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Pharm 2 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Heart failure

A

The heart muscle (myocardium) weakens and enlarges causing decreased ability to pump the blood through the heart and into systemic circulation

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2
Q

CHF

A

Compensatory mechanisms fail and the peripheral tissues and lungs become congested (fluid overload)

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3
Q

Diastolic heart failure (EF, etc)

A

normal EF
heart doesn’t relax or fill enough

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4
Q

systolic heart failure (EF, etc)

A

low EF <55%
doesn’t pump strong enough

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5
Q

left sided HF S&S (5)

A

pulmonary congestion, dyspnea, cough, oliguria, weight gain

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6
Q

right sided HF S&S (3)

A

peripheral edema, JVD, weight gain

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7
Q

cardiac glycosides MOA

A

inhibits sodium-potassium pump
increased ICF sodium
cardiac fibers contract more efficiently

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8
Q

inotrope and chronotrope of cardiac glycosides

A

+ inotrope (increases CO)
- chronotrope (decreases HR by decreasing AV conduction)

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9
Q

What do cardiac glycosides do

A

Increases CO which increases renal perfusion and increased fluid excretion and less edema

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10
Q

Lanoxin (digoxin) use and 2 routes

A

2nd line treatment for HF
used for afib/aflutter
slows down HR not BP
PO/IV

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11
Q

therapeutic window of digoxin

A

0.5-2 ng/ml
SMALL

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12
Q

who can’t take digoxin (4) and half life

A

people with low protein (malnourished)
renal insufficiency (low dose)
thyroid issues (HYPO=low dose)
watch creatinine (excreted by kidneys)
long half life accumulation can occur from long HL

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13
Q

Digoxin toxicity

A

bradycardia, anorexia, N/V/D, visual changes, confusion, delirium, ventricular dysrhythmias, yellow halos

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14
Q

digoxin antidote

A

digibind, ovine

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15
Q

drug interactions of digoxin

A

K+ loss diuretics increase risk of toxicity
cortisone taken PO/IV increases hypokalemia increasing risk of toxicity
antacids decrease absorption, stagger doses

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16
Q

nursing considerations of digoxin

A

obtain apical pulse before administration
assess for toxicity and monitor levels of drug and potassium

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17
Q

primacor (milrinone) inocor (class, MOA, route)

A

Phosphodiesterase inhibitor
increases SV, CO, and vasodilation (+ inotrope)
increases HR
IV

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18
Q

what are we concerned about with Primacor (milrinone) inocor

A

cardiac dysrhythmia (check EKG)
drop in BP since we’re vasodilating and getting rid of fluid

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19
Q

vasodilators in terms of HF

A

decrease venous blood return to the heart, decrease preload

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20
Q

arterial dilators for HF

A

decrease afterload increasing cardiac output, increased renal perfusion by dilating arterioles, improve circulation to muscles

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21
Q

ACE inhibitors for HF

A

dilate venules, arterioles, improve renal blood flow, decrease blood volume, certain ARBS also (diovan, atacand)

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22
Q

aldactone (spironolactone) for HF

A

K+ sparing diuretic, blocks the secretion of aldosterone causing decreased fluid retention

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23
Q

natrector for HF

A

Inhibits ADH, promotes vasodilation, diuresis (acute CHF), BiDil (hydralazine and isosorbide dinitrate)

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24
Q

left arm pain

A

heart

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25
Q

right arm pain

A

gallbladder

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26
Q

classic (stable) angina

A

occurs with stress or exertion

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27
Q

unstable (preinfarct) angina

A

occurs frequently with progressive severity unrelated to activity

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28
Q

variant (prinzmetal, vasospasm) angina

A

occurs during rest

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29
Q

how to antianginals work

A

increases blood flow to the heart by increasing supply or decreasing demand

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30
Q

3 types of antiaginals

A

nitrates
beta-blockers
Ca+ channel blockers

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31
Q

what do nitrates do

A

cause generalized vascular and coronary vasodilation increasing blood flow to coronary arteries, reducing ischemia

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32
Q

important stuff about nitroglycerin

A

don’t touch the med (drops BP)
patches go everywhere except chest
SL 0.4mg or 1/150 gr
take 3 times q5 min, call 911
keep away from light and heat and children
DO NOT SWALLOW SL

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33
Q

pharmacodynamics of nitroglycerin

A

acts on smooth muscle of blood vessels causing relaxation and dilation
decreases preload and afterload and myocardial O2 demand
remove patch for 8-12 hours

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34
Q

side effects of nitroglycerin

A

HA, hypotension, dizziness, weakness, and faintness

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35
Q

adverse effects of nitroglycerin

A

reflex tachycardia if not tapered off

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36
Q

drug interactions of nitroglycerin

A

not taken with BB, Ca+ blockers, vasodilators, and ETOH may cause hypotension
not taken w viagra

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37
Q

beta blockers use

A

decrease HR and contractility, reducing O2 demands and angina
used for stable angina

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38
Q

things to avoid in BB and what happens if d/c abruptly

A

avoid in 2nd and 3rd degree AV block (lower HR)
taper dose to avoid reflex tachy, recurrent angina, and SOB

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39
Q

side effects of BB

A

Mild and transient bradycardia, AV block, hypotension, bronchoconstriction, mask symptoms of hypoglycemia, inhibit glycogenolysis

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40
Q

Ca+ channel blockers

A

used for variant and stable angina
Relax peripheral arterioles and coronary spasm decreasing myocardial O2 demand (dilates coronary arteries)
decreases contractility, afterload, PVR, workload

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41
Q

Ca+ channel blocker side effects

A

bradycardia, dizziness, hypotension, constipation
Lowers BP AND HR

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42
Q

P wave

A

atrial activation

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43
Q

QRS

A

ventricular depolarization

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44
Q

T

A

ventricular repolarization

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45
Q

P-R interval

A

AV conduction time

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46
Q

Q-T

A

ventricular action potential

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47
Q

what are dysrhythmias caused by

A

MI, hypoxia, hypercapnia, thyroid disease, CAD, electrolyte imbalance (K+, Mg++)

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48
Q

class 1 antidysrhythmics

A

3 types
decreases sodium influx into cardiac cells
decreased conduction velocity, automaticity, and ectopy

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49
Q

class IA antidysrhythmic

A

quinidine, procainamide, disopyramide
slows conduction and prolongs repolarization (PAT, SVT)

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50
Q

class IB antidysrhythmic

A

lidocaine (IV), mexiletine HCL (oral)
slows conduction and shortens repolarization (VT, vfib)

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51
Q

class IC antidysrhythmic

A

flecainide

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52
Q

class 2 antidysrhythmic

A

Decrease conduction velocity, automaticity and recovery time
Examples: Propranolol (Inderal), acebutolol (Sectral), esmolol (Brevibloc), Sotalol (betapace)
BETA BLOCKERS

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53
Q

acebutolol (sectral)

A

class II antidysrhythmic
beta1 blocker
for refractory VT, recurrent stable VT, angina, HTN

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54
Q

contraindications of acebutolol (sectral)

A

2nd-3rd degree HB, bradycardia, HF, cardiogenic shock

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55
Q

caution for acebutolol (sectral)

A

undergoing major surgery, renal or hepatic impairment, labile mellitus

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56
Q

interactions of acebutolol (sectral)

A

increased effects with diuretics, prolonged hypoglycemia
antagonist effect with albuterol, terbutaline, and metaproterenol
may increase ALT, AST, ALP, BUN, K+

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57
Q

side effects of acebutolol (Sectral)

A

dizziness, nausea, HA, hypotension, diaphoresis, fatigue, bradycardia

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58
Q

Class III antidysrhythmic

A

increase refractory period and prolong action potential
amiodarone (cordarone) for afib or vtach
Monitor thyroid and pulmonary function (may cause pulmonary fibrosis)

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59
Q

Class IV antidysrhythmics examples

A

Ca+ channel blockers (ONLY ONES THAT LOWER CONDUCTION)
verapamil (calan, isopitin), diltiazem (cardizem)

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60
Q

Class IV antidysrhythmics MOA

A

blocks Ca+ influx, decreasing excitability and contractility, increases refractory period of AV node, decreasing ventricular response

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61
Q

Class IV antidysrhythmics contraindications and side effects

A

contra: AV block and heart failure
side effects: hypotension, orthostatic hypotension, bradycardia, heart block

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62
Q

LDLs (tight or loose, what are they for, what increases them)

A

tight
carried by proteins that enter circulation, broken down for energy
diabetes and alcohol increase risk of LDLs

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63
Q

HDLs (tight or loose, what are they for, what increases them)

A

loose
used for energy, pick up remnants of fat left in periphery by LDL breakdown
Exercise!

