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64 Cards in this Set
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CHAPTER 15-16 Erin has cirrhosis. What diuretic is often recommended for patients with cirrhosis? = spironolactone (Potassium-Sparing Diuretics) - diuretic choice for cirrhosis = triamterene (both can be used for when potassium depletion is dangerous) |
Diuretics: increase urine excretion - reduce circulating fluid volume to help treat edema and hypertension |
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Earl has chronic gout and takes probenecid, a uricosuric agent. How do uricosuric agents act? = By promoting urinary excretion of uric acid Uricosuric agents: act on kidney to block reabsorption and promote urinary excretion of uric acid - used to treat chronic gout, no analgesic or antiinflammatory activity, not effective in treatment of acute gout |
Gout is a form of arthritis and a metabolic disorder characterized by accumulation of uric acid crystals in various joints, tissues and sometimes kidneys, with resultant inflammation and pain. = management include treat acute attacks, uric acid-lowering therapy and preventing recurrence of acute attacks Acute gout: sudden onset of pain, redness, warmth and swelling in affected joints Treatment: corticosteroids (prednisone) who cannot tolerate NSAIDS - use NSAIDS (naproxen, indomethacin, and ibuprofen, soon after onset of symptoms, work quickly to relieve pain) - Colchicine (not analgesic) does not affect uric acid clearance = used to relieve inflammation in acute gouty arthritis (must be given 24 h of onset of symptoms for max effectiveness) - use at low doses to prevent recurrent attacks |
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Your friend's grandfather has been placed on the most often used type of diuretic. You suspect that he is taking a(n) _ = thiazide diuretic page 248 |
Thiazides increase excretion of water, sodium, chloride, and potassium - Ex: hydrochlorothiazide |
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You are providing Pamela with information about the extended release antispasmodic formulation that has been prescribed to treat her neurogenic bladder. What should she know? = She should not crush or chew the tablets. |
Tate's brain begins to swell following surgery to fix an aneurysm and he is given a diuretic What diuretic is preferred to reduce intracranial pressure? = mannitol |
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Jago takes an anticholinergic/antimuscarinic drug for the treatment of a gastrointestinal condition. What does he likely have? = irritable bowel syndrome |
Antispasmodic and anticholinergics help calm bowel. - Dicyclomine (Bentyl) (anticholinergic and antimuscarinic agent) treat irritable bowel syndrome and other functional disturbances of GI motility - GI anticholinergics work by decreasing motility (smooth muscle tone) in GI tract Inflammatory bowel disease chronic, cause inflammation lining GI tract (Crohn's disease and ulcerative colitis) |
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Cece has been taking antacids for acid indigestion nearly every day for years. She reasons that they would not be sold over-the-counter, right next to toothpaste and eyeliner, if they were not safe. Is Cece's use of antacids safe? = Possibly. The use of antacids for more than two weeks may mask signs of gastrointestinal bleeding or cancer. |
Antacids are partially neutralizing gastric hydrochloric acid and widely available OTC - relief of indigestion, heartburn, sour stomach - also used as supplement for esophageal reflux - contain aluminum, calcium carbonate, or magnesium, and most contain sodium = sodium bicarbonate alone not recommended because flatulence, metabolic alkalosis and electrolyte imbalance with prolonged use - Tums (calcium carbonate) rapid acting and possess good neutralizing capacity but may cause constipation and kidney stones if overused = Magnesium and or aluminum commonly used - magnesium can cause diarrhea - aluminum causes constipation = combinations of mg2= and Al (Maalox Gelusil, and Mylanta) used to control frequency and consistency of bowel movements p 267 |
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Oran is taking a bulk-forming laxative for constipation. Bulk-forming laxatives work by ____. = softening the stool by absorbing water and increasing fecal mass to facilitate defecation |
bulk-forming laxative Ex: fiber supplements (psyllium, cellulose derivatives, polycarbophil and bran) - dissolved or diluted in one full glass of water of juice, follow immediately another glass of fluid 1-3 times a day, effect 12-72 h - choice for older adults or laxative-dependent patients |
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Vanya's grandmother is against taking drugs in general, but decides to take an over-the-counter medication for diarrhea. Vanya informs her that some antidiarrheal medications can contain a controlled substance known as ____. = diphenoxylate |
Tina has chronic health problems requiring medications that irritate the gastric mucosa and may cause ulcers. Her doctor prescribes a medication that, when taken on an empty stomach, forms a paste that adheres to the mucosa and protects it from irritation. What drug has most likely been prescribed? = sucralfate |
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CHAPTER 17-18 Emiliano is having a stem cell transplant in hopes of curing his leukemia. The doctors explain that he will be at high risk of infection and, as a result, they will treat him prophactically to prevent the infections. What antifungal are the doctors likely to use? = micafungin |
Antifungals - Amphotericin B - Fluconazole: (Diflucan) most widely prescribed, act against many fungal pathogens including most Candida without serious toxicity of amphotericin B (intravenous and oral forms) = used treat oropharyngeal (thrush) and esophageal candidiasis and serious systemic candidal infections. - Micafungin: IV, new treatment options against Candida and Aspergillus, tret esophageal candidiasis and candidemia and stem cell transplantation prophylaxis - Nystatin: used orally to treat oral cavity candidiasis also as a fungicide topical treatment of skin and mucous membranes (diaper area, mouth, vagina) |
