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2020 Pharmacology I > Classes > Flashcards

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1
Q

H2-receptor antagonists

A
  • block histamine receptors in stomach lining, suppressing gastric acid secretion
  • prototype: raNITIdine (Zantac)
  • onset: within 1 hr
  • duration: 9-12 hr
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2
Q

proton pump inhibitors (PPIs)

A
  • MOA: block exchange of H+ for K+, ↓ acid secretion
  • onset: up to 4 days
  • duration: 24 hr to 3 days
  • greater suppression than H2 blockers
  • prototype: omeprazole (Prilosec)
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3
Q

mucosal protectant

A
  • MOA: changes to thick substance in acidic environment, adheres to ulcer to protect from acid, pepsin
  • duration: up to 6 hr
  • complication: constipation
  • prototype: sucralfate (Carafate)
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4
Q

antacids

A
  • MOA: neutralizes stomach acid
  • onset: 5 min
  • duration: 30-60 min
  • aluminum and calcium: constipation
  • magnesium: diarrhea
  • prototypes
    • aluminum hydroxide (Amphojel)
    • calcium carbonate (Maalox, Tums, Rolaids)
    • magnesium hydroxide (Phillips, Dulcolax)
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5
Q

Prostaglandin E analog

A
  • MOA: mimics prostaglandin, inhibits acid secretion
  • Pregnancy Risk Category X (termination)
  • prototype: misoprostol (Cytotec)
  • onset: 30 min
  • duration: 3-6 hr
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6
Q

antiemetics

A
  • glucocorticoid: dexamethasone (Decadron)
  • substance P/neurokinin 1 antagonist: aprepitant (Emend)
  • serotonin antagonist
    • ondansetron (Zofran)
    • granisetron (Kytril)
  • dopamine antagonist
    • promethazine (Phenergan)
    • metoclopramide (Reglan)
  • cannabinoid: dronabinal (Marinol)
  • anticholinergic: scopolamine (Transderm Scop)
  • antihistamine
    • dimenhydrinate (Dramamine)
    • hydroxyzine (Vistaril)
  • benzodiazepine: lorazepam (Ativan)
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7
Q

osmotic laxatives

A
  • MOA: draw water into intestines to stimulate BM
  • indication: occasional constipation
  • complications
    • diarrhea
    • toxic Mg levels
    • dehydration
  • caution: kidney impairment
  • drugs
    • polyethylene glycol 3350 (MiraLax, GlycoLax)
    • magnesium hydroxide (Phillips, Dulcolax)
    • lactulose
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8
Q

bulk-forming laxatives

A
  • MOA: soften fecal mass, increase bulk (like dietary fiber)
  • indications
    • temp: constipation
    • ↓ diarrhea (diverticulosis and IBS)
    • stool control for ileostomy/colostomy
  • complications: obstruction; drink plenty of water
  • prototype: psyllium (Metamucil)
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9
Q

surfactant laxatives

A
  • MOA: ↓ surface tension of stool, allow penetration of water
  • prototype: docusate sodium (Colace)
  • indications: constipation, softening of fecal impaction
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10
Q

stimulant laxatives

A
  • MOA: stimulates peristalsis, ↑ volume of water and electrolytes in intestines
  • indications: bowel prep (surgery, procedure)
  • short-term Tx of constipation (high-dose opioid use)
  • used inappropriately for wt loss, get good Hx
  • drugs
    • bisacodyl (Dulcolax)
    • senna (Senokot)
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11
Q

antidiarrheals

A
  • MOA: ↓ GI motility
  • complications: constipation
  • drugs
    • diphenoxylate/atropine (Lomotil)
    • loperamide (Imodium)
    • paregoric (off market per Davis)
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12
Q

anti-IBS agents

A
  • alosetron (Lotronex)
    • MOA: antidiarrheal; blocks 5-HT3 receptors that innervate viscera
    • complication: constipation
  • lubiprostone (Amitiza)
    • MOA: laxative; activates intestinal chloride channels, ↑ fluid secretion
    • complication: diarrhea
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13
Q

