pharm exam 4

benzodiazepines

-prototype-diazepam

-CNS depressant

-used for sleep and anxiety

-generally safe and rarely fatal

-schedule 4 drugs (counted daily)

-in BEERS criteria (be careful with elderly)

-antidote-flumazenil

nonbenzodiazepines sedative hypnotic agents

- mainly used for severe insomnia

-prototypes: eszopiclone, ramelteon, zolpidem, zaleplon; all CNS depressants

-ADR: night walking, night driving, night eating (risk for falls in hospitalized pts)

schizophrenia

-chronic mental illness with psychotic episodes with fragmented perception, thought, and emotion with gross distortions of reality

-insomnia and paranoia worst signs

-has pos (fiery) and neg symptoms (relaxed)

-drugs tend to impair sexual functioning but there are drugs to fix that

antipsychotic agents

-FGAS (conventional)-block receptors for dopamine in CNS

-SGAS-only produce moderate blockage of dopamine receptors; stronger blockage for serotonin

EPS

-movement side effects caused by both groupings

-acute dystonia-sudden muscle spasms in face, neck and tounge; risk for choking

-parkinsonism- slow, stiff, shaky, shuffling walk; risk for fall

-akathisia-motor restlessness; risk for injury

-tardive dyskinesia-repetitive/involuntary movements; lip smacking, chewing, tongue out etc;

-can also be seen with antidepressants

low potency agents (conventional)

-prototype-chlorpromazine

-small amount causes high sedation

medium potency agents

-prototype-loxapine and perhenazine

-ADR: orthostatic hypotension, dry mouth, constipation

high potency agents

-haloperidol and fluphenazine

-low sedative effect, low incidence of hypotension

-can be given IM

-large amount can cause small sedation

atypical antipsychotic (second gen)

-prototype-clozapine

-less risk of EPS

-ADR: weight gain, T2DM, high cholesterol

-clozapine specifically can cause agranulocytosis (flu like symp+mucuous membrane alterations)

depression

-most common psychiatric disorder manifested by depressed mood, no sleep/overlseeping, anorexia etc;

-evluate depression by asking how are you feeling, how are you sleeping etc; dont just bluntly ask about depression

antidepressants

-used to relieve symptoms of depression

-takes 4-6 weeks to affect neurotransmitters/work

tricyclics

-usually drugs of first choice

-block neuronal uptake of NE and serotonin

-ADR: orthostatic hypotension, anticholinergic effects; dry mouth/drink water, most dangerous tho is cardiac toxicity if OD

-"tris are taken at night" help with sleep

-prototypes: amitriptyline, nortriptyline, desipramine, imipramine

-also very sedating/drowsiness

SSRIS

-prototype fluoxetine but other drugs include sertraline, escitalopram, citalopram, paroxetine

-most prescribed antidepressants

-SE: sexual dysfunction, insomnia (take in morning to avoid)

S/NRIS

-prototype-vanlafaxine (blocks NE and seretonin uptake)

-and duloxetine (inhibits serotonin and NE reuptake

S/DRI (atypical)

-prototype-bupropion

-acts as stimulant and surpresses appetite

-helps with sexual dysfunction

MAIOS

-prototype-isocarboxazid, tranylcypromine, phenelzine sulfate (iso, trany, phen)

-converts monoamine neurotransmitters into inactive products

-ADR: risk of triggering hypertensive crisis if eat food rich in tyramine; reactivates neurotransmitters

drug therapy for bipolar disorder

-mood stabilizers-relieve symptoms during manic and depressive episodes

-antipsychotics-given during severe manic episodes

-antidepressants-given during depressive episodes

lithium

-used for bipolar disorder

-alters synthesis and release of noroepi, serotonin, dopamine, helps cells respond to neurotransmitters, facilitate regeneration of damaged optic nerves, increase gray matter in regions affected by BPD

-need normal na levels to be effective

-serum level 0.5-1.5

-ADR: tremor, monitor levels q 2-3 days at start of therapy and then every 2-3 months

other BPD drugs

-carbamazepine-serum drug level 5-12 mcg/mL

-valproic acid-serum drug level 50-125 mcg/mL

amphetamines (attention deficit/hyperactivity disorder)