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Five-year-old Thomas has brain cancer and chemotherapy and radiation have left him severely immunocompromised. He has a life threatening fungal infection that has not responded to other agents. The doctor tells his parents about a medication that may be his last chance, but emphasizes that severe side effects are expected. Which antifungal has this profile? = amphotericin B |
Amphotericin B (IV for treating severe systemic, potentially fatal infections caused by suscepible fungi (including Candida) - sometimes drug of choice to treat severe fungal infections resulting from immunosuppressive therapy (antineoplastic agents) or patients with AIDS, or severe illness (meningitis) |
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Your friend Porter believes that if he visits the doctor, he should get a prescription. More specifically, he believes that if he has an infection, whether due to an ingrown toenail, a cold, or something more serious, he should get an oral antibiotic. He reasons that he is the one taking the risk of adverse effects, so it should be his choice. Is he right? = No. The overuse of antibiotics leads to the development of resistance, which puts everyone at risk. |
Reyna's urinary tract infection is successfully treated with an antibiotic, but in the course of treatment, she develops both diarrhea and vaginitis. This suggests a(n) ____. = superinfection |
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Jalen has glaucoma and a miotic has been prescribed. The physician explains to Jalen that miotics act by ____. = increasing aqueous humor outflow |
Farrah is using ketorolac eye drops because of occular inflammation. How can she reduce the stinging and burning that occur when she instills the drops? = refrigerating the solution before use |
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Julian has just been diagnosed with open-angle glaucoma and medications are prescribed. Is he likely to have a prescription for miotics? = No. Miotics are considered third-line therapy due to side effects. |
Miotics (pilocarpine) used treat open-angle glaucoma (third-line therapy due to side effects) or short term treatment of angle-closure glaucoma BEFORE surgery - pilocarpine also used to constrict pupil and counteract mydriatic (pupil-dilating) effects of other agents - usually administered with acetazolamide and or timolol - for non-compliant patients long-term use: pilopine hydrochloride gel may provide some advantages over ophthalamic solutions |
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You are providing medication education to Petra, who has been prescribed a prostaglandin analog for the treatment of glaucoma. What should you tell her about side effects? = Systemic side effects are rare, but can include upper respiratory infections. |
Prostaglandin Analogs: first line agents = cause greatest reduction in IOP by increasing outflow of aqueous humor - contain preservative thimerosal |
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Braxton accidentally splashed a caustic liquid in his eyes. What topical medication might be prescribed to reduce inflammation and prevent scar formation? = corticosteroids |
Anti-inflammatory Agents: relieve inflammation of eye or conjunctiva in allergic reactions, burns, irritation from foreign substances or postoperatively Corticosteroids - useful in acute stages of eye injury to prevent scarring - should not be used for extended periods because danger of masking symptoms of infection or slowing healing process |
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Many anti-infective ophthalmic topical ointments and solutions treat superficial infections of eye caused by susceptible organisms - Ointments preferable for children and patients with poor adherence - drops preferred in adults since ointments will cause blurring of vision for 20 mins after instillation |
Acute (Angle-closure) glaucoma - sudden onset of pain, blurred vision and dilated pupil (medical emergency) - if untreated, blindness can result in few hours or days - treatment: miotics (pilocarpine), osmotic agents (mannitol) carbonic anhydrase inhibitors (acetazolamide) and surgery to open pathway for release of aqueous humor Chronic (open-angle) glaucoma - more common and often bilateral - develops slowly over period of years with few symptoms except a gradual loss of peripheral vision and possibly blurred vision - halos around lights and central blindness are late manifestations - treatment: miotics (pilocarpine: increase aqueous humor outflow), carbonic anhydrase inhibitors (dorzolamide Trusopt) decrease formation of aqueous humor and have diuretic effect) and local beta-adrenergic blocker (timolol (Timoptic) decrease rate of aqueous humor production - eyedrops also: prostaglandin analogs: latanoprost (Xalatan) act by increasing aqueous outflow Alpha-agonists: brimonidine (Alphagan-P) decrease production of aqueous humor and increase outflow Miotics: cause pupil to contract, reduce IOP by increasing aqueous humor outflow - act by contracting the ciliary muscle; leads to blurred vision. (third-line party) |
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Analgesics: relieve pain Sedatives: calm, soothe or produce sedation Hypnotics: produce sleep A celebrity with no history of substance abuse or bizarre behavior is found driving in circles around a fountain at three o'clock in the morning. His publicist releases a statement attributing the behavior to a prescription benzodiazepine sleep medication. Is this plausible? = Yes. Use of these medications has been associated with the occurrence of complex behaviors while asleep. |
Benzodiazepines BZDs like temazepam (restoril) and nonbenzodiazepines (non-BZDs) like zolpidem (Ambien) have supplanted barbiturates as sedative-hypnotics and less potential for abuse - respiratory depression (when taken with alcohol) can be fatal - only short term use recommended (7-10 days) - BZDs and non BZDs are controlled substances due to possible physical and psychological dependence
