Pharm Final Flashcards
(157 cards)
1
Q
Heart failure is a failure of what?
A
Both fill (diastolic) and pump (systolic)
2
Q
What are some disease processes following heart failure?
A
- Kidney disease/failure
- Liver disease/failure
- Arrhythmias
- Respiratory distress/failure
- Sudden cardiac death
3
Q
What happens when the heart cannot pump or fill properly?
A
Fluid accumulation
4
Q
What is the number 1 drug prescribed for fluid overload?
A
Furosemide (lasix)
5
Q
What are the ABCD meds prescribed for heart failure?
A
A. ACEs/ARBs
B. Beta blockers
C. Cardiac glycosides
D. Diuretics
6
Q
What is an example of tricyclic antidepressants (TCAs)?
A
Amitriptyline
7
Q
What is amitriptyline used for?
A
Major depressive disorder, neuropathy, insomnia
8
Q
What are some side/adverse effects of amitriptyline?
A
- Cardiotoxicity
- Prolonged QT interval
- Sedation
- Seizures
- Tachycardia
- Dry mouth
9
Q
What should you be very careful with considering amitriptyline?
A
Careful consideration with concurrent use of seizure meds
10
Q
What are examples of selective serotonin reuptake inhibitors (SSRIs)?
A
Fluoxetine, sertraline, escitalopram
11
Q
What are some side/adverse effects of SSRIs?
A
- Weight gain
- Sexual dysfunction (erectile/libido)
- Serotonin syndrome
- Increased suicidal ideation in children and young adults
12
Q
Nurse education with ALL antipsychotic medications:
A
DO NOT abruptly discontinue, withdrawl and increased depressive symptoms
13
Q
What are SSRIs used for?
A
Major depressive disorder, OCD, panic disorder, anxiety disorder, PTSD
14
Q
What is a BIG contraindication with SSRIs?
A
DO NOT combine with SNRIs, TCAs, or MAOI medications for depression
15
Q
Symptoms of serotonin syndrome:
A
- Hypertension
- Fever
- Dangerous fevers
- Seizures
- Rhabdomyolysis
16
Q
What are examples of serotonin norepinephrine reuptake inhibitors (SNRIs)?
A
- Venlafaxine
- Duloxetine
17
Q
What are SNRIs used for?
A
Depression, anxiety disorders, neuropathic pain, off-label ADHD and OCD
18
Q
What are some side/adverse effects of SNRIs?
A
- Weight gain
- Sexual dysfunction (erectile/libido)
- Serotonin syndrome
- Visual snow syndrome
19
Q
What are some contraindications of SNRIs?
A
LOTS of meds shouldn’t be taken with them, including MAOIs, anticonvulsants, antiemetics, lithium, etc. Cause serotonin syndrome
20
Q
What is an example of norepinephrine dopamine reuptake inhibitors (NDRIs)
A
Bupropion
21
Q
What are NDRIs used for?
A
Depression, anxiety disorders, smoking cessation
22
Q
What are some contraindications with NDRIs?
A
Seizure disorders, alcohol use and withdrawl
23
Q
When should you use caution with NDRIs?
A
History of psychosis, liver damage, kidney damage, hypertension, parkinson’s medication usage
24
Q
What are some side/adverse effects of NDRIs?
A
- Seizures
- Mania
- Tremors
- Cardiac symptoms (^ HR & BP)
25
What are examples of monoamine oxidase inhibitors (MAOIs)?
Phenelzine and Selegiline
26
What are MAOIs used for?
Depression (medication resistance), atypical depression, panic disorders, social anxiety disease, bipolar disorder
27
What are some side/adverse effects of MAOIs?
- Hypertensive crisis (tyramine)
- Dysrhythmias
- Significant drug/drug interactions
28
When should you use caution with MAOIs?
Most over the counter medicat,ions (pain-NSAIDS), caffeine, aged cheeses, wine, sausage, fish, some meats and yeast extractions
29
What are some contraindications of MAOIs?
Severe liver disease, heart failure, SSRIs, TCAS, dextromethorphan, pseudoephedrine
30
What are some nursing considerations with MAOIs?
