Level II Pharm Unit 1

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Level II Pharm Unit 1
2013-09-09 14:51:47
SCF level II pharm

Unit I
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  1. Depression is an _______ disorder.
  2. S/S of depression:
    • Low energy level
    • Sleep disturbances
    • Lack of appetite
    • Limited libido 
    • Inability to perform ADL
    • Overwhelming feelings of sadness, despair, hopelessness, and disorganization
  3. Depression can result from deficiencies of:
    • Norepinephrine (NE)
    • Dopamine
    • Serotonin (5HT)

    This is called Biogenic Amine Theory
  4. MOA stands for what?
    Monoamine Oxidase - an enzyme that breaks down NE, dopamine, and 5HT to be recycled or restored in neurons
  5. Name a Tricyclic Antidepressant (TCSs):
    • Imipramie (Tofranil)
    • Clomipramine (Anafranil)
  6. How do TCAs work?
    Reduce the uptake of 5HT(serotonin) & NE (norepinephrine)

    This leads to an accumulation in the synaptic cleft and increases stimulation of the postsynaptic receptor
  7. Indications for TCAs:
    Depression, sleep disorders, enuresis in children under age 6, chronic pain, migraines,  and OCD
  8. What drug is used to treat enuresis in children under 6?
    The tricyclic - Imipramine (Trofranil)
  9. What anti-drepressant is used to treat ODC?
  10. Pharmacokinetics of Tricyclic anti-depressants:
    • Binds to Plasma proteins & Lipid soluble
    • absorbed in GI
    • Peaks in 2- 4 hours 
    • Metabolized in liver
    • excreted in urine
    • T1/2 8-46 hours
  11. What is norepinephrine responsible for:
    released by nerves in the sympathetic nervous system
  12. Dopamine is responsible for what?
    Coordinates impulses and responses
  13. Serotonin (5TH) is responsible for what?
    • Arrosla, alertness
    • Promotes motivation
    • Mood, appetite
  14. Contraindications of TCAs:
    • Recent MI - this drug will increase heart rate
    • Myelography (using dye) within 24-48 hrs
    • Pregnancy/lactation
  15. Cautions of TCAs:
    • CV disease (due to anticholenergic)
    • Angle closure glaucoma- increases pressure
    • Urinary retention- exacerbated
    • Manic-depression-stimulatory into a manic state if previously stable (no paranoid schizophrenic)
  16. Tricyclics will increase what risks in children/adolescents (black box warnings):
    • suicide
    • seizures
  17. Nursing considerations for Tricyclics:
    • Sedation - give in evening
    • Anticoholenergic effects - bowel support (track BMs, high fiber, liquids, dry mouth)
    • no alcohol 
    • Liver/kidney impairment 
    • limit access to those already feeling suicidal
  18. Drug/Drug interactions for Tricyclics:
    • Oral anti coagulants - will increase bleeding
    •  MOAI's
  19. What should be monitored while taking Tricyclics?
    • Liver kidney fxn 
    • bone marrow suppression (white blood counts)
  20. How do MAOI's work?
    What do they treat?
    –Irreversibly inhibits MAO from breaking down, norepinephrine, serotonin, and dopamine which allows them to accumulate in the synaptic cleft.

    Relief of depression, Hysteria, sadness
  21. Why would you choose to take a MAOI ?
    They treat the S/S of depression in patients who can not tolerate or are unresponsive to other SAFER anti-depressants.
  22. Pharmacokinetics of MAOI's:
    • –Absorbed from GI tract
    • Peak 2-3 hours
    • –Metabolized in the liver, excreted in the urine
    • Cross placenta and enter breast milk
  23. Contraindications for MAOI's :
    –pheochromocytoma (tumor on the adrenal gland), CV disease, headaches, renal or hepatic impairment, Myelography (dye), alcohol consumption 