beta2-adrenergic agonists

A
  • bronchodilator
  • inhaled/oral
  • end with “terol”
  • MOA: activate receptors in smooth muscle to relax, dilate airways; relieve bronchospasm, ↑ ciliary motility
  • short-acting
    • prototype: albuterol (Ventolin, Pro-Air)
    • levalbuterol (Xopenex)
  • long-acting
    • salmeterol and formoterol
    • for significant dz
    • combined with short-acting and corticosteroid
  • often prescribed together; LABA only for asthma not controlled by SABA alone
  • corticosteroid/LABA combos: Advair, Symbicort, Dulera
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14
Q

short-acting beta2-adrenergic agonist

A
  • SABA
  • drugs: albuterol (Ventolin, Pro-Air), levalbuterol (Xopenex)
  • onset: minutes
  • duration: 2-4 hr
  • often in combo with LABA for significant dz
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15
Q

long-acting beta2-adrenergic agonist

A
  • LABA
  • drugs: salmeterol (Serevent), formoterol
  • onset: 10-25 min
  • peak and T½: 3-4 hr
  • duration: 12
  • only used for significant dz
  • available in combo with corticosteroid: Advair, Symbicort, Dulera
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16
Q

complications of beta2-adrenergic agonists

A
  • tachycardia, angina
    • monitor for
      • chest, jaw, arm pain
      • palpitations
    • check pulse, notify of ↑ > 20-30 bpm
    • avoid caffeine
    • possible ↓ dose
  • tremors: usually resolved with continued use
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17
Q

contraindications and precautions for beta2-adrenergic agonists

A
  • pregnancy risk: C
  • contra: tachydysrhythmia
  • caution
    • DM (↑ BG): effects usually transient and slight except with ↑ doses
    • HTN
    • hyperthyroid
    • heart dz
    • angina
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18
Q

interactions with beta2-adrenergic agonists

A
  • ↑ risk of angina and tachycardia: MAOIs and TCAs
  • beta blockers (metoprolol, propranolol): negates effects of both
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19
Q

administering beta2-adrenergic agonists

A
  • pt education: use before using inhaled corticosteroid
  • use SABA for acute episode
  • LABAs
    • Q12H
    • NOT for acute attack
    • always used with inhaled corticosteroid
  • have pt return demonstrate
  • follow manufacturer instructions
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20
Q

evaluation of effectiveness of SABAs and LABAs

A
  • control of asthma
  • improved Sx: clearing/improved breath sounds, ↓ wheezing and coughing, ↓ breathing effort
  • pt able to exercise without dyspnea
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21
Q

anticholinergics

A
  • prototype: ipratropium (Atrovent)
  • end with “pium”
  • oral/inhaled
  • MOA: blocks muscarinic receptors of bronchi; bronchodilation
  • uses: relieves COPD-related and allergen- and exercise-induced bronchospasm
  • off-label: asthma Tx
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22
Q

complications of anticholinergics

A
  • dry mouth, hoarseness: sip fluids, suck on sugar-free hard candy
  • blurred vision
  • ↑ IOP
  • hot, flushed skin
  • dry skin
  • bradycardia → tachycardia, palpitations, aarhythmias
  • urinary retention
  • constipation
  • rare: fever, confusion, mania, hallucinations, rashes
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23
Q

contraindicaitons and precautions for anticholinergics

A
  • pregnancy: B
  • contra: allergy to peanuts
  • caution
    • narrow-angle glaucoma
    • benign prostatic hyperplasia
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24
Q

administering anticholinergics

A
  • rinse mouth after use (bad taste
  • wait 5 min between inhaled meds
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25
Q

methylxanthines

A
  • prototype: theophylline
  • end with “phylline”
  • MOA: relax bronchial smooth muscle, bronchodilation
  • oral, IV (emergency only)
  • acts like caffeine
  • for long-term control of chronic asthma, COPD
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26
Q

complications of methylxanthines

A
  • mild toxicity: GI distress, restlessness
  • severe adverse at higher dose
    • dysrhythmias: lidocaine
    • sz: diazepam
  • serum monitoring required, narrow therapeutic range
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27
Q

glucocotricoids for respiratory disorders

A
  • steroidal anti-inflammatory
  • oral, inhaled, IV
  • end with “one”
  • prototypes
    • beclomethasone (Qvar), inhaled
    • prednisone
  • inhaled, combo with LABAs
    • budesonide
    • fluticasone
    • mometasone
  • IV
    • hydrocortisone
    • methylprednisolone
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28
Q

