Pharm 126 Exam 3 Concept Review PDF

**Pharm 126 -- Exam 3 Concept Review** **[Chapter 12]** **Barbiturates- (phenobarbital and pentobarbital) have Central Nervous System depressive effects due to which mechanism of action: enhances the activity of GABA, an inhibitory neurotransmitter.** **In 2016 the US Food and Drug Administration...

**Pharm 126 -- Exam 3 Concept Review** **[Chapter 12]** **Barbiturates- (phenobarbital and pentobarbital) have Central Nervous System depressive effects due to which mechanism of action: enhances the activity of GABA, an inhibitory neurotransmitter.** **In 2016 the US Food and Drug Administration (FDA) issued a black box warning for all opioids and all benzodiazepines regarding the risk of combined use. The combination should be used only if no other alternatives are available. Risks include extreme sleepiness, respiratory depression, coma, and death.** **diazepam (Valium)** was the first clinically available benzodiazepine drug; as such, it is the prototypical benzodiazepine. It has varied uses, including treatment of anxiety, mild sleep disturbances, procedural sedation and anesthesia adjunct, anticonvulsant therapy, and skeletal muscle relaxation following orthopedic injury or surgery. **temazepam (Restoril)** an intermediate-acting benzodiazepine, is actually one of the metabolites of diazepam and normally induces sleep within 20 to 40 minutes. Temazepam has a long onset of action, so it is recommended that patients take it approximately 1 hour prior to going to bed. **\*Disruptive to REM sleep and longer acting to a degree (although not as much as barbiturates) and, thus, can result in daytime sleepiness ([a hangover effect]).** **Herbal Supplement- Kava** Used to anxiety, and stress and promote sleep. - Contraindicated in patients with Parkinson\'s disease, liver disease, depression, or alcoholism; in those operating heavy machinery; and in pregnant and breastfeeding women - May cause temporary yellow skin discoloration (**long-term use**) and visual disturbances **eszopiclone (Lunesta) -- Non- benzodiazepine** is the first hypnotic to be FDA approved **for long-term use**. As with other hypnotics, patients should allot 8 hours of sleep time and should avoid taking hypnotics when they must awaken in less than 6 to 8 hours. **midazolam (Versed)** is most commonly used preoperatively and for moderate sedation. It is useful for this indication due to its ability to cause amnesia and anxiolysis (reduced anxiety) as well as sedation. Reversal Agent: **ramelteon (Rozerem)** **baclofen (Lioresal)** Baclofen is a skeletal muscle relaxant. The client should be cautioned against the use of alcohol and other CNS depressants, including sedatives because baclofen potentiates the depressant activity of these agents. Limiting fluid intake is not necessary. If dyspepsia occurs, the client could take the medication with food. **Patients may have a baclofen pump implanted for continuous dosing: used to treat chronic spastic muscle disorders** **Zolpidem (Ambien)** is a short-acting nonbenzodiazepine hypnotic. Its short half-life and its lack of active metabolites contribute to a lower incidence of daytime sleepiness compared with benzodiazepine hypnotics. **One special concern with this particular dosage form is the possibility of somnambulation, or sleepwalking, which has been reported with its use.** **Pentobarbital (Nembutal)** is a short-acting barbiturate. Formerly prescribed as a sedative-hypnotic for insomnia, pentobarbital is now principally used preoperatively to relieve anxiety and provide sedation. In addition, it is used occasionally to control status epilepticus. Pentobarbital may also be used to treat withdrawal symptoms in patients who are physically dependent on barbiturates or nonbarbiturate hypnotics. **cyclobenzaprine (Flexeril)** Common muscle relaxant. Muscle relaxants are a group of compounds that act predominantly within the CNS to relieve pain associated with skeletal muscle spasms. Most muscle relaxants are known as centrally-acting skeletal muscle relaxants because their site of action is the CNS. **[Chapters 26 & 54]** **Heparin** The overall effect of heparin is that it turns off the coagulation pathway and prevents clots from forming. - Will need to frequently monitor bleeding times using tests such as **activated partial thromboplastin time (aPTT)** - Reversal agent: Protamine Sulfate **Warfarin (Coumadin)** works by inhibiting vitamin K synthesis by