Pharm final exam

what are extrapyramidal symptoms?

symptoms such as tremors, masklike faces, rigidity and shuffling gait

* pseudo parkinsonism
* can be caused by medications such as metoclopramide

(Reglan)

what is tardive dyskinesia?

* protrusion and rolling of the tongue
* suck and smacking movements of the lips
* chewing motion
* involuntary movement of the body and extremities

what is akathisia?

* trouble standing still
* restless
* pacing the floor

what is dystonia?

* muscle spasms of the face, tongue, neck, and back
* facial grimacing
* abnormal or involuntary upward eye movement

what mediation is used to treat fibromyalgia?

Pregabalin (Lyrica)

myasthenia gravis occurs when antibodies attack the?

receptors for acetylcholine at the neuromuscular junction which prevent the muscle from contracting

what is neostigmine used for?

to treat muscle weakness of myasthenia gravis

when should neostigmine be given?

Administering 30-60 minutes before meals would help improve the swallowing strength of the patient

* Must be given several times per day

what might happen if neostigmine is NOT given on time?

myasthenic crisis which is characterized by generalized, severe muscle weakness that involves breathing

what is a cholinergic crisis?

occurs when excess dose of AChE like pyridostigmine

symptoms may be:

remember DUMBBELLS

diarrhea

urination

miosis (constriction of pupil)

bradycardia

bronchospasms

emesis

lacrimation

laxative/loss of muscle strength

sweating

what is the antidote for a cholinergic overdose?

atropine

what is the tensilon test?

also called edrophonium

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given to diagnose MG and also used to differentiate between a cholinergic or myasthenia crisis

what is multiple sclerosis?

an autoimmune disease where the antibodies attack the myelin sheath of nerve fibers causing lesions (plaques)

* occurs more in women

what are some teaching points with MS?

* avoid triggers: stress, sickness, sepsis, smoking, and sun exposure
* balance exercise with rest periods

what is cyclobenzaprine (flexeril)?

treats muscle spasms with MS

what is a harmless side effect of methocarbamol (robaxin) ?

green or black discoloration of the urine

* not harmful - do not need to report

what symptoms do 1st generation/typical antipsychotics treat?

positive symptoms such as

* incoherent speech, hallucinations, delusions, and paranoia

what symptoms do 2nd generation/atypical antipsychotics treat?

positive, negative and cognitive symptoms such as

* negative: poor self care, social withdrawal, flat affect, and simple speech
* cognitive: disorganized thinking, memory problems, lack of attention

which atypical antipsychotic has low incidences of EPS and TD?

clozapine (Clozaril)

which atypical antipsychotic sis used for chronic tic’s and tourette’s?

risperidone (risperadal)

what are common side effects of risperidone?

drowsiness and headaches

\-teach patient that this is common for most atypical antipsychotics

which atypical antipsychotic is used for anorexia nervosa and BPD?

olanzapine (zyprexa)

what is the treatment for NMS?

DANTROLENE

* remember signs

FEVER

fever, encephalopathy, vital signs unstable, elevated enzymes, and rigidity

can you use carisoprodol for a patient that has a history of substance abuse?

no; carisoprodol is a highly additive muscle relaxer

what is cyclobenzaprine?

a muscle relaxer that treats muscle spasms

when is sucralfate administered?

before meals on an empty stomach

what does benztropine (Cogentin) do for parkinson’s disease?

reducing some of the tremors and rigidity

what is valproic acid contraindicated with?

pt. with history of liver disease

BBW: hepatoxicity and pancreatitis

how long can benzo’s be used for?

short term only!

effect may take 1-2 weeks, tolerance develops 6-8 weeks

what is the antidote for benzo’s?

flumazenil!

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what is a common non-benzo?

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buspirone (buspar)

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what is the advantage of busprione?

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NO sedation, can be used long term (lower abuse potential), BUT takes several weeks to start working

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what are the side effects of buspirone?

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dizziness, nausea, headache

what are the most common SSRI’s?

