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Pharmacology (Dale Turley) > Exam 5 > Flashcards

Exam 5 Flashcards

1
Q

Bupropion adverse reactions ?

A 
tachycardia
photosensitivity
hyper/hypoglycemia
anorexia
weight loss
nausea 
dry mouth
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2
Q

Bupropion contrindications ?

A

Current or history of seizures
Anorexia
bulimia

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3
Q

Bupropion interactions ?

A

First pass effect – avoid drugs with hepatic metabolism with similar competitive effects

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4
Q

Bupropion information ?

A

Advise patient and family that may take 2 to 4 weeks of treatment for optimal results

Some improvement 7-10 days

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5
Q

Mirtazapine adverse reactions ?

A

Flu-like symptoms

Higher risk of inducing seizure (no history)

Sedation
Weight gain
Constipation
Dry mouth
Vomiting
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6
Q

Mirtazapine interactions ?

A

MAOI’s

CNS depressants

drugs affecting CYP-450 system

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7
Q

Amitriptyline adverse reactions ?

A

Anticholinergic effects-blurred vision, confusion, dry mouth, hot dry skin, urinary retention

Orthostatic hypotension, tachycardia, arrhythmias (torsade de pointes)

Prolonged QT interval

GI distress, jaundice, metallic taste

Confusion, hallucinations, SI

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8
Q

Amitriptyline interactions ?

A 
Many
Watch other anticholinergics
Alcohol
SSRI’s
Cimetidine
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9
Q

TCA’s in the elderly cause _________________ , especially ___ in elderly male!!

A

arrhythmias, CHF, MI

BPH

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10
Q

Class of meds tend to cause more sedation and orthostatic hypotension ?

A

Tricyclic Antidepressants


Amitriptyline (Elavil) + 8 others

Named because of their three ringed structure
1957 – used to elevate mood
Considered second-line due to side effects

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11
Q

Amitriptyline considerations ?

A

Second-line therapy

Effective with severe depression, anxiety and OCD

Overdose - fatal arrhythmias

Taper dose discontinuance

Monitor blood counts and SI

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12
Q

Monoamine Oxidase Inhibitor (MAOI)

 pharmacokinetics ?

A

Major first pass effects

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13
Q

Phenelzine adverse reactions ?

A

Dilated pupils

HTN crisis

Serotonin syndrome

Sexual dysfunction
Weight gain

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14
Q

Phenelzine drug-drug interactions ?

A

Foods high in tyramine / caffeine = HTN crisis

Ct John’s wort + MAOI’s = Serotonin Syndrome / Fatalities

Amphetamines
Antidiabetic drugs
SSRI’s, TCA’s
Alcohol

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15
Q

MAOI’s must be stopped for ________ before starting other anti-depressants

A

10-14 days

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16
Q

Monoamine Oxidase Inhibitor (MAOI)

 may cause ?

A

serotonin syndrome

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17
Q

Hypertensive crisis can be caused by ingesting foods rich in ________ , white taking MAOI’s.

A

tyramine

cheese, beer and wine and also caffeine

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18
Q

Trazodone pharmacokinetics ?

A

Peak plasma level in 1 hour on empty stomach

Absorbed well, 2/3 patients get relief in several weeks, usually by end of second week

Metabolized live
Excreted urine
Half-life 5-9 hours

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19
Q

Trazodone adverse reactions ?

A

Orthostatic hypotension 4-6 hours after dose

Nausea / vomiting

Priapism

drowsiness

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20
Q

What what when taking Trazodone ?

A

Watch with digoxin and Coumadin (protein bound drugs)

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21
Q

Trazodone interactions ?

A

Strong sedating effect

Used at bedtime for depression and insomnia

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22
Q

Haloperidol / Chlorpromazine pharmacokinetics ?

A

Absorbed well orally

Onset ½ to 1 hour

Highly metabolized by lever and GI mucosa

Excreted by kidneys

Half life 30 hours

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23
Q

Haloperidol / Chlorpromazine adverse reactions ?

A 
Dizziness
Hypotension
Photosensitivity
Hyperglycemia
Impaired thermoregulation
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24
Q

Haloperidol / Chlorpromazine adverse reactions cont.. ?

