Pharm II Exam II Chapter 13

Sumatriptan (Serotonin Receptor Agonists) (Indication)

for migraines

Phentermine (Anorexiant)

- Obesity

A patient wants to take Orlistat to assist in her weight loss program, but she is wary of its unpleasant adverse effects. What measure can be suggested to reduce these effects?

- Reduce dietary intake of fat.

Antimigraine Drugs (all end in triptan)

- Serotonin receptor agonists treat migraine headaches.

Narcolepsy

- An incurable neurologic condition in which patients unexpectedly fall asleep in the middle of normal daily activities. - "Sleep attacks" can cause car accidents. - Cataplexy is sudden acute skeletal muscle weakness. - Usually experience migraine headaches.

Doxapram (indications)

- Analeptic that can be used in conjunction with supportive measures in cases of respiratory depression that involve anesthetics or drugs of abuse and in COPD hypercapnia.

Anorexiant

- Any substance that suppresses appetite. - CNS stimulant drugs used to promote weight loss in obesity.

A patient is prescribed an anorexiant. Which statement will the nurse include in patient teaching?

- Avoid intake of caffeine

Orlistat (Anorexiant) (MOA)

- Binds to gastric and pancreatic enzymes called lipases. Blocking these enzymes reduces fat absorption by 30%

Orlistat (Anorexiant) (Adverse Effects)

- Decrease serum concentrations of Vitamin A, D, and E and beta carotene. - Fecal incontinence.

Doxapram (monitoring)

- Deep tendon reflexes and vital signs and heart rhythm to prevent overdose.

Anorexiant (contraindications)

- Drug allergy - Severe cardiovascular disease - Uncontrolled hypertension - Hyperthyroidism - Glaucoma - Mental agitation - History of drug abuse - Eating disorders - Use of MAOIs - Orlistat is contraindicated in cases of chronic malabsorption syndrome or cholestasis.

What is important for the nurse to assess in the patient's history before administering a serotonin agonist?

- Hypertension

Modafinil (nonamphetamine) (Indication)

- Improvement of wakefulness in patients with excessive daytime sleepiness associated with narcolepsy and also with shift word sleep disorder. - It has less abuse potential than amphetamines and methylphenidate do.

Obesity

- Increases risk for hypertension, dyslipidemia, coronary artery disease, gout, osteoarthritis, sleep apnea, breast and colon cancer.

Analeptics (Contraindications)

- Known drug allergy. - Peptic ulcer disease. - Serious cardiovascular conditions. - Use of sildenafil - Doxapram is contraindicated in newborns because of the benzyl alcohol (is associated with gasping syndrome).

Caffeine (Contraindication)

- Known drug allergy. - Peptic ulcers - Cardiac dysrhythmias or who have recently experienced a myocardial infarction. - IV caffeine: caffeine citrate (for neonatal apnea) and caffeine sodium benzoate (for respiratory depression in adults only)

Migraine

- Lasting 4 to 72 hours - Aura: something that triggers the migraine

Anorexiant (Adverse effects)

- May raise blood pressure and cause palpations. - At therapeutic dosages it may reflexively slow the heart rate. - May cause anxiety, agitation, dizziness, and headache. - Most common of orlistat is headache, upper respiratory tract infection, and GI distress.

Analeptics (indications)

- Neonatal apnea - Bronchopulmonary dysplasia. - Hypercapnia associated with COPD. - Postanesthetic respiratory depression. - Respiratory depression secondary to drugs abuse.

Analeptic-response respiratory depression syndrome

- Neonatal apnea - Drugs: analeptic drugs such as theophylline, aminophylline, caffeine, and doxapram.

Analeptics (Adverse effects)

- Stimulate vagal, vasomotor, and respiratory centers of the medulla in the brainstem, as well as increasing blood flow to skeletal muscles. - Vagal effects include: gastric secretions, diarrhea, and reflex tachycardia. - Vasomotor effects include: warmth and redness. - Respiratory effects include: elevated respiratory rate - Skeletal muscle effects include: muscular tension and tremors - Neurological effects include: reduced deep tendon reflexes

Analeptics (MOA)

- Stimulating areas of the CNS that control respirations, mainly the medulla and spinal cord. - Methylxanthine analeptics also inhibit the enzyme phosphodiesterase. This enzyme breaks down a substance called cAMP. When analeptics block this enzyme, cAMP accumulates, which results in smooth muscle relaxation in the respiratory tract, dilation of pulmonary arterioles, and stimulation of the CNS. - Aminophylline is a prodrug and it hydrolyzed to theophylline in the body. - Theophylline is metabolized into caffeine. - The stimulant caffeine is attributed to its antagonism of adenosine receptors in the brain, which is associated with sleep production. - Doxapram is similar to methylxanthines.

