knowledge deck Flashcards
1
Q
what is unique about Sucralfate (Carafate) MOA
A
Protective barrier
2
Q
Disadvantages of Sulcrafate?
A
QID use
GI effects
Decreases drug absorption
3
Q
When do you take Sucralfate?
A
Before meals and at bedtime
4
Q
How do you recognize PPIs by their generic name
A
-prazole
5
Q
Are PPIs more or less powerful than H2RAs
A
More powerful due to irreversible pump shutdown
6
Q
are PPIs a single drug therapy for Peptic ulcers?
A
First line treatment but but not single drug therapy for ulcers plus H.Pylori
PPI used for bleeding or NSAID ulcers; Antacids and H2RB are not
7
Q
How well tolerated are PPIS
A
very well tolerated
8
Q
Potential disadvantages to chronic PPI therapy?
A
increased risk for food poisoning, HAI (esp c-diff), pneumonia,
9
Q
How to take PPIs in relation to meals
A
take before meals to keep the acid production from coming
10
Q
For H2 receptor antagonists…
use with caution with ______ or _____ disease
A
kidney or liver
11
Q
which H2RA has the most drug interactions and why
A
most drug interactions are from cimetidine (Tagamet) due to CP450 effects
12
Q
which drug interactions are a problem and why (H2RA)
A
ETOH and CNS depressants for safety reasons
13
Q
what population group is at risk for CNS adverse effects for H2RA
A
elderly
14
Q
what are the protective factors of the stomach
A
mucous
bicarb
prostaglandin
15
Q
The stomach also secretes intrinsic factor which helps with?
A
B12 absorption
16
Q
A deficiency in B12 absorption leads to
A
macrocytic anemia
17
Q
causative bacteria for peptic ulcer disease
A
H.Pylori
18
Q
Treatment for H.Pylori
A
PPI plus a combo of 2 antibiotics for 1-2 weeks then continue with PPI for 4-8 weeks for healing to occur
19
Q
Which acid controlling drug neutralizes acid
A
antacids
20
Q
What is an example of an antacid
A
Calcium Carbonate
21
Q
which acid controlling drug blocks stimulation of production
A
H2 receptor antagonist
22
Q
What is an example of a H2 receptor antagonist
A
Ranitidine
23
Q
Which acid controlling drug stops the production of acid
A
Proton pump inhibitors
24
Q
What is an example of a PPI
A
Omeprazole
25
what does sucralfate (Carafate) do
Protects the lining of the stomach
26
What does simethicone (Mylicon) do?
breaks up gas
27
who gets stress ulcers and why
after major trauma
| due to endogenous and exogenous steroids production (anti-prostaglandins)
28
what classes of drugs are used to prevent stress ulcers
H2RBs and PPIs
29
mucous protects against
autodigestion
30
bicarbonate
helps buffer HCL
31
prostaglandins
prevent activation of proton pump and increase blood flow, bicarb and mucous production
32
which antacid has the worst rebound reaction
Calcium carbonate
33
indications for antacids
```
Hyperacidity
GERD
Gastritis
Ulcer prevention
Calcium and magnesium replacement
```
34
How does the pt prevent drug interactions when using antacids
Take 2 hours before or after other meds
35
cautions for pts using chronic or excessive use of antacids
avoid unsupervised use for greater than 2 weeks, may need a workup
36
which antacids are more risky if you have diarrhea or renal disease
magnesium
37
which antacids are more risky if you have constipation
calcium
38
which antacids are more risky if you have heart failure
sodium
39
What are the types of laxatives?
```
Bulk forming
Emollient
Hyperosmotic
Saline
Stimulant
```
40
Bulk forming MOA
High fiber
Prebiotic effect
absorb water to increase bulk
distends bowel to initiate reflex bowel activity
41
Metamucil and citrucel are examples of what type of laxative
Bulk forming
42
foods high in fiber
```
stems
seeds
skins of plants
whole grains
prunes
```
43
Emollient MOA
stool softeners and lubricants
promote more water and fat in stools
lubricate the fecal material and intestinal wall
44
colace and surfak are examples of what type of laxitive
emollient
45
Examples of lubricants
mineral oil - not absorbed
| olive oil - nutritional value (folk remedy)
46
Hyperosmotics MOA
increase fecal water content
| result in bowel distension, increase peristalsis and evacuation
47
examples of hyperosmotics
Miralax
glycerin (very mild)
Lactulose
48
what is lactulose also use for
to bring down serum ammonia levels
49
saline laxative MOA
increases osmotic pressure drawing more water into the intestines
results in bowel distension, increase peristalsis and evacuation
50
examples of saline laxatives
milk of magnesia
| mag citrate
51
stimulant laxative MOA
Increase peristalsis via intestinal nerve stimulation which is effective higher in the colon
52
examples of stimulant laxatives
Senna (Senekot)
| bisacodyl (Dulcolax)
53
adverse effects bulk forming laxatives
impaction if the pt is not taking in adequate water
| esophageal blockage - need to drink it right away or it starts to thicken
54
adverse effects of emollient laxatives
skin rashes
decreased absorption of lipid soluble vitamins
risk of aspiration pneumonia esp in a bed ridden pt
55
adverse effects of hyperosmotic laxatives
abd bloating
cramping
rectal irritation
56
saline laxative adverse effect
increased thirst, cramping, diarrhea
electrolyte imbalance
for renal insufficiency patients - mag toxicity
57
stimulant laxative adverse effects
```
nutrient malabsorption
skin rashes
gastric, rectal irritation
discolored urine
dependency
```
58
pt education on laxatives
do not use if suspect appendicitis - can lead to rupture
| -n/v and severe abd pain
59
laxative dependency
from an atonic colon, depends on the laxative
60
laxative abuse
Chronic exposure to laxatives can diminish defecatory reflexes leading to further reliance on laxatives. Laxatives can purge the bowel. Reflex wont return until bowel refills but often time someone thinks they are constipated again because they aren't having a bm daily. Can lead to electrolyte imbalance, dehydration and colitis
61
which of the laxatives is best suited for children
glycerin suppository
62
which of the laxatives is best suited for elderly
stool softeners
| Bulk
63
which of the laxatives is best suited for long term, chronic use
stool softeners
| bulk
64
which of the laxative classes is slowest on onset
stool softeners
| Bulk
65
which of the laxatives is fastest to onset
osmotics
| saline
66
which of the laxative classes is most likely to cause fluid/electrolyte imbalances
saline
67
which laxative is also used as an antacid
