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Advanced Pharmacology > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Intensive insulin regimens have proven their effectiveness with the greatest impact on lowering blood glucose. Which of these is an intensive insulin regimen?

A

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

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2
Q

To monitor the effectiveness of insulin lispro, the APN will instruct the patient to closely monitor which of these?

A

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.

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3
Q

Insulin

Caution, Contraindications, Pregnancy, Pediatrics

A

Caution: Hepatic dysfx, Renal Impairment, Hypo/Hyperthyroidism
Pregnancy & Pediatric approved

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4
Q

Glucagon

Pharmacodynamics, Contraindication

A

MOA: liver glucogenolysis

Contraindication:

  • hypersensitivity to glucagon or lactose
  • pts w/insulinoma or pheochromocytoma
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5
Q

Glucophage (Metformin)

drug class, MOA, Contraindications, Adverse Effects, Pregnancy/Breastfeeding, peds

A

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

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6
Q 
Pioglitazone (Actos) Rosiglitazone (Avandia)
Drug Class
MOA
Contraindications
Black Box Warning
Adverse Effects
Drug Interaction
Pregnancy/Lactation/children
A

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!

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7
Q

How much can Pioglitazone lower A1C?

A

1.5 to 2%

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8
Q

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?

A

Tissue insensitivity to insulin

“Metformin increases peripheral glucose uptake and utilization (insulin sensitivity), which is not a feature of type 1 DM.”

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9
Q

Metformin should be discontinued and switched to a different medication for which reason?

A

Metformin is contraindicated with GFR below 30 mL/min.

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10
Q 
Glipizide, Glyburide, Glimepiride
Drug Class
MOA
Caution
Contraindications #3
Adverse Effects #3
Pregnancy/lactation/peds
Drug Interactions #2
Labs
A

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
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11
Q

How. much do you expect A1C to be reduced using glipizide?

A

1-2%

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12
Q

Repaglinide (Prandin)
nateglinide (Starlix)

Drug Class
Most effective at??
Patient Education
MOA
Contraindication
pregnancy/lactation/peds
Side Effects #4
A

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&raquo_space; INCREASES CALCIUM&raquo_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
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13
Q

Acarbose

Drug Class
Patient education (3)
MOA
Adverse Effects (2)
Caution
Contraindication (2)
preg/lact/peds
A

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!!

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14
Q

“-flozins”
Canagliflozin (Invokana)
Dapagliflozin

Drug Class
MOA
Adverse Effects #6
Contraindication #1
Black Box Warning
preg/lact/peds
Patient education
Labs
A

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
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15
Q

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?

A

Falls

A history of falls may suggest hypotension as a result of hypovolemia.

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16
Q

“-gliptins”

MOA (2)
Caution
preg/lact/peds
adverse effects #4
Patient Education
Drug Interaction
Labs
A

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
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17
Q

“-tides”
Exenatide (Byetta), Liraglutide (Victoza)
Dulaglutide (Trulicity)

Drug Class
MOA
Adverse Effects
Contraindication #2
Black box warning
preg/lact/peds
A

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

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18
Q

Levothyroxine

Patient Education

Caution (2)
Contraindication (1)
preg/lact/peds
Adverse Effects
Education
A

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

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19
Q 
Methimazole (Tapazole)
Indication
MOA
Adverse Effects #2
Caution
preg
lact
peds
A

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!

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20
Q 
Propylthiouracil (PTU)
Indication
MOA
Adverse Effects #2
Black Box warning
preg
lact
peds
caution #2
A

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
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21
Q

Which symptom should be reported to the health-care provider and may be a reason to discontinue an antithyroid medication?

A

The most common potential adverse reaction is agranulocytosis. Patients are taught to report sore throat, fever, chills, rash, and unusual bleeding or bruising.

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22
Q

For the diabetic patient with hypothyroidism, the APN should expect to take which action?

A

Decrease Basal Insulin

Hypothyroidism may delay insulin turnover, requiring less insulin to treat diabetes mellitus.

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23
Q

Alpha-glucosidase inhibitors function by which primary mechanism of action?

A

Alpha-glucosidase inhibitors delay the absorption of complex CHO from the small bowel.

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24
Q

Canagliflozin should not be initiated in patients with which condition?

A

ESRD

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25
Q

Acarbose (Precose) has which feature?

A

Reduced postprandial peaks of plasma glucose

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26
Q

The APN would avoid use of saxagliptin (Onglyza) in which patient?

A

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.

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27
Q

Which oral medication has the most potential for hypoglycemia?

A

Sulfonylurea (glipizide, glyburide, glimepiride)

All sulfonylureas may produce severe hypoglycemia.

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28
Q

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?

A

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

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29
Q 
"-prils"
3 highlights
racial consideration
Indication
MOA (3)
Contraindication (3)
preg/lact
peds
side effects
Monitoring Parameters
A 
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

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30
Q 
"-sartans"
Indication
MOA
Caution (2)
Contraindication (2)
preg/lact
peds
adverse effects
A

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
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31
Q

What are the calcium channel blockers?

