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Pharm Final UNIT!!!! > All other topics > Flashcards

All other topics Flashcards

1
Q

What is necessary for a diagnosis of insomnia?

A

Impaired daytime functioning due to difficulty initiating sleep, maintaining sleep, or inability to return to sleep when adequate time and opportunity for sleep is provided

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2
Q

When is short term and long term insomnia separated?

A

Before or after ( 3x a week) 3 months

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3
Q

What drug classes can be used to treat insomnia?

A
  • Benzos
  • Non-benzodiazepine hypnotics
  • Orexin receptor agonists
  • Antihistamines
  • Tricyclic antidepressants
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4
Q

What are risks of use of BZDs and no-BZD hypnotics in insomnia?

A
  • Fetal malformation 1st trimester pregnancy
  • Alcohol consumption= excessive sedation
  • Renal or heaptic dz metabolic clearance
  • Pulmonary dz as they are respiratory suppressants
  • Nighttime decision makers as impair decision making abilities
  • 75+ adverse effects
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5
Q

How long should treatment last of insomnia with hypnotics?

A

6-8 weeks then taper off

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6
Q

What are ADRs common to hypnotics?

A
  • residual daytime sedation
  • drowsiness
  • Cognitive/CNS impairment
  • Dependence
  • Respiratory depression
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7
Q

What are the non-BZD hypnotic drugs?

A
  • Lunesta
  • Sonata
  • Ambien
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8
Q

What non-BZD hypnotic has the longest 1/2 life?

A

Lunesta

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9
Q

What non-BZD is the only one available for long term use?

A

Lunesta

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10
Q

If taking other drugs that are CYP 3A4 inhibitors, what drug is recommended?

A

Sonata

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11
Q

if a patient has a hard time falling asleep what drug based on 1/2 life is preferred?

A

Sonata

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12
Q

What is the Lunesta specific ADR?

A

Altered taste

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13
Q

What non-BZD hypnotic(s) are associated w/ next day impairment?

A

Lunesta and Ambien

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14
Q

What drug is an Orexin receptor antagonist?

A

Suvorexant

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15
Q

What is similar between Suxorexant and lunesta?

A
  • CS 4
  • Next day impairment
  • Prominent 3A4 substrate
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16
Q

What is different about Suroxetant and Lunesta?

A

Mechanism of action

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17
Q

What drug is a melatonin agonist?

A

Ramelteon

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18
Q

What are important factors about Ramelteon?

A
  • Not a controlled substance

- Pt must take 30 minutes before sleep (assist with sleep onset)

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19
Q

What warnings/ caution are associated with Ramelteon?

A
  • Reproductive hormone disturbances
  • Depression
  • CNS depression
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20
Q

What antidepressant can be used to treat insomnia?

A

Doxepin

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21
Q

What drugs can be used in restless leg syndrome if iron supplementation does not fix it?

A
  • Gabapentin/ Pregabalin

- Pramipexole/ Ropinirole

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22
Q

What is the 1st line treatment for narcolepsy?

A

Modafinil/ Armodafanil

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23
Q

Unless there is a C/I what approach is to be taken in helping patients quit smoking?

A

Behavioral and pharmalogical therapy

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24
Q

What are the 5 A’s of tobacco use and smoking?

A
  • Ask motivation to quit
  • Advise most important factor for health now and in the future
  • Assess determine patient willingness to quit
  • Assist quit date, tell family, friends and coworkers to assist
  • Arrange office F/U w/in week of quit date
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25
Q

What is the 6th A of tobacco use and smokign directed at pediatrics?

A

Anticipate, discuss avoidance early

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26
Q

What are the 3 pharm methods to quit smoking/ tobacco use?

A
  • Nicotine replacement therapy
  • Chantix
  • Bupropion
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27
Q

What is the best approach to treat tobacco use by NRT?

A

Combo therapy: long term transdermal patch w/ short term formulation

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28
Q

What is dosing of NRT based on?

A

Number of cigarettes per day and timing of first cigarette

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29
Q

What is meant by chew and park?

A

NRT gum cannot be chewed continually otherwise GI upset, HA, hiccups, and mouth ulcers

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30
Q

What NRT product gives the best option to address behavior and sensory aspects?

A

Inhaler but can cause bronchospasm

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31
Q

What is different about Chantix vs. NRT therapy?

A
  • Chantix start week before quitting

- NRT start use day of quitting

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32
Q

What safety issues may arise with the use of Chantix?

A
  • Neuropsychiatric: Hostility, agaitation, SI
  • CV risk those w/ CV dz
  • Seizure risk
  • CNS depression
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33
Q

What is similar about Chantix and Burpropion?

A
  • Start before quit date

- taken for 12 weeks

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34
Q

What type of drug is preferred to treat most psych illness patients that smoke? Which D/O is C/I this drug?

A
  • Bupropion

- Bipolar D/O

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35
Q

What drug regiment is best indicated for hospitalized smoking pts?

A

NRT

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36
Q

What treatment should be used in pregnant pts?

