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Pharm Exam 4
Pharm Exam 4 Drugs
| Question | Answer |
|---|---|
| "-flurane" or "ane" drug type | inhaled liquid general anesthetic |
| action of general anesthesia | depression of sensory and motor CNS function |
| action theory r/t general anesthesia | Overton-Meyer theory |
| 2 primary adverse affects r/t general anesthesia | myocardial depression and malignant hyperthermia |
| lidocaine (Xylocaine) drug type | local/regional amide type anesthetic |
| lidocaine is often given with what? why? | epinephrine- reduce blood loss by vasoconstriction and reduce systemic absorption |
| lidocaine by infiltration | circular across nerve paths |
| lidocaine by nerve block | directly into nerve trunks or ganglia |
| interferes w/ nerve impulse transmission w/o loss of consciousness | lidocaine |
| loss of autonomic, then sensory, then motor (reverse order in recovery) | lidocaine |
| 3 adverse side effects w/ lidocaine | cardiac palpitations, difficulty breathing or swallowing, spinal headache |
| treatment for spinal headache r/t lidocaine | blood patch |
| propofol (Diprivan) drug type | injectable general anesthetic |
| indications for propofol | induction or maintenance of anesthesia or sedation for ICU, intubation, stress control, induce amnesia, adjunct to inhalation anesthesia |
| succinylcholine (Anectine) drug type | depolarizing NMBA for ultra-short acting skeletal muscle paralysis |
| antidote for succinylcholine | atropine & neostigmine |
| 2 indications for succinylcholine | adjunct to GA for intubation and MV, diagnostic drug for myasthenia gravis |
| intervention required for succinylcholine | artificial mechanical ventilation |
| 2 adverse effects for succinylcholine if given too rapidly | bradycardia or CA |
| 3 adverse effects for succinylcholine if given too high a dose | tachycardia, hypotension, urinary retention |
| NMBAs do not cause what 2 things? | sedation or pain relief |
| vecuronium (Norcuron) drug type | nondepolarizing NMBA for intermediate acting skeletal muscle paralysis |
| 2 indications for vecuronium | adjunct to GA for intubation and MV, diagnostic drug for myasthenia gravis |
| intervention required for vecuronium | artificial mechanical ventilation |
| causes first muscle weakness, then flaccid muscle paralysis, then extremities, then trunk, then diaphragm (reverse w/ recovery) | vecuronium |
| long-term use of vecuronium is r/t what adverse effect | accumulated active metabolite causes difficulty weaning from MV |
| primary adverse effect r/t vecuronium | muscle soreness from transient muscle fasiculations |
| moderate/conscious sedation | combination of IV benzodiazepene and opiate analgesic |
| 4 advantages to moderate/conscious sedation | preserve ability to maintain airway, respond to verbal commands, rapid recovery, greater safety |
| indications for moderate/conscious sedation | diagnostics and minor surgery |
| moderate/conscious sedation produces what 3 effects | reduced anxiety and sensitivity to pain, amnesia |
| primary drawback to barbiturates r/t sleep | reduced REM sleep |
| sedatives | reduce nervousness, excitability, and irritability w/o causing sleep |
| hypnotics | cause sleep |
| indication for ultrashort barbiturates | anesthesia |
| 2 indications for short barbiturates | s/h or anticonvulsive |
| 2 indications for intermediate barbiturates | s/h or anticonvulsive |
| 2 indications for long barbiturates | hypnotic or epileptic seizure prophylaxis |
| uncontrollable seizures are treated by | phenobarbitol coma |
| site of action of barbiturates | brainstem- reticular formation |
| action of barbiturates | inhibits GABA and nerve impulses in cerebral cortex |
| notorious enzyme inducers | barbiturates cause metabolism of many drugs resulting in shortened duration of action |
| 2 primary drawbacks to barbiturate use | low therapeutic index and habit forming |
