701 Study Guide Week 3 PDF - Pharmacology Practice Questions

**Week 3 Study Guide** - What is pertinent/accurate patient teaching about how lidocaine cream should be applied? - Apply the smallest amount needed. - Avoid application to large areas or broken or irritated skin. - Avoid strenuous exercise, wrapping the site, and heating...

**Week 3 Study Guide** - What is pertinent/accurate patient teaching about how lidocaine cream should be applied? - Apply the smallest amount needed. - Avoid application to large areas or broken or irritated skin. - Avoid strenuous exercise, wrapping the site, and heating the site to prevent excessive absorption and systemic toxicity. - Caution against unintentional harm as anesthesia eliminates pain as a warning sign. - Apply directly to the skin or mucous membrane. Application may be made to the nose, mouth, pharynx, trachea, vagina, and urethra. - Metabolized via the liver and high doses within plasma can cause CNS and cardiovascular toxicity. - What are the benefits and risks of adding a vasoconstrictor agent to a local anesthetic? What are concerning patient symptoms after administration? - Benefit: it decreases blood flow, thus delaying systemic absorption of the anesthetic, and reduces the risk of toxicity (less mg used and slower distribution) - Risk: Absorption of the vasoconstrictor itself can result in systemic toxicity. effects like palpitations, tachycardia, nervousness, and hypertension. - Concerning symptoms: - Signs of excessive adrenergic stimulation, which may require treatment with alpha- and beta-adrenergic antagonists. - What are the risks (to mom and baby) related to the administration of epidural anesthesia? (Hint: what HR changes can it cause in a baby?) - Maternal risks: Hypotension, urinary retention, and motor blockade. - Fetal risks: Bradycardia due to decreased maternal blood pressure and placental perfusion. - What is an appropriate medication to switch to if a patient with chronic cancer pain has developed tolerance to oral oxycodone? - Fentanyl patch or Subutex, Methadone? - What are the various side effects of opioid analgesics? Which other medications (if given concurrently) can increase risk for these side effects? - Side effects: Respiratory depression, constipation, sedation, nausea, vomiting, urinary retention, hypotension, pruritus, neurotoxicity, dependence, sedation. - Medications that increase risk: Benzodiazepines, alcohol, barbiturates, and other CNS depressants increase the risk of respiratory depression and sedation. Anticholinergic drugs, tricyclic antidepressants, antihistamines, and exacerbate urinary retention. - Hypotension drugs make the hypotension related to opioids worsen. - Which medication is considered a pure opioid antagonist and is most typically used emergently? What do we know about its half-life and the need to re-dose? - Naloxone (Narcan) is the opioid antagonist used in emergencies. - It has a short half-life (\~2 hours), often requiring repeated doses to match the longer duration of action of opioids like morphine or fentanyl. - What can codeine be used to treat in addition to pain? - It is also used as a cough suppressant - What potential EKG changes need to be monitored in a patient taking methadone? - QT prolongation (Torsade's de pointes) patients should receive ECG before treatment, 30 days after treatment, and annually thereafter. - What are the first steps/interventions when evaluating a patient with infrequent migraine headaches? - Obtain a thorough history of triggers and symptoms. - Encourage lifestyle modifications such as stress reduction and dietary adjustments. - Initiate acute treatment with NSAIDs or triptans as needed. - Can take drugs to abort the attack. Triptan - Or drugs to employ prophylaxis. BB or antiepileptic drugs. - In what co-morbid condition might prescribing sumatriptan be contraindicated/concerning? - Sumatriptan is contraindicated in patients with coronary artery disease (CAD), uncontrolled hypertension, and a history of stroke or peripheral vascular disease to the risk of coronary vasospasm. Teratogenic should not be taken during pregnancy. - Don't take it within 24 hours of ergot derivative or another triptan. - Do not take with MAOI or within 2 weeks of stopping MAOI - Be aware of risk for serotonin syndrome. - Which medications can be used for daily prophylactic therapy related to migraine HAs? - Beta-blockers\*\* (e.g., propranolol, metoprolol) - Antiepileptic drugs\*\* (e.g., divalproex, topiramate) - Tricyclic antidepressants\*\* (e.g., amitriptyline) - CGRP antagonists - What is serotonin syndrome, how does it present, and when may it occur in a patient taking sumatriptan? - Serotonin syndrome\*\* is a potentially life-threatening condition caused by excessive serotonin activity. - Presentation: Altered mental status, hyperreflexia, tremors, sweating, fever, myoclonus, incoordination, and agitation. - It may occur if sumatriptan is taken with SSRIs, SNRIs, or MAOIs. - Compare and contrast the side effects of ergotamine and dihydroergotamine? - Ergotamine: More nausea and vomiting, risk of vasoconstriction leading to ischemia, and physical dependence. - Dihydroergotamine: Less nausea, minimal risk of dependence, the prominent side effect is diarrhea.