Answer:
difficulty swallowing
Q: Medication must cross _<\/em><\/strong><\/em><\/strong> to affect CNS
Answer:
BBB
Q: Goal in Parkinson’s tx is to restore ____<\/em><\/strong><\/em><\/strong> in brain
Answer:
dopamine
Q: MCSE of dopaminergics
Answer:
sleep attacks, hallucinations, confusion
Q: Med appropriate to treat acute psychosis?
Answer:
Haloperidol
Q: ASE of first-generation antipsychotic(FGA) medications such as haloperidol,
chlorpromazine: diff speaking, chewing
Powered by https:\/\/learnexams.com\/search\/study?query=<\/a><\/p>\n\n\n\n
Pt on heparin in hospital setting. Why start coumadin 2 days before dc?
Because coumadin needs a couple days before it starts working.<\/p>\n\n\n\n
Angina: bc pts dev tolerance to long-acting nitroglycerine w\/i 1 day. How to prevent?
Pts must have 8hrs with no nitroglycerine every days. Hint: At night, remove nitro patch bc no risk of exertional angina<\/p>\n\n\n\n
Underlying cause of angina
coronary disease, athlerosclerosis<\/p>\n\n\n\n
Why do we give aspirin in pts w\/atherosclerosis?
Aspirin is an antiplatelet.. Prevents the existing plaques from getting bigger. Prevents plaque rupture. Cardio protective, prevents stroke, MI, CVA<\/p>\n\n\n\n
What is prescribed for angina pts w\/DM?
ACE inhibitors to protect the kidneys and nerves<\/p>\n\n\n\n
SE of high doses of aspirin?
Tinnitus: ringing ears<\/p>\n\n\n\n
Pt education regarding Plavix(clopidogrel bisulfate)?
Anti-platelet med. S\/sx bleeding: blood in stool or vomit, excessive bruising, abd pain uterine bld, back pain, petichae. Interactions with EVERYTHING: OTC, herbals, supplements<\/p>\n\n\n\n
Pts on coumadin? What are we watching for?
INR to check therapeutic levels. Half life is long. Check 12hrs after taking.<\/p>\n\n\n\n
What can be caused if pt started on heparin?
day4, ordering blood work to check platelet count to observe for THROMBOCYTOPENIA<\/p>\n\n\n\n
coumadin and childbearing aged females
Interactions with oral contraceptives- must have a back up method during time you’re taking coumadin<\/p>\n\n\n\n
Pregnancy considerations and coumadin
Need to monitor anti-Xa levels<\/p>\n\n\n\n
biggest food group interaction with coumadin
Grapefruit, green leafy veggies. Why? high in vitamin K which counteracts warfarin<\/p>\n\n\n\n
Short duration: rapid acting insulin indication, MOA, usage
Given w\/meals
Provide bs control between meals at night
Can use in conjunction w\/intermediate or long-acting agent
lispro, aspart, gluulocene<\/p>\n\n\n\n
Short duration: short acting insulin indication, MOA, usage
Before meals to control postprandial hyperglycemia
Infused SQ via pump
humulin\/regular<\/p>\n\n\n\n
intermediate(humalin\/novalin) duration insulin indication, MOA, usage
BS control between meals and during the night
Only one suitable for mixing w\/short actings
basal coverage<\/p>\n\n\n\n
Long duration: Insulin glargine U100
up to 24hrs, once daily subq dosing, basal coverage for DM1 or Dm2<\/p>\n\n\n\n
Neostigmine is a medication uesd to tx what disease\/disorder?