Milk of Magnesia
68
which laxative is most likely to cause aspiration pneumonia or deficiency of lipid soluble vitamins with prolonged use
Mineral oil
69
esophageal/Intestinal blockage, which laxatives put you most at risk/ what group is at highest risk
bulk forming
| Those with eating disorders are most at risk
70
duration of acute diarrhea
up to 2 weeks
71
duration of chronic diarrhea
greater than 3 weeks
72
other symptoms of chronic diarrhea
```
recurring diarrheal stools
fever
poor appetite
n/v
weight loss
weakness
```
73
causes of acute diarrhea
```
bacterial
viral
drug induced
food related
protozoa
```
74
causes of chronic diarrhea
```
tumors
diabetes mellitus
Addisons disease
Hyperthyroidism
IBS
AIDS
```
75
example of probiotics
L.acidophilus ( Lactinex)
76
does probiotics treat or prevent diarrhea
both
77
example of probiotics
L.acidophilus ( Lactinex)
| Yogurt
78
examples of adsorbents
Pepto-bismol
79
danger of giving Pepto bismol to children or teenagers with virus
Risk of Reye's syndrome
80
examples of adsorbents
Pepto-bismol (Bismuth subsalicylates)
81
Examples of opiates
```
Immodium -AD
Lomotil
paregoric
opium tincture
codeine
```
82
Examples of opiates
```
Imodium -AD
Lomotil
paregoric
opium tincture
codeine
```
83
anticholinergics moa
antimotility
| slows the movement of fecal matter through GI tract
84
examples of anticholinergics
atropine - which is in Lomotil
85
cholinergic effects
```
Acronym "SLUDGE"
Salivation
Lacrimation
urination
Diarrhea
GI distress
Emesis
```
86
anticholinergic toxicity
```
Blind as a bat
mad as a hatter
dry as a bone
Hot as a dessert
red as a beet
```
87
Adverse Effects
| Adsorbents- Salicylates:
Increased bleeding time
• Decrease absorption of many other drugs
• Constipation, dark stools/ tongue
• Confusion, twitching
• Hearing loss, tinnitus, metallic taste, blue
gums
88
Adverse Effects
| Opiates
* Drowsiness, sedation, dizziness, lethargy
* Nausea, vomiting, anorexia, constipation
* Respiratory depression
* Hypotension
* Urinary retention
* Flushing
89
Adverse Effects
| Anticholinergics
```
• Urinary retention (esp who?),
hesitancy, impotence
• CNS effects: Headache, dizziness,
confusion, anxiety, drowsiness
• Dry skin, flushing
• Blurred vision (why?)
• Hypotension, bradycardia
```
90
Anticholinergic Agents MOA
Blockade of muscarinic receptors in the
| striatum
91
example of an anticholinergic agent
atropine
92
side effect of anticholinergic agents
Urinary retention, hesitancy, acute glaucoma,
| orthostatic BP, decreased sweating
93
adverse effect anticholinergic agent
Dysrhythmias, risk hyperthermia (esp for ____),
| ____ glaucoma>> _____crisis
94
adverse effect anticholinergic agent
Dysrhythmias, risk hyperthermia (esp for elderly),
| narrow angle glaucoma>> angle closure crisis
95
Anti-diarrheals:
| Monitoring/ Pt Education
Teach patients about fluid intake and
dietary changes
• Use salicylates carefully in elderly or those
with bleeding/ clotting disorders, confusion
• Assess hydration/ fluid volume status
• Needs evaluation if bloody stools, with
fever, severe pain, risk dehydration,
prolonged
96
On what basis is diarrhea defined?
Loose or watery, usually
| frequent stools
97
Which is used in MILD diarrhea?
Adsorbents or probiotics
98
Why does Lomotil contain atropine?
To
| prevent abuse
99
anti-diarrheal CI (contraindicated) in children?
Bismuth
| subsalicylates to prevent Reyes syndrome
100
Lomotil (and all anti-peristaltics) is CI in what
| kind of diarrhea and why?
AAPMC/ C diff as
antibiotics are needed and antimotilty agents
allow more (fatal) toxins to be absorbed
101
example of an Anticholinergic drugs (ACh blockers)
Scopolamine
| • Also used for motion sickness (transdermal patch)
102
```
Antihistamine drugs (H1
receptor blockers) examples
```
dimenhydrinate (Dramamine),
diphenhydramine (Benadryl), meclizine
(Antivert)- specifically for vertigo
103
Antidopaminergic drugs- phenothiazides examples
prochlorperazine (Compazine), promethazine
| Phenergan
104
Antidopaminergic/ Prokinetic drugs
if the problem is the food is sitting too long and not moving forward so causes the vomiting
105
Antidopaminergic/ Prokinetic drugs examples
metoclopramide (Reglan)
• Long-term use may cause irreversible tardive dyskinesia >>
“Litogenic” - law suit generating
106
Serotonin blockers examples
ondansetron (Zofran), dolasetron (Anzemet)
107
NK (neurokinin)1 Receptor antagonist - the only one
• Only one ex: aprepitant (Emend) - expensive
108
```
phosphorated
carbohydrate solution (Emetrol) MOA
```
```
decrease peristalsis and delay gastric
emptying
• No drug interactions, no serious reactions
• Avoid with diabetes
great for pregnancy
```
109
Taking antiemetics with _______ may cause
| severe CNS depression
alcohol
110
Teach patients to ______ to avoid
| hypotensive effects
rise and change positions
111
diet teaching for n/v
bland diet
| wet/dry diet
112
what is a wet dry diet
eat meal dry with no drink, wait and hour to drink
113
antiemetics : Many of these drugs cause severe drowsiness;
| warn patients ________
about driving/operating heavy machinery
114
Anticholinergics block
cholinergic receptors ie) Scopolamine
115
Antihistamines block
Block H1 receptors ie) meclizine
116
Antidopaminergic block
Block dopamine receptors,
| promethazine
117
Prokinetics block
- Block dopamine receptors and stimulate
| stomach emptying ie) metaclopramide
118
• Serotinin blockers block
- Block 5-HT3 receptors- odansetron
119
antiemetics Most likely to cause drowsiness?
Anticholinergics,
| Antihistamines & Antidopaminergic
120
antiemetics Most likely to cause dry mouth, blurred vision and
urinary retention?
Anticholinergics, Antihistamines &
| Antidopaminergic
121
Which of the antiemetics is most likely to
cause Parkinsonian SE and tardive dyskinesia
with long term use
Metoclopramide
122
Which of the antiemetics is indicated for
| motion sickness AND vertigo?
Meclizine (Antivert)
123
Indicated for nausea/ vomiting secondary to
| chemotherapy?
Serotonin blockers or NK1
| blockers
124
What pt population(s) are most likely to have
| paradoxical reactions from antihistamines?
Kids and elderly
125
What are alternative modes of administration
| besides orally?
Suppositories, IV or patch (scopolamine)
126
How does you monitor the therapeutic effect
| of antinausea/ antiemetic drugs?
