Pharmacology Test 3 cont Flashcards

Question

tizanidine (Zanaflex) AE

Answer 1

1. dizziness 2. drowsiness 3. asthenia 4. hypotension up to 33% within 1 hr, * peaks 2-3 hrs after doses

Answer 2

sedation: within 30 minutes of dose peak 1.5 hours after dose may take with or w/o food but be consistent due to variable absorption

Answer 3

unknown may inhibit polysnaptic reflex in SC also possible GABA and serotonin effects, varies by drug

Answer 4

1. sedation 2. dizziness

Answer 5

1. Beer's list 2. increased risk of fractures 3. some anticholinergic effects 4. may have limited efficacy at tolerable doses

Answer 6

inhibitory effects on alpha motor neuron through inhibition of excitatory neurons (blocks Ca2+ influx into presynaptic terminal = decreases NT release)

Answer 7

1. CNS depressant * sedation, ataxia, cardiac/resp depression 2. Muscle weakness 3. In older adults and TBI -\> impaired memory and cognition 4. transient drowsiness usually disappears within a few days

Answer 8

increased drug effectiveness with smaller doses usually intrathecal method

Answer 9

DO NOT abruptly stop meds = can lead to: 1. high fever 2. AMS 3. exaggerated rebound spasiticity and muscle rigidity 4. rhabdomyolysis 5. system failure

Answer 10

Androgen deficiency

Answer 11

1. Topical 2. subcutaneous 3. patch 4. gel 5. nasal spray 6. buccal 7. NO PO option = hepatotoxicity

Answer 12

1. increase risk of MI, stroke, CV death 2. Prolonged use * hepatic toxicitiy * hepatitis * jaundice 3. IM * hepatic adeomas * infertility with large doses

Answer 13

IM --\> large swings from trough to peak = variable symptoms relief and mood changes

Answer 14

1. avoid contact with path/gel areas 2. monitor BP

Answer 15

Mirabegron (Myrebetriq)

Answer 16

Men's BPH (begnin prostatic hypertrophy)

Answer 17

relaxes detrusor muscle = decreases voiding symptoms

Answer 18

increases BP

Answer 19

anticholinergic

Answer 20

Men's BPH (benign prostatic hypertrophy)

Answer 21

antispasmodic effect on smooth musce = blocks acetylcholine on smooth muscle

Answer 22

hypothyroidism

Answer 23

synthetic thyroxine (T4), converted to T3, has usual effects

Answer 24

well tolerated unless overtreated 1. sweating 2. heat sensitivity 3. tachycardia 4. dirrhea 5. nervousness 6. menstrual irregularities 7. increase BMR

Answer 25

1. take on empty stomach 2. take 30-60 mins before meal or 3-4 hours after 3. do not take with Ca, Mg, Fe, and Al products

Answer 26

1. requires monitoring/close adjustments 2. monitor for cardiac symptoms

Answer 27

highest risk: baseline CAD, HF

Answer 28

hyperthyroidism

Answer 29

used a monotherapy for 1st year to induce remission blocks formation of T3, T4 by inhibiting oxidation of iodine

Answer 30

Common 1. rash 2. GI upset 3. arthralgia (can develop into polyarthritis) Rare AE 1. agranulocytosis 2. hepatotoxicitiy 3. can cause hypothyroidism

Answer 31

refer if pt develops fever, sore throat, mouth ulcers (possible agranulocytosis) \*hepatotoxicity: increased risk with PTU

Answer 32

can cause birth defects in 1st trimester of pregnancy

Answer 33

calcium vitamin D

Answer 34

stimualtes hematoporeisis

Answer 35

overtreatment can cause: 1. hypercalcemia 2. hypercalciuria = leading to nephrolithiasis

Answer 36

Diabetes Type II

Answer 37

not fully known 1. inhibits production of glucose 2. inhibits intestinal absorption of glucose 3. increases insulin sensitivity to muscle and fat

Answer 38

1. GI cramping 2. N/V/D

Answer 39

boxed warnings: lactic acidosis more common if: 1. renal impairment 2. dehydration 3. elderly 4. acute decompensated HF 5. excess alcohol