A

NRT or Bupropion w/ behavioral therapy

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37
Q

What classification is alcohol?

A

CNS depressant

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38
Q

What occurs when there is abrupt cessation of alcohol use?

A

CNS overactivity; chronic ETOH exposure induces insensitivity to GABA

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39
Q

What are minor ETOH withdrawal sx?

A
  • Tremor
  • Mild anxiety
  • HA
  • Insomnia
  • Palpitations
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40
Q

What are severe ETOH withdrawal symptoms?

A
  • Withdrawal seizures
  • Withdrawal hallucinations
  • Delirium Tremens
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41
Q

When is the typical onset of withdrawal seizures?

A

12-48 hours after last drink

42
Q

What is dangerous about withdrawal seizures?

A

1/3 lead to delirium tremens

43
Q

When is the onset of alcoholic hallucinations and when do they resolve?

A
  • Onset w/in 12-24 hours from last drink

- Resolve w/in 24-48 hours

44
Q

What kind of hallucinations are most common during alcoholic hallucinosis?

A

Visual

45
Q

How does alcoholic hallucinosis differ from delirium tremens?

A

In alcoholic hallucinosis VS are normal and there is no global clouding of sensorium

46
Q

What signs/sx can be experienced in delirium tremens?

A
  • Hallucinations
  • Disorientation
  • Tachycardia
  • HTN
  • Fever
  • Agitation
  • Diaphoresis
  • Cardiac abnormalities
47
Q

What is the onset and duration for delirium tremens?

A
  • Onset 48-96 hours from last drink

- Duration of up to 7 days

48
Q

What are risk factors for delirium tremens?

A
  • Hx sustained drinking
  • Hx prior DT
  • > 30 yo
  • Significant w/drawal in presence of elevated BAC
  • > Longer period (2days) last drink
49
Q

What is the mortality risk associated w/ DTs?

A

5% mainly due to cardiac arrhythmia

50
Q

What is hallmark sx control and supportive care?

A
  • BZDs agitation and prevent progression
  • IV fluids
  • Nutritional supplementation
  • Frequent clinical reassessment
51
Q

What is given to DT patients to prevent Wernicke’s encephalopathy?

A
  • Thiamine

- Glucose

52
Q

What BZDs are preferred for DT tx?

A
  • Lorazepam or Diazepam

- In case of advanced cirrhosis Lorazepam or Oxazepam

53
Q

When hospitalizing pts that have Hx of seizures, DT, or prologned heavy drinking tx prophylactically with what?

A

Chlordiazepoxide

54
Q

What score from the clinical institute withdrawal assessment from alcohol-revised is consistent with no detoxification needed?

A

<8

55
Q

What score from the clinical institute withdrawal assessment from alcohol-revised is consistent with ambulatory detoxification needed?

A

8-15

56
Q

What score from the clinical institute withdrawal assessment from alcohol-revised is consistent with inpatient detoxification needed?

A

> 15

57
Q

What criteria must be met for a pt to undergo ambulatory detox?

A
  • CIWA 8-15 no DT sx
  • Able to take PO meds
  • Reliable support monitor pt continuously 3-7 days
  • Commit to daily medical visits
  • No unstable medical or psychiatric conditions
  • Not pregnant
  • No concurrent other substance abuse
  • No hx DTs or ETOH-related seizures
58
Q

What are alternatives to BZDs in ambulatory detox?

A

Anticonvulsants Carbamazepine and Valproate

59
Q

What other type of tx do these ambulatory detox pts receive?

A

-multivitamin
-Thiamine
-Folate
“banana bag”

60
Q

What is required for alcohol tx?

A

Pts that are MOTIVATED to reduce alcohol consumption

61
Q

What are the drugs for treating chronic ETOH?

A

Naltrexone, Antabuse, Campral

62
Q

What are requirements of a patient using Naltrexone?

A
  • Pt can not be taking opioids (MOA block mu receptor)

- C/I in acute heptatits or liver failure

63
Q

What ADRs associated with Naltrexone use?

A
  • Nausea
  • HA
  • Dizziness
64
Q

What are options in Naltrexone use?

A
  • Depot formulation (monthly)

- PO daily

65
Q

What is advantageous about the use of Campral?

A

Safe for liver dysfunction pts

66
Q

What are CIs for antabuse?

A
  • Severe myocardial disease
  • Psychosis
  • Pregnant
  • Nursing mothers
67
Q

How does Antabuse work?

A

Causes unpleasant physiologic reactions when alcohol is consumed

68
Q

What type of immunity is vaccine?

A

Active (takes 2 weeks)

69
Q

What vaccinations are Subcutaneous?

A
  • MMR
  • Varicella
  • Zoster
70
Q

What are rules for giving SubQ vaccination?

A
  • Use tricep
  • 23-25 gauge, 5/8 needle
  • pinch up skin and insert 45 degree angle
  • Separate multi-injection >1 inch
71
Q

What rules for giving IM injection?

