Pharmacology and Genetic Considerations
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Questions and Answers

What are the symptoms of muscarinic toxicity?

  • Diaphoresis, urination, miosis, brady, bronchospasm, emesis, lacrimation, salivation (correct)
  • Tachycardia, hypertension, mydriasis, increased respiratory rate
  • Anxiety, insomnia, tremors, seizures
  • Bradycardia, decreased respiratory rate, muscle weakness, fatigue

    • What is the primary function of cholinesterase inhibitors?

  • To break down acetylcholine and reduce cholinergic action
  • To prevent the breakdown of acetylcholine and enhance cholinergic action (correct)
  • To increase the release of acetylcholine and enhance sympathetic action
  • To decrease the release of acetylcholine and reduce parasympathetic action

    • What is the typical treatment for myasthenia gravis?

  • Neostigmine
  • Atropine
  • Pyridostigmine (Mestinon) (correct)
  • Physostigmine

    • What is a common adverse effect of muscarinic antagonists in older adults?

    <p>Urinary retention</p> Signup and view all the answers

    What is atropine often used to treat?

    <p>Muscarinic poisoning</p> Signup and view all the answers

    What is a common effect of atropine on the body?

    <p>Relaxes bronchi and decreases tone of GI tract and bladder</p> Signup and view all the answers

    What is the effect of Alpha 1 receptors?

    <p>eyes (pupil dilation), vasoconstriction, male ejaculation, contraction of bladder and prostate</p> Signup and view all the answers

    What is the antidote for atropine poisoning?

    <p>Physostigmine</p> Signup and view all the answers

    Which receptors does epinephrine activate?

    <p>All alpha and beta receptors, but not dopamine</p> Signup and view all the answers

    What is a common symptom of atropine toxicity?

    <p>Hot as a hare, dry as a bone, red as a beet, blond as a bat, mad as a hatter</p> Signup and view all the answers

    What is the effect of Beta 2 receptors?

    <p>bronchial dilation, relaxation of uterine smooth muscles, vasodilation, breakdown of glucose (higher blood sugar levels), muscle contraction</p> Signup and view all the answers

    What is the effect of Dopamine receptors?

    <p>increase renal perfusion through blood vessel dilation</p> Signup and view all the answers

    What is the effect of Acetylcholine?

    <p>activate all alpha, beta, and dopamine receptors</p> Signup and view all the answers

    What is the effect of Muscarinic Agonist?

    <p>mimics effects of acetylcholine binding; PNS response</p> Signup and view all the answers

    What is the effect of Bethanechol (Urecholine)?

    <p>used for urinary retention in postop and postpartum, and neurogenic atony of bladder</p> Signup and view all the answers

    What is the fight or flight response caused by?

    <p>Epinephrine</p> Signup and view all the answers

    What is a potential consequence of using a non-selective beta blocker to control blood pressure in a patient with asthma?

    <p>Airway constriction</p> Signup and view all the answers

    What is the primary purpose of genetic testing in pharmacology?

    <p>To study genetic variations that affect individual responses to drugs</p> Signup and view all the answers

    What is the consequence of inadequate CYP2D6 gene activity in women taking tamoxifen?

    <p>Decreased therapeutic effect of tamoxifen</p> Signup and view all the answers

    Which of the following is a characteristic of drugs that are more likely to enter breast milk?

    <p>Lipid soluble</p> Signup and view all the answers

    During which period of pregnancy are women most susceptible to teratogenic drugs?

    <p>First trimester</p> Signup and view all the answers

    What is the benefit of trastuzumab (Herceptin) in breast cancer treatment?

    <p>Increased therapeutic effect in breast cancer patients with HER2 overexpression</p> Signup and view all the answers

    What is a strategy to minimize drug concentrations in breast milk?

    <p>Dosing immediately after breast feeding</p> Signup and view all the answers

    What is a characteristic of drugs that are more likely to be excluded from breast milk?

    <p>Highly polar</p> Signup and view all the answers

    What is the primary risk for patients taking MAOI?

    <p>Hypertensive crisis</p> Signup and view all the answers

    What condition does Risperidone treat?

    <p>BPD manic episodes</p> Signup and view all the answers

    What is the main use of Lithium?

    <p>Mood stabilizer</p> Signup and view all the answers

    What is the main reason for combining Risperidone with Lithium?

    <p>To control symptoms of mania</p> Signup and view all the answers

    What are the signs and symptoms of serotonin syndrome?

    <p>Mental status changes, autonomic instability, neuromuscular problems</p> Signup and view all the answers

    What is the treatment for tremors caused by Lithium?

    <p>Divided doses or sustained release doses, or a beta blocker</p> Signup and view all the answers

    What is the treatment for polyuria caused by Lithium?

    <p>Amiloride and hydration</p> Signup and view all the answers

    What is the treatment for lithium toxicity?

    <p>Hemodialysis</p> Signup and view all the answers

    What is the primary function of acetylcholine in the brain?

    <p>Encoding memory and cognition</p> Signup and view all the answers

    What is a common side effect of first-generation antipsychotic medications?

    <p>Prolonged QTc interval</p> Signup and view all the answers

    What is the primary use of clozapine?

    <p>Reducing suicidal behavior in schizophrenia</p> Signup and view all the answers

    What is a rare but potential side effect of clozapine?

    <p>Neuroleptic malignant syndrome</p> Signup and view all the answers

    Why should the NP reduce the dosage of antidepressant medication when switching to a high potency FGA?

    <p>To reduce adverse effects on sexual function</p> Signup and view all the answers

    What is the primary reason why MAOIs and SSRIs should not be taken together?

    <p>They can cause serotonin syndrome</p> Signup and view all the answers

    What is the purpose of a washout period when switching psychiatric medications?

    <p>To allow the body to eliminate the original medication</p> Signup and view all the answers

    What patient education should be covered when starting an MAOI?

    <p>The risk of serotonin syndrome</p> Signup and view all the answers

    Why should APRNs have full prescriptive authority? Who would benefit from this?

    <p>APRNs should have full authority so that they can meet the demands for future healthcare needs. Without it, groups in areas of the greatest need may not get the care they need.</p> Signup and view all the answers

    Which schedule of drugs has no acceptable medical use with high abuse potential?

    <p>Schedule I</p> Signup and view all the answers

    What components are necessary when writing a prescription? The prescriber must include prescriber name, license number, and contact information, DEA number, NPI number, patient name, DOB, patient allergies, name of medication, indication of use, medication concentration, dose, route, frequency, number of tablets to dispense, number of refills, and if okay to use generic form of medications.

    <p>prescriber name, license number, and contact information, DEA number, NPI number, patient name, DOB, patient allergies, name of medication, indication of use, medication concentration, dose, route, frequency, number of tablets to dispense, number of refills, if okay to use generic form of medications</p> Signup and view all the answers

    Patient Education is important because medication information can be easily remembered.

    <p>False</p> Signup and view all the answers

    Match the following pharmacokinetic processes with their descriptions:

    <p>Absorption = movement of a drug from its site of administration into the blood or systemic circulation Distribution = drug's movement from the blood to the interstitial space of tissues and cells Metabolism = enzymatic mediated alteration of a drug structure, often in the liver Excretion = movement of drugs and their metabolites out of the body</p> Signup and view all the answers

    What is the purpose of Prazosin (Minipress)?

    <p>Dilate arterioles and veins and relax smooth muscle of bladder and prostate</p> Signup and view all the answers

    What is the cornerstone for Parkinson's Disease treatment?

    <p>Levodopa/Carbidopa</p> Signup and view all the answers

    Is Clozapine used to treat psychosis induced by Levodopa/Carbidopa combination?

    <p>False</p> Signup and view all the answers

    What syndrome can result from using MAOIs and SSRIs together? Serotonin ______

    <p>syndrome</p> Signup and view all the answers

    What is the purpose of genetic testing?

    <p>To study the genetic variations of an individual that affect individual responses to drugs.</p> Signup and view all the answers

    Give an example of genetic variation that affects drug responses.

    <p>CYP2D6</p> Signup and view all the answers

    Pregnant women are most susceptible to teratogenic drugs during the first trimester.

    <p>True</p> Signup and view all the answers

    The autonomic nervous system is further divided into the ____________ and the sympathetic nervous system.

    <p>parasympathetic</p> Signup and view all the answers

    Match the neurotransmitter with its description:

    <p>Acetylcholine = Employed at most junctions in the PNS, sweat glands, skeletal muscles Norepinephrine = Released by almost all postganglionic neurons of SNS Epinephrine = Released by adrenal medulla Dopamine = A neurotransmitter</p> Signup and view all the answers

    What are the signs and symptoms of drug withdrawal?

