Exam 2 Pharmacology

Front 1

Name the three Local Anesthetics?

Back 1

Procaine
Lidocaine
Cocaine

Front 2

Local anessthetics stop nerve conduction by blocking ______
in the axon membrane.

Back 2

sodium channels

Front 3

What size and type of neurons are blocked more rapidly?

Back 3

Small, unmyelinated neurons!!

Front 4

Lidocaine is an amide type anesthetic and can rarely cause _____?

Back 4

allergic reactions

Front 5

If skin is abraeded, absorption of a local anesthetic is _____, which _______ the risk of toxicity. Appliacation of a topical anesthetic to inflamed areas or to large surface areas would ______ risk of toxicity?

Back 5

increase
increase
increase

Front 6

Absorption occurs more readily through ________
membranes?

Back 6

mucous

Front 7

What is the prototype of the local anesthetic group?

Back 7

lidocaine

Front 8

What is accomplished by applying the anesthetic directly to the skin or a mucous membrane?

Back 8

surface anesthesia

Front 9

What are Morphines multiple pharmacologic effects? (5 of them)

Back 9

1. Analgesia
2. Sedation
3. Respiratory Depression
4. Cough Suppression
5. Suppresion of bowel movements.

Front 10

What will occur is the opioid is abruptly withdrawn?

Back 10

abstinence syndrome

Front 11

What is tolerance?

Back 11

is a state in which larger doses are required to produce the same response formerly produced by a lesser dose.

Front 12

What is physical dependence?

Back 12

is a state in which an abstinence ssyndrome occurs if the drug is discontinued abruptly.

Front 13

Precautions to opiod use include: (4 things)

Back 13

1. Pregnancy
2. Labor and Delivery
3. Head Injury
4. Decreased Respiratory Reserve

Front 14

Patients taking opioids should avoid what? (3 of them)

Back 14

1. Alcohol
2. CNS depressants
3. Anticholinergic drugs (antihistamines, tricyclic antidepressants, atropine-like drugs).

Front 15

What can alcohol and CNS depressants do if used with another opioid

Back 15

intensify opiod induced sedation and respiratory depression.

Front 16

What can anticholinergic drugs do if used with an opioid?

Back 16

Increase constipation and urinary retention

Front 17

Opioid overdose produces a classic triad of signs?

Back 17

coma, respiratory depression, pinpoint pupils.

Front 18

What is the advantage of Fentanyl?

Back 18

It has many routes

Front 19

Which drug is more potent than morphine?

Back 19

Fentanyl, because it is dosed in micrograms rather than milligrams.

Front 20

What does potency mean?

Back 20

a drug that provides a stronger response at a smaller dosage.

Front 21

Fentanyls half life is ____

Back 21

very long.

Front 22

With transdermal application, its level remain steady for __ to __ hours. This makes it an approriate drug for use in patients with chronic pain.

Back 22

24 to 48 hours

Front 23

Meperidine (Demerol) should not exceed __ hours to avoid accumulation of normeperidine, a toxic metabolite.

Back 23

48 hours

Front 24

Side effects of opioids

Back 24

analgesia, sedation, euphoria, respiratory depression, constipation, urinary retention, cough suppression, and miosis (pupils constrict)

Front 25

What is the m ain agonist-antagonist opioid?

Back 25

Penazocine

Front 26

What is the pure opioid antagonist?

Back 26

Naloxone

Front 27

What is the other pure opioid antagonist and how is it different from naloxone?

Back 27

Methylnatrexone-is used reverse constipation caused from opioids. It does not cross the BBB so cannot reverse the other side effects that naloxone can.

Front 28

What is addiction

Back 28

is a behavior pattern characterized by continued use of a psychoactive substance despite physical, psychologic, or social harm.

Front 29

Are physical dependence and addiction the same?

Back 29

NO!

Front 30

What is abuse?

Back 30

Abuse is defined as drug use that is inconsistent with medical or social norms.

Front 31

Physical dependence is extremely rare when taking opioids? True or False?

Back 31

TRUE!!!

Front 32

What is pain?

Back 32

A personal, subjective experience that encompasses not only the sensory perception of pain but also the patients emotional and cognitive responses to both the painful sensation and the underlying disease.

Front 33

What are the two forms of pain?

Back 33

Nociceptive
Neuropathic

Front 34

What is the difference between the two forms of pain?

Back 34

Nociceptive pain is what results from injury to tissues. Neuropathic pain is what results from injury to peripheral nerves.

Front 35

Two forms of nociceptive pain are?

Back 35

Somatic and Visceral.

Front 36

Describe visceral?

Back 36

Visceral pain is localized with a diffuse, aching quality.

Front 37

Chemotherapy can cause what three painful problems?

Back 37

1. mucositis-inflammation of mucous membrane lining digestive tract.
2. diffuse neuropathies-nerve problem affecting parts of body.
3. aseptic necrosis of joints-death or destruction of joint

Front 38

Radiation can cause what three problems?

Back 38

1. osteonecrosis-bone death
2. chronic visceral pain-
3. peripheral neuropathya
(secondary to causing fibrosis of nerves)

Front 39

What three things can contribute to cancer pain?

Back 39

1. Chemotherapy
2. Radiation
3. Surgery

Front 40

Because pain is a personal experience, the patients _______ is the cornerstone of assessment?

Back 40

self-report

Front 41

What are some barriers to inadequate pain relief?

Back 41

1. Many patients under report pain, frequently because of misconceptions.
2. Some patients fear they may be denied pain medication and hence, to ensure adequate dosing, report more pain than they actually have.
3. Language barriers and cultural barriers can impede pain assessment.
4. When assessing pain, we must keep in mind that behavior and facial expressions may be poor indicators of pain status.

Front 42

Drug selection is guided by ?

Back 42

WHO analgesic ladder.

Front 43

What is the WHO analegsic ladder?

Back 43

As pain intensity increases, treatment progresses from nonopioid analgesics to opioids of moderate strength (ex: oxycodone) and then to powerful opioids (ex: morphine). Adjuvant analegesics can be used at anytime. If pain is already intense, treatment can start with an opioid, rather than trying a non-opioid.

Front 44

Because nonopioid and opioids relieve pain by different mechanism, combining an opioid with a nonopioid can be more effective than either drug alone? TRUE OR FALSE?

Back 44

TRUE!!!

Front 45

What are NSAIDs?

Back 45

NON-Steroidal Anti-inflammatory drugs

Front 46

Give an example of a few NSAID drugs?

Back 46

-Ibuprofen (Advil, Motrin)
-Aspirin
-Aleve
-Excedrin

Front 47

By inhibiting platelet aggregation (clumping of blood), NSAID's increase the risk of bleeding in patients with _______?

Back 47

Thrombocytopenia-disease where there is not enough platelets to clot.

Front 48

Thrombocytopenia is a common side effect of what?

Back 48

Cancer chemotherapy

Front 49

Tylenol is not an NSAID? True or False?

Back 49

TRUE, tylenol is NOT an NSAID!

Front 50

For patients undergoing chemotherapy, inhibition of platelet aggregation (not allowing blood to clump) by NSAID drugs is a serious concern, b/c many anticancer drugs suppress bone marrow function and reduce platelet production. Therefore Thromboctopenia may result, putting the patient at risk for bleeding. If you were a nurse what would you expect to anticipate to do for this patient?

Back 50

Order a platelet count. B/c you don't want to put a person on NSAID's if they already have a low platelet count due to thrombocytopenia or if they are on chemotherapy.

Front 51

Acetaminophen relieves ___

Back 51

pain, does NOT suppress inflammation, inhibit platelet aggregation, or promote gastric ulceration or renal failure.

Front 52

NSAID's relieve

Back 52

pain and inflammation.

Front 53

What are some side effects of NSAID's?

Back 53

GI injury, acute renal failure, and bleeding

Front 54

Because acetaminophen (tylenol) does not affect platelets, the drug is safe for patients with _________

Back 54

thrombocytopenia.

Front 55

What drug is used for moderate pain, and does not stop the blood from clumping and therefore is a safe pain medication for a cancer patient?

Back 55

Choline Salicylate (Arthropan)

Front 56

Combining acetaminophen with alcohol, even in moderate amounts, can result in potential???

Back 56

Fatal liver damage.

Front 57

What route is preferred for pain by most patients and what is a good alternative route?

Back 57

Oral route-preffered
Transdermal- good alternative

Front 58

Intramuscular opioids are painful and should be avoided?`TRUE OR FALSE?

Back 58

TRUE

Front 59

What is a desirable method of opioid delivery because it gives patients more control over their treatment?

Back 59

PCA-(Patient Controlled Analgesia)

Front 60

Intraspinal Administration is reserved for patients with intractable pain that cannot be controlled by less invasive routes. This route would be contraindicated in a patient with excruciating bone pain and is also not indicated for patients with gastric cancer. true or false

Back 60

true

Front 61

Respiratory Depression is increased by other drugs with _________ action. Accordingly combining these agenst with opioids should be avoided.

Back 61

CNS depressants (alcohol, benzodiazepines, barbiturates)

Front 62

Nursing interventions regarding respiratory depression

Back 62

1. Measure Baseline respiratory pattern and oxygen saturation of patients receiving opioids.
2. Periodically monitor respiratory rate throughout duration of treatment.
3. Also assess level of consciousness in patients received opioids.

