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Pharmacology > medication names,catagories and misc > Flashcards

medication names,catagories and misc Flashcards

1
Q

No risk to animal fetus, info on human fetus not available

A

Category B

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2
Q

Adverse affect on animal fetus, no info on human fetus

A

Catagory c

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3
Q

Adverse affect on animal fetus, no info on human fetus

A

Category C

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4
Q

Possible fetal risk in humans reported; consideration of potential benefit vs risk may in some cases warrant use of these drugs in pregnant pt. Drug should not be used for pregnant woman.

A

Category D

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5
Q

Fetal abnormalities reported in animals & positive evidence of fetal risk in humans available from animal & human studies

A

Category X

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6
Q

Abuse potential: High
Medical Use: None
Dependency Potential: Severe physical & psychological

A

Schedule CI

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7
Q

Abuse potential: High
Medical Use: Accepted
Dependency Potential: Severe physical & psychological

A

Schedule CII

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8
Q

Abuse potential: Less than CII
Medical Use: Accepted
Dependency Potential: Moderate to Low physical & psychological

A

Schedule CIII

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9
Q

Abuse potential: Less than CIII
Medical Use: Accepted
Dependency Potential: Limited physical & psychological

A

Schedule CIV

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10
Q

Abuse potential: Less than CIV
Medical Use: Accepted
Dependency Potential: Limited physical & psychological

A

Schedule CV

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11
Q

Absorption:
Gastric PH less acidic
Gastric emptying is slowed
Intramuscular absorption faster & irregular
1-2 yr decrease absorption of acidic drugs & less acidic destruction of drug

A

Neonatal and Pediatric absorption consideration

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12
Q

Distribution:
The younger the pt. the greater % of total body water.
The greater TBW (total body weight) means fat content is lower-produce less protein
Immature blood brain barrier- more drugs enter brain

A

Neonatal and Pediatric distribution consideration

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13
Q

Premature 85% body H2O
Newborn 80% body H2O
1-12 64% body H2O

A

Neonatal and Pediatric distribution consideration

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14
Q

Metabolism: Liver immature, does not produce enough microsomal enzymes-decrease drug metabolism, may have to lower dose
Older children may have increased metabolism, requiring higher doses than infants

A

Neonatal and Pediatric metabolism consideration

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15
Q

Excretion:
Kidney immaturity affects glomerular filtration rate & tubular secretion
Decreased perfusion rate of the kidneys may reduce excretion of drug

A

Neonatal and Pediatric excretion consideration

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16
Q

Factors affecting Ped Drug Doses

A

Skin thin& permeable
Stomach lacks acid to kill bacteria
Lungs have weaker mucus barriers
Body temp less well regulated & dehydration occurs easily
Liver & kidneys immature, impairing drug metabolism & excretion

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17
Q

Cardiovascular-decreased CO & blood flow
Gastrointestinal- PH less acidic& slowed emptying, reduced blood flow to GI slowed absorption (laxatives help)
Hepatic-decreased enzyme production & blood flow (decrease of 1.5% a yr 25>
Renal- decreased glomerular filtration rate, decreased # of intact nephrons, decreased blood flow

A

Physiologic Changes in the Elderly

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18
Q 
Antibiotics
Anticoagulants
Antidiabetic drugs(particularly insulin)
Antineoplastic 
Cardiovascular 
Central Nervous System-active drugs
Vaccines
A

High Alert Drugs

Involved in serious Errors

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19
Q

Never use trailing zeros in medication orders
Wrong- 1.0mg Right- 1mg
Always use a leading zero for decimal dosages
Wrong .25mg Right 0.25mg

A

Preventing Medication Errors

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20
Q

Thought to help-memory & cerebral insufficency

A

Ginkgo

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21
Q

Thought to help- migraines

A

Feverfew

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22
Q

Thought to help- wound healing

A

Aloe

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23
Q

Thought to help- cold, flu, dermal fungal, wound healing, bladder infections

A

Goldenseal

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24
Q

Thought to help- depression & mood enhancement
MAY CHANE AFFECTS OF HORMONES IN CONTRACEPTIVES, PATCHES OR HORMONE REPLACEMENT THERAPY. MAY LEAD TO SEROTONIN SYNDROME IF USED WITH SSRI DRUGS May cause GI upset, fatigue, dizziness,confusion, dry mouth, photosensitivity;Severe interactions if taken with MAOIs and Food-drug interaction with tyramine containing foods;Have benefical effects for pt. HTN

A

ST. John’s wort

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25
Q

Thought to help- anxiety, stress,restlesness sedative, sleep problems(may cause tmpry yellowing of skin-long term therapy)
MAY CAUSE CNS DEPRESSION,N&V, HEPATOXICITY, ANOREXIA, RESTLESSNESS,INSOMNIA; interactions with MAIOs,warfin,alcohol,phenytion
Have benefical effects for pt. HTN

A

Valerian

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26
Q

Thought to help- relaxation, decrease anxiety

POSSIBLE HEPATIC TOXCITY

A

Kava

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27
Q

Thought to help - Atherosclerosis, decrease cholesterol & help in lipid control
POSSIBLE INTERFERING WITH HYPOGLYCEMIC THERAPY, & ANTICOAGULANT “WARFIN”
Have benefical effects for pt. HTN

