopamine receptors preventing the stimulation of the postsynaptic neurons by dopamine.
-they depress the RAS (reticular activating system), limiting the stimuli coming into the brain.
-they have anticholinergic, antihistamine, and alpha-adrenergic blocking effects, all r/t blocking of the dopamine-receptor sites
Adverse effects:
-CNS effects: sedation, weakness, tremor, drowsiness, extrapyramidal side effects (EPS), pseudoparkinsonism, dystonia, akathisia (feeling of inner restlessness), tardive dyskinesia, potentially irreversible neuroleptic malignant syndrome.
-anticholinergic effects: dry mouth, nasal congestion, flushing, constipation, urinary retention, impotence, glaucoma, blurred vision, and photophobia.

32
Q

Clindamycin (Cleocin)

A

Lincosamide–prototype-Other Antibiotics
Indications:
-treatment of severe infections when penicillin or other, less toxic antibiotics cannot be used
-useful in septicemia and chronic bone and joint infections
Actions:
-inhibits protein synthesis in susceptible bacteria, causing cell death
Averse effects:
-nausea, vomiting, diarrhea, pseudomembranous colitis, bone marrow suppression, hypotension, cardiac arrest with rapid IV infusion, rash, pain on injection, abscess at injection site.

33
Q

Metoclopramide (Reglan)

A

Gastrointestinal Stimulant–prototype
-Indication:
-relief of symptoms of gastroesophageal reflux disease
-prevention of nausea and vomiting after emetogenic chemotherapy or postoperatively
-relief of symptoms of diabetic gastroparesis
-promotion of gastrointestinal movement during small bowel intubation or promotion of rapid movement of barium
Actions:
-stimulates movement of the upper GI tract without stimulating gastric, pancreatic, or biliary secretions
-appears to sensitize tissues to the effects of acetylcholine
Adverse effects:
-restlessness, drowsiness, fatigue, extrapyramidal effects, Parkinson-like reactions, nausea, diarrhea

34
Q

Gastrointestinal Stimulants

A
  • act to increase parasympathetic stimulation in the GI tract and to increase tone and general movement throughout the GI system
  • patients receiving these should be monitored for generalized increases in parasympathetic activity.
35
Q

Hypothyroidism

A
  • lack of sufficient levels of thyroid hormones to maintain a normal metabolism
  • occurs in number of pathophysiological states:
  • absence of thyroid gland
  • lack of sufficient iodine in the diet to produce needed level of thyroid hormone
  • lack of sufficient functioning thyroid tissue due to tumor or autoimmune disorders
  • lack of TSH due to pituitary disease
  • lack of TRH related to a tumor or disorder of the hypothalamus
36
Q

Cretinism

A
  • lack of thyroid hormone in an infant

- if untreated, leads to mental retardation

37
Q

Myxedema

A
  • severe adult hypothyroidism
  • usually develops gradually as the thyroid slowly stops functioning
  • can develop as result of autoimmune thyroid disease (Hashimoto disease), viral infection, or overtreatment with antithyroid drugs or because of surgical removal or irradiation of the thyroid gland
38
Q

Hyperthyroidism

A
  • occurs when excessive amounts of thyroid hormones are produced and released into circulation
  • Graves disease: most common cause of hyperthyroidism
  • Goiter (enlargement of the thyroid gland) is an effect of hyperthyroidism that occurs when the thyroid is overstimulated by TSH.
39
Q

Chlordiazepoxide (Librium)

A

Benzodiazepine Used as Anxiolytics
Indications:
-anxiety
-alcohol withdrawal
-preoperative anxiolytic
Actions:
-act in the limbic system and the RAS to make gamma-aminobutyric acid (GABA) more effective, causing interference with neuron firing.
-GABA stabilizes the postsynaptic cell which leads to an anxiolytic effect at doses lower than those required to induce sedation and hypnosis.
Adverse effects:
-nervous system effects: sedation, drowsiness, depression, lethargy, blurred vision, headaches, apathy, light-headedness, and confusion
-GI conditions: dry mouth, constipation, nausea, vomiting, elevated liver enzymes
-CV: hypotension, hypertension, arrhythmias, palpitations, and respiratory difficulties

40
Q

Ergotamine (Generic)

A

Antimigraine Agents–generic–Ergot Derivatives
Indications:
-prevention or abortion of vascular headaches
Actions:
-constricts cranial blood vessels
-decreases pulsation of cranial arteries
-decreases hyperperfusion of the basilar artery vascular bed
Adverse effects:
-CNS: numbness, tingling of extremities, and muscle pain
-CV: pulselessness, weakness, chest pain, arrhythmias, localized edema and itching, MI

