2.0 Flashcards
side effects of Barbituates (sedatives/hypnotics)
sleepy hypoventilation nausea bradycardia hypotension
Benzo use and adverse effects and examples(antianxiety)
- short-term use/panic attacks
- withdrawl syndrome after as little as 4-6wks of therapy
- diazepam and lorazepam
non benzo use and examples (antianxiety)
- long term
2. hydroxyzine
Monoamine Oxidase Inhibitors (MAOI) Action, adverse effect, contraindication, patient management, and examples (Antidepressants)
- increases serotonin by inhibiting neuronal uptake to CNS
- Sexual dyfunction and insomnia
- CV issues and elderly.
- 4-6 weeks to become effective and dont take with St. Johns Wart
- Citalopram, Fluoxetine, Sertraline, Paroxetine
Selective Serotonin Reuptake Inhibitors (SSRIs) (antidepressant) Action
adverse Effect
Patient Management
Examples
- increase serotonin by inhibiting neuronal uptake to CNS
- Sexual Dysfunction and insomnia
- 4-6 weeks to become effective and dont take with St. Johns Wart
- Citalopram, Fluoxetine, Sertraline, Paroxetine
Anti psychotic action adverse effect Contraindication examples
- block dopamine receptors in the brain, causes CNS depression
- hypotension, sedation, extrapyramidal symptoms, tardive dyskinesia, neuroleptic malignany syndrome
- severly depressed and hypotension
- haloperidol and phenothiazines (specifically promethazine)
Amphetamines ( CNS Stimulants) Adverse Effects Contraindication Patient Management Examples
- Headache, dizziness, apprehension,over simulation of the CNS, insomnia, tachycardia, blurred vision, hypertension
- Hypertension, stroke, and glaucoma.
- Insomnia and anorexia usually disappear during continued therapy, decrease caffeine, and loss of appetite.
- Methylphenidate HCL and Destroamphetamine
Anti-Convulsants
Examples
Pheno
- Diazepam
- Lorazepam
Non-Pheno
1. Phenytoin
Anti-Emetic/Anti-Vertigo
- Action
- Example
- Ondansetron blocks the effects of serotonin at the 5-HT3 receptor sites
2.Promethazine
2A. Ondonsetron
2B. AntiVertigo
2C. Meclizine
2D. Diazepam
Anesthetics
- Action
- Contraindication
- Examples
- Inhibits transport of ions across neuronal membranes (Sodium-Potassium channels)
1A. Ketamine produces a cataleptic type state - Risk of laryngospasms.
2A. Ketamine: conditions in which increase BP wouldbe hazardous - Lidocaine
Ketamine
Analgesics
1. Subclasses
- Salicylate
1B. Non-Salicylates
1C. NSAIDS
1D. Urinary
NSAIDS
- Action
- Example
- inhibits the action of the enzyme cyclooygenase (COX-1 [non-selective] and COX-2 [selesctive]) which is responsible for prostaglandin synthesis
- Celecoxib (selective COX2)
Melaxicam (selective COX2)
Urinary anesthetics
- Side Effects
- Examples
- Turns urine orange-red
2. Phenazopyridine
Narcotic Analgesics
- Action
- Use
- Side Effects
- Contraindications
- Examples
1.Opiods bind to opiate receptors in the CNS
2. Short term management of moderate to severe pain
3. Resp Depression, Light headedness, Constipation, N/V
4. Codeine
Fentanyl
morphine sulfate
Narcotic Antagonist
- Action
- Use
- Example
- acts on opiod receptors, effectively blocks the receptor, preventing the body from responding to opiates and endorphins
* *Competative Antagonist** - Overdose of a narcotic
- Naloxone
Antihistamine
- Action
- Use
- Adverse Effect
- Examples
- Block H1 and CNS depressants
- Allergies, allergic reaction, sedations, insomnia, motion sickness, problems with inner ear
- Anticholinergic effects, Drying Effect, Fatigue, hypotension
- 1st Gen: diphenhydramine
Hydroxyzine
Promethazine
2nd Gen: Cetirizine
Loratadine
Decongestant
- Action
- Adverse Effect
- Examples
- alpha-adrenergic receptors induces vasoconstriction of the blood vessels of the nose, throat, and paranasal sinuses which results in reduced inflammation
- hypertension, tachycardiac
- Oxymetazoline HCL
Pseudoephedrine
Broncho Dilators (Beta 2 antagonists)
- Action
- Use
- Adverse Effects