Myastenia Gravis: AI disorder, antibodies destroy communication btw nerves and muscles. S\/S weak skeletal muscles, voluntary muscles, dysphagia, ptosis<\/p>\n\n\n\n
Myasthenia gravis is an AI disorder that may cause what s\/s?
difficulty swallowing<\/p>\n\n\n\n
Medication must cross _<\/em><\/strong><\/em><\/strong> to affect CNS Goal in Parkinson’s tx is to restore ____<\/em><\/strong><\/em><\/strong> in brain MCSE of dopaminergics Med appropriate to treat acute psychosis? ASE of first-generation antipsychotic(FGA) medications such as haloperidol, chlorpromazine: diff speaking, chewing Med to help manage panic attacks? Cholinesterase inhibitors are used in tx of what conditon? What are some diseases\/disorders\/conditions are anticonvulsants used to treat other than seizure disorders? Anti-seizure med used for prophylactic tx of migraines Anti-seizure med that is also an anti-arrhythmic Anti-seizure med w\/black box warning for blood dyscrasias and serious derm rxns First-line agent for early onset migraine Hallucinations may occur if __<\/em><\/strong> is stopped abruptly atomoxetine(Straterra), clonidine, and guanfacine are used in tx of which DO? initial intervention for infrequent migraine HA Meds that may cause QT prolongation CI for a triptan includes What to give for hives and wheezing r\/t pb? Beta blockers have been used to treat _<\/em><\/strong><\/em><\/strong>, , ___<\/em><\/strong><\/em><\/strong> Drug route for 100% bioavailability Chronic renal failure will affect _<\/strong><\/em><\/strong> element of pharmacokinetics Adrenergic antagonists or alpha blockers cause ________<\/em><\/strong><\/em><\/strong> in addition to lowering BP, alpha blockers are used in tx of __<\/em><\/strong> symptoms of BPH Common side effect of ACE inhibitors Angina is a pain caused by _____<\/em><\/strong><\/em><\/strong> All pts with angina should receive what drug for prophylaxis of a myocardial infarction? lifestyle modifications to reduce cardiac risk include Pt w\/ heart failure, angina w\/walking and slight limitation of activity is what class? pt is taking hydrochlorothiazide(HCTZ) for HTN. What lab is most impt to monitor? cardiac remodeling in HF class of medication in pts post MI to prevent cardiac remodeling When tx hyperlipidemia, calculation __<\/strong><\/em><\/strong> risk will help to determine tx. Class of medication contraindicated in pts w\/liver failure Which anticoagulant has the quickest onset of action? Pts receiving heparin are at risk for what adverse rxn? Why would heparin and warfarin be given at the same time? Risk factors that increase a pts ability to bleed Factor Xa levels may be monitored in pts on this med Meds to be avoided in pregnancy Post hip replacement, med used to prevent DVT Pt started on warfarin for a fib should be taught that________ Epoetin alfa (erythropoietin) pernicious anemia is due to deficiency in _<\/em><\/strong><\/em><\/strong> Lab monitoring for iron def anemia include Which class of antidiabetic med used to tx CKD stage 4-5 Pregnancy considerations for the pt taking diabetic meds MOA of metformin (Glucophage) When starting basal insulin, which class of med should be reduced or dc? Alcohol can mask the s\/s of hypoglycemia. Symptoms of hypoglycemia: diabetics that develop HTN should be started on what class of med? when to take levothyroxine (synthroid) Lab level that indicates effectiveness of levothyroxine Form of estrogen w\/ least SE Post menopausal screening questions before HRT Concern for male pt with 7lb wt gain requesting an early refill on testosterone. Epotetin Alfa\/ EPOGEN\/PROCRIT Vitamin B12 Deficiency Ferrous Sulfate Aspirin\/ASA often