pharm 1 final drug cards and key terms

methylphenidate

ADHD monitor weight due to reduced appetite can cause insomnia if taken too late in day can be used for narcolepsy Prototype - methylphenidate (ritalin) CNS stimulants Similar - amphetamine, dextroamphetamine Class - piperidine derivatives Indications - ADHD, narcolepsy, obesity Action - increases norepinephrine and dopamine in CNS Adverse effects - insomnia restlessness, reduced appetite, weight loss, dysrhythmias, dependence and withdrawal, possible GI symptoms Contraindications - pregnancy C, avoid in hypertension, hyperthyroidism, heart disease, anxiety and psychosis Notes - advise last dose prior to 4 pm, monitor weight and proper diet, take medication with meals consider "drug holidays" on weekends and summer break, never stop abruptly always taper, avoid all stimulants with maois avoid other stimulants such as caffeine and OTC's

Which antibiotics are contraindicated during pregnancy?

NOT SAFE tetracyclines! carbapenum gentamicin (aminoglycoside's, theoretical risk due to nephrotoxicity) trimethoprim-sulfamethoxazole cyclovir's pregnancy safe rifampin zidovudine penicillins cephalosporins

Compare and contrast the different types of insulin (onset, peak, duration)

NPH Lispro insulin regular glargine - no peak

NPH

NPH Insulin - 1-2 hr onset intermediate cloudy, neil Patrick harris, middle intermediate aged dude. Great for basal maintenance if insulin high in morning increase nightly dose NPH and premixed insulins will appear cloudy but other insulins should not adjust dose based on sliding scale NPH/isophane insulin (novolin NPH, Humulin N) antidiabetic Indications: diabetes (Type 1 and 2, gestational) Action: intermediate-acting Adverse Effects: hypoglycemia, hypokalemia, lipohypertrophy Contraindications: use cautiously with beta-blockers (can mask S/S of hypoglycemia), thiazide diuretics (can c/ hyperglycemia), & glucocorticoids (can c/ hyperglycemia) Administration: NPH and premixed insulins will appear cloudy but other insulins should not, administered by subcutaneous route Patient Teaching: encourage proper diet and exercise always draw up clear (regular) before cloudy (nph)

celecoxib

NSAID that only affects COX 2 inhibitors (no COX 1 effects) supposedly less side effects increased risk of HTN stroke MI not given to patients with significant cardiac history monitor BP used for inflammation osteoarthritis Celecoxib - inhibit prostaglandins cox 2 inhibitor, increased risk of stroke due to HTN due to kidney suppression, can cause gi ulcers, Prototype - celecoxib (celebrex) anti-inflammatory class - cyclooxygenase-2 inhibitor Indications - inflammatory suppression, milk to moderate pain, fever, colorectal cancer protection Action - inhibits cox 2 enzymes which release prostaglandins Adverse effects - GI discomfort, impaired kidney function, increased risk of heart attack or stroke Contraindications - patients with higher risk for MI or stroke (last choice medication for chronic pain in these patients), allergy to sulfonamides Notes - remind pt of bleeding risk when combined with an anticoagulant, take with food or milk to avoid GI discomfort, avoid alcohol to decrease risk of GI bleed, do not take ibuprofen with ASA (increases platelet effect), use cautiously in older adults, asthma, PUD, avoid concurrent use with ACE inhibitors and ARB's Created to reduce NSAID side effects, but later found to not have as much of a difference

ethambutol REMOVED FROM FINAL

REMOVED FROM FINAL used for TB, causes visual impairment and blindness *Prototype - isoniazid (anti tuberculosis) Similar - pyrazinamide, ethambutol, rifapentine Class - isonicotinic acid hydrazine Indications - TB, positive PPD Actions - inhibits synthesis of mycobacterial cell wall Adverse effects - peripheral neuropathy, jaundice (hepatotoxicity), hyperglycemia and decreased glucose control in diabetics Contraindications - liver disease Notes - use with rifampin (6-12 months) and pyrazinamide with or without ethambutol for the first 2 months, treat or prevent neuropathy with pyridoxine (vit B6). monitor liver function tests. Strongly encourage adherence. adherence with prescribed regimen is challenging, but prevents the emergence of resistant strains 6-12 months of isoniazid and rifampin with pyrazinamid and or ethambutol for first two months

amitriptyline

TCA can be used for insomnia, depression, anxiety and to prevent migraines used in fibromyalgia as well adjuvant pain medication adverse effects can cause sedation orthostatic hypotension anticholinergic side effects dries you out dry mouth constipation

Why are stimulants used to treat ADHD? What are the common adverse effects? When time of day should the medications be taken?

methylphenidate - increases norepi and dopamine insomnia if taken too late can also be used for narcolepsy decreased appetite weight loss guanfacine - alpha 2 agonist, causes hypotension amphetamine mixture - increases norepi and dopamine atomoxetine - SNRI

nystatin

preferential choice for yeast (candidiasis) infections compared to tinea infections mainly oral candidiasis but can be used in vaginal candidiasis too Prototype - nystatin (mycostatin) PO creams powders anti-fungal Class - polyene macrolides Indications - candidiasis, vaginal candidiasis (yeast infection) denture care (for thrush) Action - destroys fungal cells Adverse effects - n/v/d Contraindications - NA can use for thrush (oral solution)

Why should NSAIDs be avoided in patients taking blood thinners?

they cause hypertension increasing bleeding risk also make platelets less sticky so it will potentiate bleeding even more

What medications are used to treat fungal infections?

tinea - fluconazole systemic - amphotericin B candidiasis (yeast) - nystatin (oral, possibly vaginal), vaginal and oral (fluconazole) common in immunocompromised patients Hiv infection - deep, requires oral Chemotherapy - deep, Steroid use - general immuno suppression Diabetes - generally due to poor circulation, also considered immunosuppressed Indwelling catheter On broad spectrum antibiotics Female with vagina ketoconazole - severe and dandruff amphotericin B - severe nystatin - candidiasis for tinea miconazole terbinafine (also onychomycosis) clotrimazole fluconazole thrush, white stuff on tongue Nystatin, clotrimazole, fluconazole Superficial fungal infection - Love warm moist area, creams Skin, Oral mucosa - liquid or solution, Vaginal - diflucan common treatment, Hair, Nail, etc Deep or systemic fungal infection - generally indicates immunosuppression, requires oral meds, opportunistic Brain liver etc Classifications Superficial Cutaneous Subcutaneous Systemic Opportunistic - in immunocompromised patients People at risk for Fungal infections Hiv infection - deep, requires oral Chemotherapy - deep, Steroid use - general immuno suppression Diabetes - generally due to poor circulation, also considered immunosuppressed Indwelling catheter On broad spectrum antibiotics Female with vagina Can be superficial (tinea, candida) or deep (candida, aspergilla, cryptococcus, mucormycosis, blastomycosis, histoplasmosis, coccidiomycosis) Fungal = mycotic or mycoses Dematophyte infections - superficial fungal infections Dermatomycoses - fungal infection of skin and hair, called tinea Tinea capitis - ringworm of scalp Tinea corporis - ringworm of body Tinea cruris - warm moist areas or groin Tinea pedis - athletes foot Onychomycosis or tinea unguium - nail plate - treated with oral terbinafine, often not worth treating due to toxicity and due to taking months to treat Oral thrush - candidiasis, Causes in adults Immunosuppression - DB HIV chemo antibiotic or cortisone steroid inhaler Treated with nystatin solution, clotrimazole oral solution, or fluconazole orally

Tolerance vs dependance

tolerance, decreasing response to repeated drug doses -dependance is a physiologic or psychological need for a drug - physical dependance is the physiologic need for a drug to avoid physical withdrawal symptoms.

rifampin

turns bodily fluid orange, not harmful used for tb rifampin (bactericidal) tuberculosis adherence with prescribed regimen is challenging, but prevents the emergence of resistant strains 6-12 months of isoniazid and rifampin with pyrazinamid and or ethambutol for first two months *Prototype - rifampin (bactericidal) Class - semisynthetic rifamycin's Indications - TB Actions - blocks RNA synthesis of mycobacterium Adverse effects - discoloration of body fluids (orange), hepatotoxicity, GI upset, pseudomembranous colitis Contraindications - pregnancy B, liver dysfunction Notes - monitor liver function tests, changes bodily fluid colors, must complete 6-12 months of therapy. Use in combination with isoniazid (6-12 months) and pyrazinamide and or ethambutol for first two months

Describe the action of thrombolytic medications (also known as fibrinolytics). When are they used? What are the risks? What is the door-to-needle goal? What testing must be done prior to administration?

alteplase or tPA used in acute ischemic stroke and acute MI to break up clot, massive PE (pulmonary embolism), clear central line blockage high risk of bleeding will dissolve any old clots causing massive hemorrhage door to needle goal is 4.5 hours for stroke hold pressure for 30 minutes if injection or ABG neccessary, get IV's beforehand ideally if bleeding occurs FFP or whole RBC's contraindications thrombocytopenia ischemic stroke in last 3 months severe HTN (increased bleeding risk) monitor HgB, signs of bleeding and blood gas check glucose (decreases fibrinolytic activity) and platelets beforehand Alteplase (activase) - thrombolytic enzyme Similar - tissue plasminogen activator (tPA) Class - enzyme Indications: acute MI, acute ischemic stroke, Massive PE, central line blockage Action: dissolve clots which have already formed Adverse Effects: serious internal or external bleeding Contraindications: active bleeding, ischemic stroke within last 3 months (excluding current indication), recent surgery, thrombocytopenia, severe HTN Monitoring: Hgb, signs of bleeding- Blood gas Administration: only given within 4.5 hours of symptom manifestations (stroke), weight-based dosage, do not mix with any other medication, limit venipunctures and injections after administration - hold pressure for 30 minutes if injection or ABGs necessary, if life threatening bleed occurs treat with whole blood and/or fresh frozen plasma

gentamycin

aminoglycoside that causes nephrotoxicity and tinnitus ototoxic - tinnitus nephrotoxicity - normal BUN 6-20 and Cr 1.2 peak and trough levels required every 3rd dose used for conjuctivitis Prototype - gentamicin (IV, eye/ear drops) (bactericidal) Similar - tobramycin, neomycin PO, streptomycin (tuberculosis), paromomycin (intestinal parasites) Class - aminoglycoside Indications - gram negative bacilli, UTI, intraABD infections, conjunctivitis Action - disrupts protein synthesis Adverse effects - ototoxicity, nephrotoxicity Contraindications - pregnancy, renal failure Extra - monitor for tinnitus, hearing loss, kidney function (BUN and Creatinine, I&O) peak and trough level every 3rd dose

Ginger root

used for n/v upset stomach, motion sickness increased bleeding risk with blood thinners Ginger root - therapeutic class - dietary supplements What it does - relieves vertigo/ nausea, increases gastric motility, and reduces GI spasms, Inhibit platelet aggregation Indications - motion sickness, nausea, upset stomach, morning sickness, Contraindications - blood thinners, pregnancy Adverse effects - increased bleeding, hypoglycemia (controlled db), miscarriage (interacts with db drugs)

Which blood thinners require regular blood test (monitoring) and which ones do not? What levels are therapeutic and which require interventions? what are there antidotes heparin lmwh rivaroxaban warfarin

heparin - aPPT (normal 25-35 seconds, 60-80 on heparin), platelet count due to thrombocytopenia reversal protamine, usually wait for it to wear off warfarin - INR (2-3, normal is 1) or PT (9-12 seconds on warfarin), reversal vitamin K LMWH/ enoxaparin - monitor platelet count, reversal not can cause thrombocytopenia needed but protamine rivaroxaban - monitor CBC for bleeding don't need to know but reversal andexxa MONITOR for BLEEDING DARK TARRY STOOLS

metformin

lactic acidosis due to inability to excrete, accumulation and toxicity occurs Biguanides - (Metformin is the only one) increases insulin sensitivity of the cells, also reduces gluconeogenesis in the liver, A very common and effective Anti- Diabetic oral medication. Considered first line treatment in Type 2 diabetes. Increases glucose uptake and use in fat and skeletal muscles. Decreases glucose absorption in the gastrointestinal tract. Metformin (glucophage) antidiabetic Class - biguanides Indications: type 2 diabetes (1st line) May be combined with other oral antidiabetic medications Action: improves insulin sensitivity which increases glucose uptake in fat and skeletal muscles, reduced production of glucose in liver, decrease glucose absorption in gastrointestinal tract, this means that it cannot make you hypoglycemic Adverse Effects: lactic acidosis (most severe, risk increased with acute illness), GI effects (anorexia, nausea, diarrhea) - most common, Vitamin b12 and folate deficiency Does NOT cause hypoglycemia by itself, can loose weight with GI side effects Pregnancy: category B Contraindications: DKA, severe infection, kidney impairment, and any hypoxic condition, alcohol use disorder, iodine-containing contrast dye (increased risk of kidney impairment) If you have kidney impairment you are at higher risk of building up metformin levels in blood stream, a reason not to start this medication Gastrointestinal - anorexia, nausea, and diarrhea are very frequent and can result in weight loss. This side effect usually resolves with time. Lactic acidosis- most severe side effect, it will cause hyperventilation to try to improve the acidosis, somnolence is also due to the acidosis. It has a high mortality rate if it occurs, it usually occurs in the setting of a severe illness while also taking Metformin. Patients with renal insufficiency should not use metformin (can rapidly accumulate to toxic levels) since they are at higher risk of lactic acidosis. Metformin would be immediately stopped if this side effect occurs. Due to inhibition of gluconeogenesis by blocking pyruvate carboxylase, the first step of gluconeogenesis, which converts pyruvate to oxaloacetate. Blocking this enzyme leads to accumulation of lactic acid. Vitamin B12 and folic acid deficiency due to malabsorption of the Vitamins, may need to supplement with Vitamin B12 and Folate. 3)Slowing glucose absorption into the bloodstream by reducing the emptying of the stomach after eating, making you feel more satisfied after a me Used for glucose control in patients who have type 2 diabetes. Can be used with an oral antidiabetic medication, usually metformin or a sulfonylurea

Tuberculosis

you can ignore this slide its all on other slides isoniazid + rifampin pyridoxine (neuropathy, for isoniazid) ethambutol (not on final) gentamicin (not mentioned in review for this use) must complete 6-12 months of therapy. Use rifampin with isoniazid (6-12 months) and pyrazinamide and or ethambutol for first two months treat or prevent neuropathy with pyridoxine (vit B6) Tuberculosis - common in prisons and highly packed areas Highly infectious caused by mycobacterium As many as 20% HIV AIDS patients may have TB Homelessness and high immigration rates Acquired through respiratory route, transmitted by coughing or sneezing 1 person will spread to 10-15 people on average Symptoms like pneumonia, weakness, cough, SOB, chronic, weight loss, loss of appetite. PPD test, tests for antigen (could be resolved, just signifies presence or exposure, not contagious or illness). If positive chest x ray is needed to prove negativity Not always specific to TB - annual x rays given to those who test positive for PPD Sputum cultures - can take weeks to months due to slow growth of TB Nucleic acid amplification (sputum) - rapid test Interferon gamma release assay (IGRA) - newer, measures response of the immune system to a sample of the patient's blood Once positive, always positive Results read 48 to 72 hours later over 5mm is positive if immunocompromised HIV positive, recent contact with TB Nodular or fibrotic changes on chest x ray Organ transplant over 10 mm is positive if Recent arrivals from high prevalence countries (less that 5 years) IV drug users Resident or employee of high risk congregate settings Mycobacteriology lab personel Comorbid conditions Children under 4 years Infants children and adolescents exposed to high risk categories over 15 mm positive Person with no known risk factors for TB Treatment Goal - eliminate mycobacteria while avoiding emergence of resistant strains Therapy lasts - 6 to 12 months If resistance 2 years 2-7 administered concurrently for active TB Prophylactic therapy indicated for close contacts with active TB adherence with prescribed regimen is challenging, but prevents the emergence of resistant strains 6-12 months of isoniazid and rifampin with pyrazinamid and or ethambutol for first two months Considered negative after 3 negative sputum tests

How to assess and prevent those toxic effects including labs.

normal BUN 6-20 Cr 0.6-1.2

octreotide

- inhibits GH release can used in pituitary adenoma causing acromegaly or gigantism, inhibits GH release, reduces effectiveness of GH Octreotide (sandostatin) hyperpituitarism Similar lanreotide, pegvisomant Class - somatostatin analogues Indications: gigantism in children, acromegaly in adults, bleeding esophageal varices Action: limits growth hormone release, reduces portal vein blood pressure Adverse Effects: GI disturbances, hypo/hyperglycemia, Monitoring: monitor blood glucose levels in diabetes mellitus Administration: subQ or IV or IM, rotate injection sites, injection of octreotide should be to a large muscle (not deltoid) Notes - vasodilates portal vein system. If liver sclerosis it backs up portal vein causing esophageal or abdominal varices due to portal vein being backed up, also inhibits insulin and glucagon secretion in pancreas

ciprofloxacin

-floxacin = flrouroquinolone can cause tendon rupture contraindicated under 18 years old because risk of tendonitis commonly used for UTI *Prototype - ciprofloxacin (cipro) PO IV broad spectrum antibiotic Similar ofloxacin, moxifloxacin, levofloxacin, gemifloxacin, -floxacin Class - fluoroquinolones Indications - urinary infections, pneumonias and infectious diarrhea, osteomyelitis, joint, skin, soft tissue infections, anthrax Actions - bactericidal due to inhibition of an enzyme necessary for DNA replication Adverse effects - GI discomfort n/v/d, achilles tendon rupture, suprainfection, photosensitivity (and SJS) Contraindications - avoid if under 18 years of age, elderly (BEERS list), use cautiously with warfarin (check INR) and theophylline, caution in renal impairment (needs renal dosing) Extra notes - check INR dosing depends on renal function, causes confusion in elderly, report tendinopathy symptoms, avoid sunlight, report thrush and vaginitis, do not eat or drink dairy or take antacids or iron at same time. Accumulates in tendons. Interactions - warfarin and potentiates theophylline (used for COPD asthma), milk dairy antacids, elderly (confusion), kids

Compare and contrast typical (1st generation) and antitypical antipsychotics (2nd and 3rd generations). What are the adverse effects?

