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Pharm midterm 330
| Question | Answer |
|---|---|
| types of barrier defenses (4) | ★skin: 1rst defense ★mucus membranes: line areas exposed to external but have no skin ★gastric acid ★major histocompatibility complex: self vs. others |
| types of cellular defenses | MONONUCLEAR PHAGOCYTE SYSTEM (MPS): ★Thymus gland ★Lymphatic tissue ★leukocytes ★lymphocytes ★chemical mediators |
| Types of lymphoid tissues | Lymph nodes Spleen ★Thymus gland: decreases with age ★Bone marrow: makes WBC ★Lymphoid tissue in GI and Respt. |
| The inflammatory response: Hageman Factor | ★factor XII activated by cell injury ★Kinin system: clotting cascade ★Bradykinin: local vasodilation, WBC to tissues, pain |
| The inflammatory response: Histamine release | ★Locally mediated ★Vasodilation ★Capillary permeability altered to allow NEUTROPHILS in ★pain perception |
| The inflammatory response: Chemotaxis | ★activated by arachnadoic acid ★attracts neutrophils ★cellular breakdown and death ★RA, SLE ---> uncontrolled immune response |
| Clinical signs of inflammation | ★Calor/ heat ★Tumor/swelling ★Rubor/redness ★Dolor/pain ★Pyrogen/fever |
| Specific immune response: T-cells | ★Thymus ★Cytotoxic t-cells ★cell mediated immunity |
| Specific immune response: Types of T-cells | ★Cytotoxic T-cells ★helper t-cells ★suppressor T-cells |
| Specific immune response: B-cells | ★ID specific proteins or antigens ★humoral immunity ★antibodies or antigens |
| Other mediators in the immune response | ★Interferons-viral replication and tumor growth ★Interleukins: chemical signals to influence other leukocytes ★Tumor Necrosis Factor: released by macrophages |
| How do ASA and NSAIDs work? | ★Block Cox pathways so don't make prostoglandins: reduce inflammation |
| Asprin: NOT FOR: | ★Liver and renal dysfunction ★Surgery within a week (Asprin) ★Children under 16 (Reyes Syndrome!) ★Bleeding abnormalites |
| SE of Asprin: | ★★Tinnitis★★ ☹GI problems☹ ★Epigastric pain ★Heartburn ★Fecal Occult Blood (GI bleeding) |
| Asprin is FOR: | ★Antipyretic ★Decreases platelet aggregation and clotting ★analgesic ★Inflammatory conditions (RA, OA) |
| Names of common Salicylates:(8) | ★★★Asprin★★★★ ★Balsalazide: ulcerative colitis ★Trilisate ★Arthropan ★Melasamine: inflammation of L. Intest. ★Dipentam (converted to Melasamine in colon) ★Salsalate ★Rexolate: acute gout and muscle pain, rhematic fever |
| NSAIDs: how do they work? | ★Also block COX pathways ★prevents prostaglandin formation |
| What do NSAIDs do? | ★antipyretc ★antiinflammation ★anticoagulant |
| What not to use NSAIDs with: | Are a salt so screws with osmolarity ★Beta-blockers ★loop diuretics ★lithium |
| CONTRAIND for NSAIDs | ★Pg and lct ★renal and liver ★bleeding disorders ★Hypertension and CD: COX2 inhibitors ---> greater cardiac tox ★Peptic ulcer disease |
| How does acetomenophen work? | ★NOT on COX pathway ★Also blocks prostaglandin ★thermoregulatory cells of hypothalamus |
| What is acetomenophen for? | ★pain and fever ★flu ★prophylaxis DPT shot in kids ★arthritis |
| What is the main problem with tylenol? | ★★ACCIDENTAL OVERDOSE★★ in lots of stuff (ie nyquil etc) inadvertant poisoning very common |
| SE of acetomenophen: | ★renal dysfunction ★liver toxicity ★skin rash |
| Nursing interventions for acetomenophen: | ★warn parents about reading labels ★write down chemical name ★baseline therapy |
| What's the difference between RA and OA? | OA: painful, but not grossly disfiguring RA: autoimmune, actual joint destruction, debilitating and disfiguring, juvenille and adult |
| What are gold compounds used for? | ★treat RA ★Reduce "confused fighting" ★eliminate macrophage |
| NOT FOR gold compounds: | ★Congestive heart failure ★Diabetes ★Liver and kidneys |
| Drug interactions for GOLD compounds: | ★Penicillimade ★Antimalarials ★Cytotoxic drugs ★Immunosuppressives |
| Interferons: | ★Hep C ★Hairy Cell Leukemia ★Aids related Karposy Sarcoma ★are naturally released from cells in re viral invasion |
| Interferons are immune _____ and suppress ______. | a. stimulators b. tumor growth |