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64
Q

LDL levels

A

risk for MI or CVA <70
Optimal: <100
normal: 100-129
borderline: 130-159
high: 160-189
very high: >=190

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65
Q

HDL levels

A

Good: >=60
low: <40

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66
Q

triglyceride levels

A

normal: <150
borderline: 150-199
high: 200-499
very high: >=500

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67
Q

drugs for hyperlipidemia (5)

A

Bile acid sequestrants
HMG-CoA inhibitors
Fibrates
Niacin
Cholesterol absorption inhibitors

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68
Q

Bile acid sequestrants MOA

A

Bind bile acids in the intestine, allow excretion in feces instead of reabsorption
cholesterol iodized in the liver and serum cholesterol levels begin to fall

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69
Q

bile acid sequestrants indications and 3 examples

A

For patients with primary hypercholesterolemia and pruritus associated with partial biliary obstruction
Examples: Welchol, Questran, Prevalite

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70
Q

bile acid sequestrants adverse effects

A

HA, fatigue, and drowsiness
Direct GI irritation: nausea and constipation
Increased bleeding times
Vitamin A and E deficiencies bc fat soluble and we’re preventing fat absorption

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71
Q

drug-to-drug interactions of bile acid sequestrants

A

malabsorption of fat soluble vitamins

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72
Q

HMG-CoA inhibitors actions

A

decreases serum cholesterol, LDLs, and triglycerides
increases HDL

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73
Q

indications of HMG-CoA inhibitors

A

hyperlipidemia, prevention of MI, CVA

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74
Q

examples of HMG-CoA inhibitors

A

-statins

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75
Q

HMG-CoA inhibitors contraindications and caution

A

allergy
metabolized by cytochrome P450 3A4
active liver disease or alcoholic liver disease
pregnancy and lactation

caution: impaired endocrine function

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76
Q

adverse effects of HMG-CoA inhibitors

A

myopathy
liver failure
rhabdomyolysis

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77
Q

drug to drug interactions of HMG-CoA inhibitors

A

grapefruit juice BAD

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78
Q

rosuvastatin (crestor)

A

prototype
indication: decreases lipids, especially LDL and triglycerides
inhibits HMG-CoA reductase

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79
Q

side effects of rosuvastatin (crestor)

A

HA, constipation, diarrhea, myalgia

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80
Q

adverse effects of rosuvastatin (crestor)

A

rhabdomyolysis, photosensitivity, hyperglycemia, elevated LFTs

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81
Q

contraindications of rosuvastatin (crestor)

A

pregnancy, lactation, liver disease

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82
Q

adverse effects of zetia

A

abdominal pain and diarrhea
HA, dizziness, fatigue, URI, back pain
muscle aches and pain

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83
Q

niacin

A

vitamin B3, inhibits release of fatty acids from adipose tissue
increases rate of triglyceride removal
chest and face swell up

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84
Q

fenofibrates

A

inhibit triglyceride synthesis in the liver, decreases LDL
increases uric acid secretion, stimulates triglyceride breakdown

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85
Q

gemfibrozil

A

inhibits peripheral breakdown of lipids
reduces production of triglycerides and LDL
increases HDL

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86
Q

2 PSK9 inhibitors

A

alirocumab (praluent)
evolocumab (repatha)

-CUMAB

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87
Q

2 times to use injectable lipid lowering therapy

A

intolerable to -statins
patients goal is not achievable with highest statin dose

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88
Q

patient education for injectable lipid lowering therapy (how long to leave it outside the fridge)

A

take out of the fridge 30 min prior

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89
Q

peripheral vasodilators and 2 examples

A

increase blood flow to extremities in PAD and PVD
effective in raynaud’s or buerger’s disease

cilostazol (pletal)
trental

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90
Q

pletal class and trade name

A

peripheral vasodilator
cilostazol

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91
Q

pletal contraindications and caution

A

contraindications: CHF class III-IV, arterial bleeding, severe hypotension, postpartum, tachy
caution: bleeding disorders, tachy

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92
Q

pletal interactions and route

A

hypotension with antihypertensives
PO

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93
Q

therapeutic effects of pletal

A

increased circulation caused by PVD, raynaud’s, cerebral vascular insufficiency
inhibits platelet aggregation, causes vasodilation

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94
Q

side and adverse effects of pletal

A

S/E: N/V, dizziness, syncope, blood in the eye, HA, abd pain, abnormal stools, peripheral edema
A/E: tachy, palpitations

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95
Q

nursing considerations of pletal

A

obtain baseline VS
assess for signs of inadequate blood flow to extremities, pallor, coldness, and pain
monitor for tachy and hypotension

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96
Q

arterial blood clot (what type of cells and caused by what)

A

WBC and RBC
platelet aggregation
blood coagulation

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97
Q

venous blood clot (what type of cells, caused by what, CAN cause what, and prophylaxis)

A

RBC and PLT
blood stasis or slow flow
occurs rapidly
can cause DVT and PE
give heparin or lovenox

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98
Q

what to consider for artificial valves

A

pts HAVE to be on anticoagulants bc the body will attack the foreign object causing clotting and a stroke

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99
Q

anticoagulants given for what type of stroke

A

ischemic

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100
Q

fragmin class

A

anticoagulants

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101
Q

indication of heparin

A

rapid anticoagulation for thrombosis such as DVT, PE, CVA
during surgery to prevent thrombosis
DIC
DVT/PE prophylaxis
afib when off coumadin

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102
Q

MOA of heparin

A

Combines with antithrombin III, prevents formation and doesn’t break the clot
Inhibits conversion of fibrinogen to fibrin which prevents fibrin clot formation
prolongs PTT (effectiveness of heparin, bleeding is a worry)

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103
Q

Nomogram

A

like insulin sliding scale but for heparin

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104
Q

pharmacodynamics of heparin

A

poorly absorbed GI
destroyed by heparinase in the liver
IV or SQ
fast half life
flow sheet so nurses know how much to administer

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105
Q

How is lovenox administered

A

2 inches away from the umbilicus, MAINTAIN AIR BUBBLE

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106
Q

side effects of heparin (3)

A

bruising
itching
burning

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107
Q

adverse effects of heparin

A

bleeding
ecchymosis
thrombocytopenia (low platelets during allergic reaction so they start clotting, biggest concern)
hemorrhage

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108
Q

contraindications of heparin

A

bleeding disorder
peptic ulcer
hepatic or renal disease
hemophilia (clotting takes long)
CVA (hemorrhagic)

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109
Q

drug and food interactions of heparin

A

increased effect with ASA, NSAIDS, thrombolytics, and probenecid
decreased effect with nitroglycerin and protamine sulfate

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110
Q

antidote for heparin

A

protamine sulfate

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111
Q

nursing considerations of heparin

A

obtain history of abnormal clotting, ETOH, or renal or liver disease
check PTT q4 hours when changed
check stool melena
check H&H if they’re losing blood

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112
Q

indications of warfarin (coumadin)

A

bleeding disorder
peptic ulcer
hepatic or renal disease
hemophilia (clotting takes long)
CVA (hemorrhagic)

same as heparin!