A
  • Use deltoid
  • Long needle 22-25 gauage and 1-1.5 inch wide
  • Insert needle 90 degrees
  • Separate multi-injection >1 inch
72
Q

Should live viruses and immune globulins be administered on the same day?

A

No

73
Q

What is required of a practitioner in regard to vaccines?

A
  • Provide pt with vaccination information statement prior to vaccine
  • Report adverse events
74
Q

What are examples of reportable events?

A
  • Anaphylaxis shock w/in 7 days

- Encephalopathy, encephalitis, or seizures

75
Q

What are the type of allergic reactions to vaccines?

A
  • Immediate (w/in 1 hour IgE mediated)

- Delayed (several hours to days rarely IgE)

76
Q

What specific drugs should be given to mothers prior to conception?

A

-Live attenuated (MMR & Varicella)

77
Q

What drugs can be given to mothers during pregnancy?

A

Tdap and Influenza

78
Q

When is Tdap/ Td recommended in adults?

A
  • Tdap: once every pregnancy and one dose as an adult

- Td every 10 years

79
Q

When is MMR given and how many times?

A
  • 2 times

- 12 to 15 months & 4 to 6 years

80
Q

When is varicella vaccination given?

A

Adults w/o evidence of immunity receive 2 doses

81
Q

Herpes zoster immunization given?

A

Single dose 60+ regardless of whether prior episode

82
Q

How many doses of HPV are given in males/females? Age ranges?

A
  • 3 doses

- 11-26 yo

83
Q

At what age are PPSV23 and PCV13 given?

A

1 dose each at 65+ or <65 w/ immunocompromising conditions including smoking!

84
Q

How does alcohol progress through the brain?

A

Highest cortical structures to the lowest

85
Q

What receptors does alcohol work on?

A

GABA-A Receptors (depressant)

86
Q

What does rate of absorption change due to?

A

Food in the stomach

87
Q

How much of alcohol is absorbed by the stomach? What organ absorbs the rest?

A
  • 10%

- Small intestines

88
Q

What short term effects does mairjuana cause?

A
  • Distorted perception
  • Problems w/ memory or learning
  • Loss of coordination
  • Trouble w/ thinking and problem solving
  • Increased heart rate
89
Q

What effects do marijuana cause on different organs?

A
  • Lungs: similar to cigarettes burning and stinging of throat, mouth
  • Brain: Hallucinations, delusions, impaired memory, and disorientation
  • Heart: increased 20-50 BPM increasing risk of heart attack
90
Q

What is cannaboid hyperemesis syndrome?

A
  • Recurrent N/V
  • Colicky abdominal pain
  • Results from at least weekly use of marijuana
91
Q

What effects do K2/ spice have?

A
  • loss of control
  • decreased pain sensitivity
  • Agitation
  • Pale skin
  • Sweating
  • Spastic movements
  • Dysphoria
  • Paranoia
92
Q

What major effects does K2/spice have?

A
  • Similar sx withdrawls to heroin withdrawls
  • Worsen previously stable psychotic disorders
  • Trigger chronic psychosis
  • Cause myocardial infarction
93
Q

What effects do opioids cause on different systems?

A
  • PNS: reduce heart rate, BP, and respiration rate, constipation, dry mouth
  • CNS: Drowsiness, Euphoria, delirium, disorientation, analgesia
  • Withdrawl: sweating, anxiety, depression, crying, diarrhea, goose flesh, cramps, fever
94
Q

What kind of effects do methamphetamine cause?

A
  • Degeneration of dopamine terminals
  • Cognitive effects
  • Meth mouth (dental erosion)
95
Q

What are consequences/ signs of meth abuse?

A
  • Heart failure
  • Cardiac hypertrophy
  • Stroke
  • Kidney failure
  • Paranoia, delusions, hallucinations
  • Premature aging
  • Death from hyperthermia or dehydration
96
Q

What effects on systems does cocaine cause?

A
  • Systemic: increased HR, BP, vasoconstriction, and platelet aggregation
  • CNS: Euphoria, hyperactivity, increased alertness, decreased appetite
  • Withdrawal: Irritability, agitation, depression, insomnia, tremors, muscle pain, and drug cravings
97
Q

What are long term effects of cocaine use?

A
  • Decreased brain metabolism
  • Cognitive impairments
  • Heart attacks
  • Stroke
  • Psychosis
  • Oral and skin necrosis
98
Q

How does ecstasy work?

A

It promotoes serotonin release and blocks the reuptake of serotonin

99
Q

What signs/ sx does Ecstasy cause?

A
  • Increased energy
  • Euphoria
  • Emotional warmth
  • Self acceptance
100
Q

What are side effects of ecstasy?

A
  • Jaw clenching
  • Long lasting confusion
  • Inability to regulate body temp
  • Kidney damage
  • Down regulation of serotonin receptors
101
Q

What effect do salvia and bath salts have?

A

Both are hallucinogenic effects

Pharm Final UNIT!!!! (6 decks)

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