1st gen haloperidol chlorpromazine 2nd gen clozapine risperidol 1st gen antipsychotic similiar to haloperidol side effects (EPS) caused by blocking dopamine which inversely raise AcH causing EPS (cholinergic) side effects, AcH is in charge of parasympathetic nervous system so symptoms will correlate with overactive parasympathetic nervous system. EPS side effects DPART acute dystonia (involuntary movement) parkinsonism (shakiness) akasthisia (restlessness) tongue/lip smacking (tardive dystonia) irreversible treated by anticholinergics benztropine IM in face diphenhydramine NMS is caused by low dopamine FASTER fever agitation sweating tachy and BP changes lEad pipe hyoReflexia treated with dantroline 2nd and 3rd gen have less EPS side effects and are not as sedating, less anticholinergic effects first gen antipsychotics more likely to cause movement side effects second gen cause metabolic side effects like weight gain diabetes hyperlipidemia.

chlorpromazine

1st gen antipsychotic similiar to haloperidol side effects (EPS) caused by blocking dopamine which inversely raise AcH causing EPS (cholinergic) side effects, AcH is in charge of parasympathetic nervous system so symptoms will correlate with overactive parasympathetic nervous system. EPS side effects DPART acute dystonia (involuntary movement) parkinsonism (shakiness) akasthisia (restlessness) tongue/lip smacking (tardive dystonia) irreversible treated by anticholinergics benztropine IM in face diphenhydramine NMS is caused by low dopamine FASTER fever agitation sweating tachy and BP changes lEad pipe hyoReflexia treated with dantroline 2nd and 3rd gen have less EPS side effects and are not as sedating, less anticholinergic effects first gen antipsychotics more likely to cause movement side effects second gen cause metabolic side effects like weight gain diabetes hyperlipidemia. Prototype - chlorpromazine (thorazine) 1st gen antipsychotic Similar - haloperidol, fluphenazine, thiothixene, perphenazine, loxapine, trifluoperazine Class - phenothiazines Indications - psychotic disorders, schizophrenia, bipolar disorders, tourette syndrome, agitation, nausea and vomiting Action - blocks dopamine, inhibits psychotic manifestations Adverse effects - can rarely cause NMS, EPS, anticholinergic effects, orthostatic hypotension, sedation, sexual dysfunction, agranulocytosis (drop in white blood cell count due to some bone marrow suppresion), severe dysrhythmias, liver impairment Contraindications - parkinson's disease, prolactin-dependent breast cancer, hypotension, dementia, glaucoma, paralytic ileus, prostate enlargement, heart disorders, liver or kidney disease, seizure disorders Notes - avoid anticholinergic agents, CNS depressants, levodopa, consider depot administration IM every 2-4 weeks for non-adherence, improvement occurs in 2-4 weeks

clozapine

3rd gen antipsychotic can cause BMS obtain CBC due to possible severe neutropenia (agrannulocytosis) Prototype - clozapine (clozaril) antipsychotic Class - dibenzazepine derivatives Indications - schizophrenia unresponsive to other treatments Action - unknown, binds to dopamine receptors Adverse effects - seizures, CNS depression, anticholinergic effects, orthostatic hypotension (bone marrow suppression), can cause any of the first gen antipsychotic symptoms as well. Contraindications - cardiac or respiratory disease Notes - black box warning avoid use with opioids as it may cause respiratory arrest, black box warning obtain CBC before starting as this may cause severe neutropenia, may cause NMS (neuromalignant syndrome) watch for sign in patient, start low and go slow with drug especially if history of seizures, know how to respond to drug before driving or other activities, avoid other CNS depressants

What are disorders that are treated with anticoagulants and/or antiplatelet medications?

A-fib to prevent blood clot formation in left atrium causing stroke DVT - leg swellin prevention of MI in high risk patients not for acute treatment of STEMI or ischemic stroke because it will not break up the clot just prevent it thinners contraindicated in hemmorhagic stroke because that is a brain bleed

ethosuximide

ABSCENSE SEIZURES ONLY antiepileptic Prototype - Ethosuximide (zarontin) anticonvulsant Class - succinimide derivative Indications - absence seizures Action - suppresses neuronal firing, decreases seizure activity by enhancing the effects of GABA Adverse effects - N/V, CNS effects

Saw Palmetto

BPH, do not use with finasteride Saw palmetto - therapeutic class - dietary supplements Action - decreases prostate size Indications - benign prostatic hyperplasia Contraindications - antiplatelets, anticoagulants, finasteride, pregnancyX Adverse effects - blood thinning, GI disturbances

Identify HIV medication classes along with their action.

ART (anti-retro viral) therapy used to prevent the rise of new strains, spread of disease (because it will hopefully bring the client into undetectable/untransmittable status) and will hopefully reduce viral load to allow CD4 cells to increase therefor allowing client to have a healthier immune system with less adverse effects. 1 ENtry FUsion inhibitor, block the HIV virus from fusing with the cell, EnFuvirtide 2 then since its a retrovirus it must go from RNA to DNA with reverse transcriptase, so you must take a reverse transcriptase inhibitor (zidovudine) step 3 im assuming we don't need to know for test but it stops the HIV DNA from getting into and highjacking the host DNA 4 protease inhibitors (lopinavir or ritonavir) - lets say virus was able to incorporate itself into the DNA and made viral mRNA which go to ribosomes and make viral proteins. This type of drug inhibits the protein production, and reduces new viral particles lopinavir/ritonavir - proteas inhibitor Antiretroviral therapy (ART) - combines multiple antiviral medications to lower viral load Highly active antiviral therapy (HAART)- combines multiple antiviral medications to prevent mutations, lower long term adverse effects, by having increased CD4 count if you lower load to undetectable levels you cannot spread to someone else ART and HAART are basically the same thing know the goals listed above antiretroviral How HIV and many other viruses get in the cell and replicate Types of medications 1 entry inhibitors block virus from getting into the cell, 2 types of drugs can do this fusion inhibitors - enfuvirtide CCR5 inhibitors - maraviroc 2 NNRTI's and NRTI's impact the ability of the virus to convert its RNA into DNA, NNRTI, Non nuclease reverse transcription inhibitors (enfavirenz, delavirdine) - binds to reverse transcription enzyme altering its shape and stops it from being able to accept the viral RNA and convert it to DNA by using its normal nucleotides and nucleosides NRTI, Nuclease reverse transcription inhibitors (zidovudine) - don't directly block the reverse transcriptase but pretend to be different analogues of different base pairs that go into DNA, basically fake themselves into making the virus think its replicating, but since it's not the real base pairs, the viral DNA is not produced normally 3 integrase inhibitors 1st line drug (raltegravir) - prevent the virus DNA from getting into the host DNA 4 protease inhibitors (lopinavir or ritonavir) - lets say virus was able to incorporate itself into the DNA and made viral mRNA which go to ribosomes and make viral proteins. This type of drug inhibits the protein production, and reduces new viral particles Prototype - Enfuvirtide (fuzeon) subcutaneous, antiretroviral, remember En at beginning is for entry Class - entry inhibitor (stops step 1 of HIV replication) Action - blocks the virus from attaching to and entering the CD4 T cell Indication - treatment of HIV that is unresponsive to other antiretrovirals Adverse effects - pneumonia, localized erythema at injections site likely Contraindications - intentionally left blank, avoid while breast feeding Notes - monitor for pneumonia, and injection site reaction, take with meals Prototype - Efavirenz (sustavia) antiretroviral Similar - delavirdine, etravirine, nevirapine, rilpivirine Class - NNRTI Indications - used with others for HIV In combination with 2 NRTIs: atripla (emtricitabine, tenofovir, efavirenz) Actions - binds directly to reverse transcriptase, disrupting shape of the enzyme's active site, prevents viral DNA from being synthesized from HIV RNA Adverse effects - severe rashes, flu like symptoms, CNS symptoms of nightmares and drowsiness Notes - monitor CBC, CD4 levels, viral load, never skip a dose, high fat meals increase absorption by 20% Must know delavirdine as well but there was not slide on it. Prototype - zidovudine (AZT, retrovir) antiretroviral Similar - abacavir, didanosine, emtricitabine, lamivudine, stavudine, tenofovir Class - NRTI Indications - HIV/AIDS, HIV positive pregnant women, prophylaxis in newborn born to positive moms, 1st line 1st line: 2NRTI's + 3rd antiretroviral Actions - inhibits DNA synthesis in infected cells Adverse effects - seizures, pancreatitis, bone marrow suppression, lactic acidosis, myopathy with long term use (black box warning) Contraindications - liver failure, avoid while breast feeding Notes - monitor CBC, liver function tests, signs of pneumonia, signs of bone marrow suppression (infection, bruising, bleeding, weakness) take with meals to avoid upset GI Pregnant women takes same medications to obtain undetectable levels, which will reduce transmission of HIV to baby Infant will take antiretroviral medications (usually zidovudine) for 4-6 weeks until repeat blood work shows they are HIV neg Prototype - lopinavir/ritonavir (kaletra) antiretroviral Similar - atazanavir, darunavir Class protease inhibitors Indications - HIV final step in assembly of an infections HIV virion prevention Always combined to prevent resistance Actions - lopinavir is the active component of the combination, ritonavir inhibits the hepatic breakdown of lopinavir Adverse effects - GI upset, hyperglycemia, osteoporosis, high lipid levels Contraindications - caution in diabetes, heart disease, osteoporosis Notes - monitor blood sugar and bone health, follow a low fat diet, take with food to avoid GI upset this drug is a part of combination therapy

Agonist vs antagonist effect

Agonist is a ligand for a receptor, partial agonist partially or sometimes binds to receptor Antagonist blocks ligand from binding to receptor

Bactericidal vs bacteriostatic - mechanism of action and outcomes

Bactericidal - kill bacteria, irreversible, generally but not always inhibit cell wall formation, do not work with immune system of host, MBC (minimum bactericidal concencentration) refers to concentration of drug required to kill 99.99% of bacterial population Include beta-lactams antibiotics (affect cell wall, often PCN's), use pneumonic silly ceph ca mo (PCN, cephalosporin, carbapenems, monobactam) PCN cephalosporins (cousin to PCN, affect cell wall) Vancomycin (IV often staph infections) Aminoglycosides (iv only very toxic to kidney and ear) Quinolones (inhibit DNA cause tendonitis) Rifampin (tuberculosis, causes orange staining) Metronidazole (inhibits DNA) Monobacams more prone to cause oppurtunistic infections Bacteriostatic - prevent growth, reversible, generally inhibit DNA replication and or protein synthesis of bacteria, work with immune system of host, MIC (minimum inhibitory concentration) is minimum drug concentration which inhibits the bacterial growth Include tetracyclines, (acne lotion) spectinomycin, chloramphenicol, sulfonamides, (good for sulfa) sulfamethoxazole macrolines (erythromycin) Clindamycin (very likely to cause cdiff) Trimethoprim erythromycin

Black box warning

Black box warnings - warns serious risks, one of the strongest drug safety warnings

clopidogrel

Clopidergril - GI upset, inhibits platelets, bleeding risk especially GI contraindicated in thrombocytopenia PUD or anyone with increased risk of bleeding Clopidogrel (plavix) - antiplatelet Class - ADP inhibitor Indications: prevent MI (like ASA), prevent stroke and ischemic attack(like ASA), acute coronary syndromes, Post coronary artery stenting Action: inhibits platelet aggregation Adverse Effects: gastric bleeding , GI (diarrhea, dyspepsia, pain), GI bleed Contraindications: thrombocytopenia, hx of bleed due to PUD, intracranial bleed, caution taking with other blood thinners Patient Teaching: monitor & report signs of bleeding; advise patient to report melena or hematemesis immediately

hydroxychloroquine

DMARD used in lupus RA and malaria can cause retinal damage baseline eye exams with follow up exams every 6 months can cause SJS Prototype - hydroxychloroquine (plaquenil) - regular DMARD, antimalarial agent Class - aminoquinolines Indications - malaria, systemic lupus erythematosus (SLE), rheumatoid arthritis Action - may bind or alter the properties of DNA Adverse effects - retinal damage, neuropsychiatric symptoms, SJS rash, GI side effects Contraindications - breastfeeding Nursing care - baseline eye exams with follow up exams every 6 months, monitor CBC and LFT's not approved for use in covid nonbiologic DMARD can be used in RA?

methotrexate

DMARD, for autoimmune disease such as RA or psoriasis blocks dna synthesis, causes immunosuppression, pregnancy x Prototype - methotrexate (otrexup) - regular DMARD, folate antagonists Similar - leflunomide Class - folate antagonists Indications - psoriasis, rheumatoid arthritis, certain cancers Action - blocks folic acid, preventing DNA synthesis, depresses immune system Adverse effects - infection, hepatic toxicity, bone marrow suppression, ulcerative stomatitis/GI Contraindications - pregnancy X, woman of childbearing age, liver failure, alcoholism, impaired nutritional status, or infections Notes - stops immune cells from dividing, therefor causing bone marrow suppression. Stops cellular division therefore harmful to the fetus. Take with food or fluids, multiple drug interactions, use after other medications have failed due to toxicity, watch for signs of infection such as fever cough sore throat. Severe infections possible check CBC, LFT's, advise potential of GI upset and mouth ulcers because stomach is rapidly dividing cells, teratogenic, often folic acid given with it

Which antibiotics are potentially toxic that require peak and trough levels and what is their toxicity presented as?

Drugs that require peaks and troughs EVERY THIRD DOSE Gentamycin (nephrotoxicity) Vancomycin (nephrotoxicity) normal BUN 6-20 Cr 0.6-1.2

raloxifene

ESTROGEN, osteoporosis, helps decrease resorption (dissolving of bone) not reabsorption, preg X, can induce menopausal symptoms, DVT risk estrogen increases coagulability of blood (leg swelling) Raloxifene (evista) antiosteoporosis Class - selective estrogen receptor modulator Indications: osteoporosis, prevention of breast cancer in high-risk women Action: decreases bone resorption, antagonist to estrogen on breast and endometrial tissue Adverse Effects: DVT, hot flashes Contraindications: pregnancy category X, hx of venous thrombosis Monitoring: bone density scan should be done every 12-18 months, serum calcium levels should be 9-10.5 mg/dL Patient Teaching: consume adequate amounts of calcium and vitamin D, perform daily weight bearing activities

entacapone

Entacapone - enhances effects of levadopa, can be adjuvant given with other antiparkinsons meds. can be used when levadopa/carbadopa is wearing off at night for parkinsons Prototype - entacapone (comtan) antiparkinsonians Similar - tolcapone, levodopa/carbidopa/entacapone (stalevo 50) Class - COMT inhibitors Indications - parkinson's disease Action - enhance the effects of levodopa by blocking its breakdown Adverse effects - dyskinesia, vomiting, diarrhea, discoloration of urine to orange-yellow, sleepiness Contraindications liver failure Notes - take with food, monitor for sudden loss of effectiveness in medication, do not discontinue abruptly

erythropoietin

Erythropoietin (EPO) - increase RBC in anemia monitor iron hematocrit HTN increases risk for DVT and leg swelling Erythropoietin (epoetin alfa, epogen) - recombinant human erythropoietins Class - colony stimulating factors Indications: anemia (related to CKD), increasing erythrocyte count for elective surgery Action: acts on the bone marrow to increase production of red blood cells Adverse Effects: stroke, MI, seizures, HTN, DVT, headache, body aches, leg swelling Contraindications: uncontrolled HTN, some cancers as it may increase tumor growth Monitoring: BP, iron levels, CBC Administration: use each vial for one dose and do not reinsert needle to withdraw medication, increases blood thickness due to increased platelets Prototype drugs for hematopoietic growth factors 1)Erythropoietic Growth Factors: erythropoiesis stimulating agents- increase RBC's Erythropoietin 2)Leukopoietic Growth Factors: Granulocyte colony stimulating factor (G-CSF) - increase WBC especially Neutrophils, GM-CSF- increases granulocytes and macrophages Filgrastim Sargramostim 3)Thrombopoietic Growth Factors: increases Platelets Oprelvekin (Interleukin-11)

filgrastim

Filgrastim - increases WBC increases production of neutrophils side effect - bone pain often used after chemo Filgrastim (neupogen) hematopoietic Similar - pegfilgrastim Class - colony stimulating factors Indications: neutropenia, autologous transplant Action: stimulate the bone marrow to increase production of neutrophils Adverse Effects: bone pain, increased plasma uric acid, splenomegaly and rupture of spleen Contraindications: avoid within 24 hours of chemotherapy Monitoring: CBC twice a week

Urticaria causes, symptoms and treatment

Hives - urticaria Allergies, treat with benadryl most severe form - anaphylaxis treat with 0.3-0.5 mg IM epi multiple drugs have a beta lactam ring similiar to PCN so in severe PCN allergy you will possibly see allergies in peneCILLin's CEPHalosporins, CArbapenem, Meropenum use nmenonic cilly ceph ca mo to remember these drugs if PCN allergy do not give these drugs Exposure to foods, medications, insect bits, psychological stress to cold temp, or vibration can also be trigger, blood transfusions, pressure, cold, heat, exercise, sun exposure. Vary in size and appear and fade repeatedly until reaction runs cours Treat with antihistamines, if severe oral corticosteroids Wheal and flare Acute under 6 weeks Chronic over 6 weeks 2 body systems involved for anaphylaxis and epi

ibuprofen

Ibuprofen - nsaid, can cause GI ulcers, HTN stroke Prototype - ibuprofen (advil) NSAID analgesics Similar - indomethacin, ketorolac, naproxen, diclofenac, meloxicam Class - NSAIDs Indications - inflammatory suppression, mild to moderate pain, arthritis, fever Action - inhibits COX 1 and COX 2 enzymes which reduces prostaglandins Adverse effects - GI discomfort, impaired kidney function, increased risk of heat attack or stroke (due to HTN due to kidney impairment and fluid retention), HTN, PUD Contraindications - HTN, PUD, pregnancy D, bleeding disorders Notes - remind pt of bleeding risk when combined with an anticoagulant, take with food or milk to avoid GI discomfort, avoid alcohol to decrease risk of GI bleed, do not take ibuprofen with ASA (increases platelet effect), use cautiously in older adults, asthma, PUD, avoid concurrent use with ACE inhibitors and ARB's used for RA, gout flare up Side effects of NSAIDS Inflamed gastric mucosa lead to gastritis Lead to abd pain or ulcers Often taken with ant-acid van lead to GI bleed

imipramine

Imipramine (tofranil) TCA Contraindications - seizure disorders generalized anxiety disorder depression insomnia can cause sedation orthostatic hypotension anticholinergic side effects dries you out dry mouth constipation

indomethacin

Indomethacin - nsaid for acute gout Prototype - ibuprofen (advil) NSAID analgesics Similar - indomethacin, ketorolac, naproxen, diclofenac, meloxicam see ibuprofen drug card Prototype - ibuprofen (advil) NSAID analgesics Similar - indomethacin, ketorolac, naproxen, diclofenac, meloxicam Class - NSAIDs Indications - inflammatory suppression, mild to moderate pain, arthritis, fever Action - inhibits COX 1 and COX 2 enzymes which reduces prostaglandins Adverse effects - GI discomfort, impaired kidney function, increased risk of heat attack or stroke (due to HTN due to kidney impairment and fluid retention), HTN, PUD Contraindications - HTN, PUD, pregnancy D, bleeding disorders Notes - remind pt of bleeding risk when combined with an anticoagulant, take with food or milk to avoid GI discomfort, avoid alcohol to decrease risk of GI bleed, do not take ibuprofen with ASA (increases platelet effect), use cautiously in older adults, asthma, PUD, avoid concurrent use with ACE inhibitors and ARB's used for RA, gout flare up Side effects of NSAIDS Inflamed gastric mucosa lead to gastritis Lead to abd pain or ulcers Often taken with ant-acid van lead to GI bleed

selegiline

MAOI patch used for parkinsons Prototype - selegiline (ensam) antiparkinsonians Class - MAO-B inhibitors Indications - parkinson's disease Action - prevents breakdown of dopamine Adverse effects - nausea diarrhea, hypertensive crisis with certain foods, serotonin with certain medication interactions Contraindications - avoid with MAOIs antidepressants and decongestants (risk of serotonin syndrome) Notes - take with food, avoid foods high in tyramine due to hypertensive crisis, avoid OTC decongestants

phenelzine

MAOI used for depression, diet restrictions includes tyramine containing food otherwise hypertensive crisis occurs tyramine containing foods cured meats aged cheese pickled or fermented foods beer wine Prototype - phenelzine (nardil) MAOI Similar - isocarboxazid tranylcypromine selegiline (transdermal maoi) Indications - severe depression, can be tried in severe bulimia and anxiety Action - block maoi enzymes in the brain, increasing norepinephrine, dopamine, serotonin, and tyramine intensifying responses and relieving depression Adverse effects - hypertensive crisis, serotonin syndrome Contraindications - pregnancy C, pheochromocytoma (adrenal tumor), heart failure, cardiovascular and cerebrovascular disease (due to HTN possibility related to extra norepi release), renal insufficiency, multiple drug and food interactions Notes - avoid tyramine containing foods (increases bp) this includes aged cheeses and meats like pepperoni jerky smoked foods beers wines ripened bananas avocados, monitor BP, teach medication adherence, avoid stimulants (includes cold remedies, decongestants, caffeine, chocolates), avoid demerol (meperidine) causes fevers.

