Pharm Exam 5
major depressive disorder
Depression may have a genetic cause that can be influenced by environmental, biological, or other triggers; e.g., loss of loved one, stressful situations or difficult relationships. Severe depression may manifest with psychotic symptoms, such as hallucinations or delusions. People with major depression have severe symptoms that may interfere with work, sleep, eating, and life enjoyment.
bipolar disorder
Diagnosis is based on the patient presenting with a major change from normal mood or behavior; and doctors use the DSM critreria to diagnose the type of bipolar disorder. Bipolar disorder is a brain disorder that causes shifts in mood, energy, activity levels, and ability to carry out daily tasks. First-line treatment includes mood stabilizers like lithium and certain anticonvulsants. Medications, such as mood stabilizers, atypical antipsychotics, and antipressants, are key to controlling the symptoms of bipolar disorder.
In which instance would growth hormone replacement be indicated?
6 year-old lacking endogenous somatotropin based on diagnostic test findings
Based on the information in the link in your lecture notes to the Mayo Clinic Web site about hypothyroidism
A low level of thyroxine and high level of TSH indicate an underactive thyroid. Treatment is with hormone replacement therapy, usually a synthetic agent, such as levothyroxine. Over time, untreated hypothyroidism can cause goiter, heart disease, depression, peripheral neuropathy, myxedema, infertility, or birth defects. Hypothyroidism is caused by autoimmune disease, treatment for hyperthyroidism, radiation therapy, thyroid surgery, and certain medications, such as lithium.
Lakeesha is a 10-year-old who has been diagnosed with ADHD and is treated with methylphenidate three times a day. Her mother calls to tell you that she is giving the medicine in the morning, at school, and at supper. Her mother reports that Lakeesha has difficulty getting to sleep at night.
ADHD is a common behavioral disorder in children. Methylphenidate can be abused and lead to tolerance and physiological dependence. Symptoms of ADHD include inattention and hyperactivity and impulsivity, which begin between ages 3-7 years and can persist into teenage years. Methylphenidate is a CNS stimulant and a schedule II drug.
Atypical antipsychotic drugs are the most commonly prescribed first-line treatment. Psychotherapy alone can be an effective treatment for bipolar disorder.
ALL FALSE
Imaging modalities, such as MRI of the brain, are now used to make a definitive diagnosis of depression. Medication therapy is usually adequate for treatment of severe depression for individuals in all age categories. Treatment of adolescents with antidepressant medications will diminish the risk of suicide and decrease the need for careful monitoring of thoughts and behaviors.
ALL FALSE
A mainstay of Parkinson's disease treatment is carbidopa/levodopa (Sinemet). Look up the drug summary for Sinemet in the PDR and select all true statements.
Akinesia and seizures can occur with medication use as well as mental disturbances, such as hallucinations and psychosis. This drug can cause nausea, dizziness, headache, anorexia, muscle cramps, and nightmares. These drugs increase the dopamine levels within the corpus striatum of the brain. This drug belongs to the anti-Parkinson and dopamine precursors drug class for the treatment of symptoms of idiopathic Parkinson disease as well as parkinsonisms.
Learn about Alzheimer Disease on the Alzheimer Association Web site link in the lecture notes (http://www.alz.org/alzheimers_disease_what_is_alzheimers.asp and select all true statements. You Answered
Alzheimer disease is the most common form of dementia. In stages 1 and 2 neither medical exam nor family/friends/co-workers will detect problems. There are 7 stages to Alzheimer Disease beginning with no impairment and progressing to mild decline, and then, to very severe decline.
Social anxiety disorder is an excessive and unreasonable fear of social situations. Review this condition on WebMD from the link in your lecture notes and select all true statements.
Antidepressants or benzodiazepines may be used along with CBT to treat this condition. This disorder may be linked to other behavioral disorders such as panic disorder, OCD, or depression. While there is no single known cause of this disorder, it may be due to an imbalance of serotonin, experiencing a previous humiliating experience in a social situation, or observing someone else in an embarrassing or humiliating situation. Outward signs of this disorder in children may be crying, clinging to a parent, or throwing a tantrum in social situations. People with social anxiety disorder suffer from distorted thinking, including false beliefs about social situations and the negative opinions of others.
In order to understand why Joseph is suddenly having seizures, what questions should you ask him about his antiseizure medication? Mark all that apply.
Ask Joseph if he has made any lifestyle changes including staying up later, getting overly tired, or experiencing other stressors that might trigger seizures. Has Joseph missed any doses of his antiseizure medications or changed his dosing regimen in any way; e.g., freqency, time of day, amount? Review the prescribed list of medications and any use of OTC preparations with Joseph to determine if there are any drug interactions. Ask if he is using alcohol or stimulant medications or supplements that might trigger seizures.
______ is an anticholinergic medication that is used as a preoperative medication to decrease the risk of bradycardia during surgery while also drying secretions.