Hydration,
weight, urine ketones, tolerance of triggers,
intake/retention of fluids, food
127
definition of drug abuse
using a drug in a fashion inconsistent with medical or social norms
128
a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems
substance use disorder
129
results from regular drug use and can be defined as a state in which a particular dose elicits a smaller response than it did with initial use.
tolerance
130
a state in which tolerance to one drug confers tolerance to another. (generally in the same class)
cross-tolerance - example is heroin and morphine
131
an intense subjective need for a particular psychoactive drug
psychological dependence
132
a state in which an abstinence syndrome will occur if drug use is discontinued. if drug is stopped there is a visible physical symptom
physical dependence
133
the ability of one drug to support physical dependence on another drug
cross-dependence
ie) a alcoholic who needs ativan to go to work without alcohol
134
a constellation of signs and symptoms that occurs in physically dependent individuals when they discontinue drug use
withdrawal syndrome
135
being physically dependent on a drug is/is not the same as having a substance use disorder
is not
ie) someone who has seizures needs to be on a medication to stay seizure free. This is not SUD
136
explain reinforcement in drugs
a drug can give the individual an experience that is pleasurable
lets say you have someone who is anxious so they take barbituates. This makes them feel better
137
factors that contribute to substance use disorder
```
reinforcement of drugs
physical dependence
psychological dependence
social factors
drug availability
vulnerability of the individual
```
138
repeated use of a drug contributes to the transition from voluntary use to compulsive use by causing
molecular changes in the brain
139
The Comprehensive Drug Abuse Prevention and Control Act of 1970, known informally as the Controlled Substances Act (CSA) objective is to
reduce the chances that drugs originating from legitimate sources will be diverted to abusers
140
You can only prescribe controlled substances if you have
a DEA licence
141
what schedule class carry the highest risk for abuse
Schedule II
142
oral prescriptions for schedule II meds can be called in for an emergency but you must have a written prescription within ____ hours
72
143
what is the most common used and abused psychoactive agent in the US
alcohol
144
2 of the biggest negative effects of alcohol
depression of the CNS
| activation of the reward system - perpetuates the abuse of this substance
145
if alcohol is chronically used in excess
injury to CNS
significant nutritional deficiencies
cardiac depressant
146
alcohol and sleep
commonly used as a sleep aid but it actually
disrupts sleep. alters sleep cycles, decrease total sleeping time, reduces the quality of sleep
can intensify snoring and exacerbate sleep apnea
147
alcohol and cardiac
dilation of cutaneous blood vessels - increased blood flow to skin (flushing, warm sensation)
direct damage to myocardium - increases risk for heart failure (alcohol induced cardiac myopathy)
dose dependent elevation of BP - deeper tissues you see vasoconstriction
148
moderate alcohol use
2 drinks a day or less for men
one drink a day or less for women
3-4 days per week
protection is greater than someone who drinks 1-2 days per week
149
heart benefits of moderate alcohol use
```
less ischemic stroke
less CAD
less MI
less heart failure
as opposed to abstainers
raises HDL cholesterol which protects against CAD
```
150
the degree of protection with type of alcohol
nearly equal for beer, wine, and distilled spirits
151
Cardioprotection in regard to drinking is greatest for those
with an unhealthy lifestyle -
for those who exercise, eat fruits and vegetables and do not smoke - alcohol has little or no effect on the incidence of coronary events
conversely - for those who lack these behaviors, moderate alcohol intake is associated with a 50% reduction in coronary risk
152
alcohol and diabetics
has several effects on glucose metabolism that may decrease the risk for type 2 diabetes.
153
alcohol and bone health
increases bone mineral density, by increasing levels of sex hormones
154
alcohol and liver
can sustain large amounts of alcohol use
for chronic drinkers - nonviral hepatitis develops in approximately 90% of heavy users which can evolve into cirrhosis
alcohol abuse is unquestionably the major cause of fatal cirrhosis
155
alcohol and stomach
excessive use can cause erosive gastritis
156
alcohol and kidney
alcohol is a diuretic. it can eventually cause renal damage
157
alcohol and pancrease
can cause pancreatitis (2nd most common cause of this)
158
alcohol and cancer
alcohol (even in moderate amounts) is associated with increased risk for several common cancers - breast, liver, rectum, aerodigestive tract (lips, tongue, mouth, nose, throat, vocal cords, portions of the esophagus and trachea)
159
Fetal alcohol spectrum disorder
craniofacial malformations
growth restrictions
neurodevelopmental abnormalities
160
the concentration of alcohol in breastmilk parallels ____
the concentration of alcohol in blood. Recent data indicates that drinking while breastfeeding can adversely affect the infants feeding and behavior
161
alcohol is primarily absorbed through
the stomach and small intestines
162
alcohol is metabolized by
liver and stomach
| primarily in the liver
163
male and female metabolism of alcohol
females have lower activity of alcohol dehydrogenase so gastric metabolism is significantly less in women who metabolize alcohol slower than men
164
cross tolerance with alcohol
general anesthetics
barbiturates
other general CNS depressants
165
very little tolerance develops to
resp depression
alcoholics may tolerate blood alcohol levels as high as 0.4% (five times the amount defined by law as intoxicating) with no marked reduction in consciousness. However if blood levels rise only slightly above this level, death may ensue.
