Term
What are the side effects of benzodiazepines? |
|
Definition
Sedation, cognitive and psychomotor impairment Interacts with alcohol Discontinuation-related difficulties Potential for abuse in predisposed individuals Not effective for comorbid depression |
|
|
Term
What is a potentially severe and dangerous side effect of giving benzodiazepines via IV? |
|
Definition
|
|
Term
Why are benzodiazepines contraindicated in pregnancy and nursing? |
|
Definition
Birth defects may occur if used in 1st trimester Neonatal CNS depression and withdrawal if used near term |
|
|
Term
Benzodiazepines should not be combined with what? |
|
Definition
Alcohol or other CNS depressants |
|
|
Term
What are the contraindications for morphine use? |
|
Definition
Respiratory compromise, asthma, intracranial injuries (increased intracranial pressure), paralytic ileus |
|
|
Term
What are the side effects of morphine? |
|
Definition
Euphoria and dysphoria, respiratory depression, nausea, constipation, sedation, pruritus, urticaria, bronchospasms, urinary retention, anxiety, hypotension, miosis |
|
|
Term
What are the CNS effects of morphine? |
|
Definition
Analgesia (most effective for visceral pain), euphoria, sedation, cough suppression**, respiratory depression, miosis, nausea/emesis, physical and psychological dependence, tolerance |
|
|
Term
What are the cardiovascular effects of morphine? |
|
Definition
Vasodilation, decreases blood pressure, some negative inotropic response |
|
|
Term
What are the pulmonary effects of morphine? |
|
Definition
|
|
Term
What are the effects of morphine on the skin? |
|
Definition
Histamine release to cause itchiness |
|
|
Term
What are the effects of morphine on the GI? |
|
Definition
Decreases secretions and motility of gut |
|
|
Term
How does morphine effect smooth muscle? |
|
Definition
Increases smooth muscle tone Results in increased biliary tract contraction, detrusor muscle tone, urinary urgency, urinary retention, bronchoconstriction, reduced uterine tone prolonging labor, etc. |
|
|
Term
What are the adverse effects of Meperidine? |
|
Definition
Excess accumulation can cause seizures, avoid in renal patients |
|
|
Term
Tramadol should be avoided alongside what drugs? |
|
Definition
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|
Term
What are the adverse effects of TCAs? |
|
Definition
Anticholinergic effects (blockade of muscarinic receptors) Dry mouth, blurred vision, constipation, urinary retention, perspiration, orthostatic hypotension, sedation, seizures, conduction delays, weight gain |
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|
Term
What kind of drug interactions are there with TCAs? |
|
Definition
Alcohol increases CNS depression Anticholinergic agents Insulin, oral hypoglycemic agents increase hypoglycemia Monoamine oxidase inhibitors are toxic |
|
|
Term
What are the adverse effects of SNRI use? |
|
Definition
Dizziness, dry mouth, anorexia, somnolence, increased sweating, *nausea* Possible serotonin syndrome Hypertension in larger doses |
|
|
Term
Duloxetine should be avoided in what patients? |
|
Definition
Avoid in hepatic insufficiency or end-stage renal disease |
|
|
Term
What are the adverse effects of MAO-inhibitors? |
|
Definition
Orthostatic hypotension Insomnia Weight gain Sexual dysfunction Anticholinergic effects Tyramine-induced hypertensive crisis |
|
|
Term
What kind of drug interactions are there for MAO-inhibitors? |
|
Definition
CNS stimulants can cause a hypertensive crisis Any agent that would increase 5-HT levels may lead to serotonin syndrome |
|
|
Term
What are the adverse effects of SSRIs? |
|
Definition
Some tolerance, sexual dysfunction, headache Akathesia (particularly with fluoxetine) May induce a sudden switch to mania in vulnerable Withdrawal |
|
|
Term
What are potential drug interactions of SSRIs? |
|
Definition
Can cause increased concentration of clozapine and may precipitate seizures Should not be used with TCAs Cautious use with lithium – may lead to seizures Serotonin Syndrome (avoid with MAOIs) |
|
|
Term
What are the manifestations of serotonin syndrome? |
|
Definition
Akathisia-like restlessness, muscle twitches and myoclonus, hyperreflexia, sweating, shivering and tremor leading to seizures and coma |
|
|
Term
What are the adverse effects of Bupropion? |
|
Definition
Headache, nausea, dry mouth, insomnia, tremor, CNS effects due to DA Should not be used with MAOIs – may cause hypertensive crisis |
|
|
Term
What are the adverse effects of Nefazodone? |
|
Definition
Strong inhibitor of CYP3A4 Significant interaction with triazolam, alprazolam |
|
|
Term
What are the adverse effects of Mirtazapine? |
|
Definition
Significant weight gain Somnolence Dry mouth Constipation |
|
|
Term
What are the adverse effects of lithium? |
|
Definition
Low therapeutic index Initially can cause polyuria or polydipsia, may induce nephrogenic diabetes insipidus CV defects in pregnant, secreted in milk Periodic concentration determination is crucial |
|
|
Term
How do you prevent changes in in weight & depressed mood due to taking anti-epileptic drugs? |
|
Definition
Inevitable with chronic use and adjusting dosage to minimize these side effects is not recommended since it can compromise anti-seizure efficacy |
|
|
Term
How are anti-epileptics used in pregnant patients? |
|
Definition
Almost all of the established antiepileptics have been reported to cause birth defects, but the majority of mothers on antiepileptic medication deliver normal infants The fetus has a better prognosis when the pregnant woman is on a single AED vs a combination of AEDs |