Atropine
Should Lakeesha take the methylphenidate on weekends and during the summer?
Because methylphenidate is not needed during those time periods to control behaviors, Lakesha will have a drug holiday (in which she does not take the drug) to minimize the adverse effect of growth suppression.
______, such as diazepam or lorazepam, are a type of _____ that are categorized as Schedule III or IV drugs with lower potential for abuse and are recommended for short-term use to relieve anxiety disorders.
Benzodiazepines; anxiolytic
The National Institutes of Health define generalized anxiety disorder (GAD) as a pattern of constant worry and anxiety over many different activities and events. Read the medical encyclopedia information about this condition that is in the link in your lecture notes (
Both adults and children may develop GAD, and there may be a familial cause in development of this condition. Reducing or eliminating caffeine intake, avoiding OTC cold preparations and certain illicit drugs, are helpful self-management measures to improving treatment along with stress management techniques, meditation, and/or aerobic exercise. Therapy may include an anti-anxiety medication for a short period of time combined with longer term use of antidepressants and/or cognitive behavior therapy. Symptoms include difficulty concentrating, fatigue, irritability, trouble falling asleep and/or staying asleep, muscle tension and aches, and may startle easily.
The goal of treatment is to improve ADHD symptoms so that Lakeesha can concentrate on learning activities. The therapeutic drug class is ___ and it acts as a/an ______
CNS stimulant; sympathetic amine
_______ was the first antipsychotic agent and the prototype for the ______ drug class. It possesses anticholinergic, antiemetic, anthistaminic and alpha-adrenergic blocking properties and is used as adjuvant therapy with tetanus, intractable hiccups, as well as for bipolar disorder, agitation, and delirium tremens.
Chlorpromazine; phenothiazine
select all correct statements about acromegaly.
Diagnostic testing includes GH level, IGF-1 level, spine x-ray, pituitary/brain MRI, blood glucose, prolactin levels, and echocardiogram. Some symptoms of acromegaly include large hands and feet, limited joint movement and joint pain, sleep apnea, widely spaced teeth, hirsutism in the female, easy fatigue, decreased muscle strength, macroglossia and prognathism. Acromegaly is a long-term condition in which there is too much growth hormone after the skeleton and other organs have finished growing. There are no preventive measures, other than prevention of complications. Treatment includes complete or partial surgical excision of the tumor (if present), and/or radiation therapy, and may include growth hormone inhibitor medications.
review this article of Common Medications Before, During, and After SurgerySelect all true statements about these medications.
Diprivan (propofol) is often used to induce anesthesia. Barbiturates and benzodiazepines may be used to depress the CNS to calm the patient prior surgery and during recovery. A paralytic medication is used with an anesthetic to deeply relax the muscles of the patient during surgery.
What instructions should be given to patients starting on opioid analgesics? (Check all that apply.)
Do not mix your opioid pain medication with alcohol. Because opioids can make you hypotensive, take care when changing positions; e.g., going from lying to standing or sitting to standing. Do not mix antihistamines, tricyclic antidepressants or atropine-like anticholinergic medications with opioids without consulting your doctor.
What other education should Joseph have regarding effective management with phenytoin medication? Mark all that apply.
Do not omit, increase, decrease, or stop medication without talking with his doctor. Keep a record of seizures - when occurred, how long it lasted, if he lost consciousness, and if he can identify any trigger. Take the phenytoin 3 times daily at eight-hour intervals. Do not drink alcohol or use OTC medications without first discusising with his doctor. Avoid driving or operating heavy machinery until he can assess his level of alertness.
When Sinemet is prescribed for patients who have Parkinson's disease, the health care practitioner should observe them for which of these side effects?
Dystonia, dyskinesia, nausea/vomiting, and mental changes
Based on the information in the link in your lecture notes about sleep medications on WebMD http://www.webmd.com/sleep-disorders/insomnia-medications. select all true responses.
Eszopiclone helps the person fall asleep quickly for an average of 7-8 hours of sleep. Some antidepressants, such as trazodone or mirtazapine, can be prescribed for sleeplessness and anxiety. Benzodiazepines are older sleeping medications and have been used to treat sleepwalking and night terrors. Zaleplon stays active in the body for the shortest period of time and is not recommended for individuals who tend to wake up in the middle of the night.
Obesity is an indication for thyroid replacement therapy.
False
The goal of surgical anesthesia is medullary depression so that there is absence of sensory impulses to the brain, unconsciousness, and muscle relaxation.
False Medullary depression is stage 4 anesthesia, which results from anesthesia overdose, cessation of respirations and circulatory collapse and death.
Children with bipolar disorder I are commonly prescribed lithium as a mood stabilizer. A side effect of lithium may be to increase bone density and bone formation when used in treating children.
False The adverse effect is to decrease bone density and formation in children.
Alzheimer Disease is caused by deterioration of nerve pathways in the CNS. Recent curative medications, such as memantine, have been shown to reverse deterioration of cholinergic nerve pathways.
