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Pharm 2 > E4 Medications > Flashcards

E4 Medications Flashcards

1
Q

Ibutilide (covert)

A

acute treatment of a flutter, given IV for a new onset pt will convert to NSR either within infusions or 90 minutes of completion

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2
Q

Adenosine

A

drug of choice for SVT, short half life, given fast iv push to stop SVT, causes brief asystole

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3
Q

Class 1 antidysrhythmics

A

Sodium channel blockers, results in decreased conduction
Quinidine, procainamide, disopyramide phosphate (norpace)

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4
Q

Procainamide

A

Class 1A - effective for atiral and ventrical dysrhythmias, used in acute and long term treatment
Treatment of SE (systemic lupus) CBC weekly for SS of infection, watch for EKG changes (widening QRSs, prolonged QT)

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5
Q

Class 1B antidysrhythmics

A

Sodium channel blockers, accelerate repolarization and have little effect on EKG,

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6
Q

Phenytonin (dilantin)

A

treatment of atrial, AV and ventricular issues
Class 1B (sodium CB)

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7
Q

Mexiletine

A

treatment of ventricular problems
Class 1B (sodium CB)

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8
Q

Lidocaine

A

Class 1B, used as a neuromuscular blocking agent can cause respiratory depression

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9
Q

Class II antidysrhythmic drugs

A

Beta-adrenergic blockers
Decrease cardiac contractility, slows heart rate, conduction and myocardial contractility, used to mostly treat supraventricular dysrhythmias
Propanolol (nonselective), acebutolol, esmolol (cardio selective)
SE: bradycardia, hypotension, impotence

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10
Q

Class III antidysrhythmic drugs

A

Prolong (delay) repolarization and slow the rate of electrical conduction
Amiodarone (cordone) treats - a fib, pvcs, ventricular dysrhythmias and cardiac arrest, first line ACLS
Sotalol (betapace) beta blocker but considered a class III

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11
Q

Dronedarone (Multaq)

A

Class III antridysrhythmic - less toxic and less effective then amiodarone

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12
Q

Dofetilide (Tikosyn)

A

Class III antidysrhythmic, titrated while monitor ECG
Using with levoquin increases the risk of deadly dusrhythmias

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13
Q

Amiodarone Se/adverse reactions

A
  • Can cause bradycardia (slow the infusion rate) AV block
  • IV requires continuous monitoring, switch to PO before DC
  • Abruptly ceasing can cause fatal dysrhythmias, PT must be compliant with meds
  • LUNG damage: dyspnea, cough, chest pain STOP med, teach pt must report and replace with other med
  • Hypo/hyperthyroidism may develop, monitor with periodic blood work
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14
Q

Class IV antidysrhythmic

A

Block calcium influx, slows automaticity, delays conduction, decreases contractility, slow ventricular rate
Continuous monitoring for IV dosing
Verapamil (Isoptin), Diltiazem (cardizem)
SE: nausea, vomiting, bradycardia, hypotension

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15
Q

Digoxin (Lanoxin)

A

treatment of supraventricular dysrhythmias, monitor for signs of toxicity (headache, N/V, altered mental status, HALO)

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16
Q

Aspirin, special considerations

A

Effective for suppressing platelet aggregation
Stop 7 days before procedures (including dental)
CP: chew one 325 mg or 4 81 mg tabs then follow up in ER

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17
Q

Thrombolytic Drugs and their dosing times

A

Alteplase tPA (Activase) IV bolus then 90 minute infusion
Reteplase rPA (Retavase) 2 doses 30 minutes apart
Tenecteplase TNK-tPA (TNKase) Single IV bolus

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18
Q

Monitoring for adverse effects of thrombolytics

A

Monitor for hemorrhage 24 hours after infusion, no invasive procedures, limited use of NSAIDS/antiplatelet/anticoags, minimize physical manipulation, AVOID injections
- EKG monitoring
- Pts may experience hypotension when first administered

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19
Q

Oxygen administration

A

Whenever O2 is <90% (unless COPD or Dr orders say otherwise)

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20
Q

Nitroglycerin

A

Dilates both veins and arteries, imporves blood flow to ischemia myocardium
Decreased preload/O2 demand, increases cardiac blood flow, decreases BP
0.4 mg SL q5 min x 3

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21
Q

DO NOT give nitro if

A

BP <90, HR <50 or >100, suspected right ventricle infarctions
Medications for treatment of ED (sildenafil (viagra)) can lead to severe hypotension

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22
Q

Betablockers

A

Treatment of STEMIs
reduce oxygen demand, increased coronary blood flow, reduce cardiac pain
Contraindications: asthma, COPD (unless cardioselective is used)
pronounced bradycardia <50
severe heart failure/heart block
persistent hypotension

