NURS 334 PHARM EXAM QUESTIONS AND ANSWERS A
+ GRADED
What are some categories of cognitive impairment?
Delirium
Neurocognitive disorders
Cognitive impairment not dementia
Focal cognitive disorders
Intellectual disabilities
Learning disabilities
What are the target symptoms of cognitive impairment?
Psychotropics
Hyponotics
Anxiolytics
Antidepressants
Antipsychotics
Chilinesterase inhibitors
What are the standard Alzheimer's cholinesterase inhibitors?
Rivastigimine (exelon)
Galantamine (razadyne)
Donepezil (aricept)
Why do we give cholinesterase inhibitors for Alzheimer's?
There is a depletion of cholinesterase
What is the one partial NMDA antagonist for Alzheimer's?
Meantime (namenda)
Can cholinesterase inhibitors & partial NMDA antagonist stop Alzheimer's?
No
What SSRIs are used for Alzheimer's?
Fluoxetine (Prozac)
Parole time
Sertraline
Where are cholinergic receptors (nicotinic receptors)
Located in the ganglia of both the PSNS & SNS
Where are muscarinic receptors located?
Postsynaptically in the effector organs of the PSNS (smooth & cardiac muscle, glands)
What is the goal of cholinergic drugs?
Stimulate muscarinic receptors without the nicotinic receptors
What nervous system do cholinergic drugs stimulate?
PSNS
What happens with cholinergic drugs?
Rest & relax
What is the MOA indirect-acting cholinesterase inhibitors (reversible)
Bins to cholinesterase for a short period of time
What are the indirect-acting anticholinesterase drugs?
,Donepezil
Galantamine
Rivastigmine
What is the MOA of donepezil?
Causes REVERSIBLE inhibition of cholinesterase in the brain to increase levels of ACh
What is the black box warning on Donepezil?
Increased falls in the elderly
What are adverse effects of donepezil?
Nausea & diarrhea
Bradycardia
Fainting
Falls
Fall-related fractures
What are the side effects of Galantamine (reversible)
BRONCHOCONSTRICTION
Fainting
Bradycardia
Wt loss & anorexia
Is rivastigmine reversible or irreversible?
Irreversible
What are the adverse effects of rivastigmine?
N/v
Abdominal pain & anorexia
Wt loss
Intensify symptoms in patients with peptic ulcer disease
Fainting
Lung disease
What is an overstimulation of muscarinic& nicotinic receptors?
Cholinergic crisis
How can you remember cholinergic crisis?
Salivation
Lacrimation
Urinary incontinence
Diarrhea
GI cramps
Emesis
How do we tx a cholinergic crisis?
Atropine!
What do we use for Tx o severe cardiovascular reactions or bronchoconstriction?
Epi (adrenergic agonist)
What does memantine (NMDA antagonist (newer drug class) do?
Helps the cells from burning out from too much glutamate
When do we use Memantine?
Mod- severe AD
Vascular dementia
Why do we use memantine?
, There is too much NMDA in dementia patients & this drug will reduce the amount
What is the hallmark sign of psychosis?
Loss of contact with reality
What is the MOA of antipsychotics?
Block dopamine receptors in the brain (limbic system, basal ganglia) areas associated
with emotion, cognitive function, motor function
Do you have too much or not enough dopamine with psychosis?
Not enough
What is two major side effects of antipsychotic drugs?
Neuroleptic malignant syndrome
Extrapyramidal symptoms
What are the signs of neuroleptic malignant syndrome?
Potentially life threatening
High fever, unstable BP, myoglobinemia
What are the signs of extrapyramidal symptoms?
Involuntary muscle symptoms similar to those of Parkinson's disease
Akathisia
Acute dystonia (painful muscle spasms)
Treated with benztropine & trihexyphenidyl
What happens when tardive dyskinesia occurs with antipsychotics?
Involuntary contractions of oral & fasciae muscles
Choreoathetosis (wavelike movements of extremities)
Occurs with continuous long-term antipsychotic therapy
What happens with metabolic syndrome occurs with antipsychotics?
Insulin resistance
Wt gain
Changes in serum lipid levels (high LDL!!)
Agranulocytosis & hemolytic anemia
What is the MOA of haloperidol
Unclear but thinks its competitively blocks postsynaptic dopamine receptors in the
mesolimbic dopaminergic system & increases turnover of brain dopamine
What is a black box warning of antipsychotics for children & young adults?
Increased suicidal ideations
What are some contraindication for haloperidol?
Hypersensitivity, Parkinson’s disease & in patients taking large amounts of CNS
depressants
What is the MOA of atypical antipsychotics?
Block specific dopamine receptors: dopamine-2 (D2) receptors
Also block specific serotonin receptors ( responsible for their improved efficacy & safety
profiles)
What is the adverse effect of clozapine?
Agranulocytosis
What is the MOA of clozapine?
Selectively blocks the dopaminergic receptors in the mesolimbic region of the brain
When will you use Risperidone?