    <p>Dilated pupils, increased vital signs, physical fatigue, rhinorrhea, sleep disturbances, N/V, cramping, diarrhea, anxiety, irritability, and depression.</p> Signup and view all the answers

    What conditions may develop as a result of taking lithium?

    <p>Tremors, polyuria, goiter, hypothyroidism, lithium toxicity</p> Signup and view all the answers

    Which drug is the preferred choice for different types of mania?

    <p>Mood stabilizers, second-generation antipsychotics, and benzodiazepines</p> Signup and view all the answers

    What is the drug of choice for panic attacks?

    <p>SSRI (Fluoxetine) or SNRI (venlafaxine), Benzodiazepines</p> Signup and view all the answers

    Which psychiatric medications can potentiate asthma?

    <p>Typical antipsychotics (e.g., clozapine), anticholinergics (e.g., amitriptyline, imipramine)</p> Signup and view all the answers

    What health information should be monitored in patients receiving methylphenidate?

    <p>Blood levels for toxicity, creatinine concentrations, thyroid hormones, and BCB every 6 months</p> Signup and view all the answers

    What is substance abuse disorder?

    <p>A cluster of cognitive, behavioral, and physiological symptoms indicating continued substance use despite significant related issues</p> Signup and view all the answers

    What are the sequelae of long-term alcohol abuse?

    <p>Wernicke’s encephalopathy, Korsakoff psychosis, enlargement of cerebral ventricles</p> Signup and view all the answers

    What is the Ideal treatment for Parkinson Disease?

    <p>Symptomatic relief, does not cure PD</p> Signup and view all the answers

    Which neurotransmitter plays a major role in encoding memory and cognition?

    <p>Acetylcholine</p> Signup and view all the answers

    Ropinirole (Requip) is used to treat restless leg syndrome by activating D2 and D3 receptors which helps to control muscle movement. When combined with Levodopa/Carbidopa, it can result in ____, hallucinations, and postural hypotension.

    <p>dyskinesias</p> Signup and view all the answers

    Imitrex is teratogenic in pregnancy.

    <p>True</p> Signup and view all the answers

    Match the following classic adverse reactions associated with first generation antipsychotic medications:

    <p>Orthostatic hypertension = Photosensitivity Prolonged QTc interval = Neuroleptic malignant syndrome (NMS) Anticholinergic = Weight gain Diabetes = Medication-related movement disorders</p> Signup and view all the answers

    Why should APRNs have full prescriptive authority and who would benefit from this?

    <p>APRNs should have full prescriptive authority so that they can meet the demands for future healthcare needs. Groups in areas of the greatest need would benefit from this.</p> Signup and view all the answers

    What is the definition of Schedule I drugs? Choose the correct description:

    <p>Drugs with no acceptable medical use and high abuse potential</p> Signup and view all the answers

    When writing a prescription, what are the necessary components in addition to the patient name and medication name? ______

    <p>Prescriber name, license number, and contact information, DEA number when needed, NPI number, Patient DOB, Patient allergies, Indication of use for medication, Medication concentration, Dose, route, frequency, Number of tablets to dispense, Number of refills, If okay to use generic form of medications.</p> Signup and view all the answers

    Patient education is important because medication information can be difficult to recall, especially for patients taking multiple medications.

    <p>True</p> Signup and view all the answers

    Match the following drug processes with their definitions:

    <p>Absorption = Movement of a drug from its site of administration into the blood or systemic circulation Distribution = Drug's movement from the blood to the interstitial space of tissues and from there into cells and to the site of drug action Metabolism = Enzymatic mediated alteration of a drug structure Excretion = Movement of drugs and their metabolites out of the body</p> Signup and view all the answers

    What is bioavailability in pharmacokinetics?

    <p>Bioavailability refers to the amount of an active drug that reaches the systemic circulation from its site of administration.</p> Signup and view all the answers

    What symptoms are associated with drug withdrawal?

    <p>Dilated pupils, increased vital signs, physical fatigue, rhinorrhea, sleep disturbances, N/V, cramping, diarrhea, anxiety, irritability, and depression.</p> Signup and view all the answers

    What treatments are recommended for tremors caused by taking lithium?

    <p>Use divided doses, sustained release doses, or a beta blocker.</p> Signup and view all the answers

    What is the drug of choice for panic attacks?

    <p>Both a and b</p> Signup and view all the answers

    What psychiatric medications potentiate asthma?

    <p>Typical antipsychotics (clozapine), anticholinergics (amitriptyline), and imipramine</p> Signup and view all the answers

    Match the substance with its adverse effects:

    <p>Methylphenidate = Increase wakefulness, alertness, mood, stimulate respiration, decrease appetite, increase heart rate, potential for tolerance and abuse Alcohol abuse = Enlargement of cerebral ventricles, atrophy of cerebellum, memory and intellectual impairment Cocaine abuse = Agitation, dizziness, tremor, blurred vision, hyperpyrexia, convulsions, ventricular dysrhythmias, hallucinations Marijuana abuse = Euphoria, sedation, hallucinations, antimotivation syndrome, decreased sperm count Methamphetamine abuse = Delusions, paranoia, hallucinations, vasoconstriction, hypertension, deficits in cognition and memory</p> Signup and view all the answers

    What is the purpose of genetic testing in the context of drug responses?

    <p>To study the genetic variations of an individual that affect individual responses to drugs through alterations in genes that code for drug metabolizing enzymes and drug receptors.</p> Signup and view all the answers

    Provide an example of a genetic variation that affects drug response.

    <p>CYP2D6: Tamoxifen reduced therapeutic effect; women with inadequate activity of this gene cannot convert Tamoxifen to its active form, preventing protection from breast cancer.</p> Signup and view all the answers

    When are pregnant women most susceptible to teratogenic drugs?

    <p>During the embryonic period (roughly the first trimester).</p> Signup and view all the answers

    How can drug concentrations in breast milk be minimized?

    <p>By avoiding drugs with a long half-life, choosing drugs that are excluded from breast milk, and dosing immediately after breastfeeding to minimize drug concentration in milk at the next feeding.</p> Signup and view all the answers

    What affects drug metabolism in pediatric patients?

    <p>Renal drug excretion is lower in infants, and pharmacokinetic processes are immature, taking longer to process drugs until approximately one year of age.</p> Signup and view all the answers

    How do you calculate GFR?

    <p>The proper index of renal function in older adults is creatinine clearance, which takes into account serum creatinine levels, patient age, ethnicity, and race.</p> Signup and view all the answers

    What is the Beers Criteria used for?

    <p>Beers Criteria is a list of medications with a high likelihood of severe adverse effects that should be avoided in patients over the age of 65.</p> Signup and view all the answers

    What does acetylcholine activate in the Peripheral Nervous System?

    <p>Acetylcholine can activate nicotinic N, nicotinic M, and muscarinic receptors.</p> Signup and view all the answers

    What receptors do Adrenergic drugs act on?

    <p>Adrenergic drugs act on alpha 1 and 2, beta 1 and 2, and dopamine receptors.</p> Signup and view all the answers

    What are the effects of Muscarinic Agonists in the Peripheral Nervous System?

    <p>Muscarinic agonists mimic the effects of acetylcholine, leading to responses such as bradycardia, sweating, salivation, and muscle contractions in the lungs and GI tract.</p> Signup and view all the answers

    What neurotransmitter is involved in psychosis and is found in all areas of the brain?

    <p>Dopamine</p> Signup and view all the answers

    What neurotransmitter plays a major role in mediating mood and anxiety?

    <p>Norepinephrine</p> Signup and view all the answers

    Which neurotransmitter influences temperature, sensory functions, sleep, and assertiveness?

    <p>Serotonin</p> Signup and view all the answers

    What inhibitory neurotransmitter is linked with anxiety, autism, and Parkinson's?

    <p>GABA</p> Signup and view all the answers

    Which neurotransmitter plays a major role in encoding memory and cognition?

    <p>Acetylcholine</p> Signup and view all the answers

    What are classic adverse reactions associated with first generation antipsychotic medications?

    <p>Blood disorders (agranulocytosis)</p> Signup and view all the answers

    What adverse effects should be monitored when prescribing clozapine?

    <p>Sedation, weight gain, lowered BP, anticholinergic effects, new onset diabetes, dyslipidemia, seizures</p> Signup and view all the answers

    What is the black box warning associated with clozapine?

    <p>Agranulocytosis and myocarditis</p> Signup and view all the answers

    How should sexual dysfunction caused by antidepressant medications be managed?

