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Pharm test #1
| Question | Answer |
|---|---|
| drugs which reduce nervousness, excitability and irritability w/o causing sleep | sedatives |
| drugs which cause sleep | hypnotics |
| barbiturates and benzodiazepines are considered to be... | sedative-hypnotics |
| a group of compounds that act predominantly within the CNS to relieve pain associated with skeletal muscle spasms | muscle relaxants |
| These were once the standard treatment for insomnia and sedation, but because of habit-forming tendencies and other side effects, they are rarely used | barbiturates |
| These have virtually replaced barbiturates | benzodiazepines |
| cause hepatic enzyme induction and deprive people of REM sleep | barbiturates |
| the most commonly prescribed barbiturate; used as and anti-seizure med | phenobarbital |
| mechanism of action is a CNS depressant that acts primarily on the brainstem in an area called the reticular formation; potentiate the action of the inhibitory amino acid GABA | barbiturates |
| used for the prevention of of generalized tonic clonic seizures and fever-induced convulsions; classified as a long-acting drug | phenobarbital |
| used for sedation, sleep-induction, skeletal muscle relaxation; intended for short-term use only; do not repress REM sleep; must devote 8 hours to sleep to avoid "hangover effect" | benzodiazepines |
| trade name for zolpidem (a benzodiazepine) is... | Ambien |
| one of the most commonly prescribed drugs; usually prescribed at 10 mg on Med Surg floor | Ambien (zolpidem) |
| mechanism of action - the ability to depress activity in the brain; specifically, they inhibits stimulation of the hypothalamic, thalamic and limbic systems; reduce excessive sensory activity so are used to control agitation and anxiety | benzodiazepines |
| use should be short-term (2-4 weeks) because long-term use can result in rebound insomnia and severe withdrawal | benzodiazepines |
| particularly important to teach pt about the drug-food interaction with grapefruit or grapefruit juice with these drugs | benzodiazepines |
| these drugs either depress nerve transmission in the spinal cord or enhance GABA's inhibitory effect on the spinal cord | muscle relaxants |
| it is critical to teach pt about the side effects for these drugs which include euphoria, lightheadedness, dizziness, drowsiness, fatigue and general muscle weakness | muscle relaxants |
| the generic name for Lioresal and Atrofen (muscle relaxants) is... | baclofen |
| the generic name for Flexeril (a muscle relaxant) is... | cyclobenzaprine |
| these drugs are often used for chronic disorders such as MS, cerebral lesions, CP and rheumatic disorders | muscle relaxants (baclofen, cyclobenaprine) |
| the overall effect of these drugs is that they stabilize neurons and keep them from becoming hyperexcited, which leads to the generation of excessive nerve impulses to adjacent neurons | antiepileptics (AEDs) |
| the trade name for phenytoin | Dilantin |
| What is the therapeutic level for phenytion (Dilantin)? | 10-20 mcg/mL (remember "tin" and "ten") |
| What is the therapeutic level for carbomazepine (Tegretol)? | 3-14 mcg/mL |
| carbamazepine (Tegretol) is unique because of something called auto-induction. What does this mean? | this drug increases its own metabolism; pt will need more and more to maintain therapeutic blood levels |
| this drug requires a critical pt teaching aspect because it causes gingival hypertrophy; pt must practice meticulous dental hygiene while using this medication | phenytoin (Dilantin) |
| involuntary spasmodic contractions of any or all voluntary muscles throughout the body is known as a... | convulsion |
| a brief episode of abnormal electrical activity in the nerve cells of the brain is known as a... | seizure |
| if an individual has a chronic, recurrent pattern of seizures he or she is diagnosed with... | epilepsy |
| What is the name of the common seizure disorder that is a life-threatening emergency? | status epilepticus |
| What is the prototypical benzodiazepine used to treat status epilepticus? | diazepam (Valium) |
| hypertrophy of subcutaneous facial tissue is known as... | "Dilantin facies" |
| Drugs which have a narrow difference between safe and toxic levels are known as... | NTIs or narrow therapeutic index drugs |
| Which drugs create the following side effects: can't pee, can't see, can't spit, can't sh#*? | anticholenergics |
| a chronic, progressive, degenerative disorder affecting the dopamine-producing neurons in the brain | Parkinson's Disease |
| The primary cause of PD is an imbalance in which two neurotransmitters? | too little dopamine and too much acetylcholine |