naproxen

Naproxen - nsaid can cause HTN stroke also GI side effects can cause fluid retention used commonly for acute gout flare up see ibuprofen drug card Prototype - ibuprofen (advil) NSAID analgesics Similar - indomethacin, ketorolac, naproxen, diclofenac, meloxicam Class - NSAIDs Indications - inflammatory suppression, mild to moderate pain, arthritis, fever Action - inhibits COX 1 and COX 2 enzymes which reduces prostaglandins Adverse effects - GI discomfort, impaired kidney function, increased risk of heat attack or stroke (due to HTN due to kidney impairment and fluid retention), HTN, PUD Contraindications - HTN, PUD, pregnancy D, bleeding disorders Notes - remind pt of bleeding risk when combined with an anticoagulant, take with food or milk to avoid GI discomfort, avoid alcohol to decrease risk of GI bleed, do not take ibuprofen with ASA (increases platelet effect), use cautiously in older adults, asthma, PUD, avoid concurrent use with ACE inhibitors and ARB's used for RA, gout flare up Side effects of NSAIDS Inflamed gastric mucosa lead to gastritis Lead to abd pain or ulcers Often taken with ant-acid van lead to GI bleed

Broad-spectrum vs narrow-spectrum antibiotics.

Narrow spectrum antibiotic - effective against a specific group of microbes; usually after culture and sensitivity, have less effect on host flora Broad spectrum - effective against a wide variety of different microbial species. Usually started if infection is severe while waiting for lab results from culture and sensitivity. Much higher chance for superinfection or opportunistic infections. and more adverse effects common side effects N/V upset stomach diarrhea toxicity C diff (common with c. clindomycin) treat c. diff with ORAL vanco (glycopeptide)

Peak and trough definition- when and why are these levels are drawn?

Onset - time required for therapeutic effect Peak - time required for maximum therapeutic response drawn 1+ hour after administered trough level - lowest amount for therapeutic effects. Drawn before next dose Duration of action - how long drug is sufficient for therapeutic response drawn to monitor toxicity in certain drugs such as nephrotoxicity in vancomycin and gentimicin (ototoxic too) both require peak and trough levels, they are nephrotoxic so it would elevate BUN and Cr

oprelvekin

Oprelvekin - increases platelets, used int thrombocytopenia be careful in patients with heart problems or pleural effusion Oprelvekin (neumega) human thrombopoietic growth factor Class - recombinant human interleukin eleven Indications: thrombocytopenia Action: increase the production of platelets Adverse Effects: fluid retention, cardiac dysrhythmias, eye effects Contraindications: bone marrow cancer, use cautiously in patients with heart problems or pleural effusion Monitoring: obtain baseline CBC, platelet counts and electrolytes Administration: subQ once daily until desired count reached

packed red blood cells

PRBC - blood replacement, stay for 15 minutes, benadryl and tylenol for acute reaction. Check vitals (bp) before and after, dedicated line for blood products flush with NS for mind allergic reaction give acetaminophen and diphenhydramine Packed RBC's - antianemia Class - blood components Indications: anemia, hemorrhagic shock Action: increases the number of RBCs Adverse Effects: acute hemolytic reaction, febrile, nonhemolytic reaction, anaphylactic reactions, mild allergic reactions- administer Acetaminophen and diphenhydramine, hyperkalemia, sepsis Contraindications: cultural or religious values that prevent blood administration Administration & Monitoring: see whole blood 1 unit will raise hemoglobin by 1, massive hemorrhage will need packed RBC's, plasma, platelets, Packed RBC's - anemia, hemorrhagic shock - 1 unit will raise by 1 Hg

pramipexole

Pramipexole - dopamine agonist, used for parkinsons Prototype - pramipexole (mirapex) antiparkinsonians Similar - ropinirole (requip), apomorphine, bromocriptine (poorly tolerated) Class - dopamine agonists Indications - parkinson's disease, can be used for RLS Actions - activates dopamine receptors Adverse effects - daytime sleepiness, orthostatic hypotension, psychosis, dyskinesias, nausea Notes - take with food, monitor for dyskinesias or psychosis, do not discontinue abruptly, often used in conjunction as other drugs wear off

prednisone

Prednisone - steroid for inflammation, mood changes, thin skin weight gain, insomnia, increases appetite, hyperglycemia know side effects, stops hormonal negative feedback causing addisonians crisis any inflammatory disorder such as RA Adverse events from long-term therapy with Glucocorticoids 1)Suppression of inflammation and immune response of the body 2)Peptic ulcers from thinning of the stomach lining and irritating the stomach. 3)Osteoporosis - fragile thin bones from the cortisol 4)Behavioral changes- change in mood, insomnia, agitation 5) Cataracts leading to reduced vision 6)Metabolic changes- such as obesity and diabetes 7)Myopathy- muscle weakness develops from excessive cortisol use. 8) Hypertension 9) Thin skin that easily bruises addissionion crisis Prototype - predniSONE (prednisone intensol) adrenocorticoids Similar - prednisolone Class - adrenocorticoids Indications - many inflammatory conditions, MS exacerbations, flare up of RA, asthma, crohn's, ulcerative colitis Action - decreases inflammation, suppresses immune response Adverse effects - GI irritation (tough on stomach), infection (due to suppressed immune system), osteoporosis, adrenal suppression, fluid retention, hyperglycemia, hypokalemia, thin skin, bruising, weight gain, increased appetite, adrenal suppression when stopping chushings when startint Contraindications - Notes - give drug with food, monitor blood sugar and potassium levels, encourage calcium supplements, vitamin D, and bisphosphonate to protect from osteoporosis, all corticosteroids are basically the same, oral and IV, due to high level of steroid brain tells adrenal gland to stop making hormones. Must be tapered off or adensonion crisis because the adrenal gland can't suddenly make glucocorticoids. prednisone (deltasone) adrenocorticoid replacement Similar - dexamethasone, presnisolone; mineralocorticoid: fludrocortisone Class - corticosteroid Indications: inflammatory conditions, allergic conditions Action: steroid hormone that reduces inflammation and has antipruritic effects Adverse Effects: glucose intolerance, osteoporosis, adrenal suppression, peptic ulcer, GI issues, infection, insomnia, increases appetite Contraindications: active infection Monitoring: blood sugar in diabetics, weight, BP, electrolytes Patient Teaching: take orally with food, taper off with help of provider, watch for peptic ulcer signs used in RA acute gout flare up

flumazenil

Reversal agent flumazenil, can cause acute withdrawal in dependent patients. Usually reserved for extreme overdose, usually better to observe and let drug wear off

rivaroxaban

Riveroxaban - Xa inhibitor, adverse effects - major bleeding monitor CBC Rivaroxaban (xarelto) anticoagulants Similar - apixaban Class - direct inhibitor of factor Xa Indications: A. Fib (embolism prevention), DVT, PE, stroke Action: inhibits factor Xa to prevent formation of a clot Adverse Effects: major bleeding Contraindications: active bleeding, thrombocytopenia Monitoring: CBC, no bleeding time testing needed Patient Teaching: administer once daily with evening meal, avoid falls or risky activities, like warfarin but no testing needed and work immediately Reversal: Andexxa (recombinant factor Xa) Rivaroxaban - monitor CBC - reversal andrexxa

What are common withdrawal symptoms of SSRIs?

SSRI/SNRI discontinuation syndrome in adults F.I.N.I.S.H Flu like symptoms - fatigue muscle aches headache diarrhea Insomnia vivid or disturbing dreams Nausea Imbalance gait instability dizziness lightheadedness vertigo Sensory disturbance paresthesia electric shock sensation visual disturbance Hyperarousal anxiety agitation Onset 24-72 hours + resolution 1-14 days Incidence 20-40% who have been treated at least 6 weeks

What are the symptoms of serotonin syndrome?

Serotonin syndrome - caused by increased serotonin, usually due to increased drugs that increase serotonin (ssri, TCA, maoi, tryptophan etc), or accumulation Symptoms - neuromuscular - restlessness, myoclonus, tremor and rigidity hyperreflexia other symptoms - shivering/elevated temperature, arrhythmias (can be fatal) tachy, fever Treatments - stop drugs, usually resolves in no more than 24 hours, treat symptoms - cooling and benzo's, can be treated with cyproheptadine Prevention - take care when combining or switching serotonergic antidepressants

Define pharmacodynamics

Study of what the drug does to the body Involves receptor interactions and binding including post receptor effects involves agonist and antagonist and ligands that bind to receptors

sumatriptan

Sumatriptin - for migraines at or before onset, causes vasoconstriction leading to chest pain discontinue immediately if chest pain occurs SUMAtriptan (imitrex) antimigraine drugs Similar - zolmitriptan Class - selective 5-hydroxytryptamine (5HT1) receptor agonist Indications - migraines Action - vasoconstriction relieving the brain of the migraine Adverse effects - chest pressure, angina, dizziness, vertigo Contraindications - liver failure, ischemic heart disease, history of MI, uncontrolled HTN Notes - pregnancy C, notify the provider for continuous or severe chest pain, avoid driving or operating heavy machinery until medication effects are known In order to relieve the pounding headache these work on serotonin receptors to vasoconstrict the vessels in brain Serotonin receptor agonists "triptans" (sumatriptan, central vasoconstriction) (ergotamine, peripheral vasocontriction)

Therapeutic index definition (high vs low index)

Therapeutic index - a ratio between a drugs lethal dose to its effective dose,lower is more lethal. Narrow vs wide therapeutic index - relationship between amount given to be effective and amount which drug becomes toxic. Wide is good, narrow is bad

What are the antidotes for acetaminophen, anticholinergic drugs, benzodiazepines, opioids, and tricyclic antidepressants?

acetylcystate - acetaminophen anticholinergic drugs - physostigmine benzos - flumazenil opiods - naloxone (look for respiratory depression and constipation) TCA's - bicarbonate, possibly physostigmine

calcitriol

active form of vitamin D required in kidney disease due to inability of kidney to convert inactive vitamin D Calcitriol (calcijex) antihypocalcemics Similar - ergocalciferol, cholecalciferol Class - vitamin D analogues Indications: Kidney disease with reduced serum calcium, hypocalcemia, hypophosphatemia, osteomalacia (rickets), osteoporosis prophylaxis and treatment, hypo-parathyroidism, breast-fed infants (low vitamin D storage), CKD Action: promotes calcium absorption from the small intestine and encourages the liberation of calcium from the bone to the blood, active form of Vitamin D Adverse Effects: Hypercalcemia (nausea, vomiting, constipation, anorexia, apathy, headache) Contraindications: hypercalcemia, Vitamin D toxicity Administration: available in several forms, reduce dose as PTH levels decrease in response to therapy Calcium metabolism Calcium Affects heart, nervous system, muscles, blood coagulation, and bones Parathyroid gland (4 glands, total 2 pairs) - release PTH, in presence in of low serum calcium in blood, to elevate serum calcium (negative feedback loop with calcium) PTH goes to kidney, to increase production of active vitamin D (calcitriol) Calcitriol goes to small intestine to increase absorption of calcium PTH tells kidney to stop excretion of of calcium and reabsorb it, to increase serum calcium PTH stimulates osteoclasts to breakdown (to clash with bone) bones to increase serum calcium osteoBlasts Build bone using calcium and phosphate In high serum calcium, thyroid releases CalcitonIN to INhibit osteoclasts (to decrease concentration of serum calcium) Therefore, Calcitonin can be used to stop breakdown of bones in diseases such as osteoporosis if thyroid is removed you do not need to receive calcitonin to inhibit osteoclasts, due to other regulation sources Think of PTH as calci1, calcifediol (di is 2), and calcitriol (tri is 3) as forms of vit D to raise calcium levels in blood Vitamin D - main function in GI system Produced in epidermis in inactive form (cholecalciferol or D3) from cholesterol, via melanocytes stimulated by sunlight (most common, unless ingesting a bunch) Goes to liver and converted into calcifediol Goes to kidney which activates it and it becomes calcitriol (active vitamin D) (calcitriol) active vit D - acts on small intestine to increase absorption of calcium to elevate serum calcium levels Can purchase calcitriol, but don't need to due to being able to absorb other forms easier, this is why ESRD patients are on calcitriol directly, kidneys unable to convert other forms This means if you have ESRD you will be unable to activate vitamin D from dietary sources and from skin Won't be able to absorb vit D from GI tract, causes release of PTH, and bone breakdown more leading to demineralization of the bones This is why CKD patients end up with bone disease, osteoporosis Active vitamin D (calcitriol) Is needed to absorb calcium from GI tract Normal serum calcium reference be considered 9-10.5 mg/dL Vit D supplement is cholecalciferol or ergocalciferol most commonly

colchicine

acute gout attacks, explosive diarrhea causes thrombocytopenia Prototype - colchicine (colcrys) antigout drugs Class - colchicum autumnale alkaloids Indications - acute gout attacks Action - decreased inflammation caused WBC's (reducing cell division in immune system and other parts of body) Adverse effects - explosive diarrhea, NV, thrombocytopenia, rhabdomyolysis, possibly bone marrow suppression Contraindications - cardiovascular, renal (due to rhabdo), hepatic (rhabdo), or GI impairment, bone marrow suppression Notes - reserved for patients note responsive to safer agents, monitor CBC, LFT's keep out of reach of children. GI side effects (rapidly dividing cells) can be the limiting issue

Identify antiviral medications and indications of use -vir medications = antiviral acyclovir famicyclovir ganiciclovir interferon ribavarin osltamavir

acyclovir and famciclovir - varicella zoster - chicken pox herpes zoster - shingles herpes simplex 1 (oral) and 2 (genital) ganciclovir - CMV interferon - hep B Ribavarin - respiratory syncytial virus (RSV) infection causing bronchiolitis in children oseltamavir - influenza A B Prototype - acyclovir antiviral Similar - famciclovir, valacyclovir (valtrex), ganciclovir, valganciclovir (valcyte Drug class - nucleosides and nucleotides Indications - herpes simplex (1 cold sore or 2 genital), varicella-zoster viruses (active chickenpox), shingles Actions - prevent the reproduction of viral DNA and thus interrupts cell replication Adverse effects - minimal side effects orally, Contraindications - severe renal failure (if using IV) Notes - monitor kidney function and keep hydrated pre IV dosing, administer drug as soon as virus symptoms occur for best effects, avoid sexual activity until lesions healed. Topical or IV or oral ? only IV acyclovir is nephrotoxic if used for shingles MUST be administered within 72 hours PO cream or PO for hsv 1 hsv2 and chickenpox oral viral skin infections Valacyclovir Not ganciclovir - that is for CMV famciclovir Prototype - ganciclovir (cytovene) IV, poor absorption PO antiviral Similar - famciclovir, calaciclovir (valtrex), acyclovir, valganciclovir (valcyte) Class - nucleosides and nucleotides Indications - cytomegalovirus in immunocompromised patients (HIV retinitis) or infected neonates Actions - prevent the reproduction of viral DNA and thus interrupts cell replication Adverse effects - bone marrow suppression (black box warning), may impair fertility Contraindications - severe renal failure (if given IV), pregnancy, Treatment for neonates treated with ganciclovir can protect against hearing loss and developmental impairment It is preventable. Ganciclovir - cytomegalovirus prevention (in HIV, organ transplant) or treatment interferron a protein released by animal cells, usually in response to the entry of a virus, which has the property of inhibiting virus replication. Interferons are a group of signaling proteins made and released by host cells in response to the presence of several viruses. In a typical scenario, a virus-infected cell will release interferons causing nearby cells to heighten their anti-viral defenses. Interferon alpha 2b - hep b possibly hep c Interferon (cytokine made in body naturally) - alfa 2B - hepatitis B or C Drug treatments for chronic hepatitis - combination therapies Interferon based therapies - used as immune booster used in MS to slow progression Oseltamivir (tamiflu) Indication - influenza A or B prevention or treatment Adverse effects - n/v and diarrhea, often psychiatric effects Notes - used in high risk patients with many comorbidities or a severe case, much less effective then vaccine 3) Oseltamivir (Tamiflu)- used to treat influenza A or B, not very effective, used in high risk patients such as very old/very young. Gives terrible diarrhea/vomiting as side effect. possible use for viral skin infections?

pyridoxine

aka vit b6, antidote for isoniazid to prevent neuropathy use with rifampin (6-12 months) and pyrazinamide with or without ethambutol for the first 2 months, treat or prevent neuropathy with pyridoxine (vit B6). monitor liver function tests. Strongly encourage adherence.