|
|
Term
The risk of hepatotoxicity with valproic acid is greatest in what patients? |
|
Definition
Patients under 2 yrs & taking multiple medications Fatal within 4 months |
|
|
Term
What are the taratogenic effects of valproic acid? |
|
Definition
Spina bifida Cardiovascular defects Malformation of digits |
|
|
Term
What are the contraindications for the use of ethosuximide? |
|
Definition
May exacerbate tonic-clonic seizures & complex partial seizures Ineffective in management of psychomotor or major motor seizures |
|
|
Term
What are the contraindications for the use of phenytoin? |
|
Definition
Not useful in absence seizures |
|
|
Term
What are the important pharmacokinetic characteristics of phenytoin? |
|
Definition
Metabolism is saturable, if the dosing rate exceeds elimination capacity, the plasma levels of the drug quickly reach toxic levels |
|
|
Term
What is the therapeutic index of phenytoin? |
|
Definition
Very narrow Therapeutic effects are seen at plasma concentration between 50-100 µmol/L Adverse effects above 100 µmol/L |
|
|
Term
What are the side effects of chronic phenytoin use? |
|
Definition
Gingival hyperplasia especially in children & young adults Hirsutism, coarsening features Rash (hypersensitivity to hydantoins) Hyperglycemia (inhibits insulin secretion) Osteomalacia |
|
|
Term
What are the taratogenic effects of phenytoin? |
|
Definition
Cleft palate Heart malformations Hypoprothrombinemia and hemorrhage |
|
|
Term
Concurrent administration with what drug should be avoided when taking Carbamezapine? |
|
Definition
MAO-Is due to its similarity in structure to TCA's |
|
|
Term
What are the side effects of Carbamezapine? |
|
Definition
Antidiuretic effects and hyponatremia Pregnancy category D, Teratogenic Severe dermatological hypersensitivity reactions (rare) |
|
|
Term
What kind of severe dermatological hypersensitivity reactions are associated with carbamezapine use? What causes this? |
|
Definition
Toxic epidermal necrolysis (TEN) and Stevens-Johnson Syndrome (SJS) Strongly associated with HLA-B1502 allele, much greater risk in asians |
|
|
Term
What are the side effects of phenobarbital? |
|
Definition
Drowsiness, Sedation, Habit-forming Chronic treatment with high doses of causes behavioral problems in children Agitation & confusion in adults Over dose: Respiratory depression, CNS depression, coma, death |
|
|
Term
Clorazepate is not used in what demographic? |
|
Definition
|
|
Term
What are the side effects of Clonazepam and Clorazepate? |
|
Definition
Behavioral disturbances in children; hyperactivity, irritability Drowsiness, sedation, ataxia, insomnia Overdose: Respiratory depression Abrupt withdrawal can cause status epilepticus |
|
|
Term
Felbamate has what black box warning? |
|
Definition
|
|
Term
What are the problems associated with administration of Levodopa (L-DOPA) alone |
|
Definition
Less than 1% of the dose reaches cerebral circulation due to degradation by AAD and MAO Dopamine produced by peripheral conversion of L-DOPA produces side effects such as nausea, vomiting, cardiovascular effects |
|
|
Term
What are the side effects of Carbidopa/Levodopa (Sinemet)? |
|
Definition
Hypotension due to peripheral dopamine induced vasodilation Cardiac arrhythmias, daytime sleepiness, schizophrenia Mydriasis & acute increases in intraocular pressure (IOP) Dyskinesia: Involuntary writhing movements On/Off periods |
|
|
Term
Carbidopa/Levodopa (Sinemet) is contraindicated in patients with what? |
|
Definition
Psychosis Narrow angle glaucoma Peptic ulcer disease Patients taking nonspecific inhibitors of MAO |
|
|
Term
What are the consequences of long term L-Dopa therapy? |
|
Definition
Tolerance and sensitization to the medication resulting in a “narrow therapeutic window” Decreased buffer synaptic concentrations of dopamine Altered the sensitivity to synaptic dopamine levels accentuating, responses to high (On) & low (off ) concentrations |
|
|
Term
What are the disadvantages of dopamine receptor agonists compared to L-Dopa? |
|
Definition
Hallucinations and hypotension are much more common |
|
|
Term
Why is pergolide no longer used as a dopamine receptor agonist? |
|
Definition
Long-term use associated with significant damage to cardiac valves. The drug has been removed from the market |
|
|
Term
What are the side effects of ergot alkaloid non-specific dopamine receptor agonists? |
|
Definition
Initial treatment causes profound hypotension Often induce nausea and fatigue with initial treatment |
|
|
Term
What are the side effects of Ropinirole and Pramipexole (selective dopamine receptor agonists)? |
|
Definition
Hallucinations, Somnolence |
|
|
Term
What are the side effect considerations of apomorphine? What should it be given alongside? |
|
Definition
High potential to cause nausea & vomiting Pretreatment with antiemetic trimethobenzamide |
|
|
Term
Apomorphine should be avoided alongside what drugs? |
|
Definition
Antiemetics that are 5HT3 antagonists (ex. ondansetron) Causes significant hypotension and can lead to fainting episodes |
|
|
Term
Inhibition of MAO-A retards breakdown of all central & peripheral catecholamines can lead to life threatening side effects when combined with what drugs? |
|
Definition
Drugs that increase catecholamine levels (TCAs, SSRIs, SNRIs, tyramines etc.) |
|
|
Term