| Interleukins are chemical ____. They activate _____and suppress _____. | a. signalers, b. activate cellular immunity c. tumor growth |
| Interferons cause ____ symptoms due to the ______.Interleukins can cause an even stronger _____leading to potential _____. | a. flu like b. downstream cascade effect/cytokine rush c.cascade effect d. metabolic disorders, shock or cardiac toxicity. |
| Interferons should not be used with patients with: | ★cardiac disease ★myelosuppresion ★central nervous system disorders |
| Interleukins are used with: | renal carcinomas |
| Interleukins have severe SE such as: | ★myalgia ★lethargy ★arthalgia ★fatigue ★fever ★respiratory difficulties |
| T and B cell suppressors are used primarily for: | Transplant patients. |
| The most important thing to know about T and B cell suppressors is that: | They place the patient at a high risk for infection! ★Also watch for 'opportunistic'infections such as fungal infections |
| The main SE of T and B cell immunosuppressants are: | ★increased risk for infection ★hepatotoxicity ★renal dysfunction ★pulmonary edema ★increased risk of 2nd malignancies |
| The prototype for T and B cell suppressors is: | ★★CYCLOSPORINE★★ used mainly for transplant patients also RA and psoriasis |
| Other notable T and B cell suppressors: | ★Azathioprine (Imuran): renal hemotransplants, RA ★Glatiramer acetate(Copaxone): reduction of # of relapses in MS in adults ★Mycophonlate mofetil (Cellcept): renal or heart transplants |
| most common SE of T and B cell immunosuppresants: | ★pulmonary edema ★acne ★headaches ★GI upset ★hypertension ★Bone Marrow suppression |
| Most common interleukin receptor antagonist: | ★ANAKINRA (kineret) used for RA BLOCKS (antagonist) interleukin 1 |
| Antitumor antibiotics are all ____.Therefore they are commonly given using ____ instead of peripheral lines. | a.Vesicants. b. central lines |
| When giving antitumor antibiotics it is important to monitor for ____ because _____ can occur if they infiltrate. | a. extravasation B.tissue necrosis |
| Antitumor antibiotics work by: | binding with DNA to inhibit DNA/RNA synthesis |
| The three types of antitumor antibiotics that we care about here are: | ★Bleomycin ★Mitomycin ★Doxorubicin (Adriamycin) |
| Which antitumor antibiotic will turn urine RED after administration? | Doxorubicin (Adriamycin) |
| Which antitumor antibiotic can be given intracavity to stop the re-accumulation of fluid in pleural space of pts with malignant pleural effusion? | Bleomycin |
| Which two antitumor antibiotics are both indicated for breast and stomach cancer? | Doxorubicin and Mitomycin |
| What is Bleomycin indicated for? | ★Breast ★Cervical, vulvar and testicular ★Malignant pleural effusion ★squamous cell cancer of head and neck ★NHL ★HD ★Melanoma |
| What are the unique SE of Doxorubicin? | ★Red urine ★rapid hair loss immediately following therapy ★cardiac toxicity ★photosensitivity ★possible flare reaction after EBRT |
| Which diagnostic test(s) have to be performed before Doxorubicin is given? | Cardiac ejection fraction: possible cardiac toxicity |
| Which diagnostic test(s) much be performed before Bleomycin is given? | Pulmonary function tests. Test dose for lymphoma patients. |
| What are the important nursing considerations for Doxorubicin? | ★Warn about redness of urine ★Warn about immediate hair loss-suggest hair cut or wig store ★Monitor CBC ★Monitor for flare rxn/radiation recall |
| What are important nursing considerations for Bleomycin? | ★Alert the pt that sunscreen needs to be worn at all times outdoors ★Avoid direct exposure to sun (photosensitivity!) |
| What are the unique side effects of Bleomycin? | ☆Hyperpigmentation ✭hypersensitivity ✭photosensitivity ✭renal and hepatic tox ✭pulmonary fibrosis |
| What are the unique SE of Mitomycin? | ✭Anorexica ✭mucositis ✭renal and pulmonary tox |
| What are the common side effects to all three antitumor antibiotics? | ✭alopecia (only more immediate with Adria) ✭myelosuppression ✭N & V |
| Which antimetabolites work by inhibiting DNA repair? | 5FU, Methotrexate, Gemcitabine |
