Exam 2 Flashcards
Intensive insulin regimens have proven their effectiveness with the greatest impact on lowering blood glucose. Which of these is an intensive insulin regimen?
When using the intensive insulin therapy approach, three to four injections are administered per day. This regimen involves 1:1 basal bolus dosing with long-acting insulin (LAI) or the new ultra long-acting insulin (ULAI) administered either at breakfast or bedtime with either rapid-acting insulin (RAI) or short-acting insulin (SAI) bolus doses before each meal. An intensive insulin therapy would include a basal/bolus insulin combination.
EX: Lantus and Lispro
To monitor the effectiveness of insulin lispro, the APN will instruct the patient to closely monitor which of these?
Postprandial glucose would be used to monitor the effectiveness of rapid-acting insulin (RAI). The RAIs are used as bolus insulin doses to correct hyperglycemia or to affect food eaten at meals, specifically carbohydrates.
Insulin
Caution, Contraindications, Pregnancy, Pediatrics
Caution: Hepatic dysfx, Renal Impairment, Hypo/Hyperthyroidism
Pregnancy & Pediatric approved
Glucagon
Pharmacodynamics, Contraindication
MOA: liver glucogenolysis
Contraindication:
- hypersensitivity to glucagon or lactose
- pts w/insulinoma or pheochromocytoma
Glucophage (Metformin)
drug class, MOA, Contraindications, Adverse Effects, Pregnancy/Breastfeeding, peds
Biguanides Insulin Sensitizer
- **Do not cause hypoglycemia
- **1st line treatment
MOA:
- ^Peripheral glucose uptake
- Decrease hepatic glucose production & intestinal absorption glucose
CONTRAINDICATIONS:
-Liver/Renal disease
ADVERSE EFFECTS:
- lactic acidosis (prevents lactate converted to glucose)
- GI upset: diarrhea/bloating/nausea/flatulence
- Vit B12 Deficiency
PREGNANCY & BREASTFEEDING: approved
PEDIATRICS: >10 years
Labs:
GFR
HbA1C
Ketones
Pioglitazone (Actos) Rosiglitazone (Avandia) Drug Class MOA Contraindications Black Box Warning Adverse Effects Drug Interaction Pregnancy/Lactation/children
Thiazolidinediones TZD Insulin Sensitizer
***Do not cause hypoglycemia
MOA:
- ^insulin sensitivity
- Insulin utilization in muscles, liver and ADIPOSE.
- decreases hepatic glucose production
Contraindications:
- Heart failure (Class III & IV)
- Liver Disease (ALT >2.5x normal limit)
Black Box Warning
- Bladder Cancer
- Hepatoxicity
- Heart Failure
Adverse Effects:
- fluid retention/weight gain*** monitor for HF
- Bone Fracture**
- Myalgia**
- URI**
- htn
Drug Interaction:
CYP34A = Birth Control
Pregnancy/Lactation/children NO!
How much can Pioglitazone lower A1C?
1.5 to 2%
There is some debate about the use of metformin in patients with type 1 diabetes mellitus (DM) because metformin is more effective in patients with which characteristics?
Tissue insensitivity to insulin
“Metformin increases peripheral glucose uptake and utilization (insulin sensitivity), which is not a feature of type 1 DM.”
Metformin should be discontinued and switched to a different medication for which reason?
Metformin is contraindicated with GFR below 30 mL/min.
Glipizide, Glyburide, Glimepiride Drug Class MOA Caution Contraindications #3 Adverse Effects #3 Pregnancy/lactation/peds Drug Interactions #2 Labs
Sulfonylureas
- **Insulin Secretagogues
- **Type 2 diabetics only
- **Prandial coverage
MOA:
- increase endogenous insulin release from beta cells
- Reduce glucose released from liver
Contraindications:
- Elderly (hypoglycemia)
- Sulfa allergy
- G6PD
Adverse Effects:
- Hypoglycemia
- Weight gain (Potentiates Antidiuretic Hormone)
- Blood Dyscrasia
Drug Interaction:
- Thiazide
- Sulfas
Pregnancy/lactation/peds: NO!
Labs:
- GFR
- HbA1C
- CBC
How. much do you expect A1C to be reduced using glipizide?