  24. Contraindicated foods while on MAOI's:
    • Fermented foods containing tyramine 
    • Pickles, aged cheeses
    • Smoked/pickled meats, fish, poultry
    • Foods with brewers yeast
    • Red wine
  25. Drug-Drug interactions for MAOI's:
    • Other antidepressants, causing Hypertensive crisis, coma
    • –Methyldopa-Sympathomimetic effects increase
    • Insulin or oral anti diabetic agents – Additive hypoglycemia
  26. Name a MAOI drug:
    Phenelzine (Nardil)
  27. Nursing considerations for MAOI's :
    • Give in the AM to avoid insomnia
    • Discontinue 10 days before surgery or dental procedure
    • Monitor Liver fxn
    • 2-4 weeks before effective
    • decrease environmental stimulus
  28. How do  SSRI's work?
    Specifically block the uptake of 5HT, with little to NO effect on the NE
  29. Indications for SSRI's:
    • Newest group of antidepressant drugs
    • Fewer adverse reactions than with TCA or MAOI drugs
    • Depression
    • OCD
    • Compulsive activities 
    • Bulimia
    • PMDD
    • PTSD
    • Social phobia/anxiety
  30. Pharmacokinetics for SSRI's:
    • Associated with congenital abnormalities 
    • Absorbed in GI
    • Metabolized in liver
    • Excreted in urine
  31. Contraindications for SSRI's:
    • Pregnancy, lactation
    • impaired liver/renal 
    • young children / adolescents may become more suicidal 
    • exacerbates diabetes
  32. Adverse/ drug-drug reactions SSRI's:
    • MAOI's
    • TCA's increase of therapeutic & toxic effect (if not transitioned properly)
    • St. John's Wort 
    • insomnia, anxiety, tremor
    • Weight loss with Prozac
  33. Name a SSRI drug:
    • Fluoxetine (Prozac)
    • duloxetine (Cymbalta)
    • escitalopram (Lexapro)
  34. Nursing considerations for SSRI's:
    • Give in AM to avoid insomnia 
    • Use contraception
    • decrease dose for elderly to avoid insomnia 
    • lower dose for liver/hepatic impaired fxn
  35. What is Bupropion (Wellbutrin, Zyban) used to treat?
    Smoking cessation
  36. ______ is a collection of different syndromes characterized by the same features, sudden discharge of excessive electrical energy from nerve cells located within the brain, which leads to a seizure.
  37. Patients of these ethnic groups may metabolize anti-seizure agents differently due to differing liver enzyme function:
    • Arab Americans & Asian AMericans 
    • they may require lower doses and frequent adjustments
  38. Newborns (1-10 days) respond to _____ if a anti-epileptic is needed.
    IM phenobarbital
  39. Children from 2 months- 10 years old metabolize ________ drugs quicker than adults. How do you adjust to this?
    Anti-seizure drugs 

    Larger dose to maintain therapeutic levels
  40. Describe a toni-clonic seizure:
    Involuntary muscle contraction followed by relaxation appearing as an aggressive spasm.

    Loss of consciousness, followed by recovery including confusion and exhaustion
  41. Describe a Jacksonian seizure :
    begin in one area of the brain (one body part) and then spread to other parts - may develop into generalized toni-clonic seizures.
  42. Describe Myoclonic seizures:
    • Short, sporadic periods of muscle contractions that last for several minutes. 
    • They are relatively rare and are often secondary seizures.
  43. ____ seizures are caused by abnormal cells/neurons with no underlying cause.
  44. _____ seizures are caused by outside factors.
    • Secondary 
    • caused by fever, head injury, drugs, preeclamsia, CO2 poisoning ...
  45. Partial seizures have what 2 classifications?
    Simple (no loss of consciousness)