A

Garlic

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28
Q

CARDIOVASCULAR & STROKE RISK

A

Ephedra

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29
Q

AT HIGH DOSES, POSSIBLE INTERFERENCE WITH CARDIAC, ANTIDIABETIC, ANTICOAGULANT DRUGS

A

Ginger Root

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30
Q

DECREASED METABOLISM OF ESTROGENS y SOME PSYCHOTHERAPUTIC DRUGS

A

Grapefruit

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31
Q

DECREASED ELIMINATION OF MANY DRUGS THAT ARE RENALLY EXCRETED

A

Cranberry

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32
Q

Thought to help - energy stimulant

MAY CAUSE HTN, & IS CONTRAINDICATED FOR PT WITH HTN, CARDIOVASCULAR DISEASE, & IRREGULAR HEART RYTHMS

A

Ginseng

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33
Q

BPH- DIALATES BLOOD VESSELS

A

Saw palmetto

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34
Q

Thought to help - HF

MAY LEAD TO TOXIC LEVELS OF CARDIAC GYLCOSIDES(DIGITALIS) IF USED CONCURRENTLY

A

Hawthorne

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35
Q

HORMONE LEVELS DECREASE WITH AGE USED TO TX TROUBLE SLEEPING, CHANGE CYCLIC RYTHIM

A

Melontonin

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36
Q 
Medications that relieve pain without causing
loss of consciousness
 “Painkillers”
 Opioids
 acetaminophen
 NSAIDs
A

Analgesics

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37
Q 
Tissue injury causes the release of:
 Bradykinin
 Histamine
 Prostaglandins
 Serotonin
These substances stimulate nerve endings,
starting the pain process
A

Pain Transmission

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38
Q

Pain relievers that contain opium, derived
from the opium poppy or chemically related to
opium
Narcotics: very strong pain relievers(sleepy-opioids)

A

Opioid Analgesics

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39
Q

codeine sulfate(not a strong opioid)

A

opioid analgesic

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40
Q

meperidine HCl (Demerol)

A

opioid analgesic

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41
Q

methadone HCl (Dolophine)

A

opioid analgesic

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42
Q

morphine sulfate

A

opioid analgesic

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43
Q

propoxyphene HCl

A

opioid analgesic

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44
Q

hydromorphone

A

opioid analgesic

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45
Q

oxycodone

A

opioid analgesic

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46
Q

fentanyl

A

opioid analgesic

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47
Q

Mu *(primary receptor)-supraspinal analgesia, respiratory depression, euphoria, sedation(eg. morphane)
Kappa *(primary receptor)-spinal analgesia, sedation, miosis(eg ketocydazocine)
Delta *(primary receptor)- analgesia(eg. enkephallins)
Sigma
Epsilon

A

Five types of opioid receptors

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48
Q 
Often given with adjuvant analgesic drugs to assist the primary drugs with pain relief
 NSAIDs
 acetaminophen
 Antidepressants
 Anticonvulsants
 Corticosteroids
A

opioid analgesic

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49
Q

cough center depression
tx of diarrhea
balanced anesthesia

A

Alternate uses

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50
Q 
Euphoria-leads to abuse
 CNS depression
 Leads to respiratory depression
 Most serious adverse effect
 Nausea and vomiting
 Urinary retention
 Diaphoresis and flushing
 Pupil constriction (miosis)
 Constipation
 Itching -releases histimine
A

Opioid Analgesics: Adverse

Effects

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51
Q 
naloxone (Narcan)
naltrexone (Revia)
These drugs bind to opiate receptors and prevent a response
 Used for complete or partial reversal of opioid-induced respiratory depression
 Regardless of withdrawal symptoms,
when a patient experiences severe
respiratory depression, an opioid
antagonist should be given.
A

Toxicity and Management

of Overdose

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52
Q 
Analgesic and antipyretic effects
 Little to no antiinflammatory effects
 Available OTC and in combination
products with opioids 
MOA-Similar to salicylates
 Blocks pain impulses peripherally by inhibiting

prostaglandin synthesis

A

Nonopioid Analgesics:

Acetaminophen( not an NSAID)

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53
Q

OD on acetaminophen

acute hepatic failure

A

Antidote: acetylcystane (Mucomyst)

Ideally given within 12 hrs. 1st dose loading dose, then 17 more q 4hrs

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54
Q 
Salicylates
 Acetic acid derivatives
 Cyclooxygenase 2 (COX 2) inhibitors
Cyclooxygenase-COX-
 Enolic acid derivatives
 Propionic acid derivatives
A

Chemical Categories of NSAIDs

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55
Q

Inhibit platelet aggregation

Examples: aspirin, diflunisal (Dolobid)

A

NSAIDs: Salicylates

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56
Q 
indomethacin (Indocin)
 ketorolac (Toradol)
 diclofenac sodium (Voltaren)
 sulindac (Clinoril)
 tolmetin (Tolectin)
 etodolac (Lodine)
A

NSAIDs: Acetic Acids

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57
Q

celecoxib (Celebrex)
First and only remaining COX-2 inhibitor
Indicated for osteoarthritis rheumatoid arthritis
osteoarthritis, arthritis,acute pain symptoms, ankylosing spondylitis, and primary dysmenorrhea

A

NSAIDs: COX-2 Inhibitor

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58
Q

piroxicam (Feldene)
meloxicam ( Mobic)
nabumetone (Relafen)

