Pharmacology Test 2: Study Session With Brooke Tutor

Front 1

Local Anesthetics with epinephrine cause what?

Back 1

vasoconstriction, which will prolong the use of the anesthetic given

Front 2

What are the adverse effects that can be caused by topical Lidocaine?

Back 2

bradycardia, heart block, cardiac arrest

Front 3

Medications used for Chronic pain include

Back 3

Fentanyl (opiod agonist)

Front 4

Medications used for Acute pain include

Back 4

Morphine (has a short half life)
Meperidine (Demorol) (" " ")

Front 5

When would a Fentanyl patch be appropriate for a patient with pain?

Back 5

This medication should be used only for long-term (chronic) pain requiring continuous narcotic pain relief that is not helped by other less powerful pain medications or less frequent dosing.

Front 6

What is the Antagonist for opiods, used in tx of an opioid overdose?

Back 6

Naloxone (Narcan) (opioid antagonist)

Front 7

What is the antagonist for benzodiazepines, used in tx of excessive benzo induced drowsiness?

Back 7

Flumazenil

Front 8

The two main side effects of opioids are what?

other side effects include?

Back 8

Respiratory depression (monitor patient for at least 4 hours) and constipation (along with miosis the body will never be able to develop a tolerance to).

urinary retention, orthostatic hypotension, emesis, and elevation of intracranial pressure (ICP).

Front 9

Medications used to treat migraine include what?

Back 9

Abortive Therapy = eliminate pain associated with nausea and vomiting

If mild to moderate in severity use non specific (aspirin like) drugs such as acetominaphen, aspirin, or naproxen.

If moderate to severe in severity use specific (ergot alkaloids and triptans)
like ergotamine, dihyroergotamine, or serotonin ib/id.

If all else fails for abortive therapy use an opiod analgesic like Butorphanol.

Prophylactic Therapy- reduce incidence and intensity of migraine attacks. indicated for migraineurs who have frequent attacks (two or more per month), especially severe attacks, or attacks that do not respond adequately to abortive agents.

Drugs for prophylactive therapy include Propranolol, divalproex, and amitriptyline are preferred drugs for migraine prophylaxis. Beta blockers such as propranolol (Inderal) are the preferred drugs for migraine prevention.



Sumatriptan
Other Serotonin 1B/1D–Receptor Agonists
D. Sumatriptan/Naproxen Combination
E. Haloperidol

Front 10

Caffeine (+) Ergotamine =

Back 10

Ergotamine is combined with caffeine in order to enhance vasoconstriction and ergotamine absorption, which in turn, enhances migraine pain relief.

overdose of ergotamine or cafergot can cause ischemia, muscle pain, cold extremities and eventually gang green

Front 11

Why are anticholinergics used to treat Parkinsonism?

Back 11

For normal motor or muscle control, the effects of acetylcholine and dopamine need to be carefully balanced. When dopamine levels are low (as they are in people who have Parkinson's disease), a chemical imbalance results, causing symptoms such as tremor and rigid muscles. Anticholinergic medicines decrease levels of acetylcholine to achieve a closer balance with dopamine levels.

Front 12

What is akithisia and what is used to treat it?

Back 12

is a syndrome characterized by unpleasant sensations of "inner" restlessness that manifests itself with an inability to sit still or remain motionless

The first-line treatment of akathisia is usually a beta-blocker, such as propranolol or metoprolol. Benzodiazepines such as clonazepam are also effective as anticholinergics.

Front 13

Clozapine (the SGA prototype) is primarily used to treat __________.
Why should WBC counts be monitored with this drug or any other SGA?

Back 13

Schizophrenia

Clozapine and other SGA's can cause Agranulocytosis in which the bone marrow fails to make enough WBC's.

Front 14

MAOI's are contraindicated with foods rich in Tyramine.

What foods are rich in Tyramine?

What effect can the combination of these to cause?

Back 14

meat, fish, wine (basically anything fermented), aged cheeses, common fruits, and nuts, as well as soy.

Hypertensive crisis can develop. Since tyramine is broken down by MAO-A the inhibition by an MAOI can cause toxic build up of tyramine.

Front 15

Side effects associated with Antidpressants include what?

Back 15

increased risk for suicide initially, sexual dysfunction, weight gain, cardiotoxicity, hypotension, and sedation.

Front 16

What are the signs and symptoms of depression?

Back 16

the principal symptoms are depressed mood and loss of pleasure or interest in all or nearly all of one's usual activities and pastimes.

