Pharmacology Exam #1 updated

Extrapyramidal effects

-akathisia -dystonia -tardive dyskinesia -parkinson's like symptoms

Side effects of amphetamines

-decreased appetite -insomnia -nervousness -weight loss -increase BP -increase HR -suppressed growth

Benzodiazepines side effects

-drowsiness -dizziness -confusion -tolerance -dependence

Side effects of anticholinergics

-dry mouth -constipation -urinary retention -blurred vision

You are caring for a patient in the ER who is experiencing an acute asthma attack. What medications might you use to treat this?

-epinephrine -albuterol (bronchodilator) -glucocorticoid (anti-inflammatory)

What interventions are used for an overdose of amitriptyline?

-gastric lavage -activated charcoal -sodium bicarbonate (cardiac toxicity)

Side effects of corticosteroids

-immunosuppression -increased blood sugar -moon face -increased appetite -weight gain -depression -euphoria -decreased wound healing -insomnia

NMDA receptor antagonist side effects

-increased confusion at first -dizziness -headache

Salmeterol (Serevent)

-long acting beta adrenergic agonist (taken daily)

Serotonin syndrome symptoms

-muscle spasms -diarrhea -

amphetamine administration

-must be tapered -common to use drug holidays -withdraw can occur

Cholinesterase inhibitors side effects

-nausea -insomnia -headache

Iminostibenes uses

-partial and tonic clonic seizures -trigeminal neuralgia -bipolar disorder

Valproic acid uses

-seizures -bipolar -migraines

Hydatoins uses

-status epilepticus -seizures (partial and tonic clonic)

Patient teaching for benzodiazepines

-tolerance/dependence can occur -NO alcohol consumption

Antiepileptic drugs also good for bipolar disorder

-valporic acid -carbamazepine

Syngergistic

2 drugs complimenting each other; 1+1>2

Antagonistic

2 drugs working against each other; 1+1<2

Additive

2 drugs working together; 1+1=2

Neuroleptic malignant syndrome reaction (needs treatment immediately)

A 24-year-old client is being seen in the emergency department because of a high fever and cannot move the right arm. During the history-taking process, The nurse discovers the client is being treated with an antipsychotic medication for schizophrenia. The nurse knows that what may be happening with this client?

Lorazepam

A client comes to the emergency department experiencing status epilepticus. Which medication would the nurse expect to administer?

phenobarbital

A client with a history of tonic-clonic seizures who takes _____________ should be monitored closely for indications of drug dependence.

Tardive dyskenesia

A nurse observes rhythmic, involuntary facial movements in a patient who has been administered antipsychotic drugs. The patient also makes chewing movements and, at times, his tongue protrudes. What is the most likely reason for the patient's behavior?

Tardive dyskinesia

A nurse observes rhythmic, involuntary facial movements in a patient who has been administered antipsychotic drugs. The patient also makes chewing movements and, at times, his tongue protrudes. What is the most likely reason for the patient's behavior?

Labs to monitor for liver function

ALT, AST, and Alkaline Phosphate

Beta 2

Activation of ____ _ dilates the bronchial tubes- increases HR

Beta 1

Activation of ____ _ results in positive isotropic, inotropic and dromotropic effects- increases HR

Alpha 1

Activation of _____ _ vasoconstricts the peripheries- increases BP

dextroamphetamine/amphetamine brand name

Adderall

CNS depression

After administering gabapentin, the nurse should assess the client for what possible adverse effect?

Bioavailability

Amount of drug that reaches the systemic circulation after first pass effect

CNS stimulants for ADD and Narcolepsy

Amphetamines: -amphetamine and dextroamphetamine sulfate (Adderall) Non-amphetamines: -modafinil (Provigil)

AED

Antiepileptic drug

Bronchodilators are most commonly used for what 2 medical conditions?

