Exam 1 Concept Review: Pharmacology PDF

**Exam 1 Concept Review: Pharmacology** **Chapter 19:** **Side Effect: Secondary response due to drug or medication treatment** - **Example: Drowsiness, Fatigue, Nausea/Vomiting, Diarrhea, Constipation, Rash** **Adverse Effect: An unforeseen medical problem while taking the drug, undergoin...

**Exam 1 Concept Review: Pharmacology** **Chapter 19:** **Side Effect: Secondary response due to drug or medication treatment** - **Example: Drowsiness, Fatigue, Nausea/Vomiting, Diarrhea, Constipation, Rash** **Adverse Effect: An unforeseen medical problem while taking the drug, undergoing therapy or surgery** - **Example: Anaphylaxis, Death, Dosing calculation errors, look alike-sound alike, may not be alike** **Chapter 20: Anxiolytic & Hypnotic Agents** **Barbiturates:** - **End in "- barbital"** - **Decrease excitatory signals** - **Original CNS Depressant** - **Enhances GABA (calming neurotransmitter) receptors in your body** - **Side Effects:** - **Dizziness** - **Headache** - **Confusion** - **Vertigo** - **Irritability** - **Coma** - **Memory Issues** - **Low BP** - **No reversal drug, if patient overdoses, provide supportive care (sit the patient up, provide supplemental oxygen)** - **Nursing Considerations/Contradictions:** - **Low safety margin (Easy to overdose)** - **If you overdose, supportive care is the treatment (Maintain respiratory drive)** - **Dangerous interaction with other antidepressant** - **2-3x risk of birth defects in women with epilepsy** **Benzodiazepines:** - **End in "- Lam" & "-Pam"** - **Benzos increase GABA receptors in the synaptic cleft** - **There is a reversal drug \*Flumazenil\*** - **Side Effects:** - **Depression** - **Vertigo** - **Blurred Vision** - **Shaking** - **Loss of appetite** - **Confusion** - **Mood Swings** - **Slowed reflexes** - **Nursing Considerations/Contradictions:** - **Pregnant women & Children should NOT take this drug** - **This drug crosses the placenta** - **Do NOT stop taking abruptly, you will experience withdrawals (s/s: shaking, sweaty, and tremors)** - **NO alcohol** - **NO CNS depressants** - **Take at BEDTIME** - **No dangerous machinery (accidents can happen)** **Alternative Anxiolytic & Hypnotic Drugs** - **\*Buspirone\*** - **Short term treatment** - **Acts as a partial serotonin against instead of utilizing GABA** - **Great alternative because its less sedating, easy to quit (no withdrawals)** - **DO NOT USE WITH ALCOHOL** **Chapter 21: Antidepressant Agent** **Pathophysiology of Depression:** - **Deficiency of [Norepinephrine, Dopamine, and Serotonin ]** **Actions of Antidepressant Therapy:** - **Leading to increased neurotransmitter levels in the synaptic cleft** - **Inhibits effects of MAO increasing norepinephrine** - **Block reuptake by releasing nerve** - **Regulate receptor sites and break down neurotransmitters** **TCA'S: Tricycline Antidepressants \*Amitriptyline\*** - **Action: Reduce reuptake of serotonin and norepinephrine into nerves** - **Indication: [Depression], sleep disorders, enuresis, chronic pain** - **Pregnant women should NOT take this medication** - **Adverse Effects: Sedation, sleep disturbances, ataxia, dry mouth, etc** - **Cautions: Cardiotoxicity: Increases the risk of stroke** - **Do not take with MAOI's or anticoagulants** - **Risk of Suicidal Idealization: if someone has suicidal idealization before taking the drug, this drug may increase the risk of the person to act on it.** **MAOI: Monoamine Oxidase Inhibitor \*Phenelzine\*** - **Inhibits MAO (allows NE, serotonin and dopamine to accumulate in synaptic cleft) -- increases norepinephrine** - **Given to patients who are unresponsive to other antidepressant agents** - **Contraindicated: Pregnant women** - **Adverse Effects: Dizziness, mania, tremors** - **LOTS OF DRUG-DRUG INTERACTIONS** - **Can mask hypoglycemia, it can hide your blood sugars, not the best to give if the patient has diabetes** - **\*Serotonin Syndrome: so much serotonin built up in your body, bad medication reaction basically** - **H: hypothermia** - **A: autonomic instability** - **R: Rigidity** - **M: Myoclonus** - **F: Fever** - **U: Unconscious** - **L: Loss of intestinal control (diarrhea)** **SSRI: Selective Serotonin Reuptake Inhibitor \*Fluoxetine\* \*Sertraline\*** - **Inhibits the reuptake of serotonin, with little effect on norepinephrine** - **Adverse effects: Weight loss** - **May interact with certain herbal remedies like [St Johns Wart]** - **More common due to less adverse effects, and risk of dependency** - **Safer than other antidepressants** - **Always ask if they have