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119 Cards in this Set
- Front
- Back
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What do sedative's do?
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Relieve anxiety with a lower does then hyponotics.
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What do hypnotics do?
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Promotes sleep with a higher dose than sedatives.
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What is insomnia?
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Poor sleep that causes distress or impairment for 6 months or longer. Average less than 6.5 hours per day.
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What are health sleep habits (Sleep Hygiene)?
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Avoid alcohol, nicotine, caffeine, and chocolate. Cut down on non-sleeping time in bed. Do not "try to sleep". No visible bedroom clock.
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How is insomnia treated?
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Treated with BZDs and BDZ-like drugs. Should only be for short term use. Or Anithistamines that make you drowsy
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Name BZD-like drugs?
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Zolpidem (Ambien)
Eszopiclone (Lunesta) Zapelon (Sonata) - 4 hours |
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Explain BZD-like drugs?
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Limited binding to BZD site of GABA recptor-CL channel site. They are widely used for quick onset, few SE, low hangover rate. Can intensify CNS depressants
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How does Benzodiazepines (BZDs) work?
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Enhance GABA rather than mimicking, which limits the amount of CNS Depression.
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What are the uses of BDZ's? Name a BZD for each use?
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Sedation= Triazopam (Halcion)
Insomnia= Lorazapam (Ativan) Seizures= Diazepam (Valium) |
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What limitations regarding tolerance and BZDs are there?
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No tolerance to Sedative/hypnotic effects
Tolerance develops for anti-seizure effects |
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What risk with BZDs is there for physical dependency?
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Uncommon, but higher with Xanax. Warn about withdrawal- can be a bigger problem with long-term or high dose therapies
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How would you treat an overdose of BZDs? Reversal Agent?
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Gastric Lavage, activated charcoal, and Romazicon (watch for seizures)
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Name a Barbiturates? With uses?
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Hypnotic/Sedative= Secbarbitol (Seconal), Pentobarbitol (Nembutol)
AntiConvulsants= Phenobarbitol Surgical= Thiopental (Pentothol) |
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Why are barbiturates dangerous?
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They directly mimic GABA and there is no limit to the degree of CNS depression they can produce.
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What type of tolerance occurs with Barbiturates?
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Tolerance develops to sedavite/hypnotic effect, but NOT to toxic effects.
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What is hyperalgesia?
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Increase sensitivity to pain. Can cause pain in joints and along nerves. A SE of Barbiturates.
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Barbiturates physical dependency and abuse?
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Common problem and severe withdrawal syndrome (can be fatal). Taper slowly.
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Catharsis vs. Laxative effects?
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Prompt, fluid evacuation vs production of soft formed stool
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What is the Bristol Stool Scale?
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a Chart used to characterize poop. Stool form depends on the amount of time spent in the colon. Types 1 &2 Constipation and Type 7 Diarrhea
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When is a laxative use warrented?
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Reduce painful defecation, straining, adjunt to anthelmintic, Surgery prep, tx and prevention of constipation
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When is a laxative contrindicated?
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s/s appendicitis, fecal impaction, bowel obstruction, and pregnancy/lactation
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How do Bulk- forming agents work?
Name one? |
Nondigestible and give with water
Metamucil,- pass a lot of gas Citrucel- easier to use Dietary Fiber |
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How do stool softners/surfactants work?
Name one? |
Lowers stool surface tension, takes days to work, give with water.
Ducusate sodium (Colace) Docusate calcium (Surfak) |
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How do lubricants/ emollients work?
Name one? |
Makes the stool slippery. Watch for Lipid PNA, anal leakage.
Mineral Oil |
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How do Hyrdating (Osmotics) Agents work?
Name one? |
Poorly absorbed salts- draws water into intestines. Takes about 8 hrs.Can cause too much water loss.
Mg Hydroxide, Mg Cl, Na Phos, Glycerin Suppository |
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How does Polyethylene Glycol?
Name One? |
Nonabsorbable osmotic agent wih K Cl, Na Cl, Na Solfate, Na Bicarbonate. Used for Bowel Prep.
Polyethylene Glycol(GoLYTELY) |
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How do Stimulant/ Irritant?
Name one? |
Stimulate intestinal motility, alter water and electrolyte secretion.