False There has been no cure found for Alzheimer Disease. Some medications may reduce deterioration of cholinergic nerve pathways, but cannot reverse the course of the disease.
Joseph tells you that he stopped taking his antiseizure medication 2 weeks previously because he lost his job and cannot afford his medication. Because of the long half-life of these drugs, it is too soon for Joseph to be experiencing seizure activity due to medication withdrawal.
False These medication do not have a 2 week or more half-life. Not only can subtherapeutic levels of antiseizure medications result in seizure activity, subtherapeutic levels can trigger status epilepticus.
Eli Jordon, 55 years old, has just been diagnosed with type 2 diabetes mellitus and is taking Glucotrol XL, a sulfonylurea. The doctor explains that the following major side effects may occur with this category of drugs _____.
GI irritation, nausea, vomiting, weakness, fatigue, dizziness
identify the true statements about insomnia. http://www.webmd.com/sleep-disorders/guide/insomnia-symptoms-and-causes
Insomnia may be acute or chronic and can manifest as sleepiness during the day, general tiredness, irritability, and problems with concentration or memory. Primary insomnia is a condition in which the individual has sleep difficulties not associated with other health conditions. Secondary insomnia results from a health condition, pain medication, or substance use (e.g., alcohol). Diagnosis of insomnia is made via physical exam and medical history along with a sleep history or diary. In some instances, the doctor may refer the person to a sleep center for studies.
Look up phenytoin sodium (Dilantin capsules). drug summary in the PDR and select all true statements.
It is indicated for status epilepticus. Patient education stresses the importance of good dental hygiene to minimize the development of gingival hyperplasia, strict adherence to the prescribed dosage regimen, and to not abruptly stop the medication. Dilantin is a hydantoin that is indicated for tonic-clonic seizures and complex partial seizures. It is provided as extended-release capsules, suspension, and chewable tablets as well as parenteral form.
Eli Jordon, 55 years old, has just been diagnosed with type 2 diabetes mellitus and is taking Glucotrol XL, a sulfonylurea. The doctor assesses Eli's current medications because there is a possiblity that hypoglycemia can be potentiated by such drugs as _____.
MAOIs, oral anticoagulants, ranitidine, probenecid
look up midazolam on PDR hydrochloride injection drug summary, and select all true statements.
Midolazolam is a short-acting benzodiazepine with CNS depression properties. This drug carries a FDA boxed warning re: respiratory depression and arrest and a requirement for a fully-equipped setting and appropriately trained personnel to administer and monitor the patient throughout the procedure. Indications for use include preoperative sedation, anxiolysis, and amnesia or conscious sedation. It is contraindicated in patients with narrow-angle glaucoma, untreated open-angle glaucoma and for intrathecal or epidural use.
Based on the MedlinePlus link in the lecture notes about Graves' disease select all correct statements about this condition.
Most common signs/symptoms include anxiety, difficulty concentrating, double vision, exophthalmos, fatigue, frequent bowel movements, goiter, heat intolerance, increased appetite, insomnia, muscle weakness, nervousness, palpitations or arrhythmia, and weight loss. Diagnostic testing includes blood tests for TSH, T3, and free T4, and radioactive iodine uptake and scan. Graves disease, which is an abnormal immune system response that causes the thyroid gland to produce too much thyroid hormone, is the most common cause of hyperthyroidism. Treatment includes antithyroid medications, radioactive iodine, and/or surgery.
Look up somatropin (Humatrope) in the PDR and select all true statements.
Most indications for Humatrope are for growth hormone deficiency, growth failure, or short stature. There is an FDA warning that patients with idiopathic growth hormone deficiency and idiopathic or gestational short stature treated with somatropin during childhood had a 30% increased risk of death. This drug may be indicated for HIV-associated failure to thrive in children as well as AIDS-associated wasting or cachexia. Adverse reactions may include seizures, pancreatitis, peripheral edema, elevated liver enzymes, hyperlipidemia, hyperglycemia, arthralgia, and myalgia.
A chronic, nervous system disease characterized by fine, slowly spreading tremors and muscular weakness and rigidity, accompanied by a characteristic shuffling gait is known as...
Parkinson's Disease
Lakeesha experienced the side effect of insomnia because of the timing of her last daily dose of methylphenidate. How can this type of situation be avoided in the future? Mark all recommendations that apply.
Patient education is very important in ensuring compliance with the drug regimen and to optimize therapeutic response, while minimizing side effects and adverse reactions; therefore the doctor's office should provide both oral and written instructions on the patient's condition and treatment. Since the doctor will want a report on the drug action for determining if changes are needed, the education packet could contain a log that would encourage the mother to record Lakeesha's response to the medication and her abiiity to complete her schoolwork successfully, and any side effects she may experience. The office protocol should be to include times for daily dosing when it will optimize therapeutic response; e.g. Methylphenidate 10 mgm po 3 x daily with last dose no later than 4 pm.
