Pharm Exam 2 Drugs Bp

Front 1

Levodopa:mechanism
contraindications
patient teaching

Back 1

Long-term use causes “on-off” phenomena
Causes activation of malignant melanoma
Contraindicated in patients with recent MAOI use, h/o melanoma
Full therapeutic effect may take months
Do not abruptly discontinue – may cause neuroleptic malignant syndrome (NMS)

Front 2

Carbidopa: WHat does it do?

Back 2

Limits side effects of levodopa, keeps it out of periphery.
Does not cross BBB

Front 3

WHat do MAOI's do?

Back 3

MAO-B catalyzes MPP which breaks down the cells in the substantia nigra

FYI:Substantia Nigra is what dopamine works on, like the receptor or somthing.

Front 4

What are 2 MAOIs, from the BP.

Back 4

phenelzine (Nardil), isocarboxazid (Marplan)

Front 5

What do Dopamanergics do?

Back 5

directly stimulate receptors
prolong "on", period.
Often used along side caribide-levodopa

Front 6

What are some dopamanergics?

Back 6

Permax: contra in sensativity to ergot alkaloids
Parlodel:same
Mirapex
REQUIP

Front 7

What do anticholanergics do?

Back 7

Remeber: PD is a imbalance of dopamine and ach. So limting Ach helps balance them.
Block Ach
Decreases salivation
Relaxes smooth muscles
Used to treat muscle tremors and muscle rigidity

Front 8

benztropine (Cogentin):
contra

Back 8

similar to atropine
Contraindications:
Glaucoma, myasthenia gravis, GI/GU

Front 9

What are the three mechanisms of AED?

Back 9

Potentiate GABA (barbiturates and benzodiazepines)
Suppress sodium influx (hydantoin and phenytoin)
Suppress calcium influx (succinimides)

Front 10

What does Gabapentin (Neurontin) do?

Back 10

potentiates gaba

Front 11

Phenobarbital, a barbituate?
Pt. teaching
Contra
Nursing implications

Back 11

Low margin for safety
Cause profound CNS depression
High potential for dependenc

Front 12

What is given for status epilepticus?

Back 12

Amobarbital (Amytal)

Its a barbituate

Front 13

barbital means what?

Back 13

barbituate.

Front 14

What is Gabapentin (NEURONTIN)?

Back 14

GABA agonist

Front 15

Carbamazepine (Tegretol): function?

Back 15

Delays influx of Na ions across neuron membranes
Na necessary to generate action potential

Front 16

How much Dilatin are you supposed to take a day?

Back 16

 Pharmacokinetics (100 mg TID PO or 300 mg daily)

Front 17

What is Dilantin?

Back 17

Suppresses sodium influx

Front 18

What are the thearputic levels for Dilantin? And what are the toxic effects>

Back 18

therapeutic levels (10-20 g/ml)–
Above 20 is TOXIC
effects – nystagmus, ataxia, diplopia, cognitive impairment

Front 19

What are the adverse effects of Dilantin?

Back 19

Gingival Hyperplasia
 Skin Rash
 Use in Pregnancy (Category D)
Upset GI (eat with food)

Front 20

Carbamazepine (TEGRETOL): contraindication

Back 20

Mechanism: .Suppresses high frequency neuronal discharge in & around seizure foci.
Metabolized in liver
Contraindicated for patients with bone marrow depression or adverse hematologic reactions to other drugs

Front 21

What are Benzodiazepines used for and name 2 from bp?

Back 21

diazepam (Valium); lorazepam (Ativan), used to treat status epliticus.

Front 22

How long does status Epilipticus last for at least?

Back 22

20 minutes

Front 23

What are 2 Benzodiazepines and what are they used for?
What do they do?

Back 23

Diazepam (Valium)
Lorazepam (Ativan)
Treat anxiety and insomnia
Increase effect of Gaba

Front 24

What are some side efects of diasepam and lorazepam?

Back 24

drowziness and loss of coordination

Front 25

What is one of the basic functions of antidepressants?

Back 25

Correct neurotransmitter imbalances:
Block breakdown of norepinephrine
Slow reuptake of serotonin

Front 26

What is the mechanism of TCAs?

Back 26

They block the presynaptic terminals ability to reuptake of seritonin and NE

Front 27

What are2 TCAs from the BP?

Back 27

Imipramine (TOFRANIL)
Amitriptyline (ELAVIL)

Front 28

What is the main side effect of TCAs?