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23
Q

ACE + ARBS

A

-pril ACE + -sartan ARB
Reduce preload and afterload, contraindicated in hypotension
ACE ‘cough’ use ARB
ACE - contra indicated in renal failure, renal artery stenosis, hypotension

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24
Q

Atrophine sulfate

A

Muscarinic antagonist - treatment of hemodynamically significant bradycardia and some heart block
- mydriasis and paralysis of ciliary muscles, used for eye procedures
GI uses: slows motility, relaxes biliary tract for gallstones, decreased secretion’s for PUD
Requires tight titration, has short half life
Anticholinergic effects - increased HR, decreased secretions, relaxation of bronchi
Adverse: dysrhythmias, MI, continuous monitoring when giving IV

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25
Magnesium sulfate + severe adverse
Arrest associated with hypomagnesemia, treats ventircular dysrhythmias Adverse: neuromuscular blockade - hypotension, bradycardia, respiratory depression, decreased tendon reflexes
26
Mag sulfate antidote
Calcium gluconate
27
Epinephrine
Treat profound bradycardia/hypotension Causes peripheral vasoconstriction, improves perfusion to brain and heart (increased CO) SE: myocardial ischemia, peripheral tissue ischemia
28
Sodium bicarbonate
Corrects metabolic acidosis associated with cardiac arrests, monitor ABGS
29
Mannitol
osmotic diuretic used to treat cerebral edema and increased ICP Used FILTERED needle Assess: IO, electrolytes, hydration status, neuro status, must DC if signs of CHF or pulmonary edema occur
30
When would naloxone be administered
When opioid overdose is suspected, can also be administered to pts with coma of unknown etiology (after 10 minutes with no reaction another cause should be suspected)
31
Flumazenil (romazicon)
reversal agent for benzodiazepine medications, may lead to withdrawal seizures
32
Activated charcoal
prevents the absorption of toxins by binding, given via NG, best within 30 minutes of ingestion SE: vomiting (risk of aspiration) black stools
33
Dopamine
treats hypotension and bradycardia, goal to increase BP to perfuse organs can over vasoconstrict and cause poor organ perfusion, low dosages and gradual weaning - Continuous monitoring: EKG, VS, UO - Acidosis may occur, give sodium bicarb in another IV line - Extravasation - assess for edema, coolness and paleness
34
Treatment for IV infilration/extravasation
Phentolamine (Reignite) SQ
35
Doubutamine
Tx: heart failure especially when caused by shock, increase HR and force of contraction Gradual weaning important + continuous monitoring Risk of myocardial ischemia
36
Norepinephrine
vasoconstrictor used in shock when dopamine and dobutamine fail to increase the BP - continuous monitoring, risk of poor perfusion to tissues/organs including heart, risk of extravasation
37
Tx of anaphylactic shock
1. epinephrine - drug of choice 2. diphenhydramine HCl: antihistamine administered with epi to treat shock 3. steroids can also be used to reduce inflammation and the allergic response Albuterol neb can also be used to reverse bronchoconstriction
38
Treatment of hypoglycemic shock
Dextrose 50% - high-carb solution given IV, phlebitis and extravasation are risks Glucagon - pancreas-produced hormone that elevates the BS by stimulating glycogenolysis
39
Labetalol
Uses in hypertensive crisis, lowers HR, BP Reduces vasoconstriction that results from sympathetic nervous system stimulation SE: hypotension, dysrhythmias, bronchospasm, bradycardia Requires continuous monitoring
40
Nitroprusside sodium
used in hypertensive crisis, immediate venous and arterial vasodilation - Requires continuous BP monitoring - Short duration (10 min) - Protective foil kept in place to protect from light Signs of toxicity: vomiting, hypotension, SOB, liver damager/t cyanide poisoning
41
Furosemide (in terms of ER meds)
Treatment of pulmonary edema, promotes renal excretion of water, sodium, chloride, mag, hydrogen and calcium, lowers the BP Monitor: electrolytes (POTASSIUM) IO, respiratory status, lung sounds and VS
42
Morphine sulfate (er meds)
Treatment of multiple emergencies including pulmonary edema Produces venous vasodilation, decreases pulmonary congestion, decreased cardiac preload and decreased BP
43
Antiestrogen drugs
tamoxifen, toremifene, fulvestrant tumor cells must have estrogen receptors since the estrogen stimulates growth
44
Tamoxifen (Soltamox)
used for prevention and treatment of breast cancer, effective in both pre/post menopausal women Adverse: menstrual irregularities, hot flashes, fluid retention, DVT, PE, CNA, endometrial cancer
45
Aromatase inhibitors
Tumor cells must have estrogen receptors, contraindicated in premenopausal women No risk of endometrial CA, little risk of DVT, PE, CVA anastrozole, letrozole, exemestane
