pharm quiz 2

Question 1

3 types of sedative-hypnotics

Answer 1

1. Benzodiazepines
2. Barbiturates
3. Nonbarbiturate Hypnotics

Question 2

Alprazolam (Xanax)
Lorazepam (Ativan)
Midazolam (Versed)
Temazepam (Restoril)
Triazolam (Halcion)

Answer 2

benzodiazepines used as anxiolytic hypnotics

Question 3

Mechanism of Action: enhance the action of gamma-aminobutyric acid (GABA) in the CNS

Pharmacokinetics
Absorbed from GI track with peak levels in 30 minutes to 2 hours
Distributed throughout body; lipid soluble
Metabolized in liver
Excreted in urine
Cross placenta and enter breast milk

Answer 3

benzodiazepines used as anxiolytic hypnotics

Question 4

CNS depression—lightheaded, drowsiness
Anterograde amnesia
Paradoxical responses—insomnia, excitation, rage
Respiratory depression with IV administration
Physical dependence and withdrawal symptoms if rapid discontinuation
Acute toxicity if overdose—drowsy, lethargic, confused, respiratory depression; Note that Flumazenil (Romazicon) is administered to counteract sedation and reverse effects of overdose

Answer 4

S/S of Benzodiazepines Used as Anxiolytic-Hypnotics

Question 5

Known allergy
Pregnant/lactating
Sleep apnea, respiratory depression, presence of organic brain disease
Avoid alcohol and other CNS depressants such as Barbiturates and Opioids
Use cautiously if history of substance use disorder, liver dysfunction, kidney failure, and in elderly

Answer 5

contraindications of Benzodiazepines Used as Anxiolytic-Hypnotics

Question 6

depress the sensory cortex, decrease motor activity, and alter cerebellar function; produce sedation, hypnosis, and anesthesia

Answer 6

Barbiturates Used as Anxiolytics-Hypnotics

Question 7

Amobarbital (Amytal Sodium)
Butabarbital (Butisol)
Pentobarbital (Nembutal)
Phenobarbital (Luminal)
Secobarbital (Seconal)

Answer 7

Barbiturates Used as

Anxiolytics-Hypnotics

Question 8

Absorbed in GI track with peak levels in 20-60 minutes
Metabolized in liver; lipid soluble
Excreted in urine
Readily cross the placenta and enter breast milk

Answer 8

Barbiturates Used as

Anxiolytics-Hypnotics

Question 9

CNS depression—drowsiness, lethargy, vertigo, ataxia, feeling “hung-over”, paradoxical excitement, anxiety
GI—nausea, vomiting, constipation, diarrhea, epigastric pain
Cardiovascular—bradycardia, hypotension, syncope
Serious hypoventilation and respiratory depression can occur
Rash, serum sickness, Stevens-Johnson Syndrome

Answer 9

Barbiturates Used as

Anxiolytics-Hypnotics

Question 10

Known allergy
Severe hepatic, renal, cardiac, or respiratory disease
History of drug abuse or dependence
Porphyria; uncontrolled pain
Lactation
Use cautiously with children, elderly or debilitated individuals; hepatic, renal, cardiac, or respiratory impairment; depressed/suicidal individuals; pregnancy
Note: Several drug to drug interactions and additive CNS depression with alcohol

Answer 10

contraindications Barbiturates Used as Anxiolytics-Hypnotics

Question 11

Eszopiclone (Lunesta)
Zalepton (Sonata)
Zolpidem (Ambien)

Answer 11

nonbarbiturate hypnotics

Question 12

Mechanism of Action: enhance the action of GABA in the CNS

Absorbed by GI track
Metabolized in liver
Excreted in urine
Can cross the placenta and enter breast milk

Answer 12

nonbarbiturate hypnotics

Question 13

Daytime sleepiness and lightheadedness—so advise to take med just before bedtime and allow for at least 8 hours of sleep

use in caution in elderly, impaired kidney, liver or respiratory function

Answer 13

nonbarbituate hypnotics

Question 14

CNS stimulation is mediated by release of norepinephrine from central noradrenergic neurons in the cerebral cortex, reticular activating system (RAS), and brainstem. However, the action in the treatment of ADHD is unclear.

Answer 14

CNS stimulants used to treat ADHD

Question 15

calming hyperexcitability through CNS stimulation that is seen in ADHD is believed to be related to increased stimulation of the immature RAS, which leads to the ability to be more selective in response to incoming stimuli

Answer 15

paradoxical effect

Question 16

Methylphenidate (Ritalin, Concerta)
Dexmethylphenidate (Focalin)
Dextroamphetamine (Dexedrine)
Amphetamine Mixture (Adderall)
Lisdexamfetamine dimesylate (Vyvanse)

Answer 16

controlled substances of CNS stimulants used to treat ADHD

Question 17

CNS stimulation (insomnia, restlessness)
Weight loss, anorexia, nausea
Cardiovascular effects
Hallucinations; paranoia
Withdrawal reaction if abruptly discontinued
Hypersensitive skin reaction to transdermal Methylphenidate