Barbiturates rarely used now as sedative-hypnotics because of many serious potentially dangerous side effects esp CNS depression - Phenobarbital still used to treat seizure disorders |
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Anti-histamine (diphenydramine (benadryl, nytol, Sominex) and doxylamine (Unisom) extended half-life and remain in system longer - slower metabolism and impaired circulation, older or debilitated patient is particularly susceptible to side effects (blurred vision, dizziness, hypotension and confusion) - tolerance can develop to sleep-inducing effect but not side effects - Antihistamine are not as effective as other available sedative-hypnotics |
Ashley has insomnia and her doctor gives her medication to produce sleep. This type of medication is called a(n) ____. = hypnotic Casey recalls that her grandfather used a barbiturate to help him sleep. She asks her doctor about the use of barbiturates for insomnia and is told that they are rarely used for that purpose due to their side effects. What side-effect is of particular concern? = CNS depression |
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After hearing about another opioid-associated overdose death, your friend wonders why nothing is being done about this issue. You can inform your friend about the market withdrawal of propoxyphene due to its association with overdose deaths and ____. = cardiac abnormalities Propoxyphene: opioid pain reliever (narcotics) used to treat mild to moderate pain. It is sold under various names as a single-ingredient product (e.g., Darvon) and as part of a combination product with acetaminophen (e.g., Darvocet) |
Antimigraine agents - Serotonin Receptor Agonists (SRAs) - for patients unresponsive to - serotonin levels decrease (vasodilation and inflammation of blood vessels in brain increase) migraine symptoms worsen during attack - also effective treat nausea and vomiting associated w/ migraine because serotonin receptors found in the GI tract 1. sumatriptan (Imitrex) 2. rizatriptan 3. eletriptan, frovatriptan 4. zolmitriptan |
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CNS stimulants - caffeine - amphetamine / methylphenidate preparations The use of amphetamines to reduce appetite in treatment of obesity is NOT RECOMMENDED because tolerance develops rapidly and physical and or psychological dependence may develop within a few weeks = have higher potential for abuse and should be used under medical supervision Prolonged administration of CNS stimulants to children with ADHD report to cause at least a temp suppression of normal weight and or height patterns in some patients |
Wakefulness-promoting agents - potential for abuse may belower than amphetamines and methylphenidate - Modafinil effective in treating ADHD in children and adolescence (NOT ADULTS) not approved for this purpose due to serious side effects developed with doses - not demonstrated to promote weight loss - caution: fatigue and sleepiness Selective norepinephrine reuptake inhibitor (SNRI) for ADHD - Atomoxetine (Strattera) the first nonstimulant, noncontrolled drug approved for treating ADHD - structurally related to fluoxetine but no potential for abuse, less insomnia, and less effect on growth, safe and effective in adolescents and children more than 6 years old and adults with ADHD. - longer onset to therapeutic benefit and reduced efficacy compared to stimulants |
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-Arleen is being treated for chronic pain and finds that she is needing higher doses of the pain medication to control her pain. This phenomenon is known as ____. = tolerance Andie is taking an antidepressant and has been told that there are a number of foods and herbal preparations she must avoid because of potentially dangerous side effects. What type of antidepressant is she likely to be taking? = MAOI |
Chronic Pain therapy - ex: back pain - sometimes include addition of a tricyclic antidepressant or anticonvulsant to analgesic regimen - drugs that enhance analgesic effects are called adjuvant analgesics
Tolerance: larger dose of opioid needed to achieve same level of analgesia and physiological dependence: (physical adaptation of body to opioid and withdrawal symptoms after abrupt drug discontinuation) with chronic use. MAO Inhibitors (MAOI) - increasing concentration of serotonin, norepinephrine, and dopamine in neuronal synapse by inhibiting MAO enzyme that degrades or break down these neurotransmitters - interact with some drugs, foods and herbal supplements can cause hypertensive crisis, manifested by severe headache, palpitation, sweating, chest pain, and possible intracranial hemorrhage and even death |
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SSRI first-line medications for treatment of depression - preferred because of fewer side effects, greater safety in cases of overdose and increased patient compliance - selectively block reabsorption of neurotransmitter serotonin, helping to restore brain's chemical balance = fluoxetine (Prozac) and sertraline (Zoloft) |
Bryce is taking modafinil for narcolepsy. It is particularly important to caution him ____. = about the need to ensure he gets adequately restorative sleep Narcolepsy - condition characterized by an extreme tendency to fall asleep whenever in relaxing surroundings. - Modafinil (Provigil) psychostimulant med approved for narcolepsy, sleep apnea, and shift-work sleep disorder |
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Fifteen-year-old Adan has major depressive disorder. Which antidepressant is recommended for treating major depressive disorder in adolescents? = escitalopram |
Selective Norepinephrine Reuptake Inhibitors - Duloxetine (cymbalta) and venlafaxine (Effexor) are antidepressants that inhibit reuptake of both serotonin and norepinephrine - also effective in patients with chronic pain (neuropathic pain, fibromyalgia, and musculoskeletal pain) - MDD major depressive disorder is treated by Desvenlafaxine (Pristiq- SNRI) equiactive and equipotent to benlafaxine. For adults For adolescents: MDD Major Depressive Disorder is treated by Fluoxetine and escitalopram (Lexapro) only ones (ages 12-17) and fluoxetine is approved for children 8 and ol |
