Psychotherapuetics 1. TCAs: tricyclic antidepressants a.

Major AE: sedation, impotence, orthostatic hypotension, older patient (dizziness, postural hypotension, constipation, delayed micturation (delay in starting a urine stream), edema, muscle tremors.) b. Indications for this class: depression, childhood enuresis(bedwetting)imipramine, obsessive compulsive disorder-clomipramine, trigeminal neuralgia. c. Overdose with antidepressants, how to treat? i. lethal in 70-80% of cases die before reaching hospital; CNS AND CV system affected; death results from seizures and dysrhythmias. ii. no specific antidote::decreased drug absorption with activated charcoal; speed elimination by alkalinizing urine, manage seizures and dysrhythmias, basic life support. 1a. SSRIs - able to treat both condition mania and depression; at the synapse allows the serotonin re-uptake at nerve ends and more will be available a. AE: fatigue, weight gain and weight loss* a. headache, dizziness, tremor, nervousness, insomnia, fatigue, nausea, diarrhea, constipation, dry mouth,sexual dysfunction, weight gain, weight loss and sweating b. what is it called when there is too much serotonin in the system: serotonin syndrome c. SSRI-DDI- herbal reaction: St. Johns Wort d. what happens to NeuroTransmitter levels in a reaction like this? a. serotonin syndrome occurs when serotonin levels are too high. a. symptoms: delirium,tachycardia,hyperreflexia,shivering,agitation,sweating, muscle spasms, coarse tremors b. symptoms of severe cases: hyperthermia,seizures,renal failure, rhabdomyolysis,dysrhythmias, disseminated intravascular coagulation(DIC)

2.

Lithium

a. Indications: bipolar, maintenance and manic episodes b. AE: c. toxicity-how does it present with s/s of lithium toxicity. 3. MAOIs a. AE: main one is..ORTHOSTATIC HYPOTENSION; tachycardia, dizziness, insomnia, anorexia, blurred vision, palpitation, drowsiness, headache, nausea and impotence. b. AE r/t dietary consumption of tyramine causing crisis(HTN crisis), what causes this condition? a. Ingestion of foods or drinks with tyramine leads to HTN crisis, which may lead to cerebral hemorrhage, stroke, coma or death. Avoid food that contain tyramine-a. aged mature cheeses(blue, cheddar, swiss) b. smoked/pickled or aged meat, fish or poultry(herring,sausage, corned beef, salami, pepperoni, pate) c. yeast extracts d. red wines(chianti, burgundy, sherry, vermouth) e. italian broad beans(fava beans) 4. 1st line vs. 2nd line drugs, what drugs, why is one in one catorgery verse other. mania and bipolar disorder 5. Bipolar-first line treatment? a. antipsychotics 6. Anxiety-class of drugs for treating? a. anti anxiety b. antidepressants: social anxiety disorder 7. How long will it take until we see observable results from psychotherapeutics - extended period of time and what is the time frame 8. Substance abuse-treating opioid/heroin(diacetylmorphine) addiction a. withdrawal a. peak period is 1-3 days, first few days;;duration is 5-7 days total time can last up to an week.;;signs are major drug seeking behavior, mydriasis, diaphoresis, rhinorrhea, lacrimation, diarrhea, elevated BP and

pulse.;; symptoms include intense desire for drug, muscle cramps, arthralgia, anxiety, nausea, vomiting and malaise. b. use opioid antagonist, these drugs block opioid receptors so the euphoria is not produced. pt. must have concurrent counseling and needs to be free from opioids for 1 week c. other medication used to treat opioid withdrawal. 1. clonidine(catapres). 2. methadone substitution 9. Alcohol a. ETOH abuse how to treat: a. Benzodiazepines: diazepam(Valium), lorazepam(Ativan), chlordiazepoxide(Librium) b. Disulfiram (Antabuse);; acetaldehyde syndrome a. AE:dermatitis, aftertaste, garlic like or metallic, hepatitis, peripheral neuropathy, optic neuritis and psychotic disorders c. Acamprosate- newest treatment. MOA unknown, AE: headache, diarrhea, flatulence and nausea d. counseling- individual and group (AA)

10.