uses for glucocorticoids in the Tx of respiratory disorders

A
  • prevent inflammation
  • suppress airway mucus production
  • reduce airway edema
  • inhaled: used as prophylaxis
  • IV: short-term for status asthmaticus
  • PO
    • short-term: acute exacerbation
    • long-term: severe asthma
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29
Q

complications of glucocorticoids

A
  • inhaled
    • difficulty speaking
    • hoarseness
    • oral candidiasis: rinse mouth after use, monitor for s/sx of infection and report
  • ↓ production of glucocorticoids in adrenal gland: taper, do not stop abruptly
  • bone loss
  • hyperglycemia, glucosuria
  • PUD: give with food, avoid NSAIDs, watch for GI bleed
  • ↑ risk of infection
  • wt/fluid gain
  • increased hunger
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30
Q

contraindications and precautions of glucocorticoids

A
  • pregnancy: C
  • contra
    • recent live virus vaccine
    • systemic fungal infection
  • caution
    • children
    • DM
    • HTN
    • heart failure
    • PUD
    • osteoporosis
    • kidney dysfunction
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31
Q

interactions with glucocorticoids

A
  • ↑ risk for hypokalemia with K+-depleting diuretics
  • ↑ risk for ulceration with NSAIDs
  • in DM: counteracts effects of meds, ↑ blood sugar
    • may need higher dose of antidiabetics
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32
Q

administering glucorticoids

A
  • pt education
    • use on fixed schedule
    • NOT for acute asthma episode
    • use beta2-adrenergic first: bronchodilation → better absorption of glucocorticoid
  • oral: for short-term use, 3-10 days after acute attack
  • long-term therapy, switch to inhaled: ↑ dose during stress
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33
Q

leukotriene modifiers

A
  • prototype: montelukast (Singulair)
  • other: zileuton, zafirlukast
  • MOA: ↓ inflammation, bronchoconstriction, edema, mucus
  • long-term therapy of asthma in adults, children
  • prevention of exercise-induced bronchospasm
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34
Q

complications of leukotriene modifiers

A
  • depression, suicidal ideation: watch for changes, report
  • liver injury (zileuton and zafirlukast): get baseline LFTs and monitor
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35
Q

precautions for leukotriene modifiers

A
  • pregnancy: B
  • liver dysfunction
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36
Q

interactions with leukotriene modifiers

A
  • zileuton and zafirlukast
    • ↑ levels of warfarin: monitor for s/sx of bleeding, PT, INR
    • ↑ levels of theophylline: monitor level, educate about s/sx of toxicity (N&V, sz)
  • montelukast: ↓ effects with phenytoin
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37
Q

administering leukotriene modifiers

A
  • take as prescribed
  • montelukast
    • maintenance: daily HS
    • prevention, exercise-induced: 2 hr before
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38
Q

opioid antitussives

A
  • prototype: codeine
  • other: hydrocodone
  • MOA: acts on CNS to increase cough reflex threshold
  • uses: ↓ frequency, intensity of chronic dry cough
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39
Q

complications of opioid antitussives

A
  • dizziness
  • lightheadedness
  • drowsiness
  • respiratory depression
  • N&V: take with food
  • constipation: ↑ fiber and fluid intake
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40
Q

nursing actions for opioid antitussives

A
  • monitor VS for bradypnea (RR < 12)
  • monitor ambulation, assist in and out of bed (fall risk)
  • short-term use only, risk of abuse
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41
Q

contraindications and precautions for opioid antitussives

A
  • pregnancy: C
  • contra
    • respiratory depression
    • head trauma
    • acute asthma
    • liver and renal dysfunction
    • acute ETOH disorder
  • caution
    • children
    • older adults
    • hx of substance abuse
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42
Q

pt education for opioid antitussives

A
  • avoid activities requiring alertness
  • lie down if dizzy
  • get up slowly
  • avoid ETOH, other CNS depressants
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43
Q

nonopioid antitussives

A
  • prototype: dextromethorphan (Delsym, Robitussin)
  • MOA: acts on CNS to suppress cough
  • uses: cough suppression, ↑ pain reduction with opioid
  • pregnancy: C
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44
Q

complications of nonopioid antitussives

A
  • mild nause, dizziness, sedation
  • at high dose: euphoria, risk for abuse
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45
Q