Front 63

Opioids cause constipation in most patients and no tolerance develops? True or False

Back 63

TRUE

Front 64

Use of meperidine should be limited. True or False?

Back 64

TRUE

Front 65

How do adjuvant analgesics help with therapy?

Back 65

They can enhance analgesia from opoids, help manage concurrent symptoms that cause pain, and treat side effects caused by opioids. In addition several adjuvants are effective against neuropathic pain and not nust nociceptive pain.

Front 66

Basically adjuvant analgesics are given to COMPLEMENT the effects of opioids. T or F

Back 66

True

Front 67

The 4 adjuvant analgesics used in conjunction with opoids for pain control in cancer patients are

Back 67

1. Hydroxyzine
2. Dextroamphetamine
3. Carbamazepine
4. Dexamethasone

Front 68

What are invasive therapies?

Back 68

Invasive therapies (nerve blocks, neurosurgical procedures, radiation) are the last resort for relieving intractable pain. All other options should be exhausted before these are tried.

Front 69

What is the fifth vital sign?

Back 69

PAIN!!!!!

Front 70

What is breakthrough pain?

Back 70

Occurs spontaneously or may be precipitated by other movements. It is not related to dosing intervals; it can occur at anytime and spontaneously.

Front 71

What is end of dose pain?

Back 71

Occurs because analgesic levels are lowest at that time, and not because of breakthrough pain.

Front 72

What is MOH (Medication overuse headache)?

Back 72

drug induced headache or drug rebound headache because of using to much abortive medication per week. Abortive medication should be limited to 1 or 2 days per week.

Front 73

For moderate to severe symtoms patients should take a migraine specific drug either an ______ or a ________?

Back 73

-ergot alkaloid (ergotamine or dihydroergotamine)
-serotonin 1b/1d agonist

Front 74

Opoid analgesics (ex: butorphanol) are reserved for severe migraines that have not responded to other drugs already!!! true or false

Back 74

TRUE

Front 75

Overdose with ergotamine can cause ____?

Back 75

ergotism, a serious condition characterized by severe tissue ischemia secondary to generalized constriction of peripheral arteries. 1st you would have constriction of arteries and 2nd you would get tissue ischemia if you didn't reverse the problem.

Front 76

Ergotamine should not be combined with _____ because a prolonged vasospastic reaction can occur

Back 76

tripitans (sumatriptan, zolmitriptan)

Front 77

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

Back 77

vasoconstriction

Front 78

What are the first line drugs and drug of choice for abortive therapy of moderate to severe migraines?

Back 78

Triptans (Sumatriptan)

Front 79

What are the benefits of Sumatriptan and naproxen combination?

Back 79

attack migraine from multiple mechanism; naproxen reduces pain and inflammation, while sumatriptan causes vasoconstriction and inhibits release of inflammatory neuropeptides.

Front 80

What are the three preferred drugs fro migraine prophylaxis (migraine prevention)?

Back 80

1. propanolol
2. divalproex
3. amitriptyline

Front 81

Beta blockers such as propanolol are the preferred drugs for migraine prevention. TRUE or FALSE

Back 81

TRUE

Front 82

Treatment of prevention therapy of migraines can reduce the number and intensity of attacks in approximately 70% of patients but it does not abort acute attacks. Verapemil is also used as a preventive therapy but not to abort the actualy pain of a migraine present.

Back 82

TRUE

Front 83

Can ergotamine cause physical dependence?

Back 83

Yes, if it is overused.

Front 84

What are the early signs of ergotism (overdose of ergotamine)?

Back 84

muscle pain, paresthesias in fingers and toes, and extremities that are cold, pale and numb.

Front 85

The antipsychotic drugs fall into two major groups what are they?

Back 85

1. First generation antipsychotics (FGA's)
2. Second generation antipsychotics (SGA's)

Front 86

First generation drugs are called _____ antipsychotics and Second generation drugs are called ______ antipsychotics

Back 86

1. conventional
2. Atypical

Front 87

All of the FGA's block receptors for dopamine in the CNS. As a result they can casue serious movement disorders, known as

Back 87

Extrapyrimidal symptoms (EPS)

Front 88

The SGA;s carry little risk of EPS, but they do pose a risk of what?

Back 88

metabolic effects such as weight gain, diabetes, and dyslipidemia (cholesterol problem). These all cause CV events and early death.

Front 89

What drug is used to manage symptoms of dystonia?

Back 89

Diphenydramine (Benadryl)

Front 90

Vital signs should be obtained after initial management of the physiological crisis associated with symptoms of _____

Back 90

acute dystonia.

Front 91

What is acute dystonia?

Back 91

SEVERE spasms of the muscles of the tongue, face, neck, and back. MILD spasms are NOT associated with acute dystonia.

Front 92

First generation antipsychotics produce three types of early extrapyramidal symptoms?

Back 92

1. acute dystonia
2. parkinsonism
3. akathisia

Front 93

what are the symptoms of parkinsonism?

Back 93

tremors, rigidity, shuffling gait, and a masklike face.

Front 94

What is tardive dyskinesia (TD)?

Back 94

a late EPS, has no reliable treatment. For patients with severe TD, switchhing to an atypical drug may help.

Front 95

What is neuroleptic malignant syndrome?

Back 95

muscular rigidity ("lead pipe" ridigidy), high fever, confusion, and autonomic instability, which can be fatal.

Front 96

What two drugs are used for treatment of neuroleptic malignant syndrome?

Back 96

1. Dantrolene
2. Bromocriptine

Front 97

What is the prototype drug for the low potency FGAs and what patient teaching would be important for a patient prescribed the drug in terms of side effects of this drug?

Back 97

- Chlorpromazine (Thorazine)
sedation, orthostatic hypotension, dry mouth,

Front 98

What drug is the prototype for high potency drugs

Back 98

haloperidol

Front 99

What is the first SGA and the most effect antipsychotic drug available?

Back 99

-Clozapine

Front 100

What is the potentially fatal side effect of clozapine?

Back 100

-Fatal agranulocytosis (failure of bone marrow to make enough WBC's, lowered WBC count).

Front 101

What are the side effects of atypical antipsychotics?

Back 101

-weight gain
-diabetes mellitus
However, atypical antipsychotics their use does result in a lower rate of relapse.

Front 102

Atypical Antipsychotic agents have the same effect as conventional antipsychotic agents on positive symptoms of schizophrenia, and they have a greater effect on negative symptoms and cognitive dysfunction. Atypical antipsychotics cause fewer EPS symptoms. t or f

Back 102

TRue

Front 103

positive symptoms of schizophrenia.
negative symptoms and

Back 103

positive symptoms-hallucinations, dellusions, tension, paranoia and agitation
negative symptoms-blunted effect, lack of motivation, poverty of speech, poor self care, and social withdrawal.

Front 104

What antipsychotic drug causes high weight gain?

Back 104

Olanzapine (zyprexa)

Front 105

What antipsychotic drug has been shown to cause only a small weight gain compared to other antipsychotic meds?

Back 105

geodon (ziprasoidone)

Front 106

What two antipsychotic drugs cause moderate weight gain?

Back 106

1. thioridazine and quetiapine

Front 107

Tardive dyskinesia symptoms are?

Back 107

twisting, writhing, wormlike movements of the tongue and face.

Front 108

Initial responses to antidepressants develop in __ to __ weeks.

Back 108

1 to 3

Front 109

Maximal responses to antidepressants develop in __ to __ months

Back 109

1 to 2 months

Front 110

What drug category are the drugs of first choice for antidepressants?

Back 110

-TCA's

Front 111

What drug category is just as effective and better tolerated but are more expensive than TCA's?

Back 111

-SSRI's

Front 112

What drug category is generally reserved for patients who have not responded to TCA's or SSRI's

Back 112

MAOI's

Front 113

What is the prototype of TCA's?

Back 113

-Imipramine

Front 114

Antidepressant therapy should continue for __ to __ months after symptoms have abated (been gone)

Back 114

6 to 12 months

Front 115

What are the most common adverse effects of TCA's?

Back 115

-sedation, orthostatic hypotension, and anticholinergic effects (drug mouth and constipation).

Front 116

What is the most serious adverse effect of TCA's?

Back 116

cardiotoxicity, which can be lethal if an overdose is taken.

Front 117

What can happen if a TCA was combined with an MAOI?

Back 117

a hypertensive crisis could occur, the combination is generally avoided.

Front 118

SSRI's have two major advantages over TCA's

Back 118

1. cause fewer side effects
2. safer when taken in overdose

Front 119

What is the prototype of SSRI's?

Back 119

-Fluoxetine

Front 120

What is the side effect of fluoxetine?

Back 120

weight gain

Front 121

What is the most common side effect of SSRI's

Back 121

-sexual dysfunction, to manage sexual dysfunction you have a drug holiday-discontinuation of SSRI medication on Friday and Saturdays.

Front 122

SSRI's can cause serotonin syndrome, especially when combined with MAOI's and other seroteonergic drugs. When do the symptoms of serotonin syndrome develop?

Back 122

Symptoms begin 2 to 72 hours after initiation of treatment and include agitation, confusion, hallucinations, hyperreflexia, tremor, and fever.

Front 123

Monitor responses of wafarin closely when on antidepressant. T or F

Back 123

TRUe

Front 124

What is the prototype of SNRI's?