    <p>Reducing the dosage of the medication or switching to a high potency first-generation antipsychotic (FGA)</p> Signup and view all the answers

    Why should MAOIs and SSRIs not be taken together?

    <p>Combining MAOIs and SSRIs can lead to serotonin syndrome</p> Signup and view all the answers

    What conditions does Risperidone treat?

    <p>Bipolar disorder manic episodes</p> Signup and view all the answers

    What neurotransmitter influences how we interact with the world, is found in all areas of the brain, and is involved in psychosis?

    <p>Dopamine</p> Signup and view all the answers

    Which neurotransmitter serves as a chemical mediator in pain perception, normal and abnormal behaviors, moods and drives, regulation of food intake, and neuroendocrine functions?

    <p>Serotonin</p> Signup and view all the answers

    What are classic adverse reactions associated with first-generation antipsychotic medications?

    <p>Neuroleptic malignant syndrome (NMS)</p> Signup and view all the answers

    Lithium is used to treat depressive episodes in bipolar illness.

    <p>False</p> Signup and view all the answers

    What condition does Risperidone treat? Bipolar disorder _____________.

    <p>manic episodes</p> Signup and view all the answers

    What neurotransmitter is involved in psychosis and is linked to schizophrenia, bipolar disorder, and Alzheimer's?

    <p>Dopamine</p> Signup and view all the answers

    Which neurotransmitter plays a major role in mood regulation, anxiety, and is used in treating mood disorders like major depression, bipolar disorder, and Alzheimer's?

    <p>Norepinephrine</p> Signup and view all the answers

    Which neurotransmitter influences temperature, sensory perception, sleep, and mood, and is associated with major depression, bipolar disorder, Alzheimer's, and anxiety?

    <p>Serotonin</p> Signup and view all the answers

    What inhibitory neurotransmitter is linked with anxiety, autism, and Parkinson's?

    <p>GABA</p> Signup and view all the answers

    Name the first neurotransmitter that plays a major role in memory encoding and cognition.

    <p>Acetylcholine</p> Signup and view all the answers

    List some classic adverse reactions associated with first-generation antipsychotic medications.

    <p>Orthostatic hypertension, prolonged QTc interval, anticholinergic effects, weight gain, diabetes, sexual side effects, blood disorders (agranulocytosis), neuroleptic malignant syndrome (NMS), photosensitivity, lowered seizure threshold, medication-related movement disorders</p> Signup and view all the answers

    What education should a nurse practitioner provide to a patient and family when prescribing clozapine?

    <p>Blocks receptors for serotonin and dopamine. Used for schizophrenia and reducing suicidal behavior when other drugs have failed. Monitor CBC, cardiovascular exam, and blood glucose. Adverse effects include sedation, weight gain, lowered blood pressure, anticholinergic effects, new-onset diabetes, dyslipidemia, and seizures. Black Box Warning: agranulocytosis and myocarditis. Rare effects: neuroleptic malignant syndrome (NMS), photosensitivity, lowered seizure threshold.</p> Signup and view all the answers

    How can sexual dysfunction caused by antidepressant medications be managed?

    <p>Reducing the dosage of the medication or switching to a high-potency first-generation antipsychotic may help reduce adverse effects.</p> Signup and view all the answers

    Why should MAOIs and SSRIs not be taken together?

    <p>Combining MAOIs and SSRIs can leave a patient vulnerable to serotonin syndrome.</p> Signup and view all the answers

    What should be covered in patient education when starting an MAOI, and why?

    <p>Patient education should include the risk of hypertensive crisis due to consuming foods high in tyramine. MAOIs inhibit the breakdown of tyramine, leading to potential hypertensive crises.</p> Signup and view all the answers

    What conditions does Risperidone treat?

    <p>Bipolar disorder manic episodes</p> Signup and view all the answers

    What condition does Lithium treat?

    <p>Mania and depressive episodes of bipolar illness</p> Signup and view all the answers

    Are Risperidone and Lithium ever used in combination?

    <p>Yes, Lithium is used as a mood stabilizer and can be combined with Risperidone to control symptoms during an acute manic episode.</p> Signup and view all the answers

    What are the signs and symptoms of serotonin syndrome?

    <p>Mental status changes (hallucinations, agitation), autonomic instability (tachycardia, hyperthermia, blood pressure changes), neuromuscular problems (hyperreflexia, incoordination), GI disturbances (nausea, vomiting, diarrhea), potentially life-threatening</p> Signup and view all the answers

    What are the signs and symptoms of drug withdrawal?

    <p>Dilated pupils, increased vital signs, physical fatigue, rhinorrhea, sleep disturbances, nausea, vomiting, cramping, diarrhea, anxiety, irritability, and depression</p> Signup and view all the answers

    What conditions may develop as a result of taking lithium, and how can they be treated?

    <p>Tremors can be managed using divided doses, sustained release doses, or beta blockers. Polyuria can be addressed with amiloride and adequate hydration. Goiter and hypothyroidism may require dose adjustments and Synthroid. Lithium toxicity may necessitate hemodialysis in severe cases.</p> Signup and view all the answers

    What is the substance abuse disorder, and what are the manifestations of it?

    <p>Substance abuse disorder is characterized by cognitive, behavioral, and physiological symptoms indicating continued substance use despite issues. Physical dependence is not necessary for addiction. Manifestations may include cognitive impairment, continued substance use, and neglect of responsibilities.</p> Signup and view all the answers

    What medications should patients with alcohol abuse disorder avoid, and why?

    <p>Patients with alcohol abuse disorder should avoid CNS depressants, NSAIDs, acetaminophen (due to liver injury risk), disulfiram (Antabuse for maintaining abstinence), and antihypertensive drugs (counteracting effects of alcohol).</p> Signup and view all the answers

    What are the sequelae of long-term alcohol abuse, and which body system does alcohol adversely affect?

    <p>Long-term alcohol abuse can lead to conditions like Wernicke's encephalopathy, Korsakoff psychosis, and cerebral atrophy. Alcohol adversely affects the central nervous system.</p> Signup and view all the answers

    What are the physical manifestations of cocaine abuse, ecstasy abuse, marijuana abuse, and methamphetamine abuse?

    <p>Cocaine abuse may present with euphoria, agitation, tremors, blurred vision. Ecstasy abuse can cause euphoria, psychedelic effects, seizures. Marijuana abuse may lead to euphoria, sedation, hallucinations. Methamphetamine abuse can result in increased physical strength, psychosis, vasoconstriction.</p> Signup and view all the answers

    What lab parameters should be monitored in a patient taking lithium?

    <p>Blood levels for toxicity (0.8-1.2 mEq/L), creatinine concentrations, thyroid hormones, and CBC every 6 months.</p> Signup and view all the answers

    Study Notes

    Drug Interactions and Contraindications

    • Two or more medical conditions may interact with each other when taking medications, for example, asthma and hypertension, where a non-selective beta blocker may worsen asthma through airway constriction.

    Genetic Considerations

    • The purpose of genetic testing is to study genetic variations that affect individual responses to drugs through alterations in genes that code for drug-metabolizing enzymes and drug receptors.
    • Examples of genetic variations that affect drug responses:
      • CYP2D6: Tamoxifen reduced therapeutic effect in women with inadequate gene activity, preventing protection from breast cancer.
      • HER2 overexpression: Trastuzumab (Herceptin) increases therapeutic effects in breast cancer treatment.

    Drug Therapy Across the Lifespan

    • Pregnant women are most susceptible to teratogenic drugs during the embryonic period (first trimester).
    • Ways to minimize drug concentrations in breast milk:
      • Lipid-soluble drugs readily enter breast milk, while ionized, highly polar, or protein-bound drugs are excluded.
      • Dose immediately after breast feeding to minimize drug concentration in milk at next feeding.
      • Avoid drugs with a long half-life.

    Alpha, Beta, and Dopamine Receptors

    • Alpha 1: eyes (pupil dilation), vasoconstriction, male ejaculation, contraction of bladder and prostate.
    • Alpha 2: no significant effects.
    • Beta 1: increase HR, force of contraction, and velocity of AV node; renin elevates BP.
    • Beta 2: bronchial dilation, relaxation of uterine smooth muscles, vasodilation, breakdown of glucose (higher blood sugar levels), muscle contraction.
    • Dopamine: increase renal perfusion through blood vessel dilation.
    • Epinephrine: activates all alpha and beta receptors, but not dopamine receptors, causing a fight or flight response, dilation of blood vessels, and increased glucose availability.
    • Norepinephrine: activates alpha 1 and 2 and beta 1 receptors, but not beta 2 receptors.