prescribed w\/levodopa-carbidopa in tx of Parkinson’s Disease taking too much of these can make you “blind as a bat” or “mad as a hatter” absorption, distribution, metabolism, excretion drug used to relieve myasthenic crisis drug w\/very narrow therapeutic index and high risk for toxicity, therefore levels should be monitored frequently drug class that carries an increased risk of suicidality in children, adolescents and young adults antidote for organophosphate poisoning do not stop this class of drug abruptly due to an increased risk of cardiovascular events agents that indirectly block the breakdown of acetylcholine and are often used in tx of Alzheimer’s disease drug has led to the death of children in ultrarapid metabolizers as 10% is converted into morphine leading cause of liver failure in U.S. autoimmune disease that attacks the nicotinic receptors in skeletal muscle opioid agonist that works quickly to reverse CNS and respiratory depression how drug affects the body term for amt of drug that reaches systemic circulation. Often affected by route of admin. symptoms for this syndrome include confusion, irritability, tachcardia, htn, diaphoresis, and is caused by having too much of this “happy” substance dopamine agonist often used in tx of Parkinson’s disease that is least likely to cause sleep attacks clonidine is often prescribed to children to tx this disorder Drug most effective in ETOH withdrawal Drug used for anaphylactic rxn or cardiac arrest 1st line drug for migraine prevention parasympatholytic used for unstable bradycardia drug class used to tx ADHD drugs that have no medical use and high potential for abuse this drug is an antispasmodic muscle relaxant that must be tapered off due to risk of seizure or hallucinations if stopped abruptly this muscle relaxant is also a schedule IV controlled substance 1st line abortive drug for mild to moderate HA 1st line abortive drug for mod to severe migraine HA used in tx of non hypovolemic hypotension drug used for acute mgmt. of seizure used in tx of beta blocker overdose often used for tx of opiod use disorder. May cause QT prolongation this opioid analgesic is used for tx of postop shivering or rigors antiseizure medication that carries black box warning for severe skin rxns such as Steven-Johnson syndrome Stevens-Johnson syndrome (SJS) is a rare, serious disorder of the skin and mucous membranes. It’s usually a reaction to medication that starts with flu-like symptoms, followed by a painful rash that spreads and blisters. Then the top layer of affected skin dies, sheds and begins to heal after several days.<\/p>\n\n\n\n drug class used to tx extrapyramidal symptoms cause of menstrual associated migraine chronic use may cause amotivational syndrome of hyperemesis syndrome a deadly bacterial toxin used in prevention of chronic migraine HA Pt taking epoetin alpha. What do I need to monitor? What three meds to we prescribe to pts w\/angina? If I want to self-donate blood, what would I take. 2 drugs: If I prescribe iron, what lab to I order 1 week out? pt education for iron replacement when taking B12, what do we need to monitor for in first couple of days? how long for NPH onset? biggest SE for tx of DM? alcohol plus beta blockers risk? switching pt from NPH(intermediate) to glargine(long-acting), what do I have to do dosing glargine? Considerations for prescribing metformin Gliptins (DPP-4 Inhibitors) GLP-1 agonists MOA Angina w\/o s\/s, staging? Two reasons we see pts go into HF CI with flagyll With any prescribed hepatotoxic meds, what are needed baseline labs? Most dangerous time for pregnant person to consume a teratogen BFing pt. When should she take a med with questionable safety? What does baclofen treat? Rivastigmine (Exelon) Oxycodone tolerance methadone monitoring parameters If pt is on MAOI and I want them started on an SNRI, what must we do