1-2%
Repaglinide (Prandin)
nateglinide (Starlix)
Drug Class Most effective at?? Patient Education MOA Contraindication pregnancy/lactation/peds Side Effects #4
Meglitinides
Insulin Secretagogues-Most effective at reducing postprandial glucose ***Quicker on quicker off
Patient education: Take 30mins before a meal,
skip meal skip dose
MOA:
- Block ATP-dep channels»_space; INCREASES CALCIUM»_space;pancreas secretes insulin
- Stimulate insulin release from beta cells
Contraindication:
-Elderly
Pregnancy/lactation/peds NO!
Adverse Effects:
- Hypoglycemia & Weight gain
- H/A
- Diarrhea
- Chest & back pain
Acarbose
Drug Class Patient education (3) MOA Adverse Effects (2) Caution Contraindication (2) preg/lact/peds
Alpha-Glucosidase Inhibitors
Patient Education: GI upset, “add on” therapy, take w/food, don’t give sucrose for hypoglycemia
MOA:
-inhibits absorption carbs in small bowel
Adverse Effects:
- GI upset
- Elevated serum transaminases (Monitor LFTs)
Caution:
Renal/Hepatic impairment
Contraindication:
-Bowel disease/predisposed to intestinal obstruction
PREGNANCY/LACTATION/peds NO!!
“-flozins”
Canagliflozin (Invokana)
Dapagliflozin
Drug Class MOA Adverse Effects #6 Contraindication #1 Black Box Warning preg/lact/peds Patient education Labs
Selective Sodium-Glucose Cotransporter 2 Inhibitors
(SGLT-2 Inhibitors)
“Flowin’”
MOA:
-Inhibit SGLT-2 in proximal tubule = urinary excretion of glucose
Adverse Effects
- Hyperkalemia
- GU: fungal infect/UTI/urinary frequency
- Hyperlipidemia
- Bladder Cancer
- Bone fracture
- 2-3x risk BKA
Contraindication:
Renal Failure
Black Box:
-Fournier’s gangrene
preg/lact/peds NO!
Education:
Monitor for new pain or sores
Labs:
- Potassium &
- Lipids
A 72 y/o male patient is taking an SGLT2 inhibitor for type 2 diabetes mellitus. The APN should be concerned if the patient reports which symptom?
Falls
A history of falls may suggest hypotension as a result of hypovolemia.
“-gliptins”
MOA (2) Caution preg/lact/peds adverse effects #4 Patient Education Drug Interaction Labs
Dipeptidyl Peptidase-4 Inhibitors
DPP-4 Inhibitors
MOA:
- Inhibit DPP-4 enzyme = prolonged (GLP1) incretin in GI tract = increase insulin synthesis & shut off glucagon
- Effect Pre & post prandial Blood glucose
Caution:
-Renal Impairment
Preg/lact/ped NO!
Adverse Effects:
- Pancreatitis (makes pancreas work harder)
- hypersensitivity
- Arthralgas
- hypoglycemia (when combined with secretagogue
Patient Education: Report abdominal pain (pancreatitis)
Drug Interaction:
-ACE = angioedema
Labs
- GFR
- HbA1C
“-tides”
Exenatide (Byetta), Liraglutide (Victoza)
Dulaglutide (Trulicity)
Drug Class MOA Adverse Effects Contraindication #2 Black box warning preg/lact/peds
GLP-1 Agonist
MOA:
- injection!
- mimis incretin = increase insulin secretion & decrease glucagon, slows gastric emptying
- protein binding
Adverse Effects:
-N/V/D
Contraindication:
ESRD
GI disease
Black Box Warning:
Thyroid tumor
preg/lact/ped NO
Levothyroxine
Patient Education
Caution (2) Contraindication (1) preg/lact/peds Adverse Effects Education
MOA:
Synthetic T4
Caution:
CVD
Adrenal insuff
Contraindications:
Recent MI
preg/lact/peds YES
Adverse Effects:
^HR ^BP insomnia etc etc
Education: Recheck 6-8 weeks
Methimazole (Tapazole) Indication MOA Adverse Effects #2 Caution preg lact peds
Indication: Hyperthyroidism
MOA:
Prevents production of Thyroid Hormone
Adverse Effects:
- Urticaria
- Blood Dyscrasia,
- Bone marrow suppression
Caution:
Other medications that can suppress bone marrow
preg: Do NOT use in 1st trimester
lact: lowest dose
peds: YES!
