Pharm Final: Etsu Dec 2012 Pt Iii

Front 1

25. Parkonsonism
qualities

Back 1

slow onset, resting tremor=1st sign, extrapyramidal system disorder; cog wheel movement, no swing in gait on one side, facial expression loss Dyskinesias: tremor at rest, rigidity, postural instability; disruption of neurotm, end stage-> dementia (Louis Body)
no cure, symptom mgt only

Front 2

25. Levodopa
antiparkinson
dopaminergic

Back 2

symptom relief from dyskinesia
maintains balance between dopamine and ACH in extrapyramidal NS, crosses BBB, effective for 1-2yr, then eff decreases

Front 3

25. Levodopa
Interaction

Back 3

antipsychotics, MAOIs (w/in 2 wks), anticholinergics, B6

Front 4

25. Levodopa
Adverse effect

Back 4

falls, HoTN, N/V, dyskinesia, ortho HoTN, psychosis, Sundowner's, dark sweat/urine, malignant melanoma, FREEZE , monitor Liver/Kidney

Front 5

25. Levodopa
Admin

Back 5

no high protein meals, supervised drug holiday ok

CARBIDOPA-potentiates (inc. duration and effectivenss) *take 12 hours later

Front 6

25. Donazepril
actions

Back 6

slows Alz process, best in early stage, with impulsivity/judgment, mild/mod symptoms, effective in 25-30%

Front 7

25. Donazepril
Adverse effects

Back 7

N/V/D, dyspepsia, dizziness, HA, bronchostriction (contra: Asthma, COPD)

Front 8

26. Phenytoin (Dilantin)
action

Back 8

anticonvulsant (+ antidysrhythmic), Na channel
Range 10-20mg/L
Max IV rate 50 mg/min

Front 9

26. Phenytoin (Dilantin)
Adverse Effect

Back 9

CNS depression, gingival hyperplasia, rash, CV (anemia), pregnancy (teratogenic)-cleft palate, Stevens-Johnson , HoTN, bradycardia, purple glove if given in hand vein!

Front 10

26. Phenytoin (Dilantin)
Interaction

Back 10

INH (for TB), warfarin (bleeding), alcohol, herbals (SJW, gingko)

Front 11

26. Phenytoin (Dilantin)
Admin

Back 11

withdraw slowly, no other drugs w/o MD consent, decrease eff of birth control and warfarin, take w food, track seizures, carry ID, no driving if CNS is depressed, no alcohol, suicide watch, take Ca and Vit D

Front 12

26. Carbamazepine
anticonvulsant
TX

Back 12

partial seizures, tonic-clonic, bipolar, neuralgias (trigeminal, glossopharyngeal)

Front 13

26. Carbamazepine
Adverse Effect

Back 13

*Asian, inc risk
aplastic anemia, agranulocytosis, dermatological rns (Stevens-Johnson), photosensitivity, vision, renal

Front 14

26. Carbamazepine
Interactions

Back 14

grapefruit jc, oral BC, warfarin (PT/INR), gingko, SJW

Front 15

26. Carbamazepine
contraindications

Back 15

HF, renal, bone marrow suppression, bleeding disorder

Front 16

26. Carbamazepine
Admin

Back 16

build strength of dose, give at bedtime

Front 17

27. Cyclobenzaprine (Flexerile)
action

Back 17

mm relaxant, NE releasing agent
increase ROM, decrease pain, opioid use

Front 18

27. Cyclobenzaprine
Adverse Effects

Back 18

CNS depression, hepatic (liver fn test!), dependence

Front 19

27. Cyclobenzaprine (Flexerile)
Admin

Back 19

avoid driving when CNS depressed, avoid alcohol, antihistamines
don't DC immediately

Front 20

22. Anxiety
classes

Back 20

Generalized Anxiety Disorder
Panic Disorder
Social Anxiety Disorders
Obsessive Compulsive Disorder
Post Traumatic Stress Disorder

Front 21

22. Benzodiazepines
action, TX

Back 21

GABA receptor binding (inhibitory system) for generalized anxiety and ST insomnia

Front 22

22. Alprazolam (Xanax)
Tx

Back 22

benzodiazepine for anxiety, depression, panic, seizure, insomnia, mm spasm,
CATEGORY D