BBB<\/p>\n\n\n\n
dopamine<\/p>\n\n\n\n
sleep attacks, hallucinations, confusion<\/p>\n\n\n\n
Haloperidol<\/p>\n\n\n\n
tardive dyskinesia<\/p>\n\n\n\n
SSRI<\/p>\n\n\n\n
Alzheimer’s disease. MOA block normal breakdown of acetylocholine which increases their levels and duration of action in the CNS and PNS (neuromuscular junction). Also used in tx of myasthenia gravis Ex: neostigmine, donepezil, galantamine, rivastigmine<\/p>\n\n\n\n
migraine HA prevention, bipolar DO, epilepsy Examples: carbamazepine(Tegretol), gabapentin(Neurontin), phenobarbital, topiramate(Topamax)<\/p>\n\n\n\n
topiramate<\/p>\n\n\n\n
phenytoin(Dilantin)<\/p>\n\n\n\n
carbamazepine(Tegretol)<\/p>\n\n\n\n
NSAIDs<\/p>\n\n\n\n
baclofen<\/p>\n\n\n\n
ADHD<\/p>\n\n\n\n
HA diary<\/p>\n\n\n\n
methadone, tricyclic antidepressants, amiodarone<\/p>\n\n\n\n
htn, CAD, MAOI use. Triptans used to ease migraine symptoms by calming overactive nerves in the brain and vasoconstriction of blood vessels in the brain<\/p>\n\n\n\n
epinephrine IM<\/p>\n\n\n\n
post MI, HTN, HF<\/p>\n\n\n\n
IV<\/p>\n\n\n\n
excretion<\/p>\n\n\n\n
vasodilation<\/p>\n\n\n\n
BPH<\/p>\n\n\n\n
urinary frequency and urgency, nocturia, hesitancy and difficulty continuing to urinate, reduced force and size of urinary stream (“weak” stream), sensation of incomplete bladder emptying, straining to begin urination, post-void dribbling or leaking, hematuria, enlarged prostate<\/p>\n\n\n\n
dry cough<\/p>\n\n\n\n
cardiac ischemia<\/p>\n\n\n\n
aspirin- antiplatelet<\/p>\n\n\n\n
Wt loss (at least 10lbs), stop smoking, daily exercise<\/p>\n\n\n\n
Class II<\/p>\n\n\n\n
K, for hypokalemia.
Hypokalemia can result in abnormal heart rhythms, cramp and twitch muscles.
HCTZ, thiazide diuretic, removes excess salt and water<\/p>\n\n\n\n
Worsens HF. The wall of the left ventricle thickens and enlarges in an attempt to compensate for the increased workload.<\/p>\n\n\n\n
ACE inhibitors. ACE inhibitors are known to increase tissue bradykinin accumulation. Bradykinin has antigrowth effects and reduces vasomotor tone.<\/p>\n\n\n\n
ASCVD risk, Atherosclerotic cardiovascular disease<\/p>\n\n\n\n
HMG-CoA inhibitors(Statins). Because all statins are hepatically cleared and can cause elevations in liver biochemistries, there is a concern that patients with underlying liver disease may be at increased risk for hepatotoxicity.<\/p>\n\n\n\n
Heparin<\/p>\n\n\n\n
thrombocytpenia. Condition in which you have a low blood platelet count, not enough platelets, increased risk of bleeding<\/p>\n\n\n\n
warfarin has a delayed effect<\/p>\n\n\n\n
herbal supplements, aspirin use, TPA<\/p>\n\n\n\n
low molecular wt heparin, LMWH has better bioavail and longer half-life than heparin(ex: enoxaparin)<\/p>\n\n\n\n
statins, warfarin, ACE inhibitors<\/p>\n\n\n\n
enoxaparin<\/p>\n\n\n\n
INR should be between 2-3<\/p>\n\n\n\n
biologic response modifier
can treat anemia to increase Hgb concentration, carries risk of tumor dev, can cause HTN, increases RBC production<\/p>\n\n\n\n
B12<\/p>\n\n\n\n
reticulocyte count in 1 wk, total iron binding capacity (TIBC) in 4 wks, Hgb\/Hct in 4 wks<\/p>\n\n\n\n
Sulfonylureas: Sulphonylureas are insulin secretagogues, which means they work by causing the body to secrete insulin.
DPP-4 inhibitors: help keep blood glucose from going too high by increasing the insulin produced by pancreas, especially right after a meal and decreasing glucagon, a hormone that releases glucose from the liver.