A

NSAIDs: Enolic Acid Derivatives

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59
Q

Cox1 & Cox 2 inhibitor(nonslective)
salicylates (aspirin)
More potent effect on platelet aggregation
Analgesic
Antipyretic
Antiinflammatory
Antithrombotic effect: used in the treatment of MI and other thromboembolic disorders

A

NSAIDs: Salicylates-asprin

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60
Q 
fenoprofen (Nalfon)
 flurbiprofen (Ansaid)
 ibuprofen (Motrin, Advil)
 ketoprofen (Orudis KT)
 naproxen (Naprosyn, Aleve)
 oxaprozin (Daypro)
A

NSAIDs: Propionic Acids

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61
Q

Renal;
Reductions in creatinine clearance
Acute tubular necrosis with renal failure
Gastrointestinal;
Dyspepsia, heartburn, epigastric distress, nausea
GI bleeding*
Mucosal lesions* (erosions or ulcerations)
*misoprostol (Cytotec) can be used to reduce these dangerous effects

A

NSAIDs: Adverse Effects

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62
Q

Adults: tinnitus and hearing loss
Children: hyperventilation and CNS effects
Metabolic acidosis and respiratory alkalosis may be present

A

NSAIDs: Salicylate Toxicity

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63
Q

Serious interactions can occur when given with:
Anticoagulants
Aspirin
Corticosteroids and other ulcerogenic drugs
Protein bound drugs

A

NSAIDs: Interactions

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64
Q

Gout: condition that results from inappropriate uric acid metabolism
decreased excretion of uric acid
excessive production of uric acid
Uric acid crystals are deposited in tissues and
joints, resulting in pain

A

Antigout Drugs

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65
Q

allopurinol (Zyloprim)

Used to reduce production of uric acid

A

Antigout Drugs

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66
Q

colchicine
Reduces inflammatory response to the deposits of urate
crystals in joint tissue
DECEASED MOBILITY OF LEUKOCYTES & MIGRATION OF LEUKOCYTES TO JOINTS AFFECTED BY GOUT THUS RESULTING IN DECREASE INFLAMMATION; ASSES PT FOR DECREASED FLUID; N&V

A

Antigout Drugs

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67
Q

probenecid (Benemid), sulfinpyrazone (Anturane) Increases excretion of uric acid in the urine

A

Antigout Drugs

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68
Q

Inhaled anesthetics
Volatile liquids or gases that are vaporized/mixed in oxygen and inhaled
Parenteral anesthetics
Administered intravenously

A

General Anesthetics

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69
Q 
Inhaled gas
 nitrous oxide
 Inhaled volatile liquids
 desflurane
 enflurane (Ethrane)
 halothane (Fluothane)
 isoflurane (Forane)
 methoxyflurane (Penthrane)
 sevoflurane
A

Inhaled Anesthetics

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70
Q

Used:
To induce or maintain general anesthesia
To induce amnesia
As an adjunct to inhalation-type anesthetics

A

Injectable Anesthetics

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71
Q 
etomidate (Amidate)
 ketamine (Ketalar)
 methohexital (Brevital)*
propofol (Diprivan)*
 thiamylal (Surital)
 thiopental (Pentothal)*
A

Injectable Anesthetics

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72
Q

Sedative-hypnotics
Barbiturates (pentobarbital, secobarbital)
Benzodiazepines (diazepam, midazolam)
hydroxyzine
promethazine
Opioid Analgesics
fentanyl, sufentanil, meperedine, morphine

A

Adjunct Drugs for Anesthetics

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73
Q 
Neuromuscular blocking drugs (NMBDs)
 Depolarizing drugs (succinylcholine)
 Nondepolarizing drugs (pancuronium
pancuronium,
d-tubocurarine, vecuronium)
 Anticholinergics
 atropine, glycopyrrolate, scopolamine
A

Adjunct Drugs for Anesthetics

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74
Q 
Vary according to dosage and drug used
 Sites primarily affected
 Heart, peripheral circulation, liver, kidneys,
respiratory tract
 Myocardial depression is commonly seen
A

Adverse Effects to Anesthetics

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75
Q

Malignant hyperthermia
Occurs during or after general anesthesia or use of the NMBD succinylcholine
Sudden elevation in body temperature (greater than 104° F)
Tachypnea, tachycardia, muscle rigidity
Life-threatening emergency
Treated with dantrolene (skeletal muscle relaxant)

A

Adverse Effects to Anesthetics

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76
Q

Also called conscious sedation, procedural
sedation
Combination of an IV benzodiazepine and an opiate analgesic
Anxiety and sensitivity to pain are reduced, and patient cannot recall the procedure
Preserves the patient’s ability to maintain own airway and to respond to verbal commands

A 
Moderate Sedation
used for:
diagnostic procedures and minor surgery
Topical anesthetic may be applied
Rapid recovery time and greater safety profile
than general anesthesia
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77
Q 
procaine (Novocain)
 tetracaine (Pontocaine)
 lidocaine (Xylocaine)
 mepivacaine (Carbocaine)
 bupivacaine
A

Parenteral Anesthetics

Parenteral
Injected parenterally or into the CNS by various spinal injection techniques

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78
Q

First, autonomic activity is lost
Then pain and other sensory functions are
lost
Last, motor activity is lost
As local drugs wear off, recovery occurs in
reverse order (motor, sensory, then
autonomic activity are restored)