What does the DEA classification mean when the methylphenidate prescription needs to be renewed?
Renewals require a new written prescription from the physician.
_____ is an idiopathic condition marked by an intolerable creeping sensation in the lower legs causing an irresistible urge to move the legs.
Restless leg syndrome
Look up desmopressin (DDAVP Injection) drug summary in the PDR and select all true statements.
Route of administration includes intranasal, IV SQ, sublingual, and oral tablet. Adverse reactions include anaphyactic shock and anaphylactoid reactions. When administered to patients with central diabetes insipidus, desmopressin exerts antidiuretic effects including reduction in urine output with an increase in urine osmolality and a decrease in symptoms of urinary frequency and nocturia. Synthetic vasopressin analog is indicated in the management of central DI.
What is the DEA classification for methylphenidate?
Schedule II
Learn about schizophrenia in adults on the Mayo Clinic Website. Access from the link in the lecture notes
Schizophrenia is a chronic condition requiring lifelong treatment. Manifestations that may be positive for schizophrenia include delusions, hallucinations, thought disorder resulting in disorganized speech or word salad, extremely disorganized behavior along with lack of emotion. Negative findings that may raise suspicion of schizophrenia may include loss of interest in every day activities, lack of affect, reduced ability to plan or carry out activities, neglect of personal hygiene, social withdrawal, inability to experience pleasure. No one sign or symptom can be used to pinpoint a diagnosis of schizophrenia because they may vary; however, the signs/symptoms ultimately reflect an impaired ability to function. Medications, like second-generation antipsychotics, are the cornerstone of treatment; but because of agitation or resistance to taking medication, patients may not cooperate with a treatment regimen.
Based on the link in your lecture notes on the Epilepsy Foundation Web site An Introduction to Epilepsy select all true statements about this condition. (http://www.epilepsy.com/start-here/introduction-epilepsy
Seizure medications act on brain cells to affect the way substances move in and out of the cells or change the way neurotransmitters stimulate or inhibit the way information is sent from one cell and area of the brain to another. Epilepsy is a neurological condition affecting the nervous system in which there are seizures caused by disturbances in the electrical activity of the brain. About 70% of people with epilepsy are able to control their seizures with medication that acts to stop seizures from occurring. Medication is the primary method of treatment for controlling seizures and is first-line therapy.
Addison disease
Signs/symptoms include changes in blood pressure/heart rate, chronic diarrhea, n/v, patchy darkening of the skin, paleness, extreme weakness, fatigue, mouth lesions, and salt craving. Laboratory serum levels of cortisol and sodium will be low, but potassium is elevated and blood pressure is decreased with the potential for orthostatic hypotension. Addison disease results from damage to the adrenal cortex causing decreased production of its hormones. While this is usually an autoimmune disorder, Addison disease may also result from infections, hemorrhage, or tumors.
Go to the PDR and look up methimazole (Tapazole) drug summary and select all correct statements.
Tapazole is an anti-thyroid preparation for the treatment of hyperthyroidism. The adult dosage is given at 8-hour intervals with maintenance dose at 30-60 mg/day based on the severity of the hyperthyroid disease. Some adverse reactions include agranulocytosis, pancytopenia, aplastic anemia, hepatic necrosis and hepatic encephalopathy.
Glucocorticoids regulate metabolism of proteins and carbohydrates, particularly when the body is under stress. With therapeutic use, glucocorticoids cause sodium and water retention potentially resulting in hypertension. Other adverse effects include joint tissue damage and cushingoid symptoms. What administration techniques are used to decrease the incidence of adverse effects? Check all that apply.
Tapering dose so that the body receives a rapid therapeutic dose initially in 2-day increments then dependent on increments and total dosage, the dosage declines by a tablet per day until the total dosage is given. Alternate-day therapy (ADT) reduces or eliminates adverse drug reactions by giving short-acting steroids every other morning allowing the adrenal gland negative feedback mechanism to continue functioning.
Learn about diabetes insipidus, then select all true statements about this condition.
Tests for determining type and cause of DI include water deprivation test, urinalysis, and MRI of the head (imaging of pituitary gland). Central diabetes insipidus is frequently caused by damage to the hypothalamus or the pituitary gland in which there is disruption of the production, storage, and release of ADH causing increased excretion of large amounts of urine (polyuria). The rate of fluid excreted by the kidneys is controlled by the antidiuretic hormone, which is produced in the hypothalamus and stored in the pituitary gland. Dipsogenic diabetes insipidus may be caused by mental illness.
Look up propofol (Diprivan) drug summary in the PDR and select all true statements.
