How can we help?

You can also find more resources in our Help Center.

732 terms

The Motherload 732 - Pharm Test 2

732 questions. CV, CNS, and renal meds, pharmacokinetics, and pharmacodynamics, including indications, side-effects, and antidotes.
STUDY
PLAY
What do diuretics do for CHF patients?
Reduce pre-load and afterload
What do diuretics fo for HTN patients?
Reduce BP
What are diuretics used for?
CHF, HTN, head trauma, pulmonary edema, renal failure, glaucoma, edema, weight loss
What are thiazide diuretics used for?
HTN, mild CHF, edema
What are side effects of thiazide diuretics?
Hypokalemia, hyperuricemia, hyperglycemia, hypercalcemia. May cause hypotension
What class of diuretics have increased toxic reactions to digoxin and lithium?
Thiazides
Chlorothiazide (Diuril) belong to what group of drugs?
Thiazide Diuretic
Hydrochlorothiazide (HydroDiuril) belong to what group of drugs?
Thiazide Diuretics
What are loop diuretics used for?
CHF, renal disease, hypertensive crisis
What class of diuretics cause a great amount of potassium loss and therefore require a K supplement in conjunction with the prescription?
Loop Diuretics
What class of diuretics can have a side effect of ototoxicity?
Loop Diuretics
Furosemide (Lasix) belongs to what group of drugs?
Loop Diuretics
What class of diuretics are used in combination with other diuretics (especially thiazides) to treat HTN?
Potassium-Sparing Diuretics
If used alone, what can potassium-sparing diuretics put a patient at risk for?
Hyperkalemia
What group of drugs does Spironolactone (Aldactone) belong to?
Potassium-Sparing Diuretics
What might Spironolactone be used for?
Hyperaldosteronism
What diuretic drug may cause an endocrine balance like hirsutism or gynecomastia?
Spironolactone (Aldactone)
What group of drugs does Triamterene (Dyrenium) belong to?
Potassium-Sparing Diuretics
What drug and class of drug may cause a patient's urine to turn blue?
Triamterene (Dyrenium)-- Potassium-Sparing Diuretic
What are Osmotic Diuretics used for?
Renal failure, increased drug excretion, decrease ICP and IOP.
What class of diuretics may be used for glaucoma?
Osmotic Diuretics
Which class of diuretics can only be given IV and may increase venous BP initially and could induce heart failure?
Osmotic Diuretics
What group of drugs does Mannitol (Resectisol) belong to?
Osmotic Diuretics
What are some side effects of Osmotic Diuretics?
Headache, NVD (nausea/vomiting/diarrhea).
What class of diuretics will potassium supplements absolutely be necessary for?
Loop Diuretics
What class of diuretics may or may not require potassium supplements?
Thiazide Diuretics
What are some examples of potassium-rich foods?
Citrus fruits, nuts, spinach, bananas, tomatoes, salt substitutes
When should diuretics be administered?
early a.m.
What signs and symptoms should be monitored in a patient taking diuretics?
s/s of loss of electrolytes: dehydration, hypokalemia, muscle cramps, fatigue, anorexia
What should the nurse record daily for a patient taking diuretics?
Weight
What side effects can diuretics cause?
Drop in BP-- postural hypotension
What should the nurse warn the patient of before starting diuretics?
They will produce a copious flow of urine.
-dipine
Calcium channel blocker
-olol
Beta blocker
-sartan
ARB
-pine
ACE inhibitor
-thiazide
Diuretic
-semide
Diuretic
-lactone
Diuretic
-dogril
Anticoagulant
-farin
Anticoagulant
-statin
HMG-CoA reductase inhibitor (statin)
-terol
Beta 2 agonist
-afil
Erectile dysfunction drug
Morphine
Opiate - full agonist
11 dosing formulations including PCA
Schedule II
Fentanyl
Opiate - full agonist
100x more potent than Morphine
Duragesic transdermal
palliative
Schedule II
Oxycodone (OxyContin/Percocet)
Opiate - full agonist
PO for pain
abuse-proof formulations now
Schedule II
Hydrocodone (Lortab/Vicodin)
Opiate - full agonist
PO for pain
Schedule III
Oxymorphone
Opiate - full agonist
newer, PO, potent, do now chew/crush/dissolve
Schedule II
Meperidine (Demerol)
Opiate - full agonist
accumulates - don't use more than 48hrs, with MAOI, or in seizure pts
Schedule II
Pentazocine
Opiate - partial agonist
Good if opiate naive, only moderate pain
Schedule IV
Naloxone
Opiate - antagonist
treatment of narcotic OD; will induce withdrawal
Ritalin
CNS stimulant
ADHD, narcolepsy
alertness, mood elevation, less fatigue
SE: MI, HTN, Stroke, Psychosis, Hallucinations
Strattera
CNS non-stimulant
ADHD - results take about a week to be seen; less potential for abuse
ADR: suicidal ideation
D-amphetamine
CNS stimulant
more potent than Ritalin, more SE
Phenobarbital
Anticonvulsant/AED - traditional
sedation / RED FLAG
Diazepam
Anticonvulsant/AED - traditional; also sedative, muscle relaxant
IV for status epilepticus (30 min seizure)
Ethosuximide
Anticonvulsant/AED - traditional
sedation, RED FLAG, rash
Valproic acid
Anticonvulsant/AED - traditional (also for BPAD)
sedation, RED FLAG, hepatoxicity
Carbamazepine
Anticonvulsant/AED - traditional
sedation, RED FLAG, Stevens-Johnson syndrome
Gabapentin (Neurontin)
Anticonvulsant/AED - newer
adjunct for seizures
also migraines, peripheral neuropathies
Topiramate (Topamax)
Anticonvulsant/AED - newer
adjunct for seizures
also migraines, alcohol/cocaine addiction, weight loss
Levetiracetam
Anticonvulsant/AED - newer
not a red flag drug - does not metabolize at all
Haloperidol
Antipsychotic - older
chemical restraint; best with positive symptoms
extrapyramidal SE, anti-cholinergic, big weight gain
Compazine
Antipsychotic - older
good for nausea/vomiting
Olanzepine
Antipsychotic - atypical
long-acting (2-4 week) IM injection
better for negative syptoms
SE: weight gain, headache, CNS stimulation
Aripiprazole
Antipsychotic - atypical (Abilify)
better for negative syptoms
SE: weight gain, headache, CNS stimulation
Clozapine
Antipsychotic - atypical
most effective drug for schizophrenia
better for negative syptoms
SE: weight gain, headache, CNS stimulation
ADR: agranulocytosis (fatal destruction of WBCs) - requires MONITORING (1m, 2m, 6m, q6m)
Secobarbital
Sedative (barbiturate)
short-acting - 3-6hrs - night before surgery
Alprazolam (Xanax)
Sedative - BZD
pt. cooperation for a procedure
top 20 in US / highly abused
Midazolam (Versed)
Sedative - BZD
sedation, induction for anesthesia, pt. cooperation for procedure
Zolpidem (Ambien)
Sedative - BZD-like
SE: sleep-driving, eating, hangover
Amitriptyline
Antidepressant - tricyclic
blocks reuptake of NE and 5-HT
used for depression, panic, agoraphobia, OCD, pain, migraine
SE: sedation, anticholinergic
2-3 weeks to see effect
Fluoxetine (Prozac)
Antidepressant - SSRI
used for depression, OCD, PMDD, anxiety, etc.
SE: nausea, nervousness, headache, anorexia, suicide, sexual dysfunction
Citalopram (Celexa)
Antidepressant - SSRI
used for depression, OCD, PMDD, anxiety, etc.
SE: nausea, nervousness, headache, anorexia, suicide, sexual dysfunction
Paroxetine (Paxil)
Antidepressant - SSRI
used for depression, OCD, PMDD, anxiety, etc.