| baclofen (Lioresal) drug type | muscle relaxant |
| indications for baclofen | muscle spasm r/t MS, CP, or spinal cord injury or alcohol withdrawal syndrome |
| drug derivative of GABA that is structurally similar | baclofen |
| drug that inhibits neuronal activity w/in brain and spinal cord | baclofen |
| cyclobenzaprine (Flexeril) drug type | muscle relaxant |
| indications for cyclobenzaprine | muscle spasm when r/t to problems originating in muscle, not in nerves |
| depresses motor activity in brainstem and increases circulating levels of norepinephrine | cyclobenzaprine |
| dantrolene (Dantrium) drug type | muscle relaxant |
| indication for dantrolene | malignant hyperthermia crisis |
| temazepam (Restoril) drug type | benzodiazepene- short acting sedative-hypnotic |
| advantage of benzodiazepenes over barbiturates | do not suppress as much REM sleep |
| indication for temazepam | sleep problems/insomnia r/t anxiety |
| positive aspect of temazepam | does not increase metabolism of other drugs |
| severe adverse affect of temazepam | swelling |
| zaleplon (Sonata) drug type | nonbenzodiazepene hypnotic |
| zaleplon should be taken when | 15-30 min before bed for insomnia |
| 3 primary adverse affects of nonbenzodiazepenes | habit forming, hangover, rebound insomnia |
| zolpidem (Ambien) drug type | nonbenzodiazepene sedative/hypnotic |
| selectivity of nonbenzodiazepene s/h | little muscle relaxant and antiseizure effects and more sedative effects |
| antidote for benzodiazepene- anxiolytics | Flumazenil |
| alprazolam (Xanax) drug type | benzodiazepene- anxiolytics |
| chlorodiazepoxide (Librium) drug type | benzodiazepene- anxiolytics |
| diazepam (Valium) drug type | benzodiazepene- anxiolytics |
| cause increased action of GABA, which depresses activity of brainstem and limbic system | benzodiazepene- anxiolytics |
| lorazepam (Ativan) drug type | benzodiazepene- anxiolytics |
| fluoxetine (Prozac) drug type | antidepressant- SSRI |
| advantage of SSRIs over TCAs and MAOIs | little effect on cardiovascular system |
| indication for fluoxetine | depression |
| drugs that selectively inhibit serotonin uptake w/o effect on norepinephrine and dopamine, causing increased serotonin at nerve endings | SSRIs |
| primary drug-drug interaction of SSRIs and effect | MAOIs and serotonin syndrome |
| SSRIs, MAOIs, and 2nd generation ADs are decreased in effectiveness by what 2 things | cigarettes and caffeine |
| drugs that should be weaned before surgery to prevent adverse interactions w/ anesthesia | SSRIs |
| 2 drug types that are highly protein bound and inhibit cytochrome P450 system | SSRIs and 2nd generation ADs |
| drug types that take 4-6 weeks to reach max clinical effectiveness | SSRIs and 2nd generation ADs |
| fatigue, wt. loss, wt. gain, and sexual DF are the primary adverse affects seen w/ what drug type | 2nd generation ADs |
| bupropion (Wellbutrin) drug type | 2nd generation AD |
| indications for bupropion | depression, smoking cessation |
| mirtazapine drug type | 2nd generation AD |
| indicated for depression w/ reverse vegetative symptoms such as increased sleep and appetite | MAOIs |
| drugs w/ potential to cause hypertensive crisis when taken w/ tyramine | MAOIs |
| assess patients w/ MMSE before giving what drugs? | antipsychotics |
| olanzapine (Zyprexa) drug type | antipsychotic |
| drug used to treat BPD, depressive and drug-induced psychoses, schizophrenia, autism, movement disorders (Tourette's), hiccups or nausea | olanzapine |
| drugs that block dopamine receptors in brain to decrease dopamine levels for tranquilizing effect | antipsychotics |
| what should not be taken w/in 1 hr of antipsychotics | antidiarrheals or antacids |
| instruct patient to wear sunscreen if taking | antipsychotics due to photosensitivity |
| antipsychotics may be contraindicated with | elderly- sedation and profound CNS depression |
