Pharm final- old stuff

Question 1

What is the MOA of phenytoin?

Answer 1

-selective inhibition of sodium channels
-slows recovery of Na channels from the inactive state

Question 2

What are some ADRs r/t phenytoin?

Answer 2

-SJS/ toxic epidermal necrolysis> associated with genetic mutation
-gingival hypertrophy
-hyperplasia>excessive growth of gum tisue
-reduced with folic acid
- regularly brush teeth, floss gently
-interferes with metabolism of vitamin D (Do not give to an older adult who already has osteoporosis)
-hirsutism

Question 3

What are some ADRs r/t phenytoin?

Answer 3

-SJS/ toxic epidermal necrolysis> associated with genetic mutation
-gingival hypertrophy
-hyperplasia>excessive growth of gum tissue
-reduced with folic acid
- regularly brush teeth, floss gently
-interferes with metabolism of vitamin D
-hirsutism

Question 4

MOA of valproic acid?

Answer 4

• suppresses neuronal firing by blocking sodium channels
  -suppresses calcium influx by blocking calcium channels
  -potentiates the inhibitory influence of GABA

Question 5

What is a drug interaction of valproic acid?

Answer 5

-topiramate (hyperammonemia)
-excessive ammonia in body when these drugs are combined

Question 6

How may a patient appear if valproic acid and topiramate are combined?

Answer 6

-confusion
-vomiting
- altered LOC

Question 7

What is the drug of choice for absence seizures?

Answer 7

Ethosuximide

Question 8

What are some ADRs of lamotrigine?

Answer 8

-life-threatening rashes (SJS and TEN)
-Aseptic meningitis
(confusion, photophobia, n/v, Nuchal rigity (main sign), inflammation of the meninges)

Question 9

What is the MOA of vigabatrin?

Answer 9

-inhibits GABA transaminase
- Prevents GABA inactivation, so it enhances GABA mediated inhibition of neuronal activity

Question 10

What is the MOA of Ezogabin?

Answer 10

Promotes potassium efflux in the neuronal membrane
(nonselective)
It activates potassium channels in the bladder which can cause urinary retention

Question 11

What are some therapeutic uses of Gabapentin?

Answer 11

-Neuropathic pain
-migraine prophylaxis
-fibromyalgia
-Postmenopausal hot flashes

Question 12

Endogenous opioids work on..

Answer 12

Mu, Kappa, delta

Question 13

Exogenous opioids work on…

Answer 13

MU and Kappa

Question 14

Mu side effects include?

Answer 14

-respiratory depression
-euphoria

Question 15

Kappa side effects include?

Answer 15

• no euphoric effects
  -decreased potential for addiction

Question 16

What is the prototype for a pure opioid agonist? (STRONG)

Answer 16

Morphine
-activates Mu and Kappa receptors
-most effective against constant, dull pain

Question 17

Prototype for moderately strong opioid agonist?

Answer 17

Codeine
-used to control mild/moderate pain

Question 18

What is the prototype for agonist-antagonist opioid (partial agonist)

Answer 18

Pentazocine
-no euphoric effects
-less abuse potential

Question 19

Pentazocine acts as an _____ at kappa receptors and an _______ at Mu receptors.

Answer 19

agonist
antagonist

Question 20

What is the prototype for a pure opioid antagonist?

Answer 20

Naloxone
-used to diagnose and treat overdose

Question 21

What are some adverse effects of morphine?

Answer 21

-Resp. depression
-orthostatic hypotension
-Neurologic effects (sedation, euphoria, elevation of ICP, miosis)
-Cough suppression
-constipation
-Promotes N/V/ emesis
-Urinary retention

Question 22

How do you monitor the effectiveness of furosemide?

Answer 22

-daily weight, urine output ( OUTPUT SHOULD EXCEED INTAKE), decreased edema, clear lung sounds

Question 23

What are some ADRs of furosemide?

Answer 23

-hypovolemia, hypokalmeia, hypochloremia, hyponatremia
-hyperglycemia, hyperuricemia, high LDL, high triglycerides
-ototoxicity
-hypotension
-Arrythmias (low potassium)
-metabolic alkalosis

Question 24

What are some drug interactions with furosemide?

Answer 24

-Antihypertensives- lowers BP
-Digoxin- Toxicity
-Aminoglycosides- ototoxicity
-Lithium- low sodium level
-NSAIDS
-Potassium-sparing diuretics (POSITIVE)

Question 25

What can you teach your patient that is taking furosemide?

Answer 25

-They will pee ALOT
-stand up slowly
-increase potassium intake for potassium eliminating diuretics
- take in the morning if QDAY and morning afternoon if BID
-hypokalemia s/s= muscle weakness
- Call provider if they gain more than 2 llbs in a day, experiencing SOB, changes in hearing, or pain in joints= GOUT

Question 26

What is the difference between ADRs of hydrochlorothiazide compared to furosemide?

Answer 26

Same ADRs as furosemide EXCEPT ototoxicity and hypocalcemia

Question 27

What are some advantages of using hydrochlorothiazide compared to furosemide?

Answer 27

-Protects against post-menopausal osteoporosis
-prevents calcium-induced renal calculi
-Enhances actions of ADH- can be used for diabetes insipidus

Question 28

MOA of spironolactone?

Answer 28

• Acts at late distal tubule to decrease both sodium reabsorption and potassium secretion

Question 29

What are some ADRs of spironolactone?

Answer 29

-Androgenic effects
-impotence
-hirsutism
-gynecomastia/amenorrhea