Asthma and COPD

diazepam (Valium) & lorazepam (Ativan)

Benzodiazepine uses: -anxiety -muscle spasms -surgery prep -alcohol withdraw MOA: -enhances inhibitory effects of GABA SE: -drowsiness -dizziness -slurred speech -dependence -overdose *overdose = flumazenl *must taper

Alpha-Adrenergic blockers

Block vasoconstriction & prevent contraction of smooth muscle

cyclobenzaprine (Flexeril)

CNS Depressant for Muscle Spasms uses: -acute muscle spasms MOA: -enhances inhibitory effects of GABA in spinal cord Side effects: -drowsiness -dizziness

baclofen (Lioresal)

CNS Depressant for Muscle Spasms uses: -chronic muscle spasms (given PO or intrathecally) MOA: -enhances inhibitory effects of GABA in spinal cord Side Effects: -drowsiness -dizziness

dantrolene (Dantrium)

CNS Depressant for Muscle Spasms uses: -malignant hypothermia MOA: -inhibits release of calcium, prevents muscle contraction

Phenytoin (Dilantin) & fosphenytoin (Cerebryx)

CNS Depressant for Seizures (Hydatoins) uses: -status epilepticus -seizures MOA: -inhibits influx of Na+, decreases firing of neurons Side Effects: -gingival hyperplasia -drowsiness *narrow therapeutic range (must monitor blood levels) *must be tapered

carbamazepine (Tegretol)

CNS Depressant for Seizures (iminostillbenes) uses: -seizures -trigeminal neuralgia -bipolar disorder MOA: side effects: -fluid retention -visual disturbances -rash

temazepam (Restoril)

CNS Depressant for Sleep Disorders use: -sleep disorders -anxiety -status epilepticus MOA: -enhances inhibitory effects of GABA (slows neuron activity) side effects: -drowsiness -dizziness -tolerance/dependence

zolpidem (Ambien)

CNS Depressants for Sleep Disorders uses: -sleep disorders MOA: -enhances inhibitory effects of GABA side effects: -drowsiness -dizziness -amnesia

amphetamine/dextroamphetamine (Adderall)

CNS Stimulant for ADD and Narcolepsy uses: -ADD -narcolepsy -short term weight loss MOA: -increases release of norepi and dopamine in the brain SE: -decreased appetite -insomnia -nervousness -increase BP, HR -suppresses growth *must be tapered *schedule II *common for drug holidays *given in the morning

Drug Therapy for Alzheimer's

Cholinesterase Inhibitors: - donepezil (Aricept) NMDA receptor antagonist: - memantine (Namenda)

CNS Depressants for Seizures category

D

EC (enteric coated)

Does not dissolve until it gets past the stomach and into the intestine (shiny and coated)

levodopa/carbidopa (Sinemet)

Dopamine replacement drug uses: -Parkinson's -RLS MOA: -levodopa: converts to dopamine -carbidopa: added to levodopa so it doesn't get destroyed as easily SE: -orthostatic hypotension -cardiac dysrhythmia -nausea/vomiting -aggitation *start with lowest dosage *can take up to 6 months to be therapeutic *can NOT be used in patients with glaucoma!!!

Drug Therapy for Parkinson's

Dopamine replacement drugs: -levadopa/carbidopa (Sinemet) Direct acting dopamine receptor agonist: -pramipexole (Mirapex) Indirect acting dopamine receptor agonists/MAOI's -selegiline (Eldepryl)

metabolism

Enzyme cytochrome C450 is responsible for __________.

What beta adrenergic agonist is used to treat shock, anaphylaxis, and severe acute asthma attacks?

Epinephrine

chlorpromazine or haloperidol

First Generation Antipsychotic uses: -schizophrenia -manic bipolar MOA: -blocks dopamine SE: -extrapyramidal effects -neuroleptic malignant syndrome

CNS depressants for seizures

Hydantoins: -phenytoin (Dilantin) -fosphenytoin (Cerebryx) Iminostilbenes: -carbamazepine valproic acid Barbiturates: -phenobarbital (usually only used in children)

intramuscular

IM

intravenous

IV

cholinesterase inhibitors MOA

Inhibition the breakdown of ACh by acetylcholinesterases

Beta-Adrenergic blockers

Inhibitory effect on the heart (beta1) and causes bronchoconstriction (beta2)

Neuroleptic Malignant Syndrome

Life-threatening muscle rigidity and fever

What is given for a Tylenol overdose?

acetylcholinesterase

Bioavailability

amount of drug that is absorbed and circulates throughout the bloodstream

What class of drugs is commonly used in maintenance therapy for COPD?