Nicotine a. nicotine withdrawal drugs used for treatment? a. Bupropion (Zyban) may be Rx. to aid in smoking cessation, its nicotine free and sustained release b. Varenicline (Chantrix) stimulation of nicotine receptors b. how long cravings can persist about 3 yrs.

CANCER 11. Solid vs. disseminated tumors-various drugs for each type of tumor; broad term treatment of cancer 12. Cancerous growth precursor to cancer

13.

Growth fraction: what is it?

- cell turn over rate; the higher the growth fraction the better response to treatment. 14. difference: Benign vs. malignant, know morphology, shape, dissemination/devision. Causes/etiology of Cancer 15. Goals of chemo, what goals are realistic vs. non-realistic? a. benefits of treatment must outweigh the risks. - Karnofsky Performance Scale- less than 40% not an ideal candidate for treatment; look at if able to care for yourself and if level is below 40% pt. are not a good candidate for chemo. b. patients must be given some idea of benefits of proposed therapy. one of these threes should be possible cure (kill all cancer cells, and get cancer cells down to zero to be considered a cure), prolongation of life, palliative(make pt. comfortable). 16. Staging of cancer, what does it tell us 17. Chemo may not work well, what features of pt. makes chemo difficult for a pt? a. toxicity to normal cells b. cure require 100% cell kill c. absence of truly early detection(b/c 1gm smallest detectable contain 100billion cells) d. solid tumors respond poorly- low doubling time and low growth fraction e. drug resistance f. heterogeneity of tumor cells g. limited drug access to tumor cells 18. Cell cycle and classes that work on which phase: know the classes of drugs and where they work in the cell cycle. - genetic material replication? 19. MEthotrexate=how it works, AE, Luconovic +MEthotrexate, why? 20. Chemo-Induced-Nausea-Vomiting-Why give anti-emetics to pt. , when do we give them med (before or after chemo)? before chemo 21. General AE for chemo agents and rational for AE, how to monitor AE in pt., how to treat AE 22. Thrombocytopenia-what to do for a cancer pt with this

23.

5 fluorouracil - Antimetabolites: pyrimidine antagonists a. why given: results in interruption of DNA and RNA; interrupts metabolic pathways of pyrimidine bases 24. Bleomycin-AE: pulmonary toxicity

25.

Extravasation of the Vesicle a. what is it? leaking of an antineoplastic drug into surrounding tissues during IV administration. can result in permanent damage to nerves, tendons, muscles, loss of limbs. skin grafting or amputation may be necessary. prevention is key. continuous monitoring of IV site is essential. b. what to do for this pt? is suspected stop the IV infusion immediately but do not remove the IV tube, if possible aspirate remaining drug or blood from the tube. Follow instructions for giving the appropriate antidote through the existing IV tube, then remove the catheter (some antidotes are not given via IV).Cover area with sterile, occlusion dressing if ordered. Apply warm or cold compresses, depending on the extravasated drug. Rest and elevate the affected limb. ANALGESICS 26. Opiod vs. non-opiod, when given 27. AE of Opiod, how to treat pt with these AE 28. Know addiction, tolerance,toxicity etc. for opiodis 29. Acetaminophen- where metabolized, what to do in overdose, how pt presents, supportive therapy 30. Antidote to morphine, how pt. presents with morphine OD 31. Cox1 and Cox2-how different from one another 32. Aspirin-Indications vs. other NSAIDS; and how they differ, who should not get Aspirin, why that pt population who should not get asa 33. AE of Cox inhibitors, Their. Effects of all NSAIDS 34. Anesthesia-Post-OP concern after Anesthesia administered. 35. MAC- minimal alveolar concentration 36. DM-short and long term effects when DM not WELL controlled 37. DKA-presentation of Pt 38. Type 2DM-going to surgery, NPO, need to take oral agents, what to do in this scenario? critical thinking:: hold the medication dose for the morning