| high fever, unstable BP, myoglobinemia w/ antipsychotics may indicate | neuroleptic malignant syndrome |
| 3 major adverse effects of antipsychotics | neuroleptic malignant syndrome, extrapyramidal symptoms, tardive dyskinesia |
| extrapyramidal symptoms are similar to | Parkinsonism |
| w/ long term therapy w/ antipsychotics- cx of oral and facial muscles and choreoathetosis | Tardive dyskinesia |
| risperidone (Risperdal) drug type | antipsychotic |
| treatment for extrapyramidal symptoms | benztropine and trihexyphenidyl |
| amitriptyline (Elavil) drug type | antidepressent- TCA |
| drug type for depression, childhood enuresis, OCD, adjunct analgesic for chronic pain r/t trigeminal neuralgia | TCAs |
| drugs that block uptake of norepinephrine and serotonin causing accumulation at nerve endings | TCAs |
| TCAs should be used cautiously in | elderly |
| overdose is lethal and 70-80% of patients die before reaching hospital due to seizure or dysrhythmias | TCAs |
| overdose treatment for TCAs | activated charcoal and urine alkalinization |
| lithium drug type | antimanic |
| drug for treatment of mania r/t BPD | lithium |
| drug that causes shift in sodium ions and catecholamine metabolism and is thought to potentiate serotonergic transmission | lithium |
| lithium serum levels should be checked why? what should the level be? | narrow therapeutic index and serum levels of 0.6-1.2 mEq/L |
| albuterol sulfate (Proventil, Ventolin) drug type | bronchodilator- short acting selective beta2 adrenergic receptor agonist |
| indicated for relief of acute bronchoconstriction r/t asthma and bronchitis and protection against exercise-induced asthma | albuterol sulfate |
| salmeterol (Serevent) drug type | bronchodilator- beta 2 adrenergic |
| indicated for long-term maintenance treatment of asthma, not for acute attacks, bronchospasm r/t COPD, and prevention of exercise-induced bronchospasm | salmeterol |
| salmeterol should be taken when before exercise | 30-60 min before |
| drug that comes as a MDI | salmeterol |
| salmeterol is contraindicated in patients w/ what | liver dysfunction |
| dobutamine drug type | vasoactive adrenergic- beta1 selective |
| drug structurally similar to dopamine | dobutamine |
| indicated for cardiac decompensation, heart failure, and orthostatic HTN | dobutamine |
| drug that stimulates B1 receptors on heart muscle to increase CO, contractility, and SV | dobutamine |
| decreased CO r/t adverse drug effects, ineffective tissue perfusion r/t intense vasoconstrictive reactions, and acute pain r/t adverse effects of tachycardia and palpitations are possible nursing diagnoses for what drug type? | vasoactive adrenergics |
| dopamine drug type | vasoactive adrenergic |
| indicated for shock syndrome, cardiopulmonary arrest, and low BP | dopamine |
| pseudoephedrine (Sudafed or Afrin) drug type | nasal decongestant adrenergic- alpha and beta |
| natural plant alkaloid obtained from ephedra plant | pseudoephedrine |
| rebound phenomenon w/ nasal spray | pseudoephedrine |
| pseudoephedrine is contraindicated w/ what 4 conditions | diabetes, HTN, thyroid disorders, enlarged prostate |
| epinephrine drug type | bronchodilators or vasoactive adrenergic |
| norepinephrine drug type | vasoactive adrenergic |
| phentolamine (Regitine) drug type | alpha-blocker |
| drug that reduces peripheral vascular resistance | phentolamine |
| indicated for HTN, HTN r/t pheochromocytoma, and treatment of alpha-adrenergic drug extravasation | phentolamine |
| phentolamine is contraindicated for patients with what 2 things | MI or CAD |
| prazosin (Minipress) drug type | alpha-blocker |
| indicated for HTN or to reduce urinary obstruction r/t BPH | prazosin |
| primary adverse effect of prazosin | orthostatic HTN |
| atenolol (Tenormin) drug type | beta-blocker- cardioselective |