anticholinergics: -ipratropium -tiotropium

risperidone (Risperdal)

atypical antipsychotic (2nd generation) uses: -schizophrenia -bipolar MOA: -blocks serotonin and dopamine SE: -increased blood sugar

Example of an Inhaled Corticosteroid:

beclamethasone

CNS Depressants for sleep disorders

benzodiazepines -temazepam (Restoril) non-benzodiazepines -zolpidem (Ambien)

Ipratropium and tiotropium MOA

block acetylcholine causing bronchodilation

Cumulative effect

body cannot metabolize one dose of a drug before another dose is administered; accumulation in the body

Beta 1

cardiac stimulation

CNS depressants for muscle spasms

centrally acting: -baclofen (Lioresal) -cyclobenzoprine (Flexerile) peripheral-acting: -dantrolene (Dantrium)

donepezil (Aricept)

cholinesterase inhibitor uses: -Alzheimer's MOA: -prevents acetylcholinesterase from breaking down ACh SE: -nausea -vomiting -insomnia *given at night

NMDA receptor antagonist MOA

decreases overstimulation of NMDA receptors (Alzheimer's)

Drug dependency vs addiction

dependence is more physical while addiction is more psychological

pramipexole (Mirapex)

direct acting dopamine receptor agonist uses: -parkinson's -RLS MOA: -binds to dopamine receptors and mimics dopamine action side effects: -same as levodopa/carbidopa

EC (enteric coated)

doesn't break down until it reaches the small intestines

Agonist

drug binds and stimulates receptor (stimulates)

Free drug

drug that does not bind to blood protein

Benzodiazepines MOA

enhances inhibitory effects of GABA (slows neuron activity)

ER/SR

extended/sustained release

Baclofen administration

given PO or intrathecal

Cholinesterase inhibitors administration

given at night unless dealing with insomnia

Which class of drugs has anti-inflammatory, immunosuppressive and anti-allergic properties?

glucocorticoids

What happens to a patient's blood sugar when taking systemic corticosteroids?

increase in blood sugar

Amphetamines MOA

increase release of norepinephrine and dopamine in brain

selegiline (Eldepryl)

indirect-acting dopamine receptor agonist (MAOI) uses: -parkinson's -anti-depressant MOA: -inhibits MAO enzyme so more dopamine is available SE: -insomnia -decrease in BP

Montelukast (Singulair)

inhaled corticosteroid: leukotriene modifier, chewable version available for kids

Montelukast MOA

inhibits leukotriene which causes a decrease in inflammation specific to the bronchioles & edema in the lungs

Antagonist

inhibits/ blocks receptor (inhibits)

intrathecal

injection into the meningeal space surrounding the brain and spinal cord

tardive dyskinesia

involuntary movements of the facial muscles, and tongue; smacking and tongue thrusting; usually permanent even after stopping medication

Which drug can not be used in patients with glaucoma?

levodopa/carbidopa

Beta 2

lungs (bronchodilation)

example of a systemic parenteral corticosteroid

methylprednisone

beta blockers are often used to prevent

migraines

buspirone (Buspar)

non-benzodiazepine uses: -anxiety -first line before benzos MOA: -inhibits serotonin reuptake SE: -minimal side effects *taken every day to prevent anxiety *recommended to taper

What drug interacts with tiramine?

phenelzine (Nardil)

example of a systemic oral corticosteroid

prednisone

Cholingergic

related to parasympathetic NS (rest & digest)

Adrenergic

related to sympathetic NS (fight or flight)

akathasia

restlessness; patient can not stop moving

dystonia

rigidity of the neck muscles

benzodiazepine schedule for anti-anxiety

schedule IV

benzodiazepines schedule/category

schedule IV category X

Barbiturates uses

seizures

What does SSRI stand for?

selective serotonin reuptake inhibitor

Methylphenidate (Ritalin)

similar use, MOA, and side effects as Adderall

Adrenergic

stimulation of the sympathetic nervous system

SL

sublingual

Therapeutic range

the concentration of drug in the blood that produces the desired effect without causing toxicity

Antagonist

the drug binds and inhibits the receptor (blocks)