41
Q

Propylthiouracil

A

Antithyroid Agent
Indications:
-treatment of hyperthyroidism
Actions:
-lower thyroid hormone levels by preventing the formation of thyroid hormone in the thyroid cells, which lowers the serum levels of thyroid hormone.
-partially inhibit the conversion of T4 to T3 at the cellular level
Adverse effects:
-effects of thyroid suppression: drowsiness, lethargy, bradycardia, nausea, skin rash

42
Q

Oprelvekin (Neumega)

A

Interleukins–Immune Stimulants
Indications:
-prevention of severe thrombocytopenia (an abnormal decrease in the number of platelets) after myelosuppressive chemotherapy
Actions:
-activate cellular immunity and inhibit tumor growth by increasing lymphocyte numbers and their activity.
Adverse effects:
-severe hypersensitivity reactions–patients should be closely watched when beginning therapy and encouraged to report any difficulty breathing or swallowing, chest tightness, or swelling

43
Q

Sucralfate (Carafate)

A

GI Protectant–prototype
Indications:
-short-term treatment of duodenal ulcers
-maintenance of duodenal ulcers (at reduced dose) after healing in adults
-treatment of oral and esophageal ulcers due to radiation, chemotherapy, or sclerotherapy
-prophylaxis of stress-induced ulcers
-relief of symptoms of heartburn and acid indigestion
Actions:
-inhibits the actions of histamine at H2 receptor sites of the stomach, inhibiting gastric acid secretion and reducing total pepsin output.
Adverse effects:
-dizziness, confusion, headache, somnolence, cardiac arrhythmias, cardiac arrest, diarrhea, impotence, gynecomastia, rash

44
Q

Indomethacin (Indocin)

A

Acetic Acid–NSAIDs
Indication:
-relief of moderate to severe pain in PO, topical, and PR forms
-closure of patent ductus arteriosus in premature infants (given IV)
Actions:
COX = Cyclooxygenase Receptors
-block prostaglandin synthesis at COX-1 and COX-2 sites. this blocks inflammation but also blocks protection of the stomach lining, as well as the kidney’s regulation of water
Adverse effects:
-nausea, dyspepsia, GI pain, constipation, diarrhea, flatulence caused by GI effects of the drug.
-potential for GI bleeding is often a cause of discontinuation
-headache, dizziness, somnolence, and fatigue also occur and could be r/t prostaglandin activity in the CNS

45
Q

Baclofen (Lioresal)

A

Centrally Acting Skeletal Muscle Relaxant–prototype
Indications:
-alleviation of S&S of spasticity
-may be of use in spinal cord injuries or spinal cord diseases
Actions:
-Gamma-aminobutyric acid (GABA) analogue
-inhibits monosynaptic and polysynaptic spinal reflexes
-CNS depressant
Adverse effects:
-transient drowsiness, dizziness, weakness, fatigue, contsipation, headache, insomnia, hyptoension, nausea, urinary frequency

46
Q

Enalapril (Vasotec)

A

Angiotensin-Converting-Enzyme (ACE) Inhibitor–Drugs Affecting BP
Indications:
-treatment of hypertension, HF, left ventricular function in adults
Actions:
-act in the lungs to prevent ACE from converting angiotensin I to angiontensin II (a powerful vasoconstrictor and stimulator of aldosterone release).
-this leads to decrease in BP and in aldosterone secretion, with a slight increase in serum potassium and a loss of serum sodium and water.
Adverse effects:
-r/t effects of vasodilation and alterations in blood flow
-reflex tachycardia, chest pain, angina, HF, and cardiac arrhythmias
-GI irritation, ulcers, constipation, and liver injury
-renal insufficiency, renal failure, and proteinuria
-rash, alopecia, dermatitis, and photosensitivity
*generally well tolerated, but cause an unrelenting cough

47
Q

Metronidazole (Flagyl, MetroGel, Noritate)

A

Other Antiprotozoals–prototype
Indications:
-acute intestinal amebiasis, amebic liver abscess, trichomoniasis, acute infections caused by susceptible strains of anaerobic bacteria, and preoperative and postoperative prophylaxis for patients undergoing colorectal surgery
Actions:
-inhibits DNA synthesis of specific anaerobes, causing cell death
-mechanism of action as an antiprotozoal and amebicidal is not known
Adverse effects:
-headache, dizziness, ataxia (uncoordinated muscle movements), nausea, vomiting, metallic taste, diarrhea, darkening of the urine

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