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pharm#3test
pharmacology
| Question | Answer |
|---|---|
| two major groups of drugs used to treat psychosis? | conventional and atypical psychosis |
| of the conventional (positive symptoms) and atypical (positive and negative) antipsychotics which one has more extrapyramidal symptoms EPS | conventional |
| positive symptoms of schizophrenia | hallucinations, delusions, agitation, tension, and paranoia |
| negative symptoms of schizophrenia | low motivation, lack of speech, blunted affect, social withdrawl |
| MOA of conventional antipsychotic drugs | blocks dopamine, ACH, histamine and norepinephrine |
| how long does it take to reach therapeutic response when using antipsychotic drugs | initial 1-2 days, substantial improvement 2-4 weeks, full effects a few months |
| conventional antipsychotic drugs have anticholinergic, neuroendocrine, and sexual side effects. What can they do to BP and mental state? | cause sedation |
| What are examples of EPS-extrapyramidal symptoms? | acute dystonia, Parkinsonism, akathesia, and tardive dyskinesia |
| What is acute dystonia? | severe spasms of the muscles in the tongue, face, neck, or back |
| what class of drugs can be used to treat acute dystonia | anticholinergics |
| what is characterized by bradykinesia, mask like faces, drooling, tremor rigidity, shuffling gait, cog-wheeling, and stooped posture | Parkinsonism |
| define akathesia | pacing and squirming |
| what is tardive dyskinesia | involuntary twisting, writhing, worm like movements of the tongue |
| lead pipe rigidity, high fever, sweating, autonomic instability, dysrhythmias, and BP fluctuations | neuroleptic malignant syndrome |
| 2 examples of conventional or first generation neuroleptics | chlorpromazine(thorazine) and haloperidol(Haldol) |
| all antipsychotics can cause weight gain | true |
| do conventional or atypical antipsychotics have less EPS | atypical |
| What class of drug atypical or conventional have a greater effect on negative symptoms and cognitive dysfunction that occurs with schizophrenia | atypical |
| Why should anticholinergic agents be avoided when using low potency antipsychotics such as chlorpromazine? | they both have anticholinergic effects |
| When is clozapine contraindicated | when taking drugs that suppress bone marrow function causing agranulocytosis |
| When is clozapine used | when pts do not respond to other drug treatments |
| what lab test should be monitored when clozapine is prescribed | CBC checking for agranulocytosis |
| What is the monamine hypothesis of depression | insufficiency of norepinephrine and serotonin |
| what atypical antipsychotic is most sedating and can lead to cataracts | Quetiapine(Seroquel) aka baby heroin/quell |
| MOA of TCA-tricyclic antidepressants | blocks neuronal reuptake of norepinephrine and serotonin |
| therapeutic response to treatment of TCA's | initial 1-2 weeks, maximal 1-2 months |
| common adverse effect to TCA | sedation, anticholinergic effects, orthostatic hypertension |
| most serious adverse effect of TCA | cardiotoxicity |
| Who should not be treated with TCA | patients who have suicidal ideation---potential for OD |
| MAO inhibitors, direct and indirect acting sympathomimetics drugs, anticholinergic agents and other CNS depressants including alcohol, opiods, antihistamines, and barbiturates should be avoided while taking | TCA----tricyclic antidepressants |
| Why not give more then one week supply at a time ? | lethal dose is 8 times the average dose--narrow negative safety profile--minimize risk of death by suicide |
| anticholinergic and cardiotoxic symptoms including dysrhythmias--tachycardia, intraventricular blocks, complete heart blocks, ventricular tachycardia, and V-fib are all toxic manifestations of which agent used to treat depression | TCA |