Back 124

Venlafaxine
side effect: nausea

Front 125

What are the first choice drugs only for patients with atypical depression? They are second or third choice anti-depressants for most patients, after selective serotonin reuptake inhibitors and tricyclic antidepressants. They are not used as first line treatment of depression. They are not used in patients who have serotonin syndrome or in those having difficulty sleeping.

Back 125

MAOI's

Front 126

The MAOI's are second or third choice antidepressants for most patients. Although these drugs are as effective as the tri-cyclic antidepressants and SSRI's, they are more dangerous! t or f

Back 126

TRue

Front 127

Patients taking MAOI's must not eat ____ rich foods because what will happen?

Back 127

tyramine rich foods because could cause a hypertensive crisis. Tyramine rich foods include yogurt, aged cheeses, chocolate, red wine, and other foods.

Front 128

What is an atypical antidepressant that is a unique antidepressant similiar to structure of amphetamine.

Back 128

Buproprion (Wellbutrin)

Front 129

Bupropion is well tolerated but can cause ??

Back 129

seizures

Front 130

TCA's and MAOI's both produce orthostatic hypotension. t or f

Back 130

True

Front 131

What is a bipolar disorder?

Back 131

a severe biologic illness characterized by recurrent fluctuations in mood.

Front 132

Patients with bipolar disorder may experience four types of mood episodes?

Back 132

1. Pure manic episode
2.Hypomanic depressive episode
3. Major depressive episode
4. Mixed episode (mania and depression)

Front 133

Bipolar disorder is treated with three kinds of drugs?

Back 133

mood stabilizers, antipsychotic drugs, and antidepressants.

Front 134

For acute therapy of bipolar disorder mood stabilizers and mood stabilizers plus antidepressants are used. t or f

Back 134

true

Front 135

What are the two preferred mood stabilizers for BPD?

Back 135

lithium and valproic acid

Front 136

Lithium has a low therapeutic index t or f

Back 136

true

Front 137

Antimanic effects begin __ to __ days after treatment onset but full benefits may not develop for __ to __ weeks

Back 137

5 to 7
2 to 3

Front 138

To minimize the risk of toxicity, lithium levels must be monitore. the trough level, measured 12 hours after the evening dose, should be less than __?

Back 138

1.5 mEq/L

Front 139

When Lithium plasma levels exceed 1.5 mEq/L more serious toxicities appear. At drug levels above __ death can occur. Patients should be informed about early signs of toxicity and instructed to interrupt lithium dosing if these appear.

Back 139

2.5 meq/L

Front 140

In adherent patients, the most common cause of lithium accumulation is

Back 140

sodium depletion

Front 141

Lithium may be teratogenic. true or false

Back 141

true

Front 142

A reducation in sodium levels reduce lithium excretion, causing lithium to accumulare possibly to toxic levels. Patients must maintain normal sodium intake and levels. True or false

Back 142

true

Front 143

Lithium levels can be increased by __ and by several ____?

Back 143

diuretics (especially thiazides) and NSAID's.

Front 144

NSAIDS can increase lithium levels by as much as ___%?

Back 144

60%

Front 145

What was the first antiseizure agent approved for Bipolar disorder?

Back 145

-Valproic Acid (depakote)

Front 146

Valproic acid has a higher therapeutic level than lithium but can cause serious toxicity. true or false

Back 146

true

Front 147

Five antipsychotic agents are approved for BPD?

Back 147

zyprexa
seroquel
risperdal
abilify

Front 148

IF THE PATIENT DOES NOT HAVE ENOUGH SODIUM, A HIGH TOXIC LEVEL OF LITHIUM CAN DEVELOP. DIARRHEA AND DEHYDRATION IS ALSO AT RISK FOR DEVELOPMENT OF LITHIUM TOXICITY. CHECK WHAT LEVELS?

Back 148

SODIUM INTAKE LEVEL
HYDRATION LEVEL

Front 149

what are the three major groups of sedative hypnotics?

Back 149

-benzodiazepine
-benzodiazepine like drugs
-barbiturates

Front 150

Benzodiazepines are drugs of first choice for ___ and ____?

Back 150

anxiety and insomnia

Front 151

Benzodiazepines can cause physical dependence the withdrawal syndrome is mild (except in patients who have undergone prolonged high-dose therapy). true or false

Back 151

true

Front 152

to minimize withdrawal symptoms benzodiazepines should be discontinued quickly? true or false

Back 152

FALSE, they should be discontinued gradually over several weeks or even months.

Front 153

The principal indications for benzodiazpeines are ___ , ___, and ____?

Back 153

anxiety, insomnia, and seizure disorders

Front 154

The principal adverse effects of benzodiazepines are ?

Back 154

-daytime sedation
-anterograde amnesia

Front 155

With prolong use of benzodiazepines ____ develops

Back 155

tolerance

Front 156

What is the benzodiazepine receptor antagonist to treat benzodiazepine overdose?

Back 156

Flumazenil

Front 157

What are the three benzodiazepine like drugs?

Back 157

-Lunesta
-Sonata
-Zolpidem

Front 158

Benzodiazepines and the benzodiazpine like drugs are the drugs of choice for ______?

Back 158

insomnia

Front 159

Zolpidem has a side effect profile like that of the benzodiazepines. what are the two common ones?

Back 159

-daytime drowsiness
-dizziness
these occur in 1 to 2% of patients.

Front 160

Sonata does not produce next day sedation or a hangover feeling? true or false?

Back 160

true

Front 161

Eszopiclone(lunesta) is generally well tolerated. The most common adverse effect is what?

Back 161

- bitter aftertaste reported by 17% of patients given 2 mg and 34% of those given 3 mg.

Front 162

Ramelteon (Rozerem) is a relatively new hypnotic with a unique mechanism of action with activation of receptors for ____?

Back 162

melatonin

Front 163

Of all the major drugs for insomnia which drug is the only one not regulated as a controlled substance?

Back 163

Ramelteon (Rozerem)

Front 164

Transient insomnia can be treated with ______, _______,_______?

Back 164

prescription drugs, nonprescription drugs, and alternative medicines.

Front 165

What are the current first line choices for General anxiety disorders?

Back 165

benzodiazepines, buspirone, and antidepressants (ex:venlafaxine, paroxetine, and escitalopram (lexapro)).

Front 166

Benzodiazepines are the first drug choice for anxiety true or false?

Back 166

true

Front 167

The two agents prescribed most often are?

Back 167

-Alprazolam
-lorazepam

Front 168

What is buspirone?

Back 168

is an anti-anxiety medication that differs from the benzodiazepines.

Front 169

Buspirone has three distinct advantages over benzodiazepines:

Back 169

- does not cause sedation (CNS depression)
- no abuse potential
- does not intensify the effects of the CNS depressants.

Front 170

Buspriones major disadvantage:

Back 170

the anti-anxiety effects develop SLOWLY: initial responses take 1 week to appear, and several more weeks must pass before responses peak. Because therapeutic effects are delayed, buspirone is not suitable for as needed (PRN) use or for patients who need immediate relief.

Front 171

Buspirone is generally well tolerated but has tehs common reaction such as

Back 171

1.dizziness
2. nausea
3. headache
4. nervousness
5. lightheadedness
6. excitement

Front 172

At this time only three antidepressants are approved for generalized anxiety disorders:

Back 172

1. venlafaxine
2. paroxetine
3. lexapro

Front 173

Which drug was the first drug approved for GAD?

Back 173

venlafaxine

Front 174

Benzodiazepines are CNS depressants and hence can cause sedation and psychomotor slowing. In addition they can intensify CNS depression caused by other drugs. true or false?

Back 174

true

Front 175

Benzodiazepines have some potential for abuse, and hence should be used with caution in patients known to abuse alcohol or other psychoactive drugs. True or false

Back 175

true

Front 176

If taken long term benzodiazpines can cause

Back 176

physical dependence.

Front 177

SSRI's are the first line drugs for panic attacks and decrease the frequency and intensity of panic attacks, anticpatory anxiety, and avoidance behavior, and they work regardless of whether the person has depression.

Back 177

true

Front 178

What drugs are first line drugs for OCD

Back 178

SSRI's

Front 179

Five drugs have been proven for OCD: All five enhance serotenoergic transmission. The SSRI's are better tolerated than clomipramine and hence are preferred.

Back 179

-four SSRI's
-one TCA (clomipramine)

Front 180

SSRI's are safer than _____ when it comes to OCD.

Back 180

clomipramine

Front 181

Benzodiazepines are an option for some patients.
(xanax, clonazepam) t or f

Back 181

true

Front 182

What two drugs are approved by the U.S food and drug administration FDA for post traumatic stress disorder?

Back 182

-paroxetine
-sertraline

Front 183

Paroxetine is a SSRI, it allows the brain to have increased levels of serotonin, which should lessen feelings of anxiety. The initial effects of paroxetine take about ___ weeks to be seen; optimal effects develop in __ to __ weeks.

Back 183

4 weeks
8 to 12 weeks

Front 184

What are the drugs of choice for facilitating withdrawal in alcohol?

Back 184

-benzodiazepines

Front 185

What three drugs are approved for maintaining alcohol abstinence?