| Why is leukovorin given with 5FU? | Increase the effectiveness of 5FU (Fluororacil) |
| Why is leukovorin given with Methotrexate? | To prevent deadly toxicity |
| What are the nursing considerations with 5FU? | ✭Sunscreen outdoors at all times, avoid direct sun exposure ✭Ice chips 10-15 min before bolus admin to decrease mucositis |
| What are the unique SE of 5FU? | ✭Increased lacrimation ✭photosensitivity ✭darkening of skin pigmenation ✭Darkening of veins ✭cardiac tox (rarely) ✭dry skin |
| What are indications for 5FU? | ✭Colorectal ✭breast ✭head and neck ✭pancreatic ✭stomach & esophageal |
| What are the unique SE of methotrexate? | ✭oral and GI ulceration ✭photosensitivity ✭liver toxicity ✭neurotox with high doses ✭✭acute pneumonitis |
| What are the nursing considerations for methotrexate? | ✭Monitor CBC and LFTs ✭high doses must be followed with leukovorin to prevent deadly toxicity ✭vigorous hydration ✭Monitor serum methotrexate levels ✭Urine pH must be greater then or equal to 7 ✭ORAL CARE ✭NO multivitamins with FOLIC ACID |
| What are the contraindications for methotrexate? | ✭acites ✭pleural or pericardial effusions--drug can accumulate in the fluids and increase tox |
| What are the indications for methotrexate? | ✭Leukemia ✭HD ✭NHL ✭CNS metastasis ✭lung ✭breast ✭head and neck ✭osteogenic sarcoma ✭gestational trophoblastic tumors |
| What are the indications for Gemcitabine? | ✭Pancreatic ✭breast ✭ovarian ✭NSCLC |
| What are the unique SE of Gemcitabine? | ✭flu-like symptoms ✭rash ✭anemia |
| What are the nursing considerations for Gemcitabine? | ✭monitor CBC ✭skin care |
| Which antimetabolites work by inhibiting enzyme production for DNA synthesis leading to strand breaks or premature chain termination? | Capecitabine |
| Which antimetabolites can be taken PO? | Methotrexate, Capecitabine |
| What is Capecitabine given for? | ✭breast ✭metastatic colon |
| What are the unique SE of Capecitabine? | ✭Palmar-plantar erythrodsethesia ✭mucositis ✭increased bilirubin ✭Diarrhea |
| What are the nursing considerations for capecitabine? | ✭Increased effect of coumadin ✭monitor INR and PT ✭Give with FOOD and WATER ✭Oral care ✭Monitor LFTs and CBC |
| Which antimetabolites work by disrupting folate dependant metabolic processes essential for cell repair? | Pemetrexed |
| What is pemetrexed given for? | ✭Malignant pleural mesothelioma ✭NSCLC |
| What are the unique SE of pemetrexed? | Renal and liver tox |
| What are the nursing considerations for pemetrexed? | ✭Give with folic acid B12 injections to decrease hematologic and GI tox ✭Dexamethasone decreases skin rash ✭Monitor CBC, SCr and LFTs ✭Avoid Ibuprofin--increases renal tox. |
| What are the SE common to all the antimetabolites? | ✭N/V ✭Mylosuppression ✭GI discomfort ✭fatigue |
| How do the alkylating agents work? | Break DNA helix strand, interfere with DNA replication |
| Which alkylating agents have pulmonary fibrosis as a common SE? | Chlorambucil and Oxaliplatin |
| Of the alyklating agents, which is the strongest vesicant? | Cisplatin |
| Which of the alkylating agents can be given PO? | Chlorambucil and cyclophosphamide |
| What are the indications for chlorambucil? | ✭✭Leukemia- most common ✭HD ✭NHL |
| What are the unique SE for chlorambucil? | ✭ovarian and sperm suppression ✭2ndary malignancy ✭hyperuricemia ✭pulmonary fibrosis ✭seizures |
| What are the nursing considerations for chlorambucil? | ✭CBC |
| What are the contraindiactions for chlorambucil? | known seizure disorder ✭barbituates may increase toxicity |
| What should be given with cisplatin to prevent irreversible renal tublar damage? | Amifostine--cytoprotective agent |
| What are the SCr levels that must be maintained with cisplatin? | Less than 1.5 mg/dL |
| What are the unique SE of cisplatin? | ✭SEVERE NEPHROTOXICITY ✭Severe acute and delayed N/V ✭dose-limiting mylosuppression ✭ototoxicity ✭neurotoxcity ✭hyperurecemia ✭hypersensitivity rxn ✭hypomagnemesia ✭peripheral neuropathy |
