NR 565 PHARM MIDTERM QUESTIONS AND ANSWERS A COMPLETE EXAM SOLUTION THAT COVERS 2024/2025, Exams of Nursing

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CYP2D6 - CORRECT ANSWERS Need to increase doses of SSRI, beta blockers etc. Codeine can be deadly CYP2C9 - CORRECT ANSWERS Decrease warfarin dose Test for gene VCORC1 mutation CYP3A4 - CORRECT ANSWERS Decreases elimination Increase toxicity of Amio Schedule I - CORRECT ANSWERS no accepted medical use in the US it may not be prescribed. heroin,various opium derivatives,hallucinogenic substances Schedule II - CORRECT ANSWERS No refills, no telephone orders Narcotics, Stimulants, Depressants Schedule III - CORRECT ANSWERS Drugs in this category are considered to be at moderate or low risk for physical dependence, and with current reasons for medical use Anabolic steroids, most barbituates and ketamine Must prescribe every 6 months, can be by phone Schedule IV - CORRECT ANSWERS Abuse potential exists, but less than Sch III. Examples are: Ambien, Darvocet and Lorazepam Schedule V - CORRECT ANSWERS Not always necessary to have a prescription Loperamide, diphenoxylate and cough medicine with less than 200mg/100 ml pregabalin

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Preclinical research - CORRECT ANSWERS Research of drug potential, animal testing, preparation for human testing Phase I - CORRECT ANSWERS Initial clinical safety studies in humans. May be as few as 10 subjects, often healthy volunteers Phase II - CORRECT ANSWERS The study drug or treatment is given to a larger group of people (100-300) to see if it is effective and to further evaluate its safety Phase III - CORRECT ANSWERS The study drug or treatment is given to large groups of people (1,000-3,000) to confirm its effectiveness, monitor side effects, compare it to commonly used treatments, and collect information that will allow the drug or treatment to be used safely Phase IV - CORRECT ANSWERS A study conducted after a drug has been shown to work and has been granted a license (post-marketing surveillance study) Adrenergic agonists - CORRECT ANSWERS Drugs that stimulate and mimic the actions of the sympathetic nervous system. Also called sympathomimetics. alpha 2 agonists - CORRECT ANSWERS Decrease sympathetic impulses from the CNS to the heart and arterioles, causing vasodilation Lowers blood pressure, diuretic may be needed Clonodine, Methyldopa, Guanabenz SE: dry mouth, urinary retention, weight gain etc. Adrenergic Antagonist - CORRECT ANSWERS A drug that blocks the actions of the sympathetic nervous system.

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Alpha 1 Antagonist - CORRECT ANSWERS Decreases arterial and venous vasoconstriction Decreases blood pressure, helps relieve bph, Diuretic may be needed -osin Beta adrenergic antagonists - CORRECT ANSWERS drugs that block beta-adrenergic receptors; may be nonselective or selective; also called beta blockers Beta 1 Antagonist - CORRECT ANSWERS Effects heart muscle, blocks receptors in SA node to decrease hr, decrease contractility Reduces bp, reduces arrethymias, decreases angina incidences Metoprolol Beta 2 antagonist - CORRECT ANSWERS Lowers bp Effects lungs, bronchial constriction, avoid in asthma patients Propranolol Propranolol Interactions - CORRECT ANSWERS do not take with acetaminophin or warfarin Propanolol other uses - CORRECT ANSWERS Migraine prophylaxis, tremor, glaucoma Beta Blocker teaching points - CORRECT ANSWERS Monitor bp/hr so it's not too low report difficulty breathing or wheezing

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alpha and beta adrenergic antagonists - CORRECT ANSWERS Lowers BP and reduces heart failure progression carvedilol, labetalol, epinephrine Cholinergic agonists - CORRECT ANSWERS drugs that stimulate the parasympathetic nervous system, mimic acetylcholine Muscarinic Agonists - CORRECT ANSWERS Treat glaucoma, improve GI/urinary bladder tone Acetylcholine, Pilocarpine, Methacholine, Bethanechol Cholinesterase inhibitors - CORRECT ANSWERS A class of drugs to treat people with dementia that help increase levels of acetylcholine in the brain, also used for myasthenia gravis Donepezil, Rivastigmine, Galantamine Cholinergic blockers - CORRECT ANSWERS Treats parkinsons, bladder overactivity, EPS, N/V from motion sickness, IBS adjunct therapy Cogentin, Artane, Symmertrel, Atropine, Anorexiants - CORRECT ANSWERS drugs that suppress the activity of the brain's appetite center, causing reduced food intake phendimetrazine tartrate, benzphetamine, diethylpropion HCL, phentermine, lorcaserin