| List 4 classic Parkinsonian symptoms | bradykinesia, "cogwheel" rigidity, tremor "pin-rolling", and hesitation in gait which increases the danger of falling |
| List 3 classes of antiparkinsonian agents | selective monoamine oxidase inhibitor (MAOI), dopaminergics and anticholinergics |
| What do MAOs do? | break down catecholamines (seratonin) |
| Where are MAOs found in high concentrations in the body? | liver, kidneys, stomach, intestinal walls and in the brain |
| List 3 catecholamines | dopamine, norepinephrine and epinephrine |
| Selective MAOIs (MAO-B inhibitor) cause an increase in the levels of dopaminergic stimulation in the __________ | CNS |
| What is the "cheese effect"? | severe HTN caused by interaction of a drug with tyramine-containing foods like cheese, red wine, beer and yogurt |
| This drug causes the "cheese effect" when doses exceed 10 mg/day because it becomes a nonselective MAOI | selegiline (Eldepryl) |
| Often, interactions with MAOIs cause fatal ____________ ______________ | hypertensive episodes |
| the trade name for selegiline is __________ | Eldepryl |
| This drug is a selective MAOI | selegiline (Eldepryl) |
| This drug is a dopaminergic: which means it increases dopamine in the brain | levodopa-carbidopa (Sinemet) |
| Why can't we simply give PD patients dopamine? | Because dopamine cannot cross the blood-brain barrier; the nerve terminals that take up dopamine will take up levodopa instead and convert it into dopamine |
| Why is carbidopa combined with levodopa? | levodopa is broken down in the periphery of the body so by the time it gets to the CNS, there is very little left over; with carbidopa, while the periphery is dealing with the carbidopa, the levodopa can slip by |
| Name the anticholinergic drug we need to know | benztropine mesylate (Cogentin) |
| Too much acetylcholine can cause _______________ and _______________ | muscle tremors and rigidity |
| Anticholinergics work to block ____________ | acetylcholine |
| Anticholinergics are used as antidyskinetic agents in PD. What two symptoms of PD do anticholinergics treat? | muscle tremors and muscle rigidity |
| confusion, constipation, urinary retention and mydriasis (dilated pupils) are side effects of what class of drugs? | anticholinergics |
| What do sympathomimetic drugs do? | They are CNS stimulants that mimic the actions of the sympathetic nervous system neurotransmitters norepinephrine and epinephrine |
| What are two of the oldest known stimulants? | cocaine and amphetamines |
| Drugs which enhance the activity in the brain of one or more of the excitatory neurotransmitters are known as _________________ | CNS stimulants |
| specific CNS stimulants used to treat ADHD and narcolepsy | methylphenidate (Ritalin, Concerta) |
| CNS stimulant used to treat obesity | sibutramine (Meridia) |
| CNS stimulant used to treat migraines | sumatriptan (Imitrex) |
| How does Ritalin work? | it increases the effects of norepinephrine and dopamine in the CNS synapses by increasing their release and blocking their reuptake |
| How does Meridia work? | inhibits the reuptake primarily of norepinephrine and serotonin (and to lesser extent, dopamine) which results in reduced appetite |
| How does Imitrex work? | it is a serotonin receptor agonist; it stimulates serotonin receptors in the brain, causing vasoconstriction and a reduction in the production of inflammatory neuropeptides |
| CNS stimulants have a wide range of side effects but most important to remember is that they do what to body systems? | speed them up; increased HR and BP |
| What are some of the commonly used CNS stimulants that can have an additive effect with CNS stimulating drugs? | coffee, tea, cola and chocolate |
| taking some chemical form and turning it into something the body can use; disintegration of dosage form or dissolution of a drug | pharmaceutical phase of drug activity |
| what the body does to a drug (i.e. absorption, distribution, metabolism and excretion) | pharmacokinetics phase of drug activity |
| what the drug does to the body (drug-receptor interaction) | pharmacodynamics phase of drug activity |
| focuses on the use of drugs and the clinical indications for administering drugs to prevent and treat illnessesds; defines the principles of drug actions, the toxic effects, etc | pharmacotherapeutics phase of drug activity |
| List some of the factors which affect the rate of drug absorption | stomach acidity; food or no food, route of administration, dosage formulation, the status of the absorptive surface, the rate of blood flow to the small intestines, GI motility |
| the extent of drug absorption is referred to as its _____________ | bioavailability (example: a drug that is absorbed from the intestine must first pass through the liver before it reaches the systemic circulation) |
