pharmacy test 1 Flashcards
Medication Used to Treat Status Epilepticus
Diazepam. It works faster than Lorazepam
Phenytoin (Dilantin) Therapeutic Levels
10-20 μg/mL
Highly protein bound
Phenytoin (Dilantin) Administration
Administered with a very slow IV push. Very irritating to the vein because of fucking ANTIFREEZE
Large gauge (20) needle with a filter
May only be mixed with normal saline
Carbamazepine (tegretol) Adverse Effects
anemia, leukemia, and steven-johnsons syndrome. Interactions with warfarin and decreases effectiveness of contraceptives.
Do Antiepileptics Have a Black Box Warning?
Yes, for suicidal ideation
Levetiracetam (keppra)
mostly used for adjunct therapy for partial seizures with or without secondary generalization.
Mechanism unknown. No known drug interactions. Generally well tolerated but may have adverse CNS effects.
Pregabalin (lyrica)
schedule V controlled substance
Indication: adjust therapy for partial seizures, neuropathic pain, postherpetic neuralgia, and fibromyalgia.
Adverse reactions are CNS related but none were highlighted or stressed in lecture.
Valproic Acid (depakote)
Highly protein bound for treatment of seizures
Valproic Acid (depakote)
Highly protein bound for treatment of seizures
Phenytoin (Dilantin) Adverse Effects
GIGIVAL HYPOPLASIA, acne, hirsutism (excessive male pattern hair growth in women), Dilantin facies, and osteoporosis
Convulsions Vs Seizures
Seizures: nerves are too excited
Convulsions: spasmodic contractions
Amantadine (symmetrel)
Used early in the Parkinson’s disease process, ineffective after 6-12 months.
Common side effects: dizziness, insomnia and nausea. Interacts with anticholinergic drugs.
Benztropine (cogentin) and diphenhydramine (benadryl)
block the effects of acetylcholine (ACh) relaxing smooth muscle.
Not for patients with bradykinesia symptoms. Adjust therapy for anti-dyskinetic properties.
HIGH RISK FOR HYPERTHERMIA. Cause dry mouth, urinary retention, decrease GI motility also used to block EPS with antipsychotics.
Selegiline (eldepryl) and rasagiline (azilect)
avoid fermented foods.
are selective MAO-B inhibitors. Either given alone or in adjective therapy with levodopa. Cause an increase in levels of dopaminergic stimulation in the CNS. Watch out for the cheese effect. Do not use with meperidine (demerol).
cheese effect
An acute attack of hypertension that can occur in a person taking a monoamine oxidase inhibitor (MAOI) drug who eats cheese or other fermented foods.
Lovenox
Given in the abdomen. Lovenox in love handles.
pre filled syringe, give WITH the air bubble.
Low-molecular weight heparins contraindication
never give when a patient has an epidural because it can lead to epidural hematomas
unfractured heparin antidote
protamine sulfate
side effects of heparin
you’re bleeding everywhere.
hematuria, melena (blood in the stool), petechiae, ecchymoses, and gum or mucous membrane bleeding
side effects of heparin
you’re bleeding everywhere.
hematuria, melena (blood in the stool), petechiae, ecchymoses, and gum or mucous membrane bleeding
Dabigatran (Pradaxa)
thrombin inhibitor approved for stroke and thrombosis prevention.
Dabigatran (Pradaxa) Antidote
Idarucizumab (Praxbind).
seizure assessment
last occurrence, length, and description.
CBC and liver panel
Gabapentin (neurontin)
chemical analogue of GABA, a neurotransmitter that inhibits brain activity. Treatment of partial seizures, but most often used for treatment of neuropathy. Do not give if the patient is allergic. Adverse effects include CNS and GI symptoms.
Tolcapone (tasmar) and entacapone (comtan)
locks COMT, the enzyme that catalyzes the breakdown of the body’s catecholamines.
Prolongs duration of action of levodopa.
Can decrease the on/off effect
Tolcapone (tasmar) and entacapone (comtan) adverse effects
Adverse effects: GI upset; urine discoloration; can worsen dyskinesia that may already be present. Tolcapone has been associated with cases of severe liver failure.
Direct-Acting Dopamine Receptor Agonists
Pramipexole, ropinirole, and bromocriptine
Used in early and later stages of parkinson’s. Stimulates receptors to increase dopamine.