    Cholinergic Drugs

    • Muscarinic Agonist: mimics effects of acetylcholine binding, causing PNS response, bradycardia, sweating, salivation, increased secretions, contraction of muscles in the lungs and GI tract, release of urine, pupillary constriction, and near vision.
    • Bethanechol (Urecholine): used for urinary retention in postoperative and postpartum and neurogenic atony of the bladder.
    • Muscarinic toxicity: diaphoresis, urination, miosis, brady, bronchospasm, emesis, lacrimation, salivation; treat with atropine.
    • Cholinesterase Inhibitors: prevent breakdown of acetylcholine, enhancing cholinergic action, used to treat MG, glaucoma, Alzheimer's, Parkinson's, and poisoning by muscarinic antagonist.

    Muscarinic Antagonists

    • Block the action of acetylcholine, causing a SNS-type reaction.
    • Contraindicated in older adults due to potential to cause confusion, blurred vision, tachycardia, urinary retention, and constipation.
    • Atropine (Atropen): prevents bradycardia in surgery, antidote to muscarinic poisoning, sinus bradycardia, and AV block; increases HR, decreases secretions and salivation, relaxes bronchi, and decreases tone of GI tract and bladder; antidote: physostigmine.

    Adrenergic Agonist

    • SNS-type reaction:
      • Alpha 1: vasoconstriction and mydriasis
      • Alpha 2: no significant effects
      • Acetylcholine: first NT; plays a major role in encoding memory and cognition.

    Antipsychotic Medications

    • First-generation antipsychotic medications:
      • Orthostatic hypertension, prolonged QTc interval, anticholinergic, weight gain, diabetes, sexual side effects, blood disorders (agranulocytosis), neuroleptic malignant syndrome (NMS), photosensitivity, and lowered seizure threshold
    • Clozapine:
      • Blocks receptors for serotonin and dopamine
      • Used for schizophrenia and reducing suicidal behavior when other drugs have failed
      • Monitor CBC, cardiovascular exam, and blood glucose
      • Adverse effects include sedation, weight gain, lowered BP, anticholinergic effects, new onset diabetes, dyslipidemia, and seizures
      • Rare effects: agranulocytosis, myocarditis, NMS, photosensitivity, and lowered seizure threshold

    Managing Sexual Dysfunction and Changing Psychiatric Medications

    • Reduce dosage of the medication or switch to a high potency FGA to reduce adverse effects.
    • Taper off the original antipsychotic, followed by a washout period, and then start a slow and tapered dose of the second medication to prevent complications.

    MAOIs and SSRIs

    • Combining MAOIs and SSRIs leaves a patient vulnerable to serotonin syndrome.
    • Patient education: avoid foods high in tyramine, as MAOI does not allow the body to process tyramine correctly, leading to an excess buildup and hypertensive crisis.

    Risperidone and Lithium

    • Risperidone treats BPD manic episodes.
    • Lithium treats mania and depressive episodes of bipolar illness.
    • Lithium can be combined with risperidone to help control symptoms during an acute manic episode.

    Signs and Symptoms of Serotonin Syndrome and Drug Withdrawal

    • Serotonin syndrome: mental status changes, autonomic instability, neuromuscular problems, and GI disturbances.
    • Drug withdrawal: dilated pupils, increased vital signs, physical fatigue, rhinorrhea, sleep disturbances, N/V, cramping, anxiety, irritability, and depression.

    Module 1: Foundational Principles of Pharmacotherapeutics

    • APRNs should have full prescriptive authority to meet the demands of future healthcare needs and provide care to areas of greatest need.
    • Groups that may benefit from full prescriptive authority include those in areas of greatest need.

    Controlled Substance Classification

    • Schedule I: no acceptable medical use, high abuse potential (e.g., heroin, marijuana, LSD, MDMA)
    • Schedule II: high abuse potential, severe psychic or physical dependence liability (e.g., opium, morphine, dilaudid, methadone, Demerol, hydrocodone)
    • Schedule III: abuse potential less than I or II, contains limited quantities of certain narcotics (e.g., products with no more than 90 mg of codeine, such as Tylenol with codeine, buprenorphine (Suboxone))
    • Schedule IV: abuse potential less than III (e.g., barbital, phenobarbital, Xanax, Domalin, chloral hydrate, clorazepate)
    • Schedule V: abuse potential less than IV, contains preparations with limited quantities of certain narcotic and stimulants used for cough, diarrhea, and pain (e.g., buprenorphine and propylhexedrine)

    Prescribing Medications

    • Components necessary when writing a prescription:
      • Prescriber name, license number, and contact information
      • DEA number when needed
      • NPI number
      • Patient name and DOB
      • Patient allergies
      • Name of medication
      • Indication of use for medication
      • Medication concentration
      • Dose, route, frequency
      • Number of tablets to dispense
      • Number of refills
      • If okay to use generic form of medication
    • Factors to consider when prescribing medications:
      • Cost and availability
      • Guidelines
      • Interactions and side effects
      • Allergies
      • Liver and renal function
      • Monitoring parameters
      • Special populations
      • Never pre-sign scripts
      • Do not use abbreviations
      • Write in ink and use tamper-resistant scripts
    • Factors to consider when refilling medications:
      • Is this a new medication for the patient?
      • Am I changing the dose or frequency?
      • Am I adding new medications to their regimen?
      • Is the patient having undesired side effects?
      • When do I expect to follow up with this patient?
      • When was the last time I saw this patient? Do I need to see them again before refill?
      • Is this a schedule II medication?

    Patient Education

    • Information to include in patient education materials:
      • Name of medication
      • Purpose
      • Dose
      • Administration
      • Adverse effects
      • Storage
      • Laboratory testing
      • Interactions
      • Duration of therapy
    • Importance of patient education:
      • Medication information can be easy to forget, especially for patients taking multiple medications
      • Education is the best way to promote positive outcomes with drug therapy

    Promotion of Safe Outcomes

    • Best way to promote positive outcomes with drug therapy:
      • Selecting and prescribing the most appropriate drug for the patient and providing them with appropriate education
    • Reasons to monitor drug therapy:
      • Determining therapeutic dosage
      • Evaluating medication adherence
      • Identifying adverse effects
    • Reasons patients may not take their medications:
      • Forgetfulness
      • Lack of planning
      • Cost
      • Dissatisfaction
      • Altered dosing

    Pharmacokinetics, Pharmacodynamics, and Drug Interactions

    • Pharmacokinetics: science that analyzes how the human body interacts with a drug
    • Pharmacodynamics: science that studies the biochemical and physiologic effect of a drug and its organ-specific mechanism of action
    • Processes of pharmacokinetics:
      • Absorption: movement of a drug from its site of administration into the blood or systemic circulation
      • Distribution: drug's movement from the blood to the interstitial space of tissues and from there into cells and to the site of drug action
      • Metabolism: enzymatic mediated alteration of a drug structure
      • Excretion: movement of drugs and their metabolites out of the body
    • Bioavailability: the amount of an active drug that reaches the systemic circulation from its site of administration
    • Factors that affect bioavailability:
      • Genetics
      • Gender
      • Race
      • Body weight
      • Age
      • Physiologic alterations
      • Bioavailability
      • Comorbidities

    Adverse Drug Reactions

    • Ways to minimize adverse drug reactions:
      • Monitor kidney, liver, and bone marrow function through labs
      • Monitor signs and symptoms
      • FDA special alerts: medication education, black box warnings, risk evaluations and mitigation strategy (REMS) to minimize drug-induced harm
    • Handling patient complaints about side effects:
      • If it is a new symptom, suspect the drug is the cause
      • Report the effect to MedWatch, the FDA Medical Products Reporting Program
      • Be sure to investigate before reporting
      • Address the patient's concerns

    Medication Errors

    • Factors that contribute to medication errors:
      • Prescribing practices
      • Oversight
      • Communication
    • Ways to minimize medication errors:
      • Prescribing practices
      • Oversight
      • Communication

    Individual Drug Responses

    • Patient scenarios where individual variations in drug response may occur:
      • Body weight
      • Age
      • Physiologic alterations
      • Bioavailability
      • Gender and race
      • Comorbidities

    Genetic Considerations

    • Purpose of genetic testing:
      • To study the genetic variations of an individual that affect individual responses to drugs
    • Examples of genetic variations that affect drug responses:
      • CYP2D6
      • HER2 overexpression

