Pharmacology 2 Exam 3- Quiz 2 (Molly) Pharm 2 exam 3 for Pharmacology and Physiological Functioning II academic year 2020 PDF

Preview

Summary

Pharmacology 2 Exam 3- Quiz 2 (Molly) Pharm 2 exam 3 for Pharmacology and Physiological Functioning II academic year 2020...

Description

Drugs Acting on the Central and PNS: Chapter 23: Anti-Seizure Agents ● Anti seizure Agents ○ Epilepsy: most prevalent neurological disorder ■ Collection of different syndromes ● Caused by ○ Sudden discharge of electrical activity → seizures ○ Overstimulation of the neurons ■ Stimulation of motor neurons ● Tonic clonic seizures: rigidity and relaxation ■ Stimulate sensory neurons ● Temporary loops of consciousness ○ Caused by triggers: smells, flashing lights (sympathetic reaction) ● Nature of seizures ○ Depends on the location of cells discharged in brain / neural pathways ○ Epilepsy ■ Abnormal neurons overstimulated / hypersensitive ● Primary seizures: don’t know what causes them ○ Outside factors that cause seizures ■ Head injury ■ Drug overdose ■ Environmental exposure ○ Classification of seizures ■ Generalized seizures: effects both hemispheres ■ Partial seizures: only affects part of the brain ■ Secondary seizures: they are caused by an outside source such as drugs, alcohol, trauma, tumor in brain, MS, stroke, surgery

● Drugs for Treating Generalized Seizures ○ Stabilize nerve membranes by blocking channels in the cell membrane ○ Alter receptor sites ○ Work on CNS ■ Cause sedation and other CNS effects ○ Affect entire brain / reduce chance of electrical outburst ○ Drugs: stabilize nerve membranes, they work because they cause sedation, lethargy, calm feeling ■ Hydantoins (2nd choice give loading dose then maintenance) ■ Barbiturates / barbiturate-like ■ Benzodiazepines (1st line used in emergency) ■ Succinimides – Modulate the inhibitory neurotransmitter GABA ● Treats absence seizures ○ Types of Seizures ■ General: start in one side of the brain and spread rapidly, experience a loss of consciousness ■ Tonic clonic seizure: involuntary muscle spasms followed by relaxation, causes them to be aggressive, lose consciousness, post ictal stage when the body is recovering (lethargic and snoring) ■ Absent seizures: abrupt brief loss of consciousness, starting at age 3 and with them there are no muscle contractions they just zone out ■ Myoclonic seizures: sporadic periods of muscle contractions that last several minutes ■ Febrile seizures: in children who have high fever which causes them to go into clonic tonic seizures (generally outgrow this one) ■ Status epilepticus: haves multiple seizures w/ very little rest in between, hard on the body since they cant breathe on their own need to be intubated

Phenytoin Expected Pharmacological Action: Hydantoins ● Stabilize nerve membranes directly by influencing ionic channels ● Decrease excitability / hyperexcitability ● Reduce tonic-clonic muscular responses ● Reduce emotional responses

Who is it used to Treat?:

Adverse Effects: ● CNS effects: CNS depression, confusion, drowsiness, fatigue ● CV effects: cardiac arrhythmias., change in BP, ● GI effects: constipation, dry mouth, gingival hyperplasia: gums overtake their teeth causes bleeding ● Integumentary effects: urinary retention, decreased libido, severe liver toxicity, bone marrow suppression, Stephen johnson syndrome, malignant lymphoma, cellular toxicity

How do we administer it? ● PO, IM, IV ● If given IV needs to be given through a filter & w/ normal saline ○ If given w/ dextrose turns into a clump in the tubbing and needs changed

Contradictions ● Allergies ● P/L: causes birth defects ● Elderly/debilitated ○ Increases CNS depression ● Renal/Liver dysfunction ○ Hard on the liver ● CV disease: increase risk of MI ● Coma/depression/psychosis ○ Makes them all worse

Drug/Food Interactions? ● Alcohol: will cause CNS depression ● Multiple drugs – Check reference book prior to administration ● Many herbs (Primrose): increases risk of seizures ●

Nursing Interventions ● Monitor phenytoin levels ● Watch for bone marrow suppression