Propylthiouracil (PTU) Indication MOA Adverse Effects #2 Black Box warning preg lact peds caution #2
Indication: Hyperthyroidism
MOA:
- Prevents comversion of T4 to T3
- Highly protein-bound = more drug interactions
Adverse Effects:
- Urticaria
- Blood Dyscrasia
- GI upset
Black Box Warning:
Hepatotoxicity
preg: 1st trimester
lact: low dose
peds: No (undeveloped liver)
Caution:
- Increased bleeding risk
- Other meds that suppress bone marrow
Which symptom should be reported to the health-care provider and may be a reason to discontinue an antithyroid medication?
The most common potential adverse reaction is agranulocytosis. Patients are taught to report sore throat, fever, chills, rash, and unusual bleeding or bruising.
For the diabetic patient with hypothyroidism, the APN should expect to take which action?
Decrease Basal Insulin
Hypothyroidism may delay insulin turnover, requiring less insulin to treat diabetes mellitus.
Alpha-glucosidase inhibitors function by which primary mechanism of action?
Alpha-glucosidase inhibitors delay the absorption of complex CHO from the small bowel.
Canagliflozin should not be initiated in patients with which condition?
ESRD
Acarbose (Precose) has which feature?
Reduced postprandial peaks of plasma glucose
The APN would avoid use of saxagliptin (Onglyza) in which patient?
DPP-4 Inhibitor
Cases of acute pancreatitis have been reported with dipeptidyl peptidase-4 inhibitors (DPP-4) inhibitors such as saxagliptin.
It should be avoided in a patient with history of pancreatitis.
Which oral medication has the most potential for hypoglycemia?
Sulfonylurea (glipizide, glyburide, glimepiride)
All sulfonylureas may produce severe hypoglycemia.
A patient with type 2 diabetes mellitus (DM) is taking a rapid-acting insulin before meals and an alpha-glucosidase inhibitor three times a day. Her blood glucose log reveals a fasting glucose of 50 on several occasions. The APN instructs the patient that which of these will increase glucose levels when the patient is experiencing hypoglycemia?
Treatment of hypoglycemia cannot be accomplished with the usual ingestion of sucrose, fructose, or starches because alpha-glucosidase inhibitors delay the absorption of these disaccharides.
SHE NEEDS GLUCAGON
"-prils" 3 highlights racial consideration Indication MOA (3) Contraindication (3) preg/lact peds side effects Monitoring Parameters
ACE inhibitor ***Renal protective for DM ***1st line Tx for HF (Cardioprotective) ***if bp goes up it's because kidneys are not working Racial consideration: More adverse reactions in Black/Asian
Indication: HTN, hypertensive proteinuric diabetes, IHD, post-MI, HF
MOA:
ACE inhibit…
-inhibit bradykinin degradation
-^^synthesis of vasodilating prostaglandins
Contraindication:
- bilateral renal artery stenosis****
- idiopathic angioedema
- Do NOT USE WITH ARBS
Side Effect:
- cough
- Angioedema
- ^^K+ (r/t shutting down RASS)
- rash (hypersensitivity), altered taste, hypotension
preg/lact NO!
peds >6yrs
Monitoring: If BP goes up its r/t renal stenosis
"-sartans" Indication MOA Caution (2) Contraindication (2) preg/lact peds adverse effects
Angiotensin Receptor Blocker (ARB)
Indication: htn, hypertensive proteinuric diabetes, angina, IHD, post-MI, HF
MOA:
ARB
Shuts down RAS (holds onto K+ and excrete NA+
Caution:
- Other meds that cause ^^^K+ hyperkalemia
- renal/hepatic impairment
Contraindication:
- bilateral renal artery stenosis
- DO NOT USE WITH ACE
preg/lact NO!
peds >6yrs
adverse effects:
- dizzy, hypotension, fatigue
- ^^^K+ hyperkalemia
- URI
What are the calcium channel blockers?