A

Drug Effects: Paralysis

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79
Q

Minor surgical and dental procedures
Injection of the anesthetic solution intradermally, subcutaneously or submucosally across the path of nerves supplying the target area
May be given in a circular pattern around the
operative area

A

Infiltration anesthesia

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80
Q

Infiltration anesthesia and epinephrine
Some local anesthetics used for infiltration or nerve block are combined with vasoconstrictors
• To prevent systemic absorption of anesthetic
• To help confine local anesthetic to injected area
• To reduce local blood loss during procedure
• Epinephrine, phenylephrine, norepinephrine

A

Infiltration anesthesia

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81
Q

Adverse effects result if:
Inadvertent intravascular injection occurs
Excessive dose or rate of injection is given
Slow metabolic breakdown occurs
Injection into highly vascular tissue occurs
“Spinal headache,” treated with an epidural blood patch

A

Adverse effects of Infiltration anesthesia

82
Q 
Prevent nerve transmission in certain
muscles, resulting in muscle paralysis
 Used with anesthetics during surgery 
When used during surgery, artificial
mechanical ventilation is required
These drugs paralyze respiratory and skeletal
muscles
 Patient cannot breathe on his or her own
 Do not cause sedation or pain relief
 Patient may be paralyzed yet conscious
A

Neuromuscular Blocking Drugs(NMBD)

83
Q 
Depolarizing drugs
 Nondepolarizing drugs
 Short acting
 Intermediate acting
 Long acting
A

Neuromuscular Blocking Drugs(NMBD)

84
Q

Succinylcholine
Works similarly to neurotransmitter acetylcholine(Ach), causing depolarization
Metabolism is slower than Ach so as long as
Ach, succinylcholine is present,repolarization cannot occur
Result: flaccid muscle paralysis

A

NMBAs: Depolarizing Drug

85
Q 
Short acting
mivacurium (Mivacron)
 Intermediate acting
 atracurium (Tracrium), vecuronium (Norcuron)
 rocuronium (Zemuron)
 Long acting
 pancuronium (Pavulon), doxacurium (Nuromax)
 d-tubocurarine
A

NMBAs: Nondepolarizing Drugs

86
Q

Prevent Ach from acting at neuromuscular
junctions
Muscle fibers are not stimulated
Skeletal muscle contraction does not occur

A

NMBAs: Nondepolarizing Drugs MOA

87
Q

First sensation is muscle weakness
Followed by total flaccid paralysis
Small, rapidly moving muscles affected first (fingers,eyes) then limbs neck trunk
Finally, intercostal muscles and diaphragm affected,resulting in cessation of respirations
Recovery of muscular activity usually occurs in reverse order
Transient muscle fasciculations may result in later muscle soreness

A

NMBAs

88
Q

Main use: maintaining controlled ventilation
during surgical procedures
Endotracheal intubation (short acting)
To reduce muscle contraction in an area that
needs surgery

A

NMBAs:

Indications

89
Q 
Few when used appropriately
 May cause:
 Hypotension (blockade of autonomic ganglia)
 Tachycardia (blockade of muscarinic receptors)
Hypotension (release of histamine)
SAFETY
Respiratory muscle paralysis occurs with
these drugs
 Emergency ventilation equipment must be
immediately available
A

NMBAs:

Adverse Effects

90
Q

CNS to the degree that they reduce:
Nervousness
Excitability
Irritability without causing sleep

A

CNS Depressants-Sedatives

91
Q

Cause sleep
sedative can become a hypnotic it is given in
large enough dose

A

CNS Depressants-Hypnotics

92
Q

Sedative-hypnotics—dose dependent
At low doses, calm the CNS without inducing sleep
At high doses, calm the to the point of causingsleep
Barbiturates
Benzodiazepines

A

FYI

93
Q

A commonly prescribed drug class
Favorable drug effect profiles, efficacy, and
safety
Classified as either:
Sedative-hypnotic
Anxiolytic (medication that relieves anxiety)

A

Benzodiazepines

94
Q

Long-acting
estazolam (Prosom), flurazepam (Dalmane),
lorazepam (Ativan)
Short-acting
temazepam (Restoril), alprazolam (Xanax),
triazolam (Halcion)

A

Benzodiazepines:

Sedative-Hypnotic Types

95
Q

Share many characteristics of benzodiazepines
Used to treat insomnia
Examples: zaleplon (Sonata), zolpidem (Ambien),
eszopiclone (Lunesta), and ramelteon (Rozerem)
Eszopiclone and extended-release zolpidem (Ambien
CR) approved for long-term therapy

A

CNS Depressants:

Nonbenzodiazepine Hypnotics

96
Q

Ramelteon (Rozerem)
Does not cause CNS depression
No potential for abuse
No withdrawal signs and symptoms

A

CNS Depressants:

Nonbenzodiazepine Hypnotics

97
Q

Depress CNS activity
Affect hypothalamic, thalamic, and limbic
systems of the brain
Benzodiazepine receptors
Do not suppress REM sleep as much as barbiturates do
Do not increase metabolism of other drugs

A

Benzodiazepines:

Mechanism of Action

98
Q 
Calming effect on the CNS
 Useful in controlling agitation and anxiety
 Reduce excessive sensory stimulation,
inducing sleep
 Induce skeletal muscle relaxation
A