amphotericin B

amphoterrible - used in severe systemic mycotic infections and is known for its terrible adverse effects IV phlebitis, nephrotoxicity (monitor BUN), BMS (monitor CBC) do not give to immunocompromised people or people with KIDNEY disease Prototype - amphotericin B (ambisome) IV antifungal Class - polyene antibiotics Indications - severe systemic fungal infections Actions - inhibits synthesis of mycobacterial cell wall Adverse effects - IV site phlebitis, nephrotoxic, bone marrow suppression, infusion reaction (fever chills shaking tachycardia hypotension vomiting) hypokalemia Contraindications - NA Monitoring CBC, electrolytes creatinine, check IV site for phlebitis Notes - hydrate beforehand, monitor for infusion reaction; pretreatment for infusion reaction (acetaminophen and diphenhydramine) would need a handbook to list all the drug to drug interactions, not a great drug, can cause recurrent UTI's due to bone marrow suppression, do not use with aminoglycosides due to nephrotoxicity

metronidazole

antibiotic and antiparasitic can be used for vaginal trichomoniasis, amebiases, giardia second line for c. diff imposter, not a anti fungal, the suffix lies Prototype - Metronidazole (flagyl R) antiprotozoal Class - nitroimidazoles Indications - protozoal GI infections (giardia and amoeba), trichomoniasis (STD protozoa), PUD, bacterial vaginosis, and anaerobic bacterial infections, c diff (second line) Actions - disrupting the DNA of cells Adverse effects - GI n/v, dry mouth and metallic taste; CNS ataxia and seizures; disulfiram like reaction with alcohol Contraindications - alcoholism, seizure disorder, first trimester of surgery, caution use with warfarin (monitor INR) Notes - not a drop alcohol (disulferam reaction, violent GI symptoms), monitor INR with warfarin, darkening of urine is harmless second line for superinfections such as c diff bactericidal - Bactericidal - kill bacteria, irreversible, generally but not always inhibit cell wall formation

tetracycline

antibiotic commonly used in the treatment of acne causes photosensitivity great for PCN allergies contraindicated in pregnancy (and under 8) goes for all tetracyclines Prototype tetracycline (broad spectrum) Similar - doxycycline, minocycline Class tetracycline Indications - PCN allergy, acne, dental infections, STD (chlamydia), some pneumonias, peptic ulcer (H pylori), Lyme disease Action - prevents protein synthesis in bacteria Adverse effects - GI upset, esophageal ulceration, tooth discoloration under 8 yr old, hepatotoxicity, photosensitivity, superinfection Contraindications - pregnancy, liver and kidney dysfunction, children under 8 yr age Extra - avoid sexual contact until dosing complete in chlamydia, avoid laying down after oral admin (irritates esophageus) affects birth control, take on empty stomach with water 1-2 hr after meals ALL tetracyclines interact with milk calcium and iron, laxatives with magnesium, causes formation of nonabsorbable chelates, reducing absorption. can be used for rheumatoid arthritis? theoretically all cyclines affect birth control can it be used for rosacea? Bacteriostatic - prevent growth, reversible, generally inhibit DNA replication and or protein synthesis of bacteria, work with immune system of host

doxycycline

antibiotic commonly used in the treatment of acne causes photosensitivity great for PCN allergies contraindicated in pregnancy (and under 8) goes for all tetracyclines Prototype tetracycline (broad spectrum) Similar - doxycycline, minocycline Class tetracycline Indications - PCN allergy, acne, dental infections, STD (chlamydia), some pneumonias, peptic ulcer (H pylori), Lyme disease Action - prevents protein synthesis in bacteria Adverse effects - GI upset, esophageal ulceration, tooth discoloration under 8 yr old, hepatotoxicity, photosensitivity, superinfection Contraindications - pregnancy, liver and kidney dysfunction, children under 8 yr age Extra - avoid sexual contact until dosing complete in chlamydia, avoid laying down after oral admin (irritates esophageus) affects birth control, take on empty stomach with water 1-2 hr after meals ALL tetracyclines interact with milk calcium and iron, laxatives with magnesium, causes formation of nonabsorbable chelates, reducing absorption. can be used for rheumatoid arthritis? theoretically all cyclines affect birth control can it be used for rosacea? Minocycline (minocin) antibiotics PO Similar - doxycycline, minocycline Class - tetracyclines Indications: Acne Vulgaris, Rosacea, & many other infections Action: broad spectrum, prevents protein synthesis in bacteria Adverse Effects: GI upset, tooth discoloration under 8 years, hepatoxicity, photosensitivity, superinfection (c.diff) Contraindications: pregnancy, liver & kidney dysfunction, children< 8 years Patient Teaching: take orally, avoid lying down after administration d/t esophageal ulceration, consider 2nd contraceptive method with any antibiotic(not in real life), take on an empty stomach with 8 oz water (1 hr before or 2 hr after meals), usually used for 6-8 months

phenytoin

antiepileptic that causes gum swelling serum levels can be drawn Prototype - phenytoin (dilantin) anticonvulsant Class - hydantoin derivatives Indications - epilepsy, seizure disorders Action - slows and suppresses neuron firing, slows action potential of neurons Adverse effects - fatigue, sedation, ataxia (loss of balance), nystagmus ( unintentional shaky eye movement) and confusion, gum swelling and overgrowth (common), rashes, hirsutism (hair growth) Contraindications - allergy Notes - check for symptoms of toxicity (ataxia, confusion), stop if severe rash occurs, IV dilantin needs slow infusion (max 50 mg/min) to avoid hypotension, avoid with heart block/bradycardia, never stop any antiepileptic suddenly. Serum levels are checked occasionally All anticonvulsants can potentially cause SJS (steven johnson syndrome), never stop medication, can cause resistant seizure returning as serum levels drop

valproic acid

antiepileptic used for seizures, as mood stabilizer in bipolar, and headaches Prototype - valproic acid (depakote, depakene) antiepileptic Class - carboxylic acid derivative Indications - epilepsy, seizures, bipolar, migraines, mania, rapid cycling bipolar disorders Action - suppresses neuronal firing, decreases seizure activity by enhancing the effects of GABA, potentiates GABA, inhibits glutamic acid Adverse effects - indigestion, N/V (settles down with eating), hepatotoxicity, pancreatitis, thrombocytopenia (low platelet includes bleeding petechiae), high ammonia levels (affects amino acids) causes CNS effects such as confusion, teratogenesis, weight gain Contraindications - pregnancy D Notes - monitor plasma levels if needed, phenobarbital and pheytoin levels are increased with concurrent use can be checked as well. monitor for hepatitis and pancreatitis with LFT's and a lipase or amalase (pancreatic enzyme), can lower platelet count

carbamazepine

antiepileptic used for seizures, trigeminal neuralgia, and as mood stabilizer for bipolar sedative fall risk, can cause BONE MARROW SUPPRESION watch for fever/infection serum levels can be drawn Prototype - carbamazepine (TEGretol) antiepileptics Class - iminostilbene derivative Indications - epilepsy and seizure disorder, trigeminal neuralgias (pinching of trigeminal nerve causing extreme shocking pain on one side of face) mania, rapid cycling bipolar disorder Action - suppresses neuronal firing, decreases seizure activity by enhancing the effects of GABA, potentiates GABA, inhibits glutamic acid suppressing CNS excitation Adverse effects - bone marrow suppression (petechiae, fever, low WBC, anemia, SOB), SJS, photosensitivity, sedative-fall risk, CNS effects (nystagmus, double vision, vertigo, teratogenesis, bone marrow suppression, skin disorders, hepatotoxic Contraindications - pregnancy category D, bone marrow suppression (fever, bruising, bleeding gums animea dizziness fatigue), bleeding disorders, breastfeeding Notes - stop drug if severe reaction occurs, monitor plasma levels and CBC, educate patient medications are for control and note a cure, do note stop without direction of provider, avoid activities requiring alertness until seizures are controlled, avoid grapefruit (elevates levels), check serum levels, monitor CBC (due to bone marrow suppression, LFT (hepatotoxic) (jaundice RUQ pain anorexia), serum drug levels, report fevers, bruising and anemia, check for signs of hepatitis, SJS, careful in elderly due to sedation effects can cause fall. can be used in bipolar (manic states) adjuvant medication - Carbamazepine - anti-seizure drug, trigeminal neuralgia

diphenhydramine

antihistamine with anticholinergic effects can be used for EPS EPS side effects DPART acute dystonia parkonsonism akisthisia (restlessness) Tardive diskinisea (irreversable) tongue/lip smacking pretreatment for infusion reaction with acetaminophen in amphotericin B Betablocker (propanolol) used to treat one of these? Anticholinergic is caused by low AcH, DUCT Dilated pupils, Urinary retention, Constipation, Tachycardia EPS caused by high AcH, DPART, dystonia (involuntary movement), parkinsonism (shaky), Akasthisia (restlessness), Tongue/lip smacking caused by antipsychotics treated with anticholinergics. Benztropine or diphenhydramine NMS low dopamine FASTER fever agitation sweating tachy lEad pipe hypoReflexia, treat with dantroline If dopamine low acetylcholine rises and vice versa Serotonin symptoms - fever restlessness myoclonus arrythmia metabolic acidosis, rhabdo hepatomegaly, cardiac and renal failure Serotonin discontinuation - FINISH flu like symptoms, insomnia/vivid dreams, nausea, Imbalance, sensory disturbances, hyperarousal Understand what deficiency causes each disease, and how the med works and the rest is mostly able to be figured out Psychosis drug considerations When you block dopamine with a medication you increase acetylcholine and prolactin in brain Extrapyramidal side effects are characterized by increased acetylcholine Acute Dystonia (hours to days) spasm and stiffness of tongue, cheek, neck, face, and back Treated with anticholinergic's (benztropine or diphenhydramine) Akathisia (day 5-60) compulsive, repetitive motions, agitation Feeling of wanting to jump out of your own skin or extremely restless Treated with IV anticholinergics (benztropine, diphenhydramine) sometimes beta blockers or benzo's Parkinsonism (day 5-30) which is a deficiency in dopamine, tremors, shuffling gait, drooling, stooped posture, instability Treated with anticholinergics Tardive dyskinesia (months to years) lip smacking, worm like tongue movements, fly catching Often alter dose or medication, can remain permanent Use mnemonic DPART, Dystonia, Parkinsonism, Akathisia, Restlessness, Tongue lip smacking Neuromuscular Malignant Syndrome (NMS) blocking dopamine in hypothalamus will increase the body's temperature set point Leads to fever, hyperreflexia, tremor, clonus, autonomic instability (usually HTN), tachycardia, agitation, diaphoresis, increased bowel sounds diarrhea FASTER Fever, Agitation, Sweating, Tachycardia, lEad pipe hypoReflexia Treated with dantrolene

risperidone

antipsychotics used for schizophrenia adverse affects metabolic syndrome hypercholesterolemia orthostatic hypotension anticholinergic effects agitations dizziness sedations sleep disruption weight gain and DB? Prototype - risperidone (risperdal) 2nd and 3rd gen atypical antipsychotic Similar - olanzapine, quetiapin, ziprasidone, clozapine, lurasidone, paliperidone, iloperidone, aripiprazole, brexpiprazole, cariprazine Class - benzisoxazole derivative Indications - schizophrenia spectrum disorders, psychotic episodes, bipolar disorders, impulse control disorders, diabetes insipidus Action - block serotonin and dopamine receptors leading to effect Adverse effects - Diabetes, weight gain, hypercholesterolemia, orthostatic hypotension, anticholinergic effects, agitations, dizziness, sedation, sleep disruption, mild extrapyramidal symptoms (discussed above), elevated prolactin levels (irregular period in women, milk in men), sexual disfunction. Have more metabolic side effects Contraindications - pregnancy C, dementia, cardiovascular disease, seizures Notes - avoid CNS depressants, may take several weeks to see therapeutic results, assess patient for cheeking and adherence

What medications are given to treat general anxiety disorder?

anxiolytic - buspirone benzos - drugs that end in -pam or -zolam lorazepam MAOI - phenelzine SSRI - paroxetine, fluoxetine, citalopram, escitalopram, sertraline SNRI - TCA - amytriptiline anxiolytics Benzo's affect GABA system in brain - GABA is an inhibitory system in the brain that acts similar to a sedative when the GABA neurotransmitter is stimulated All end in -lam or -pam suffix Used for anxiety, preoperatively for sedation, procedural sedation, insomnia, seizures Relax muscles and have a depressant effect on the CNS, including respiratory function Extremely addictive, must be weaned off slowly Withdrawals cause Agitation, tremors, tachycardia, seizures Avoid in elderly due to sedation, higher risk of falls, and injury Can cause paradoxical (opposite) effect in children Overdose For oral overdose use activated charcoal, adsorbent, MUST not use in decreased level of consciousness, charcoal aspiration is a huge deal Gastric lavage, laxatives and NS, to force drug through GI system Reversal agent flumazenil, can cause acute withdrawal in dependent patients. Usually reserved for extreme overdose, usually better to observe and let drug wear off Azapirones All end in -pirone, buspirone main one Mostly effective in Generalized Anxiety disorders

alprazolam

benzo that can be used for sleeping seizures, muscle spasms, alcohol withdrawal (delirium tremens) antidote - flumazenil Prototype - alprazolam (xanax) sedative hypnotic anxiolytic Similar - diazepam, lorazepam, chlordiazepoxide, clorazepate, oxazepam, clonazepam Class - benzodiazepine, Indications - acute stress disorder (ASD), post traumatic stress disorder (PTSD), seizures, insomnia, muscle spasm, alcohol (ETOH) withdrawal, induction of anesthesia, Action - enhance the inhibitory effects of gamma-aminobutyric acid (GABA) in the CNS Adverse effects - GI upset, CNS depression, anterograde amnesia, toxicity, paradoxical response, withdrawal effect Contraindications - pregnancy D, sleep apnea, respiratory depression, glaucoma, history of substance abuse. Extra notes - schedule 4, short term use due to dependency, avoid grapefruit, avoid high fat meals reduced absorption, avoid other CNS depressants, Avoid high risk activities such as driving, and use of ladders etc. don't chew oral benzos, avoid with breastfeeding

lorazepam

benzo that can be used for sleeping, anxiety, insomnia, alcohol detox (for delirium tremens), benzo's generally used for seizures can cause respiratory depression antidote - let them sleep off unless emergency, flumenzinil Benzos - general info across all benzos therapeutic class - sedative, hypnotic anxiolytics Indications - anxiety disorders, PTSD, seizures, insomnia, muscle spasm, alcohol (ETOH) withdrawal, induction of anesthesia suffix - pam, -zolam Similar - alprazoman, diazepam, lorazepam, chlordiazepoxide, clorazepate, oxazepam, clonazepam, midazolam, temazepam, triazolam Action - enhance the inhibitory effects of gamma-aminobutyric acid (GABA) in the CNS Adverse effects - GI upset, CNS depression, toxicity, paradoxical response, dependence Contraindications - pregnancy D, sleep apnea, respiratory depression, breastfeeding, history of substance abuse Extra notes - short term use due to dependency, avoid other CNS depressants, Avoid high risk activities such as driving, and use of ladders etc. don't chew oral benzos, avoid with breastfeeding

Which medications cause cardiac and respiratory depression?

benzo's alprazolam lorazepam opiates fentynal oxycodone hydromorphone morphine

alendronate

bisphosphonate for pagest and osteoporosis esophagitis (notify provider in case of dysphagia) can cause osteonecrosis Alendronate (fosamax) anti osteoporosis Class - bisphosphonates Indications: prophylaxis and treatment of osteoporosis, Paget's disease, prophylaxis and treatment of steroid induced osteoporosis Action: decrease action of osteoclasts Adverse Effects: esophagitis, bisphosphonate-related osteonecrosis of the jaw, GI (N/V, constipation), musculoskeletal pain, visual disturbances Contraindications: dysphagia, esophageal stricture, esophageal disorders, serious kidney impairment, hypocalcemia Monitoring: bone density, blood calcium (9-10.5 mg/dL) Administration: wait at least 2 hours after taking before using antacids or supplements, notify provider if difficulty swallowing or worsening heartburn, perform weight bearing activities daily, take with full glass of water & sit up for 30 minutes after taking. Taken daily or weekly in the morning, notify dentist that you are taking Notes - often used with corticosteroid associated osteoporosis with calcium and vit D Interacts - food and drugs containing large amounts of calcium magnEsium or aluminum (antacids), decrease the absorption of alendronate interacts with calcium iron magnusium antacids orange juice and caffeine

heparin

blood thinner intrinsic pathway monitor aPPT monitor bleeding (GI bleed, dark tarry stool) monitor platelets causes thrombocytopenia reversal protamine Heparin - anticoagulant Class - anticoagulant Indications: , DVT (deep vein thrombosis), PE (Pulmonary Embolism), Unstable Angina, NSTEMI or STEMI, prophylaxis if at risk for DVT Action: prevent clotting by inhibiting fibrin formation Adverse Effects: heparin-induced thrombocytopenia, bleeding Contraindications: active bleeding, low platelet counts, surgery, shock, advanced renal disease, severe HTN, concomitant use with NSAIDs Pregnancy: safe Patient Teaching: report bleeding, tarry stools, or coffee ground emesis; safe in pregnancy Monitoring: obtain baseline & periodically monitor aPTT (normal 30-40s; maintain at 1.5-2X normal), platelet count, Hg Administration: IV only, get 2nd check on dosage before administering Reversal: protamine

warfarin

bridge with LWMH extrinsic path monitor PT or INR reversal vit K pt can continue regular diet but should not change intake of dark leafy greens Warfarin (coumadin) anticoagulant Class - vitamin K antagonist, coumarin derivatives Indications: DVT, PE, Atrial Fibrillation, mechanical heart valve Action: antagonist to vitamin K dependent clotting factors (2,7,9,10) Adverse Effects: hemorrhage, hepatitis, warfarin skin necrosis (reverse blood clotting at beginning) Contraindications: low platelet counts or uncontrolled bleeding, surgeries, liver disorders, alcohol (ETOH) use disorder Monitoring: PT or INR (maintain at 2-3 for most indications or 3-4.5 for mechanical heart valve), CBC Administration: bridge with LMWH when initiating until INR is in therapeutic range Patient Teaching: take orally at same time each day, avoid ETOH & NSAIDs due to increased bleeding risk, wear medical alert bracelet, use soft toothbrush, dietary takes 4 or 5 days to reach therapeutic dose, pt can continue regular diet, notify provider if changeIn diet teaching (vitamin K) Reversal: vitamin K, can use fresh frozen plasma too International normalized ratio INR 1 if normal 2-3 on warfarin

cephalexin

broad spectrum beta-lactam - great for cellulitis do not give to someone with severe PCN allergy Cephalexin (keflex) Similar - cefazolin, cloxacillin Class - 1st gen cephalosporin Indications: broad spectrum for infection, skin infections Action: bactericidal, destroy bacterial cell walls Adverse Effects: N/V/D, colitis (diarrhea), may lead to superinfection & C. diff, oral thrush, and vaginal yeast infection (vaginitis) Contraindications: severe allergy to PCN or cephalosporins, caution in renal impairment Labs: obtain cultures prior to initiating Patient Teaching: ask about allergies; take with food Prototype - cefalexin (keflex) PO broad spectrum antibiotic Similar - cefazolin -cef, -ceph, Class - first gen cephalosporin IM or IV equivalent cefazolin Indications - skin infections such as cellulitis or empatido Action - bactericidal, destroy bacterial cell walls Adverse effects - n/v/d, super infection of colitis (diarrhea, c diff), thrush, yeast infection Contraindications - severe allergy to PCN or cephalosporins, caution in renal impairment and bleeding disorders Labs obtain culture and sensitivity prior to initiation Teaching - check allergies, take with food Extra notes - has beta lactam ring like PCN but it is slightly different so it behaves similarly Can be used with MILD PCN allergy, has beta lactam ring Ceftriaxone (rocephin) - 3rd gen cephalosporin (IV) antibiotic Indication - Sepsis, pneumonia, prophylactic for surgery IM for gonorrhea Extra notes - often lidocaine is mixed in because it causes stinging pain, has beta lactam ring PO for infection due to bed bugs used PO for impetigo