    Drug Therapy Across the Lifespan

    • Susceptibility of pregnant women to teratogenic drugs:
      • During the embryonic period (roughly the first trimester)
    • Ways to minimize drug concentrations in breast milk:
      • Lipid soluble drugs
      • Dose immediately after breast feeding
      • Avoid drugs with a long half-life
      • Avoid sustained release formulations
      • Choose drugs that tend to be excluded from breast milk
    • Factors that affect drug metabolism in pediatric patients:
      • Renal drug excretion
      • Pharmacokinetic processes
      • Body weight
    • Changes that occur in the organ function of older adults:
      • Altered pharmacokinetics and variable drug sensitivities
      • Multidrug therapies
      • Poor adherence
      • Absorption of drugs
      • Distribution of drugs
      • Metabolism of drugs
      • Excretion of drugs

    Beers Criteria

    • Purpose of Beers Criteria:
      • To avoid using medications with a high likelihood of severe adverse effects in patients over the age of 65
    • Examples of Beers Criteria:
      • Medications to avoid if you are over 65 and not in a hospice or palliative setting
      • Medications to avoid among people with certain health conditions
      • Medications to avoid that cause drug interactions when combined with other medications
      • Medications to avoid due to harmful side effects that outweigh the benefits
      • Medications to use at limited doses or avoided due to effects on kidney function### Autonomic Nervous System (ANS)
    • Epinephrine:
      • Activates all alpha and beta receptors, but not dopamine receptors
      • Causes fight or flight response, dilates blood vessels, increases blood flow, and relaxes uterine smooth muscles
      • Only catecholamine to act on beta 2 receptors
    • Norepinephrine:
      • Activates alpha 1 and 2, and beta 1 receptors, but not beta 2 receptors
    • Dopamine:
      • Activates alpha 1, beta 1, and dopamine receptors

    Cholinergic Drugs (Activate PNS)

    • Muscarinic Agonist:
      • Mimics effects of acetylcholine binding
      • PNS response: bradycardia, sweating, salivation, increased secretions, contraction of muscles in lungs and GI tract, release of urine, pupillary constriction, and near vision
      • Not safe in pediatrics, pregnancy, or breastfeeding
      • Watch for decreased hepatic, cardiac, and renal function in older adults
      • Bethanechol (Urecholine) used for urinary retention and neurogenic atony of bladder
    • Muscarinic toxicity: diaphoresis, urination, miosis, brady, bronchospasm, emesis, lacrimation, salivation
      • Give atropine to reverse

    Cholinesterase Inhibitors

    • Prevents breakdown of acetylcholine, enhancing cholinergic action
    • Used to treat myasthenia gravis, glaucoma, Alzheimer's, Parkinson's, poisoning by muscarinic antagonist, and reversal of neuromuscular blockade
    • Not safe in kids, maybe necessary in pregnancy and labor, associated with dementia and Alzheimer's in older adults
    • Pyridostigmine (Mestinon) treatment of MG, increasing strength and muscle control

    Muscarinic Antagonists (SNS-type reaction)

    • Blocks the action of acetylcholine (blocking PNS)
    • Do not use in older adults due to potential to cause confusion, blurred vision, tachycardia, urinary retention, and constipation
    • Atropine (Atropen) prevents bradycardia in surgery, antidote to muscarinic poisoning, sinus bradycardia and AV block, long-term ophthalmic preparations
    • Increases HR, decreases secretions and salivation, relaxes bronchi, decreases tone of GI tract and bladder, pupil dilation, and lens focus

    Adrenergic Agonist (SNS-type reaction)

    • SNS drugs:
      • Alpha 1: vasoconstriction and mydriasis
      • Alpha 2: do not worry about
      • Beta 1: increase HR and force of contraction
      • Beta 2: bronchodilation, uterine relaxation, and glucose breakdown
    • Used in pediatrics in emergency situations, pregnancy can decrease oxygen to the fetus, breastfeeding use caution, and older adults have an increased risk for adverse effects
    • Epinephrine: delay local anesthetics, control superficial bleeding, elevate BP, AV heart block, cardiac arrest, asthma, anaphylactic shock

    Adrenergic Antagonists

    • Causes direct blockage of adrenergic receptors
    • Only certain ones approved for pediatric use, not usually seen in pregnancy and breastfeeding, and Beers criteria due to orthostatic hypertension
    • Prazosin (Minipress): dilates arterioles and veins, relaxes smooth muscle of bladder and prostate, treatment for HTN, BPH, Raynaud's, PTSD

    Centrally Acting Alpha 2 Agonists

    • Selective activation of alpha 2 receptors in the CNS: produces vasodilation and bradycardia
    • Mainly used to treat hypertension, can also be used for severe pain and ADHD
    • Across the lifespan: kids above 6 years old, avoid in pregnancy and breastfeeding, and Beers criteria for patients over 65
    • Causes CNS depression: drowsiness, rebound hypertension, dry mouth, high abuse potential

    Central Nervous System

    • 21 different neurotransmitters
    • Different drugs effects based on the brain's ability to adapt

    Parkinson Disease

    • Ideal treatment does not exist, only symptomatic relief
    • Too little dopamine and too much acetylcholine
    • Medical treatment works to activate dopamine receptors and block receptors for acetylcholine
    • Levodopa/Carbidopa: cornerstone for PD treatment, increasing dopamine synthesis and inhibiting breakdown of levodopa
    • Full therapeutic response can take a few months to reach, and after 5 years, the medication stops working as well

    Alzheimer's Disease

    • Two main drugs discussed: Donepezil (Aricept) and Memantine (Namenda)
    • Donepezil (Aricept):
      • Reversible inhibition of acetylcholine, making more acetylcholine available, improving communication cells in the brain, and improving memory and cognition
      • Contraindicated in high degree heart blocks
    • Memantine (Namenda):
      • Moderates glutamate at NMDA receptors, slowing decline of AD and possible symptom improvement
      • Severe hepatic impairment issues and can cause corneal issues to worsen

    Seizure Disorders

    • Phenytoin (Dilantin):
      • Selective inhibition of sodium channels, resulting in decreased action potentials
      • Used for partial and generalized tonic-clonic seizures, not absence seizures
      • Test for HLA B *1502 gene mutation: TENS or SJS reaction
    • Oxcarbazepine (Trileptal):
      • Blocks sodium channels in neuronal membranes, derivative of Tegretol
      • Monotherapy and adjunctive for partial seizures
      • Can worsen osteo-conditions
      • CNS depression

    Muscle Spasms and Spasticity

    • Baclofen (Lioresel):
      • Suppresses hyperactive reflexes involved in regulation of muscle movement
      • Reduces muscle spasticity associated with MS and spinal cord injury
      • Abrupt withdrawal results in high fever, AMS, rebound spasticity, muscle rigidity, rhabdomyolysis, MOSF, and death
    • Dantrolene (Dantrium):
      • Acts on skeletal muscles, suppressing calcium release, and decreasing muscle contraction
      • Spasticity due to spinal cord injury or CNS condition
      • Contraindicated in liver disease

    Local Anesthetics

    • Lidocaine: localized pain relief, blocks sodium channels
    • Do not combine with epinephrine, risk for necrosis in certain body areas
    • CNS excitement and then depression

    Opioid Analgesics

    • Morphine:
      • Pain relief by activating mu receptors in CNS
      • Contraindications: respiratory depression issues
      • Adverse effects: constipation, orthostatic hypotension, urinary retention, N/V, sedation, neurotoxicity, tolerance
    • Naloxone (Narcan):
      • Competitive antagonist at opioid receptors
      • Reversal agent for opioid agonist (respiratory depression, coma, analgesia)

    Headache

    • Imitrex:
      • Selective activation of serotonin receptors, causing vasoconstriction
      • Aborts ongoing migraine
      • Teratogenic in pregnancy, ischemic heart conditions, MI, or uncontrolled HTN
      • Adverse effects: bad taste in mouth, coronary vasospasm (angina)

    Neurotransmitters in Psych

    • Dopamine: influences how we interact with the world, found in all areas of the brain, involved in psychosis
    • Norepinephrine: excitatory impact, major role in mediating mood and anxiety, regulation of NE is generally used in treating mood and anxiety disorders
    • Serotonin: influence temperature, sensory, sleep, and assertiveness areas of the brain, serves as chemical mediator in pain perceptions, normal and abnormal behaviors, moods and drives, regulation of food intake, and neuroendocrine functions
    • GABA: chemical made in the brain, inhibitory NT, reduces a nerve cell's ability to send and receive chemical messages through CNS
    • Acetylcholine: first NT, plays a major role in encoding memory and cognition

    Classic Adverse Reactions Associated with First Generation Antipsychotic Medications

