Pharm Exam II study guide

Therapeutic goals for neuromuscular drugs (3)

-increase ROM, increase ADLs, decrease pain

-assess to see if pt is meeting their goals c/ ROM, pain, & ADLs

- assess for side effects like impact on liver and GI (constipation)

imipramine (Tofranil) (5)

-Tricyclics (TCAs less used bc less selective)

-Treat depression and anxiety conditions

-Inhibit reuptake of NE and serotonin

-common is orthostatic hypotension, nausea, and sedation, sexual dysfunction

- interacts with many medications

methylphenidate (Ritalin) (4)

-CNS stimulants

-used to tx sx of ADHD/ narcolepsy

-accurate hx needed to be prescribed safely

-high abuse potential ->Schedule II drug, weight loss, paradoxical hyperactivity, don't stop taking suddenly

phenobarbital (Luminal) (3)

-Barbiturate

- tx seizures (except absence seizures!!!!) by causing CNS depression via GABA action

-small margin of safety, high potential for dependence/tolerance, major CNS depression

Antidepressant pharmacotherapy all classes (3)

Selective serotonin reuptake inhibitors (SSRIs), Serotonin and norepinephrine reuptake inhibitors (SNRIs), Atypical antidepressants, Tricyclic antidepressants (TCAs), Monoamine oxidase inhibitors (MAOIs)

Pharmacotherapy for analgesia/assessment (4)

-ask pt about pain

-quality, location, severity, onset, acute vs chronic, aggravation, etc.

-depending on cause/severity opioids, NSAIDs, or non opioid analgesics could be prescribed

-try to tx before it becomes intolerable

lithium carbonate (Eskalith) (5)

-mood stabilizer for bipolar disorder

-is very commonly used, very tolerable

-Lithium acts like sodium in the body, so conditions where sodium is lost (ex. sweating/dehydration)->lithium toxicity

-Narrow therapeutic index->monitored by serum levels

-take as prescribed + adhere for results, don't discontinue suddenly

Antidepressant pharmacotherapy

-Neurotransmitter dysfunction in brain r/t focused cognition and emotion

-Meds do not restore imbalance completely, provide relief while coping skills developed

-can be selective or nonselective in their targets

-FDA "black box warning": advise and monitor patients and family for suicidal ideation when meds initiated or changed in children and adolescents ← TEST QUESTIONS

Nursing scope of practice regarding anesthesia drugs

- Analgesia/paralytic

-many of these drugs should only be administered by those with specialized training

-Moderate (conscious) sedation: RN directed by MD

-Monitored Anesthesia Care (MAC), Local/Regional anesthesia, General anesthesia can only be administered by CRNA or Anesthesiologist

donepezil (Aricept) (5)

-Drug for Alzheimer's Disease

-cholinesterase inhibitor: reduced breakdown of acetylcholine (indirect parasympatkomemetic)

-offer modest improvement, and only at beginning of disease (needs neurons to act on -> few nerons= not function)

-maintain ALDs, cognition, behavior -> retain independence for as long as possible

-slows progression only

phenelzine (Nardil) (5)

-Monoamine oxidase inhibitors (MAOIs)

-last resort for depression/anxiety tx as it interacts with foods (anything c/ tyramine)/rx ( SSRIs)

- can cause Hypertensive crisis from interactions

-May take several weeks for therapeutic effect/ monitor for suicidal ideation

-may need to wear medical alert band if taking

levodopa,carbidopa, & entacpone (Stalevo) (3)

-Tx for Parkinson's

-levodopa/carbidopa are dopamine agonists

-precurser to dopamine

-entacpone (Stalevo) is a MOA-B (COMT) inhibitor

-slows breakdown of dopamine

benztropine (Cogentin) (3)

-Anticholinergic

-most common anticholinergic to Tx Parkinson's/ Parkinsonism sx

- inhibit action of acetylcholine in the brain

another approach to changing the balance

naloxone (Narcan) (5)

-Opioid Antagonist

- will stop an overdose/ opioid resp. depression, will stop any analgesia too so make sure to have alt pain rx to give after admin, if dependent pt will go into withdrawal immediately