SLGT-2 inhibitors: also known as gliflozins, prevent the reabsorption of glucose from blood that’s filtered through kidneys, therefore facilitating glucose excretion in the urine.<\/p>\n\n\n\n
she will be switched to insulin during pregnancy<\/p>\n\n\n\n
Increases action in peripheral tissues to increase insulin sensitivity, decreases hepatic glucose production, reduces glucose absorption in the gut<\/p>\n\n\n\n
sulfonylurea bc these cause the body to secrete insulin<\/p>\n\n\n\n
sweating, fatigue, tired, dizzy, hungry, shaky or trembling, tachycardia, irritable, anxious, moody, tingly lips<\/p>\n\n\n\n
ACE inhibitor<\/p>\n\n\n\n
First thing in the morning, 30 mins prior to eating<\/p>\n\n\n\n
decrease in TSH<\/p>\n\n\n\n
transdermal<\/p>\n\n\n\n
Smoker?
Hysterctomy?
Hx DVT\/PE?<\/p>\n\n\n\n
Testosterone abuse<\/p>\n\n\n\n
o Erythopoesis stimulating agent
o Used in anemia especially in presence of CKD or chemo-related
o May be used preoperatively for transfusion reduction- start 10 days before sx and cont for 4 days post
o Check Hgb weekly w\/tx start until stable
o Black Box:
\u00a7 Increased CV events with adm to Hgb>11
\u00a7 Increased mortality CAN CAUSE TUMORS and tumor progression in CA pts, dc once chemo completed
\u00a7 Increased thromboembolic events in sx pts- use DVT prophylaxis<\/p>\n\n\n\n
o Causes
\u00a7 Impaired absorption
\u00a7 Lack of intrinsic factor (PERNICIOUS ANEMIA)
o Consequences: megaloblastic anemia, neurological damage, death
o DX: megaloblastic anemia, low plasma B12
o TX: parental cyanocobalamin<\/p>\n\n\n\n
o TX of choice for IDA (iron def. anemia)
o Preferred drug for preventing def when iron needs unmet by diet
o ASE: GI disturbance- nausea, heartburn, constipation, diarrhea. May cause dark green\/black stools.
o Avoid in pts w\/peptic ulcers or ulcerative colitis
o Toxicity: LEADING CAUSE OF POISONING FATALITIES IN CHILDREN, death rare in adults
o Antacids reduce absorption
o ASCORBIC ACID INCREASES ABSORPTION
o RETICULOCYTES WILL INCREASE IN 4-7 DAYS, Hgb\/Hct w\/in 1 wk, Hgb should rise 2g\/dl after 1 mos<\/p>\n\n\n\n
o Cyclooxygenase inhibitor (inhibits Cox-1 and Cox-2)
o Chemical family: salicylates- acetic salicylic acid
o Inhibition of COX-2:
\u00a7 reduction of pain, inflammation, fever
\u00a7 harmful SE: renal impairment, prevention of MI, stroke (suppresses vasodilation)
o Inhibition of COX-1:
\u00a7 Protection against MI\/stroke secondary to reduced platelet aggregation
\u00a7 Harmful SE: gastric erosion\/ulcers, bleeding tendencies, renal impairment
o Decreases risk of colorectal CA (r\/t effects of COS-2 inhibition which slows tumor growth)
o Saliclyism: supratherapeutic levels- tinnitus, sweating, HA, dizziness
o Reye syndrome: avoid use under 18yrs<\/p>\n\n\n\n
Bromocriptine<\/p>\n\n\n\n
anticholinergics & antimuscarinics<\/p>\n\n\n\n
pharmacokinetic processes<\/p>\n\n\n\n