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113
Q

how to adjust the dose of warfarin

A

according to pt/INR
check INR within 3 days of antibiotics

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114
Q

ranges of INRs for warfarin (afib, DVT/PE/mechanical valves)

A

afib: 2-3
DVT/PE/mechanical valve: 2.5-3.5

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115
Q

antidote for warfarin

A

vitamin K

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116
Q

novel anticoagulants

A

no antidote
no INR to monitor
for afib, DVT/PE, NOT MECHANICAL VALVES (use warfarin)

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117
Q

examples of NOAC

A

xarelto, eliquis, pradaxa
high incidence of bleeding but less than warfarin

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118
Q

dabigatran etexilate (pradaxa) use

A

thromboembolism (DVT/PE) treatment and prophylaxis, stroke prophylaxis (non-valvular afib)

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119
Q

MOA of dabigatran etexilate (pradaxa)

A

inhibits thrombin

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120
Q

important info about dabigatran etexilate (pradaxa)

A

excreted by kidneys, decrease dose in CKD, avoid in hemodialysis

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121
Q

side effects of dabigatran etexilate (pradaxa)

A

bleeding, bruising, gastritis (leads to bleeding)

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122
Q

adverse effects of dabigatran etexilate (pradaxa)

A

hemorrhage, hematoma, thrombocytopenia

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123
Q

black box warning of dabigatran etexilate (pradaxa)

A

increase thrombotic event and stroke risk when d/c prematurely, epidural and spinal hematoma risk PARALYSIS!!

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124
Q

antidote for dabigatran etexilate (pradaxa)

A

praxbind

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125
Q

MOA of antiplatelets

A

used to prevent thrombosis in arteries by suppressing platelet aggregation

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126
Q

indications of antiplatelets

A

prevention of MI, CVA, or TIA

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127
Q

examples of antiplatelets

A

ASA
ticagrelor (brilinta) must use with 100 mg ASA, or less usually 81mg
(prasugrel) effient
clopidogrel (plavix)
pletal
agrylin
reopro
integrilin

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128
Q

pletal is an antiplatelet for WHERE

A

peripheral, NOT heart

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129
Q

use of agrylin

A

If we’re concerned about MI or clots

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130
Q

clopidogrel (plavix) class, dose

A

antiplatelet
loading dose 300-600mg then 75 mg daily, check P2Y12

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131
Q

indications of clopidogrel (plavix)

A

prevent recurrence of CVA, vascular death

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132
Q

MOA of clopidogrel (plavix)

A

inhibits platelet aggregation

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133
Q

contraindications and caution of clopidogrel (plavix)

A

contra: intracranial hemorrhage, peptic ulcer
caution: liver disease, GI bleeding, surgery (talk to cardiologist if not brain or spinal), bleeding from trauma

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134
Q

side effects and adverse of clopidogrel (plavix)

A

S/E: URI, flu-like symptoms, dizziness, HA, fatigue, CP, diarrhea, bruising, bleeding
A/E: HTN, bronchitis

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135
Q

interactions of clopidogrel (plavix)

A

May increase bleeding when used with NSAIDS
Interferes with the metabolism of phenytoin, warfarin, fluvastatin, tamoxifen, tolbutamide, NSAIDS, and torsemide
May increase bleeding when taken with ginger, garlic, gingko, feverfew

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136
Q

thrombolytics MOA

A

STRONGEST
promotes fibrinolytic mechanism
converts plasminogen to plasmin DESTROYING fibrin in the clot
disintegrates within 4 hours

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137
Q

use of thrombolytics

A

MI, PE, DVT, CVA
must be EMBOLIC stroke

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138
Q

ending of thrombolytics

A

-ase
remember -ase is enzymes which speed things up and thrombolytics are strong and fast

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139
Q

Alteplase (tPA) drug class and indications

A

thrombolytic
dissolves clot following AMI, PE, acute ischemic stroke
for emergency situations!

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140
Q

MOA of Alteplase (tPA)

A

promotes conversion of plasminogen to plasmin, digesting the fibrin matrix of clots, initiating fibrinolysis

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141
Q

side and adverse effects of Alteplase (tPA)

A

S/E: bleeding
A/E: intracerebral hemorrhage, stroke, atrial or ventricular dysrhythmias

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142
Q

contraindications of Alteplase (tPA)

A

internal bleeding, bleeding disorders, recent CVA, surgery or trauma, bacterial endocarditis, severe liver dysfunction, uncontrolled HTN

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143
Q

drug-food interactions of Alteplase (tPA)

A

increased bleeding with anticoags, NSAIDS, cefotetan, plicamycin

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144
Q

Sodium-glucose Co-transporter 2 (SGLT-2) inhibitors ending

A

-flozin

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145
Q

MOA of Sodium-glucose Co-transporter 2 (SGLT-2) inhibitors

A

induced glucosuria independent of insulin secretion
reduces ability of renal tubules to absorb glucose, allows increased insulin sensitivity, decreased gluconeogenesis
used for diabetes and HF (low EF) even without diabetes

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146
Q

contraindications of Sodium-glucose Co-transporter 2 (SGLT-2) inhibitors

A

type 1 DM, DKA, severe renal disease (GFR <30), on HD

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147
Q

adverse effects of Sodium-glucose Co-transporter 2 (SGLT-2) inhibitors

A

hyperkalemia, mycotic infections, UTI, renal insufficiency, hypotension, fungal infection

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148
Q

empagliflozin (jardiance) dosing

A

10mg PO in the morning, titrate up to 25 mg
D/C if GFR persistently below 45

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149
Q

dapagliflozin (farxiga) dosing

A

5 mg can increase to 10
D/C if GFR <60

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150
Q

canagliflozin (invokana) dosing

A

100 mg before 1st meal of the day
increase to 300 for pt with normal renal function (GFR >60)

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151
Q

sacubitril/valsartan (entresto) indication

A

heart failure with reduced EF, NYHA class II-IV

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152
Q

sacubitril/valsartan (entresto) side effects

A

hypotension, dizziness, cough, hyperkalemia, renal failure

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153
Q

sacubitril/valsartan (entresto) adverse effects

A

hypersensitivity, angioedema, severe hypotension, renal failure

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154
Q

sacubitril/valsartan (entresto) black box warning

A

fetal toxicity

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155
Q

Chronic bronchitis

A

constriction

156
Q

bronchiectasis

A

obstruction of airflow

157
Q

asthma

A

Constriction and inflammation of bronchial tubes
Increased mucus production

158
Q

restrictive lung disease

A

prevents lungs from expanding

159
Q

causes of chronic bronchitis

A

smoking
chronic lung infections

160
Q

lung sounds in chronic bronchitis

A

rhonchi

161
Q

examples of beta2 adrenergic agonists

A

albuterol/proventil (ONLY RESCUE MED)
ventolin
metaproterenol

162
Q

Xopenex

A

like proventil
less rapid HR
good for pts with afib or tachy

163
Q

how to use aerosol inhaler

A

Insert medication canister into plastic mouthpiece
Shake inhaler before using, remove cap from mouthpiece
Breath out through mouth, place mouthpiece 1-2 inches from or in mouth (don’t wrap your lips around mouthpiece)
Take slow, deep breath while pressing top of medication canister once
Hold breath for a few seconds, exhale slowly through pursed lips
Wait two minutes, repeat starting from shaking again
Spacer can be used for kids or elderly (or anyone having trouble)

