Pharm Ex 2

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Pharm Ex 2
2015-09-22 00:58:34

pharm exam 2
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  1. Ambien safety
    • Zolpidem
    • used to treat insomnia
    • take immediately before sleep, since onset is 7 - 27 mins
    • AE: sleepwalking
    • Preg catalog B
    • Shouldn't take while nursing
  2. anatomy of anxiety and insomnia
    caused by activation of limbic system and RAS (reticular activating system)
  3. Recall limbic system
    • an area in middle of brain responsible for emotional expression, learning, and memory
    • signal routed through limbic system ultimately connect w hypothalamus
  4. reticular formation
    • a network of neurons found along entire length of brainstem
    • stimulation of reticular formation causes heightened alertness and arousal
    • inhibition causes general drowsiness and induction of sleep
    • hypothalamus connects to reticular formation
  5. reticular activating system
    • RAS
    • the larger area in which the reticular formation is found
    • projects from the brainstem to the thalamus
    • responsible for sleeping and wakefulness and preforms an alerting function for entire cerebral cortex
    • helps a person focus attention on individual tasks by transmitting info to higher brain centers
  6. Benzodiazepine antidote
    Flumazenil (Romazicon)
  7. Benzodiazepine withdrawal
    seizures, anorexia, fever, muscle cramps, disorientation

