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pharm#3test

pharmacology

QuestionAnswer
two major groups of drugs used to treat psychosis? conventional and atypical psychosis
of the conventional (positive symptoms) and atypical (positive and negative) antipsychotics which one has more extrapyramidal symptoms EPS conventional
positive symptoms of schizophrenia hallucinations, delusions, agitation, tension, and paranoia
negative symptoms of schizophrenia low motivation, lack of speech, blunted affect, social withdrawl
MOA of conventional antipsychotic drugs blocks dopamine, ACH, histamine and norepinephrine
how long does it take to reach therapeutic response when using antipsychotic drugs initial 1-2 days, substantial improvement 2-4 weeks, full effects a few months
conventional antipsychotic drugs have anticholinergic, neuroendocrine, and sexual side effects. What can they do to BP and mental state? cause sedation
What are examples of EPS-extrapyramidal symptoms? acute dystonia, Parkinsonism, akathesia, and tardive dyskinesia
What is acute dystonia? severe spasms of the muscles in the tongue, face, neck, or back
what class of drugs can be used to treat acute dystonia anticholinergics
what is characterized by bradykinesia, mask like faces, drooling, tremor rigidity, shuffling gait, cog-wheeling, and stooped posture Parkinsonism
define akathesia pacing and squirming
what is tardive dyskinesia involuntary twisting, writhing, worm like movements of the tongue
lead pipe rigidity, high fever, sweating, autonomic instability, dysrhythmias, and BP fluctuations neuroleptic malignant syndrome
2 examples of conventional or first generation neuroleptics chlorpromazine(thorazine) and haloperidol(Haldol)
all antipsychotics can cause weight gain true
do conventional or atypical antipsychotics have less EPS atypical
What class of drug atypical or conventional have a greater effect on negative symptoms and cognitive dysfunction that occurs with schizophrenia atypical
Why should anticholinergic agents be avoided when using low potency antipsychotics such as chlorpromazine? they both have anticholinergic effects
When is clozapine contraindicated when taking drugs that suppress bone marrow function causing agranulocytosis
When is clozapine used when pts do not respond to other drug treatments
what lab test should be monitored when clozapine is prescribed CBC checking for agranulocytosis
What is the monamine hypothesis of depression insufficiency of norepinephrine and serotonin
what atypical antipsychotic is most sedating and can lead to cataracts Quetiapine(Seroquel) aka baby heroin/quell
MOA of TCA-tricyclic antidepressants blocks neuronal reuptake of norepinephrine and serotonin
therapeutic response to treatment of TCA's initial 1-2 weeks, maximal 1-2 months
common adverse effect to TCA sedation, anticholinergic effects, orthostatic hypertension
most serious adverse effect of TCA cardiotoxicity
Who should not be treated with TCA patients who have suicidal ideation---potential for OD
MAO inhibitors, direct and indirect acting sympathomimetics drugs, anticholinergic agents and other CNS depressants including alcohol, opiods, antihistamines, and barbiturates should be avoided while taking TCA----tricyclic antidepressants
Why not give more then one week supply at a time ? lethal dose is 8 times the average dose--narrow negative safety profile--minimize risk of death by suicide
anticholinergic and cardiotoxic symptoms including dysrhythmias--tachycardia, intraventricular blocks, complete heart blocks, ventricular tachycardia, and V-fib are all toxic manifestations of which agent used to treat depression TCA
MOA of SSRI--selective serotonin reuptake inhibitors inhibition of serotonin reuptake. more serotonin at synapses
how long does it take to achieve therapeutic effect when using fluoxtine(prozac) about 4 weeks are required to produce steady state plasma drug levels
sexual dysfunction, N, headache, insomnia, anxiety, wght gain, serotonin syndrome, withdrawal syndrome and neonatal withdrawal syndrome are all AE of SSRI---selective serotonin reuptake inhibitors
all SSRI can cause insomnia true
SSRI blackbox warning increases of suicidal ideation can occur with initiation of treatment
disorientation, agitation, confusion, anxiety, hallucinations, incoordination, myoclonus, hyperreflexia, excessive sweating and fever all symptoms of serotonin syndrome
problem encountered with the concurrent use of St. John's Wort and SSRI increase potential for serotonin syndrome---similar in action
