Pharm HESI - Med Surg II, Over 400 QA

Pharm HESI - Med Surg II, Over 400 QA This Anti-Parkinson's medication should be: • Taken orally • Not to be taken with B6 or tricyclic antidepressants • Take 30 min. before eating proteins Levodopa-Carbidopa (Sinemet) Anti-Parkinson's How does the Levidopa and Carbidopa compliment each other in the combined drug, Sinemet? • Levodopa is a precursor for dopamine and must be given in high doses because it is broken down outside the CNS • Carbidopa prevents the breakdown of Levodopa in the peripheral What is a dopamine replacement drug that is used in the later stages of Parkinson's? Levodopa-Carbidopa [Sinemet] How many times can Levodopa-Carbidopa [Sinemet] be halved? once (it is scored) After how many years (range) does the medication Levodopa-Carbidopa [Sinemet] become ineffective for Parkinson's? after 5 to 10 years What anti-Parkinson's drug is not to be used with narrow angle glaucoma or any undiagnosed sign problem because it activates malignant melanoma? Levodopa-Carbidopa [Sinemet] Name that anti-Parkinson's drug: • Only dopamine modulator • Was first an anti viral • Causes release of dopamine from storage in presynaptic fibers • Blocks reuptake of dopamine • Given in early stages of Parkinson's • Relieves dyskinesia symptoms Amantadine (Symmetrel) How long is Amantadine (Symmetrel) usually effective? 6 to 12 months What are some adverse effects of Amantadine (Symmetrel)? dizziness, insomnia, and nausea What anti-Parkinson's drug helps control the tremors, including muscle rigidity, because of both its dopaminergic and anticholinergic effect? Amantadine (Symmetrel) What is a COMT inhibitor? a drug that inhibits the action of catechol-O-methyl transferase. This enzyme is involved in degrading neurotransmitters. They are used in the treatment of Parkinson's disease. The following are advantages of what classification of drugs (Anti-Parkinson's)? • Blocks breakdown of catecholamines • 2 COMT inhibitors ( tolcopone and entapone) • Entapone prolongs the effects of levodopa • Reduces the wearing-off phenomenon • Therapeutic effects in a few days • Entapone (Comtan) COMT inhibitor • Prolongs the effects of levodopa • GI upset and discolored urine • Not to be used with liver problems • Not be taken with nonselective MAOEs COMT Inhibitors What is Dyskinesia? a term for abnormal and distressing involuntary movement; inability to control movement which often occurs as a side effect of levodopa therapy (used for Parkinson's). What is Chorea? irregular, spasmodic, involuntary movements of limbs and facial muscles What is Dystonia? abnormal muscle tone leading to impaired movement of head, neck, or feet What is the Wearing-off phenomenon? is a gradual worsening of Parkinson symptoms as a patient's medications begin to lose their effectiveness, despite maximal dosing with a variety of medications. How can you reduce the wearing-off phenomenon? by giving carbidopa with levodopa Name that medication: • MAOI • Antidepressant and used to treat Parkinson's • Increase CNS depressant effects • Can cause serotonin syndrome • Cheese effect • Avoid cold or cough medicines • Avoid Tyramine!! Can cause a hypertensive crisis!! Nardil (phenelzine) If a patient is taking a medication that is linked to the "cheese effect", what should they avoid in their diet? TYRAMINE containing foods such as: - aged cheeses - smoked or pickled meats - aged or fermented meat - yeast extracts - red wines Why should patients taking Nardil (phenelzine) avoid Tyramine? Can cause a hypertensive crisis!! Can cause a hypertensive crisis!!! What drug is the mainstay for treatment of angina or other cardiac problems, and prophylaxis? Nitroglycerin What is Long-Acting Nitroglycerin used for? prevention of angina What is Short-Acting Nitroglycerin used for? acute angina attacks What is the MAIN adverse effect of Nitro? Headache Nitroglycerin has a very LARGE first pass effect in the liver, therefore what route should be avoided if possible? Oral When should a patient take SUBLINGUAL Nitroglycerin? at the first sign of chest pain and not delayed until the pain is severe. What should a patient do (position) before taking SUBLINGUAL Nitroglycerin? Sit or lie down This drug causes relaxation of smooth muscle in arteries and veins, have a potent vasodilating effect on large and small coronary arteries-causes redistribution of blood and oxygen to ischemic myocardial tissue and reduces angina symptoms. Nitroglycerin What should a patient do if chest pain or discomfort is not relieved within 5 minutes after taking one dose of Nitroglycerin? According to current guidelines, if the chest pain or discomfort is not relieved in 5 minutes, after one dose, the patient (or family member) must call 911 immediately. The patient can take one more tablet while awaiting emergency care and a third tablet 5 minutes later, but no more than three tablets total. What do the current Nitroglycerin administration guidelines reflect? The fact that angina pain that does not respond to nitroglycerin may indicate a myocardial infarction. Can Nitroglycerin be swallowed? No. The SUBLINGUAL dose is to be placed under the tongue and the patient must avoid swallowing until the tablet is dissolved. Instruct the patient not to eat or drink until the drug has completely dissolved. Name that Antibiotic: - Bacteriostatic. Inhibits bacterial growth. - Must be avoided in pregnant and nursing women and children under 8 years old - Can interact with dairy, antacids, or iron salts - Can interact with Warfarin Tetracycline Indications for this type of antibiotic include: • Acne in adolescents and adults • Chlamydia • Mycoplasma • Gram negative and gram positive microorganisms • Protozoa • Rickettsia (Rocky Mountain Spotted Fever) • Syphilis • Lyme disease Tetracycline Adverse effects of this type of antibiotic include: • Discoloration of the permanent teeth and tooth enamel hypoplasia in both fetuses and children and possibly retard fetal skeletal development if taken during pregnancy • Photosensitivity ( most common in pt. taking demeclocycline) • Alteration of the intestinal and vaginal flora Which can result in diarrhea or vaginal candidiasis • Bulging fontanelles in neonates • Thrombocytopenia • Possible coagulation irregularities • Hemolytic anemia: Tetracycline The following refers to what medication? • relieves severe ongoing pain (such as due to cancer) • can wear transdermal patch for 72 hours • can cause severe respiratory depression • should not be taken with grapefruit or grapefruit juice Fentanyl (transdermal) Math - IM mg to mcg Math - IV - secondary infusion - meQ/hr Math - IM - mg/ml Math - IV dose rate • Nonstimulant drug used for obesity • Works locally in the small and large intestine where it inhibits absorption of caloric intake from fatty foods by binding to lipases • Contraindicated in malabsorption syndrome (e.g. Crohn's disease, colitis, short bowel syndrome) or cholestasis • Can cause headache, upper respiratory tract infection, GI distress, including fecal incontinence and oily stools • Can cause deficiency of vit. A, D, and E and beta carotene • Available OTC Orlistat (Xenical) Anorexiant • potassium-sparing diuretic , known as "water-pill" • used to treat HTN, HF, edema, high levels of aldosterone, and low potassium conditions Aldactone (Spironolactone) What classification of drugs can mask the effects of too much aspirin (toxicity) such as ringing in the ears? antihistamines What classification of drugs can add to the effects of alcohol and other CNS depressants? antihistamines These drugs may cause drowsiness, even if taken at bedtime.