Back 28

orthstatic hypotension

Front 29

Can overdose of TCA's be an issue?

Back 29

Overdose with TCA’s is life-threatening: heart block, dysrhythmias, tachycardia, hypotension, seizures, coma
Rx of overdose: activated charcoal, Na bicarb, gastric lavage, antiseizure drugs

Front 30

WHat does SSRI stand for?

Back 30

selective seritonin reuptake inhibitor.

Front 31

What are the three SSRIs from the bp?

Back 31

Fluoxetine (PROZAC) (*Prototype*)
Paroxetine (PAXIL)
Sertraline (ZOLOFT)

Front 32

What are some important properties to know about paxil, in regards to nursing implications?

Back 32

Compete with warfarin and phenytoin
Weight loss (initially)
Eating disorders
Assess suicide potential
Drug effect takes several weeks
Do not withdraw abruptly

Front 33

How does Seritonin syndrome occur?

Back 33

Symptoms due to accumulation of serotonin
Often due to drug interaction, e.g., SSRI and TCA
Reaction may occur quickly or may be delayed
Sx: MS changes, HTN, tremors, sweating, fever, ataxia
Rx: supportive

Front 34

What does MAOI stand for?

Back 34

Monoamine oxidase inhibitors

Front 35

What are 2 MAOIs from the bp?

Back 35

phenelzine (Nardil),
isocarboxazid (Marplan)

Front 36

What does monoamine oxidase do?

Back 36

it destroys seritonin and NE

So the inhibitor helps prolong the life of them.

Front 37

What is the most dangerous side effect of MAOIs?

Back 37

Hypertensive crisis
1.      Causes – tyramine in certain foods
2.  Symptoms
3.      Antidote: calcium channel blockers
4.      Foods to avoid

Front 38

How does MAOIs cause a hypertensive crisis?

Back 38

Tyramine in foods is normally broken down by MAO enzymes in GI tract
In presence of MAOI’s, increased amt of tyramine is absorbed into blood
Tyramine releases stored NE from nerve terminals
Result= hypertensive crisis

Front 39

What is the dossing for Nardil?

Back 39

1mg for every Kg a day

MAX IS 90mg a Day.
CAN OVERDOSE

Front 40

What is the mood stabilizer from the bp?

Back 40

lithium carbonate (Eskalith);

Front 41

Lithium: thearputic index

Back 41

Narrow therapeutic index
Maintain adequate Na++ intake: hyponatremia increases lithium retention)

Front 42

What are the toxic levels for lithium?

Back 42

1.5 mEq/L is desired
1.5 – 2.0 mEq/L = mild to mod toxicity
2.0-2.5 mEq/L = mod to severe toxicity
>2.5 mEq/L = life-threatening toxicity

Front 43

WHat are the steps for the WHO pain scale?

Back 43

1.Non-opioid + adjuvant
2. Mild to moderate opioid + non-opioid + adjuvant
3. moderate to sever opioid +non-opioid+ adjuvant

Front 44

NSAIDs- what do they do?

Back 44

inhibt cox1 and 2.
Cox 1(good)-mucoso in stomach
Cox 2-causes pain

Front 45

What is the worst thing that can happen with asprin or NSAIDs?

Back 45

Salicylate Poisoning – NO ANTIDOTE!
Life threatening

10-30gm for adults, 5-8 gm for children.

Front 46

What are the adverse effects of asprin?

Back 46

bleeding,
renal impairment,
Reye’s syndrome (encephalopathy and fatty liver degeneration),
gout

Front 47

What are some important things to know about acetaminophen?

Back 47

People who consume alcohol on a regular basis should take no more than 2 gm of acetaminophen per day
Limit total daily dose to <4gm/day
Can increase drug levels of warfarin
Toxicity: hepatic necrosis
Antidote: Acetylcysteine

Front 48

What is fetnyl?

Back 48

Opioid, 100 times more potent then morphine.
Comes in patches or lozenges.

Front 49

What are important nursing implicatory information about Codine?

Back 49

Effective cough suppressant: caution in persons who NEED cough reflex!

Front 50

What is hydromorphone or diluaded?

Back 50

opioid- 10x stronger then morphine.

Front 51

What is Narcan?`

Back 51

It is an opioid antagonist
precaustions with dependence.

Front 52

WHat is the first line of deffence against migranes?

Back 52

NSAIDs
First-line treatment choice for all migraine attacks
Consistent evidence in support of aspirin, ibuprofen, naproxen sodium, and the combination of acetaminophen + aspirin + caffeine [EXCEDRIN]

Front 53

sumatriptan [IMITREX]: does what?