    Complex (consciousness impaired)
  46. Generalized seizures involve what in the brain?
    Both hemispheres and loss of consciousness
  47. Absence seizures are most common in what age group?
    children at age 3 - Disappear by puberty
  48. Rapidly reocurring seizures without periods of recovery are called _______.
    Status Epilepticus
  49. Partial seizures are also called  _____ seizures.
  50. GABA modulators work to do what?
    inhibit nerve activity / help prevent over excitability
  51. Name a Hydantoin drug:
    Phenytoin (Dilantin)
  52. Hydantoins used to treat what?
    • Tonic-clonic 
    • Prevention of status epilepticus
    • Treatment following neuro surgery
  53. What is the therapeutic level of Phenytoin (Dilantin)?
    10-20 mcg/ml
  54. What makes Hydantoins more desirable than other, less toxic anti-seizure drugs?
    Less sedating
  55. How do hydantoins work?
    Stabilize the nerve membrane and limit spread of excitability from the initiating focus
  56. Contraindications for Phenytoin (Dialantin) & Phenobarbital :
    • Hepatic/renal impairment
    • Pregnancy 
    • Coma, depression, psychoses, elderly/ debilitated patients who may respond adversely to CNS depression
  57. Adverse effects for phenytoin (Dialanton)
    • Bone Marrow suppression 
    • Gingival hyperplasia 
    • Excessive hair growth 
    • Steven Johnson's syndrome 
    • Dry mouth
    • constipation
  58. Drug/drug interactions for phenytoin:
    • Alcohol 
    • Herbals - evening primrose, ginkgo
  59. Name a barbiturate used to treat seizures:
    Phenobarnital ( Solfoton, Luminal)
  60. Adverse Effects for barbituates:
    • CNS depression
    • Low BP
    • Paradoxical excitement and exacerbation of hyperkinetic behavior in children 
    • Dermatologic
  61. What drug is given in an emergent situation to treat status epilepticus, tetanus, eclampsia, or meningitis:
  62. Benzodiazepines prototype :
    diazepam (Valium)
  63. What is Diazepam used for?
    • Adjunct in status epilepticcus or reoccurring Seizures 
    • Delirium tremors in alcohol with drawl 
    • Sedative before surgery 
    • Muscle spasms
  64. Adverse effects for Diazepam:
    CNS depression - drowsiness, sedation, fatigue, lethargy, disorientation, urinary retention, loss of libido, physical dependence and withdrawal syndrome
  65. Reversal agent for Diazepam:
  66. Name a succinimide:
    • Ethosuximide (Zarontin) 
    • Methsuximide (Celontin)
  67. What are Succinimides indicated for:
    • Suppression of abnormal activity in the brain 
    • Absence seizures (formerly petit-mal)
    • Sometimes migraine prevention
  68. Contraindication for use of Ethosuximide :
    • Intermittent porphyria (metabolic disorder)
    • Hepatic/renal impairment
    • Pregnancy & lactation
  69. Adverse effects when taking Ethosuximide:
    • Bone marrow depression (fever may indicate)
    • Dermatologic reactions
  70. Drug/Drug interactions with Ethosuximide:
    Primidone (barbituate) for treating migraines - may cause decreased serum levels
  71. What is Valproic acid (Depakene) used to treat?
    • Myoclonic seizures 
    • 2nd drug of chose for absence seizures 
    • Reduces abnormal electric activity on the brain and may INCREASE GABA activity at the inhibitory receptors
    • PSYCH patients for mania
  72. Valproic acid is contraindicated for those patient with what?
    • Suicidal ideations
    • Pregnant/ lactation
    • Impaired hepatic/renal fxn
  73. Adverse effects for Valproic acid (Depakene):
    • Liver toxicity 
    • CNS depression
  74. Carbamazepine (Tegretol, Atretol) is used to treat what?
    • Partial seizures  (simple or complex)
    • Tonic seizures 
    • Trigeminal Neuralgia
    • Bi-polar disorder
  75. Carbamazepine (Tegretol, Atretol) should not be used in patients with what issues?
    • Bone marrow suppression 
    • Severe hepatic dysfunction 
    • Pregnancy/lactation
  76. Adverse effects associated with taking Carbamazepine (Tegretol, Atretol):
    • Severe headache 
    • Insomnia
  77. Do not take Carbamazepine (Tegretol, Atretol) with what other substances?
    • Alcohol 
    • other CNS depressants
  78. _____ is a progressive neurological disorder.
  79. Parkinsonism
    • symptoms of Parkinson's with out having a diagnosis - may be the result of a brain injury or side effect of drugs .
    • may exhibit tremors or bradykinesia
  80. Levodopa (Dopar) is used to treat what?
    Parkinson's  & Parkinsonism
  81. Parkinson disease is caused by what?
    Degeneration of dopamine-releasing neurons
  82. Name an anticholinergic used to treat Parkinson's disease:
    Benztropine (Cogentin) - 6th edition

    Diphenhydtamine (Benadryl) used in children/elderly -earlry in disease process - or if its drug induced
  83. How do anticholinergics work to treat Parkinson's?
    Block the action of acetylcholine-dopamine imbalance
  84. Do not give anticholinergics to patients who have what contraindications?
    • Narrow Angle Glaucoma 
    • GI/GU  obstruction
    • Myasthenia gravis (neuro-muscular disorder)
    • Prostatic hypertrophy
  85. When using anticholinergics in Parkinson's, do not mix with what other drugs?
    Tricyclic antidepressants and the phenothiazines, because they also have anticholinergic affects.
  86. What is unique about the anticholinergic Bentropine from others?
    Patients are not able to sweat as readily. May be at greater risk for heat exhaustion
  87. Name a domaminergic agent:
    Levodopa (Dopar)
  88. Levadopa may be used in combination with what other drug?
    cardibopa (Sinemet)
  89. Dopaminergic agents are contraindicated for patients with a history of what?
    • History of the presence of suspicious skin lesion or malignant melanoma
    • Angle closure glaucoma
  90. Use domamergic agents with caution in patients with ...
    • Psych disorders
    • Cardiovascular diseases
  91. Drug/drug interactions with Levodopa :
    • MAOI's 
    • Vitamin B6 (from supplements/ multi vitamins / bran)