Neostigmine\/pyridostigmine (cholinergic or ace inhibitor)<\/p>\n\n\n\n
Lithium<\/p>\n\n\n\n
SSRI\/SNRIs<\/p>\n\n\n\n
Atropine<\/p>\n\n\n\n
Beta Blockers<\/p>\n\n\n\n
Cholinesterase inhibitors<\/p>\n\n\n\n
Codeine<\/p>\n\n\n\n
Hepatotoxic drugs<\/p>\n\n\n\n
Myasthenia Gravis<\/p>\n\n\n\n
Naloxone\/Narcan<\/p>\n\n\n\n
Pharmacodynamics<\/p>\n\n\n\n
Bioavailability<\/p>\n\n\n\n
Serotonin<\/p>\n\n\n\n
Pramipexole<\/p>\n\n\n\n
ADHD<\/p>\n\n\n\n
lorazepam\/ ATIVAN<\/p>\n\n\n\n
epinephrine<\/p>\n\n\n\n
beta blockers (propanolol)<\/p>\n\n\n\n
atropine<\/p>\n\n\n\n
stimulants<\/p>\n\n\n\n
schedule I controlled substances\/ illicit<\/p>\n\n\n\n
baclofen<\/p>\n\n\n\n
carisoprodol\/SOMA<\/p>\n\n\n\n
NSAIDs<\/p>\n\n\n\n
sumatriptain\/IMITREX<\/p>\n\n\n\n
norepinephrine or phenylephrine<\/p>\n\n\n\n
lorazepam<\/p>\n\n\n\n
glucagon (increases heart rate and myocardial contractility)<\/p>\n\n\n\n
methadone<\/p>\n\n\n\n
meperidine\/ DEMEROL<\/p>\n\n\n\n
carbamazepine.<\/p>\n\n\n\n
anticholinergics<\/p>\n\n\n\n
drop in estrogen level<\/p>\n\n\n\n
marijuana or THC<\/p>\n\n\n\n
botox\/botulinum toxin<\/p>\n\n\n\n
BP, epoetin alpha can cause HTN because it can produce too many RBCs<\/p>\n\n\n\n
statin, ASA, nitro<\/p>\n\n\n\n
Epogen and iron<\/p>\n\n\n\n
Reticulocyte count. Rationale: reticulocytes are the immature (teen) red blood cells. A high count confirms production is being increased.
TIBC- 4 wk
Ferratin-4 wk
Hgb\/hct-4wk<\/p>\n\n\n\n
Empty stomach
with glass of OJ<\/p>\n\n\n\n
Hypokalemia can happen first two days as a result of increased rbc requirements during hematopoiesis<\/p>\n\n\n\n
60-90 mins<\/p>\n\n\n\n
hypoglycemia: cold and clammy needs some candy<\/p>\n\n\n\n
ETOH masks s\/s hypoglycemia in DM pts<\/p>\n\n\n\n
Decrease glargine by 20% to avoid hypoglycemia<\/p>\n\n\n\n
Contrast studies= hydration status, A1C (is it working?), renal function baseline,<\/p>\n\n\n\n
indirectly increase insulin production through incretin system<\/p>\n\n\n\n
-directly bind to pancreatic cells to stim insulin production
-reduce glucose output, lowering blood sugar
-slows glucose absorption into bloodstream by reducing speed of stomach emptying, increasing satiety<\/p>\n\n\n\n
Stage I
Stage II- angina w\/min exertion
Stage III- angina even without much exertion\/ activity
Stage V- even at 4, ready for a CABG<\/p>\n\n\n\n
cardiac remodeling r\/t myocardial ischemia or MI<\/p>\n\n\n\n
ETOH, cannot drink on flagyll<\/p>\n\n\n\n
AST,ALT<\/p>\n\n\n\n
1st trimester, neural tube defects<\/p>\n\n\n\n
Right after feeding baby.<\/p>\n\n\n\n
spasticity, muscle spasms, MS, spinal cord injuries, cerebral palsy<\/p>\n\n\n\n
alzheimer’s tx
daily transdermal patch<\/p>\n\n\n\n
If pt dev. tolerance, w go to something stronger, long-acting.<\/p>\n\n\n\n
EKG once a year bc QT prolongation risk<\/p>\n\n\n\n
Need to stop for 2 weeks before starting the other<\/p>\n\n\n\n
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