Pharm Final Review 2nd Sheet

Question 1

What are the adverse effects of anasthetics?

Answer 1

Death, H/A, Parasthesia, Nausea, Seizures, Resp. Failure, coma, death, hypotension, cardiac depression, loss of visceral muscle tone (careful with myasthenia patients), allergic reaction (ester type more common),

Question 2

What is an adverse drug effect for prilocaine (anasthetic)?

Answer 2

Methemoglobinemia

Question 3

What is an adverse drug effect for halothane (anasthetic)?

Answer 3

Liver tox called halothane hepatitis

Question 4

What are adverse drug effects for halogenated inhalants and molecules (anasthetic)?

Answer 4

malignant hyperthermia (muscle break down, live failure) Dantrolene cures this

Question 5

What is an adverse drug effect for nitrous oxide (anasthetic)? (chronic)

Answer 5

megaloblastic anemia

Question 6

What is an adverse drug effect for fentanyl (anasthetic)?

Answer 6

chest wall rigidity

Question 7

What is an adverse drug effect for ketamine (anasthetic)?

Answer 7

BBB hallucinations, delirium

Question 8

Where do antipsychotics work?

Answer 8

Dopamine 2 receptors, these drugs suppress motor activity and emotional expression. They competetively block dopamine and serotonin receptors.

Question 9

What are the adverse drug effects of TCA’s?

Answer 9

lower seizure threshold, sedation, arrhythmia, suicide risk

Question 10

What are the differences between codeine and morphine?

Answer 10

Codeine causes GI upset, it should be taken with food. It has less 1st pass metabolism than morphine. It has better bioavailibility. It is eventually converted to morphine anyway by CYP450. People without this enzyme get little relief. Codeine is used to treat mile to moderate pain. It is not for nursing mothers. There is a morphine risk to the baby. Morphine has high 1st pass metabolism, smaller IV to PO. Vasodilation, relieving pain, anxiety. Higher abuse. Uses for morphine are severe pain, MI and cancer.

Question 11

What are the typical drugs to treat negative and positive symptoms?

Answer 11

Typical antipsychotics have bigger impact on the positive symptoms. Low potency is Chlorpromazine and Thorazine, Medium potency is Fluphenazine, and high potency is haloperidol. These can cause akasthesia, pseudoparkinsonism, dystonia, tardive dyskinesia (to combat this, reduce dosage and give bentroprine)

Question 12

What are negative and positive symptoms?

Answer 12

Positive= delusions and hallucinations for schizophrenia

Negative= apathy, withdrawl, lack of motivation in schizophrenia

Negative is more difficult to treat, are persistent and have poorer prognosis

Question 13

What are the drugs to treat negative symptoms?

Answer 13

Atypical antipsychotics treat negative symptoms. These drugs have less side effects (EPS) than the typical drugs. Clozapine, Olanzapine (Zyprexa), Rispiridone, Molindone, Ziprasodone, Aripiprazole.

Question 14

What are the interactions for Donepezil (Aracept)? (drug to treat alzheimer’s)

Answer 14

It is a centrally acting cholinesterase inhibitor. It is used to slow deteriorization of cognitive function but will not affect the underlying disorder. It selectively inhibits cholinesterase in the CNS. Increases ACH in the cerebral cortex. ADR’s are nausea, vomiting and diarrhea. Given once daily.

Question 15

What are the interactions for Tacrine? (drug to treat alzheimer’s)

Answer 15

Must be given several times a day. Has a significant risk of hepatotoxicity. May cause diarrhea, nausea, urinary incontinence. Not normally used and has major S/E.

Question 16

What are the interactions for Rivastigmine and Galantamine? (drugs to treat alzheimer’s)

Answer 16

These are newer reversible cholinesterase inhibitors. They significantly delay cognitive impairment for at least 6 months. Rivastigmine is now available in a patch which increases compliance.

Question 17

What is the pathophysiology and symptoms of multiple sclerosis?

Answer 17

Demylination of neurons in the CNS (the body attacks itself in the CNS). The etiology is unknown, but believed to be viral or autoimmune. Plaques are formed in the brain and spinal cord which contain oligodendrocytes. The symptoms include: pain, spasticity, weakness, ataxia, fatigue, problems with speech, vision, gait and bladder.

Question 18

How do you treat multiple sclerosis?

Answer 18

Interferon 1 B was the first drug to halt the progression of MS. Interferon 1 A prevents the relapsing form of MS. Natalizumab draws lympocytes to the CNS. Mitoxantrone is a chemotherapy the suppresses white blood cells that attack the myelin sheath.

Question 19

How do you treat spasticity in MS?

Answer 19

Physical therapy and baclofen

Question 20

How do you treat acute exacerbations in MS?

Answer 20

steroids

Question 21

What are the goals for seizure therapy?

Answer 21

Successful if incidences reduce by 50%. One drug is most desirable, you can add another if a single one isn’t doing the job. Use a different type of drug.

Question 22

What is balanced anasthesia? What are the stages?

Answer 22

The ability to rapidly control the depth of anasthesia increases its safety.
Stage 1- Neurons in cord prevented from firing, analgesia, and sedation starts.
Stage 2- Inhibition of firing small inhibitory neurons, paradoxical excitation, bucking!
Stage 3- Loss of consciousness, inhibition of spinal reflexes
Stage 4- Cardiovascular collapse, BAD!

Question 23

Why is nitrous oxide used in balanced anesthesia?

Answer 23

It is used in combo with other drugs to reduce dosage needed from other drugs.

Question 24

Which drug can cause delayed type EPS?

Answer 24

Haloperidol (haldol therapy). It is the most potent anti-psychotic, dopamine blocker. Lip smacking occurs, tardive dyskinesia (involuntary movement)- which usually develops months to years after treatment. Start antipsychotics low and watch for this. Other symptoms are anasthesia, pseudoparkinsonism, dystonia. Patients MUST be educated about this drug.

Question 25

Why are MAOI’s not the first line treatment for depression?

Answer 25

They have many negative interactions with different drugs and foods.

Question 26

What are the ADR’s for MAOI’s?

Answer 26

Hypertensive crisis which can be fatal (occipital H/A, N/V, palpitations, nuchal rigidity, photophobia). This can occur from ingesting tyramine, (aged cheese, wine, beer, some meats and fish.)

Question 27

Which drugs have abuse potential?

Answer 27

Anything that causes euphoria and withdrawl (drug neuronal adaptation). Benzos=euphoria and inhibition. Barbituates=euphoria and resp. depression. Cocaine=reserved for nose and eye injuries. NO=mild euphoria, generally safe but can cause megaloblastic anemia.