Pharm exam 4

  1. Myasthenia Gravis has the Tensilon test

    - whats the test for 

    What drug do you give for that?
    Tensilon test ( Edrophium) = a short acting cholinergic drug 

    - Give by IV have atropine in case 

    - dont give it to those with asthma, or sick sinus, BPH, or urinary retention 

    Its to diagnose myasthenia gravis vs cholinergic crisis
  2. 5 Myasthenia crisis signs
    • Breathing should improve with edrophium
    • 1) receptors go down
    • 2) normal secretions
    • 3) tachycardia
    • 4) normal/dilated pupil
    • 5) muscle weakness
  3. 5 signs of a cholinergic crisis 
    what to give
    weakness with edrophium 

    • -- stop anticholinesterase ( it overstimulates the parasympathetic syst) 
    • - give atropene 

    • (SLUD)
    • 1) cholinergic goes up
    • 2) more secretions
    • 3) bradycardia 
    • 4) pupil constriction
    • 5) weak muscle and fasciculation
  4. Name an acetylcholinesterase inhibitor ( indirect- acting cholinergic) 

    When to give it 
    How to give it 
    Neostigmine for myasthenia crisis 

    • - by slow IVP w food 
    • - rest between activities
    • - dont give it to elderly
  5. Name a reversible indirect acting cholinergic 

    When to take it
    who shouldn't take it
    Donepezil ( for Alzheimer's) 

    • Take it before bed 
    • It may take weeks/months to notice effects 
    • Dont give to those with liver failure 

    AE: n/v, insomnia, dizzy 

    Dont give memantine ( in the same class) to those with kidney failure
  6. The medication for urinary retention ( flaccid bladder) 

    - how to give it 
    -what to check while on it 
    - when to give it
    Bethanechol Chloride 

    PO on an empty stomach, post op and post partum 

    • - check for a cholinergic crisis
    • - if someone is orthostatic
    • - for heart block 

    Should pee 1 hr after taking
  7. Name a dopamine receptor agonist

    how to take it 
    what not to take it with
    Levodopa-Carbidopa ( for Parkinsons)

    PO with food ( not iron, high protein, B6) dont stop abruptly

    • - Dont take it with benzos
    • - No MAOI ( cause hypertensive crisis)
    • - not for those with glaucoma
    • - not for malignant melanoma

    Given with dihydrochloride + ropinirole hydrochloride for restless leg syndrome
  8. Name a catechol-o-methyltransferase inhibitor 

    what is it taken with 
    black box warning

    PO with levodopa/carbidopa 

    • - can cause acute liver failure
    • -must be tapered off
  9. Name a bella donna alkaloid anticholinergic 

    What to do before giving and during 

    What it reacts with + antidotes
    Atropine sulfate 

    IV - void before admin, and drink a lot 

    check for urinary retention, bowel, temperature ( hot) 

    NO tricyclic antidepressants, anti histamines while on it 

    The antidote for cholinergic crisis, mushroom poisoning
  10. Central anticholinergic 

    Benzotropine mesylate 

    - restore cardiac/ arterial pressure 

    - AE: hot, blind, red, mad, dry
  11. GI Anticholinergic 

    whats it for
    Diclomine hydrochloride 

    for IBS ( overactive bladder) 

    AE: hot, blind, red, mad, dry
  12. Urinary anticholinergic 

    whats it used for 

    how to give

    neurogenic bladder ( incontin, urg, freq) 

    Patch q 3-4 days 

    AE: hot, blind, red, mad, dry
  13. Name a opioid agonist



    What not to take it with

    • Dont give to those with ...
    • -respiratory depression
    • -BPH
    • -Chronic lung,liver, kidney disease 
    • -Raised intracranial pressure 

    Antidote: naloxone ( opiod antagonist) 

    Dont take it with...

    - antidep/psychotic, barbituates, benzos, sedatives, antihistamines, MAOI 

    • Other drugs in the same class...
    • - fentanyl
    • - oxycodone
    • - methadone ( used for opioid withdrawal)
  14. Opioid Agonist/ Antagonists -- 3 of them 

    Butorphanol : cautious if pregnant causes withdrawl 

    Nalbuphine: not controlled


    1/3 as strong as morphine ( not as addictive)

    • Cautious in older adults 
    • - Resp depression with ceiling effect, BP goes up in large doses
  15. NSAID for migraine treatment 

    how to take it

    Dont crush/chew , take with food 

    AE: GI upset/ bleeding
  16. Ergot Alkaloid 

    when/how to take/ interventions 

    ergotamine tartrate 

    take it with onset of a migraine, sublingual 

    AE: tachy/brady 

    stay in a dark room 2-3 hrs after 

    caffeine/grapefruit increase the effects
  17. Triptan

    when to take
    max amount 
    what to report

    take at the 1st sign of a migraine 

    max amount 2 injections in 24 hrs 

    AE: chest pain

    report heat/flushing
  18. Hydantoin drug 

    whats it for
    how to take
    serum level should be at 
    when not to give it
    Phenytoin ( -toin) 

    For tonic-clonic seizures, psychomotor seizure, and non-epileptic seizures 

    • PO
    • serum level 5-20 
    • AE: gingival hyperplasia, steven johnson 

    • Dont stop abruptly 
    • dont give to hypoglycemic, bradycardia, or heart block
  19. Barbiturate drug 

    serum level 
    Dont use it with
    Phenobarbital for long term use 

    serum level 10-40

    AE: SJS, depression, suicide 

    Dont use with ETOH, MAOI
  20. Benzodiazepine drug
    whats it for

    what not to mix it with
    Diazepam is for status epilepticus 

    Dont mix it with ETOH

    theophylline, and ranitide lowers the effects
  21. Iminostibenes drug

    whats it for

    carbamezepine is for partial seizures with complex symptoms 

    AE are av block and suicide

    drug in another class= Valproic acid serum level should be 50-100
  22. Whats carisoprodol for
    for acute muscle spasm 