Patient Education: ● Barrier contraceptives ○ Use condoms

● Treatment of seizures

Therapeutic levels: 10-20mcg/ml (narrow margin) ● Over 20 or under 10 increased risk of seizures

○ Increased risk of bleeding, infection, etc ● If given IV needs to be given w/ a filter and normal saline ● Cause phlebitis ○ Needs changed after ● Assess site frequently How do we know its working? ●

Other: ● Well absorbed in the Gi tract ● Metabolized in liver/ excreted in urine

Phenobarbital, Primidone

Expected Pharmacological Action: Barbiturates & Barbiturate Like Drugs ● Inhibit impulse conduction in RAS ● Depress cerebral cortex ● Alter cerebellar function ● Depress motor nerve output ● Stabilize nerve membranes

Who is it used to Treat?: ● Phenobarbital ○ Decreases in conduction in the lower brain stem

Adverse Effects: ● CNS effects: cns depression, confusion, drowsiness, reduce hypnosis, put a pt in a deep coma, ● CV effects: cardiac arrhythmias, changes in BP, ● GU effects: urinary retention, ● Dermatological effects: Stephen johnson, physical dependence, withdrawal syndrome

How do we administer it? ● Phenobarbital: IV or oral ● Primidone: Oral only

Contradictions ● Allergies ● P/L: causes birth defects ● Elderly/debilitated ○ Increases CNS depression ● Renal/Liver dysfunction ○ Hard on the liver ● CV disease: increase risk of MI ● Coma/depression/psychosis ○ Makes them all worse ● Latent Porphyria

Drug/Food Interactions? ● Alcohol ○ Causes CNS depression

How do we know its working? ●

Other: ● Have long half life ● Long onset

Clonazepam, Diazepam, Lorazepam

Expected Pharmacological Action: Benzodiazepines ● Potentiate GABA effects ● Act in the limbic system and RAS ● Stabilize nerves membranes to decrease hyperexcitability / excitability

Who is it used to Treat?: ● Reduces tonic-clonic seizures as well as muscular and emotional responsiveness ● Lorazepam can be given sublingual ○ Dissolving tablet ● Alcohol Withdrawal

Adverse Effects: ● CNS effects: cns depression ● Physical dependence/ withdrawal symptoms ○ Need weaned off

How do we administer it? ● Available in PO, IM, IV, rectal form

Contradictions ● Allergies ● P/L: causes birth defects ● Elderly/debilitated ○ Increases CNS depression ● Renal/Liver dysfunction ○ Hard on the liver ● CV disease: increase risk of MI ● Coma/depression/psychosis ○ Makes them all worse

Drug/Food Interactions? ● Alcohol ○ Causes CNS depression and stops breathing all together

Nursing Interventions ● Clonazepam ○ Loses its effectiveness after 3 months needs dose adjusted

Patient Education: ● Don't stop suddenly

How do we know its working? ●

Other: ● Metabolized in liver/ excreted in urine ● Long half life: 18-50 hrs

Ethosuximide

Expected Pharmacological Action: Succinimides ● Suppress abnormal electrical activity

Who is it used to Treat?: ● Absence seizures

Adverse Effects: ● CNS effects: depression, drowsiness, fatigue, ataxia, insomnia, headache, blurred vision ● GI effects: N,V, D, C, gi pain, wt loss, ● Other effects: bone marrow suppression, fatal hand cytopenia, ● Dermatological: pruritus, hives, alopecia, Stephen johnson syndrome

How do we administer it? ● Oral

Contradictions ● Allergies ● Intermittent porphyria: skin condition with extreme redness, rashes, exacerbates that condition ● Renal / hepatic dysfunction ● P/L

Drug/Food Interactions? ● Primidone ○ Increased risk for seizures

How do we know its working? ●

Other: ● Cross placenta / breast milk ● Absorbed in GI ● Metabolized liver / Excreted urine ● Long half-life: in kids 30 hrs, adults: 60 hrs

Acetazolamide, Valproic Acid, Zonisamide Expected Pharmacological Action: ● Valproic Acid