| What is the "first-pass effect?" | reduces the bioavailability of a drug because it must be metabolized in the liver or excreted in the bile |
| the first-pass effect occurs with _________________ | oral medications |
| If a drug is bound to a protein, it is generally too ________ to pass into tissues | large |
| the most important blood protein is _____________ | albumin |
| the biological transformation of a drug into an inactive metabolite, a more soluble compound or a more potent metabolite is referred to as ______________________ | biotransformation |
| a variety of enzymes involved in hepatic biotransformation | cytochrome P-450 enzymes |
| this antibiotic is a P-450 inhibitor, causing other drugs (i.e. birth control pills) to be less effective | Erythromycin |
| List some of the conditions which reduce the level of albumin in the bloodstream; must be careful of drug toxicity with these pts | malnourishment, liver disease, chronic renal failure, burns |
| the primary organ responsible for elimination of drugs is the __________ | kidney |
| excretion by the intestines is called ___________ excretion | biliary |
| biliary excretion is also referred to as _______________ _______________ | enterohepatic recirculation |
| the amount of a drug in the blood in between not effective enough and too high is called the ___________ ___________ | therapeutic window |
| the time it takes for the drug to elicit a therapeutic response is referred to as the _____________ | onset |
| the time it takes for a drug to reach its maximum therapeutic response is referred to as its _________ | peak |
| the time that drug concentration is sufficient to elicit a therapeutic response is the _______________ | duration |
| What are the 3 basic mechanisms of action? | receptor interaction, enzyme interaction or nonselective interaction (interfering with the cellular process) |
| drugs which help with symptoms but do not eradicate the problem are administered for __________________ | maintenance (i.e. meds for HTN or oral contraceptives) |
| drugs which supply the body with a substance needed for normal function are administered as _______________ drugs | supplemental (i.e. insulin, iron) |
| the goal of this type of drug therapy is to make the pt as comfortable as possible | palliative (i.e. high-dose opioid analgesics to releive pain in the late stages of cancer) |
| this type of drug administration maintains to integrity of body functions while the pt is recovering from illness or trauma | supportive (i.e. fluid and electrolytes to a pt with the flu) |
| this type of drug therapy is provided to prevent illness or other undesirable outcome | prophylactic (i.e. antibiotic administration before surgery) |
| this type of drug therapy does not have a scientific basis but is instead based on experience | empiric (i.e. acetaminophen is given to reduce fever; the cause of the fever may be unknown) |
| intensive drug therapy given to sustain life | acute |
| What must the RN monitor after drug therapy has been administered? | adverse effects, therapeutic index, drug concentration, pt's condition, tolerance, dependence, interactions |
| When two drugs with similar effects of given together, the result is an __________ effect | additive (1+1 = 2) |
| When an additional "good" interaction occurs it is a _______________ effect | synergistic (1+1 = 3) |
| Interactions which are considered "bad" are _____________ effects | antagonistic (both drugs are fighting for the same receptor; 1+1 = 0) |
| What does ADEs stand for? | adverse drug effects |
| What does ADRs stand for? | adverse drug reactions |
| an extension of a drug's normal effects is called a _______________ reaction | pharmacologic |
| a reaction which involves a pt's immune system is an ____________ reaction | allergic or hypersensitivity |
| a reaction which is not the result of known drug property or pt allergy but is peculiar to the pt is an ______________ reaction | idiosyncratic |
| teratogenic effects of a drug cause _____ _____ | birth defects |
| mutagenic effects cause changes in the _____ | DNA |
| carcinogenic effects cause ___________ | cancer |
| What is the gestational period of greatest danger for drug-induced developmental defects? | the 1st trimester |
| drug therapy in an elderly pt is more likely to result in adverse effects and toxicity due to ______________________ | polypharmacy, slower metabolism, reduced blood flow |
| One of the most important roles of the RN in relation to drug therapy is __________ __________ | patient (and loved ones) teaching |
| adrenergic drugs elicit "______ or _______" responses | "fight or flight" |
| Does alpha 1 stimulation cause vessel constriction or dilation? Would BP increase or decrease? | causes vessel constriction and BP would then increase |