| MOA of SSRI--selective serotonin reuptake inhibitors | inhibition of serotonin reuptake. more serotonin at synapses |
| how long does it take to achieve therapeutic effect when using fluoxtine(prozac) | about 4 weeks are required to produce steady state plasma drug levels |
| sexual dysfunction, N, headache, insomnia, anxiety, wght gain, serotonin syndrome, withdrawal syndrome and neonatal withdrawal syndrome are all AE of | SSRI---selective serotonin reuptake inhibitors |
| all SSRI can cause insomnia | true |
| SSRI blackbox warning | increases of suicidal ideation can occur with initiation of treatment |
| disorientation, agitation, confusion, anxiety, hallucinations, incoordination, myoclonus, hyperreflexia, excessive sweating and fever all symptoms of | serotonin syndrome |
| problem encountered with the concurrent use of St. John's Wort and SSRI | increase potential for serotonin syndrome---similar in action |
| Should SSRI be abruptly discontinued | NO can result in withdrawal syndrome |
| are SSRI and MAOI compatible | NO risk serotonin syndrome |
| What happens when warfin and flouxetine(Prozac) are used together | bleeding can occur.. Prozac displaces warfin from albumin molecule |
| what occurs with simultaneous use of lithium and fluoxetine (prozac) | flouxetine can elevate levels of lithium |
| NSRI that can cause HTN and has an intense withdrawal syndrome that includes anxiety, agitation, tremors, headache, vertigo, N, tachycardia, and tinnitus | Venafaine (Effexor) |
| Which NSRI has been used to treat pain such as diabetic neuropathy, can increassse BP, and can cause liver damage | Duloxetine (cymbalta) |
| MOA of monoamine oxidase inhibitors | inhibit MOA more norepinephrine and serotonin are available for release (MAO-found brain, liver, intestines) |
| Why are MAO rarely used | poor safety profile |
| AE of MAOI | anxiety, agitation, hypomania, orthostatic hypotension, HTN crisis |
| why are food high in tyramine avoided when taking MAO | tyramine is not broken down when MAO is inhibited can lead to HTN crisis |
| avocado, soybeans, figs, fermented meats, cured fish, cheeses, yeast extract, imported beer, chianti wine, protein dietary supplements are all examples of foods high in | tyramine |
| can you combine MAO with TCA and or SSRI | NO can produce HTN crisis |
| Why are sympathomimetics and MAOi incompatible | they promote the release of norepinephrine and can contribute to HTN crisis |
| alternating episodes in which mood is abnormally elevated or abnormally depressed, separated by periods in which mood is relatively normal are all clinical manifestations of | Bipolar---lol my ex-husband |
| drug of choice for bipolar | valprioc acid has replaced lithium for drug of choice |
| therapeutic plasma level of lithium | 0.8-1.4 mEq/L |
| GI upset, D, muscle weakness, thirst,, incoordination, severe hypotension, convulsions, and death AE of | lithium in excessive amounts |
| AE of lithium at therapeutic levels: GI upset, fatigue, muscle weakness, headache, polyuria, renal toxicity, goiter and.... | HYPOthyroid |
| What occurs when diuretics are used with lithium | toxicity----due to sodium loss |
| what occurs when sodium is low in patients taking lithium | toxicity |
| Why do peeps taking lithium need to stay hydrated | lithium promotes polyuria by antagonizing the effects of ADH |
| Why is diarrhea a problem with lithium | dehydration and low sodium= increase lithium levels |
| is it advisable for pregnant women to take lithium | NO Category D |
| MAO of BZD--benzodiazepines | potentiates the action of GABA, an inhibitory neurotransmitter |
| therapeutic uses of BZD | anxiety, insomnia, and seizure disorder |
