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Pharm > Week 2 > Flashcards

Week 2 Flashcards

1
Q

Which drug class is Chlorpromazine in?

A

Typical antipsychotic (works on positive symptoms)
Phenothiazine first gen antipsychotic

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2
Q

Which drugs are first generation (typical psychotics)?

A

Haloperidol and chlorpromazine hydrochloride

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3
Q

What are delusions?

A

False beliefs that persist even in the absence of reason

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4
Q

What is paranoia?

A

Belief that others are trying to control their thoughts and are out to get them

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5
Q

What is the basic patho of schizophrenia

A

Abnormal neurotransmission systems - Especially dopamine, serotonin, and glutamate

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6
Q

When does schizophrenia usually present in males and females?

A

Early 20s for males
Later 20s, early 30s females

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7
Q

What are positive symptoms?

A

Present but should not be there

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8
Q

What are negative symptoms?

A

Missing but should be there

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9
Q

What is the goal when treating psychosis?

A

Relieve symptoms with minimal/tolerable side effects

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10
Q

What do first generation antipsychotics do?

A

Block dopamine receptors
Depress RAS

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11
Q

What is the MOA of chlorpromazine?

A

Blocks dopamine receptors in the brain

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12
Q

How is chlorpromazine given?

A

PO or IM (Ventrogluteal)

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13
Q

What is the pathway for chlorpromazine?

A

Metabolized in the liver and excreted in the urine

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14
Q

What are the indications for chlorpromazine?

A

Schizophrenia
Treatment of psychotic symptoms r/t brain impairment

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15
Q

When can chlorpromazine be used in children?

A

Pre-op anxiety
Psychosis in children older than 6 months
Treatment of nausea/vomiting

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16
Q

What is a precaution r/t to giving chlorpromazine to older adults?

A

Small doses and titrate

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17
Q

How else can Chlorpromazine be used?

A

In the critically ill to treat delirium

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18
Q

What are some side effects of chlorpromazine in the critically ill?

A

Anticholinergic symptoms
Hypotension/tachycardia
Arrhythmias
Extrapyramidal symptoms
Lowers seizure threshold

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19
Q

What are adverse effects of chlorpromazine?

A

Seizures and sedation
Extrapyramidal movements
Neuroleptic malignant syndrome
Prolonged QT
agranulocytosis

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20
Q

What drug can cause neuroleptic malignant syndrome and what are the symptoms?

A

Chlorpromazine

Fever, muscle rigidity, decreased LOC, diaphoresis, arrhythmia

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21
Q

What are the contraindications for chlorpromazine?

A

Liver disease
Coronary artery disease
Parkinson’s disease
Bone marrow depression
Severe hypo/hypertension

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22
Q

What are some nursing considerations for chlorpromazine?

A

Inpatient for psychosis: IM s 48-72 hours until pt can take PO meds
IM: supine positioning for 30-60 minutes
PO: 1-2 hours before bedtime; contact dermatitis can happen if the liquid hits the skin
Take with food

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23
Q

How to assess if chlorpromazine is working?

A

Decreased- agitation, combativeness, psychomotor activity
Decreased hallucinations and/or delusions

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24
Q

What are some monitoring rules for chlorpromazine?

A

Baseline ECG
I/O and daily weight to assess for dehydration
CBC, renal/hepatic function
CNS depression and abnormal movements
Aspiration risk

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25
Q

What are some teaching points for chlorpromazine?

A

Avoid OTC meds and alcohol
Keep hydrated
Orthostatic hypotension

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26
Q

What drug class is Haloperidol?

A

Nonphenothiazine first generation antipsychotic
Typical antipsychotic

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27
Q

What is the MOA of haloperidol?

A

Blocks dopamine receptors in the brain
Not fully understood

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28
Q

What is Haloperidol used for?

A

Used to control symptoms of schizophrenia and psychotic disorders

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29
Q

What is the pathway for Haloperidol?

