Exam 9: GI/CNS Flashcards

Question

Docusate Sodium

Answer 1

constipation tx (stool softener) --> increases intestinal fluid secretion and inhibits reabsorption so stains in stool prevent straining for BM often in hospital

Answer 2

stimulant laxative -> irritates nerve endings in the intestinal mucosa to stimulate motility and fluid movement in bowel PR: burning sensation, 6-8 hr onset

Answer 3

(milk of mag) (fleet) osmotic laxative -> retains and draws water into lumen to soften feces ADRs: substantial fluid loss, magnesium contra for renal, sodium contra for HF/HTN educ: encourage to drink, renal function labs

Answer 4

saline osmotic laxative uses: constipation & **hepatic encephalopathy** -> known to pull serum ammonia into the bowel for excretion

Answer 5

is bowel prep when combined with electrolyte solution Golytely and Move-Prep

Answer 6

4 is ideal, want a 4-5 and don't want to see 1-3 or 6-7

Answer 7

IBS-D tx slows down bowel, increases absorption of H2O and Na+, increases firmness of BM ADRs: constipation, impaction, obstruction, ischemic colitis

Answer 8

weight loss tx inhibits gastric and pancreatic lipases to decrease absorption of fats ADRs: oily rectal seepage, leaky flatulence, fecal urgency, vit deficiencies

Answer 9

dopaminergic - converts to dopamine, crosses BBB carbe allows more levo to enter brain (2% vs 10%) --> **important because can give smaller dose** and fewer ADRs N/V, dyskinesia, psychosis, hypotens, dysrythmias **on-off phenomenon** --> abrupt loss of effect don't eat high protein meals (spread throughout the day) interacts w/ antipsychotics, MAOIs (HTN)

Answer 10

dopamine agonists - directly stimulates dopamine receptors early/mild s/s, better absorption no dyskinesias, but still hallucinations/daytime drowsy/postural hypo

Answer 11

COMT inhibitors - blocks enzyme that inactivates dopamine given w/ levodopa to be more effective (longer 1/2 life) and smaller doses "stalevo" = levo/carbe/entacapone ADRs: levo's adrs

Answer 12

anticholinergic - lowering acetylcholine compared to dopamine reduces tremors/rigidity, not as effective as other agents anticholinergic ADRs

Answer 13

MAO-B inhibitor stops breakdown of dopamine used alone or w/levodopa start early in disease large doses --> inhibit MAO-A as well (norepi & serotonin) --> also need to be careful of tyramine rich food (HTN crisis) and serotonin syndrome

Answer 14

Parkinsons - MOA unclear, originally antiviral

Answer 15

neurodegenerative, no cure acetylcholine 90% below norm, neurofibrillary tangles, neuritic plaque areas the control breathing and HR eventually destroyed --> death

Answer 16

acetylcholinesterase inhibitors (stop the enzyme that breaks down acetylcholine) all levels of severity ADRs: GI, dizzy, HA, bronchoconstriction, bradycardia (cholinergic effects) avoid anticholinergic drugs (atropine, diphen, etc)

Answer 17

acetylcholinesterase inhibitors (stop the enzyme that breaks down acetylcholine) for mild/moderate and don't stop disease just help w/ s/s, stopped as disease progresses same ADRs

Answer 18

NMDA receptor antagonist receptor triggered by excessive glutamate in Alzheimers that allows toxic levels of calcium into cell MOA: slow/controls the influx of calcium into cells only drug approved for severe s/s ADRs: well tolerated, some dizzy, HA, confusion, constipation, hallucination

Answer 19

fever, epilepsy, genetic disorders, infx, hypoxia at birth, TBI, stroke, cancer abnormal firing of cerebral neurons decrease in GABA and increase in glutamate

Answer 20

start low & slow, only control seizures 60-70% of the time, CNS depress and should not be stopped abruptly, SI risk suppress discharge of over-firing neurons and suppress propagation of seizure important to monitor serum levels for most AEDs -> adjust dosage, monitor adherence, determine the cause when seizures happen, identifying cause of toxicity (polypharm) meds must be taken at the same time - to maintain small therapeutic range many are liver enzyme inducers --> decrease effect of other drugs top class causes Steven-Johnsons (flu-like, then rash) alt tx when don't work: vagus nerve stim, keto diet, neurosurg