| What are the nursing considerations for cisplatin? | ✭CBC and renal function ✭Strict I&O ✭premedicate with antiemetic ✭aggressive hydration ✭mannitol for osmotic diuresis and prevention of renal tubular damage ✭monitor BUN and SCr |
| What is cisplatin used for? | ✭✭most commonly used for solid tumors ✭ovarian, testicular, cervical ✭breast ✭prostate ✭Wilms tumor ✭head and neck ✭brain ✭leukemia ✭bladder |
| What is carboplatin used for? | Ovarian cancer |
| What are the unique SE of carboplatin? | ✭thromocytopenia ✭neutropenia (more pronounced w/ compromised renal fxn) ✭skin rash ✭hypersensititivy (usually after 7th dose) |
| What are the nursing considerations specific to carboplatin? | ✭Must have SCr to calculate appropriate dose ✭less renal tox then Cisplatin, so less hydration and diuretic therapy ✭Emergency meds on hand-hypersensitivity rx usually occurs after SEVENTH dose |
| What is Oxaliplatin used for? | Colorectal cancer |
| What are the SE unique to oxaliplatin? | ✭anaphalactic rx ✭neurotox AGGRAVATED by COLD TEMP ✭pulmonary fibrosis ✭N/V ✭mylosuppression |
| What are the nursing considerations unique to oxaliplatin? | ✭CBC and renal ✭monitor for neural tox ✭AVOID COLD for 3-4 days ✭admin with D5W solution only ✭premedicate with antiemetics |
| What drug should always be given with Ifosfamide? | MESNEX-cytoprotective agent to prevent hemorrhagic cystitis |
| What is ifosfamide used for? | ✭testicular ✭breast ✭head and neck ✭NHL ✭pancreatic ✭sarcomas |
| What are the unique SE of ifosfamide? | ✭✭Hemorrhagic cystitis ✭neurotoxic: somnolence, confusion, hallucinations, encephalopathy, depressive psychosis |
| What are the nursing considerations for ifosfamide? | ✭Monitor CBC ✭Strict I&O ✭hydration ✭Neuro assessment ✭safety and falls precautions |
| What is cyclophosphamide used for? | ✭breast ✭ovarian ✭multiple mylenoma ✭lymphona ✭neuroblastoma ✭retinoblastoma ✭mycosis fungoides |
| What are the unique SE of cyclophosphamide? | ✭high doses: cardiomyopathy ✭dose-limiting mylosuppression ✭2ndary malignancy (leukemia, MDS) ✭Testicular and ovarian failure |
| What are the nursing considerations for cyclophosphamide? | ✭CBC ✭hydration (2-3 L per day) ✭Mesna may be given to prevent hemorrhagic cystitis ✭Empty bladder frequently and before bed |
| How do the mitotic inhibitors work? | Inhibit mitosis |
| What is essential to know about vincristine that is unique to it among the mitotic inhibitors? | It is LETHAL if administered INTRATHECALLY. |
| What are the three mitotic inhibitors that we care about? | ✭Docetaxel (Taxotere) ✭Paclitaxel (Taxol) ✭Vincristine (Oncovin) |
| What are the common SE to all the mitotic inhibitors? | ✭N/V ✭Alopecia ✭Hypersensitivity (less so with vincristine bc synthetic) ✭myelosuppression |
| What are the common nursing actions that should be done for all the mitotic inhibitors? | ✭Monitor CBC ✭Premedicate with antiemetic and antihistimine to prevent rxn |
| What is docetaxel used for? | ✭Breast ✭NSCLC ✭prostate ✭gastric cancers |
| What is paclitaxel used for? | ✭Metastatic breast ✭ovarian ✭head and neck ✭NSCLC ✭AIDS related Karposi sarcoma |
| What is Vincristine used for? | ✭ALL ✭HD ✭NHL ✭CML ✭sarcoma ✭Breast ✭SCLC ✭Wilms tumor ✭neuroblastoma |
| What are the unique SE of docetaxel? | ✭Hypersensitivity ✭Skin and nail changes ✭neurotoxicity ✭mucositis |
| What are the unique SE of paclitaxel? | ✭Hypersensitivity ✭facial flushing ✭Cardiac arrhythmias |
| What are the unique SE of Vincristine? | ✭peripheral neuropathies ✭constipation ✭paralytic ileus ✭foot drop ✭jaw pain (neuro symptoms more pronounced for children) |
| What are the nursing actions that should be performed when giving Vincristine? | ✭Stool softeners for constipation ✭Monitor neuro status prior to each dose |
| What are the nursing considerations for docetaxel? | ✭Monitor CBC ✭I&O ✭premedicate ✭GLASS bottles or NON-PVC tubing |
| What are the nursing actions for paclitaxel? | ✭premedicate ✭Monitor CBC ✭Monitor cardiac fxn (possible arrhythmias) ✭Glass bottles, non-pvc tubing, micron filter ✭ |
| What are all the chemotherapy drugs used for breast cancer?(12) | ✭Doxorubicin ✭Mitomycin ✭Docetaxel ✭Paclitaxel (metastatic) ✭Vincristine ✭Cyclophosphamide ✭Ifosphamide ✭Cisplatin ✭5FU ✭Methotrexate ✭Gemcitabine ✭Capecitabine |