Answer 40

Vitamin B12 deficiency can be misdiagnosed as peripheral neuropathy

Answer 41

Sulfonylureas

Answer 42

Diabetes Type II

Answer 43

binds sulfonurea receptor in pancreas --\> depolarization causes insulin release

Answer 44

1. hypoglycemia (especially in elder and renal dysfunction) 2. weight gain

Answer 45

take before breakfast immediate release must be 30 mins before meal

Answer 46

if not taken correctly can increase hypoglycemia risk

Answer 47

on ther Beer's List

Answer 48

1. mixed amphetamine salts (Adderall) 2. methyphenidate (Concerta, Ritalin)

Answer 49

Stimulants

Answer 50

block dopamine and NE reuptake, increase dopamine and NE release

Answer 51

1. decrease appetite 2. wt. loss 3. stomach ache 4. insomnia 5. HA 6. irritabililty/jitteriness

Answer 52

1. dysphoria 2. spacey state 3. Tics 4. HTN and HR fluctuations 5. hallucinations 6. chemical leukoderma (white skin from patch)

Answer 53

if taken with food, slower onset and may decrease absorption and some AE

Answer 54

report concerns about dependence or non therapeutic use

Answer 55

1. CV risk -- misuse can cause death or CV AE 2. use w/caution w/CV disease present 3. abuse potential (especially illictly)

Answer 56

selective NE reuptake ihibitor (SNRI)

Answer 57

similar to other stimulants but more fatigue, sedation, and dizziness

Answer 58

1. onset: 2-4 weeks 2. 6-12 weeks when reaching full benefit (must build up)

Answer 59

Boxed warnings: monitor for suicidal ideation in adolescents/children monitor mood changes

Answer 60

1. Dopamine replacement therapy 2. Dopamine agonist therapy

Answer 61

dopamine replacement therapy

Answer 62

1. L-dopa is a precursor to dopamine that can cross the BBB and be converted to have CNS action 2. carbidopa stops the breakdown of l-dopa to dopamine in periphery so that more l-dopa crosses BBB

Answer 63

1. motor disturbances 2. end of dose "wearing off" 3. delayed or "no on" effect 4. freezing 5. "on" perioid dyskinesia

Answer 64

stiffness returns (short 1/2 life of l-dopa)

Answer 65

sudden inhibition of LE function

Answer 66

involuntary mvmt of neck, trunk, extremities due to peak drug levels causing increase dopamine response

Answer 67

L-dopa has a short 1/2 life. have consistent meal routine (high protein meal decreases absorption)

Answer 68

ask them if they are taking the med regularly

Answer 69

Dopamine Agonist Therapy

Answer 70

Binds to and agonizes dopamine receptors - helps with restless leg syndrome

Answer 71

1. Nausea 2. drowsiness 3. dizziness 4. syncope 5. light headedness 6. postural hypotension 7. hallucinations 8. lower extremity edema

Answer 72

1. impulsive behavior 2. sleep attacks

Answer 73

in younger pts. normally be used as adjunct to reduce end of dose wearing off of l-dopa

Answer 74

1. Interferon beta 2. glatiramer acetate 3. fingolimod (Gilenya) 4. dimethyl fumarate (Tecfidera) 5. natalizumab (Tysabri) 6. ocrelizumab (Ocrevus)

Answer 75

Interferon

Answer 76

exact is unknown in MS IFN-B is a protein produced by fibroblasts and has impact on immune function

Answer 77

1. \>50% -- flu like symptoms 2. \>20% 1. fatigue 2. depression 3. pain 4. abdominal pain 5. nausea 6. leukopenia 7. increased LFTs 8. myalgia 9. back pain 10. weakness 11. fever

Answer 78

1. monitorr for neuropyschic changes 2. drug induced hyperthyroidism 3. worsening cardiac function in HF

Answer 79

reduce autoimmune response to myelin by reducing T cell response against myelin

Answer 80

1. \*\*\*injection site rxns (most common) 2. rash 3. dyspnea 4. chest pain

Answer 81

fingolimod (gilenya)