SE: nausea, nervousness, headache, anorexia, suicide, sexual dysfunction
Wellbutrin
Antidepressant - atypical
may affect 5-HT and DA
SE: rash, seizures, weight loss, lower sexual SE than others
Lithium
DOC for BPAD
Goal is to control the mania - even it out
Narrow TI - may cause DM and toxicity: vomiting, muscle weakness, seizures, coma
SE: GI upset, polyuria, fine tremor
Halothane
Anesthetic
Most widely used used general anesthetic
Not good for muscle relaxation; may cause arrhythmia
Lidocaine
local anesthetic
Fast onset (< 1min) longer duration (~2hrs)
May cause heart block or arrhythmias
Bupivicaine
local anesthetic
Slow onset (>10min) long duration (3+hrs)
Used for spinal, epidural, infiltration and nerve block
May cause arrhythmias
Propofol
general anesthetic
General CNS depressant
SE: Causes respiratory depression
"purposeful sedation" for shorter things
Scopolamine
Anticholinergic
used as an adjunct to anesthesia
Clonidine
HTN
Centrally-acting sympathetic agonist (alpha-2)
SE: low mood, energy (decreased sympathetic outflow)
Do not d/c abruptly d/t rebound HTN
Not our first choice
also a new drug for ADHD
Reserpine
HTN
Peripherally-acting sympathetic antagonist
Over 50 yrs old
Now our 4th/5th choice in a cocktail
Some suicides
SE: sedation, depression, GI motility
Propranolol
HTN, Angina, STEMI, CHF, Dysrhythmia
Beta-Blocker (B1 & B2)
Do not d/c abruptly d/t rebound HTN
SE: exercise intolerance, tiredness
Contraindications: asthma, diabetes (may mask signs of hypoglycemia)
Good for digoxin induced arr's—Atrial arr's
Angina - decreases work of heart; not used for variant angina
Hydralazine
HTN
Peripheral Arterial Vasodilator
Directly relax arterioles via decreased Ca+2 flux in smooth muscle cells; decreases BP (afterload)
reflex increased HR, decreased Na/H20 retention; drug-induced SLE; safe in pregnancy
Minoxidil
HTN
Peripheral Arterial Vasodilator
Directly relax arterioles via decreased Ca+2 flux in smooth muscle cells; decreases BP (afterload)
also Rogaine - refractory HTN only - 4th/5th choice in cocktail
Nitroprusside
HTN - IV in Crisis
Arterial-Venous Vasodilator
Converted to nitric oxide which is a vasodilator (preload and afterload)
OD - cyanide poisoning
Prazosin
HTN
Alpha 1 blocker (vasodilation)
First dose syncope - take at night
Mild-moderate HTN
Verapamil
HTN (low dose), Angina (med dose), Dysrhythmia (high dose)
Calcium-Channel Blocker
May cause AV node block, constipation (offset with fiber and water), dizziness
decreased AV nodal conduction for Atrial arrhythimas
For Angina - dilates coronary arteries - good for all 3 types
Amlodipine
HTN (low dose), Angina (med dose), Dysrhythmia (high dose)
Calcium-Channel Blocker
May cause AV node block, constipation (offset with fiber and water), dizziness
top 20 in USA
For Angina - dilates coronary arteries - good for all 3 types
Lisinopril
HTN, HF, post-MI
ACE Inhibitor
Lowers BP, Na+, H20 by inhibiting ACE
Longer t ½; q day dosing
Causes first-dose syncope, dizziness, GI SE
Begin within 24hrs of MI, continue at least 6wks
Monitor for cough, K levels
Losartan
HTN, HF
ARB
Lowers BP, Na+, H20 by inhibiting ACE
Longer t ½; q day dosing
Causes first-dose syncope, dizziness, GI SE
Hydrochlorothiazide
Diuretic (Thiazide)
Causes Na+ and H20 Loss
SE: dizziness, electrolyte imbalance, hypotension
First step for HTN
1-2 extra trips to pee per day
Furosemide
Diuretic (Loop)
Causes Na+ and H20 Loss
SE: dizziness, electrolyte imbalance
ADR: ototoxicity (balance/hearing)
Requires K+ supplement
2-3 extra trips to pee per day
Quinidine
Antidysrhythmic
Na+ channel blocker (decreases automaticity of ectopic foci)
Atrial & vent. Arr.; can cause cinchonism (headache, blurred vision, tinnitus)
Flecainide
Antidysrhythmic
Na+ channel blocker (decreases automaticity of ectopic foci)
Vent. Arr. - good for chronic management
Lidocaine
Antidysrhythmic
Na+ channel blocker (decreases automaticity of ectopic foci)
IV only; vent. arrs following MI or surgery
Bretylium
Antidysrhythmic
Given IV
For life-threatening vent arr; vent fibrillation
Amiodarone
Antidysrhythmic
Given PO
For life-threatening vent arr; vent fibrillation
Dobutamine
Antidysrhythmic
Sympathetic agonist
DOC for cardiac stimulation; B1: HR, contractility
Atropine
Antidysrhythmic
Parasympathetic antagonist / anticholinergic
ER Codes
Nitroglycerin
Angina, STEMI
Venous Vasodilator (decreases afterload and preload)
Lots of dosage forms
Have to take a break or tolerance will develop
For all 3 types of angina
Contraindicated with tachycardia, bradycardia, systolic hypotension, right ventricular infarction, viagra/cyalis, tadalafil
Isosorbide dinitrate
Angina
Vasodilator
Decreases preload
Daily PO prophy for unstable/vasospastic angina
Heparin
Anticoagulant
IV/SC - blocks free thrombin
Monitor: APTT (activated partial thromboplastin time), blood in stool or urine; CBC/platelet count
ADR: Hemorrhage
Antidote: protamine sulfate
Enoxaparin
Anticoagulant
SC-abdominal; blocks free thrombin
DVT & PE prevention post-op
APTT monitoring not reqd
Bivalrudin
Anticoagulant
IV - during angioplasty
Warfarin
Anticoagulant
PO - antagonizes Vitamin K
Monitor PT/INR - clotting time - LOTS of follow-up
Lots of drug/diet interactions
ADR: Hemorrhage
Antidote: phytonadione
Alteplase
Fibrinolytic
Dissolve clots - best within 4-6 hrs of MI and 2-3 hrs of stroke
Cost-benefit: very expensive ($4000+), but when given within 30 minutes of arrival at ED - really good results
Bleeds are the major risk of use
Tenecteplase
Fibrinolytic
Dissolve clots - best within 4-6 hrs of MI and 2-3 hrs of stroke
Cost-benefit: very expensive ($4000+), but when given within 30 minutes of arrival at ED - really good results
Bleeds are the major risk of use
Aspirin
Antiplatelet
unstable angina, MI, stroke
80-325mg/day
risk for bleeds, esp. GI, so not for all
Clopidogrel (Plavix)
Antiplatelet
decreases platelet aggregation
Ticlopidine (Ticlid)
Antiplatelet
decreases platelet aggregation
Dabigatran
Direct Thrombin Inhibitor
stroke, DVT prophy, etc.
Ribaroxaban
Direct Factor Xa Inhibitor
PO
No need for INR monitoring
Only approved as anticoagulant following knee/hip replacement, to prevent stroke in afib patients, DVT, PE; being tested in MI patients
Lower risk for fatal bleeds than Warfarin, but no antidote
Atorvastatin (Lipitor)
Statin
inhibits cholesterol synthesis in the liver
Significant LDL decrease
Monitor liver function
Decreased risk of MI and mortality after 2 years
SE: "fogginess"/dementia
top 20 in USA
Rosuvastatin (Crestor)
Statin
inhibits cholesterol synthesis in the liver
Significant LDL decrease
Monitor liver function
Decreased risk of MI and mortality after 2 years
SE: "fogginess"/dementia
top 20 in USA
Gemfibrozil
for cholesterol - esp. triglycerides
monitor Liver function like Statins
Fenofibrate
for cholesterol - esp. triglycerides
monitor liver function like Statins
Nicotinic Acid
for cholesterol
Most effective with lowering triglycerides and raising HDL
SE: hot flashes from vasodilation for 30 mins after taking
Iron
Most often d/t blood loss - need to correct this
Oral iron - constipating; elixir will stain teeth
Parenteral iron (iron dextran) given by Z track technique subQ to prevent pooling (watch for anaphylaxis with test dose)
Cyanocobalamin
B-12 supplement
IM - q day for 1-2 weeks
d/t decreased intrinsic factor, gastrectomy (d/t stomach CA, perhaps), or vegetarian diet
Epoetin alpha (Procrit)
Hematopoetic
stimulates RBC production in bone marrow
In profound anemia from renal disease, HIV, CA, wasting syndromes
Filgrastim (Neupogen)
Hemapoetic
WBC stimulation, especially for chemo pts.
SE: bone pain
Potassium-sparing diurectics
Used in combination with other diuretics (esp. thiazides) to make K neutral
Mannitol
Osmotic diuretic
Very acute - IV
Can flush nephrotoxic drugs
Lose a lot of fluid very quickly
Lanoxin (digoxin)
Increases cardiac contractility. Treatment of CHF.
Diuretics
Increases sodium and water excretion. Treatment of CHF.
ACE inhibitors
Decrease BP and blood volume. Treatment of CHF.
Vasodilators
Decreases BP. Treatment of CHF.
Dobutamine
Increases ventricular contractility. Treatment of CHF.
Dopamine
Increases ventricular contractility. Treatment of CHF.
PDE (phosphodiesterase) inhibitors
Increases ventricular contractility. Treatment of CHF.
Lanoxin (digoxin)
In the hospital setting, always ask patients whether they take tablets or capsules of this drug at home, since capsular absorption is greater than tablet absorption and sudden change in dosage format may result in toxicity or physiologic side effects/adverse reactions.
Lanoxin (digoxin)
This drug is 70% renally excreted. Therefore, good renal function is important.
Lanoxin (digoxin)
Cardiac glycoside. Increased cardiac contractility, positive inotropic effect by inhibiting Na-K ATPase, leading to increased cardiac output. Decreased heart rate. Decreased AV nodal conduction.
Lanoxin (digoxin)
Adverse drug reactions include anorexia; nausea, vomiting, diarrhea (NVD); confusion; blurred vision (halos); and arrhythmias.
Lanoxin (digoxin)
Toxicity of this drug is made worse by hypokalemia or any factor affecting drug clearance.
Lanoxin (digoxin)
Treatment for toxicity of this drug may include administration of potassium.
Lanoxin (digoxin)
Treatment for toxicity of this drug may include administration of Digibind.
Lanoxin (digoxin)
Quinidine displaces this drug from tissues and decreases its secretion.
Lanoxin (digoxin)
Decrease the dose of this drug when using quinidine.
Lanoxin (digoxin)
Antacids bind this drug, decreasing its absorption.
Lanoxin (digoxin)
Diuretics increase toxicity of this drug.
Diuretics
May cause hypokalemia.
ACE
"Angiotensin-converting enzyme"
ACE
Converts angiotensin I to angiotensin II in the lungs.
Renin
Converts angiotensinogen (a plasma protein) to angiotensin I.
Congestive heart failure (CHF)
Cardiac output is decreased, resulting in decreased blood flow to the kidneys.
Angiotensin II
Plays a major role in maintaining fluid balance in the body.
Angiotensin II
Worsens CHF by acting as a vasoconstrictor, increasing preload and afterload.