Dihydropyridines
(Nifedipine, Amlodipine)
Non-dihydropyridines
(Verapamil, Diltiazem)
-pines
Nifedepine (Procardia)
Amlodipine (Norvasc)
Felodipine (Plendil)
Drug class Highlights (2) Indication (2) MOA Contraindication Black Box preg peds racial concerns adverse reactions
Calcium Channel Blocker
dihydro (for BP or you will DI from htn)
DO NOT DEPRESS SA/AV NODES
****no direct effect on heart, SMOOTH MUSCLE RELAXATION because you don’t have the calcium in your muscle…makes muscles more leaky = peripheral edema/increasing workload of heart = WHY WE DON’T USE IN HF
Indication: HTN & angina
MOA:
- inhibit calcium ion from crossing cell membrane = smooth muscle relaxation
- CYP450 system
CONTRAINDICATION:
- patients with peripheral edema (increases workload on heart)
- unstable angina/post MI/HF
BLACK BOX:
Nifedipine high mortality post-MI
PREG: Nifedipine only
peds: >6yrs
Racial concerns:
1st choice for blacks
Adverse Reactions:
flushing, dizzy, h/a, hypotension,
Peripheral Edema
Verapamil
Diltiazem (Cardizem)
Drug class highlights (1) Indication (3) MOA Contraindication (4) preg/lact Adverse Effects (4)
Non-dihydropyridines (Calcium channel blocker)
**Depresses SA/AV nodes
Indication:
angina
htn
afib/SVT
MOA:
inhibit Ca+ crossing cell membrane = smooth muscle relaxation & coronary vasodilation
-negative inotrope, negative chronotrope
Contraindication: EF <40% Ventricular dysfunction SA/AV disturbances SBP <90
preg/lact: NO!!
Adverse Effects: Edema h/a gingival hyperplasia constipation (smooth muscle effects)
Which suffix is best associated with DPP-4 inhibitors?
-gliptin
What MOA best describes sitagliptin (januvia) ?
Increases Insulin release
What is a consideration when prescribing sitagliptin (januvia)
“add-on agent”
A new patient presents today for evaluation of hypertension. The patient states that he has been feeling weak and thinks that his heartbeat is irregular at times. The APN notes that the patient is being treated with lisinopril and spironolactone. Which condition would the APN most likely suspect?
Hyperkalemia
In this patient scenario, the patient is taking an angiotensin-converting enzyme inhibitor (ACEI) and a potassium-sparing diuretic. Concurrent administration of potassium-sparing diuretics and ACEIs may lead to significant hyperkalemia.
What kind of diet would you recommend to someone on a potassium sparing diuretic or ACE-inhibitor?
Low Potassium
All calcium channel blockers (CCBs) are in which pregnancy category?
Pregnancy Category C
CCBs are Pregnancy Category C. Female patients capable of childbearing should be made aware of the risks of these drugs, and contraception should be instituted before CCBs are prescribed. They should be used only when benefits clearly outweigh risks.
A patient with left ventricular dysfunction is taking a calcium channel blocker (CCB) and a beta blocker (BB). This combination may induce which condition?
Heart Failure & Bradycardia
Combinations of BBs and CCBs have been shown to be more effective than the individual drugs used alone. However, these combinations are questionable for patients with left ventricular dysfunction because together they may induce heart failure or bradycardia. Verapamil and diltiazem also should be avoided in these combinations.
Calcium channel blockers (CCBs) are indicated to treat which condition?
Chronic Angina
Both type 1 and type 2 CCBs are effective in the treatment of stable and exertional angina. They act on both sides of the supply–demand equation: peripheral vasodilation and negative inotropism reduce oxygen demand; dilation of coronary arteries increases oxygen supply.
The highest rate of adverse reactions is found in which calcium channel blocker (CCB)?
Nifedipine
Which action should be considered when planning the management of angiotensin II receptor blockers (ARBs) or ACE-I?
Stop diuretics 2-3 days to allow hydration before starting ARB or ACE-I to reduce risk of adverse effects
Which adverse reaction is uncommon with use of angiotensin-converting enzyme inhibitors (ACEIs)?
Blood Dyscrasia
Which medication sometimes induces a lupus-like syndrome that appears to be dose-related with an incidence highest in white women?