suicidal ideations** **SNRI:** - **Fourth category of antidepressants** - **DO NOT TAKE WITH OTHER ANTIDEPRESSANTS** **Chapter 22: Psychotherapeutic Agents** - **Used to treat psychoses: perceptual and behavior disorders** - **Drugs do not cure the disorder -- help patients function in a more acceptable manner and carry on activities of daily living** - **Used in both children & adults** **Antipsychotic/Neuroleptic** - **[Action:]** - [ **Block dopamine receptors**]**, preventing stimulation of the postsynaptic neurons by dopamine** - **[Contradictions:]** - **Underlying diseases that could be exacerbated by dopamine-blocking effects on these drugs (i.e: parkinson's disease can be contraindicated)** - **[Indications: ]** - **Schizophrenia, hyperactivity, combative behavior, agitation in the elderly, severe behavioral problems in children** - **[Adverse Effects: ]** - **Sedation** - **Weakness** - **Tremors** - **Constipation** - **Drowsiness** - **[\*Extrapyramidal Effects\*]** - **Pseudoparkinsonism: symptoms look like Parkinson's (slow movement, muscle stiffening, shuffled walk)** - **Dystonia: involuntary muscle contractions; involuntary upward eye movement** - **Akathisia: inability to remain still; restlessness; feet constant motion, rocking back & forth** - **Tardive Dyskinesia: uncontrollable, abnormal, and repetitive movements of the face, torso, and/or other body parts; involuntary and abnormal movements of jaw, tongue, and lips; Typical symptoms is sticking out the tongue, sucking, or fishlike movements in the mouth.** - **Dry Mouth** - **Nasal Congestion** - **[\*Neuroleptic Malignant Syndrome]\*: Life threatening reaction to an antipsychotic** - **F: fever** - **E: encephalopathy: damage or disease to the brain** - **V: vitals are unstable** - **E: elevated enzymes in lab work** - **R: rigid muscles** **Mental Disorders and Their Classification:** - **[Schizophrenia:] Hallucinations, paranoia, delusions, speech abnormalities, and affective problems** - **Schizophrenia caused by strong genetic association** - **Antipsychotics/Neuroleptic drugs: \*Fluphenazine\*** - **[Bipolar]: Extremes of depression followed by hyperactivity and excitement** - **Cause: May reflect a biochemical imbalance followed by overcompensation on the part of neurons and their inability to re-establish stability** - **Antipsychotics/Neuroleptic drugs: \*Lithium\*** - **[Action: ]** - **[Inhibits the release of norepinephrine and dopamine, but NOT serotonin, from stimulated neurons]** - **Alters sodium transport in nerve and muscle cells** - **Adverse Effects:** - **[Effects directly related to the lithium serum level ]** - **Therapeutic lithium level: \< 1.5 mEq/L** - **Lithium toxicity** - **s/s: changes in weight, thyroid, cognitive ability \*weird things happen while taking lithium = lithium toxicity\*** - **Considerations:** - **Monitor for sodium depletion (normal sodium 135-145)** - **Watch for s/s of mania or depression because they may become heightened** - **Monitor use of diuretics, sodium follows water; low sodium increases risk for arrythmias** - **[Narcolepsy:] Daytime sleepiness and sudden periods of loss of wakefulness** - **Cause: [ ] Problems with stimulation of the brain by reticular activating system (RAS); problems with response to that stimulation** - **Drug: \*CNS Stimulant\*** - **[Attention deficit disorders (ADD):] Inability to concentrate on one activity for longer than a few minutes** - **State of hyperkinesis** - **Usually diagnosed in school aged children, but can occur in adults** - **Drug: \*CNS Stimulant\*** **Chapter 23: Antiseizure Agents** **Epilepsy:** - **[Most prevalent] of the neurological disorders** - **Seems to be caused by abnormal neurons sensitive to stimulation or prone to over-responsiveness** - **[Seizures]** - **A loss of control** - **Frightening to patients** **Classification of Seizures** - **[Grand mal (Tonic-clonic seizures) ]** - **Tonic: Stiffening** - **Clonic: Jerking or Twitching** - **[Petit Mal (absence seizures) ]** - **Brief, sudden lapses in attention** - **Partial: One hemisphere of the brain** - **Generalized: Both hemispheres of the brain** - **Myclonic: brief, shock- like jerks of a muscle of a group of muscles** - **Febrile: convulsion in a child that's caused by a fever** - **Jacksonian: focal partial seizure, also known as a simple partial seizure** - **Psychomotor: Typically limited to the temporal lobe of the brain and results in impairment of responsiveness and awareness to ones surrounding** - **[Status Epilepticus:] Lasts longer than 5 minutes, or having more than 1 seizure within