166
drug interactions for alcohol
CNS depression
benzodiazepines
opioids
barbituates
NSAIDS - increase chance of GI bleeding
Acetaminophen - potentially fatal liver injury when taking normal dosing with large amounts of alcohol
Antihypertensive drugs
tends to counteract the effects of antihypertensive medications
monitor BP closely
167
alcohol poisoning treatment
alcohol lavage
168
drugs to facilitate alcohol withdrawal
Benzodiazepines in inpatient or outpatient settings
169
What does benzodiazepines do in alcohol withdrawal
stabilize vital signs
reduce symptom intensity
decrease risk for seizures and delirium tremens
170
Benzodiazepines used in alcohol withdrawal
chlordiazepoxide
clorazepate (Tranxene)
Oxazepam
Lorazepam (Ativan)
171
adjunct therapy with benzodiazepines for alcohol withdrawal
B blockers
172
drugs used to maintain alcohol abstinence
Naltrexone (Vivitrol) - reduces craving for alcohol
blocks the pleasurable effect of alcohol
decreases their high
Acamprosate - not used as much
reduces unpleasant feelings - anxiety, tremors
should be used with counseling
Disulfiram (antabuse) - violent physical reaction
must be careful - risk of death from the physical reaction
173
types of anxiety disorders
```
Generalized anxiety disorder (GAD)
Panic Disorder (PD)
Obsessive Compulsive Disorder (OCD)
Social Anxiety Disorder (SAD)
Posttraumatic Stress Disorder (PTSD)
```
174
for most patients a combination of drug therapy and psychotherapy is
more effective together than either alone
175
2 drugs used most for anxiety
SSRIs
| SNRIs
176
med used for anxiety with long onset of action
Buspar
177
first line choices for anxiety disorders
SRIs
SSRIS
SNRIs
Buspar
178
2nd line for anxiety disorders
Benzos
179
only 4 antidepressants approved for GAD
Venlafaxine (Effexor)
Duloxetine (Cymbalta)
Paroxetine (Paxil)
Escitalopram (Lexapro)
180
compared with Benzodiazepines the antidepressants do a better job of decreasing cognitive and psychiatric symptoms of anxiety but they are not as good at decreasing
somatic symptoms
so antidepressants do not carry risk for abuse like benzos do
181
What was the first antidepressant approved for GAD
Venlafaxine (Effexor)
182
NEVER combine Venlafaxine (Effexor) with a
MAOI inhibitor (rule is to never combine an antidepressant with one)
183
Buspar is a
anxiolytic - no abuse potential - takes a month to see results. they will need something else while they are waiting for this drug to take effect
184
Buspar adverse effects
dizziness, nausea, headache, nervousness, sedation, lightheadedness
185
Drug and food interactions for Buspar
levels greatly increased by erythromycin and ketoconazole and grapefruit juice
186
panic disorder typically respond to
all 4 classes of antidepressants
187
what is first line for panic disorders
SSRIS
188
only 3 SSRIs are approved for panic disorders
fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)
189
first line drugs for OCD
Fluoxetine (Prozac)
Fluvoxamine (Luvox)
Sertraline (Zoloft)
Paroxetine (Paxil)
190
____ therapy is most important in OCD than any other disorder
Behavioral
191
what TCA is used to treat OCD
Clomipramine (Anafranil)
192
social anxiety disorder - 2 drugs approved
Paroxetine (Paxil)
| Sertraline (Zoloft)
193
Beta blocker beneficial for social anxiety disorder
Propranolol - musicians and actors use this frequently - also good for test anxiety
off label use
194
when you prescribe a drug off label, what must you do
inform the patient that it its not approved for this use
195
PTSD should be treated with ____ in addition to drugs
psychotherapy
196
drugs for PTSD
```
beneficial
fluoxetine (Prozac)
paroxetine (Paxil) - approved
Sertraline (Zoloft) - approved
Venlafaxine (Effexor)
```
197
Sertraline (Zoloft) is used very commonly and more problematic for
GI side effects - so if they have IBS, zoloft wont be your DOG
198
how long do patients have to have signs of depression before it can be considered major depression?
2 weeks
199
SSRI MOA is to
increase serotonin available at the presnyeptic cleft
200
SSRI effects
HEAD
decrease anxiety, decrease impulsivity, decrease sex drive
RED
interfere with plt and bleeding
FED
GI motility
Nausea
201
What is the number one reason people want to stop taking SSRI
decrease sex drive
202
How long do SSRI take to work?
4 to 6 weeks
203
Fluoxetine (Prozac)
SSRI
longest 1/2 life
-1 week
"flu" worst week of your life
if you switch too fast to another SSRI/ MAOIs you can cause Serotonin syndrome
204
Sertraline (Zoloft)
SSRI
Harsher GI side effects...."Squirt-aline"
take with meal to decrease GI SE
safer for BFing and pregnant women
205
Paroxetine (Paxil)
SSRI
rapidly absorbed worst SE
inital SE, before clinical improvement
Withdrawal will happen much faster if stopped abruptly
NOT safe during pregnancy d/t withdrawal syndrome
206
Citalopram (Celexa)
SSRI
effect on QT interval if given >40mg/day >20mg/day in elderly get yearly EKG
207
Escitalopram (Lexapro)
Cleanest SSRI
208
Fluvoxamine (Luvox)
SSRI
only approved for OCD
209
Venlafaxine (Effexor)
SNRI
may be better for patients with lack of energy, decreased concentration
Can cause HTN, don't use with someone with hx of HTN
210
Duloxetine (Cymbalta)
SNRI
also helps with chronic pain "dull" for dulls the pain
211
Mirtazapine (Remeron)
a-2 adrenergic receptor antagonist
- nursing homes cancner clinics
- because it helps increase appetite
- may decrease nausea
212
Mirtazapine (Remeron)
a-2 adrenergic receptor antagonist
- nursing homes cancner clinics
- because it helps increase appetite
- may decrease nausea
213
Tricyclic Antidepressants MOA
inhibit the reuptake of SE and NE
antagonizing Ach and histamine
inhibiting Na and calcium channels
214
TCA overdose can cause
severe cardiac issues
widen QRS complex
215
what TCA do you give if patient has insomnia
Doxapin
216
What TCA do you give if you don't want more sedation
desipramine
217
If someone has ACH issues (glaucoma, constipation, BPH) what TCA do you give them?
Give notriptyline due to weak ACH effects
218
Imipramine (Tofranil)
TCA
sometimes used for bed wettting in children
219
Clomipraimine (anafranil)
TCA
gold standard for OCD but d/t high SE use SSRI first line
220
use of benzodiazepines in pregnancy and lactation
use during first trimester is associated with increased risk for congenital malformations
use near term can cause CNS depression in the neonate
contraindicated
221
drug given to promote sleep
hypnotics
222
what are the 4 major groups of sedative-hypnotics
Barbiturates
Benzodiazepines
Benzodiazepine-like
new agents with unique MOA
223
When treating anxiety and insomnia which is more preferred out of Barbiturates and Benzodiazepines?
Benzodiazepines
224
When taken ____, Benzodiazepines have no affect on the heart, but when given ____ can produce profound hypotension and cardiac arrest
PO
| IV
225
What is the drug of choice for acute anxiety
Benzodiazepines
226
anterograde amnesia
benzodiazepines can cause anterograde amnesia (impaired recall of events that take place after dosing).
227
anterograde amnesia is especially bad with what drug
triazolam (Halcion)
228
benzodiazepines and sleep related
taking benzodiazepines in sleep inducing doses may carry out complex behaviors and then have no memory of their actions. include sleep driving, preparing and eating meals, phone calls, ect
229
benzodiazepines and breastfeeding
can pass through milk easily and can reach toxic levels in the infant. do not use
230
are drugs for insomnia meant for long term or short term use
short term
231
Zolpidem (Ambien) is approved only for
short term management of insomnia
232
Ambien vs Ambien CR
Ambien is good for those who have difficulty falling asleep
Ambien CR is good for those who have difficulty staying asleep
233
rebound insomnia
When a pt is on long term insomnia therapy when they discontinue the med they are more likely to have rebound insomnia enforcing the behavior that they feel like they need the medication
234
Zaleplon (Sonata) is approved only for the short-term management of
insomnia
235
Zaleplon (Sonata) is good for what sleep problem
falling asleep but not staying asleep
236
Common side effects of Zaleplon (Sonata)
```
headache
nausea
drowsiness
dizziness
myalgia
abd pain
rare cases of sleep driving
```
237
Eszopiclone (Lunesta) is approved for
treating insomnia with no limitation on how it can be used
however there are no studies on use for greater than 6 mos
238
Eszopiclone (Lunesta) reduced sleep ____
latency and nighttime awakening, increased total sleep time and sleep quality
239
other common side effects are
```
headache
somnolence
dizziness
dry mouth
sleep driving
anaphylaxis or angioedema
```
240
Ramelteon (Rozerem) moa
melatonin agonist
| approved for insomnia characterized by difficulty with sleep onset but not with staying asleep
241
what is the only drug for insomnia that is not regulated as a controlled substance
Ramelteon (Rozerem)
242
did the FDA put a limit on how long Ramelteon (Rozerem) can be used?