Hydralazine
Which calcium channel blocker (CCB) is the drug of choice during lactation if a CCB is required?
Nifedipine
First-generation antihistamines are contraindicated in patients with which condition
contraindicated in patients with narrow-angle glaucoma, lower-respiratory tract symptoms (they thicken secretions and impair expectoration), stenosing peptic ulcer, BPH, bladder neck obstruction, pyloroduodenal obstruction, and (MAOI) use.
Which medication is used to treat seasonal allergic rhinitis and vasomotor rhinitis?
Azelastine (Astelin, Astepro) and olopatadine (Patanase)
are the intranasal histamine (H1) blockers currently available in the United States. They are used for the treatment of seasonal allergic rhinitis and
vasomotor rhinitis. Afrin causes rebound decongestion.
Which statement about long-acting beta agonists (LABAs) is most accurate?
LABAs should be used for the shortest duration of time required to achieve control of asthma symptoms and discontinued, if possible, once asthma control is achieved. Patients should then be maintained on an asthma controller medication.
Pediatric and adolescent patients who require the addition of a LABA to an inhaled corticosteroid should use a combination product containing both an inhaled corticosteroid and a LABA to ensure compliance with both medications.
A patient who has been diagnosed with asthma presents today for follow-up. She states that she has been using a short-acting beta2 agonist (SABA) four times a week. Which action taken by the APN is most appropriate?
Add a low-dose inhaled corticosteroid.
In 2009, the U.S. Food and Drug Administration (FDA) established a recommendation that patients be informed of the potential for neuropsychiatric events associated with which drug?
Leukotriene modifiers
neuropsychiatric events include agitation, aggression, anxiousness, dream abnormalities and hallucinations, depression, insomnia, irritability, restlessness, suicidal thinking and behavior (including suicide), and tremor
A patient has just been prescribed azelastine for her allergic rhinitis. She asks about driving with this medication. Which response by the APN is most appropriate?
“You may feel sleepy with azelastine, so you should not drive when using it.”
Patients should not use alcohol or other central nervous system (CNS) depressants while using azelastine.
The nurse practitioner has prescribed zafirlukast (Accolate) to a 12-year-old for asthma control. Which is a common adverse effect of this medication?
The most common adverse effect of zafirlukast is headache.
What is a common side effect of zileuton?
Dyspepsia
Albuterol
“think of what stimulating the adrenergic system does”
Drug Class Indication MOA Contraindication #2 Caution #4 Side Effects peds
Short Acting Beta2 Agonist (SABA)
Indication: Asthma, COPD
MOA: activate beta2 by relaxing smooth muscle & increasing volume, capacity, and airflow
Contraindication:
- avoid in arrhythmia,
- pheochromocytoma (massive release of catecholamines (epi/norepi)=severe htn),
Caution:
- CVD (CHF, htn),
- DM (increases blood sugar = increase diabetic needs), -Glaucoma (increase in BP = increases eye pressure),
- Hyperthyroidism (stimulates thyroid)
Albuterol Safe in all ages
Used 3+ days per week = asthma not well controlled
What would you give to an asthmatic that could handle the side effects of albuterol? Why?
Levalbuterol (Zopenex)
more selective so less beta1 activation
Semeterol (Serevent)
Drug class Indication Caution Block box warning Age range
Long Acting Beta2 Agonist (LABA)
Indication: Asthma, COPD
Caution: Hyperglycemia
BLACK BOX: should not be used as monotherapy = 2x increase in catastrophic events
Contraindicated if there is not another controller medication like steroid
- Digitalis glycosides
- Beta Blockers
Peds >4yrs old
What asthma reliever medication would you give to pregnant person?
Terbutaline is safe in pregnancy
Steps to prescribing for asthma
Step 1: Always start with SABA, if 3+ days/wk…
Step 2: Maintenance: inhaled corticosteroids, still not managed
Step 3: LABA
beta blockers MR BEAN is selective and has no Nads
If they have asthma and need to be on a beta blocker it NEEDS TO BE A MR BEAN (selective beta blockers)
including beta blocker eye drops
Theophylline
Drug class Indication MOA #2 Patient Education Toxicity s/s Contraindications #4
“Theo shouldn’t drink coffee”
Indication: Asthma, COPD
MOA: Relaxation of bronchial smooth muscle, general sympathomimetic agent (increasing SNS)
-CYP450 system and converted into caffeine
Patient Education:
- *inducers speed up metabolism into caffeine!
