Pharm midterm 330
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| 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
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| types of cellular defenses | MONONUCLEAR PHAGOCYTE SYSTEM (MPS):
★Thymus gland
★Lymphatic tissue
★leukocytes
★lymphocytes
★chemical mediators
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| Types of lymphoid tissues | Lymph nodes
Spleen
★Thymus gland: decreases with age
★Bone marrow: makes WBC
★Lymphoid tissue in GI and Respt.
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| The inflammatory response: Hageman Factor | ★factor XII activated by cell injury
★Kinin system: clotting cascade
★Bradykinin: local vasodilation, WBC to tissues, pain
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| The inflammatory response: Histamine release | ★Locally mediated
★Vasodilation
★Capillary permeability altered to allow NEUTROPHILS in
★pain perception
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| The inflammatory response: Chemotaxis | ★activated by arachnadoic acid
★attracts neutrophils
★cellular breakdown and death
★RA, SLE ---> uncontrolled immune response
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| Clinical signs of inflammation | ★Calor/ heat
★Tumor/swelling
★Rubor/redness
★Dolor/pain
★Pyrogen/fever
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| Specific immune response: T-cells | ★Thymus
★Cytotoxic t-cells
★cell mediated immunity
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| Specific immune response: Types of T-cells | ★Cytotoxic T-cells
★helper t-cells
★suppressor T-cells
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| Specific immune response: B-cells | ★ID specific proteins or antigens
★humoral immunity
★antibodies or antigens
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| 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
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| How do ASA and NSAIDs work? | ★Block Cox pathways so don't make prostoglandins: reduce inflammation
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| Asprin: NOT FOR: | ★Liver and renal dysfunction
★Surgery within a week (Asprin)
★Children under 16 (Reyes Syndrome!)
★Bleeding abnormalites
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| SE of Asprin: | ★★Tinnitis★★
☹GI problems☹
★Epigastric pain
★Heartburn
★Fecal Occult Blood (GI bleeding)
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| Asprin is FOR: | ★Antipyretic
★Decreases platelet aggregation and clotting
★analgesic
★Inflammatory conditions (RA, OA)
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| 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
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| NSAIDs: how do they work? | ★Also block COX pathways
★prevents prostaglandin formation
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| What do NSAIDs do? | ★antipyretc
★antiinflammation
★anticoagulant
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| What not to use NSAIDs with: | Are a salt so screws with osmolarity
★Beta-blockers
★loop diuretics
★lithium
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| CONTRAIND for NSAIDs | ★Pg and lct
★renal and liver
★bleeding disorders
★Hypertension and CD: COX2 inhibitors ---> greater cardiac tox
★Peptic ulcer disease
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| How does acetomenophen work? | ★NOT on COX pathway
★Also blocks prostaglandin
★thermoregulatory cells of hypothalamus
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| What is acetomenophen for? | ★pain and fever
★flu
★prophylaxis DPT shot in kids
★arthritis
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| What is the main problem with tylenol? | ★★ACCIDENTAL OVERDOSE★★
in lots of stuff (ie nyquil etc)
inadvertant poisoning very common
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| SE of acetomenophen: | ★renal dysfunction
★liver toxicity
★skin rash
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| Nursing interventions for acetomenophen: | ★warn parents about reading labels
★write down chemical name
★baseline therapy
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| 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
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| What are gold compounds used for? | ★treat RA
★Reduce "confused fighting"
★eliminate macrophage
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| NOT FOR gold compounds: | ★Congestive heart failure
★Diabetes
★Liver and kidneys
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| Drug interactions for GOLD compounds: | ★Penicillimade
★Antimalarials
★Cytotoxic drugs
★Immunosuppressives
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| Interferons: | ★Hep C
★Hairy Cell Leukemia
★Aids related Karposy Sarcoma
★are naturally released from cells in re viral invasion
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| Interferons are immune _____ and suppress ______. | a. stimulators
b. tumor growth
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| Interleukins are chemical ____. They activate _____and suppress _____. | a. signalers,
b. activate cellular immunity
c. tumor growth
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| 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.