| What are all the chemotherapy drugs used for colon/colorectal cancers?(4) | ✭Mitomycin ✭5FU ✭Capecitabine (metastatic) ✭Oxaliplatin |
| Which chemotherapy drugs are used for head and neck cancers? (6) | ✭5FU ✭Methotrexate ✭Cisplatin ✭Ifosphamide ✭Bleomycin (squamous cell) ✭Mitomycin |
| Which chemotherapy drugs are used for ovarian/gyn cancers? (6) | ✭Bleomycin (cervical and vulvar) ✭Doxorubicin (ovarian) ✭Gemcitabine ✭Cisplatin (ovarian and cervical) ✭Carboplatin ✭Cyclophosphamide |
| Which drugs are used for testicular/prostate cancers? | ✭Ifosphamide (test) ✭Cisplatin (test. and prostate) ✭Doxorubicin (prostate) ✭Bleomycin (testicular) ✭ |
| Which drugs are used for NHL? | ✭Bleomycin ✭Methotrexate ✭Chlorambucil ✭Ifosphamide |
| What are the SE of hormone modulators? | ✭increased risk of CV disease ✭increased risk of DVT ✭Hypercalcemia--osteoporosis |
| What is the prototype for hormone therapy/hormone modulators? | Tamoxifen |
| What is tamoxifen used for? | post menopausal women with breast cancer where tumor cells express estrogen and progest. |
| How long is it recommended to take tamoxifen for? | 5 years |
| Which class is the most frequently used anxiolytic? | Benzodiazepines |
| Which systems are acted on by benzos? | RAS and GABA: sleep-wake cycle and muscle tone |
| What are the indications for use of benzodiazepines? | ✭Anxiety disorders ✭Seizure disorders ✭alcohol withdrawal ✭Hyperexcitability and agitation ✭insomnia ✭preop tension and anxiety ✭conscious sedation ✭pre-IV anesthetics ✭skeletal muscle relaxation-pain/strain ✭ideopathic muscle spasm |
| Which benzodiazepines can be used for emeregency tx of status epilepticus? | ✭Lorazepam (Ativan) ✭Valium |
| What is the prototype for benzos? | Dizaepam (valium) |
| What are the common SE of benzos? | ✭Nervous system effects: sedation ataxia blurred vision ✭GI effects constipation, dry mouth ✭increased liver enzymes ✭Hypo/hypertension ✭arrhythmias ✭palpitation ✭blood dyscrasias & anemia ✭GU loss of libido, urinary r |
| What should you tell your pt about taking benzos? | Do not stop abruptly. |
| _______ are genetically predisposed to delayed metabolism of benzos: can lead to toxicity/OD | African-Americans |
| Which drug is used as an antidote to Benzodiazepines? | Flumazenil reverses sedation caused by benzos for general anesthesia or diagnostic tests. Also used for OD |
| What effect does alcohol have on benzodiazepines? | Increases CNS depression. can cause respiratory problems |
| What are the drugs which increase in effect when given with benzos? | ✭Cimetadine ✭Oral Contraceptives ✭Disulfiram |
| What are the drugs which decrease in effect when given with benzos? | ✭Theophylline ✭Ranitidine |
| What are the contraindications for benzodiazepams? | ✭Psychosis ✭Acute narrow angle glaucoma ✭Shock ✭Coma ✭Acute alcohol intoxication ✭Anticonvulsant meds ✭pg&lct ✭elderly/debilitated ✭renal/hepatic dysfxn |
| How do barbituates work? | ✭CNS depressants ✭Also work on RAS (like benzos) ✭alter cerebellar fxn ✭depress motor output--SAFETY/fall risk |
| What aspect of barbituates reduced their usage as an anxiolytic/hypnotic? | Risk of physical dependence and more severe SE development of tolerance and physical dependence is common after long term use |
| What drugs interact with barbituates? | ✭Alcohol ✭antihistamines ✭tranquilizers ✭phenytoin ✭MAOIs ✭✭Oral anticoagulants ✭✭Digoxin ✭TCAs ✭Corticosteroids ✭✭Oral BC ✭Estrogens ✭Acetomenophen ✭Beta blockers ✭Griseofulvin ✭Quinidine ✭Doxycycline |
| What are the contraindications for barbituates? | ✭Previous hx of addition ✭Porphyria ✭pg&lct ✭seizure disorders ✭Chronic hepatic, respiratory or cardiac disease ✭nephritis ✭Acute/chronic pain |
| What are the most common SE of barbituates? | ✭Sedation ✭Ataxia ✭Epigastric pain ✭Bradycardia ✭Hypotension (IV administration) ✭Syncope ✭Hypoventilation ✭Larygospasm ✭Respiratory depression ✭✭hypersensitvity: SJS Rash Serum sickness |
| What are barbituates used for? | ✭Anxiety ✭Sedation ✭Pre-anesthesia ✭Seizures ✭Acute manic rxns |