Back 185

-disulfiram (Antabuse)
-naltrexone
-acamprosate (campral)

Front 186

Two neurpsychiatric syndromes are common in person's with alcoholism and both disorders cause a _____ defiency?

Back 186

thiamin, which results from poor diet and alcohol-induced suppression of thiamin absorption.

Front 187

Abuse of alcohol results in direct damange to the ____, thereby increasing the risk of _____?

Back 187

myocardium
heart failure

Front 188

Alcohol produces a dose dependent increase in ___ ___?

Back 188

blood pressure

Front 189

Chronic heavy drinking can cause ___ and ____?

Back 189

hepatitis
cirrhosis-scarring of liver due to liver disease. People with liver disease should avoid alcohol

Front 190

Heavy drinking can cause erosive ____?

Back 190

gastritis

Front 191

Moderate drinkers live longer than those who abstain from alcohol? true or false?

Back 191

true

Front 192

Tolerance to alcohol confers to cross tolerance to general anesthetics, barbiruates, and other general CNS depressants except_______

Back 192

opioids.

Front 193

The combo of alcohol and acetaminophen can cause fatal ___ failure?

Back 193

hepatic

Front 194

Acute overdose of alcohol produces these symtpoms?

Back 194

-vomitting
-coma
-pronounced hypotension
-respiratory depression

Front 195

Management of withdrawal depends on the degree of dependence. however, when dependence is great, withdrawl carries a risk for death. t or f

Back 195

true

Front 196

Benzodiazepines are drugs of choice for facilitating withdrawal in alcohol dependent individuals. Benzodiazepines suppress syptoms b/c of cross dependence with alcohol true or false?

Back 196

true

Front 197

Combining a benzodiazepine with another drug may improve withdrawal outcome. Agents that have been tried include?

Back 197

-carbamazepine (antiepileptic drug)
-clonidine (alpha-adrenergic blocker)
-atenolol and propanolol (beta adrenergic blockers)

Front 198

Chronic heavy drinking can cause ___ and ____?

Back 198

hepatitis
cirrhosis-scarring of liver due to liver disease. People with liver disease should avoid alcohol

Front 199

Heavy drinking can cause erosive ____?

Back 199

gastritis

Front 200

Moderate drinkers live longer than those who abstain from alcohol? true or false?

Back 200

true

Front 201

Tolerance to alcohol confers to cross tolerance to general anesthetics, barbiruates, and other general CNS depressants except_______

Back 201

opioids.

Front 202

The combo of alcohol and acetaminophen can cause fatal ___ failure?

Back 202

hepatic

Front 203

Acute overdose of alcohol produces these symtpoms?

Back 203

-vomitting
-coma
-pronounced hypotension
-respiratory depression

Front 204

Management of withdrawal depends on the degree of dependence. however, when dependence is great, withdrawl carries a risk for death. t or f

Back 204

true

Front 205

Benzodiazepines are drugs of choice for facilitating withdrawal in alcohol dependent individuals. Benzodiazepines suppress syptoms b/c of cross dependence with alcohol true or false?

Back 205

true

Front 206

Combining a benzodiazepine with another drug may improve withdrawal outcome. Agents that have been tried include?

Back 206

-carbamazepine (antiepileptic drug)
-clonidine (alpha-adrenergic blocker)
-atenolol and propanolol (beta adrenergic blockers)

Front 207

The B vitamins (thiamin, folic acid, and cyanocobalamin) are especially needed especially b/c of poor nutritional state of person thats alcoholic) true or false

Back 207

true

Front 208

Disulfiram (antabuse) therapy what should you tell a patient that is beginning to take this drug?

Back 208

-Any alcohol consumption with this drug may produce severe potentially fatal reactions. Alcohol needs to be avoided in all forms. the patient shod be informed that some sauces for food contain alcohol and that these must be avoided. Lotions, colognes, and liniments may contain alcohol. they should read labels and avoid these products.

Front 209

Respiratory alkalosis is produced by ______?

Back 209

hyperventilation, by hyperventilating a patient or person will blow off co2 (carbon dioxide), causing the pH of their blood to rise, causing respiratory alkalosis.

Front 210

Respiratory acidosis results from retention of ___ secondary to ______?

Back 210

CO2, hypoventilation

Front 211

Sodium Bicarbonate is used for what purpose?

Back 211

to treat the acidosis by administering an alkalinizing salt (sodium bicarbonate). When an alkalinizing salt is indicated, sodium bicarbonate is usually preferred. It is only used if the pH is less than 7.1.

Front 212

What is a symptom of digoxin toxicity?

Back 212

seeing halos around lights

Front 213

Furosemide causes us to lose potassium. Anyone who takes furosemide may have low levels of potassium, which can cause the body to retain digoxin and cause some side effects such as seeing halos around lights. true or false?

Back 213

true

Front 214

The stroke volume is determined by what three things?

Back 214

myocardial contractility, cardiac preload, cardiac afterload

Front 215

What does Starling's Law state?

Back 215

That the force of ventricular contraction is proportional to myocardial fiber length. because of this relationship when more blood enters the heart, more blood is pumped out. As a return, the healthy heart is able to precisely match output with venous return.

Front 216

The RAAS supports AP (arterial pressure) causing what two things to happen?

Back 216

-constriction of arterioles and veins.
-retention of water by the kidneys.

Front 217

Vasoconstriction is mediated by _______, water retention is mediated in part by _______?

Back 217

-angiotensin II
-aldosterone

Front 218

What two enzymes form angiotensin II?

Back 218

-renin
-ACE

Front 219

The RAAS is poised to help regulate what?

Back 219

blood pressure

Front 220

The ACE inhibitors can produce serious first dose _____ by causing a sharp drop in circulating angiotensin II

Back 220

hypotension

Front 221

By suppressing aldosterone release, ACE inhibitors can cause _____? exercise caution in patients taking what?

Back 221

hyperkalemia
-potassium supplements, salt substitutes, or potassium-sparing diuretics.

Front 222

Aldosterone acts on the kidneys to promote what?

Back 222

retention of water and sodium

Front 223

ACE inhibitors can cause a large drop in blood pressure in patients with what problem?

Back 223

bilateral renal artery stenosis (or stenosis in the artery to a single remaining kidney). ACE inhibitors can cause severe renal insufficiency in patients with bilateral renal artery stenosis.

Front 224

What is one ARB (angiotensin II receptor blocker)?

Back 224

-Losartan (Cozaar)

Front 225

How do ARB's differ from ACE inhibitors?

Back 225

they do not cause hyperkalemia or cough

Front 226

What are two aldosterone antagonists?

Back 226

-spironlactone
-eplerenone
they are used to treat hypertension and hEeart failure

Front 227

What are the cardiosupressant effects of verapamil and diltiazem?

Back 227

-bradycardia
-partial or complete AV block
-heart failure

Front 228

Verpamil and Diltiazem are also antihypertensive medications, therefore what needs to be monitored?

Back 228

blood pressure

Front 229

Other common effects of calcium channel blockers?

Back 229

-vasodilation-#1
-dizziness
-facial flushing
-headache
-edema of the ankles and feet

Front 230

Which drug increases the suppression of impulse conduction through the AV node?

Back 230

-digoxin

Front 231

What drug category intensifies cardiosuppression caused by verapamil and diltiazem?

Back 231

-beta blockers

Front 232

Other common effects of calcium channel blockers?

Back 232

-vasodilation-#1
-dizziness
-facial flushing
-headache
-edema of the ankles and feet

Front 233

All CCB's promote ____?

Back 233

vasodilation

Front 234

Which drug increases the suppression of impulse conduction through the AV node?

Back 234

-digoxin

Front 235

Beta blockers can be used to suppress ___ _____ caused by nifedipine (procardia) and other dihydropyridines.

Back 235

reflex tachycardia

Front 236

What drug category intensifies cardiosuppression caused by verapamil and diltiazem?

Back 236

-beta blockers

Front 237

The selectivity of a vasodilator determinies its _____ effects.

Back 237

hemodynamic

Front 238

All CCB's promote ____?

Back 238

vasodilation

Front 239

Drugs that dilate resistance vessels (arterioles) cause a decrease in cardiac _____

Back 239

afterload. (the force the heart works against to pump blood).

Front 240

Beta blockers can be used to suppress ___ _____ caused by nifedipine (procardia) and other dihydropyridines.

Back 240

reflex tachycardia

Front 241

Drugs that dilate capacitance vessels (Veins) reduce the force with which blood is returned to teh heart, which reduces ventricular filling. This reduction in filling decreases cardiac _____?

Back 241

preload (the degree of stretch of the ventricular muscle before contraction).

Front 242

Drugs that dilate arterioles and vein cause cause ___ ___?

Back 242

fluid retention (a response can be blunted with a diuretic)

Front 243

The selectivity of a vasodilator determinies its _____ effects.

Back 243

hemodynamic

Front 244

Name the 4 vasodilators?

Back 244

1. hydralazine
2. minoxidil
3. diazoxide
4. Sodium Nitroprusside

Front 245

Drugs that dilate resistance vessels (arterioles) cause a decrease in cardiac _____

Back 245

afterload. (the force the heart works against to pump blood).

Front 246

Drugs that dilate capacitance vessels (Veins) reduce the force with which blood is returned to teh heart, which reduces ventricular filling. This reduction in filling decreases cardiac _____?

Back 246

preload (the degree of stretch of the ventricular muscle before contraction).