- *Smoking increases the excretion and increase BP and more blood through kidneys
- *Narrow therapeutic index
Over range: N/V/D
HIGHER toxic: seizure, cardiac, hypotension
Contraindication:
- hypersensitivity,
- SZ disorders,
- -PUD,
- decrease appetite (puts you in fight or flight)
Ipratropium bromide (Atrovent)
Drug Class Indication MOA Contraindication (2) Side Effects
Short-Acting Anticholinergics (SAMA)
Short acting muscarinic antagonist
-Ipratropium (I=immediate release)
Asthma Exacerbation (like Combivent/DuoNeb),»_space;»COPD««
MOA: Blocks muscarinic acetylcholine receptor
“blocks cholinergic receptors…(acetylcholine not absorbed (PNS-rest and digest) = Cholinergic Effects
Contraindication:
Legume allergy,
Cholinergic Effects
Side Effect: Cholinergic Effects
Tiotropium Bromide (Spiriva) Aclidinium bromide (Tudorza Pressair)
Drug Class Indication MOA Contraindications Side Effects
Long-Acting Anticholinergic (LAMA)
Indication: COPD (Maintenance)
MOA: Muscarinic M3 antagonist
Contraindication: **anticholinergic Effects (not for glaucoma, BPH, urinary retention etc), not to be used for exacerbations
Side Effects: Anticholinergic Effects (dry mouth, cough, constipation)
What are the cholinergic Effects?
“can’t think, see, spit, pee, poop”
Confusion/dizzy Blurred Vision Dry mouth urinary retention constipation
Steps to prescribing for COPD
Step 1: SABA, SAMA or Combination of both
Step 2: Maintenance LABA or LAMA or Combination of both
Step 3: if an increase in exacerbations: Corticosteroids to reduce # of exacerbations
Zafirlukast
Montelukast (Singulair)
Drug Class Indication MOA Contraindication Side Effects #2 Patient Education #2 Pregnancy Peds
Leukotrine receptor Antagonists
Indication: Allergic Rhinitis, or someone’s allergies are causing asthma to worsen
MOA: Blocks cysteinyl leukotriene receptor (CysLT1)= prevents inflammatory processes from happening
Contraindication:
If it starts w/ “Z”afirlukast/Zileuton can’t take with liver issues monitor LFTs
Montelukast should not take if SEVERE LIVER DISEASE,
Side Effects: Headache, Neuropsychiatric symptoms
Patient Education:
Neuropsychiatric symptoms (AMS, depression, agitation),
Take at night
Pregnant: NO!
Peds: Montelukast preferred
Ages for prescribing Leukotrine Modifiers
Montelukast 1+ yrs
Zafirlukast 5+ yrs
Zileuton 12+ yrs
Zileuton
Drug class Indication MOA Side Effects Education
Leukotriene Modifier
Indication: Chronic Asthma/allergies
MOA: inhibits enzyme (5-liopoxygenase) that produces leukotrienes = reduce inflame, edema, mucus, bronchoconstriction
Side effects: headache, Neuropsych events
Patient Education Monitor ALT (hard on liver)
Fluticasone (Flovent (inh)) or Flonase (nasal)) “-sone” Budesonide (Pulmicort)
Indication MOA #3 Contraindication #2 preg adverse #4 Education #2
Corticosteroids
Indication: Asthma, COPD, allergic rhinitis (intranasal)
MOA:
- Extremely vasoconstrictive and
- Anti-inflammatory activity,
- decreases airway responsiveness
Contraindication:
asthma exacerbation,
active infection (don’t want to suppress immune system),
Pregnancy NO!
Adverse: hoarse, oral candidiasis, irritation, urticaria
Education:
- Rinse mouth after!!!