Is a last resort if NO OTHER medications have worked, rarely ever used anymore, BLACK BOX WARNING
31
What is some patient education with MAOIs?
- Won’t kick in for a month (like all antiphycosis meds)
- Must be compliant as possible
- Suicidal ideations may INCREASE when first taking
- Avoid foods high in tyramine
- Carry an MAOI card so EMS knows to be cautious with things like epinephrine and norepinephrine
32
Nursing implications for ALL antidepressants:
- Don’t start taking effect for up to a month
- BLACK BOX WARNING: individuals under 24 have an increased risk of suicidal thoughts and ideations
- Must be compliant as possible
- Suicidal ideation may INCREASE when first taking these medications
33
What are examples of first geberation antipsychotics?
Haloperidol and chlorpromazine
34
What are first gen antipsychotics used for?
Depending on potency, treats psychosis symptoms
35
What are some side/adverse effects of first gen antipyschotics?
- Sedation
- Arrhythmias
- Prolonged QT interval
- Extrapyramidal symptoms (parkinson-like)
- Neuroleptic malignant syndrome
36
What are some contraindications of first gen antipyschotics?
Parkinson’s disease, alzheimer’s dementia, cardiac disease particular with rhythm
37
When do you use caution with first gen antipyschotics?
Glaucoma, seizures, alcohol use
38
What are examples of second generation antipsychotics?
Olanzapine, aripiprazole, risperidone
39
What are 2nd gen antipyschotics used for?
Depending on potency, treats psychosis symtpoms, bipolar disorder, agitation in dementia, autism, anxiety, and OCD
40
What are some side/adverse effects of 2nd gen antipyschotics?
- Tardive dyskinsia (effects the nervous system by long term use of psychiatric drugs)
- Cardiovascular disease
- Neutropenia
- Agranulocytosis
41
What are 2nd gen antipyschotics contraindicated with?
Hypersensitivity to these meds, bone marrow disease, low white blood cell count
42
What are some cautions to take with 2nd gen antipyschotics?
Severe renal and liver disease, cardiovascular disease, diabetes
43
What is a nursing implication with 2nd gen antipyschotics?
Tends to have more metabolic side effects- patient’s with metabolic issues and diabetes should NOT take. BLACK BOX WARNING
44
What is an example of a mood stabilizer?
Lithium
45
What are mood stabilizers used for?
Bipolar disorder, major depressive disorder
46
What are side/adverse effects of mood stabilizers?
- Hand tremors
- Kidney damage
- Hypothyroidism
- Metallic taste in mouth
47
When should you use caution with mood stabilizers?
ACEs, diuretics, NSAIDs, increase/decrease of sodium intake
48
When are modd stabilizers contraindicated?
Renal failure, cardiovascular insufficiency, Addison’s disease, untreated hypothyroidism, children < 12, pregnancy
49
Patient education with mood stabilizers:
VERY NARROW therapeutic window- monthly blood draws, fluid volume status, and sodium levels are KEY
50
What are some nursing implications with lithium toxicity?
- Monitor creatinine and GFR (renal function)
- Monitor fluid volume status closely
- Very narrow therapeutic range
51
What are some examples of benzodiazepines?
Lorazepam, Diazepam, Midazolam
52
What are benzos used for?
Short term treatment of anxiety disorders, sedation, sleep, alcohol withdrawl
53
What are some side/adverse effects of benzos?
- Dependance
- Sedation
- Respiratory depression
- Paradoxical effects
54
What are some contraindications for benzos?
Kids < 6 months old, severe liver damage, myasthenia gravis, concurrent use with alcohol and sedatives
55
What is an education point for benzos?
VERY ADDICTIVE: recommend short term usage due to dependance and potential for abuse and withdrawl
56
What are some nursing considerations with benzos?
Monitor with withdrawl:
- Rebound anxiety
- Gastric disturbances
- Insomnia
- Seizures & delirium tremors
BLACK BOX WARNING
Educate on importance of tapering off (withdrawl can potentially can be life threatening)
57
What is an example of nonbenzodiazepine sedative-hyponotics?