- Contraindications
- Examples
- Beta 2 receptors are in bronchial smooth muscle and when stimulated cause relation of bronchioles, mydrasis
- reversible airway obstruction caused by bronchospasm due to bronchial asthma
- tachycardia, increase respiration
- Cardiac arrhythmias
- albuterol sulfate
Broncho dilators (Corticosteroids)
- Adverse Effects
- Examples
- Throat irritation/cough and candidae albicans
2. Fluticasone
Broncho dilators (antitussives)
- Action
- Examples
- Central acting: depresses cough center
- Codeine sulfate
Benzonatate
Mucolytics (bronchodilators)
1. action
- brings fluids to loosen respiratory secretions
Expectorants (bronchodilators)
- Action
- Example
- Raises mucus from respiratory system
2. Guafenesin
Anti Arrhythmics (Class 2)
Action
2. Example
Beta blockers block stimulation of the beta receptors of the heart. Adrenergic neurohormones stimulate the beta receptors and increase the heart rate
2. Metoprolol
Antiarrythmics (Class 3)
- Action
- Use
Amiodarone blocks potassium channels in the heart. this is used for ventricular dysrrthmias and atrial fibrillation
2. Amiodrone
Antiarrythmics (Class 4)
- Action
- Use
Verapamil blocks calcium channels which are critical to the production of muscle contraction and electrical conduction atrial fibrillation
2. Verapamil
Nitrates (Antifungal)
1.Patient Management
- if BP is <100 systolic do not give
do not use with Viagra, Cialis, Levitra
ACE inhibitors (antihypertensives)
- Action
- Adverse Effects
- Example
- Breakdown of angiotensin 1 in the lungs
- dry hacking cough
- Lisinopril
Calcium Channel Blockers (antihypertensives)
1. Action
2. Use
3.
- Reduces excitability
2. Cardiac conduction and contractibility
Beta Blockers (antihypertensives)
- Action
- Adverse Effect
- beta blockers compete with adregenic for adrenergic receptors sites (beta)
- Orthostatic hypotension
HMG-Coa statins (antihyperlipidemic)
- Action
- Use
- Examples
- reductase inhibitors inhibit an enzyme involved in cholesterol synthesis (Most Common)
- Reduction of blood lipids
- Atorvastatin: Lipitor
Simvastatin: Zocor
Thiazide Diuretics (diuretics)
- Action
- Contraindication
- Examples
- inhibit reabsorption of sodium and chloride ions in the kidney
- hydrochlorothiazide
Antacids
- Action
- Contraindications
- Examples
- Neutralize of reduce the acidity
- Severe abdominal pain of unknown cause
- Calcium caronate
Histamine H2 Antagonist
- Action
- Examples
- reduces the secretion of gastric Acid
2. Ranitidine
Antidiarrheal
1. Contraindication
- abdominal pain o funknown origin
bloody stool
Antiflatulents
1. Examples
- Simethicone
Laxatives
- Contraindications
- Examples (irritant/stimulant and bulk producing)
- persistent abdominal pain, nausea, vomiting of unknown cause
- biscodyl
Psyillium
Proton pump inhibitors
- Action
- use
- Examples
- blocking the final step in the production of gastric acid
- ulcers with helicobacter pylori
- omeprazole
Hemorrhoid Agents
- Action
- Adverse Effects
- Examples
- Antiinflammatory
- Atrophy
- Hydrocortisone
Insulin (Antidiabetics)
- Action
- Use
- Adverse Effects
- stimulates the synthesis of glycogen by the liver
- insulin is necessary for controlling type 1
severe and complicated type 2 - hypoglycemia
Sulfonylureas (oral antibiotics)
- action
- contraindications
- stimulates beta cells of pancreas
2. severe infection
biguanide (oral antibiotics)
- Action
- Contraindication
- Examples
- reduces hepatic glucose production and decrease intestinal ansorptiono of glucose and improve insulin sensitivity in fat and muscle in muscle and fat cells
- severe infection
- metformin
Thyroid (hormones)
1. Examples
- levothyroxine
Male Hormones (hormones)
- Adverse Reaction
- Examples
- May result in breast enlargement
2. Methyltestosterone
Contraceptive (hormones)
- Action
- Examples
- Estrogen-inhibition of ovulation
Progestin-
Sulfonamides (antibacterial)