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| Interferons should not be used with patients with: | ★cardiac disease
★myelosuppresion
★central nervous system disorders
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| Interleukins are used with: | renal carcinomas
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| Interleukins have severe SE such as: | ★myalgia
★lethargy
★arthalgia
★fatigue
★fever
★respiratory difficulties
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| T and B cell suppressors are used primarily for: | Transplant patients.
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| 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
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| The main SE of T and B cell immunosuppressants are: | ★increased risk for infection
★hepatotoxicity
★renal dysfunction
★pulmonary edema
★increased risk of 2nd malignancies
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| The prototype for T and B cell suppressors is: | ★★CYCLOSPORINE★★
used mainly for transplant patients
also RA and psoriasis
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| 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
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| most common SE of T and B cell immunosuppresants: | ★pulmonary edema
★acne
★headaches
★GI upset
★hypertension
★Bone Marrow suppression
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| Most common interleukin receptor antagonist: | ★ANAKINRA (kineret)
used for RA
BLOCKS (antagonist) interleukin 1
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| Antitumor antibiotics are all ____.Therefore they are commonly given using ____ instead of peripheral lines. | a.Vesicants.
b. central lines
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| When giving antitumor antibiotics it is important to monitor for ____ because _____ can occur if they infiltrate. | a. extravasation
B.tissue necrosis
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| Antitumor antibiotics work by: | binding with DNA to inhibit DNA/RNA synthesis
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| The three types of antitumor antibiotics that we care about here are: | ★Bleomycin
★Mitomycin
★Doxorubicin (Adriamycin)
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| Which antitumor antibiotic will turn urine RED after administration? | Doxorubicin (Adriamycin)
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| Which antitumor antibiotic can be given intracavity to stop the re-accumulation of fluid in pleural space of pts with malignant pleural effusion? | Bleomycin
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| Which two antitumor antibiotics are both indicated for breast and stomach cancer? | Doxorubicin and Mitomycin
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| What is Bleomycin indicated for? | ★Breast
★Cervical, vulvar and testicular
★Malignant pleural effusion
★squamous cell cancer of head and neck
★NHL
★HD
★Melanoma
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| What are the unique SE of Doxorubicin? | ★Red urine
★rapid hair loss immediately following therapy
★cardiac toxicity
★photosensitivity
★possible flare reaction after EBRT
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| Which diagnostic test(s) have to be performed before Doxorubicin is given? | Cardiac ejection fraction: possible cardiac toxicity
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| Which diagnostic test(s) much be performed before Bleomycin is given? | Pulmonary function tests.
Test dose for lymphoma patients.
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| 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
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| 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!)
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| What are the unique side effects of Bleomycin? | ☆Hyperpigmentation
✭hypersensitivity
✭photosensitivity
✭renal and hepatic tox
✭pulmonary fibrosis
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| What are the unique SE of Mitomycin? | ✭Anorexica
✭mucositis
✭renal and pulmonary tox
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| What are the common side effects to all three antitumor antibiotics? | ✭alopecia (only more immediate with Adria)
✭myelosuppression
✭N & V
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| Which antimetabolites work by inhibiting DNA repair? | 5FU, Methotrexate, Gemcitabine
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| Why is leukovorin given with 5FU? | Increase the effectiveness of 5FU (Fluororacil)
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| Why is leukovorin given with Methotrexate? | To prevent deadly toxicity
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| 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
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| What are the unique SE of 5FU? | ✭Increased lacrimation
✭photosensitivity
✭darkening of skin pigmenation
✭Darkening of veins
✭cardiac tox (rarely)
✭dry skin
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| What are indications for 5FU? | ✭Colorectal
✭breast
✭head and neck
✭pancreatic
✭stomach & esophageal
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| What are the unique SE of methotrexate? | ✭oral and GI ulceration
✭photosensitivity
✭liver toxicity
✭neurotox with high doses
✭✭acute pneumonitis
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| 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
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| What are the contraindications for methotrexate? | ✭acites
✭pleural or pericardial effusions--drug can accumulate in the fluids and increase tox
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| What are the indications for methotrexate? | ✭Leukemia
✭HD
✭NHL
✭CNS metastasis
✭lung
✭breast
✭head and neck
✭osteogenic sarcoma
✭gestational trophoblastic tumors
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| What are the indications for Gemcitabine? | ✭Pancreatic
✭breast
✭ovarian
✭NSCLC
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| What are the unique SE of Gemcitabine? | ✭flu-like symptoms
✭rash
✭anemia
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| What are the nursing considerations for Gemcitabine? | ✭monitor CBC
✭skin care
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| Which antimetabolites work by inhibiting enzyme production for DNA synthesis leading to strand breaks or premature chain termination? | Capecitabine
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| Which antimetabolites can be taken PO? | Methotrexate, Capecitabine
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| What is Capecitabine given for? | ✭breast
✭metastatic colon
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| What are the unique SE of Capecitabine? | ✭Palmar-plantar erythrodsethesia
✭mucositis
✭increased bilirubin
✭Diarrhea
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| 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
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| Which antimetabolites work by disrupting folate dependant metabolic processes essential for cell repair? | Pemetrexed
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| What is pemetrexed given for? | ✭Malignant pleural mesothelioma
✭NSCLC
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| What are the unique SE of pemetrexed? | Renal and liver tox
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| 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.