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Anticonvulsants - CORRECT ANSWERS prevent or control seizures clonazepam, phenytoin, gabapentin Hydantoins - CORRECT ANSWERS Inhibit and stabilize electrical discharges in the brain by effecting sodium ions influx during depolarization and repolarization, slows down abnormal discharges Treat tonic-clonic and partial complex seizures, least sedating option Metabolized in liver, decreases bc effectiveness phenytoin (Dilantin), ethotoin (Peganone), fosphenytoin (Cerebyx) Iminostilbenes - CORRECT ANSWERS Partial, Tonic-clonic seizures, Mood stabilizer for bipolar disorder, Reduces pain of trigeminal neuralgia carbamazepine (tegretol) decreases bc effectiveness, risk for stevens-johnson syndrome, can depress bone marrow Succinimides - CORRECT ANSWERS treats absence seizures in children ethosuximide, methsuximide Drugs that affect GABA - CORRECT ANSWERS treats neuropathic pain and migraines eliminated by urine

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must be tapered off, suicidal risk, drowsiness, topiramate watch for decreased sweating benzodiazepines, gabapentin, topiramate, tiagabine Levetiracetam (Keppra) - CORRECT ANSWERS Approved for: Focal, Generalized tonic-clonic, juvenile myoclonic epilepsy Do not stop suddenly Side effects:Somnolence, dizziness, anxiety, psychiatric manifestations Lamotrigine (Lamictal) - CORRECT ANSWERS Anticonvulsant, bipolar 1 disorder Do not stop suddenly, risk for stevens-johnson syndrome, severe rash, bc will decrease lamictal effectiveness SE: suicidal thoughts, mood change tricyclic antidepressants - CORRECT ANSWERS block reuptake of serotonin and norepinephrine treat depression, anxiety, enuresis in children, ocd, eating disorders do not give to people with cardiac disease, causes sedation and anticholinergic effects Amitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, amoxapine.

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Monoamine Oxidase Inhibitors (MAOIs) - CORRECT ANSWERS antidepressant medications that increase the amount of monoamine neurotransmitter in synapses Liver metabolism, major dietary restrictions (no fermented foods/drinks), must have healthy liver/heart to take Not commonly used phentolamine (regitine) Selective Serotonin Reuptake Inhibitors (SSRIs) - CORRECT ANSWERS a group of second- generation antidepressant drugs that increase serotonin activity specifically, without affecting other neurotransmitters Fluoxetine, paroxetine, sertraline, fluvoxamine citalopram, escitalpram SE: decreased libido, dizziness, weight gain serotonin syndrome: can be deadly, nausea, diarrhea, chills, sweating, hyperthermia hypertension, myoclonic jerking, tremor, agitations, ataxia, delerium Typical Antipsychotics - CORRECT ANSWERS A class of older drugs to treat schizophrenia and related psychotic disorders primarily by reducing excess levels of dopamine in the brain do not give to elderly, neuroleptic malignang syndrome with high fever, increased HR, diaphoresis, rigidity, coma, many EPS do not stop suddenly, do not drive with it, wear sunscreen, monitor gait

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chlorpromazine, thioridazine, fluphenazine, fluphenazine decanoate, perphenazine, trifluoperazine, haloperidol, loxapine atypical antipsychotics - CORRECT ANSWERS Antipsychotics that do not have significant side effects common to older antipsychotics agranulocytosis is deadly s/e, has EPS but less than others, no alcohol Olanzapine (obesity), Clozapine (agranulocytosis), Respiradone (increase prolactin) Dopaminergics - CORRECT ANSWERS Treat parkinsons by enhancing dopamine do not give to schizophrenic patients levodopa (sinemet) stand up slowly, inhibited by protein Benzodiazepines - CORRECT ANSWERS The most common group of antianxiety drugs, increases GABA and decreases neuronal excitation do not mix with cns depressive agents Valium, xanax, ativan Serotonergic anxiolytics - CORRECT ANSWERS Enhances serotonin to relieve anxiety No CNS depression, no anticonvulsant properties, very mild SE

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Buspirone, ipsapirone, gepirone Barbiturates - CORRECT ANSWERS drugs that depress the activity of the central nervous system, reducing anxiety but impairing memory and judgment, treat epilepsy, seizures, insomnia do not suddenly discontinue, CNS depression does occur, decreases many other medications such as beta blockers pentobarbital, -barbital etc sedative-hypnotics - CORRECT ANSWERS Drugs that can act in the body either as sedatives or as hypnotics, depress the CNS Benzodiazepine hypnotics - CORRECT ANSWERS Diazepam, Midazolam, Zolazepam Potentiates the inhibitory action of GABA. Activation of the receptor causes an influx of Cl- ion movement into the neuron and hyperpolarization and inhibition of membrane depolarization addicting Nonbenzodiazepine hypnotics - CORRECT ANSWERS Zolpidem, Zaleplon, exZopiclone. "ALL ZZZs put you to sleep." MOA: act via BZ1 subtype of GABA receptor. Effects reversed by flumazemnil Use: insomnia