164
Q

bronchodilators and steroid inhalers

A

Administer bronchodilator first, wait 5 minutes then steroid inhaler

165
Q

ipratropium (spiriva)

A

anticholinergic
for bronchospasm of COPD
EVERY DAY
relaxes smooth muscle of bronchioles

166
Q

when to administer spiriva with beta-agonists and cromolyn/steroids

A

Administer 5 minutes after beta-agonist (if also using)
Administer 5 minutes before steroid or cromolyn (this allows the bronchioles to dilate so the steroids or cromolyn can be deposited in the bronchioles

167
Q

SE of spiriva

A

dry mouth, hoarseness

168
Q

AE of spiriva

A

angioedema, dehydration, hyperglycemia

169
Q

contraindications and caution of spiriva

A

contra: pregnancy or peanut allergy
caution: lactose sensitivity, hypersensitivity, narrow-angle glaucoma, breastfeeding

170
Q

perks of spiriva

A

less systemic effects
more tolerable

171
Q

Methylxanthine (xanthine) derivatives

A

treatment of asthma
stimulates CNS and respirations, dilates coronary artery and pulmonary vessels
diuresis

172
Q

Methylxanthine (xanthine) derivatives examples

A

aminophylline
theophylline
caffeine

173
Q

therapeutic range of Methylxanthine (xanthine) derivatives

A

NARROW
10-20 mcg/ml

174
Q

contraindications of theophylline

A

GI problems, coronary disease, respiratory dysfunction, renal or hepatic disease, alcoholism, and hyperthyroidism

175
Q

adverse effects of theophylline

A

if levels >20 mcg/ml
Range from GI upset, nausea, irritability, and tachycardia to seizure, brain damage, coma, and even death

176
Q

Leukotriene receptor antagonists and synthesis inhibitors

A

EVERY DAY, NOT A RESCUE MED
not for asthma attacks
exercise induced asthma
moves eosinophils (seasonal asthma) and mast cells

177
Q

Leukotriene receptor antagonists prototype montelukast (singulair)

A

inhibits smooth muscle contraction and bronchoconstriction

178
Q

side effects of Leukotriene receptor antagonists prototype montelukast (singulair)

A

fever, HA, dizziness, fatigue, nasal congestion, cough, sore throat

179
Q

contraindications of Leukotriene receptor antagonists prototype montelukast (singulair)

A

hypersensitivity, severe asthma attack, status asthmaticus

180
Q

caution in Leukotriene receptor antagonists prototype montelukast (singulair)

A

severe liver disease

181
Q

black box warning for Leukotriene receptor antagonists prototype montelukast (singulair)

A

FOR KIDS
INCREASED RISK OF PSYCHOSIS AND SUICIDAL IDEATION

182
Q

Glucocorticoids

A

can be used for asthma and COPD
causes hyperglycemia, adrenal suppression, ulcer formation, immunosuppression if long term PO

183
Q

why are inhaled steroids better

A

less systemic effects

184
Q

use of Glucocorticoids (inhaled)

A

prevents COPD/asthma exacerbations
ant inflammatory
used if bronchodilator therapy doesn’t work or maximum dose of theophylline or adrenergics used
synergistic with beta2 agonist
takes 1-4 weeks
preferred

185
Q

should Glucocorticoids be taken with food

A

yes to prevent ulcers

186
Q

what are Glucocorticoids combined with to alleviate constriction

A

advair

187
Q

side effects of oral Glucocorticoids

A

Generally local, throat irritation, hoarseness, dry mouth
Oral and pharyngeal fungal infections, reversed with d/c and antifungal treatment
Candida albicans (fungal infections) can be prevented by using a spacer, rinse mouth out with water after each dose, wash the apparatus daily with warm water

188
Q

cromolyn (intal) indications

A

prophylactic treatment of bronchial asthma (NOT for acute attacks)
daily inhalation

189
Q

MOA of cromolyn (intal)

A

inhibits release of histamine

190
Q

side effects of cromolyn (intal)

A

bad taste (drink water after)
rebound bronchospasm (don’t D/C abruptly)

191
Q

nedocromil MOA

A

suppresses release of histamine, leukotrienes, and mediators from mast cells
NOT for acute asthma attack
more effective than cromolyn
less SE and bad taste

192
Q

SE of nedocromil

A

bad taste, rinse mouth

193
Q

mucomyst (acetylcysteine)

A

loosens mucus
administered by nebulizer
orally diluted
used as adjunct to bronchodilators when excess secretions are happening
antidote for acetaminophen if within 12-24 hours
5min after bronchodilators

194
Q

SE of mucomyst (acetylcysteine)

A

N/V, stomatitis (oral ulcers), and runny nose
smells nasty

195
Q

common cold

A

rhinovirus
1-4 days before onset of symptoms, transmission from contaminated surfaces
watery discharge
21 day course

196
Q

acute rhinitis

A

acute inflammation of the mucous membranes accompanies common cold

197
Q

sinusitis

A

inflammation of the sinuses, usually viral so we have to let it run its course; can be bacterial so we use abx

198
Q

acute pharyngitis

A

usually viral, similar to cold

199
Q

antihistamines

A

block nasal secretions
h1 blocker/antagonist

200
Q

H1

A

when stimulated, the extravascular smooth muscle in the nasal cavity are constricted

201
Q

H2

A

when stimulated, increase gastric secretions

202
Q

1st gen antihistamines

A

can cause dry mouth, drowsiness and other anticholinergic symptoms. OTC.
Example: Benadryl

203
Q

2nd gen antihistamines

A

non-sedating antihistamines, fewer anticholinergic effects
Examples: zyrtec (cetirizine), allegra (fexofenadine), loratadine (claritin)
Less side effects, better dosing profile, or better efficacy

204
Q

diphenhydramine (benadryl)

A

treats allergic rhinitis and itching, prevents motion sickness, sleep aid, antitussive, decreases swelling and secretions

205
Q

diphenhydramine (benadryl) contraindications

A

acute asthma attack, severe liver disease, lower respiratory disease, neonate, MAOIs, COPD, asthma
Dries secretions, we don’t want to thicken secretions
limit use in BPH bc urinary retention

206
Q

anticholinergic effects (4 big)

A

constipation
dry mouth
urinary retention
orthostatic hypotension

207
Q

diphenhydramine (benadryl) contraindications interactions

A

increased CNS depression with ETOH, narcotics and hypnotics, and barbiturates
avoid with MAOI

208
Q

side effects and AR of diphenhydramine (benadryl)

A

SE: drowsiness, dizziness, fatigue, urinary retention, constipation, dry mouth and throat, decreased secretions, excitation in children
AR: life-threatening agranulocytosis, hemolytic anemia,
thrombocytopenia

209
Q

benadryl in kids

A

used to make u sleep, might give paradoxical reaction (more awake)

210
Q

pharmacokinetics of antitussives

A

rapid absorption
metabolized in liver
excreted in urine

211
Q

contraindications of antitussives

A

patients who need to cough to maintain the airway (trach patients)
head injury
impaired CNS (coma or sedation)

212
Q

caution of antitussives

A

hypersensitivity or history of narcotic addiction (codeine)

213
Q

adverse effects of antitussives

A

drying effect on the mucous membranes, drowsiness and sedation (CNS effects), and GI upset

214
Q

centrally acting

A

sedating

215
Q

Dextromethorphan hydrobromide prototype (robitussin, sucrets cough control, benylin, vicks 44)

A

temporary suppression of a non-productive cough, reduces viscosity of tenacious secretions, dries up mucous membranes, sedative

216
Q

contraindications of Dextromethorphan hydrobromide

A

COPD, chronic productive cough, hypersensitivity, MAOIs, and children under 2, HTN, cardiac pts should take something else (vasoconstriction), diabetic patients need to look for diabetic-safe version