Angiotensin II
Stimulates the release of aldosterone from the adrenal cortex.
Aldosterone
Hormone which increases sodium and water retention, increasing blood volume and preload/afterload.
ACE Inhibitors
Class of drugs used both both hypertension and CHF.
ACE Inhibitors
This class of drugs decreases angiotensin II, leading to decreased total peripheral resistance and decreased blood volume.
ACE Inhibitors
May cause cough.
ACE Inhibitors
Side effects of this class include increased serum potassium.
ACE inhibitors
Angioedema is a life-threatening side effect of this class.
ACE inhibitors
Drug class used as first-line treatment for CHF.
Prinivil (lisinopril)
ACE inhibitor
Accupril (quinapril)
ACE inhibitor
Beta blockers
Favorable impact on cardiac remodeling. Reduces cardiac work.
Congestive heart failure (CHF)
Diuretics are ALWAYS used in treatment of this condition.
Congestive heart failure (CHF)
Combination therapy is common in treatment of this condition, often taking digoxin or ACEI, along with a thiazide diuretic.
Drugs end in -pril.
ACE inhibitors
Drugs end in -olol.
Beta blockers
Nitroglycerin
Nitrate
Nitrates
Reduces afterload. Some reduce both preload and afterload.
Inotropic agents
Increases myocardial contractile force, which increases cardiac output.
Inotropic agents
Used in heart failure treatment.
PDE (phosphodiesterase) inhibitors
Used in heart failure treatment.
ACE inhibitors
Used in heart failure treatment.
Aldosterone antagonists
Used in heart failure treatment.
ACE inhibitors
Not for use in acute decompensated heart failure.
Toprol XL (metoprolol)
Beta blocker
Beta blocker
Used in heart failure treatment.
Beta blocker
May take up to a month to show response/improvement.
Thiazide diuretics
Used in treatment of CHF if renal function is good.
Lanoxin (digoxin)
Cardiac glycoside.
Lanoxin (digoxin)
Does more harm than good in females.
Cardiac glycosides
Does more harm than good in females.
Centrally acting sympathetic agonists
Antihypertensive class
Peripherally acting sympathetic antagonists
Antihypertensive class
Beta blocker
Antihypertensive class
Peripehral arterial vasodilators
Antihypertensive class
Arterial-venous vasodilators
Antihypertensive class
Calcium-channel blockers
Antihypertensive class
ACE inhibitors
Antihypertensive class
ARBs
Antihypertensive class
Diuretic
Antihypertensive class
Why are antihypertensive drugs not well liked by patients?
Antihypertensives work centrally, leading to many undesired side effects.
Catapres (clonidine)
Centrally-acting sympathetic agonist
Aldomet (methyldopa)
Centrally-acting sympathetic agonist
Serpasil (reserpine)
Peripherally-acting sympathetic antagonist
Arfonad (trimethaphan)
Emergency use only for hypertensive crisis.
Inderal (propranolol)
B1 and B2 blocker
Lopressor (metoprolol)
B1 blocker
Tenormin (atenolol)
B1 blocker
Normodyne (labetolol)
B1 and B2 blocker, A1 blocker
Catapres (clonidine)
Stimulates A2 receptors in the CNS, leading to decreased norepinephrine release.
Aldomet (methyldopa)
Metabolized to alpha-methyldopa which activates alpha 2 receptors, leading to decreased norepinephrine.
Aldomet (methyldopa)
Vasodilation, decreased heart rate, decreased blood pressure.
Catapres (clonidine)
Vasodilation, decreased heart rate, decreased blood pressure.
Aldomet (methyldopa)
Causes sedation, dry mouth, nasal stuffiness, edema.
Catapres (clonidine)
Blunts opioid withdrawal symptoms.
Kapvay (clonidine)
Low-dose formulation used for treatment of ADHD.
Catapres (clonidine)
Centrally acting agent available in transdermal form.
Serpasil (reserpine)
Depletes stores of catecholamines in neurons.
Serpasil (reserpine)
Peripherally-acting drug which decreases total peripheral resistance and cardiac output.
Serpasil (reserpine)
Peripherally-acting drug which causes sedation, depression, increased GI motility, and nasal stuffiness.
Lopressor (metoprolol)
Beta blocker. Do not use in COPd and diabetes.
Tenormin (atenolol)
Beta blocker with a long half-life.
Normodyne (labetolol)
Beta blocker which decreases total peripheral resistance without a reflex increased heart rate.
Beta blocker drug reactions
Bronchoconstriction, sleep disorders, rebound hypertension, exercise intolerance, tiredness
Beta blocker contraindications
CHF, bradycardia, asthma.
Beta blocker
Masks signs of hypoglycemia.
Apresoline (hydralazine)
Peripheral arterial vasodilator
Loniten (minoxidil)
Peripheral arterial vasodilator
Nipride (nitroprusside)
Arterial-venous vasodilator
Minipress (prazosin)
Arterial-venous vasodilator
Isoptin (verapamil)
Calcium channel blocker
Procardia (nifedipine)
Calcium channel blocker
Cozaar (losartan)
ACE inhibitor
Causes hypertrichosis.
Loniten (minoxidil)
Hydrochlorothiazide
Thiazide diuretic
Lasix (furosemide)
Loop diuretic
First line treatment for early hypertension.
Diuretics
Every heart failure patient takes a drug from this therapeutic class.
Diuretics
Dizziness and electrolyte imbalance, specifically potassium loss, are caused by this therapeutic class.
Diuretics
Mary began a diuretic for mild hypertension and now urinates about once more per day than before she began the drug. Which type of diuretic has likely been prescribed to Mary?
Thiazide diuretic
David suffers from CHF and has been prescribed a diuretic. He now urinates 2-3 more times per day than before he began treatment with this drug. Which type of diuretic has likely been prescribed to David?
Loop diuretic
David, a CHF patient, recently began a diuretic to aid in passage of fluid. His family complains that, since beginning this drug, he has been a little "fuzzy" mentally. Which type of diuretic has likely been prescribed to David?
Loop diuretic
Most widely therapeutic class of antihypertensive.
Diuretics
Therapeutic class which reduces blood volume by promoting sodium and water loss. Also reduces arteriolar resistance.
Diuretics
Drugs end in -sartan.
ARBs
Quinaglute (quinidine)
Antiarrhythmic
L-Caine (lidocaine)
Anesthetic, antiarrhythmic
Causes first-dose syncope.
Minipress (prazosin)
Minipress (prazosin)
A1 blocker
Given IV in hypertensive crisis.
Nipride (nitroprusside)
Nipride (nitroprusside)
Converted to nitric oxide, a vasodilator.
Norvasc (amlodipine)
Calcium channel blocker
Side effects may include AV node block, CHF, constipation, dizziness.
Isoptin (verapamil)
Side effects may include AV node block, CHF, constipation, dizziness.
Norvasc (amlodipine)
May cause edema, hypotension, headache, dizziness, increased heart rate.
Procardia (nifedipine)
Causes first-dose syncope.
Prinivil (lisinopril)
Antihypertensive with a long half-life for daily dosing.
Prinivil (lisinopril)
Antihypertensive with a long half-life for daily dosing.
Cozaar (losartan)
Active ingredient in Rogaine.
Minoxidil
Blocks calcium - flux in smooth muscle cells - vasodilation, decreased total peripheral resistance.
Isoptin (verapamil)
Blocks calcium - flux in smooth muscle cells - vasodilation, decreased total peripheral resistance.
Norvasc (amlodipine)
Blocks calcium - flux in smooth muscle cells - vasodilation, decreased total peripheral resistance.
Procardia (nifedipine)
Blocks sodium channels. Decreases automaticity of ectopic foci.
Quinaglute (quinidine)
Blocks sodium channels. Decreases automaticity of ectopic foci.
L-Caine (lidocaine)
Used for ventricular arrhythmias following MI or surgery. Only given IV.
L-Caine (lidocaine)
Used for atrial and ventricular arrhythmias.
Quinaglute (quinidine)
Can cause cinchonism (headache, blvi, tinnitus).
Quinaglute (quinidine)
Inderal (propranolol)
Antiarrhythmic
Isoptin (verapamil)
Antiarrhythmic
Cordarone (amiodarone)
Antiarrhythmic
Good for digoxin-induced arrhythmias, atrial arrhythmias.
Inderal (propranolol)
Nitro-Bid, Nitrostat (nitroglycerin)
Effective for all types of angina.
Isordil (isosorbide dinitrate)
Used for prophylaxis of angina (not stable).
Nitro-Bid, Nitrostat (nitroglycerin)
Contraindicated in tachycardia (greater than 100 bpm), bradycardia (less than 50 bpm), systolic hypotension (less than 90), and right ventricular infarct.
Nitro-Bid, Nitrostat (nitroglycerin)
Contraindicated when using sildenafil, vardenafil, or tadalafil for erectile dysfunction treatment.
Tenormin (propranolol)
Used for angina. Do not discontinue abruptly.
Drugs end in -afil.
Erectile dysfunction
Isopten (verapamil)
Used for angina. Reflex increased heart rate.
Norvasc (amlodipine)
Used for angina. Reflex increased heart rate.
Bob takes Viagra for erectile dysfunction. Which drug class is likely to be prescribed for his angina?
Beta blockers
This drug class may be used to treat angina when vasodilators are contraindicated.
Beta blockers
Used in unstable angina and variant prophylaxis.
Long-acting nitrates
Used for all types of angina.
Calcium channel blockers
Used for all types of angina.
Nitroglycerin
Used in the patient with ACS and/or NSTEMI to decrease cardiac work, pain, infarct size, and short-term mortality.
