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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
Donepezil
For Alzheimer’s
26
Rivastigmine
For Alzheimer’s
27
Galantamine
For Alzheimer’s
28
Neostigmine
For myasthenia gravis
29
Pyridostigmine
For myasthenia gravis
30
Edrophonium
Diagnostic agent for myasthenia gravis
31
Bethanechol
For urinary retention
32
Carbachol
For glaucoma
33
Cevimeline
For dry mouth
34
Pilocarpine
For dry mouth
35
Cycloplegia
Inability to focus on objects up close
36
Belladonna
Plant from which Anticholinergic drugs come
37
Receptor(s) Anticholinergic block
Cholinergic receptors in sympathetic Only muscarinic in parasympathetic Not nicotinic
38
Stenosing
Narrowing
39
Cholinergic agonists, drug-drug
Acetylcholinerase - increases effects NSAIDS increase bleeding Other Cholinergic drugs increase effects
40
Anticholinergic drug-drug
Antihistamines, antiparkinsonian, MAOI, TCAs
41
Hyperglycemia >
126 mg/dL
42
Atherosclerosis
MI and strokes from plaque in vessels
43
Retinopathy
Vision loss from narrowing eye vessels
44
Neuropathy
Motor and sensory changes to nerves due to decreased oxygen; Pain, numbness, tingling
45
Nephropathy
Renal dysfunction
46
Beta cells still work in
DM 2
47
Polyuria
Increased pee
48
Polydipsia
Increased thirst
49
Polyphagia
Increased hunger
50
Signs of dangerous hyperglycemia
Fruity breath Dehydration Kussmar’s respiration- slow, deep Loss of orientation Acting drunk
51
Hypoglycemia <
70 mg/dL
52
Signs of hypoglycemia
Shaking Dizzy Sweating Hungry Tachycardia Decreased concentration Confusion Moody
53
Only DM oral for kids
Metformin
54
Garlic’s effect on blood sugar
Decreases
55
DM drug for pregnant/lactating
Insulin
56
Insulin actions
Stimulates glycogen synthesis Drives glucose into cells Lowers blood sugar
57
Insulin indications
DM 1 - replaces insulin due to damaged beta cells DM 2 - when diet and exercise is not enough
58
Insulin contraindications
None!
59
Insulin adverse
Hypoglycemia from overdosing Keto acidosis from underdosing
60
Insulin drug-drug
Beta blockers (for hyperT) mask hypoG effects
61
Insulin assessment
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
62
Insulin diagnoses
Risk for unstable blood glucose Imbalanced nutrition Disturbed sensory perception Risk for infection from injection Risk for injury Ineffective coping Deficient knowledge
63
Insulin implementation
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
64
Insulin evaluation
Stable glucose levels? Complications? Adverse effects? Compliance?
65
Regular onset
30-60 minutes
66
Regular peak
2-4 hours
67
Regular duration
6-12 hr
68
NPH onset
60-90 minutes
69
NPH peak
4-12 hr
70
NPH duration
24 hr
71
Inhaled onset
12-15 minutes
72
Inhaled peak
60 minutes
73
Inhaled duration
2.5-3 hr
74
Lispro onset
< 15 minutes
75
Lispro peak
30-90 minutes
76
Lispro duration
2-5 hr
77
Aspart onset
10-20 minutes
78
Aspart peak
1-3 hr
79
Aspart duration
3-5 hr
80
Glargine onset
60-70 minutes
81
Glargine peak
None
82
Glargine duration
24 hr
83
Glulisine onset
2-5 min
84
Glulisine peak
30-90 minutes
85
Glulisine duration
2 hr
86
Detemir onset
1-2 hr
87
Detemir peak
3-6 hr
88
Detemir duration
5.7-23.3 hr
89
Combo onset fast
30-60 min
90
Combo peak fast
2-4 hr
91
Combo duration fast
6-8 hr
92
Combo onset long
1-2 hr
93
Combo peak long
6-12 hr
94
Combo duration long
18-24 hr
95
Chlorpropamide
First gen sulfonylureas
96
Glipizide
Second gen sulfonylureas
97
Glyburide
Second gen sulfonylureas
98
Sulfonylureas action
Increased binding to insulin receptors Stimulate insulin release from beta Only for type 2
99
Sulfonylureas indications
DM 2 with diet and exercise
100
Sulfonylureas contraindications
Allergy DM complications- trauma, renal/hepatic disease, keto acidosis Pregnancy and lactation (Use insulin instead)
