• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/119

Click to flip

119 Cards in this Set

  • Front
  • Back
What do sedative's do?
Relieve anxiety with a lower does then hyponotics.
What do hypnotics do?
Promotes sleep with a higher dose than sedatives.
What is insomnia?
Poor sleep that causes distress or impairment for 6 months or longer. Average less than 6.5 hours per day.
What are health sleep habits (Sleep Hygiene)?
Avoid alcohol, nicotine, caffeine, and chocolate. Cut down on non-sleeping time in bed. Do not "try to sleep". No visible bedroom clock.
How is insomnia treated?
Treated with BZDs and BDZ-like drugs. Should only be for short term use. Or Anithistamines that make you drowsy
Name BZD-like drugs?
Zolpidem (Ambien)
Eszopiclone (Lunesta)
Zapelon (Sonata) - 4 hours
Explain BZD-like drugs?
Limited binding to BZD site of GABA recptor-CL channel site. They are widely used for quick onset, few SE, low hangover rate. Can intensify CNS depressants
How does Benzodiazepines (BZDs) work?
Enhance GABA rather than mimicking, which limits the amount of CNS Depression.
What are the uses of BDZ's? Name a BZD for each use?
Sedation= Triazopam (Halcion)
Insomnia= Lorazapam (Ativan)
Seizures= Diazepam (Valium)
What limitations regarding tolerance and BZDs are there?
No tolerance to Sedative/hypnotic effects
Tolerance develops for anti-seizure effects
What risk with BZDs is there for physical dependency?
Uncommon, but higher with Xanax. Warn about withdrawal- can be a bigger problem with long-term or high dose therapies
How would you treat an overdose of BZDs? Reversal Agent?
Gastric Lavage, activated charcoal, and Romazicon (watch for seizures)
Name a Barbiturates? With uses?
Hypnotic/Sedative= Secbarbitol (Seconal), Pentobarbitol (Nembutol)
AntiConvulsants= Phenobarbitol
Surgical= Thiopental (Pentothol)
Why are barbiturates dangerous?
They directly mimic GABA and there is no limit to the degree of CNS depression they can produce.
What type of tolerance occurs with Barbiturates?
Tolerance develops to sedavite/hypnotic effect, but NOT to toxic effects.
What is hyperalgesia?
Increase sensitivity to pain. Can cause pain in joints and along nerves. A SE of Barbiturates.
Barbiturates physical dependency and abuse?
Common problem and severe withdrawal syndrome (can be fatal). Taper slowly.
Catharsis vs. Laxative effects?
Prompt, fluid evacuation vs production of soft formed stool
What is the Bristol Stool Scale?
a Chart used to characterize poop. Stool form depends on the amount of time spent in the colon. Types 1 &2 Constipation and Type 7 Diarrhea
When is a laxative use warrented?
Reduce painful defecation, straining, adjunt to anthelmintic, Surgery prep, tx and prevention of constipation
When is a laxative contrindicated?
s/s appendicitis, fecal impaction, bowel obstruction, and pregnancy/lactation
How do Bulk- forming agents work?
Name one?
Nondigestible and give with water
Metamucil,- pass a lot of gas
Citrucel- easier to use
Dietary Fiber
How do stool softners/surfactants work?
Name one?
Lowers stool surface tension, takes days to work, give with water.
Ducusate sodium (Colace)
Docusate calcium (Surfak)
How do lubricants/ emollients work?
Name one?
Makes the stool slippery. Watch for Lipid PNA, anal leakage.
Mineral Oil
How do Hyrdating (Osmotics) Agents work?
Name one?
Poorly absorbed salts- draws water into intestines. Takes about 8 hrs.Can cause too much water loss.
Mg Hydroxide, Mg Cl, Na Phos, Glycerin Suppository
How does Polyethylene Glycol?
Name One?
Nonabsorbable osmotic agent wih K Cl, Na Cl, Na Solfate, Na Bicarbonate. Used for Bowel Prep.
Polyethylene Glycol(GoLYTELY)
How do Stimulant/ Irritant?
Name one?
Stimulate intestinal motility, alter water and electrolyte secretion.