Anorexiant (MOA)

- Suppressing appetite control centers in the brain. - Increase the body's basal metabolic rate. - Orlistat differs from other antiobesity drugs in that it is not a CNS stimulant, it inhibits the enzyme lipase.

Phentermine (Anorexiant) (MOA)

- Sympathomimetic anorexiant that is structurally related to amphetamines but with much lower abuse potential.

A teenage boy will be receiving atomoxetine as part of treatment for ADHD. Which statement about this drug therapy is accurate

- The patient should be monitor for possible suicidal thoughts and behaviors.

Serotoning Receptor Agonists (Triptans)

- Treat migraine headaches. - Relief within 2 hours

Ergot Alkaloids

- Treatment and prevention of migraines but not frequently - Available in injectable form and nasal spray. - Ergotamine tartrate with caffeine is available in tablet form.

Antimigraine Drugs (Indications)

- Triptan antimigraine drugs are indicated for abortive therapy of an acute migraine headache. These drugs are not for preventative migraine therapy. - First-line drugs are for preventative therapy: propranolol, amitriptyline, valproic acid, and topiramate. - Second-line therapy include the ergot alkaloid dihydroergotamine mesylate, NSAIDS. - Combination of acetaminophen and aspirin plus the barbiturate butalbital plus the analeptic caffeine for abortive therapy.

Antimigraine Drugs (Contraindications)

- Triptans o Known drug allergy. o Cardiovascular disease, due to their vasoconstrictive potential. - Ergot alkaloids o Uncontrolled hypertension o Cerebral, cardiac, or peripheral vascular disease. o Dysrhythmias, glaucoma, and coronary or ischemic heart disease.

Antimigraine Drugs (adverse effects)

- Triptans o Potential vasoconstrictor effects including effects on the coronary circulation. o Injectable forms cause local irritation at the site. o Tingling, flushing, and a congested feeling in the head and chest. - Ergot alkaloids o Nausea, vomiting, cold or clammy hands and feet, muscle pain, dizziness, numbness, a vague feeling of anxiety, a bitter or foul taste in the mouth or throat, and irritation of the nose. o Overuse can cause rebound headaches.

Antimigraine Drugs (MOA)

- Triptans stimulate receptors in cerebral arteries causing vasoconstriction and reducing or eliminating headache symptoms.

Anorexiant (Indications)

- Used for the treatment of obesity. - Effects are minimal without accompanying behavioral modifications involving diet and exercise.

Drugs for Specific Respiratory Depression Syndromes: Analeptics

- Used to treat neonatal and postoperative respiratory depression. Neonatal use is more common.

Atomoxetine (non-stimulating drug) (Indication)

- treating ADHD in children older than 6 years and in adults. - Not a controlled substance because it lacks addictive properties.

A patient has asked for a cup of coffee. The nurse keeps in mind that patients with a history of which condition need to avoid caffeine? A. cardiac dysrhythmias b. asthma c. diabetes mellitus d. gallbladder disease

A. cardiac dysrhythmias

The nurse is reviewing the history of a patient who will be starting the triptan sumatriptan as part of treatment for migraine headaches. Which condition, if present, may be a contraindications to triptan therapy? A. cardiovascular disease B. Chronic bronchitis C. history of renal calculi D. diabetes mellitus type 2

A. cardiovascular disease

The nurse is administering a stimulant drug and expects which responses from stimulation of the CNS A. increased fatigue B. Decreased drowsiness C. increased respirations D. Bradycardia E. Euphoria

B. Decreased drowsiness C. increased respirations E. Euphoria

A patient has a new prescription for sumatriptan. The nurse providing patient teaching on self-administration will include which information? A. Correct technique for IM injections B. Take the med before the headache worsens. C. Allow at least 30 mins between injections. D. take no more than 4 doses in a 24 hour period

B. Take the med before the headache worsens.

The nurse is reviewing a patient's med administration record. Which best describes a common use for doxapram? A. to control increased respiration caused by other drugs B. To treat drug-induced respiratory depression .c To treat postop respiratory excitation D. To stimulate respirations in a patient with a head injury

B. To treat drug-induced respiratory depression

A patient with narcolepsy will begin treatment with a CNS stimulant. The nurse expects to see which adverse effects? A. bradycardia B. anxiety C. increased blood pressure D. tremors E. Drowsiness at night

B. anxiety C. increased blood pressure D. tremors

The nurse is reviewing med therapy with the parents of an adolescent with ADHD. Which statement is correct? A. Be sure to have your child blow his nose before administration of the nasal spray B. This med is used only when symptoms of ADHD are severe C. The last dose should be taken 4 to 6 hours before bedtime to avoid interference with sleep D. Be sure to contact the physician right away if you notice expression of suicidal thoughts E. We will need to check your child height and weight periodically to monitor physical growth F. If adverse effects become severe, stop the medication for 3 to 4 days

