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Pharmacology 1 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Cholinergic agonists - effects

A

Increase: salivation, GI motility, urination
Decrease: HR, BP
Constrict: pupils (miosis) and bronchioles
Dilate: blood vessels

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2
Q

Cholinergic agonists - why are they prescribed?

A

Glaucoma, urine retention, dry mouth, myasthenia gravis, Alzheimer’s disease

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3
Q

Cholinergic agonists - safe administration and relevant practice factors

A

For glaucoma eye drops - pinch nose to keep local
For adults - don’t drive
Older adults - increased risk of toxic levels, start low and go slow, beware of falling
Stay near toilet
At home: beware of tripping hazards and dim lights
Increased bleeding risk if taken with NSAIDs

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4
Q

Cholinergic agonists - medical related assessments

A

Measure heart rate to make sure it’s not too low before administering.
Look at I/O, baselines, allergies

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5
Q

Cholinergic agonists - therapeutic actions

A

Direct: stimulate nicotinic and muscarinic directly
Indirect: block acetylcholinerase, leading to accumulation of ACh
These both lead to a parasympathetic effect

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6
Q

Cholinergic agonists - timing and route

A

Orally on empty stomach (direct)
Indirect with meals
Galantamine: solution to swallow twice/day
Rivastigmine: solution to swallow twice/day or XR once/day
Donepezil: once/day rapidly dissolving tablet
Edrophonium: diagnostic agent for myasthenia gravis
IV slowly and keep Atropine close by

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7
Q

Cholinergic agonists - adverse effects

A

Diarrhea and vomiting, sweating, drowsiness, dizziness, urinary urgency

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8
Q

Cholinergic agonists - contraindications and cautions

A

Bradycardia, asthma, bowel or urinary obstruction, hypotension, allergy, peptic ulcer disease, epilepsy, Parkinsonism
Caution for pregnant and lactating

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9
Q

Anticholinergic agents - therapeutic actions

A

Block the effects of acetylcholine
Lyse/block effects of parasympathetic
This allows the sympathetic nervous system to kick in
Do not block nicotinic, only muscarinic

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10
Q

Anticholinergic agents - why are they prescribed?

A

Patient has bowel hyperactivity, antidote for Cholinergic OD (Atropine), overactive bladder, drooling, COPD to prevent bronchospasm, motion sickness

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11
Q

Anticholinergic agents - effects

A

Increase- HR, BP
Decrease- bowel and urine activity, salivation
Constrict- blood vessels, sphincter
Dilate- pupils (mydriasis)

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12
Q

Anticholinergic agents - safe administration and relevant practices

A

Keep hydrated and stay out of sun for long periods of time due to decreased sweating.
No driving.
Older adults: Start low go slow

Drink water, pee before, lozenges for dry mouth, increased fiber and exercise
At home beware of dim lights and tripping hazards

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13
Q

Anticholinergic agents - medical related assessments

A

Monitor vitals, check ECG, assess for disease that decreases bowel motility, neurological status, reflexes, papillary response, renal function labs

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14
Q

Anticholinergic agents - timing and route of administration

A

Take after peeing to help with urine retention

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15
Q

Anticholinergic agents - adverse effects

A

Blurred vision, cycloplegia, photophobia, palpitations, tachycardia, dry mouth, altered taste, constipation
“Can’t spit can’t see can’t poop can’t pee”

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16
Q

Anticholinergic agents - contraindications and cautions

A

Glaucoma, allergy, stenosing peptic ulcer disease, enlarged prostate, bladder or bowel obstruction
Caution with breastfeeding and brain damage