Cascara Bisacodyl (Dulcolax) Senna (Ex-lax) Caster Oil |
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How do Anticolgulants work?
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Used for Venous Thrombi, enhances the antithrombin activity= inactives thrombin and factor Xa. Production of fibrin is reduced and clotting is suppressed.
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Risk factors for DVT
In hospital? Out of hospital? |
Immobility, surgery and trauma
Smoking, truck drivers, long airplane rides, obesity, births |
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What are the anticoagulant therapies?
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Heparin, Lovenox, Warfarin (Coumadin)
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Pro's and Con's of Heparin Therapy?
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Anticoagulant
Rapid onset, doesnt cross placent, inexpensive, easily reversed with PROTAMINE vs. Freq. Monitering aPTT, bleeding, HIT |
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What is Heparin Induced Thrombocytopenia (HIT)?
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potentially fatal immune-mediated disorder. HIT should be suspected when platelets fall rapidly.
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Pro's and Con's of Lovenox?
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Low Molecular weight. predictable plasma levels, doesn't require monitering vs. expensive
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Pros and Con's of Warfarin (Coumadin)?
Monitered by what level? |
Vit. K antagonist anticoagulant
Oral dosing vs Protein bond takes three days to reach peak levels, many drug reactions INR |
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How do Antiplatelet therapies work?
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Prevents thrombus formation in Arteries, which would result in an heart attack
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What are the anitplatelet therapies? Name one for each therapy?
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ASA=
Asenosine diaphosphate receptor antagonist= Plavix Glycoprotein IIb/IIa receptor antagonist= Aggrastat |
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How do ASA's work?
Uses? |
Suppresses platele aggregation by causing irreversible inhibition of COX
Stroke, TIA, MI, CABG patency, unstable angina |
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How do Adenosine Diphosphate Receptor Antagonist (ADP's) work?
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Causes irreversible blockade of ADP receptors on platelet surface. Exerts its action for the life of the platelets
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Name an ADP's?
Uses of an ADP's? |
Clopidogrel (Plavix)
Ticlopidine (Ticlid) Prevention of MI and CVA |
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How do Glycoprotein IIa/IIb receptor antagonist (Super Aspirins) work?
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Inhibits the final step of platelet aggregation. Most effective antiplatelet drug available. Given after a PCI
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Name a Super Aspirin?
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Abeiximab (Reo Pro)
Tirofiban (Aggrastat) Epifibatide (Integrelin) |
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How do thrombolytic therapy work?
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Clot busters , remove thrombi that have already formed. Acts by activation of plasminogen into plasmin= digest clots
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Name a thrombolytic therapy?
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-ase ending= Streptokinase, Alteplase (tPA), Tenecteplase (TNKase), Reteplase, Urokinase.
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Precaution to take with thrombolytic therapies?
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Causes bleeding so insert IV's, NG tubes, foleys and all other tubes needed before thrombolytic administration.
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How to moniter and reverse thrombolytic therapies?
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Moniter by thrombin time and reverse with Fresh frozen plasma or cryopreipitate
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What are the types of Depression?
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Dysthymia, Bipolar disorder, Seasonal affective disorder, and Postpartum Depression
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What are the treatments for depression?
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TCA's, SSRI's, MAOI's
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What is depression?
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At least symptoms for two weeks or more and must be a change from previous functioning.
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What are the signs and symptoms of depression?
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Depressed mood, loss of interest, In/decreased appetite, weight, insomnia, psychomotor agitation, fatigue, feeling worthless, thoughts of suicide/death...
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What is the theory of depression?
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Depression is caused be functional insufficiency of monoamine neurotransmitters- NE, serotonin or both.
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Name a TCA?
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Amitriptyline (Elavil)- most common
Doxepin (Sinequan) Imipramine (Tofranil) |
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What are the side effects of TCA's?
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Orthostatic Hypotension, sedation, anticholinergic effects, diaphoresis, cardiac toxicity, seizures
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What is a TCA? Use?
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Tricyclic AntiDepressants
Treatment for depression |
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What is a fatal dose of a TCA? Drawback
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Lethal dose is only 8 times average daily dose!
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How long does it take TCA's to work?
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Initial Response- 1-3 weeks
Max Response 1-2 months Long half life |
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What is the treatment for TCA overdose?
