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)