- Action
- Use
- Examples
1.Bacteriostatic
2. UTI
Silver sulfadizine is topical and sued to treat burns
3. Silver sulfadiazine
Trimethoprim
sulfamethoxazole
Penicillins (antibacterial)
- Action
- Use
- Examples
- prevents bacteria from using a substance that is necessary for the maintenance of the bacterias outer wall
- Gonorrhea
Syphillis
3.PENVK
Amoxicillin
Cephlosporone (antibacterial)
- Action
- Contraindication
- Examples
- ffects the vacterial cell wall making it defective and unstable. Will work on bacteria that has become resistance to PCN
- Allergy to cephalosporins
- 1st Gen
-Cephalexin
-Cefazolin
3rd Gen
-ceftriaxone
Tetracyclines (antibacterial)
- Action
- Use
- Examples
- bacteriostatic, broad spectrum
- Rickettsia
- Doxycyclin
Macrolides (antibacterial)
- Action
- Use
- Examples
- Bacteriostatic
2.pneumonia - Azithromycin
erythromycin
Fluoroquinolones (antibacterial)
- Action
- Use
- Adverse Effects
- Bactericidal
- pneumonia
UTI
STI - Achilles tendon ruptures
aminoglycocides (antibacterial)
- Action
- Adverse effects
- Contraindication
- Examples
- disrupt the functional ability of the bacterial cell membrane
- nephrotoxicity
ototoxicity
neurotoxicity - preexisting hearing loss
- gentamycin
Carbapenems (antibacterial)
- Action
- Examples
- extended spectrum beta lactamases
2. ertapenem
Nitroimidazole (antibacterial)
- Use
- Examples
- (a) Anaerobic bacterial infections
2. metronidazole
Lincosamide (antibacterial)
- use
- examples
- (alternative agent)(a) Skin and soft tissue infections ( MRSA)
- clindamycin
antivirals
- action
- Examples
- most agents inhibit viral replication
- penciclovir
oseltamivir
Antifungals
- adverse effects
- examples
- oral ketoconazole can include herpatic toxicity
- topical
- clotrimazole
Systemic
-fluconazole
-terbinafine
Muscle relaxers
1. Examples
- cyclobenzaprine
methocarbamol
Corticosteroids
- action
- use
- adverse effects
- Examples
- potent antiinflammatory
- rheumatic disorders
allergic reactions - if abrupt cessation occurs a potentiall life threatening adrenal insufficiency can occur
- prednisone
Triptan (antimigraine)
- Action
- Adverse Effects
- Contraindication
- examples
- causes vasoconstriction and reduces neurogenic inflammation
- hypertension
- ischemic heart disease
- sumatriptan
Scabicide (skin disorder)
- action
- Adverse effects
- paralysis and death of the pest
2. Seizures
Antibiotic (topical anti-infective)
- use
- Example
- prevent superficial infection
2. bacitracin
Anti fungal (topical anti-infective) 1. Examples
- Clotrimazole
Anti viral (topical anti-infective) 1. Examples
penciclovir
antiseptics and germicides
1. Examples
- Chlorohexidine gluconate
2. povidone iodine
topical corticosteroids
1. adverse effects
. Contraindications
3. Examples
- atrophy and secondary infection
- use on face, groin, and axilla
- hydrocortisone 1% cream and ointment
Triamcinolone 0.1% cream
Keralytics
- Use
- Examples
- anywhere on the body
- podofilox
- salicylic acid
Otic preparations
- Action
- use
- Contraindications
- Examples
- Antibiotic, steroid combination, miscellaneous
- treat infection and inflammation and aid in the removal of ear wax
- dont use if the ear drum is perforated
4.Aluminum acetate/acetic acid
Carbamide peroxide
1% hydrocortisone 3.3mg neomycin sulfate
ciprofloxacin
Antiviral Preparations (opthalmic preparations)
- Use
- Examples
- herpes simplex infection of the eye
2. gandclovir
Artificial tears (opthalmic preparations) 1. use
lubricates the eyes
Smoking cessation aid
1. examples
Transdermal patch gum inhaler nasal spray lozenge
What does the liver do
Metabolize
What does liver disease effect
Half life
Different routes for drugs
Tst-interdermal
āknow the other routesā
Different types of oral route
- buccal
sublingual
oral
NG tube
Drugs and alcohol at the same time produces what kind of effect
synergistic
MAOI interacts with what?