    • Orthostatic hypertension, prolonged QTc interval, anticholinergic, weight gain, diabetes, sexual side effects, blood disorders, neuroleptic malignant syndrome, photosensitivity, lowered seizure threshold, medication-related movement disorders### Cocaine Abuse

    • Produces euphoria similar to amphetamines through uptake of dopamine

    • Toxic effects include agitation, dizziness, tremors, blurred vision, hyperpyrexia, convulsions, ventricular dysrhythmias, and hemorrhagic stroke

    • Additional symptoms include anxiety, paranoia, and hallucinations

    Ecstasy Abuse

    • Low doses produce euphoria and psychedelic effects
    • High doses produce amphetamine-like effects
    • Toxic effects include neurotoxicity, seizures, excessive cardiac stimulation, and hyperthermia

    Marijuana Abuse

    • Produces euphoria, sedation, and hallucinations
    • Increases sensitivity and humor, and can cause delusions
    • Toxic effects include antimotivation syndrome, cannabinoid hyperemesis syndrome, increased heart rate, orthostatic hypotension, and reddening of conjunctiva
    • Chronic use causes bronchodilation, but constricts airways, decreases sperm count, and reduces size of hippocampus and amygdala

    Methamphetamine Abuse

    • Increases norepinephrine and dopamine uptake, producing arousal, elevated mood, euphoria, and talkativeness
    • Increases physical strength and mental capacity
    • Toxic effects include delusions, paranoia, hallucinations, psychosis, vasoconstriction, angina, hypertension, weight loss, and tooth decay (meth mouth)
    • Long-term effects include deficits in cognition and memory

    Module 1: Foundational Principles of Pharmacotherapeutics

    • APRNs should have full prescriptive authority to meet the demands of future healthcare needs and provide care to areas of greatest need.
    • Groups that may benefit from full prescriptive authority include those in areas of greatest need.

    Controlled Substance Classification

    • Schedule I: no acceptable medical use, high abuse potential (e.g., heroin, marijuana, LSD, MDMA)
    • Schedule II: high abuse potential, severe psychic or physical dependence liability (e.g., opium, morphine, dilaudid, methadone, Demerol, hydrocodone)
    • Schedule III: abuse potential less than I or II, contains limited quantities of certain narcotics (e.g., products with no more than 90 mg of codeine, such as Tylenol with codeine, buprenorphine (Suboxone))
    • Schedule IV: abuse potential less than III (e.g., barbital, phenobarbital, Xanax, Domalin, chloral hydrate, clorazepate)
    • Schedule V: abuse potential less than IV, contains preparations with limited quantities of certain narcotic and stimulants used for cough, diarrhea, and pain (e.g., buprenorphine and propylhexedrine)

    Prescribing Medications

    • Components necessary when writing a prescription:
      • Prescriber name, license number, and contact information
      • DEA number when needed
      • NPI number
      • Patient name and DOB
      • Patient allergies
      • Name of medication
      • Indication of use for medication
      • Medication concentration
      • Dose, route, frequency
      • Number of tablets to dispense
      • Number of refills
      • If okay to use generic form of medication
    • Factors to consider when prescribing medications:
      • Cost and availability
      • Guidelines
      • Interactions and side effects
      • Allergies
      • Liver and renal function
      • Monitoring parameters
      • Special populations
      • Never pre-sign scripts
      • Do not use abbreviations
      • Write in ink and use tamper-resistant scripts
    • Factors to consider when refilling medications:
      • Is this a new medication for the patient?
      • Am I changing the dose or frequency?
      • Am I adding new medications to their regimen?
      • Is the patient having undesired side effects?
      • When do I expect to follow up with this patient?
      • When was the last time I saw this patient? Do I need to see them again before refill?
      • Is this a schedule II medication?

    Patient Education

    • Information to include in patient education materials:
      • Name of medication
      • Purpose
      • Dose
      • Administration
      • Adverse effects
      • Storage
      • Laboratory testing
      • Interactions
      • Duration of therapy
    • Importance of patient education:
      • Medication information can be easy to forget, especially for patients taking multiple medications
      • Education is the best way to promote positive outcomes with drug therapy

    Promotion of Safe Outcomes

    • Best way to promote positive outcomes with drug therapy:
      • Selecting and prescribing the most appropriate drug for the patient and providing them with appropriate education
    • Reasons to monitor drug therapy:
      • Determining therapeutic dosage
      • Evaluating medication adherence
      • Identifying adverse effects
    • Reasons patients may not take their medications:
      • Forgetfulness
      • Lack of planning
      • Cost
      • Dissatisfaction
      • Altered dosing

    Pharmacokinetics, Pharmacodynamics, and Drug Interactions

    • Pharmacokinetics: science that analyzes how the human body interacts with a drug
    • Pharmacodynamics: science that studies the biochemical and physiologic effect of a drug and its organ-specific mechanism of action
    • Processes of pharmacokinetics:
      • Absorption: movement of a drug from its site of administration into the blood or systemic circulation
      • Distribution: drug's movement from the blood to the interstitial space of tissues and from there into cells and to the site of drug action
      • Metabolism: enzymatic mediated alteration of a drug structure
      • Excretion: movement of drugs and their metabolites out of the body
    • Bioavailability: the amount of an active drug that reaches the systemic circulation from its site of administration
    • Factors that affect bioavailability:
      • Genetics
      • Gender
      • Race
      • Body weight
      • Age
      • Physiologic alterations
      • Bioavailability
      • Comorbidities

    Adverse Drug Reactions

    • Ways to minimize adverse drug reactions:
      • Monitor kidney, liver, and bone marrow function through labs
      • Monitor signs and symptoms
      • FDA special alerts: medication education, black box warnings, risk evaluations and mitigation strategy (REMS) to minimize drug-induced harm
    • Handling patient complaints about side effects:
      • If it is a new symptom, suspect the drug is the cause
      • Report the effect to MedWatch, the FDA Medical Products Reporting Program
      • Be sure to investigate before reporting
      • Address the patient's concerns

    Medication Errors

    • Factors that contribute to medication errors:
      • Prescribing practices
      • Oversight
      • Communication
    • Ways to minimize medication errors:
      • Prescribing practices
      • Oversight
      • Communication

    Individual Drug Responses

    • Patient scenarios where individual variations in drug response may occur:
      • Body weight
      • Age
      • Physiologic alterations
      • Bioavailability
      • Gender and race
      • Comorbidities

    Genetic Considerations

    • Purpose of genetic testing:
      • To study the genetic variations of an individual that affect individual responses to drugs
    • Examples of genetic variations that affect drug responses:
      • CYP2D6
      • HER2 overexpression

    Drug Therapy Across the Lifespan

    • Susceptibility of pregnant women to teratogenic drugs:
      • During the embryonic period (roughly the first trimester)
    • Ways to minimize drug concentrations in breast milk:
      • Lipid soluble drugs
      • Dose immediately after breast feeding
      • Avoid drugs with a long half-life
      • Avoid sustained release formulations
      • Choose drugs that tend to be excluded from breast milk
    • Factors that affect drug metabolism in pediatric patients:
      • Renal drug excretion
      • Pharmacokinetic processes
      • Body weight
    • Changes that occur in the organ function of older adults:
      • Altered pharmacokinetics and variable drug sensitivities
      • Multidrug therapies
      • Poor adherence
      • Absorption of drugs
      • Distribution of drugs
      • Metabolism of drugs
      • Excretion of drugs

    Beers Criteria

    • Purpose of Beers Criteria:
      • To avoid using medications with a high likelihood of severe adverse effects in patients over the age of 65
    • Examples of Beers Criteria:
      • Medications to avoid if you are over 65 and not in a hospice or palliative setting
      • Medications to avoid among people with certain health conditions
      • Medications to avoid that cause drug interactions when combined with other medications
      • Medications to avoid due to harmful side effects that outweigh the benefits
      • Medications to use at limited doses or avoided due to effects on kidney function### Cholinergic Drugs
    • Activate PNS response
    • Muscarinic Agonist:
      • Mimics effects of acetylcholine binding
      • Causes bradycardia, sweating, salivation, increased secretions
      • Contraction of muscles in lungs and GI tract
      • Release of urine, pupillary constriction, and near vision
      • Not safe in peds, pregnancy, or breastfeeding
      • Watch in older adults due to decreased hepatic, cardiac, and renal function
      • Bethanechol (Urecholine): used for urinary retention in postop and postpartum and neurogenic atony of bladder
    • Muscarinic toxicity: diaphoresis, urination, miosis, brady, bronchospasm, emesis, lacrimation, salivation
    • Give atropine to reverse