| What is the prototype drug for barbituates? What is it used for? | ✭phenobarbitol ✭used for status epilepticus emergent situations ✭anxiety |
| What is chloral hydrate used for? | ✭nocturnal sedation ✭pre-op sedation |
| What is dexmedetomidine used for? | newly intubated and ventilated patients, in ICU |
| What are diphenydramine and promethazine? what are they used for? | ✭Antihistamines ✭Decrease the need for postop pain relief ✭preop sedation ✭treat insomnia and allergic rxn |
| What are zolpidem, zaleplon, eszoplicon and remlteon used for? | Insomnia and sedation zolpidem=ambien |
| What are the nursing considerations for anxiolytic/hypnotics? | ✭Increased risk for FALLS! ✭Respiratory distress/depression possible ✭Concerns about dependence ✭Check blood levels for tox ✭monitor level of consciousness |
| What are TCAs used for? How do they work? | ✭used for depression ✭sleep disorders ✭enuresis in kids over 6 ✭chronic pain ✭OCD (clomipramine) Work on seratonin and NE, reduce reuptake |
| What are the dr-drug interactions with TCAs? | ✭MAOIs ✭Cimetidine ✭Fluoxetine ✭Ranitidine ✭oral anticoagulants |
| What is the prototype for TCAs?What is it used for? | Imiprimine (Tofranil) ✭Depression ✭Sleep disorder ✭Enuresis in kids over 6 All TCAs are similar-choice based on pt tolerance of SE |
| What are the common SE of TCAs? | ✭Sedation ✭Sleep disturbance ✭Hallucinations ✭Visual disturbances ✭Ataxia ✭tremors a not used often bc of SE ✭ |
| What are the major contraindications for TCAs? | ✭MI ✭Myelography within 24 hrs ✭pg&lct ✭bipolar disorder |
| What are the CAUTIONS for use of TCAs? | ✭CV disease ✭angle glaucoma ✭urinary ret ✭manic-depression |
| Of the antidepressants which are the oldest and which are the newest? | SSRI-new MAOI-old |
| Why are MAOIs not used much anymore? | Severe SE and dietary restrictions |
| What are the three MAOIs? | ✭Marplan ✭Nardil ✭Parnate All mostly used for pt that don't respond to newer, safer antidepressants |
| What are the contraindications for MAOIs? | ✭Pheochromocytoma ✭CV disease ✭renal/hepatic impairment |
| What are the SE of MAOIs? | ✭Mania ✭hyperreflexia ✭tremors ✭liver toxicity ✭weight gain ✭abdominal pain ✭agitation |
| What are the dr-dr interactions with MAOIs? | ✭not to be used with other hypertensive drugs--can cause coma ✭Methyldopa-increase sympathomimetics ✭Insulin or oral antidiabetic agents |
| What are the dietary restrictions with MAOIs? | nothing with Tyramine in it no wine, aged cheese, fermented meats |
| How do SSRIs work? | block reuptake of seratonin. no effect on NE |
| What are SSRIs used for? | ✭Depression ✭OCD ✭panic attacks ✭bulimia ✭PMDD ✭PTSD ✭social phobias ✭social anxiety disorders |
| Contraindications for SSRIs | ✭pg&lct ✭severely impaired renal and liver fxn |
| What is the prototype for SSRIs? | Fluoxetine (Prozac) |
| Which of the SSRIs have a block box warning and for what? | Paxil Suicidal ideation in children and teens |
| What is lithium used for? | Bipolar disorder |
| How does lithium work? | inhibits release of NE and Dopamine, but not seratonin |
| What do you need to know about lithium? | ✭very toxic to CNS, renal and pulmonary systems |
| What are the theraputic levels of lithium? | 0.6-1.2 mEq/L |
| What are the contraindications for lithium? | ✭Renal disease ✭cardiac disease ✭leukemia ✭metabolic disorders -dehydration ✭No diuretics (lithium is a salt) ✭pg&lct |
| What are the SE of lithium? | ✭less than 1.5: lethargy, slurred speech, muscle weakness, N/V ✭1.5-2.0: plus ECG changes ✭2.2-2.5: ataxia, clonic movements, hyperreflexia, seizures ✭greater then 2.5: complex multiorgan toxicity, significant risk of death |
| What are the drug-drug interactions with lithium? | ✭haloperidol: irreversible brain damage, leukocytosis ✭Carbamazapine: hypothyroidism ✭thiazide diuretics:reduced Na levels, increased litihum retention |
| What are the miscellaneous antidepressants mostly used for? | Smoking cessation and depression |
| What is a major problem with the antidepressants used for smoking cessation? | Need to have medication reconcilliation-double prescribing |