What are the side effects of Selegiline? |
|
Definition
MAO-B inhibitor, increases the adverse motor and cognitive effects of L-DOPA therapy in advanced Parkinson's Metabolized into amphetamine and methamphetamine |
|
|
Term
What are the side effects of muscarinic receptor antagonists? |
|
Definition
Sedation and mental confusion Blurred vision through cycloplegia Cautious use in narrow-angle glaucoma Constipation Urinary retention |
|
|
Term
What drugs increase the symptoms of schizophrenia by increasing neurotransmitter levels? |
|
Definition
Amphetamines Methyphenidate and Cocaine L-DOPA |
|
|
Term
What are the side effects of typical anti-psychotics? |
|
Definition
Significant motor side effects (EPS) and hyperprolactinemia |
|
|
Term
What are the side effects of atypical anti-psychotics? |
|
Definition
Minimal EPS and hyperprolactinemia |
|
|
Term
What causes the side effects seen in first generation typical anti-psychotics? |
|
Definition
Non-target blockade of D2 receptors Motor side effects aka extrapyramidal symptoms (EPS) due to blockade of dopamine receptors in the nigrostriatal pathway |
|
|
Term
What causes the autonomic histaminergic side effects seen with the use of all anti-psychotics? |
|
Definition
Blockade of D2 receptors in the tuberoinfundibular pathway causes hyperprolactinemia Blockade of muscarinic receptors: Dry mouth, difficulty urinating or retention, constipation, blurred vision, confusion Blockade of α adrenoceptors: Orthostatic hypotension Blockade of H1 histamine receptors: Sedation |
|
|
Term
Which atypical anti-psychotics also cause the EPS and neuroendocrine symptoms at high doses seen with typical anti-psychotic use? |
|
Definition
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|
Term
What side effect is slightly more pronounced in atypic anti-psychotics compared to typicals? |
|
Definition
Weight gain Less of a problem with the newest atypicals (Ziprasidone & Aripiprazole) |
|
|
Term
Why is the use of Clozapine (atypical) restricted? |
|
Definition
Danger of fatal neutropenia |
|
|
Term
What is an unusual side effect of Clorazapine? |
|
Definition
Instead of causing dry mouth, this drug causes hyper salivation |
|
|
Term
What are the drawbacks of Olanzapine (atypicals) |
|
Definition
Minimal effective dose is 10 mg. Increased incidence of EPS at doses > 25-30 mg Weight gain more than the other antipsychotics |
|
|
Term
What are the drawbacks of Risperidone (atypical)? |
|
Definition
At doses higher than 8 mg: EPS, Hyperprolactinemia, Weight gain |
|
|
Term
What are the side effects of Quetiapine (atypical)? |
|
Definition
Somnolence/Sedation Postural hypotension |
|
|
Term
What is the black box warning for Aripirprazole? |
|
Definition
Studies have shown that older adults with dementia have an increased chance of death during treatment. Older adults with dementia may also have a greater chance of having a stroke or ministroke or other severe side effects during treatment |
|
|
Term
Which of the following should not be used in patients with sulfonamide allergies? |
|
Definition
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|
Term
What are general concerns with use of all anesthetic drugs? |
|
Definition
Very narrow therapeutic index, must monitor levels since the margin between surgical anesthesia and fatal respiratory/circulatory depression is narrow Most decrease myocardial contractility and reduce BP All depress respiration markedly and increase arterial PCO2 |
|
|
Term
What are the dangers of using Thiopental as an anesthetic? |
|
Definition
Slowly metabolized, accumulates in the body, prolonged effect if given repeatedly, tissue damage if extravascular Precipitates when it comes in contact with drugs in acidic solution Narrow margin of error: CV depression |
|
|
Term
What are the drawbacks of using Etomidate as an anesthetic? |
|
Definition
Severe nausea Causes involuntary movements during induction Risk of adrenocortical suppression |
|
|
Term
What are the drawbacks of using Ketamine as an anesthetic? |
|
Definition
High incidence of hallucinations etc Can raise intracranial pressure |
|
|
Term
What are the side effects of Ziprasidone? |
|
Definition
Newer generation atypical similar to Aripiprazole Potential for cardiac arrhythmia in patients with baseline risk factors: Elderly, preexisting cardiac disease Taking diuretics or medication that prolong QT interval |
|
|
Term
What is nitrous oxide toxicity? |
|
Definition
Caused by chronic use Leads to symptoms similar to B12 deficiency (pernicious anemia) such as neuropathy, tinnitus, numbness Increases cerebral blood flow Expands air-filled cavities due to being 40x as soluble as nitrogen, is passes from the blood into the cavity faster than nitrogen can diffuse out |
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|
Term
Nitrous oxide use is contraindicated in what patients? |
|
Definition
Patients with bowel obstruction pneumothorax middle ear and sinus disease during general anesthesia for gas-filled eye procedures Patients with increased intracranial pressure |
|
|
Term
The Minimal Alveolar Concentration (MAC) for anesthetics decreases in what kind of patients? |
|
Definition
Elderly patients, patients with hypothermia, presence of adjuvant drugs, hypoxemia, hypotension, or anemia |
|
|
Term
How do inhaled anesthetics affect the cardiovascular system? |
|
Definition
Decrease mean arterial pressure in direct proportion to alveolar concentration Decrease systemic vascular resistance Reduce myocardial oxygen consumption causing ischemia |