no because there was no rebound insomnia
243
side effects of Ramelteon (Rozerem)
```
SOMNOLENCE
dizziness
fatigue
may also cause sleep driving
hallucinations
agitation
mania
```
```
can increase the levels of prolactin causing
amenorrhea
galactorrhea
reduced libido
fertility problems
```
anyphylaxis
angioedema
244
drug interactions for Ramelteon (Rozerem)
Fluvoxamine (Luvox) can increase levels more than 50 fold
alcohol can intensify symptoms
245
what drug may be given during abstinence syndrome to facilitate the withdrawal process
phenobarbital - a long acting barbiturate - dosage should be reduced gradually over 10 days to 3 weeks
246
Ramelteon (Rozerem) and pregnancy
avoid
247
Suvorexant (Belsomra)
orexin antagonist
| treats insomnia for going to sleep and maintaining sleep
248
does Suvorexant (Belsomra) have abuse potential
yes
249
drug interactions for Suvorexant (Belsomra)
Use with strong inhibitors of CYP3A can increase the effects
Can also increase digoxin levels requiring close monitoring
250
Pregnancy and lactation for Suvorexant (Belsomra)
studies are lacking
251
Prolonged use of Barbiturates results in ____ ____, a state in which continued use is required to avoid an ____ _____.
physical dependence
| abstinence syndrome
252
symptoms of withdrawal from general CNS depressants
| abstinence syndrome
```
weakness
confusion
restlessness
insomnia
hyperthermia
orthostatic hypotension
disorientation
by 3rd day seizures may develop
then psychotic delirium (similar to alcoholic delirium tremens)
in extreme cases followed by exhaustion cardiovascular collapse and death
```
progresses over 8 days
253
what drug may be given during abstinence syndrome to facilitate the withdrawal process
phenobarbital - a long acting barbituate - dosage should be reduced gradually over 10 days to 3 weeks
254
overdose of barbiturates
apnea and death
255
what is a heavily abused barbiturate
Xanax
256
to minimize drug-dependency insomnia, hypnotics should be employed judiciously. That is, they should be
used in the lowest effective dosage for the shortest time required.
257
Trazodone (oleptro) can decrease
sleep latency and prolong sleep duration
258
major adverse affect of Trazodone
Can cause Priapism, a medical emergency
259
Doxepin is an
TCA with strong sedative and also is really good for appetite. used for sleep maintenance in low doses
260
Doxepin is contraindicated in
pts with severe narrow angle glaucoma and severe urinary retention
261
another TCA that will help with sleep
Elavil
262
antihistamines used for sleep aid
Diphenhydramine (Nytol, sominex)
263
passage across the blood brain barrier is limited to
lipid soluble agents ant to drugs that cross by way of specific transport systems. Protein-bound drugs and highly ionized drugs cannot cross
264
Can you use a drug that treats muscle spasms to relieve spasticity?
no, these groups are not interchangeable
As a rule, the drugs used to treat spasticity do not relieve acute muscle spasm and the drugs used to treat acute muscle spasm do not relieve spasticity.
265
A group of movement disorders of CNS origin. characterized by heightened muscle tone, spasm and loss of dexterity.
Spasticity
266
Spasticity is most commonly caused by
sclerosis
cerebral palsy
other causes - traumatic spinal cord injury
stroke
267
what are the 4 drugs used to treat spasticity
Baclofen
Diazepam
Tizanidine
Dantrolene
268
Which is the drug approved for spasticity that instead of working on the CNS, it works on the skeletal muscle
Dantrolene
269
What is the drug that is approved to relieve spasticity r/t MS and some spinal cord injuries but not approved for spasticity r/t Cerebral Palsy, stroke, Parkinson disease or Huntington chorea
Baclofen
270
Does Baclofen decrease muscle strength?
no
Because baclofen has no direct muscle relaxant action, it does not decrease muscle strength. For this reason Baclofen is preferred over Dantrolene
271
Baclofen and CNS
```
drowsiness
dizziness
weakness
fatigue
most intense during early phase of therapy and diminishes with continued drug use
```
avoid alcohol
272
Antidote for Baclofen overdose
There is none.
can produce coma and resp depression
supportive therapy should be started immediately
273
symptoms of abrupt withdrawal of oral Baclofen
visual hallucinations
paranoid ideation
seizures
274
adverse effects of Baclofen
n/v
constipation
urinary retention
hypotension
275
Pt education for Baclofen
- possible depressant effects such as drowsiness, lightheadedness, and fatigue
- Avoid driving and operating heavy machinery
- Avoid other CNS depressants
- Frequently causes hypotension, nausea, constipation, urinary retention
- Abrupt discontinuation can cause psychiatric symptoms such as hallucinations, paranoia and seizures
276
What is the only benzodiazepine labeled for treating spasticity
Diazepam (Diastat, Valium)
277
Patient education for Dantrolene
- possible depressant effects such as drowsiness, lightheadedness, and fatigue
- Avoid driving and operating heavy machinery
- signs of liver dysfunction are jaundice, abd pain, malaise
- Avoid CNS depressants
278
Dantrolene can relieve spasticity associated with
multiple sclerosis
cerebral palsy
spinal cord injury
279
What drug that is approved to relieve spasticity may be associated with a significant reduction in strength
Dantrolene
280
What should you do if you do not see benefit from Dantrolene within 45 days
discontinue the drug
281
Black Box Warning for Dantrolene
fatal hepatotoxicity has occurred . The lowest effective dose should be used. Because patients may be asymptomatic, baseline liver function tests should be obtained followed by frequent monitoring of these levels throughout therapy.