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17
Q

Dicyclomine

A

For bowel hyperactivity

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18
Q

Glycopyrrolate

A

For drooling

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19
Q

Ipratropium

A

For COPD to prevent bronchospasm

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20
Q

Meclizine

A

For motion sickness

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21
Q

Oxybutynin chloride

A

For overactive bladder

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22
Q

Scopolamine

A

For motion sickness

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23
Q

Tiotropium

A

For COPD bronchospasm

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24
Q

Tolterodine

A

For overactive bladder

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25
Q

Donepezil

A

For Alzheimer’s

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26
Q

Rivastigmine

A

For Alzheimer’s

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27
Q

Galantamine

A

For Alzheimer’s

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28
Q

Neostigmine

A

For myasthenia gravis

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29
Q

Pyridostigmine

A

For myasthenia gravis

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30
Q

Edrophonium

A

Diagnostic agent for myasthenia gravis

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31
Q

Bethanechol

A

For urinary retention

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32
Q

Carbachol

A

For glaucoma

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33
Q

Cevimeline

A

For dry mouth

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34
Q

Pilocarpine

A

For dry mouth

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35
Q

Cycloplegia

A

Inability to focus on objects up close

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36
Q

Belladonna

A

Plant from which Anticholinergic drugs come

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37
Q

Receptor(s) Anticholinergic block

A

Cholinergic receptors in sympathetic
Only muscarinic in parasympathetic
Not nicotinic

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38
Q

Stenosing

A

Narrowing

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39
Q

Cholinergic agonists, drug-drug

A

Acetylcholinerase - increases effects
NSAIDS increase bleeding
Other Cholinergic drugs increase effects

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40
Q

Anticholinergic drug-drug

A

Antihistamines, antiparkinsonian, MAOI, TCAs

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41
Q

Hyperglycemia >

A

126 mg/dL

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42
Q

Atherosclerosis

A

MI and strokes from plaque in vessels

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43
Q

Retinopathy

A

Vision loss from narrowing eye vessels

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44
Q

Neuropathy

A

Motor and sensory changes to nerves due to decreased oxygen;
Pain, numbness, tingling

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45
Q

Nephropathy

A

Renal dysfunction

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46
Q

Beta cells still work in

A

DM 2

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47
Q

Polyuria

A

Increased pee

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48
Q

Polydipsia

A

Increased thirst

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49
Q

Polyphagia

A

Increased hunger

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50
Q

Signs of dangerous hyperglycemia

A

Fruity breath
Dehydration
Kussmar’s respiration- slow, deep
Loss of orientation
Acting drunk

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51
Q

Hypoglycemia <

A

70 mg/dL

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52
Q

Signs of hypoglycemia

A

Shaking
Dizzy
Sweating
Hungry
Tachycardia
Decreased concentration
Confusion
Moody

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53
Q

Only DM oral for kids

A

Metformin

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54
Q

Garlic’s effect on blood sugar

A

Decreases

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55
Q

DM drug for pregnant/lactating

A

Insulin

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56
Q

Insulin actions

A

Stimulates glycogen synthesis
Drives glucose into cells
Lowers blood sugar

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57
Q

Insulin indications

A

DM 1 - replaces insulin due to damaged beta cells

DM 2 - when diet and exercise is not enough

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58
Q

Insulin contraindications

A

None!

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59
Q

Insulin adverse

A

Hypoglycemia from overdosing
Keto acidosis from underdosing

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60
Q

Insulin drug-drug

A

Beta blockers (for hyperT) mask hypoG effects

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61
Q

Insulin assessment

A

Physical, history, vitals
Urinalysis for sugar or ketones
Asthma, COPD, skin lesions, orientation, reflexes, consciousness
Diet, exercise, weight changes, footwear
Lab values - HbA1c for average blood sugar levels for last 3 months

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62
Q

Insulin diagnoses

A

Risk for unstable blood glucose
Imbalanced nutrition
Disturbed sensory perception
Risk for infection from injection
Risk for injury
Ineffective coping
Deficient knowledge

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63
Q

Insulin implementation

A

Diet and exercise
Introduce client to American Diabetic Association website
Gently rotate vial- don’t shake
Subcutaneous or inhaled
Teach: how and when to test glucose, when to seek medical help, F/Us, diary
Verify insulin name
2 nurse check
Administer with meal
Inspect feet
Store in dark dry place
Get family involved

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64
Q

Insulin evaluation

A

Stable glucose levels?
Complications?
Adverse effects?
Compliance?