Beta blockers
Contraindications include severe HF, severe bradycardia, severe hypotension, advanced heart block, and cardiogenic shock.
Beta blockers
Letter A - Useful Education Tools for Patients with ACS and CAD
Aspirin and antianginals.
Letter B - Useful Education Tools for Patients with ACS and CAD
Beta blockers and blood pressure.
Letter C - Useful Education Tools for Patients with ACS and CAD
Cholesterol and cigarettes.
Letter D - Useful Education Tools for Patients with ACS and CAD
Diet and diabetes.
Letter E - Useful Education Tools for Patients with ACS and CAD
Exercise and education.
MONA - M
Morphine relieves pain. Dilates veins, so also reduces preload. May also reduce afterload a bit.
MONA - O
Oxygen increases O2 delivery to ischemic myocardium.
MONA - N
Nitroglycerin reduces preload. limits infarct size and improves LV function but does not reduce mortality.
MONA - A
Aspirin suppresses platelet aggregation. Chew first dose.
Anticoagulants
Prevent thrombus formation or extension.
Thrombolytics/fibrinolytics
Dissolve clots.
Antiplatelet drugs
Keep platelets from adhering to the fibrin meshwork of a clot.
Hep-Lock (heparin)
Anticoagulant
Lovenox (enoxaparin)
Anticoagulant
Lovenox (enoxaparin)
Low molecular weight heparin (LMWH)
Coumadin (warfarin)
Anticoagulant
Prevents or retards formation of new thrombi. Prevents clots from extending. Given IM only.
Hep-Lock (heparin)
Postoperative DVT and PE prevention, DVT treatment, knee/hip surgery.
Lovenox (enoxaparin)
Lab monitoring of APTT not necessary. Shorter half-life.
Lovenox (enoxaparin)
This type of anticoagulant is more expensive but does not require aPTT monitoring because of its decreased half-life.
Low molecular weight heparin (LMWH)
First-line therapy for DVT due to decreased tendency to cause thrombocytopenia.
Low molecular weight heparin (LMWH)
Antidote for heparins.
Protamine sulfate
Coumadin (warfarin)
Antagonizes vitamin K's role in activating clotting factors.
Coumadin (warfarin)
Prevents extension of a thrombus. Prevents formation of new thrombi.
Antidote for Coumadin (warfarin).
Phytonadione (vitamin K)
May cause hemorrhage.
Coumadin (warfarin)
May cause hemorrhage.
Hep-Lock (heparin)
May cause hemorrhage.
Lovenox (enoxaparin)
Aspirin
Antiplatelet
Plavix (clopidogrel)
Antiplatelet
Ticlid (ticlopidine)
Antiplatelet
Inhibits cyclooxygenase. Blocks formation of TXA2 which aggregates platelets.
Aspirin
Inhibits platelet phosphodiesterase. Decreased platelet aggregation.
Plavix (clopidogrel)
Inhibits platelet phosphodiesterase. Decreased platelet aggregation.
Ticlid (ticlopidine)
Bleeds are a major risk of use.
Fibrinolytic therapy
Absolute contraindications to fibrinolytic therapy.
Any prior intracranial hemorrhage, ischemic stroke within last 3 months (except ischemic stroke within last 3 hours), intracranial neoplasm, active internal bleeding, suspected aortic dissection, aortic aneurysm.
Xarelto (rivaroxaban)
Factor Xa inhibitor
No need for INR monitoring.
Xarelto (rivaroxaban)
Xarelto (rivaroxaban)
Used as an anticoagulant following knee or hip replacement, to prevent stroke in AFib patients, DVT, PE. Being tested in MI patients.
Xarelto (rivaroxaban)
Lower risk for fatal bleeds than warfarin but no antidote in overdose.
TNKase (tenectaplase)
Fibrinolytic
tPA, Activase (alteplase)
Fibrinolytic
When given within 30 minutes of patient presentation to emergency department, LV function improves, infarct size is limited, and mortality improves.
Fibrinolytic
Chest pain must be present no more than 12 hours prior to drug administration.
Fibrinolytic
tPA, Activase (alteplase)
Binds to fibrin then activates plasminogen-plasmin.
TNKase (tenectaplase)
Binds to fibrin then activates plasminogen-plasmin.
Clot busters
Fibrinolytic
Given after acute MI or stroke. Work best when given within 6 hours of an MI or within 3 hours or a stroke.
Fibrinolytic
Converts plasminogen to plasmin.
Fibrinolytic
Most preferred fibrinolytic.
TNKase (tenectaplase)
Pradaxa (dabigatran)
Direct thrombin inhibitor
Pradaxa (dabigatran)
Indicated for stroke, heparin-induced thrombocytopenia, DVT prophylaxis.
Most easily used thrombolytic because of bolus dosing.
TNKase (tenectaplase)
Lipitor (atorvastatin)
Statin
Crestor (rosuvastatin)
Statin
Drugs end in -statin.
Statins (for hyperlipidemia).
Pravachol (pravastatin)
Statin
Lopid (gemfibrozil)
Fibric acid derivative
Tricor (fenofibrate)
Fibric acid derivative
Lopid (gemfibrozil)
Increases lipoprotein lipase activity. Decreases lipolysis in adipose tissue and decreases hepatic uptake of fatty acids.
Tricor (fenofibrate)
Increases lipoprotein lipase activity. Decreases lipolysis in adipose tissue and decreases hepatic uptake of fatty acids.
Concurrent use with statins may increase risk of myositis and rhabdomyolysis.
Fibric acid derivative
Increases risk of hepatotoxicity and requires monitoring of LFTs.
Fibric acid derivative
Decrease risk of MI and/or mortality after 2 years.
Statins
Niacin, Niaspan (nicotinic acid)
Vitamin used for treatment of hyperlipidemia.
Niacin, Niaspan (nicotinic acid)
Inhibits lipolysis in adipose tissue. Decreases hepatic production of VLDL, which decreases serum triglycerides and LDL-C.
May cause hot flashes or flushing.
Niacin, Niaspan (nicotinic acid)
B12-deficiency anemia
Due to decreased intrinsic factor, gastrectomy, or vegetarian diet.
Folic acid-deficiency anemia
Seen in alcoholics and malnourished individuals.
Epogen, Procrit (epoetin)
Hematopoeitic
G-CSF, Neupogen (filgrastim)
Hematopoeitic
Stimulates RBC production. Used in renal disease, HIV, infection, and patients receiving chemotherapy.
Epogen, Procrit (epoetin)
Increases neutrophil production. Used for neutropenia (severe cyclic, chronic) especially that seen in chemotherapy patients.
G-CSF, Neupogen (filgrastim)
Side effect is bone pain.
G-CSF, Neupogen (filgrastim)
Bretylol (bretylium)
Antiarrhythmic
Bretylol (bretylium)
Good for life-threatening ventricular arrhythmias, such as ventricular fibrillation.
Bretylol (bretylium)
Increased duration of the action potential.
Tambocor (flecainide)
Antiarrhythmic
Tambocor (flecainide)
Blocks sodium channels. Decreased automaticity of ectopic foci.
Tambocor (flecainide)
May cause arrhythmias. Good for chronic ventricular arrhythmia management.
Dobutrex (dobutamine)
Inotropic
Dobutrex (dobutamine)
Only works on B1 receptors to increase cardiac output and contractility.
Atro-Pen (atropine)
Antiarrhythmic
Atro-Pen (atropine)
Anticholinergic
Atro-Pen (atropine)
Used widely during anesthesia for anticholinergic effects of dry mouth, decreased urine output, decreased GI motility.
What is another name for opioids?
Narcotics
What does binding to opiate receptors produce?
Analgesia, sedation, respiratory depression, miosis, constipation, nausea
Opioids can suppress what?
The cough reflex
What do opioids produce that can cause addiction?
Euphoria, dependence, tolerance
What are three signs of opioid toxicity?
Coma, pinpoint pupils, respiratory depression
If opioid overdose or toxicity is suspected, what does the nurse need to monitor the patient for?
Decreased respirations, excessive sedation, hypotension, muscle weakness, and altered mental state
What are full narcotic agonists good for?
Severe pain. May give a feeling of euphoria.
What are partial narcotic agonists good for?
Moderate pain.
What group of opioids would be good to give to a patient who might get sick from opioid use?
Partial agonists.
What are narcotic antagonists responsible for?
Reversing all narcotic effects including pain relief, euphoria, and respiratory depression.
What might a narcotic antagonist be used for?
Reverse adverse effects, put a patient into withdrawal, reverse opiate constipation
What are common side effects of narcotics?
Hypotension, sedation, nausea, itching, muscle weakness, constipation
What group of drugs is Morphine put into?
Full opiate agonist.
What is Morphine used for?
Pain. Most preps last 4-5 hrs. Extended release caps last 24 hours. Used in the PCA pump.
What is the PCA pump?
Patient-Controlled Analgesia pump that allows a patient to administer opioids as needed.
What is a lock-out interval?
The amount of time a patient has to wait before administering their own dose of drug. (ex: 1mg every 10 min vs 20 mg every 3-4 hrs).
What is the benefit of using a PCA pump?
Evidence shows shorter stays, decreased drugs use, and better outcomes.
What group of drugs is Meperidine (Demerol) put into?
Full opiate agonist.
What is Meperidine (Demerol) used for?
Pain. May accumulate- do not use over 48 hours.
What full opiate agonist should not be used with MAOIs?
Meperidine (Demerol)
What full opiate agonist should not be used in seizure disorders?
Meperidine (Demerol)
What full opiate agonist might be used for labor and delivery pain?
Meperidine (Demerol)
What highly addictive, full opiate agonist was used to "detox" heroin addicts, and ended up being abused?