| AE of BZD | CNS and Respiratory depression, anterograde amnesia, and abuse |
| agents to avoid while taking BZD | CNS depressants, alcohol, barbiturates, and opioids |
| can BZD leaad to physical dependance | yes |
| manifestations of oral BZD overdose | drowsiness and lethargic |
| which BZD increased potential for developing dependance | xanax (alprazolam) |
| name of the reversal agent used to treat BZD overdose | flumazenil(Romazicon) |
| advise to a pregnant mother with regards to BZD | NO category D and X |
| side effects of barbiturates | CNS depression and cardiovascular effects decreased BP and HR |
| what happens when barbiturates stimulate synthesis of hepatic microsomal enzymes | they accelerate their metabolism and that of many other drugs |
| what type of agent is ambiem | sedative hypnotic agent |
| warning is now given to patients taking agents similar to zolpidem (Ambien) | unusual activity such as driving, sleep walking, and eating (not remembering) |
| principal drugs used to treat panic disorder | SSRI and BZD |
| SE of BZD | sedation, physical dependance, and withdrawal syndrome |
| TCA approved to treat OCD--Obsessive-compulsive disorder | Clomipramine |
| Buspirone (Buspar) is used to treat | anxiety-----NOT panic disorder |
| atypical antidepressant wellbutrin(bupropion) is used for smoking cessation. It is contraindicated in seizure disorder because it _____the seizure threshold | increases |
| Ritalin(methylphenidate is used to treat AHDH can cause weight | loss |
| drugs used to treat ADHD are schedule_____. refills are not permitted.PAtients must have a hard prescription copy each month. | II |
| BMI of 28 is | overweight------kg x meters=BMI |
| primary pathophysiology of Parkinson | degeneration of neurons=imbalance of dopamine and ACH |
| when extrapyramidal function is disrupted, disorders of movement can result---called | dyskinesia |
| drugs used to treat parkinson such as levodopa______dopamine | increase |
| Major side effect of levodopa | N, V, dyskinesia, hypotension, dysrhythmias, and psychosis |
| How long before seeing a full therapeutic effect upon initiating levodopa | may take several months |
| cardiovascular effects of levodopa | postural hypotension and dysrhythmias |
| visual hallucinations, vivd dreams, night mares, and paranoid ideation are all major SE of which therapeutic agent that treats PD | Levadopa |
| which drug used to treat PD can lighten sweat and urine and activate malignant melanoma | levadopa darkens urine and sweat and activates malignant melanoma |
| high protein___________ absorption of levadopa | absorption declines |
| central acting anticholinergic drugs used in PD block muscarinic receptors to __________ACH | decrease. symptoms of PD are improved when ACH is blocked |
| how does decreased amounts of ACH improve symptoms in PD | restore balance between ACH and dopamine |
| goal of pharmacologic therapy in treating PD | to balance cholinergic and dopaminergic activity in brain |
| Alzheimers disease (AD) have reduced cholinergic transmission and _______ levels of acetylcholine | decreased. levels of ACH are found to be diminished in AD |
| ny blocking the enzyme that breaks down ACH, cholinesterase inhibitors used to treat AD________the availability of ACH at cholinergic synapses | increase...... cholinesterase inhibitors are recommended for AD |
| why would a pt with AD taking a cholinesterase inhibitor be advised not to take an antihistmine for cold symptom relief | anticholinergic effects negate the effect of the AD drug |
| Tacrine(Cognex), donepezil(ARICEPT) RIVASTIGMINE (EXELON), GALANTAMINE (RAZADYNE FORMERLY CALLED REMINYL) ARE DRUGS TO TREAT AD. ALL INCREASE LEVELS OF ACH AND ARE KNOWN AS | CHOLINESTERASE INHIBITORS |
