Pharm HESI - Med Surg II, Over 400 QA
This Anti-Parkinson's medication should be:
• Taken orally
• Not to be taken with B6 or tricyclic antidepressants
• Take 30 min. before eating proteins
Levodopa-Carbidopa (Sinemet) Anti-Parkinson's
How does the Levidopa and Carbidopa compliment each other in the combined
drug, Sinemet?
• Levodopa is a precursor for dopamine and must be given in high doses because it is
broken down outside the CNS
• Carbidopa prevents the breakdown of Levodopa in the peripheral
What is a dopamine replacement drug that is used in the later stages of
Parkinson's?
Levodopa-Carbidopa [Sinemet]
How many times can Levodopa-Carbidopa [Sinemet] be halved?
once (it is scored)
After how many years (range) does the medication Levodopa-Carbidopa
[Sinemet] become ineffective for Parkinson's?
after 5 to 10 years
What anti-Parkinson's drug is not to be used with narrow angle glaucoma or any
undiagnosed sign problem because it activates malignant melanoma?
Levodopa-Carbidopa [Sinemet]
Name that anti-Parkinson's drug:
• Only dopamine modulator
• Was first an anti viral
• Causes release of dopamine from storage in presynaptic fibers
• Blocks reuptake of dopamine
• Given in early stages of Parkinson's
• Relieves dyskinesia symptoms
Amantadine (Symmetrel)
How long is Amantadine (Symmetrel) usually effective?
6 to 12 months
What are some adverse effects of Amantadine (Symmetrel)?
dizziness, insomnia, and nausea
What anti-Parkinson's drug helps control the tremors, including muscle rigidity,
because of both its dopaminergic and anticholinergic effect?
Amantadine (Symmetrel)
What is a COMT inhibitor?
a drug that inhibits the action of catechol-O-methyl transferase. This enzyme is involved
in degrading neurotransmitters. They are used in the treatment of Parkinson's disease.
The following are advantages of what classification of drugs (Anti-Parkinson's)?
• Blocks breakdown of catecholamines
• 2 COMT inhibitors ( tolcopone and entapone)
• Entapone prolongs the effects of levodopa
,• Reduces the wearing-off phenomenon
• Therapeutic effects in a few days
• Entapone (Comtan) COMT inhibitor
• Prolongs the effects of levodopa
• GI upset and discolored urine
• Not to be used with liver problems
• Not be taken with nonselective MAOEs
COMT Inhibitors
What is Dyskinesia?
a term for abnormal and distressing involuntary movement; inability to control
movement which often occurs as a side effect of levodopa therapy (used for
Parkinson's).
What is Chorea?
irregular, spasmodic, involuntary movements of limbs and facial muscles
What is Dystonia?
abnormal muscle tone leading to impaired movement of head, neck, or feet
What is the Wearing-off phenomenon?
is a gradual worsening of Parkinson symptoms as a patient's medications begin to lose
their effectiveness, despite maximal dosing with a variety of medications.
How can you reduce the wearing-off phenomenon?
by giving carbidopa with levodopa
Name that medication:
• MAOI
• Antidepressant and used to treat Parkinson's
• Increase CNS depressant effects
• Can cause serotonin syndrome
• Cheese effect
• Avoid cold or cough medicines
• Avoid Tyramine!! Can cause a hypertensive crisis!!
Nardil (phenelzine)
If a patient is taking a medication that is linked to the "cheese effect", what
should they avoid in their diet?
TYRAMINE containing foods such as:
- aged cheeses
- smoked or pickled meats
- aged or fermented meat
- yeast extracts
- red wines
Why should patients taking Nardil (phenelzine) avoid Tyramine?
Can cause a hypertensive crisis!! Can cause a hypertensive crisis!!!
What drug is the mainstay for treatment of angina or other cardiac problems, and
prophylaxis?
Nitroglycerin
What is Long-Acting Nitroglycerin used for?
prevention of angina
,What is Short-Acting Nitroglycerin used for?
acute angina attacks
What is the MAIN adverse effect of Nitro?
Headache
Nitroglycerin has a very LARGE first pass effect in the liver, therefore what route
should be avoided if possible?
Oral
When should a patient take SUBLINGUAL Nitroglycerin?
at the first sign of chest pain and not delayed until the pain is severe.
What should a patient do (position) before taking SUBLINGUAL Nitroglycerin?
Sit or lie down
This drug causes relaxation of smooth muscle in arteries and veins, have a
potent vasodilating effect on large and small coronary arteries-causes
redistribution of blood and oxygen to ischemic myocardial tissue and reduces
angina symptoms.
Nitroglycerin
What should a patient do if chest pain or discomfort is not relieved within 5
minutes after taking one dose of Nitroglycerin?
According to current guidelines, if the chest pain or discomfort is not relieved in 5
minutes, after one dose, the patient (or family member) must call 911 immediately. The
patient can take one more tablet while awaiting emergency care and a third tablet 5
minutes later, but no more than three tablets total.
What do the current Nitroglycerin administration guidelines reflect?
The fact that angina pain that does not respond to nitroglycerin may indicate a
myocardial infarction.
