Pharmacy Study For Nclex

Front 1

Agonist

Back 1

An agonist does what the neurotransmitter does.

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Antagonist

Back 2

Blocker - blocks the neurotransmitter from working so that the final effect is the opposite of what the neurotransmitter does.

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Reuptake

Back 3

It is a way to remove the neurotransmitter from the synaptic cleft.

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Reuptake inhibitors

Back 4

These block the reuptake of the neurotransmitter and so the final effect is to cause the neurotransmitter to remain longer in the cleft and so do more of what it does.

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Synaptic Enzyme Inhibitors

Back 5

These inhibit the enzymes that break down the neurotransmitter and so the final effect is to cause the neurotransmitter to remain longer in the cleft and so do more of what it does.

Front 6

Acetylocholine

Back 6

This neurotransmitter affects the parasymathetic nervous system effectors, skeletal muscle and the CNS.

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Acetylocholinesterase

Back 7

Synaptic enzyme that removes Ach from the synaptic cleft.

Front 8

Effectors

Back 8

These receive instructions from the control enter and carry them out to get the variable back to normal.

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Control center

Back 9

Usually found in the hypothalamus of the brain. It contains "set point" for the variable and it receives information from receptors and sends instructions to effectors.

Front 10

Receptors

Back 10

These detect or sense the variable and send that information to the control center.

Front 11

Where does Ach act (which receptors)?

Back 11

Nicotinic receptors and muscarinic receptors

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Nicotinic Receptors

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These are found at the neuromuscular junction (skeletal muscles) and when activated by Ach will cause skeletal muscle contraction.

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Muscarinic receptors

Back 13

These are found on parasympathetic target organs and when activated cause decrease in HR, BP, constriction of the pupils and increased digestive activity.

Front 14

What happens when acetylocholinestarase is inhibited?

Back 14

Too much Ach - and so decrease in HR and BP.

Front 15

What is an antidote for decreased heart rate and blood pressure?

Back 15

Atropine drug

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Alzheimer's Disease

Back 16

Decreased Ach is found in the brain of AD patients and so they have decreased memory and language ability (Ach excitatory in the brain)

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Epinephrine/Norepinephrine

Back 17

These neurotransmitters affect the SNS. They are removed by reuptake and by the synaptic enzyme MAO (Monoamine oxidase). They act at 2 receptors - alpha and beta.

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Alpha receptors

Back 18

There are two types - alpha1 and alpha2.

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Alpha1

Back 19

Alpha1 are found on the iris of the eye (where they cause mydriasis or dilation of the pupil) and on blood vessel smooth muscle (where they cause vasoconstriction and so increased BP). Alpha1 agonist placed in your eye for eye exam will cause dilation of the pupil.

Front 20

Alpha2

Back 20

Found on presynaptic membranes and they prevent any further norepinephrine release when they are activated.

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Beta receptors

Back 21

Two types Beta1 and Beta2

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Beta1 Receptors

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Found on the heart and when they are activated, they cause increase in heart rate and in strength of contraction (AKA stroke volume).

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Beta2 Receptors

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Found on bronchioles (where they cause bronchodilation) and skeletal muscle (where they cause increased strength of contraction of skeletal muscle).

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A beta blocker will cause...

Back 24

decrease in HR and bronchoconstriction

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An MAOI (Monoamine oxidase inhibitor) will cause...

Back 25

increase in HR and all fight or flight responses.

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A drug used to treat asthmatic attack would be....

Back 26

Beta2 agonist

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Serotonin

Back 27

This neurotransmitter is made from the amino acid tryptophan. It is removed from the synaptic cleft by reuptake.

Front 28

Roles of serotonin

Back 28

Serotonin is excitatory to muscles, it regulates food intake and reproductive activity, it plays a role in mood and anxiety.

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Depression

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Depression may involve a decrease in excitatory neurotransmitters in the brain and some antidepressants work to increase the amounts of neurotransmitter at the synaptic cleft.

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Adrenergic antidepressants = MAOI drugs

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Inhibit MAO and so cause an increase epinephrine and norepinephrine at the synaptic clefts.