|
|
Term
What unique side effect does Halothane have on the cardiovascular system? |
|
Definition
Sensitizes the myocardium to catecholamines Enflurane and halothane have greater myocardial depressant effects |
|
|
Term
What are the side effects on the respiratory system when using inhaled anesthetics? |
|
Definition
Dose-dependent decrease in tidal volume and increase in respiratory rate during spontaneous ventilation Decreased minute ventilation & ventilatory response to CO2 Depresses mucociliary function in the airway Bronchodilatory effects |
|
|
Term
What are the side effects on the kidneys when using inhaled anesthetics? |
|
Definition
Decreased renal blood flow Theoretical nephrotoxicity |
|
|
Term
How might enflurane and sevoflurane cause nephrotoxicity? |
|
Definition
Metabolism could lead to formation of fluoride ions intrarenally. However, there are no reports of renal injury, risk is theoretical |
|
|
Term
Which anesthetic can, in rare cases, cause potentially severe and life-threatening hepatitis, particularly in obese patients undergoing multiple exposures within a short amount of time? |
|
Definition
|
|
Term
How might inhaled anesthetics cause malignant hyperthermia? |
|
Definition
Autosomal dominant genetic disorder of skeletal muscle Occurs in susceptible individuals undergoing general anesthesia with inhaled agents and muscle relaxants |
|
|
Term
Which inhaled anesthetics are most likely to cause malignant hyperthermia in susceptible individuals? |
|
Definition
Halothane and enflurane Involves increase in free calcium concentration |
|
|
Term
The anesthetic Isoflurane has what unintended side effects? |
|
Definition
May cause MI in patients with coronary disease Irritant to respiratory tract |
|
|
Term
The anesthetic Desflurane has what unintended side effects? |
|
Definition
Similar to isoflurane, faster onset and recovery Respiratory irritant causes cough and laryngospasm |
|
|
Term
The anesthetic Sevoflurane has what unintended side effects? |
|
Definition
Similar to desflurane but no respiratory irritation Theoretical risk of nephrotoxicity : No evidence |
|
|
Term
The anesthetic Enflurane has what unintended side effects? |
|
Definition
Similar to halothane but less metabolism, less toxicity Risk of epilepsy like seizures |
|
|
Term
What are the risks associated with spinal anesthesia? |
|
Definition
Bradycardia, hypotension, respiratory depression if it spreads to the brain, urinary retention |
|
|
Term
What are the neurotoxic effects of local anesthetics? |
|
Definition
All can be neurotoxic at very high concentrations. Ex. Pooling in the cauda equina |
|
|
Term
Which local anesthetics are more clinically likely to cause neurotoxicity? |
|
Definition
Lidocaine or chlorprocaine When used for continuous spinal(subarachnoid) block |
|
|
Term
What are the cardiovascular side effects of local anesthetics? |
|
Definition
Depression of myocardial contractility/strength, conduction block and vasodilation due to blocked Na+ influx Blockade of AV conduction and Ca+ stores Vasodilation at vasculature and indirectly inhibited sympathetic activity causes sudden fall in BP |
|
|
Term
What are the unique cardiovascular effects of cocaine? |
|
Definition
Hypertension, arrhythmias |
|
|
Term
How might local anesthetics cause cardiovascular collapse? |
|
Definition
Epidural needle or continuous infusion catheters enter an epidural vein and is not recognized Epidural veins enlarge during pregnancy |
|
|
Term
How do you rule out inadvertent subarachnoid injection (total spinal results) or intravascular injection (seizure, cardiac effects) with local anesthetics? |
|
Definition
Give a "test dose" of epinephrine containing lidocaine prior to giving a large volume of local anesthetic epidurally Not always 100% accurate |
|
|
Term
What are the CNS side effects of local anesthetics? |
|
Definition
Light-headedness, tinnitus, metallic taste, circumoral numbness, drowsiness, slurred speech and nystagmus At higher levels: Anxiety development of fine tremors of the muscles of the hands and/or face Tonic/Clonic seizures Severe CNS depression and death |
|
|
Term
What local anesthetic has high CNS and CV side effects and are therefore not used? |
|
Definition
|
|
Term
Prilocaine causes what unusual side effect in high doses? |
|
Definition
Methhemoglobinemia May lead to accumulation of o-toluidine (oxidizing agent capable of converting HgB to methemoglobin) |
|
|
Term
What are the concerns associated with the use of epinephrine? |
|
Definition
Cardiac arrhythmias in patients with heart disease or with concomitant use of halothane May be detrimental to flap viability (grafts) Dangerous if used on tips of fingers, penis Hypertension |
|
|
Term
What types of drugs interact poorly with phase I of succinylcholine? |
|
Definition
|
|
Term
What are the side effects of succinylcholine? |
|
Definition
Postoperative muscle pain due to fasciculations Decreases HR, increases IOP at high doses by blocking ganglionic nicotinic receptors Hyperkalemia |
|
|
Term
What types of patients experience greater bouts of hyperkalemia as a side effect of succinylcholine? |
|
Definition
Patients with burns (peaks in 7-10 days) trauma or spinal cord injury, peripheral nerve dysfunction, or muscular dystrophy |
|
|
Term
What is the most serious possible side effect of succinylcholine? |
|
Definition
|
|
Term