Should SSRI be abruptly discontinued NO can result in withdrawal syndrome
are SSRI and MAOI compatible NO risk serotonin syndrome
What happens when warfin and flouxetine(Prozac) are used together bleeding can occur.. Prozac displaces warfin from albumin molecule
what occurs with simultaneous use of lithium and fluoxetine (prozac) flouxetine can elevate levels of lithium
NSRI that can cause HTN and has an intense withdrawal syndrome that includes anxiety, agitation, tremors, headache, vertigo, N, tachycardia, and tinnitus Venafaine (Effexor)
Which NSRI has been used to treat pain such as diabetic neuropathy, can increassse BP, and can cause liver damage Duloxetine (cymbalta)
MOA of monoamine oxidase inhibitors inhibit MOA more norepinephrine and serotonin are available for release (MAO-found brain, liver, intestines)
Why are MAO rarely used poor safety profile
AE of MAOI anxiety, agitation, hypomania, orthostatic hypotension, HTN crisis
why are food high in tyramine avoided when taking MAO tyramine is not broken down when MAO is inhibited can lead to HTN crisis
avocado, soybeans, figs, fermented meats, cured fish, cheeses, yeast extract, imported beer, chianti wine, protein dietary supplements are all examples of foods high in tyramine
can you combine MAO with TCA and or SSRI NO can produce HTN crisis
Why are sympathomimetics and MAOi incompatible they promote the release of norepinephrine and can contribute to HTN crisis
alternating episodes in which mood is abnormally elevated or abnormally depressed, separated by periods in which mood is relatively normal are all clinical manifestations of Bipolar---lol my ex-husband
drug of choice for bipolar valprioc acid has replaced lithium for drug of choice
therapeutic plasma level of lithium 0.8-1.4 mEq/L
GI upset, D, muscle weakness, thirst,, incoordination, severe hypotension, convulsions, and death AE of lithium in excessive amounts
AE of lithium at therapeutic levels: GI upset, fatigue, muscle weakness, headache, polyuria, renal toxicity, goiter and.... HYPOthyroid
What occurs when diuretics are used with lithium toxicity----due to sodium loss
what occurs when sodium is low in patients taking lithium toxicity
Why do peeps taking lithium need to stay hydrated lithium promotes polyuria by antagonizing the effects of ADH
Why is diarrhea a problem with lithium dehydration and low sodium= increase lithium levels
is it advisable for pregnant women to take lithium NO Category D
MAO of BZD--benzodiazepines potentiates the action of GABA, an inhibitory neurotransmitter
therapeutic uses of BZD anxiety, insomnia, and seizure disorder
AE of BZD CNS and Respiratory depression, anterograde amnesia, and abuse
agents to avoid while taking BZD CNS depressants, alcohol, barbiturates, and opioids
can BZD leaad to physical dependance yes
manifestations of oral BZD overdose drowsiness and lethargic
which BZD increased potential for developing dependance xanax (alprazolam)
name of the reversal agent used to treat BZD overdose flumazenil(Romazicon)
advise to a pregnant mother with regards to BZD NO category D and X
side effects of barbiturates CNS depression and cardiovascular effects decreased BP and HR
what happens when barbiturates stimulate synthesis of hepatic microsomal enzymes they accelerate their metabolism and that of many other drugs
what type of agent is ambiem sedative hypnotic agent
warning is now given to patients taking agents similar to zolpidem (Ambien) unusual activity such as driving, sleep walking, and eating (not remembering)
principal drugs used to treat panic disorder SSRI and BZD
SE of BZD sedation, physical dependance, and withdrawal syndrome
TCA approved to treat OCD--Obsessive-compulsive disorder Clomipramine
Buspirone (Buspar) is used to treat anxiety-----NOT panic disorder
atypical antidepressant wellbutrin(bupropion) is used for smoking cessation. It is contraindicated in seizure disorder because it _____the seizure threshold increases
Ritalin(methylphenidate is used to treat AHDH can cause weight loss
drugs used to treat ADHD are schedule_____. refills are not permitted.PAtients must have a hard prescription copy each month. II
BMI of 28 is overweight------kg x meters=BMI
primary pathophysiology of Parkinson degeneration of neurons=imbalance of dopamine and ACH
when extrapyramidal function is disrupted, disorders of movement can result---called dyskinesia