217
Q

SE and AE of Dextromethorphan hydrobromide

A

SE: nausea, dizziness, drowsiness, sedation
AE: hallucinations at high doses (codeine), HTN crisis

218
Q

topical nasal decongestants action

A

Sympathomimetic
Affect sympathetic nervous system to cause vasoconstriction esp in the nose
Cause less inflammation of the nasal membrane

219
Q

topical nasal decongestants indications

A

Relieve the discomfort of nasal congestion that accompanies the common cold, sinusitis, and allergic rhinitis (decrease in secretions when we constrict blood vessels)

220
Q

topical nasal decongestants contraindications

A

lesion or erosion in mucous membranes

221
Q

caution in topical nasal decongestants

A

may cause CVA, HTN, renal failure
not big worry bc not systemic

222
Q

AE of topical nasal decongestants

A

local stinging and burning
rebound congestion (use only when sick)
sympathomimetic effects

223
Q

2 drugs to avoid with topical nasal decongestants

A

cyclopropane and halothane

224
Q

indications of Prototype topical nasal decongestants

A

Symptomatic relief of nasal and nasopharyngeal mucosal congestion due to the common cold, hay fever, or other respiratory allergies; adjunctive therapy of middle ear infections to decrease congestion around the eustachian ostia

225
Q

actions of Prototype topical nasal decongestants

A

Sympathomimetic effects, partly due to release of norepinephrine from nerve terminals; vasoconstriction leads to decreased edema and inflammation of the nasal membranes

226
Q

adverse effects of Prototype topical nasal decongestants

A

Disorientation, confusion, light-headedness, nausea, vomiting, fever, dyspnea, rebound congestion

227
Q

action of oral decongestants

A

Shrink the nasal mucous membrane by stimulating the alpha-adrenergic receptors in the nasal mucous membranes
Vasoconstrict to decrease secretions

228
Q

indications of oral decongestants

A

Promote drainage of the sinuses and improve air flow
Decrease inflammation in sinuses, causing them to drain
VERY drying, increase fluid intake

229
Q

contraindications of oral decongestants

A

Any condition that might be exacerbated by sympathetic activity (HTN, stroke, cardiovascular disease, etc)

230
Q

adverse effects of oral decongestants

A

rebound congestion
sympathetic effects

231
Q

drug-to-drug interactions of oral decongestants

A

OTC products that contain pseudoepinephrine (not anymore bc abuse) concurrent can cause serious SE

232
Q

indications of nasal steroid decongestants

A

seasonal allergic rhinitis
inflammation after removal of nasal polyps

233
Q

contraindications and caution of topical nasal steroid decongestants

A

contra: acute infection
caution: active infection + avoid exposure to airborne infections

234
Q

AE of topical nasal steroid decongestants

A

Local burning, irritation, stinging, dryness of the mucosa, and headache
Suppression of healing can occur in a patient who has had nasal surgery or trauma

235
Q

indications of prototype topical nasal steroid decongestants

A

Treatment of seasonal allergic rhinitis for pts who are not getting any response from other decongestant preparations; relief of inflammation after the removal of nasal polyps

236
Q

actions of prototype topical nasal steroid decongestants

A

Anti-inflammatory action, which results from the ability to produce a direct local effect that blocks many of the complex reactions responsible for the inflammatory response

237
Q

adverse effects of prototype topical nasal steroid decongestants

A

local burning, irritation, stinging, dryness of the mucosa, headache, increased risk of infection

238
Q

actions of expectorants

A

Enhances the output of the respiratory tract fluids by reducing the adhesiveness and surface tension of these fluids, allowing easier movement of the less viscous secretions
Hydration is the best natural expectorant
Help the body cough more effectively by decreasing the viscosity of secretions
When secretions are thinner, they can be drained easier

239
Q

indications of expectorants

A

Symptomatic relief of respiratory conditions characterized by a dry, non-productive cough

240
Q

guaifenesin

A

prototype expectorant
Symptomatic relief of respiratory conditions characterized by dry, nonproductive cough and in the presence of mucus in the respiratory tract

241
Q

action of guaifenesin

A

Enhances the output of the respiratory tract fluid by reducing the adhesiveness and surface tension of the fluid, facilitating the removal of viscous mucus

242
Q

adverse effects of guaifenesin

A

N/V, HA, dizziness, rash

243
Q

mucolytics action

A

Work to break down mucus in order to aid the high-risk respiratory patient in coughing up thick, tenacious secretions
Decreases thickness so pts can cough them or drain them out easier

244
Q

mucolytics indications

A

Patients who have difficulty coughing up secretions
Patients who develop atelectasis (alveoli become deflated or filled with fluid)
Patients undergoing diagnostic bronchoscopy
Postoperative patients
Patients with tracheostomies
Nebulization or direct instillation into the trachea

245
Q

caution and adverse effects of mucolytics

A

Cautions: Acute bronchospasm, peptic ulcer, and esophageal varices
Adverse effects: GI upset, stomatitis, rhinorrhea, bronchospasm, rash

246
Q

acetylcysteine

A

prototype mucolytic
Mucolytic adjunctive therapy for abnormal, viscid, or inspissated mucous secretions in acute and chronic bronchopulmonary disorders; to lessen hepatic injury in cases of acetaminophen toxicity

247
Q

acetylcysteine actions

A

Splits links in the mucoproteins contained in the respiratory mucus secretions, decreasing the viscosity of the secretions; protects liver cells from acetaminophen effects

248
Q

adverse effects of acetylcysteine

A

Nausea, stomatitis, urticaria, bronchospasm, rhinorrhea

249
Q

phenothiazine (phenergan)

A

antiemetic
blocks H1, inhibits chemoreceptor trigger zone

250
Q

phenothiazine (phenergan) contraindications

A

hypersensitivity, narrow-angle glaucoma, severe liver disease, intestinal obstruction, bone marrow depression

251
Q

phenothiazine (phenergan) caution

A

CV disease, liver dysfunction, asthma, respiratory dysfunction, HTN, older adults, and debilitated patients

252
Q

phenothiazine (phenergan) side effects and adverse reactions

A

Side effects: drowsiness, confusion, anorexia, dry mouth and eyes, constipation, blurred vision, photosensitivity, HTN, transient leukopenia, urinary retention
OLDER ADULTS GET VERY TIRED FROM THIS
Adverse reactions: extrapyramidal syndrome (tardive dyskinesia, akathisia)
Like Parkinson’s, uncontrollable movements, lip smacking, eye rolling, tongue protruding

253
Q

drug interactions and labs of phenothiazine (phenergan)

A

Drug interactions: increases CNS depression and anticholinergic effects when taken with ETOH and other CNS depressants (also increases risk of respiratory depression
lab: false + pregnancy

254
Q

non-pharm antiemetics

A

Weak tea
Flattened carbonated beverage (cola)
Gelatin (gives you electrolytes and fluid, citrus flavors help, even just sniffing them)
Gatorade (lots of sugar so it might make everything worse so dilute it by half)
Pedialyte (not as much sugar, replaces electrolytes and has some salt, ice pops!)
Crackers/dry toast (no butter or anything)
IV fluids with severe dehydration
Cool rag on forehead or neck
Lemon ice (you can’t eat it very quickly which is good)
Ginger

255
Q

OTC antihistamine antiemetics

A

Dimenhydrinate (dramamine), mostly used for motion sickness, take beforehand, works better
Meclizine hydrochloride (antivert), for vertigo (room is spinning)
Diphenhydramine hydrochloride (benadryl), stabilizes inner ear and helps with nausea and motion sickness

