Final Study Guides pharm.docx

Like a lead pipe bone break if you try and move

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(like a lead pipe – bone break if you try and move extremities), sudden high fever, autonomic instability Treatment – Dantrolene (reduce fever) and Bromocriptine Goal is to reduce fever to prevent development of seizures (cooling blankets, antipyretics, hydration with fluids) 29. How long before you see results for antidepressants? How long should it continue? Effects develop slowly (1-3, up to 6 weeks) Initially the pts suicidal tendency may increase (the medicine is giving them energy but they are still severely depressed – monitor closely for signs of suicide ideation) Treatment should continue for 4-9 months, up to a year, after symptoms have subsided (even if the pt is feeling better, it does not mean they are no longer depressed – this means the medication is working to stop their depression) 30. What are adverse effects of Tricyclic antidepressants (TCA)? TCA = Amitriptyline (Elavil) – drug of first choice for many pts with major depression
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Initial treatment increases suicide risk Cardiac Toxicity (lethal with overdose) – most serious adverse effect Dysrhythmias, tachycardia, heart block can cause fatal arrhythmia Hook up to EKG, continuously monitor Sedation (tolerance develops) Orthostatic hypotension Anticholinergic effects (dry mouth, blurred vision, photophobia, urinary hesitancy, constipation, tachycardia, diaphoresis) Diaphoresis Seizures (lowers threshold – increased risk for seizures) Hypomania (decreased communication) Yawngasm (orgasm when yawning) 31. How do the different classes of laxatives work? What classes are docusate sodium, bisacodyl, and miralax? Bulk-forming laxatives : function like dietary fiber; swell with water to form a gel to soften the fecal mass and increase mass; increased mass stretches the bowel wall, and thereby stimulates peristalsis Surfactant laxatives ( Docusate Sodium ): stimulate intestinal motility, increase amount of water and electrolytes in the intestinal lumen Stimulant laxatives ( Bisacodyl ): acting to speed up colonic muscle movement (motility) Osmotic laxatives ( Miralax ): poorly absorbed salts that draw water into intestinal lumen; fecal mass softens and swells, wall stretches, and peristalsis is stimulated 32. Why can TCAs not be given with MAOIs? Can cause a hypertensive crisis if combined with an MAOI (use caution in combining MAOIs with any drug) The combination is generally avoided Don’t use an MAOI unless the pt has responded to nothing else (very dangerous) 33. Dietary restrictions with MAOIs. What happens if not followed? Do not consume tyramine-rich foods Avocado, fig, bananas in large amounts, smoked or otherwise aged meats, fermented sausages (pepperoni, salami, bologna), smoked or dried fish, all hard cheeses, foods with yeast that have not been cooked, some beers, chianti wine, soy sauce Can result in hypertensive crisis (SOB, excruciating HA, tachy/bradycardia) Hypertensive diet increases risk for stroke
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Avoid tyramine in diet for two weeks after stopping med 34. What advantage do SSRIs have over TCAs?
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