Who is it used to Treat?: ● Absence Seizures & migraines

○

Reduces electrical activity and increases GABA activity at the inhibitory receptors ● Alters electrolyte movement ● Inhibits voltage sensitive Na and Ca channels

● Acetazolamide ○ Tx Glaucoma by decreasing the aqueous humor (carbonic anhydrase) ● Valproic Acid ○ Tx bipolar by enhancing the mood

Adverse Effects: ● GI effects: gi upset, N/V ● CNS effects: weakness fatigue, paresthesia, dizzy & vertigo ● Dermatologic effects: rash, ● Other effects: bone marrow suppression, renal calculi, ○ Primidone: ween off it

How do we administer it? ● Oral, IV, IM

Contradictions ● Allergy ● P/L ● Kidney/ Liver Dysfunction ○ Valproic acid ● Risk of precipitating seizures ○ Increase risk of seizures

Drug/Food Interactions? ● Anti- seizure meds ○ Increases risk of toxicity ■ (valproic acid) ● Amphetamines ● Quinidine ○ Increase in risk of toxicity w/ tricyclic antidepressant, amphetamines ● Aspirin ○ increases risk of salicylate toxicity

Nursing Interventions ● Zonisamde ○ Needs weaned off it ● Assess contraindications, P/L status, any cardiac issues ● Figure out type of seizure they are having ○ Prepare pt for EEG ● Assess skin for any rashes or issues ● Assess CNS effect ○ Cns depression dizziness headache? ● Baseline Liver, renal, and CBC ● Monitor drug levels ○ Phenytoin and valproic acid

Patient Education: ● Category X ● Take phenytoin on an empty stomach ○ Due to absorption issue ○ If on tube food hold food 1-2 hours before and after administering ● Can't stop drugs suddenly needs weaned off them ● If a young woman able to bear children go on BC and used protection

How do we know its working? ●

Other: ● Metabolized in liver/excreted in urine

● Drugs for treating partial seizures ○ May be a simple partial seizure ■ Moving only one muscle ○ May be a complex partial seizure ■ Series of reactions or emotional changes ● Hallucinations, mental distortion, personality changes, change in LOC , loss of social inhibition, sexual inappropriate, involuntary urination, chewing motion, diarrhea, lip smacking, starts in late teens ○ Symptoms of partial seizures ■ Blank staring, chewing, fumbling, wandering, shaking, confused speech

Carbamazepine, Pregabalin, Topiramate, Gabapentin, Lacosamide, Lamotrigine, Levetiracetam Expected Pharmacological Action: Drugs for Treating Partial Seizures ● Stabilizes nerve membranes

Who is it used to Treat?: ● Pregabalin ○ Tx diabetic neuropathy

○ Altering Na/Ca channels ○ Increasing activity of GABA ● Some inhibits postsynaptic response

● ● ● ●

○ Tx partial seizures ○ Controlled substance 5 Topiramate ○ Tx migraines Lacosamide ○ Tx brain bleeds Lamotrigine ○ Enhances mood or stabilizes it Levetiracetam ○ Given to people who have had a brain surgery used to prevent seizures after it

Adverse Effects: How do we administer it? ● Oral, IV ● CNS effects: depression, irritability, agitation, increase the risk of seizure activity ● GI effects: N,V, anorexia, liver toxicity ● Other effects: can cause upper respiratory infctions, bone marrow suppression, many of these cause black box warning: increased risk of suicide Contradictions ● Allergies ● Bone marrow suppression ○ Watch CBC closely ● Renal/Hepatic Dysfunction ○ Very toxic to liver ● P/L ○ Harmful to baby ● Men considering fathering a child ○ Causes it to be toxic ● Renal Stones ○ Increases risk of developing more

Drug/Food Interactions? ● CNS depressants ○ Increases it ● Alcohol ○ Increases CNS depression ● Hormonal contraceptives ○ Loses effectiveness

Nursing Interventions ● Baseline labs ○ CBC, renal, EEG ● Can be administered with food ● Monitor labs throughout treatment ○ Ween off if you notice adverse effects

Patient Education: ●

● Monitor drug levels for therapeutic effects/levels How do we know its working? ●