Better in younger patients who can tolerate drowsiness and postural hypotension. Also used for restless leg syndrome
On-Off Phenomenon
Rapid swings in response to levodopa can occur. PD worsens when too little dopamine is present. Dyskinesia occurs when too much dopamine is present.
Carbidopa-Levodopa (Sinemet)
Sinemet CR can increase the “on” time and decrease “off” time. Best taken on an empty stomach to minimize GI upset.
Most effective PD drug
Carbidopa (Lodosyn)
Best taken on an empty stomach to minimize GI upset. Carbidopa is often given with levodopa because it does not cross the blood brain barrier and somehow promotes more levodopa to get across. The most effective drug available.
Benztropine (cogentin) and diphenhydramine (benadryl)
block the effects of acetylcholine (ACh) relaxing smooth muscle. Not for patients with bradykinesia symptoms. Can cause dry mouth, urinary retention, decrease GI motility also used to block EPS with antipsychotics.
Levodopa
is the biologic precursor of dopamine and works presynaptically to increase brain levels of dopamine. It is able to cross the blood brain barrier to be converted to dopamine in the brain. It is generally only effective for 5-10 years. Must be given orally. Effectiveness decreases after the first 1-2 years of treatment.
Adverse effects include confusion, involuntary movements, GI distress, etc
Anticoagulants
also known as antithrombotic drugs. Do not affect clots that are already formed, can only prevent further clotting. Used prophylactically.
Low-molecular weight heparins order
DVT prophylaxis order is typically 5000 units SQ given 2-3 times daily
Lovenox and Fragmin
low molecular weight heparins
Unfractured heparin therapeutic route
IV. must monitor with aPTT
Heparin induced thrombocytopenia
can lead to thrombosis, which can be fatal
Can be treated with thrombin inhibitors lepirudin and argatroban.
Warfarin (coumadin) antidote
Vitamin K
Kcentra and Profiline
Warfarin (coumadin) therapeutic level
2-3.5
Factor Xa drugs
Fondaparinux (Arixtra), Apixaban (Eliquis), Edoxaban (Savaysa), Betrixaban (Bevyxxa),
Rivaroxaban (Xarelto) - used for prevention of strokes in patients with a-fib
Direct Thrombin Inhibitors
Human antithrombin III (Thrombate), Lepirudin (Refludan), Argatroban (Argatroban), Bivalirudin (Angiomax), Dabigatran (Pradaxa)
Dabigatran (Pradaxa) antidote
Idarucizumab (Praxbind)
Aspirin contraindications
for flu-like symptoms in children and teenagers (Reye’s Syndrome)
most common prescription for aspirin
81 mg
Do not take on an empty stomach, recommend enteric coated version to protect the stomach lining.
Clopidrogrel (Plavix)
is the most widely used ADP inhibitor
Eptifibatide (Integrilin)
is a GP lib/IIIa inhibitor. Given IV (typically in an ICU or cardiac unit).
Alteplase (activase)
fibrin specific so it does not produce a systemic lytic state.
Typical order: 0.9 mg/kg IV over 60 minutes, not to exceed 90 mg.
drugs to treat systemic fungal infections
-zoles and -ins
caspofungin, voriconazole, Amphotericin B
fluconazole, flucytosine, griseofulvin, itraconazole, ketoconazole, micafungin, nystatin, terbinafine, posaconazole, anidulafungin
drug of choice for Aspergillus for patients not tolerant to other drugs
Caspofungin
warfarin blood test
pt/INR
prothrombin time
also called bleeding time
heparin blood test
aPTT
Activated Partial Thromboplastin Clotting Time
Fluconazole special skill
passes through the blood brain barrier
the b in Amphotericin B stands for bitch because
To reduce the severity of the infusion-related reactions, pretreatment with an antipyretic (acetaminophen), antihistamines, antiemetics, and corticosteroids may be given.
the b in Amphotericin B stands for bitch because
To reduce the severity of the infusion-related reactions, pretreatment with an antipyretic (acetaminophen), antihistamines, antiemetics, and corticosteroids may be given.
Mupirocin (Bactroban) is no longer effective against
MRSA
topical drugs for lice and scabies
spinosad (Natroba)
Ivermectin – you do not need to comb out the knits
lindane (Kwell)
malathion (Ovide)
crotamiton (Eurax)
benzyl alcohol 5% (Ulesfia)