A

Dihydropyridines
(Nifedipine, Amlodipine)

Non-dihydropyridines
(Verapamil, Diltiazem)

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32
Q

-pines
Nifedepine (Procardia)
Amlodipine (Norvasc)
Felodipine (Plendil)

Drug class
Highlights (2)
Indication (2)
MOA 
Contraindication 
Black Box
preg
peds
racial concerns
adverse reactions
A

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

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33
Q

Verapamil
Diltiazem (Cardizem)

Drug class
highlights (1)
Indication (3)
MOA
Contraindication (4)
preg/lact
Adverse Effects (4)
A

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)
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34
Q

Which suffix is best associated with DPP-4 inhibitors?

A

-gliptin

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35
Q

What MOA best describes sitagliptin (januvia) ?

A

Increases Insulin release

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36
Q

What is a consideration when prescribing sitagliptin (januvia)

A

“add-on agent”

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37
Q

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?

A

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.

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38
Q

What kind of diet would you recommend to someone on a potassium sparing diuretic or ACE-inhibitor?

A

Low Potassium

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39
Q

All calcium channel blockers (CCBs) are in which pregnancy category?

A

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.

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40
Q

A patient with left ventricular dysfunction is taking a calcium channel blocker (CCB) and a beta blocker (BB). This combination may induce which condition?

A

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.

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41
Q

Calcium channel blockers (CCBs) are indicated to treat which condition?

A

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.

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42
Q

The highest rate of adverse reactions is found in which calcium channel blocker (CCB)?

A

Nifedipine

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43
Q

Which action should be considered when planning the management of angiotensin II receptor blockers (ARBs) or ACE-I?

A

Stop diuretics 2-3 days to allow hydration before starting ARB or ACE-I to reduce risk of adverse effects

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44
Q

Which adverse reaction is uncommon with use of angiotensin-converting enzyme inhibitors (ACEIs)?

A

Blood Dyscrasia

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45
Q

Which medication sometimes induces a lupus-like syndrome that appears to be dose-related with an incidence highest in white women?

A

Hydralazine

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46
Q

Which calcium channel blocker (CCB) is the drug of choice during lactation if a CCB is required?

A

Nifedipine

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47
Q

First-generation antihistamines are contraindicated in patients with which condition

A

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.

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48
Q

Which medication is used to treat seasonal allergic rhinitis and vasomotor rhinitis?

A

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.

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49
Q

Which statement about long-acting beta agonists (LABAs) is most accurate?

A

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.

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50
Q

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?

A

Add a low-dose inhaled corticosteroid.

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51
Q

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?

A

Leukotriene modifiers

neuropsychiatric events include agitation, aggression, anxiousness, dream abnormalities and hallucinations, depression, insomnia, irritability, restlessness, suicidal thinking and behavior (including suicide), and tremor

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52
Q

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?

A

“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.

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53
Q

The nurse practitioner has prescribed zafirlukast (Accolate) to a 12-year-old for asthma control. Which is a common adverse effect of this medication?

A

The most common adverse effect of zafirlukast is headache.

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54
Q

What is a common side effect of zileuton?

A

Dyspepsia

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55
Q

Albuterol
“think of what stimulating the adrenergic system does”

Drug Class
Indication
MOA
Contraindication #2
Caution #4
Side Effects
peds
A

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

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56
Q

What would you give to an asthmatic that could handle the side effects of albuterol? Why?

A

Levalbuterol (Zopenex)

more selective so less beta1 activation

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57
Q

Semeterol (Serevent)

Drug class
Indication
Caution
Block box warning
Age range
A

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

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58
Q

What asthma reliever medication would you give to pregnant person?

A

Terbutaline is safe in pregnancy

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59
Q

Steps to prescribing for asthma

A

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

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60
Q

Theophylline

Drug class
Indication
MOA #2
Patient Education
Toxicity s/s
Contraindications #4
A

“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)
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61
Q

Ipratropium bromide (Atrovent)

Drug Class
Indication
MOA
Contraindication (2)
Side Effects
A

Short-Acting Anticholinergics (SAMA)
Short acting muscarinic antagonist

-Ipratropium (I=immediate release)

Asthma Exacerbation (like Combivent/DuoNeb),&raquo_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

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62
Q 
Tiotropium Bromide (Spiriva)
Aclidinium bromide (Tudorza Pressair)

Drug Class
Indication
MOA
Contraindications
Side Effects
A

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)

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63
Q

What are the cholinergic Effects?