Which isoqinolone based non-depolarizing blocker can cause hypotension due to ganglion block and release of histamine, bronchoconstriction due to histamine release |
|
Definition
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|
Term
Which isoqinolone based non-depolarizing blocker is associated with hypotension, histamine release, the toxic metabolite laudanosine, and has greater accumulation with renal failure |
|
Definition
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|
Term
Which isoqinolone based non-depolarizing blocker causes the least amount of hypertensive side effects as well as less histamine release and less formation of toxic metabolites? |
|
Definition
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|
Term
Which amino steroid based non-depolarizing blocker can promote muscarinic block as a side effect? |
|
Definition
|
|
Term
What are the side effects of neuromuscular junction blockers? |
|
Definition
Respiratory paralysis, histamine release, autonomic effects |
|
|
Term
Which anesthetics can strongly potentiate and prolong neuromuscular blockade? |
|
Definition
Inhaled neuromuscular junction blocking anesthetics, particularly isoflurane |
|
|
Term
Potentiation and prolonged relaxant action of neuromuscular blockers occurs with what drugs? |
|
Definition
Aminoglycoside antibiotics and antiarrhythmic agents |
|
|
Term
What are the side effects of Cyclobenzaprine? |
|
Definition
Marked sedative and antimuscarinic action May cause confusion and visual hallucinations in some patients |
|
|
Term
Methocarbamol is contraindicated under what conditions? |
|
Definition
|
|
Term
What is the primary side effect of Carisoprodol? |
|
Definition
Drowsiness, avoid with alcohol |
|
|
Term
Triggered rhythms are in danger of progressing to what? |
|
Definition
|
|
Term
What causes Torsades de Points? |
|
Definition
Prolongation of QT due to: Electrolyte imbalance Persistent bradycardia Class I or III drugs (block cardiac K+ channels) Certain non-cardiac drugs Congenital QT prolongation |
|
|
Term
What effect do class IA drugs have on ECG readings? |
|
Definition
|
|
Term
What effect do class IB drugs have on ECG readings? |
|
Definition
|
|
Term
What effect do class IC drugs have on ECG readings? |
|
Definition
Inc PR Inc QRS QT unchanged or inc |
|
|
Term
What effect do class II drugs have on ECG readings? |
|
Definition
PR non or inc QT non or dec |
|
|
Term
What effect do class III drugs have on ECG readings? |
|
Definition
PR non or inc QRS non or inc QT inc |
|
|
Term
What effect do class IV drugs have on ECG readings? |
|
Definition
|
|
Term
What are the effects of class IA antiarrhythmics on AP propagation? |
|
Definition
Intermediate acting Prolongs AP |
|
|
Term
What are the effects of class IB antiarrhythmics on AP propagation? |
|
Definition
|
|
Term
What are the effects of class IC antiarrhythmics on AP propagation? |
|
Definition
Slow acting No effect on AP |
|
|
Term
What drug interactions are seen with Quinidine? |
|
Definition
Reduces Digoxin clearance |
|
|
Term
What are the side effects of Quinidine? |
|
Definition
Marked nausea Diarrhea Cinchonism (deafness, tinnitus, blurred vision) Thrombocytopenic purpura |
|
|
Term
Quinidine is contraindicated with what condition? |
|
Definition
|
|
Term
What are the effects of class IA antiarrhythmics on AP propagation? |
|
Definition
Intermediate acting Prolongs AP |
|
|
Term
What are the effects of class IB antiarrhythmics on AP propagation? |
|
Definition
|
|
Term
What are the effects of class IC antiarrhythmics on AP propagation? |
|
Definition
Slow acting No effect on AP |
|
|
Term
What are the side effects of Procainamide? |
|
Definition
Lupus-like syndromes, hypotension, depression, hallucination, psychosis Adjust dosage with renal function |
|
|
Term
What are the side effects of Disopyramide? |
|
Definition
Pronounced antimuscarinic effects Dry mouth, blurred vision, constipation, urine retention, and sometimes precipitates glaucoma Can also worsen heart block & adversely effect sinus node activity Prolongs QT interval, can cause Torsades Contraindicated in long QT syndrome |
|
|
Term
How do you treat class IA antiarrhythmic overdose? |
|
Definition
Cardiac effects can be exacerbated by hyperkalemia Arrhythmias revered by Sodium Lactate IV which increases the ionic gradient Sympathomimetics can reverse hypotension |
|
|
Term
What are the limitations of Lidocaine? |
|
Definition
IV only limits to emergency setting, no maintenance therapy Adjust dose with reduced hepatic flow such as in CHF or older patients |
|
|
Term
What are the side effects of Flecainide? |
|
Definition
Very proarrhythmic CNS effects Negative ionotropic effects, can aggravate CHF |
|
|
Term
What are the side effects of Propranolol? What are its contraindications? |
|
Definition
Excessive bradycardia Bronchospasms Depression, fatigue Use with caution in asthma and diabetes |
|
|
Term
What are the side effects of Sotalol? |
|
Definition
Can prolong QT intervals and cause Torsades Dyspnea and dizziness Adjust in renal disease |
|
|
Term
What are the side effects of Class IV antiarrhythmics and what makes them worse? |
|
Definition
AV block in large doses or in patients with partial block Made worse with beta-blockers |
|
|
Term
What are the side effects of Adenosine? |
|
Definition
Flushing, hypotension, chest pain, dyspnea |
|
|
Term
What electrolyte abnormality causes AV block with Digitalis? |
|
Definition
|
|
Term
What are the side effects of nitrates? |
|
Definition
