Pharmacology Exam 2

1. ____________ are a class of drugs that function by competing with the naturally occurring nucleosides within the cell that the virus would use to build the DNA chain.

Nucleosides

1. Intestinal candidiasis can be treated with the oral medication ___________________.

Nystatin (generic)

Lamotrogine (Lamictal)

Uses Lamotrigine is used alone or with other medications to prevent and control seizures. It may also be used to help prevent the extreme mood swings of bipolar disorder in adults. Lamotrigine is known as an anticonvulsant or antiepileptic drug. It is thought to work by restoring the balance of certain natural substances in the brain. This drug is not approved for use in children younger than 2 years due to an increased risk of side effects (such as infections). "Many clinicians think that lamotrigine helps achieve and sustain even moods over time by virtue of its antidepressant properties, rather than anti-manic (mood-stabilizing) properties,."It works with mood stabilizers like lithium and Divalproex, but it's not interchangeable with these drugs and cannot be used in their place."

Drug of choice for treatment of myoclonic seizures and stabilizes labile moods.

Valproic Acid/Depicote therapeutic drug level=

What is the therapeutic range for lithium?

0.5-1.5 mEq/L

T/f: Antiinfective drugs act selectively on foreign organisms that have infected the host body.

1. True

Therapeutic serum levels for patients taking phenytoin (dilantin) range from _to_ mcg/ml

10-20

CASE STUDY chapter 10. The nurse working in a public health department has assessed patients with various viral infections. A. Describe characteristics of common viruses. B. Describe the clinical presentations of common viral infections.

2.a A virus cannot replicate on its own. It must attach to and enter a host cell. It then uses the host cell's energy to synthesize protein, DNA, and RNA. Viruses are difficult to kill because they live inside our cells. Any drug that kills a virus may also kill our cells. 2b. Respiratory virus o Cough o Fever o Inflammation of the nasal mucosa o Inflammation of the mucosa of the respiratory track Herpes virus o Painful vesicles that often occur in clusters on skin, cornea, or mucous membranes o Usual course of primary disease is 2 weeks. o Duration of recurrences varies. HIV/AIDS o Acute infection: fever rash, myalgia o Asymptomatic infection: follows acute infection; duration varies. o Persistent generalized lymphadenopathy: Adenopathy persists more than 3 months. o Constitutional symptoms: fever lasting more than a month, involuntary weight loss, chronic fatigue o Neurological disease: dementia o Secondary infections: Pneumocystis carinii, disseminated herpes simplex

CASE STUDY chapter 10. Gail is a 9-year-old girl with fever, cough, and generalized body aches for the past 12 hours. Her health care provider has diagnosed her with influenza A. Which antiviral medication is indicated for children over 7 years of age? Describe its therapeutic action. What are the adverse effects that may occur with antiviral medications? Are there any age-specific issues for this patient taking antiviral medication?

3a. Rimantadine (Flumadine) Inhibits viral replication, possibly by preventing the uncoating of the virus 3b. Light-headedness and dizziness Insomnia Nausea Orthostatic hypotension Urinary retention 3c. Children are very sensitive to the effects of most antiviral drugs, and more severe reactions can be expected when these drugs are used in children. Many of these drugs do not have proven safety and efficacy in children, and extreme caution should be used. Most of the drugs for prevention and treatment of influenza virus infections can be used, in smaller doses, for children.

Stevens-Johnson Syndrome

A severe, possibly fatal reaction that mimics a burn; may be due to a medication.

Is Remeron approved for pediatric patients?

No

Can you use lithium and lamictal together?

YES

1. The only nucleoside that has been proven to be safe when used during pregnancy is _______________.

Zidovudine

1. ______________ drugs have an antiinfective action that prevents the pathogen or invading organisms from reproducing.

bacteriostatic/fungastatic

1. Antibiotic therapy that uses two or more types of drugs to treat an infection is known as _______________ ________________.

combination therapy

What is the current biogenic theory for depression?

common disorder of feelings of sadness and severe hopelessness, millions have it, caused by depletion of deficiency of norepinpehrine, dopamine, or serotonin

T/F 1. Aminoglycosides are an example of antiinfectives that are classified as bacteriostatic.

false

T/F Antifungal agents can be used to treat bacterial superinfections that have been unresponsive to antibiotics.

false

Problem with MAO inhibitors

food-drug interactions tyramine

mycosis

fungal infection

Immediate treatment for tyramine crisis

hold the dose, treat the high BP with blood pressure meds to lower the BP, monitor for intracranial bleeding (stroke), may have a micro bleed that can get bigger, might need multiple CT's if they're fine the first time, and then take another CT that could show a bigger bleed

Serotonin Syndrome

hyperthermia, confusion, myoclonus, cardiovascular instability, flushing, diarrhea, seizures. -Treatment: cyproheptadine (5-HT2 receptor antagonist).