Everything
Donāt take with SSRIs
Worse case scenario for abrupt corticosteroid cessation
Adrenal insufficiency and death
ACE inhibitors/ARBs, Beta blockers, Calcium Channel Blockers, and Diuretics are what class of drugs
Antihypertensive
How do diacritics work
exchange of ions removes water in the nephrons. All about the ions
Medication for ventricular dysrhythmia
amiodarone
What type of drug stops a response
Antagonist
Bacteriostatic
Slows/retards bacterial regeneration
Greatest effect on platelets
Salicylates (aspirin) make the platelets slick - something about aggregation
Why wouldnt we use a laxative
impactino
unknown abdominal pain
what are beta blockers used for prophy;actically
migrains
immergent reasons for beta blockers
aortic dissection and aneyurisms
1:1 drug reaction
additive
Pharmokinetic
Lip to tip
Antipsychotic goal
CNS depression
Statans are what kind of drug
hypolipidemias
Examples of antacids
laxatives can also be antacids
Treating hemorrhoids does what
reduces inflammation
Drug that treats flu
osotamovir
Sulfdrugs
- can be used for what
- Contraindications
- Examples
- Good for burns
- G^PD and Sulfas cant be mixed
- Silver sulfadiazine
- Trimethoprine/sulfamethoxazole
PCN
- does what
- examples
- prevents bacteria from using a substance that is necessary for the maintenance of the bacterias outer wall
2.PENVK
Amoxicillin
Cephalosporins
- used to be what and is now what
- prefix
- Used to be gram pos but now broad
2. CEPH/CEF
Tetracyclines
- Use
- Adverse effect
- Arthropod or insect bite or infectious disease
2
Macrolides are used when
As a back up for PCN allergies
Azithromycin
Erythromycin
Fluoroquinolones
- Adverse Reactions
- Examples
- Achilles tendon ruptures
2. Ciprofloxacin
Aminoglycocides
- Action
- examples
1.disrupt the functional ability of the bacterial cell membrane
2. Gentomycin
Neomycin
Carbapenems
1. Examples
Ertapenem
Heavy Hitters used during Heavy Trauma
Nitromidazole
- Uses
- Example
- Patient MAnagement
- (a) Anaerobic bacterial infections
- Metronidazole-BV or used as a secondary for other gut stuff
- No alcohol
Sedatives and hypnotics
a. Action
Breakdowns
- Barbituates
Antianxiety
- What are they
- How long does it take to kick in
- How do they work
- Benzos/ NonBenzos
IDCs use Hydroxyzine for non benzo. Any SSRI for the physician
Diazepam for pnic attacks on ship IDC - 4-6WKs
- Benzos works on
Antidepressant
for sleep
examples
- Trazadone
2. SSRIs end with (ine, tine, and line [sometimes pram])
Antipsychotic
- use
- exmples
- for psychoses
2. promethazine
CNS stimulants
- Action
- Adverse Effects
- PT management
- Contraindications
- Stimulates the CNS
- Increases the BP and HR
- Reduce caffeine, surpresses the appetite
- Glaucoma
Anticonvulsants
- Drug of choice
- Which on prevents new onset
- Diazepam
2. Phenytoin
Local anesthetics
Block ion channels
Ketamine works on which receptors
GABA
Which meds is not given if marines are in combat
NSAIDs and salucylates
Which drug for UTI
phenopyridadine
Whos recognized as the ships controlled substance custodian
Ships MDR
How is accountability for controlled substances taken
through a working stock log and periodic inventories
Working Stock Custodian shall maintain a minimum of how much of each authorized controlled substance in the working stock safe at all times.