| What are the important nursing considerations for antidepressants? | ✭4-6 weeks till theraputic benefits are seen ✭do not stop abruptly-need to taper:increase suicide risk ✭Be careful with the elderly:CNS effects |
| How do antipsychotic drugs work? | typical: ✭block dopamine receptors ✭anticholinergic ✭antihistimine ✭alpha-adrenergic blocking effects Atypical: ✭block both dopamine and seratonin: decreased unpleasant neurological effects |
| Which of the antipsychotics is also an antiemetic? | perchlorperazine |
| What are the indications for antipsychotic drugs? | ✭schizophrenia ✭psychotic disorders -agitation in elderly -severe behavior problems in kids -hyperactivity -combative behavior -bipolar disorder |
| What are the contraindications for antipsychotic drugs? | ✭Seizure disorders ✭CNS depression ✭circulatory collapse ✭parkinsons ✭coronary disease ✭severe hypotension ✭prolonged QT interval ✭elderly with dementia |
| What are the major SE for antipsychotics? | ✭CNS effects: EPS, tardive dyskenesia ✭Anticholinergenic effects: dry mouth, nasal congestion, flushing, constipation, urinary ret., impotence, glaucoma, photophobia, blurred vision ✭CV effects: orthostat. hypotension arrhythmias, CHF, pulmonary edema, |
| What are drug-drug interactions with antipsychotics? | ✭Beta blockers: increase effects of both drugs ✭haloperidol ✭carbamazepine ✭thiazide diuretics ✭alcohol ✭thiothixene |
| What is the prototype for typical antipsychotics? | Chlorpromazine (Thorazine) |
| What is the prototype for atypical antipsychotics? | Clozapine (Clozaril) |
| What is Thorazine used for? | ✭psychotic disorders ✭preop restlessness & anxiety ✭tetnus ✭porphyria ✭severe behavior problems in kids ✭hiccups |
| What are the SE of Thorazine? | ✭EPS ✭orthostatic hypotension ✭photophobia ✭photosensitivity ✭blurred vision |
| What is the atypical prototype and what is it used for? | ✭Clozapine used for: ✭severe schizophrenia ✭suicide reduction in schizophrenia |
| What are the SE of clozapine? | ✭seizures ✭syncopy ✭tachycardia ✭neuroleptic malignant syndrome |
| What should you be concerned about with CNS stimulants? | ✭Potential for addiction |
| What are CNS stimulants used for? | ✭ADD ✭Narcolepsy (grossly obese sleep apnea, shift workers) |
| What are CNS stimulants CONTRAINDICATED for? | ✭marked anxiety ✭glaucoma ✭severe fatigue ✭seizure disorders ✭cardiac disease ✭hypertension |
| What are the SE of CNS stimulants? | ✭CNS: -insomnia -difficulty accomodating ✭GI: -anorexia -N/Constipation/Wt. loss ✭CV -hypertension, arrythmia, angina |
| What is the prototype for CNS stimulants? | Ritalin |
| What are the SE for CNS prototype? | Ritalin SE: ✭Tachycardia ✭Increased or decreased pulse |
| Which of the CNS stimulants is not a controlled substance? | Strattera |
| What do all the anti-seizure drugs have in common? | ✭no alcohol ✭no herbal supplements ✭always look up all drugs, very reactive! |
| What are hydantoins used for? | ✭Tonic-clonic seizures ✭psychomotor seizures |
| When are hydantoins not used? | ✭pg&lct ✭renal and liver |
| What are the major SE of hydantoins? | ✭CNS depression ✭cardiac arrythmias, changes in BP ✭Urinary retention ✭loss of libido ✭severe liver toxicity ✭Bone marrow suppression ✭Gingival hyperplasia ✭SJS, hirsuitism |
| What is the prototype for hydantoins? | Phenytoin (Dilantin) ✭CNS ✭SJS ✭gingival hyperplasia |
| Which barbituate is used for tonic-clonic seizures and status epilepticus? | ✭Phenobarbitol ✭acute seizures r/t eclampsia, tetnus, febrile seizures |
| Which of the benzos are used for anti-seizure meds? | ✭Clonazepam (klonopin) ✭Diazepam (Valium) -severe convulsions -status epilepticus -alcohol withdrawal ✭librium -alcohol withdrawal, DTs |
| What are succinimides used for? | seizures not responding to conventional therapy |
| What is the prototype for succinimides? | ✭Ethosuximide SE: - absence seizures -pancytopenia -Bone marrow suppression used for both kids and adults |
| Which other drugs are used to treat absence seizures? | ✭Diamox: diuretic used with glaucoma ✭Valproic acid: -cause hepatic and renal disease -very reactive ✭✭Tegratol most common for partial seizures |