- High dose for a long time watch HYPERGLYCEMIA and HYPOKALEMIA and WEIGHT GAIN
Cromolyn Sodium
Drug Class Indication MOA Education Contraindication Peds Inhaled & Intranasal side effects
Inhaled antiinflammatory agent
Indication: bronchospasm, exercise induced bronchospasm (people who need something for after soccer practice everyday)
MOA: Mast cell stabilizer/degranulation inhibitor
Education: take before soccer practice
Contraindication: not for exacerbation (prophylaxis only)
Peds >2yrs
Inhaled side effects: drowsy, bronchospasm, cough
Intranasal side effects: nasal irritation
Diphenyhydramine (Benadryl)
Drug Class Indication MOA Contraindication peds
First generation Antihistamine
Indication: allergic rhinitis, hypersensitivity reactions, insomnia, seasickness
MOA: Block H1 receptors …crosses blood-brain barrier
Contraindication: Avoid in glaucoma, BPH, CNS depressants (related to anticholinergic effects)
Paradoxical effect with children
>2yrs
DON’T TAKE IN LACTATION
Adverse Effects: sedation, urinary retention, dry mouth, blurred vision “anticholinergic effects”
Certizine
Loratadine
“ine”
Drug class
Indication
MOA
Fun fact about certirizine
Second-Generation Antihistamine
Certizine, Loratadine, “-ine”
Indication: Respiratory allergies & urticaria
MOA: Block H1 receptor NO ANTICHOLINERGIC EFFECTS
Certirizine: fastest onset and least metabolized by CYP450, less drug interactions, kids 6 months+
Loratadine Age 2+
phenylephrine & Pseudoephedrine
Indication MOA Contraindication #4 peds Side Effects
Decongestant
Systemic
MOA: sympathomimetic agent, Alpha1 agonist, potent vasoconstrictor
(alpha 1= “on” switch for fight or flight)
Contraindication:
- severe htn
- CAD,
- MAOI
- Beta-blockers (don’t increase SNS if you are on a drug that’s blocking it)
Peds >4yrs
Side Effects: “meth heads’
What decongestant is safe for cardiac patients?
phenylephrine (much less potent)
What is Verapamil? A unique side effect?
Non-dihydro Ca++ Channel blocker
Antiarrythmic
Lowers sphincter tone = ^^GERD s/s
HCTZ
Drug Class Indication MOA #2 Location Fun fact Side Effects #3 Special Patient Considerations
Diuretic
Indication: htn, mild fluid retention
Hardest on Kidneys
MOA: Blocks reabsorption of sodium and Cl- = keeping Na+ in urine and H2O stays in urine
CYP450 metabolizer
Location: distal convoluted tubule
Fun Fact: Maintenance, long-lasting effect not brisk
Important Side Effects: hypokalemia, hyperglycemia (DM), hyperuricemia (gout) Hyperlipidemia
Special patient considerations: Hyperlipidemia
Furosemide
Drug class Indication MOA Location Side effect #3 Contraindication #2
Loop diuretic
Indication: Acute exacerbation
*best option for renal dysfx
MOA: Blocks reabsorption of Na+ & Cl-
Location: LOOP OF HENLE (most water is absorbed here = shut down = profound effect)
Side effect:
hypokalemia,
hyperuricemia (gout),
ototoxicity
Contraindication:
- anuric
- Sulfa allergy
Aldactone (Spironolactone)
Indication MOA Location Fun Fact Side Effects #3
Indication: edema r/t HF
MOA: inhibits reabsorption of Na+ & excretion of K+
Location: early collecting duct
Fun fact: aldosterone antagonist (anti androgen effects)
Side effects:
- Hyperkalemia,
- Gynecomastia/menstrual irregularities (anti androgen effects),
- hyperuricemia
Ranexa
Caution
MOA
Drug Interaction
anti anginal/refractory angina
-last resort
Caution: QT interval
MOA: restrict late sodium flow in the myocytes
- improve O2 demand
- no effect on BP
Drug Interaction: Do not use with CYP450 inducers
Hydralazine
Indication #2
MOA
Side Effects #3
Contraindication
Vasodilator
Indication:
hypertensive crisis,
HF (need to be on BB and diuretic (to prevent peripheral edema))
MOA: dilate smooth muscles & vasculature
Adverse Effects:
- Reflex tachycardia (therefore could cause angina)
- Lupus syndrome,
- fluid retention/peripheral edema
Contraindicated:
-CAD