    Adrenergic Agonists

    • SNS-type reaction
    • Alpha 1: vasoconstriction and mydriasis
    • Alpha 2: do not worry about
    • Beta 1: increase HR and force of contraction
    • Beta 2: bronchodilation and uterine relaxation and glucose breakdown
    • Used in peds in emergency situations
    • Pregnancy: decrease oxygen to the fetus
    • Breastfeeding: use caution
    • Older adults: increased risk for adverse effects

    Adrenergic Antagonists

    • Causes direct blockage of adrenergic receptors
    • Across the lifespan: only certain ones approved for pediatric use
    • Used for BPH, not usually seen in pregnancy and breastfeeding
    • Beers criteria due to orthostatic hypertension
    • Prazosin (Minipress): dilates arterioles and veins and relaxes smoother muscle of bladder and prostate
    • Treatment for HTN, BPH, Raynaud's, and PTSD

    Centrally Acting Alpha 2 Agonists

    • Selective activation of alpha 2 receptors in the CNS
    • Produces vasodilation and bradycardia
    • Mainly used to treat hypertension
    • Can also be used for severe pain and ADHD
    • Across the lifespan: kids above 6 years old, avoid in pregnancy and breastfeeding
    • Beers criteria for patients over 65
    • Causes CNS depression: drowsiness, rebound hypertension, dry mouth, high abuse potential

    Alzheimer's Disease

    • Two main drugs discussed: Donepezil (Aricept) and Memantine (Namenda)
    • Donepezil (Aricept):
      • Reversible inhibition of acetylcholine
      • Makes more acetylcholine available
      • Improving communication cells in the brain
      • Contraindicated in high degree heart blocks
      • Long half-life, but takes up to 15 days to achieve steady state
      • Causes cholinergic affects: increased secretions, increased muscle contractions, decreased HR, weight loss

    Parkinson Disease

    • Ideal treatment does not exist; only symptomatic relief
    • Too little dopamine and too much acetylcholine
    • Medical treatment works to activate dopamine receptors and block receptors for acetylcholine
    • Levodopa/Carbidopa: cornerstone for PD treatment
    • Levodopa increases dopamine synthesis and carbidopa inhibits breakdown of levodopa
    • Full therapeutic response can take a few months to reach
    • Avoid high protein meals, get up slowly, and the drug can induce psychosis
    • Drug that prolongs the half-life of Levodopa: Entacapone

    Seizure Disorders

    • Phenytoin (Dilantin):
      • Selective inhibition of sodium channels
      • Used for partial and generalized tonic-clonic seizures
      • Test for HLA B *1502 gene mutation: TENS or SJS reaction
      • No stopping abruptly
      • Narrow therapeutic index: 10-20
      • CNS effects, gingival hyperplasia, rash, hirsutism
      • Neural tube defects in pregnancy

    Muscle Spasms and Spasticity

    • Baclofen (Lioresal):
      • Suppress hyperactive reflexes involved in regulation of muscle movement
      • Reduces muscle spasticity associated with MS and spinal cord injury
      • BBW: abrupt withdrawal results in high fever, AMS, rebound spasticity, muscle rigidity, rhabdomyolysis, MOSF, and death
      • Start with smaller doses and gradually increase; do not stop suddenly

    Local Anesthetics

    • Lidocaine: localized pain relief; blocks sodium channels
    • Do not combine with epinephrine; risk for necrosis in certain body areas
    • CNS excitement and then depression
    • CV can affect heart and blood vessel; can cause brady, heart block, and even cardiac arrest in extreme situations
    • Risk for injury due to numbness

    Opioid Analgesics

    • Morphine:
      • Pain relief by activating mu receptors in CNS
      • Contraindications: respiratory depression issues
      • Adverse effects: constipation, orthostatic hypotension, urinary retention, N/V, sedation, neurotoxicity, tolerance
      • Opioid overdose: Narcan
    • Naloxone (Narcan):
      • Competitive antagonist at opioid receptors
      • Reversal agent for opioid agonist (resp depression, coma, analgesia)
      • IM, IV, or SQ: 0.4 to 2 mg, repeat every 2-3 minutes

    Headache

    • Imitrex:

      • Selective activation of serotonin receptors
      • Aborts ongoing migraine
      • Teratogenic in pregnancy, ischemic heart conditions, MI, or uncontrolled HTN
      • Adverse effects: bad taste in mouth, coronary vasospasm (angina)
      • SSRI use can lead to serotonin syndrome### Cocaine Abuse

    • Produces euphoria similar to amphetamines through dopamine uptake

    • Toxic effects include:

      • Agitation, dizziness, tremors, and blurred vision
      • Hyperpyrexia, convulsions, ventricular dysrhythmias, and hemorrhagic stroke
      • Anxiety, paranoia, and hallucinations

    Ecstasy Abuse

    • Produces euphoria and psychedelic effects in low doses, and amphetamine-like effects in high doses
    • Toxic effects include:
      • Neurotoxicity, seizures, excessive cardiac stimulation, and hyperthermia

    Marijuana Abuse

    • Produces euphoria, sedation, and hallucinations, with increased sensitivity and humor, and delusions
    • Toxic effects include:
      • Antimotivation syndrome, cannabinoid hyperemesis syndrome, and increased heart rate
      • Orthostatic hypotension, reddening of conjunctiva, bronchodilation, and decreased sperm count
      • Constriction of airway with chronic use, and reduction in size of hippocampus and amygdala

    Methamphetamine Abuse

    • Increases norepinephrine and dopamine uptake, producing arousal, elevation of mood, euphoria, and talkativeness
    • Increases physical strength and mental capacity
    • Toxic effects include:
      • Delusions, paranoia, hallucinations, psychosis, vasoconstriction, angina, and hypertension
      • Weight loss, tooth decay (meth mouth), and deficits in cognition and memory

    Neurotransmitters in Psych

    • Dopamine: influences interaction with the world, found in all brain areas, involved in psychosis (Schizophrenia, bipolar, Alzheimer's)
    • Norepinephrine: excitatory impact (fight or flight), mediates mood and anxiety, regulated in treating mood and anxiety disorders (Major depression, bipolar, Alzheimer's, anxiety)
    • Serotonin: influences temperature, sensory, sleep, and assertiveness areas of the brain, involved in pain perceptions, normal and abnormal behaviors, moods and drives, regulation of food intake, and neuroendocrine functions (Major depression, bipolar, Alzheimer's, anxiety)
    • GABA: an inhibitory neurotransmitter, reduces nerve cells' ability to send and receive chemical messages, linked with anxiety, autism, and Parkinson's (bipolar, anxiety)
    • Acetylcholine: plays a major role in encoding memory and cognition (Alzheimer's, bipolar)

    Adverse Reactions and Medications

    • Classic adverse reactions associated with first-generation antipsychotic medications: orthostatic hypertension, prolonged QTc interval, anticholinergic, weight gain, diabetes, sexual side effects, blood disorders, neuroleptic malignant syndrome, photosensitivity, and lowered seizure threshold
    • Education for patients and family regarding possible side effects and patient monitoring when prescribing clozapine: blocks receptors for serotonin and dopamine, used for schizophrenia and reducing suicidal behavior, monitor CBC, cardiovascular exam, and blood glucose
    • Adverse effects of clozapine: sedation, weight gain, lowered BP, anticholinergic effects, new onset diabetes, dyslipidemia, seizures, agranulocytosis, and myocarditis
    • Managing sexual dysfunction caused by antidepressant medications: reducing dosage, switching to a high potency FGA, examples include Haldol
    • Why MAOIs and SSRIs should not be taken together: combination leaves a patient vulnerable to serotonin syndrome
    • Preventing complications when changing psychiatric medications: tapering off the original antipsychotic, followed by a washout period, and then starting a slow and tapered dose of the second medication

    Psychiatric Medications and Conditions

    • Risperidone treats: BPD manic episodes
    • Lithium treats: mania and depressive episodes of bipolar illness
    • Combination of Lithium and Risperidone: used to control symptoms during an acute manic episode
    • Signs and symptoms of serotonin syndrome: mental status changes, autonomic instability, neuromuscular problems, and GI disturbances
    • Signs and symptoms of drug withdrawal: dilated pupils, increased vital signs, physical fatigue, rhinorrhea, sleep disturbances, N/V, cramping, anxiety, irritability, and depression
    • Conditions that may develop as a result of taking lithium and their treatments: tremors, polyuria, goiter and hypothyroidism, and lithium toxicity

