pharm exam 2

Uterine stimulants: Dinoprastone

Prostin E2, Cervidil, Prepidil

Indications of Prostin E2

Expel uterine contents after fetal death, second trimester abortion, and miscarriage

Method of action of Prostin E2

Cause uterine and GI smooth muscle stimulation, start and continue cervical ripening at term

Side effects of Prostin E2

Orthostatic hypotension, nausea, vomiting, diarrhea, and fever

Administration route for Prostin E2

Vaginal suppository or gel applied to the cervix

Uterine Stimulants: Ergonovine/Methylergonovine

Ergotrate Maleale/ Methergine

Indications of -gonovine

Control bleeding and maintain uterine firmness in postpartum, patients

Method of action for -gonovine

Directly stimulate uterine contractions

Side effects of -gonovine

Nausea, vomiting, abdominal cramping, hypertension

Contraindications of -gonovine

Eclampsia or preexisting hypertension

Vitamin K

Phytonadione

Indications of Phytonadione

Newborns are given vitamin K to prevent bleeding disorders such as hemorrhagic disease of the newborn.

Method of action for Phytonadione

Fat soluble vitamin k for production of clotting factors

Side effects of Phytonadione

Bruising, hemorrhage, and allergic reactions.

Indications for Magnesium Sulfate

Inhibit preterm labor, seizure activity and management of eclampsia.

Method of action for Magnesium Sulfate

Produce anticonvulsant effects, smooth muscle relaxation, and inhibit uterine contractions

Side effects of Magnesium Sulfate

Absence of deep tendon reflexes, confusion and reduced urine output

Signs of toxicity for Magnesium Sulfate

Feeling hot all over, thirst, flushed skin, diaphoresis, CNS symptoms, and hypotension

RH_o (D) Immune Globulin brand name

RhoGAM/WinRHo

Indications of RhoGAM

Prevents RH immunization of Rh-negative patient exposed to Rh-positive blood in pregnancy

Method of action of RhoGAM

Suppress stimulation of active immunity by Rh-positive foreign blood cells; prevents RH disease of newborns

Side effects of RhoGAM

Tenderness, fever, arthralgias, aches and pains, urticaria, tachycardia, hypotension

Method of action for Biophosphanates

Inhibit bone reabsorption by actions of osteoclasts

Medication Class: Biophosphates

Alendeonate, risedronate, and zoledeonic acid

Side effects of Biophosphonates

Headache, abdominal pain, constipation, diahrrea, dysphasia, necrosis of the jaw, musculoskeletal pain, nephrotoxicity

Indications of Biophosphonates

Osteoporosis

Antiandrogen agents

Finasteride

Brand name for Finasteride

Proscar

Indications of Proscar

Treatment of benign prostatic hyperplasia and male pattern baldness.

Method of action for Antiandrogen agents

Inhibits enzyme 5 alpha reductase, reduce DHT levels

Side effects of Proscar

Impotence, decreased libido, and decreased ejaculate volume

Patient education for Proscar

Ensure patient is aware of the side effects before starting treatment as it may be something to consider

 levetiracetam (Keppra)

Broad Spectrum

topiramate (Topamax)

Broad Spectrum

Valproic acid (Depakene)

Broad spectrum

Lamotrigine (Lamictal)

Broad spectrum

 Phenytoin (Dilantin)

Narrow spectrum

 Phenytoin (Dilantin)

Narrow spectrum

Oxcarbazepine (Trileptal)

Narrow spectrum

Tiagabine (Gabitril)

Narrow spectrum

Gabapentin (Neurontin)

Narrow spectrum

Pregabalin (Lyrica)

Narrow spectrum

Phenytoin (Dilantin)

Hydantoins

Administration of Phenytoin

IV has to be given slowly and never mixed with other medications

Signs of Phenytoin toxicity

Nystagmus, involuntary eye movements

Partial seizure

Begin in a localized area in one hemisphere of the brain

Generalized onset seizure

Affects both hemispheres of the brain

Tonic-clonic

Generalized seizure with a period of sudden intense muscular contraction (tonic) followed by rhythmic jerking (clonic) movements