Back 53

Treats migranes
Action: binds to serotonin receptors
(5HT 1B/1D ) to cause vasoconstriction of cranial blood vessels

Front 54

Trpitans: sumatriptan [IMITREX], contraindcations?

Back 54

Contraindicated for patients with risk for heart disease, basilar or hemiplegic migraine, or uncontrolled HTN

Front 55

What is dihydroergotamine (Migranal)?

Back 55

Migranes

Front 56

What is Amitriptyline (Elavil)?

Back 56

Anti deppresent used as adjvant thearpy for migranes.

Front 57

What are 2 Non-salicylates from the bp?

Back 57

ibuprofen (Advil, Motrin)

Front 58

What is ‘selective toxicity’ and why is it significant?

Back 58

They only harm the invading organism and not the human

Front 59

What’s the difference between gram-positive and gram-negative organisms?

Back 59

Gram-positive
Generally aerobic, require oxygen
Staph aureus, Streptococcus pyrogenes, Streptococcus pneumoniae
Gram-negative
Generally anaerobic
Pseudomonas, E. coli, Enterobacter

Front 60

Bacteriocidal vs. bacteriostatic

Back 60

Bactericidal: kills susceptible bacteria
Bacteriostatic: inhibits growth of susceptible bacteria

Front 61

How do organisms develop resistance?

Back 61

Bacteria secretes a drug-metabolizing enzyme (e.g., penicillinase or beta-lactamase)

Bacteria stop uptake of the drug by strengthening cell wall
Receptors on bacteria evolve so that abx cannot bind with them
Bacteria synthesize compounds that antagonize drug actions
Drug concentrations are too low in tissues to kill resistant organisms

Front 62

When is it appropriate to use prophylactic antibiotic therapy?

Back 62

Precoitic drugs

Front 63

Gram + and - outter layer?

Back 63

Gram positive have cell walls
Gram negative have membranes.

Front 64

WHat kinda drugs work a against + and -

Back 64

Narrow-spectrum: effective against gram-positive organisms
Broad-spectrum: active against more gram-negative organisms

Front 65

how can bacteria resistant be prevented?

Back 65

Use antibiotics only when necessary
Use proper dose and duration of antibiotic therapy
Use narrow-spectrum antibiotics
Do not use newer drugs unless necessary
Avoid prophylactic antibiotics unless appropriate, e.g. recurrent UTI, neutropenia, surgery, bacterial endocarditis, exposure to STD

Front 66

What do bata lactam rings do and what drugs have them?

Back 66

Destroy bacteria cell walls
Penacillin G
Cephalosporins: cefazolin (Ancef)

Keep in mind bata lactamase containing organisms are resistant.

Front 67

WHat does Penacillin G treat?

Back 67

bacterial endocarditis, gas gangrene, tetanus, meningitis, syphilis, prophylaxis of bacterial endocarditis, syphilis, rheumatic fever

Front 68

What do Cephalosporins help treat?

Back 68

UTIs, post-op infections, pelvic infections, meningitis

Front 69

What are some adverse effects of Cephalosporins?

Back 69

Hypersensitivity, e.g., maculopapular rash
N/V/D
Pseudomembranous colitis associated with cefazolin
Superinfection
Thrombophlebitis at IV site

Front 70

What are some indications of Vancomycin

Back 70

Highly toxic; reserved for serious infections
Used for MRSA, MRSE, C. difficile induced pseudomembranous colitis
Can be used in penicillin-allergic patients

Front 71

What are some adverse effects of Vancomycin?

Back 71

Can cause ototoxicity and nephrotoxicity
Anaphylactoid reaction
“red neck” or “red man” syndrome due to histamine release
Phlebitis at IV site

Front 72

What drug inhibits bacterial protein synthesis from the bp?

Back 72

Tetracyclines & erythromycin (azithromycin, clindamycin)
Getamycin-an aminoglycoside

Front 73

What are some properties of tetracyclines?

Back 73

Broad-spectrum; active against gram-pos and gram-neg
Many resistant strains have developed
Bacteriostatic action
Inhibit protein synthesis in sensitive organisms, prevent cell division and replication

Front 74

What are some adverse effects of tetracyclines?

Back 74

N/V/D
Superinfection
Photosensitivity and rash
Hepatotoxicity
Tooth discoloration and gingival hypoplasia

Front 75

What are Azithrmomycin used for and and important dosing info?