Benzodiazepines:

Drug Effects

99
Q 
Sedation
Sleep induction
Skeletal muscle relaxation
Anxiety relief
Treatment of alcohol withdrawal 
Agitation
Depression
Epilepsy
 Balanced anesthesia
 Moderate/conscious sedation
A

Benzodiazepines:

Indications

100
Q 
Somnolence
Confusion
Coma
Diminished reflexes
Do not cause hypotension and respiratory
depression unless taken with other CNS
depressants
Treatment symptomatic and supportive
*Flumazenil as an antidote******
A

Benzodiazepines:

Toxicity and Overdose

101
Q

First introduced in 1903; were the standard
drugs for insomnia and sedation
Habit forming; low therapeutic index
Only a handful commonly used today due in
part to the safety and efficacy of
benzodiazepines

A

Sedative-Hypnotics: Barbiturates

102
Q

Site of action
Brainstem (reticular formation)
By facilitating GABA, nerve impulses traveling
in the cerebral cortex are inhibited

A

Sedative-Hypnotics: Barbiturates MOA

103
Q

Low doses: sedative effects
High doses: hypnotic effects (also lower
respiratory rate)
Notorious enzyme inducers
Stimulate liver enzymes that cause the metabolism
or breakdown of many drugs
Result: shortened duration of action

A

Barbiturates: Drug Effects

104
Q

Hypnotics
Sedatives
Anticonvulsants
Anesthesia for surgical procedures

A

Barbiturates: Indications

105
Q

Ultra short-acting
Anesthesia for short surgical procedures
Short-acting & Intermediate-acting
Sedation/sleep induction and control of convulsive conditions
Long-acting
Sleep induction, epileptic seizure prophylaxis

A

Barbiturates: Four Categories

106
Q 
Ultrashort
 methohexital, thiopental
 Short
 pentobarbital, secobarbital
 Intermediate
 butabarbital
 Long
 phenobarbital, mephobarbital
A

Barbiturates: Four Categories

107
Q 
CNS- Drowsiness, lethargy,
vertigo mental depression
vertigo, 
Respiratory -Respiratory depression,
apnea, bronchospasms,
cough
A

Barbiturates Body System Adverse Effects

108
Q 
GI -Nausea, vomiting, diarrhea,
constipation
Other -Agranulocytosis,
hypotension, Stevens-
Johnson syndrome
A

Barbiturates Body System Adverse Effects

109
Q

Overdose frequently leads to respiratory depression,and subsequent respiratory arrest
Overdose produces CNS depression (sleep to coma and death)
Can be therapeutic
Anesthesia induction
Uncontrollable seizures: “phenobarbital coma”

A

Barbiturates:

Toxicity and Overdose

110
Q

Symptomatic and supportive

Activated charcoal

A

Barbiturates:

Toxicity and Overdose TX

111
Q 
Act to relieve pain associated with skeletal
muscle spasms
 Majority are central-acting
 CNS is the site of action
 Similar in structure and action to other CNS depressants
 Direct-acting
 Act directly on skeletal muscle
 Closely resemble GABA
A

Muscle Relaxants

112
Q

Relief of painful musculoskeletal conditions
Muscle spasms
Management of spasticity of severe chronic disorders, eg. multiple sclerosis, cerebral palsy
Work best when used along with physical
therapy

A

Muscle Relaxants: Indications

113
Q

dantrolene (Dantrium) used in treatment of Malignant hyperthermia

A

Muscle Relaxants: Indications

114
Q 
baclofen (Lioresal)
 cyclobenzaprine ( Flexeril)
 dantrolene (Dantrium)
 metaxalone (Skelaxin)
 tizanidine (Zanaflex)
A

Common Muscle Relaxants

115
Q

Used in the treatment of emotional and
mental disorders
Ability to cope with emotions can range from
occasional depression or anxiety to constant
emotional distress
When emotions significantly affect an individual’s ability to carry out normal daily functions,treatment with a psychotherapeutic drug is a possible option

A

Psychotherapeutic Drugs

116
Q

Anxiety
Affective disorders
Psychoses

A

Psychotherapeutic Drugs

Three main emotional and mental disorders

117
Q

Antianxiety drugs
Antimanic drugs
Antidepressant drugs
Antipsychotic drugs

A

Types of psychotherapeutic drugs

118
Q

Unpleasant state of mind, characterized by a
sense of dread and fear
May be based on actual anticipated
experiences or past experiences
May be exaggerated responses to imaginary
negative situations

A

Anxiety

119
Q 
Obsessive-compulsive disorder (OCD)
 Posttraumatic stress disorder (PTSD)
 Generalized anxiety disorder (GAD)
 Panic disorder
 Social phobia
 Simple phobia
A

Six major anxiety disorders (persistent anxiety)

120
Q 
Changes in mood that range from mania
(abnormally pronounced emotions) to
depression (abnormally reduced emotions)
 Some patients may exhibit both mania and
depression: bipolar disorder (BPD)
A

Affective Disorders

Mood Disorders

121
Q

Severe emotional disorder that impairs the
mental function of the affected individual to
the point that the individual cannot participate
in activities of daily living
Hallmark: loss of contact with reality
Examples
Schizophrenia
Depressive and drug-induced psychoses