256
Q

antihistamine antiemetics indication

A

used to prevent motion sickness, nausea, vomiting, and dizziness (vertigo)
Not effective treatment for severe vomiting R/T anticancer agents, radiation or toxins
Benadryl also indicated to prevent or alleviate allergic reactions to insect bites, allergens, or foods (antagonist to histamine receptors H1)

257
Q

side effects of antihistamine antiemetics

A

drowsiness, dry mouth, constipation
don’t use for pregnancy

258
Q

tremethobanzamide

A

antiemetic
preg category C don’t use unless it threatens mother or baby health

259
Q

pepto-bismol contraindication

A

DON’T take if allergic to ASA

260
Q

pepto-bismol

A

shake it up
chalky
acts on gastric mucosa to suppress V/D

261
Q

guaiac

A

blood in stool

262
Q

when to and not to use emetics

A

If someone ingested a substance that could be toxic to them
If someone ingested too much of something
HAS TO BE ALERT AND ORIENTED (aspiration risk)
No longer than 24 hours (or 60 min in some cases)
NOT IF SOMEONE INGESTED A CAUSTIC SUBSTANCE LIKE BLEACH, DYE, OILS (body can’t break it down), CLEANERS
USE ACTIVATED CHARCOAL INSTEAD

263
Q

Ipecac

A

to induce vomiting when pt is alert and within 1 hr
stimulates CTZ and acts directly on gastric mucosa

264
Q

what kind of ipecac should pts take

A

syrup only (fluid potent)
take with glass of water

265
Q

if ipecac doesn’t work what to do

A

wait 15 min, use absorbent

266
Q

ipecac in EDs

A

cardiomyopathy, vfib from hypokalemia, death

267
Q

causes of diarrhea

A

Spicy foods (irritation and increased secretions)
Spoiled foods (bacteria)
Bacteria or virus
Laxative abuse (INCREASE GI MOTILITY)
Bowel tumor (“CAUTION”, the “C” is “change in bowel habits”)
IBS (crohn’s disease, ulcerative colitis)
Stress/anxiety
Malabsorption syndrome (celiac!)

268
Q

risks of diarrhea

A

Dehydration (losing fluid in vomit and diarrhea)
Electrolyte imbalance (lose K+, Mg++, and vit K)
Can be serious in the elderly or young children (unable to compensate)

269
Q

nonpharm ways to treat diarrhea

A

Avoid milk products/rich foods (gravies, things with flavor)
Gatorade, pedialyte - DILUTE GATORADE WITH WATER TO DECREASE SUGAR INTAKE
IV solutions if serious
Yogurt because it replaces good bacteria in the gut (d/c if pt has more diarrhea after having yogurt)

270
Q

travelers diarrhea

A

from E. coli in contaminated water, fruit, veggies, meat
treatment: immodium or fluoroquinolones if infectious

271
Q

four classes and examples of antidiarrheals

A

Opiates- opiate related
Ex: camphorated opium tincture (paregoric), deodorized opium tincture (lomotil, motofen)

Somatostatin analogue
Ex: octreotide acetate (sandostatin)

Absorbents
Bismuth subsalicylate (pepto-bismol, kapectolin, kaopectate)

Miscellaneous
Ex: rifaximin (xifaxan)

272
Q

opiate prototype (lomotil)

A

slows intestinal motility

273
Q

lomotil SE and AE

A

Side effects: drowsiness, dizziness, constipation, dry mouth, weakness, flush, rash, blurred vision, urine retention, confusion, sedation
Adverse reactions: angioneurotic edema

274
Q

lomotil contraindications and LT reactions

A

Contraindications: hepatic or renal disease, glaucoma, severe electrolyte imbalance, children <2
Life threatening: paralytic ileus, toxic megacolon, severe allergic reaction

275
Q

lomotil drug/food interactions and labs

A

Drug/food interactions: increased CNS depression with ETOH, antihistamines, narcotics, MAOIs (lots of drug-to-drug/food interactions) may enhance HTN crisis
Labs: increased LFTs, amylase

276
Q

somatostatin analogue

A

decreases motility and gastric movements

277
Q

octreotide (sandostatin)

A

Inhibits gastric acids, pepsinogen, gastrin, cholecystokinin, serotonin secretions, and intestinal fluid
Prescribed for diarrhea resulting from metastatic cancer or chemo

278
Q

example of an absorbent

A

pepto-bismol
caution with ASA allergy
false + guaiac

279
Q

four types of laxatives/cathartics

A

Osmotics (saline)
Ex: glycerin, lactulose, magnesium citrate, MOM, sodium biphosphate

Stimulants (contacts or irritants)
Ex: bisacodyl (dulcolax), castor oil (neolid, purge), senna (senokot)

Bulk-forming
Fiber, increases size of the stool
Ex: polycarbophil (fibercon), methylcellulose (citrucel)

Emollients (stool softeners)
Ex: docusate sodium calcium (colace, surfak, dialose)

280
Q

what to use instead of osmotic laxatives for HF pts

A

golytely (refrigerate to improve taste)

281
Q

stimulant laxatives

A

bisacodyl
short term treatment of constipation or bowel prep
effects smooth muscle of intestine

282
Q

bisacodyl contraindications

A

hypersensitivity, fecal impaction, intestinal/biliary obstruction, appendicitis, abdominal pain, N/V, rectal fissures

283
Q

bisacodyl SE, AR, and LT

A

Side effects: anorexia, N/V/D, cramps
Adverse reactions: dependence, hypokalemia
Life threatening: tetany

284
Q

drug food interactions of bisacodyl

A

decreased effectiveness with antacids, histamine2 blockers, milk
Most frequently used and abused laxative in anorexic and bulimic patients

285
Q

castor oil

A

NOT to be used on early pregnancy (stimulates contractions and abortion)

286
Q

bulk forming laxative

A

psyllium (metamucil)
TAKE WITH 8 OZ OF WATER AND FOLLOW (intestinal obstruction)

287
Q

contraindications of metamucil

A

hypersensitivity, fecal impaction, intestinal obstruction, abdominal pain

288
Q

SE, AR, LT of metamucil

A

Side effects: anorexia, N/V/D, cramps
Adverse reactions: esophageal or intestinal obstruction if not taken with adequate water
Life-threatening: bronchospasm, anaphylaxis

289
Q

nursing considerations of laxatives

A

Store suppositories in less than 86℉ (30℃) (looks like little waxy bullets, make sure they’re cold so they aren’t too soft)
Do not take within 1 hr of any other drugs
D/C if rectal bleeding, N/V or cramping occurs

290
Q

triple therapy for ulcers

A

Flagyl
Omeprazole (PPI)
Clarithromycin

291
Q

what is GERD treated with

A

H2 blockers and PPIs

292
Q

nonpharm management of ulcers, avoid

A

Smoking (increases acid production in stomach)
Alcohol (acidic and destroys stomach lining)
Hot, spicy, and greasy foods (increase acid production)
NSAIDS (increased risk of ulcer formation), steroids
Raise the head of the bed (pressure on sphincter increased, lets everything come up)
Do not eat before bed
Wear loose fitting clothes (sphincter pressure when you wear tight clothes)

293
Q

tranquilizers and example

A

antiulcer
decreases vagal stimulation and anxiety
librium combined with quarzan (anticholinergic)

294
Q

anticholinergics for ulcers

A

decreases GI motility
pro-banthine (propantheline bromide)

295
Q

antacids for ulcers

A

neutralize HCL acid, decreased pepsin
Ex: amphojel, Ca+ carbonate (tums), maalox, mylanta, gaviscon

296
Q

H2 blockers for ulcers

A

Ex: cimetidine (tagamet), famotidine (pepcid), nizatidine (axid), ranitidine (zantac)

297
Q

PPIs for ulcers

A

Ex: prevacid, prilosec, nexium, protonix

298
Q

aluminum hydroxide (amphojel)