Front 247

Drugs that dilate arterioles and vein cause cause ___ ___?

Back 247

fluid retention (a response can be blunted with a diuretic)

Front 248

Name the 4 vasodilators?

Back 248

1. hydralazine
2. minoxidil
3. diazoxide
4. Sodium Nitroprusside

Front 249

Minoxidil (vasodilator) can cause what side effect?

Back 249

hypertrichosis-excessive growth of hair on body. (werewolf syndrome).

Front 250

What is the drug of choice for hypertensive emergencies?

Back 250

Sodium Nitroprusside

Front 251

Prolonged infusion of nitroprusside can result in toxic accumulation of ___ and ___?

Back 251

1. cyanide
2. thiocyanate

Front 252

The uses for vasodilators is to treat 5 main things?

Back 252

1. hypertension
2. hypertensive crisis
3. angina pectoris
4. heart failure
5. MI

Front 253

Nitroprusside can vasodilate both arteries and veins whereas the other vasodilators only dilate the arteries. true or false?

Back 253

true

Front 254

What is primary hypertension?

Back 254

defined as hypertension with no identifiable cause, is the most common form of hypertension. Primary hypertension can lead to significant morbidity.

Front 255

What is secondary hypertension?

Back 255

an elevation of BP brought on by an identifiable primary cause. Secondary hypertension, which usually occurs as a consequence of another disease process, can also lead to morbidity.

Front 256

Both primary and secondary hypertension are treatable and managed with what two types of meds?

Back 256

-antihypertensive
-diuretics

Front 257

Chronic hypertension is

Back 257

associated with increased morbidity and mortality

Front 258

Untreated hypertension

Back 258

can lead to heart disese, kidney disease, and stroke

Front 259

Hypertension has two types of factor risks?

Back 259

-existing target-organ damage and major cardiovascular risk factors.

Front 260

The ultimate goal in treating hypertension is to reduce cardivovascular and renal morbidity and mortality. t or f

Back 260

true

Front 261

lifestyle chances offer multiple cv benefits. true or false

Back 261

true

Front 262

Cardiac output is influenced by four main factors?

Back 262

1. heart rate
2. myocardial contraction
3. blood volume
4. venous return of blood to heart
An increase in any of these will increase cardiac output, thereby causing BP to rise.

Front 263

Peripheral vascular resistance is regulated by

Back 263

arteriolar constriction.
In order to reduce BP with drugs that promote areriolar dilation.

Front 264

The baroreceptor reflex, kidneys, and RAAS can oppose our attempts to lower blood pressure by counteracting the baroreceptor reflex with what kind of drug? the kidneys with what type of drug? what kinds of drugs to counteract RAAS?

Back 264

-beta blocker
-diuretics
-ACE inhibitor, ARB receptor blocker, DRI (direct renin inhibitor), or aldosterone antagonist.

Front 265

Beta blockers such as

Back 265

propanolol tend to lower BP.

Front 266

Thiazide diuretics (hydrocholorothiazide) and loop diuretics (furosemide) reduce BP in two ways?

Back 266

1. reduce blood volume (by promoting diuresis).
2. reduce arterial resistance
(by an unknown mechanism).

Front 267

Both loop diuretics and thiazides are potassium wasting diuretics and can increase the potential of ____?

Back 267

hypokalemia

Front 268

Thiazides can elevate what?

Back 268

blood glucose

Front 269

Thiazides don't work well when glomerular filtration rate is ___?

Back 269

low.
Thats why loop diuretics are used in this case b/c thiazides dont work well if the GFR isn't working well.

Front 270

What are the preferred drugs for initial therapy of uncomplicated hypertension?

Back 270

-thiazide diuretics b/c they help reduce blood volume and arterial resistance ( as long as patient does not have renal failure).

Front 271

A severe hypertensive emergency exists when diastolic BP exceeds

Back 271

120 mmHg and there is ongoing end-organ damage.

Front 272

What drug is the preferred drug of choice for hypertensive emergencies?

Back 272

nitroprusside (IV)

Front 273

What is the drug of choice for treating chronic hypertension of pregnancy?

Back 273

-methyldopa, it causes no fetal harm.

Front 274

As the initial phase of HF (heart failure) consists of cardiac remodeling-a process in which the ventricles dilate (grow larger), hypertrophy (increase in wall thickness), and becomes more spherical-coupled with cardiac fibrosis and myocyte death. As a result of these changes what happens to the cardiac output?

Back 274

It is reduced.

Front 275

Treatment of heart failure with a synthetic form of natriuretic peptide called?

Back 275

Nesiritide (Natrecor). It resuls in a reduction in a both preload and afterload through the action of dilating arterioles and veins.

Front 276

Side effects of Nesiritide?

Back 276

may cause hypotension b/c of its vasodilation effects, therefore must monitor blood pressure carefully. many adverse effects have been associated with the use of nesiritide and thus it is still being investigated. When it is given, it is administered IV only.

Front 277

What are the three major groups of drugs for heart failure?

Back 277

1. diuretics
2. angiotension-converting enzymes (ACE) inhibitors or angiotension receptor blockers (ARB's)
3. beta blockers

Front 278

First line therapy of heart failure now consist of a what three drugs

Back 278

1. diuretics
2. ACE inhibitor, ARB blocker.
3. beta blocker
-Cardiac glycosides (digoxin) have been used widely in the past, but may be added as indicated.

Front 279

What diuretics are effective even when GFR is low for heart failure?

Back 279

-Loop diuretics are preferred to thiazides( which are not effective when GFR is low) for most patients.

Front 280

A decrease in a patients GFR will require a need for a stronger diuretic to help pull volume off? true or false?

Back 280

true

Front 281

Loop diuretics are preferred and what is the drug of choice for diuresis?

Back 281

-furosemide

Front 282

A decrease in GFR would indicated a decrease in Cardiac output, and again, loop diuretics are preferred to other diuretic types, such as thiazides, when cardiac output is greatly reduced.

Back 282

true

Front 283

What are some adverse effects of beta blockers treating heart failure?

Back 283

1. fluid retention and worsening HF
2. fatigue
3. hypotension
4. bradycardia or heart block

Front 284

Digoxin and other cardiac glycosides are best known for their what?

Back 284

positive inotrophic actions, and that is their ability to increase myocardial contractile force.

Front 285

What drug can be used in place of an ACE inhibitor for heart failure if an ACe inhibitor cannot be used?

Back 285

Isosorbide dinitrate which dilates veins.

Front 286

What is BiDil?

Back 286

a fixed dose combination of hydralazine and isosorbide dinitrate, is approved for treating heart failure in african americans.

Front 287

The normal potassium level range is?

Back 287

3.5-5 mEq/L

Front 288

Unfortunantly digoxin can improve symptoms but it does not prolong life if someone has heart failure.

Back 288

true

Front 289

In patients with HF, benefits of digoxin are not due solely to improved cardiac output but also what else?

Back 289

neurohormonal effects

Front 290

digoxin helps HF by two things

Back 290

1. improving cardiac output
2. improve neurohormonal effects

Front 291

Digoxin can produce dysrhythmias though? true or false?

Back 291

true

Front 292

What is the antidote used to lower digoxin levels?

Back 292

Digibind.
This drug will reduce toxic levels of digoxin in the blood.

Front 293

What are the common adverse effects of digoxin toxicity.

Back 293

-GI effects (anorexia, nausea, vomitting)
-CNS effects (fatigue, visual disturbances)
-dysrhythmias

Front 294

GI and CNS effects often occur before dysrhythmias occur and therefore can provide advance warning of serious toxicity of what drug?

Back 294

digoxin

Front 295

If the patient has visual disturbances and complains of seeing yellow halos around lights what does this mean?

Back 295

digoxin toxicity and the patient should also be assessed for headache, nausea, and vommitting, while drawing blood to measure the serum dig level.

Front 296

Does digoxin have a narrow therapeutic range?

Back 296

yes

Front 297

Although routine monitoring of digoxin levels is generally unnecessary, monitoring can be helpful when dosage is changed, symptoms of HF intensify, kidney function declines, signs of toxicity appear, or drugs that affect digoxin levels are added to or deleted from the regimen. It is however, understood that patients will need routine chemistry profiles to monitor for electrolyte balance and renal function. t or f

Back 297

true

Front 298

What is the normal plasma levels for digoxin-the optimal range is

Back 298

0.5-0.8 ng/ml

Front 299

Whenever digoxin is to be adminstered check to make sure that the patients dig level is within normal range and what is the other thing to check for?

Back 299

check the patients apical pulse to make sure it is also with a safe range (60-100bpm)

Front 300

How long should the apical heart range be assessed before adminstering digoxin?

Back 300

1 full minute.
-digoxin should be withhedl and the primary care provider should be notified if the heart rate is less than 60 bpm.

Front 301

You should explain to the patient that a low sodium diet is impt for a patient with heart failure what should salt intake be limited to per day? why?

Back 301

2 g/day and excessive fluids should be avoided. The salt will cause the patient to retain fluids.

Front 302

The P-wave of an ECG is caused by what?

Back 302

depolarization of the atria

Front 303

The QRS complex is caused by what?

Back 303

depolarization of the ventricles. Widening of the QRS complex indicates slowed conduction through the ventricles.