| What happens to HR and heart contractility when beta 1 receptors are stimulated? | causes increased contractility and increased heart rate |
| stimulation of what receptor causes decreased GI motility? | beta 2 |
| a client's pupils are dilated. What receptors have been stimulated? | alpha 1 |
| stimulation of dopaminergic receptors causes renal, mesenteric, coronary and cerebral arteries to _________ | dilate |
| these drugs mimic the effects of norepinephrine, epinephrine and dopamine | adrenergic drugs |
| List some of the adverse effects of alpha-adrenergic agents | headache, restlessness, excitement, insomnia, euphoria, chest pain, vasoconstriction, HTN, tachycardia, palpitations or dysrhythmias, anorexia, dry mouth, nausea, vomiting |
| List some of the adverse effect of beta-adrenergic agents | mild tremors, headache, nervousness, dizziness, increased HR, palpitations and fluctuations in BP, sweating, nausea, vomiting,muscle cramps |
| The combination of adrenergic agents and monoamine oxidase inhibitors (MAOIs; antidepressants) can lead to life-threatening ___________ ___________ | hypertensive crisis |
| There are two additional commonly used drugs that can also increase the effects of adrenergic drugs. What are they? | antihistamines and thyroid preparations |
| What is the drug class for albuterol (Proventil, Ventolin)? | beta-adrenergic agonist (beta 2 predominant); it is a bronchodilator: relaxes the smooth muscles of the bronchioles |
| What is the drug effect and the indications for albuterol (Proventil, Ventolin)? | activates beta 2 receptors; given for asthma, bronchodilation |
| What is the drug class for epinephrine (Adrenalin)? | bronchodilator |
| What is the drug effect and indications for epinephrine (Adrenalin)? | alpha 1, beta 1 and beta 2 receptors; given for acute asthma attacks and anaphalaxis |
| What is the primary side effect for albuterol? | increased HR |
| What is the primary side effect for epinephrine? | it is vasoactive so it can increase BP |
| pseudoephedrine (Afrin)is a _________ decongestant | nasal decongestant; causes vasoconstriction in the nasal mucosa |
| What is the mechanism of action when alpha-blockers are used for migraines? | they cause vasoconstriction in the cerebrum that relieves symptoms of vascular migraines due to dilated arteries |
| What is the mechanism of action when alpha-blockers are used for postpartum bleeding? | they are used as oxytocics which increase the intensity of uterine contractions and induce local vasoconstriction |
| What is the mechanism of action when alpha-blockers are used for HTN? | they reduce peripheral vascular resistance and blood pressure by causing arterial and venous dilation |
| What is the mechanism of action when alpha-blockers are used for pheochromocytoma (a tumor that forms on the adrenal gland)? | they inhibit excitatory responses to adrenergic stimulation by noncompetitively blocking alpha-adrenergic receptors on smooth muscles and various exocrine glands |
| What is the mechanism of action when alpha-blockers are used for extravasation of vasopressors (infiltration)? | the infiltration of vasopressors leads to tissue necrosis; alpha-blockers can reverse this potent vasoconstriction and restore blood flow |
| Where are alpha-receptors primarily located? | in the arterioles |
| Where are beta 1 receptors primarily located? | heart |
| Where are beta 2 receptors primarily located? | lungs |
| What do beta-blockers do? | block adrenergic stimulation at beta-receptors |
| Nonspecific beta-blockers antagonize both beta1 and beta2 receptors, with beta2 receptors located in the _________ muscles of the _______________ and blood vessels | smooth; bronchioles |
| any drug that ends in "lol" is a(n)________-blocker | beta |
| abruptly stopping the use of beta-blockers can result in worsened ___________ | angina |
| The drug phentolamine (Regitine) is a(n)__________-blocker | alpha |
| The drug prazosin (Minipress) is a(n) _________-blocker | alpha 1 |
| The drug metoproplol (Lopressor) is a(n) __________-blocker | selective beta 1 |
| The drug propranolol (Inderal) is a(n) _________-blocker | nonspecific beta |
| phentolamine (Regitine) reduces peripheral vasculature resistance and is thus prescribed to treat _____________, ____________ and ____________ | HTN, pheochromocytoma and extravasion of vasoconstriction agents |
| prazosin (Minipress) dilates vasculature and smooth muscle and it is prescribed to treat ______ and ________ | HTN and BPH (benign prostate hypertrophy) |
| metoprolol (Lopressor) inhibits the stimulation of the myocardium by circulating catecholamines and is prescribed after a ________ __________ | myocardial infarction (MI) |