Answer 82

converted to active metabolites which blocks release of lymphocytes into CNS = reduces inflammation

Answer 83

1. \>15% = HA, increased LFTs 2. rare = macular edema, infection

Answer 84

may have anti-inflammatory properties

Answer 85

1. GI (N/V/D, abdominal pain in 12-18%) 2. flushing (40%) 3. \*\*\*Rare = hepatoxicity

Answer 86

1. infusion related rxns 2. HA 3. fatigue 4. arthalgia 5. monitor for infection (respiratory, skin, herpes related)

Answer 87

acetylcholinesterase inhibitor

Answer 88

inhibit acetylcholinesterase which breaks down ACh = increased ACh, corrects for ACh deficiency in AD

Answer 89

SLUDGE DUMBELLS

Answer 90

taper if discontinuing and monitor for worsening cognitive function

Answer 91

1. Beer's list for bradycardia 2. avoid if history of syncope that may be related to bradycardia

Answer 92

NMDA antagonist

Answer 93

antagonised NMDA receptor = stops excessive receptor activation by glutamate = decreases excitation and neuronal death

Answer 94

usually well tolerated monitor for falls

Answer 95

Alpha 2 adrenergic agonist

Answer 96

selectively bind to alpha 2 receptors in CNS to decrease release of excitatory NTs from presynaptic terminals = decreased excitability of postsynaptic neurons

Answer 97

1. dizziness 2. drowsiness 3. asthenia 4. HTN up to 33% within 1 hr (peaks 2-3 hrs after dose)

Answer 98

sedation can occur within 30 minutes of dose peaks ~1.5 hrs after dose may take with or w/o food but be consistent due to variable absorption

Answer 99

Centrally Acting Antispasmodics

Answer 100

unclear may inhibit polysnaptic reflex in spinal cord also possible GABA and serotonin effects

Answer 101

1. sedation 2. dizziness

Answer 102

on Beer's list = increased risk for 1. fractures 2. some anticholinergic effects 3. may have limited efficacy at tolerable doses

Answer 103

inhibitory effect on alpha motor neuron through inhibition of excitatory neurons (blocks Ca influx into presynaptic terminal) = decreases NT release

Answer 104

1. CNS depression 2. muscle weakness 3. impaired memory and cognition in older adults and TBI

Answer 105

increased drug effectiveness with smaller doses using intrathecal method (ITB)

Answer 106

Do not abruptly stop med \>\> can lead to: 1. altered mental state (AMS) 2. fever 3. exaggerated rebound spasticity 4. rhabdomylosis 5. organ failure

Answer 107

psychotic illness w/periods of psychosis chronic dysfunction of mood, cognition, and social behavior

Answer 108

Unknown possible genetic disposition and birth complications

Answer 109

Possible cause reduced prefrontal blood flow during cognitive tasks along with dopamin "dysregulation" (imbalance with overactivity and underactivity in various brain regions)

Answer 110

1. Positive - presence of behaviors 2. Negative - diminished/absent behaviors 3. Cognitive - impaired behaviors

Answer 111

1. hallucinations 2. disturbed reality 3. abnormal motor behaviors

Answer 112

1. diminished speech 2. flattened emotions 3. social withdrawal

Answer 113

1. reduced attention 2. decreased executive function

Answer 114

reduce symptoms and mediate AE while improving function and QOL

Answer 115

easier = positive symptoms harder = negative symptoms

Answer 116

antipsychotics at a min takes 4-6 weeks to observe changes

Answer 117

1. First generation (FGA) = older, more AE 2. Second generation (SGA) = newer, less EPS and TD AEs

Answer 118

SGA = there are less extrapyramidal symptoms and tardive dyskinesia

Answer 119

collection of symptoms that are drug induced movement disorders. include: 1. actue dystonia 2. akathesia 3. delayed tardive dyskinesia 4. acute parkinsonism

Answer 120

repetitive and involuntary movements such as grimicing and eye blinking \*orofacial dyskinesia

Answer 121

spasm of muscles of tongue, face, neck and back

Answer 122

restlessness and inability to stay still, manifests with finger-tapping, pacing

Answer 123

block dopamine receptors in mesolimbic tract where excess dopamine may contribute to postive symptoms