Methadone (Dolophine)
What group of drugs is Fentanyl (Duragesic) put into?
Full opiate agonist
What full opiate agonist is a preop medication that was developed for cancer patients that were tolerant to morphine?
Fentanyl (Duragesic)
What full opiate agonist can be a transdermal prep for chronic pain?
Fentanyl (Duragesic)
What group of drugs is Hydrocodone (Lortab, Vicodin) put into?
Full opiate agonist
What schedule III full opiate agonist can be taken PO for pain?
Hydrocodone (Lortab, Vicodin)
What group of drugs is Oxycodone (OxyContin, Endocet, Percocet, Combunox) put into?
Full opiate agonist
What schedule II full opiate agonist can be taken PO for pain?
Oxycodone (OxyContin, Endocet, Percocet, Combunox)
What tablet form of Oxycodone should not be crushed or broken?
OxyContin
What group of drugs is Oxymorphone (Opana) put into?
Full opiate agonist
What full opiate agonist taken PO for moderate to severe pain, not to be used as prn, and should not be chewed, crushed, or dissolved.
Oxymorphone (Opana)
What is the most widely prescribed drug in the US?
Hydrocodone
What group of drugs is Pentazocine (Talwin) put into?
Partial opiate agonist
What is Pentazocine (Talwin) used for?
Pain. May cause withdrawal. PO.
What group of drugs is Butorphanol (Stadol) put into?
Partial opiate agonist
What is Butorphanol (Stadol) used for?
Pain. Nasal spray, injectable.
What group of drugs is Nalbuphine (Nubain) put into?
Partial opiate agonist
What group of drugs is Tramadol (Ultram) put into?
Partial opiate agonist
What schedule drug is Fentanyl?
II
What schedule drug is Meperidine?
II
What schedule drug is Morphine?
II
What schedule drug is Oxymorphone?
II
What schedule drug is Hydrocodone?
III
What schedule drug is Oxycodone?
II
What schedule drug is Buprenoorphine (Buprenex)?
V
What schedule drug is Butorphanol?
IV
What schedule drug is Nalbuphine?
Not regulated
What is the new rule for Schedule II prescribing?
The DEA now allows prescriber to write several C-II rx's on the same day, for the same patient, for the same drug...for up to a 90 day supply.
What other classes of drugs interact with opiates?
CNS depressants, anticholinergics, antihypertensives
What group of drugs is Naloxone (Narcan) put into?
Opiate Antagonists
What is Naloxone (Narcan) used for?
Treatment of narcotic overdose. Decrease respiratory depression post-op. Possibly reverse opiate constipation.
What group of drugs is Methylnaltrexone (Relistor) put into?
Opiate Antagonists
What is Methylnaltrexone (Relistor) used for?
Decrease respiratory depression post-op. Possibly reverse opiate constipation. Not approved for use in opiate addiction.
What kind of warnings do all opiates have?
Black box.
What are most CNS stimulants based on?
Either amphetamines or caffeine.
What is the mechanism of action for CNS stimulants?
Increase the release of NE in CNS, resulting in increased alertness, decreased fatigue, and mood elevation
What are CNS stimulants generally used for?
Narcolepsy, ADD in children.
What should CNS stimulant users be monitored for?
Growth, high blood pressure, sleep disorders. Drug holidays encouraged.
What is a drug holiday?
A patient stops taking a drug for a period of time in hopes that when they start taking it again, it will have a more therapeutic effect.
What are some things that are linked to ADHD?
Exposure to organophosphates (insectisides), diet high in sugar, child's classroom age.
What groups of drugs is Dextraoamphetamine (Dexedrine, Dextro, Stat) put into?
CNS Stimulant
What group of drugs is Methylphenidate (Ritalin, Metadate, Methylin and Concerta, Daytrana) put into?
CNS Stimulant
What group of drugs is Dexmethylphenidate (Focalin) put into?
CNS Stimulant
What group of drugs is the Amphetamine mixture of Adderall put into?
CNS Stimulant
What group of drugs is Atomoxeline (Strattera) put into?
CNS Stimulant, although it is not a true stimulant. It's abuse potential is lower because results take about a week to be seen.
What is the goal in the prescribing of stimulants?
Increase attention span, decrease impulsivity/hyperactivity/distractibility.
What group of drugs is caffeine put into?
CNS Stimulant
What effects does caffeine have?
tachycardia, bronchodilation, diuresis
What group of drugs is Guanfacine (Intuniv) put into?
CNS Stimulant. Alpha 2 agonist.
What group of drugs is Clonidine (Kapvay) put into?
CNS Stimulant. Alpha 2 agonist.
What is seen with CNS Stimulants that are alpha 2 agonists?
Additive effects are seen with drugs that lower BP or drugs that sedate. Must be withdrawn slowly, because BP is so toned down that if the medication is abruptly ended, it will spike back up.
CNS Stimulants have what kind of side effects?
MI, stroke, psychosis, hallucination. Atomexitine carries a warning about causing suicidal thoughts.
Drugs to treat seizures are known as what?
Anticonvulsants. Antiepileptics.
Focal seizure
Partial seizure. Limited spread.
Simple seizure
Partial seizure. Manifest with discrete symptoms depending on the region of the brain affected. No loss of consciousness. 20-60 sec duration.
Complex seizure
Partial seizure. Impaired consciousness, lack of motor function, fixed gaze followed by automatism--repetitive, purposeless movements. 45-90 sec.
Secondarily Generalized seizure
Partial seizure. Begin as simple; evolve into tonic-clonic with LOC. 1-2 min duration.
Tonic-clonic (Grand mal) seizure
Generalized seizure. Both hemispheres of cerebral cortex affected. Convulsions followed by rigidity, then muscle jerks. 90 sec or less in duration.
Absence (Petit Mal) seizure
Generalized seizure. LOC for 10-30 sec +/- mild motor activity. Usually seen in childhood, and abating in teenage years.
Atonic seizure
Generalized seizure. Sudden loss of muscle tone; seen mostly in children.
Myoclonic seizure
Generalized seizure. Focal or entire body muscle contractions that last for 1 sec or less.
Status Epilepticus seizure
Generalized seizure. May be life threatening. Lasts for 30 min or longer, manifesting as convulsive, absence, myoclonic or generalized convulsive SE.
Febrile seizure
Generalized tonic-clonic seizures seen mostly in children 6 mo-5 yrs who have a sudden spike in temp.
Mixed seizures
Lennox-Gestaut syndrome. Mixture of partial and generalized seizures that typically develops during the preschool years. Associated with developmental delays as well. Seizure types include partial, atonic, tonic, generalized tonic-clonic, and atypical absence.
What are the basic mechanisms of action of anticonvulsants?
Suppression of sodium influx. Suppression of calcium influx. Antagonism of glutamate (suppresses CNS excitation). Potentiation of GABA.
What group of drugs is Phenytoin (Dilantin) put into?
Anticonvulsant
What group of drugs is Carbamazepine (Tegretol) put into?
Anticonvulsant
What group of drugs is Phenobarbital (Luminal) put into?
Anticonvulsant
What group of drugs is Diazepam (Valium) put into?
Anticonvulsant
What group of drugs is Ethosuximide (Zarontin) put into?
Anticonvulsant
What group of drugs is Valproic Acid (Depacon, Depakene, Depakote) put into?
Anticonvulsant
Valproic acid is contraindicated in a patient with what?
Hepatic disease
Phenytoin toxicity may present with what?
Nystagmus, ataxia, sedation, gingival hyperplasia (rare), rashes (Stevens-Johnson syndrome), cardiovascular collapse with rapid infusion.
What is Steven-Johnson syndrome?
Blistering rash around mucus membranes
When you are about to put a patient on Phenytoin, what should talk to them about?
Warn that it will sedate patient. Ask them about other meds, as there are many drug interactions. Warn that it may cause a rash.
What are some ADRs of Carbamazepines?
Sedation, bone marrow suppression, Stevens-Johnson syndrome, vertigo, nausea, hepatitis, fluid retention. Many drug interactions. Red flag drug.
What are some ADRs of Valproic acid?
Tremor, sedation, GI upset, blood dyscrasias, alopecia, severe hepatoxicity. Many drug interactions. Red flag drug.
What are some ADRs of Ethosuximide?
GI upset, sedation, fatigue, rashes, depression, insomnia. Many drug interactions. Red flag drug.
What are some ADRs of Diazepam?
Drowsiness, ataxia, rashes, hypotension, amnesia. Many drug interactions. Red flag drug.
What anticonvulsant interacts with alcohol and other CNS depressants?
Diazepam
What drug is used as an IV for status epilepticus?
Diazepam
What drug is used for big tonic-clonic seizures?
Diazepam
What group of drugs is Gabapentin (Neurontin) put into?
Newer anticonvulsant
What is Gabapentin (Neurontin) used for?
Used as an adjunct for seizures; also used for migraines, chronic pain, peripheral neuropathies. Used for neuro pain. Not many drug interactions, so good for combination.
What side effects does Gabapentin (Neurontin) cause?
Fatigue, dizziness, aches and pains, edema.
What group of drugs is Topiramate (Topamax) put into?
Newer anticonvulsant
What is Topiramate (Topamax) used for?
Used as an adjunct for seizures in children 2 and older with partial seizures, generalized tonic-clonic, Lennox-Gestaut syndrome; also for migraines (at higher doses), alcohol and cocaine addiction.
What side effects does Topiramate (Topamax) cause?
Sedation, ataxia, nervousness, weight loss. Can cause metabolic acidosis.
What group of drugs is Pregabalin (Lyrica) put into?
Newer anticonvulsants
What is Pregabalin (Lyrica) used for?