Atonic

Sudden loss of muscle tone and dropping

Myoclonic

Lightning like repetitive contractions of face, trunk, and extremities

Carbamazepine ( Tegretol) Method of action

Blocks reuptake of norepinephrine

Side effects of Carbamazepine

Nausea, vomiting, drowsiness, orthostatic hypotension dyspepsia and dizziness

Serious adverse effects of Carbamazepine

Potentially fatal skin reactions, edema, dyspepsia, nephro and hepato toxicity

Indications of Carbamazepine

Anticonvulsant

Lamotrigine brand name

Lamictal

Method of action for lamotrigine

Block voltage sensitive calcium channels in the brain to control seizure activity

Side effects of Lamictal

Nausea, vomiting, indigestion, sedation, drowsiness, blurred vision

Severe adverse reactions of Lamictal

Skin rash can can become serious and aseptic mengities stiff neck headache

Brand name for Phenobarbital

Luminal

Method of action for Luminal

Long acting barbiturate increases seizure threshold

When is Phenobarbital normally prescribed?

Used as alternative when single anticonvulsants are ineffective or not tolerated.

What kinds of seizures does the long acting barbituate Luminal, treat?

Treats partial-tonic clonic seizure and generalized monotonic seizures

Topiramate action

Prolongs blockage of sodium and increases activity of GABA

Side effects of Topiramate

Sedation, drowsines and dizziness

What interaction does Topiramate have when taken with other CNS medications

Enhance sedation

Topiramate interaction with birth control

Can cause spotting or bleeding indicating the contraceptive is losing effectiveness, educate patients to use alternative contraceptives

Typical antipsychotics

Blocks dopamine in the brain

Atypical antipsychotics

Blocks both dopamine and serotonin

Patient teaching for antidepressant therapy

Medication does not work overnight, consistency and time will show results

Monoamine oxidase inhibitors (MAOI) indications

atypical depression, panic disorder, OCD, and some phobias

What are TCAs?

Tricyclic antidepressants used for depression, anxiety, and chronic pain.

Side effects of TCA

Orthostatic hypotension, sedative effect, blurred vision, constipation, dryness of mouth nose and throat

Serious side effects of TCA

tremors, parkinsonian symptoms, seizure activity, dysthymias, tachycardia, heart failure, and suicidal ideation

Anticholinergic agents method of action

Blocks the action of acetylcholine, reducing bodily secretions and causing smooth muscle relaxation.

Indications for Anticholinergic agents

Parkinson disease and some GI disorders

Side effects of Anticholinergic agents

Blurred vison, constipation, dryness of mouth nose and throat

Serious side effects of Anticholinergic agents

Confusion, depression, hallucinations, nightmares, glaucoma, palpitations, and dysrhythmias

Cholinergic agents Indications

Reverse muscle relaxant used for Myasthenia gravis

Cholinergic agent side effects

nausea, vomiting, diarrhea, abdominal cramping, dizziness, hypotension

Severe side effects of Cholinergic agents

Bronchospasm, wheezing, and bradycardia

Indications for Benzodiazepines

Treats anxiety from alcohol withdrawal

Why should Benzodiazepines not be suddenly stopped

Can cause symptoms similar to alcohol withdrawal, including and increased anxiety.

Side effects of Benzodiazepines

Drowsiness, hangover, sedation, and lethargy

Dopamine agonists

Carbidopa, Levodopa

What is the difference between levodopa and Carbidopa

Levadopa supplies dopamine to the brain, Carbidopa slows down metabolism

Acetylcholinesterase inhibitors

Donepezil/Rivastigmine

Indications of acetylcholinesterase inhibitors

Used to improve cognitive function in Alzheimer patients

Side effects of Donepezil/Rivastigmine

Nausea, vomiting, diahrrea, and dyspepsia and seriously bradycardia

Severe adverse effects of antipsychotics

pseudoparkinsonism tardive dyskinesia, hepatotoxicity, blood dyscrasia, hypersensetivity, photo sensetivity, neuroleptic malignant syndrome

What is the expected outcome of treatment of MOA-B inhibitors

Works to establish a balance of dopamine and acteylcoline

Method of action for SSRI

Inhibit reuptake of seratonin

Why are SSRI’s preferred over other antidepressants

Side effects are safer and no risk of cardiac arrest