Drug Review Flashcards
Drug to give for hypokalemia
potassium chloride
How do you give potassium by IV?
dilute; K is very irritating to veins
What else is K irritating to?
GI tract; take with food and water
If potassium chloride worked too well, what do you watch for?
hyperkalemia
What are s/s of hyperkalemia?
peaked T waves, prolonged PR interval, bradycardia, dyspnea, dysrhythymias, fatigue, muscle weakness
hypokalemia s/s
generalized weakness, fatigue, n/v, leg cramps
Name four catagories of reasons to get hypokalemia?
- drugs (furosemide, hctz)
- vomiting and diarrhea/laxative abuse
- alkalosis and excessive insulin
- insufficient dietary intake
what med do you give for overactive bladder?
oxybutynin
How does oxybutynin work?
anticholinergic that blocks M3 receptors in smooth muscle of bladder. this decreases contractions and the urge to void
side effects of oxybutynin?
tachycardia anticholinergic effects (dry eye, photophobia, blurred vision, dry mouth, constipation)
what conditions are oxybutynin contraindicated for?
glaucoma and myesthenia gravis
symptoms of overactive bladder?
urgency
urge incontinence
frequency (8 + x per day)
nocturia (2+ x per night)
how to treat overactive bladder?
behavior therapy (plan times to void, plan times to drink, limit caffeine, kegel exercises) medication
two catagories of oral contraceptives and medications under each
combination
ethinyl estradiol/norethindrone
progestin only
norethindrone
how do the combo drugs work?
estrogen suppresses the release of FSH. Progestin suppresses the release of LH. this prevents ovulation, thins the lining of the uterus and thickens cervical mucus
how does norethindrone alone work?
progestin suppresses the release of LH which thins the uterine lining and thickens cervical mucus
what are the other two convenient options for OC?
transdermal patch
How does the transdermal patch work
wear once a week for three weeks and no patch on the fourth week
What is the other option for OC?
vaginal contraceptive ring
how does the contraceptive ring work?
wear for three weeks
no ring on the fourth week
if it falls out, wash with warm water and reinsert
what is the major problem with OC?
thromboembolic events…like PE, MI, DVT, or thrombotic stroke
what are the risk factors for thromboembolic events?
heavy smoking, history of thromboembolism, thrombophilias, older than 35 years
we give lower doses now so not as big of a risk as in the past
how do OC affect breast cancer?
can increase the growth rate of estrogen fed breast cancers…will not increaase the risk of breast cancer
what are the drug interactions with OC?
St John’s Wort
antiseizure meds (phenytoin, carbamazapine, phenobarbitol)
antibiotics (penicillans, cephalosporins, rifampin)
what are the s/s of DVT?
redness,
warmth, (back of hand)
swelling,
and sometimes pain
what are some uses for OC?
contraception
acne
dysfxal uterine bleeding
menopausal hormone therapy
If you miss doses of OC how do you start back up? for combo?
combo- one of more pills in first week,
take one asap and then continue (use back up for 7 days)
1-2 missed pills in 2nd or 3rd week–
take 1 asap then continue; skip placebo pills and go straight to new pack after all active taken
3 or more pills missed in 2nd or 3rd week–
take 1 asap then continue; skip placebo pills; go straight to new pack after all active pills taken; use additional contraception for 7 days
if you miss doses of OC in progestin only?
one of more pills in first week,
take as soon as remembered, use back up for 2 days
1-2 missed pills in 2nd or 3rd week
take 2 pills as soon as remembered; use back up for 2 days
3 or more pills missed in 2nd or 3rd week
stop
do not resume until menstration occurs or until pregnancy ruled out
when do you start taking
begin on 1st day or 1st sunday after onset of menses
what meds do you give for BPH? catagories and meds
Alpha 1 blockers tamulosin doxazosin 5 Alpha reductase inhibitors finasteride dutasteride Saw Palmetto
alpha 1 blockers MOA
relax smooth muscle in the neck of bladder; allows urine to flow more freely thru the urethra; alpha 1 blockers also block receptors in the vasculature; decrease BP
which one is the nonselective alpha 1 blocker?
doxazosin
which one is the selective alpha 1 blocker?
tamsulosin
what do alpha 1 blockers treat?
BPH, hypertension
problems for nonselective alpha 1 BPH meds?
hypotension, dizziness, nasal congestion, sleepiness
problems with selective alpha 1 BPH meds?
abnormal ejaculation
two 5 alpha reductase inhibitors are? MOA?
Dutasteride, Finasteride
Block enzyme that converts testosterone into DTH a more potent version of testosterone. This halts the growth of the prostate and even shrinks it (DTH triggers prostate to grow);
These drugs help regrow hair (DTH plays a role in male pattern baldness)
problems with 5 Alpha Reductase (name 5)
Pregnancy catagory X -- pregnant women must not handle broken or crushed tabs decreased libedo abnormal ejaculation falsely decreased PSA levels Gynecomastia
what is the herbal that is really not effective for BPH
saw palmetto
what are 5 alpha reductase drugs given for? do you remember names of these?
BPH and male pattern baldness
what catagory and drugs are ED?
PDE5 inhibitors
Sildenafil
Verdenafil
Tadalafil
Problems with these PDE5 inhibitors?
hypotension
priaprism
sudden hearing loss
How do PDE5 inhibitors work?
MOA: block PDE5 increasing cGMP levels allowing for enhanced blood flow of corpus cavernosum and penile erection
What drug can you not take with PDE5 Inhibitors and why?
nitrates
fatal hypotension
both nitrates and PDE5 inhibitors increase cGMP levels; wait at least 24 hours between these drugs
How soon do you take these drugs
take about one hour before activity
be careful combining PDE5 inhibitors with?
alpha blockers
if erections last longer than __ hours seek medical attention
4
Common causes of ED
vascular, neurologic, hormonal, drug-induced, psychogenic
What can increase plasma concentrationsfor PDE5 inhibitors?
grapefruit juice
ED by age? 50’s? 60’s? 70’s?