Paroxetine (Paxil)

Escitalopram (Lexapro)

Sertraline (Zoloft)

Citalopram(Celexa)

fluoxetine (Prozac)

what is the most common side effect of SSRI’s?

decreased libido

* teach patient that this will decrease over time

what is the most appropriate action to do when a patient has improved mood from SSRI’s?

switch to alternative once a week dosing

what should be monitored when taking lithium?

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sodium levels ,kidney function, avoid dehydration – encourage fluids (2-3 L/day)

what are some teaching points when taking lithium?

* Patients should not drink any caffeine-containing drinks, including tea and cola
* Patients must continue taking lithium even when symptoms subside, or else symptoms will recur
* It is not recommended to consume a sodium-restricted diet.

what foods should be avoided when taking MAOI’s?

tyramine foods like yogurt, salami, soy products, avocados, chocolate, bananas, aged cheese

what are some examples of MAOI’s?

* Tranylcypromine (Parnate)
* Phenelzine (Nardil)
* Isocarboxazid (Marplan)
* (MAO type B: Selegiline – used for Parkinson Disease)

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what is the black box warning for selegiline?

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high risk for suicide in children!

what does donepezil (aricept) do for alzheimer’s disease?

decreases the deterioration of cognition

what are some teaching points for donepezil?

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* take at bedtime- due to symptoms of bradycardia and heart block which can cause fainting
* AVOID NSAIDs and alcohol

what are some teaching points while taking montelukast (singulair)?

* affects lower enzymes, so periodic LFTs should be performed
* pt. taking this should NOT use ibuprofen or aspirin for pain
* take in the evening for maximum effectiveness

what is promethazine (Phenergan) contraindicated with?

glaucoma

what are common side effects of H2 blockers?

impotence and gynecomastia

* these symptoms resolve when stopping the medication

are proton pump inhibitors or H2 blockers more potent?

proton pump inhibitors such as pantoprazole, BUT is mor expensive

what is the **first** priority when a patient is losing a large amount of blood?

hydrate the patient to avoid shock!

taking furosemide and steroids may lead to?

increased potassium loss- check K levels

what is spironolactone (Aldactone)?

a potassium-saving diuretic

what foods should be avoided when taking spironolactone?

leafy greens, beans, nuts, dairy foods

what do beta blockers increase the risk of with patients that have asthma?

bronchospasm

* discuss a change in meds

what are the signs of angioedema?

peripheral edema, swelling of the face, lips, and tongue

what causes angioedema?

most likely to associated with ACE/ARBS

what intervention should the nurse take for patient with angioedema?

hold the dose and notify the HCP

what is the most common side effect of ACE inhibitors?

dry, nonproductive cough

what is an alternative to ACE inhibitors?

ARBS

when should lispro be given?

no more than 5 minutes before meals because it is rapid acting!

how do steroids affect blood sugars?

increases the blood sugars

what should you teach a patient with diabetes who is taking steroids?

you may need to increase the insulin dose

what class of medications is considered first line of therapy for type 2 diabetes?

biguanides such as metformin

SE: N/D and abdominal bloating

what are Selective Sodium-Glucose Transporter 2 (SSGT2)?

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* think of “flozins” since they are flowing glucose into the urine
* high sugar in the urine can cause UTI’s and genital fungal infections
* other side effects may be orthostatic hypotension and weight loss

what are some teaching points for sulfonylureas drugs?

* avoid alcohol (disulfiram reaction: flushing,sweating,nausea, vomiting)
* NO sulfa allergies
* NO renal or hepatic dysfunction

what do Dipeptidyl Peptidase 4 Inhibitors (DPP4) do?

an **oral** incretin med

* best used as 2nd line of therapy to metformin
* **LOW risk of hypoglycemia; GREAT for obese and elderly pt.**
* REPORT abdominal pain
* typically end in -tin

what is Phenazopyridine (Pyridium) used for?

used to provide symptomatic pain relief associated with urination

* This is not an antibiotic

what is a harmless side effect of pryridium?