101
Sulfonylureas adverse
HypoG, GI distress, allergic skin reaction
102
Sulfonylureas drug-drug
Beta blockers, alcohol
103
Prototype chlorpropramide onset, peak, duration
Oral 1 hr, 3-4 hr, 60 hr
104
Prototype glyburide onset, peak, duration
Oral 1 hr, no peak, 24 hr
105
Biguanide
Metformin
106
DPP-4 Inhibitor
Sitagliptin
107
GLP-1 Agonists
Dulaglutide Liraglutide
108
SGLT-2 Inhibitors
Canagliflozin
109
During stress
Use insulin
110
Unique adverse effect of “other” DM drugs
Increased chance of UTI due to it being excreted in urine
111
Metformin onset, peak, duration
Slow, 2-2.5 hr, 10-16 hr
112
Metformin actions
(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
Metformin adverse
HypoG Lactic acidosis GI upset Allergic skin reaction
114
Liraglutide actions
(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
Liraglutide onset, peak, duration
(Subcutaneous) Slow onset, 8-12 hr, 24 hr
116
Liraglutide adverse
HypoG and GI upset
117
Sitigliptin actions
Increase insulin release, decrease glucagon release, slow GI absorption
118
Sitagliptin onset, peak, duration
(Oral) Rapid onset, 1-4 hr, 10-16 hr
119
Canagliflozin actions
Increased excretion of glucose from kidney- leads to decreased serum glucose levels
120
Canagliflozin onset, peak, duration
(Oral) Rapid onset, 1-2 hr, 10-16 hr
121
Canagliflozin adverse
UTI Genital fungal infection HypoT Dehydration
122
Glucagon action
Increase blood glucose Decrease insulin release Increase breakdown of glycogen in liver to release glucose
123
Glucagon indication
HypoG
124
Glucagon contra
Allergy, pregnancy, lactation
125
Glucagon adverse
GI upset, hyperG
126
Glucagon drug-drug
Anticoagulants
127
Glucagon onset, peak, duration
(IV) 1 min, 15 min, 9-20 min
128
Ascorbic acid
Vitamin C For wound healing Assists in iron absorption
129
Calcifediol
1 of vitamin Ds Calcium absorption
130
Cholecalciferol
1 of vitamin Ds For calcium absorption
131
Ergocalciferol
1 of vitamin Ds Ca absorption
132
Cyanocobalamin
Vitamin B12 For anemia, ETOH, vegans
133
Niacin
For pellegra To decrease lipids/cholesterol
134
Phytomadione
Vitamin K Warfarin antidote
135
Thiamine
For ETOH
136
Vitamin A
Wound healing
137
Vitamin E
Wound healing
138
Water soluble vitamins
Vitamin B complex Vitamin C Need everyday Excreted in urine
139
Fat soluble vitamins
“Don’t Always Eat Kale” Vitamin D, A, E, K Stored in liver
140
Vitamin drug-drug
Fat soluble may not be absorbed if taken with mineral oil, cholestyramine, or colestipol
141
Vitamin nursing diagnoses
Acute pain GI discomfort Risk for imbalanced nutrition Knowledge deficit
142
Signs of vitamin A deficiency
Weakened skin Night blindness Vision problems
143
Signs of vitamin A toxicity
Mouth ulcers Cracked fingernails Bone pain Decreased appetite Cracked corners of mouth Dizziness Vision problems
144
Signs of vitamin C deficiency
Scurvy, gingivitis, hair and tooth loss, bruising, nose bleeds
145
Vitamin C adverse
Kidney stones, too much iron absorption leading to toxicity
146
Signs of vitamin D deficiency
Rickets in kids Osteomalacia in adults Osteoporosis, tetany
147
Cyanocobalamin deficiency
Anemia, cheillosis/stomatitis/glossitis Tingling, unbalanced, memory and cognition problems
148
Vitamin E toxicity
GI, headache, fatigue, easy bruise and bleed
149
Niacin deficiency
Stomatitis/cheillosis/glossitis Flushed skin (aspirin helps) Itchy skin GI problems
150
Vitamin K toxicity
Jaundice, anemia, hyperbilirubinemia, kernicterus in infants
151
Thiamine deficiency
Beriberi Wernicke-Korskoff’s (alcoholic) encephalopathy Peripheral neuritis
152
Indirect Cholinergic AKA
Acetylcholinerase
153
Indirect Cholinergic treat…
Alzheimer’s Myasthenia gravis
154
What are the Alzheimer’s drugs?