| WHICH DRUG USED TO TREAT AD CAN ELEVATE ALT | TACRINE (COGNEX) HAS BEEN ASSOCIATED WITH LIVER FAILURE |
| PROVEN RISK FACTORS FOR AD | FAMILY HISTORY AND AGE-----ARE ONLY PROVEN |
| MEMANTINE(NAMENDA) MODULATES THE EFFECTS OF AN EXCITATORY TRANSMITTER(GLUTAMATE) AT THE NMDA RECEPTOR WHICH ARE IMPORTANT FOR MEMORY AND LEARNING. IT IS A NEWER AGENT USED TO TREAT | MODERATE TO SEVERE AD |
| A SEIZURE THAT BEGINS FOCALLY IN THE CEREBRAL CORTEX AND UNDERGOES LIMITED SPREAD TO ADJACENT CORTICAL AREAS IS KNOWN AS A ________________SEIZURE | PARTIAL SEIZURE |
| SEIZURE IN WHICH THE ACTIVITY IS CONDUCTED THROUGHOUT BOTH HEMISPHERES IS KNOWN AS A | GENERALIZED SEIZURE |
| DRUGS THAT SUPPRESS THE DISCHARGE OF NEURONS WITHIN A SEIZURE FOCUS AND SUPPRESS PROPAGATION OF SEIZURE ACTIVITY FROM THE FOCUS AREAS OF THE BRAIN ARE CALLED | ANTIEPILEPTIC DRUGS ------AEDS |
| WHAT ARE THE 4 BASIC MECHANISMS BY WHICH AEDS CONTROL SEIZURE ACTIVITY | SUPPRESSION OF NA, CA INFLUX, BLOCKADE OF GLUTAMATE AND POTENTIATION OF GABA |
| RECOMMENDED THERAPEUTIC SERUM CONCENTRATION OF PHENYTOIN (DILANTIN) | 10-20MCG/ML |
| DESCRIBE THE CNS EFFECTS OF EXCESSIVE DOSAGE OF DILANTIN | NYSTAGMUS, SEDATION, ATAXIA, DIPLOPIA, AND COGNITIVE IMPAIRMENT |
| MAJOR AE OF DILANTIN | GINGIVAL HYPERPLASIA, SKIN RASH, DYSRHYTHMIAS, AND HYPOTENSION |
| AE OF USING DILANTIN DURING PREGNANCY | CLEFT PALATE, HRT MALFORMATIONS, AND FETAL HYDANTOIN SYNDROME |
| GROWTH DEFICIENCY, MOTOR OR MENTAL DEFICIENCY, MICROCEPHALY, CRANIOFACIAL DISORDER, POSITIONAL DEFORMITIES OF THE LIMB, HYPOPLASIA OF THE NAILS AND FINGERS AND IMPAIRED NEURODEVELOPMENT ARE ALL FEATURES OF | FETAL HYDANTOIN SYNDROME---- WHILE USING AEDS |
| PHENYTOIN (DILANTIN) CAN _________THE SYNTHESIS OF VITAMIN K DEPENDANT CLOTTING FACTORS IN THE NEWBORN | DECREASE.... VITAMIN K GIVEN AT TERM |
| HOW IS IV PHENYTOIN ADMINISTERED | SLOWLY DILUTE WITH SALINE NO MORE THEN 50MG/MIN TO AVOID CV COLLAPSE |
| HOW MANY MG/MIN OF PHENYTOIN CAN BE ADMINISTERED | 50MG/MIN |
| SEDATION, R-DEPRESS, EXAB OF INTERMITTANT PORPHYRIA, PHYSICAL DEPENDANCE AND INTERFERENCE WITH METABOLISM OF VIT D ARE ALL MAJOR SE FROM WHICH AED USED TO TREAT SEIZURES | PHENOBARBITAL |
| CNS SYMPTOMS (NYSTAGMUS AND ATAXIA), ANEMIA, LEUKOPENIA, THROMBOCYTOPENIA, AND BIRTH DEFECTS ARE ALL MAJOR SE OF WHICH AED | CARBAMAZEPINE. MONITOR CBC WHILE ON AED---ANTI-EPILEPTIC DRUGS |
| lab test that should be closely monitored using carbamazepine | CBC, leukopenia, thrombocytopenia, anemia |
| AE of valporic acid(Depakote) | LFT--AST ALT |
| is the combination of AEDs and chronic use of alcohol a problem | alcohol can decrease plasma levels of AEDs |
| signs of liver injury would you describe in teaching your pt about AE of valproic acid | reduce appetite, malaise, N, abdominal pain and jaundice |
| what is the drug of choice for absence seizure | Ethosuximide(zarontin) |
| is it necessary to withdrawal AEDs gradually | YES. else can cause seizure activity and possible epilepticus |
| _____________is a rare life threatening syndrome that can be triggered by and general anesthetic agent and by succinylcholine (neuroblocking agent) | malignant hyperthermia |
| muscle rigidity and profound elevation in temperature are prominent symptoms of | malignant hyperthermia |
| dantrolene | agent of choice for treating malignant hyperthermia |
| AE from centrally acting muscle relaxants | CNS depression, drowsiness, dizziness, weakness and fatigue |
| consequence of prolong use of dantrolene | fatal liver damage |
| the difference between opioids and narcotics---opioids apply to compounds present in opium. narcotics on the other hand not only include opioids but drugs such as | cocaine, marijuana, and LSD |