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Franklin is taking an antipsychotic that acts by blocking serotonin receptors and transiently blocking dopamine receptors. What antipsychotic might he be taking? = clozapine (Atypical antipsychotics) |
Antipsychotic meds or major tranquilizers are sometimes called neuroleptics - traditional or typical (first-generation) and newer or atypical (second-generation) useful in 2 areas 1. relieving symptoms of psychoses (delusion, hallucinations, agitation and combativeness) 2. Relieving nausea and vomiting (prochlorperazine (Compazine)) - agents work by blocking dopamine receptors which accounts for their antiemetic effects but results in unbalanced cholinergic acivity cause frequent extrapyramidal side effects (EPS) to include tardive dyskinesia (TD) Other class: atypical antipsychotics Ex: risperidone blcok both serotonin and transiently blocking dopamine receptors - less potential for adverse effects esp EPS and TD no FDA approved med for treating dementia-related psychosis, if antipsychotics used for dementia behaviors: use lowest effective dose for shortest duration = side effects based on potency of agent Low potency: chlorpromazine and thioridazine more likely to produce sedation, hypotension and anticholinergic effects |
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Typical Antipsychotics (Phenothiazines) chlorpromazine fluphenazine perphenazine prochlorperazine thioridazine trifluoperazine page 395 Atypical Antipsychotics aripiprazole clozapine olanzapine paliperidone quetiapine risperidone ziprasidone |
Adrian's mother and father have personal and family histories of drug addiction. Therefore, Adrian's mother asks whether there are any nonstimulant medications that can be used to treat his ADHD. What drug might be suggested? = atomoxetine (SNRI, nonstimulant, noncontrolled for ADHD) |
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Antidepressants - MAOI SSRI (first line for treatment of depression) - Tricyclics: potentiation of norepinephrine and serotonin activity by blocking their reuptake = have delayed action, elevating mood and increasing alertness after 2-4 weeks, given at bedtime because of mild sedative effect used with caution in older adults (strong sedative and anticholinergic properties and increased risk of FALLS) Ex: tricyclics imipramine (Tofranil) are anticholinergic in action |
Antimanic Agents - bipolar disorders: sometimes called manic depression - patients may experience high (mania) or low (depression) mood swings with diminished capacity for daily functioning - Lithium salts approved for treatment of mania and treatment and prophylaxis of bipolar disorder = only mood stabilizer that has lowered suicide rate in bipolar patients - maintenance dose is established by monitoring blood levels |
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Illegal drugs - hallucinogens - dextromethorphan: semisynthetic morphine derivative, safe, effective, nonadditctive, OTC cough suppressant (found in Robitussin) - Flunitrazepa (Rohypnol) illegal drug, potent BDZ, approved in central and south americak for ethanol withdrawal, in US used as recreational drug, street "roofies" also "date-rape drug" ability to induce amnesia |
Marlee has heard that COX-2 inhibitors are less likely to cause GI bleeds than are NSAIDs. What property of COX-2 inhibitors makes them less likely to cause GI bleeds? = COX-2 inhibitors do not inhibit platelet aggregation. |
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COX-2 Inhibitors - Celecoxib (Celebrex) is an NSAID that exhibits anti-inflammatory, analgesic, and antipyretic actiivity by selectively inhibiting cyclooxygenase-2 (COX-2) prostaglandin synthesis - does not inhibit COX-1 and therefore does not inhibit platelet aggregation (clotting) or inhibit production of mucosal-protective prostaglandins, - does not pose bleeding risk of other nonselective NSAIDS = Celecoxib (Celebrex) potential to cause FEWER gastric problems and poses LESS RISK of GI bleeding unless used concurrently with aspirin. COX-2 inhibitors shut down only the "good" prostaglanding, raising risk of high blood pressure, atherosclerosis and clotting *Self-treatment with an OTC NSAID should not exceed 10 days, unless directed by physician FDA issued warning regarding OTC NSAID |
Cayden is using a diclofenac patch for pain from his recent knee injury. How does the patch compare to oral medications? = Concentrations in joint tissues are higher with the patch. diclofenac - Traditional Nonselective NSAIDS ibuprofen ketorlac naproxen oxaprozin partially selective NSAIDS - etodolac meloxicam nabumetone |
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Hormones: page 418 Estrogen Selective Estrogen Receptor Modifiers = Raloxifene (Evista) selective estrogen receptor modifier (SERM) with estrogen agonist activity on bone and lipids and estrogen antagonist activity on breast and uterine tissue = result in increased bone mineral density, decreased bone reabsorption and reduce fracture risk without promoting breast or endometrial cancer Calcitonin-Salmon= synthetic form of hormone calcitonin in nasal spray (miacalcin) or subcutaneous injection for treatment of post-menopausal osteoporosis in women who are more than 5 years past menopause = reserved for women who refuse or cannot tolerate HRT or in whom HRT is contraindicated store nasal spray in refrigerator Parathyroid Hormone |
While helping her friend move into a third floor walk-up, Elisabeth experiences painful muscle spasms in her back. Her doctor prescribes a centrally acting muscle relaxant. This medication is most likely ____. = diazepam Centrally acting drugs used to treat acute, painful musculoskeletal conditions = benzodiazepines, diazepam (Valium) and methocarbamol (Robaxin) |
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Different type of muscle relaxant, dantrolene causes direct effect on skeletal muscles used to manage spasticity resulting from upper motor neuron disorders such as multiple sclerosis or cerebral palsy - ineffective for ALS amyotrophic lateral sclerosis and not indicated for treatment of muscle spasms resulting from rheumatic disorders or musculoskeletal trauma |