    Safety First, Don't Consume Alone
  8. Buspar Evaluation of teaching
    • Buspirone
    • Recall Buspar is Non Benzo, Non Barb used to treat anxiety
    • Takes a few weeks to achieve optimal anxiety reduction 
    • Can cause dizziness, HA, drowsiness
  9. GAD Recognition
    • Generalized Anxiety Disorder recognition
    • Excessive anxiety that lasts 6 months or more
    • interferes with function
  10. Lexapro indications in anxiety
    • Escitalopram Oxalate
    • SSRI
    • treats depression and anxiety
  11. Dilantin Therapeutic Index
    • Phenytoin
    • Very narrow index
    • Need blood tests
    • take on continuous basis to prevent seizures
    • NO ASA
    • Dosen't work for absence seizures
  12. Epilepsy
    defined as any disorder characterized by recurrent seizures
  13. Epilepsy pt teaching
    • Keep seizure diary
    • Rise from laying/sitting slowly
    • Keep doc appt
    • report any abd pain
    • support groups
    • Don't withdraw meds abruptly, may cause tonic clonic seizures
    • most meds are preg cat D
  14. Phenobarbital in pregnancy
    Category D
  15. Treatment for absence seizures
  16. Classifications of seizures
    • Partial
    • Generalized
    • Special syndromes
  17. Partial seizures
    • includes:
    • simply partial
    • Complex partial
  18. Simple partial seizure symptoms
    • Olfactory, auditory and visual hallucinations
    • Intense emotions
    • Twitching of arms, legs, and face
  19. Complex partial seizure
    • psychomotor seizure
    • Aura (preceding)
    • Brief period of confusion or sleepiness after w no memory of seizure
    • Fumbling w or attempting to remove clothing
    • No response to verbal commands
  20. Absence seizure
    • Classified as generalized 
    • Old name was Petit mal
    • Lasts a few seconds
    • Seen most often in children (staring off into space, no response to verbal, may have fluttering eyes or jerking)
    • Often misdiagnosed (especially w kids) as ADD or daydreaming
  21. Atonic seizures
    • Classified as generalized
    • "drop attacks"
    • Falling or stumbling for no reason
    • Lasting a few seconds
  22. Tonic-clonic seizure
    • Classified as generalized
    • "grand mal"
    • Aura (preceding)
    • Intense muscle contraction (tonic phase) followed by alternating contraction & relaxation of muscles (clonic phase)
    • Crying @ beginning as air leaves lungs,
    • loss of bladder/bowel control
    • Shallow breathing w periods of apnea, 1-2 mins
    • Disorentation & deep sleep after
  23. Febrile seizure
    • classified as special syndromes
    • Tonic-clonic activity lasting 1-2 minutes
    • Rapid return to consciousness
    • Occurs in kids btwn 3 months & 5 yrs
  24. Myoclonic seizure
    • Classified as special syndromes seizure
    • Large jerking movements of major muscle group, such as arm
    • Falling from a sitting position or dropping what is held
  25. Status epileptius
    • Classified as special syndromes seizure
    • Considered a medical emergency
    • Continuous seizure activity, which can lead to coma or death
  26. Valproic acid w aspirin side effects
    • Depakote
    • can cause severe bleeding
    • will cause seizures
  27. ADHD drug classifications
    • CNS stimulants-amphetamine
    • Non-CNS stimulants ~ when taken alone for ADHD exhibit less efficacy, but generally more effective as adjunctive therapy
  28. Amitriptyline timing for effectiveness
    2-6 weeks
  29. define bi polar
    • characterized by episodes of depression alternating with episodes of mania
    • likely results from abnormal functioning of neurotransmitters or receptors in brain
  30. depression assessment before starting antidepressants
    • check for suicide ideation
    • Depression may mimic a variety of medical or neurologic disorders
  31. MAOI's
    • monoamine oxidase inhibitors
    • inhibits monoamine oxidase, the enzyme that terminates the actions of neurotransmitters such as dopamine, norepinephrine, epinephrine, and serotonin
    • have low margin of safety
    • Adverse interaction btwn MAOI's and foods containing tyramine, a form of amino acid
  32. MAOI foods to avoid
    • Avacodos, bananas, raisins
    • Dairy: cheese, sour cream, yogurt
    • Beer & wine
    • Meat: beef or chicken liver, pepperoni, sausage
    • chocolate
    • All Yeasts
  33. MAOI mechanism of action
    inhibits monoamine oxidase, which is the enzyme that terminates the actions of neurotransmitters like dopamine, norepinephrine and serotonin
  34. Ritalin timing of doses
    • don't take after 4 pm
    • CNS stimulant
  35. Therapeutic drug levels of Lithium
    • narrow therapeutic index
    • is monitored via serum levels every 1 - 3 days when beginning therapy, every 2 -3 months thereafter 
    • concentrations in blood must remain w/in range of 0.6 to 1.5 mEq/L
    • Less than 0.6 causes mania
    • More than 1.5 causes renal failure, unconsciousness, death
  36. EPS
    • Extrapyramidal side effects
    • Set of AE to antipsychotic drugs
    • Includes: 
    • Dystonia
    • Akathisia
    • Pseudo-parkinsonism
    • Tardive Dyskinesia
  37. Anticholinergic side effects
    • Dries the body up....
    • Dry mouth
    • urinary retention
    • constipation
    • blurred vision
    • Nasal congestion
    • delirium
  38. Akathisia
    • Restless/can't sit still
    • inability to relax
    • most common symptom of EPS
  39. dystonia
    • muscle cramping/spasms 
    • particularly in back, neck, tounge and face
    • symptom of EPS
  40. Pseudo-parkinsonism
    • tremor, shuffling gait, rigidity, stooped posture
    • symptom of EPS
  41. Tardive Dyskinesia
    • Unusual tongue and face movements such as lip smacking and worm like motions w tongue
    • tic like face & tongue movements
    • finger rubbing
    • symptom of EPS
  42. Clozapine lab assessment for side effects
    • weight gain, obesity and associated risks (diabetes & hypertension)
    • can cause agranulocytosis (Lowered WBC count)
  43. Clozapine therapeutic effects
    controls + and - affects of schizophrenia
  44. Positive symptoms of schizophrenia
    • those symptoms that add on to normal behavior
    • include hallucinations, delusions, and a disorganized thought or speech pattern
  45. Negative symptoms of schizophrenia
    • those that subtract from normal behavior 
    • include lack of interest, motivation, responsiveness, or pleasure in daily activities
  46. Neuroleptic Malignant Syndrome
    NMS ~ adverse effects to anti-psychotic meds

    • Fever
    • muscle rigidity
    • Labile (unpredictable)
    • Diaphoresis
    • increase WBC
    • muteness

    Dont Fu*# ↑ My Love Making

  47. EPS
    Extrapyramidal side effects
  48. Aspirin Adverse effects
    • Ringing in the ears leading to ototoxicity (toxic to ears) which is non-reversible
    • Bleeding (guaiac stools)
    • GI effects
    • Reye's syndrome
    • Pregnancy Cat D
  49. Methadone teaching
    • Methadone is used for treating opioid dependence
    • Is an opioid but does not cause euphoria
    • does not cure opioid dependence, pt must continue taking to avoid withdrawal
    • allows pt to return to productive work and social relationships w/o physical, emotional and criminal risks of illegal drug use
  50. Migraine patho and treatment
    • thought to be caused by an initial vasoconstrictive episode followed by a vasodilation and acute pain
    • Treat with vasoconstrictors (Triptans) like Imitrax and Zomig
    • Prevention with vasodilators (beta blockers, calcium blockers, antidepressants, antiseizure drugs)
  51. Morphine AE
    • dysphoria (depression, anxiety, restlessness)
    • hallucinations
    • nausea
    • constipation
    • dizziness
    • itching
    • With OD... severe respiratory depression and cardiac arrest