The antiemetic effect of propofol is greatest during infusion, but there is an increased risk of nausea and vomiting after administration. Indications for use general anesthesia induction and maintenance. While this drug is not a class II drug, it has been abused. This drug is only administered intravenously and should only by administered by individuals trained in general anesthesia. NOT a barbiturate anesthetic.
identify all correct statements about conscious sedation. read the link in the lecture notes on conscious sedation for endoscopic procedures http://www.practicalgastro.com/pdf/February11/KhalidArticle.pdf
The drug most commonly used for conscious sedation is midazolam, a short-acting benzodiazepine that has both anxiolytic and amnestic properties. Controversy continues about the use of sedation in endoscopic procedures with those against citing increases in expenses to perform the procedures and risk of complications. In one study of 120 people, 88% completed colonoscopy without sedation and reported a mean pain score of 2.0. Prior to administering conscious sedation, an H&P and appropropriate laboratory studies should be performed to identify any contraindications or precautions.
Based on the MedlnePlus, link in the lecture notes about deficient growth hormone in children, select all true statements.
The growth hormone stimulation test measures the ability of the pituitary gland to release GH after a stimulant is given. If untreated, GH deficiency can lead to short stature and delayed puberty. A hand x-ray is a method for determining bone age. Children with growth hormone deficiency will have a growth rate that is slow or flat on the growth chart, usually noted when the child is 2 or 3 years of age.
The prescription for Methylphenidate is 10 mgm po 3 x per day. Lakeesha is taking her medication at breakfast (7:00 am), lunch (at school (11:00 am), and supper (6:00 pm). What time of day should she be taking the last dose?
The last dose of the day should occur no later than 4 pm.
Common side effects of medications used for behavioral disorders include _______ (check all that apply).
dizziness, drowsiness, confusion impotence; increased or decreased libido hypotension dry mouth
Parkinson disease is thought to be caused by ____ deficiency and an _____ excess within the central nervous system.
dopamine; acetylcholine
Based on the link in your lecture notes about Parkinson disease, select all true statements about the condition.
The main therapy for Parkinson disease is L-dopa. Parkinson disease is a slowly progressive disorder that affects movement, muscle control, and balance. There are no specific tests that are diagnostic of Parkinson disease, but certain tests may be ordered to rule out other causes of tremors and dyskinesia. Movement problems include slowness of movement, stiffness of trunk and limbs, tremors of head, arms, legs, and/or hands, balance impairment and lack of coordination. Dopamine is a brain chemical that controls muscle movement. In Parkinson disease the nerve cells that produce this chemical are gradually destroyed.
What education do you provide Joseph regarding phenytoin and mouth care? Mark all that apply.
The sequelae of gingival hyperplasia includes gingivitis, plaque buildup, and caries. Practice good dential hygiene with flossing, routine brushing, gum care, and regular checkups. Phenytoin causes gingival hyperplasia.
Based on the link in the Lecture notes in the Medscape Reference about Topical Anesthesia .identify the true statements about topical anesthesia.
There are more recent warnings about topical cocaine mixtures due to toxic effects, expense, and federal regulatory issues making cocaine no longer recommended for topical use. Indications for medical use of cocaine in anesthetic mixtures has been for use in minor skin lacerations (face and scalp) particularly for individuals, who cannot tolerate injections or who have difficulty following instructions or sitting still. Topical anesthetics may cause burning or stinging at application site, CNS stimulation causing seizures or cardiac depression with high plasma concentrations, or suppression of gag reflex with oral adminstration. Topical anesthetics block nerve impulse conduction by decreasing nerve cell membrane permeability to sodium ions. Absorption of topical anesthetic agents is highly variable with eutectic mixtures resulting in liquids that melt at lower temperatures thus achieving higher concentrations of anesthetics.
Look up eszopiclone (Lunesta) drug summary in the PDR and select all true statements.
This drug is chemically unrelated to the benzodiazepines, but shares a mechanism of action similar to these drugs and is considered a short-acting non-benzodiazepine hypnotic. It's rapid onset and relatively short half-life (6 hours) reduces the incidence of "hangover" effects. Adverse effects include bronchospasm, oliguria, depression, hallucinations, memory impairment.
Look up octreotide (Sandostatin drug summary) in the PDR and select all true statements.
This drug is designated an orphan drug by the FDA for treatment of symptoms associated with carcinoid tumors - diarrhea and cutaneous flushing. Octreotide has been designated an orphan drug by the FDA for the treatment of acromegaly. This drug has a similar mechanism of action as the natural hormone somatostatin by acting at the somatostatin receptors; it inhibits both pituitary and gastrointestinal hormones secretion. Octreotide acetate is a somatostatin analog indicated for treatment of acromegaly.
Joseph is a 25-year-old male with a diagnosis of epilepsy, which has been well-controlled until this past month. He presents to the neurologist with complaint of 3 tonic-clonic seizures x1 month. He has been seizure free for 2 years prior to this past month. What are the issues to consider in this case? Mark all the apply.
