Exam 2 Drug Classes Flashcards
MOA of antacids
- neutralize gastric acidity
- increases stomach pH from 1.3-3.5
- symptomatic relief and some ulcer healing
antacids medications
calcium carbonate (Tums)
AE of antacids
- motility of gastric system
- DDI, increased pH reduces absorption of acidic groups
- electrolyte imbalance
- do not take within 2 hours of other oral meds
- take with foods
MOA of H2 receptor antagonists
reduce the secretion of stimulated acid
indication for H2 receptor agonist
treats acid reflux and heal ulcers
H2 receptor agonist medications
ranitidine (Zantac)
famotidine (Pepcid)
AE of H2 receptor agonists
- diarrhea
- muscle pain
- rashes
- cimetidine inhibits P450 enzymes and can cause gynecomastia
- take on empty stomach
MOA of PPI
irreversibly inhibits ATPase pump and blocks final steps in acid secretion into stomach
indication of PPI
treat acid reflux and heal ulcers (most effective)
PPI medications
omeprazole (Prilosec)
esomeprazole (Nexium)
AE of PPIs
- generally well tolerated
- long term use gastric polyps, altered calcium reabsorption, cvd abnormalities
- take on empty stomach
what are the 3 mucosal protectors
- bismuth chelate
- sucralfate
- misoprost
MOA of bismuth chelate
- coat ulcers
- increase gastric mucous
- protects against H. pylori induced ulcers
MOA of sucralfate
- aluminum salt that coats the ulcer
indication of sucralfate
high-risk cases
- trauma
- burns
- ARDS
- major surgery
MOA of misoprostol
PGE2 that inhibits acid secretion
indication of misoprostol
prevent NSAID induced ulcers
what is the combo therapy used to treat H. plylori infection
acid controlling drug + antibiotic
(usually PPI + 2 antibiotics)
- can eliminate bacterium within one week
- if NSAID ulcer use GI friendly COX2 inhibitor)
MOA anticholinergics
binds to ACh receptor on vestibular nuclei and blocks communication
indication of anticholinergics
motion sickness related vomiting
AE of anticholinergics
- dizziness
- drowsiness
- dry mouth
- blurred vision
- dilated pupils
- cant see, spit, pee or poo
anticolinergic antiemetic medication
scopolamine (Transderm Scop)
MOA antiemetic antihistamines
inhibit vestibular input to CTZ
indication antiemetic antihistamines
motion-sickness related vomiting
antiemetic antihistamine medications
meclizine
AE antiemetic antihistamines
dizziness and sedation
MOA neuroleptic drugs
block dopamine receptors in CTZ
indication for neuroleptic drugs
post op N/V and chemo-induced vomiting
AE of neuroleptic drugs
- OH
- tachycardia
- blurred vision
- dry eyes
- urinary retension
- long term use can lead to extrapyramidal sx
TONS
MOA of prokinetic drugs
- block dopamine in CTZ
- produce central and peripheral antiemetic effects
indicator of prokinetic drugs
nausea and vomiting
AE of prokinetic drugs
- diarrhea, weakness, prolactin release
- prolonged use causes extrapyramidal signs, motor restlessness
- hypo- and hypertension, tachycardia
MOA of serotonin blockers
block serotonin receptors in GI tract, CTZ, and vomiting center
Indication of serotonin blockers
used to prevent vomiting
prokinetic medications
metoclopramide
serotonin blockers medications
ondansetron
AE of serotonin blockers
- HA
- dizziness
- diarrhea
- no extrapyramidal signs
what may be used in combo with serotonin blockers to control chemo-induced emesis
corticosteroids
neurokin - 1 receptor blockers MOA
blocks substance p from binding, prevents both central and peripheral
indication for neurokinin-1 receptor blockers
used to prevent emesis from chemotherapy
AE of neurokinin-1 receptor blockers
- sedation
- GI issues
- stevens johnson syndrome (life threatening rash)
MOA of cannabinoids
is unclear
indication for cannabinoids
- used to block acute and delayed emesis
- used for chemo-induced n/v
AE of cannabinoids
- ataxia
- light headedness
- blurred vision
- dry mouth
- weakness
- tachycardia or bradycardia
- CNS sx (being stoned)
indication of phosphorated carbohydrate solution (Emetrol)
used for mild cases of intestinal flu or food-borne causes
MOA of phosphorated carbohydrate solution (Emetrol)
relaxes GI tract smooth muscle
Drug classes used to treat Nausea and vomiting
- anticholinergics
- antihistamines
- neuropletic drugs
- pro kinetic drugs
- serotonin blockers
- neuokinin-1 receptor blockers
- cannabinoids
- phosphorated carbohydrate solution (Emetrol)
indication for absorbents
diarrhea
MOA of absorbents
binds to bacteria causing diarrhea to carry them out with feces
absorbent medications
bismuth subsalicylate (Pepto-Bismol)
AE of absorbents
- aspirin products: so use with caution in children recovering from the flu/chickenpox bc of Reye’s syndrome
- increased bleeding time
- GI bleed
- tinnitus
- decrease effectiveness of many drugs
MOA antidiarrheal anticholinergics
reduce peristalsis of GI tract, inhibits the PNS
AE of antidiarrheal anticholinergics
tons of anticholinergic AEs