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65
Q

Regular onset

A

30-60 minutes

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66
Q

Regular peak

A

2-4 hours

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67
Q

Regular duration

A

6-12 hr

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68
Q

NPH onset

A

60-90 minutes

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69
Q

NPH peak

A

4-12 hr

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70
Q

NPH duration

A

24 hr

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71
Q

Inhaled onset

A

12-15 minutes

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72
Q

Inhaled peak

A

60 minutes

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73
Q

Inhaled duration

A

2.5-3 hr

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74
Q

Lispro onset

A

< 15 minutes

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75
Q

Lispro peak

A

30-90 minutes

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76
Q

Lispro duration

A

2-5 hr

77
Q

Aspart onset

A

10-20 minutes

78
Q

Aspart peak

A

1-3 hr

79
Q

Aspart duration

A

3-5 hr

80
Q

Glargine onset

A

60-70 minutes

81
Q

Glargine peak

A

None

82
Q

Glargine duration

A

24 hr

83
Q

Glulisine onset

A

2-5 min

84
Q

Glulisine peak

A

30-90 minutes

85
Q

Glulisine duration

A

2 hr

86
Q

Detemir onset

A

1-2 hr

87
Q

Detemir peak

A

3-6 hr

88
Q

Detemir duration

A

5.7-23.3 hr

89
Q

Combo onset fast

A

30-60 min

90
Q

Combo peak fast

A

2-4 hr

91
Q

Combo duration fast

A

6-8 hr

92
Q

Combo onset long

A

1-2 hr

93
Q

Combo peak long

A

6-12 hr

94
Q

Combo duration long

A

18-24 hr

95
Q

Chlorpropamide

A

First gen sulfonylureas

96
Q

Glipizide

A

Second gen sulfonylureas

97
Q

Glyburide

A

Second gen sulfonylureas

98
Q

Sulfonylureas action

A

Increased binding to insulin receptors
Stimulate insulin release from beta
Only for type 2

99
Q

Sulfonylureas indications

A

DM 2 with diet and exercise

100
Q

Sulfonylureas contraindications

A

Allergy
DM complications- trauma, renal/hepatic disease, keto acidosis
Pregnancy and lactation
(Use insulin instead)

101
Q

Sulfonylureas adverse

A

HypoG, GI distress, allergic skin reaction

102
Q

Sulfonylureas drug-drug

A

Beta blockers, alcohol

103
Q

Prototype chlorpropramide onset, peak, duration

A

Oral
1 hr, 3-4 hr, 60 hr

104
Q

Prototype glyburide onset, peak, duration

A

Oral
1 hr, no peak, 24 hr

105
Q

Biguanide

A

Metformin

106
Q

DPP-4 Inhibitor

A

Sitagliptin

107
Q

GLP-1 Agonists

A

Dulaglutide
Liraglutide

108
Q

SGLT-2 Inhibitors

A

Canagliflozin

109
Q

During stress

A

Use insulin

110
Q

Unique adverse effect of “other” DM drugs

A

Increased chance of UTI due to it being excreted in urine

111
Q

Metformin onset, peak, duration

A

Slow, 2-2.5 hr, 10-16 hr

112
Q

Metformin actions

A

(With diet and exercise for type 2)
Increased insulin production
Increased peripheral use of glucose
Decreased hepatic glucose production
Alters intestinal absorption of glucose

113
Q

Metformin adverse

A

HypoG
Lactic acidosis
GI upset
Allergic skin reaction

114
Q

Liraglutide actions

A

(With diet and exercise for type 2)
Acts on beta to increase insulin release
Decrease glucagon release
Slows GI absorption
Stimulates satiety center to decrease appetite

