Maryville 615 Pharm Exam 6 Practice
Questions and Answers 100% Pass
What are the precautions and contraindications when prescribing phentermine? -
ANSWER✔✔-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? - ANSWER✔✔-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? - ANSWER✔✔-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
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,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? - ANSWER✔✔-
Phenytoin hypersensitivity syndrome is fever, skin rash, and lymphadenopathy, occurs
between weeks 3-8 of treatment.
What is auto metabolism of carbamazepine? - ANSWER✔✔-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? - ANSWER✔✔-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
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,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? - ANSWER✔✔-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.
What is the pharmacodynamics of carbamazepine? - ANSWER✔✔-Carbamazepine
(tegretol) exerts its effect by depressing transmission in the nucleus ventralis anterior of
the thalamus. This area is associated with the spread of seizure discharge. Seizure
spread is believed to occur through inhibition of voltage-gated sodium channels.
Absorption and distribution: Its absorbed through the stomach, the suspension being
absorbed more quickly than the tablet form. Absorption from immediate-releasing
tablets is slow and erratic because of its low water solubility. The drug is highly
lipophilic, resulting in high body tissue binding.
Metabolism and excretion: It is metabolized in the liver and has the unique ability to
induce its own metabolism (autoinduction). Due to autoinduction, initial concentrations
with in a therapeutic range may later fall despite good compliance. It also induces the
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, metabolism of many CYP450 enzymes and other substrates. Excretion through urine
and feces.
Onset, peak, and duration: Average peak blood levels occur aprox 6 hours after
administration. Half-life can be as long as 65 hours with initial dosing, but is typically
12-17 hours as administration continues. It's noteworthy that the half-life after a single
dose is much longer than the half-life after long-term use. Steady state is attained in 2-4
days.
What are the adverse effects of ethosuximide (Zarontin) and what blood values should
be monitored? - ANSWER✔✔-Even though it's uncommon, succinimides can cause
blood dyscrasias. Prior to treatment CBC and LFT should be obtained prior to initiating
treatment. During treatment, monitor ethosuximide serum plasma levels (40-100
mcg/mL is therapeutic), liver panel, renal panel, and hematological studies. Seizure
activity should be monitored in addition to blood levels.
How will you monitor patients for suicidal ideations when prescribing central nervous
system medications? - ANSWER✔✔-Monitor for emergent or worsening of depression,
SI, or changes in behavior. Mood changes, signs of depression, anxiety, and SI should
be monitored with AED's.
Topiramate will cause weight loss. What patient teaching will you provide? -
ANSWER✔✔-Topiramate has a side effect of anorexia and has previously been studied
as an off-label weight loss drug. Talk to your doctor regarding increasing you caloric
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