| analgesia, R depression, euphoria, and sedation are all effects from the activation of what receptors? | Mu receptors |
| R depression, constipation, orthostatic hypotension, urinary retention, cough suppression and biliary colic are all adverse effects of what | opioid agonist |
| AE effects of opioid agonist | emesis, increased ICP, euphoria, dysphoria, sedation, miosis, neurotoxicity |
| nausea is a common SE of morphine. what measures may help alleviate the Nausea | temporary SE and can be lessened by staying still |
| WHy is meperidine(Demoral) used in pt who had biliary surgery rather then morphine for pain relief | morphine can induce spasm of the common bile duct and intensify pain |
| Why is meperidine (Demoral) not widely used in pt who had biliary surgery | because of it toxic metabolite |
| what effects does opioids have on pt with ICP | decreased R rate can lead to build up of CO2=brain edema |
| demerol is not recommended for pt with cancer pain because of it short half life and | toxic metabolite |
| why are opioids given on a fixed schedule | to prevent pain before it returns, sparing the pt of needless discomfort |
| advantage of PCA pump | provides protection against pain reoccurrence AND therapeutic levels stay with therapeutic range |
| Which class of drugs used with opioids can exacerbate opioid induced constipation and urine retention | drugs with anticholinergic effects(antihistamines, TCAs and antipsychotics) |
| why is acetaminophen used in pts with thrombocytopenia | does not effect platelets and will not cause bleeding |
| what happens when acetaminophen and alcohol are combined | can result in potentially fatal liver damage |
| explain what happens when a partial opioid agonist such as pentazocine (Talwin) is given to an individual that is dependent on morphine | withdrawal symptoms can occur since the weaker agent occupies the receptor site |
| what type of headache is characterized by a neurovascular disorder that involves vasodilatation and inflammation of intracranial blood vessels | migraines |
| medication overuse headache (MOH) or rebound headache is the result of over use of medications for headaches. patients using abortive therapy more then 2-3 times a week should be considered for____________treatment | Prophylactic treatment with beta adrenergic antagonist |
| increased plasma levels of CGRP__________migraines | promote |
| what is the syndrome of toxicity of ergot alkaloids characterized by constriction of peripheral arteries and arterioles in which extremities become cold, pale, and numb, muscle pain develops and gangrene may result | ergotism |
| can ergotamine cause physical dependance | YES |
| is is advisable in pregnancy (ergotamine) | NO category X |
| which agent used to treat migraines release inflammatory neuropeptides that diminish perivascular inflammation and cause vasoconstriction by binding to 5-HT 1B/1D receptors | serotonin 1B1D-receptor agonist aka triptans |
| Triptans cause vasoconstriction and decrease perivascular inflammation | TRUE |
| an overwhelming feeling of tightness and heavy sensation in the chest is a common SE of which agent used to treat migraines | triptans |
| is it advisable to use triptan with an ergot alkaloid or MAOI | NO MAOI can suppress degradation of sumatriptan, increasing plasma levels |
| the following: stress, fatigue, alcohol, and tyramine rich foods are common for migraine | triggers |
| can pt with heart disease or cardiovascular risk factors take triptans | NO most severe AE of triptans are vasospams |
| what is the problem with combination SSRI and triptans | serotonin can result due to excess seronergic activity |
| can triptans be used in pregnancy | triptans should be avoided during pregnancy |
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