Schizophrenia, including negative symptoms, acute psychosis
+ GRADED
What are some categories of cognitive impairment?
Delirium
Neurocognitive disorders
Cognitive impairment not dementia
Focal cognitive disorders
Intellectual disabilities
Learning disabilities
What are the target symptoms of cognitive impairment?
Psychotropics
Hyponotics
Anxiolytics
Antidepressants
Antipsychotics
Chilinesterase inhibitors
What are the standard Alzheimer's cholinesterase inhibitors?
Rivastigimine (exelon)
Galantamine (razadyne)
Donepezil (aricept)
Why do we give cholinesterase inhibitors for Alzheimer's?
There is a depletion of cholinesterase
What is the one partial NMDA antagonist for Alzheimer's?
Meantime (namenda)
Can cholinesterase inhibitors & partial NMDA antagonist stop Alzheimer's?
No
What SSRIs are used for Alzheimer's?
Fluoxetine (Prozac)
Parole time
Sertraline
Where are cholinergic receptors (nicotinic receptors)
Located in the ganglia of both the PSNS & SNS
Where are muscarinic receptors located?
Postsynaptically in the effector organs of the PSNS (smooth & cardiac muscle, glands)
What is the goal of cholinergic drugs?
Stimulate muscarinic receptors without the nicotinic receptors
What nervous system do cholinergic drugs stimulate?
PSNS
What happens with cholinergic drugs?
Rest & relax
What is the MOA indirect-acting cholinesterase inhibitors (reversible)
Bins to cholinesterase for a short period of time
What are the indirect-acting anticholinesterase drugs?
,Donepezil
Galantamine
Rivastigmine
What is the MOA of donepezil?
Causes REVERSIBLE inhibition of cholinesterase in the brain to increase levels of ACh
What is the black box warning on Donepezil?
Increased falls in the elderly
What are adverse effects of donepezil?
Nausea & diarrhea
Bradycardia
Fainting
Falls
Fall-related fractures
What are the side effects of Galantamine (reversible)
BRONCHOCONSTRICTION
Fainting
Bradycardia
Wt loss & anorexia
Is rivastigmine reversible or irreversible?
Irreversible
What are the adverse effects of rivastigmine?
N/v
Abdominal pain & anorexia
Wt loss
Intensify symptoms in patients with peptic ulcer disease
Fainting
Lung disease
What is an overstimulation of muscarinic& nicotinic receptors?
Cholinergic crisis
How can you remember cholinergic crisis?
Salivation
Lacrimation
Urinary incontinence
Diarrhea
GI cramps
Emesis
How do we tx a cholinergic crisis?
Atropine!
What do we use for Tx o severe cardiovascular reactions or bronchoconstriction?
Epi (adrenergic agonist)
What does memantine (NMDA antagonist (newer drug class) do?
Helps the cells from burning out from too much glutamate
When do we use Memantine?
Mod- severe AD
Vascular dementia
Why do we use memantine?
, There is too much NMDA in dementia patients & this drug will reduce the amount
What is the hallmark sign of psychosis?
Loss of contact with reality
What is the MOA of antipsychotics?
Block dopamine receptors in the brain (limbic system, basal ganglia) areas associated
with emotion, cognitive function, motor function
Do you have too much or not enough dopamine with psychosis?
Not enough
What is two major side effects of antipsychotic drugs?
Neuroleptic malignant syndrome
Extrapyramidal symptoms
What are the signs of neuroleptic malignant syndrome?
Potentially life threatening
High fever, unstable BP, myoglobinemia
What are the signs of extrapyramidal symptoms?
Involuntary muscle symptoms similar to those of Parkinson's disease
Akathisia
Acute dystonia (painful muscle spasms)
Treated with benztropine & trihexyphenidyl
What happens when tardive dyskinesia occurs with antipsychotics?
Involuntary contractions of oral & fasciae muscles
Choreoathetosis (wavelike movements of extremities)
Occurs with continuous long-term antipsychotic therapy
What happens with metabolic syndrome occurs with antipsychotics?
Insulin resistance
Wt gain
Changes in serum lipid levels (high LDL!!)
Agranulocytosis & hemolytic anemia
What is the MOA of haloperidol
Unclear but thinks its competitively blocks postsynaptic dopamine receptors in the
mesolimbic dopaminergic system & increases turnover of brain dopamine
What is a black box warning of antipsychotics for children & young adults?
Increased suicidal ideations
What are some contraindication for haloperidol?
Hypersensitivity, Parkinson’s disease & in patients taking large amounts of CNS
depressants
What is the MOA of atypical antipsychotics?
Block specific dopamine receptors: dopamine-2 (D2) receptors
Also block specific serotonin receptors ( responsible for their improved efficacy & safety
profiles)
What is the adverse effect of clozapine?
Agranulocytosis
What is the MOA of clozapine?
Selectively blocks the dopaminergic receptors in the mesolimbic region of the brain
When will you use Risperidone?
Schizophrenia, including negative symptoms, acute psychosis