Front 31

Serotonergic Antidepressants = SSRI (Serotonin Reuptake Inhibitors)

Back 31

These prevent reuptake of serotonin and so more serotonin remains at the synaptic celfts (ex. zoloft and paxil)

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Dopamine

Back 32

Involved in mood, GI motility, and motor control.

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Parkinson's Disease

Back 33

There is decreased dopamine in PD and so decreased motility occurs, problems with motor control.

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Schizophrenia

Back 34

May involve increased dopamine levels (antipsychotic drugs used to treat schizophrenia are dopamine antagonists).

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Three groups of antidepressants

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TCAs - Tricyclic antidepressants and atypical agents
MAOIs - Monoamine oxidase inhibitors
SSRIs - Selective Serotonin Reuptake Inhibitors

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TCAs

Back 36

Oldest antidepressants. This class of drugs is less widely used with the advent of new antidepressants. Common SE include blood dyscasia and cardiotoxicity.

Front 37

Clomiprimine (Anafranil)

Back 37

One of TCAs. Sedation and anti-cholinergic SE include dry mouth, cognitive impairment, memory loss, confusion, termors, blurred vision, bloating, weight gain, urinary retention.

Front 38

Remeron

Back 38

Sedation and anticholinergic SE include dry mouth, disturbed concentration, confusion, constipation, nausea, agranulocytosis, neutropenia.

Front 39

MAOIs

Back 39

Developed in 1960s. Severe SE including hypertensive crises result from complex interactions with food and other meds. Thus clients taking MAOIs must avoid foods such as dairy products (especially aged cheese and yogurt), meats (especially processed), and fish (dried, processed, or fermented), beer, red wine, chocolates, certain fruits and vegetables (avocados, raisins, figs, bananas). For this reason MAOIs are not used much today except for atypical depression.

Front 40

Phenelzine Sulfate (Nardil)

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MAOI. It has many SE. The most serious is hypertension crises.

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SSRI - Side effects

Back 41

More tolerable SE than other antidepressants, but they may interfere with sexual performance. These are the newest class of drugs and are known as designer drugs. Nurses should caution clients not to stop these drugs suddenly as they may experience body shivers, black outs, and short-term memory problems.

Front 42

penicillin G (Bicillin LA)

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Penicillins. Destroy bacteria by weakening bacterial wall.

Front 43

amoxicillin-clavulante (Augmentin)

Back 43

Penicillin type; broad-spectrum

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nafcillin (Unipen)

Back 44

Penicillin type; antistaphyloccocal

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methicillin

Back 45

Rarely used now; penicillin; MRSA (methicillin-resistant staph aureus) bacteria

Front 46

carbenicillin (Geocillin)

Back 46

penicillin type; antipseudomonas

Front 47

ticarcillin-clavulante (Timentin)

Back 47

penicillin type; antipseudomonas

Front 48

piperacillin-tazobactam (Zosyn)

Back 48

penicillin type; antipseudomonas

Front 49

Penicillins

Back 49

Meds of choice for gram-positive bacteria; first choice for meningitis, syphilis. Additional birth control may be required when taking ampicillin; do not mix penicillin and aminoglycoside in the same IV solution b/c penicillin inactivates aminoglycosides.

Front 50

Cephalosporins

Back 50

beta-lactam antibiotics, simialr to penicillins; broad-spectrum with high therapeutic index to tx UTI, infections, meningitis; grouped in 4 generations - each generation is more effective against gram-negative organisms, less likely to be destroyed by beta-lactamase, and more able to reach cerebrospinal fluid.

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cephalexin (Keflex)

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1st generation

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cefaclor (Ceclor)

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2nd generation

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ceftriaxone (Rocephin)

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3rd generation

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cefepime (Maxipime)

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4th generation

Front 55

Contraindications for cephalosporins

Back 55

Don't give if allergy to penicillin present; use caution in renal impairment; caution when given with drugs that promote bleeding.

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imipenem (Primaxin)

Back 56

carbapenems; used to tx infections

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Carbapenems

Back 57

broad antimicrobial spectrum effective against serious infections such as pneumonia, peritonitis, UTIs, etc.