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| What are the SE common to all the antimetabolites? | ✭N/V
✭Mylosuppression
✭GI discomfort
✭fatigue
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| How do the alkylating agents work? | Break DNA helix strand, interfere with DNA replication
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| Which alkylating agents have pulmonary fibrosis as a common SE? | Chlorambucil and Oxaliplatin
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| Of the alyklating agents, which is the strongest vesicant? | Cisplatin
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| Which of the alkylating agents can be given PO? | Chlorambucil and cyclophosphamide
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| What are the indications for chlorambucil? | ✭✭Leukemia- most common
✭HD
✭NHL
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| What are the unique SE for chlorambucil? | ✭ovarian and sperm suppression
✭2ndary malignancy
✭hyperuricemia
✭pulmonary fibrosis
✭seizures
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| What are the nursing considerations for chlorambucil? | ✭CBC
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| What are the contraindiactions for chlorambucil? | known seizure disorder
✭barbituates may increase toxicity
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| What should be given with cisplatin to prevent irreversible renal tublar damage? | Amifostine--cytoprotective agent
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| What are the SCr levels that must be maintained with cisplatin? | Less than 1.5 mg/dL
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| 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
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| 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
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| What is cisplatin used for? | ✭✭most commonly used for solid tumors
✭ovarian, testicular, cervical
✭breast
✭prostate
✭Wilms tumor
✭head and neck
✭brain
✭leukemia
✭bladder
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| What is carboplatin used for? | Ovarian cancer
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| What are the unique SE of carboplatin? | ✭thromocytopenia
✭neutropenia (more pronounced w/ compromised renal fxn)
✭skin rash
✭hypersensititivy (usually after 7th dose)
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| 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
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| What is Oxaliplatin used for? | Colorectal cancer
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| What are the SE unique to oxaliplatin? | ✭anaphalactic rx
✭neurotox AGGRAVATED by COLD TEMP
✭pulmonary fibrosis
✭N/V
✭mylosuppression
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| 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
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| What drug should always be given with Ifosfamide? | MESNEX-cytoprotective agent to prevent hemorrhagic cystitis
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| What is ifosfamide used for? | ✭testicular
✭breast
✭head and neck
✭NHL
✭pancreatic
✭sarcomas
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| What are the unique SE of ifosfamide? | ✭✭Hemorrhagic cystitis
✭neurotoxic: somnolence, confusion, hallucinations, encephalopathy, depressive psychosis
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| What are the nursing considerations for ifosfamide? | ✭Monitor CBC
✭Strict I&O
✭hydration
✭Neuro assessment
✭safety and falls precautions
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| What is cyclophosphamide used for? | ✭breast
✭ovarian
✭multiple mylenoma
✭lymphona
✭neuroblastoma
✭retinoblastoma
✭mycosis fungoides
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| What are the unique SE of cyclophosphamide? | ✭high doses: cardiomyopathy
✭dose-limiting mylosuppression
✭2ndary malignancy (leukemia, MDS)
✭Testicular and ovarian failure
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| 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
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| How do the mitotic inhibitors work? | Inhibit mitosis
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| What is essential to know about vincristine that is unique to it among the mitotic inhibitors? | It is LETHAL if administered INTRATHECALLY.