Flushing, Nausea Throbbing Headache (meningeal artery vasodilation) Orthostatic Hypotension Reflex Tachycardia Syncope, Dizziness Large IV dose can cause methemoglobinemia |
|
|
Term
What is the drawback of continued use of nitrates? |
|
Definition
Tolerance develops after days of continual therapy Overcome with treatment free intervals during the night |
|
|
Term
Nitrates are contraindicated with what other drugs? |
|
Definition
Phosphodiesterase inhibitors (Sildenafil, Tadelafil)prolongs effects, can cause hypotensive shock Migraine medication can increase BP and decrease effects |
|
|
Term
What is the drawback of nitrate tablets? |
|
Definition
Volatile, loses potency when exposed to air and light, only usable for 6 months after opening |
|
|
Term
What are the side effects of Bepiridil? |
|
Definition
Heart failure if combined with beta-blockers Torsades and other arrhythmias Agranulocytosis |
|
|
Term
What are the side effects of Verapamil? |
|
Definition
Constipation & Gingival hyperplasia Sinus bradycardia High doses can cause myocardial depression, heart failure, edema, hypotension |
|
|
Term
What are the side effects of Diltiazem? |
|
Definition
Sinus bradycaria AV block, Heart failure (When used in combination with beta blockers) Peripheral effects (hypotension, edema) |
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Term
What cardiac drugs are generally avoided in variant angina? |
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Definition
Beta-lockers, have minimal effects |
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Term
What is acute coronary syndrome (ACS)? |
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Definition
A life threatening condition in pts w/coronary disease Continuum that ranges from an unstable pattern of angina pectoris to the development of a large acute myocardial infarction (irreversible necrosis of the heart muscle) |
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Term
What are the side effects of heparin? |
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Definition
Bleeding is primary adverse effect Osteoporosis Heparin induced throbocytopenia Allergy due to animal origin |
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Term
What are the contraindications to heparin? |
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Definition
Hypersensitivity to UFH Hypersensitivity, pork products, or methylparaben with LMWH History of HIT |
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Term
What is given for a heparin overdose? |
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Definition
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Term
What are the side effects of Rivaroxaban? |
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Definition
Bleeding Black box warning of possible paralysis with enuraxial anesthesia or spinal puncture |
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Term
What are the side effects of the monovalent direct thrombin inhibitors (Argatroban and Dabigatran etexilate)? |
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Definition
Hemorrhage (serious, most common) |
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Term
Lepirudin is contraindicated alongside what condition? |
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Definition
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Term
Argatroban is contraindicated alongside what condition? |
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Definition
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Term
Dabigatran should be avoided alongside what other drugs? |
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Definition
P-glycoprotein inducers (i.e. rifampin) reduces exposure |
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Term
What are the side effects of Warfarin? |
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Definition
Hemorrhage of the bowel or the brain Correct dosing requires continual monitoring Birth defects, crosses placenta |
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Term
What are contraindications to thrombolytic therapy? |
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Definition
Recent surgery (w/in 10 days) Serious GI bleed w/in 3 months History of HTN Active bleeding disorder Previous cerebrovascular accident w/in 30mo Aortic dissection Acute pericarditis |
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Term
What are the side effects of fibrinolytic drugs? |
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Definition
Hemorrhage due to lysis of fibrin in physiological thrombi |
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Term
What are the side effects of Tranexamic acid and Aminocaproic acid? |
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Definition
Thrombi formation that can lead to renal failure |
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Term
How does injury encourage the formation of a thrombus? |
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Definition
When underlying basal lamina is exposed to the blood stream, PGI2 decreases -> GPIa/IIa receptors on platelets and von Willebrand factor -> COX-1 -> ADP -> GPIIb/IIIa activation -> platelet aggregation |
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Term
What are the side effects of Aspirin? |
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Definition
Bleeding, salicylism – generally with larger doses than used for this indication |
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Term