Zolpidem (ambien)
58
What are nonbenzopiazepine sedative-hypnotics used for? (zolpidem-ambien)
Short term treatment of insomnia
59
What are side/adverse effects of nonbenzopiazepine sedative-hypnotics (zolpidem-ambien)?
- Daytime drowsiness
- Agression
- Confusion
- Suicidal ideation
- Hallucinations
- Respiratory depression
- Angioedema
- Severe rebound insomnia
60
When should you AVOID using nonbenzopiazepine sedative-hypnotics (zolpidem-ambien)?
with adults older than 65- increased risk for confusion, agression, and falls
61
What are some contraindications for nonbenzopiazepine sedative-hypnotics (zolpidem-ambien)?
Driving, severe liver impairment, sedative use and alcohol use
62
What are some nursing implicationd with nonbenzopiazepine sedative-hypnotics (zolpidem-ambien)?
Must also be withdrawn gradually, sudden stopping can lead to withdrawl symptoms
63
What are examples of CNS stimulants?
Methylphenidate and Dextroamphetamine
64
What are CNS stimulants used for?
ADHD treatment, narcolepsy
65
What are some side/adverse effects of CNS stimulants?
- Insomnia
- Seizures
- Sudden cardiac death
- Stroke
- Hypertension
66
What are some contraindications of CNS stimulants?
Seizure disorders, recent cardiac events, arrhythmias, heart failure, severe hypertension, history of psych disorders
67
What cautions should you take with CNS stimulants?
Interacts with a lot of psych meds so use extreme caution. Is basically meth so abuse is potential and illicit use is VERY HIGH
68
With Myasthenia Gravis, what is there not enough of?
Not enough acetylcholine
69
What are some medication examples of acetylcholine inhibitors?
Pyridostigmine and Neostigmine
70
What are some side/adverse effects of acetylcholine inhibitors?
- Diaphoresis
- Nausea/vomiting
- Tearing (crying)
- Cholinergic crisis (over production of fluids)
S: salivation
L: lacrimation
U: urination
D: defecation
G: gastric upset
E: emesis
71
Difference between cholinergic crisis and myasthenic crisis:
Cholinergic crisis: TOO MUCH ACh
Myasthenic crisis: NOT ENOUGH ACh
Both look very similar as both have profound muscle weakness as a result
72
What major differences is important to assess between myasthenia and Cholinergic crisis?
Myasthenic crisis: muscular weakness (poor ventilatory exchange)
Cholinergic crisis: bulbar paralysis (accumulated secretions)
73
What is important to know with Alzheimer’s disease- subset of dementia?
- MEDS: cholinesterase inhibitors are used
- Antipsychotics are NOT tolerated well to treat psychosis: shorter life span
74
What is a med example of acetylcholinesterase inhibitors?
Aricept (Donepezil)
75
What does Aricept (donepezil) do?
Increases acetylcholine at cholinergic synapses (in the brain)
76
What does Aricept (donepezil) treat?
Mild to moderate Alzheimer’s: takes about 15 days to reach steady state
77
What are some side/adverse effects of Aricept (donepezil)?
- AV block
- Seizures
- Bronchoconstriction
- Bradycardia
- “SLUDGE”
78
What are some interactions of Aricept (donepezil)?
- Antipsychotics (these block this medication’s effectiveness)
- Antihistamines
- Muscarinic antagonists
79
Nursing considerations for Aricept (donepezil)?
- Treats symptoms, NOT a cure
Monitor for:
- Psychosis effects
- Worsening dementia
- Try to keep patient safety the highest priority
80
What is an example of NMDA receptor antagonists?
Memantine
81
What does memnatine do?
Improves memory and reduces dementia symptoms- slows rate of clinical progression but does not stop or cure Alzheimer’s
82
What is memantine used for?
Moderate to severe Alzheimer’s
83
What are some side/adverse effects of memantine?
- Hepatitis JSJ
- Psychosis
- Hallucinations
- Sleepiness/dizziness
- Blood clots
84
When should you use caution with memantine?
Those with renal and hepatic impairment
85
What should you monitor for with memantine?
- Psychosis effects
- Lack of effective symptom relief
- Worsening dementia
- Patient safety is KEY
86
What is an education point for memantine?