282
involuntary contraction of a muscle or muscle group
muscle spasm
283
what causes muscle spasm
epilepsy
hypocalcemia
acute and chronic pain syndromes
localized muscle injury
284
treatment of acute muscle spasm involves
physical measures
| drug therapy
285
What are some examples of adjunct therapy for muscle spasms
physical therapy
specific exercises
whirlpool baths
heat application
286
application of a cold compress following a musculoskeletal injury
used initially to relieve pain and reduce swelling not to relieve muscle spasm
287
drug therapy for localized muscle spasms
analgesics (acetaminophen or NSAIDS)
| Centrally acting muscle relaxants
288
What are the centrally acting muscle relaxants used to relieve muscle spasm
```
carisoprodol
chlorzoxazone
cyclobenzaprine
diazepam
metaxalone
methocarbamol
orphenadrine
```
289
what is the drug of choice for acute muscle spasm
Cyclobenzaprine
290
CNS adverse effects of Cyclobenzaprine
It is a CNS depressant so
drowsiness
dizziness
fatigue
291
anticholinergic effects of Cyclobenzaprine
```
dry mouth
blurred vision
photophobia
urinary retention
constipation
```
292
Cardiac effects of Cyclobenzaprine
cardiac rhythm disturbances- sinus tachycardia and significant conduction delays
293
Cyclobenzaprine is contraindicated for patients taking
```
Monoamine Oxidase (MAO) Inhibitors (-ine)
make sure there as been at least a 2 week dry out period before starting
```
SSRI
SNRI
Tricyclic antidepressants
294
Taking Cyclobenzaprine with an MAO Inhibitor could lead to
potentially fatal serotonin syndrome
- high fevers
- Seizures
- rhabdomyolysis
295
Tizanidine is indicated for _____ and has been used off label to treat _____
spasticity
| acute back pain
296
What drug is approved for treatment of both spasticity and muscle spasm
Diazepam
297
what two centrally acting muscle relaxants can cause liver damage and liver function should be assessed before starting treatment
Tizanidine (Zanaflex)
| Metaxalone (Skelaxin)
298
what centrally acting skeletal muscle relaxant can cause hepatitis and potentially fatal hepatic necrosis
Chlorzoxazone (Lorzone)
299
what centrally acting skeletal muscle relaxant may turn urine brown, black, dark green (harmless)
Methocarbamol
300
What centrally acting skeletal muscle relaxant may turn urine orange to purple-red (harmless)
Chlorzoxazone
301
What centrally acting skeletal muscle relaxant can cause dry mouth, hypotension, hallucinations and psychotic symptoms
Tizanidine
302
What needs to happen when discontinuing Tizanidine and why
The dose needs to be tapered to avoid rebound hypertension
303
Which antidepressants can be taken safely while breastfeeding?
Sertraline
304
what are the 2 indications for CNS stimulants
ADHD
| narcolepsy
305
what are the three most widely used CNS stimulants
amphetamines
methylphenidate (Ritalin)
methylxanthines (caffeine)
306
what drugs are in the amphetamine family
-amphetamine
lisdexamfetamine (Vyvance)
amphetamine
dextroamphetamine
methamphetamine
307
amphetamines and CNS
```
prominent affects on mood and arousal
increase wakefulness and alertness
reduce fatigue
elevate mood
augment self confidence and initiative
```
308
Amphetamines and cardiac
increase HR, atrioventricular conduction, force of contraction
can cause dysrhythmias
can cause HTN
309
Do amphetamines have a high or low potential for abuse? withdrawal syndrome
chronic use will produce physical dependence
| if abruptly stopped withdrawal syndrome will ensue
310
adverse effects of amphetamines
insomnia
restlessness
weight loss
311
antiseizure for pregnancy
Lamictal
312
a disorder characterized by daytime somnolence and uncontrollable attacks of sleep
Narcolepsy
313
Caffeine and other methylxanthines with neonatal apnea
used to reduce the number and duration of apnea episodes and can promote a more regular pattern of breathing
314
Modafinil (Provigil) - what is it, what is it used for
non-amphetamine stimulant
approved for wakefulness in patients with narcolepsy, shift-work sleep disorder (SWSD) and obstructive sleep apnea-hypopnea syndrome (OSAHS)
315
can you use Modafinil during pregnancy
no
316
what to look for in Modafinil (adverse reactions)
```
headache
nausea
nervousness
Steven Johnson syndrome
erythema multiforme
toxic epidermal necrolysis
```
report - swelling, rash esp with fever
or changes in oral mucosa
317
does Modafinil affect nighttime sleep
no
318
drug interactions for Modafinil
Cytochrome P450
| accelerates the metabolism of oral contraceptives, cyclosporine and certain other drugs
319
What is the typical drug of choice for children with ADHD
Methylphenidate (Ritalin, Concerta)
320
ADHD is characterized by
Inattention
hyperactivity
impulsivity
321
To make a diagnosis for ADHD...
symptoms must appear before age 7 and be present for at least 6 months
322
subclassifications of ADHD
predominantly inattentive type
predominantly hyperactive-impulsive type
combined type
323
In addition to drugs, what can be used for the management of ADHD
family therapy
parent training
cognitive therapy for child
324
second choice drugs for ADHD in kids
nonstimulants
atomoxetine
guanfacine
clonidine
325
first line treatment for ADHD in adults
methylphenidate (Ritalin, Concerta)
dexmethylphenidate (Focalin)
dextroamphetamine-amphetamine mixture (Adderall)
lisdexamfetamine (Vyvanse)
326
For ADHD with stimulants they do not create _____behavior; they only reduce ____ behavior
positive; negative
327
principle adverse affects of stimulants are
insomnia and growth suppression (secondary to appetite suppression)
328
what is a "drug holiday" with stimulants
some physicians recommend drug holidays on weekends and summers which creates opportunity for the growth to catch up. However, other clinicians argue against this because this can be hard on the kids. a rebound increase in growth will take place - as a result adult height may not be affected
329
Atomoxetine (Strattera)
approved for ADHD in adults and kids
first non-stimulant approved for ADHD
not regulated as a controlled substance
taken once a day
330
Adverse effects of Atomoxetine (Strattera)
```
GI (dyspepsia, n/v)
reduced appetite
dizziness
somnolence
mood swings
trouble sleeping
sexual dysfunction and urinary retention in adults
angioneurotic edema - d/c drug and contact dr
SI in children and adolescence
weight loss and growth delay
severe liver injury
raise or lower bp
hypotension
syncope
```
331
what bowel cleaners are used for colonoscopy prep
sodium phosphate
a combination of sodium picosulfate, magnesium oxide and citric acid
PEG plus electrolytes
332
Polyethylene glycol-electrolyte solutions
| (CoLyte, GoLYTELY) adverse effects
dehydration does not occur and electrolyte balance is preserved
nausea, bloating, abd discomfort
333
Are CoLyte and GoLYTELY safe for patients with electrolyte imbalances, heart failure, kidney disease or advanced liver disease
yes because they do not alter water and electrolyte status
334
what bowel prep laxative is not safe for heart failure, kidney disease, advanced liver disease or patients with electrolyte imbalances
sodium phosphate products. This is an osmotic laxative
335
What type of therapy is Phenytoin (Dilantin)?
| What type of seizures is it approved for
monotherapy
partial seizures
primary generalized tonic clonic seizures
NOT absent seizures
336
Can you use Phenytoin (Dilantin) in pregnancy?
no
337
What precautions do you need to take when you give Phenytoin (Dilantin) IV
can cause severe hypotension and cardiac dysrhythmias. Cardiac monitoring should be used
338
What type of dosing considerations do you need for Phenytoin (Dilantin)?
