Quiz 3 Flashcards
Undertreated acute pain can lead to what kind of pain?
chronic
what makes Cox-2 inhibitors different from NSAIDs
Cox-2 inhibitors effect Cox 2 enzyme while NSAIDs effect Cox-1 & 2 inhibtors
What is the common explanation for cerebrovascular and cardiovascular events in patients taking Cox-2 inhibitors?
They don’t inhibit thromboxane (which naturally causes vascular constriction and platelet aggregation) while they do inhibit helpful prostaglandins that stabilize plaques (atherosclerosis) and platelet aggregation.
Why do NSAIDs cause more GI bleeding than COX-2 inhibitors?
NSAIDs block both cox-1 and cox-2 therefore platelet aggregation is unable to occur. while cox 2 inhibitors just block heat and inflammation responses
Why does 1 aspirin effect your platelets for a week?
It’s an irreversible Cox-1 & Cox-2 antagonist
What are important side effects of NSAIDs?
Renal insufficiency or failure, peripheral edema, bleeding, GI bleeding, mild increase in BP, CHF (due to fluid retention), allergic reactions
Does Tylenol decrease swelling? What does?
No, but NSAIDs & Cox-2 inhibitors do
Know Tylenol toxicity
significant risk of hepatotoxicity (liver toxicity
Opioids can have dangerous synergistic effects when combined with what other CNS depressants?
benzodiazepines, barbiturates, alcohol
What are the symptoms of opioid withdrawal?
Don’t forget mydriasis, diaphoresis, diarrhea, anxiety
What is the antidote for opioid overdose
Narcan (naloxone)
Which causes more peaks & troughs in terms of pain relief/ euphoria/ low serum opioid level?Long acting opioids (oxycontin, fentanyl patch, controlled release morphine) or short acting opioids (oxy IR, Percocet, morphine IR, IV fentanyl)? Which has a higher abuse potential? Answer: short acting opioids.
short acting opioids
Can Personality disorders be cured with medication?
no, only controlled
What neurotransmitter in certain antidepressants is thought to be useful in treating pain?
Norepinephrine
What are the common adverse effects of SSRIs
Fatigue, difficulty with sleep, appetite changes, GI upset, HYPONATRENIA
Why might a patient’s SSRI be thought to be a cause of excess bleeding or impaired clotting ability?
They impair platelet aggregation.
What neurotransmitter is affected with SSRIs?
Seratonin
What neurotransmitters are affected with tricyclic antidepressants
seratonin and norepinepherine
What are side effects of TCA’s?
Anticholinergic: GI upset, constipation, urinary retention, dry mouth, blurry vision. Sleepiness, fatigue
What neurotransmitters are affected with SNRIs?
seratonin and norepinepherine
What could happen to a patient eating a high tyramine diet while on an MAO inhibitor?
high blood pressure
How long does it take for a patient to really feel the benefit of an antidepressant?
3-4 weeks
Which is potentially more lethal in overdose, SSRI’s or TCAs?
TCAs can cause cardiac dysrhythmia in over dose
If the prescriber is concerned about a patient overdosing on any medication what can the prescriber do?
, hospitalization is considered, a week supply (or less) is given at one time. Family members are incorporated into patient’s care (i.e. the family holds onto the medication supply and administers it when due).
SSRIs, SNRIs, MAOIs, & TCAs help with what 2 conditions?
depression and anxiety
Dopamine stimulation in the brain is associated with what?
reward (such as enjoyable activity)
what is a good treatment of OCD?
very high doses of antidepressents
Pseudobulbar affect is a neurological condition. The laughing & crying should improve after a few days of what drugs?
TCA, SSRI or Neudexta
if the patient has depression will it take longer or shorter for antidepressents to work?
longer
why does breslin dislike neudexta
because neudexta when given to an already mentally compromised patient can cause even greater mental cloudiness and misjudgement when they need all the marbles they can get.
Patients who “switch” or become manic or hypomanic while taking an antidepressant may be what condition?
bipolar. They will probably need a mood stabilizing medication in addition to the antidepressant
what is the gold standard to treat bipolar disorder?
lithium
what are side effects of lithium? 5
after years of therapy? 2
include tremor, muscle weakness, change in appetite, thirst, anticholinergic effects of dry mouth & blurry vision). After years of therapy: thyroid dysfunction & renal failure).
what drugs can be used to treat patients with bipolar disorder and patients with other disorders suffering from mood instability (mania, hypomania, rage, aggression, depression). (3)
antiepileptic (Antiseizure) medicines such as Depakote, tegretol, Topamax
which drugs require serum blood level monitoring?
lithium, depakote, and tegretol
what drugs are used to treat patients with schizophrenia and psychosis? (5)
what else can they treat?