| indicated to prevent future MI w/ history of MI, HTN, and angina | atenolol |
| primary life-threatening adverse effect of beta-blockers | bronchial constriction |
| nonselective beta-blockers are contraindicated in patients w/ | asthma or COPD |
| esmolol drug type | beta-blocker- very potent short acting |
| indicated for acute situations to control ventricular rate r/t supraventricular tachycardia | esmolol |
| beta-blocker only given IV due to very short half-life | esmolol |
| metoprolol (Lopressor) drug type | beta-blocker |
| indicated to increase survival post MI | metoprolol |
| propanolol (Inderal) drug type | nonselective beta-blocker |
| indicated for angina, HTN, tachycardia r/t cardiac glycoside intoxication, hypertrophic subaortic stenosis, pheochromocytoma, thyrotoxicosis, migraine | propanolol |
| bethanechol (Urecholine) drug type | direct-acting cholinergic muscarinic |
| indicated for non-obstructive urinary retention, neurogenic atony of bladder, post-op GI atony and gastric retention | bethanechol |
| drug that increases movement and relaxes sphincters to allow emptying | bethanechol |
| contraindicated in patients w/ hyperthyroidism, peptic ulcer, active bronchial asthma, cardiac disease, CAD, epilepsy, Parkinsonism | bethanechol |
| adverse effects include increased salivation, sweating, abdominal cramping, hypotension, and fainting | bethanechol |
| donepezil (Aricept) drug type | indirect-acting cholinergic- anticholinesterase |
| indicated for Parkinson's disease | donepezil |
| cholinergic given PO 1x day | donepezil |
| increases ACh by inhibiting AChE | indirect-acting cholinergics |
| major adverse effect is cholinergic crisis | indirect-acting cholinergics |
| increasing muscle weakness including respiratory muscles that may result in death; fever, visual changes, difficulty swallowing, psychomotor agitation | cholinergic crisis |
| physostigmine (Antilirium) drug type | indirect-acting cholinergic- anticholinesterase |
| indicated for diagnosis and treatment of myasthenia gravis, reversal of neuromuscular blockade, anticholinergic poisoning, and TCA overdose | physostigmine |
| pyridostigmine (Mestinon) drug type | indirect-acting cholinergic |
| indicated for treatment of symptomatic myasthenia gravis and reversal of nondepolarizing NMBAs after surgery | pyridostigmine |
| contraindicated in patients w/ hyperthyroidism, peptic ulcer, active bronchial asthma, cardiac disease, CAD, epilepsy, and bradycardia | cholinergics |
| atropine drug type | anticholinergic- antimuscarinic- cholinergic blocker |
| indicated for muscarinic overdose, organophosphate or carbomate poisoning, IBS or hypermotility of GI, bradycardia, pupil dilation for exam, reduction of secretions, saliva, and GI secretions pre-op | atropine |
| contraindicated in patients w/ narrow angle glaucoma, asthma, and liver or renal dysfunction | atropine |
| dicyclomine (Bentyl) drug type | anticholinergic- antimuscarinic |
| indicated for treatment of IBS | dicyclomine |
| tolterodine (Detrol) drug type | anticholinergic- antimuscarinic |
| indicated for urinary frequency, urgency, and urge incontinence | tolterodine |
| anticholinergic w/ lower incidence of dry mouth | tolterodine |
| contraindicated in patients w/ narrow angle glaucoma, urinary retention, and liver dysfunction | tolterodine |
| benztropine mesylate (Cogentin) drug type | synthetic anticholinergic |
| drug that resembles atropine and diphenhydramine w/ anticholinergic and antihistamine properties | benztropine mesylate |
| contraindicated in patients w/ narrow angle glaucoma, myasthenia gravis, urinary rtention, peptic ulcer disease, megacolon, prostate hypertrophy, and children under 3 yrs | benztropine mesylate |
| indicated for Parkinson's disease and extrapyramidal reactions r/t phenothiazine | benztropine mesylate |
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