-Minimal toxicity

-Administer if respirations < 10/minute

-assess pain level, N & V, and CNS function after admin

salicylates (aspirin) (6)

-Nonopioid Analgesics

-inhibit cyclooxygenase enzymes that form prostaglandin (reduce inflammation AND pain)

- primary alternate when NSAIDs or ASA not tolerated

-Drugs of choice for moderate pain

-analgesic, antipyretic, anti-inflammatory, also has anti platelet activity

-Know patient indication!-> long term use for thinning blood vs short term for pain/inflammation

zolpidem (Ambien) (6)

-Nonbenzodiazepine Anxiolytics

-Tx anxiety/ insomnia

-most commonly prescribed rx to tx insomnia

-doesn't cause waking drowsiness bc shorter half life

-SE: hallucinations, SI, sensory distortions

-Schedule 4 drug!!

sumatriptan (Imitrex) (5)

-antimigraine drug (triptan)

-causes vasoconstriction in cranial arteries

-onset 10-30 min depending on route

-SE: dizziness/ drowsiness

-contraindication: angina, MI, HPT, diabetes

valproic acid (Depakene) pharmacotherapy (4)

- anti-epileptic drug

-GABA agonist

-BLACK BOX WARNING: can cause liver failure -> test for function

-SE: sedation, drowsiness, GI upset, prolonged bleeding, and tremors

chlorpromazine (Thorazine) (5)

-Conventional Antipsychotics (1st Generation)

Phenothiazines

-sedation and anticholinergic side effects

-Vary in potency & SE's

-act by blocking dopamine and or serotonin receptors

Adverse effects limit pharmacotherapy

- Tx POSITIVE psychotic sx

haloperidol (Haldol) (7)

-first generation antipsychotic ->Nonphenothiazine

- slightly less side effects/risks than phenothiazine 1st generation antispych.

-still some sedation and anticholinergic side effects

-act by blocking dopamine and or serotonin receptors

-Adverse effects limit pharmacotherapy

-6-7 weeks to work

- Tx POSITIVE psychotic sx

Sleep disorder pharmacotherapy (4)

-slows neuronal brain activity helps to tx insomnia and anxiety

-CNS depressants, antidepressants, bezodiazapines

-can also help tx the anxiety that may be contributing to the insomnia

-all other contributors/conditions should be ruled out before medication is given

Sertraline (Zoloft) side effects (3)

- MONITOR FOR SUICIDAL IDEATIONS

-drug/drug interactions -> MAOI

-agitation, insomnia, h/a, dizziness, fatigue, or hypomania

ethosuximide (Zarontin) (4)

-Succinimide / Antiseizure drug

- inhibits Ca+ and increase threshold required to trigger a seizure by keeping the neurons from firing too quickly

-used to tx absence seizures

-SE: extreme mood swings, depression, suicidal behavior, h/a, drug/drug interactions

Non-pharmacologic pain relief interventions (2)

-yoga, PT, hypnosis, acupuncture, hot/cold, mediation, prayer, art, etc.

- any tx not using medications/OTCs

cyclobenzaprine (Flexeril) (5)

-Centrally acting skeletal muscle relaxant

-inhibits neurons at CNS level (in brainstem)

-used to tx acute muscle pain (NOT spasticity)

-drowsiness, blurred vision, dizziness, dry mouth, rash, tachycardia, angioedema (swelling of the

tongue)

-Drug/drug interactions and ETOH

alendronate (Fosamax) (3)

-Bisphosphonate; bone resorption inhibitor (osteoporosis rx/pagets)

-n/v, metallic taste, hypocalcemia, hypophosphatemia

-Hypocalcemia is an expected effect

and may be treated with PO or IV calcium salts.

allopurinol (Lopurin)/ colchicine (Colcrys) (4)

-Xanthine oxidase inhibitor / Tx for gout (both)

-used to decrease excruciating joint pain/inflammation by decreasing uric acid levels by blocking synth and increasing excretion

(gout often manifests in big toe)

-AVOID future attacks by avoiding purine rich foods (organ meats, red meat, shellfish, anchovies, beer, sugary drinks)