What are the side effects of ADP antagonists (Clopidogrel and Prasugrel)? |
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Definition
Thrombotic thrombocytopenic purpura |
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Term
What are the side effects of Aspirin? |
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Definition
Bleeding, salicylism – generally with larger doses than used for this indication |
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Term
What are the side effects of ADP antagonists (Clopidogrel and Prasugrel)? |
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Definition
Thrombotic thrombocytopenic purpura |
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Term
When is Celocoxib contraindicated? |
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Definition
With cardiovascular disorders |
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Term
How does aspirin affect uric acid secretion? |
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Definition
At low doses, uric acid secretion is decreased At high doses, excretion is increased, can precipitate gout |
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Term
What are the side effects of aspirin? |
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Definition
Reye's syndrome Liver dysfunction and encephalopathy Contraindicated in children with viral infections |
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Term
What are the symptoms of aspirin overdose? |
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Definition
GI distress and bleeding Bronchoconstriction Renal dysfunction Hypersensitivity Renal dysfunction |
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Term
What are the effects of Indomethacin? |
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Definition
Prominent anti-inflammatory, antipyretic and analgesic activity Reduces polymorphonuclear leukocyte motility Reduces development of cellular exudates and reduces vascular permeability in injured tissue |
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Term
What is the ONLY NSAID that does not cause renal dysfunction? |
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Definition
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Term
Why are COX-2 selective inhibitors such as Celocoxib or Dicolfenac dangerous in patients with cardiovascular disease? |
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Definition
May increase risk of thrombosis which increases risk of MI or stroke |
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Term
When are NSAIDs contraindicated with pregnancy? |
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Definition
During the third-trimester due to risk of post-partum hemorrhage and delayed labor |
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Term
What is the side effect of colchicine that severely limits its use? |
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Definition
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Term
Probenicid is contraindicated with what condition? |
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Definition
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Term
What factors promote rheumatic arthritis? |
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Definition
Genetic disposition Age related wear and tear Hypothermia Infection |
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Term
What are the pro-inflammatory cytokines involved in the progression of rheumatoid arthritis? |
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Definition
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Term
C-reactive protein in the blood is indicative of the presence of what? |
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Definition
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Term
What are the systemic signs of rheumatoid arthritis? |
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Definition
Rheumatoid nodules Vasculitis in finger beds Pleural effusions and pulmonary fibrosis Pericarditis Splenomegaly, neutropenia |
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Term
What is the drawback of DMARD therapy for rheumatoid arthritis? |
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Definition
Slow acting, may take months for benefit No analgesic activity |
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Term
What should be avoided with Methotrexate? |
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Definition
Alcohol Essential to monitor liver function Must give with folic acid supplements |
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Term
What are the side effects of Methotrexate? |
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Definition
Hepatotoxicity Pulmonary fibrosis GI distress Pregnancy category X |
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Term
What are the side effects of Hydroxychloroquine? |
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Definition
A quinine containing drug which causes cinchoism ( flushed and sweaty skin, ringing of the ears (tinnitus), blurred vision, impaired hearing, confusion, reversible high-frequency hearing loss, headache, abdominal pain, etc) |
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Term
What are the side effects of Sulfasalazine? |
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Definition
Causes GI distress, start with low dose |
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Term