A

Psychosis

122
Q

Biochemical imbalance theory
Mental disorders are associated with
abnormal levels of endogenous chemicals,
such as neurotransmitters, in the brain

A

Psychotherapeutics:

Pathophysiology

123
Q 
Brain levels of certain neurotransmitters play an important role in maintaining mental health
 Catecholamines
 Dopamine
 Norepinephrine
 Indolamines
 Serotonin
 Histamine
A

Psychotherapeutics:

Pathophysiology

124
Q

Reduce anxiety by reducing overactivity in
CNS
Benzodiazepines
• Depress activity in the brainstem and limbic system
Miscellaneous drug: Buspirone (BuSpar)
• Nonsedating and non–habit forming
• May have drug interaction with SSRIs (serotonin syndrome)
• Do not administer with MAOIs

A

Antianxiety Drugs

125
Q 
diazepam (Valium)
 lorazepam ( Ativan)
 alprazolam (Xanax)
 clonazepam (Klonopin)
 chlordiazepoxide (Librium)
A

Common Benzodiazepines

126
Q

Midazolam (Versed)*
Reduces anxiety and patient’s memory of painful procedures that do not require general anesthesia (moderate sedation)
Injection only
*Limited to use as sedative and anesthetic during invasive medical or surgical procedures

A

Common Benzodiazepines

127
Q

Potentially habit-forming and addictive
Should be used at lowest effective dosages
and frequencies needed for symptom control

A

Benzodiazepines

128
Q

Benzodiazepine adverse effects are an
overexpression of their therapeutic effects
Decreased CNS activity sedation activity, Hypotension
Drowsiness, loss of coordination, dizziness, headaches
Nausea, vom iting, dry mouth, constipation

A

Benzodiazepines:

Adverse Effects

129
Q

Treatment is generally symptomatic and
supportive
** Flumazenil may be used to reverse
benzodiazepine effects ****

A

Benzodiazepines: Overdose

130
Q 
Mood stabilizers
 Used to treat bipolar disorder
• Involves cycles of mania, hypomania, and depression
 Antidepressants
 Used to treat depression
A

Affective Disorder Drugs

131
Q

Lithium is the drug of choice for the treatment
of mania
It is thought to potentiate serotonergic
neurotransmission
May be used with other medications to stabilize mood
Narrow therapeutic range: maintenance serum levels should range between 0.6 and 1.2 mEq/L
Monitor sodium levels
Low TI

A

Mood Stabilizer: Antimanic Drugs

132
Q

Narrow therapeutic range: maintenance serum levels should range between 0.6 and 1.2 mEq/L

A

Safe therapeutic range for Lithium

133
Q

Etiology
Biogenic amine hypothesis
Depression and mania are caused by an alteration in neuronal and synaptic catecholamine concentration at adrenergic receptor sites in the brain
• Depression: deficiency of catecholamine, especially norepinephrine
• Mania: excess amines

A

Depression

Biogenic amine hypothesis

134
Q

Etiology (cont’d)
Permissive hypothesis
Affective disorders are caused by decreased
concentrations of serotonin
• Depression results from decreases in both serotonin and catecholamine levels
• Mania results from increased catecholamine but decreased serotonin levels

A

Depression

Permissive hypothesis

135
Q

Tricyclic antidepressants
Monoamine oxidase inhibitors (MAOIs)
Newer-generation antidepressants
Selective serotonin reuptake inhibitors (SSRIs)
Second- and third-generation antidepressants

A

Antidepressants

136
Q

Have largely been replaced by SSRIs as
first-line antidepressant drugs
Considered second-line
For patients who fail with SSRIs or other newer-newergeneration antidepressants
As adjunct therapy with newer-generation
antidepressants

A

Tricyclic Antidepressants:

First-Generation Antidepressants

137
Q 
amitriptyline (Elavil, Endep)
 doxepin (Sinequan)
 imipramine (Tofranil)
 desipramine (Norpramin)
 nortriptyline (Aventyl, Pamelor)
A

Common Tricyclics

138
Q

Block reuptake of neurotransmitters, causing
accumulation at the nerve endings
It is thought that increasing concentrations of
neurotransmitters will correct the abnormally
low levels that lead to depression

A

MOA of Tricyclics

139
Q 
Blockade of norepinephrine reuptake
 Antidepressant,* tremors, tachycardia
 Blockade of serotonin reuptake
 Antidepressant,* nausea, headache, anxiety,
sexual dysfunction
A

Tricyclics Drug Effects

140
Q 
Depression
 Childhood enuresis (imipramine)
 Obsessive-compulsive disorders
(clomipramine)
 Adjunctive analgesics for chronic pain
conditions, such as trigeminal neuralgia
A

Tricyclics Indications

141
Q 
Sedation
 Impotence
 Orthostatic hypotension
 Dysrhythmias
 Seizures
 Older patients
 Dizziness, postural hypotension, constipation,
delayed micturation, edema, muscle tremors
A

Adverse Effects of Tricyclics

142
Q

Lethal—70% to 80% die before reaching the
hospital
CNS and cardiovascular systems are
mainly affected
Death results from seizures or dysrhythmias

A

Tricyclics Overdose

143
Q 
No specific antidote
 Decrease drug absorption with activated charcoal
 Speed elimination by alkalinizing urine
 Manage seizures and dysrhythmias
 Basic life support
A