drugs used to treat parkinson such as levodopa______dopamine increase
Major side effect of levodopa N, V, dyskinesia, hypotension, dysrhythmias, and psychosis
How long before seeing a full therapeutic effect upon initiating levodopa may take several months
cardiovascular effects of levodopa postural hypotension and dysrhythmias
visual hallucinations, vivd dreams, night mares, and paranoid ideation are all major SE of which therapeutic agent that treats PD Levadopa
which drug used to treat PD can lighten sweat and urine and activate malignant melanoma levadopa darkens urine and sweat and activates malignant melanoma
high protein___________ absorption of levadopa absorption declines
central acting anticholinergic drugs used in PD block muscarinic receptors to __________ACH decrease. symptoms of PD are improved when ACH is blocked
how does decreased amounts of ACH improve symptoms in PD restore balance between ACH and dopamine
goal of pharmacologic therapy in treating PD to balance cholinergic and dopaminergic activity in brain
Alzheimers disease (AD) have reduced cholinergic transmission and _______ levels of acetylcholine decreased. levels of ACH are found to be diminished in AD
ny blocking the enzyme that breaks down ACH, cholinesterase inhibitors used to treat AD________the availability of ACH at cholinergic synapses increase...... cholinesterase inhibitors are recommended for AD
why would a pt with AD taking a cholinesterase inhibitor be advised not to take an antihistmine for cold symptom relief anticholinergic effects negate the effect of the AD drug
Tacrine(Cognex), donepezil(ARICEPT) RIVASTIGMINE (EXELON), GALANTAMINE (RAZADYNE FORMERLY CALLED REMINYL) ARE DRUGS TO TREAT AD. ALL INCREASE LEVELS OF ACH AND ARE KNOWN AS CHOLINESTERASE INHIBITORS
WHICH DRUG USED TO TREAT AD CAN ELEVATE ALT TACRINE (COGNEX) HAS BEEN ASSOCIATED WITH LIVER FAILURE
PROVEN RISK FACTORS FOR AD FAMILY HISTORY AND AGE-----ARE ONLY PROVEN
MEMANTINE(NAMENDA) MODULATES THE EFFECTS OF AN EXCITATORY TRANSMITTER(GLUTAMATE) AT THE NMDA RECEPTOR WHICH ARE IMPORTANT FOR MEMORY AND LEARNING. IT IS A NEWER AGENT USED TO TREAT MODERATE TO SEVERE AD
A SEIZURE THAT BEGINS FOCALLY IN THE CEREBRAL CORTEX AND UNDERGOES LIMITED SPREAD TO ADJACENT CORTICAL AREAS IS KNOWN AS A ________________SEIZURE PARTIAL SEIZURE
SEIZURE IN WHICH THE ACTIVITY IS CONDUCTED THROUGHOUT BOTH HEMISPHERES IS KNOWN AS A GENERALIZED SEIZURE
DRUGS THAT SUPPRESS THE DISCHARGE OF NEURONS WITHIN A SEIZURE FOCUS AND SUPPRESS PROPAGATION OF SEIZURE ACTIVITY FROM THE FOCUS AREAS OF THE BRAIN ARE CALLED ANTIEPILEPTIC DRUGS ------AEDS
WHAT ARE THE 4 BASIC MECHANISMS BY WHICH AEDS CONTROL SEIZURE ACTIVITY SUPPRESSION OF NA, CA INFLUX, BLOCKADE OF GLUTAMATE AND POTENTIATION OF GABA
RECOMMENDED THERAPEUTIC SERUM CONCENTRATION OF PHENYTOIN (DILANTIN) 10-20MCG/ML
DESCRIBE THE CNS EFFECTS OF EXCESSIVE DOSAGE OF DILANTIN NYSTAGMUS, SEDATION, ATAXIA, DIPLOPIA, AND COGNITIVE IMPAIRMENT
MAJOR AE OF DILANTIN GINGIVAL HYPERPLASIA, SKIN RASH, DYSRHYTHMIAS, AND HYPOTENSION
AE OF USING DILANTIN DURING PREGNANCY CLEFT PALATE, HRT MALFORMATIONS, AND FETAL HYDANTOIN SYNDROME
GROWTH DEFICIENCY, MOTOR OR MENTAL DEFICIENCY, MICROCEPHALY, CRANIOFACIAL DISORDER, POSITIONAL DEFORMITIES OF THE LIMB, HYPOPLASIA OF THE NAILS AND FINGERS AND IMPAIRED NEURODEVELOPMENT ARE ALL FEATURES OF FETAL HYDANTOIN SYNDROME---- WHILE USING AEDS
PHENYTOIN (DILANTIN) CAN _________THE SYNTHESIS OF VITAMIN K DEPENDANT CLOTTING FACTORS IN THE NEWBORN DECREASE.... VITAMIN K GIVEN AT TERM
HOW IS IV PHENYTOIN ADMINISTERED SLOWLY DILUTE WITH SALINE NO MORE THEN 50MG/MIN TO AVOID CV COLLAPSE
HOW MANY MG/MIN OF PHENYTOIN CAN BE ADMINISTERED 50MG/MIN
SEDATION, R-DEPRESS, EXAB OF INTERMITTANT PORPHYRIA, PHYSICAL DEPENDANCE AND INTERFERENCE WITH METABOLISM OF VIT D ARE ALL MAJOR SE FROM WHICH AED USED TO TREAT SEIZURES PHENOBARBITAL
CNS SYMPTOMS (NYSTAGMUS AND ATAXIA), ANEMIA, LEUKOPENIA, THROMBOCYTOPENIA, AND BIRTH DEFECTS ARE ALL MAJOR SE OF WHICH AED CARBAMAZEPINE. MONITOR CBC WHILE ON AED---ANTI-EPILEPTIC DRUGS
lab test that should be closely monitored using carbamazepine CBC, leukopenia, thrombocytopenia, anemia
AE of valporic acid(Depakote) LFT--AST ALT
is the combination of AEDs and chronic use of alcohol a problem alcohol can decrease plasma levels of AEDs
signs of liver injury would you describe in teaching your pt about AE of valproic acid reduce appetite, malaise, N, abdominal pain and jaundice
what is the drug of choice for absence seizure Ethosuximide(zarontin)