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Monobactams

Back 58

Beta-lactam antibiotics that destroy bacterial cell walls causing destruction of micro-organisms. For serious infections caused by MRSA; also for antibiotic-associated pseudomembranous colitis caused by C-diff.

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vancomycin (Vancocin)

Back 59

monobactams; administer slowly over 60 min.

Front 60

SE of monobactams

Back 60

possible ototoxicity - evaluate pt's for hearing loss

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Tetracyclines

Back 61

broad-spectrum antibiotics that inhibit micro-organism growth by preventing protein synthesis (bacteriostatic).

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Tetracyclines therapeutic uses

Back 62

Meds of choice topically and orally for acne; first-line meds for rickettsia (Rocky Mountain fever, typhus fever, Lyme disease, pneumonia, anthrax, GI infections by Helicobacter pylori, and peridontal disease)

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tetracycline hydrochloride (Sumycin)

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tetracycline

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doxycycline (Vibramycin)

Back 64

Tetracycline; should be given with food; can be administered to pt's with renal disease

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Contraindications of tetracyclines

Back 65

Should not be given to clients with renal disease except for doxycycline and minocycline; use of tetracycline during pregnancy after the 4th month can cause staining of decidous teeth, but will ot have a permament effect on permanent teeth.

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Med/Food interactions of tetracyclines

Back 66

Should not be taken with milk products, calcium or iron supplements, magnesium-containing laxatives, and most antacids (b/c nonabsorbable chelates will form); should be taken on empty stomach with full glass of water; decreases efficacy of oral contraceptives.

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Bacteristatic inhibitors

Back 67

Used to tx infections in pts with allergy to penicillin; preferred meds for whooping cough (pertussis), Chlamydia infections, respiratory infections caused by Streptococcus.

Front 68

erythromycin (E-Mycin)
clindamycin (Cleocin)
azithromycin (Zithromax)
clarithromycin (Biaxin)

Back 68

bacteriostatic inhibitors

Front 69

Meds interactions with erythromycin

Back 69

To avoid toxicity don't give erythromycin with antihistamines, theophylline (asthma medication), carbamazepine (anticonvulsant), and warfarin.

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Aminoglycosides

Back 70

bactericidal antibiotics - disrupt protein synthesis; meds of choice against aerobic gram-negative bacilli.

Front 71

gentamicin (Garamycin)
streptomycin
paromomycin (oral)

Back 71

aminoglycosides; paromomycin (oral) - used for intestinal amebiasis and tapeworm infections

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SE of aminoglycosides

Back 72

possible ototoxicity; nephrotoxicity

Front 73

sulfoamides and trimethoprim

Back 73

inhibit bacterial growth by preventing syntesis of folic acid (essential for production of DNA, RNA, and proteins).

Front 74

trimethroprim-sulfamethoxazole (TMP-SMZ, Bacterim)

Back 74

Drug of choice for UTIs caused by E.coli; SE - avoid prolonged exposure to sunlight (photosensitivity)

Front 75

Meds/Food interaction with Bacterim

Back 75

Reduce or don't give Coumadin, Dilantin, Orinase - sulfamides can increase effects of these meds by inhibiting hepatic metabolism

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Urinary Tract Antiseptics

Back 76

broad spectrum urinary antiseptics withbacteristatic action at low doses and bactericidal action at high doses. Bacterial injury occurs by damaging DNA. For acute UTIs or prophylaxis for recurrent lower UTIs.

Front 77

nitrofurantoin (Macrodantin)

Back 77

urinary tract antiseptic; contraindicated in clients with renal dysfunction (b/c pt will have increased levels of drug b/c can't excrete and lower levels of drug in urine would not be effective). Urine may have brownish discoloration.

Front 78

Peripheral neuropathy

Back 78

tingling, numbness, burning...

Front 79

antimycobacterial (antituberculosis)

Back 79

highly specific for mycobacteria.

Front 80

isoniazid (INH)

Back 80

Indicated for latent and active TB; latent - daily for 6 months; active - multiple medication therapy including INH, rifampin, pyrazinamide, and/or pyridoxine daily for 6 months.

Front 81

Isoniazid Side effects

Back 81

Peripheral neuropathy, hepatotoxicity (monitor livel function tests and instruct client to avoid alcohol); interfers with phenytoin (resulting in ataxia and incoordination).