115
Q

Liraglutide onset, peak, duration

A

(Subcutaneous)
Slow onset, 8-12 hr, 24 hr

116
Q

Liraglutide adverse

A

HypoG and GI upset

117
Q

Sitigliptin actions

A

Increase insulin release, decrease glucagon release, slow GI absorption

118
Q

Sitagliptin onset, peak, duration

A

(Oral)
Rapid onset, 1-4 hr, 10-16 hr

119
Q

Canagliflozin actions

A

Increased excretion of glucose from kidney- leads to decreased serum glucose levels

120
Q

Canagliflozin onset, peak, duration

A

(Oral)
Rapid onset, 1-2 hr, 10-16 hr

121
Q

Canagliflozin adverse

A

UTI
Genital fungal infection
HypoT
Dehydration

122
Q

Glucagon action

A

Increase blood glucose
Decrease insulin release
Increase breakdown of glycogen in liver to release glucose

123
Q

Glucagon indication

A

HypoG

124
Q

Glucagon contra

A

Allergy, pregnancy, lactation

125
Q

Glucagon adverse

A

GI upset, hyperG

126
Q

Glucagon drug-drug

A

Anticoagulants

127
Q

Glucagon onset, peak, duration

A

(IV)
1 min, 15 min, 9-20 min

128
Q

Ascorbic acid

A

Vitamin C
For wound healing
Assists in iron absorption

129
Q

Calcifediol

A

1 of vitamin Ds
Calcium absorption

130
Q

Cholecalciferol

A

1 of vitamin Ds
For calcium absorption

131
Q

Ergocalciferol

A

1 of vitamin Ds
Ca absorption

132
Q

Cyanocobalamin

A

Vitamin B12
For anemia, ETOH, vegans

133
Q

Niacin

A

For pellegra
To decrease lipids/cholesterol

134
Q

Phytomadione

A

Vitamin K
Warfarin antidote

135
Q

Thiamine

A

For ETOH

136
Q

Vitamin A

A

Wound healing

137
Q

Vitamin E

A

Wound healing

138
Q

Water soluble vitamins

A

Vitamin B complex
Vitamin C
Need everyday
Excreted in urine

139
Q

Fat soluble vitamins

A

“Don’t Always Eat Kale”
Vitamin D, A, E, K
Stored in liver

140
Q

Vitamin drug-drug

A

Fat soluble may not be absorbed if taken with mineral oil, cholestyramine, or colestipol

141
Q

Vitamin nursing diagnoses

A

Acute pain
GI discomfort
Risk for imbalanced nutrition
Knowledge deficit

142
Q

Signs of vitamin A deficiency

A

Weakened skin
Night blindness
Vision problems

143
Q

Signs of vitamin A toxicity

A

Mouth ulcers
Cracked fingernails
Bone pain
Decreased appetite
Cracked corners of mouth
Dizziness
Vision problems

144
Q

Signs of vitamin C deficiency

A

Scurvy, gingivitis, hair and tooth loss, bruising, nose bleeds

145
Q

Vitamin C adverse

A

Kidney stones, too much iron absorption leading to toxicity

146
Q

Signs of vitamin D deficiency

A

Rickets in kids
Osteomalacia in adults
Osteoporosis, tetany

147
Q

Cyanocobalamin deficiency

A

Anemia, cheillosis/stomatitis/glossitis
Tingling, unbalanced, memory and cognition problems

148
Q

Vitamin E toxicity

A

GI, headache, fatigue, easy bruise and bleed

149
Q

Niacin deficiency

A

Stomatitis/cheillosis/glossitis
Flushed skin (aspirin helps)
Itchy skin
GI problems

150
Q

Vitamin K toxicity

A

Jaundice, anemia, hyperbilirubinemia, kernicterus in infants

151
Q

Thiamine deficiency

A

Beriberi
Wernicke-Korskoff’s (alcoholic) encephalopathy
Peripheral neuritis

152
Q

Indirect Cholinergic AKA

A

Acetylcholinerase

153
Q

Indirect Cholinergic treat…

A

Alzheimer’s
Myasthenia gravis

154
Q

What are the Alzheimer’s drugs?