-release NE and dopamine

-affect CNS and CV systems

-ADR: cns stimulation, weight loss, CV effects

-measure weight and height, assess sleep, how they're doing in school, vitals

methylphenidates and dexmethylphen

- nearly identical in structure and function in structure and pharmacological action as dexmethylphenidate and pharmacology of both are nearly identical to amphetamines); some negative symptoms (catatonic/non responsive)

anorexiants

-prototype-pherntermine

-stimulates release of noroepri and dopamine

-most frequently prescribed adrenergic anorexiant

-ADR: nervousness

lipase inhibitors

-prototype-orlistat

-binds to gastric and pancreatic lipases in GI tract; can prevent absorption of 30% of ingested fat

-try to avoid eating fatty things

-ADR: GI symptoms, abdominal pain, flatulence, greasy stools

bulk forming laxatives (lowest)

-psyllium

-functions like dietary fiebrary-swell with water to form gel to soften fecal mass and increase mass; produces stool

-used for temp use of constipation and even diverticulosis and IBS

-ADR: minimal

surfactant vs laxatives stimulant

-both increase amount of water and electrolytes in intestinal lumen

-surfactant: prototype is ducasate

-stimulant: much stronger; used for opioid induced constipation (OIC), prototype bisacodyl

osmotic laxatives (super strong)

-draw water into intestines to soften stool

-gives more of fast and explosive effect

-low doses result in 6-12 hrs and high 2-6 hrs

-ADR: dehydration and sodium retention, keep eye on vitals specifically bp (dehydration lowers)

specific antidiahhreal agents

- prototype: diphenoxylate and loperamide; also come out of opioids

-activate opioid receptors in GI tract

-decrease secretion of fluid in small into si and increase absorption of fluid and salt

IBS

-pt can have diahrea, constipation, or both

-symptoms present 12 weeks in past year

-crampy abdominal pain that cannot be explained by structural or chemical abnormalities

drugs used for IBS

bulk forming agents, antidiahhreals, tricyclic antidepressants,

peptic ulcer disease

-degrees of erosion in gut wall; severe can cause hemorrhage and perforation

-usually associated with h pylori

anti ulcer drugs

-antibiotics-eradicate H pylori

-antisecretory agents, misoprostol-reduce gastric acidity

-sucralfate (and misoprostol)-enhance mucosal defenses

h pylori treatment antibiotics

-prescribed to decrease risk for developing resistance

-amoxcillin-inhibit cell wall synthesis

-tetracycline-inhibit protein synthesis

-metroniadazole-protozoan

-all can cause n/v/d yeast

histamine 2 receptor antagonists

-treat gastric and duodenal ulcers

-stop acid production, all end in tidine

-ADRS uncommon

-cimetidine-CNS effects, pneumonia, IV bolus (can experience hypotension and dysrythmmias

-rantidine-fewer ADR and drug interactions than cimetidine

-famotidine-otc/frequently used

-nizatidine-similar to ranitidine and famotidine

protein pump inhibitors

-suppress gastric acid secretion

-inhibit protein pump-only intended short term (1-3 most); linked to alzhemiers/dementia

-"prazoles"

-prototype- omeprazole; has GI effects (constipation)

antacids

-work to neutralize acids and prevent conversion of pepsinogen to pepsin in stomach; also may enhance mucosal protection by stimulating prostaglandin production

-does not alter systemic ph

-side effects: constipation/diahhrea

-be careful with renal impaired pts

antiemetics

-given to surpress cause and vomiting

-main drug to give is ondansetron (zofran), then promethazine or dipenhydramine

phenothiazines

-block dopamine receptors in CTZ

-SE: extrapyramidal reaction, anticholinergic effects, hypotension/sedation

substance p/neurokininl antagonists

-prototype-aprepitant

-blocks neurokinin 1 type receptors (for substance p) in CTZ

-prevent post op n/v and chemo induced n/v

-prolonged duration of action

antihistamines

-ex: diphenhydramine and meclizine

-considered anticholinergics; block both receptors for acetylcholine and histamine