Answer 17

CNS stimulants for ADHD

Question 18

Caution parents and the patient regarding physical and psychological dependence; need to taper dose under MD supervision if meds discontinued; and safe storage of these controlled substances
Big teaching point – can’t just give it when it’s due. Needs to be locked up/monitored to prevent complications with children

Answer 18

CNS stimulants for ADHD

Question 19

Avoid concurrent use of MAOIs; caffeine; over the counter (OTC) cold medications and decongestants
OTC: increase BP and heart rate and the stimulant itself already increases this
Use caution if concurrent use of Methylphenidate with Phenytoin (Dilantin), Warfarin (Coumadin), and Phenobarbital—as Methylphenidate inhibits metabolism of these meds leading to increased serum levels

*As with all medications, inform MD about current meds so an informed decision can be made prior to prescribing additional meds/using OTC meds

Answer 19

interactions with CNS stimulants for ADHD

Question 20

Atomoxetine (Strattera)—not a controlled substance

Answer 20

Other meds to treat ADHD

Question 21

blocks reuptake of norepinephrine at synapse in the CNS. Action in the treatment of ADHD is unclear. (May take 1-3 weeks for therapeutic effect.)

Answer 21

other meds for ADHD

Strattera

Question 22

is usually well tolerated with minimal side effects
Anticholinergic –dry mouth, urinary hesitancy, constipation, nausea
Adverse effects—undesirable effects that are not anticipated may include appetite suppression; nausea and vomiting; suicide ideation; hepatotoxicity

Answer 22

Strattera

Question 23

Known allergy
Current or prior history of pheochromocytoma
-Tumor: headache, hypertension, palpitation, increase heart rate
Use cautiously if cardiovascular disorder
Narrow angle glaucoma
Avoid use if pregnant or lactating
Avoid concurrent use with MAOIs

Answer 23

contraindications for Strattera

Question 24

Benzodiazepines
Atypical Anxiolytic Medications
Other Medications used to treat anxiety

Answer 24

antianxiety meds

Question 25

Potentiate the effects of gamma-aminobutyric acid (GABA) which is a powerful inhibitory neurotransmitter

Answer 25

antianxiety meds: benzodiazepines

Question 26

``` Alprazolam (Xanax) Chlordiazepoxide (Librium) Clonazepam (Klonopin) Chlorazepate (Tranxene) Diazepam (Valium) Lorazepam (Ativan) ```

Answer 26

antianxiety meds: benzodiazepines

Question 27

Absorbed from GI track with peak levels achieved within 30 minutes to 2 hours Distributed throughout body; lipid soluble Metabolized in liver Excreted in urine Cross the placenta and enter breast milk

Answer 27

antianxiety meds: benzodiazepines

Question 28

CNS depression Anterograde amnesia Acute toxicity if overdose—drowsiness, lethargy, confusion; respiratory depression, severe hypotension, cardiac arrest (Note: Flumazenil (Romazicon) administered to counteract sedation and reverse the adverse effects) Paradoxical response—insomnia, rage, euphoria Withdrawal effects if abruptly discontinued WITHDRAWAL EFFECTS: Can be life threatening – depression, insomnia, increase anxiety, abdominal and muscle cramps, tremors, vomiting, sweating, convulsions and delirium

Answer 28

antianxiety meds: benzodiazepines

Question 29

Known allergy Shock Coma Pregnancy or lactating Use cautiously if substance use disorder history; liver disease Use short-term due to risk for dependence

Answer 29

antianxiety meds: benzodiazepines

Question 30

Abuse and dependency concerns, so carefully evaluate drug/alcohol history before benzodiazepines prescribed on a long-term basis Benzodiazepines are used on short-term basis in alcohol withdrawal situations

Answer 30

special considerations for antianxiety benzodiazepines

Question 31

Buspirone HCl (BuSpar)—may take 3-6 weeks to reach full therapeutic effect

Answer 31

NOT a benzodiazepine | Atypical anxiolytic meds

Question 32

is unknown; binds to serotonin and dopamine recepto

Answer 32

atypical anxiolytic meds

Question 33

CNS—dizziness, nausea, headache, light headedness, agitation

Answer 33

atypical anxiolytic meds Buspar

Question 34

Known allergy Concurrent use with MAOIs or 14 days after MAOIs are discontinued (could result in hypertensive crisis) Not recommended for use if breast feeding Used cautiously in elderly; if liver or renal dysfunction

Answer 34

atypical anxiolytic meds Buspar

Question 35

Avoid grapefruit juice Avoid herbal preparations that contain St. John’s wort Avoid the use of Erythromycin and Ketoconazole

Answer 35

atypical anxiolytic meds Buspar

Question 36

Beta-adrenergic blockers such as Propranolol HCl (Inderal) Some SSRIs approved to treat specific anxiety disorders, for example Paroxetine (Paxil) used to treat Generalized Anxiety Disorder (GAD), Panic Disorder, Obsessive Compulsive Disorder (OCD), Social Anxiety Disorder, PTSD Sertraline (Zoloft) used for Panic Disorder, OCD, PTSD, Social Anxiety Disorder Escitalopram (Lexapro) used for GAD and OCD Fluoxetine (Prozac) used for Panic Disorder and GAD Flovoxamine (Luvox) used for OCD and Social Anxiety q

Answer 36

other meds for anxiety

Question 37

Two categories: Typical/First Generation/ Conventional Neuroleptic Medications Atypical/ Second Generation Medications Both categories of medications take 2-4 weeks before signs of significant improvement; effects can be seen within a few days

Answer 37

antipsychotic meds

Question 38

Absorbed from the GI track IM doses provide 4-5 times the active dose as oral Distributed widely in the tissues and stored there- can be released up to 6 months after medication is discontinued Cross the placenta and enter breast milk

Answer 38

antipsychotic meds

Question 39

Legal-right to refuse treatment including meds;except in emergency situations when patient’s thoughts/behaviors pose danger to self or other Ethical-principle of autonomy; however need tobalance freedom of choice and the individual’s autonomy with personal/public safety concerns

Answer 39

antipsychotic meds

Question 40

Used to control positive symptoms of psychotic disorders | Block dopamine receptors, histamine, acetylcholine, and norepinephrine

Answer 40

typical and first generation

Question 41

