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Pharm Oral > anti-.... cholenergics, n/v,Oxytocin, octreotide > Flashcards

anti-.... cholenergics, n/v,Oxytocin, octreotide Flashcards

1
Q

MOA for Anticholinergics

A

Aromatic esters that competitively inhibit the effects of ACh at the muscarinic receptors thereby decreasing PNS activity (prevent c AMP and cGMP effects); used for symptomatic brady, anti-sialagogue, Gi spasms and decreases GI secretions, bronchodilation, pea, systole, promotes AW relaxation by inhibing the M2 and M3 causing bronchial SM relaxation and increase HR by blocking the ACh effects at SA node; use with NMB reversal agent

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2
Q

Atropine PK

A

40%PB to alpha-1-glycoprotein, Vd=1.6L/KG, onset 1 min, peak 1-2min, Do a 30-60min, e1/2 2 hours, hydrolyzed in the liver to tropine and tropic acid and excreted 18% unchanged in the urine

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3
Q

Atropine Se

A

sedation bc crosses bbb, increases HR, CO, IOP, arrhythmias, blurry vision, decrease secretions and GI motility, bronchodilation

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4
Q

Atropine class

A

tertiary amine anticholinergic

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5
Q

Atropine CI

A

glaucoma, patients that tachycardia would be harmful- such as-CAD, hyperpyrexia pts, mobitz type 2
avoid other sympathomimetics

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6
Q

Atropine Dose

A

0.01mg/kg for reversal; 0.4-0.6 preop antisialagogue, 0.4-1mg for bradycardia; 1mg q3-5min for systole/PEA

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7
Q

Glycopyrrolate class

A

synthetic quaternary ammonium anticholinergic

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8
Q

Glycopyrrolate Pk

A

onset 2-3 min, peak 3-5min, DOA 2-4 hours, e1/2 1hour, liver metabolism and 85% excreted unchanged in the urine, poorly lipid soluble

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9
Q

Glycopyrrolate SE

A

increase HR, CO, IOP, arrhythmias, H/A, blurry vision, decrease secretions and go motility, bronchodilation, MH, decreases sweating, anaphylactic reaction

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10
Q

Glycopyrrolate CI

A

MH, neonates, CAD, HTN, CHF, glaucoma, hyperpyrexia pts

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11
Q

Glycopyrrolate dose

A

reversal 0.01-0.02mg/kg IV

anti-sialagogue and bradycardia 0.1-0.2mg

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12
Q

Scopolamine- class

A

tertiary amine anticholinergic

used for motion sickness, PONV, sedation, bronchodilation; biliary and ureteral SM relaxation, NOT USED FOR REVERSAL NMB

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13
Q

Scopolamine Pk

A

lipid soluble, onset 10 min, DOA 2 hours, e1/2 4 hours, may last 3-7 days, metabolized by the liver with <1% excreted unchanged in the urine

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14
Q

Scopolamine SE

A

increase HR, CO, IOP, OH. sedation, arrhythmias, blurry vision. decreases secretions and GI motility

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15
Q

Scopolamine CI

A

glaucoma liver disease, GI/GU obstruction

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16
Q

Scopolamine dose

A

0.3-0.6mg IV q4-6 hours

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17
Q

Metoproclamide/reglan

A

antiemetic, dopamine receptor antagonist and serotonin receptor agonist

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18
Q

Metoproclamide/reglan MOA

A

blocks the DA2 receptors in the chemo receptor trigger zone of the medullar preventing N/V; also a pro kinetic increasing gastric motility via serotonin increasing peristalsis and increases ACh at the muscarinic receptors post synaptically

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19
Q

Metoproclamide/reglan PK

A

onset 1-3 min, DOA 1-2 HR, e1/2 2-4hours, metabolized in the liver and 40% excreted unchanged in the urine

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20
Q

Metoproclamide/reglan SE

A

increase gastric motility, LES tone, decrease N/V, extrapyramidal SE, abd cramping, sedation, prolactin secretion, dry mouth, good for RSI

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21
Q

Metoproclamide/reglan CI

A

Parkinsons, bowel obstruction, GI hemorrhage, sz, arrhythmias esp if administered with zofran, no phenothiazides

Increased sedative effects of Cns depressants

22
Q

Metoproclamide/reglan dose

A

10-20mg iv over 3-5min 15 min before induction
10mg preinduction pt with gastroparesis
0.15/kg mom ponv and kid