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| What are the three mitotic inhibitors that we care about? | ✭Docetaxel (Taxotere)
✭Paclitaxel (Taxol)
✭Vincristine (Oncovin)
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| What are the common SE to all the mitotic inhibitors? | ✭N/V
✭Alopecia
✭Hypersensitivity (less so with vincristine bc synthetic)
✭myelosuppression
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| 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
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| What is docetaxel used for? | ✭Breast
✭NSCLC
✭prostate
✭gastric cancers
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| What is paclitaxel used for? | ✭Metastatic breast
✭ovarian
✭head and neck
✭NSCLC
✭AIDS related Karposi sarcoma
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| What is Vincristine used for? | ✭ALL
✭HD
✭NHL
✭CML
✭sarcoma
✭Breast
✭SCLC
✭Wilms tumor
✭neuroblastoma
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| What are the unique SE of docetaxel? | ✭Hypersensitivity
✭Skin and nail changes
✭neurotoxicity
✭mucositis
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| What are the unique SE of paclitaxel? | ✭Hypersensitivity
✭facial flushing
✭Cardiac arrhythmias
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| What are the unique SE of Vincristine? | ✭peripheral neuropathies
✭constipation
✭paralytic ileus
✭foot drop
✭jaw pain
(neuro symptoms more pronounced for children)
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| What are the nursing actions that should be performed when giving Vincristine? | ✭Stool softeners for constipation
✭Monitor neuro status prior to each dose
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| What are the nursing considerations for docetaxel? | ✭Monitor CBC
✭I&O
✭premedicate
✭GLASS bottles or NON-PVC tubing
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| What are the nursing actions for paclitaxel? | ✭premedicate
✭Monitor CBC
✭Monitor cardiac fxn (possible arrhythmias)
✭Glass bottles, non-pvc tubing, micron filter
✭
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| What are all the chemotherapy drugs used for breast cancer?(12) | ✭Doxorubicin
✭Mitomycin
✭Docetaxel
✭Paclitaxel (metastatic)
✭Vincristine
✭Cyclophosphamide
✭Ifosphamide
✭Cisplatin
✭5FU
✭Methotrexate
✭Gemcitabine
✭Capecitabine
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| What are all the chemotherapy drugs used for colon/colorectal cancers?(4) | ✭Mitomycin
✭5FU
✭Capecitabine (metastatic)
✭Oxaliplatin
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| Which chemotherapy drugs are used for head and neck cancers? (6) | ✭5FU
✭Methotrexate
✭Cisplatin
✭Ifosphamide
✭Bleomycin (squamous cell)
✭Mitomycin
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| Which chemotherapy drugs are used for ovarian/gyn cancers? (6) | ✭Bleomycin (cervical and vulvar)
✭Doxorubicin (ovarian)
✭Gemcitabine
✭Cisplatin (ovarian and cervical)
✭Carboplatin
✭Cyclophosphamide
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| Which drugs are used for testicular/prostate cancers? | ✭Ifosphamide (test)
✭Cisplatin (test. and prostate)
✭Doxorubicin (prostate)
✭Bleomycin (testicular)
✭
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| Which drugs are used for NHL? | ✭Bleomycin
✭Methotrexate
✭Chlorambucil
✭Ifosphamide
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| What are the SE of hormone modulators? | ✭increased risk of CV disease
✭increased risk of DVT
✭Hypercalcemia--osteoporosis
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| What is the prototype for hormone therapy/hormone modulators? | Tamoxifen
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| What is tamoxifen used for? | post menopausal women with breast cancer where tumor cells express estrogen and progest.
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| How long is it recommended to take tamoxifen for? | 5 years
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| Which class is the most frequently used anxiolytic? | Benzodiazepines
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| Which systems are acted on by benzos? | RAS and GABA: sleep-wake cycle and muscle tone
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| 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
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| Which benzodiazepines can be used for emeregency tx of status epilepticus? | ✭Lorazepam (Ativan)
✭Valium
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| What is the prototype for benzos? | Dizaepam (valium)
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| 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
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| What should you tell your pt about taking benzos? | Do not stop abruptly.
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| _______ are genetically predisposed to delayed metabolism of benzos: can lead to toxicity/OD | African-Americans
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| 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
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| What effect does alcohol have on benzodiazepines? | Increases CNS depression. can cause respiratory problems
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| 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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