Front 304

The T wave is caused by

Back 304

repolarization of teh ventricles

Front 305

The PR interval represents the time between onset of the __ wave and onset of the ___? PR prolongation indicates what?

Back 305

-P-wave
-QRS complex
-PR prolongation indicates delayed AV conduction.

Front 306

The QT interval represents the time b/w onset of the ____ and completion of the ______? QT prolongation indicates what?

Back 306

-QRS complex
-T wave
-QT prolongation indiciates delayed ventricular repolarization. QT elongation is often associated with torsades de pointes or sustained ventricular tachycardia.

Front 307

Dysrhythmias arise from what?

Back 307

disturbances of impulse formation (automaticity) or impulse conduction.

Front 308

Recentrant dysrhythmias are?

Back 308

result from a localized, self-sustaining circuit capable of repetitive cardiac stimulation.

Front 309

Tachycardias can be divided into two major groups:

Back 309

supraventricular dysrhythmias and ventricular dysrhythmias. ventricular dysrhythmias are more dangerous.

Front 310

Five groups of antidysrhythmias?

Back 310

Class I: sodium channel blockers
Class 2: beta blockers
Class 3: Potassium channel blockers
Class 4: Calcium channel blockers
Class 5: other antidysrhythmias: adenosine and digoxin

Front 311

Beta blockers have three prominent effects on the heart?

Back 311

1. in the SA node, the reduce automaticity
2. In the AV node, they slow conduction of velocity
3. In the atria and ventricles they reduce contractility.

Front 312

What does adenosine and digoxin antidysrhythmia drugs do?

Back 312

suppress dysrhythmias by decreasing conduction through the AV node and reducing automaticity in the SA node.

Front 313

Digoxin (Lanoxin) may be used to slow the ventricular rate in patients with ____ and ____?

Back 313

atrial fibrillation and atrial flutter.

Front 314

If digoxin toxicity, dysrhythmias can occur. true or false?

Back 314

true

Front 315

What drug is used to treat digoxin-induced dysrhythmias, because it reduces automaticity, especially in the ventricles, and increases AV node conduction.

Back 315

phenytoin (dilantin)

Front 316

Treatment of supraventricular tachycardias is often achieved by

Back 316

-blocking impulse conduction through teh AV node, rather than at eliminating the dysrhthmia.

Front 317

For ventricular tachycardia (antidysrhythmias) the antidysrhythmic drugs that are indicated are?

Back 317

-class I (sodium channel blockers) or class III (potassium channel blockers) are usually used.

Front 318

All antidysrhythmic drugs are also prodysrhythmic (proarrhythmic). That is they can worsen existing dysrhythmias and generate new ones.

Back 318

true

Front 319

That is why therapy for antidysrhythmic drugs is based on what?

Back 319

-treatment only if there is a clear benefit, and then, only if the benefit outweighs the risks.

Front 320

Name a class IA drug for antidysrhythmias?

Back 320

Quinidine (a class IA drug).

Front 321

Quinidine levels can elevate digoxin levels?

Back 321

yes, if the drugs are used together, digoxin levels must be reduced.

Front 322

Procainamide is similar to quinidine except serious side effects limit its use. what are the side effects?

Back 322

1. systemic-lupus-erythematousus-like syndrome(SLE) is a chronic, inflammatory
autoimmune disorder. It may affect the skin, joints, kidneys, and
other organs.
2. blood dyscrasia-(blood disease)
3. cardiotoxicity

Front 323

Class IB sodium channel blockers of antidysrhythmias (Lidocaine, Phenytoin) are different from class IA (quinidine, procainamide) agents in two ways?

Back 323

1. they accelerate repolarization
2. have little or not effect on the ECG.

Front 324

Only class IB drugs increase repolarization. Class IA drugs delay repolarization. Class IC drugs (Flecaninide) prolong pordysrhythmic actions.

Back 324

true

Front 325

Class IC drugs should not be used for any patients with ___?

Back 325

MI patients with associated dysrhythmias unless the dysrhythmias are life-threatening.

Front 326

Lidocaine is a class IB agent and it does what?

Back 326

slows conduction in the atria, ventricles, and His-Purkinje system. It reduces automaticity in the ventricles and accelerates depolarization. Lidocaine has no significant impact on the ECG.

Front 327

Class IC agents reduce conduction velocity. true or false

Back 327

true

Front 328

Class II agents, the beta blockers have a drug called

Back 328

propanolol which is especially useful for treating dysrhythmias caused by excessive sympathetic stimulation of the heart.

Front 329

Class III agents-potassium channel blockers have two main drugs what are they?

Back 329

1. Bretylium
2. Amiodarone ( a class III agent)

Front 330

Amiodarone has multiple serious side effects what are they?

Back 330

-damage to the lungs, eyes, liver, and thyroid.

Front 331

What does amiodarone do?

Back 331

delays repolarization, increases action potential, blocks calcium and sodium channels and promotes peripheral vessel vasodilation.

Front 332

Class IV agents , the calcium channel blocker have two orphan drugs what are they?

Back 332

1. Verapamil
2. Diltiazem

Front 333

The effects of class IV-calcium channel blockers are the same as what other class?

Back 333

beta blockers

Front 334

The nurse needs to be especially cautious administering either of these drugs (diltiazem, verapamil) with ?

Back 334

digoxin, because of the increased risk of AV block, since both calcium channel blocker and digoxin reduce AV conduction.

Front 335

Verapamil and Diltiazem are used to slow ventricular rate in patients with

Back 335

atrial fibrillation and atrial flutter and to terminate SVT caused by an AV nodal reentrant circuit. In both cases, benefits derive from suppressing AV nodal conduction.

Front 336

Adenosine is a drug of choice for terminating paroxysmal SVT. t or f

Back 336

true

Front 337

Quinidine therapeutic drug range is what?

Back 337

2 to 5 mcg/ml

Front 338

When taking quinidine with wafarin make sure that the patient knows that it is impt for them to follow the instructions for taking their medications to prevent the risk of embolism development.

Back 338

true

Front 339

What drugs are the most widely used cholesterol lowering agents?

Back 339

-drugs that inhibit the enzyme called the statins

Front 340

What are lipoproteins?

Back 340

structures that transport lipids (cholesterol and triglycerides) in the blood.

Front 341

VLDL's are called what?

Back 341

very low density lipoproteins.

Front 342

VLDL's transport __ to peripheral tissues

Back 342

triglycerides (TG's)

Front 343

LDL's are called what?

Back 343

low density lipoproteins.

Front 344

LDL's transport ___ to peripheral tissues?

Back 344

cholesterol

Front 345

Elevation of LDL cholesterol makes the greatest contribution to atherosclerosis and greatly increase the risk of CHD. Which is called what?

Back 345

Coronary heart disease

Front 346

HDL's are called what?

Back 346

High density lipoproteins

Front 347

HDL's transport ___ back to the ____!!!

HDL's promote cholesterol removal!! TRUE!

Back 347

cholesterol back to the liver.

Front 348

The Adult treatment Plan (ATPIII) states that adults over the age of 20 should be screened every 5 years for total cholesterol, LDL cholesterol, HDL cholesterol, and TG's. Also under ATP III treatement of high LDL cholesterol is based on the individuals 10 year risk of having a major coronary risk. The guideliens states that screening for all children and adolescents with a family history of high cholesterol or heart disease is necessary. t or f

Back 348

true

Front 349

Therapeutic lifestyle changes are necessary as nondrug measures used to lower what?

Back 349

LDL cholesterol

Front 350

What is the primary method for reducing LDL cholesterol?

Back 350

diet modification along with exercise

Front 351

Drug therapy employed to lower LDL cholesterol is necessary. t or f

Back 351

TRue

Front 352

Which cholesterol drug is the most effective drugs for lowering LDL cholesterol?

Back 352

statins (HMG-CoA reductase inhibitors).

Front 353

Statins can slow progression of CHD, decrease the number of adverse cardiac events and reduce mortality. t or f

Back 353

true

Front 354

Statins reduce what?

Back 354

LDL cholesterol levels

Front 355

Name the three statins?

Back 355

-atorvastatin
-lovastatin
-simvastatin

Front 356

Statins rarely cause ___ and ___?

Back 356

liver damage and myopathy (muscle pain or soreness).

Front 357

Nicotinic acid (niacin) does what?

Back 357

increases HDL levels better than any other drug. In patients with high LDL levels, nicotinic acid reduces the risk of major coronary events and may also reduce total mortality.
- It has reduces LDL cholesterol by 5 to 25% and TG's by 20 to 50%. Unfortunantly it causes adverse effects in nearly all patients.

Front 358

What are the adverse effects of patients taking nicotinic acid (niacin)

Back 358

-Reaction involving skin
(itching, flushing)-most frequent.
-GI tract upset, nausea, vomitting, diarrhea.
-flushing of the face nedck and ears occurs in practically all patients receiving nicotinic acid in pharmacologic doses (of immediate release formulation).

Front 359

The bile acid sequestrants are used for cholesterol. Name one drug?

Back 359

Colesevelam

Front 360

The drug ezetimibe lowers LDL cholesterol by reducing cholesterol absorption in the small intestine. t or f

Back 360

true

Front 361

Name two fibric acid derivatives, the fibrates

Back 361

-gemfibrozil and other fibrate are the most effective drugs for lowering TG levels

Front 362

Fibric acid (fibrates) are most effective drugs in lowering ___levels?

