Flashcards: PHARM SI

"Hangover" poor judgement, amnesia, coordination loss and headache

Kava kava and Valerian

An herbal supplement made of dried rhizomes from Piper methysticum. Can cause discoloration of hair skin and nails with long term use. It has CNS depressing effects and is used to treat anxiety, insomnia and sometimes ADHD.

The root of contains acids that are used to treat anxiety, restlessness or sleep disorders. It is used as a CNS depressant. It interacts with most CNS depressants, MAOIs and Phenytoin.

Primarily women, 10-20% suffer from in the US, increases with age.

Specific sleep schedule/ritual

insomnia, muscle spasms, anxiety, anesthesia, seizures, and status epilepticus

Depress CNS- thought to stimulate GABA

narrow angle glaucoma, allergy or pregnancy

hangover- drowsy, lethargic confused dizzy amnesic and impaired cognitively

They end in -pam and -lam

More likely when used with other CNS depressants including alcohol, valerian or kava kava

Flumazenil is antidote for overdose/ or do bring patient out of anesthesia. Not often used for general toxicity as it can cause seizures.

Benzodiazepine

Benzodiazepine

Benzodiazepine

Benzodiazepine

Benzodiazepine

Benzodiazepine

Benzodiazepines

1.Alcohol and other CNS depressants.

Zolpidem (Ambien)

Non−benzodiazepine hypnotic, acts via inhibition of the BDZ1 (omega1) neurotransmitter receptor subtype and is reversed by flumazenil; less amnesia and muscle relaxation; lower dependence liability

Indicated for use in insomniacs

"hangover" (especially amnesic), tolerance, dependence and binge eating.

Facilitate GABA(a) action by inc duration of Cl- channel opening --> dec neuron firing

insomniacs, seizure disorders, anesthetic

Most life threatening: respiratory depression, hypotension

supportive: Ventilation (mainstay airway assisted ventilation due to respiratory depression), oxygen, fluid replacement and vasopressors (counteract hypotension)

No longer used to regularly used to treat insomniacs because of dependency and rapid development of tolerance. Not prescribed more than 2 weeks for sleep.

Drug history, including supplement use (kava/valerian)

-give at night

-Drug history: Previous use, drugs that may interact

Use bed alarm for elderly or first time users

don't drive, do not use or supplement other drugs with CNS depressing effects, do not stop treatment abruptly and will not take longer than 2 weeks for barbits or 3-4 weeks benzos

1 Identify cause of insomnia

relaxes skeletal muscle via CNS stimulus; indicated for muscle spasms; contraindicated in those with severe renal impairment and na glaucoma; has anticholinergic effects, hallucinations, ED, hypotension and fatigue; Interacts with CNS depressants

Emergency drug! act directly on skeletal muscle, Closely resemble GABA; indicated for malignant hyperthermia or neuroleptic malignant syndrome.

CNS acting Muscle Relaxant

direct acting muscle relaxant

drugs that stimulate norepinephrine and dopamine release, causing speeded-up body functions and associated energy and mood changes

ADHD and Narcolepsy

glaucome, hyperthyroidism, structural cardiac abnormalities, parkinson's and anxiety

Tachycardia, palpitations and hypertension

failure to gain weight with age/weight loss that can be symptomatic of growth deficiency

MAOIs- hypertensive crisis that can lead to stroke or MI

Ritalin

Amphetamine-like drug used to treat adhd

1. Report tachycardia or palpitations

Migraine tx; constricts cranial arteries, but can have systemic effects; therefore should not be used in patients with cardiovascular disease or uncontrolled hypertension, previous MI or stroke.

numbness, tingling and warm sensation

tingling, numbness, warm sensation N/V/D, muscle cramps dysrhythmia, thromboembolism MI and Stroke

Paroxysmal, uncontrolled electrical discharge of neurons in the brain that interrupts normal function.

The final phase of a generalized seizure, during which the patient becomes extremely fatigued and is recovering.