A

“can’t think, see, spit, pee, poop”

Confusion/dizzy
Blurred Vision
Dry mouth
urinary retention
constipation
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64
Q

Steps to prescribing for COPD

A

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

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65
Q

Zafirlukast
Montelukast (Singulair)

Drug Class
Indication
MOA
Contraindication
Side Effects #2
Patient Education #2
Pregnancy
Peds
A

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

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66
Q

Ages for prescribing Leukotrine Modifiers

A

Montelukast 1+ yrs
Zafirlukast 5+ yrs
Zileuton 12+ yrs

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67
Q

Zileuton

Drug class
Indication
MOA
Side Effects
Education
A

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)
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68
Q

Fluticasone (Flovent (inh)) or Flonase (nasal)) “-sone” Budesonide (Pulmicort)

Indication
MOA #3
Contraindication #2
preg
adverse #4
Education #2
A

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
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69
Q

Cromolyn Sodium

Drug Class
Indication
MOA
Education
Contraindication
Peds
Inhaled & Intranasal side effects
A

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

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70
Q

Diphenyhydramine (Benadryl)

Drug Class
Indication
MOA
Contraindication
peds
A

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”

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71
Q

Certizine
Loratadine
“ine”

Drug class
Indication
MOA
Fun fact about certirizine

A

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+

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72
Q

phenylephrine & Pseudoephedrine

Indication
MOA
Contraindication #4
peds
Side Effects
A

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’

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73
Q

What decongestant is safe for cardiac patients?

A

phenylephrine (much less potent)

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74
Q

What is Verapamil? A unique side effect?

A

Non-dihydro Ca++ Channel blocker
Antiarrythmic

Lowers sphincter tone = ^^GERD s/s

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75
Q

HCTZ

Drug Class
Indication
MOA #2
Location
Fun fact
Side Effects #3
Special Patient Considerations
A

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

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76
Q

Furosemide

Drug class
Indication
MOA
Location
Side effect #3
Contraindication #2
A

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
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77
Q

Aldactone (Spironolactone)

Indication
MOA
Location
Fun Fact
Side Effects #3
A

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
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78
Q

Ranexa

Caution
MOA
Drug Interaction

A

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

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79
Q

Hydralazine

Indication #2
MOA
Side Effects #3
Contraindication

A

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

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80
Q

Older adults taking ranitidine should be monitored carefully for which of these?

A

Mental Status Changes/confusion

81
Q

Which is the standard first-line therapy for the treatment of gastroesophageal reflux disease (GERD)?

A

Proton pump inhibitors (PPIs)

82
Q

Many patients are prescribed opioid analgesics for the amelioration of chronic pain. Chronic constipation often results from taking these medications long term. Which medication is the best choice for the APN to prescribe to help with the constipation?

A

Methylnaltrexone

an antagonist to the mu-receptor in the gastrointestinal (GI) tract. It is used for treating constipation from chronic opioid use.

83
Q

What would you prescribe for a women with constipation from IBS?

A

Lubiprostone (Amitiza)

84
Q

Patients with uncomplicated peptic ulcer disease or mild gastroesophageal reflux disease (GERD) may benefit from taking antacids daily. Which instruction should the APN give the patient regarding an antacid suspension?

A

Taking the antacid 1 to 3 hours after eating will prolong the antacid effect.

85
Q

A patient with gastroesophageal reflux disease (GERD) has been self-medicating with various antacids at home. The APN is reviewing the patient’s prescription medications with him. Which medication decreases lower esophageal sphincter (LES) tone and could potentially exacerbate GERD?

86
Q

The APN is caring for a patient who will be receiving epoetin alfa preoperatively to reduce the need for blood transfusion during the surgery. Which prescriptions will the patient need in addition to the one for the epoetin alfa?

A

Both—a prophylactic anticoagulant and an iron supplement are recommended in this situation.

87
Q

Which of these would be first-line therapy for mild acne vulgaris with closed comedones?

A

Benzoyl Peroxide

Acne is classified as mild, moderate, or severe, and pharmacological intervention is based on the severity of acne. Benzoyl peroxide has antibacterial activity against P. acnes, the predominant organism in sebaceous follicles and comedones of acne vulgaris.

88
Q

A 60-year-old female patient is being treated for pernicious anemia. In addition to anemia, she has neurologic symptoms associated with vitamin B12 deficiency. Which regimen is recommended for treatment in this situation?

A

Vitamin B12 1,000 mcg weekly for 1 month, then twice monthly for 6 months, and then monthly for life

Increased doses are required to treat neurologic symptoms at the onset of treatment. After improvement in neurologic symptoms, monthly treatment with injectable vitamin B12 is adequate.

89
Q

A patient taking warfarin is having pain associated with an acute musculoskeletal injury. He asks the APN if he can take acetaminophen because he knows he should not take an NSAID for pain while on warfarin. Which response by the APN is most appropriate?

A

“You can take the acetaminophen as needed, and then I will check your [international normalized ratio] INR in a few days to see if there is a change.”

Close monitoring of INR is needed to identify a possible drug-drug interaction.

90
Q

Most common side effect of Metformin?

91
Q

Rare but serious side effect of Metformin?

A

Lactic Acidosis

Increased risk with liver damage, alcohol, and dehydration

92
Q

What is the one true contraindication of Metformin?

A

Renal Impairment

93
Q

What is the first line therapy for gestational diabetes?

