pharm test

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pharm test
2011-07-01 18:15:26
pharm test

pharm test 4
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  1. donepizil
    acetylcholinesterase inhibitor used for alzheimer's disease
  2. symptoms for drugs used for alzheimer's
    • do not improve symptoms, will only slow the decline
    • if MMSE declines >2-4 points after treatment for one year, consider aternate agent
    • GI effects are common
    • hypotension, dizzyness, muscle cramping, fatigue, anorexia
    • overdose manifested by severe GI upset, bradycardia, muscle weakness including respiratory muscle
  3. acetylcholinesterase inhibitors used for myasthenia gravis
    • edrophonium
    • neostigmine
    • pyridostigmine
  4. edrophonium
    • extremely short acting
    • extremely short duration
  5. neostigmine
    used after anesthesia to reverse muslce relaxants
  6. pyridostigmine
    • useful for chronic treatment
    • administer on time
  7. acetylcholinesterase inhibitors:
    myasthenia gravis
    adverse effects
    • cholinergic therefore think sludge
    • bradycardia, hypotension
    • antidote: atropine
  8. another use for Ach inhibitor
    distingish between myasthenia crisis and cholinergic crisis

    • use edrophonium to distingish
    • if cholinergic - will not change anything
  9. neuromuscular blockers
    mechanism of action
    block Ach at the neuromuscular junction

    • eliminate spontaneous breathing
    • decrease oxygen consumption of muscles

    pt must be sedated and have pain control
  10. non-depolarizing agent

    • muscles are paralyzed
    • causes major histamine release and ganglionic blockade -

    • means: vasodilation increased bp
    • bradycardia - major respiratory depression
  11. succinylcholine
    • only depolarizing agent
    • rapid onset
    • short duration
    • can not be reversed
    • primary agent for endotracheal intubation
  12. succinylcholine

    adverse effects
    • may have long duration - 1-2 hours
    • upper body/back pain for 24 hr post op
    • malignant hyperthermia (temps up to 109 degrees)
    • can cause the release of K+ from tissue therefore always check renal function and K+ prior to use and monitor K+ levels
  13. neuromuscular blockers

    adverse effects
    • respiratory arrest
    • histamine release: bronchospasm, hypotension, salivary and bronchiole secretions
    • ganglionic block - hypotenstion
    • vagolytic - bradycardia
    • hyperkalemia/malignant hyperthermia - succinylcholine
  14. parkinson's disease

    • unknown etiology
    • results from the loss of dopaminergic neurons
    • symptoms appear after 80% loss of dopaminergic neurons
  15. levodopa & carbidopa
    • peripheral dopa-decarboxylase inhibitor
    • prevents metabolism of levodopa in the periphery therefore dopaminergic because more levo stays available
  16. pramipexole

    dopamine agonist
    act directly on dopamine adonist receptors

    • sometimes is a preferred single drug therapy in early stage PD
    • used as adjunct med in late stage PD
    • only useful for younger people who can tolerate daytime drowsiness and postural hypotenstion

    make most of dopamine you already have - because assumes body is still making it
  17. central acting anticholinergic

    • blocks acetylcholine
    • restores balance of dopamine/acetylcholine - therefore effective against tremors

    • uses:
    • parkinson's - effective against tremor
    • control of EPS symptoms (except tardive dyskinesia)
    • not recommened in elderly - associated with falls
  18. amantadine
    • anticholinergic
    • stimulates release of dopamine
    • inhibits reuptake of dopamine

    • adverse effects:
    • insominia, daytime fatigue, livedo reticularis, anticholinergic effects
  19. barbiturates
    • sedation, cognitive dysfunction, paradoxical aggression in children
    • vitamin D deficiency
    • nystagmus, respiratory depression, coma, hypotenstion, death
  20. phenytoin/fosphenytoin
    • iv route for status epileptcus
    • highly protein bound
    • gingival hypertrophy, ataxia, nystagmus
    • rash, hepatic damage, dysrhythmias, hypotension
  21. diazepam (valium)
    • respiratory depression
    • anterograde amnesia

    flumazenil - reversal agent used for over sedation of benzo's
  22. carbamazepine
    • bipolar
    • can cause absence seizures
    • dizziness, somnolence, ataxia, N/V, rash
    • hyponatremia, stevens-johnson syndrome

    bone marrow suppression

    no grapefruit juice
  23. ethosuximide
    • absence seizures only
    • nausea, hiccups, drowsiness

    stevens-johnson syndrome, lupus, blood dyscrasia
  24. valproate
    • bipolar
    • migraines
    • hepatic metabolism
    • highly protein bound
    • hepatic failure resulting in death
    • nausea/gi upset, thrombocytopenia, elevation of LFT's
  25. gabapentin
    • monotherapy or adjunct for partial seizures
    • migraine headaches
    • neuropathic pain

    drowsiness, nystagmus
  26. skeletal muscle relaxants

    central acting
    peripheral acting
    diazepam - potential for dependence, controlled substance

    • dantrolene - used as treatment for malignant hyperthermia
    • the only agent to act directly on spastic muscles and inhibit their contraction by preventing release of calcium in skeletal muscles
  27. oxybutynin
    control urge to void
  28. bethanechol
    for non-obstructive urinary retention
  29. extrapyramidal side effects
    • dystonia
    • akathisia
    • pseudoparkinsonism
    • tardive dyskinesia
  30. haldol
    block dopamine receptors

    • uses:
    • schizophrenia
  31. haldol
    • increases EPS
    • decreases hypotension, anticholinergic SE

    increases risk for seizure
  32. chlorpromazine
    • low-potency
    • increased sedation, hypotension, dermatitis, anticholinergic effects but decrease EPS
  33. antipsychotics - conventional

    teach patient
    • manage antisludge effects
    • take dose at bedtime due to sedation
    • skin effects common- avoid sun and avoid direct contact with the medication (dermatitis)
    • takes 6 weeks for max effect
    • come in for followup
  34. antipsychotics - atypical

    • block mainly serotonin
    • greater reduction of negative symtoms with less EPS and eventual development of tardive dyskinesia