Medications for smoking cessation

bupropion (atypical antidepressant, increases norepi, dopamine) varencicline (partial nicotinic agonist)

Which medication classes treat osteoporosis? What are the potential serious adverse effects?

calcium, vitamin D, in kidney disease active form (calcitriol must be administered) calcitriol reduce dose as PTH levels decrease in response to therapy used in hypoparathyroidism weight bearing exercise bisphosphonate alendronate - also used in pagets, prophylaxis for steroid induced osteoarthritis causes esophagitis (notify provider if difficulty swallowing), and osteonecrosis (painful jaw) GI effects and visual disturbances SERM raloxifene - pregnancy X, it interacts as estrogen in some parts of the body so it could cause early menopause, DVT, hot flashes bone density scan should be done 12-18 months normal serum calcium levels should be 9.5-10.5 Calcitriol (calcijex) antihypocalcemics Similar - ergocalciferol, cholecalciferol Class - vitamin D analogues Indications: Kidney disease with reduced serum calcium, hypocalcemia, hypophosphatemia, osteomalacia (rickets), osteoporosis prophylaxis and treatment, hypo-parathyroidism, breast-fed infants (low vitamin D storage), CKD Action: promotes calcium absorption from the small intestine and encourages the liberation of calcium from the bone to the blood, active form of Vitamin D Adverse Effects: Hypercalcemia (nausea, vomiting, constipation, anorexia, apathy, headache) Contraindications: hypercalcemia, Vitamin D toxicity Administration: available in several forms, reduce dose as PTH levels decrease in response to therapy Raloxifene (evista) antiosteoporosis Class - selective estrogen receptor modulator Indications: osteoporosis, prevention of breast cancer in high-risk women Action: decreases bone resorption, antagonist to estrogen on breast and endometrial tissue Adverse Effects: DVT, hot flashes Contraindications: pregnancy category X, hx of venous thrombosis Monitoring: bone density scan should be done every 12-18 months, serum calcium levels should be 9-10.5 mg/dL Patient Teaching: consume adequate amounts of calcium and vitamin D, perform daily weight bearing activities Alendronate (fosamax) anti osteoporosis Class - bisphosphonates Indications: prophylaxis and treatment of osteoporosis, Paget's disease, prophylaxis and treatment of steroid induced osteoporosis Action: decrease action of osteoclasts Adverse Effects: esophagitis, bisphosphonate-related osteonecrosis of the jaw, GI (N/V, constipation), musculoskeletal pain, visual disturbances Contraindications: dysphagia, esophageal stricture, esophageal disorders, serious kidney impairment, hypocalcemia Monitoring: bone density, blood calcium (9-10.5 mg/dL) Administration: wait at least 2 hours after taking before using antacids or supplements, notify provider if difficulty swallowing or worsening heartburn, perform weight bearing activities daily, take with full glass of water & sit up for 30 minutes after taking. Taken daily or weekly in the morning, notify dentist that you are taking Notes - often used with corticosteroid associated osteoporosis with calcium and vit D Interacts - food and drugs containing large amounts of calcium magnEsium or aluminum (antacids), decrease the absorption of alendronate Calcium metabolism Calcium Affects heart, nervous system, muscles, blood coagulation, and bones Parathyroid gland (4 glands, total 2 pairs) - release PTH, in presence in of low serum calcium in blood, to elevate serum calcium (negative feedback loop with calcium) PTH goes to kidney, to increase production of active vitamin D (calcitriol) Calcitriol goes to small intestine to increase absorption of calcium PTH tells kidney to stop excretion of of calcium and reabsorb it, to increase serum calcium PTH stimulates osteoclasts to breakdown (to clash with bone) bones to increase serum calcium osteoBlasts Build bone using calcium and phosphate In high serum calcium, thyroid releases CalcitonIN to INhibit osteoclasts (to decrease concentration of serum calcium) Therefore, Calcitonin can be used to stop breakdown of bones in diseases such as osteoporosis if thyroid is removed you do not need to receive calcitonin to inhibit osteoclasts, due to other regulation sources Think of PTH as calci1, calcifediol (di is 2), and calcitriol (tri is 3) as forms of vit D to raise calcium levels in blood Vitamin D - main function in GI system Produced in epidermis in inactive form (cholecalciferol or D3) from cholesterol, via melanocytes stimulated by sunlight (most common, unless ingesting a bunch) Goes to liver and converted into calcifediol Goes to kidney which activates it and it becomes calcitriol (active vitamin D) (calcitriol) active vit D - acts on small intestine to increase absorption of calcium to elevate serum calcium levels Can purchase calcitriol, but don't need to due to being able to absorb other forms easier, this is why ESRD patients are on calcitriol directly, kidneys unable to convert other forms This means if you have ESRD you will be unable to activate vitamin D from dietary sources and from skin Won't be able to absorb vit D from GI tract, causes release of PTH, and bone breakdown more leading to demineralization of the bones This is why CKD patients end up with bone disease, osteoporosis Calcium homeostasis To maintain homeostasis, sufficient dietary calcium is necessary. Recommended dietary allowance of calcium for healthy adults is 1000-1200 mg/day Active vitamin D (calcitriol) Is needed to absorb calcium from GI tract Normal serum calcium reference be considered 9-10.5 mg/dL Vit D supplement is cholecalciferol or ergocalciferol most commonly 97-98% of calcium in body is in bones Medications Calcium supplements SERMS Bisphosphonates calcitonin hypercalcemia/parathyroid gland Caused by parathyroid adenoma (produces excess PTH), bone breakdown from a bone cancer Symptoms Kidney Stones, painful Bones, abd Groans, psychiatric Moans (changes in nervous system) Hypocalcemia Poor vitamin D intake (after years, due to high calcium storage in bones) Skin vitamin D deficiency, limited UV exposure Chronic renal disease (inability to activate vitamin D) Accidental removal of parathyroid gland during surgery, requires calcium supplementation for rest of life Lack of vitamin D leads to poor calcium absorption Symptoms Nervous system, cardiac symptoms (arrhythmia), muscle issues (calcium needed for contraction), bone issues (takes calcium from bones), coagulation issues (needed for enzymes and clotting factors to work properly) Neuro, CATS go numb, Convulsions (muscular spasms), arrhythmias, Tetany (severe muscle spasms), Spasms and Stridor, numbness in fingers Weakness, tetany Positive trousseau's sign - pump up BP cuff, and hand goes into spasm (nerve issues) Positive chvostek's sign - tap on facial nerve, and face contracts (nerve issues) Laryngeal stridor - muscles in larynx Dysphagia - difficulty swallowing, muscle issue Tingling around mouth or in extremities (very common) Pharmacotherapy and indications for hypocalcemia Calcium supplements - oral prototype drug - calcium salts Hypocalcemia - vit d deficient, CKD, missing PT gland Osteoporosis - calcium supplements and vit D Paget's disease rickets/osteomalacia - rickets is vit D deficiency during childhood, osteomalacia in adults lactation/pregnancy Rapid childhood growth Chronic hypoparathyroidism Iv calcium for hyperkalemia Osteoporosis - thinning of bone, loss of bone matrix, made of calcium and phosphate Most common in post menopausal women, chronic steroid use, Diagnosed with bone density or DEXA scan, osteopenia (not quite osteoporosis yet) won't show up Bone demineralization and fragile bones Decreased bone density and strength Women 4 times more likely than men to develop this condition Treatment usually includes calcium, vitamin D, weight bearing exercise and bisphosphonate or SERM wrist , hip, and vertebral compression fractures leading to kyphosis Risk factors - family history, smoking, alcohol use, sedentary lifestyle, thin and small frame, low dietary vit D and Ca, early onset bone fractures, hyperthyroidism or hyperparathyroidism, Medications such as steroids, surgeries (having ovaries removed), european or asian decent, inactivity, eating disorder, infrequent menstrual cycles SERMS Primarily used in osteoporosis, can be used in paget's disease too, Increases bone density and reduces likelihood of fractures in postmenopausal women Also take calcium and vitamin D supplements with it, and weight bearing exercise so bone can be produced by osteoblasts Inadequate amounts of dietary calcium and vitamin D will cause the release of parathyroid hormone, which stimulates calcium release from the bone, leading to osteoporosis. Perform weight-bearing exercises daily (walking 30 to 40 min each day) to stimulate bone strength. Bones get stronger with regular activity, so inactivity is a risk factor for osteoporosis. Estrogen in women maintains bone strength and integrity until menopause. Also protects against breast cancer by blocking estrogen receptor in breast Basically pretend to be estrogen to stimulate bone mass, act like estrogen in some tissues, act like anti-estrogens in other tissues Works as an estrogen stimulator in bone (increased bone density), lipid metabolism, and blood coagulation (increased coagulation). It decreases bone resorption, which slows bone loss and preserves bone mineral density. Also works as an antagonist to estrogen on breast (reduced breast cancer)and endometrial tissue (reduced uterus cancer) Increase proteins from liver causing pro coagulant effect Side- effects: Increased risk for pulmonary embolism and deep‑vein thrombosis (DVT) since acts like an estrogen agonist leading to increased blood clotting. It should be stopped prior to scheduled immobilization (surgery) and can be resumed when the patient is fully mobile. Monitor for symptoms of DVT (red, swollen leg). Discourage long periods of sitting and inactivity Hot flashes- The medication can exacerbate hot flashes, since it has anti-estrogen effects on some tissues leading to menopausal symptoms Raloxifene belongs to a class of drugs called selective estrogen receptor modulators (SERMs). It is used for the prevention and treatment of osteoporosis in postmenopausal women and to reduce risk of invasive breast cancer in postmenopausal women at high risk or with osteoporosis. Bisphosphonates More commonly used for osteoporosis than SERMS Evidence shows that they reduce the risk of fracture in post-menopausal women with osteoporosis. Bisphosphonates inhibit the digestion of bone by encouraging osteoclasts to undergo apoptosis, or cell death, thereby slowing bone loss. The uses of bisphosphonates include the prevention and treatment of osteoporosis, Paget's disease of bone, Long-term treatment with bisphosphonates produces anti-fracture and bone mineral density effects. The bisphosphonate alendronate reduces the risk of hip, vertebral, and wrist fractures. Risedronate has also been shown to reduce the risk of hip fractures Side effects: Esophagitis, esophageal ulceration. Advise the patient to sit upright or ambulate for 30 min after taking this medication orally. Instruct the patient to take tablets with at least 240 mL (8 oz) water. Discontinue the medication and contact the provider for difficulty swallowing or new heartburn. GI disturbances (all bisphosphonates) Abdominal pain, nausea, diarrhea, constipation. Osteonecrosis of the jaw - a rare but severe side effect to all Bisphosphonates INTERACTIONS Alendronate absorption decreases when taken with calcium, iron, magnesium supplements, antacids, orange juice, and caffeine. NURSING ACTIONS: Wait at least 2 hr after administration to administer antacids or supplements. CLIENT EDUCATION: Take the medication on an empty stomach with at least 240 mL (8 oz) water. CONTRAINDICATIONS/PRECAUTIONS Most bisphosphonates are Pregnancy Risk Category D. Ibandronate and etidronate are Pregnancy Risk Category C. Zoledronate has been associated with an increase in stillbirths and a decreased survivability of neonates. These medications are contraindicated for clients who have dysphagia, esophageal stricture, esophageal disorders, serious kidney impairment, and hypocalcemia. This medication should not be administered to clients who cannot sit upright or stand for at least 30 min after medication administration. Use cautiously for clients who are lactating, and in clients who have upper GI disorders, infection, and liver impairment. Older adults are at slight risk for femoral fractures, which can occur without trauma while taking bisphosphonates

glucagon

can be used for beta blocker -lol overdose can cause lactic acidosis especially in kidney faillure can cause GI upset N/V diarrhea Glucagon (glucogen hypokit) antihyperglycemics Class - diagnostic agents Indications: hypoglycemia, beta blocker overdose Action: Raises glucose level by glycogen breakdown, relaxes smooth muscle of stomach, duodenum, small bowel, and colon Adverse Effects: hypotension, nausea/vomiting Contraindications: pheochromocytoma, insulinoma Patient Teaching: teach how to recognize S/S of hypoglycemia; teach how to administer medication (IM or IV); immediately report syncope, severe dizziness, fast or slow heart rate, or severe headache B-blockers- Glucagon is given to reverse the effects of a b-blocker overdose, it bypasses the b-blocker effects on the heart to increase HR and Inotropy

canagliflozin

can cause UTI "flo" can cause uti cystitis, bacteria love glucose, candidiasis. "can" "flo" for urine Canagliflozin (invokana) antidiabetic Class - sodium-glucose cotransporter 2 Indications: type 2 diabetes, used in combo with insulin for type 1 DM Action: limits rising glucose levels after food, prevents reabsorption of glucose in kidneys (has diuretic effect by preventing reabsorption of glucose in kidneys) Adverse Effects: cystitis (urine infection, due to sugar in urine), candidiasis (due to high glucose levels), polyuria (due to increased glucose having diuretic effect), hypotension Contraindications: DKA, caution using with thiazide & loop diuretics (increases their effect) Patient Teaching: take once a day before breakfast

levothyroxine

can cause hyperthyoidism/cushings if dose too high and addisonion crisis if abruptly stopped addisons high K low NA Levothyroxine (eltroxin) thyroid hormone replacements Similar - liothronine, liotrix, thyroid USP Class - thyroid hormones Indications: hypothyroidism, myxedema coma, cretinism, simple goiter, post thyroid surgery, radiation of thyroid Action: synthetic form of thyroxine which helps to maintain therapeutic levels of the thyroid hormone Adverse Effects: hyperthyroidism, osteoporosis, atrial fibrillation Contraindications: thyrotoxicosis, adrenal insufficiency, cardiovascular disease Monitoring: TSH & T4 Patient Teaching: usually lifelong therapy, never abruptly stop medication, Dosing: higher doses needed during pregnancy, start low and go slow, don't stop abruptly

insulin regular

commonly used IV for DKA and commonly used for sliding scale IV insulins - all are short acting, used in DKA usually regular insulin Regular insulin (humulin R, actrapid) antidiabetics Similar - regular insulin (U-500 strength) Class - insulin Indications: diabetes (Type 1 and 2, gestational) can be used prior meal, commonly used in IV in DKA Action: short-acting insulin Adverse Effects: hypoglycemia, hypokalemia, lipohypertrophy Contraindications: use cautiously with beta-blockers (can mask S/S of hypoglycemia), thiazide diuretics (can c/ hyperglycemia), & glucocorticoids (can c/ hyperglycemia) Monitoring: S/S of hypoglycemia Administration: when mixing short acting and intermediate acting draw up short acting insulin first, most common type of insulin for IV administration, fill IV tubing with fluid

alteplase

dissolve all clots even old ones used in central line catheter blockage, contraindicated if ischemic stroke in last 3 months recent surgery thrombocytopenia monitor for bleeding Alteplase (activase) - thrombolytic enzyme Similar - tissue plasminogen activator (tPA) Class - enzyme Indications: acute MI, acute ischemic stroke, Massive PE, central line blockage Action: dissolve clots which have already formed Adverse Effects: serious internal or external bleeding Contraindications: active bleeding, ischemic stroke within last 3 months (excluding current indication), recent surgery, thrombocytopenia, severe HTN Monitoring: Hgb, signs of bleeding- Blood gas Administration: only given within 4.5 hours of symptom manifestations (stroke), weight-based dosage, do not mix with any other medication, limit venipunctures and injections after administration - hold pressure for 30 minutes if injection or ABGs necessary, if life threatening bleed occurs treat with whole blood and/or fresh frozen plasma

haloperidol

first gen antipsychotic more likely to have side effects then 2nd gen antipsychotics side effects (EPS) caused by blocking dopamine which inversely raise AcH causing EPS (cholinergic) side effects, AcH is in charge of parasympathetic nervous system so symptoms will correlate with overactive parasympathetic nervous system. EPS side effects DPART acute dystonia (involuntary movement) parkinsonism (shakiness) akasthisia (restlessness) tongue/lip smacking (tardive dystonia) irreversible treated by anticholinergics benztropine IM in face diphenhydramine NMS is caused by low dopamine FASTER fever agitation sweating tachy and BP changes lEad pipe hyoReflexia treated with dantroline Prototype - chlorpromazine (thorazine) 1st gen antipsychotic Similar - haloperidol, fluphenazine, thiothixene, perphenazine, loxapine, trifluoperazine Class - phenothiazines Indications - psychotic disorders, schizophrenia, bipolar disorders, tourette syndrome, agitation, nausea and vomiting Action - blocks dopamine, inhibits psychotic manifestations Adverse effects - can rarely cause NMS, EPS, anticholinergic effects, orthostatic hypotension, sedation, sexual dysfunction, agranulocytosis (drop in white blood cell count due to some bone marrow suppresion), severe dysrhythmias, liver impairment Contraindications - parkinson's disease, prolactin-dependent breast cancer, hypotension, dementia, glaucoma, paralytic ileus, prostate enlargement, heart disorders, liver or kidney disease, seizure disorders Notes - avoid anticholinergic agents, CNS depressants, levodopa, consider depot administration IM every 2-4 weeks for non-adherence, improvement occurs in 2-4 weeks Anticholinergic is caused by low AcH, DUCT Dilated pupils, Urinary retention, Constipation, Tachycardia EPS caused by high AcH, DPART, dystonia (involuntary movement), parkinsonism (shaky), Akasthisia (restlessness), Tongue/lip smacking caused by antipsychotics treated with anticholinergics. Benztropine or diphenhydramine NMS low dopamine FASTER fever agitation sweating tachy lEad pipe hypoReflexia, treat with dantroline If dopamine low acetylcholine rises and vice versa Serotonin symptoms - fever restlessness myoclonus arrythmia metabolic acidosis, rhabdo hepatomegaly, cardiac and renal failure Serotonin discontinuation - FINISH flu like symptoms, insomnia/vivid dreams, nausea, Imbalance, sensory disturbances, hyperarousal Understand what deficiency causes each disease, and how the med works and the rest is mostly able to be figured out