94
Q

Biggest side effect of medications that increase insulin?

A

hypoglycemia

weight gain

95
Q

Lispro & Aspart - Rapid Acting
onset
peak
duration

A

onset 5 mins

Peak: 1 hour

Duration: 4 hours

96
Q

Short Acting - Regular Humulin

Directions
Onset
Peak
Duration

A

Directions: 30mins prior to eating

Onset: 30 mins

Peak 1-2 hours

Duration: 3-7 hours

97
Q

Intermediate - NPH

Onset
peak
duration
directions

A

Onset 1.5 hours

Peak: 4-12 hours

Duration: 10-16 hours

Directions: Draw clear than cloudy

98
Q

Long Acting - Glargine & Detemir

onset
Duration

A

Onset 2-4 hours

Duration 24 hours

99
Q

What sulfonylurea can you take concurrently with insulin?

A

Glimepiride

100
Q

Noninflammatory comedonal acne drug selection

A

Topical retinoid or benzoyl peroxide

101
Q

Inflammatory papularpustular acne drug selection

A

Topical Combination therapy:
topical antibiotic
Benzoyl peroxide
topical retinol

102
Q

Severe inflammatory acne drug selection

A

Oral antibiotics w/topical combination therapy

103
Q

Last resort drug choice for acne

A

Accutane - Isotretinoin

104
Q

Benzoyl Peroxide
MOA
Side Effects
Patient Education

A

MOA: comedeolytic/desquamation & slightly antibacterial

Side Effects:
Photosensitivity, Irritating

Education:
Bleaches clothes
Inactivates retinol

105
Q

Erythromycin

Drug interaction

A

Topical Antibiotic

Do not use concurrently with Clindamycin

106
Q 
Clindamycin
Drug Interaction
Side Effects
Contraindication
Patient Education
A

Topical Antibiotic
Don’t use with erythromycin

Contraindication: crohn’s, ulcerative colitis, etc

Monitor for diarrhea/colitis and stop medication

Side Effects: burning, peeling

107
Q

Azelaic Acid
Drug class
Caution

A

Topical Antibiotic

mostly antibacterial

Caution: Dark skin pigmentation

108
Q

Tertinoin (Retin-A)
Drug Class
MOA
Patient Education

A

Retinoid

MoA: reduces cohesion between keratanized cells

Pt Education:
6-8 weeks to see improvement

109
Q

Tetracycline

Drug Class
Education
Pregnancy
Pediatric

A

Oral Antibiotic

Pt Education:
Photosensitivity
Take on empty stomach

Pregnancy: NO!
Pediatric: Teeth staining

110
Q

What is the first line treatment for oral antibiotics for acne?

A

Tetracycline

Unless contraindicated

111
Q

What oral antibiotic for acne would you recommend for a pregnant person?

A

Azithromycin or Erythromycin

112
Q

Minocycline

Drug class
Education
pregnancy
pediatrics

A

Oral antibiotic

Pt Education: Empty stomach

Pregnancy: NO!

Pediatrics: teeth staining

113
Q

Doxycycline

Drug class
Education
Pregnancy

A

Oral antibiotic:Tetracycline

Education:
Take with meal & water

Pregnancy NO!

114
Q

Isotretinoin (Accutane)

Drug class
MOA
Side Effect #4
3 labs to draw

A

Systemic Retinoid “IPledge”

MOA:

  • reduces sebum production, -reduces hyperkeratinized follicle
  • prodrug

Side Effect:

  • Chelitis (sore around mouth),
  • hypertriglyceridemia,
  • hyperglycemia
  • bone fracture

3 labs to draw and monitor:

  • lipid (hard on liver),
  • serum HcG (tetragenic),
  • hyperglycemia
115
Q

LDL Goal vs Guidelines
HDL Goal
Triglycerides Goal

A

LDL <100 OR <190 GUIDELINES
HDL >40
Triglycerides <150

116
Q 
"-statins"
MOA #3
Side Effect #3
Labs to check #3
Contraindications #3
Patient Education #2
A

MOA:

  • metabolized by CYP34A
  • HMG CoA Reductase Inhibitors (inhibits the enzyme to mevalonate) rate limiting step in production of cholesterol
  • Increases LDL receptors on liver

Side Effect:

  • myalgia,
  • rhabdo,
  • liver

Labs to check:

  • creatine kinase &
  • LFTs before therapy,
  • lipids 4-6 wks

CONTRAINDICATION: PREGNANCY, liver disease, no grapefruit juice

Education:

  • new onset myopathy,
  • abdominal pain (liver)
117
Q

What are the 4 statin benefit groups

A

Group 1:
CAD <75 yrs old = high intensity statin
>75 yrs old = mod intensity

Group 2:
LDL >190

Group 3:
Diabetes = moderate statin

Group 4:
ASCVD risk >7.5%

118
Q

Niacin
“think 5 hour energy shot”

Indication
MOA #3
Side Effect 
Fun Fact
Education
Contraindication #5
Lab Monitoring
A