Other: ● Absorbed in Gi ● Metabolized in liver/ excreted in urine

Chapter 24: Antiparkinsonism Agents ● Parkinson’s Disease and Parkinsonism ○ Parkinson’s Disease: unilateral trimmers with slow onset ■ Lack of coordination ■ Rhythmic tremors ■ Slow onset ■ Bradykinesia ■ Shuffling gait ■ Drooling / Speech slow/ slurred ■ Top half of body moves faster

● Common injury is falling on their face ■ Difficult with intentional movements ● Tend to be slow and sluggish ○ Parkinsonism ■ Describes the symptoms associated with medication or brain injuries ● Caused by medication or trauma ● Pathophysiology ○ Cause of parkinson is unknown ○ Theories: damage is due to viral infection, trauma to the head, infection, atherosclerosis, exposure to certain drugs, environmental factors, ● Signs and Symptoms ○ RT damaged neurons in basal ganglia ○ Substantia nigra sends nerve impulses to corpus striatum using dopamine ■ Area that is a dopamine rich area, nerve cell body begin to degenerate result in deduction of impulses ○ When dopamine decreases, it allows cholinergic or exciting cells to dominate ● Adjunctive Agents ○ Used to improve patient response to traditional therapy ■ Entacapone ■ Talcapone ■ Selegiline ○ Nursing Consideration- same as dopaminergic agents

Amantadine, Levodopa, CarbidopaLevodopa Expected Pharmacological Action: Dopaminergic Agents ● Goal is aimed at restoring balance of dopamine and ACHE ○ Increase effects of dopamine at sites ● Increases effects of dopamine at receptor sites ● Works in substantia nigra ● Levodopa is precursor of dopamine

Who is it used to Treat?: ● Used for relief of symptoms Parkinson ● Helps to restore balance between dopamine and ACHe ○ Need intact neurons to be able to respond to treatment ● Carbidopa-Levodopa ○ Stops metabolism of levodopa so that there are increased levels to cross the blood brain

○ Crosses the blood brain barrier ○ Converted to dopamine

barrier so dopamine is able to work

Adverse Effects: How do we administer it? ● Anticholinergic effects ● Oral ○ Urinary retention & dry mouth ● Apomorphine is given SQ ● Rotigotine is given transdermal ● CNS effects: anxiety, nervousness, ● Pair it with a laxative headache, malaise, fatigue, confusion, mental changes, blurred vision, muscle twitching ● Peripheral effects: anorexia, constipation, diarrhea, difficult swallowing, hypotension, palpitations, erythema, urinary retention, flushing, hot flashes, bone marrow suppression Contradictions ● Allergy ● Angle-closure glaucoma: due to anticholinergic effects ● P/L ● Suspicious skin lesions: can turn into melanoma ● CV disease: can cause MI ● Asthma: makes it worse ● Urinary tract obstructionsL: makes it worse ● Psychiatric disorders: exacerbates it ● Kidney / liver dysfunction: makes it worse

Drug/Food Interactions? ● MAOIs: decrease effect of levodopa ○ Stop 14 days before starting these medications ● Vitamin B6 ● Phenytoin ● OTC vitamins ● Tyramine-containing foods: mixed with dopamine agents causes serious reactions ● St. John’s wort ● Meperidine

Nursing Interventions ● Want to asses bph, glaucoma, urinary retention ● Monitor vs, cardio status ● do they have MG? ● Current neuro status ● GI status: what are normal bowel patterns for them, diarrhea, constipation, how often, stool color? ● Renal/liver function pt taking these medications need to know how to decrease dose if having adverse effects ● Pt at high risk for heat stroke ● Anticholinergic effects you don’t

Patient Education: ●

sweat so that’s why we overheat and have a heat stroke How do we know its working? ●

Other: ● Dopamine does NOT cross the bloodbrain barrier ● Oral ● Well absorbed in GI ● Metabolized liver / excreted urine

Benztropine Expected Pharmacological Action: Anticholinergic Agents ● Greater affinity for cholinergic receptor sites in CNS ● Block the cholinergic receptors responsible for parasympathetic nervous system postganglionic effectors ● Oppose effects of acetylcholine: hoping to restore that balance ● Restore chemical balance

