Pharm_Exam2MegaReview

Law-Ham Pharm Exam 2 Review **Know every drug that is on the PowerPoint – have a one-line mechanism of action on a table for each drug and understand it, as well as how and where it works Carbamazepine (Tegretol) – is ...

Law-Ham Pharm Exam 2 Review **Know every drug that is on the PowerPoint – have a one-line mechanism of action on a table for each drug and understand it, as well as how and where it works Carbamazepine (Tegretol) – is an anticonvulsant = thought to affect Na+ channels to slow spread of abnormal activity  SE = decreases body’s production of blood cells, rare reports of aplastic anemia and agranulocytosis, can cause Steven Johnson Syndrome and Toxic Epidermal Necrolysis  Should get a CBC Q3-4 months (watch for WBC count in particular)  Carbamazepine is a strong inducer of hepatic enzymes/metabolism and can lead to lower levels  Do NOT stop taking abruptly, has a shorter half-life w/repeated uses Topiramate (Topamax) – is for tx of epilepsy, seizures, migraine prophylaxis  Blocks sodium channels or potentiate GABA  Peaks 2 hours after oral admin, mostly eliminated via urine  Can cause ↓ Na bicarb levels which can lead to hyperchloremic metabolic acidosis  Serum bicarbonate should be monitored at baseline and periodically  Can cause ocular syndrome (acute myopia and glaucoma) – should inform provider immediately if pt experiences eye pain or blurred vision  Rare side effect is oligohidrosis (↓sweating) and hyperthermia  Can increase the risk of suicidal behavior/ideation, cause weight reduction  Should NOT be discontinued abruptly  Is a pregnancy category D and can increase risk of cleft lip/palate in infants Levetiracetam (Keppra) – antiepileptic, does NOT affect GABA, does inhibit burst firing and spread of seizure activity  Mostly cleared through renal system, is not extensively metabolized  Absolute contraindication is sensitivity to the drug  At increased risk for suicidal thoughts and depression, behavioral changes, somnolence, fatigue, dizziness, muscle coordination difficulties  Potential for withdrawal seizures if keppra is stopped abruptly  Safer med for seizures in children and pregnancy Valproate (Depakote) – is an anticonvulsant, for tx of bipolar disorder and mania also  Blocks GABA uptake into presynaptic neurons  SE = GI distress, heartburn, CNS depressant  Is a pregnancy category X, known teratogen, may only be taken after the 1st trimester if necessary, bur should recommend switching to different anticonvulsant like Keppra Ethosuximide (Zarontin) – tx for seizures  Should be monitored for blood dyscrasia (an abnormal condition or dx of the blood) Antiepileptics block transmission, raise the seizure threshold, so that the patient will not peak over the seizure threshold and have a seizure. Anticonvulsants in terms of monitoring (most common side effects, most serious side effects) – know that they are all monitored with blood work for their levels so that is a similarity amongst them  Carbamazepine – CBC – Causes agranulocytosis so be watching the white count in particular although there is other bone marrow suppression as well  What do you monitor? – TSH because the med can affect the thyroid  Never want anyone to d/c suddenly, must be weaned off  Talk to patients about safety – driving limitations, may have to report patient to DMV if they are having active seizures  Oral health can be affected by anti-seizure meds and extra trips to the dentist may be required Neurotransmitters  GABA – calming  Acetylcholine – muscle action, thought and learning ***If a specific drug is listed on the PowerPoint, know all about it.  All these drugs are listed on the PowerPoint  Seizure o Topiramate – topamax o Carbamazepine – Tegretol o Valproate – Depakote o Levetiracetam – Keppra  MAOI o Phenelzine – Nardil  Anxiolytics Phentermine (Adipex-P) – used for obesity, stimulating satiety centers  Should only be used short-term (6 months or less)  DO NOT mix w/ SSRIs or St. John’s Wart (Serotonin Syndrome), or w/ MAOIs (HTN crisis) Lithium— tx of choice for manic-depressive (bipolar) illness, ↓ severity/frequency of mania  Replaces Na+ during depolarization in neurons = stops transmission of electrical impulses  Inversely proportional to Na+ --- ↓Na+ = ↑Lithium ↑Na+ = ↓Lithium  Lithium Toxicity can occur = drowsiness, nausea, course tremors, diarrhea, confusion, stupor  NOT to be used in renal pts, children under 12, or pregnant women  Pt education = avoid dehydration, eat a diet with consistent Na+ levels Antidepressants – SSRIs (fluoxetine, paroxetine, sertraline, citalopram, escitalopram)  SSRI blocks the reuptake of serotonin which keeps it present in the synapse for longer, so you get more effect from it  All of the antidepressants, whether a drug family or specific drug, you need to know and understand that drug and mechanism of action  Common side effects of SSRIs – weight gain, sometimes weight loss, anticholinergic effects like dry mouth and constipation, nausea, vomiting, sexual side effects – diminished, delayed or absent orgasm, premature ejaculation, decreased libido  Nausea can occur when first starting SSRI, but will resolve in a week or so  With citalopram, appetite and concentration improve in the first 1-2 weeks, works quickly  Interacts w/ MAOIs  SSRIs – serotonin syndrome – HA, hallucinations, shivering, agitation, sweating, high body temperature, tremor, hyperreflexia, dilated pupils, nausea, diarrhea  DO NOT stop abruptly or miss doses = serotonin withdrawal – can see this in shorter acting SSRI’s when people forget to take them (paroxetine is the shortest acting), sertraline and citalopram can also happen but not as quickly as paroxetine.  Serotonin withdrawal syndrome – tremulous, paresthesia’s, nausea, vomiting, sweating SNRIs  Effect and block the reabsorption of norepinephrine – norepi effects specifically the sympathetic nervous system and also has serotonergic effects  Sevilla, Cymbalta, etc. names of drugs  An initial tx for depression w/ symptoms of fatigue, sleeping all the time, and lack of motivation  Side effects – headaches, nausea, somnolence, dry mouth, anticholinergic things, palpitations, hypertension, and hyperhidrosis (excessive sweating). TCAs (amitriptyline, nortriptyline, imipramine, trimipramine)  Effect brain chemicals o Serotonin – 5ht o Noradrenaline/norepinephrine o Acts on Histamine and Acetylcholine  This group of medications has the highest anticholinergic effects – the highest amount of dry mouth and constipation  People who have BPH, glaucoma, urinary problems should not take this medication due to the degree of anticholinergic effect  Should be prescribed cautiously in patients with heart disease  Can behave like class 1 antiarrhythmics = terminate Vfib, ↓ heart contractility, increase collateral blood flow to ischemic heart muscles  SE = anticholinergic, sedating, increas