Symptoms of ETOH withdrawal . Medications for ETOH withdrawal and abstinence

for alcohol withdrawals use benzos (suffix -lam, -pam) to prevent seizures and delirium tremens (shaking, hallucinating, HTN, confusion) lorazepam alprazolam Withdrawal - 4-12 hours of last intake of alcohol (can continue 5-7 days) Alcohol withdrawal delirium tremens - can occur 2-3 days after cessation of alcohol Stage one 6-8 hours Headaches, nausea, vomiting, sweating, trouble sleeping Stage 2 12-24 hours into recovery General discomfort Dehydration Loss of appetite Hallucinations Continued stage 1 symptoms Stage 3 1-2 days into detox Delirium tremens Syndrome of intense agitation, confusion, terrifying hallucinations, uncontrollable tremors, panic attacks, paranoia Without treatment 35% of those with delirium tremens will die Use of benzodiazepines and antipsychotic drug therapy Prevention of seizures and delirium tremens is a top priority Grand mal seizures Low blood sugar Mood swings acamprosate - abstinence only disurlfuram - abstinence only, reacts with alcohol for violent GI effects naltrexone - action unknown abstinence diazepam - benzo for delirium tremens clonidine - a2 agonist causes hypotension

Client education and treatment of scabies and lice treatment

for lice Combing wet hair with fine toothed nit comb may remove lice and some nits, repeated 3-4 days, 2 weeks later, problem solved Wash items in hot water. Wash bedding, stuffed animals and clothing in hot, soapy water and dry at high heat. Main treatment is Permethrin lotion, it does not kill nits, and treatment needs to be repeated in around 10 days leave in hair for 10 minutes scabies treat whole family leave applied for 8-12 hours

permethrin

for lice apply for 10 minutes for scabies treat whole family apply neck down Permethrin (actinin) antiparasitic Class - scabicidal agents Similar - crotamiton, ivermectin, lindane, malathion, pyrethrin Indications: lice & scabies Action: causes paralysis in the parasite through nervous system penetration, parasites die within 24-28 hours Adverse Effects: local site reaction, pruritus, rash, burning Contraindications: inflamed skin, lactation Patient Teaching: remove lice nits with a comb, medication should remain on the hair & scalp for 10 minutes prior to removal, apply cream from neck down for scabies, itching from scabies can last up to 3 weeks after treatment, wash all linens in the home, remove objects that have encountered parasites. With scabies treat whole family if scabies treat family, neck down

baclofen

for muscle spasms do not stop abruptly (risk of seizures), must be tapered Prototype - baclofen (lioresal) centrally acting spasmolytic Class - GABA ergic agonist Indications - muscle spasms in neurologic spasitc disorders, cerebral palsy, MS, strokes Action - central action, enhances the action of GABA in CNS Adverse effects - sedation, fatigue, dizziness, nausea, constipation, urinary retention, seizures Contraindications - AKI, epilepsy, avoid use with ETOH, barbiturates and opioids Notes - avoid ETOH, take with meals to reduce GI issues, eat more high fiber food, taper medication when stopping, must be tapered

isotretinoin

for severe cystic acne pregnancy X photosensitivity can limit night vision monitor CBC fasting lipids (cholesterol) LFT's pregnancy test SI Isotretinoin (accutane) antiacne drug PO Class - retinoic acid derivative Indications: nodulocystic acne (Severe acne) Action: strong Vitamin A analogue, able to decrease the size and activity of sebaceous glands Adverse Effects: depression, suicidal thoughts, acute pancreatitis, anemia, hypertriglyceridemia, dry peeling skin, dry lips and eyes, photosensitivity, teratogenicity Contraindications: Pregnancy Category X, depression or suicidality Monitoring: CBC, fasting lipids, LFTs (triglycerides), pregnancy testing Patient Teaching: can limit night vision, so caution about driving; do not take vitamin A supplements; use artificial tears if eyes become dry; use sunscreen and avoid prolonged sun exposure; monitor for depression; Absolute requirement to avoid pregnancy

Which medications treat urinary tract infections?

fosfomycin ciprofloxacin (severe) trimethoprim-sulfamethoxazole (upper or lower) nitrofurantoin (lower UTI) meropenem (sometimes) aztreonam gentamicin phenazopyridine - used to relieve UTI pain Lower UTI - cystitis Upper UTI pylonephritis Cranberry juice is ineffective in treating UTI but will prevent UTI because it makes urine acidic due to vitamin C/absorbic acid Do not take probiotic at same time as antibiotic. Space apart by at least 2 hours

vancomycin

glycopeptide first line for C. Diff PO MUST BE ORAL FOR CDIFF due to stomach not absorbing it nephrotoxic - monitor BUN Cr peak and trough required every third dose red man syndrome if given too fast Prototype - Vancomycin (PO IV rectal) antibiotic Class - glycopeptides Indications - staph, MRSA, C diff, colitis Action - inhibits bacterial wall synthesis Adverse effects - phlebitis, red man syndrome (if administered rapidly), nephrotoxicity, ototoxicity Contraindications - allergy Monitor BUN and creatinine, I and O Notes - not absorbed by GI tract so oral/rectal used for C diff, and IV staph, MRSA etc needs peak and trough levels every 3rd dose for serum level, admin over 60 mins Red man syndrome - fever/chills, low BP, tachy, n/v, rash, itchiness, weakness. Looks similar to allergies or anaphylaxis. It is a histamine response, NOT allergies, treat with benadryl and discontinuing vanco SJS? first line for c diff (oral) due to not being absorbed by stomach

What are the bleeding precautions that patients should take while taking blood thinners?

go to ER if fall and hit head, risk of intracranial bleed GI bleed report dark tarry stools (upper GI bleed) risk of increased bruising

Define extrapyramidal symptoms (EPS)- what medications do we most often see this adverse effect? What is the treatment?

haloperidol chlorpromazine 1st gen antipsychotic similiar to haloperidol side effects (EPS) caused by blocking dopamine which inversely raise AcH causing EPS (cholinergic) side effects, AcH is in charge of parasympathetic nervous system so symptoms will correlate with overactive parasympathetic nervous system. EPS side effects DPART acute dystonia (involuntary movement) parkinsonism (shakiness) akasthisia (restlessness) tongue/lip smacking (tardive dystonia) irreversible treated by anticholinergics benztropine IM in face diphenhydramine NMS is caused by low dopamine FASTER fever agitation sweating tachy and BP changes lEad pipe hyoReflexia treated with dantroline 2nd and 3rd gen have less EPS side effects and are not as sedating, less anticholinergic effects first gen antipsychotics more likely to cause movement side effects second gen cause metabolic side effects like weight gain diabetes hyperlipidemia.

acetaminophen

hepatotoxic, symtpoms of progressive overdose liver failure don't mix with alcohol antidote - acetylcystate Acetaminophen (tylenol) analgesic Class - para-aminophenol derivatives Indications - mild pain, fever Action - slows the production of prostaglandins in the CNS Adverse effects - rare with appropriate dosage. Acute toxicity of the liver (early signs: NV, diarrhea, sweating, and ABD discomfort, which progresses to liver failure, coma, death) Contraindications - pregnancy B for oral and rectal, C for IV, follow dosage instructions, only take one product with acetaminophen at a time, take with a full glass of water, if pain persists for more than 3 days contact provider, adults should not take for more than 10 days and children should not take for more than 5 days without doctor approval, 4 grams is the maximum dose in 24 hours. Antidote is acetylcysteine used in - rheumatoid arthritis, osteoarthritis, adjuvant with pain medications, can be used with diphenhydramine for pre infusion reaction for amphotericin B NOT NSAID, no anti-inflammatory properties do not use with alcohol, hepatotoxic

What are the effects of the growth hormone (somatotropin)?

hyperglycemia Growth hormone aka somatotropin Produced adn secreted by anterior pituitary gland Anabolic, promotes growth Targets bone and skeletal muscle Increases length and width of bone, stimulates cartilage, skin connective tissue growth Also stimulates many types of body cells to grow and replicate Enhances cellular uptake of amino acids and increased protein synthesis, also breaks down adipose tissue to release fatty acids for use as fuel Hypo secretion during childhood - dwarfism Hypersecretion of GH during childhood - gigantism Hypersecretion after long bone growth has ended - acromegaly

albumin

increases blood volume, moves fluid into blood, helps with cirrhosis, (liver makes albumin in body) burns prevents hypotension can cause fluid overload - extreme caution in heart failure think of it this way albumin is protein in blood that attracts water so it will suck all the fluid from your body into the intravascular space Albumin (albuminar) - plasma volume expanders Class - blood derivatives Indications: thoracentesis, paracentesis, hypoalbuminemia, burns, adult respiratory distress, cirrhosis Action: using oncotic pressure expands blood volume Adverse Effects: risk for fluid volume excess (pulmonary edema) Contraindications: use cautiously in heart failure, severe anemia, pulmonary edema Can be used in cases where blood products are refused for cultural or religious reasons Administration: 5% (250-500 ml bottle): infuse 1-10 ml/min, 25% (50-100 ml bottle): infuse 4 ml/min

What are the first-line antibiotics used to treat TB?

isoniazid, rifampin, and pyridoxine (for peripheral neuropathy) if the question only gives one option for first line use isoniazid as answer 6-12 months of isoniazid and rifampin with pyrazinamid and or ethambutol for first two months

When can metformin use result in acute kidney failure?

lactic acidosis due to inability to excrete, accumulation and toxicity occurs Metformin (glucophage) antidiabetic Class - biguanides Indications: type 2 diabetes (1st line) May be combined with other oral antidiabetic medications Action: improves insulin sensitivity which increases glucose uptake in fat and skeletal muscles, reduced production of glucose in liver, decrease glucose absorption in gastrointestinal tract, this means that it cannot make you hypoglycemic Adverse Effects: lactic acidosis (most severe, risk increased with acute illness), GI effects (anorexia, nausea, diarrhea) - most common, Vitamin b12 and folate deficiency Does NOT cause hypoglycemia by itself, can loose weight with GI side effects Pregnancy: category B Contraindications: DKA, severe infection, kidney impairment, and any hypoxic condition, alcohol use disorder, iodine-containing contrast dye (increased risk of kidney impairment) If you have kidney impairment you are at higher risk of building up metformin levels in blood stream, a reason not to start this medication

Describe "wearing off" phenomenon that occurs with levodopa-carbidopa and the medications can be added to decrease the phenomenon.

levodopa-carbidopa (converts to dopamine in the brain) wears off at night entacapone - blocks breakdown of levadopa, enhancing its effect is often used to supplement.

Identify medications used to treat bipolar disorder.

lithium antiepileptics valproic acid carbamazepine antipsychotics chlorpromazine haloperidol risperidone

enoxaparin

lmwh, monitor for bleeding monitor increased bruising monitor platelet count due to heparin induced thrombocytopenia dark tarry stools (upper GI bleed) contraindicated in htn bleeding can cause thrombocytopenia reversal protamine do not rub or apply heat rotate injection sites Enoxaparin (lovenox) - LMWH Similar - dalteparin (fragmin) Class - LMWH Indications: PE, DVT, unstable angina, NSTEMI, acute STEMI Action: prevent clotting by inhibiting fibrin formation Adverse Effects: hemorrhage, heparin-induced thrombocytopenia Contraindications: active bleeding, low platelet counts, surgery, shock, advanced renal disease, severe HTN, avoid NSAIDs Monitoring: no lab monitoring is required; monitor for bleeding Administration: subQ, rotate sites and inject at least 2 inches from the umbilicus, do not aspirate, do not rub the site for 1-2 minutes after injection Reversal: protamine

Which medications are used for general anesthesia, deep sedation, and conscious sedation?

local anesthetic lidocaine general anesthetic propofol (deep sedative, no analgesic) fentynal (analgesic, conscious induction) ketamine (general, has sedative anmesia, and analgesic affects) benzos alprazolam lorazepam could be used for conscious sedation

lidocaine

local anesthetic can be used topically Prototype - lidocaine, local anesthetic Class - amides (lower incidence of allergies compared to esters) Onset 2-5 minutes; duration 10-90 minutes (depending on route) Injection - local anesthesia of tissue or regional block and epidural/spinal Patches - relieve pain related to post therapeutic neuralgia or dental procedures Topical - do not apply to damaged skin from trauma burns or eczema Lidocaine toxicity - S.A.M.S. Slurred/difficult speech (parasthesias, numbness of lips and tongue), Altered central nervous system (drowsiness, dizziness, arrhythmias, restlessnes, confusion), Muscle twitching (tremors), Seizures (convulsions, respiratory depression, respiratory arrest and cardiac arrest)

glargine

long acting insulin with no peak, if BG is high in morning increase the dose the previous morning ? because its only once a day if it were an intermediate increase night dose Insulin glargine U-100 (lantus) antidiabetic Similar - U-300 insulin glargine, insuling degludec, insulin detemir (levemir) Class - insulins Indications: diabetes (Type 1 and 2, gestational) Action: long-acting insulin Adverse Effects: hypoglycemia, hypokalemia, lipohypertrophy Contraindications: use cautiously with beta-blockers (can mask S/S of hypoglycemia), thiazide diuretics (can c/ hyperglycemia), & glucocorticoids (can c/ hyperglycemia) Administration: do not mix with other insulins, clear in color, subQ only (NOT given IV)

lithium

mood stabilized for bipolar monitor serum level 0.6-1.2, BUN/Cr, Na, thyroid hormone sensitive to dehydration, exercise, diuretics because reduced circulating volume will increase concentration in body NSAIDs reduce exretion lithium toxicity slurred speed inability to walk straight seizure coma death Prototype - lithium carbonate (eskalith) antimanic Class - alkali metal Indications - bipolar disorders, acute mania Action - modulates neurochemical changes in the brain, reduces norepinephrine and increase serotonin Adverse effects - GI distress (avoided by taking with meal), fine hand tremors (fought with beta blocker), polyuria (inhibits effect of ADH), anuria (extreme toxicity), mild thirst, weight gain, renal toxicity, goiter (due to blocking of production and secretion of thyroid hormone, thyroid then tries to overstimulate thyroid hormones) , hypothyroidism (thyroid toxicity), bradycardia (due to toxicity), hypotension (due to toxicity), electrolyte imbalances, diabetes insipidus (urination), Contraindications - pregnancy D (teratogenic effects during first semester), breastfeeding, renal dysfunction, hyponatremia Notes - lithium toxicity and serum levels required, therapeutic level 06-1.2 mEq/L, avoid diuretics due to decreasing circulating volume and draining sodium (low plasma volume and low sodium lead to lithium toxicity), NSAIDs (reduce lithium excretion) and anticholinergics since can magnify lithium effects, patients on lithium need regular TSH, Creatinine, and electrolyte testing. Lithium is sensitive to circulating plasma volume due to concentration, and NSAID's which also reduces kidney function due to less lithium being excreted, lithium is sensitive to dehydration hyponatremia and diuretics. Ace inhibitors decrease lithium excretion -pril ending, caffeine and stimulants enhance excretion Lithium toxicity causes neuro effects and increased kidney effects above 2.5 kidneys not produce urine, seizures, coma, death Tests taken on lithium - lithium level, bun, creatinine, thyroid hormone level, electrolyte level weight(low sodium) Lithium toxicity - slurred speech, inability to walk straight seizure coma death also potentiated by calcitonin-salmon

Which medications for muscle spasms/spasticity are centrally acting? What are the adverse effects?

muscle relaxers baclofen dantrolen if abruptly stopped causes seizures carbomethanol cyclobenzaprine if abruptly stopped do not cause seizures benzos lorazepam alprazolam if abruptly stopped will cause seizures all have sedative fall risk do not drive or do risky activities until you know how they affect you

How does the nurse assess renal, liver, bone marrow, cardiac, oto, eye, musculoskeletal, and skin toxicity?

nephrotoxicity - normal BUN 6-20 normal Cr 0.6-1.2 ototoxicity - ringing ears, gentamicin hepatotoxic - jaundice and LFT like isoniazid cardiotoxic - qt prolongation changes in vision - efambutol, hydroxychloriquine muscoskeletal - tendinitis - ciprofloxacin skin toxicity - photosensitivity SJS sulfa drugs

zolpidem

non-benzo only used short term for sleeping, because the body will adapt and then reflex insomnia will occur when you come off the medication Prototype - zolpidem (ambien) hypnotic Similar - zaleplon, eszopiclone Class - imidazopyridines Indications - short term use in insomnia Actions - enhances action of GABA in the CNS Adverse effects - daytime sleepiness, lightheadedness, headaches Contraindications - pregnancy C, breastfeeding, caution in older adults, kidney, liver, or respiratory disease Notes - schedule 4, lower risk for dependence, avoid concurrent use with ETOH, barbiturates, opioids, and other CNS depressants

naloxone

opiate antidote can cause withdrawal symptoms opiate side effects constipation and respiratory depression Prototype - buprenorphine (subutex) analgesic Similar - buprenorphine-naloxone (suboxone) Class - narcotic agonist-antagonist, opioid partial agonist Indications - opioid withdrawal and maintenance Action - partial antagonist and agonist at certain opioid receptors Adverse effects - HA, sedation, vertigo, bradycardia, hypotension, NV, constipation, urinary retention, respiratory depression, diaphoresis, pruritus, Contraindications - actively using opioids, avoid in patients who are not in withdrawal yet, this will send them into withdrawal Notes - discourage alcohol use, schedule III controlled substance, less risk compared to methadone, can be combined with naloxone (to prevent abuse of crushing or IV use, in the oral form narcan doesn't make a difference) Buprenorphine with naloxone - opioids for withdrawal and abstinence

fentanyl

opiate, can be used for analgesic effects monitor respiratory depression antidote naloxone opiate side effects constipation respiratory depression often used as induction agent with midazolam in sedatoin Prototype - fentynal (sublimaze, duragesic) Similar - alfentanil, sufentanil, morphine sulfate Class - opioid agonist Indications - IV analgesic/pain relief, induction of anesthesia, conscious sedation, chronic pain (patch form) Action - elimination of response to painful stimuli by acting on opioid receptors Adverse effects - respiratory and cardiac depression, hypotension, sedation, constipation, confusion Contraindications - opioid allergy, hypotension, respiratory compromise Notes - monitor vitals, ECG, have resuscitation and airway equipment ready incase of apnea or hypotension, schedule 2 drug Fentynal only comes as IV or patch Three main types of anesthesia used Local - numbs one small area of body, stay awake and alert commonly used in small procedures such as stitched biopsies, lesion removals, no LOC Lidocaine (prototype) is most common. Onset 2-5 minutes, duration 10-90 minutes (depending on route) Usually local creams or gels, or local injection, common in dental procedures, stitches Often amide (lower incidence of allergies) or ester based Can be topically applied or infiltration anesthesia. Regional - block pain in an area of the body, such as an arm or leg, epidural is common regional anesthesia, often used during childbirth Bier block is good example pump up BP cuff and use local anesthetic to numb entire limb Includes nerve block injection - injected surrounding a peripheral nerve and all regions innervated by the nerve lose sensation (dental or regional) Epidural anesthesia - injected into epidural space surrounding spinal cord (blocks sensation to multiple nerve roots) Spinal anesthesia - drug injected into CSF (usually lumbar region) to block sensation to larger areas of lower abd or pelvis and legs General - patient is unconscious, inhaled gasses (halothane), iv drugs are used (propofol, fentanyl, ketamine) plus a paralytic (succinylcholine, rocuronium)

hydromorphone

opioid agonist - causes repiratory depression and constipation reversal - naloxone, can cause withdrawal monitor breathing Prototype - morphine (duramorph) narcotic analgesic Similar - fentanyl or duragesic, meperidine (demerol), methadone, codeine, oxycodone (oxycontin), hydromorphone (dilaudid), hydrocodone, acetaminophen-hydrocodone (vicodin), acetaminophen-oxycodone (percocet), acetaminophen-codeine (tylenol #3) Class - opioid agonist Indications - moderate to severe pain, reduction of bowel motility, cough suppression Action - activation of the mu receptors to alter patient perception of pain, also acts on kappa receptors which decrease GI motility. Adverse effects - itching, respiratory depression, constipation, orthostatic hypotension, urinary retention, sedation, N/V, opioid toxicity triad (coma, respiratory depression, and pinpoint pupils) Contraindications - caution with respiratory disorders, obesity, bowel issues, urinary retention, pregnancy C, and labor Monitoring - assess and document pain level frequently, obtain baseline vital signs Notes - most opioids are schedule II controlled substances, administer slowly and have resuscitation equipment nearby; if patients have severe pain, administer on a fixed schedule with supplemental PRN doses; consider prescribing a stool softener, avoid alcohol, high fiber diet, tolerance and dependency may develop. Watch out for sedative drugs like benzos or anti cholinergic drugs, due to risk of hypotension monitor if on anti hypertensive meds

