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