MOA of intestinal flora modifiers
resides in intestines to keep “bad” bacteria in check . helps restore normal gut balance
indications of intestine flora modifiers
good to use while taking antibiotics for diarrhea
MOA of opiates
- decrease GI motility and propulsion
- slows transit time in intestines
indication of opiates
- can be used to reduce pain
- diarrhea
opiates for antidiarrheal - medications
dipenoxylate (Lomotil)
- has added atropine to prevent recreational opioid use
AE of opiates
- sedation
- dizziness
- constipation
- nausea
- vomiting
- respiratory depression
- bradycardia
- hypotension
- urinary retention
classes of antidiarrheal agents
- absorbents
- anticholinergics
- intestinal flora modifiers
- opiates
classes of medications for constipations
- bulk forming laxatives
- hyperosmotic laxatives
- saline laxatives
- emollient laxatives
- stimulant laxatives
MOA of bulk forming laxatives
increases water absorption to soften and increase bulk of intestinal contents
bulk forming laxatives medications
- methycellulose (Citrucel)
hyperosmotic laxatives MOA
draws fluid into the colon to increase stool fluid content
hyperosmotic medications
- lactulose
- polyethylene glycol 3350 (Miralax)
AE of hyperosmotic medications
- abdominal bloating
- rectal irritation
- electrolyte imbalance: dont use with heart issues
MOA of saline laxatives
pushes water/electrolytes into intestines
AE of saline laxatives
salts may cause issues with individuals with diminished cardiac or renal failure
MOA of emollient laxatives
facilitate water and fat absorption into the stool, lubricates
emollient laxative medications
decussate sodium (Colace)
AE of emollient laxatives
- skin rash
- decreased vitamin absorption
- electrolyte imbalance
MOA of stimulant laxatives
stimulates peristalsis through enteric nervous system
Stimulant laxative medications
Senna
AE of stimulant laxative medications
dependence with long term use and damage to intestinal cells/loss of colon function
NOT best for long term constipation issues
what nervous system are anticholinergics associated with?
PNS
what neurotransmitter bings cholinergic receptors?
acetylecholine
what are the two types of cholinergic receptors?
- muscarinic
- nicotinic
what are the AEs of anticholinergic drugs
- cant see, spit, pee, shit ABCDs - agitation - blurred vision - constipation and confusion - dry mouth - stasis of urine and sweat
what are contraindications to taking an anticholinergic drug
avoid (esp systemic use) if history of urinary retention, narrow angle closure glaucoma
Indication of atropine
- pre-surgery or end of life care of decrease saliva and secretions
- mydriasis for eye exams
- treat poisoning from muscarinic-containing mushrooms, organophosphates, insecticides, or nerve agents
MOA inhaled anticholinergic (aka antimuscarinics)
primarily bind M3 in airway smooth muscle to bronchodilate
indication of an inhaled anticholinergic
asthma and COPD
anticholinergic medications
- SAMA
- LAMA or LAAC
AE of inhaled anticholinergics
dry mouth, but generally well tolerated
MOA of anticholinergics used to treat overactive bladder (patch)
antagonize muscarinic receptors on bladder smooth muscle = decrease contraction
what are the uses for anticholinergic drugs
COPD, asthma, parkinson’s disease, OAB, motion sickness, decreasing saliva/secretions pre-surgery, treating poisonings, ophthalmic exams
AE of anticholinerics for Parkinson’s
may produce extrapyramidal sx
- aka drug induced movement disorders
moa of anticholinergics for parkinson’s
block M1 receptors in CNS, may also increase dopamine which plays a role in PD
what receptor types do antihistamines act on?
histamine and muscarinic
1st generation antihistamines (H1 antagonists) AEs
- bind to histamine receptors in periphery and CNS (more sedation)
- bind muscarinic receptors (anticholinergic AE)
(Crosses BBB)
indication of 1st gen H1 antagonists (antihistamines)
used for allergies, sleep aid, motion sickness, N/V
2nd generation antihistamines AE
Does not cross BBB so not as many sedative effects. generally well tolerated
indication of anticholinergic - antidepressants
TCAs (tricyclic antidepressants)
- used for depression, OCD, bulimia, neuropathy and more
MOA anticholinergic antidepressants
varies by product
- primarily act by increasing serotonin and NE
H1 antagonists (sedating) muscarinic antagonists
AE anticholinergic antidepressants
- can have anticholinergic AEs
- prolong QTc (deadly in overdose)
MOA anticholinergic muscle relaxers
serotonin antagonism, also binds muscarinic receptors
MOA anticholinergic antipsychotics
antagonize alpha adrenergic, serotonin, dopamine, histamine, and muscarinic receptors to varying degrees
MOA anticholinergic anti arrhythmics
primary action is to inhibit sodium channels but also binds muscarinic receptors
when to avoid anticholinergics in elderly
- be aware all the time!!