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Gastric Lavage followed by activated charcoal and Physiostiamine , Antirrhythmics
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What is an MAOI's?
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Monoamine Oxidase Inhibitors
Antidepressant effects of MAOIs result from inhibiting MAO in nerve terminals |
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What foods are contra indicated with MAOIs? What does it do?
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Tyramine rich foods such as: CHEESE, cured meats, alcohol, and liver
Causes massive vasoconstriction and excessive cardiac stimulation |
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What is a drawback with taking MAOI's?
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Many Drug reactions
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Name a Monoamine Oxidase Inhibitors (MAOIs)?
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Selegiline (Eldepryl)
Phenelzine (Nardil) |
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What are the uses of MAOIs?
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Depression (when other meds fail), Bulimia, OCD, Panic Disorders
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What is a SSRI's? Mechanism of action?
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Selective Serotonin Reuptake Inhibitors
Produces selective inhibition of serotonin reuptake; intensifies transmissional at serotonergic synapses. |
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Name a SSRI's?
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Fluoxetine (Prozac)
Paroxetine (Paxil) Sertraline (Zoloft) Fluvoxamine (Luvox) |
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What are the therapeutic uses of SSRI's?
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Major depression, anxiety disorders, OCD, Bulimia, premenstrual dysphoric disorder
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Why are SSRI's so great?
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Safer and better tolerated than TCA's and MAOI's. Half life is two days, and there have been no OD deaths reported
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What are some side effects of SSRI's?
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Sexual dysfunction (#1 reason why clients discontinue), Nausea, H/A. insomnia, anxiety
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Name a Benzidiazepines (BZDs)?
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Loraepam (Ativan)
Diazepam (Valium) Alprazolam (Xanax) Clorazepate (Tranxene) |
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What are the side effects of BZDs?
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CNS depression, respiratory depression, paradoxical effects, antegrade amnesia, abuse
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What drugs are used fro Anti-Anxiety agents?
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BZDs, Buspar, antihistamines, antidepressants, AED's, Atypical antipsychotics
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What happens with abrupt discontinuation of BZDs after chronic use?
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Phyiscal dependence withdrawal?
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Name a Buspirone?
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Buspar
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What are the pro/cons of Buspar?
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No sedation, CNS depression, abuse vs. slow effect 1-4 weeks, don't give with grapefruit juice
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Can Buspar be a PRN medication?
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No, because it has a slow effect 1-4 weeks
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Why is Buspar good for anti anxiety?
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It is not a BZD and therefore No CNS depression or sedation
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What is Bipolar Disorder?
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Manic depression. Results in pathological mood swings from mania to depression
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Name the drugs that are used for mood disorders?
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Lithium, Valproic Acid (Depakote), Lamtrigine (Lamictal), AED's
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Does Lithium need to be monitered? And if so how?
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Yes, dosing is highly individualized. Adjustments are based on plasma drug levels (1.0- 1.5 mEq/L) and clinical response. Compliance is an issue TID or QID
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What are the adverse side effects of Lithium?
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Therapuetic- GI Upset, Confusion, renal toxicity, goiter
Exessive- Ataxia, seizures, giddiness, hypotension, tinnitus, oliguria, coma, death |
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What is Valproic Acid (Depakote)
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An AED, first line of treatment for BPD, Better tolerated, fast onset, and need to moniter plasma levels
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Does Depakote need monitering?
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Yes, the plasma levels need to be monitered.
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What is Lamictal?
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An AED, this drug is gaining in popularity for BPD. It is expensive, but plasma levels do not need to be monitered.
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What is the side effect of Lamictal?
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Steven-Johnson Rash
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What is psychosis?
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is a thought disorder characterized by distrubancesof reality and perception, impaired cognitive functioning, and inapproproate or diminished affect
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What is the use of Antipsychotic drugs?
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Schizophrenia and other psychotic disorders
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What is the problem with Antipsychotic drugs?
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The make the person seem normal, but doesn't increase life satisfaction.
EPS and NMS |
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Name a Antipsychotic drug?
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Chlopromazine (Thorazine)
Haloperidol (Haldol) |
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What is Tardative Dyskinesia?
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Side effect of antipsychotic drug- involuntary movements, irreversible
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What is Neuroleptic Malignant Suyndrome (NMS)? S/S?