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DOT

Back 82

Direct observation therapy - done to ensure compliance with INH for active TB

Front 83

dapsone and other meds such as clofazimine (Lamprene), and rifampin (Rifadin)

Back 83

against Anti-Hansen's Disease (Leprosy). Hepatotoxicity may occur as SE; may have to take increased amounts of Coumadin, oral contraceptives, meds for HIV b/c rifampine will accelerate metabolism of these drugs.

Front 84

Antiviral meds

Back 84

Antivirals meds of choice for herpes simplex virus, varicella-zoster virus, and cytomegalovirus.

Front 85

acyclovir (Zovirax)

Back 85

Acyclovir prevents reproduction of viral DNA; administer acyclovir infusion slowly over 1 hr; ensure adequate hydration during infusion to prevent nephrotoxicity; should be used catiously in clients with renal impairment, dehydration or other neprotoxic meds.

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Other antivirals

Back 86

ganciclovir (Cytovene), interferon alfa, ribavirin (Rebetol), amantadine (Symmetrel), lamivudine (Epivir HBV)

Front 87

Possible side effects of antivirals

Back 87

Nephrotoxicity, granulocytopenia, thrombocytopenia, and reproductive toxicity.

Front 88

ganciclovir (Cytovene)

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contraindicated in pregnancy (Teratogenic); risk of sterility for males; don't give when neutrophil count below 500/mm3.

Front 89

ciprofloxacin (Cipro)

Back 89

should not be administered to children under 18 due to risk of Achilles tendon rupture; it is a fluoroquinolone

Front 90

Fluoroquinolones

Back 90

bactericidal - inhibit enzyme necessary for DNA replication. Broad-spectrum antimicrobials; for respiratory, urinary, GI, bone, joint, skin infections.

Front 91

metronidazole (Flagyl)

Back 91

Antiprotozoal med; broad-spectrum antimicrobial; used to treat protozoal infections; SE can include metallic taste and darkening of urine; avoid alcohol; it also inhibits inactivation of warfarin (warfarin will work longer).

Front 92

amphotercin B deoxycholate (Fungizone)

Back 92

Antifungal;

Front 93

Other antifungal meds

Back 93

ketoconazole (Nizoral); nystatin (clotrimazole)

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side effects of antifungals

Back 94

they are highly toxic and should be reserved for life-threatening conditions; Can cause - infusion reactions, nephrotoxicity, hypokalemia, hapatotoxicity, gynecomastia (in males), irregular menstrual flow.

Front 95

Oral contraceptives

Back 95

Doses of estrogen and progestreone are given to suppress FSH and LH (to inhibit ovulation); also changes in endometrium to make implantation more difficult.

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Oral contraceptives Side effects

Back 96

increased risk of blood clots (counsel pt's not to smoke and once over 35 to use other forms of contraception); interacts with antibiotics, anticonvulsants, and anti-tubercular/HIV drugs (use other forms of contraception while on those types of drugs)

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Hormone Replacement Therapy (HRT)

Back 97

Fallen out of favor for menopausal women b/c risk of: breast cancer, thromboembolism, heart disease, stroke; HRT can be used for prevention of osteoporosis but not by itself.

Front 98

Types of Hormone Replacement theray

Back 98

Oral (conjugated estrogens - Premarin) or transdermal (Estraderm, Climara)

Front 99

Prevention of osteoporosis

Back 99

calcium and vitamin D; smoking cessation; daily weight bearing exercise.

Front 100

Meds for osteoporosis: bisphosphonates

Back 100

Slow the rate of bone loss and or increase bone tickness. Ex. alendronate (Fosamax), ibandronate (Boniva), risedronate (Actonel)

Front 101

Osteoporosis meds: Selective estrogen receptor modulator (SERM)

Back 101

Act like estrogen to prevent bone loss (decreases bone resorption); ex. Raloxifene (Evista)

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Androgens

Back 102

Male sex hormones: Testosterone (natural, synthetic, anabolic steroids) for tx of: delayed male puberty, hypogonadism in males, inoperable metastatic cancer in females
High potential for abuse