Narrow therapeutic range
| Non-linear relationship between dosing
339
What population do you need to avoid prescribing Phenytoin (Dilantin) to without specific testing
Asian population
340
CYP interactions may decrease effectiveness of what drugs when taking Phenytoin (Dilantin)?
oral contraceptives
warfarin
glucocorticoids (ie) prednisone, dexamethasone, hydrocortisone
341
what are some adverse effects for Phenytoin (Dilantin)
gingival hyperplasia
| Dress syndrome
342
when is Fosphenytoin (Cerebyx) used
when PO Phenytoin is contraindicated. This is the IV formulation
343
What type of seizures is Carbamazepine (Tegretol) used for?
Tonic-clonic
simple partial
complex partial
344
When you compare Carbamazepine (Tegretol) to Phenytoin, which drug is preferred and why?
Carbamazepine (Tegretol) - less side effects
345
What is important to know about the pharm of Carbamazepine (Tegretol)
The half life decreases as the therapy progresses
initial treatment 40 hours
continued treatment 15 hours
346
what is the blackbox warning for Carbamazepine (Tegretol)
may cause serious skin reactions such as SJS and TEN
Aplastic anemia and agranulocytosis can occur
347
What population of people do you have to be cautious when giving Carbamazepine (Tegretol)
Asian population (test for HLA-B 1502
348
What adverse effects are important to know for Carbamazepine (Tegretol)
```
Bone marrow suppression
aplastic anemia
Water retention - caution with patients who have HF
Hyponatremia
monitor for DRESS
Hepatic and renal failure
```
349
what do you need to tell your patient to watch for with Carbamazepine (Tegretol)
fever, sore throat, pallor, weakness, infection, easy bruising, petechiae - notify provider if these occur
350
What food should they avoid while taking Carbamazepine (Tegretol)
Grapefruit juice
351
What labs need to be monitored for Carbamazepine (Tegretol)
Na+
Hepatic
Renal
Blood counts
352
Avoid prescribing Valproic Acid (Depakene, Depakote) in children less than
2 years old
353
Can you give Valproic Acid (Depakene, Depakote) to someone who is pregnant?
no
354
What type of seizures can you prescribe Valproic Acid (Depakene, Depakote) for?
all of them
355
what is the blackbox warning for Valproic Acid (Depakene, Depakote)
Fatal hepatic failure has occurred. Young children and patients with mitochondrial disease are at increased risk. Fatal and rapidly progressing pancreatitis has occurred. Highly teratogenic
356
what are the symptoms for pancreatitis?
n/v
anorexia
abd pain
357
tell me about the therapeutic window for Valproic Acid (Depakene, Depakote)
wide
358
what are the most common side effects for Valproic Acid (Depakene, Depakote)
GI side effects - give enteric coated and take with food
359
what patient population can you not give Valproic Acid (Depakene, Depakote)
with decreased liver function - evaluate liver function at baseline and periodically
360
signs and symptoms of liver injury
```
reduced appetite
malaise
nausea
abd pain
jaundice
```
361
are CNS effects common for Valproic Acid (Depakene, Depakote)
no
362
what are the drug interactions for Valproic Acid (Depakene, Depakote)
combined with Topiramate = increased risk for hyperammonemia
Do not take with Carbapenem ABX -mero and imipenem can reduce plasma levels of valproic acid
363
signs and symptoms of hyperammonemia
vomiting
lethargy
altered LOC
altered cognitive function
364
what is Ethosuximide used for?
drug of choice for absence seizures
365
how many times per day do you take Ethosuximide
once per day but twice per day is better tolerated
366
how is Ethosuximide dosed
This is by monitoring clinical response. The balance is high enough to control the symptoms or the adverse effects become too great
367
adverse effects of Ethosuximide
systemic lupus erythematosus
leukopenia
aplastic anemia
SJS
368
Phenobarbital falls under what class of drugs?
Barbituates
369
What schedule class is Phenobarbital
Schedule IV
370
what type of seizures does Phenobarbital treat
partial and generalized tonic clonic
NOT absence
371
what is the metabolism of Phenobarbital
long half life - about 4 days
372
how long does it take to reach the plateau of Phenobarbital and why is that important?
2-3 weeks, loading doses are often given to increase serum levels
373
What problem should you avoid prescribing Phenobarbital having to do with familial history
avoid in pt with personal or familial history of porphyria
374
Don't give Phenobarbital to patients with
resp compromise as it can cause resp depression
375
What vitamin deficiency is Phenobarbital linked to and what problems does this cause
Vit D, Vit K and calcium causing rickets and osteomalacia. eat foods high in vitamin D, K and calcium
376
symptoms of Phenobarbital tox
nystagmus
ataxia
generalized CNS depression
Death from resp depression
377
Drug interactions for Phenobarbital
CYP interactions decrease the effects of oral contraceptives and warfarin
Avoid other CNS depressants
When used with valproic acid can cause Phenobarbital levels to increase which could worsen adverse effects - decrease dose of Phenobarbital
378
Primidone is very similar to what drug?
Phenobarbital
379
what type of seizures is Primidone used for
tonic clonic
simple partial
complex partial
NOT absence
380
Primidone - monotherapy or adjunct?
adjunct therapy used usually with phenytoin or carbamazepine. NEVER use with phenobarbital
381
CNS effects Primidone
confusion in older adults
hyperactivity in children
sense of acute intoxication can occur after dosing
382
Primidone is contraindicated in
patients or family history of porphyria
383
adverse effects Primidone
acute psychosis
leukopenia
thrombocytopenia
systemic lupus
384
drug interactions Primidone
reduce the effects of oral contraceptives and warfarin
385
Risk with Zofran
prolongs QT interval
386
What should you monitor when giving zofran long term?