Haldol, thorazine, Zyprexa, Risperdal (Seroquel), Abilify
They can also be used to treat patients with bipolar disorder and patients with other disorders suffering from mood instability (mania, hypomania, rage, aggression, depression). They also help augment the antidepressant in patients with resistant depression
what do antipsychotics block in the brain?
Dopamine
Typical antipsychotics are broader spectrum and block dopamine heavily. This results in more what?
what are 2 examples of this?
dystonias, movement disorders, parkinsonism, NMS, sedation. Haldol and Thorazing are examples)
Atypical antipsychotics are narrower spectrum and are more specific in dopamine blockade in the brain. what are some common side effects of these?’
what are some examples of this
sedation, weight gain, metabolic syndrome elevated prolactin levels.
Zyprexa, Clozaril, Risperdal, Abilify, Seroquel
Atypical antipsychotics have a boxed warning about increased what?
cerebrovascular and cardiovascular disorder
What is NMS?
is a life-threatening neurological disorder most often caused by an adverse reaction to neuroleptic or antipsychotic drugs.
what are the symptoms of NMS?
Muscle rigidity, fever, autonomic instability, and cognitive changes such as delirium
Tardive Dyskinesia
involuntary, repetitive body movements. slow or belated onset. appears after long-term or high-dose use of antipsychotic drugs
what are the most common cause of NMS?
Haldol antispsychotic
Unless contraindicated, everyone with CAD (coronary artery disease) gets daily of what drug?
Asprin
following ischemic stroke what is the number 1 ASA drug of choice for stroke prophyslaxis?
Asprin
If a patient has an ischemic stroke and they were taking ASA daily, they get put on another antiplatelet agent instead. what are these drugs?
is Plavix or Aggrenox. Newer agents include Brilinta and Effient.
patients with a stent are usually placed on what kind of agent?
what does this prevent?
antiplatlet agent such as clopidogrel (Plavix) brilinta, or effient which help prevent occlusion
Antiplatelet agents such as what are given to patients who have an ischemic stroke while taking aspirin.
Plavix and Aggrenox
what drugs are used for DVT/PE?
Low dose subcutaneous Heparin, enoxaparin (Lovenox) or fonduparinux (Arixtra)
what drugs are given for DVT, PE or thrombus treatment?
Higher dose Heparin (IV), Lovenox, & Arixtra
what is HIT caused by?
Heparin & Lovenox. Serum platelet count drops with HIT. In HIT patient develops positive heparin antibodies
what is coumadin (warfarin)?
orally administered anticoagulant
what blood test is used to test titrate coumadin dosing?
INR
Pradaxa and Xarelto don’t require blood testing.
what vitamin does coumadin block in the liver?
vitamin K (needed to produce clotting factors
what is used to lyse a clost in acute non-hemorrhagic stroke?
t-PA There are protocols for its use in the ICE and ER settings such recent trauma, TBI, ICH, high INR which prohibit the use of t-PA
drugs which do which three things can make patients bleed?
inhibits platelets, anticoagulants or dissolves clots
what are common unwanted side effects of anticoagulants? 4
intracranial hemorrhage (ICH), GI bleed, hemorrhagic conversion of stroke, bleeding at surgery site(s)
what 2 things can suppress bone marrow creation?
what 3 conditions does this lead to?
chemotherapy and radiation
leukopenia, anemia, and thmbocytopenia
what is the most common anemia?
iron deficiencyanemia
what is the best method to increase iron in the body?
diet
what vitamin helps absorbtion of iron?
vitamin C
what are side effects of iron supplementation?
Constipation, nausea, and dark stools
what are given to patients who have high iron? why?
IV steroids are given prior to the iron to suppress overreaction of the inflammatory response
taking iron with food helps what condition?
nausea
Severe leukopenia leaves a patient at risk for what?
Infection
what injections help bring up WBC counts?
what rare thign can occur during this?
Filgrastim (Neulasta, Neupogen) injection
splenic rupture
what kind of anemia is B12 deficiency
what are symptoms of this?
how to treat?
macrocytic anemia
ataxia, decreased sensation, and decreased vibratory sense
B12 supplementation
folate sufficiency is treated with what?
folic acid
Macrocytic anemia is a high what? micro?
cell volume in blood
Severe anemia can be treated with a drug that simulates what?
erythropoietin
what are side effects of epogen? 3
thrombosis, allergic reaction and worsening of underlying cancer