Cascara Bisacodyl (Dulcolax)
Senna (Ex-lax)
Caster Oil
How do Anticolgulants work?
Used for Venous Thrombi, enhances the antithrombin activity= inactives thrombin and factor Xa. Production of fibrin is reduced and clotting is suppressed.
Risk factors for DVT
In hospital?
Out of hospital?
Immobility, surgery and trauma
Smoking, truck drivers, long airplane rides, obesity, births
What are the anticoagulant therapies?
Heparin, Lovenox, Warfarin (Coumadin)
Pro's and Con's of Heparin Therapy?
Anticoagulant
Rapid onset, doesnt cross placent, inexpensive, easily reversed with PROTAMINE vs. Freq. Monitering aPTT, bleeding, HIT
What is Heparin Induced Thrombocytopenia (HIT)?
potentially fatal immune-mediated disorder. HIT should be suspected when platelets fall rapidly.
Pro's and Con's of Lovenox?
Low Molecular weight. predictable plasma levels, doesn't require monitering vs. expensive
Pros and Con's of Warfarin (Coumadin)?
Monitered by what level?
Vit. K antagonist anticoagulant
Oral dosing vs Protein bond takes three days to reach peak levels, many drug reactions
INR
How do Antiplatelet therapies work?
Prevents thrombus formation in Arteries, which would result in an heart attack
What are the anitplatelet therapies? Name one for each therapy?
ASA=
Asenosine diaphosphate receptor antagonist= Plavix
Glycoprotein IIb/IIa receptor antagonist= Aggrastat
How do ASA's work?
Uses?
Suppresses platele aggregation by causing irreversible inhibition of COX
Stroke, TIA, MI, CABG patency, unstable angina
How do Adenosine Diphosphate Receptor Antagonist (ADP's) work?
Causes irreversible blockade of ADP receptors on platelet surface. Exerts its action for the life of the platelets
Name an ADP's?
Uses of an ADP's?
Clopidogrel (Plavix)
Ticlopidine (Ticlid)
Prevention of MI and CVA
How do Glycoprotein IIa/IIb receptor antagonist (Super Aspirins) work?
Inhibits the final step of platelet aggregation. Most effective antiplatelet drug available. Given after a PCI
Name a Super Aspirin?
Abeiximab (Reo Pro)
Tirofiban (Aggrastat)
Epifibatide (Integrelin)
How do thrombolytic therapy work?
Clot busters , remove thrombi that have already formed. Acts by activation of plasminogen into plasmin= digest clots
Name a thrombolytic therapy?
-ase ending= Streptokinase, Alteplase (tPA), Tenecteplase (TNKase), Reteplase, Urokinase.
Precaution to take with thrombolytic therapies?
Causes bleeding so insert IV's, NG tubes, foleys and all other tubes needed before thrombolytic administration.
How to moniter and reverse thrombolytic therapies?
Moniter by thrombin time and reverse with Fresh frozen plasma or cryopreipitate
What are the types of Depression?
Dysthymia, Bipolar disorder, Seasonal affective disorder, and Postpartum Depression
What are the treatments for depression?
TCA's, SSRI's, MAOI's
What is depression?
At least symptoms for two weeks or more and must be a change from previous functioning.
What are the signs and symptoms of depression?
Depressed mood, loss of interest, In/decreased appetite, weight, insomnia, psychomotor agitation, fatigue, feeling worthless, thoughts of suicide/death...
What is the theory of depression?
Depression is caused be functional insufficiency of monoamine neurotransmitters- NE, serotonin or both.
Name a TCA?
Amitriptyline (Elavil)- most common
Doxepin (Sinequan)
Imipramine (Tofranil)
What are the side effects of TCA's?
Orthostatic Hypotension, sedation, anticholinergic effects, diaphoresis, cardiac toxicity, seizures
What is a TCA? Use?
Tricyclic AntiDepressants
Treatment for depression
What is a fatal dose of a TCA? Drawback
Lethal dose is only 8 times average daily dose!
How long does it take TCA's to work?
Initial Response- 1-3 weeks
Max Response 1-2 months
Long half life
What is the treatment for TCA overdose?