Lithium toxicity

levels of 2 or greater tremors, metallic taste, severe diarrhea, number one intervention, give fluids, if sweating give electrolytes too

1. One way that microorganisms develop _____________ to antibiotics is by producing an enzyme that deactivates the drug and prevents it from acting on the infected cell.

resistance

1. A ___________ obtained from infected tissue or body areas can be used to help identify infective agents.

culture

1. Fungi that cause infections of the skin and mucous membranes are called _____________.

Dermatophytes

S/S of hypertensive crisis

Diaphoretic Dilated pupils Chest pain, palpitations Tachycardia Severe head ache

Caspofungin (Cancidas)

Antifungal

Foods with tyramine

"dairy is a problem"- cheese, milk, yogurt, aged cheese cured meats fava beans chocolate wine beer caffeine figs yeast MSG soybeans shrimp paste ginseng protein supplements avocados

1. Herpes virus infections can be treated with ____________________.

1. Acyclovir (Zovirax)

1. A bacterium that depends on oxygen in order to survive is called _______________.

1. Aerobic

1. Gangrene is an example of a(n) _______________ bacteria that do not use oxygen to survive.

1. Anaerobic

1. Bacteria whose cell wall lose a stain or are decolorized by alcohol are called _______________.

1. Gram-negative

1. The class of drugs that treats infections by inhibiting folic acid synthesis is called _______________.

1. Sulfonamides (sulfa drugs)

1. When antibiotics are given in combination so that their combined effects are greater than if they were given individually, they are considered to be _______________.

1. Synergistic

Carbamazepine (Tegretol)

Shouldn't get pregnant- need to use a barrier method like condoms

Patients with a history of of seizure should always carry a what?

Alert bracelet

1. Antiinfective drugs that act by destroying the pathogen or invading organisms are called _____________________.

Bactericidal

MAO inhibitors (MAOIs)

Class of drugs that inhibit monoamine oxidase (MAO), thereby causing an accumulation of catecholamines and serotonin in the brain. They are often used to treat clinical depression. Depression found self destructive amines that dont make it to the next neuron, so it helps to get it across the synapse.

Tricyclic Antidepressants (TCAs)

Drugs that inhibit the reuptake of norepinephrine and serotonin by the presynaptic neurons in the central nervous system, increasing the amount of time they are available to the postsynaptic receptors. Muscarinic blockage leads to anticholinergic effects such as blurred vision, dry mouth, tachycardia, urinary retention, and constipation.

t/f: 1. Antibiotics are generally effective against both bacteria and viral infective organisms.

FALSE

1. Cidofovir (generic) is used to treat CMV retinitis in otherwise healthy patients.

False

1. Drugs used for the treatment of herpes and CMV are safe to use in lactating patients.

False

T/F Systemic antifungal agents are easily tolerated by patients with a low risk of toxicity.

False

T/F: 1. Fluoroquinolones are used to treat susceptible strains of gram-positive bacteria.

False

True/False Asian Americans patients taking anti-epileptic drugs may require larger and more frequent dosing to achieve the same therapeutic effects as Caucasian Americans.

False- Asians don't need different doses

Diazepam (Valium) is recommended for long term management of seizures

False- its addicting, get a tolerance and wont prevent seizures

MAO inhibitors risk if eaten foods with tyramine

Fatal Hypertensive crisis which may lead to stroke

Fill in the Blank 1. ____________ has been found to be effective in treating uncomplicated influenza infections if taken within 2 days of the onset of symptoms.

Fill in the Blank 1. ____________ has been found to be effective in treating uncomplicated influenza infections if taken within 2 days of the onset of symptoms.

St Johns Wort drug to drug interaction:

For example, mixing St. John's wort with an SSRI such as Prozac can lead to a complication called serotonin syndrome.

_________________ ________________ prevent the HIV-1 virus from entering the cell by stopping fusion of the virus with the human cellular membrane

Fusion inhibitors

Teaching for Dilantin for breakthrough seizures

Gingival Hyperplasia Can cause hyperglycemia Take at the same time every day Do not stop abruptly Do not take OTC drugs- harms liver No drinking No Pregnancy Will need routine bloodwork for therapeutic levels Assess for rash- Steven Johnson Syndrome Stabilizes nerve membranes and limits spread of in the brain. LESS SEDATING than other anti-seizure drugs.