| propranolol (Inderal) is used to treat tachydysrhythmias, pheochromocytoma and _________ _________ | migraine headaches |
| The neurotransmitter responsible for nerve impulse transmission is acetycholine; the receptors that bind to acetylcholine are called _____________ | cholinergic |
| Direct-acting cholinergic agonists bind to cholinergic receptors and _____________ them | activate |
| Indirect-acting cholinergic agonists act by stimulating postsynaptic nerve cell release of acetylcholine at the receptor site, which allows acetylcholine to bind to and ___________ the receptor | stimulate |
| the effects of the parasympathetic nervous system on the body are known as the "______ and _______" effects | rest and digest |
| List some of the effects of the PNS | stimulates the intestine and bladder (increased gastric secretions and GI motility; urinary frequency) pupillary constriction (miosis), increased salivation and sweating, decreased HR amd vasodilation, constriction of the bronchi |
| What is the mechanism of action when cholinergic drugs are used for the treatment of glaucoma? | they are used topically to reduce IOP by stimulating pupil to constrict |
| What is the mechanism of action when cholinergic drugs are used for myasthenia gravis? | indirect-acting drugs work by increasing ACh concentrations at the receptor sites, stimulating the effector cells; they cause muscle contraction |
| What is the mechanism of action when cholinergic drugs are used to treat Alzheimer's disease? | they increase concentrations of ACh in the brain and thereby improve cholinergic function; they inhibit AChE increases |
| What are the symptoms of cholinergic crisis? | circulatory collapse, hypotension, bloody diarrhea, shock and cardiac arrest |
| What drug is used to treat cholinergic crisis? | atropine; a cholinergic antagonist |
| What does SLUDGE stand for? | salivation, lacrimation, urinary incontinence, diarrhea, GI cramps and emesis (side effects associated with cholinergic drugs) |
| bethanechol (Urecholine) is a direct-acting cholinergic drug used to treat _________ ___________ | urinary retention |
| bethanechol (Urecholine) stimulates cholinergic receptors on bladder smooth muscle. Under what conditions is it normally prescribed? | postoperative and postpartum; to treat urinary retention |
| donepezil (Aricept) is an indirect-acting cholinergic drug which increases the levels of ACh by blocking its breakdown. This drug is commonly used to help treat the symptoms of what disease? | Alzheimer's |
| physostigmine (Antilirium) is an indirect-acting cholinergic drug which increases ACh to improve muscle contractility by inhibiting the enzyme that breaks it down. This drug is commonly used to treat the symtoms of what disease? | myasthenia gravis |
| neostigmine (Prostigmin) is an anticholinesterase agent, which indirectly increases ______ | ACh |
| Why is physostigmine (Antilirium) given to patients with myasthenia gravis before meals? | allows for onset of action and therapeutic effects (such as decreased dysphagia |
| What drug should be on hand for pts who are taking cholinergic drugs? | Atropine; it is a potent cholinergic-blocking agent |
| anticholinergics or cholinergic-blocking drugs allow the sympathetic system to dominate, so cholinergic blockers have the same effects as ________________ | adrenergics |
| List some of the effects of cholinergic-blocking drugs | increased HR, increased BP, midriosis, bronchodilation |
| What is the mechanism of action when cholinergic blockers are used to treat the symptoms of PD? | decrease muscle rigidity and diminish tremors |
| What is the mechanism of action when cholinergic blockers are used to treat bradycardia? | at high doses, cholinergic blockers block the inhibitory vagal effects on the pacemaker cells of the SA and AV nodes, which leads to acceleration of the HR due to unopposed sympathetic activity |
| What is the mechanism of action when cholinergic blocking drugs are used for the treatment of IBS? | decreased secretions, relaxation of smooth muscles and decreased GI motility and peristalsis |
| How is atropine administered? | IV only |
| What is the primary effect of atropine? | increases HR |
| dicyclomine (Bentyl) is a synthetic antispasmodic cholinergic blocker used to treat _______ | IBS |
| tolterodine (Detrol) is used to decrease ____ activity | GU; it is used to treat overactive bladder |
| When thinking of cholinergic blockers, think of the phrase: "hot as a ______; blind as a ______; dry as a ______; and mad as a ________" to help remember the effects | hare; bat; bone; hatter |
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KCdoula200
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