Answer 124

quetiapine (Seroquel)

Answer 125

block D2 receptors but less than FGA; more affinity for 5-HT receptors \*variable effect on histamine, muscarinic and alpha receptors = more variable AE

Answer 126

1. Motor = bradykinesia, and possible EPS 2. Endocrine (higher risk for metabolic syndromes) 3. Neuroleptic malignant syndrome

Answer 127

1. H1 receptors * sedation and wt gain 2. Muscarinic receptors 1. ABCDs 3. a1 receptors 1. hypotension, dizziness

Answer 128

1. CV risks 2. caution with UV exposure 3. imapired thermoregulation = caution with overexertion 4. monitor for EPS

Answer 129

1. wt gain, hyperglycemia, and lipid abnormalities 2. CV abnormalities risk 3. risk for heat intolerance

Answer 130

1. Bipolar I disorder 2. Bipolar II disoder

Answer 131

one manic episode accompanied by history of one or more major depressive episodes

Answer 132

major depressive disorder accompanied by at least one hypomanic or milder manic phases

Answer 133

at least 4 days of elevated/irritable mood combined with over-activity

Answer 134

Unknown appears to be dysregulation in dopamine and serotonin systems

Answer 135

1. limbic-cortical dysfunction * hippocampus and prefrontal cortex have diminished acitivty w/smaller volumes * amygdala is hyperactivity leading to emotional sensitivity

Answer 136

1. acute depressive episode = SSRI, bupropion 2. acute manic episode = lithium 3. maintenance trx = lithium

Answer 137

1. Management of acute manic or hypomanic episode 2. prevention of further manic and depressive episodes

Answer 138

Lots of AEs

Answer 139

1. GI 2. weight gain 3. polydipsia and polyuria 4. CNS issues * mental dullness, decreased memory and concentration, fine hand tremor, fatigue and muscle weakness

Answer 140

can be toxic and toxicity can occur at doses close to therapeutic levels

Answer 141

1. persitent diarrhea 2. vomiting 3. coarse tremor 4. mild ataxia 5. drowsiness 6. muscular weakness

Answer 142

1. medial illness 2. crash diets and Na+ restriction diets 3. strenuous exercise 4. very hot climate 5. surgery 6. advanced age 7. prenancy and delivery

Answer 143

Anticonvulsant medications 1. Valproic acid (VPA 2. Carbamazepine

Answer 144

1. Valproix acid = hepatotoxicity 2. Carbamazepine = Stevens-Johnson Syndrome and toxi epidermal necrolysis (TEN)

Answer 145

decrease HR, CO, and BP

Answer 146

increase sweating by 10% during exercise

Answer 147

beware of premature fatigue -- espeically around 90 min after meds are taken

Answer 148

1. Dihydropyridines 2. Benzothiazepines

Answer 149

1. increased HR at rest and during exercise 2. can leadto angina due to increased myocardial O2 consumption 3. coronary steal phenomenon

Answer 150

shunting of blood from ischemic to normally perfused areas of myocardium all the vessels are dilated reducing any gradient that would drive blood towards ischemic regions

Answer 151

1. reduce HR at rest and during exercise 2. more effective for treating exertional angina 3. less likely to cause reflex tachycardia

Answer 152

nitroglycerin (Nitrates) if they were prescribed to them, make sure it is available during PT

Answer 153

1. 3-5 days/week, 20-60 min duration 2. limit HR increases to 20 bpm above RHR when pt. misses dose or has a dose adjustment

Answer 154

causing bleeding --\> so monitor/prevent for falls!