Gastric Lavage followed by activated charcoal and Physiostiamine , Antirrhythmics
What is an MAOI's?
Monoamine Oxidase Inhibitors
Antidepressant effects of MAOIs result from inhibiting MAO in nerve terminals
What foods are contra indicated with MAOIs? What does it do?
Tyramine rich foods such as: CHEESE, cured meats, alcohol, and liver
Causes massive vasoconstriction and excessive cardiac stimulation
What is a drawback with taking MAOI's?
Many Drug reactions
Name a Monoamine Oxidase Inhibitors (MAOIs)?
Selegiline (Eldepryl)
Phenelzine (Nardil)
What are the uses of MAOIs?
Depression (when other meds fail), Bulimia, OCD, Panic Disorders
What is a SSRI's? Mechanism of action?
Selective Serotonin Reuptake Inhibitors
Produces selective inhibition of serotonin reuptake; intensifies transmissional at serotonergic synapses.
Name a SSRI's?
Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)
Fluvoxamine (Luvox)
What are the therapeutic uses of SSRI's?
Major depression, anxiety disorders, OCD, Bulimia, premenstrual dysphoric disorder
Why are SSRI's so great?
Safer and better tolerated than TCA's and MAOI's. Half life is two days, and there have been no OD deaths reported
What are some side effects of SSRI's?
Sexual dysfunction (#1 reason why clients discontinue), Nausea, H/A. insomnia, anxiety
Name a Benzidiazepines (BZDs)?
Loraepam (Ativan)
Diazepam (Valium)
Alprazolam (Xanax)
Clorazepate (Tranxene)
What are the side effects of BZDs?
CNS depression, respiratory depression, paradoxical effects, antegrade amnesia, abuse
What drugs are used fro Anti-Anxiety agents?
BZDs, Buspar, antihistamines, antidepressants, AED's, Atypical antipsychotics
What happens with abrupt discontinuation of BZDs after chronic use?
Phyiscal dependence withdrawal?
Name a Buspirone?
Buspar
What are the pro/cons of Buspar?
No sedation, CNS depression, abuse vs. slow effect 1-4 weeks, don't give with grapefruit juice
Can Buspar be a PRN medication?
No, because it has a slow effect 1-4 weeks
Why is Buspar good for anti anxiety?
It is not a BZD and therefore No CNS depression or sedation
What is Bipolar Disorder?
Manic depression. Results in pathological mood swings from mania to depression
Name the drugs that are used for mood disorders?
Lithium, Valproic Acid (Depakote), Lamtrigine (Lamictal), AED's
Does Lithium need to be monitered? And if so how?
Yes, dosing is highly individualized. Adjustments are based on plasma drug levels (1.0- 1.5 mEq/L) and clinical response. Compliance is an issue TID or QID
What are the adverse side effects of Lithium?
Therapuetic- GI Upset, Confusion, renal toxicity, goiter
Exessive- Ataxia, seizures, giddiness, hypotension, tinnitus, oliguria, coma, death
What is Valproic Acid (Depakote)
An AED, first line of treatment for BPD, Better tolerated, fast onset, and need to moniter plasma levels
Does Depakote need monitering?
Yes, the plasma levels need to be monitered.
What is Lamictal?
An AED, this drug is gaining in popularity for BPD. It is expensive, but plasma levels do not need to be monitered.
What is the side effect of Lamictal?
Steven-Johnson Rash
What is psychosis?
is a thought disorder characterized by distrubancesof reality and perception, impaired cognitive functioning, and inapproproate or diminished affect
What is the use of Antipsychotic drugs?
Schizophrenia and other psychotic disorders
What is the problem with Antipsychotic drugs?
The make the person seem normal, but doesn't increase life satisfaction.
EPS and NMS
Name a Antipsychotic drug?
Chlopromazine (Thorazine)
Haloperidol (Haldol)
What is Tardative Dyskinesia?
Side effect of antipsychotic drug- involuntary movements, irreversible
What is Neuroleptic Malignant Suyndrome (NMS)? S/S?