Seizure is a one time occurrence or one time collection of seizures due to trauma.

a seizure that affects only one part or one side of the brain

a partial seizure, starting from a focus and remaining localized, that produces loss of consciousness

the patient maintains consciousness, is aware and remembers

seizures that involve the entire brain

peculiar sensations that precede a seizure, may take the form of a taste, smell, sight, or sound; dizziness; or funny feeling

Increased risk of having a seizure while pregnant, hypoxia occurs during these episodes putting mom and fetus at risk, many drugs are teratogens and can inhibit optimum pregnancy folate and potassium levels

Most commonly prescribed antiepileptic and are indicated for use in tonic-clonic and complex/partial seizures

Hydantoin Anticonvulsant

can cause gingival hyperplasia and is a teratogen

Anti coagulants- warfarin

Very small therapeutic range 10-20mcg/mL

a barbiturate used as a sedative and as an anticonvulsant

brain stem depressant

Narrow therapeutic range 15-40 mcg/mL

sedation and tolerance

anticonvulsant class of drugs including carbamazepine

Anticonvulsant

bone marrow suppression

Narrow therapeutic range (4-12 mcg/mL)

Anticonvulsant

pregnancy, caution in young pts and elderly, pts with hepatic impairment

Liver failure/ jaundice

Narrow therapeutic range (50-125 mcg/mL)

Seizures that result from sudden high fevers; most often seen in children and lead to increased risk of developing epilepsy.

Assess location, duration, and characteristics or seizure activity

IV phenytoin can only be mixed with normal saline

Maintain proper oral hygeine and biannual dentist visits

Peak:1-3 days

Peak:1-3 days

Short acting

Mild alcohol withdrawal: symptoms similar to other depressants.

Nicotinic receptors all over body, reduced stimulation=w/drawl S/S

the division of the autonomic nervous system that calms the body, conserving its energy. Rest and Digest

the division of the autonomic nervous system that arouses the body, mobilizing its energy in stressful situations.

relaxation techniques, group therapy, solo therapy.

Lorazepam (Ativan) and diazepam (Valium)

Psych

grapefuit juice

Emotional disorders that are characterized by changes in mood.

a person experiences elation, extreme confusion, distractibility, feelings of grandeur and racing thoughts

lack of energy, concentration, low self esteem, loss of interest, and helplessness

Indicated for SEIZURES and BIPOLAR disorder

Last resort bipolar treatment as it has lts of adverse effect, narrow therapeutic range and lots of interactions

Alters Na transport in neurons

At toxic levels, Li can cause ataxia, dysarthria, coarse tremors, and delirium, potentially culminating in seizures, coma, and death.

-Diuretics (BP management)

- monitor effectiveness (1-2 weeks)

-antidepressants that inhibit the action of an enzyme (monoamine oxidase) that is responsible for breakdown of NE and 5-HT

MAOI antidepressant.Avoid tyramine (aged meat/cheese) --> HTN crisis

MAOi antidepressant. Avoid tyramine (aged meat/cheese) --> HTN crisis

MAO-B inhibitor transdermal patch. Avoid tyramine (aged meat/cheese) --> HTN crisis

selective serotonin reuptake inhibitors that take about 3 weeks to work.

Prozac (SSRI)

SSRI

Celexa

Zoloft

SSRI (Paxil)

SSRI

Side effects of SSRIs may include, among others:

MAOIs or St. John's Wort = serotonin syndrome

With any drug that increases 5-HT (e.g., MAO inhibitors, SNRIs, TCAs) hyperthermia, confusion, myoclonus, cardiovascular instability, flushing, diarrhea, seizures.

serotonin and norepinephrine reuptake inhibitors used to treat depression, anxiety and social anxiety, or adjunct treatment for chronic pain.

*BAD SNRI*

MAOIs, SSRI, Alcohol, kava, valerian, and st. johns wort

tricyclic antidepressant indicated for major depression and agitated depression

SNRI

SNRI

SNRI

TCA

TCA

Careful use in clients who have a seizure disorder or recent MI, clients at risk for suicide should receive one weeks supply at a time.

anticholinergics (atropine, scopalamine)

extrapyramidal symptoms

Dystonia

a condition of abnormal muscle tone that causes the impairment of voluntary muscle movement

A medication-induced temporary constellation of symptoms associated with Parkinson's disease, including tremors at rest, reduced accessory movements, impaired gait, drooling and stiffening of muscles.

Most common EPS-restlessness, inability to sit still, pacing, shifting from side to side.

a late-onset, irreversible neurologic side effect of antipsychotic medications; characterized by abnormal, involuntary movements such as lip smacking, tongue protrusion, chewing, blinking, grimacing, and choreiform movements of the limbs and feet

-NMS is like S&M;

typical and atypical

Antipsychotics that do not have significant side effects common to older antipsychotics.