Front 23

22. Alprazolam (Xanax)
Adverse effects

Back 23

CNS depression, amnesia, resp. depression (IV), physical dependence

Front 24

22. Alprazolam (Xanax)
contraindications

Back 24

apnea, resp depression, pregnant/lactating, substance abuse, liver/renal

Front 25

22. Alprazolam (Xanax)
Antidote

Back 25

Oral-gastric lavage, charcoal, saline cathartic
IV-flumazenil
OD=drowsiness, confusion, diminished reflexes, coma
avoid D/C quickly

Front 26

22. Alprazolam (Xanax)
interacts

Back 26

barbituates, alcohol, caffiene

Front 27

22. Zolpidem (Ambien)
TX

Back 27

sedative/hypnotic, non-benzo
for ST insomnia, enhances GAPA, sleep longer, wake less (not antianxiety, mm relaxer, or antiepileptic) Low risk for: tolerance, abuse, dependence

Front 28

22. Zolpidem (Ambien)
Contraindications

Back 28

breastfeeding, impaired kidney/liver/resp

Front 29

22. Zolpidem (Ambien)
Interaction

Back 29

CNS depressants (alcohol, barbituates, opiods)

Front 30

22. Zolpidem (Ambien)
Admin

Back 30

allow for 8 hours sleep, not immediately after eating (absorption)

Front 31

22. Phenobartitol (Luminal)
TX

Back 31

Schedule IV
seizures, reduces time to drift off, lengthens sleep time

Front 32

22. Phenobartitol (Luminal)
Adverse Effects

Back 32

Stevens Johnson Syndrome, Coma

Front 33

22. Phenobartitol (Luminal)
Adverse Effects

Back 33

Stevens Johnson Syndrome, Coma

Front 34

22. Phenobartitol (Luminal)
Admin

Back 34

15-40 mcg/mL
D/C gradually, no alcohol or CNS depressants

Front 35

23. Depression

Back 35

depressed mood, loss of pleasure, interest, insomnia/hypersomnia, anorexia, weight loss, lack of concentration, feelings of guilt/worthlessness/helplessness
RX should be smallest no of doses, caution: cheeking

Front 36

23. Imipramine (Tofranil)
action, TX

Back 36

block NE & serotonin, Tx for depression, bipolar, autism, ADHD, PTSD, OCD

Front 37

23. Imipramine (Tofranil)
Adverse effects

Back 37

orthoHoTN, anticholinergic (dry mouth, blurred vision, photophobia, urinary retention, constipation, tachy), weight gain, sedation, cardiotox, diaphoresis, seizures, hypomania, suicide risk

Front 38

23. Imipramine (Tofranil)
Interactions

Back 38

cardiac suppressants, MAOIs, antihistamine, CNS depressants

Front 39

23. Imipramine (Tofranil)
Toxicity!

Back 39

dysrhythmia, hyperthermia, flushing, dry mouth, dilated pupils, CNS symptoms, confusion/agitation/hallucination, seizures->coma

Front 40

23. Imipramine (Tofranil)
Contraindications

Back 40

seizures, DM, liver, kidney, respiratory issues, hyperthyroidism
start small dose and build, when established QDnoc

Front 41

23. Prozac (Fluoxetine)
actions

Back 41

SSRI, does not block dopamine or NE

Front 42

23. Prozac (Fluoxetine)
TX

Back 42

depression, bulemia, PTSD, OCD, ADHD

Front 43

23. Prozac (Fluoxetine)
Adverse Effects

Back 43

CNS stimulation, weight loss, Serotonin Syndrome (w MAOI use), sexual dysfunction, GI bleed, rash, withdrawal syndrome (do so gradually)

Front 44

23. Prozac (Fluoxetine)
Contraindications/
Interactions

Back 44

liver, renal, cardiac, seizure, DM, ulcers/GI,
warfarin, lithium, NSAID, MAOI, TCA

Front 45

23. Bupropion (Wellbutrin)

Back 45

TX for depression, seasonal affective, off label for nicotine WD with smoking cessation

Front 46

23. MAOI
TX

Back 46

atypical depression, bulemia, OCD

Front 47

23. MAOI
Adverse Effects

Back 47

CNS stimulation, orthoHoTN, rash, dietary tyramine-cause HTN crisis (HA, HTN, NV, tachy)