Skeletal Muscle Relaxants - associated with pain, spasm, abnormal contraction, or impaired mobility = baclofen, carisoprodol, cyclobenzaprine, dantrolene, methocarbamol, tizanidine Neuromuscular Blocking Agents: cause direct effect on muscles including the diaphragm 9NMBAs) - succinylcholine and rocuronium (Zemuron) used during surgical, endoscopic, or orthopedic procedures = these are potentially dangerous and can result in respiratory arrest because potential to paralyze major muscle of ventilation, the diaphragm - administered only by anesthesiologist or skilled intubation, medically induced paralysis and cardiopulmonary resuscitation - these agents paralyze muscles, analgesics and sedatives are mandatory concurrent meds because patient can still feel pain but cannot react to it. |
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Caitlin strained her back and her doctor prescribes a centrally-acting muscle relaxant during the initial checkup. After the pain subsides, her doctor is likely to prescribe ____. = exercise |
Rajesh, an active and fit young adult, injures his shoulder in a weekend baseball game. His doctor tells him to take an NSAID and reminds him of the acronym RICE. What does the R indicate? = Rest I = ICE C = Compression E = Elevate |
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Epilepsy is defined as the recurrence of ____. = unprovoked seizures |
Anticonvulsants used to reduce number or severity of seizures in patients with epilepsy Epilepsy is the recurrence of unprovoked seizures, characterized by sudden attacks of altered consciousness motor activity, or sensory impairment Treatment based on type, severity and cause of seizures 1. Generalized: bilaterally symmetrical and without local onset; further classified as convulsive (tonic, clonic and tonic-clonic = grand mal) or nonconvulsive (absence = petit mal, myoclonic and atonic) 2. Partial Seizures: temporal lobe or psychomotor seizures - onset limited to one cerebral hemisphere and involve no loss of consciousness (simple) or loss of consciousness (complex symptomatology) 3. Atypical or unclassified - insufficient data to classify Treatment failure can be result of inappropriate selection of an anticonvulsant for specific type - Carbamazepine used to treat many types of seizures - however it is known to aggravate myoclonic and absence seizures |
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Alex, 34 years of age, was recently diagnosed with Parkinson's. What medication might he be prescribed as a "levodopa-sparing" strategy? = ropinirole |
Generalized seizures: - tonic-clonic are abrupt loss of consciousness and falling, with tonic extension of trunk and extremities (tonic phase) follow alternating contractions and relaxation of muscles (clonic phase) = urinary and fecal incontinence may occur - if seizures are prolonged or so frequent that patient does not regain consciousness between seizures, = status epilepticus and considered neurologic emergency = treatment of choice is IV lorazepam (Ativan), simultaneously loading IV phenytoin or fosphenytoin Absence epilepsy (petit mal) absence of convulsions, characterized by sudden onset, brief 10-20 sec loss of consciousness with NO FALLING, usually occur in children Febrile Seizure: most common childhood seizure disorder 6 months to 6 years. - acute infection (sepsis or bacterial meningitis) = most are single, simple brief) less than 15 mins) |
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Partial Seizures (psychomotor epilepsy or temporal lobe seizure) - caused by lesion in temporal lobe and limited to one cerebral hemisphere 10 sec to 5 min - may be preceded by subjective but recognizable sensation (an aura) that seizure is going to occur Unilateral Seizure - affects one side of body - some patients may have mixed seizure combining more than one type |
Drug Therapy for Generalized and Partial Seizures - First-Generation Anticonvulsants = prophylactic treatment of generalized and partial seizures when indicated should be started with single drug (valproate, lamotrigine, levetiracetam, carbamazepine, oxcarbazepine or phenytoin) = prevent seizures without oversedation = *grapefruit juice potentiates action and can increase risk of serious adverse effects = DO NOT TAKE GRAPEFRUIT JUICE with CARBAMAZEPINE!* Oxcarbazepine (Trileptal) second-generation oral anticonvulsant for partial seizure (analogue of carbamazepine) = as effective as first generation agents and may be less likely than carbamazepine to cause CNS side effects and hematological abnormalities - have less significant drug interactions and does not really require drug monitoring Valproic acid (Depakene, Depakote) braod spectrum anti-convulsant for managing many seizure types (generalized tonic-clonic, absence and myoclonic seizure) *hepatotoxicity, life-threatening pancreatitis (black box warning) and blood dyscrasias |
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The American Academy of Pediatrics Subcommittee does not recommend continuous or intermittent antiepileptic drug (AED) therapy for children with one or more simple febrile seizures Drug choice for treating absence epilepsy is often ethosuximide (Zarontin) effective only for Absence Seizures and lacks the idiosyncratic hepatotoxicity of valproic acid When Zarontin is ineffective, include clazepam (klonopin), valproic acid (depakene, and lamotrigine (lamictal) |
Second-generation Anticonvulsants - gabapentin (Neurontin), lamotrigine (Lamictal) , levetiracetam (keppa), oxcarbazepine and topiramate (topamax) = used for adjuvant treatment of partial (psychomotor) and generalized seizures = usually do not require drug level monitoring, fewer side effects, fewer drug interactions than first-generation. (may improve adherence with once or twice daily dosing) - second-generation should be used in caution with pregnant women and lactating women, and should not be abruptly discontinued. ** |