Answer 21

selective inhibition of sodium channels (influx) very narrow range - 10-20 mcg/mL ADR: gingival hyperplasia, rash, tissue damage at site, hypoten, dysrhy, teratogenic toxicity - nystagmus, SJ synd, unclear thinking, diplopia, sedation, ataxia, cardiac depression educ - soft toothbrush and dental appt **only dilute w/NS**

Answer 22

suppression of sodium influx and potentiates GABA, less cognitive function effects than pheny ADRs: rash, CNS (nystagmus, ataxia, sedation), bone marrow suppression (CBC), fetal harm, hypovolemia/natremia oral contraceptives - need alternative decreases efficacy warfarin - decreases effect, higher risk of clot grapefruit - toxicity

Answer 23

suppression of calcium influx, increases availability of GABA broad spectrum of effectiveness (v for variety) --> all types of seizures ADRs: GI, highly teratogenic, hepatotoxic and pancreatitis, hyperamonemia

Answer 24

converts to phenytoin when metabolized IV/IM - short term use for status eplilepticus same ADRs as phenytoin cardiac monitoring

Answer 25

suppression of calcium influx indic: absence seizures don't stop abrupt, monitor closely

Answer 26

MOA: potentiates and mimics GABA generalized and partial seizures, rarely used due to significant ADRs fetal harm

Answer 27

MOA unknown, binds w/ GABA widely used in acute care PO/IV, not for absence, off label for migraine, bipolar least amount of ADRs and risk of abuse or dependence, mild drowsy/weak/CNS, safe in pregnancy

Answer 28

blocks sodium and partially calcium, good for all types, also used bipolar ADRs: CNS, teratogenic, derm, risk for SI -> increased behavior monitoring

Answer 29

analog of GABA --> inhibits calcium influx ADRs: dizzy, sedation, blurred vision, hypersensitivity, **abuse/dependence** dc slowly, avoid other CNS depressants

Answer 30

risk for SI

Answer 31

approved by FDA for partial seizures, analog of GABA, mostly for off-label like nerve pain ADRs: well tolerated but, somnolence, nystagmus no drug interactions

Answer 32

most common of newer AEDs gen and part seizures, blocks sodium channels, more expensive than older AEDs but better tolerated ADRs: CNS, hypoNa, hypothyr, bone marrow suppression, rash/SJ, hypersens

Answer 33

LOC, tachy, HTN, fever, hypoglycemic, acidotic, hypoxic immediate: airway, rescue med, hypoglycemia IV --> glucose, AED, benzo (lorazepam)

Answer 34

etiology not known (no identifiable cause), but vessel dilation causes pain CGRP increased (vasodilate & inflame), S5HT decreased (protective) estrogen help only hormone related

Answer 35

1st line for abortive, constricts intracranial vessels, PO/SQ/IN/transdermal (PO fastest onset <30 min, SQ=30 min, IN = <60 min) MOH - medication overuse HA, turns episodic HA into chronic from too many abortive meds ADRs: heavy arms/chest pressure, coronary vasospasm, teratogenic; contra: CAD/HTN sero syn w/ SSRIs

Answer 36

INH agent migraine lasts longer, so have to take more and more, MOH (acute -> chronic HAs)

Answer 37

2nd line abortive, PO/IN/sublingual/PR; contras: CAD/HTN/PVD N/V (admin w/antiemetic), risk of dependence, rebound headaches, vasoconstrict and HTN w/triptans OD = sever tissue ischemia in the periphery from constriction (gangrene)

Answer 38

CGRP antagonist, very expensive

Answer 39

bblkrs (propanolol), TCAs, AEDs - get put on if more than 2 migraines a month Serotonin receptor agonist

Answer 40

preventative, can reduce # and severity of migraines

Exam 9: GI/CNS Flashcards

(65 cards)