Agonist

the drug binds and stimulates the receptor

amitriptyline (Elavil)

tricyclic antidepressant uses: -increased mood -insomnia -neuropathic pain (diabetes) MOA: -blocks reuptake of norepi and serotonin SE: -drowsiness -tachycardia -orthostatic hypotension -increased risk for suicide -anticholinergic effects *overdose requires gastric lavage, activated charcoal, or sodium bicarbonate (for cardiac toxicity)

Modafinil (Provigil)

used for narcolepsy, sleep apnea, and nurses on night shifts

phenobarbital

used for seizures mostly in kids, if used in the US

methylphenidate (Ritalin)

uses: -ADD -narcolepsy MOA & SE: -same as amphetamine/dextroamphetamine

bupropion (Wellbutrin)

uses: -depression -season affective disorder -smoking cessation MOA: -blocks dopamine reuptake SE: -suicidal ideations at first -seizures

lithium carbonate (Lithobid)

uses: -manic bipolar disorder MOA: -alters sodium transport ions, promotes neuronal growth in the brain SE: -drowsiness -headache -confusion -cardiac dysrhytmia (when toxic) *must stay in therapeutic range *lithium levels check with blood draws

valporic Acid (Depakote)

uses: -seizures -bipolar -migraine prevention MOA: -inhibits GABA, decreases Na+ influx, decreases Ca influx Side effects: -GI bleeding and upset *black box warning for liver toxicity and pancreatitis

What drug has a black box warning for liver toxicity and pancreatitis?

valporic acid

Extravasation

when meds get outside of the vein and eat away at the surrounding tissue

liver toxicity

What should the nurse include as a possible adverse effect when teaching a client about phenytoin?

WBC count

Which test should be scheduled every week for a patient taking clozapine?

the tongue is vasular

Why is the major benefit of sublingual drug form?

Zolpedman

_________ is a non-benzodiazepine used for sleep disorders (side effect- forgetfulness)

serotonin

_________ is associated with depression and sleep disorders.

Grapefruit juice

__________ _____ cannot take with a lot of drugs because iy interacts with metabolism enzyme Cytochrome P450

Antipsychotic medications

_____________ ___________ take 6 to 10 weeks to demonstrate an effect on the disorder

Benzodiazepines

_______________ are a schedule 4 that enhances the effects of GABA (decreases CNS activity)- Temazepam, Triazolam and Flurazepam (used for sleep)

Prochlorperazine

________________ can make you very sensitive to light

phenelzine (Nardil)

MAOI uses: -last line of treatment for depression MOA: -MAO inhibitor, increases availability of dopamine, norepi, and serotonin SE: -orthostatic hypotension -increase in suicidal thoughts *INTERACTS WITH TIRAMINE

memantine (Namanda)

NMDA Receptor Antagonist uses: -alzheimer's MOA: -decrease overstimulation of NMDA receptors SE: -increased confusion at first -dizziness -headache

modafinil (Provigil)

Non-amphetamine uses: -narcolepsy -sleep apnea -night shift nurses MOA: -unknown

IV

What is the quickest form of drug administration?

venlafaxine (Effexor)

SNRI uses: -depression -anxiety MOA: -blocks reuptake of serotonin and norepi, excites the CNS SE: -insomnia -nervousness -nausea -vomiting *take with food *take in the morning *several weeks to become therapeutic

injected into fat

SQ

fluoxetine (Prozac)

SSRI uses: -depression -depressive bipolar -OCD -PMS MOA: -excites CNS, blocks reuptake of serotonin SE: -insomnia -nervousness -increased suicidal thoughts at first -sexual dysfunction *given in the morning *4 to 6 weeks to be therapeutic *take with food

What schedule is amphetamine/dextroamphetamine?

Schedule II

5

Schedule _ is least addictive

1

Schedule _ is most addictive

Beta adrenergic agonists often cause many cardiac side effects. This is because these drugs are not _____

Selective

Cholinergic

Stimulates PNS in manner of acetylcholine

First-pass effect

The breakdown of oral drugs in the liver immediately after absorption

IM

What is the second quickest form of drug administration?

First pass effect

The initial metabolism in the liver of a drug absorbed from the gastrointestinal tract before the drug reaches systemic circulation through the bloodstream.

sumatriptan (Imitrex)

Triptan Modifier uses: -relieves symptoms of existing migraine MOA: -causes vasoconstriction by activating serotonin receptors SE: -chest pressure (DANGEROUS)