Used as an adjunct; approved for neuropath and postherpetic neuralgia, fibromyalgia. ADRs: dizziness, somnolence, weight gain
What group of drugs is Levetiracetam (Keppra) put into?
Newer anticonvulsants
What is Levetiracetam (Keppra) used for?
Adjunctive therapy of myoclonic seizures, partial onset seizures, tonic-clonic seizures. ADR: drowsiness and weakness. NOT a red flag drug.
What do psychotic disorders present with?
An impaired sense of reality, disturbances of thoughts and emotions, hallucinations, delusions and confusion.
What is psychosis due (in part) to?
Increased dopamine (DA) transmission in the CNS.
What do antipsychotics block?
Dopamine (DA) transmission.
Newer antipsychotics also block what?
5-HT (serotonin) transmission.
What may some negative symptoms of psychosis be due to?
Elevated 5-HT (serotonin) in the brain.
What are positive symptoms of schizophrenia?
Hallucinations, delusions, disordered thinking, disorganized speech, agitation, paranoia,
What are negative symptoms of schizophrenia?
Social and emotional withdrawal, lack of motivation, poverty of speech, blunted affect, poor insight/judgement/self-care.
What causes schizophrenia?
"chemical imbalance" theory of too much dopamine, insufficient glutamate (excitable neurotransmitter in brain), too much serotonin
Atypical Antipsychotics are thought to be better at helping what type of symptoms of psychosis?
Negative
What are first generation antipsychotics effective for?
Effective against the positive symptoms of schizophrenia, sometimes used to manage mania in BPAD, Tourette's, NV, dementia, Huntington's chorea, delirium.
What kind of side effects do first generation antipsychotics cause?
Extrapyramidal
What are the extrapyramidal symptoms?
Acute dystonia (hours-5 days). Parkinsonism (5-30 days). Akathisia (5-60 days). Tardive dyskinesia (months to years).
What is acute dystonia?
Spasm of muscles of the tongue, face, neck or back. Oculogyric crisis may occur (eyes roll back).
What is parkinsonism?
Drug-induced. Symptoms of bradykinesia, mask-like facies, tremor, rigidity, shuffling gait.
What is akathisia?
Pacing, restlessness.
What is the rx for akathisia?
beta-blockers, benzodiazepines and/or anticholinergics. switch to low-potency FGA.
What is the rx for parkinsonism?
Anticholinergic or amantadine. Switch to SGA.
What is tardive dyskinesia?
Choreoathetoid movements of the tongue and face (uncontrolled rolling movement of tongue; can't retract tongue, may be permanent). Limbs, toes, fingers, trunk may eventually be affected.
What is the rx for tardive dyskinesia?
Switch to SGA. Use drugs for shortest time possible.
What symptoms do most patients complain about with First Generation Antipsychotics?
Weight gain, sedation, dry mouth, urinary retention, constipation
What group of drugs is Haloperidol (Haldol) put into?
First Generation Antipsychotic
What is Haloperidol (Haldol) used for?
Used to treat acute psychosis (perhaps due to meth overdose or true psychosis).
What group of drugs is Compazine put into?
First Generation Antipsychotic
What is Compazine used for?
First Generation Antipsychotic used for nausea and vomiting.
What group of drugs is Clozapine (Clozaril, FazaClo) put into?
Second Generation Antipsychotic
What group of drugs is Olanzepine (Zyprexa) put into?
Second Generation Antipsychotic
What group of drugs is Risperidone (Risperdal) put into?
Second Generation Antipsychotic
What group of drugs is Aripiprazole (Abilify) put into?
Second Generation Antipsychotic
What can Aripiprazole (Abilify) also be used for beyond psychosis?
Uncomfortable shyness
What is the most effective drug for schizophrenia?
Clozapine (Clozaril, FazaClo)
What can Clozapine cause?
Agranulocytosis
What are the main side effects seen with second generation antipsychotics?
Metabolic effects (weight gain, dyslipidemia, diabetes), and some can cause seizures and anticholinergic effects. EPS are far less.
Which generation of antipsychotics are much cheaper?
First generation
If a patient is positive for diabetes, heart disease or dyslipidemiam, what generation antipsychotic should be considered?
First generation
What group of drugs does Inhaled Loxapine (Loxitane) belong to and what is its benefit?
Antipsychotic. Less traumatic than an injection.
Barbiturates are also known as...
Sedative/Hypnotics/Antianxiety drugs
What are barbiturates used for?
Epileptic seizures, component of anesthesia, sedation. Mostly used as CNS depressants for seizures.
At low doses, barbiturates are ______. At high doses they are _______.
Sedative. Hypnotic.
What is a side effect of barbiturates?
They can cause respiratory depression, which may be fatal in overdose.
What group of drugs is Secobarbital (Seconal) put into?
Sedatives. Barbiturate. Short-acting.
What groups of drugs is Diazepam (valium) put into?
Sedative. Benzodiazepine.
What is Diazepam (valium) used for?
Anticonvulsant, muscle relaxant.
What group of drugs is Lorazepam (Ativan) put into?
Sedative. Benzodiazepine.
What is Lorazepam (Ativan) used for?
Preanesthetic (amnesia), alcohol withdrawal, sedation. Highly used as a sedative...pt is in hysterics and needs to be calmed down.
What group of drugs is Midazolam (Versed) put into?
Sedative. Benzodiazepine.
What is Midazolam (Versed) used for?
Sedation, induction into anesthesia. Used procedurally.
What group of drugs is Alprazolam (Xanax) put into?
Sedative. Benzodiazepine.
What is Alprazolam (Xanax) used for?
Anxiety. Abused for sleep.
Benzodiazepines have a _____ therapeutic index.
high
What side effects do benzodiazepines have?
Anticholinergic effects. Drugs interactions with other CNS depressants. Have active metabolites that prolong effects of drug.
What are the "date rape" drugs (roofies, GHB) modeled after?
Benzodiazepines
What is the antidote for a benzodiazepine overdose?
Flumazenil (Romazicon)
What does Flumazenil (Romazicon) do?
Reverses the sedative effect of benzodiazepines
What group of drugs is Zolpidem (Ambien, Zolpimist) put into?
Sedative
What is Zolpidem (Ambien) used for?
Sleep
What are side effects of Zolpidem (Ambien)?
Sleep-driving/eating, hangover.
How do antidepressants work?
Elevate NE, DA or serotonin in the synapse by blocking their re-uptake. Or by inhibiting degradation of serotonin or NE by inhibition of MAO.
What is the first line of treatment for depression?
an SSRI (selective serotonin reuptake inhibitor) or an atypical antidepressant.
If SSRIs or atypical antidepressants do not work or are not tolerated by the patient, what might be used?
a Tricyclic Antidepressant (TCA).
What are the last choice drugs for depression?
MAOIs
What negatively interacts with MAOIs to cause an increase in BP and HR?
Tyramine
What kind of foods should a person taking MAOIs stay away from?
Chocolate, sausages, cheese, raisins, beer/wine
What group of drugs does Amitriptyline belong to?
Tricyclic Antidepressant
What are Tricyclic Antidepressants used for?
Depression, panic, agoraphobia, OCD, pain, migraine
What are side effects of Tricyclic Antidepressants?
Frequent anticholinergic effects, sedation. Antidepressant effect not seen until 2-3 weeks of taking.
What group of drugs does Trazodone belong to?
Atypical SSRI (fewer anticholinergic effects)
What group of drugs does Fluoxetine (Prozac) belong to?
SSRI
What group of drugs does Citalopram (Celexa) belong to?
SSRI
What group of drugs does Escitalopram (Lexapro) belong to?
SSRI
What group of drugs does Paroxetine (Paxil) belong to?
SSRI
What group of drugs does Sertaline (Zoloft) belong to?
SSRI
What are SSRIs used for?
Depression, OCD, PMDD, anxiety
What are the side effects of SSRIs?
Nausea, nervousness, headache, anorexia, may increase risk of suicide, sexual dysfunction
What SSRIs are approved for patients under 18?
Fluoxetine (Prozac) and Citalopram (Celexa)
What SSRI is the worst for weight gain?
Paroxetine (Paxil)
What group of drugs does Bupropion (Wellbutrin, Zyban) belong to?
Atypical Antidepressant
What are side effects of atypical antidepressants?
Rash, seizures, weight loss. They have the lowest incidence of sexual side effects. Cigarettes shouldn't be combined with these.
What is the mechanism of action for SSRIs?
Block re-uptake of serotonin
What is the mechanism of action for TCAs?
Block re-uptake of serotonin and NE
Venlafaxine (Effexor) and Duloxetine (Cymbalta) belong to what group of drugs?
SSRIs that block re-uptake of serotonin as well as NE
Are SSRIs that also affect NE as well tolerated as normal SSRIs? Why or why not?
No; They will cause a withdrawal syndrome upon discontinuance.
What group of drugs does Phenelzine (Nardil) belong to?
MAOIs
What are MAOIs used for?
Depression when TCAs fail
Which MAOI has less of a risk of a dietary hypertensive crisis?
Selegiline (Emsam)-transdermal
What interactions do MAOIs have?
Interact with foods that contain tyramine, interact with meperidine and sympathomimetics. Will cause hypertensive crisis.
What is the drug of choice for Bipolar Affective Disorder?
Lithium
What are side effects of Lithium?
GI upset, polyuria, fine tremor. Chronic use may cause diabetes insipid us with resulting toxicity (vomiting, muscle weakness, seizures, coma)
What dietary intake/loss must be considered with Lithium?
Sodium. Increase in sodium intake with decrease drug absorption in kidney. Decrease in sodium intake will increase risk of toxicity.
