Pharmacology > Exam > NURS 615 Pharm_Exam 2_2022/2023 | NURS615 Pharm_Exam 2_Graded A+ (All)
NURS 615 Pharm_Exam 2 (2022) – Maryville University Law-Ham Pharm Exam 2 Review **Know every drug that is on the PowerPoint – have a one-line mechanism of action on a table for each drug and... understand it, as well as how and where it works Carbamazepine (Tegretol) – is an anticonvulsant = thought to affect Na+ channels to slow spread of abnormal activity • SE = decreases body’s production of blood cells, rare reports of aplastic anemia and agranulocytosis, can cause Steven Johnson Syndrome and Toxic Epidermal Necrolysis • Should get a CBC Q3-4 months (watch for WBC count in particular) • Carbamazepine is a strong inducer of hepatic enzymes/metabolism and can lead to lower levels • Do NOT stop taking abruptly, has a shorter half-life w/repeated uses Topiramate (Topamax) – is for tx of epilepsy, seizures, migraine prophylaxis • Blocks sodium channels or potentiate GABA • Peaks 2 hours after oral admin, mostly eliminated via urine • Can cause ↓ Na bicarb levels which can lead to hyperchloremic metabolic acidosis • Serum bicarbonate should be monitored at baseline and periodically • Can cause ocular syndrome (acute myopia and glaucoma) – should inform provider immediately if pt experiences eye pain or blurred vision • Rare side effect is oligohidrosis (↓sweating) and hyperthermia • Can increase the risk of suicidal behavior/ideation, cause weight reduction • Should NOT be discontinued abruptly • Is a pregnancy category D and can increase risk of cleft lip/palate in infants Levetiracetam (Keppra) – antiepileptic, does NOT affect GABA, does inhibit burst firing and spread of seizure activity • Mostly cleared through renal system, is not extensively metabolized • Absolute contraindication is sensitivity to the drug • At increased risk for suicidal thoughts and depression, behavioral changes, somnolence, fatigue, dizziness, muscle coordination difficulties • Potential for withdrawal seizures if keppra is stopped abruptly • Safer med for seizures in children and pregnancy Valproate (Depakote) – is an anticonvulsant, for tx of bipolar disorder and mania also • Blocks GABA uptake into presynaptic neurons • SE = GI distress, heartburn, CNS depressant • Is a pregnancy category X, known teratogen, may only be taken after the 1st trimester if necessary, bur should recommend switching to different anticonvulsant like Keppra Ethosuximide (Zarontin) – tx for seizures • Should be monitored for blood dyscrasia (an abnormal condition or dx of the blood) Antiepileptics block transmission, raise the seizure threshold, so that the patient will not peak over the seizure threshold and have a seizure. Anticonvulsants in terms of monitoring (most common side effects, most serious side effects) – know that they are all monitored with blood work for their levels so that is a similarity amongst them • Carbamazepine – CBC – Causes agranulocytosis so be watching the white count in particular although there is other bone marrow suppression as well • What do you monitor? – TSH because the med can affect the thyroid • Never want anyone to d/c suddenly, must be weaned off • Talk to patients about safety – driving limitations, may have to report patient to DMV if they are having active seizures • Oral health can be affected by anti-seizure meds and extra trips to the dentist may be required Neurotransmitters • GABA – calming • Acetylcholine – muscle action, thought and learning ***If a specific drug is listed on the PowerPoint, know all about it. • All these drugs are listed on the PowerPoint • Seizure o Topiramate – topamax o Carbamazepine – Tegretol o Valproate – Depakote o Levetiracetam – Keppra • MAOI o Phenelzine – Nardil • Anxiolytics Phentermine (Adipex-P) – used for obesity, stimulating satiety centers • Should only be used short-term (6 months or less) • DO NOT mix w/ SSRIs or St. John’s Wart (Serotonin Syndrome), or w/ MAOIs (HTN crisis) Lithium— tx of choice for manic-depressive (bipolar) illness, ↓ severity/frequency of mania ♣ Replaces Na+ during depolarization in neurons = stops transmission of electrical impulses ♣ Inversely proportional to Na+ --- ↓Na+ = ↑Lithium ↑Na+ = ↓Lithium ♣ Lithium Toxicity can occur = drowsiness, nausea, course tremors, diarrhea, confusion, stupor ♣ NOT to be used in renal pts, children under 12, or pregnant women ♣ Pt education = avoid dehydration, eat a diet with consistent Na+ levels Antidepressants – SSRIs (fluoxetine, paroxetine, sertraline, citalopram, escitalopram) • SSRI blocks the reuptake of serotonin which keeps it present in the synapse for longer, so you get more effect from it • All of the antidepressants, whether a drug family or specific drug, you need to know and understand that drug and mechanism of action - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - A pt who is experiencing non-infectious diarrhea related to ABX administration will need to be assessed for C. diff colitis, so advise pt to increase probiotic intake w/yogurt to repopulate the gut flora. If a child comes to the clinic with a cough, low-grade fever, rhinorrhea, and the mucous is greenish-yellow then NO ABX should be prescribed because this is a virus. Antivirals • Make sure you know what the names are for influenza drugs and simplex and zoster drugs • Influenza – oseltamivir (Tamiflu) or zanamivir (Relenza) – start within 48 hours of influenza symptoms in order to successfully treat o Prophylactic treatment will occur in places such as nursing homes to prevent death • Acyclovir, famciclovir, valacyclovir – antivirals of choice for herpes simplex 1 and 2 as well as zoster o Start as soon as symptoms begin – numbness or tingling feeling o Drink lots of fluids when taking acyclovir (to help prevent nephrotoxicity) • Zoster o For herpes zoster (shingles) – asses renal function prior to taking valacyclovir o Unilateral rash along nerve root – will also be put on gabapentin or possible tricyclic to help with the pain o People who are on antivirals for any length of time need monitoring for their liver function Antifungals • Organized according to polyenes, azoles, allyamines • Can be systemic or topical depending on the infection • Some require system – example is griseofulvin for ringworm (often seen on client’s head) • Ketonazole – can cause hepatoxicity (need to monitor AST/ALT, alkaline phosphatase, and bilirubin) • Amphotericin B is systemic and for serious type of fungal infection • Candidiasis – topical tx (clotrimazole) = yeast, thrush, commonly used things are nystatin, mycostatin, itraconazole, fluconazole (big treatment for oral, oropharyngeal, or esophageal yeast, as well as vaginal yeast infection). • Take note that these drugs can be hepatotoxic (need baseline LFTs) and nephrotoxic so good follow up is required for use Antihelminetics • Lice and scabies = use permethrin cream and Ivermectin • Mebendazole and agromectin used to tx intestinal parasitic worms • Elimite cream – apply from head to toe, leave on for 8 hours before rinsing off How do we know what we use? • Lexicomp – expensive program but most hospitals have this • Uptodate online – also expensive for individuals – most practices have one or the other • Harriet lane is a good book – also online and is a good reference for pediatrics • Consult infectious disease society of America • American college of physicians • Sanford guide – can place as download on phone [Show More]
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