Indication: hyperlipidemia

MOA:

  • Naturally occurring B3 vitamin,
  • Reduces VLDL synthesis
  • Increases HDL

Side Effect:
-Flushing/pruritus (from increasing prostaglandin activity “energy shot”)

Education:
-NSAID 30 mins prior admin to stop flushing

Contraindication:

  • hepatic dysfx,
  • diabetes (vasodilating drops blood sugar),
  • gout (vasodilation uric acid forced into joints),
  • reflex tachycardia/afib (vasodilating),
  • peptic ulcers,

Labs:
Creatinine

119
Q

Gemfibrozil, Fenofibrate

Class
Indication
MOA
Side Effect
Drug Interaction
Lab Monitoring
Contraindication
A

Class: Fibrates

Indication:
-Triglycerides >400

MOA: increase lipolysis of triglycerides via lipoprotein lipase = DECREASE IN TRIGLYCERIDES

Side Effects:

  • Gall stones/abdominal pain/dyspepsia (hard on GI),
  • hard on liver
  • Phototoxicity

Drug interactions:
-increased risk hepatotoxicity & myalgias if on -statins OR niacin

Lab Monitoring:
-Check LFTs

Contraindication:

  • Liver disease
  • Gall bladder disease
  • Elevated ALT/AST
120
Q

What drug class for lipids has no effect on pregnancy?

A

Bile Acid Sequestrants

121
Q

What drug class for lipids has no effect on liver?

A

Bile Acid Sequestrants

122
Q

Cholestyramine
Colestipol
Colesevelam

MOA
Side Effect #3
Patient Education
Pregnancy

A

Bile Acid Sequestrant

MOA:
-exchanges chloride ions for negatively charged acids in bowel
forms nonabsorbable complex w/bile acid in intestines&raquo_space; bile salts can no longer be reabsorbed & stay in small intestine & fecally removed LDL

Side Effect:

  • All fat stays in intestines&raquo_space;> flatulence, bloating, abdominal pain, constipation
  • Increased Triglycerides
  • biliary obstruction,

OKAY FOR PREGNANCY AND LIVER DISEASE

Patient Education: Take 1 hour before, 4 hrs after

123
Q

Ezetimibe (Zetia)

Drug Class
MOA
Side Effect #4
Prescribing information #2

A

Cholesterol Absorption Inhibitor

MOA: blocks absorption of cholesterol across intestinal border (keeps in GI tract)

Side Effect:

  • Fatigue,
  • Diarrhea,
  • LFT
  • Arthralgia

Adjunctive w/ statin
NO EFFECT ON LIVER

124
Q

CYP3A inhibitors ____ stain concentrations

A

increase

Verapamil, Diltiazem, -azole, antifungals, erythromycin, fluoxetine, nefazodone, protease inhibitors

125
Q

CYP3A inducers ____ stain concentrations

A

decrease

Rifampin, phenytoin, phenobarbital

126
Q

What hyperlipidemia drug is most effective in combination with a statin?

A

Ezetimibe (Zetia)

127
Q

Evolocumab (Repatha)

Indication
MOA
Side Effect

A

PCSK9 Inhibitor
SQ & expensive

Indication:
-genetic cases (familial homozygous

MOA:
-monoclonal antibody binds to PCSK9 so it doesn’t bind and destroy LDL receptors

Side Effects:

  • pain at injection
  • hypersensitivity
128
Q 
Pyrethrins (RID) 
Indication
MOA
Allergy caution
Side Effect
Preg/lact 
Peds
Education
A

Indication:
*prescription strength

MOA:

  • absorbed through exoskeleton causing paralysis & death,
  • no residual activity

Caution: Chrysanthemum or ragweed allergy

Side Effect:
localized

Prep/lact OK

Peds >2yrs

Education: works best on dry hair, active only when applied then rinses off

129
Q

Permethrin

Indication
MOA
preg/lact
Peds
Education
A

Permethrin

Indication:
-1st line head lice and scabies

MOA: Absorbed through exoskeleton = paralysis & death
-Residual activity for 10 days

Preg/lact OK

Education: Treat whole family

Contraindication: eyes

Peds >2months

130
Q

Malathione (Ovide)

Indication
MOA/residual effects
Education #2
Preg/lact
peds
Side Effects #2
A

2nd line lice

MOA:
-inhibits cholinesterace activity and residual 7 days.

Education:

  • do not use hair dryer (Flammable)
  • Rinse Ovide off & shampoo hair 8-12 hrs after

Preg/lact: NO!

Peds: >6yrs

Side Effects:

  • organophosphate poisoning
  • respiratory distress if ingested
131
Q

Benzyl Alcohol (Ulesfia)

Indication
MOA
Peds

A

Indication: Live head lice

MOA: non-neurotoxin, stuns lice and leads to asphyxiation

Peds >6months

132
Q

Ivermectin (Sklice)

MOA
Preg
Peds

A

MOA: Nerve Agent, Paralysis & Death,
Single application effective to eradicate head lice

Preg: NO

Peds >6yrs

133
Q

What factors does warfarin act on?