23
Q

Ondansetron/Zofran class

A

antiemetic, serotonin antagonist

24
Q

Ondansetron/Zofran MOA

A

blocks the serotonin receptors peripherally and in the CRTz- coupled to fast sodium channels and k channels

25
Q

Ondansetron/Zofran PK

A

onset 30min, DOA 4-8hours, e1/2 3-4 hours, metabolized in the liver with renal excretion 5% unchanged

26
Q

Ondansetron/Zofran SE

A

HA with rapid administration, sedation, arrhythmias, constipation, diarrhea, fatigue

27
Q

Ondansetron/Zofran CI

A

hypersensitivity, liver disease, SSRIs, MAOis

28
Q

Ondansetron/Zofran dose

A

4-8mg IV over 2-5min

29
Q

Promethazine/Phenergan class

A

antiemetic, H1 and Dopamine 2 antagonist.

30
Q

Promethazine/Phenergan MOA

A

blocks DA receptors and antagonizes H1 @ receptor. response decreases histamine mediated release in respiratory tract, GI and blood vessels

31
Q

Promethazine/Phenergan Pk

A

93%PB, onset 3-5min, DOA 2-4 hours, e1/2 9-16hours, metabolized in the liver by CYP450 and excreted in the urine

32
Q

Promethazine/Phenergan SE

A

extrapyramidal effects, anticholinergic effects, sedation, arrhythmias, neuroleptic malignant syndrome

33
Q

Promethazine/Phenergan CI

A

hypersensitivity, parkinson’s on levodopa, rena/hepatic/pulmonary diseases, peds <2yrs

34
Q

Promethazine/Phenergan dose

A

6.25-25mg IB

35
Q

Omeprazole/Prilosec class

A

Antiemetic/ PPI

36
Q

Omeprazole/Prilosec MOA

A

prodrug that irreversibly inhibits H=/K= ATPase proton pump in the parietal cells decreasing gastric secretion

37
Q

Omeprazole/Prilosec PK

A

95% PB, onset 1hr, DOA 72 hr, metabolized in the liver by CYP 2C19 to inactive metabolites

38
Q

Omeprazole/Prilosec SE

A

HA, confusion, agitation, dizziness, N/V/D, abd pain

39
Q

Omeprazole/Prilosec CI

A

hyprsensitivity, prolongs metabolism of diazepam, warfarin, dilantin

40
Q

Omeprazole/Prilosec dose

41
Q

Octreotide class

A

somatostatin analog

42
Q

Octreotide MOA

A

binds to somatostatin receptor on carcinoid tumors to decrease the amount of serotonin released from tumors and decrease vasoactive amides; inhibits the production and release of GH, glucagon and insulin

43
Q

Octreotide pk

A

65% PB, onset rapid, peak 2 hours; E1/2 2 hours; liver metabolism and excreted 32% unchanged in the urine

44
Q

Octreotide SE

A

decrease glucose tolerance, hyperglycemia, N/V/C, decreases GI motility, gallstones, bradycardia, AV block

45
Q

Octreotide CI

A

hypersensitivity, decreases effects of codeine and cyclosporine

46
Q

Octreotide dose

A

50-100mcg/hr; 25-200mcg prn; 25-50mcg/hr for varices

47
Q

Oxytocin class

A

endogenous posterior pituitary hormone

48
Q

Oxytocin MOA

A

binds to oxytocin receptors on the uterus= SM contraction; used to induce or augment labor and contract the uterus post delivery and decrease chance of hemorrhage

49
Q

Oxytocin PK

A

onset 1 min, DOA 1hour, E1/2 3-5min; metabolized by the liver and kidney; broken down by plasma oxytocinase and metabolism in mammary gland

50
Q

Oxytocin SE

A

mom- anaphylaxis, N/V, PP hemorrhage, uterine rupture, arrhythmias and PVCs; baby- bradycardia, problematic fetal positioning, fetal distress

51
Q

Oxytocin CI

A

fetal distress, hypertonic contractions, hypersensitivity

52
Q

Oxytocin dose

A

10-40 units in 1L at 0.5-2mU/min ( increase gtt q15 min by 0.5-2mU/min until contractions are 2-3 min apart)

Pharm Oral (10 decks)

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