Which drugs are given to increase the following: RBCs, neutrophils, WBCs, platelets?

oprelvekin - for thrombocytopenia caution in heart problems and pleural effusion does cause fluid retention erythropoeitin - for low RBC/anemia can cause HTN, DVT and leg swelling packed RBC's - for low RBC/anemia, hemoraghic shock, for mild allergic reaction give acetaminophen and diphenhydramine filgrastim - for neutrophils, causes bone pain sargramostim is for low WBC causes bone pain Packed RBC's - antianemia Class - blood components Indications: anemia, hemorrhagic shock Action: increases the number of RBCs Adverse Effects: acute hemolytic reaction, febrile, nonhemolytic reaction, anaphylactic reactions, mild allergic reactions- administer Acetaminophen and diphenhydramine, hyperkalemia, sepsis Contraindications: cultural or religious values that prevent blood administration Administration & Monitoring: see whole blood 1 unit will raise hemoglobin by 1, massive hemorrhage will need packed RBC's, plasma, platelets, Oprelvekin (neumega) human thrombopoietic growth factor Class - recombinant human interleukin eleven Indications: thrombocytopenia Action: increase the production of platelets Adverse Effects: fluid retention, cardiac dysrhythmias, eye effects Contraindications: bone marrow cancer, use cautiously in patients with heart problems or pleural effusion Monitoring: obtain baseline CBC, platelet counts and electrolytes Administration: subQ once daily until desired count reached Sargramostim (leukine) hematopoietic Class - colony stimulating factors Indications: bone marrow transplant, acute myelogenous leukemia Action: acts on the bone marrow to increase production of WBCs Adverse Effects: bone pain, thrombocytosis, malaise Contraindications: avoid within 24 hours of chemotherapy, caution in patient with heart problems or pleural effusion Administration: subcutaneous injections need to be mixed with sterile water by gentle shake, if client has hx of heart failure or respiratory disease discontinue IV if increase in dyspnea occurs Filgrastim (neupogen) hematopoietic Similar - pegfilgrastim Class - colony stimulating factors Indications: neutropenia, autologous transplant Action: stimulate the bone marrow to increase production of neutrophils Adverse Effects: bone pain, increased plasma uric acid, splenomegaly and rupture of spleen Contraindications: avoid within 24 hours of chemotherapy Monitoring: CBC twice a week Erythropoietin (epoetin alfa, epogen) - recombinant human erythropoietins Class - colony stimulating factors Indications: anemia (related to CKD), increasing erythrocyte count for elective surgery Action: acts on the bone marrow to increase production of red blood cells Adverse Effects: stroke, MI, seizures, HTN, DVT, headache, body aches, leg swelling Contraindications: uncontrolled HTN, some cancers as it may increase tumor growth Monitoring: BP, iron levels, CBC Administration: use each vial for one dose and do not reinsert needle to withdraw medication, increases blood thickness due to increased platelets

What are the symptoms of hyperthyroidism vs hypothyroidism?

primary hypothyroidism has high TSH secondary hypothyroidism has low TSH weakness fatigue, weight gain, cold intolerance, hypotension, lethargy, slowed reflexes, mental dullness Goiter due to pituitary gland making tsh due to so much stimulation Myxedema coma or crisis - coma, hypothermia, cv collapse hashimoto thyroiditis removal during surgery rare - pituitary failure treated with levothyroxone primary hyperthyroidism has low TSH secondary hyperthyoidism has high TSH symptoms excessive sweating, heat intolerance, increased bowl movements, tremor, nervousness and agitations, tachy, (a-fib possible) weight loss, fatigue, decreased concentration, irregular and scant menstrual flow goiter due to lack of iodine Can lead to thyrotoxicosis Can lead to thyroid storm - rare and life threatening - fever tachy, heart fails, neuro effects, delirium due to overstimulation, all other hyperthyroidism symptoms graves disease theoretically pituitary adenoma could be secondary cause Levothyroxine (eltroxin) thyroid hormone replacements Similar - liothronine, liotrix, thyroid USP Class - thyroid hormones Indications: hypothyroidism, myxedema coma, cretinism, simple goiter, post thyroid surgery, radiation of thyroid Action: synthetic form of thyroxine which helps to maintain therapeutic levels of the thyroid hormone Adverse Effects: hyperthyroidism, osteoporosis, atrial fibrillation Contraindications: thyrotoxicosis, adrenal insufficiency, cardiovascular disease Monitoring: TSH & T4 Patient Teaching: usually lifelong therapy, never abruptly stop medication, Dosing: higher doses needed during pregnancy, start low and go slow, don't stop abruptly thyroid Hypothyroidism Reduced production of t3/t4 Primarily caused by loss of thyroid gland function Main disease is hashimoto's thyroiditis (autoimmune destruction) (primary) Antibodies attack thyroid gland leading to low T4 and high TSH due to the negative feedback loop Rarely caused by pituitary failure (secondary) Leads to elevated TSH levels from reduced feedback of t4 to pituitary gland Much more common in females 5-10 times more Symptoms - weakness fatigue, weight gain, cold intolerance, hypotension, lethargy, slowed reflexes, mental dullness Goiter due to pituitary gland making tsh due to so much stimulation Low t3 t4 elevated tsh Myxedema coma or crisis - coma, hypothermia, cv collapse Treatment Levothyroxine t4 Levothyroxine plus liothyronine t3 (rarely needed) Older adults low and slow to prevent overstimulation Monitor serum TSH and free T4 levels Hyperthyroidism Elevated levels of thyroid hormone Reduced levels of TSH from feedback loop High t3 t4 and low tsh Symptoms - excessive sweating, heat intolerance, increased bowl movements, tremor, nervousness and agitations, tachy, weight loss, fatigue, decreased concentration, irregular and scant menstrual flow Can lead to thyrotoxicosis Can lead to thyroid storm - rare and life threatening - fever tachy, heart fails, neuro effects, delirium due to overstimulation, all other hyperthyroidism symptoms Medications - beta blockers to block symptoms Methimazole or propylthiouracil to reduce production Radioactive iodine to cause gradual destruction surgery Graves disease is most common (autoimmune stimulation of TSH receptors) Eyes bulge out, heat intolerance, htn, tachy, weight loss Goiter due to making so much thyroid hormone

ketamine

procedure sedative often used for children has both sedation and analgesia effects so it can be used alone Prototype - ketamine (ketalar) sedative Class - general anesthetic Indications - any procedure needing deep sedation/amnesia and analgesia, only hospital based drug Action - loss of consciousness, elimination of painful stimuli, complete disassociation of mind of body Adverse effects - hallucinations, mental confusion and agitation upon awakening, increases secretions in mouth and lungs Contraindications - substance abuse history, mental illness (due to possibility of bad trip), cold/cough Notes - used in children for procedures, advise a quiet room for awakening, IV dose lasts 20 minutes, sometimes need midazolam if awakening with agitation or hallucinations, avoid in people with cold or cough due to increased secretions. Works great for sedation amnesia and analgesia, so it's often used alone

propylthiouracil

propylthiouracil (PTU) - hyperthyroidism, graves disease, slows down conversion of iodine to active hormone, agranulocytosis (low WBC BEN basophils, eosinophils, neutrophils) pregnancy safe Propylthiouracil (PTU) (propyl-thyracil) antithyroid drugs Class thyroid hormone inhibitor Indications: hyperthyroidism, Graves' disease, thyrotoxicosis Action: stops production of thyroid hormones, prevents iodine from being turned into an active form Adverse Effects: hypothyroidism, agranulocytosis, hepatitis Contraindications: avoid in liver and bone marrow disease Pregnancy: safe in pregnancy & lactation Monitoring: thyroid hormone blood levels, weight, signs of infection Patient Teaching: report signs of hypothyroidism, monitor weight, monitor for signs of infection Hyperthyroidism Elevated levels of thyroid hormone Reduced levels of TSH from feedback loop High t3 t4 and low tsh Symptoms - excessive sweating, heat intolerance, increased bowl movements, tremor, nervousness and agitations, tachy, weight loss, fatigue, decreased concentration, irregular and scant menstrual flow Can lead to thyrotoxicosis Can lead to thyroid storm - rare and life threatening - fever tachy, heart fails, neuro effects, delirium due to overstimulation, all other hyperthyroidism symptoms

lispro

rapid 15-30, most likely to cause hypoglycemia, easily calculate peak Lispro insulin (humalog) antidiabetics Similar - insulin aspart, insulin glulisine, inhaled human insulin Class - insulin Indications: Diabetes (Type 1 and 2, and gestational) Action: rapid acting hormone to allow cellular glucose uptake Adverse Effects: hypoglycemia, hypokalemia, lipohypertrophy Contraindications: use cautiously with beta-blockers (can mask S/S of hypoglycemia), thiazide diuretics (can c/ hyperglycemia), & glucocorticoids (can c/ hyperglycemia) Administration: adjust dose based on sliding scale, rotate vial in fingers before drawing up, NPH and premixed insulins will appear cloudy but other insulins should not, administered subcutaneously or IV (rare), subcutaneous injections should be to one specific area, ensure stored properly (refrigerated for stated times) Nursing care - beta blockers can mask hypoglycemia, thiazide diuretics and glucocorticoids can raise blood glucose levels counteracting insulin.

Considerations in Geriatric care

reduced cardiac output increased blood pressure reduced renal function reduced liver function decreased muscle: reduced body mass thinner skin increased blood pressure is why you would not want to give a geriatric something such as an NSAID, because it will increase BP even more if thin skin already something like prednisone may not be a good idea because it will cause you to have even thinner skin Polypharmacy Use of 5 or more medications to treat a patient High prevalence in the geriatric population Comorbidities require use of several medications Increases risk of drug interactions and adverse effects Patients may receive medications that have conflicting pharmacological actions Higher healthcare costs Ask pt to disclose all medications, dietary supplements, Pt use multiple physicians, may not be aware of all drug orders Most often seen in elderly causing falls and confusion Non adherence can affect interactions. Changes in elderly Cv output decreases bp increases and arteriosclerosis develops Lungs show impaired gas exchange decrease in capacity and slower expiratory rates less elastic Creatinine clearance decreases Slowing of gi system Altered hepatic drug metabolism Gradual elevation of bg due to pancreas Osteoporosis Skin Lean body mass declines due to atrophy or muscle cells Degenerative changes in joints Liver decline Orthostatic hypotension - abrupt change in position due to heart not pushing blood to brain for a few seconds First dose phenomenon - common in blood pressure meds after first dose, cause orthostatic hypotension and syncope Adherence Visual impairment to find bottle Functional disabilities like inability to open bottle Cognitive disabilities - trouble remembering Hearing impairment to listen to instructions Affordability Believe in efficacy Appropriately self administer Adjust to lifestyle changes Report side effects Provider must Provide manageable and understandable instructions Nurse should provide spouse or caregiver adequate information Medication regimen Lifestyle changes Emotional support monitoring Mistakes Overuse underuse and erratic use May be unintentional or deliberate Self adjusting dose common Splitting doses to make expensive medication last longer Patients rarely report these practice to provider Beers criteria guidelines for healthcare professionals to help improve the safety of prescribing medication for older adults Potentially inappropriate medications Drugs that have a high risk causing adverse reactions Use of these drugs should be avoided or closely monitored Nurses should be familiar with list and potential adverse effects

Garlic

reduces atherosclerosis contraindicated in NSAIDs, heparin, warfarin Garlic therapeutic class - dietary supplements What it does - blocks LDL, increases HDL, suppresses platelet aggregation, vasodilates (due to allicin) Indications - atherosclerosis, hyperlipidemia, hypertension Contraindications - NSAIDs heparin warfarin hemophilia, surgery Adverse effects - bad breath, body odor, increased bleeding.

somatotropin

replacement growth hormone causes hyperglycemia Somatotropin (genotropin) anterior pituitary hormones/growth hormones Class - anterior pituitary hormones Indications: growth hormone deficiency, AIDS wasting syndrome, pediatric growth failure Action: purified growth hormone which helps stimulate production of protein used for skeletal, muscle, and organ growth Adverse Effects: hyperglycemia Contraindications: severely obese, sleep apnea, use of glucocorticoids (can counteract effects) Monitoring: monitor growth patterns Administration: subQ or IM, rotate injection sites Notes - protein so it would be digested in stomach, must be IM or subcut Growth hormone aka somatotropin Produced adn secreted by anterior pituitary gland Anabolic, promotes growth Targets bone and skeletal muscle Increases length and width of bone, stimulates cartilage, skin connective tissue growth Also stimulates many types of body cells to grow and replicate Enhances cellular uptake of amino acids and increased protein synthesis, also breaks down adipose tissue to release fatty acids for use as fuel Hypo secretion during childhood - dwarfism Hypersecretion of GH during childhood - gigantism Hypersecretion after long bone growth has ended - acromegaly

What are the physiological actions and serious adverse effects of opioids?

respiratory depression and constipation naloxone is antidote

What should the nurse include in client teaching for antiepileptic drugs?

sedative fall risk, do not abruptly stop due to high risk of seizures as serum levels drop

acarbose

slows down gi tract, causes flatus, bloating, cramping, "without carbs' Oral hypoglycemics for type 2 diabetics 7 types, either stimulate pancreas to produce more insulin, or reduce insulin resistance acarbose is exception Alpha - glucosidase inhibitors - (Acarbose) are anti-diabetic medicines that help to reduce post meal blood glucose levels. Unlike most other types of diabetes drugs, they don't have a direct effect on insulin secretion or sensitivity to insulin by the cells. It blocks the enzyme Glucosidase in the small intestines, slowing down the digestion of carbohydrates and absorption of glucose, not very effective Acarbose (glucobay) antidiabetic Similar - miglitol Class - alpha-glucosidase inhibitor Indications: type 2 diabetes Action: slows carbohydrate absorption and digestion Adverse Effects: GI effects (diarrhea, excessive gas, abdominal pain),anemia, hepatotoxicity, impaired breakdown of sucrose Does not cause hypoglycemia by itself Contraindications: DKA, gastrointestinal disorders Patient Teaching: instruct client to take with first bite of food three times a day; if a dose is missed take with the next meal but do not take two doses, cant cause hypoglycemia by itself Works on GI system not pancreas to slow down carbohydrate absorption Hepatotoxic with long term use, baseline LFT's and periodically

varenicline

smoking cessation Prototype - varenicline (chantix) smoking cessation aids Class nicotinic acetylcholine receptor partial agonist Indications smoking cessation Actions - promotes the release of dopamine which mimics the pleasurable effects of nicotine Adverse effects - nausea most common, nightmares, abnormal dreams, HA, insomnia, fatigue, depression, SI, may cause hypoglycemia in type 1 DM Contraindications - schizophrenia, manic depression, SI, avoid use with stimulants, caution in diabetica (increase glucose monitoring) Notes - avoid caffeine and other CNS stimulants, banned with commercial drivers and pilots, one of most successful for smoking cessation

fluoxetine

ssri that can be used for sleep in low doses can be used for depression anxiety ssri discontinuation syndrome serotonin syndrome ssri side effects sexual dysfunction weight gain or loww hyponatremia sleep disturbances SI (black box warning) SSRI 2-4 weeks to work serotonin syndrome Symptoms - neuromuscular - restlessness, myoclonus, tremor and rigidity hyperreflexia other symptoms - shivering/elevated temperature, arrhythmias (can be fatal) tachy, fever SSRI/SNRI discontinuation syndrome in adults F.I.N.I.S.H Flu like symptoms - fatigue muscle aches headache diarrhea Insomnia vivid or disturbing dreams Nausea Imbalance gait instability dizziness lightheadedness vertigo Sensory disturbance paresthesia electric shock sensation visual disturbance Hyperarousal anxiety agitation Prototype - fluoxetine (prozac) SSRI Similar - citalopram, escitalopram, paroxetine, sertraline, fluvoxamine Indications - anxiety, depression Action - blocks reuptake of serotonin in the synaptic space Adverse effects - sexual dysfunction, CNS stimulation, weight loss early in therapy, serotonin syndrome, withrawal syndrome, hyponatremia, rash, sleepiness, faintness, lightheadedness, GI bleed, bruxism (grinding of teeth) Contraindications - pregnancy C (mostly safe), MAOI or TCA use concurrently Notes - first line treatment for depression can take up to 1-3 weeks to become effective, monitor liver and kidney function, use cautiously in cardiac, seizure diabetics and GI bleed history patients. One of the more stimulating SSRI's can cause anxiety, agitation and insomnia.

paroxetine indications side effects how long to work

ssri that works for sleeping in low doses, used for depression, and generalized anxiety disorder can cause serotonin syndrome and serotonin discontinuation syndrome (insomnia, anxiety, dizziness) SSRI side effects sexual dysfunction weight loss or weight gain hyponatremia SI (black box warning) sleep disturbances 2-4 weeks to work Prototype - paroxetine (paxil) SSRI Similar - sertraline, citalopram, escitalopram, fluoxetine, fluvoxamine Indications - anxiety disorders, depression Action - selectively inhibits serotonin reuptake, more serotonin stays in the synaptic junction Adverse effects - early - nausea, diaphoresis, tremor, fatigue, drowsiness, later - insomnia, headache, sexual dysfunction, weight loss or gain, GI bleeding, hyponatremia, serotonin syndrome, bruxism (grinding of teeth), withdrawal syndrome, postural hypotension, SI (black box warning) Contraindications - pregnancy D (not alot of information) generally not discontinued, concurrent use of MAOI's or TCA, liver disease, anticoagulants Notes - takes up to 4 weeks to produce therapeutic medication levels avoid ETOH, increased risk of bleeding, some SSRI are more sedating and some stimulating, paroxetine can be more sedating. Withdrawal effect