Can Nitroglycerin be swallowed?
No. The SUBLINGUAL dose is to be placed under the tongue and the patient must
avoid swallowing until the tablet is dissolved. Instruct the patient not to eat or drink until
the drug has completely dissolved.
Name that Antibiotic:
- Bacteriostatic. Inhibits bacterial growth.
- Must be avoided in pregnant and nursing women and children under 8 years old
- Can interact with dairy, antacids, or iron salts
- Can interact with Warfarin
Tetracycline
Indications for this type of antibiotic include:
• Acne in adolescents and adults
• Chlamydia
• Mycoplasma
• Gram negative and gram positive microorganisms
• Protozoa
• Rickettsia (Rocky Mountain Spotted Fever)
• Syphilis
• Lyme disease
, Tetracycline
Adverse effects of this type of antibiotic include:
• Discoloration of the permanent teeth and tooth enamel hypoplasia in both
fetuses and children and possibly retard fetal skeletal development if taken
during pregnancy
• Photosensitivity ( most common in pt. taking demeclocycline)
• Alteration of the intestinal and vaginal flora
Which can result in diarrhea or vaginal candidiasis
• Bulging fontanelles in neonates
• Thrombocytopenia
• Possible coagulation irregularities
• Hemolytic anemia:
Tetracycline
The following refers to what medication?
• relieves severe ongoing pain (such as due to cancer)
• can wear transdermal patch for 72 hours
• can cause severe respiratory depression
• should not be taken with grapefruit or grapefruit juice
Fentanyl (transdermal)
Math - IM mg to mcg
Math - IV - secondary infusion - meQ/hr
Math - IM - mg/ml
Math - IV dose rate
• Nonstimulant drug used for obesity
• Works locally in the small and large intestine where it inhibits absorption of
caloric intake from fatty foods by binding to lipases
• Contraindicated in malabsorption syndrome (e.g. Crohn's disease, colitis, short
bowel syndrome) or cholestasis
• Can cause headache, upper respiratory tract infection, GI distress, including
fecal incontinence and oily stools
• Can cause deficiency of vit. A, D, and E and beta carotene
• Available OTC
Orlistat (Xenical) Anorexiant
• potassium-sparing diuretic , known as "water-pill"
• used to treat HTN, HF, edema, high levels of aldosterone, and low potassium
conditions
Aldactone (Spironolactone)
What classification of drugs can mask the effects of too much aspirin (toxicity)
such as ringing in the ears?
antihistamines
What classification of drugs can add to the effects of alcohol and other CNS
depressants?
antihistamines
These drugs may cause drowsiness, even if taken at bedtime.
This Anti-Parkinson's medication should be:
• Taken orally
• Not to be taken with B6 or tricyclic antidepressants
• Take 30 min. before eating proteins
Levodopa-Carbidopa (Sinemet) Anti-Parkinson's
How does the Levidopa and Carbidopa compliment each other in the combined
drug, Sinemet?
• Levodopa is a precursor for dopamine and must be given in high doses because it is
broken down outside the CNS
• Carbidopa prevents the breakdown of Levodopa in the peripheral
What is a dopamine replacement drug that is used in the later stages of
Parkinson's?
Levodopa-Carbidopa [Sinemet]
How many times can Levodopa-Carbidopa [Sinemet] be halved?
once (it is scored)
After how many years (range) does the medication Levodopa-Carbidopa
[Sinemet] become ineffective for Parkinson's?
after 5 to 10 years
What anti-Parkinson's drug is not to be used with narrow angle glaucoma or any
undiagnosed sign problem because it activates malignant melanoma?
Levodopa-Carbidopa [Sinemet]
Name that anti-Parkinson's drug:
• Only dopamine modulator
• Was first an anti viral
• Causes release of dopamine from storage in presynaptic fibers
• Blocks reuptake of dopamine
• Given in early stages of Parkinson's
• Relieves dyskinesia symptoms
Amantadine (Symmetrel)
How long is Amantadine (Symmetrel) usually effective?
6 to 12 months
What are some adverse effects of Amantadine (Symmetrel)?
dizziness, insomnia, and nausea
What anti-Parkinson's drug helps control the tremors, including muscle rigidity,
because of both its dopaminergic and anticholinergic effect?
Amantadine (Symmetrel)
What is a COMT inhibitor?
a drug that inhibits the action of catechol-O-methyl transferase. This enzyme is involved
in degrading neurotransmitters. They are used in the treatment of Parkinson's disease.
The following are advantages of what classification of drugs (Anti-Parkinson's)?
• Blocks breakdown of catecholamines
• 2 COMT inhibitors ( tolcopone and entapone)
• Entapone prolongs the effects of levodopa
,• Reduces the wearing-off phenomenon
• Therapeutic effects in a few days
• Entapone (Comtan) COMT inhibitor
• Prolongs the effects of levodopa
• GI upset and discolored urine
• Not to be used with liver problems
• Not be taken with nonselective MAOEs
COMT Inhibitors
What is Dyskinesia?
a term for abnormal and distressing involuntary movement; inability to control
movement which often occurs as a side effect of levodopa therapy (used for
Parkinson's).