Educating families is extremely important both for knowledge and support
87
What is the underlying cause of motor symptoms with Parkinson’s disease?
Loss of dopamine in neurons
88
What are hallmark signs of Parkinson’s?
Extrapyramidal symptoms (can be caused by other meds like antipsychotics
89
What is a medication example of dopaminergics?
Levodopa and Carbidopa
90
What are dopaminergics (levodopa/carbidopa) used ?
Very effective for Parkinson’s disease- for a time, takes up to 6 months to be effective
91
What do dopaminergics interact with?
Anti-nausea medications in the phenothiazine class (promethazine, etc.)
92
What are some side/adverse effects of dopaminergics?
- Dyskinesia (around optimal dosage)
- Cardiovascular (hypertension & dysrhythmias)
- Psychosis (hallucinations, vivid dreams, poor impulse control, paranoia)
93
What is on/off phenomenon with levodopa?
Wears off and motor symptoms return before next dose, occurs with disease progression when med becomes less and less effective
94
What is a med example of dopamine antagonists- antivirals?
Amantadine
95
What does amantadine do?
Limits dyskinesia Sid effects from levodopa
96
What are some side/adverse effects of amantadine?
- Lightheadedness
- Anxiety
- Purple skin rash
- Suicidal ideation
97
What are the contraindications with amantadine?
Alcohol and sedatives
98
What is an example of hydantoin anticonvulsants?
Phenytoin
99
What are some side/adverse effects of phenytoin
- Nystagmus
- Sedation
- Gingival hyperplasia
- Suicidal ideation
100
What is a nursing implication with Phenytoin?
VERY narrow therapeutic range
101
What is Phenytoin used for?
Seizure prevention
102
What is an example of a barbiturates medication?
Phenobarbital
103
What are some side/adverse effects of barbiturates (phenobarbital)?
- Sedation
- Respiratory depression
104
What are some contraindications of barbiturates (phenobarbital)?
Severe liver disease, severe kidney disease, severe respiratory disease
105
What is an example of a iminostilbenes drug?
Carbamazepine
106
What are some side/adverse effects of iminostilbenes (carbamazepine)?
- Bone marrow suppression
- Agranulocytosis
- SIADH
- Leukopenia
107
What is a nursing implication with iminostilbenes (carbamazepine)?
VERY narrow therapeutic range, requires monitoring
108
What is an example of fatty acid/valproates?
Valproic Acid
109
What are some side/adverse effects of Valproic acid?
- Somnolence (excessive sleepiness)
- Liver enzyme disorder
- Headaches
- Tremors
110
Contraindications of Valproic acid:
Advanced liver disease, pregnancy, pancreatitis
111
Nursing implications with Valproic Acid:
BLACK BOX WARNING: severe pancreatitis, bleeding and clotting risk may be severe, fetal development could be impaired
112
What is a medication example of pyrrolidine anticonvulsants?
Levetiracetam (Keppra)
113
What are side/adverse effects of levetricetam (keppra)?
- Psychosis
- Suicidal ideation
- Emotional liability
- Fatigue
114
What is a nursing implication for levetricetam (keppra)?
BLACK BOX WARNING: may cause series of life threatening behavioral manifestations and psychotic symptoms
115
What is an example of gabapentinoids?
Neurontin (gabapentin)
116
What is Neurontin (gabapentin) used for?
Diabetic neuropathy, restless leg syndrome, migraine headaches
117
When should you use caution with Neurontin (gabapentin)?
- With kidney patients and patients taking antidepressants: suicidal ideation increases
- Anything that can respiratory depress or neuro depress should NOT be given unless absolutely necessary
118
What are some side/adverse effects of Neurontin (gabapentin)?
- Somnolence (excessive sleepiness)
- Ataxia (impaired coordination)
119
What is an education point for Neurontin (gabapentin)?
Medication adherence is a MUST, DO NOT stop taking abruptly
120
What are some nursing implications for Neurontin (gabapentin)?
Interactions include: alcohol, anticoagulants, h2 receptor blockers, isoniazid, corticosteroids, oral contraceptives, sedative meds
121
What are examples of hormone replacement therapy for females?