Who is it used to Treat?: ● Parkinson

Adverse Effects: ● CNS effects: disorientation, confusion, memory loss, agitation, nervousness,

How do we administer it? ● Oral, IM, IV

● GI effects: N/V/ C, ● CV effects: tachycardia, palpitations, low blood pressure, ● Other effects: urinary retention, blurred vision, photophobia, flushing, decreased ability to sweat

Contradictions ● Allergy ● Narrow-angle glaucoma: anticholinergic effect ● GI/GU obstructions: ● BPH ● Myasthenia gravis ● CV disease ● Hepatic dysfunction ● P/L ● Working in hot environments

Drug/Food Interactions? ● Other anticholinergic drugs ● TCAs: high risk for neuroleptic malignant syndrome ● Phenothiazines: fatal paralytic ileus, pinkish reddish urine ● Antipsychotic drugs: toxic psychosis

Nursing Interventions ● Watch lab values ● Assess bowel habits ● Increase fluid intake ● Watch renal/liver function

Patient Education: ● Stay well hydrated

How do we know its working? ●

Other: ● Absorbed in GI ● Metabolized in liver/ excreted in cellular pathways ● Crosses placenta/breast milk

Chapter 25: Muscle Relaxants ● Muscle Relaxants ○ Injuries and accidents result in muscle or skeletal anchors of muscles ○ Lead to muscle spasms and pain ○ Damage to CNS may cause permanent muscle spasticity ○ Can treat neuron damage ○ Work in brain and spinal cord ● Nerves and Movement ○ Posture, balance, movement ■ Regulated by spinal motor neurons ■ Cerebellum: site of conscious movement, balance, gait ■ Basal ganglia: unconscious muscle movement, ■ Cerebral cortex: conscious thought to regulate muscle movement ○ Spinal reflexes: monitor movement and posture, simple reflexes ARCs involves sensory perception in peripheral and spinal nerves stretch receptors ○ Brain control: includes brain stem, basal ganglia, cerebellum, pyramidal tract deals with intentional movement, extrapyramidal movement modulates and controls unconscious controlled activity ○ Cerebral cortex ■ Conscious thought to regulate movement-orientation, head, eye movement

○ Basal Ganglia ■ Unconscious muscle movement- changing positions in bed ■ Lower area of the brain ● Associated w/ coordination of unconscious muscle movements that involve movement and position ○ Frontal Lobe ○ Pyramidal Tract ■ Intentional movement ■ Fibers within the CNS that controls precise intentional movements ○ Extrapyramidal Tract ■ Cells from cortex and subcortical areas including basal ganglia and the cerebellum ● Which coordinates unconsciously controlled muscle activity ● Allows the body to make automatic adjustments in posture and position and balance ○ Occipital Lobe ■ Coordination of eye movement, perception, image receptors ○ Cerebellum ■ Conscious muscle movement- gait, balance, coordination ■ Lower portion of the brain ● Associated w/ coordination of muscle movements including voluntary motion as well as extrapyramidal control of unconscious movements

● Neuromuscular Abnormalities ○ Muscle spasms occur because of (actual injury to muscle) ■ Injury to muscle ■ Overstretching ■ Wrenching a joint ■ Tearing tendon / ligament ○ Muscle spasticity due to damage to neurons in central ■ Damage to neurons in CNS ■ Permanent condition ■ Excessive stimulation of muscles / hypertonia ■ Causes an abnormal flow of information in and out of CNS motor pathway ● Other Modalities of Treatment for Muscles ○ Rest affected area ○ Heat application ○ Physical therapy ○ Anti-inflammatory agents ■ NSAIDs

Baclofen, Cyclobenzaprine, Tizanidine, Diazepam Expected Pharmacological Action: Centrally Acting Skeletal Muscle Relaxants

Who is it used to Treat?:

●

Interfere with the reflexes that are causing the muscle spasm ○ AKA spasmolytic ● Thought to involve actions in the upper or spinal interneurons ● Used as an adjunct

Adverse Effects: ● CNS effects drowsiness, fatigue, weakness, confusion, insomnia ● GI effects: n/ c, dry mouth, anorexia, ● CV effects: arrhythmias: low BP ● Renal effects: night time bed wetting(enuresis), urgency,