Maryville 615 Pharm Exam 6 | 139 Questions with 100 % correct answers |Verified

What are the precautions and contraindications when prescribing phentermine? - It carries a high risk of tolerance and dependence, physically and psychologically. Caution using with patients with history of alcohol or drug dependence because of cross-tolerance. Actively drinking alcoholics can get depression, paranoia, or psychoses when taking phentermine. Use should be limited to max of 6 months. Contraindicated in patients who abuse substances such as cocaine, meth or PCP because of potential for excessive adrenergic stimulation. Patients with diabetes may experience altered insulin or hypoglycemic dosage requirements. What is the length of time that anorexiants should be prescribed? - 6 months is the max amount of time for treatment with anorexiant. Alternative treatment regime-use the drug for a few weeks. What is rectal diazepam (Diastat) used to treat? - Not found in the text at all. Per Micromedex, it is indicated in refractory seizures in adults and children as an adjunctive treatment. FDA labeled for alcohol withdrawal symptoms, anxiety, sedation, skeletal muscle spasm, tetanus, skeletal muscle spasms, adjunctive treatment, and status epilepticus. Per Epocrates, used as adjunctive treatment for seizure disorder in adults and children age 2 and up. What is phenytoin hypersensitivity syndrome and when does it occur? - Phenytoin hypersensitivity syndrome is fever, skin rash, and lymphadenopathy, occurs between weeks 3-8 of treatment. What is auto metabolism of carbamazepine? - Carbamazepine is metabolized in the liver and has the unique ability to induce its own metabolism. D/t autoinduction, initial concentrations with in a therapeutic range may later fall despite good compliance. It also induces the metabolism of many CYP450 enzymes and other substrates. Excretion is through urine and feces. What is the Black Box Warning of carbamazepine? - Carbamazepine has a black box warning regarding serious dermatological reactions (Steven Johnson syndrome and toxic epidermal necrolysis) and the risk of developing aplastic anemia and agranulocytosis. Use with caution in patients with increased intraocular pressure because of its mild anticholinergic effects. Caution is also advised in patients with a history of previous adverse hematologic reactions to any drugs in those with cardiac, renal, or hepatic impairment. Carbamazepine has a black box warning d/t its potential to cause blood dyscrasias, some potentially lethal. Although a transient decrease of the WBC can occur and is manageable, carbamazepine can depress bone marrow and lead to leukopenia, thrombocytopenia, agranulocytosis, and aplastic anemia. For that reason a baseline blood screen that includes a CBC, LFT, TSH should be obtained and then periodic. Following up studies should be more frequent initially,decreasing to every 3-4 months if the results remain normal or the CBC and differential are only minimally lowered. Other adverse reactions to carbamazepine hepatic damage and impaired thyroid function. Less serious early adverse events may include drowsiness, dizziness, blurred vision, ataxia, n/v, dry mouth, diplopia, and HA. What blood values should be monitored with carbamazepine? - Plasma carbamazepine levels should be monitored on a regular basis. The therapeutic range is 4-12. Higher levels can lead to toxic symptoms consisting of the initial adverse effects and also HTN, tachycardia, ECG changes, and coma.