QT level and electrolytes
387
what two steroids are used to treat nausea but not FDA approved?
methylprednisonlone
and
dexamthasone
388
Aprepitant (Emend) pairs with what drugs when treating chemo induced n/v
dexamthasone and zofran
389
Aprepitant (Emend) Drug Interactions
rifampoin and phenytoin can decrease levels of emend
emend can raise levels of docetaxel, paclitaxel, etop, irinotecan, ifosfamide, imatinib, vinorelbine, vinblastine, and VCR, steroids (So reduce doses of steroids)
emend can decrease warfarin oral contraceptives
390
black box warning with phenergan
contraindicated in children below 2 years old
391
first line nausea in pregnancy
doxylamine and vitamin B6
392
n/v meds safe for bfing
phenergan
393
n/v meds to avoid in bfing
reglan, marinol,
394
n/v meds to avoid in older adults
benzo, scopolamine, reglan
395
when can you use methylpredisone in preg.
after 10 weeks gestation
396
why do they put atropine with lomotil?
to reduce the chance of abusing the drug
397
treating e.coli diarrhrea
cipro
398
treating e.coli in children and pregnant women
azithromycin
399
alosetron bbw
ischemic colitits
400
alosetron is contraindicated in pts with
severe constipation
intestinal obstruction
ischemic colitis
crohns disease
ulcerative colitis
diverticulitis
401
drug therapy for IBS
```
5-aminosalicylates
glucocorticoids
immunosuppressants
immunomodulators
abx
```
402
sulfasalazine use
5-aminosalicylates used for IBS reduces inflammation by reducing prostoglandin
403
sulfasalazine baseline labs
cbc
404
How is oxcarbazepine (Oxtellar XR, Trileptal) used?
monotherapy and adjunctive therapy for management of partial seizures
405
Is oxcarbazepine (Oxtellar XR, Trileptal) safe for kids?
yes used in adults in children
4 years and older for monotherapy
2 years and older for adjunctive therapy
406
adverse effect for oxcarbazepine (Oxtellar XR, Trileptal)
hyponatremia if combined with other drugs that reduce NA then you should monitor NA levels
407
If you are allergic to _______, you should not take oxcarbazepine (Oxtellar XR, Trileptal)
Carbamazepine
408
drug interactions for oxcarbazepine (Oxtellar XR, Trileptal)
If you combine with Perampanel or
phenobarbital and valproic acid
It can decrease your oxcarbazepine (Oxtellar XR, Trileptal) levels. Monitor levels closely
not recommended with Eslicarbazepine - can increase levels of Eslicarbazepine
birth control
409
oxcarbazepine (Oxtellar XR, Trileptal) and bone
decreased bone mineral density - osteopenia and osteoporosis with increased risk of fractures
410
Lamotrigine (lamictal) black box warning
may cause skin reactions such as SJS and TEN
411
what is Lamotrigine (lamictal) approved for
Adj therapy in adults and children older than 2
- generalized seizures associated with lennox-gastaut syndrome in adults and children
- primary generalized tonic clonic sizures in adults and children older than 2
monotherapy
- partial seizures in patients at least 16
412
Lamotrigine (lamictal) and psych
risk of SI is greater compared to other anti-seizure drugs
413
Gabapentin (Neurontin) is approved for
adjunctive therapy of partial seizures
414
is the absorption of Gabapentin (Neurontin) affected by food?
no
415
Gabapentin (Neurontin) and driving
avoid driving until tolerance develops
416
Gabapentin (Neurontin) drug interactions
it has none. Well combined with other drugs
417
Pregabalin (Lyrica) is used for
adjunct therapy of partial seizures
418
Pregabalin (Lyrica) has similar effects to _____ and is a schedule ____
Diazepam
| Schedule V
419
Can you give Pregabalin (Lyrica) in pregancy
no
420
CNS effects of Pregabalin (Lyrica) and does it improve with time
Dizziness, somnolence - does not improve with time
421
Vision and Pregabalin (Lyrica)
Blurred vision, typically improves with time
422
other side effects of Pregabalin (Lyrica)
weight gain, concentration issues, headache, peripheral edema, dry mouth
423
Adverse effects Pregabalin (Lyrica)
Angioedema - d/c at the start of reaction
Rhabdomyolysis - d/c med
424
symptoms of rhabdomyolysis
muscle injury pain
tenderness
weakness
425
Abrupt d/c of Pregabalin (Lyrica)
insomnia
nausea
headache
diarrhea
withdraw slowly over one week
426
drug interactions for Pregabalin (Lyrica)
alcohol, opioids, benzodiazepines, and other CNS depressants may intensify the depressant effects of Pregabalin (Lyrica), so you should avoid
427
Levetiracetam (Keppra) approved for
myoclonic seizures in adults and adolescents 12 years and older
partial onset seizures in adults and children 4 and older
Primarily generalized tonic-clonic seizures 6 years old and older
428
side effects of Levetiracetam (Keppra)
possible like between keppra and renal injury
otherwise mild to moderate SE
most common: drowsiness and asthenia (lack of strength or weakness)
does not affect speech, cognition or other cognitive fx
429
drug interactions for Levetiracetam (Keppra)
There are none
430
can you use keppra in pregnancy
yes
431
Topiramate (Topamax) is approved for
Adj therapy of adults and children 2 years old and older with partial seizures, primary generalized tonic clonic seizures, and seizures associated with lennox gastaut syndrome
Monotherapy of adults and kids 10 yo and older with partial seizures or primary generalized tonic-clonic seizures
432
Topiramate (Topamax) adverse affects
can cause metabolic acidosis (hyperventilation develops)
prolonged use can lead to kidney stones, fractures, growth delay
angle closure glaucoma
433
what are the risk factors for Topiramate (Topamax)
pt with renal dx
severe resp disorders
diarrhea
ketogenic diet
434
What should the pt taking Topiramate (Topamax) do if they notice hyperventilation
notify the provider
| their dose should be tapered slowly so you dont have rebound effects
435
What labs should be monitored periodically for Topiramate (Topamax)
Serum bicarb
436
signs of angle closure glaucoma
ocular pain, redness, vision changes
437
can you take Topiramate (Topamax) with pregancy
no
438
drug interactions for Topiramate (Topamax)
Phenytoin and carbamazepine can decrease levels of Topiramate (Topamax) by 45%
Increased risk for hyperamonia if given with valproic acid (encephalopathy)
439
Tiagabine (Gabitril) indications
partial seizures in pt at least 12yo
440
Tiagabine (Gabitril) drug interactions
levels of Tiagabine (Gabitril) can be decreased by Phenytoin, phenobarbital and carbamazepine
441
Zonisamide (Zonegran) indications
adjunct therapy of partial seizures in adults
442
Zonisamide (Zonegran) and driving
avoid driving
443
Zonisamide (Zonegran) and kidney patients
may effect kidneys, use in caution with patients that have kidney issues
444
Zonisamide (Zonegran) and fluids
drink 6-8 glasses of water per day
| avoid grapefruit juice
445
labs for Zonisamide (Zonegran)
bicarb at baseline and periodically there after
446
drug interactions for Zonisamide (Zonegran)
st johns wort
phenytoin
phenobarbital
carbamazepine can all accelerate the metabolism of Zonisamide (Zonegran) which would reduce its half life
447
Felbamate (Felbatol) indications
adjuctive or monotherapy in adults with partial seizures
adjuctive therapy in children with lennox gastaut syndrome
448
Felbamate (Felbatol) black box warning
increased risk for aplastic anemia
may cause acute liver failure