Reddish-brown/orange urine

what are the symptoms of pyelonephritis?

urinary frequency with pain on urination, flank pain, fever, and chills

* upper urinary tract (kidney)

what is a common symptom of renal calculi?

right-sided flank pain

what is nitrofurantoin (Macrobid)?

it is used for UTIs

S/E: urine discoloration (brown) and superinfection

* may cause a false positive glucose on urine dipstick

what is an example of a urinary stimulant and what does it do?

bethanechol chloride

* Used to treat urinary retention, neurogenic bladder: Stimulates urination by contracting the bladder
* parasympathetic action

what should you watch for when taking bethanechol chloride?

can cause BRADYCARDIA and orthostatic hypotension.

It can cause reflex tachycardia due to drop in BP

what does trimethoprim/ sulfamethoxazole do?

* effective against most gram + and gram - bacteria
* inhibits folic acid synthesis
* NO sulfa allergies!

what are the signs of digoxin toxicity?

N/V, headache, and HR less than 60 beats/min

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pt. may also present with visual disturbances and particularly colored halos around objects

what should the nurse do if a patient has digoxin toxicity?

nurse should hold the dose and notify the HCP

what is the immediate SE of nitroglycerin?

headaches

what is a teaching point with nitroglycerin transdermal patch?

rotate the sites when changing the patch

what are some teaching points with alpha-glucosidase inhibitors?

Takes weeks to months to begin working; causes flatulence and bloating

what are some teaching points with Thiazolinediones (Pioglitazone and Rosiglitazone)?

Avoid with Class III and Class IV HF due to fluid retention side effects

what are beta 1's selective to?

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heart -- atenolol, metoprolol, esmolol

what are beta 2's selective to?

lungs -- albuterol, salmeterol, terbutaline

what does it mean when a beta blocker is non-selective?

they have actions on both the heart and lungs -- nadolol, propranolol, pindolol, sotalol

what are the most common side effects seen with calcium channel blockers?

peripheral/pulmonary edema, headaches, hypotension and CONSTIPATION

what should you avoid when taking calcium channel blockers?

grapefruit juice and alcohol (increase drug levels)

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you should also restrict sodium and fluid intake to minimize edema

how does verapamil work?

it relaxes the coronary arteries

what is the most common class 3 antidysrhythmic?

amiodarone--potassium channel blockers

* first line drug for ventricular tachycardia and ventricular fibrillation

what medication treats supraventricular tachycardia?

adenosine

how is adenosine administered?

**IV rapid push, rapid flush**

* may cause a temporary flat line -- patients must be on a CR

what cholesterol level is considered at risk for coronary artery disease?

270 mg/dL

what is rhabdomyolysis?

the breakdown of muscle tissue releases muscle fiber contents into the blood -- these substances can cause kidney damage

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* adverse side effect of statins
* REPORT muscle aches as side effect

what are statin's contraindicated with?

the liver

* **check baseline liver enzymes before therapy**

why are statins given at bedtime?

this is when cholesterol is produced in larger amounts by the liver

what is Gemfibrozil (Lopid)?

a cholesterol medication

when are fibrates given?

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30 minutes before breakfast and dinner

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what can fibrates never be combined with?

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statins -- increases the risk for myopathy

what deficiency is seen with resins?

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folate -- due to the interference of vitamins A, D, E, and K (fat-soluble)

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what is Questran (cholestyramine) ?

used to treat hyperlipidemia

(bile acid sequestrant)

* SE: constipation and abdominal discomfort
* increase fluid and fiber intake to reduce risk of abdominal discomfort

what are some teaching points when taking levodopa/carbidopa?

* may take weeks to see improvement
* AVOID high protein meals
* do NOT abruptly stop --can cause NMS

what mediation is used to treat intermittent claudication?

Cilostazol (Pletal)

* takes weeks to work

what is the antidote for heparin?

protamine sulfate