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Pharmacology Quiz 2
Terms in this set (35)
What muscle relaxers are used specifically for spasticity?
Baclofen, dantrolene, diazepam, tizanadine.
What s/s will manifest with abrupt D/C of baclofen?
Visual hallucination, paranoid ideation and seizures
Due to MOA, what is an expected SE of using Baclofen? What SE warrant the PCP to be notified?
- Lethargy, weakness, dizziness, fatigue and drowsiness are expected.
- Constipation and urinary retention are symptoms that should be notified to the PCP.
What s/s will a pt present with due to baclofen OD? Is there an antidote?
- Unresponsive and show s/s of respiratory depression and coma.
- Respiratory support is essential to prevent a fatal outcome.
- There is no antidote.
When is baclofen a DOC for a pt?
Used to treat muscle spasticity associated with multiple sclerosis, spinal cord injury and cerebral palsy.
What patients must use dantrolene with caution?
Pts with liver problems
What are the uses for dantrolene?
Used to treat spasticity associated with multiple sclerosis, cerebral palsy, and spinal cord injury. Its also used to treat malignant hyperthermia.
What PMH warrants caution when using tizanadine? baselines needed?
- Hepatotoxicity; liver damage
- Baseline liver enzymes should be obtained before dosing and periodically after.
What AE can occur when using tizanadine?
- Hallucinations and psychotic symptoms
What prominent AE can occur when suing cyclobenzaprine?
Dry mouth, blurred vision and constipation
What AE can occur when using methocarbamol that does NOT warrant a nurse to notify the PCP?
May turn urine black, brown or green.
What organ is at risk when using metaxolene ?
What are the beneficial used that differ between inhibitors of Cox-1 vs Cox-2?
- COX-1 inhibitors: reducing platelet aggregation and thus reducing the risk of myocardial infarction and stoke.
- COX-2 inhibitors: protect against colorectal cancer, reduce inflammation and reduce fever.
What type of pain is aspirin effective for? Not effective against - what should be used?
- Joint pain, muscle pain, and headache.
- Ineffective against visceral pain.
- FG NSAID should be used.
In what cases are increased doses of ASA used>
Rheumatic fever, tendonitis and bursitis
When should ASA not be used for fever?
How does ASA effect renal function? What may indicate a decline in such, and how should this be approached?
- ASA can cause acute, reversible renal impairment.
- PT will show signs of RI, weight gain despite the use of diuretics, decrease urine output, hypertension, and elevated serum creatinine and BUN.
What are s/s of salicylism? Is this toxicity? How should it be approached
- Tinnitus, sweating, headache and dizziness.
- ADA should be withheld until symptoms subside.
- This is not toxicity
Comment on the use of ASA in pregnancy? How does ASA affect labor - do NSAIDS pose the same risk?
- Poses risk to the pregnant pt and fetus, including premature closure of the ductus arteriosus.
- ASA pro longs labor.
- NSAIDS have similar effects and also should be avoided.
How many pts initially present with a hypersensitivity to ASA? How should this be approached dependent on dose? Do NSAIDS have any cross-sensitivity?
- May start with profuse watery rhinorrhea and process to generalized urticaria bronchospasm, laryngeal edema and shock.
- Epinephrine is the treatment of choice.
- Pts with sensitivity to ASA often also have sensitivity to NSAIDS.
What is the MOA for non-aspirin FG NSAIDS, how does this compare to ASA?
- Non-Aspirin first-generation NSAIDS do cause suppression of platelet aggregation, but the suppression is reversible.
- These agents cause reversible COX inhibition whereas ASA causes irreversible COX inhibition.
Does a non-aspirin FG NSAID carry a risk of cross-sensitivity to pt with an ASA ALL?
Do NSAIDS have a cardio protective effect like that of ASA?
NSAIDS do not provide protective benefits.
In regards to AE GI effects, how should pts be educated on using a FG non-aspirin NSAID?
Should be cautioned to limit alcohol intake.
Taking NSAIDS with meals helps prevent GI upset.
Do NSAIDS pose the risk of salicylism?
Can NSAIDS be used in lactation?
They are safe to use while breastfeeding
What type of drug is ibuprofen? What is the MDD of ibuprofen?
- non-aspirin FG NSAID.
- Max dose is 3200mg/day or 800 mg/4x a day
What type os pain is ketoralac used for? Comment on the max duration of TX with ketoralac?
- Not indicated for chronic or minor pain.
- Should not be used longer than 5 days.
What forms if diclofenac available in? How is it properly dosed when being used as a topical? Does the SE profile change if the dosage form changes?
- Available in topical and oral preparations.
- Apply smaller amounts to the upper extremities.
How does the MOA for APAP differ from ASA/NSAID - why may this be beneficial?
- Differences between the effects of acetaminophen and aspirin are thought to result from selective inhibition of cyclooxygenase. Acetaminophen has only minimal effects on cyclooxygenase at peripheral sites, which may explain why acetaminophen does not have adverse GI, renal and anti-platelet effects.
How is APAP OD TX - time frame to administer effectively? Why should we avoid using charcoal for TX?
- Given within 8 to 10 house after ingestion.
- Activated charcoal is effective only is given before the medication is absorbed.
Comment on the MDD for APAP then would this be decreased?
- MDD is 4 g/day
- Pts who drink regularly should be advised to take acetaminophen in low doses and not to exceed 2g per day.
Why is colchicine often given concurrently along with initial gout medications?
Because gouty episodes have a tendency to increase during this time.
For what s/s should colchicine be D/C as it may indicate a serious AE?
- Vomiting may indicate injury to the GI endothelium.
What drug class should be avoided with colchicine and why?
Simvastatin or other statin drug because it can cause rhabdomyolysis.
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