A

Decreased libido

Urinary retention

Extrapyramidal symptoms

Impaired memory

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25
Haloperidol / Chlorpromazine contrindication ?
Parkinsonism Blood dyscrasias Liver impairment Cardiac disease Rey’s syndrome
26
________ only atypical with clear evidence in tx of resistant-schizophrenia
Clozapine
27
Introduced in the 1990’s with breakthrough in treating Schizophrenia Ability to NOT cause extrapyramidal side effects Some may cause elevated prolactin levels
Antipsychotics (Second Generation)
28
Antipsychotics (Second Generation) examples ?
Aripiprazole (Abilify) Olanzapine (Zyprexa) Quetiapine (Seroquel) Risperidone (Risperdal) Clozapine (Clozaril)
29
Antipsychotics (Second Generation) pharmacokinetics ?
Metabolized liver Excreted 50% urine, 50% feces Half-Life 4-66 hours
30
Antipsychotics (Second Generation) BBW ?
May increase mortality in elderly with dementia-related psychosis Increased risk of agranulocytosis, seizures and myocarditis / Cardiomyopathy Severe neutropenia Orthostatic hypotension, bradycardia, syncope
31
Methylphenidate interactions and adverse effects ?
Not with MAOI’s Ay cause “Tourette like” syndrome Hypoglycemia Arrhythmias
32
Methylphenidate pharmacokinetics ?
Metabolized CYP-450 Excreted urine, small amt feces Half-life 3.5 hrs
33
Methylphenidate facts ?
Get echo after 5 years use Watch weights loss, insomnia, agitation, HTN May cause dependency
34
Methylphenidate (Concerta) | / Atomoxetine facts ?
Newer generation of medications Reduced dosage BID Higher incidence of “Tourette” like syndrome Addictive properties Abuse / Black market
35
Benzodiazepines
 pharmacokinetics ?
Most lipid soluble and thus taken orally Popular PO anxiolytic Traditional drug for treatment of seizures however replaced by lorazepam Active metabolites Absorption -Well absorbed orally diazepam onset 30-60 min -Peak effects usually occur in 1 to 2 hours (valium slow) -Duration last 2 to 3 hours -Given IM midazolam and lorazepam onset 1 to 5 min **Active metabolites increase the effective half-life**
36
what benzos are all injectable ?
Midazolam (Versed) Diazepam (Valium) Lorazepam (Ativan)
37
__________ only available in injectable (only water soluble) can be given intranasal
Midazolam
38
_______ poorly absorbed via IM injection
Diazepam
39
Benzodiazepines
 what is better than injectable ?
Oral
40
Benzodiazepines adverse effects ?
Respiratory depression Retrograde amnesia (why midazolam used preoperatively) Orthostatic hypotension Constipation, nausea, vomiting, diarrhea CNS effects of ataxia, drowsiness, dizziness, slurred speech, confusion, somnolence
41
Benzodiazepines prescribing considerations ?
DEA schedule IV controlled substance Beers Criteria in elderly Addictive property Not a primary therapy Not effective comorbid depression Lethal when used with alcohol or other CNS depressants Impaired driving / cognitive skills 1mg alprazolam = BAC 0.15
42
Benzo OD tx. ?
Flumazeril (Romazicon)
43
Benzodiazepines BBW ?
watch for seizures with chronic use and withdrawal, prepare seizure management
44
Flumazeril (Romazicon) | dosing ?
0.2 mg IV q min x 1 to 5 doses
45
Selective serotonin reuptake
inhibitors (SSRIs) examples ?
fluoxetine (Prozac paroxetine (Paxil) sertraline (Zoloft) citalopram (Celexa) Escitalopram (Lexapro)
46
Selective serotonin reuptake
inhibitors (SSRIs) BBW ?
Increased suicide risk in children, adolescents, and young adults w/ major depressive or other psychiatric disorders **suicide risk in kids **
47
Selective serotonin reuptake
inhibitors (SSRIs) pharmacokinetics ?
Significant first pass metabolism by liver Excreted by Kidneys Half-life 24 hours average Prozac half-life 4-6 days, effects up to 14 days MUCH LONGER HF
48
Selective serotonin reuptake
inhibitors (SSRIs) adverse reactions ?
Aggitation, insomnia, headache, nervousness, sedation, tremor Serotonin syndrome - Nausea / Vomiting - Anorgasmia in both men and women - Ejaculatory disturbances in men
49
Serotonin Syndrome ?
Myoclonus (intermittent jerking or twitching) Hyperreflexia (greater in upper limbs) Increased heart rate Shivering Sweating Dilated pupils
50
Serotonin Syndrome , other information ?
abnormalities such as hyperactive bowel sounds, high blood pressure and hyperthermia temperature as high as 40 °C (104 °F) Mental changes include hypervigilance or insomnia and agitation include metabolic acidosis, rhabdomyolysis, seizures and renal failure Seen in OD and MDMA’s (Ecstasy) **almost like encephalopathy with a fever check a CK-MM ( if this is high then check CR) **
51
Venlafaxine pharmacokinetics ?
Metabolized Liver Excreted Urine
52
Venlafaxine PO dosing ?
Start: 37.5-75 mg PO qd, incr. by 75 mg/day q4-7 days Max: 225 mg/day Info: give w/ food; may open cap, but do not cut/crush/chew/dissolve contents
53
Venlafaxine taper dose by no more than ?
75 mg/wk to D/C **dont abrutply stop it cause they will get the worse flu like sxs. they ever had **
54
Venlafaxine BBW ?
Increased suicidality risk in children, adolescents, and young adults w/ major depressive or other psychiatric disorders
55
Trazodone (DESYRYL) 
 pharmacokinetics ?
Metabolized liver Excreted in urine
56
Trazodone (DESYRYL) 
50 mg ?
light orange circle
57
Trazodone (DESYRYL) 100 mg ? 