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Antiparkinsonian Drugs - given for Parkinson's disease (PD) characterized by fine, slowly spreading muscle tremors, rigidity, and generalized slowness of movement (bradykinesia) - before initiation: important to rule out drug-induced parkinsonism (DIP) as a causative factor |
Antiparkinsonian Drugs Dopamine Replacement: Carbidopa-Levodopa - crosses blood brain barrier, converted to dopamine - Carbidopa enhance effects of levodopa = increasing therapeutic effect of dopamine in CNS, reducing adverse reactions - Sinemet (combo of levodopa and carbidopa) used for long-term and recommend as an initial drug treatment for patients with bradykinesia uncontrolled by other PD meds. = patients taking Sinemet for prolonged time (2-5 years) may develop tolerance = "wearing-off" |
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Jim has been taking a carbidopa-levodopa agent for almost two years and is experiencing wearing off. What medication might be useful? = Selegiline |
Selegiline (and rasagiline are selective MAO type-B inhibitors Selegiline sometimes prescribed as adjunctive therapy for PD after Levodopa has been used for several years and begins to "wear off" or less effective When Sinemet and selegiline or rasagiline used concurrently = Sinemet dosage is reduced by 10-30% to lessen chance of additive side effects |
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Kerri is the primary caregiver for her mother, who has moderate Alzheimer's dementia and appears to be deteriorating. What medication has been approved for patients whose dementia has progressed to the moderate or severe stages? = memantine |
Kristian has generalized epilepsy that is not as well-controlled in his opinion. He wonders if he should be switched to a second-generation anticonvulsant. How are second-generation anticonvulsants typically used in the management of epilepsy? = |
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Dopamine Agonists - non-ergot derivatives = new pramipexole (Mirapex) and ropinirole (Requip) used in conjunction with levodopa to delay onset of levodopa-caused motor complications or used alone in early PD or in younger patients as a "levodopa-sparing" strategy - dopamine agonist may reduce the required dose of levodopa for patients with advanced Parkinson's. - bromocriptine (Parlodel) used much less frequently due to serious adverse effects - Rotigotine (neupro patch) applied topically once daily dosing. = may be advantageous |
Three-year-old Wiley is small for his age; testing reveals that he has very low levels of human growth hormone. What gland produces human growth hormone? = pituitary Bennie has hyperthyroidism due to Grave's disease. What is his likely course of treatment? = an antithyroid agent followed by treatment with radioactive iodine |
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Anticholinergic Agents: restore cholinergic-dopaminergic balance in PD, include synthetic atropine-like drugs (benztropine (Cogentin) and trihexyphenidyl (Artane) treat Parkinson like tremors associated with long-term use of antipsychotics or other forms of parkinsons. Amantadine (antiviral agents) alters dopamine release and has anticholinergic properties - treat Parkinsonism (extrapyramidal reactions) with prolonged use of phenothiazines, carbon monoxide poisoning, cerebral arteriosclerosis in older adults = used early for PD as monotherapy, little benefit when added to Levodopa. |
COMT inhibitors - entacapone (Comtan) and tolcapone (tasmar) block enzyme responsible for metabolizing peripheral levodopa - increase concentration of levodopa and dopamine = allows patient's dose of levodopa to be lowered and result in decrease in incidence or severity of dose-related side effects of levodopa (e.g. dyskinesia and nausea) - Entacapone: combo with carbidopa/levodopa (Stalveo) provides convenience of fewer pills but dosing less flexible for patients who need varying amounts of levodopa - severe nature of adverse effects (talcapone) and extensive monitoring, it is reserved for patients who do not respond to other therapies |
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Restless Legs Syndrome (RLS) sensorimotor neurologic disorder characterized by distressing urge to move legs, often accompanied by marked sense of discomfort in legs - triggered by rest or inactivity and temporarily relieved by movement = disruptive to sleep which is why patients seek treatment - involves CNS and dopaminergic pathway = Gabapentin (Neurontin) , benzodiazepine (clnazepam) and opiods (hydrocodone, oxycodone tramadol) second line agents |
Agents for Alzheimer's Disease - group of disease and conditions develop when nerve cells in brain die or no longer function normally - devastating, progressive decline in cognitive function, gradual onset, between 60-90 years followed by increasingly severe impairment in social and occupation functioning. - AD is ultimately fatal |
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Agents for Alzheimer's - Colinesterase Inhibitors = first class of agents shown to be efficacious for delay of symptoms in AD = prevent breakdown of acetylcholine in the synaptic cleft, increasing acetylcholine levels = improving cognitive function , but do not treat pathology of disease, may slow progression but do not cure disease - Tacrine: first drug approved but was associated with significant hepatotoxicity, no longer available - Donepezil, galantamine, and rivastigimine not associated with hepatotoxicity but do exhibit cholinergic side effects and dizziness |
NMDA receptor antagonist Memantine (namenda) first NMDA approved for treatment of moderate-to-severe dementia of Alzheimer's type - block excitotoxic effects with abnormal transmission of NT glutamate - can be used early stages of AD, delaying progression of symptoms |
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Three-year-old Wiley is small for his age; testing reveals that he has very low levels of human growth hormone (HGH) = somatotropin. What gland produces human growth hormone? = pituitary |