    AE: irritable, dizzy 

    class: carbamate derivative
  23. what is baclofen for
    Multiple sclerosis muscle spasms 

    AE: CNS depression 

    class: gamma aminobutric acid
  24. Cyclobenzaprine is for?
    muscle spasms

    • AE: anticholinergic effects 
    • class: tricyclic antidepress
  25. Tizanidine is for
    muscle spasms

    AE: hypotension
  26. 2 Stimulants used for ADHA/Narcolepsy
    • Amphetamine
    • Xanthine
    • Modanifil specificially for narcolepsy

    Contra: CV disorder, hyperthyroidism
  27. Name a Benzodiazepine 

    what are they for 

    whats the antidote
    • Diazepam  ( -pam: clonazepam,)
    • Alprazolam ( -lamL midazolam) 

    PO/IV for anxiety 

    DONT stop abruptly or use with alcohol 

    Antidote: Flumazenil
  28. Chloral hydrate is for 
    how to give
    sleep and anxiety 

    doesnt suppress REM 

    PO in cold liquid
  29. Eszopiclone 
    whats it for 
    how long to take
    • long term sleep aid 
    • sched IV 
    • adverse : weird/aggressive behavior
  30. Zolpidem 

    whats it for, how long to take
    • for sleeping 
    • 7-10 days
  31. 2 Stimulates given for ADHD/Narcolepsy
    • Amphetamine
    • Xanthine 

    Modanifil specifically for narcolepsy 

    Dont give if CV disorder , hyperthyroidism
  32. Name Benzodiazepine 

    How to give 

    • For anxiety 
    • Diazepam ( -pams ex. clonazepam) 
    •                (-lam ex. alprazolam, midazolam,                    cloridiazepoxide  for withdrawal) 

    PO/IV dont give to sedated kid/liver 

    Dont stop abruptly 

    Antidote= Flumazenil
  33. Chloral Hydrate 

    drug class
    what its for 
    how to take
    Non Benzo/Hypnotic 

    • Its for sleep and anxiety 
    • PO in cold liquid 

    doesnt suppress REM
  34. Eszopiclone 

    drug class
    what its for 
    Non benzo/hypnotic 

    Long term sleep aid 

    adverse: aggressive/bizarre behavior
  35. Zolpidem 

    drug class
    whats it for 
    how long to take it

    for insomnia

    can only be taken 7-10 days
  36. Name Tricyclic Anti-Depressants 

    How to give 
    What not to give with
    Amitriptyline, Clomipramine, Desipramine, Nortriptyline, Imipramine 

    • PO HS
    • Dont stop abruptly, dont give post acute MI, MAOI 

    Avoid ETOH, CNS, other CNS depressants, St Johns Wort
  37. Name Monamine Oxidase Inhibitor (MAOI)

    when is it used 

    what to avoid
    • Phenelzine
    • Isocarboxazid
    • Tranylcypromine

    Used when other antidepressants dont work

    • Dont give to kids
    • dont stop abruptly 

    Dont eat tyramine --> hypertensive crisis 

    Tryptophan ex. meat, soy, seaweed. seafood increase the effects
  38. Name a Selective Serotonin Reuptake Inhibitor SSRI

    whats it for 
    how to give 
    • Fluoxetine
    • Citalopram
    • escitalopram
    • paroxetine 

    • For depression, anxiety, OCD, bulimia, PND
    • PO AM 

    AE: serotonin syndrome, DM= hypoglycemia 

    contra: MAOI--> serotonin synd
  39. Serotonin Norepinephine Reuptake Inhibitors SNRI 

    whats it for 
    when to give
    what not to give
    • Venlafaxine
    • Desvenlafaxine
    • Duloxetine

    • First line treatment for depression 
    • PO AM 
    • Suicide 18-24, dont stop abruptly 

    Dont take with MAOI-> serotonin synd
  40. Bupropion

    whats it for
    Atypical antidepressant

    For depression, bipolar, SAD, smoking censation 

    another drug in class mirtazipine
  41. Lithium
    whats it for 
    Mood stabilizer for mania 

    excreted but not metabolized by the kidneys 

    Serum .5-1.2 ( dont take salt sub)

    • AE: metallic , polyuria
    • No diuretics--> lose salt, no pregnancy
  42. Aripiprazole is for 

    what class
    who not to give it to
    Atypical antipsych for compulsive gambling, shopping, binging 

    not for dementia
  43. Gen 1 antipsychotics 

    whats it for 
    how to give
    who not to give to
    • Chlorpromazine - phenothiazine gen 1 
    • Haloperidol - non phenothizaine gen 

    for psychosis, and schizophrenia

    IM. PO with food HS 

    Dont stop abruptly, give to 65+, pregnant, parkinsons, seizures
  44. Gen 2 drug for psychosis, schizophrenia 

    how to give
    what to monitor

    PO/IM 1 week at a time 

    monitor CBC ( wbc and neutrophils can go down)

    • dont give to dementia/old = death 
    • contra: seizures, hyperglycemia, agranulo
Card Set
Pharm exam 4
ch 46-57