Block D2 (Gs) therefore high chance of EPS

typical antipsychotic- moderate EPS risk, weight gain and severe orthostatic HoTN possible

typical antipsychotic often used for antiemetic effects- SEVERE EPS, low sedation

typical antipsychotic- low EPS, possible NMS, weight gain and anticholinergic effects

typical antipsychotic can cause EPS, NMS, sedation, anticholinergic effect, and seizures

anticholinergics

atypical antipsy that is used in patients who are intolerant of other drugs and can cause agranulocytosis-monitor WBC

atypical antipsychotic- BLOCKS SEROTONIN and especially known for weight gain

atypical antipsychotic- does not cause agranulocytosis and less likely to cause EPS

atypical antipsychotic- very low incidence of EPS- insomnia and akathisia

atypical antipsychotic-caution in cardiac patients, prolongs QT in contraction therefore monitor ECG

1. Check for cheeking

1. takes approx three weeks for effect

also known as sulfa drugs

Sulfonamides abx

Sulfonamides abx

Sulfonamides abx

abx from fungus, beta lactam ring interferes with cell wall synthesis inhibiting division and homeostatic water control

natural- narrow gram+

ALLERGY (monitor 1st and 2nd dose, especially in penicillin naive)

Allergy/anaphylaxsis

NSAIDs, oral contraceptives, warfarin

ends in -cillin

inhibit cell wall synthesis (similar MOA as penicillin therefore cross allergies possible)

Begins with cef- or ceph-

Interacts with calcium salts. Calcium salt found in total nutrition and lactaid ringers.

Causes pain with fast infusion therefore infuse over 30 minutes

-renal fx (BUN, urine output and creatinine)

Active gallbladder dz, existing C.dif infection, allergy to penicillin or cephalo

5th generation cephalosporin that can fight MRSA

Translation inhibiting abx, broad spectrum and can be bacteriostatic or bactericidal depending on dosage

all end in -thromycin or -thromicin

Macrolide abx that interferes with penicillin effectiveness

macrolide abx

Macrolide abx

hypokalemia or hypomagnesemia

patients who are allergic to penicillin

IM injection is painful and not given

Tinnitus/Ototoxicity and hearing loss

-inhibit metabolism of drugs like warfarin/digoxin

inhibit translation, broad spectrum and dose dependent bactericidal/static

tetracycline

TOXIC AND DANGEROUS- last resort abx

nephrotoxicity and ototoxicity

Other ototoxic drugs (loop diruetics, vancomycinand cephalosporins)

Aminoglycosideabx

Aminoglycoside abx

Aminoglycoside abx

Aminoglycoside abx

end in micin/mycin NOT thromycin

quinolones and tetracyclines should not be given to pregnant women due to teratogenic effects

act against prokaryotic DNA gyrase

they end in -floxacin

Fluoroquinolone Antibiotic

Quinolones or fluoroquinolones abx

Fluoroquinolone abx

pregnant, myasthenia gravis, or renal dz

those with seizures, renal disorders, elderly, kids under 14 and those with cardiac dysrhythmias

Glycopeptide abx used for treatment of MRSA and C. dif infections

Measure troughs regularly

Vancomycin mediated rash from giving it too quickly

Monitor serum levels of abx to prevent ototoxicity and renal toxicity

Disrupt central Dogma

nitromidazoles- metranidazole

nitromidazole

Stevens-Johnson Syndrome

Antiviral: inhibits DNA synthesis in herpes simplex and varicella zoster. Requires activation by viral thymidine kinase (TK− strains are resistant). Tox: behavioral effects and nephrotoxicity (crystalluria), but not myelosuppression

Tamiflu

highly active antiretroviral therapy- use of combinations of drugs that are effective against AIDS to reduce symptoms increse survival rate and prevent oppurtunistic infections.

Decrease VL to undetectable levels

type of tuberculosis in which the person carries the disease but does not show symptoms and cannot infect others.

RIPE (rifampin, isoniazid, pyrazinamide, ethambutol)

hepatotoxicity and other drugs that can cause should be avoided

Antitubercular

Antitubercular

1. treatment long term (up to 2 years)

have a weakened immune system-most are opportunistic

treats systemic fungal infections. IV only in ICU incredibly potent

Antifungal

wash area with warm water and mild soap, dry completely and apply

1. shake-suspension may settle