interactions with nonopioid antitussives

A

MAOI: life-threatening serotonin syndrome if taken within 2 wks

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46
Q

administering nonopioid antitussives

A
  • some products contain ETOH and/or sucrose
  • available in capsules, lozenges, liquids, syrups
47
Q

expectorants

A
  • prototype: guaifenesin (Mucinex, Robitussin)
  • MOA: promotes productive cough, thins secretions
  • uses: clear airway of mucus
  • available in combo with antitussives or decongestants
48
Q

complications of expectorants

A
  • GI distress: take with food
  • drowsiness, dizziness: avoid driving, etc.
49
Q

contraindications and precautions for expectorants

A
  • pregnancy: C
  • talk with provider if breastfeeding
  • may be contraindicated in children
50
Q

administering expectorants

A
  • ↑ fluids to thin secretions
  • available in tablets, capsules, syrups
  • pt education: READ LABELS (often in combos) to avoid unintentional OD
51
Q

mucolytics

A
  • prototype: acetylcysteine (Mycomyst)
  • other: hypertonic saline
  • MOA: thin and enhance flow of secretions
  • use: acute, chronic pulmonary disorders; cystic fibrosis, antidote for acetaminophen poisoning
52
Q

complications of mucolytics

A
  • PO: aspiration and bronchospasm
  • dizziness, drowsiness, hypotension, tachycardia: monitor VS, fall risk
  • hepatotoxicity: monitor LFTs
53
Q

precautions for mucolytics

A
  • pregnancy: B
  • asthma
  • hypothyroidism
  • CNS depression
  • renal and liver dz
  • sz disorder
54
Q

administering mucolytics

A
  • smells like rotten eggs
  • inhaled, PO, IV
  • in acetaminophen OD, monitor
    • LFTs
    • PT
    • BUN
    • glucose
    • electrolytes
    • acetaminophen level
55
Q

decongestants

A
  • prototype: phenylephrine
  • other: ephedrine, naphazoline (ophthalmic), pseudoephedrine
  • MOA: stim of alpha1-adrenergic receptors, ↓ inflammation of nasal membrane
  • uses: allergic or non-allergic rhinitis, sinusitis, common cold
  • sympathomimetic
56
Q

complications of decongestants

A
  • rebound congestion (topical use): use 3-5 days max, taper
  • agitation, nervousness: report and stop med
  • vasoconstriction: avoid with HTN, cerebrovascular dz, CAD, dysrhythmias
57
Q

contraindications and precautions for decongestants

A
  • contra: closed-angle glaucoma
  • caution
    • HTN
    • cerebrovascular dz
    • CAD
    • dysrhythmias
58
Q

administering decongestants

A
  • topical
    • associated with rebound congestion
    • work faster
    • more effective
    • shorter duration
    • systemic effects uncommon
  • oral
    • effects similar to amphetamine
    • ID needed to purchase OTC
59
Q

antihistamines

A
  • 1st generation
    • diphenhydramine (Benadryl)
    • promethazine (Phenergan)
    • dimenhydrinate (Dramamine)
  • 2nd generation
    • loratadine (Claritin)
    • cetirizine (Zyrtec)
    • fexofenadine (Allegra)
    • desloratadine (Clarinex)
  • intranasal
    • azelastine
    • olopatadine
60
Q

antihistamines MOA, uses

A
  • MOA: act on H1 receptors and block histamine release caused by allergic reaction
  • uses
    • mild allergic reaction
    • anaphylaxis
    • motion sickness
    • insomnia
    • nausea
    • with sympathomimetic for nasal decongestion
61
Q

antihistamine complications

A
  • sedation: take at night, avoid ETOH/CNS depressants, caution during driving, etc.
  • dry mouth
  • GI distress: take with food, ↑ fluids and fiber
  • acute toxicity, excitation, hallucinations, incoordination, sz, high fever: activated charcoal, cathartic
  • premoethazine: resp. depression and tissue injury at IV site
62
Q

contraindications and precautions for antihistamines

A
  • contra
    • 3rd trimester, breastfeeding, newborns
    • promethazine: children < 2 yr, liver dz, MAOI use, dysrhythmias
  • caution
    • children
    • older adults
    • sz disorder
    • heart dz
    • renal dz
    • urinary retention
    • open-angle glaucoma
    • HTN
    • prostate hypertrophy
    • asthma
63
Q