    Never Cum In Deep Dark Houses
  52. Morphine GI AE
    • may intensify or mask pain of gallbladder disease, due to biliary tract spasms
    • should be avoided in cases with acute or severe asthma, GI obstruction and severe hepatic or renal impairment
  53. Nonpharm pain management
    • Deep breathing
    • massage
    • acupuncture
    • exercise
  54. Opioid Analgesia Antagonist
    Narcan, reverses respriatory depression
  55. Opioid receptors for pain
    Mu and Kappa
  56. Tylenol instructions
    • DO NOT exceed 3 gm per day
    • no alcohol
    • may cause liver toxicity
  57. Types of pain recognition
    • Acute or Chronic
    • Nociceptor = somatic (sharp) or visceral (dull, hard to pinpoint)
    • Neuropathic = caused by neuro-issues. shooting, burning, numbness
  58. What is substance P
    The neurotransmitter that is responsible for passing the pain message on to the brain once message reaches spinal cord
  59. Four stages of general anesthesa
    • 1. loss of pain: pt loses general sensation but may be awake
    • 2. excitement and hyperactivity: pt may be delirious & try to resist treatment
    • 3. Surgical anesthesia: skeletal muscles paralyzed, cardio & resp stabilize, pt still
    • 4: paralysis of medulla region in brain (responsible for resp & cardio activity) could result in death... this stage usually avoided in general
  60. General anesthesia induction protocol
    • If for major surgery, get through stage 2 quickly
    • IV first or used alone for surgeries 15 min or less; then add inhalant to maintain
    • Prevents flow of Na to neurons
  61. Nerve block teaching
    • Will still feel pressure but no pain
    • usually local
    • Ex: dentist, epidural
  62. Neuromuscular blocker assessment
    • Paralyzes muscles including respiratory (pt must be intubated) 
    • General anesthetic used or pt would not lose consciousness & no ability to move
    • Baseline neurologic assessment before admin
    • Dosage maintained using peripheral nerve stimulation during procedure
    • to ensure adequate sedation, pt should be monitored during entire surgery
  63. Acetylcholinesterase inhibitors mechanism of action
    Prevents enzymes from breaking down acetylcholine
  64. Alzheimers treatment
    • AchE inhibitor (Aricept or Exelon, etc) 
    • used short term 6-12 months
    • for slowing progress only
    • no reversal of structural damage, no cure
  65. Levodopa Pharmacotherapy
    • Treats Parkinsons
    • Increases levels of dopamine
  66. Levodopa toxicity manifestations
    • Uncontrollable muscle twitching
    • irregular heartbeat
    • N & V
  67. Parkinsons manifestations
    • Tremor or shaking 
    • Stiff muscles and achiness
    • limited movement
    • difficulty with balance
  68. Sinemet administration
    • Levodopa~Treats parkinsons
    • PO on empty stomach at bedtime (pt may fall asleep unexpectedly) 
    • Watch for signs of NMS 

  69. Botulinum Toxin type B toxicity
    • used to treat muscle spasms
    • Can be mild injection pain and local edema
    • erythema, transient numbness, headache, malaise (general feeling of discomfort) or mild nausea
  70. Dantrium lab values to know
    • used to treat muscle spasms
    • black box warning for hepatoxicity
    • therefore, lab values for liver tests "AST AND ALT ARE LIVER FUNCTION TESTS"
  71. Flexaril side effects
    • muscle relaxant
    • drowsiness, dizziness, dry mouth, constipation, tachycardia
    • Rare SE: swelling of tongue
  72. Goal for neuromuscular disorders
    • Pt independence
    • reduce pain & discomfort
  73. Muscle spasm treatment options
    Analgesics, muscle relaxers, hydrotherapy, massages, heat or cold
  74. Multiple sclerosis pharmacotherapy
    • Immunomodulators are main approach, they reduce severity and frequency of symptoms
    • If those are not successful, IV immunosuppressant's may be successful
    • corticosteroids reduce nerve inflammation