Back 75

Legionnaire disease, whooping cough,
Give a loading dose

Front 76

What are some adverse effects of Erythromycin?

Back 76

N/V/D, uticaria, rash
Pseudomembranous colitis

Front 77

What is an Aminoglycoside and what is it used for?

Back 77

gentamicin
UTI, gynecologic infections, peritonitis, endocarditis, bacteremia and sepsis, osteomyelitis

Front 78

What are some adverse effects of gentamicin?

Back 78

Ototoxicity and nephrotoxicity
Neuromuscular blockade (leading to respiratory depression)
A risk for patients under general anesthesia or with myasthenia gravis

Front 79

What are some nursing implications of genatamicin?

Back 79

Check BUN/Cr, I&O
Careful monitoring of patient receiving general anesthesia

Front 80

What are some cross sensativities of antibiotics?

Back 80

Be aware of possible cross-sensitivities, e.g., penicillins and cephalosporins; sulfonamides and sulfonylureas

Front 81

What are two sulfonamides and mechanism?

Back 81

Sulfonamides and trimethoprim
Prevent bacteria from synthesizing folate, thus inhibits synthesis of essential proteins
Humans need folate, too, but they get it from the diet; bacteria cannot absorb folate, they must make it

Front 82

What are some cotraidications of sulfonamides?

Back 82

Contraindicated for patients with G6PD deficiency (can cause RBC hemolysis)
Contra in Pregos,and infants less then 2

Front 83

What is the abrevations for sulfonamides and trimethoprim?

Back 83

SMZ-TMP

Front 84

What are some adverse effects of SMZ and TMP?

Back 84

Usually well-tolerated
Hematologic effects: megaloblastic anemia in people with folate deficiency (e.g., elderly or malnourished)
Allergic reactions: urticaria, rashes, Stevens-Johnson syndrome, photosensitivity

Front 85

What are some ongoing assments that should be made with SMZ and TMP?

Back 85

Monitor patients for signs of hematologic dysfunction, such as sore throat, fever, bruising, or bleeding.

Front 86

How SMZ and TMP be administered? (important)

Back 86

Administer SMZ-TMP 1 hour before or 2 hours after a meal with a full glass of water to enhance the absorption of the drug.

Front 87

What is a Fluoroquinolone from the bp?

Back 87

Prototype: ciprofloxacin [Cipro]
Inhibits bacterial DNA synthesis

Front 88

What are some potential adverse effects of Cipro?

Back 88

Tendon rupture (e.g., Achilles)
Arthropathy, esp in children <18

Front 89

What population is most at risk for UTI?

Back 89

Elderly and postmenopausal women

Front 90

what is Asymptomatic bacteriuria?

Back 90

a UTI causing bacteria

Front 91

IS Asymptomatic bacteriuria common in pregos?

Back 91

Asymptomatic bacteriuria is common during pregnancy. It is important to identify in pregnant women because it increases the risk of pyelonephritis during the second and third trimesters. Additionally, untreated UTI is associated with an increased risk of miscarriage.

Front 92

What is a good treatment for UTIs?

Back 92

SMZ and TMP

Front 93

What are Urinary tract antiseptics and what is an example from the bp?

Back 93

Urinary tract antiseptics are drugs that work by local action because high serum levels are not achievable.

Nitrofurantoin: Macrobid

Front 94

What is a drug used as a Urinary tract analgesic?

Back 94

Phenazopyridine (Pyridium) is used frequently for UTIs but does not itself have any antibacterial activity.

Front 95

TB skin test interpratation?

Back 95

High risk: >5mm
Moderate: >10mm
Low risk: >15mm

Front 96

How long to we treat TB for?

Back 96

Active 6-24months
Latnent 6-9 months

Front 97

What are some drugs that treat TB?

Back 97

Isoniazid (INH), Rifampin, and Pyrazinamide

Front 98

What are some adverse effects INH?

Back 98

Peripheral neuropathy
Reduced with vitamin B6
Hepatotoxicity
CNS effects: optic neuritis, seizures, dizziness, ataxia, psychologic disturbances, anemia, GI distress

Front 99

WHat are some adverse effects of RIfampin and importrant detail?

Back 99

Adverse effects: hepatotoxicity and discoloration of body fluids:red pea and tears
Inducer of P-450 enzyme system

Front 100

What are some adverse effects of Pyrazinamide?

Back 100

Adverse effects:
Hepatotoxicity
Hyperuricemia