A

Metabolized in the liver and Excreted in urine and bile

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30
Q

How is Haloperidol given?

A

PO or IM ventrogluteal

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31
Q

What are some special precautions for Haloperidol?

A

Black box warning for children- Extrapyramidal and withdraw symptoms in those exposed

Older adults- Not approved for dementia-related psychosis- increased risk of death in those with a hx of it

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32
Q

What are some adverse effects of Haloperidol?

A

Prolonged QT
Extrapyramidal, Neuroleptic malignant syndrome
Hyper/hypoglycemia

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33
Q

What are contraindications for Haloperidol?

A

Parkinson’s disease
Seizure disorder
Severe depression

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34
Q

Nursing considerations for haloperidol?

A

Put in a light protected container
Deep in dorsogluteal muscle

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35
Q

How to assess if Haloperidol is working?

A

Pt is thinking clearer
Pt is calmer and less anxious

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36
Q

What are some monitoring tidbits for Haloperidol?

A

Heart rate
blood pressure
Watch for respiratory depression
Adverse effect includes increase in temperature

Have pt lay down for an hour after giving if they have orthostatic hypotension

37
Q

What are some labs to watch when someone is given Haloperidol?

A

EKG- prolonged QT
blood glucose
Baseline renal and hepatic

38
Q

What are some education topics for Haloperidol?

A

Report symptoms of adverse effects including: tardive dyskinesia (uncontrolled facial movements), dystonia (uncontrolled muscle spasms), and akathisia (hard to stay still)

39
Q

What do typical and atypical antipsychotics work on?

A

Positive symptoms- typical
Negative symptoms- atypical

40
Q

What is the drug class of Clozapine?

A

Second generation antipsychotic

41
Q

What is the drug example for second generation antipsychotics?

A

Clozapine

42
Q

What is the MOA of clozapine?

A

Unclear

Blocks dopamine, serotonin, and glutamate receptors

43
Q

What is the use of clozapine?

A

For treatment resistant schizophrenia

To reduce suicide risk in schizophrenia or schizo affective disorders

44
Q

What is the pathway of clozapine?

A

Liver metabolizes, excreted in urine/feces

45
Q

What are some special population considerations for clozapine?

A

Children should only receive with treatment resistant disease- higher risk of agranulocytosis

Black box warning for elderly with dementia - not approved for dementia related psychosis

46
Q

When is clozapine contraindicated?

A

Pregnancy
Immunocompromised
Diabetics
Those with seizure disorders

47
Q

What are adverse effects of clozapine?

A

Severe constipation
Myocarditis
Infection risk
Hyperglycemia

48
Q

How should the nurse assess a pt who is given clozapine during an acute psychotic episode?

A

The nurse should observe for sedation, decreased agitation, combativeness, and psychomotor activity

49
Q

How should the nurse assess a pt who is given clozapine for an acute or chronic psychosis?

A

Decreased psychotic behaviors

50
Q

What are some monitoring rules for clozapine?

A

CBC
frequent ANC
Glucose
temperature

51
Q

What are some teaching points for clozapine?

A

Take 1 week of medication at a time
Report lethargy, weakness, flu like symptoms to provider

52
Q

What do the dopamine sites of action relate to with addiction?

A

Alcohol, amphetamines, cocaine, nicotine

53
Q

What do the norepinephrine sites relate to with addiction?

A

Amphetamines and cocaine

54
Q

What drug class is Chlordiazepoxide?

A

Benzo for acute alcohol withdrawal

55
Q

What is the pathway of Chlordiazepoxide?

A

Metabolized in liver and excreted in kidneys

56
Q

What are contraindications for Chlordiazepoxide?

A

Pregnancy and lactation
Glaucoma
Shock
Acute alcohol intoxication

57
Q

What are adverse effects of Chlordiazepoxide?

A

CNS depression
Paradoxical reactions
Anticholinergic symptoms
Jaundice

58
Q

How to monitor and assess pts on Chlordiazepoxide?