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Side effect of antipsychotic drug. Primary sign- lead pipe rigidity, fever, sweating, autonomic instability
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Thorazine vs Haldol?
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Both are conventional antipsychotic- Phenothrazines
Low-potency, Superior psychotic relief vs. high potency, less sedation and hypotension, used for Schizo, tourettes |
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What is EPS?
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Extrapyramidal symptoms = acute dystonia, parkinsonism, and tardative dyskinesia
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How is EPS treated?
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acute dystonia = Benadryl, Parkinsonism= Parkinson meds, and tardative dyskinesia= Antipsychotic meds
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Name an Atypical Antipsychotic Agent?
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Clozapine (Clozavil)
Risperidone (Risperdal) Olanzapine (Zyprexa) |
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What are Atypical antipsychotic Agents used for?
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Schizophrenia- causes fewer EPS than conventional agents
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What is a Clozapine (Clozaril)? Side effects?
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Atypical antipsychotic agent- cause agranulocytosis
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What is Risperidone (Risperdal)? Side effects?
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Atypical antipsychotic agent- few side effects and popular drug
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What is the treatment for NMS?
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D/c drug, hydration, monitering, cool blankets, and meds= BZDs, Dantrium, or Parlodel
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What is Electroconvulsive Shock Therapy (ECT)?
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Safe and effective used to treat depression and psych disorders
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What is the patho of Parkinsons?
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Loss of dopamine producing cells of the sustantra nigra. There is an unbalance between ACh and dopamine
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Why can't we just give patients dopamine?
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Dopamine doesn't cross the blood brain barrier and it has a very short half life.
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What are the signs and symptoms of Parkinson's diease?
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Tremor, rigidity, bradykinesia, postural instability.
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What is the first line of defense for Parkinson's?
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Dopamine Agonist such as Not-Ergot Receptors and Ergot Derviates
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Name a Non-Ergot Receptors?
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Pramipexol (Mirapex)
Ropinrole HCL (Requip) Pregolide Mesylate (Permax) |
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Name a Ergot Derviates?
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Bromocriptine Mesylate (Parodel)
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What are the side effects of Non-Ergot Receptors?
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N/V, Constipation, dizziness, orthostatic hypotension, daytime somnlence, hallucinations
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What are the side effects of Ergot Derviates?
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N/V, Pysch distrubances, nightmares, orthostatic hypotension, dyskinesias
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What drugs are used for Parkinson's Disease?
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Dopamine Agonists, Anticholinergics, MAO-BIs, Levodopa- Carbidopa
Mono or adjunct therapy |
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Name an Anticholinergics used for Parkinsons? S/S
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Trihexphenidyl HCL (Artane)
Benztropine Mesylate (Cogentin) Can't Pee, see, poop and spit |
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Name a MAO-BI used for Parkinson's? Use?
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Slegiline HCL (Eldepryl)
May retard PD progression |
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What interactions are you concerned with, with MAO-BIs?
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Cheese Rx and Lethal with Demerol
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What does Lepodopa do?
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It crosses the BBB via active transport, but only small fractions reach the brain.
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What is a Drug Holiday?
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Off drug for 10 days, is the treatment for diminished response to Levodopa, better control, needs to be done in the hospital.
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Adverse side effects of Levodopa?
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Nausea, Dyskenisias, Orthostatic Hypotension, Dark sweat and urine, Psychosis, Activation of Malignant melanoma
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What drug reacts with Levodopa?
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MAOIs-
Anticholinergics-Hypertensive Crisis Vitamin B6- Reduces effectiveness High Protein Meals |
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Why is Carbidopa so good?
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It delays conversion of Levodopa into dopamine until it reached the brain.
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Name of Drug with Carbidopa and Levodopa?
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Sinemet, 5yr before durg become ineffective.
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What are the two main classes of seizures?
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Partial (focal) and Generalized
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What is a Tonic Clonic Seizures?
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Grand mal, most common, Aura, Tonic- Rigid no breathing, Clonic- Contration/relaxation, rolled back eyes, frothing, Incontinent, Postictal- Confusion, amnesia, sleep
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What is a Absence Seizure>
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Petit Mal, Brief loss of consciousness, blank stare 10-30 secs, more common in children
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What is an Atonic Seizure?
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Akinetic Seizure or Drop Attack, sudden muscle contraction
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