A

2, 7, 9, 10

134
Q

Warfarin

Indication
MOA
Antidote
Caution
Side Effect #2
Black Box Warning
Contraindication #2
Monitoring Parameters & labs
Half life
Pregnancy
Lactation
A

Warfarin

Indication: DVT & PE & -Mechanical Heart Valve (INR 2.5-3.5)**

MOA:
-inhibits VKORC1 complex depletes Vitamin K = can’t produce clotting factors 2, 7, 9, 10 ……Vitamin K antagonist -CYP2C9, highly protein bound
“shot gun effect”
2+7 = 9 & 10

Antidote: Vitamin K

Caution: Hepatic impairment

Side Effect:

  • Skin necrosis,
  • rare macularpapular rash

Black Box Warning:
Fatal bleeding

Contraindication:

  • hypermetabolic state,
  • blood dyscrasias
Monitor: 
-INR daily until therapeutic 
2 days > 3x weekly 2 weeks > Q6 weeks, 
-LFTs, 
-TSH

Half-Life 3-4 days

Pregnancy: NO

Lactation: OK

135
Q

If someone on an “-azole” antifungal on warfarin, the INR would ____

A

“-azole” is an inhibitor so INR increases

136
Q

If a person on warfarin is prescribed rifampin, the INR would ____

A

Rifampin is an inducer so INR decreases

Antiseizure medications are inducers

137
Q

Heparing

Indication
MOA #2
Pregnancy
Side Effect
Caution
Contraindication #2
Drug interactions #3
Monitor
Antidote
A

Indication: Postoperative thromboembolism

MOA:

  • Increasing antithrombin III which inactivates thrombin to prevent conversion to fibrinogen to fibrin
  • Highly Protein bound

Pregnancy: OK

Side Effect:
-Hyperkalemia

Caution:
-combining drugs that predispose to hyperkalemia**

Contraindication:
Liver & renal disease

Drug interaction:

  • cephalosporin,
  • PCN,
  • Valproic Acid

Monitor: aPTT, PLT, Hct

Antidote: Protamine Sulfate

138
Q

What is the anticoagulation of choice in pregnancy?

139
Q

Low molecular weight heparin

Indication
MOA
Pregnancy
Contraindication #3
Side Effect #1
Monitor
A

Indication: DVT, PE, bridging

MOA:
-Activates antithrombin III and inactivates Xa and IIa (thrombin)

Pregnancy Drug of Choice

Contraindication:
allergies to pork, sulfites, or benzyl alcohol

Side effect: Peripheral Edema

Monitor: PLT and Hct

140
Q

Dabigatran (Pradaxa)

MOA
Black Box Warning #2
Pregnancy
Side Effect
Antidote
A

MOA: Direct thrombin (factor II) inhibitor

Black Box Warning:

  • Discontinuation = increased risk thrombolytic events,
  • Epidural/Spinal hematomas

Pregnancy: NO!

Side Effect: Dyspepsia, gastritis

Antidote:
idarucizumab (Praxbind)

141
Q

Factor Xa Inhibitors
Rivaroxaban, Apixaban, Edoxaban Betrixaban

"put a band around your Xa"
MOA
Caution
Antidote
Black Box #2
Pregnancy
Side Effect
A

MOA: direct Xa inhibitor

Caution: Liver and renal impairment

Antidote: Andexxa

Black Box:

  • Discontinuation and increase of thrombotic evens,
  • epidural/spinal hematoma

Pregnancy: NO!

Side Effect
Hemorrhage

142
Q

Absolute contraindication in Rivaroxaband

A

Do not use in liver disease or GFR less than 30

143
Q

Side Effects specific to Apixaban

144
Q

Endoxaban specific side effects

A

Rash

GI bleed

145
Q

What is the safest anticoagulation drug in kidney dysfunction?

146
Q

Aspirin

Indication #3
MOA
Contraindication #4
Used to prevent..?
Drug Interaction #4
Side Effect #3
A

Indication: MI & Stroke prevention & ACS

MOA: Cyclooxygenase pathway antagonist

Contraindication:

  • Flu,
  • Chickenpox,
  • Liver disease,
  • Reye’s syndrome

used to prevent preeclampsia

Drug Interaction:
NSAIDs,
gingko, garlic, ginseng

Side Effect:

  • GI ulcer,
  • Tinnitus,
  • Steven Johnson syndrome
147
Q

Clopidrogel (Plavix)

MOA
How is it different from aspirin?
Metabolized by what system?

A

MOA:
-ADP receptor antagonist,

  • no effect on prostaglandins*
  • Prodrug metabolized by CYP2C19*

PPI, Psychotropics, anticonvulsants are 2C19 Inhibitor = Plavix ineffective

148
Q

If you take PPI with Plavix are you more likely to clot?