Answer 155

1. Heparin 2. Warfarin 3. LMWH

Answer 156

prevents conversion of fibrinogen to fibrin

Answer 157

1. increased risk for HIT 2. increased risk for osteoporosis 3. requires monotoring of aPTT

Answer 158

decreaes Vitamin K stores which stops production of coagulation factors

Answer 159

1. monitor INR (increased INR = less clotting factors = increased risk of bleeding) 2. many drug & food inreactions

Answer 160

increases inhibition of FXa (more specific than Heparin)

Answer 161

1. simpler dosing than Heparin and requires no lab monitoring 2. decreased risk of HIT and osteoporosis

Answer 162

1. avoid soft tissue mobilization 2. avoid pressure 3. avoid cutting ot tissue (sharp debridement)

Answer 163

Angina (exertional, variant, and unstable) \*may be used in conjunction with CCB and BB

Answer 164

1. decrease intracellular Ca to work directly on heart smooth muscle 2. this decresaes preload/afterload and decreases O2 demand

Answer 165

IV sublingual (used for acute attacks, tingle means its working) topical (transderm patches)

Answer 166

up to 3 doses in 15 minutes store in dark, brown glass bottle good for 6 months unopened and only 3 months once opened

Answer 167

restore normal rhythm or control abnormal

Answer 168

1. origin = ventricular/atrial (supraventricular) 2. pattern/rhythm = fibrillation or flutter 3. speed/rate = brady or tachycardia

Answer 169

Class II Class III Class IV

Answer 170

beta-blocker try to control rate

Answer 171

Amiodarone controls rhythm (works by blocking K⁺ channles to lengthening AP) \*\*remember blue man

Answer 172

recurrent V-tachycardia

Answer 173

verapril and diltiazem (CCBs) - used for atria \*used to control origin NOT for pts w/HFrEF

Answer 174

1. smoking cessation 2. long-term O2 therapy

Answer 175

Bronchodilators

Answer 176

increased exercise capacity which can improve QOL

Answer 177

1. beta 2 agonists 2. muscarinic antagonists

Answer 178

drug = albuterol used for acute exacerbations onset 5 min duration 4-6 hrs

Answer 179

drug = salmeterol used to maintenance, daily use duration = 12-24 hrs

Answer 180

bronchospasms

Answer 181

1. tremor 2. tachycardia 3. hypokalemia (when taken w/thiazide)

Answer 182

drug = ipratropium used w/nebulizer onset = 15-20 min duration = 6-8 hrs

Answer 183

drug = tiotropium used for maintenance, daily use duration = 12-24 hrs

Answer 184

ABCDs \*specifically dry mouth

Answer 185

PDE-4 Inhibitors

Answer 186

decrease cyclic AMP breakdown = decreased inflammation

Answer 187

1. nausea 2. diarrrhea 3. weight loss

Answer 188

1. CFTR Modulators 2. Bronchodilators 3. Mucolytics

Answer 189

increase chloride transport = increased regulation of Na⁺ and water = mucous thinning

Answer 190

1. GI 2. HA 3. \*Orkambi = hypotension

Answer 191

hypertonic saline dornase alfa

Answer 192

2-4x daily almost all pts use them work by increases salt which increases water in airway = water down mucus = increased function of mucociliary elevator

Answer 193

1-2x daily amost all pts work by cleveing DNA = decreased viscosity of mucus AE: chest pain

Answer 194

1. time PT w/meds 2. watch for paradoxial breathing 3. B-agonists and methylxanthines = Increase RHR 4. watch for R vent failure 5. pts should always carrier rescue inhaler (especially during PT sessions)

Answer 195

Diabetic Autonomic Neuropathy

Answer 196

1. exercise intolerance (BP and HR response blunted) 2. orthostatic hypotension 3. Silent MI 4. hypoglycemima unawareness

Answer 197

delay in recognizing angina unexplained fatigue, condusion, dyspnes, N/V, hemoptysis, diaphoresis, dysrrhthmias, edema

Answer 198

exercise does not increase glucose uptake, possibly due to increased free fatty acids

Answer 199

1. monitor blood glucose with exercise * before * during * after (2 hrs after, possibly middle of night) 2. make changes in insulin and carb consumption

Answer 200

1. Proper footwear is essential 2. avoid high impact activitees for older adults 3. keep fast acting CHO nearby 4. no exercise if glucose \>300 mg/dL 5. injest CHO if glucose \<70 mg/dL prior to activity 6. avoid insuling injection sites 7. illness can increase glucose levels

Answer 201