a 5 minute period, without returning to a normal level fo consciousness between episodes** - **[Post-ictal phase:] right after seizure; tired, out of it, body went through something very violent** **Drugs for Treating Generalized Seizure:** - **Work generally on the CNS, sedation and other CNS effects often result** - **Major adverse affect: respiratory depression** **Hydantoins:** - **\*Phenytoin\*** - **Generally less sedating; not as strong** - **Therapeutic range: 10-20 mcg/mL** - **When you first start, loading dose is required; Higher dose to acclimate your body** - **Monitor for gingival hyperplasia (overgrowth of the gums); very common in seizure patients** - **Adverse effects: CNS depression** - **Drug-Drug interaction: Alcohol** **Barbiturates and Barbiturate- Like Drugs:** - **\*Phenobarbital (Solfoton, Luminal)\*** - **Used for seizures and anxiety** - **No reversal drugs (it's a -barbital)** - **Can become dependent** - **Significant CNS depression** **Benzodiazepines:** - **\*Clobazam\* \*Clonazepam\* \*Diazepam\*** - **Used for seizures** - **Reversal drug available \*flumazenil\*** - **Can become dependent** - **CNS Depression** **Succinimides:** - **Most frequently used to treat [absence seizures]** - \*Ethosuximiden\* (zarotin) - \*Methsuximide\* (celotin) - **Suppress the abnormal electrical activity in the brain that is associated with absence seizures** - **Adverse Effects: CNS depressant** **Chapter 24: Antiparkinsonism Agents** **Parkinson's Disease:** - **Progressive chronic neurological disorder** - **Degeneration of substantia nigra (these are your nerve cells that allow for movement, over time these cells die, or become impaired, when these cells are impaired, they lose the ability to produce dopamine)** - **Therapy is aimed at management for signs & symptoms** - **[Cardinal Signs: ]** - **Tremors** - **Bradykinesia (slow movements)** - **Rigidity (stiffness)** - **Postural Instability** - **\*\* LOW dopamine & HIGH Acetylcholine levels\*\*** - **Allow patients to be independent; if you take away independence they will become more depressed** **Dopaminergic (Type 1 Drugs Increase Dopamine):** - **\*Levodopa (generic)\*** - **Increases dopamine** - **If dopamine levels don't rise enough you will switch to the carbidopa-levodopa** - **Causes dopamine levels to increase** - **[Mainstay of treatment for parkinsonism ]** - **[Almost always given in combination with carbidopa as a dixed combination drug ]** - **\* Carbidopa- Levodopa (Sinemef)\*** - **Carbidopa allows levodopa to pass through the blood brain barrier.** - **"Protector" of levodopa** - **Causes dopamine levels to increase** - **Carbidopa prevents levodopa from being broken down in the bloodstream** - **Actions:** - **Increasing the levels of dopamine in the substantia nigra** - **Directly stimulating the dopamine receptors in that area** - **Indications:** - **Relief of the signs and symptoms of idiopathic Parkinson's Disease** - **Contraindications:** - **Pregnancy** - **Known allergy** - **Adverse Effects:** - **SLOW; Hypotension** - **Drug-Drug Interactions:** - **MAOIS** **Anticholinergic Agents (Type 2 Drug: Lowers Acetylcholine)** - **\*Benztropine (Cogentin)\*** - **\*Diphenhydramine (Benadryl)\*** - **Blocks the action of acetylcholine** - **Adverse effects: CNS effects** - **Drug-Drug interaction: other anticholinergics, antipsychotics** **Chapter 25: Muscle Relaxants** - **Spasms are in the extrapyramidal tract: modulates unconsciously controlled muscle activity; allows the body to make automatic adjustments in posture & position** - **\*Cyclobenzaprine (Flexeril)\*** - **Actions:** - **Works in upper levels of CNS to interfere with reflexes causing muscle spasm** - **Indications:** - **Alleviation of signs and symptoms of spasticity; use in spinal cord injuries or diseases** - **Adverse Effects:** - **\*Drowsiness\*** - **Fatigue** - **Dry mouth** - **Weakness** - **Confusion** - **Nausea** - **Headache** - **Hypotension** - **Drug-Drug interactions:** - **CNS Depressants** - **Alcohol** - **\*Dantrolene Sodium (Dantrolene)\*** - **[Assess:]** - **[Respiration and adventitious (abnormal) sounds; pulse, electrocardiogram, and cardiac output; bowl sounds and reported output; and liver and renal function tests ]** - **Drug-Drug interactions:** - **Estrogen** - **Adverse Effects:** - **Fatigue** - **Weakness** - **Confusion** - **GI Irritation** - **Enuresis** - **Contraindications:** - **Hepatic Disease** - **Known Allergy** - **Lactation** - **Spasticity** - **Cautions:** - **Women** - **All patients older than 35 years** - **Cardiac disease**