A

neutralizes gastric acidity
not daily
decreases phosphate

299
Q

contra of amphojel

A

hypersensitivity to aluminum products, hypophosphatemia
Caution in older adults

300
Q

SE and AR of amphojel

A

SE: constipation
AR: hypophosphatemia, long term use can cause GI obstruction

301
Q

nursing considerations of antacids

A

Avoid administering with other oral drugs, antacid may delay absorption
Give antacid 1-2 hours after other medications
Shake suspension well before administering, drink water after dose
Tell pt to report pain, coughing, or vomiting of blood
Alert healthcare provider if taking >2 weeks
Avoid taking with milk or foods high in vitamin D (can increase acidity)
Stools may become speckled white (medication is very white and chalky)

302
Q

H2 blockers for GERD

A

ranitidine (zantac)
prevents and treats ulcers
inhibits gastric acid secretion
BEFORE meals

303
Q

zantac contraindications and caution

A

contra: hypersensitivity, severe renal and liver disease
caution: preg and lactation

304
Q

zantac SE and AR

A

Side effects: HA, constipation, confusion, N/D, vertigo, depression, rash, blurred vision, malaise, may increase effects of oral AC
Adverse reaction: hepatotoxicity and blood dyscrasia which can both be life threatening

305
Q

drug interactions of zantac

A

decreased absorption with antacids, decreased absorption of ketoconazole, toxicity with metoprolol
This med got discontinued because of high incidence of cancer

306
Q

nursing considerations of zantac

A

Administer drug before meals to decrease acid secretions
Reduce drug for older adults
Instruct client to report pain, coughing, or vomiting of blood
Avoid smoking and poor lifestyle habits, may decrease drug effectiveness
Separate dose from antacid by 1 hour

307
Q

esomeprazole (nexium)

A

PPI
treats peptic and duodenal ulcers, GERD, erosive esophagitis, h. pylori, and zollinger-ellison syndrome
suppresses gastric acid secretion by inhibiting H+ and K+ in gastric parietal cells

308
Q

SE and AR of nexium

A

Side effects: HA/dizziness, fatigue, thirst, increased appetite, anorexia, N/D/C, rash, thrombocytopenia
Adverse reaction: elevated AST, ALT
makes aspirin less acidic so aspiration PNA when throwing up

309
Q

nexium drug interactions and use

A

Drug interactions: may increase theophylline levels, decreased prevacid with sucralfate, may interfere absorption of ampicillin, ketoconazole, digoxin, plavix
PLAVIX IS FOR PPL WITH STENTS, HEART ATTACKS CAN HAPPEN, H2 BLOCKERS INSTEAD
Usually used as prophylaxis against ulcer formation (hospitals cause stress and stuff so it makes you likely to develop an ulcer)

310
Q

pepsin inhibitor sucralfate (carafate)

A

non-absorbable and combines with protein to cover ulcer and protect it
4x/day, before meals, and at bedtime

311
Q

contraindications of sucralfate

A

hypersensitivity and renal failure

312
Q

SE of sucralfate

A

dizziness, N/C, dry mouth, rash, pruritus, back pain, sleepiness

313
Q

nursing considerations of sucralfate

A

Administer on empty stomach
Administer antacids 30 min before or after sucralfate
Allow 1-2 hours between sucralfate and other drug
Avoid smoking and ETOH
Proper diet

314
Q

starting SE of anticonvulsants (4)

A

dizziness, slurred speech, ataxia, confusion

315
Q

three MOA of anticonvulsants

A

Suppressing Na+ influx through drug binding to inactivated sodium channel, prolonging Na+ channel activation, preventing neuron firing

Suppressing Ca+ influx , preventing electrical current generated by ca+ ions to T-type channel

Increasing the action of gamma aminobutyric acid (GABA), which inhibits neurotransmitters

316
Q

hydantoins

A

inhibit Na+ influx, stabilizes cell membranes, reducing repetitive neuronal firing
NOT DURING PREGNANCY (cleft lip and palate)

317
Q

therapeutic range of hydantoins

A

10-20 mcg/ml

318
Q

dilantin

A

prevents seizures
reduces motor cortex activity by altering transport of ions

319
Q

dilantin contraindications

A

hypersensitivity, heart block, psychiatric disorders, pregnancy

320
Q

dilantin SE and AR

A

Side effects: HA, diplopia (seeing double), confusion, dizziness, sluggish, ↓coordination, ataxia, slurred speech, rash, anorexia, N/V, hypotension (after IV administration), pink-red/brown color of urine, fevers

Adverse reactions: leukopenia, hepatitis, depression, gingival hyperplasia (overgrown gums), gingivitis, nystagmus, hirsutism, osteoporosis

321
Q

nursing considerations for dilantin

A

Utilize seizure precautions
Advise female patients taking oral contraceptives must use a back up contraception
Monitor CBC
Shake suspension well before dispensing
Advise patient to avoid driving or other hazardous activities initiating therapy
CAN’T drive until cleared by neurologist
Need to be seizure free for 6 months
Avoid alcohol and other CNS depressants
Do not stop drug abruptly, obtain medic alert bracelet

322
Q

phenobarbital

A

for seizures, meningitis, toxic reaction eclampsia
reduces seizures by enhancing GABA
less SE than dilantin, less teratogenic
can be used for preeclampsia

323
Q

succinimides

A

ethosuximide (zarontin)
treats seizures, in combination
decreases Ca+ influx through t-type Ca+ channels

324
Q

zarontin therapeutic range

A

40-100 mcg/ml

325
Q

zarontin adverse effects

A

blood dyscrasia, renal and liver impairment, SLE

326
Q

diazepam, clonazepam

A

for seizures
high risk for abuse
used for status epilepticus IV
breakthrough seizures

327
Q

diazepam,clonazepam therapeutic range

A

5-12 mcg/ml

328
Q

2 antianginals lower BP AND HR, which one only lowers BP?

A

nitrates

329
Q

Iminostilbenes

A

example: Carbamazepine (tegretol)
treats seizures when not responding to other therapies, bipolar disorders, trigeminal neuralgia, ETOH withdrawal

330
Q

therapeutic range of tegretol

A

5-12 mcg/ml

331
Q

what to AVOID with tegretol and why

A

avoid grapefruit juice
metabolized by cytochrome P450 3A4

332
Q

valproic acid

A

for seizures

333
Q

important things about valproic acid

A

avoid in children <2 and pts with liver disease
monitor LFTs
start low and go slow

334
Q

Levetiracetam (Keppra)

A

prevents hypersynchronization of epileptiform burst firing
for seizures

335
Q

pregnancy risks and adverse reactions of keppra

A

low teratogenic risk but may need to lower dose bc of intrauterine growth restriction
AR: aggression (lower dose)

336
Q

which two meds are linked to cleft lip and palate

A

dilantin and tegretol (keppra is an alternative but doesn’t always work)

337
Q

what vitamin do anticonvulsants inhibit

A

vitamin K (clotting factor)
given to pregnant woman if on anticonvulsant during last week of pregnancy, then 10 days later
also given to baby!

338
Q

febrile seizures

A

occurs in children between 3 months and 5 years
epilepsy more common in ppl with febrile seizures
NO VALPROIC ACID
from rapid change in temp, not high fever

339
Q

three major features of parkinsonism

A

Bradykinesia: slow movement and tremors
Rigidity: increased muscle tone w/increased movement
Posture: forward leaning, shuffle gait (fall risk, may need to d/c anticoags)

340
Q

dopamine and acetylcholine in parkinsonism

A

low dopamine and high acetylcholine
WANT TO INCREASE DOPAMINE AND DECREASE ACETYLCHOLINE

341
Q

nonpharm treatments for parkinsonism

A

exercise
diet with fiber and hydration
support groups

342
Q

anticholinergics for parkinson’s examples

A

ex: artane, congentin, norflex, parsidol, BENADRYL?