A

Neuro assessment and sedation level

Check for adverse effects

Monitor heart rate and BP and 02 levels

Keep eye on urine and liver enzymes labs

59
Q

What is the drug that is a benzo for acute alcohol withdrawal?

A

Chlordiazepoxide

60
Q

What drug class is Disulfiram in?

A

Enzyme inhibitor for maintenance alcohol sobriety

61
Q

What is the drug that is an enzyme inhibitor for maintenance of alcohol sobriety?

A

Disulfiram

62
Q

What is the MOA of disulfiram?

A

Inhibits aldehyde dehydrogenase to block the oxidation of alcohol

63
Q

What happens when disulfiram is taken with alcohol?

A

Produces unpleasant reactions when taken with alcohol

64
Q

What is the pathway of disulfiram?

A

Metabolized in the liver slowly and excreted in the lungs and feces

65
Q

What is the indication for disulfiram

A

Chronic alcoholism to maintain sobriety

66
Q

What are adverse effects when disulfiram is taken with alcohol?

A

Arrhythmia
Cardiovascular collapse
MI
Death

67
Q

What are contraindications for disulfiram?

A

Use with alcohol
Multiple drug dependence
History of MI, coronary occlusion, or psychosis

68
Q

Teaching for disulfiram?

A

Never consume alcohol in any form or hold the medication if alcohol is consumed

Includes mouthwash, OTC cold meds, vinegars, sauces

69
Q

What drug class is methadone hydrochloride in?

A

Opioid agonist

70
Q

What is the drug within the class opioid agonist

A

Methadone hydrochloride

71
Q

What is the MOA of methadone hydrochloride?

A

Binds And activates opioid receptors

72
Q

What is an important consideration for methadone hydrochloride?

A

Risk of death when started; emergency services on standby, QT prolongation

73
Q

What are contraindications for methadone hydrochloride?

A

Acute/severe asthma in uncontrolled setting

Paralytic ileus

Significant respiratory depression

74
Q

What are some adverse effects of methadone hydrochloride?

A

Prolonged QT
bronchospasm

75
Q

What are some nursing considerations and teaching for methadone hydrochloride?

A

Compliance with daily dosing at clinic

Monitor QT prolongation

Many pts abuse other drugs while on methadone

76
Q

What drug class is Naltrexone in?

A

Opioid antagonist

77
Q

What drug is within the class opioid antagonist?

A

Naltrexone

78
Q

What is the MOA of naltrexone?

A

Block opioid from binding to receptor sites

Suppresses/blocks cravings

79
Q

What are the uses for naltrexone?

A

Opioid dependence and treatment of alcoholism

80
Q

What are contraindications for naltrexone?

A

Hepatitis

Acute opioid withdrawal

Concurrent use of opioid meds (positive urine screening)

81
Q

What are adverse effects of naltrexone?

A

Suicidal ideation

ITP

pneumonia

Hepatotoxicity

82
Q

What are some nursing considerations and teaching for naltrexone?

A

Risks of using large doses of opioids during/after naltrexone therapy can result in coma, serious injury, and death

Monitor suicidal ideation

83
Q

What drug class is Buprenorphine?

A

Opioid-agonist antagonist

84
Q

What drug is in the class opioid-agonist antagonist?

A

Buprenorphine

85
Q

What is the MOA of Buprenorphine?

A

Binds to opioid receptors to cause sedation and decreased pain

86
Q

What are the uses for Buprenorphine?

A

Opioid withdrawal/maintenance and treatment of severe pain

87
Q

What drug are side effects of Buprenorphine similar to?

A

Morphine

88
Q

What is the pathway of Buprenorphine?

A

Metabolized in the liver and excreted in the urine or feces

89
Q

What are some nursing considerations and teaching r/t Buprenorphine?

A

Fatal overdose in children who accidentally ingest it

Naloxone (Narcan) is the overdose anecdote

Has serious drug interactions with other CNS depressants

Pharm (9 decks)

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