Back 362

TG

Front 363

Fibrates can increase the risk of bleeding in patients taking ___ and the risk of rhabdomyolsis in patients taking ______?

Back 363

-warfarin

-statins

Front 364

What are some drug combos used to treat LDL elevation?

Back 364

1. Lovastatin (immediate-release) and niacin (extended release)
2. Simvastatin and extended release niacin
3. Simvastatin and ezetimibe
4. pravastatin tablets and aspirin tablets

Front 365

The drug combo Simvastatin and extended release niacin have a common name what is it?

Back 365

Simcor- the product is indicated for hypercholesterolemia and hypertriglyceridemia.

Front 366

The drug combo lovastatin (immediate release) and niacin (extended release) have a common name called?

Back 366

-Advicor
-lovastatin serves primarily to lower LDL cholesterol and niacin raises HDL cholesterol and lowers TG

Front 367

Simvastatin and ezetimibe combo have a common name called

Back 367

Vytorin used to treat hypercholesterolemia.

Front 368

Pravastatin tablets and aspirin tablets combo has a common name called?

Back 368

-Pravigard PAC. This product is approved for preventing MI, stroke, and death in patients with evidence of cardiovascular or cerebovascular disease. Pravastatin is intended to improve lipid profiles. Aspirin is included to suppress aggregation (stop blood from clotting of platelets.

Front 369

What is anginal pain?

Back 369

Anginal pain occurs when the cardiac oxygen supply is insufficient to meet oxygen demand.

Front 370

Cardiac oxygen demand is determined by

Back 370

heart rate, contractility, preload, and afterload. Drugs that reduce these factors can help relieve anginal pain.

Front 371

Drugs that increase oxygen supply reduce anginal pain. t or f

Back 371

true

Front 372

There are three forms of angina pectoris?

Back 372

1. chronic stable angina
2. variant (vasospastic) angina
3. unstable angina

Front 373

because stable angina usually occurs in response to strain, the condition is also known as

Back 373

exertional angina or angina of effort.

Front 374

The underlying cause of stable angina is because of

Back 374

coronary artery atherosclerosis.
-All we can do is decrease cardiac oxygen demand to help cardiac oxygen supply.

Front 375

Stable angina can be treated with three main types of drugs?

Back 375

1. organic nitrates
2. beta blockers
3. calcium channel blockers CCB's

Front 376

What drug can be combined with the three main types of drugs to treat stable angina?

Back 376

Ranolazine-gives additional benefit

Front 377

What is the cause of variant angina?

Back 377

-coronary artery spasm.

Front 378

Drugs relieve pain of variant angina by doing what?

Back 378

increasing cardiac oxygen supply. They do not decrease oxygen demand like stable angina does.

Front 379

Vasospastic angina is treated with two groups of drugs?

Back 379

1. CCB's
2. Organic nitrates
-Both drugs relax coronary artery spasm

Front 380

Unstable angina is what?

Back 380

a medical emergency.

Front 381

What are some symptoms of unstable angina?

Back 381

-symptoms result from severe coronary artery disease (CAD) complicated by vasospasm, platelet clumping, and coronary emobli.

Front 382

Several drugs are used to treat unstable angina what are they?

Back 382

1. Nitroglycerine
2. Beta Blockers
3. O2
4. IV morphine
5. ACE inhibitors
6. antiplatelet therapy
7. aspirin
8. clopidogrel
9. abiciximab

Front 383

nitroglycerin and other organic nitrates are what?

Back 383

vasodilators

Front 384

Nitroglycerin relieves pain of what?

Back 384

stable angina by dilating veins, which decreaes venous return, which decreases preload, which decreases oxygen demand.

Front 385

Nitroglycerin relieves pain of what?

Back 385

variant angina by relaxing coronary vasospasm, which increases oxygen supply.

Front 386

When Nitroglycerin is given orally, what happens?

Back 386

-Most of each dose is destroyed before reaching the systemic circulation.

Front 387

When nitroglycerin is adminstered sublingually, what happens?

Back 387

it is absorbed directly into the systemic circulation and therefore bypasses the liver. Therefore, sublingual (under tongue) can be much smaller doses than oral doses.

Front 388

Nitroglycerin can have three side effects?

Back 388

-headache, orthostatic hypotension, and reflex tachycardia!!!!!@

Front 389

Reflex tachycardia from nitroglycerin can be prevented by a three drugs?

Back 389

beta blocker
verapamil
diltiazem

Front 390

Sublingual nitroglycerin is used to abort an ongoing anginal attack and to provide acute prevention when exertion is expected. Nitroglycerin is adminstered on an as needed basis (PRN).

Back 390

true

Front 391

Nitroglycerin preparations that have a long duration are used for extended protection against anginal attacks.

Back 391

-patches, sustained release oral capsules.
-administration is on a fixed schedule but allows at least 8 drug free hours a day.

Front 392

Beta blockers prevent pain of stable angina primarily by decreasing heart rate and contractility, which does what?

Back 392

reduces cardiac oxygen demand.

Front 393

Beta blockers for angina pain are adminsterd on a fixed schedule, not PRN. t or f

Back 393

true

Front 394

Beta blockers can produce a variety of adverse effects name them?

Back 394

-bradycardia
-decreased AV conduction
-reduction of contractility

Front 395

CCB's relieve pain just like beta blockers do by relieving stable angina by reducing cardiac oxygen demand. t or f

Back 395

true

Front 396

CCBs relieve pain of variant angina by increasing cardiac oxygen suppy. t or f

Back 396

true

Front 397

The major adverse effects of CCB's are cardiovascular such as?

Back 397

-dilation of peripheral arterioles lowers blood pressure
-induces reflex tachycardia

Front 398

When a CCB is combined with a beta blocker, a dihydropyridine (ex: nifedipine) is preferred to verapamil or diltiazem. Why?

Back 398

because verapamil and diltiazem will intensify cardiosuppresion caused by the beta blocker, whereas a dihydropyridine will not.

Front 399

Ranolazine is a drug used for?

Back 399

to reduce anginal pain by helping the heart generate energy for quickly. The drug should not be used alone. Rather it should be combined with a nitrate, a beta blocker, or the CCB amlodipine.

Front 400

Ranolazine is not used for first-line therapy. t or f

Back 400

true

Front 401

Ranolazine increase the QT interval and may thereby pose a risk fo torsades de pointes, a severe ____ _____?

Back 401

ventricular dysrhythmia.

Front 402

There are two types of revascularization therapy what are they?

Back 402

1. CABG-Coronary Artery Bypass graft
2. PCI-Percutaneous Coronary Intervention.

Front 403

As a rule, revascularization with CABG surgery or PCI is indicated only after treatment with two or three antianginal drugs has failed. Which surgery is the treatment of choice for patients with multivessel disease?

Back 403

-CABG

Front 404

The risk of MI and death can be decreased with two types of drugs?

Back 404

-antiplatelet agents (ex: aspirin)
-cholesterol lowering drugs

Front 405

Anginal pain is prevented with one or more long acting antianginal drugs (beta blockers, CCB's, long acting nitrate) supplemented with sublingual nitroglycerin when breaththrough pain occurs. T or F

Back 405

true

Front 406

What are the two antiplatelet drugs that are the most effective agents?

Back 406

-Aspirin
-Clopidogrel

Front 407

There is strong evidence that patients with CAD-coronary artery disease, that ___ ____ greatly reduce the incidence of adverse outcomes.

Back 407

ACE inhibitors.

Front 408

The guideliens now recommend ACE inhibitors for patients with established ___, and especially for those with ___?

Back 408

-CAD
-diabetes

Front 409

Nitroglycerin decreases venous return to the heart and therby decreases ventricular filling, resulting in decrease in wall tension (preload), which decreases oxygen supply demand. t or f

Back 409

true

Front 410

In stable angina nitroglyerin affects the

Back 410

peripheral blood vessels.

Front 411

In variant angina nitryoglycerin acts by

Back 411

relaxing or preventing spasm in the coronary arteries.

Front 412

Variant angina is that type of angina that determines the medication administration guidelines, which are a critical componenet of patient teaching, which the nurse performs. t or f

Back 412

true

Front 413

Nitroglycerin can intensify the effects of other hypotensive agents. CAre must be taken when it is administered with what drugs

Back 413

beta blockers
CCB's
diuretics
and other drugs that can lower Blood pressure

Front 414

Beta blockers, verapamil, and diltiazem can suppress nitroglycerin induced ____?

Back 414

tachycardia

Front 415

What drug can greatly intensify nitroglycerin-induced vasodilation and result in life threatening hypotension?

Back 415

-viagra.

Front 416

What is a common complication of nitroglycerin therapy?

Back 416

headaches

Front 417

How should you store nitroglycerin? when should they be discarded?

Back 417

-dark, airtight container.
-Tablets should be discarded after 6 months and replaced with fresh supply.

Front 418

If one tablet of nitroglycerin fails to relieve pain then is it ok to take 1 or 2 additional tablets at 5 minute intervals?

Back 418

yes, but if those additional ones dont work then the patient should seek medical help if the pain is not relieved immediately

Front 419

what is hemostasis

Back 419

-occurs in two stages formation of a platelet plug, followed by coagulation (production of fibrin a protein that reinforces a platelet plug.