1. Itraconazole (Sporanox) should not be used in patients with ____________ failure.

Hepatic

Diazapam

Its a Benzo. Generally administered rectally via a gel torpedo. Drug of choice for status epilepticus Stabilizes nerve cell membranes through GABA

Lithium

Lithium (Eskalith, Lithobid) is one of the most widely used and studied medications for treating bipolar disorder. Lithium helps reduce the severity and frequency of mania. It may also help relieve or prevent bipolar depression. Studies show that lithium can significantly reduce suicide risk. Lithium also helps prevent future manic and depressive episodes. As a result, it may be prescribed for long periods of time (even between episodes) as maintenance therapy. Lithium acts on a person's central nervous system (brain and spinal cord). Doctors don't know exactly how lithium works to stabilize a person's mood, but it is thought to help strengthen nerve cell connections in brain regions that are involved in regulating mood, thinking and behavior.

1. Common side effects of topical antifungals include _______________, ________________, ____________________, and _________________.

Local irritation, burning, rash, swelling

Suicide risk and antidepressants

Most antidepressants are generally safe, but the FDA requires that all antidepressants carry black box warnings, the strictest warnings for prescriptions. In some cases, children, teenagers and young adults under 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. Anyone taking an antidepressant should be watched closely for worsening depression or unusual behavior. If you or someone you know has suicidal thoughts when taking an antidepressant, immediately contact your doctor or get emergency help.

Can you take kava or drink alcohol while on lithium?

No

Most common drug for status epileptics and acute seizures associated with eclampsia

Phenobarbital (Luminol)

Venlafaxine (Effexor)

SNRI antidepressant dont abruptly stop taking monitor for suicide s/s serotonin syndrome take with a full glass of water extended release

How SNRIs work

SNRIs ease depression by affecting chemical messengers (neurotransmitters) used to communicate between brain cells. Like most antidepressants, SNRIs work by ultimately effecting changes in brain chemistry and communication in brain nerve cell circuitry known to regulate mood, to help relieve depression. SNRIs block the reabsorption (reuptake) of the neurotransmitters serotonin (ser-o-TOE-nin) and norepinephrine (nor-ep-ih-NEF-rin) in the brain.

Zoloft (Sertraline) patient teaching

SSRI's Increase suicidal ideation Depression is a mood disorder Have a person checking in until it works 4-6 weeks around 2 weeks have energy to kill themselves Not an overnight transition Assess emotional support system to establish that its adequate Risk for Seratonin Syndrome

SSRIS and bleeding

SSRIs may increase your risk of bleeding, especially when you're taking other medications that increase the risk of bleeding, such as nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, warfarin (Coumadin, Jantoven) and other blood thinners.

SSRIS info

SSRIs treat depression by increasing levels of serotonin in the brain. Serotonin is one of the chemical messengers (neurotransmitters) that carry signals between brain nerve cells (neurons). SSRIs block the reabsorption (reuptake) of serotonin into neurons. This makes more serotonin available to improve transmission of messages between neurons. SSRIs are called selective because they mainly affect serotonin, not other neurotransmitters. SSRIs may also be used to treat conditions other than depression, such as anxiety disorders.

Lamictal

Should not become pregnant. If delivers- don't breastfeed. Is used for partial focal seizures in conjunction with a stronger more reliable medication like Tegretol

T/F: 1. Sensitivity testing is used to determine which drugs are capable of controlling an infective organism.

TRUE

T/F: When patients are allergic to penicillin, erythromycin has proven to be an effective alternative

TRUE

t/f: Common adverse reactions to antiinfective agents include toxic effects on the kidneys, gastrointestinal tract, and nervous system

TRUE

t/f: 1. Some antiinfectives are used as a means of prophylaxis when patients expect to be in situations that will expose them to a known pathogen.

TRUE

Time of day to take an SSRI:

Take drug afternoon or else nervous and insomnia occur

Common Side Effects of MAOIs

This list is not all-inclusive and you may experience other side effects not mentioned here. You should report all medication-related side effects to your doctor. •Confusion •Decreased sleep/insomnia3 •Diarrhea3 •Dizziness •Dry mouth •Edema (water retention) •Hypertension (high blood pressure) •Hypotension (low blood pressure)4 •Muscle spasms •Nausea •Sexual dysfunction4 •Weakness5 •Weight gain4

1. Ketoconazole (generic) is a topical shampoo used to treat ________________.

Tinea corporis

1. Viruses survive by injecting their own DNA or RNA into a healthy cell and taking over its function.

True

Evening Primrose may increase the risk of seizures in patients with epilepsy

True

T/F 1. A Gram stain is used to identify gram-positive bacteria by retaining a stain within its cell wall.