For a diagnosis to be made, symptoms must be present most of the day, nearly every day, for at least 2 weeks.

Front 17

What types of drugs are used for anxiety when treatment is needed quickly and what is used when immediate effect is not necessary?

Back 17

Benzo's for immediate treatment and the first choice drug for tx of Anxiety it discourage for prolonged use for several reasons including the fact that it can be easily abused.

Busparone if immediate action is not necessary because aside from that it has three strong advantages

1.It does not cause sedation
2. has no abuse potential
3. It does not intensify the effects of CNS depressants (benzodiazepines, alcohol, barbiturates, and related drugs)

Front 18

What is Busparones relationship to the P450 system?

Back 18

Levels of buspirone can be greatly increased (5- to 13-fold) by erythromycin and ketoconazole. Levels can also be increased by grapefruit juice. Elevated levels may cause drowsiness and subjective effects (dysphoria, feeling “spacey”). Buspirone does not enhance the depressant effects of alcohol, barbiturates, and other general CNS depressants.

Front 19

Which diuretic will cause the most diuresis?

Back 19

Lasix (High-ceiling Loop diuretic)

Front 20

Which diuretics are potassium sparing and which are potassium wasting?

Back 20

potassium sparing= spironalactone, triamterene

*these are sometimes used to counteract the wasting that is done
potassium wasting= furosemide (Lasix),

Front 21

Thiazides and high ceiling Loop diuretics are similar in a lot of ways in terms of the effect they have on the body except for what?

Back 21

The Thiazides produce considerably less diuresis.

Also Thiazides will not produce diuresis when urine is scant whereas High ceiling loops will.

Front 22

What are the side effects of thiazides?

Back 22

hypokalemia(hypo- lots of things and dehydration), teratogen, hyperglycemia and hyperuricemia. It can produce toxic levls of digoxin, lithium (they are almost identical to loop diuretics AE with the exception of the ototoxicity)

Front 23

What can happen if Lasix is given to quickly?

Back 23

it can be ototoxic (furosemide-induced hearing loss is increased by concurrent use of other ototoxic drugs—especially aminoglycoside antibiotics (eg, gentamicin)

Front 24

What is the association between diuretics and digoxin?

Back 24

In the presence of low potassium, the risk of serious digoxin-induced toxicity (ventricular dysrhythmias) is greatly increased. Since high-ceiling diuretics promote potassium loss, use of these drugs in combination with digoxin can increase the risk of dysrhythmias.

Front 25

What is a normal level of the following:
Na
K
Digoxin
Lithium?

Back 25

Na= 135-145
K= 3.5-5
Digoxin= 0.5-0.8
Lithium= 0.8-1.4

Front 26

Why is it possible to have Lithium toxicity when you have low levels of Na?

Back 26

When levels of Na are low your body retains Lithium (a salt) and it can do so up to a toxic level.

Front 27

What are the side effects associated with using ACE inhibitors?

Back 27

cough, hyperkalemia, angio edema, first dose hypotension, teratogenic

Front 28

In terms of nursing interventions and drug interactions how do Akathisia and Tardive Dyskinesia differ?

Back 28

Akathisia develops early in the treatment (hours to months), occurs most frequently with high potency FGA's,TD develops later on.

Akathisia NI's= Take care to differentiate these reactions from worsening of psychotic symptoms. Inform patients and their families about symptoms (eg, muscle spasm of tongue, face, neck, or back; tremor; rigidity; restless movement), and instruct them to notify the prescriber if these appear.
Akathisia DI's= if confused with exaccerbated psychosis giving more of antipsychotic will worsen akathisia. Akathisia may respond to anticholinergic drugs, beta blockers, or benzodiazepines

TD occurrs within months to years of treatment onset

TD NI's= Inform patients and their families about early signs (eg, fine, worm-like movements of the tongue), and instruct them to notify the prescriber if these develop.
TD DI's= discontinue all anticholinergic drugs; give a benzodiazepine; and discontinue the antipsychotic, or at least reduce the dosage. For severe TD, switch to an SGA.

Front 29

Which class of drugs are used to treat alcohol withdrawal?

Back 29

Benzodiazepines

Front 30

The Laundry List

100% on every exam

Back 30

The DTPA includes a list of 27 acts or practices that are deemed to be false, deceptive, or misleading under the Act. These are the most common claims & conduct may violate more than one section of the laundry list. (RELIANCE IS REQUIRED BY A CONSUMER)
Meaning- H buys widget for W, H relies on seller, widget catches fire, W can recover b/c H relied.