interactions with

A
  • ETOH
  • other CNS depressants
64
Q

administering antihistamines

A

more sedative effect with 1st generation

65
Q

nasal glucocorticoids

A
  • prototype: mometasone (Nasonex)
  • other: fluticasone (Flonase), triamcinolone (Nasocort), budesonide (Rhinocort)
  • MOA: ↓ inflammation in allergic rhinitis; first-line Tx
  • uses: allergic rhinitis (sneezing, itching, drainage, congestion)
66
Q

complications and precautions for nasal glucocorticoids

A
  • SE
    • sore throat
    • nosebleed
    • headache
    • burning
  • pregnancy: C
67
Q

administering nasal glucocorticoids

A
  • dosing is daily
  • seasonal allergies: 7+ days for max benefit
  • perennial allergies: 21+ days for full effect
  • may need topical decongestant before using
68
Q

Tx for asthma includes what classes of drugs? (BAM/SLM)

A
  • Beta2-adrenergic agonists (bronchodilators)
  • Anticholinergic
  • Methylxanthines
  • anti-inflammatories
    • Steroids (glucocorticoids)
    • Leukotriene modifiers
    • Mast cell stabilizers
69
Q

non-opioid analgesics

A
  • acetaminophen, NSAIDs
  • for mild to moderate pain
  • also antipyretics
70
Q

non-steroidal anti-inflammatory drugs (NSAIDs)

A
  • MOA: inhibit inflammatory effects of COX-1 and/or COX-2
  • ↓ pain, inflammation, fever
  • 1st-generation (COX-1 and COX-2)
    • aspirin
    • ibuprofen (Advil, Motrin)
    • naproxen (Aleve)
    • indomethacin
    • diclofenac
    • ketorolac
    • meloxicam
  • 2nd-generation (COX-2 only)
    • celecoxib (Celebrex)
71
Q

complications of NSAIDs

A
  • ↑ risk of GI ulcer, bleeding, renal impairment
    • take with food or adjuvant GI protectant
    • monitor for s/sx of GI bleed, other bleeding
  • celecoxib: ↑ risk of MI/stroke
  • aspirin: ↓ risk of MI/stroke
72
Q

precautions for NSAIDs

A
  • older age
  • smoking
  • alcohol use disorder
  • renal impairment
  • GI issues
  • pregnancy
  • bleeding disorders
  • use of anticoagulant meds
73
Q

administering NSAIDs

A
  • mostly PO; some IV and IM forms
  • stop OTC aspirin 1 wk before procedures/surgery
  • don’t crush or chew enter-coated pills
  • notify provider of bleeding, N&V, abd pain
74
Q

interactions with NSAIDs

A
  • ↑ risk of bleeding with warfarin, glucocorticoids
  • ↑ all risks: concurrent use of multiple NSAIDs
75
Q

Reye syndrome

A
  • rare but serious
  • when ASA used in children with viral illness
  • DO NOT treat pediatric fever with ASA
  • s/sx
    • diarrhea
    • tachypnea
    • vomiting
    • severe fatigue
    • fever
    • hypoglycemia → confusion, sz, LOC
76
Q

salicylism

A
  • mild ASA toxicity
  • max dose: 4 g/day
  • s/sx
    • tinnitus
    • sweating
    • HA
    • dizziness
    • respiratory alkalosis
    • stop taking and contact provider
  • → toxicity
77
Q

aspiring toxicity

A
  • max dose: 4 g/day
  • s/sx
    • high fever
    • sweating
    • acidosis
    • dehydration
    • electrolyte imbalance
    • coma
    • respiratory depression
  • medical emergency
  • Tx
    • gastric lavage/activated charcoal
    • hemodialysis
    • cooling with tepid water
    • IV fluid correction
    • bicarb for acidosis
78
Q

acetaminophen

A

MOA: slows production of prostaglandins in CNS

79
Q

acetaminophen considerations

A
  • max dose: 4 g/day
  • ETOH
    • use caution if > 1-2 drinks/day
    • max dose: 2 g/day
  • use cautiously with warfarin: monitor PT, INR
  • liver dysfunction: check LFTs before giving
  • pt education: READ LABELS, don’t accidentally OD by taking multiple acetaminophen combos
  • monitor for concurrent admin with combos
80
Q