is it necessary to withdrawal AEDs gradually YES. else can cause seizure activity and possible epilepticus
_____________is a rare life threatening syndrome that can be triggered by and general anesthetic agent and by succinylcholine (neuroblocking agent) malignant hyperthermia
muscle rigidity and profound elevation in temperature are prominent symptoms of malignant hyperthermia
dantrolene agent of choice for treating malignant hyperthermia
AE from centrally acting muscle relaxants CNS depression, drowsiness, dizziness, weakness and fatigue
consequence of prolong use of dantrolene fatal liver damage
the difference between opioids and narcotics---opioids apply to compounds present in opium. narcotics on the other hand not only include opioids but drugs such as cocaine, marijuana, and LSD
analgesia, R depression, euphoria, and sedation are all effects from the activation of what receptors? Mu receptors
R depression, constipation, orthostatic hypotension, urinary retention, cough suppression and biliary colic are all adverse effects of what opioid agonist
AE effects of opioid agonist emesis, increased ICP, euphoria, dysphoria, sedation, miosis, neurotoxicity
nausea is a common SE of morphine. what measures may help alleviate the Nausea temporary SE and can be lessened by staying still
WHy is meperidine(Demoral) used in pt who had biliary surgery rather then morphine for pain relief morphine can induce spasm of the common bile duct and intensify pain
Why is meperidine (Demoral) not widely used in pt who had biliary surgery because of it toxic metabolite
what effects does opioids have on pt with ICP decreased R rate can lead to build up of CO2=brain edema
demerol is not recommended for pt with cancer pain because of it short half life and toxic metabolite
why are opioids given on a fixed schedule to prevent pain before it returns, sparing the pt of needless discomfort
advantage of PCA pump provides protection against pain reoccurrence AND therapeutic levels stay with therapeutic range
Which class of drugs used with opioids can exacerbate opioid induced constipation and urine retention drugs with anticholinergic effects(antihistamines, TCAs and antipsychotics)
why is acetaminophen used in pts with thrombocytopenia does not effect platelets and will not cause bleeding
what happens when acetaminophen and alcohol are combined can result in potentially fatal liver damage
explain what happens when a partial opioid agonist such as pentazocine (Talwin) is given to an individual that is dependent on morphine withdrawal symptoms can occur since the weaker agent occupies the receptor site
what type of headache is characterized by a neurovascular disorder that involves vasodilatation and inflammation of intracranial blood vessels migraines
medication overuse headache (MOH) or rebound headache is the result of over use of medications for headaches. patients using abortive therapy more then 2-3 times a week should be considered for____________treatment Prophylactic treatment with beta adrenergic antagonist
increased plasma levels of CGRP__________migraines promote
what is the syndrome of toxicity of ergot alkaloids characterized by constriction of peripheral arteries and arterioles in which extremities become cold, pale, and numb, muscle pain develops and gangrene may result ergotism
can ergotamine cause physical dependance YES
is is advisable in pregnancy (ergotamine) NO category X
which agent used to treat migraines release inflammatory neuropeptides that diminish perivascular inflammation and cause vasoconstriction by binding to 5-HT 1B/1D receptors serotonin 1B1D-receptor agonist aka triptans
Triptans cause vasoconstriction and decrease perivascular inflammation TRUE
an overwhelming feeling of tightness and heavy sensation in the chest is a common SE of which agent used to treat migraines triptans
is it advisable to use triptan with an ergot alkaloid or MAOI NO MAOI can suppress degradation of sumatriptan, increasing plasma levels
the following: stress, fatigue, alcohol, and tyramine rich foods are common for migraine triggers
can pt with heart disease or cardiovascular risk factors take triptans NO most severe AE of triptans are vasospams
what is the problem with combination SSRI and triptans serotonin can result due to excess seronergic activity
can triptans be used in pregnancy triptans should be avoided during pregnancy
Created by: andreafuturefnp
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