A

True

PPI are 2C19 inhibitors and Plavix is a prodrug

149
Q

Vitamin B12 Deficiency

Cause
anemia type
Side Effect
Monitoring Parameters

A

Lack of intrinsic factor from gastric bypass

Macrocytic Anemia

Side Effect:
Hypokalemia
Anaphylaxis

Monitor:
Potassium

150
Q

What is Oxymetazoline

A

Afrin

Intranasal Decongestant

151
Q

Aluminum hydroxide, magnesium hydroxide, calcium carbonate

Indication
MOA
Contraindication
Caution
Patient Education
Drug Interaction
A

Postively charged ions

Indication:
acute hyperacidity,
GERD

MOA:
antacids are weak bases to neutralize gastric acidity and increase pH

Contraindication: abdominal pain

Caution:
HF r/t hypernatremia

Patient Education:
2 hours before/after any meds

Drug Interaction:

  • Do not take with Iron (will not be absorbed)
  • Increased absorption of enteric coated tablets
152
Q

Aluminum and calcium based antacid side effect education

A

Constipation

153
Q

Magnesium based antacid side effect education

154
Q

Ranitidine (Zantac) & Famotidine (Pepcid) & cimetidine

Drug Class
Indication
MOA
Best > worse
Side Effects
Lab monitoring
A

Histamine Receptor 2 Antagonist

Indication: mild intermittent GERD (maintenance)

MOA:
-blocks the histamine receptor = no activation of proton pump reduced stomach acid to 35-50%

Famotidine > ranitidine > cimetidine

Cimetidine side effects:
anti androgen & crosses blood-brain barrier (CNS)

preg/lact/kids not safe WITH cimetidine

Side effects:

  • anti androgen (gynecomastia and impotence and menstrual cycle effected),
  • CNS effects (confusion, agitation, psychosis ESPECIALLY IN ELDERLY), blood dyscrasias

Monitor:
LFTs

155
Q

Cimetidine Side Effects

A

Anti Androgen

CNS

156
Q

Omeprazole, Pantoprazole, Esomeprazole “-prazole”

MOA
Indication
Drug Interaction
Caution
how long does one dose last?
preg/peds
Side Effects #3
A

Proton Pump Inhibitor

MOA: shut downs proton pump. Reduce stomach acid >90%
“H+/K+ ATPase pump inhibitor”

Indication: 
GERD, 
erosive gastritis, 
ulcers, 
multi drug regimen for H. pylori infection

Education: 30-60mins to work and before breakfast

Drug interactions:

  • metabolized by CYP450 system
  • Omeprazole reduces effectiveness of Plavix…Pantoprazole is better agent to use

Caution:

  • elderly,
  • hepatic dysfx/renal dysfx

One dose lasts 72 hours

Safe kids & pregnancy Omeprazole, Esomeprazole

PANTOPRAZOLE NOT SAFE IN KIDS OR PREGNANCY

Side Effects:

  • Bone fractures/Osteoporosis,
  • increased risk GI infection,
  • Vit B12 deficiency (pernicious anemia)
157
Q

What are the DPP-4 Inhibitors?

A

-gliptins

Sitagliptin (Januvia)
Linaglipton (Tradjenta)

158
Q

CYP3A4 & CYP2C9 Inducers ___ meglitinide metabolism

159
Q

What are common CYP inducers?

A

Phenobarbital
phenytoin
Rifampicin
Glucocorticoids

160
Q

What are common CYP inhibitors

A
  • Clarithromycin, erythromycin
  • CCB non-dihydro (Diltiazem, Verapamil)
  • Grapefruit juice!
  • “-azoles”/antifungals
161
Q

What are Constipation stimulants?

A

Castor Oil
Senna
Bisacodyl (dulcolax)

162
Q

What are constipation bulk laxatives?

A

Psyllium
Methylcellulose
Polycarbophil

163
Q

What is the safest laxative?

A

Bulk Laxatives

Psyllium
methylcellulose
polycarbophil

164
Q

What are osmotic laxatives?

A

Magnesium hydroxide
lactulose
polyethylene glycol

165
Q

What category is polythylene glycol?

A

osmotic laxative

166
Q

What are the constipation lubricants?

A

Mineral oil

Glycerin

167
Q

Steps to treating constipation

A

Step 1: Bulk Laxatives, Sool softeners
Step 2: Saline, osmotic and lubricating laxatives
Step 3: Stimulants

168
Q

What do you need to monitor for with lactulose?

A

Dehydration
Electrolytes
Hyperglycemia in DM

169
Q

Senna, Bisacodyl, Castor Oil

MOA
Side Effects
Contraindication
Pregnancy
Peds
A

Stimulant, short term only

MOA: stimulates myenteric plexus&raquo_space; prostaglandin release (increases motility)

Side Effects:
abdominal cramping

Contraindication:
-bowel obstruction

Pregnancy SAFE

castor oil cannot be used in pregnancy may stim. contractions

Peds >2yrs (Senna weaker and ok)

Peds >6yrs (bisacodyl)

170
Q

Which stimulant is not safe for pregnancy?