Front 420

Platelet aggregation

Back 420

-platelet clumping of blood

Front 421

Fibrin

Back 421

fiber protein that is involved in the clotting of blood.

Front 422

Four factors in the coagulation pathways require an activated form of what vitamin?

Back 422

vitamin K synthesis

Front 423

what is plasmin?

Back 423

the activated form of plasminogen, serves to degrade the fibrin meshwork of clots.

Front 424

Which drugs act by promoting conversion of plasminogen into plasmin?

Back 424

thrombolytic drugs (ex: streptokinase and alteplase)

Front 425

What is a thrombus?

Back 425

a blood clot formed within a blood vessel or within the heart.

Front 426

The drugs for thromoembolic disorders fall in three major groups:

Back 426

1. anticoagulants drugs
2. antiplatelets drugs
3. thrombolytic drugs

Front 427

What are the two anticoagulants?

Back 427

heparin
warfarin

Front 428

What are the two thrombolytic drugs?

Back 428

1. alteplase
2. streptokinase

Front 429

What are the antiplatelet drugs?

Back 429

-aspirin
-clopidogrel

Front 430

Arterial thrombi are best prevented by which drug category?

Back 430

-best prevented with antiplatelet drugs (ex: aspirin)

Front 431

Venous thrombi are best prevented by which drug category?

Back 431

-best prevented with anticoagulants (ex: warfarin and heparin)

Front 432

Anticoagulants are drugs that reduce formation of ___?

Back 432

fibrin

Front 433

How is heparin administered?

Back 433

IV or SUB-Q

Front 434

Heparin is a preferred anticoagulant for used during ____ and in situation that require ____ _____ of anticoagulant effects?

Back 434

-pregnancy
-rapid onset of

Front 435

When would you need to use heparin since it has rapid onset of anticoagulant effects?

Back 435

-pulmonary embolism (PE)
-Evolving stroke
-Massive deep vein thrombosis (DVT)

Front 436

The major adverse effect of heparin is what?

Back 436

bleeding

Front 437

How can severe heparin-induced bleeding be treated with what drug?

Back 437

-Protamine sulfate, a drug that binds heparin and therby stops it from working.

Front 438

Heparin-induced thrombocytopenia (HIT) is what?

Back 438

-a potentially fatal condition caused by development of antibodies against heparin-platelet protein complexes. HIT should be suspected whenever platelet counts fall significantly or when the thrombosis develops despite anticoagulant treatment.

Front 439

Heparin therapy is monitored how?

Back 439

By measuring activated partial thromboplastin time (aPTT).

Front 440

What is the target aPTT?

Back 440

60 to 80 seconds (1.5 to 2 times the normal value of 40 seconds).

Front 441

What is the antidote to serve heparin overdose?

Back 441

-protamine sulfate

Front 442

Why do people sometimes use Low Molecular weight (LMW) heparins?

Back 442

-They do not bind nonspecifically to plasma proteins and tissues. As a result their bioavaliability is high, making their plasma levels predictable.

Front 443

LMW heparins are approved for what cases?

Back 443

-prevention of DVT(deep vein thrombosis) following abdominal surgery, hip replacement surgery, or knee replacement surgery.
2. treatment of established DVT, with or without PE (pulmonary emobilism)
3. prevention of ischemic complications in patients with unstable angina, non-Q wave myocardial infarction (MI), and ST elevation MI (STEMI).

Front 444

Compared with unfractionated heparin, LMV heparins have higher ____ and ___ half lives?

Back 444

-bioavaliability
-longer half lives

Front 445

What are two selective factor Xa inhibitors?

Back 445

-fondaparinux
-rivaroxaban

Front 446

Fondaparinux is approved for what?

Back 446

1.preventing DVT following hip fracture surgery, hip replacement surgery, or knee replacement surgery.
2. treating acute PE (in conjuction with warfarin)
3. treating acute DVT (in conjunction with warfarin).

Front 447

One direct thrombin inbititor to know and what route is it adminstered by?

Back 447

-main one we need to know is argatroban-are administered by continous IV infusion

Front 448

What is the only oral anticoagulatn available in the US (although two others are nearing approval)?

Back 448

warfarin

Front 449

What percentage of warfarin binds to albumin

Back 449

99%

Front 450

Warfarin is employed most frequently for long-term prophylaxis(prevention) of thrombosis. Specific indication are

Back 450

1. preventing of venous thrombosis and associated pulmonary embolism.
2. prevention of thromboemobolism in patients with prosthetic heart valves
3. prevention of thrombosis during atrial fibrillation

Front 451

Warfarin therapy is monitored by measuring what?

Back 451

-Prothrombin time (PT). Results are expressed as an international normalized ratio (INR). An INR of 2 to 3 is the target for most patients.

Front 452

Genetic testing for variant genes that code for VKORC1 and CYP2C9 can identify people with increased sensitivity to warfarin, and who therefore may need a dosage reduction. t or f

Back 452

true

Front 453

moderate warfarin overdose is treated with what?

Back 453

vitamin K

Front 454

Warfarin is significantly subject to a large number of drug interactions. Drugs can increase the anticoagulant effects by displacing warfarin from plasma albuminin and by inhibiting hepatic enzymes that degrade warfarin. Drugs can decrease anticoagulant effects by inducing hepatic drug-metabolizing enzymes, increasing synthesis of clotting factors, and inhibiting warfarin absorption. Drugs that promote bleeding such as, heparin and aspirin, will increase the risk of bleeding in patients taking warfarin. t or f

Back 454

true

Front 455

Dietary vitamin K can reduce the effects of anticoagulants effects of warfarin. What are some rich dietary sources?

Back 455

-mayonnaise, canola oil, soybean oil, and green leafy vegetables.

Front 456

Life of a platelet is how many days?

Back 456

7 to 10 days.

Front 457

Why is aspirin given?

Back 457

Aspirin is given for primary prophylaxis of MI, prevention of MI recurrence, and prevention of stroke in patients with a history of transiet ischemic attacks (TIA's).

Front 458

Even in low doses aspirin increases the risk of what?

Back 458

-GI bleeding
-hemorrage stroke

Front 459

What are the indications for clopidogrel?

Back 459

-used for recent stroke and acute coronary symtoms.

Front 460

Ticlopidine is approved only to prevent what?

Back 460

stroke

Front 461

What are the GP IIb/IIIa receptor antagonists?

Back 461

-abciximab-effective antiplatelet

Front 462

What are GP IIB/IIIa antagonists used for?

Back 462

used short term to prevent ischemic events in patients with acute coronary syndromes (ACS) and those undergoing percutaneous coronary intervention (PCI).

Front 463

Thrombolytic therapy is most effective when started early (within 4 to 6 hours of symptom onset and preferably sooner) true or false

Back 463

true

Front 464

What is the greatest concern for thrombolytic drugs?

Back 464

-hemorrhage
-bleeding is 2nd

Front 465

What drug is for patients with acute MI?

Back 465

alteplase (tPA)

Front 466

The class of MI is called what?

Back 466

ST-elevation MI (STEMI) becaues it causes elevation of the ST segment on the electrocardiogram (ECG).

Front 467

how is ST elevation MI diagnosed?

Back 467

by the presence of chest pain, characteristic ECG changes, and elevated serum levels of cardiac troponins; cardiac troponin I and cardiac troponin T.

Front 468

How would you manage ST elevation MI?

Back 468

-Put patient on supplemental oxygen
-Adminster aspirin suppressest platelet aggregation.
-Give IV morphine for STEMI associated pain
-in patients undergoing acute stemi beta blockers help more than IV morphine.
-In addition to aspirin and a beta blocker, three other drugs are used for STEMI therapy-oxygen, morphine, and nitroglycerin.

Front 469

What do fibrinolytic drugs do?

Back 469

dissolve the clots
-Alteplase is most effective

Front 470

The most common PCI surgery is what?

Back 470

-balloon angioplasty, with or without the stent implantations.

Front 471

Heparin an anticoagulant is recommended for patients undergoing fibrinolytic therapy or PCI. The drug was shown to decrease mortality, reinfarction, stroke, pulmonary emobolism, and deep vein thrombosis.

Back 471

true

Front 472

Clopidogrel (antiplatelet drug) combined with aspririn is recommended for all patients undergoing reperfusion therapy either with PCI or with fibrinolytic drug.

Back 472

true

Front 473

Glycoprotein inhibitors IIb/IIIa (ex: abciximab) are powerful antiplatet drugs that can enhance the benefits of primary PCI.

Back 473

true

Front 474

In patients with acute MI, ACE inhibitors decrease mortality, severe heart failure, and recurrent MI. All patients should receive an ACE inhibitior in the absence of specific contraindications. For patients who cannot tolerate ACE inhibitors an ARB may be used instead. true or false

Back 474

true

Front 475

Heart failure can be treated with a diuretic (ex: furosemide) and inotropic agent (ex: digoxin). A diuretic is given to decrease preload and pulmonary congestion. Digoxin is given to increase cardiac output by enhancing contractility.

Back 475

true

Front 476

Long term therapy to reduce your risk of a second MI is used with three drugs?

Back 476

1. beta blocker
2. an ACE inhibitor or an ARB
3. an antiplatelet drug (aspirin or clopidogrel) or warfarin (anticoagulant).