white circle
58
Trazodone (DESYRYL) 
150 mg ?
light orange bar
59
Trazodone (DESYRYL) 
PO dosing ?
Start: 25-50 mg PO bid-tid, may incr. by 50 mg/day q3-4 days Max: 400 mg/day if outpatient 600 mg/day if inpatient Info: taper dose gradually to D/C **start low and go slow **
60
Trazodone (DESYRYL) 
BBW ?
Increased suicidality risk in children, adolescents, and young adults w/ major depressive or other psychiatric disorders
61
Bupropion (Wellbutrin SR, Zyban) 
 PO dosing ?
Start: 150 mg PO qam, Increase after 3 days Max: 400 mg/day Info: do not cut/crush/chew tab
62
Bupropion (Wellbutrin SR, Zyban) 
BBW ?
Monitor for serious neuropsychiatric events including behavior change, hostility, agitation, depression, and suicidality Worsening of preexisting psychiatric con’d -pts taking bupropion for smoking cessation and after discontinuation
63
Bupropion (Wellbutrin SR, Zyban) 
BBW pt. 1 ?
Some cases possibly complicated by nicotine withdrawal symptoms Reported in patients who continue to smoke while taking bupropion Weigh bupropion risks vs. benefits of smoking cessation
64
Bupropion (Wellbutrin SR, Zyban) 
 PO dosing smoking cessation ?
Start: 150 mg PO qd x3 days Max: 300 mg/day Info: separate doses by at least 8h last dose no later than 6pm stop smoking after 5-7 days of tx do not cut/crush/chew tab
65
Mirtazapine (Remeron) PO dosing ?
Start: 15 mg PO qhs; Info: taper dose gradually to D/C
66
Mirtazapine (Remeron) BBW ?
Increased suicidality risk in children, adolescents, and young adults w/ major depressive or other psychiatric disorders
67
Duloxetine (Cymbalta)


 pharmacokinetics ?
Metabolized by Liver Excreted in Urine
68
Duloxetine (Cymbalta) PO dosing ?
Start: 15 mg PO qhs Info: taper dose gradually to D/C
69
Duloxetine (Cymbalta) BBW ?
Increased suicidality risk in children, adolescents, and young adults w/ major depressive or other psychiatric disorders
70
Lithium side effects related to serum level ?
Nausea / Vomiting Tremor Muscle weakness Hyper-reflexia Drowsiness Increased thirst and urinary frequency Hypokalemia
71
Lithium levels > 4 = ?
Impaired renal function Decreased consciousness, seizures, or life-threatening dysrhythmias, regardless of lithium levels **difference is how fast it is metabolized off **
72
Levels are _____ mEq/L, significant confusion is noted, or the expected time to reduce levels to ____ mEq/L is more than 36 hours
>5.0 < 1.0 **difference is how fast it is metabolized off **
73

Lithium Toxicity
 treatment ?
Supportive therapy is the mainstay treatment Protect airway Seizure control with benzo’s Gastric lavage if < 1 hour IV Fluid therapy (Watch CHF patients) Monitor electrolytes Dialysis if needed **Lithium OD are bad as soon as you lavage then get them to the ICU**

Pharmacology (Dale Turley) (31 decks)

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