A

Castor Oil

May stimulate contractions

171
Q

Which stimulants are safe for Children 2+ years?

A

Senna weakest

172
Q

Psyllium, methylcellulose, polycarbophil

MOA
Contraindication
Adverse Effects

A

Bulk Laxatives Safest laxative

MOA: Soluble fiber absorbs water into the intestine that promotes peristalsis and reduces transit time

Contraindication:
-narrowed GI tract/obstruction,

Adverse Effects:

  • abdominal pain/bloat,
  • intestinal obstruction**
173
Q

Magnesium hydroxide, Lactulose, polyethylene glycol

MOA
Adverse Effects
Caution #2
Peds

A

Osmotic Laxative
Safer for Acute Effects

MOA: pulls water into intestine to distend colon and increase peristalsis

Adverse Effects:
-Abdominal cramping/diarrhea/bloating

Caution:

  • Lactulose (a sugar) hyperglycemia in diabetic patients*
  • Magnesium in renal impairment*

Peds >2yrs

174
Q

What osmotic laxative is contraindicated in renal impairment?

A

Magnesium hydroxide

175
Q

Docusate Sodium

MOA
preg/lact
peds
side effect

A

Stool Softener

MOA: Turns stool into emollient by mixing oil & water

Preg/lact safe

Peds >2yrs

Side Effect: diarrhea

176
Q

Mineral Oil, glycerin

Indication
MOA
Contraindication
Side Effect

A

Lubricants

Indication: Usually given PR, fecal impaction

MOA: Lubricates stool

lubricant and osmotic can be used together

Contraindication:
-Elderly (beers criteria) r/t aspiration from oil going down throat

Preg NO!

Side Effect:

  • abdominal cramp,
  • oily rectal leakage
177
Q

What laxatives can be used together?

A

Lubricants and osmotics

178
Q

Lubiprostone (Amitiza)

Indication
MOA
Contraindication
Preg/peds

A

Chloride Channel Activator

Indication: idiopathic constipation

MOA:
-“hyperosmotic” produces chloride rich secretions that soften stool & increase motility

Contraindication:
-Bowel obstruction,

Preg/peds NO!

179
Q

Methylnaltrexone

Indication
MOA
Contraindication
How is this given?

A

Opioid-receptor Antagonist

MOA:
-antagonist at peripheral mu receptors in the GI tract

Contraindication:
-bowel obstruction

**Weight based injection

180
Q

PPIs have would make Plavix more or less effect?

A

PPI are 2C19 Inhibitor
Plavix is a Prodrug
Plavix would be ineffective

181
Q

For patients taking warfarin, INRs are best drawn

A

In the morning if the patient takes their warfarin at night

182
Q

Patients receiving heparin therapy require monitoring of

A

Platelets every 3 days for thrombocytopenia that may occur on day 4

Hyperkalemia starts as early as day 4

183
Q

Routine monitoring of LMWH is?

184
Q

The first lab value indication that vitamin B12 therapy is adequately treating pernicious anemia is…

A

Hemoglobin levels return to normal

185
Q

Patients who are beginning therapy with vitamin B12 need to be monitored for

A

Leukopenia that occurs at 1-3 weeks of therapy

186
Q

A 17 y/o competitive runner presents w/ complaint of hip pain that occur after he fell after running. His only medical problem is severe acne for which he takes Accutane. What are you concerned for?

A

Bone fractures

187
Q

Scabies Treatment for a 4 year old child includes a prescription for

A

Permethrin 5% cream applied from the neck down

188
Q

What lab values should be monitored before beginning vitamin B12 therapy

A 
Potassium
Vitamin B12
Iron
Reticulocyte count
Hemoglobin
Hematocrit
189
Q

What drug class are the “-tides”

A

GLP-1 Agonist
Exenatide (Byetta), Liraglutide (Victoza)
Dulaglutide (Trulicity)

190
Q

What drug class are the “-gliptins”

191
Q

What drug class are the “-flozins”

A

Selective Sodium-Glucose Cotransporter 2 Inhibitors

SGLT-2 Inhibitors

192
Q

How long until NPH insulin begins to take effect? “onset of action”

A

60-90 mins

193
Q

What is a fasting glucose target for type 1 diabetics?

194
Q

What is a third generation sulfonylurea?

A

glimepiride

195
Q

Symptoms of diabetic autonomic neuropathy

A

resting tachycardia
exercise intolerance
orthostatic hypotension

196
Q

After administering PTU, what effect would the nurse anticipate the drug will have in the patient’s body

A

inhibit production of TH in thyroid gland

197
Q

What are the highest to lowest strength statins?

A

atorvastatin, rosuvastatin, simvastatin, lovastatin

198
Q

Pregnant people with asthma can safely use what during their pregnancy?

A

inhaled corticosteroids (budesonide)

199
Q

What are the histamine 2 receptor antagonists?

A

Ranitidine (Zantac) & Famotidine (Pepcid) & cimetidine

Advanced Pharmacology (5 decks)

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