A

Donepezil
Galantamine
Rivastigmine

155
Q

What are the myasthenia gravis drugs?

A

Pyridostigmine
Neostigmine
Edrophonium

156
Q

What are the direct Cholinergic drugs?

A

Bethanechol
Carbachol
Cevimeline
Pilocarpine

157
Q

Ophthalmic Beta Adrenergic Blockers Suffix and examples

A

“-olol”
Betaxolol
Timolol

158
Q

How do Beta Adrenergic Blockers and Carbonic Anhydrase Inhibitors decrease IOP?

A

Decrease aqueous humor production

159
Q

How do Ophthalmic Prostaglandin Agonists decrease IOP?

A

Increase uveoscleral outflow.

160
Q

Ophthalmic Carbonic Anhydrase Inhibitors suffix and examples

A

“-zolamide”
Brinzolamide
Dorzolamide

161
Q

Ophthalmic Prostaglandin Agonist suffix and examples

A

“-prost“
Latanoprost
Travoprost
Bimatoprost

162
Q

“chlor”

A

Thiazides

163
Q

Mild diuretic

A

Thiazide

164
Q

Thiazide prototype

A

Hydrochlorothiazide

165
Q

High ceiling

A

Loop

166
Q

“ide”

A

Loop

167
Q

Blocks chloride pump

A

Loops and thiazides

168
Q

Loop prototype

A

Furosemide

169
Q

Prototype for carbonic anhydrase inhibitor diuretic

A

Acetazolamide

170
Q

MOA for carbonic anhydrase inhibitor diuretic

A

Decreases hydrogen movement

171
Q

Potassium sparing diuretics examples

A

Spironolactone
Triamterene

172
Q

Potassium sparing diuretics MOA

A

Na lost but K retained
Aldosterone antagonist (Spironolactone)

173
Q

Osmotic diuretic prototype

A

Mannitol

174
Q

Osmotic diuretic indications

A

Shock, trauma, OD leading to intracranial pressure and acute renal failure
Can also be given pre eye surg or during acute glaucoma attacks

175
Q

6 Ls of hypokalemia

A

Leg cramps
Lethargy
Limp muscles
Low shallow respirations
Lethal cardiac dysrhythmias
Lots of urine

176
Q

K rich foods

A

I know the banana spin pot song
Bananas
Spinach
Potato
Salt
Orange
Nuts
Grapefruit

177
Q

MOA for bile acid sequestrants

A

Binds bile acids in intestine
Leads to excretion instead of reabsorption of bile acids

178
Q

Bile acid sequestrant prototype

A

Cholestyramine

179
Q

“chole-“ or “cole-“

A

Bile acid sequestrants

180
Q

HMG-CoA Reductase inhibitors AKA

A

Statins

181
Q

Statin MOA

A

Block the cholesterol synthesizing enzyme in liver (HMG-CoA reductase)
Decreases cholesterol, serum LDL, and serum cholesterol
Increase HDL

182
Q

Statin prototype

A

Atorvastatin

183
Q

Don’t use grapefruit or St. John with…

A

Statins

184
Q

Cholesterol absorption inhibitors MOA

A

Decrease cholesterol absorption at small intestine, decreasing in liver, circulation, and overall cholesterol

185
Q

Cholesterol absorption inhibitor prototype

A

Ezetimibe

186
Q

“-ocumab”

A

PCSK9 inhibitors

187
Q

PCSK9 inhibitors MOA

A

Prevent PCSK9 from attaching to LDL site at liver cells

188
Q

For cholesterol meds, liver disease isn’t contraindicated in…

A

PCSK9 inhibitors because they are injected subcutaneously

189
Q

PCSK9 inhibitors prototype

A

Evolocumab

Pharmacology 1 (5 decks)

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