Bennie has hyperthyroidism due to Grave's disease. What is his likely course of treatment? = an antithyroid agent followed by treatment with radioactive iodine |
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Adrenal Corticosteroids page 448 - act on immune system to suppress body's response to infection or trauma - relieve inflammation, reduce swelling, and suppress symptoms in acute conditions. 2 categories 1. replacement therapy when secretions of pituitary adrenal glands are deficient (e.g. Addison's disease) 2. Anti-inflammatory and immunosuppressant agents. Corticosteroid Therapy is not curative but used as supportive therapy with other medications Some conditions treated with Corticosteroids - allergic reactions - acute flare-ups of rheumatic or collagen disorders - acute flare-ups of severe skin conditions - acute respiratory disorders - Long-term - malignancies - cerebral edema - organ transplant - life-threatening shock - acute flare-ups = prolonged use: cause suppression of pituitary gland with adrenocortical atrophy, body no longer produces its own hormone - because of potential serious side effects: corticosteroids are adminisntered for short time as possible and locally if possible to reduce systemic effects (ointment, intra-articular injections, ophthalmic drops and respiratory aerosol inhalants) Ex: cortisone, dexamethasone, fludrocortisone, hydrocortisone, methylprednisolone, prednisone, triamcinolone |
Thyroid Disorders Thyroxine is major product of thyroid gland and must of it later converted into T3 active form (Triiodothyronine) TSH promotes biosynthesis and secretion of 2 bioactive thyroid hormones: thyroxine (T4) and T3 - thyroid agents used in replacement therapy for hypothyroidism caused by diminished or absent thyroid function - Cretinism (congenital, requires immediate treatment to prevent mental retardation) - Hashimoto's thyroiditis - hypothyroidism causes slowed metabolism with symptoms ranging from fatigue, dry skin, thinnning hair, weight gain, constipation, |
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Lauri is being treated for hypothyroidism with a synthetic replacement. What signs might indicate that her dose is too high? = exophthalmos |
Routine newborn testing reveals that Kassandra has congenital hypothyroidism. If congenital hypothyroidism is untreated, Kassandra might develop ____. = cognitive disabilities |
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Phebian takes rosiglitazone for his Type 2 diabetes. How does rosiglitazone act? = It decreases insulin resistance and improves sensitivity to insulin. |
Antidiabetic agents Insulin: replacement for Type 1 diabetes with insufficient production of insulin from islets of Langerhans in pancreas - also required in Type 2 diabetes - indicated for |
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Antithyroid agents - for hyperthyroidism can be caused by Grave's disease (autoimmune disorder where antibodies mistakenly attack thyroid gland) - orally administered radioactive iodine ablation therapy is most common treatment = permanent cure: surgery remove all or part - antithyroid agent: methimazole or Tapazole and propylthiouracil or PTU) used to relieve symptoms of hyperthyroidism in prep for surgical or radioactive iodine therapy or for those who are not candidates for either procedure - not helpful in treating thyroiditis - insulin must be administered parenterally (other than mouth or anus) (because it is destroyed in the GI tract) = two types: biosynthetic human or analog - biosynthetic: human because aa structure is identical to naturally occurring human insulin - analog (aspart, detemir, glargine, glulisine and lispro) pg 455-457 |
Diabetes Therapy with insulin focus on initially controlling fasting plasma glucose with use of long-acting insulin analog (Lantus or Levemir) - rapid-acting insulin given 15 min before (as with insulin mixtures) or immediately after meal Rapid-acting insulin (short acting) may be combined with isophane insulin in same syringe: draw short/rapid acting to syringe first |
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PAge 466 oral and injectable noninsulin antidiabetic agents biguanides: metformin incretin therapies: GLP-1 receptor agonist exenatide DPP-4 inhibitors linagliptin sitagliptin saxagliptin Meglitinides: nateglinide, repaglinide Thiazolidinediones: pioglitazone, rosiglitazone Combinations: glyburide/metformin, rosiglitazone/metformin, sitagliptin/metformin |
Meglitinides - Nateglinide (Starlix) and repaglinide (Prandin) stimulate beta cells of pancreas to produce insulin - have rapid onset and short duration of action and taken before each meal Thiazolidinediones - Pioglitazone (Actos) and rosiglitazone (Avandia) lower blood glucose by decreasing insulin resistance and improving sensitivity to insulin in muscle, liver and adipose tissue - black box warning: for pioglitazone and rosiglitazone: potential for agents to cause or exacerbate congestive heart failure in some and contraindicated with class II or IV heart failure |
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Biguanides: metformin (Glucophage) decrease hepatic glucose production and enhance insulin uptake in muscle tissue = Metformin is first-line monotherapy or used in combo with sulfonylureas, alpha-glucosidase inhibitors or insulin to treat Type 2 diabets page 462 |
Incretin Therapies: GIP and GLP-1 (naturally occurring) - released by cells in GI tract in response to food - Exenatide (Byetta) GLP-receptor agonist given subcutaneously 2x daily mimic action of incretin GLP-1, decrease glucagon secretion, delay gastric emptying time, decrease food intake (increase satiety) result in weight loss = adjunctive therapy for Type 2 patients who have not achieved glycemic control and are taking metformin (sulfonylurea or glitazone) |
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Alpha-Glucosidase Inhibitors acarbose (Precose) delay digestion of complex carbs, and subsequent absorption of glucose = smaller rise in blood glucose concentrations following meals |
Brayan has inadequate androgen production, but his testicles are healthy and intact. The likely cause is a malfunctioning ____. = pituitary |