343
Q

example of dopaminergics

A

carbidopa-levodopa (GOLD STANDARD)
relieves tremors and rigidity

344
Q

dopamine agonists

A

stimulate dopamine receptors

345
Q

dopamine agonists

A

stimulate dopamine receptors
ex: amantadine, bromocriptine, Mirapex, requip

346
Q

MAO B inhibitors

A

ex: eldepryl and azilect

347
Q

examples of comt inhibitors

A

comtan and tasmar

348
Q

anticholinergics

A

reduce rigidity and tremors
little effect on bradykinesia
inhibits release of acetylcholine

349
Q

SE of anticholinergics

A

dry mouth, dry secretions, urinary retention, constipation blurred vision, ↑HR, restlessness, confusion

350
Q

contraindications of anticholinergics

A

glaucoma

351
Q

dopaminergics (carbidopa-levodopa/sinemet) drug interactions

A

increased HTN crisis with MAOIs
decreased effect with anticholinergics, avoid foods with vit b6 (protein)

352
Q

contraindications of dopaminergics (carbidopa-levodopa/sinemet)

A

narrow angle glaucoma, severe cardiac, renal, or hepatic disease, suspicious skin lesions (malignant melanoma activated)

353
Q

SE of dopaminergics (carbidopa-levodopa/sinemet)

A

anorexia, nausea, vomiting, dysphagia, fatigue, dizziness, headache, dry mouth, bitter taste, twitching, blurred vision, insomnia, dark urine

354
Q

AR and LT of dopaminergics (carbidopa-levodopa/sinemet)

A

Adverse reactions: Involuntary movements, palpitations, orthostatic hypotension, urinary retention, priapism, psychosis, severe depression with suicidal ideation, hallucinations
Life threatening: Agranulocytosis, hemolytic anemia, thrombocytopenia, cardiac dysrhythmias, neuroleptic malignant syndrome

355
Q

nursing considerations of sinemet

A

Symptoms of parkinsonism will be decreased or absent after 1-4 weeks of drug therapy
Instruct client to rise slowly to avoid orthostatic hypotension
Administer with low protein foods, high proteins diets interfere with drug transport to CNS
Avoid abrupt discontinuation rebound parkinsonism can occur
Urine and perspiration may darken

356
Q

dopamine agent (amantadine hydrochloride [symmetrel])

A

taken alone or with levodopa or anticholinergic
treats symptoms
tolerance develops fast

357
Q

side effects of symmetrel

A

well tolerated but side effects increase with combinations of drugs, orthostatic hypotension, confusion, urinary retention, constipation

358
Q

dopamine agonist mirapex and requip side effects

A

Less side effects than the older drugs: may cause nausea, dizziness, somnolence, weakness and constipation
SUPER tired
Intensify dyskinesia and hallucinations

359
Q

dopamine agonist bromocriptine (parlodel)

A

more effective than symmetrel, not as much as carbidopa-levodopa
when pts can’t tolerate carbidopa-levodopa

360
Q

SE of parlodel

A

nausea, orthostatic hypotension, palpitations, chest pain, LE edema, nightmares, delusions, confusion

361
Q

MAO-B inibitors

A

selegiline
prolongs action of levodopa
used for new diagnosis

362
Q

MAO-B inhibitors food-drug interactions

A

large dose prevents metabolism of tyramine (red wine, bananas, aged cheeses) causing HTN crisis
severe reaction with TCA and SSRIs

363
Q

comt inhibitor

A

increases levadopa in brain

364
Q

tasmar

A

1st comt inhibitor, for advanced parkinson’s
monitor LFTs (turns urine bright yellow)

365
Q

entacapone (comtan)

A

comt inhibitor
no effect on liver
dark yellow-orange urine

366
Q

acetylcholine in alzheimer’s

A

low
WANT TO INCREASE (A for acetylcholine and alzheimer’s)

367
Q

what do alzheimer’s drugs act like

A

CHOLINERGIC DRUGS

368
Q

acetylcholinesterase inhibitor

A

rivastigmine (exelon)
improves memory loss

369
Q

contraindications of exelon

A

liver/renal dx, urinary tract obstruction, orthostatic hypotension, bradycardia

370
Q

drug interactions of exelon

A

increased effects OF theophylline
increased effect WITH cimetidine

371
Q

SE of exelon

A

Anorexia, N/V/D/C, HA, dizziness, rhinitis, depression, myalgia, peripheral edema, dry mouth, Restless leg, dehydration, dry mouth

372
Q

AR and LT of exelon

A

Adverse reactions: bradycardia, orthostatic hypotension, MI, HF
Life threatening: Hepato-toxicity, suicidal ideation, stevens-Johnson syndrome

373
Q

myasthenia gravis

A

lack of acetylcholine receptor sites
ineffective muscle contraction and weakness
thymus gland involved, shrinks
THYMIC HYPERPLASIA (remove thymus)

374
Q

symptoms of myasthenia gravis

A

dysphagia, dysarthria respiratory muscle weakness, respiratory failure
Early symptoms ptosis (drooping eyelids), diplopia (double vision)

375
Q

pyridostigmine bromide (Mestinon)

A

cholinesterase inhibitor
controls and treats myasthenia gravis
prevents destruction of Ach

376
Q

contraindications of pyridostigmine bromide (Mestinon)

A

GI and GU mechanical obstruction, severe renal dx

377
Q

caution of pyridostigmine bromide (Mestinon)

A

asthma, hypotension, bradycardia, peptic ulcer, cardiac dysrhythmias, renal dysfunction, hyperthyroidism and pregnancy

378
Q

SE of pyridostigmine bromide (Mestinon)

A

N/V/D, HA, dizziness, abdominal cramps, excessive saliva, sweating and rash, miosis

379
Q

AR and LT of pyridostigmine bromide (Mestinon)

A

AR: hypotension and brady
LT: resp depression, bronchospasm, seizures

overdosing=CHOLINERGIC CRISIS (extreme muscle weakness, salivation, tears, sweating, miosis, ANTIDOTE IS ATROPINE)

380
Q

MS

A

attacks myelin sheath fibers in brain and spinal cord (lesions cause plaques)
affects caucasian women 20-40

381
Q

MS symptoms

A

diplopia, weakness or spacticity

382
Q

drugs to avoid with MS

A

Histamine 2 H2 blockers such as cimetidine and ranitidine
Indomethacin
BB

383
Q

meds for spasticity

A

Baclofen (lioresal), diazepam (valium), dantrolene (dantrium), tizanidine (Zanaflex)
used for 1-3 weeks bc of high tolerance and dependence
centrally acting muscle relaxants

384
Q

cyclobenzaprine (flexeril) contraindications

A

Acute MI, BBB (bundle branch block), AV block, cardiac arrhythmias, HF, hypothyroid, paralytic ileus, MAOI use within 14 days

385
Q

drug interactions with flexeril

A

increased CNS depression with ETOH, narcotics, sedative –hypnotics, Kava Kava, Valerian

386
Q

SE and AR of flexeril

A

Side effects: anticholinergic effects (drowsiness, dizziness, HA, constipation, dry mouth, tachycardia, urinary retention), fever, abd pain
Adverse effects: angioedema, MI, seizures, paralytic ileus

387
Q

nursing considerations for skeletal muscle relaxants for spasticity

A

Do not stop abruptly, taper over 1 week to avoid rebound spasm
Do not drive or operate machinery
Do not take for longer than 3 weeks
Avoid alcohol and CNS depressants
Contraindicated with nursing or pregnant mothers
Take with food to avoid GI upset

Pharm 2 (5 decks)

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