Estrogen and estradiol
122
What can estrogen or estradiol help minimize in females?
Osteoporosis, women are at a higher risk as they age
123
What are some side/adverse effects of estrogen or estradiol?
- Weight gain
- Mood changes
- CVA (stroke)
- Heart failure
- Abnormal clotting
124
What are some contraindications with estrogen or estradiol?
CLOTTING DISORDER, breast cancer, breastfeeding and pregnancy
125
What is a patient education point with Combined oral contraceptives (COC) “the pill”?
Medication adherence is key
126
What are some side/adverse effects of progestin-only pill (POP)?
- INCREASED BLEEDING RISK
- Ovarian cysts
- irregular menstruation
- Depression
127
What are patient education points for oral contraceptives?
- Smoking increases risk of clots tremendously
- Antibiotics DECREASE the effectiveness
- Taking an anticoagulant will be less effective
128
What medication is an ovulation INDUCER?
Clomiphene, HCG
129
What is a contraindication with ovulation inducers?
People who are pregnant or have liver damage should NOT take
130
Education point for ovulation inducers?
Chance for multiple births INCREASE (twins)
131
What are some side/adverse effects of ovulation inducers?
- Ovarian cancer
- Seizures
- Bleeding
- Hot flashes
132
What are the 2 basic tenets of uterine motility we want to accomplish?
1. Speeding up contractions
2. Slow down contractions
133
What is a nursing implication for uterine motility basics?
These meds are extremely dangerous and require close monitoring
134
What is a med example of oxytocics?
Oxytocin (pitocin)
135
What are some side/adverse effects of oxytocin (pitocin)?
- Dysrhythmias
- Impaired uterine blood flow
- Subarachnoid hemorrhage (bleeding in the space between the brain and tissue)
136
What is a med example of tocolytics?
Magnesium sulfate
137
What is magnesium sulfate used for?
Slowing down labor, treating preeclampsia (high BP)
138
What are side/adverse effects of magnesium sulfate?
- Decreased LOC
- Hypotension
- Respiratory depression
139
Nursing implication with magnesium sulfate:
Limit the amount of time used to 5-7 days AT MOST, otherwise fetus will experience adverse effects
140
What is benign prostate hyperplasia (BPH)?
Enlarged prostate, but not cancerous
141
What is a med example of androgens?
Testosterone
142
What are some side/adverse effects of test?
- Prostate enlargement
- Prostate cancer
- Heart failure
- Hyperlipidemia
143
What is a contraindication with test?
Heart disease, sleep apnea, prostate disease
144
What are some drug interactions with test?
Anticoagulants (bleeding), and anti-diabetics (hypoglycemia)
145
What are examples of PDE5 inhibitors?
Sildenafil, tadalafil (viagra)
146
Side/adverse effects of sildenafil (viagra)?
- Hypotension
- Headaches
- Nasal congestion
- Vision changes
147
Patient education on sildenafil (viagra):
Patients that take antihypertensives AND/OR nitro for chest pain should NOT take this- dangerous hypotension
148
What are examples of alpha blockers?
Tamsulosin and Terazosin
149
What does tamsulosin/terazosin do?
Helps those with BPH urinate more easily, works a LOT faster than finasteride
150
Patient education on tamsulosin/terazosin:
Does NOT decrease size of prostate, relaxes the muscles around the prostate
151
Side/adverse effects of tamsulosin/terazosin:
- Hypotension
- Floppy iris syndrome (pupil constriction)
- Dizziness
152
Interactions with tamsulosin/terazosin:
Anti-hypertensive meds, nitro, sildenafil
153
What is an example of a 5-alpha antagonists drug?
Finasteride
154
Side/adverse effects of finasteride:
- Decreased libido
- Erectile dysfunction
- Gynecomastia
- More hormonal & can shrink prostate
155
Patient education for finasteride:
Takes 6-12 months to be effective
156
Nursing implication for finasteride:
Monitor PSA (prostate specific antigen) levels- should be decreased
157
What can finasteride also be used for?
Hair loss: women who take it for that off-label purpose should NOT be pregnant or consider becoming pregnant