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SE: ataxia, headaches, confusion. Short duration. Decreased depdence risnk like bneozs and only modest daf-after pscyhomoter depression mood stabilizers - CORRECT ANSWERS drugs used to control mood swings in patients with bipolar mood disorders Lithium - CORRECT ANSWERS Inhibits IP3 second messenger cascade, mood stabilizer for bipolar therapeutic range 0.6 to 1. causes congenital malformations Valproates - CORRECT ANSWERS Blocks GABA uptake, treats seizures, mania, bipolar, manic depressive SE: alopecia, drosiness, heartburn Valproic acid or V P A, Depakote, Depakene nonclassified mood stabilizers - CORRECT ANSWERS nonbenzodiazepine gaba-ergics that help treat epilepsy and bipolar, all effect GABA somehow risk for kidney stones and steens-johnson syndrome (rash) lamotrigine (Lamictal, gabapentin (Nuerontin) and topiramate (Topamax)

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Centrally acting muscle relaxants - CORRECT ANSWERS Relieves skeletal muscle spasm in: spinal cord injury, multiple sclerosis, cerebral palsy sedative effect, serotonin syndrome possible, do not take with MAO inhibitors cyclobenzaprine, methocarbamol, baclofen, carisoprodol, chloraxazone Direct-acting antispasmotics - CORRECT ANSWERS Treats spasticity with upper neuron disorders, spinal cord injury, stroke, cerebral palsy, ms effects calcium, botox inhibits acetylcholine release dantrolene titrated specially, no CNS depressing drugs, botox can have deadly respiratory response Dantroline sodium (Dantrium), botulinum toxin type A (Botox) Opioid Analgesics and Antagonists - CORRECT ANSWERS synthetic drugs that bind to opiate receptors to relieve pain SE of these drugs include dependence, withdrawal syndrome, sedation, euphoria, respiratory depression nausea and vomiting, constipation codeine, fentanyl, morphine, oxycodone, naloxone, etc. Stimulants - CORRECT ANSWERS Drugs (such as caffeine, nicotine, and the more powerful amphetamines, cocaine, and Ecstasy) that excite neural activity and speed up body functions treat ADD/ADHD

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SE: insomnia, anorexia, NSAIDS - CORRECT ANSWERS medication that exerts analgesic and anti-inflammatory actions Treats fever, pain, rheumatoid arthritis, osteoarthritis, gout, dysmenorrhea, tendinitis Aspirin - CORRECT ANSWERS Antiplatelet for theumatic fever, tias, coronary artery disease, DVT, decrease MI, fever, mild pain can cause stomach irritation/ulcer, do not give to children with flu-like/chicken pox because of reye syndrome How to diagnose major depression episode - CORRECT ANSWERS 2 week period of depressed mood or anhedonia (loss of pleasure) Also has to include one of these: significant weight change, sleep patterns are off, fatigue, loss of energy, feelings of worthlessness, excessive guilt, thoughts of death Screen for these to rule them out if depressed - CORRECT ANSWERS hypothyroidism, anemia, kidney/renal impairment, cancer, cardiac illness, HIV Mood Disorder Questionnaire - CORRECT ANSWERS Screens for Bipolar Disorder looks for prior hypomania or mania episodes SAFE-T Assessment of Suicide Risk - CORRECT ANSWERS Identify risk factors Identify protective factors

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Conduct suicide inquiry Determine risk/level of interventions Document General Algorithm for the Treatment of Adults with Anxiety Disorders - CORRECT ANSWERS Screen for anxiety disorders, look at other medical issues, start an SSRI/SNRI, refer them to a mental health provider for therapy, if lack of response send them to psychiatric provider STAR*D Effectiveness Algorithm for Treatment of Depression - CORRECT ANSWERS Look at other potential issues causing depression, start on SSRI, refer to a mental health therapist If that doesn't work, switch to another SSRI, NDRI or SNRI OR add NDRI or 5HT1A to current treatment If that doesn't work refer to a psychiatric provider Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) - CORRECT ANSWERS Block the reuptake of NE and 5HT, treats depression, one kind treats fibrmyalgia SE: increased bp, insomnia do not stop suddenly effexor, cymbalta, pristiq norepinephrine-dopamine reuptake inhibitors - CORRECT ANSWERS drugs used to treat depression; inhibit the reuptake of both norepinephrine and dopamine SE: high dose can cause seizures, lower sexual side effects

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bupropion (wellbutrin) Serotonin Agonist Reuptake Inhibitor - CORRECT ANSWERS Inhibit the reuptake of 5HT and block postsynaptic 5HT2 receptors hepatotoxic, helps with sleep, little sexual side effects nefazadone, trazadone Norepinephrine and Serotonin Specific Agonists - CORRECT ANSWERS Treats anxiety and depression, 5HT agonist and reuptake inhibitor for NE and somo-dendritic reuptake of 5HT less GI/sexual effects, weight gain, drowsiness Mirtazapine (Remeron) Propranolol for headache prevention - CORRECT ANSWERS start with 60-80 mg/d and increase every 3-7 days