Why are many other drugs besides Lithium used to treat BPAD?
Lithium has a narrow therapeutic index. Fine tremors- convulsions/death with minimal changes in dose.
What seizure drugs are also approved for BPAD?
Carbamazepine (Equetro) and Lamotrigine (Lamictal)
What seizure medication is also considered a first-line mood stabilizer for BPAD and puts a patient at risk for liver toxicity?
Valproic Acid (Depakote)
What other types of drugs are used to treat BPAD?
Haloperidol, Phenobarbital, and many drugs used for seizure disorders, blood pressure management, as well as other sedatives.
What benzodiazepine is also good preanesthetic drug because it produces sedation and amnesia?
Lorazepam (Ativan)
What barbiturate is also a good preanesthetic drug and is order the night before surgery to induce sleep?
Secobarbital (Seconal)
What anticholinergic drugs are preanesthetics given to patients to decrease secretions and bowel movements in preparation for surgery?
Atropine and Glycopyrrolate
What are the goals of anesthetic drugs?
Sedation, muscle relaxation, amnesia
What general anesthetic is the most widely used, does not give good skeletal muscle relaxation, and may cause arrhythmias?
Halothane (Fluothane)
What group of drugs does Halothane (Fluothane) belong to?
General Anesthetic
What antipsychotic and narcotic drug is given for neuroleptic anesthesia?
Droperiodol/Fentanyl (Innovar)
What group of drugs does Propofol (Diprivan) belong to?
General Anesthetics
What is Propofol (Diprivan) used for?
General CNS depressant. Causes respiratory depression. "Purposeful sedation"
What group of drugs does Lidocaine (Xylocaine) belong to?
Local Anesthetic
What is a benefit of Lidocaine?
Fast onset (~1 min), longer duration (~2 hrs)
What may Lidocaine and Bupivacaine cause?
Heart block or arrhythmias
What group of drugs does Bupivacaine (Marcaine) belong to?
Local Anesthetic
What is Bupivacaine used for?
Spinal, epidural, infiltration, and nerve block anesthesia.
What might local anesthetics be combined with in order to keep them "local"?
Epinephrine
What drug is used as a transdermal patch to prevent nausea and vomiting caused by motion sickness and can also be used as an anesthetic for surgery?
Scopolamine (Scopoderm)
Half of women with newly diagnosed coronary artery disease/heart disease present with this as their first symptom.
Sudden death - first and only symptom.
In which region of the U.S. is patient compliance lowest?
Southeastern U.S.
Ventricular work is determined by _____.
Preload and afterload
Preload
Venous return to the heart.
Afterload
Total peripheral resistance.
As venous return increases _____.
volume of blood in the left ventricle increases.
The heart works harder to pump blood out as _____.
Total peripheral resistance increases.
The heart works harder to pump blood out as _____ increases.
total peripheral resistance
Low output
The heart is unable to pump sufficient blood out.
Name two causes of low cardiac output.
Myocardial infarction (MI) and hypertension (HTN)
Which side of the heart is most often affected in MIs, particularly among patients experiencing their first infarction?
Left side of heart
Work of the heart is increased by _____.
Increased preload or afterload
How does the heart compensate for age-related decreased efficiency as a pump?
Ventricular dilation with increased heart rate, increased contractility, increased BP, and sodium and water retention.
Name the primary signs and symptoms of left heart failure.
Pulmonary congestion (SOB), left ventricular hypertrophy (LVH), edema, tachycardia.
Name the primary signs and symptoms of right heart failure.
Venous hypertension, pitting edema, hepatomegaly (enlarged liver), and anorexia.
Hypertension
Persistently elevated blood pressure greater than 130/85.
Essential hypertension
No identifiable cause. Most common subcategory of this disease (95-90%).
Secondary hypertension
Identifiable cause. Least common subcategory of this disease (6-10%).
Normotensive blood pressure
120/80
Which type of hypertension leads to increased total peripheral resistance and decreased cardiac output?
Both types of hypertension (essential and secondary).
Hypertension complication
Stroke
Hypertension complication
Angina
Hypertension complication
Congestive heart failure (CHF)
Hypertension complication
Myocardial infarction (MI)
Hypertension complication
Chronic renal failure
Hypertension complication
Retinal lesions
Hypertension complication
Blindness
What percentage of Americans with hypertension have controlled blood pressure?
24%
Hypertension treatment is of extreme importance in which demographic populations?
Age greater than 50, diabetes, dyslipidemia, smoking.
Treatment for moderate elevation of blood pressure on 2-3 occasions, with no other cardiovascular risk factors.
Weight loss, increased physical activity, DASH diet, smoking cessation, alcohol curtailment, stress reduction, limited caffeine use.
If moderate blood pressure elevation continues after 6 months of lifestyle changes, what is the next step in treatment?
Drug therapy. This conservative approach avoids premature overtreatment.
Isolated systolic hypertension (ISH)
Systolic greater than 160 and diastolic less than 90.
Isolated systolic hypertension (ISH)
Common with aging.
Isolated systolic hypertension (ISH)
Increased arterial stiffness and peripheral vascular resistance increases amount of pump pressure required for circulation.
Isolated systolic hypertension (ISH)
Increased systolic BP and decreased diastolic BP.
Pulse pressure
Difference between maximum and minimum blood pressures produced during one heartbeat.
ISH represents what percentage of elderly hypertension?
65-75%
What is the treatment for ISH?
Diuretic then long-acting calcium-channel blockers.
What is the most common problem with antihypertensive medications?
Noncompliance due to side effects and lifelong treatment regimen.
There are how many classes of antihypertensive drugs?
Eight.
Hypertrichosis
Abnormal hair growth over the body.
Two therapeutic classes of antihypertensives most effective in African American patients.
Thiazides and calcium channel blockers.
Therapeutic class of antihypertensive most effective in elderly African American patients.
Calcium channel blockers
Two therapeutic classes of antihypertensives most effective in white patients.
Beta blockers and ACE inhibitors.
Therapeutic class of antihypertensive most effective in elderly white patients.
Calcium channel blockers or thiazides.
Preferred therapeutic class for treatment of ISH in elderly patients.
Diuretics.
Drug class which reduces morbidity and mortality.
Beta blockers.
Hypertensive crisis
Diastolic BP greater than 120 mmHg.
If a patient is in hypertensive crisis, which route is most likely used for drug administration?
IV administration
Occur when conductance of cardiac tissue is altered.
Dysrhythmias
Modify ion conductance in cardiac tissue, restoring cells to normal (sinus) rhythm.
Antiarrhythmimc drugs
Three options to treat arrhythmias.
Ablation, pacemaker, or medication.
First line antihypertensive treatment.
Lifestyle changes: Diet, exercise, etc.
Second line antihypertensive treatment.
Add diuretic or beta blocker or ACE inhibitor/ARB.
Third line antihypertensive treatment.
Two drugs OR increase doses of current regimen OR add a drug from another class.
Cinchonism
Quinine overdose.
Stable angina
Chest pain caused by exercise/stress.
Unstable angina
More severe than stable angina. May develop at rest and cause myocardial damage.
Variant (Prinzmetal) angina
Due to vasospasm of coronary vessels. May occur at rest, same time each day.
Angina pectoris treatment goal
Restore blood flow to myocardium, either by increasing oxygen delivery to the heart with vasodilators or decreasing cardiac oxygen consumption with beta blockers.
Acute coronary syndrome
A common presentation of coronary artery disease, accounting for more than 1 million hospital admissions in the USA annually.
This patch must be removed each day for at least a few hours to prevent development of drug tolerance.
Nitro-Bid, Nitrostat (nitroglycerin)
What is the acronym used in STEMI treatment?
MONA (morphine, oxygen, nitroglycerin, aspirin).
Leading cause of disability in the US.
Stroke
Derived from liver synthesis and diet.
Cholesterol
Lipoproteins
Serum proteins which carry cholesterol in the bloodstream.
Four classes of lipoproteins.
VLDL-C, ILDL-C, LDL-C, HDL-C.
Percentage of patients who would benefit from lipid-lowering therapy, actually receiving therapy.
25%
Primary demographics being undertreated for hyperlipidemia.
Women and the elderly.
Major risk of thrombolytic therapy.
Intracranial bleeding
Full Agonists
good for sever pain, may give a feeling of euphoria
Partial Agonists
good for moderate pain, may act as antagonists at some receptors and precipitate withdrawal for someone who is addicted to opiods
Antagonists
will reverse all narcotic effects including pain relief, euphoria, and respiratory depression
Common SE of nartotics
hypotension, sedation, nausea, itching, muscle weakness, constipation
Opioids
(narcotics)
relieve pain and induce euporia by binding to "opiate receptors" in the brain, disrupt transmission of pain to the brain, can also suppress cough reflex; may cause tolerance, dependence and/or addiction
Morphine
Full Opiate Agonist, antidote is naloxone, used for pain (preps last 4-5hrs), extensive first-pass effect, tolerance occurs, PCA pump can be used
Fentanyl
(Duragesic)
Full Opiate Agonist, much more potent that morphine, used for pain, used in preop med and in anesthesia, transdermal prep for chronic pain, IR, ER
Oxycodone
(OxyContin, Endocet, Percocet, Combunox)
Full Opiate Agonist, schedule II drug, PO (do not crust or break), used for pain
PCA Pump
Allows pt to administer opioids as needed, delivers bolus drug with a set interval between doses
Hydrocodone
(Lortab, Vicodin)
Full Opiate Agonist, schedule III drug, PO, used for pain, #1 abused drug in Alabama
Oxymorphone
(Opana)
Full Opiate Agonist, PO (do not chew, crush, or dissolve), potent, for moderate to sever pain, not a prn med (taken as needed)
Meperidine
(Demerol)
Partial Opioid Agonist, schedule II drug, used for pain, DO NOT use with MAO or in seizure disorders
Pentazocine
(Talwin)
Partial Opioid Agonist, schedule IV drug, used for pain, may cause withdrawal (PO), injected for pain
Naloxone
(Narcan)
Opiate Antagonist, treatment for narcotic overdose, decreases respiratory depression post-operatively, induce withdrawal syndrome-can be life-threatening
REMS
Risk Evaluation and Mitigation Strategies (REMS), prescribers may be edu on the risks of use and abuse of addictive opiates before getting a DEA #
Seizure
due to hyperactivity in the brain, where certain groups of cells or the whole brain fires action potentials too frequently.