-ADR: sedation, dry mouth, blurred vision, retention, constipation

questions to ask when assessing pain

location, duration, intensity, asses vitals before and after drug

drugs for pain

-level 1-3-mild pain; give nonopoids (NSAID, acetaminophen)

-level 3-6-moderate pain; give nonopoids+weak opioid combo

-level 7-10-severe pain; give strong opoids

-ADR of pain meds: respiratory depression, sedation, n/v, constipation

opoids vs analgesics

-anaglesics-relieve pain without causing loss of consciousness

-opoids-most effective pain relievers; occupy specific opioid receptors in CNS

morphine (opoids)

-relieves pain by mimicking action of endogenous opioid peptides

-strong opioid (7-10)

-ADR: resp depression, constipation, urinary retention, orthostatic hypotension

-can compromise pt with impaired pulmonary function

-only small fraction of each dose reaches site of analgesia action

moderate to strong opioid agonists

-produce analgesia, sedation, and euphoria

-similar ADR to morphine

-can be reversed with naloxone

codeine

-moderate to strong opioid agonist

-cough suppression

-activate opioid receptors

-usually PO; given alone or with asprin+acetaminophen

oxycodone

-long lasting analgesic

-can be combined with aspirin, acetaminophen, or ibuprofen

hydrocodone

-moderate to strong opioid agonist

-combined with aspirin, acetaminophen, or ibuprofen

opioid antagonists

-drugs that block effects of opioid agonists

-used for opioid overdose, reversal of post op opioid effects, management of opioid addiction

-ex: naloxone (short 1/2 life)

Patient-controlled analgesia (PCA)

Allows patients to self-administer pain relief (similar to a insulin pump); dont have outside ppl press button

Nonopoid centrally acting analgesics

-relieve pain by mechanisms largely or completely unrelated to opioid receptors; central acting

-no resp depression or abuse

-use for 1-3 pain threshold

tramadol

-combo of opioid and non opioid mechanisms

-CNS depressant

clonidine

-alpha 2 adrenergic agonist

-used in combo with opioid anaglesic

-ADR: cardiovascular; severe hypotension, rebound hypertension, bradycardia

ondasteron

-seretonin antagonists (look at slides)

-help with nausea

-ADR: sleepiness

methods for diagnosing headache

-migraine symptoms (you get them so think), aura/visual disturbances

selective serotonin 1b/1d receptor agonists

-prototype-sumatriptan

-binds to receptors on inter cranial blood vessels and causes vasoconstriction; diminishes perivascular inflammation

-oral or intranasal admin; 2.5 day 1/2 life (once a week dosing)

-ADR: transient heavy arms or chest pressure (heart attack feeling), vertigo, tingling sensations

drug for preventing migraines

-non selective beta blockers (beta 1 and beta 2) (propanol)

glaucoma

-increased intraocular pressure

-treat by reducing pressure

-prostaglandinds most important drug (cause brown pigmentation)

-increased intraocular pressure leading in damage to the retina and optic nerve with loss of vision

drugs for glaucoma

-prostaglandins-lower IOP by increasing aqueous outflow (usually start with these)

-alphas-cause decreased aqueous formation

-beta blockers-cause decreased aqueous formation; ADR: heart block, bradycardia, hypotension

procedure for applying eye drops

pull down the lower eyelid to and put drops in conjunctival sac and apply pressure to the inner canthus (specifically for alphas and betas)

drugs for otitis media and swimmers ear

-amoxcillin-inhibit protein synthesis

and ciprofloxacin-inhibits DNA replication

; n/v/d/yeast

apply ear drops

straighten ear canal (up and back for adults and down+back for children), drop 1-2 inches above, remain laying on side for 3 couple mins and massage

drugs for skin

-topical bacterial-neosporin (neomycin with polymyxin B,)

-clindamycin-antibacterial

-erthromycin-antibacterial

-corticosteroids-inflammatory

-documentation with skin things