Tricyclics Overdose Tx

144
Q 
Highly effective
 Considered second-line treatment for
depression, not responsive to cyclics
 Disadvantage: potential to cause
hypertensive crisis when taken with tyramine
A

MAOIs

145
Q

phenelzine (Nardil)

tranylcypromine (Parnate)

A

MAOIs

146
Q 
Inhibit MAO enzyme system in the CNS
 Amines (dopamine, serotonin,
norepinephrine) are not broken down,
resulting in higher levels in the brain
 Result: alleviation of symptoms of depression
A

MAOIs: Mechanism of Action

147
Q

Depression, especially types characterized by
increased sleep and appetite
Depression that does not respond to other
antidepressants

A

MAOIs: Indications

148
Q

Ingestion of foods or drinks with tyramine
leads to hypertensive crisis, which may lead
to cerebral hemorrhage, stroke, coma, or
death
Avoid foods that contain tyramine!
Aged, mature cheeses (cheddar, blue, Swiss)
Smoked/pickled or aged meats, fish, poultry (herring,sausage, corned beef, salami, pepperoni, paté)
Yeast extracts
Red wines (Chianti, burgundy, sherry, vermouth)
Italian broad beans (fava beans)

A

Hypertensive Crisis

and Tyramine

149
Q 
Concurrent use of MAOIs and SSRIs may
lead to serotonin syndrome
 If the decision is made to switch to an SSRI,
there must be a 2- to 5-week “wash-out”
period between MAOI therapy and SSRI
therapy
A

MAOIs contraindication

150
Q

Fewer adverse effects than tricyclics and
MAOIs
Very few drug-drug or drug-food interactions
Still take about 4 to 6 weeks to reach
maximum clinical effectiveness
Now considered first-line drugs for
depression

A

Newer-Generation

Antidepressants

151
Q 
trazodone (Desyrel)
 bupropion (Wellbutrin)
 SSRIs
 fluoxetine (Prozac)
 paroxetine (Paxil)
 sertraline (Zoloft)
 fluvoxamine (Luvox)
 citalopram (Celexa)
 escitalopram (Lexapro)
A

Newer-Generation

Antidepressants

152
Q 
venlafaxine (Effexor)
 nefazodone (Serzone)
 mirtazapine (Remeron)
 duloxetine (Cymbalta)
 desvenlafaxine (Pristiq)
A

Newer-Generation

Antidepressants

153
Q

Mechanism of action
Selectively inhibit serotonin reuptake
Little or no effect on norepinephrine or dopamine reuptake
Result in increased serotonin concentrations at nerve endings
Advantage over tricyclics and MAOIs: little or
no effect on cardiovascular system

A

SSRIs

154
Q 
Depression
Bipolar disorder
 Obesity
 Eating disorders
 Obsessive-compulsive disorder
A

Newer-Generation

Antidepressants: Indications

155
Q 
Panic attacks or disorders
Social anxiety disorders
 Posttraumatic stress disorders (PTSDs)
 Treatment of various substance abuse
problems (bupropion [Zyban] is used for
smoking cessation treatment)
A

Newer-Generation

Antidepressants: Indications

156
Q

Headache, dizziness,tremor, nervousness,
insomnia,FATIGUE, Nausea diarrhea
constipation, dry mouth Other Sexual dysfunction,WEIGHT GAIN, WEIGHTLOSS, sweating

A

Newer-Generation

Antidepressants: Adverse Effects

157
Q

Signs/symptoms
Delirium, tachycardia, hyperreflexia, shivering,agitation, sweating, muscle spasms, coarse tremors
Signs/symptoms of severe cases
Hyperthermia, seizures, renal failure,
rhabdomyolysis, dysrhythmias, disseminated
intravascular coagulation (DIC)

A

Serotonin Syndrome

158
Q

Highly bound to plasma proteins
Compete with other protein-binding drugs,
resulting in more free, unbound drug to cause
a more pronounced drug effect
Inhibition of cytochrome P-450 system
MAOIs

A

Newer-Generation
Antidepressants: Drug
Interactions

159
Q

Drugs used to treat serious mental illness
Behavioral problems or psychotic disorders
Have been known as tranquilizers or
neuroleptics

A

Antipsychotics

160
Q 
Thioxanthenes: thiothixene (Navane)
 Butyrophenones: haloperidol (Haldol)
 Dihydroindolones: molindone (Moban)
 Dibenzoxazepine: loxapine (Loxitane)
 Phenothiazines: three structural groups
 Atypical antipsychotics: new class
A

Antipsychotics

161
Q

Block dopamine receptors in the brain (limbic
system, basal ganglia)—areas associated
with emotion, cognitive function, motor
function
Result: tranquilizing effect in psychotic
patients

A

Antipsychotics MOA

162
Q 
clozapine (Clozaril)
 risperidone (Risperdal)
 olanzapine (Zyprexa)
 quetiapine (Seroquel)
 ziprasidone (Geodon)
 aripiprazole (Abilify)
 paliperidone (Invega)
A

Atypical Antipsychotics:
Second-Generation
Antipsychotics

163
Q

Block specific dopamine receptors: DA-2 (D2)
receptors
Also block specific serotonin receptors: 5HT 2
5HT-(5HT2) receptors
 This is responsible for their improved efficacy and
safety profiles

A

Atypical Antipsychotics:

