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Pharm Test 2 > Unit 5 Discussion Questions > Flashcards

Unit 5 Discussion Questions Flashcards

0
Q

Which CYP450 Enzyme metabolizes most SSRIs ?

A

CYP2D6

No “one effect only” when using these and all drugs

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1
Q

What is the pathophysiological reason that many CNS drugs are on the Beers Criteria coda avoiding in elderly?

A

The Anticholinergic side effects are seen in both the peripheral and central nervous system.

Many if the listed meds can cause unstable gaits and predispose pt to falls

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2
Q

Which antidepressant group of drugs should be avoided if a patient is on Warfarin?

A

Fluoxetine
Fluvoxamine

Will increase bleeding !

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3
Q

A patient is taking warfarin and is depressed. Which of the following is an unsafe prescription?
A. Celexa
B. Fluoxetine
C. Lexapro

A

Fluoxetine will increase bleeding

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4
Q

A patient is taking citalopram for depression and should take which med to help with his arthritis?

A

Acetaminophen.

Avoid NSAIDs!!!! Citalopram is substrate of CYP2C19 enzyme and can cause increased bleeding with NSAIDs. Or NSAIDs will decrease effectiveness of citalopram or escitalopram.

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6
Q

Why can’t a patient on duloxetine (Cymbalta) take hydrocodone/APAP?

A

The two drugs will compete for metabolism of 2D6 and one of them will have decreased effectiveness.

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7
Q

Why can’t a patient taking methadone for withdrawal begin a course of carbamazepine for trigeminal neuralgia?

A

carbamazepine is an enzyme inducer which can increase elimination of oxycodone via CYP3A4 resulting in a reduced analgesic effect. This could cause withdrawal symptoms

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8
Q

Which CYP450 enzyme class changes codeine to its active form?

A

CYP2D6 converts codeine into morphine.
poor metabolizer: won’t convert, no pain relief
rapid metabolizer: toxic dose of morphine

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9
Q

Which CYP450 enzyme family is responsible for metabolism of most narcotics?

A

CYP2D6 metabolizes:

codeine, hydrocodone, opiods,tramadol, SSRIs, antidepressants

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10
Q

Which of the agents for ADHD has best record for treating the disorder?

A

methylphenidate (Ritalin)

will lower threshold in seizure patients*

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11
Q

What medication is contraindicated with methylphenidate (Ritalin)?

A

MAOIs: cause hypertensive crises for 2 weeks post drug due to increased levels of dopamine, serotonin, and norepinephrine from taking methylphenidate.
Glaucoma, motor tics.

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12
Q

Why is modafinil not recommended in patients with known cardiac disease?

A

it is a psychostimulant and can cause cardiac stimulation, dilation of artery and peripheral blood vessels, constriction of cerebral blood vessels, skeletal muscle stimulation and diuretic activity. Tachycardia and PVCs as well.

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13
Q

Which neurotransmitter is defecit in Alzheimers disease?

A

acetylcholine

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14
Q

Which neurotransmitter is defecit in Parkinson’s disease?

A

Dopamine

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15
Q

Which neurotransmitter is defecit in depression?

A

serotonin and norepinephrine

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16
Q

Name 2 types of drugs given for Alzheimers disease

A

cholinesterase inhibitor: donepezil (Aricept)
-more acetylcholine remains in synaptic cleft
NMDA receptor: memantine (Namenda)
-stimulated by glutamic acid and linked to learning and memory

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17
Q

What side effects would you expect to be more common in elderly due to donepezil and memantine?

A

donepezil: N/V, diarreha, dizziness, weakness, weight loss, liver metabolizes.
memantine: same but monitor renal impairment

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18
Q

Define opioid tolerance

A

a pharmacologic phenomenon characterized by decreasing drug effect over time. Patients need more drug for same effect.

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19
Q

Define opioid dependence

A

body develops withdrawal symptoms when drug is discontinued or antagonist is given. Drugs must be slowly tapered to eliminate withdrawal symptoms.

20
Q

Define opioid addiction

A

psychological dependence. obsession over the drug. dangerous.

21
Q

Between opioid tolerance, dependence, or addiction; which is most problematic?

A

addiction.

Addiction is a problem but do not deprive adequate pain relief for fear of addiction.

22
Q

Pain occurring from connective tissue, muscle, or bone and skin described as sharp well localized or dull, aching, or throbbing describes:

A

somatic pain

23
Q

Pain occurring in the internal organs and is poorly localized with presence of nausea vomiting, constant, deep, cramps, or sharp describes:

A

visceral pain

24
Q

Pain arising from a lesion or dysfunction of the peripheral or central nervous systems or both described as sharp, shooting, electric and numbness kind of pain describes:

A

neuropathic pain

25
Q

What are some non pharmacologically treatment options to pain relief?