- avoid in delirium, dementia, cognitive impairment, urinary retention, lower urinary tract sx, BPH
MOA direct acting cholinergic drugs
act directly on muscarinic receptors
MOA indirect acting cholinergic drugs
inhibit acetylcholinesterase (AChE)
uses of cholinergic drugs
glaucoma, GI disorders, urinary retention, alzheimer’s disease, diagnosis of myasthenia graves
MOA cholinergic drugs for glaucoma
meds stimulate muscarinic receptors in the eye
- miosis
- constrict ciliary muscle
- decrease resistance to aqueous humor outflow
when to use cholinergic drugs for urinary retention
- neurogenic bladder
- post surgery (potentially due to atropine given before surgery)
why take cholinergic drugs for alzheimers?
alzheimer’s is associated with decreased levels of ACh
MOA cholinergic drugs for Alzheimer’s
reversibly bind AChE so it does not break down ACh
- overtime may be less effective bc of disease progression (decrease in cholinergic receptors)
AE of cholinergic drugs from alzheimers
- varies some by product
- GI (n/v/d)
- less AEs with patch
what are the off-label uses for alzheimer’s disease medication
Lewy-Body dementia
traumatic brain injury cognitive impairment
what is myasthenia gravis
antibodies bind nicotinic ACh receptors in neuromuscular junction = inability to maintain muscular contractions
how to cholinergic drugs help dx of myasthenia gravis
edrophonium is administered and if muscle strength temp improves this assist dx
cholinergic AEs
SLUDGE
- sweating, lacrimation, urination, diarrhea, GI cramping, emesis
DUMBELLS
- diarrhea, urination, mitosis, bradychardia, emesis, lacrimation, lethargy, salvation/sweating
contraindications to cholinergic medications
- hx of COPD or asthma
- urinary tract obstruction
- PD
- PUD
therapeutic concerns with direct and indirect acting muscarinic agents (cholinerginic drugs)
- significant CVD effects
- decreased CO
- hypotension
- GI issues
- lungs
- frequent urination
- increase secretions
- cholinesterase inhibitors - syncope - pacemaker placement
therapeutic effects of anticholinergic drugs
atropine
- dry mouth in low doses
- blurred vision in higher doses
- blocked vagal effects
- constipation, urinary retention
- high doses have CNS effects
tachycardia and hyperthermia
what nervous system to adrenergic drugs act on
SNS
adrenergic agonists =
sympathomimetic
adrenergic antagonists =
sympatholytic
amphetamine MOA
- sympathomimetic indirect acting adrenergic drug
- taken up by NE receptors which leaves more NE available to have effect
indications of amphetamine
used for ADHD and narcolepsy
- increases alertness and decreases fatigue
amphetamine AE
- increased BP and HR
- decreased appetite
- enters the CNS and stimulates dopamine receptors = euphoria = abuse potential
cocaine MOA
sympathomimetic indirect acting adrenergic drugs
- inhibits reuptake of NE
indication of cocaine
used topically during nasal surgeries
cocaine AEs
significant vasoconstriction = hypertensive crisis
- MI
- stroke
ephedrine MOA
sympathomimetic indirect acting adrenergic drugs
- stimulates adrenergic receptors, facilitates NE release, enters CNS - similar impact to amphetamine
- synthetic in chinese herbal remedies
indication of ephedrine
marketed for increased energy, not regulated by FDA
classes of antihypertensive drugs
- diuretics
- calcium channel blockers
- beta blockers
- ACE inhibitors
- ARBs
- central acting alpha agonist
- nitrates
MOA diuretics
act directly on the nephron to limit water and sodium reabsorption
- increase excretion of NA and water by kidneys
- increases amount of urine formed
- decreases blood volume
what is the recommended initial therapy for all HTN pts
diuretics
loop diuretics MOA
act primarily on ascending loop of Henle and inhibit reabsorption of Na/K/Cl which prevents reabsorption of water
- increases urine production
loop diuretic classification
moderate antihypertensive, strong diuretic
thiazide diuretic classification
powerful antihypertensive, moderate diuretics
what are the 3 major classifications of diuretics
- loop
- thiazide
- potassium-sparing
examples of loop diuretics
furosemide (Lasix)
AE loop diuretics
dehydration, hypokalemia, hyponatremia, hypocalcemia, toxicity, hyperglycemia, increased LDLs
thiazide diuretics MOA
- act on early part of distal convoluted tubule
- Na and K excretion and reabsorption of Ca
what type of diuretic is the primary choice for HTN
thiazide diuretics
- lowers systolic BP more than other classes of antihypertensive drugs