Final-Part 3

Question 1

How do you administer a glaucoma medication:

1. What do you form?
2. What do you do to prevent it from spreading systemically?
3. Can we touch the dropper it
4. How long do we space drops?
5. What if we wear contacts?
6. When is the best time to administer the drops?

Answer 1

1. Form pocket in lower lid (conjunctival sac) and insert drops
2. Place finger on nasolacrimal duct for 1-3 min
3. DONT touch the dropper tip
4. Space drops by 5 min
5. Wait 5-10 min before putting contacts in
6. Apply drops in the morning

Question 2

What are the common adverse effect and drug interactions of garlic, ginger, and ginkgo biloba?

Answer 2

All increase risk of bleeding! Do not combine with blood thinners!

Question 3

Adverse effects of corticosteroid inhalers for asthma and COPD?

Answer 3

Thrush–also steroids cause you to be immunosuppressed

Question 4

Common adverse effects of benzodiazepines (anti-anxiety)

Answer 4

Sedation
Slurred speech
Ataxia

*common to ETOH

Question 5

Dietary precautions when taking an MAOI?

Answer 5

1. Avoid tyramine (aged meats, cheeses, alcohols, etc)–HYPERTENSIVE CRISIS
2. Don’t mix with OTC cold meds–HYPERTENSION
3. Don’t mix with other antidepressants bc can lead to HYPERTENSION (TCAs) or SEROTONIN SYNDROME (SSRIs)
4. Don’t mix with meperidine (opioid)–can cause HYPERPYREXIA (increased fever)

Question 6

What lab tests for lithium (mood stabilizer) therapy?

Answer 6

Levels need to be between 0.8-1.4…Once stabilized levels need to be 0.4-1

Other tests to look at is BUN and creatinine (get baseline and yearly tests) because lithium effects kidneys

Also get T3, T4, and TSH levels at baseline and yearly because lithium can cause HYPOthyroidism

Question 7

Lab monitoring for valporate (biopolar disorder drug)?

Answer 7

LFT baseline and periodically since it can cause hepatotoxicity

Amylase levels since it can cause Pancreatitis

Question 8

SSRI vs. TCA

Answer 8

SSRI only blocks serotoning; main complaint= sexual die effects–very selective, very few side effects; also increases risk of suicidal thoughts especially younger than 18

TCA are more dangerous than SSRI bc narrow TI and not as selective
Blocks serotonin, norepi, histamine, and ACh–very small OD can lead to Vfib!!

Question 9

Second generation antipsychotics? (4)

Answer 9

1. Clozapine
2. Risperidone
3. Olanzapine
4. Quetiapine

Question 10

What second gen antipsychotic has side effect of agranulocytosis?

Answer 10

Clozapine

Question 11

What second gen antipsycchotic is associated with gynecomastia?

Answer 11

Risperidone (sounds like whisper–people whispering about man boobs)

Question 12

What second gen is most associated with metabolic syndrome?

Answer 12

Olanzapine (weight gain, increase blood glucose, increased TG=metabolic syndrome)

Question 13

What second gen is very sedating and sometimes used as sleep aid?

Answer 13

Quetiapine (looks like the word quiet)

Question 14

What has higher risk for EPS: first or second gen?

Answer 14

First

Question 15

What are the major risks for metabolic syndrome. Which second gen does this the most?

Answer 15

Increased weight
Increased blood glucose
Increased TG

Olanzapine

Question 16

First and second gens antipsychotics can cause neuroleptic malignant syndrome. What are signs and symptoms (FEVERS)?

Answer 16

Fever
Encephalitis
VS instabilit
Elevated WBC and CPK
Rigidity (leadpipe)
Sweating

Question 17

What do you teach your patient who is on alzheimers meds?

Answer 17

We are trying to make the functioning neurons work harder by blocking acetycholinesterase

Side effects: NVD, dyspepsia, dizziness, HA, bronchoconstriction

Drugs that block cholinergic effects should be avoided

CV effects are uncommon and serious concern–if they do happen, it can lead to falls!

Question 18

Which EPS is this?

Cant sit still; motor restlessness

Answer 18

Akathisia

Question 19

Which EPS is this?

Muscle spasms usually of neck and shoulders and can involve tongue and eyes

Answer 19

Acute dystonia

Question 20

Which EPS is this?

Symptoms of Parkinsons

Answer 20

Parkinsonism

Question 21

Which EPS is this?

Involuntary movement of tongue, eyes, lips, and face (smacking tongue, bonbon sign)
Late movement disorder; usually permanent

Answer 21

Tardive dyskinesia

Question 22

Levothyroxine toxicity: STORM?

Answer 22

Severe tachycardia
Tremors
Over 40.5 temp
Restlessness
Mean

Question 23

S&S of neuroleptic malignant syndrome?

FEVERS

Answer 23

Fever
Encephalitis
VS instability
Elevated WBC and CPK
Rigidity (leadpipe)
Sweating

Question 24

Lithium is a salt. Should you change your salt intake when on lithium?

Answer 24

No

Question 25

What are the expected SE of lithium?

Answer 25

``` Fine hand tremor Polyuria Mild thirst Mild nausea/GI discomfort Weight gain (10-20lbs) ``` *if these are extreme, we worry!!

Question 26

Lithium test blood every ___ for first few weeks then once every ___ after stabilization

Answer 26

week; 3

Question 27

CNS stimulants therapeutic effects?

Answer 27

- Increase levels of NE and DA in prefrontal cortex - They are NOT paradoxical--they STIMULATE the part of the brain to help you FOCUS (prefrontal cortex-executive function)