What are the side effects of Leflunomide? |
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Definition
Metabolized to active metabolite, caution in renal dysfunction Can combine with methotrexate but high risk of hepatotoxicity |
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Term
Etanercept should be avoided alongside what drugs? |
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Definition
May be combined with DMARD with the exception of Anakinra |
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Term
What are the general side effects of most DMARDs? |
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Definition
Injection site reactions 1st dose phenomenon Headache, dizziness Immunosuppressive (AVOID with infections) |
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Term
Anakinra is contraindicated with what drugs? |
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Definition
TNF antagonists (Etanercept and Infliximab) Abatacept |
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Term
Rituximab should be avoided with what conditions? |
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Definition
Renal dysfunction Separate from hypertensive therapy for 12hrs |
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Term
What are the side effects of Rituximab? |
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Definition
Angioedema Fatigue Nausea, vomiting Headache Hypotension Rash, urticaria |
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Term
How does beta-2 receptor polymorphism impact the treatment of asthma with beta-2 agonists? |
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Definition
An Arginine at position 16 increases the risk for exacerbations with short- or long-term agonists |
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Term
When should oral agents be used instead of inhaled for the treatment of asthma? |
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Definition
Greater incidence of side effects vs. inhaled Used in young children unable to use inhalers |
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Term
What are the side effects of beta-2 agonists? |
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Definition
Nervousness/anxiety Palpitations Tachycardia Tremors |
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Term
What drug interactions are there for beta-2 agonists? |
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Definition
MAO-I TCA antidepressents Avoid Anything that increases catecholamines |
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Term
Beta-2 agonists should be avoided with what conditions? |
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Definition
Cardiovascular disorders Convulsive disorders Diabetes mellitus |
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Term
What are the side effects of glucocorticoids? |
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Definition
Epistaxis Bone demineralization (less likely in inhaled) Oropharyngeal candidiasis Pharyngitis HPA axis suppression (unlikely with inhaled) Glaucoma Headache Fewer systemic effects when inhaled |
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Term
Glucocorticoids should be avoided alongside what conditions? |
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Definition
Infections Glaucoma If oral, caution with CYP450 metabolizers, diabetes, diabetes, peptic ulcers, osteoporosis |
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Term
What are the side effects of leukotriene inhibitors? |
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Definition
Elevated liver enzymes with Zileuton Nausea/dyspepsia Neuropsychiatric events: agitation, depression, anxiety, etc. |
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Term
Leukotriene inhibitors have what drug interaction? |
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Definition
Zileuton decreases warfarin and theophylline clearance |
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Term
Ipratropium should be cautioned alongside what other asthma drug? |
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Definition
Combined with albuterol can cause rare occurrence of MI |
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Term
What are the side effects of muscarinic antagonists? |
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Definition
Palpitations Nervousness Fatigue Headache Dry mucus membranes Influenza-like symptoms |
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Term
What conditions require caution when using muscarinic antagonists? |
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Definition
Acute episode of bronchospasm Myasthenia gravis Narrow-angle glaucoma Prostatic hyperplasia Bladder obstruction |
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Term
Why is theophylline not commonly used to treat asthma? |
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Definition
Narrow therapeutic window Caution in drugs that decrease metabolism or clearance such as zileuton High doses can cause seizures or cardiac arrhythmia |
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Term
What are the side effects of Amalizumab? |
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Definition
Injection-site reactions Anaphylactic shock, give under supervision Symptoms return upon cessation of treatment |
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