Mechanism of Action

164
Q

Sedation, delirium
Orthostatic hypotension,syncope, dizziness,ECG changes,Photosensitivity, skin
rash, hyperpigmentation,pruritus Dry mouth, constipation Urinary hesitancy or
retention, impaired erection, Leukopenia and
agranulocytosis

A

Adverse Effects of Atypical Antipsychotics

165
Q

Galactorrhea,irregular menses,increased appetite,polydipsia,
Neuroleptic malignant syndrome (NMS)
Potentially life threatening
High fever, unstable BP, myoglobinemia
Extrapyramidal symptoms (EPS)
Involuntary muscle symptoms similar to those of Parkinson’s disease
Akathisia (distressing muscle restlessness)
Acute dystonia (painful muscle spasms)
Treated with benztropine (Cogentin) and
trihexyphenidyl (Artane)

A

Adverse Effects of Atypical Antipsychotics

166
Q

Tardive dyskinesia (TD)
Involuntary contractions of oral and facial muscles
Choreoathetosis (wavelike movements of
extremities)
Occurs with continuous long-term antipsychotic therapy

A

Adverse Effects of Atypical Antipsychotics

167
Q

Pt about to have surgery tells the nurse of his cocaine addiction. What should nurse do?

A

Inform the anesthesiologist of pt. addiction; it can cause anesthetic-induced complications.

168
Q

probencad (Benenad)

A

Prevents gout by preventing reabsorption of uric acid prolongs effect of penicillan

169
Q

Calcium channel blockers worsen constipation

A

FYI

170
Q

1/2 Life in elderly lengthens due to decreased liver and renal function

A

FYI

171
Q

verapamil (Calan)

A

Calcium Channel blocker

172
Q

spironolactone (Aldactone)

A

a K+ sparing diuretic

173
Q

methylphedate (Ritalin)

A

is a CII written perscription only 0 refills;container must have a warning label

174
Q

acetylcystane (Mucomyst)

A

antidote for acetaminophen OD

175
Q

naloxone (Narcan)

A

antidote for narcotic analgesic

176
Q

When monitoring pt for adverse effect from morphine sulfate, nurse assess for ?

A

Chemoreceptor trigger zone-area of medulla that triggers vomiting

177
Q

fentanyl (Duragesic)

A

synthetic opioid agonist; schedule II

patch is change q 72 hrs

178
Q

propofol (Diprivan)

A

sedative hypnotic drug used for induction & maintenance of anesthesia as well as continued sedation for vent pt.

179
Q

Why is epinephrine given with lidocaine?

A

It vasoconstricts blood vessels which enhances the duration of lidocaine (fences it in) & minimizes bleeding.

180
Q

What would nurse do if pt has tmp of 102 immediately following surgery?

A

Notify Dr. immediately.

181
Q

glucosamine sulfate(herbal)

A

limited results for arthritic pain & stiffness/ when given with chondrotin it has deminstrated promising results in the tx of joint stiffness & pain. Discuss taking with Dr.

182
Q

allopurinol (zyloprim)

A

inhibits enzyme xanthine oxidase which decreases the serum & urine levels of uric acid & is used in tx of gout & renal calculi caused by uric acid. TEACH PT TO DRINK 3L FLUID A DAY.

183
Q

misoproto ( cytotec)

A

antiulcer agent- prevents gastric mucosal injury from NSAIDs, including asprin, in high rist pt. (geriatrics) It increases production of mucosal lining. PREG. CLASS X

184
Q

ketorolac (Toradol)

A

given IM/IV short term tx of severe to moderate pain.

185
Q

indomethocin ( Indocin)

A

antirheumatic,nsaid antiflammitory, antipyretic

may have side effect of nausea

186
Q

Cox2 inhibitors has advantage over NAIDs by not decreasing the cytoprotective lining of stomach

A

FYI

187
Q

succinylcholine

A

The only depolerizing NMBA

188
Q

Asprin inhibit Cox1 and Cox2 (nonslectively)

A

FYI

189
Q

thiopental (Pentohal)

A

injectable general anesthetic, rapid onset; barbiturate

190
Q

Carbidopa

A

MOA is a decagoxlase inhibitor

191
Q

Benzodiazepines

A

Schedule IV used for insomnia and anxiety

s.e. in older adults nurse monitor for ataxia(muscle relaxation)

192
Q

antomoxetine (Strattera)

A

used to tx ADHD not a controlled subtance because lacks addictive properties

193
Q

flurazepam (Dalmane)

A

it is a benzodiazepine used for insomnia OD antidote flumazenil

194
Q

barbituate OD

A

activated charcoal

195
Q

dantrolene (Dantrium)

A

muscle relaxer used in tx of malignant Hyperthermia

196
Q

midazolam (Versed)

A

Anesthesia-s.e. amnesia used in surgical procedure, diagnostic testing

197
Q

zolpidem (Ambien)

A

less likely to cause grogginess in am, preg. category C, sholuld belimited to 7-10 days

198
Q

caffine

A

s.e cardiac dysrrythmias

199
Q

orlistat (xenical)

A

limited fat <30% of caloric intake

200
Q

CNS Stimulant

A

increase release of & block reuptake of neurotransmitters

201
Q

methlyphenidate (Ritalin)

A

CNS stimulant schedule II used in tx of narcolepsy & ADHD s.e. HA, insomnia, addiction, irritability

Pharmacology (7 decks)

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