Tonic-clonic seizures begin with muscle rigidity followed by synchronous muscle jerks and marked impairment of consciousness. Tonic-clonic seizures are also known as grand mal seizures. Antiseizure medication should be titrated to a therapeutic level that will control seizure activity, while minimizing side effects and adverse reactions. Abrupt discontinuation of antiseizure (anticonvulsant) medications may trigger seizures or status epilepticus. Patients taking antiseizure (anticonvulsant) medications should not omit, increase, or decrease medications or abruptly discontinue without consulting a physician. Patients should be educated to keep a record of seizures including date, time, length of seizure, loss of consciousness, amount of current medication, and any missed doses.
Butyrophenone derivatives, like haloperidol, may be prescribed for _____, a CNS disease with rapid, involuntary, repetitive motor movements of muscles and involuntary vocal tics or noises.
Tourette's syndrome
Read about schizophenia in children on the Mayo Clinic Web site from the link in the lecture notes
Treatment is lifelong and can include medications, individual and family psychotherapy, social and academic skills training, and possible hospitalization for severe symptoms or crisis. The diagnostic criteria for childhood schizophrenia is in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The earliest symptoms may include developmental problems such as language delays, late or unusual crawling, late walking, or other abnormal motor behaviors like rocking or arm flapping. Auditory and visual hallucinations and delusions are later symptoms; signs can progress to abnormal motor behaviors, lack of emotion with poor eye contact or speaking in a monotone, disorganized speech, withdrawal and neglect of hygiene. Childhood schizophrenia is the same as schizophrenia in adults, only occurring earlier in life and affecting behavior and development.
Lakeesha's mother is concerned because Lakeesha is experiencing difficulty with sleep. Dr. Merry will tell Lakeesha's mother to give the last dose no later than 4 pm so that she can have the needed help with focusing on homework while not interfering with her ability to sleep.
True
Sedative-hypnotic medications have the potential for psychological and physical dependence.
True
The only FDA-approved drug for restless legs syndrome is ropinirole, a dopamine agonist.
True
Corticosteroids may be contraindicated in which of the following patients?
a 30-year-old with a systemic fungal infection
neuroleptic malignant syndrome (NMS)
a life-threatening, neurological disorder which includes high fever, sweating, unstable blood pressure, stupor, muscular rigidity and autonomic dysfunction
Generalized nonconvulsive seizures
absence, or petit mal, seizure with loss of consciousness (10-30 seconds), mild symmetric or no motor activity
T2DM (Type 2 Diabetes Mellitus)
adult onset, usually 40 years may control with diet and exercise may be asymptomatic, or may experience polyuria, polydipsia, polyphagia, along with tingling of hands/feet usually positive family history etiology is related to insulin resistance or decrease in amount of insulin produced gradual onset
Children taking long-term neuroleptics may develop ____, which is motor restlessness characterized by continuous body movement with pacing, difficulty standing still, constant foot motion (rocking back and forth), and insomnia.
akathisia
The posterior pituitary gland produces two hormones. Hypofunction of the posterior pituitary gland causes inhibition of the ________ and results in ________, which is a condition causing profuse voiding of large amounts of dilute urine, leading to dehydration.
antidiuretic hormone; diabetes insipidus
While the exact pathology for ADHD is unknown, the symptoms do respond to CNS stimulants. Most medications for ADHD are Schedule II drugs; however _____ selectively inhibits uptake of norepinephrine causing a calming effect and is not a Schedule II medication.
atomoxetine
Albuterol
beta agonist to provide bronchodilation in respiratory diseases such as asthma
A direct-acting cholinergic medication, ______, attaches to receptors to mimic or increase acetylcholine and is used to treat urinary retention.
bethanechol
Metoprolol
binds to beta-adrenergic receptors, particularly in the heart, to decrease cardiac activity and reduce oxygen need
timolol
binds to beta-adrenergic receptors, used as a topical to treat glaucoma
Doxazosin
blocks norepinephrine from producing a sympathetic response with resultant lowering of blood pressure and vasodilation for treatment of hypertension and BPH
Epinephrine
catecholamine for treatment of anaphylaxis by decreasing bronchospasm, increasing heart rate,and causing vasoconstriction to elevate blood pressure
focal simple seizure
convulsion of single limb or muscle group and no loss of consciousness
The hormones that act on the immune system to suppress the body's response to infection or trauma and relieve inflammation are called ____.
corticosteroids
The neurologist writes orders for phenytoin ER capsules (Dilantin - extended release) 100 mgm po tid. He also gives Joseph a 30-day supply from office samples. The office nurse helps him apply for a patient assistance program for prescription drugs decreases hyperexcitability of neurons to reduce seizure activity http://healthfinder.gov/rxdrug/ What is the mechanism of action of phenytoin
decreases hyperexcitability of neurons to reduce seizure activity
Eli Jordon, 55 years old, has just been diagnosed with type 2 diabetes mellitus and is taking Glucotrol XL, a sulfonylurea. Treatment for his T2DM may possibly include an alpha-glucosidase inhibitor (Acarbose) along with the sulfonylurea. Alpha-glucosidase inhibitors act to ____.