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Progesterone - secreted by corpus luteum and adrenal glands - responsible for changes in uterine endometrium (menstrual cycle in prep for implantation of fertilized ovum) |
Contraceptives page 486 Estrogen progestin table page 483 |
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Drugs for delivery and labor - oxytocin: IV infusion - prostaglandins: natural part of cervical ripening process, cause contractions of myometrial muscle (dinoprostone or prostaglandin E2 (Prostin E2, Cervidil, Prepidil), oral syntehtic prostaglandin E1 analog, misoprostol (Cytotec) and porstaglandin F2-alpha analog carboprost (hemabate) = all stimulate smooth muscle in GI tract accounting for GI side effects seen - dinoprostone intravaginal gel or vaginal insert (cervical ripening) - dinoprostone vaginal suppositories or - carboprost injection: therapeutic abortion in 2nd 3rd trimester and uterine evacuation - use of carboprost injection include: treatment of postpartum bleeding due to uterine atony that is unresponsive to oxytocin IV, uterine massage, uterine manipulation and injectable ergot prep |
Mifepristone (RU-486) antiprogesterone drug used to terminate unwanted pregnancy (in conjunction with misoprostol) - used for very early in pregnancy within 49 days from beginning of last menstrual period page 492 |
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Suzette is in need of emergency contraception. She has several contraindications to oral contraceptives. Can she use emergency contraception? = Yes. Emergency contraception can be taken by women with contraindications to oral contraceptives. |
Abigail just started taking oral contraceptives. How long should she use backup contraception? = 4 weeks |
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Sarah is breastfeeding her newborn son, and at her six-week check up, asks her obstetrician about birth control. What type of oral contraceptive can safely be used by women who are breastfeeding? = progestin only |
The principal mediator in attaining and maintaining an erection is ____. = nitric dioxide |
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Dawson, who is on warfarin therapy, is surprised to learn that he must try to keep his intake of foods high in vitamin K consistent, as they can alter the effectiveness of his therapy. What are some foods that are high in vitamin K? = asparagus and cabbage |
Davina is rushed to the hospital shortly after she begins to experience symptoms of what is diagnosed as an ischemic stroke. What agent can be administered that will dissolve the clot? = altephase |
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Mateo takes an antiarrhythmic that acts by inhibiting adrenergic nerve receptors. He is most likely taking ____. = propranolol |
Jake takes nicotinic acid for the treatment of diabetic dyslipidemia. How does nicotinic acid act? = It reduces hepatic synthesis of triglycerides. |
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Boris takes digoxin for heart failure. What is important for him to know? = He should regularly take his pulse. |
Bartholomew has a cold with a cough and runny nose. He has an antihistamine that worked wonderfully with his spring allergies. Should he use this for his cold? = No. The thickening of bronchial secretions may result in further airway obstruction. |
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Justin has come to the conclusion that caring for a three-year-old with a bad cold is far more challenging than calculus. He wonders if one of the over-the-counter cold medicines might help. Would an OTC cold medicine help? = No. There is no proof that these medications ease cold symptoms in children. |
Mercedes takes an oral agent that helps to control the inflammatory process of her asthma. What medication might she be taking? = montelukast |
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Edward has COPD and uses oxygen. What adverse effect does he risk if an excessively high concentration is used? = hypoventilation |
Short-acting beta agonists are ____. = rescue medications |
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Hudson, 73 years of age, has severe arthritis and takes an NSAID. What is especially concerning about the use of NSAIDs in elderly individuals? = Even fatal bleeds may not be preceded by any warning signs or symptoms. |
Cristobal, 79 years of age, has early renal failure. What process might this affect? = excretion |
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Lachlan, 87 years of age, has routine blood work that indicates liver impairment. What process is importantly affected by liver function? = metabolism |
Clifton, 77 years of age, takes phenytoin to control his seizures. What age-related change may alter distribution and necessitate changing his dose? = decreased production of albumin |
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Randy, 82 years of age, has relative achlorhydria. What process will this affect? = absorption achlorhydria production of hydrochloric acid in gastric secretions of the stomach and other digestive organs is absent or low, respectively |
Jadon, 67 years of age, has impaired exchange of gasses in his lungs. What process might this affect? = excretion |
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Chad is concerned about all of the medications his grandfather takes and after his grandfather is involved in a serious motor vehicle accident, decides to do some research. He finds that risk of cognitive impairment, delirium, falls, fractures, and motor vehicle accidents is elevated in older individuals who take ____. = benzodiazepines |
Lela works in a nursing home and notices copies of The Beers List at nursing stations and in medication rooms. What does The Beers List list? = potentially inappropriate medications |
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In the United States, what percentage of people over the age of 60 take at least five medications? = 40% |
Deann, 79 years of age, simply doesn't drink as much water or other fluids as she used to when younger. What process might this affect? = absorption |