Front 48

23. MAOI
Interactions

Back 48

Food: yeast, cheese, fermented meats, wine, beer, avocado, soybean, figs, bananas
Med: Wellbutrin, amphetamines (Sudafed), TCA, SSRIs, antiHTN drugs, Demerol

Front 49

44. Aspirin, NSAID, Cox 2 inhibitor
TX

Back 49

mild/mod pain, fever, thrombosis, RA/inflammation, dysmennohrea, clotting, prophylaxis for colon cancer

Front 50

44. Ibuprofen & Naproxen
Cox 1 & Cox 2 (nonselective)
vs. Aspirin

Back 50

safe for kids
does not protect against MI/stroke
inc. risk for thrombosis
GI irritating, ulcer/bleed

Front 51

44. Celecoxib (selective) 2nd gen
Cox 2 inhibitor
TX

Back 51

inflammation, pain, arthritis, prophylaxis for colon cancer risk

Front 52

44. Celecoxib
Adverse Effects
Contraindications

Back 52

GI ulcer, CV (inc. MI, stroke), renal
HTN, edema, HF, kidney, sulfa allergy

Front 53

44. Acetaminophen (selective) 2nd generation
Actions

Back 53

metabolized by liver, excreted in urine

Front 54

44. Acetaminophen
Interactions
Adverse Effects

Back 54

alcohol, warfarin
rare AE @ therapeutic doses (no GI, renal, platelet)
Toxicity-4++G/24h
leading cause of liver failure in US
(increased risk with fasting, alcohol, warfarin)
Mucomyst-antidote

Front 55

44. Morphine (opiod, schedule II)
Adverse Effects

Back 55

Resp depression <12, constipation, ortho HoTN, urinary retention, cough suppression, emesis, "high" euphoria, sedation, neurotoxicity, toxicity (dec RR, coma, pinpoint pupils)

Front 56

44. Morphine
Contraindications

Back 56

Elderly, young, biliary colic, pregnancy, L & D (slows progression), head injury

Front 57

44. Morphine
Admin

Back 57

Withdraw slowly to reduce WD symptoms, tolerance happens gradual (sudden onset changes are not tolerance)

Front 58

44. Morphine
Interactions

Back 58

CNS depressants, anticholinergics (antihistamines), hypotensives, MAOIs w/ morphine can be fatal, agonist/antagonist opioids, antagonist opioids (Narcan)

Front 59

44. Naloxone (Narcan)
Admin

Back 59

to reverse opioid OD, post op to reverse operative CNS depression, neonates to reverse respiratory depression
IV-(2-5min reaction, small dose, gradually increase to reverse OD and maintain analgesia) NOT PO

Front 60

Old Mat'l
Anticoagulants: Heparin

Back 60

Dose=units (also insulin & PCN)
AE: abnormal bleeding, allergy, osteoporosis
Black Box: epidural/spinal hematomas w/ anesthesia

Front 61

Old Mat'l
Anticoagulants: Coumadin

Back 61

monitor for bleeding frequently in adults, INR labs
AE: bleeding, osteo, fx
Vitamin K: contracoumadin: green tea, ginkgo, garlic, ginger

Front 62

Old Material
Antidiabetic: Insulin

Back 62

Short-Humalog-clear, IV ok, before meals, short duration
Combination: 75/25: 75% long, 25% rapid
Peak-greatest effect achieved
Duration-length of time effect lasts
Short-Rapid (4h), Short-Slow (8), Int (16), Long (24-no peak)

Front 63

Old Material
Glucocorticoid/Corticosteroid:
Hydrocortisone

Back 63

TX: inflammation, allergic disorders, adrenocortical insufficiency
Raise Blood Sugar, lead to/contra DM
taper off to avoid WD symptoms
3-4 divided doses per day
mask infection ss, osteoporosis, psychologic, mm wasting, delayed wound healing

Front 64

Old Material
Terms:
Half life
First pass effect

Back 64

half life-time it takes for plasma levels of med to be reduced by 1/2
first pass-amount of drug lost or filtered before reaching its target (typically liver)

Front 65

Old Material:
Rights of Med Administration

Back 65

right patient, med, dose, mode, time, documentation
Ck allergies!