acute acetaminophen toxicity

A
  • rare at therapeutic dose
  • → liver damage
  • s/sx
    • N&V
    • diarrhea
    • sweating
    • abd pain
    • liver failure
    • coma
    • death
  • max dose: 4 g/day
  • antidote: acetylcysteine
81
Q

opioid agonists

A
  • prototype: morphine
  • fentanyl
  • meperidine
  • methadone
  • codeine
  • oxycodone
  • hydromorphone
82
Q

side effects of opioid agonists

A
  • worse with ETOH, CNS depressants
    • respiratory depression: monitor VS
    • sedation: fall risk, avoid driving, etc.
  • constipation
    • prevention/mild: ↑ fluid and fiber, docusate sodium
    • acute: stimulant laxative
    • long-term opioid use: opioid antagonist
  • N&V: give antiemetic (promethazine is synergist), worse with antihypertensives
  • urinary retention
    • monitor I&O
    • encourage voiding Q4H
    • assess for distention
    • worse with BPH, concurrent anticholinergics
83
Q

opioid agonist long-term use

A
  • physical dependence
    • can → abuse, illicit use
    • withdrawal: taper use
  • tolerance
    • diminished therapeutic response
    • no relief or SE from normal dose
84
Q

opioid agonist acute overdose

A
  • s/sx
    • respiratory depression
    • coma
    • pinpoint pupils
  • Tx
    • stop med
    • CPR
    • naloxone
    • mechanical ventilation
85
Q

administering opioid agonists

A
  • always assess pain level first and medicate per level
  • reassess an appropriate amount of after admin according to route
  • monitor respiratory status
  • do not over-medicate
  • fixed schedule for severe chronic pain
  • PRN for acute pain, giving meds before pain is severe
86
Q

agonist-antagonist opioids

A
  • MOA: agonist for Kappa opioid receptors, antagonist for Mu
  • for moderate to severe pain
    • ideal for labor pain
  • compared to opioid agonists
    • ↓ effective
    • ↓ respiratory depression
    • ↓ risk of abuse
  • drugs
    • prototype: butorphanol
    • nalbuphine
    • buprenorphine
    • penazocine
87
Q

complications of opioid agonist-antagonists

A
  • sedation
  • respiratory depression
  • dizziness: fall risk, avoid machinery, etc.
  • headache
  • abstinence syndrome
    • ↓ activity of Mus → withdrawal in opioid-dependent pt
    • cramping
    • HTN
    • vomiting
    • fever
    • anxiety
88
Q

contraindications and precautions for opioid agonist-antagonists

A
  • contra: opioid use disorder
  • caution
    • chronic dz
    • head injury
89
Q

opioid antagonists

A
  • MOA: compete for receptors, blocking opioid action
  • drugs
    • prototype: naloxone
    • methylnaltrexone
    • alvimopan
  • use: reverses respiratory depression, euphoria, constipation, and pain control
90
Q

complications of opioid antagonists

A
  • tachycardia
  • tachypnea
91
Q

contraindications for opioid antagonists

A

opioid dependency, except in case of OD

92
Q

tricyclic antidepressants

A
  • uses: depression, adjuvant for fibromyalgia, nerve pain (usually chronic)
  • prototype: amitriptyline
  • SE
    • orthostatic hypotension: avoid falls
    • sedation: avoid driving, etc.
    • anticholinergic effect: ↑ fluid, comfort measures
  • contraindications/precautions
    • recent MI
    • taking MAOI
    • glaucoma
    • BPH
    • Sz
    • liver dz
    • kidney dz
93
Q

anticonvulsants

A
  • uses: sz prevention, adjuvant for neuropathy pain (common in DM)
  • drugs: carbamazepine, gabapentin
  • lots of interactions
94
Q

contraindications and precautions for anticonvulsants

A
  • bone marrow suppression
  • MAOI use
  • pregnancy
95
Q

interactions with anticonvulsants

A
  • warfarin
  • oral contraceptives
  • grapefruit
  • other anticonvulsants
  • CNS depressants
96
Q

complications of anticonvulsants

A
  • drowsiness: take at night, avoid driving
  • GI upset: take with food, ↑ fluid and fiber, stool softener, laxative
  • bone marrow suppression: monitor for bruising, bleeding, sore throat, and fever
  • rash: HOLD and notify provider
97
Q

