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What does it mean when drugs have a Narrow Therapeutic Index?
It is a drug in which small changes in the dose and/or blood concentration could potentially result in clinically important changes in drug efficacy or safety
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What do drugs with Narrow Therapeutic Indexes require frequently?
Adjustments in the dose of the drug and careful patient monitoring irrespective of whether the drug is brand or generic product
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What is the "Orange Book"?
Approved drugs with therapeutic Equivalence Evaluations
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What is the rule associated with Narrow Therapeutic Indexes?
Rx must be refilled with the same drug product that the pharmacist last dispensed (same manufacturer, no generics if brand was dispensed previously)
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Therapeutic range is also known as:
optimal therapy
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What does Digoxin do chemically and what type of medication is it?
It inhibits the sodium-potassium ATPase; it's an antiarrhythmic medication
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What is Digoxin used for?
CHF, a fib, a flutter
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What are some of the adverse effects of Digoxin?
Nausea, vomiting, anorexia, blurred/yellow vision
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What does the thyroid gland do?
helps regulate temperature and basal rate through the use of thyroid hormones
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What is hyPERthyroidism?
when there is too much of the thyroid hormone produced
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What is hyPOthyroidism?
When too little thyroid hormone is produced
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What are some symptoms of hypERthyroidism?
irritability/nervousness, muscle weakness/tremors, infrequent or scant menstrual periods, weight loss, sleep disturbances, enlarged thyroid gland, vision problems or eye irritation, heat sensitivity
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What are some symptoms of hyPOthyroidism?
fatigue, weight gain, depression, cold intolerance, elevated cholesterol levels, heart disease, and infertility
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What is the generic for Synthroid, Levoxyl?
Levothyroxine
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What are some of the adverse side effects of Synthroid?
hypoglycemia, insomnia, tachycardia, anxiety
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What is some patient education associated with Synthroid?
do not discontinue without consulting a physician
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What is major depression?
a disease with certain characteristic signs and symptoms that interferes with the ability to work, sleep, eat, and enjoy once pleasurable activities.
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What is the DSM-IV?
a manual that provides diagnostic criteria for mental disorders including depression
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How do anti-depressant medications work?
by slowing down the removal of certain chemicals in the brain (neurotransmitters)
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Why are neurotransmitters needed?
for normal brain function and for mood control
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What are some major neurotransmitters in the body?
Dopamine, GABA, Norepinephrine, Serotonin
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What is the role of GABA in the body?
it is the major inhibitory neurotransmitter in the brain
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What are neurotransmitters produced by?
nerve cells in the brain
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What are neurotransmitters used by and how are they used>
They are used by nerves to communicate with one another
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What can low levels of neurotransmitters cause?
depression
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What two actions can neurotransmitters complete once released into space surrounding the nerve?
1. Either travels across space and attaches to receptors of another nerve or 2. Attaches to receptors on the nerve thatr produced it (recycled and released again or degraded)--> known as reuptake
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What does blocking the reuptake cause?
higher levels of neurotransmitters so that messages can be communicated
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What are some diseases associated with neurotransmitter malfunction?
depression, autism, ADD, ADHD, anxiety
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What does SSRI stand for?
Selective Serotonin Reuptake Inhibitors
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How do SSRIs work?
they inhibit the removal of serotonin from the brain which increases the amount of serotonin in the brain
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SSRI's are often used early in...
depression
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How long does it take before full effect is seen with SSRIs?
3-4 weeks
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What are some indications for SSRIs?
major depression, anxiety disorders, panic disorders, obsessive-compulsive disorders, social phobias, and eating disorders
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What are some adverse effects of SSRIs?
nausea, drowsiness, headache, changes in weight and appetite, changes in sexual behavior, increased feelings of depression and anxiety, tremors, and increased sweating
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What is some patient education associated with SSRIs?
take as directed, may take 3-4 weeks before full effect, avoid alcohol, may impair cognitive and motor performance
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Are SSRIs addictive?
No, your body cannot become physically addictive
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What is the required box warning on SSRI's in the US about?
increased suicide risk in children and young adults
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In May 2007, what age was the warning extended to?
24
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What is the drug class and brand name for citalopram?
SSRI; Celexa
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What is the drug class and brand name for escitalopram?
SSRI; Lexapro
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What is the drug class and brand names for fluoxetine?
SSRI; Prozac and Sarafem
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What is the drug class and brand names for paroxetine?
SSRI, Paxil and Paxil CR
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What is the drug class and brand name for sertraline?
SSRI, Zoloft
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What is the drug class and what are the brand names for Digoxin?
Inotropic Agent; Lanoxin, Lanoxicaps, Digitek
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