Side effect of antipsychotic drug. Primary sign- lead pipe rigidity, fever, sweating, autonomic instability
Thorazine vs Haldol?
Both are conventional antipsychotic- Phenothrazines
Low-potency, Superior psychotic relief vs. high potency, less sedation and hypotension, used for Schizo, tourettes
What is EPS?
Extrapyramidal symptoms = acute dystonia, parkinsonism, and tardative dyskinesia
How is EPS treated?
acute dystonia = Benadryl, Parkinsonism= Parkinson meds, and tardative dyskinesia= Antipsychotic meds
Name an Atypical Antipsychotic Agent?
Clozapine (Clozavil)
Risperidone (Risperdal)
Olanzapine (Zyprexa)
What are Atypical antipsychotic Agents used for?
Schizophrenia- causes fewer EPS than conventional agents
What is a Clozapine (Clozaril)? Side effects?
Atypical antipsychotic agent- cause agranulocytosis
What is Risperidone (Risperdal)? Side effects?
Atypical antipsychotic agent- few side effects and popular drug
What is the treatment for NMS?
D/c drug, hydration, monitering, cool blankets, and meds= BZDs, Dantrium, or Parlodel
What is Electroconvulsive Shock Therapy (ECT)?
Safe and effective used to treat depression and psych disorders
What is the patho of Parkinsons?
Loss of dopamine producing cells of the sustantra nigra. There is an unbalance between ACh and dopamine
Why can't we just give patients dopamine?
Dopamine doesn't cross the blood brain barrier and it has a very short half life.
What are the signs and symptoms of Parkinson's diease?
Tremor, rigidity, bradykinesia, postural instability.
What is the first line of defense for Parkinson's?
Dopamine Agonist such as Not-Ergot Receptors and Ergot Derviates
Name a Non-Ergot Receptors?
Pramipexol (Mirapex)
Ropinrole HCL (Requip)
Pregolide Mesylate (Permax)
Name a Ergot Derviates?
Bromocriptine Mesylate (Parodel)
What are the side effects of Non-Ergot Receptors?
N/V, Constipation, dizziness, orthostatic hypotension, daytime somnlence, hallucinations
What are the side effects of Ergot Derviates?
N/V, Pysch distrubances, nightmares, orthostatic hypotension, dyskinesias
What drugs are used for Parkinson's Disease?
Dopamine Agonists, Anticholinergics, MAO-BIs, Levodopa- Carbidopa
Mono or adjunct therapy
Name an Anticholinergics used for Parkinsons? S/S
Trihexphenidyl HCL (Artane)
Benztropine Mesylate (Cogentin)
Can't Pee, see, poop and spit
Name a MAO-BI used for Parkinson's? Use?
Slegiline HCL (Eldepryl)
May retard PD progression
What interactions are you concerned with, with MAO-BIs?
Cheese Rx and Lethal with Demerol
What does Lepodopa do?
It crosses the BBB via active transport, but only small fractions reach the brain.
What is a Drug Holiday?
Off drug for 10 days, is the treatment for diminished response to Levodopa, better control, needs to be done in the hospital.
Adverse side effects of Levodopa?
Nausea, Dyskenisias, Orthostatic Hypotension, Dark sweat and urine, Psychosis, Activation of Malignant melanoma
What drug reacts with Levodopa?
MAOIs-
Anticholinergics-Hypertensive Crisis
Vitamin B6- Reduces effectiveness
High Protein Meals
Why is Carbidopa so good?
It delays conversion of Levodopa into dopamine until it reached the brain.
Name of Drug with Carbidopa and Levodopa?
Sinemet, 5yr before durg become ineffective.
What are the two main classes of seizures?
Partial (focal) and Generalized
What is a Tonic Clonic Seizures?
Grand mal, most common, Aura, Tonic- Rigid no breathing, Clonic- Contration/relaxation, rolled back eyes, frothing, Incontinent, Postictal- Confusion, amnesia, sleep
What is a Absence Seizure>
Petit Mal, Brief loss of consciousness, blank stare 10-30 secs, more common in children
What is an Atonic Seizure?
Akinetic Seizure or Drop Attack, sudden muscle contraction