| What are skeletal muscle relaxants used for? | ✭s and s of spacticity ✭spinal cord disease/injury ✭acute muscle spasm, convulsive and seizures |
| What are the contraindications for skeletal muscle relaxants? | ✭Seizure disorders due to CNS depression ✭hepatic, cardiac, renal dfxn |
| What are the main SE of skeletal muscle relaxants? | ✭decreased parasympathetic response ✭CNS depression ✭GI ✭hypotension ✭arrhythmia ✭urinary frequency |
| What are the main dr-dr interactions with skeletal muscle relaxation? | ✭EtOH ✭CNS depressants |
| What is the prototype for skeletal muscle relaxants? | ✭✭baclofen -taper to prevent psychosis ✭used for acute episodes |
| What is a commonly used skeletal muscle relaxant? | ✭cyclobenzaprine (PO) |
| Which is the major skeletal muscle relaxant used for kids? | Metaxalone (Skelaxin): used for acute musculo-skeletal disorders |
| Which skeletal muscle relaxant is used for tetnus in kids and acute muscolo-skel. problems in adults? | Methocarbamol (Robaxin) |
| Which skeletal muscle relaxant turns urine orange-purple-red? | ✭Paraflex |
| Which skeletal muscle relaxant is safest for older adults and renal and hepatic disorders? | ✭Soma |
| What are the nursing considerations for use of skeletal muscle relaxants? | ✭watch heart ✭watch liver ✭NO alcohol ✭sleepy and dry mouth (CNS depression) |
| How does ✭✭✭Dantrolene work? | ✭✭✭prototype for direct acting skeletal mr ✭interfere with calcium --doesn't interfere with neuromusc transmission |
| What are direct acting MR used for? | ✭spacticity affecting peripheral muscles ✭spacticity assc with neuromusc. disease ✭malignant hyperthermia |
| What are the contraindications for Direct Acting MR? | ✭Liver disease ✭patients over 35-higher cardiac to ✭cardiac disease ✭ |
| What are the SE for DA MR? | ✭Enuresis ✭GI irritation ✭Fatigue, weakness, confusion ✭abnormal sweating ✭hepatocellular damage ✭hepatitis ✭ |
| What are the drug-drug interactions for DA MR? | ✭Estrogen ✭NM junction blockers |
| What are the three types of DA MR used here? | Botox A and B and Dantrolene |
| How does botox work? | inhibits release of acytlcholine-muscle paralysis |
| What is botox most commonly used to treat? | cervical dystonia |
| What are the cautions for botox? | ✭peripheral neuropathic disease ✭neuromuscluar disorders ✭CV disease ✭Respiratory or skin infections! |
| What are the two types of neuromuscular blocking agents? | Nondepolarizing and depolarizing agents |
| Both types are neuromuscular blocking agents are used to cause what? | paralysis: -as an adjuct to general anesthesia during surgery -to prevent the pt "bucking the machine" while being vented -electroshock therapy |
| NMR blockers are NOT used when: | ✭myasthenia gravis ✭renal/hepatic disease ✭pg&lct ✭malignant hyperthermia (pt or family member) ✭pulmonary or cardiac dfxn ✭altered fluid and electrolyte balance |
| What does malignant hyperthermia cause? | ✭extreme muscle ridgitity ✭severe fever ✭acidosis ✭death |
| which of the nondepolarizating NMJB is the most rapid acting? | ✭succinylcholine --very rapid onset, short duration -used for surgical procedures, mechanical vent, intubation |
| Which of the nondepol. NMJB is used for short surgical procedures? | Zemuron --rapid onset -outpatient surgical procedures -can cause pulmonary hypertension -caution with liver disease |
| Which of the nondepol. NMJB is used for long term use with ventilated pts? | ✭Pavulon --can raise HR --long term use --surgery |
| What is the prototype for nondep NMJB? | Pavulon --long acting --long term ventilation --increase HR |
| What is the prototype for depolarizing NMJB? | Succinylcholine --cautious!! ✭Fractures: can increase muscle contractions ✭narrow angle glaucoma and eye injuries-can raise occular pressure ✭paraplegia or spinal cord injuries -increased risk of hyperkalemia: cardiac arrest ✭conditions (genetic |
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SarahTzipporah
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