Mechanisms of Action of AEDs (Anti Epileptic Drugs)
1. Suppression of Na influx
2. Suppression of Ca influx
3. Antagonist of glutamate
4. Potentiation of GABA
Phenobarbital
(Luminal)
AED, interacts with GABA receptors on nerve. This interaction increase Cl flux across nerve, causing decrease in nerve firing
**Never d/c abrupty, red flag drug
Diazepam
(Valium)
AED, interacts with GABA receptors on nerve. This interaction increase Cl flux across nerve, causing decrease in nerve firing
**Never d/c abruptly, red flag drug
*ADR: drowsiness, ataxia, rashes, hypotention, amnesia
*drug interaction with alcohol, other CNS depressants-red flag drug
*used IV for status epiepticus, PO, MI for other seizure disorders
Topiramate
(Topamax)
Newer AED, used as an adjunct for seizures, also for migraines, alcohol and cocaine addiction. Causes sedation and weight loss
Valaproic acid
AED, cannot be used in the pt with hepatic disease
*ADR: tremor, sedation, GI upset, blood dyscrasias, alopecia
*severe hepatoxicity
*many drug interactions-red flag drug
Ethosuximide
AED
*ADR: GI upset, sedation, fatigue, rashes, depression, insomnia
*many drug interaction- red flag drug
Carbamazepine
AED
* start with a low initial dose and increase weekly
*autoinduction-red flag drug
*ADR: sedation, bone marrow suppression, Stenens-Johnson syndrome, vertigo, nausea, hepatitis, fluid retention
*MANY drug interations
Gabapentin
(Neurontin)
Newer AED, used as an adjunct for seizures, also used for migraines, chronic pain, peripheral neuropathies. Causes fatigue, dizziness, aches and pains, edema.
Levetiraceta
(Keppra)
Newer AED, adjuntive theropy of myoclonic seizures, partial onset seizures, tonic-clonic seizures.
SE: Drowsiness, weakness
NOT a red flag drug
NOT metabolized
Antipsychotics
Psychosis is due to an increase in DA transmission in the CNS. Antipsychotics BLOCK DA transmission. Newer drugs block the trans of serotonin as well. All can be given PO, IV or IM in depot forms.
Positive Symptoms of Schizophrnia
hallucinations, delusions, disordered thinking, disorganized speech, agitation, paranoia
Negative Symptoms of Schizophrnia
social and emotional withdrawal, lack of motivation, poverty of speech, blunted affect, poor insight, judgment, self-care.
Acute Symptoms of Schizophrnia
symptoms of grandiose thinking, religious delusions, etc. may also present
First Generation Antipsychotics
Effective against the positive symptoms of schizophrenia, sometimes used to manage mania in BPAD, Tourette's, NV, dementia, Huntington's chorea, delirium
Many SE, most notably extrapyramidal—d/t effects on DA
1. Acute dystonia (hours-5 days)
2. Parkinsonism (5-30 days)
3. Akathisia (5-60 days)
4. Tardive dyskinesia (Months to years)
Acute Dystonia
spasm of muscles of the tongue, face, neck or back. Oculogyric crisis may occur. Give benztropine or diphenhydramine IM or IV to treat
Akathisia
pacing, restlessness. Rx with beta-blockers, benzodiazepines and/or anticholinergics. Switch to low-potency FGA
Tardive Dyskinesia
choreoathetoid movements of the tongue and face. Limbs, toes, fingers, trunk may eventually be affected. Switch to SGA. Use drugs for shortest time possible
SE of FGAs
1. Prolactin release
2. Weight gain
3. Sedation
4.Dry mouth, urinary retention, constipation, blurred vision, tachycardia (anticholinergic!)
5. Orthostatic hypotension
6. Sometimes, Neuroleptic Malignant Syndrome....Rx with Dantrolene
Haloperidol
(Haldol)
First generation anti-psychotic drug, for acute psychosis-PO, injectable, depot
Compazine
First generation anti-psychotic drug, given for nausea and vomiting
Second Generation Antipsychotics
SE include metabolic effects (weight gain, dyslipidemia, diabetes), and some can cause seizures and anticholinergic effects
(Parkinsonism and tremors and other extapyramidal effects are much less with these drugs but can occur)
Olanzepine
(Zyprexa)
Second Generation Antipsychotic
Aripiprazole
(Abilify)
Second Generation Antipsychotic
Clozapine
(Clozaril, FazaClo)
Second Generation Antipsychotic, Clozapine is the most effective drug for schizophrenia but it can cause agranulocytosis (it can wipe out WBC count, has to be monitored) , EPS are far less in this drug
What type of hematoma occurs from a ruptured middle meningeal vessel between the skull and dura due to falls, or MVA, and is sometimes seen in athletes?
Epidural hematomas
-most common in ages 20-40 (bc of MVAs)
-headache, LOC, motor dysfunction
-sometimes seen in athletes
What type of hematoma occurs between the dura and arachnoid and is usually seen in elderly or alcoholics as a result of falls, and could also result from blunt trauma, with MVAs being the most common cause?
Subdural hematoma---
-headache, drowsiness, restlessness, agitation, LOC=acute; may be fatal
-chronic headaches and dementia
Subarachnoid hemorrhages
-between arachnoid and pia
-preceded by berry aneurysms which rupture (often fatal outcome)
What type of hemorrhage is due to trauma (blunt or gunshot) or a stroke and is usually fatal because of increased ICP or a coma?
Intracerebral hemorrhage
Ischemic stroke
-80% of strokes
-occurs when a blocked artery disrupts flow to brain
Hemorrhagic stroke
-20% of strokes
-blood vessel in the brain bursts and damages nearby tissue
Agnosia
Failure to recognize objects, colors, things
Dysphasia
Impaired speech--comprehending or production
What are the categories that the Glasgow Coma Scale evaluates?
-Eye opening
-Verbal response
-Motor response
What is the minimum score on the Glasgow Coma Scale?
3
What is the maximum score on the Glasgow Coma Scale?
15
Encephalitis
-viral infection of the brain (herpes, Eastern Equine, West Nile)
-invades the neural or glial cells
Myelitis
Infection of the spinal cord
Meningitis
Inflammation of the meninges due to viral or bacterial infection
S/S: headache, neck stiffness, photophobia, cloudy or purulent CSF (bacterial), high protein content (viral)
What autoimmune disease results in demyelination of nerves, causing sensory and motor loss?
Multiple Sclerosis
What are the first signs and symptoms seen in MS?
Tingling, blurred vision, muscle weakness, unsteady gait, urinary incontinence; eye pain, double vision, sudden color blindness in a young person are diagnostic
What is the Charcot triad that occurs with cerebral involvement in a person with MS?
Nystagmus, intention tremor, telegraphic speech.
Within 2 weeks, a patient that has been in a coma has a _____ prognosis.
good
Recovery of consciousness within 6 months in a coma is correlated with...
severe disability.
After one year in a coma there is...
no recovery without severe disability
3 months in a vegetative state is associated with what type of recovery?
no recovery
One year in a coma from a traumatic brain injury is associated with what type of recovery?
no recovery
What type of vitamin deficiency has the most impact on the CNS?
Vitamin B
What presents with vitamin B12 deficiency?
Uncoordinated movement and other neural deficits
Pellagra results from what type of deficiency?
Nicotinic acid deficiency
What presents with pellagra?
3 D's: dermatitis, diarrhea, delirium
What type of hematoma is an alcoholic at risk for and why?
Subdural hematomas due to falls.
What is the neurodegenerative disease that results in amyloid plaques being formed in the brain, causing neuronal loss?
Alzheimer's Disease
What is the neurodegenerative disorder that results in decreased dopamine in the substantia nigra?
Parkinson's Disease
What is the autosomal dominant neurodegenerative disease that presents with involuntary gyrating movements, dementia, and slight personality changes?
Huntington's Disease
What is the neurodegenerative disease resulting in motor weakness and muscle wasting in which hand muscles are affected and respiratory muscles become paralyzed?
Amyotrophic Lateral Sclerosis
Gliomas
Malignant tumors arising from glial cells; 50% of CNS tuners; primary brain tumors
Astrocytomas
About 50% of CNS tumors are this type; fairly common in young adults
Undifferentiated or Precursor cell tumors
Cells resemble neural tube cells; may be undifferentiated; 2% of the CNS tumors are of this type
Meningioma
Arise from the meninges; seizures often first S/S. Can be surgically removed. 15% of CNS tumors are this type.
Tumors of spinal cord or cranial nerves
Neuromas: many benign...headache, hearing loss, tingling are S/S. 5% of CNS tumors are this type
What are characteristics of a migraine?
Unilateral; most present WITHOUT an aura; visual and sound stimuli aggravate the migraine.
Yawngasm
Related to Anafranil (clomipramine) use. A spontaneous orgasm while yawning. Anafranil (clomipramine) is used off-label for major depression.