True

T/F 1. Caspofungin (Cancidas) has been approved for the treatment of invasive aspergillosis that is unresponsive to other treatment.

True

T/F: 1. Cephalosporins can be classified as either bactericidal or bacteriostatic depending on which specific drug and dose are used.

True

The most common adverse effects of barbiturates and benzodiazipines are related to cns depression, including drowsiness fatigue and confusion

True

True/False Febrile Seizures are related to very high fevers in children and generally do not reoccur

True- Febrile means fever

Lithium toxicity

Tremors, Metallic taste, neuro symptoms besides parenthesia

1. Protease inhibitors are effective by blocking the protease activity within HIV.

True

1. Rimantadine (Flumadine) is a synthetic antiviral agent used to prevent and treat influenza A.

True

SNRIs (serotonin-norepinephrine reuptake inhibitors)

also work on dopamine. In some patients, they need drugs that slow down dopamine, so an SNRI may be needed.

Remeron (mirtazapine)

antidepressant; alpha-2 antagonist Mirtazapine is used to treat depression. It improves mood and feelings of well-being. Mirtazapine is an antidepressant that works by restoring the balance of natural chemicals (neurotransmitters) in the brain. Agranulocytosis, also known as agranulosis or granulopenia, is an acute condition involving a severe and dangerous leukopenia (lowered white blood cell count), most commonly of neutrophils, and thus causing a neutropenia in the circulating blood.

How does caffeine effect lithium?

inverse relationship •. Caffeine found in coffee, tea, and soft drinks may have an effect on lithium levels. Less caffeine can cause your lithium levels to rise, while more can cause it to lower.

How does salt affect lithium levels?

inverse relationship between salt and lithium less salt can make your lithium levels rise while increasing your salt intake can cause it to fall

Dulexetine (Cymbalta) effect on liver?

may worsen liver problems

Atypical Antidepressants

miscellaneous group of drugs with antidepressant effects but only mild side effects Atypical anti Atypical antidepressants include bupropion (Wellbutrin), mirtazapine (Remeron), nefazodone, and trazodone (Desyrel). They have all been found to be effective in monotherapy in major depressive disorder and may be used in combination therapy for more difficult to treat depression.depressants include agomelatine, bupropion, mianserin, mirtazapine, nefazodone, opipramol, tianeptine, and trazodone. Like most antidepressants, atypical antidepressants work by ultimately effecting changes in brain chemistry and communication in brain nerve cell circuitry known to regulate mood, to help relieve depression. Atypical antidepressants change the levels of one or more neurotransmitters, such as dopamine, serotonin or norepinephrine.

Seizures that involve one hemisphere of the brain are classified as

partial

Elavil (amitriptyline)

tricyclic antidepressant for major depression also for fibromylagia and arthritis abused to acheive sedation DONT TAKE WITH MAO in the past 14 days

T/F Fluconazole (Diflucan) can be used as a prophylactic agent for reducing the incidence of candidiasis in bone marrow transplant recipients.

true

Candiadiasis

yeast infection

CASE STUDY chapter 10. John is a 28-year-old male who was diagnosed with a viral gastrointestinal infection. Discuss problems with treating viral infections in humans. John asks why the health care provider did not order him a medication for his virus. How would you respond?

· Because viruses are contained inside human cells while they are in the body, researchers have difficulty developing effective drugs that destroy a virus without harming the human host. 1b. Students' answers should include the following: · Some drugs that are used in treating viral infections are not natural substances and have been effective against only a limited number of viruses. Viruses that respond to some antiviral therapy include influenza A and some respiratory viruses, herpes viruses, cytomegalovirus (CMV), the human immunodeficiency virus (HIV) that causes acquired immunodeficiency syndrome (AIDS), hepatitis B, hepatitis C, and some viruses that cause warts and certain eye infections.

SNRIS and bleeding:

•SNRIs may increase your risk of bleeding, especially when you're taking other medications that also increase the risk of bleeding, such as ibuprofen (Advil, Motrin IB, others), aspirin, warfarin (Coumadin, Jantoven) and other blood thinners.

Types of SSRIS:

•citalopram (Cipramil) •dapoxetine (Priligy) •escitalopram (Cipralex) •fluoxetine (Prozac or Oxactin) •fluvoxamine (Faverin) •paroxetine (Seroxat) •sertraline (Lustral) •vortioxetine (Brintellix)