4%
17%
47%
L&D meds?
Oxytocin
methylergonovine
terbutaline
magnesium sulfate
MOA of oxytocin
increase strength, frequency and length of contractions
what do you use with oxytocin
pump
when do you stop the infusion of oxytocin?
resting uterine pressure of >15-20 mmHG
contractions lasting > 1 min
contraction frequency of > 2-3 min
pronounced alteration of FHR or rhythm
methylergonovine controls what?
postpartum bleeding by causing powerful uterine contractions
what is there an increased risk of with methylergonovine?
hypertension;
safer agents such as oxytocin are usually tried 1st
terbutaline does what?
suppresses preterm labor by activating beta 2 receptors in the uterus causing uterine relaxation
major side effects of terbutaline?
heart: tachycardia, hypotension
lungs: pulmonary edema (crackles)
hyperglycemia
what is magnesium sulfate used for
preeclampsia to prevent seizures
MOA of magnesium sulfate
inhibits release of Ach in synapes of skeletal muscle and uterus; relaxes smooth muscle
why is magnesium sulfate not used anymore for preterm labor?
ineffective and dangerous
what are the s/s of magnesium sulfate toxicity?
hypotension
loss of DTR
RR<12
UO <25-30 mL/hr
preterm labor is before ___ weeks
37
preterm labor is the leading cause of infant ___ & ___
mortality and morbidity (75% of neonatal deaths)
more than ___% deliveries are induced
22
when should you induce labor
if beyond term (42 weeks)
when early delivery reduces morbidity and mortality to infant and mother
what are the type of drugs that affect uterine function?
Oxytocics (either promote cervix ripening or promote contractions)
Tocolytics (prevent preterm labor or stop preterm labor)
What catagories and drugs are Beta Lactam antibiotics?
penicillins–amoxicillan/clavulanate
cephalosporins–cephalexin
carbapenems–imipenem
Problems with beta lactam antibiotics?
Allergic reactions (penicillans are the most common cause of drug allergy–0.4-7%)
severity varies from rash to anaphylaxis
1% cross sensitivity to cephalosporins
most likely to occur within 30 min
Name another problem with beta lactam antibiotics
superinfection–can cause c diff (cephalosporins); advise clients to report watery diarrhea; treat with metronidazole or vancomycin
beta lactams MOA
interfere with enzyme within bacteria called penecillin binding protein…it is what helps bacteria make strong cell walls. By blocking PBP they can’t build strong cell walls…they swell and burst
what are the other type of antibiotics? name the drugs within?
protein synthesis inhibitors tetracyclines--tetracycline aminoglycosides--amikacin, neomycin, gentamicin, streptomycin, tobramycin macrolides--erythromycin azithromycin
problems with tetracyclines?
esophogeal ulceration
teeth discoloration (<8 yrs)
photosensitivity
many food interactions (milk products, calcium, iron supplements, magnesium containing laxatives, antacids)
problems with macrolides?
distorted taste (metallic) prolonged QT intervals
problems with amiNOglycosides
nephotoxicity
ototoxicity
which drug is inactivated by penicillins
aminoglycosides
When do you draw peaks and troughs?
peaks-30 min after IM/IV dose
trough-right before the next dose
MOA of protein synthesis inhibitors
bind to bacterial ribosomes blocking their ability to make proteins necessary for their survival (prevent protein synthesis)
Which drug class disrupts DNA replication in bacterial cells?
Fluoroquinolones
Name drugs within fluoroquinolone class
Levofloxacin Moxifloxacin oflofloxacin Norfloxacin Ciprofloxacin
what is the problem with fluoroquinolones?
achilles tendon rupture (avoid use in children <18 years)
photosensitivity
multiple food interactions (dairy products, aluminum magnesium antacids, iron)
Ciprofloxacin treats?
UTI, traveller’s diarrhea, and anthax
Instruct clients to report what with fluoroquinolones?
pain, swelling, redness or any tendons or joints
what are the differences in human and bacterial cells
cell walls
ribosomes
unique enzymes
bactericidal
kills microbes
bacteriostatic
slows growth of microbes
treatment challenges: difficult \_\_\_/\_\_\_ to treat 1. 2. 3. \_\_\_ resistance \_\_\_\_\_\_\_\_\_\_\_
sites/infections 1. CNS infections 2. endocarditis 3. purulent abscesses bacterial resistance superinfection
always collect…
specimens before starting antibiotics
what type are preferred?
narrow spectrum antibiotics
antibiotics don’t kill ___
viruses
complete how much?
full course
What is common with antibiotics?
GI disturbances
What are the urinary tract medications
sulfamethoxazole-trimethoprim
nitrofurantoin
phenazopyridine
MOA of sulfamethoxazole-trimethoprim
blocks 2 seperate enzymes bacteria need to create their own folic acid
problems with sulfamethoxazole-trimethoprim
hypersensitivity SJS
crystalluria–precipitates in urinary tract (drink 8 plus cups water daily)
kernicterus (pregnant women and infants <2 months old can’t have)–jaundice, increased bilirubin, neurotoxic in newborns
nitrofurantoin MOA
enters bacteria and is converted into toxic substances that destroy bacterial DNA
Problems with nitrofurantoin
urine turns brown
food increases absorbtion (40%) and decreases GI discomfort
peripheral neuropathy (rare)
contraindicated if renal impairment (inc risk of toxiity)
phenazopyridine MOA
analgesic that works directly on the mucosa of the GU tract
problems with phenazopyridine
urine orange-red color (stains) GI discomfort (take with food)