Donepezil Galantamine Rivastigmine
155
What are the myasthenia gravis drugs?
Pyridostigmine Neostigmine Edrophonium
156
What are the direct Cholinergic drugs?
Bethanechol Carbachol Cevimeline Pilocarpine
157
Ophthalmic Beta Adrenergic Blockers Suffix and examples
“-olol” Betaxolol Timolol
158
How do Beta Adrenergic Blockers and Carbonic Anhydrase Inhibitors decrease IOP?
Decrease aqueous humor production
159
How do Ophthalmic Prostaglandin Agonists decrease IOP?
Increase uveoscleral outflow.
160
Ophthalmic Carbonic Anhydrase Inhibitors suffix and examples
“-zolamide” Brinzolamide Dorzolamide
161
Ophthalmic Prostaglandin Agonist suffix and examples
“-prost“ Latanoprost Travoprost Bimatoprost
162
“chlor”
Thiazides
163
Mild diuretic
Thiazide
164
Thiazide prototype
Hydrochlorothiazide
165
High ceiling
Loop
166
“ide”
Loop
167
Blocks chloride pump
Loops and thiazides
168
Loop prototype
Furosemide
169
Prototype for carbonic anhydrase inhibitor diuretic
Acetazolamide
170
MOA for carbonic anhydrase inhibitor diuretic
Decreases hydrogen movement
171
Potassium sparing diuretics examples
Spironolactone Triamterene
172
Potassium sparing diuretics MOA
Na lost but K retained Aldosterone antagonist (Spironolactone)
173
Osmotic diuretic prototype
Mannitol
174
Osmotic diuretic indications
Shock, trauma, OD leading to intracranial pressure and acute renal failure Can also be given pre eye surg or during acute glaucoma attacks
175
6 Ls of hypokalemia
Leg cramps Lethargy Limp muscles Low shallow respirations Lethal cardiac dysrhythmias Lots of urine
176
K rich foods
I know the banana spin pot song Bananas Spinach Potato Salt Orange Nuts Grapefruit
177
MOA for bile acid sequestrants
Binds bile acids in intestine Leads to excretion instead of reabsorption of bile acids
178
Bile acid sequestrant prototype
Cholestyramine
179
“chole-“ or “cole-“
Bile acid sequestrants
180
HMG-CoA Reductase inhibitors AKA
Statins
181
Statin MOA
Block the cholesterol synthesizing enzyme in liver (HMG-CoA reductase) Decreases cholesterol, serum LDL, and serum cholesterol Increase HDL
182
Statin prototype
Atorvastatin
183
Don’t use grapefruit or St. John with…
Statins
184
Cholesterol absorption inhibitors MOA
Decrease cholesterol absorption at small intestine, decreasing in liver, circulation, and overall cholesterol
185
Cholesterol absorption inhibitor prototype
Ezetimibe
186
“-ocumab”
PCSK9 inhibitors
187
PCSK9 inhibitors MOA
Prevent PCSK9 from attaching to LDL site at liver cells
188
For cholesterol meds, liver disease isn’t contraindicated in…
PCSK9 inhibitors because they are injected subcutaneously
189
PCSK9 inhibitors prototype
Evolocumab

Pharmacology 1 (5 decks)

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