46
Anastrozole (Arimidex)
Estrogen depletion shrinks the tumor SE: menopause symptoms, HTN, msk pain, osteoporosis/fractures Drug of choice for post menopausal women as it has fewer side effects
47
Androgen Deprivation Therapy
suppresses androgen production in testes, after 18-24 months disease progression resumes Gonadotropin-Releasing hormone agonists and Gonadotropin-releasing hormone antagoinists
48
Leuprolide (Lupron depot)
Androgen receptor blocker used in treatment of prostate cancer Route: SQ daily, IM weekly or monthly SE: hot flashes, ED, gynecomastia, loss of libido, loss of muscle mass, DM, MI, CVA, osteoporosis
49
Cetuximab (Erbitux)
IV - epidermal growth factor tyrosin kinase inhibitor, inhibits the pathway for cell division results in limited cell proliferation SE: interstitial lung disease, pts should report breathing difficulties
50
Gefitinib (Iressa)
Oral EGFRI Teaching: st. johns wort decreases levels of drug in system
51
Tyrosine Kinase Inhibitor (TKI)
Stops proliferation of cancer medications, resistance can develop Gold standard for chronic myeloid leukemia (CML)
52
Imatinib mesylate (Gleevec)
Tyrosine Kinase Inhibitor SE: N/V, headache, fatigue CBC to be done weekly r/t neutropenia + thrombocytopenia Contents of tablet are toxic GLOVES must be worn if tablet is crushed or broken
53
Sirafenib (Nexavar)
Multi-Tyrosine Kinase inhibitor, inhibits the activity of specific cancer cells in the vasculature Treatment of renal cell, hepatocellular and thyroid carcinomas SE: diarrhea, fatigue, dysrhythmias, HIGH risk of bleeding
54
Vemurafenib (Zelboraf)
BRAF V600E Kinase inhibitor Treatment of metastatic melanoma, suppresses tumor growth SE: cutaneous squamous cell carcinoma, steven-johnson syndrome, fatal dysrhythmias
55
Rituximab (Rituxan)
CD-Directed antibodies treatment of b-cell non-hodgkins lymphoma and b-cell chronic leukemia Stimulates the immune system to cause lysis of the cancer cells SERIOUS SE: hypotension, bronchospasm, angioedema (crash cart when infusing) Tumor lysis syndrome
56
Cyclophosphamide
anti-cancer drug that can have anti-cancer effects and neutropenia but not neurotoxicity. interferes with growth & spread of cancer cells (disrupts RNA and DNA synthesis) given PO or IV, active form converted in liver SE: N/V, diarrhea, loss of appetite, hair loss, increased infection risk, bone marrow suppression indications: Hodgkin's, Non-Hodgkins, multiple myeloma, solid tumors of the head, neck, ovary, and breast can cause damage to the bladder need to have regular blood tests while on the medication SEVERE emetogenic potential IV drug
57
Vincristine
disrupts the formation of the mitotic spindle during cell division = prevents cancer cells from dividing and proliferating (disrupts mitosis). effective ONLY during the M phase “bone marrow sparing” typically given IV, extravasation can occur and damage tissues near the vein SE: peripheral neuropathy, constipation, hair loss, N/V indications: Hodgkin's, Non-Hodgkins, acute lymphocytic leukemia, Wilms’ tumor, rhabdomyosarcoma, Kaposi’s sarcoma, breast cancer, bladder cancer need to have regular blood tests while on the medication, NOT to be used during pregnancy unless benefits outweigh the risks MINIMAL emetogenic potential IV drug
58
Filgrastim (Neupogen)
stimulates bone marrow to produce more WBC (neutrophils) to help fight infection. used to prevent or treat neutropenia given IV or SQ SE: bone pain, muscle aches, headaches, fatigue, injection site reactions increases risk of spleen enlargement or rupture
59
ondansetron (zofran)
blocks serotonin which is involved in nausea and vomiting. helps to prevent N/V with chemo drugs SE: headache, constipation, diarrhea, dizziness, fatigue careful w patients with hx of heart disorders, electrolyte imbalances, liver disease
60
dexamethasone
corticosteroid with anti-inflammatory and immunosuppressant properties. helps to reduce inflammation with certain cancers can be given tablet, injection, eye drops SE: weight gain, fluid retention, mood changes, insomnia, indigestion, nausea
61
Bevacizumab (Avastin)
Angiogenesis inhibitor: reduces the vascular growth that supports the tumor, does not kill tumor but prevents further growth Treatment of colon, lung, brain, renal and cervical/ovarian CA SE: Boxed for GI perforations, wound dehiscence, impaired wound healing, hemorrhage and fistula formation Should not be used 28 days after a major surgery
62
Bortezomib (Velcade)
Proteasome inhibitor: suppresses cancer cell division promoting apoptosis, treats multiple myloma SE: N/V, anorexia, hematologic issues, peripheral neuropathy Teaching: St. Johns wort can decrease the levels of bortezomib

Pharm 2 (13 decks)

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