delay digestion of complex carbohydrates and subsequent absorption of glucose from the small intestines
One of the most common psychiatric disorders, which is characterized by feelings of intense sadness, helplessness, and worthlessness causing impaired functioning, is known as . Mood disorders, also known as , include a major form of this disorder referred to as unipolar affective disorder, as well as, , also called manic-depressive disorder.
depression affective disorders bipolar disorder
T1DM (Type 1 Diabetes Mellitus)
develops in childhood or adolescence etiology associated with loss of insulin secretion must always treat with insulin rapid onset autoimmune disorder symptoms include polyuria, polydipsia, polyphagia, weight loss
The prototype drug for benzodiazepines is generic , which is indicated for anxiety disorders, alcohol withdrawal, preoperative medications, insomnia, seizures, and skeletal muscle spasms. While these drugs are safer than barbiturates, administration should be intermittent and prescribed for only 2-3 weeks because of the risk of . However, the withdrawal syndrome is usually mild. With longer use, benzodiazepines should be tapered over weeks to months to prevent , a severe adverse effect.
diazepam dependence seizures
Methylphenidate is used with children who have attention-deficit/hyperactivity disorder to improve attention and focus. It is a CNS stimulant, which has the adverse effect of growth suppression. This can be mitigated by giving the child a ____ on weekends and during summer break, which is a period during which drug doses are withheld to allow reversal of side effects or adverse reactions.
drug holiday
Patients with T1DM have very little or no insulin, which is produced by the beta-cells in the islets of Langerhans. Therefore, these patients require insulin, which is provided from an external source and given parenterally.
endogenous exogenous
Long-term use of antipsychotics produce an adverse effect of _____, which are characterized by a variety of nervous system effects including tremors, impaired muscle tone, facial dyskinesia, or slow irregular, involuntary movements of the upper extremities, especially of the hands and fingers.
extrapyramidal symptoms
Normally people with social anxiety disorder have a fear of only one specific situation and will avoid that activity to the detriment of normal daily routines, social activities and relationships.
false
Social anxiety is the most common type of anxiety disorder and the second most common mental disorder in the US after depression and alcohol dependence.
false
Eli Jordon, 55 years old, has just been diagnosed with type 2 diabetes mellitus and is taking Glucotrol XL, a sulfonylurea. Treatment for T2DM may also include an alpha-glucosidase inhibitor (Acarbose) along with the sulfonylurea. Side effects of Acarbose that may diminish with time or with reduction in dose are ____.
flatulence, abdominal distention/pain, and loose stools/diarrhea
Which insulin preparation should not be directly mixed in the same syringe with any of the other available types of insulin?
glargine (Lantus)
Lakeesha's mother should be educated about the side effects/adverse reactions of CNS stimulants, so that she can observe and report to Dr. Merry. When Lakeesha is on maintenance therapy, the doctor should be assessing to determine if the drug should be discontinued. What are some additional side effects of CNS stimulants? Mark all that apply.
growth suppression, abdominal pain, headache, irritability, weight loss
A ______ is a substance originating in an organ, gland, or body part that is secreted directly into the blood stream and carried to another part of the body to begin a chemical action to increase the activity of that part or to increase another secretion.
hormone
Which of these toxic adverse effects would the health care practitioner observe/monitor in a patient who is taking a thyroid replacement therapy for hypothyroidism?
hypertension, tachycardia, nervousness
Antihistamines, such as diphenhydramine (Benadryl), have an extended half-life, leading to "morning after" problems (the hangover effect) when used as a/an ______ in older adults.
hypnotic
Located in the brain, the regulates hormone secretions, and is often called the master control center. It functions through a/an loop, which is a control mechanism in which a stimulus produces a response that reverses or reduces a previous stimulation, thus stopping the initial response. This process helps the body maintain homeostasis.
hypothalamus negative feedback
What is one of the side effects of Methylphenidate?
insomnia
NPH (Novolin N)
intermediate-acting
isophane (Humulin N)
intermediate-acting
When teaching someone to give insulin injections, it is important to teach the individual how to rotate injection sites in order to decrease the likelihood of ____ at the injection site. This condition results from an abnormality in the distribution and metabolism of fats.
lipodystrophy
Lidocaine is both a topical and injectable , which reduces sensitivity to pain without loss of consciousness. Some of these types of anesthetics may be mixed with to cause vasoconstriction and prolong anesthestic effects in the region.
local anesthetic epinephrine
detemir (Levemir)
long-acting
glargine (Lantus)
long-acting
tonic-clonic seizure
major convulsions with muscle rigidity and synchronous muscle jerks; marked impairment of consciousness
Another class of antidepressants are the ______, which are used only for atypical depression that is resistant to other medications. These drugs inhibit the breakdown of norepinephrine and serotonin to increase the amount of these neurotransmitters resulting in CNS stimulation. This class of drugs has numerous interactions with prescription and OTC medications as well as caffeine- and tyramine-containing foods and beverages.