-micropapular rash, fatal toxic epidermal necrolysis (rare), and hypersensitivity

Purpose of studying prototypes - application to drugs in same class (4)

-an individual drug that represents a drug class

- similar chemical structures

-similar mechanism of action/mode of action

-similar side effects/adverse effects

Alzheimer pharmacotherapy (4)

-only staves off sx, is not a cure

-prolong independence and ADLs

-Cholinesterase inhibitors: intensify ACH effects at the receptor by decreasing rate of degradation of ACH by AchE

-indirect parasympathomimetics

Osteomalacia pharmacotherapy (4)

-rickets (softening of bones without alteration in structure, due to deficiency of Vitamin D & calcium)

-seen in kids

-tx with calcium, Vit D, SERMs, bishphosphonates, & calcitonin

- try to maintain function and prevent disfigurement

Calcium supplement pharmacotherapy (2)

-calcium, Vit D, SERMs, bishphosphonates, & calcitonin

- bishphosphonates must taken on an empty stomach with full glass of water 30 minutes BEFORE first food/fluid of day & remain upright 30 minutes after dose KNOW FOR TEST

flumazenil (Romazicon) (2)

-benzodiazepine antagonist for overdoses/ reverse effects

- shorter half life than benzodiazepines so will need many doses to ensure there is no reoccurrence

risperidone (Risperdol) (3)

-Atypical Antipsychotic/ 2nd gen

-Act by partially blocking dopamine & serotonin receptors

-weight gain & specifically obesity, DM, ↑ lipids, CVA risk, blood dyscrasias, and postural hypotension

ANS response - anticholinergic atropine (Atropen) (4)

-Parasympathomimetic

-tx those in cholinergic crisis

- contraindication glaucoma!! TEST QUESTION

- often used in ophthalmic procedures

ANS response - adrenergic agonist phenylephrine (Neo-synephrine) (5)

- increases sympathetic response (fight/flight)

-adrenergic agent

-causes systemic and pulmonary vasoconstriction

-used as an nasal decongestant

-can increase BP

ANS response - adrenergic antagonist ps (Minipress) (4)

-rest and digest

-adrenergic blocker -> cholinergic increase

-lowers HR, BP, orthostatic hypotension-> monitor

-limit driving when first taking the rx

ANS neurotransmitters & medications (2)

-can block and or stimulate ANS branches

-can't make the body do something it couldn't do before

ANS response - cholinergic agonist bethanechol (Urecholine) (5)

- direct acting cholinergic

-DO NOT USE IF THERE IS A GI BLOCK

-stimulates bowel and urinary muscles

-tx urinary retention, alzheimer's

-counteract with Atropine

escitalopram oxalate (Lexapro) (4)

-SSRI

-helps tx sx of depression

-inhibits serotonin reuptake in the brain

-serotonin syndrome, SI, Nausea, Diarrhea, Dry mouth, and Constipation

phenytoin (Dilantin) (5)

-anticonvulsant

-suppress sodium influx

-no abuse risk, and no CNS depression side effects

-very narrow therapeutic range

-INCREASES risk for oral infection

morphine (Morphine sulfate contin) (4)

-opioid analgesic

-tx for moderate to extreme pain

-naloxone to reverse overdose!!

-SE: high addiction risk!!!, respiratory depression, sedation, hypotension

Parkinson's Disease & safety (4)

-dopamine processing neurons die ->imbalance in brain

-sx: lessened control of muscles, difficulty starting muscle moments, slowing of moments, poor balance, fall risk

--> can make pt a choking risk

-tx increase muscle control and decrease swelling, by restoring balance between acetylcholine and dopamine

Multiple Sclerosis symptoms; treatment aims (4)

-chronic, inflammatory, autoimmune disorder of CNS resulting in demyelination of neurons

-TX with immunosuppressants/ immune modulator

- manage symptoms, reduce relapses, slow disease progression, and improve quality of life

-sx: fatigue, heat sensitivity, neuropathic pain, vision loss, and impaired coordination

ANS anatomy & physiology (3)

-ANS controls involuntary responses

-smooth muscles, glands, organs

-parasympathetic and sympathetic divisions