39. HA1C-what does this measure - patient compliance over a period of 120 days. 40. Glucose too high or low, what to give for type 2 pt? - when blood sugar is low want to give glycogen, food; - when blood sugar is high give insulin 41. BMI values as it relates to DM 42. Endocrine-Thyroid and Parathyroid 43. Pt. gets pituitary drugs-duration of treatment for these drugs== life 44. PTU (thyroid disorders)-rational of when and why you give for a thyroid pt 45. Women- Contraceptives, mono-phase, bi-phase, tri-phase- Which matches normal hormones the closest? the more phase there are the most closely will mimic natural response. 46. Who should not take oral contraceptives, why and valid contraindications? - estrogens stimulation; stroke; 47. AE of ovulation inducing drugs 48. Estrogen-when given, why, potent. AE

Men 49. Testosterone, why given:: they have similar endogenous androgens effects: - stimulation of normal growth and development of the male sex organs - development and maintenance of male secondary sex characteristics - stimulate increase synthesis of body proteins aiding in the formation of muscular and skeletal proteins.( allow men to grow bigger muscles, good for men with not enough GH or sports professionals) - Why give transdermal patch vs. other routes? oral medication have a high 50. BPH -finesteride( 5-Alpha- Reductase inhibitors) - blocks the effects of endogenous androgens, used to tx. BPH, helps alleviation of symptoms and make passage of urine easier. may also be used to treat male pattern baldness

- AE: loss of libido, loss of erection, ejaculatory dysfunction and other effects. may cause PSA concentrations to decrease. 51. ED- hypertension meds are contraindication with ED drugs, what to tell pts (teaching) 52. Cholinesterase agents given for long time, antidote for these anticholinergic drugs OLD STUFF: last session 53. life: the time required for the amount of drug in the body to be decreased by 50% 54. plateau: time to plateau is 4 half lifes 55. Vasopressin (Pitressin)-indications: Diabetes Insipidus , how classified-endocrine metabolic agent; vasopressin 56. Digoxin: cardiac glycoside - indications: heart failure; supra ventricular dysrhythmias (A-FIB &A-flutter) 57. Parkinsons Disease -various NeuroTransmitters: imbalance b/w dopamine and ACh results from degeneration of the neurons that supply dopamine to the striatum. -goals of treatment for these pts: improve patients ability to carry out activities of daily life. Drug selection and dosages are determined by extent to which PD interferes with work, dressing, eating and bathing. 58. ALZHEIMER Disease - Memantine, how it works 59. Phenytoin-graph of toxicity vs. there dose, changes over time 60. Allopurinol-Why given for gout. 61. Penicillins-other similar structured drugs, why it is important to know? 62. Fungal infection- are they difficult to tx; how long to treat - systemic mycoses can be difficult to treat, infections often resist to treatment, treatment may require prolonged therapy with drugs that frequently prove toxic. - Fluconazole has a one time tx with one PO dose tablet - Topical agents- anywhere from 7-14 days; most drugs are 3-7days of treatment - may take months to treat and 63. Cephalosporines- old vs. new generation drugs 64. Aminoglycosides- AE

- monitor peak and trough blood levels of these agents to prevent nephrotoxicity and ototoxicity - ototoxicity: dizziness, tinnitus and hearing loss - nephrotoxicity: urinary casts, proteinuria and increases BUN and Creatinine levels

65. Red man syndrome -pushing VAnco too fast will have flushing of face; skin will be red for a while 66. TB -how do we know if treatment is effective== treatment is considered effective when no mycobacteria are observed in sputum and no colonies are present in culture. -How long to treat==minimum of 6months for drug sensitive TB and up to 24 months for MDR or HIV/AIDs; - what agents may be used==antiTB drugs... - 1st line agents- isoniazid, rifampin - rifapentine, rifabutin, pyrazinamide and ethambutol - 2nd line agents- levofloxacin, moxifloacin, kanamycin, amikacin, capreomycin, para-aminosalicylic acid, ethionamide and cycloserine EAR... 67. Acute Oitis Media, how to treat, acute vs. with effusion 68. Recurrent OM 69. OM vs. OE Pharm. treatment for each 70. How to prevent OE 71. Fungal OE, how to treat 72. when do you not want to give pt. ear drops 73. Classes of Agents for Acne-AE 74. Psoriasis-treatment, pharm vs. non-pharm 75. Graphs and Diagrams-surmountable vs. insurmountable 76. Antagonism, life, There. range