monoamine oxidase inhibitors
tension headache
muscle contraction headache, characterized by moderate, nonthrobbing pain distributed in the head, neck and scalp with tightness and pressure-like pain
Medication used to treat psychoses, such as schizophrenia, are classed as major tranquilizers, or antipsychotics. Another term for this group of medications is .
neuroleptics
Minor tranquilizers, such as anxiolytics, or major tranquilizers, such as neuroleptics/antipsychotics, are prescribed for individuals who display anxiousness, agitation, hyperactivity, and inappropriate behavior based on the level and severity of their mental disorder. A/An .... is abnormal behavior resulting from increased anxiety, tension, or emotional imbalance. A/An ..... is a mental illness accompanied by bizarre behavior and altered personality with failure to perceive reality.
neurosis Psychosis
Pseudoephedrine
noncatecholamine, reduces nasal congestion
cluster headache
nonthrobbing, unilateral pain usually located around the eye with no aura, nausea or vomiting; occurring in a series with each attack lasting 15 minutes to 2 hours.
Persistent and recurrent thoughts or ideas with which the mind is continuously preoccupied and cannot be expunged voluntarily is termed _____.
obsession
When patients are on corticosteroids for an extended duration, serious adverse effects may occur, such as ______.
osteoporosis with fractures, especially in older women
Cholinergic blocking agents do not allow adequate acetylcholine to bind to receptor sites and are also called ____ agents.
parasympatholytic
focal complex partial seizure
partial seizure, confused and bizarre behavior with impaired consciousness
The most commonly prescribed barbiturate for treating seizures is generic . The most common broad-spectrum anti-seizure hydantoin is generic , which is prescribed for both partial and tonic-clonic seizures. A parenteral medication, generic is used for status epilepticus.
phenobarbital phenytoin fosphenytoin
Treatment of mental illness through mental means, or "talk therapy", rather than physical or chemical therapy is termed...
psychotherapy
aspart (NovoLog)
rapid-acting
glulisine (Apidra)
rapid-acting
lispro (Humalog)
rapid-acting
A type of psychosis, which is a group of mental disorders characterized by abnormal thinking, affect and behavior is termed Persons with this condition have symptoms of withdrawal from the social environment accompanied by , which are sense perceptions that have no basis in reality, and/or , which are false beliefs that cannot be changed with reason.
schizophrenia hallucinations delusions
Sedative-hypnotic medications are used to promote ____ in smaller doses and promote ___ in larger doses.
sedation; sleep
Antidepressants, which act to block the reuptake of serotonin and inactivate its brain action thereby causing stimulation to reverse depression, are in the category of _______. These drugs do not block cholinergic, adrenergic, or histamine receptors, and therefore, have fewer side effects than other antidepressants.
selective serotonin reuptake inhibitors
regular (Humulin R)
short-acting
regular (Novolin R)
short-acting
Eli Jordon, 55 years old, has just been diagnosed with type 2 diabetes mellitus. T2DM may be treated with several types of oral antidiabetic agents, individually or in combination. If the physician orders a sulfonylurea for Eli, he will need to understand that it works by _______.
stimulating insulin production by the beta cells in the pancreas
Medications for headaches are specific to the type of headache. Match the medication to the most common indication for use in treatment of headaches.
sumatriptan: a triptan, related to serotonin, in oral or subcutaneous form to relieve both migraine headacheand accompanying symptoms propranolol: a beta blocker and drug of choice for migraine prophylaxis verapamil: a calcium channel blocker used for treating cluster headaches aspirin, butalbital, caffeine: nonopioid combination analgesic used to treat an acute tension headache cyclobenzaprine: centrally-acting muscle relaxant for treatment of acute tension headache amitriptyline: tricyclic antidepressant prescribed for tension headache prophylaxis
Neuroleptics block dopamine receptors, which when used for prolonged periods of time, can produce extrapyramidal effects. Slow, rhythmic, involuntary movements including tics, jerking of extremities causing postural imbalance, protrusion and rolling of the tongue, chewing motion, sucking and smacking of the lips, and facial dyskinesia are termed ____.
tardive dyskinesia
tonic-psychomotor seizure
tonic muscle contractions with uncontrolled seizures (usually in children with multiple seizures per day), atonic seizures, myoclonic seizures, or febrile seizures
status epilepticus
uncontrolled seizures lasting 30 minutes or more; may be life-threatening
migrane headache
unilateral, throbbing or nonthrobbing pain often accompanied by nausea, vomiting and sensitivity to noise and light, may or may not have an aura
Individuals with bipolar disorder I, who do not respond to lithium or cannot tolerate its side effects, may be prescribed antiseizure medications, such as ___________. Both these medications control acute manic episodes and may prevent recurrent episodes of mania and depression.
valproic acid or divalproex sodium