CNS stimulants

A
  • prototype: methylphenidate
  • MOA: ↑ analgesia, ↓ sedation
  • monitor for wt loss
  • SE: insomnia (take before 1600, ↓ caffeine
  • caution
    • HTN
    • Hx of substance use disorder
    • OTC meds
  • contra
    • MAOI use
98
Q

muscle relaxants/antispasmodics

A
  • centrally acting
    • diazepam (Valium)
    • baclofen
    • cyclobenzaprine (Flexeril)
    • tiZANidine (Zanaflex)
  • peripherally acting
    • dantrolene (Dantrium)
  • interactions: CNS depressants, additive effects
  • precautions: liver and kidney impairment, pregnancy
99
Q

migraine medications

A
  • acute: not more than 2x/wk
    • NSAIDs
    • acetaminophen
    • triptans
    • ergots
  • prophylactic
    • TCAs
    • anticonvulsants
    • beta blockers
    • estrogens
100
Q

triptans

A
  • for Tx of acute migraine
  • all names end in “triptan”
  • contraindications
    • ischemic heart dz
    • liver failure
    • uncontrolled HTN
  • interactions
    • do not take with: ergots, MAOIs or below drugs
    • ↑ risk of serotonin syndrome
      • St. John’s wort
      • SSRIs, SNRIs, TCAs
      • other triptans
      • bupropion (Wellbutrin)
      • buspirone (BuSpar)
      • meperidine (Demerol)
101
Q

ergots

A
  • for Tx of acute migraine
  • all have “ergot” in the name
  • contraindications: renal, liver dysfunction; CAD; HTN
  • pregnancy category X: use contraception
102
Q

beta blockers

A
  • Tx of HTN, tachyarrhythmias, angina, MI, HF, hyperthyroidism
  • prevention of migraine
  • all end in “lol”
  • monitor for orthostatic hypotension
  • caution: pregnancy, lactation, lung dz, DM, severe liver dz
  • do not stop abruptly in pts with CV dz
  • interactions
    • bronchodilators: ↓ effect
    • other meds that slow the heart: + effect
    • DM meds: alter dose
    • cimetidine: ↓ metabolism, ↑ effects of beta blocker
103
Q

neuromuscular blockers

A
  • MOA: block ACh at neuromuscular junction → muscle relaxation, hypotension; paralysis without LOC or analgesia
  • use: facilitate intubation, control muscles during ECT
  • drugs
    • succinylcholine: can cause MH; treat with dantrolene
    • pancuronium: reversed by neostigmine
  • must have airway and mechanical vent stat
  • monitor for return of respiratory ftn
104
Q

IV sedatives and anesthetics

A
  • giving in anesthetic context requires additional training
  • non-opioid sedation
    • barbiturates: phenobarbital
    • benzodiazepines (preop, conscious sedation)
      • midazolam (Versed): induces amnesia
      • diazepam (Valium)
      • lorazepam (Ativan)
    • propofol
    • ketamine
  • opioid analgesia
    • fentanyl
    • morphine
105
Q

anesthesia care

A
  • pt continuously monitored 1-on-1 by RN
  • RN must be trained in ACLS and admin of sedation
  • administer slowly
  • after admin, monitor for
    • VS return to baseline
    • orientation x4
    • pt can void within 8 hr
    • control of N&V
    • no driving for pt
106
Q

anticoagulants

A
  • MOA: activate anti-thrombin, inactivate thrombin and factor Xa
  • parenteral
  • drugs
    • unfractionated: heparin
    • low molecular weight
      • enoxaparin
      • dalteparin
    • activated factor Xa inhibitor: fondaparinux
107
Q

vitamin K inhibitors

A
  • prototype: warfarin
108
Q

direct thrombin inhibitors

109
Q

direct factor Xa inhibitors

110
Q

antiplatelets

111
Q

thrombolytic meds

112
Q

contraindications and precautions for anticoagulants

A
  • contra
    • thrombocytopenia
    • uncontrolled bleeding
    • surgery of eyes, brain, spinal cord
    • lumbar puncture
    • regional anesthesia
  • caution
    • hemophilia
    • PUD
    • severe HTN
    • liver or kidney dz
    • threatened abortion

2020 Pharmacology I (21 decks)

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