Understand the process of the four categories of pharmacokinetics

study of what happens to a drug from the time it is put into the body until the parent drug and all metabolites have left the body ADME Absorption - process which the drug enters the body, see routes. what is the best route to administer a drug to assist absorption? Distribution - movement of the drug between various compartments of the body. If drug is bound to plasma proteins such as albumin, drug is too large to pass through the wall of capillaries into tissues. Special considerations such as BBB, lipid soluble drugs able to cross, can cause inflammation like meningitis. Fetal- placental barrier, inefficient, alcohol/ cocaine and etc can cross. LIVER Metabolism - mechanisms by which the drug is structurally altered into another chemical entity Biochemical alteration into an inactive metabolite which is more soluble and potent. Most common organ responsible is liver, if liver impairment (common in elderly) lower doses needed otherwise drug will accumulate. Some drugs activated by metabolism like morphine, some drug excrete without any metabolism Factors include age, nutrional status, first pass effect, genetics, other drugs, gender, diseases. Mainly liver in charge of metabolism Grapefruit juice interacts with alot of drugs. Must be hydrophilic to be excreted by kidneys, often liver will make the drug hydrophilic Lipophilic, liver has bile so lipophylic drugs must be excreted through liver drugs often excreted with both liver and kidney Elimination - clearance of drug and its metabolites from the body. Mainly kidney secondary liver thirdary bowel. Half life is the time required for one half of a given amount of drug to be removed and is a measure of the rate at which the drug is eliminated. if damaged kidneys some drugs may not be able to excrete such as metformin

trimethoprim‑sulfamethoxazole

sulfa based medication that can cause SJS MOST sulfa medications can cause SJS sulfa allergy is common Trimethoprim-sulfamethoxazole (bactrim) (2 in 1 antibiotic) Similar - sulfadiazine, trimethoprim Class - sulfonamides - folate antagonists Indications - UTI (most common, upper or lower), pneumonia, otitis media, HIV, pneumonia, many other types of infections Actions - bactericidal by preventing the metabolism of folic acid (folic acid blocker) Adverse effects - steven johnson syndrome or severe rash, C diff diarrhea, bone marrow suppression, crystals in urine and nephrons, photosensitivity (possible sjs), kernicterus (brain damage) in newborns, hyperkalemia Contraindications - allergy to sulfa, furosemide and hydrochlorothiazide sometimes, renal failure, term pregnancy Interactions - ace inhibitors or ARB and causing hypokalemia, potentiates warfarin (monitor INR) Notes - monitor CBC and culture and sensitivity prior administration, have pt watch for rash and stay hydrated, avoid sun, take on empty stomach Bacteriostatic - prevent growth, reversible, generally inhibit DNA replication and or protein synthesis of bacteria, work with immune system of host

desmopressin

synthetic ADH, promotes reabsorption of water in kidneys, can cause hyponatremia monitor I O, urine specific gravitry, BMP BP HR, daily weight Desmopressin (DDVAP) antidiuretic hormone Similar - desmopressin, vasopressin Class - posterior pituitary hormones Indications: diabetes insipidus, nocturnal enuresis, von Willebrand's disease (increases level of clotting factor missing in this disease) Action: increases reabsorption of water from the kidneys Adverse Effects: water intoxication, CHF, hyponatremia leading to headache (more fluid entering brain), nausea, decreased LOC, seizures Toxicity may lead to water restriction or discontinuation of the medication Contraindications: coronary artery disease, renal failure, hypertension, coronary artery disease, hyponatremia Monitoring: VS, I&Os, specific gravity, BMP, BP, HR, weight (daily) Administration: intranasal dose given at night for nocturia Fun fact used to be used in cardiac arrest instead of epi

glipizide

type 2 oral diabetic med -ide's increase pancreas secretion so it can cause hypoglycemia Sulfonylureas - (Glyburide, Glipizide) Sulfonylureas are an older class of medication . They work by increasing the release of insulin from the pancreas to reduce blood glucose levels. oral antidiabetic medications ending in -ide can cause hypoglycemia Glyburide (diabeta) antidiabetic Similar - glupizide (glucotrol), tolazamide, glimepiride (amaryl), chlorpropamide Class - sulfonylureas Indications: type 2 diabetes Action: stimulates the pancreas to release insulin, which means it can cause hypoglycemia Adverse Effects: hypoglycemia, hyponatremia Contraindications: DKA, use cautiously with beta-blockers (can mask S/S of hypoglycemia) Patient Teaching: monitor for S/S of hypoglycemia, adhere to proper diet and exercise, best taken 30 minutes before breakfast, do not take if not able to eat, keep log of glucose levels and note patterns, use of beta blockers with this med can mask SNS response to hypoglycemia, can cause weight gain due insulin telling liver to store glycogen and tells fat cells to store more fat

What foods should be avoided to prevent a hypertensive crisis in patients taking MAOIs?

tyramine containing foods aged cheese cured meats beer wine etc

dantrolene

used for NMS associated with first gen antipsychotics can also be used for muscle spasms (must be tapered off) 1st gen antipsychotics can cause EPS they can also cause NMS (neuro malignant syndrome) which dantrolene is used for. NMS symptoms FASTER Fever, Agitation, Sweating, Tachycardia, lEad pipe hypoReflexia side effects (EPS) caused by blocking dopamine which inversely raise AcH causing EPS (cholinergic) side effects, AcH is in charge of parasympathetic nervous system so symptoms will correlate with overactive parasympathetic nervous system. EPS side effects DPART acute dystonia (involuntary movement) parkinsonism (shakiness) akasthisia (restlessness) tongue/lip smacking (tardive dystonia) irreversible treated by anticholinergics benztropine IM in face diphenhydramine NMS is caused by low dopamine FASTER fever agitation sweating tachy and BP changes lEad pipe hyoReflexia treated with dantroline Prototype - dantrolene (dantrium) peripherally acting spasmolytics Class hydantoin derivative Indications - malignant hyperthermia, muscle spasticity, neuroleptic malignant syndrome (NMS, lead pipe rigidity) Action - peripheral action, inhibits muscle contraction by preventing calcium from being released in skeletal muscles Adverse effects - sedation hepatic toxicity symptoms Monitoring - obtain baseline liver blood levels and continue to follow up with periodic tests, monitor for effectiveness Notes - monitor for effectiveness, use care with concentration and driving or other sedating drugs, use only for as long as necessary Psychosis drug considerations When you block dopamine with a medication you increase acetylcholine and prolactin in brain Extrapyramidal side effects are characterized by increased acetylcholine Acute Dystonia (hours to days) spasm and stiffness of tongue, cheek, neck, face, and back Treated with anticholinergic's (benztropine or diphenhydramine) Akathisia (day 5-60) compulsive, repetitive motions, agitation Feeling of wanting to jump out of your own skin or extremely restless Treated with IV anticholinergics (benztropine, diphenhydramine) sometimes beta blockers or benzo's Parkinsonism (day 5-30) which is a deficiency in dopamine, tremors, shuffling gait, drooling, stooped posture, instability Treated with anticholinergics Tardive dyskinesia (months to years) lip smacking, worm like tongue movements, fly catching Often alter dose or medication, can remain permanent Use mnemonic DPART, Dystonia, Parkinsonism, Akathisia, Restlessness, Tongue lip smacking Neuromuscular Malignant Syndrome (NMS) blocking dopamine in hypothalamus will increase the body's temperature set point Leads to fever, hyporeflexia, tremor, clonus, autonomic instability (usually HTN), tachycardia, agitation, diaphoresis, increased bowel sounds diarrhea FASTER Fever, Agitation, Sweating, Tachycardia, lEad pipe hypoReflexia Treated with dantrolene

isoniazid

used for TB can cause peripheral neuropathy (loss of feeling) used adjuvant medication pyridoxine (vit B6) to prevent neuropathy hepatotoxicity manifested by jaundice monitor LFT's *Prototype - isoniazid (anti tuberculosis) Similar - pyrazinamide, ethambutol, rifapentine Class - isonicotinic acid hydrazine Indications - TB, positive PPD Actions - inhibits synthesis of mycobacterial cell wall Adverse effects - peripheral neuropathy, jaundice (hepatotoxicity), hyperglycemia and decreased glucose control in diabetics Contraindications - liver disease Notes - use with rifampin (6-12 months) and pyrazinamide with or without ethambutol for the first 2 months, treat or prevent neuropathy with pyridoxine (vit B6). monitor liver function tests. Strongly encourage adherence. adherence with prescribed regimen is challenging, but prevents the emergence of resistant strains 6-12 months of isoniazid and rifampin with pyrazinamid and or ethambutol for first two months Isoniazid- a drug used to treat tuberculosis, can cause a peripheral neuropathy and Vit B6 deficiency which is reversed with Pyridoxine ( Vit.B6) Isoniazid's antidote is pyridoxine

fosfomycin

used for UTI's take on empty stomach one time use Prototype - Fosfomycin antibiotic Class - phosphonic acid derivative Indications - UTI Action - inhibits bacterial wall synthesis Contraindications - renal and hepatic impairment Notes - take on empty stomach

bupropion

used for depression and smoking cessation Prototype - Bupropion (wellbutrin SR and zyban) atypical antidepressant Class - aminoketones Indications - depression, smoking cessation, seasonal depression, ADHD (not usually used for people with anxiety with their depression) Action - inhibits norepinephrine and dopamine uptake Adverse effects - headache, dry mouth, GI distress, constipation, tachycardia, HTN, restlessness, insomnia, N/V, anorexia, weight loss, seizures, anxiety Contraindications - pregnancy B, MAOI use, seizure or eating disorders, narrows seizure threshhold Notes - notify provider if side effects intolerable, monitor for smoke cessation success and advise concurrent counseling with medication, avoid caffeine Bupropion - smoking withdrawal and abstinence bupropropion and maoi? inhibit seizure on test question but bupropion was the wrong answer?

St Johns wort

used for depression contraindicated in many drugs (antidepressants and buspirone) risk of serotonin syndrome serotonin syndrome - remember hypers hyper sweating hyper tonia - rigidity and spasms St johns wort - therapeutic class - dietary supplements Action - increases serotonin, analgesic, reduce inflammation Indications - mild depression, mild pain Contraindications - antidepressants, amphetamine, cocaine Adverse effects - dry mouth constipation, sun sensitivity, serotonin syndrome contraindicated with buspirone Serotonin syndrome - caused by increased serotonin, usually due to increased drugs that increase serotonin (ssri, TCA, maoi, tryptophan etc), or accumulation Symptoms - neuromuscular - restlessness, myoclonus, tremor and rigidity hyperreflexia other symptoms - shivering/elevated temperature, arrhythmias (can be fatal) tachy, fever Treatments - stop drugs, usually resolves in no more than 24 hours, treat symptoms - cooling and benzo's, can be treated with cyproheptadine Prevention - take care when combining or switching serotonergic antidepressants

buspirone

used for generalized anxiety disorder contraindicated for use with st johns wort Prototype - buspirone (buspar) Drug class - azaspirodecanedione derivatives Therapeutic class - anxiolytics Indications - panic disorder, social anxiety disorder, OCD and related disorders, PTSD, generalized anxiety disorder Action - unknown mechanism, binds to serotonin and dopamine receptors Adverse effects - GI upset, dizziness, nausea, headache, lightheadedness, agitation, constipation, suicidal ideation (SI) Contraindications - multiple drug interactions, ketoconazole and erythromycin and MAOI inhibitors, st johns wort Extra notes - takes 2-4 weeks for full therapeutic response, avoid grapefruit, take with meals, doesn't create dependence such as benzos, not PRN, not sedating, not requiring tapering Azapirones All end in -pirone, buspirone main one Mostly effective in Generalized Anxiety disorders

propofol

used for short term sedation, due to Propofol infusion syndrome Propofol infusion syndrome - metabolic acidosis and organ failure, hyperkalemia, rhabdo, hepatomegaly, cardiac and renal failure Prototype - propofol (deprivan) hypnotic Class - phenol derivatives Indications - deep sedation, intubation, mechanical ventilation, can be used in seizures if benzos are not working well Action - loss of consciousness or deep sedation Adverse effects - bacterial infection if vial left out, propofol infusion syndrome, hypotension, apnea, phlebitis during infusion Contraindications - hypotension, respiratory compromise Notes - monital vitals, check for apnea/hypotension, always have airway equipment at bedside, does not treat pain, must treat pain separately Propofol infusion syndrome - metabolic acidosis and organ failure, hyperkalemia, rhabdo, hepatomegaly, cardiac and renal failure

fluconazole

used in a variety of fungal infections such as yeast (candidiasis) and tinea infections Prototype - Ketoconazole (nizoral) topical, PO, IV (rare) anti-fungal Similar - fluconazole (diflucan), clotrimazole (lotrimin) Class - imidazole derivatives Indications - several fungal infections, including dandruff Actions - inhibits fungal cell membrane production Adverse effects - hepatitis (jaundice, dark urine, pale stools), gynecomastia in men, irregular menses in women if oral only, anti-androgen effects, can prolong QT (many drug interactions) Contraindications - renal failure, liver failure, oral and IV drug of last resort Notes - monitor liver function, anti-androgen effects develops breasts in males potentiates digoxin, and warfarin, monitor INR Oral thrush - candidiasis, Causes in adults Immunosuppression - DB HIV chemo antibiotic or cortisone steroid inhaler Treated with nystatin solution, clotrimazole oral solution, or fluconazole orally Superinfections - secondary opportunistic infection due to antibiotic killing host flora creating environment where a different bacteria can colonize Examples are thrush, white stuff on tongue Nystatin, clotrimazole, fluconazole c diff, - smelly bloody diarrhea Oral vanco since its not absorbed by stomach, metronidazole (second line) yeast infections - itchy and smelling Treat with nystatin Clotrimazole (canesten) antifungal Similar - terinafine, miconazole, oral fluconazole (diflucan) Class - imidazole derivatives Indications: superficial fungal infections, candidiasis Action: inhibits fungal growth Adverse Effects: urticaria, redness, burning, and itching of skin, Contraindications: caution in patients with recurrent oral yeast infections (may indicate HIV or immunosuppression) Administration: available as a topical cream, vaginal cream (with applicator), or vaginal suppository Patient Teaching: continue full course and notify provider if improvement is not seen within 4 weeks' time

benztropine

used in parkinsons (anticholinergic effects cause constipation and dry mouth) used for EPS in antipsychotic side affects Prototype - benztropine (cogentin) antiparkinsonian drugs Similar - trihexyphenidyl Class - centrally actin anticholinergics Indications - parkinson's disease Action - anticholinergic antagonists diminishes cholinergic effect due to decreased dopamine Adverse effects - NV, anticholinergic effects, dry mouth, blurry vision, sedation, confusion, drowsiness, atropine-like adverse effects Notes - take with food relieve dry mouth with chewing gum, increase fluid intake, very sedating, increased fall risk Antipsychotics Block dopamine, when dopamine is blocked you increase acetylcholine levels which causes these distinct adverse effects. Adverse effects - acute dystonia (tight muscles in neck or face, mostly in first dose fought with anticholinergics like benadryl or benztropine), parkinsonism (parkinsons is a dopamine deficiency), akathisia (feeling you want to jump out of skin treated with anticholinergic benadryl and benztropine), tardive dyskinesia (long term side effect not reversible, abnormal movements of face), neuroleptic malignant syndrome (rare, any antipsychotic, high fever, muscle stiffness, agitation, alteration in bp and hr), anticholinergic effects (dry mouth, blurry vision, constipation, dilated pupils, difficulty urinating), orthostatic hypotension, sedation/fatigue (good idea to avoid in older people) these are all extrapyramidal side effects (EPS) sexual dysfunction 2nd and 3rd gen have less EPS side effects and are not as sedating, less anticholinergic effects Contraindications - parkinson's, increased prolactin (due to blocking dopamine, can increase prolactin stimulated cancers, causes irregular periods, milk production in men), paralytic ileus (anticholinergic symptom due to anticholinergic effects, avoid other drugs with anticholinergic or sedating effects. Psychosis drug considerations When you block dopamine with a medication you increase acetylcholine and prolactin in brain Extrapyramidal side effects are characterized by increased acetylcholine Acute Dystonia (hours to days) spasm and stiffness of tongue, cheek, neck, face, and back Treated with anticholinergic's (benztropine or diphenhydramine) Akathisia (day 5-60) compulsive, repetitive motions, agitation Feeling of wanting to jump out of your own skin or extremely restless Treated with IV anticholinergics (benztropine, diphenhydramine) sometimes beta blockers or benzo's Parkinsonism (day 5-30) which is a deficiency in dopamine, tremors, shuffling gait, drooling, stooped posture, instability Treated with anticholinergics Tardive dyskinesia (months to years) lip smacking, worm like tongue movements, fly catching Often alter dose or medication, can remain permanent Use mnemonic DPART, Dystonia, Parkinsonism, Akathisia, Restlessness, Tongue lip smacking Neuromuscular Malignant Syndrome (NMS) blocking dopamine in hypothalamus will increase the body's temperature set point Leads to fever, hyperreflexia, tremor, clonus, autonomic instability (usually HTN), tachycardia, agitation, diaphoresis, increased bowel sounds diarrhea FASTER Fever, Agitation, Sweating, Tachycardia, lEad pipe hypoReflexia Treated with dantrolene Betablocker (propanolol) used to treat one of these? Anticholinergic is caused by low AcH, DUCT Dilated pupils, Urinary retention, Constipation, Tachycardia EPS caused by high AcH, DPART, dystonia (involuntary movement), parkinsonism (shaky), Akasthisia (restlessness), Tongue/lip smacking caused by antipsychotics treated with anticholinergics. Benztropine or diphenhydramine NMS low dopamine FASTER fever agitation sweating tachy lEad pipe hypoReflexia, treat with dantroline If dopamine low acetylcholine rises and vice versa Serotonin symptoms - fever restlessness myoclonus arrythmia metabolic acidosis, rhabdo hepatomegaly, cardiac and renal failure Serotonin discontinuation - FINISH flu like symptoms, insomnia/vivid dreams, nausea, Imbalance, sensory disturbances, hyperarousal Understand what deficiency causes each disease, and how the med works and the rest is mostly able to be figured out

Cannabis

used to stimulate appetite such as in cachexia, secondary to cancer, also increases heartrate Cannabis - therapeutic class - dietary supplements Activates cannabinoid receptor in CNS, produces pleasure Indications - cachexia (loosing muscle mass like cancer), nausea, chronic pain, neuropathic spasticity Contraindications - asthma, cardiac disease Adverse effects - increased HR, increased appetite sleepiness, dry mouth/eyes, paranoia, anxiety, impaired attention/memory, dependency