C. The last dose should be taken 4 to 6 hours before bedtime to avoid interference with sleep D. Be sure to contact the physician right away if you notice expression of suicidal thoughts E. We will need to check your child height and weight periodically to monitor physical growth

A patient with narcolepsy is having problems with excessive daytime sleepiness. The nurse expects which drug to be prescribed to improve the patient's wakefulness. A. phentermine B. almotriptan C. modafinil D. Methylphenidate

C. modafinil

A patient at a weight management clinic who was given a prescription for orlistat calls the clinic hotline complaining of a "terrible side effect". The nurse suspects that the patient is referring to which problem? A. Nausea B. Sexual dysfunction C. Urinary incontinence D. Fecal incontinence

D. Fecal incontinence

The nurse is developing a plan of care for a patient receiving an anorexiant. Which human need statement is most appropriate? A. Altered oxygenation B. altered sexual needs C. altered freedom from pain D. altered food and nutrient intake

D. altered food and nutrient intake

Amphetamines (Indication)

Used to treat ADHD and narcolepsy.

In which patient population would the nurse expect to see the use of analeptics in the treatment of respiratory depression? a. neonates b. children c. adults d. older adults

a. neonates

a patient will be taking sumatriptan as part of treatment for migraine headaches. Before beginning therapy, the nurse reviews the patinet's current list of meds. Which med may have an interaction with sumatriptan? a. opioids b. ergot alkaloids c. SSRIs d. MAOIs e. NSAIDs

b. ergot alkaloids c. SSRIs d. MAOIs

a patient with migraine headaches is being treated with a serotonin antagonist. Which condition would cause the nurse to question the use of this class of me to treat the patinets migraines? a. asthma b. hypertension c. glaucoma d. diabetes mellitus

b. hypertension

When a child is taking drugs for ADHD what will the nurse instruct the caregivers to closely monitor in the child? a. blood glucose levels b. physical growth, especially weight c. grades at school d. respiratory rate

b. physical growth, especially weight

The physician has ordered orlistat. The nurse recognizes that this drug is used to treat which condtion. a. anorexia b. malnutrition c. narcolepsy d. obesity

d. obesity

Drugs for Attention-Deficit/Hyperactivity Disorder and Narcolepsy (adverse effects)

o "Speeds up" body systems. o Increased heart rate and blood pressure. o Angina, anxiety, insomnia, headache, tremor, blurred vision, increased metabolic rate (beneficial in treating obesity), GI distress, dry mouth, and worsening of psychiatric disorders: mania, psychoses, or aggression.

Drugs for Attention-Deficit/Hyperactivity Disorder and Narcolepsy (Interactions)

o CNS stimulants o MAOIs o Serotonergic drugs o SSRIs o Antifungals o Macrolide antibiotics

Drugs for Attention-Deficit/Hyperactivity Disorder and Narcolepsy (MOA)

o Elevate mood (euphoria), produce a sense of increased energy and alertness, decrease appetite, and enhance task performance impaired by fatigue and boredom. o Amphetamines stimulate areas of the brain associated with mental alertness, specifically the cerebral cortex and the thalamus. o Respiratory effects most commonly seen include relaxation of bronchial smooth muscle, increased respiration, and dilation of pulmonary arteries. o Amphetamines and phenidates increase the effects of norepinephrine and dopamine in CNS by Increasing their release and blocking their reuptake.

Methylphenidate (amphetamine) (indication)

o First prescription drug indicated for ADHD and is also used for narcolepsy.

Drugs for Attention-Deficit/Hyperactivity Disorder and Narcolepsy (Contraindications)

o Known drug allergy or cardiac structural abnormalities. o Can increase anxiety or agitation, Tourette syndrome, hypertension, and glaucoma. o These drugs cannot be used in patients who have received treatment with MAOIs.

Drugs for Attention-Deficit/Hyperactivity Disorder and Narcolepsy (Random Facts)

o Most common psychiatric in children. o Boys are affected three times more often than girls. o Inappropriate ability to maintain attention span and or the presence of hyperactivity and impulsivity or both. o Many children outgrow ADHD. o There is some social controversy regarding possible overdiagnosis and overmedication for this disorder. o Most common drugs for ADHD and narcolepsy.

Atomoxetine (non-stimulating drug) (Adverse Effect)

o Suicidal thinking and behavior in small numbers of adolescent patients receiving this med. o Erectile dysfunction is common.

Drugs for Attention-Deficit/Hyperactivity Disorder and Narcolepsy (indications)

o Treat ADHD and narcolepsy. o Dexmethylphenidate is indicated for ADHD alone. o Amphetamine sulfate was used to treat obesity, however the only amphetamine approved for this indication are benzphetamine and methamphetamine. o Modafinil and armodafinil are indicated for narcolepsy. o Specialists recommend periodic "drug holidays" without medication to diminish the addictive tendencies.