bacteria in the gastrointestinal (GI) tract. - requires careful monitoring of the prothrombin time/international normalized ratio (PT/INR) - A normal INR (without warfarin) is 1, **whereas a therapeutic INR (with warfarin) ranges from 2 to 3.5, depending on the indication for use of the drug** (e.g., atrial fibrillation, thromboprevention, prosthetic heart valve) - Herbal products can interact with warfarin and result in increased risk for bleeding including dong quai, **garlic**, and ginkgo. St. John's wort decreases warfarin's effect. - Need to watch intake of green leafy vegetables and foods high in Vit K - Taken with NSAIDs increase risk for excessive bleeding (Ibuprofen, motrin, ASA) **enoxaparin (Lovenox) is the prototypical low molecular weight heparin and is obtained by enzymatically cleaving large unfractionated heparin molecules into small fragments.** - Laboratory monitoring, as done with heparin therapy, is not necessary when enoxaparin is given because of its greater affinity for factor Xa. - Available only as a SQ injectable - Patient education required for home use: monitor signs of bleeding, rotation of injection sites **Rivaroxaban (Xarelto)** is an oral factor Xa inhibitor approved for use as a postoperative thromboprophylaxis**.** Prevents clot formation is of benefit in certain settings in which there is a high likelihood of clot formation. **Epoetin alfa (Epogen, Procrit)** is a biosynthetic form of the natural hormone erythropoietin, which is normally secreted by the kidneys in response to a decrease in RBCs. It promotes the synthesis of erythrocytes (RBCs) by stimulating RBC progenitor cells in the bone marrow. Used to treat anemia. - **Normal Hgb:** for men ranges from 13.5 to 17.5 g/dL. Normal range for women is 12.0 to 15.5 g/dL - Guidelines recommend that the drug be stopped when the hemoglobin level reaches 10 g/dL for cancer patients, 11 g/dL for renal patients - **Hypertension** is an adverse effect of hematopoietic drugs, along with headache, fever, pruritus, rash, nausea, vomiting, arthralgia, cough, and injection site reaction **Thrombolytic Therapy** coagulation modifiers that lyse thrombi in the coronary arteries, which supply the heart with blood. This reestablishes blood flow to the blood-starved heart muscle - indications for thrombolytic therapy include acute MI, arterial thrombosis, DVT, occlusion of shunts or catheters, PE, and acute ischemic stroke - **The most common undesirable effects of thrombolytic therapy are internal, intracranial, and superficial bleeding**. Other problems include hypersensitivity, anaphylactoid reactions, nausea, vomiting, and hypotension. These drugs can also induce cardiac dysrhythmias **Antiplatelet Therapy** modifiers that prevent clot formation comprises the antiplatelet drugs. Remember, the anticoagulants work in the clotting cascade. In contrast, antiplatelet drugs work to prevent platelet adhesion at the site of blood vessel injury, which actually occurs before the clotting cascade - Common antiplatelets: **aspirin**, cilostazol (Pletal), clopidogrel (Plavix), Prasugrel (Effient) Treprostinil (Remodulin), abciximab (ReoPro), eptifibatide (Integrilin), tirofiban (Aggrastat), anagrelide (Agrylin), dipyridamole (Persantine) - Apirin is officially recommended by the American Stroke Society for stroke prevention in daily doses of 50 to 325 mg. (However, in clinical practice, dosages may vary, with the most common dose being 81 mg/day - Aspirin is an antiplatelet most commonly given daily to prevent cardiac events **Iron** Essential mineral in the body, oxygen carriers for hemoglobin and myoglobin, deficiency of this mineral is the principal nutritional deficiency resulting in anemia. Can give Oral, IM, IV. - Most common adverse effects are GI related: nausea, vomiting, upset stomach - **Recommend to drink liquid oral with a straw to prevent staining of the teeth** - **When giving an IV dose, administer a test dose and assess for signs of reaction/anaphylaxis** **Some foods enhance iron absorption:** - Orange juice (vitamin C) - Veal - Fish - Ascorbic acid **Some foods impair iron absorption:** - Eggs - Corn - Milk/yogurt (calcium) **THE Z-TRACK METHOD of I.M. injection prevents leakage of irritating and discoloring medications (such as *iron dextran*) into the subcutaneous tissue.** Z-Track Injection \| Definition and Patient Education Liquid oral forms of iron need to be taken through a plastic straw to avoid discoloration of tooth enamel.