Maryville NURS 615 Pharm Exam 2

1. Carbamazepine (Tegretol) can sometimes show subtherapeutic range due to what? - Carbamazepine auto-induces metabolism, leading to lower levels despite good compliance 2. What are the black box warnings for Carbamazepine? - Dermatologic reactions 1. Steven's Johnson 2. Toxic epidermal necrolysis 3. What lab test should be ordered for patients on Carbamazepine? - CBC every 3-4 months because it can cause decreased WBC, decreased platelets, and trouble with RBC 4. What kind of teaching needs to be done with families of patients who have seizure disorders? - Prevention is important, patient safety is important, Do NOT abruptly stop taking medication. 5. Ethosuximide (Zarontin), an anti-seizure medication can cause what? - Blood dyscrasias 6. Patients taking Topiramate need to be monitored for what electrolyte imbalance? - Decreased sodium bicarb leading to hyperchloremic metabolic acidosis 7. Topiramate treats seizures and what is one common side effect? - Normal side effect is weight loss, especially in higher dose patients 8. A child on Topiramate that wants to play sports should monitor what? - Don't get overheated. Topiramate may affect his ability to sweat in the heat. 9. What should a pregnant patient be told about taking Valproate (Depakote)? - It is a known teratogen and category X medication. It should not be used in the first trimester, it may be restarted in second trimester. 10. What patient population should tricyclic antidepressants be used cautiously in? - Heart Disease patients 11. Phenelzine (Nardil) is a MAOI. What teaching needs to be done with this medication? - He should not use serotonergic drugs like Imitrex. Also, this class of medication interacts with yogurt, sour cream, soy sauce, etc. 12. Phenelzine (Nardil) may cause what if there is an interaction with known contraindicated foods? - Hypertensive crisis 13. What are the side effects of tricyclic antidepressants? - Anticholinergic type effects like dry mouth, sedation, constipation, increased appetite, blurred vision, tinnitus, euphoria, mania 14. How long does it take for SSRIs to take effect - 2-6 weeks 15. SSRIs may cause what onset of action symptoms? - Nausea, but this will usually resolve in a week. 16. What is one thing you should not do with SSRIs? - Drink alcohol 17. What should happen when going off an SSRI? - Wean slowly, do not stop abruptly 18. What medications would a patient with depression and anxiety respond well to? - Buspar and an SSRI combined Celexa (Citalopram) Lexapro (Escitalopram) 19. Why should you combine an SSRI with Buspar? - Buspar augments the SSRI and is a good combo for anxiety and depression 20. What is a first line drug for mild to moderate generalized anxiety disorder? - Buspirone 21. How fast does Celexa start to demonstrate effects? - Improved appetite and concentration in 1-2 weeks. 22. What is a major drug to treat bipolar disease? - Lithium 23. Blood levels need to be monitored with Lithium because why? - Lithium has a narrow therapeutic range so it is important to recognize toxicity 24. What are symptoms of lithium toxicity? - Drowsiness and Nausea 25. What dietary teaching needs to be done with patients taking lithium? - Salt intake needs to be consistent 26. What are the side effects of SSRIs (selective seratonin reuptake inhibitor)? - N/V, dizziness, light headedness, dry mouth, increased sweating, weight changes, agitation, sexual side effects. 27. What are the side effects of SNRIs (serotonin norepinephrine reuptake inhibitor) - Headache, somnolence, dizziness, insomnia, nervousness, dry mouth, constipation, abnormal ejaculation, anorexia/weight loss, elevated BP 28. What are the side effects of MAOIs? - Insomnia, anxiety, agitation, dizziness, headache, restlessness, hypotension, dry mouth, blurred vision, constipation 29. What Benzo has the greatest likelihood of dependence? - Xanax /alprazolam 30. What receptors do Benzos act on? - Enhances the neurotransmitter GABA (gamma-aminobutyric acid) receptors 31. What result do Benzos have on the body? – sedative hypnotic anxiolytic anticonvulsant muscle relaxer 32. What are long acting Benzos prescribed for? - Treatment of anxiety 33. What are short acting Benzos prescribed for? - Treatment of insomnia 34. What would be a good medication to prescribe for panic disorder? - Diazepam (Valium) 35. What is a anorexiant medication to treat obesity? - Phentermine 36. What is a precaution with Phentermine? - Anorexiants may cause tolerance and should only be used for 6 months 37. What medications or herbals should be avoided with Phentermine? Why? - SSRIs and St. Johns Wort...the combination may cause serotonin syndrome 38. Phentermine releases what two chemicals? - Epinephrine and norepinephrine 39. Epi and norepi causes what to break down? - Fat cells to break down stored fat 40. What are Signs and symptoms of seratonin syndrome? - Headache, agitation, mental confusion, hallucinations, coma 41. What are autonomic effects that you can get from seratonin syndrome? - Shivering, sweating, hyperthermia, vasoconstriction, tachycardia, nausea, diarrhea 42. What factors place a patient at risk for developing antimicrobial resistant organisms? – Inappropriate use of antibiotics Children less than 2 years of age Adults older than 65 yrs of age Patients who do not finish their antibiotic regimen 43. What are appropriate antibiotics to prescribe to pregnant women and children? – PCN or Cephalosporins (Amoxicillin, or Augmentin) 44. Which antibiotics inhibit cell wall synthesis? – Beta-lactam antibiotics Vancomycin 45. Why is clavulanate added to Amoxicillin? – Clavulanate is a Beta-lactam inhibitor. This increases the spectrum of action and is effective at preventing amoxicillin-resistant bacteria that produce Beta-lactamase 46. What type of antibiotics should be avoided in children and pregnant women? - Tetracycline, fluoroquinolones 47. What is a normal side effect of amoxicillin? – Diarrhea and it is recommended to continue to take the medicine, drink lots of water, and take probiotics daily, eat yogurt 48. The American Heart Association recommedations for prophylaxis antibiotic use prior to dental care are... – 1. Prosthetic cardiac valve or prosthetic material used in valve repair 3. Previous Endocarditis 4. The following congenital diseases I. Unrepaired cyanotic congenital heart disease including palliative shunts and conduits II. Completely repaired congenital heart disease with prosthetic material device, whether placed surgically or with a catheter for 6 months following the procedure III. Repaired congenital heart disease with residual effects at the site or adjacent to the site of a prosthetic patch or prosthetic device which inhibit endothelialization IV. Cardiac transplantation recipients with cardiac valvular disease 49. What antibiotic is used for dental appointments? - Amoxicillin 2 gm for adults