What is Chorea?
irregular, spasmodic, involuntary movements of limbs and facial muscles
What is Dystonia?
abnormal muscle tone leading to impaired movement of head, neck, or feet
What is the Wearing-off phenomenon?
is a gradual worsening of Parkinson symptoms as a patient's medications begin to lose
their effectiveness, despite maximal dosing with a variety of medications.
How can you reduce the wearing-off phenomenon?
by giving carbidopa with levodopa
Name that medication:
• MAOI
• Antidepressant and used to treat Parkinson's
• Increase CNS depressant effects
• Can cause serotonin syndrome
• Cheese effect
• Avoid cold or cough medicines
• Avoid Tyramine!! Can cause a hypertensive crisis!!
Nardil (phenelzine)
If a patient is taking a medication that is linked to the "cheese effect", what
should they avoid in their diet?
TYRAMINE containing foods such as:
- aged cheeses
- smoked or pickled meats
- aged or fermented meat
- yeast extracts
- red wines
Why should patients taking Nardil (phenelzine) avoid Tyramine?
Can cause a hypertensive crisis!! Can cause a hypertensive crisis!!!
What drug is the mainstay for treatment of angina or other cardiac problems, and
prophylaxis?
Nitroglycerin
What is Long-Acting Nitroglycerin used for?
prevention of angina
,What is Short-Acting Nitroglycerin used for?
acute angina attacks
What is the MAIN adverse effect of Nitro?
Headache
Nitroglycerin has a very LARGE first pass effect in the liver, therefore what route
should be avoided if possible?
Oral
When should a patient take SUBLINGUAL Nitroglycerin?
at the first sign of chest pain and not delayed until the pain is severe.
What should a patient do (position) before taking SUBLINGUAL Nitroglycerin?
Sit or lie down
This drug causes relaxation of smooth muscle in arteries and veins, have a
potent vasodilating effect on large and small coronary arteries-causes
redistribution of blood and oxygen to ischemic myocardial tissue and reduces
angina symptoms.
Nitroglycerin
What should a patient do if chest pain or discomfort is not relieved within 5
minutes after taking one dose of Nitroglycerin?
According to current guidelines, if the chest pain or discomfort is not relieved in 5
minutes, after one dose, the patient (or family member) must call 911 immediately. The
patient can take one more tablet while awaiting emergency care and a third tablet 5
minutes later, but no more than three tablets total.
What do the current Nitroglycerin administration guidelines reflect?
The fact that angina pain that does not respond to nitroglycerin may indicate a
myocardial infarction.
Can Nitroglycerin be swallowed?
No. The SUBLINGUAL dose is to be placed under the tongue and the patient must
avoid swallowing until the tablet is dissolved. Instruct the patient not to eat or drink until
the drug has completely dissolved.
Name that Antibiotic:
- Bacteriostatic. Inhibits bacterial growth.
- Must be avoided in pregnant and nursing women and children under 8 years old
- Can interact with dairy, antacids, or iron salts
- Can interact with Warfarin
Tetracycline
Indications for this type of antibiotic include:
• Acne in adolescents and adults
• Chlamydia
• Mycoplasma
• Gram negative and gram positive microorganisms
• Protozoa
• Rickettsia (Rocky Mountain Spotted Fever)
• Syphilis
• Lyme disease
, Tetracycline
Adverse effects of this type of antibiotic include:
• Discoloration of the permanent teeth and tooth enamel hypoplasia in both
fetuses and children and possibly retard fetal skeletal development if taken
during pregnancy
• Photosensitivity ( most common in pt. taking demeclocycline)
• Alteration of the intestinal and vaginal flora
Which can result in diarrhea or vaginal candidiasis
• Bulging fontanelles in neonates
• Thrombocytopenia
• Possible coagulation irregularities
• Hemolytic anemia:
Tetracycline
The following refers to what medication?
• relieves severe ongoing pain (such as due to cancer)
• can wear transdermal patch for 72 hours
• can cause severe respiratory depression
• should not be taken with grapefruit or grapefruit juice
Fentanyl (transdermal)
Math - IM mg to mcg
Math - IV - secondary infusion - meQ/hr
Math - IM - mg/ml
Math - IV dose rate
• Nonstimulant drug used for obesity
• Works locally in the small and large intestine where it inhibits absorption of
caloric intake from fatty foods by binding to lipases
• Contraindicated in malabsorption syndrome (e.g. Crohn's disease, colitis, short
bowel syndrome) or cholestasis
• Can cause headache, upper respiratory tract infection, GI distress, including
fecal incontinence and oily stools
• Can cause deficiency of vit. A, D, and E and beta carotene
• Available OTC
Orlistat (Xenical) Anorexiant
• potassium-sparing diuretic , known as "water-pill"
• used to treat HTN, HF, edema, high levels of aldosterone, and low potassium
conditions
Aldactone (Spironolactone)
What classification of drugs can mask the effects of too much aspirin (toxicity)
such as ringing in the ears?
antihistamines
What classification of drugs can add to the effects of alcohol and other CNS
depressants?
antihistamines
These drugs may cause drowsiness, even if taken at bedtime.