Front 31

ACE inhibitors:
Indications
DI's
use in pregnancy?

Back 31

Indications= essential hypertension and heart failure

DI's= diuretics may intensify first dose hypotension (withdraw 1 week prior), other hypertensive agents potentiate and may need to be reduced, NSAIDS will reduce drug effect on hypertension, Lithium can increase to toxic levels with ACE Inhibitor use, by supressing aldosterone secretion they decrease excretion of potassium so drugs that raise potassium levels are a no no.

pregnancy= NO. If in second and third trimesters of pregnancy can injure the developing fetus. Women who become pregnant while using ACE inhibitors should discontinue treatment as soon as possible. Infants who have been exposed to ACE inhibitors during the second or third trimester should be closely monitored for hypotension, oliguria, and hyperkalemia.

Front 32

Reflex tachycardia can be supressed with what drugs?

Back 32

Beta Blockers + Nifedipine

Front 33

Digoxin: used to treat supraventricular dysrythmicity
expected outcome of therapy
AE
physical signs of toxicity
electrolyte imbalance

Back 33

expected outcome: by slowing AV conduction and reducing SA automacity even when dig levels are in the therapeutic range there could be a problem but they are less likely
AE: dysrhythmias are the most common.
physical signs of toxicity:fatigue, nausea/vomiting, and muscle weakness.

It is very hard to determine the dysrhymthmia was digoxin induced. Resolution of the dysrhythmia following digoxin withdrawal confirms the diagnosis
electrolyte imbalance: toxicity is more frequent in patients with low potassium levels

Front 34

PSVT and DOC (drug of choice) to restore sinus rhythym?

Back 34

(awaiting answer)

Front 35

What are the classic AE's associated with Niacin (used to manage cholesterol)?

What patient teaching should be done concerning Niacin use?

Back 35

include flushing, pruritus, and headache

take once daily at bedtime and with a low fat snack to reduce Niacin associated upset stomach.

Front 36

CCB's (Diltiazem)

Back 36

USE: Like Verapamil it lowers blood pressure through arteriole dilation. Indicated for essential hypertension, angina pectoris, and cardiac dysrythmias.

Bioavailability is 50% and it hits peak in 30 minutes.

AE:dizziness, flushing, headache, and edema of the ankles and feet, ecxzema rash in elderly, cardiac dysfunction in those with pre existing heart problems.

DI: Digoxin or Beta blockers can cause increased or complete AV block.

Front 37

Nitroglycerin: angina pectoris prototype (decreases oxygen demand)
absorption
dosing
DI's

Back 37

absorption:highly lipid soluble and crosses membranes with ease. Because of this property, nitroglycerin can be administered by uncommon routes (sublingual, buccal, transdermal) as well as by more conventional routes (oral, intravenous).
This drug if worn as a patch must be removed for at least 8 hours out of a 24 hour day so that tolerance does not build.
The quickest route is to do so sublingually because it bypasses first pass metabolism.
dosing: plasma half life of 5-7 minutes (VERY FAST)
DI's: can intensify affects of hypotensive drugs, some erectile dysfunction drugs can cause Nitro induced vasodilation leading to life threatening hypotension

Front 38

Amiodarone:
AE's

Back 38

This drug is used only for life threatening dyryythmias.

Has a ton of them but to make it worse the drug is protracted so these AE's can last months after drug withdrawal.

pulmonary toxicity, cardiotoxicity, toxicity in pregnancy and breast feeding, corneal deposits, optic neuropathy, skin color change,

Front 39

Drugs used for STEMI's
The objective is to minimize possible myocardial necrosis while waiting for a clear diagnosis. Once STEMI has been diagnosed, more definitive therapy—reperfusion—can be implemented

Back 39

MONAB (Morphine, Oxygen, Nitroglycerin, Aspirin, Beta Blockers)

non aspirin NSAIDS NO LONGER okay!

(may want to look at pgs 621-623 to get more info on mechanism if you want)

Front 40

When someone is taking Metoprolol for treating high blood pressure, angina, or CHF what is a sign of overdose or toxicity?

Back 40

wheezing, fatigue, or decreased breathing

Front 41

APTT levels when normal and when using Heparin

Back 41

normal value APTT- 40 seconds

heparin therapy target for APTT: 60-80 seconds.

should be measured every 4-6 hours.

Front 42

With thrombocytopenia (low platelet count is below 100K) what should be done?

HIT (Heparin induced thrombocytopenia)

Back 42

STOP Heparin!

This can be seen physically when there is petichiae, brusing, nosebleeds or bleeding mouth.