    Psychiatric Disorders and Treatments

    • Drug of choice for different types of mania: mood stabilizers, second-generation antipsychotics, and benzodiazepines
    • Drug of choice for depression: SSRIs, such as Fluoxetine (Prozac)
    • Drug of choice for panic attacks: SSRIs (Prozac) or SNRIs (venlafaxine), and benzodiazepines
    • Psychiatric medications that potentiate asthma: typical antipsychotics (clozapine), anticholinergics (amitriptyline), and imipramine

    Substance Abuse Disorders

    • What is substance abuse disorder: a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related issues
    • Medications that should not be taken by patients with alcohol abuse disorder: CNS Depressants, NSAIDs, Acetaminophen, Disulfiram (Antabuse), and Antihypertensive drugs
    • Sequelae of long-term alcohol abuse: Wernicke's encephalopathy, Korsakoff psychosis, and enlargement of cerebral ventricles
    • Physical manifestations of cocaine abuse, ecstasy abuse, marijuana abuse, and methamphetamine abuse, including overdose symptoms

    Neurotransmitters in Psych

    • Dopamine: influences interaction with the world, found in all brain areas, involved in psychosis (Schizophrenia, bipolar, Alzheimer's)
    • Norepinephrine: excitatory impact (fight or flight), mediates mood and anxiety, regulated in treating mood and anxiety disorders (Major depression, bipolar, Alzheimer's, anxiety)
    • Serotonin: influences temperature, sensory, sleep, and assertiveness areas of the brain, involved in pain perceptions, normal and abnormal behaviors, moods and drives, regulation of food intake, and neuroendocrine functions (Major depression, bipolar, Alzheimer's, anxiety)
    • GABA: an inhibitory neurotransmitter, reduces nerve cells' ability to send and receive chemical messages, linked with anxiety, autism, and Parkinson's (bipolar, anxiety)
    • Acetylcholine: plays a major role in encoding memory and cognition (Alzheimer's, bipolar)

    Adverse Reactions and Medications

    • Classic adverse reactions associated with first-generation antipsychotic medications: orthostatic hypertension, prolonged QTc interval, anticholinergic, weight gain, diabetes, sexual side effects, blood disorders, neuroleptic malignant syndrome, photosensitivity, and lowered seizure threshold
    • Education for patients and family regarding possible side effects and patient monitoring when prescribing clozapine: blocks receptors for serotonin and dopamine, used for schizophrenia and reducing suicidal behavior, monitor CBC, cardiovascular exam, and blood glucose
    • Adverse effects of clozapine: sedation, weight gain, lowered BP, anticholinergic effects, new onset diabetes, dyslipidemia, seizures, agranulocytosis, and myocarditis
    • Managing sexual dysfunction caused by antidepressant medications: reducing dosage, switching to a high potency FGA, examples include Haldol
    • Why MAOIs and SSRIs should not be taken together: combination leaves a patient vulnerable to serotonin syndrome
    • Preventing complications when changing psychiatric medications: tapering off the original antipsychotic, followed by a washout period, and then starting a slow and tapered dose of the second medication

    Psychiatric Medications and Conditions

    • Risperidone treats: BPD manic episodes
    • Lithium treats: mania and depressive episodes of bipolar illness
    • Combination of Lithium and Risperidone: used to control symptoms during an acute manic episode
    • Signs and symptoms of serotonin syndrome: mental status changes, autonomic instability, neuromuscular problems, and GI disturbances
    • Signs and symptoms of drug withdrawal: dilated pupils, increased vital signs, physical fatigue, rhinorrhea, sleep disturbances, N/V, cramping, anxiety, irritability, and depression
    • Conditions that may develop as a result of taking lithium and their treatments: tremors, polyuria, goiter and hypothyroidism, and lithium toxicity

    Psychiatric Disorders and Treatments

    • Drug of choice for different types of mania: mood stabilizers, second-generation antipsychotics, and benzodiazepines
    • Drug of choice for depression: SSRIs, such as Fluoxetine (Prozac)
    • Drug of choice for panic attacks: SSRIs (Prozac) or SNRIs (venlafaxine), and benzodiazepines
    • Psychiatric medications that potentiate asthma: typical antipsychotics (clozapine), anticholinergics (amitriptyline), and imipramine

    Substance Abuse Disorders

    • What is substance abuse disorder: a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related issues
    • Medications that should not be taken by patients with alcohol abuse disorder: CNS Depressants, NSAIDs, Acetaminophen, Disulfiram (Antabuse), and Antihypertensive drugs
    • Sequelae of long-term alcohol abuse: Wernicke's encephalopathy, Korsakoff psychosis, and enlargement of cerebral ventricles
    • Physical manifestations of cocaine abuse, ecstasy abuse, marijuana abuse, and methamphetamine abuse, including overdose symptoms

    Neurotransmitters in Psych

    • Dopamine: influences interaction with the world, found in all brain areas, involved in psychosis (Schizophrenia, bipolar, Alzheimer's)
    • Norepinephrine: excitatory impact (fight or flight), mediates mood and anxiety, regulated in treating mood and anxiety disorders (Major depression, bipolar, Alzheimer's, anxiety)
    • Serotonin: influences temperature, sensory, sleep, and assertiveness areas of the brain, involved in pain perceptions, normal and abnormal behaviors, moods and drives, regulation of food intake, and neuroendocrine functions (Major depression, bipolar, Alzheimer's, anxiety)
    • GABA: an inhibitory neurotransmitter, reduces nerve cells' ability to send and receive chemical messages, linked with anxiety, autism, and Parkinson's (bipolar, anxiety)
    • Acetylcholine: plays a major role in encoding memory and cognition (Alzheimer's, bipolar)

    Adverse Reactions and Medications

    • Classic adverse reactions associated with first-generation antipsychotic medications: orthostatic hypertension, prolonged QTc interval, anticholinergic, weight gain, diabetes, sexual side effects, blood disorders, neuroleptic malignant syndrome, photosensitivity, and lowered seizure threshold
    • Education for patients and family regarding possible side effects and patient monitoring when prescribing clozapine: blocks receptors for serotonin and dopamine, used for schizophrenia and reducing suicidal behavior, monitor CBC, cardiovascular exam, and blood glucose
    • Adverse effects of clozapine: sedation, weight gain, lowered BP, anticholinergic effects, new onset diabetes, dyslipidemia, seizures, agranulocytosis, and myocarditis
    • Managing sexual dysfunction caused by antidepressant medications: reducing dosage, switching to a high potency FGA, examples include Haldol
    • Why MAOIs and SSRIs should not be taken together: combination leaves a patient vulnerable to serotonin syndrome
    • Preventing complications when changing psychiatric medications: tapering off the original antipsychotic, followed by a washout period, and then starting a slow and tapered dose of the second medication

    Psychiatric Medications and Conditions

    • Risperidone treats: BPD manic episodes
    • Lithium treats: mania and depressive episodes of bipolar illness
    • Combination of Lithium and Risperidone: used to control symptoms during an acute manic episode
    • Signs and symptoms of serotonin syndrome: mental status changes, autonomic instability, neuromuscular problems, and GI disturbances
    • Signs and symptoms of drug withdrawal: dilated pupils, increased vital signs, physical fatigue, rhinorrhea, sleep disturbances, N/V, cramping, anxiety, irritability, and depression
    • Conditions that may develop as a result of taking lithium and their treatments: tremors, polyuria, goiter and hypothyroidism, and lithium toxicity

    Psychiatric Disorders and Treatments

    • Drug of choice for different types of mania: mood stabilizers, second-generation antipsychotics, and benzodiazepines
    • Drug of choice for depression: SSRIs, such as Fluoxetine (Prozac)
    • Drug of choice for panic attacks: SSRIs (Prozac) or SNRIs (venlafaxine), and benzodiazepines
    • Psychiatric medications that potentiate asthma: typical antipsychotics (clozapine), anticholinergics (amitriptyline), and imipramine

    Substance Abuse Disorders

    • What is substance abuse disorder: a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related issues
    • Medications that should not be taken by patients with alcohol abuse disorder: CNS Depressants, NSAIDs, Acetaminophen, Disulfiram (Antabuse), and Antihypertensive drugs
    • Sequelae of long-term alcohol abuse: Wernicke's encephalopathy, Korsakoff psychosis, and enlargement of cerebral ventricles
    • Physical manifestations of cocaine abuse, ecstasy abuse, marijuana abuse, and methamphetamine abuse, including overdose symptoms

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    Description

    This quiz covers the interactions between medical conditions and medications, as well as the role of genetic testing in understanding individual responses to drugs.

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