``` Chlorpromazine (formerly as Thorazine) Fluphenazine (formerly as Prolixin)** Haloperidol (Haldol)** Loxapine (Loxitane) Perphenazine (Trilafon) Thiothixene (Navane) **Available in the decanoate form- a long lasting injectabl ```

Answer 41

typical and first generation

Question 42

Anticholinergic (dry mouth, blurred vision, urinary retention, constipation, tachycardia, photophobia)

Answer 42

s/e of typical first generation

Question 43

Neuroendocrine- gynecomastia, galactorrhea, menstrual irregularities Orthostatic hypotension, sedation, seizures, dysrhythmias, sexual dysfunction, photosensitivity NEUROLEPTIC MALIGNANT SYNDROME- medical emergency Severely high fever (102+), tachycardia, tachypnea, fluctuations in blood pressure (labile BP), severe parkinsonian muscle rigidity, diaphoresis, and rapid deterioration of mental status to stupor and coma

Answer 43

Typical first generation

Question 44

Coma; CNS depression; Parkinson’s disease; prolactin-dependent breast cancer; prolonged QT waves; severe hypotension Use cautiously if glaucoma; paralytic ileus; prostate enlargement; heart disorders; liver or kidney disease; seizure disorders; pregnant or lactating Avoid alcohol and other CNS depressants; Levodopa

Answer 44

typical and first generatoin

Question 45

Used to relieve both positive and negative symptoms of psychotic disorders Blocking serotonin, dopamine receptors, histamine, acetylcholine, and norepinephrine Medications of choice for initial treatment -Decrease depression, anxiety and suicidal behaviors -Improve neurocognitive deficits- memory -Fewer EPS -Less relapse Some Atypical Antipsychotics approved for treatment of: -Major Depressive Disorder -Bipolar Disorder

Answer 45

atypical second generation

Question 46

Clozapine (Clozaril) Risperidone (Risperdal)—and Risperdal Consta Aripiprazole (Abilify)—and Abilify Maintena Olanzapine (Zyprexa)—and Zyprexa Relprevv Paliperidone (Invega)—and Invega Sustenna Asenapine (Saphris) Ziprasidone (Geodon) Quetiapine (Seroquel) Iloperidone (Fanapt) Lurasidone (Latuda)

Answer 46

atypical second generation

Question 47

``` New onset diabetes mellitus Weight gain, lots of weight gain Hypercholesterolemia Orthostatic hypotension Anticholinergic effects Agitation, dizziness, sedation, sleep disruption Mild EPS, such as tremor ```

Answer 47

atypical second generatoin

Question 48

potentially fatal adverse effect associated with Clozapine (Clozaril) so close monitoring of neutrophils (a type of WBC that helps fight off infections

Answer 48

agranulocytosis | S/E of atypical 2nd generation

Question 49

Black box warning for individuals with Dementia Avoid concurrent use of alcohol; Levodopa; meds that prolong QT intervals Use cautiously with cardiovascular or cerebrovascular disease; seizures; diabetes mellitus; pregnant and breast-feeding

Answer 49

atypical second generation

Question 50

Anticholinergic medications are used to relieve some of the EPS associated with Antipsychotic Medications Mechanism of Action: blocks acetylcholine receptors; and Diphenhydramine (Benedryl) also blocks histamine release Select Antiparkinson Medications include: Benztropine (Cogentin) Trihexyphenidyl (Artane) Diphenhydramine (Benadryl) Pharmacokinetics Absorbed in GI tract Cross the placenta and enter breast milk

Answer 50

antiparkinson meds

Question 51

``` CNS effects (disorientation, confusion, memory loss) Agitation; nervousness; delirium; dizziness; weakness Anticholinergic effects (dry mouth, blurred vision, urinary retention, constipation, paralytic ileus, nausea and vomiting) Cardiovascular (tachycardia, palpitations, hypotension) ```

Answer 51

antiparkinson meds