one unit of issue
In the absence of a Pharmacy Technician, the Working Stock Custodian will be
the Independent Duty Corpsman
Who cant be the WSC
must not be the Bulk Stock Custodian or a member of the CSIB
Who provides training in accordance with Controlled Substances Standard Operating Procedures to the Bulk Stock Custodian and all CSIB members prior to appointment
This person also tests them out
WSC
All records must be maintained for how long
3 years
Who does the WSC report directly to?
CO
Who should be the BSC
- a commissioned officer appointed in writing with responsibilities delineated by the current CO
- must not be the Working Stock Custodian or a member of the Controlled Substance Inventory Board (CSIB)
A minimum of how many safes must be onboard
two safes
-The only exceptions are DDG 1000, LCS, MCM and PC platforms
Where do you place SF 700s
combination change envelope (SF 700) shall be used and placed in the custody of the CO or an officer designated in writing by the CO
When do you change safe combinations
immediately upon turnover, suspicion of compromise, and periodically every six months
can IDCs prescribe controlled substances in port
NO
ONLY the controlled substances on the AMAL specific to their platform. Except?
granted in writing by the applicable TYCOM Force Surgeon
What is the only form and method authorized to prescribe and dispense outpatient medications
A DD Form 1289
- prepared
- dated
- have the quantity strength
- prescription number
- signature of dispenser
prescriptions will be signed by the SMDR and must be countersigned by
the CO or designated commissioned officer representative (usually the executive officer).
The letter āCā will be utilized as a prefix to all controlled substance prescriptions and must be filed sequentially. It is recommended to maintain an electronic log of Rx numbers to ensure prescription numbers are used in sequential order
true
What is the CSIB comprised of
at least three members; two must be commissioned officers and the third may be enlisted E-7 or above
Can CSIB members shall not be involved in the direct procurement of controlled substances
No
All CSIB members must complete the required training in accordance with Controlled Substance Standard Operating Procedures and score ___ or above
90 %
The board will perform inventories according to which schedule
i. (1) At least quarterly (every 90 days) if there have been no transactions.
ii. (2) Within one month (30 days) of any transaction (prescription, receipt, survey, etc.) involving controlled substances. The Working Stock Custodian must notify the Senior CSIB member of the transaction.
iii. (3) At the time of the relief of the CO, or MDR.
iv. (4) At the request of the CO.
v. (5) Upon direction from higher authority.
NAVMED 6710/18
NAVMED 6710/22
NAVMED 6710/23
INTERNAL CONTROLS QUESTIONNARIE
COVER SHEET
CSIB AUDIT SHEET
- DESCRIBE the procedures necessary for reporting lost, stolen, expired, or unaccounted controlled substances
Send one copy to the nearest DEA office, one copy to BUMED, and one copy to the nearest field representative of the NCIS. (you make a total of 4 copies-1 from you and three others)
DD Form 200
Financial Liability of Property Loss
How do we properly destroy controlled substances
i. (1) CO approval must be received prior to destruction of any controlled substances.
ii. (2) A minimum of three CSIB members, including the Senior CSIB Member, must be present to at time of destruction.
iii. (3) Each CSIB member must sign as witness to destruction on the DD Form 200.
iv. (4) Destruction shall be annotated on NAMVED 6710/5 with sequential transaction number (e.g., D-001).
Thermogenics Highest risk is
dehydration
Pre workout highest risk.
Dehydration and caffeine overdose