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Pharm midterm 330

QuestionAnswer
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
Created by: SarahTzipporah