A

distraction, meditation, music, art, physical therapy, acupuncture, massage, chiropractic manipulation, TENS stimulation, thermal applications (ice or heat)

26
Q

How do adjuvant medications help in management of chronic, progressive pain?

A

antidepressants, antiinflammatories, anticonvulsants, and muscle relaxants can be given in conjunction with opioids and provide pain relief by working through opioid independent pathways.

27
Q

What is the role of rescue pain medications in hospice care?

A

serve as a short-acting medication for immediate control of pain. Important to teach patients to ANTICIPATE PAIN exacerbations and act proactively when pain will worsen. Especially with post op patients.

28
Q

What side effect of meperidine (Demerol) when used for chronic pain can be serious?

A

high risk for seizures and neurotoxicity .
watch renal patients= toxicity
meperidine travels down 2 hepatic pathways to metabolize and turn drug into normeperidine which has a 2 to 3 times longer half life.

29
Q

Why should a transdermal patch of fentanyl not be cut before application?

A

rapid action can immediately cause respiratory depression and death related to destruction of patch. narrow therapeutic / toxic window.

30
Q

What medications are useful in aborting an early, mild migraine? In preventing migraine?

A

Triptans - early in the attack

31
Q

Why should sumitriptan not be used in a patient with known myocardial ischemia?

A

sumitriptan causes coronary vasospasm- life threatening arrhythmias can occur.
Migraine is caused by vasospasm that leads to vasodilation (this is when pain sets in). the earlier period of vasospasm can exacerbate angina!

32
Q

What is ergotism?

A

Ergotism is the adverse effect of ergot alkaloid use. Severe vasoconstriction of blood vessels results in peripheral vascular ischemia and even gangrene.

33
Q

A patient is taking Cafergot for a migraine. What drugs are contraindicated with Cafergot?

A

Any med for which the primary metabolism would be 3A4 system. CYP3A4 inhibitors would cause levels of the ergots to increase leading to potential for ergotism. (protease inhibitors, azole antifungals, and some macrocolides)

34
Q

At which ion channels does phenytoin act?

A

Phenytoin acts by blocking sodium channels

35
Q

Mechanism of action: phenytoin

A

the site of action for hydantoins is in the primary motor cortex causing the spread of seizure activity to be inhibited. Phenytoin also has antiarrhthmic properties and can be used “off label” for arrhythmia treatment.
* Monitor phenytoin- narrow therapeutic index!

36
Q

Which drugs activate the inhibitory neurotransmitter, gamma amino butyric acid (GABA)?

A

Benzodiazepenes

37
Q

Most effective drug treatment for Parkinson’s:

A

Levodopa

38
Q

Which group of antidepressant drugs must be stopped prior to a Parkinson’s patient taking Levodopa?

A

MAOI antidepressants Nardil, Parnate, Marplan
must be stopped because they will cause increased concentrations of the neurotransmitters serotonin, norepinephrine, and dopamine.

39
Q

What is serotonin syndrome?

A

potentially life threatening when significant amounts of serotonin build up in body. It can accumulate with drugs: SSRIs, migraine headache meds, and pain meds.

40
Q

What drug classes most likely cause serotonin syndrome?

A

SSRIs: citalopram, paroxetine, fluoxetine, sertraline
SNRIs: Effexor
Tricyclic antidepressants: nortriptyline, amitriptyline
MAOIs: Nardil, Parnate, Marplan
Wellbutrin
Migraine meds: axert, amerge, imitrex
illegal drugs: LSD, ecstasy, cocaine, amphetamines
herbal supplements: St. John’s wort, ginseng
OTC meds: dextromethorphan, Robitussin DM, Delsym

41
Q

Which drug classes produce the side effect of depression?

A

Benzodiazepines
Calcium channel blockers
Estrogens
Beta-adrengergic blockers

42
Q

What does the black box warning indicate on antidepressant meds?

A

SSRIs: risk of suicide and suicidal tendencies among children and adolescents

43
Q

Why should SNRIs not be taken with monoamine oxidase inhibitors (MAOIs)?

A

hypertensive reaction or serotonin syndrome

44
Q

When doing a med reconciliation form for your hypertensive patient you notice they are on an SNRI. What other med could be causing the hypertension?

A

MAOIs . patients need to wait at least 2 weeks after stopping SNRIs to begin MAOI course.
serotonin syndrome will happen!

45
Q

What are cardinal points of treatment for insomnia?

A
  1. Natural first: sleep hygiene, regular schedule, avoid caffeine and alcohol etc.
46
Q

What drugs are indicated for insomnia?

A

Benzodiazepines
Nonbenzodiazepines
Sedatives
Melatonin agonists

47
Q

Are insomnia drugs safe during pregnancy?

A

NO- birth defects. encourage natural remedies.

Pharm Test 2 (11 decks)

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