exam 2 drugs and additional notes Flashcards
Contraindications for which drug?
- preexisting CV disease
- taking nitrate
- hypotension
sildenafil
s/e
- transient burning and discomfort
- systemic effects if drops are not kept local
s/e
- Well tolerated
s/e
- burn/sting
- dry mouth
- fatigue
- h/a
- blurry vision
- hypotension
s/e
- stinging
- bitter taste
- allergic reactions – conjunctiva or lid reactions
Timolol
brimonidine
betaxolol
Latanoprost
dozolamide
Timolol
betaxolol
-
Latanoprost
-
brimonidine
-
dozolamide - 2nd line
___________________Glomerulonephritis
- This type of glomerulonephritis is caused by an underlying systemic disease or infection.
Secondary Glomerulonephritis, Primary Glomerulonephritis
Secondary Glomerulonephritis
Bactrim (trimethoprim/sulfamethoxazole)
Ciprofloxacin
treats ______
Pyelonephritis
s/e
- Peripheral edema
- Nausea
- Ascites
- Dizzy
- Fatigue
- Pruritis
- Skin rash
- Abdominal pain
- Anemia
cirrhosis treatment
Lactulose or Rifaximin?
Rifaximin
pancreatic enzymes
__________ = edema, necrosis, hemorrhage
___________= hemorrhage
___________= fat necrosis
___________ = edema, vascular permeability (fluid seeps into pancreas), smooth muscle contraction, shock
________ = fat necrosis
phospholipase A, trypsin, elastase, kallikrein, lipase
pancreatic enzymes
- trypsin = edema, necrosis, hemorrhage
- elastase = hemorrhage
- phospholipase A = fat necrosis
- kallikrein = edema, vascular permeability (fluid seeps into pancreas), smooth muscle contraction, shock
- lipase = fat necrosis
bile flow obstruction -
what causes steatorrhea (fatty stool)
no bile salts are getting to stool b/c of obstruction
lack of bile salts decreases fat digestion = fatty stool
- Also used to treat male pattern baldness – increases hair growth
finasteride
male reproductive drugs
MOA
- Inhibits PDE5 which increases and preserves cGMP levels
sildenafil (Viagra)
(PDE5 removes cGMP which is a key part of the erection process)
Open angle glaucoma pharmacotherapy -
which drug(s) decreases aqueous humor production
timolol
betaxolol
Latanoprost
brimonidine
dozolamide
timolol
betaxolol
dozolamide - 2nd line
s/e
- h/a
- flushing
- dyspepsia - indigestion
which drug?
sildenafil
Open angle glaucoma pharmacotherapy -
which drug(s)
decreases aqueous humor production
AND may also increase drainage of aqueous humor
timolol
betaxolol
Latanoprost
brimonidine
brimonidine
Open angle glaucoma pharmacotherapy -
which drug(s) Increases outflow drainage of aqueous humor
timolol
betaxolol
Latanoprost
brimonidine
dozolamide
Latanoprost
Timolol and betaxolol
Patient teaching:
- Must take, or it will progress to __________
- Apply ___________ pressure with instillation
Patient teaching:
- Must take, or it will progress to blindness
- Apply nasolacrimal pressure with instillation
forms of alcoholic liver disease stages
o Fibrosis and scarring alter liver structure
o Irreversible
- Alcoholic cirrhosis
which eye condition would someone come into ED with
-severe eye pain
-Typically Unilateral
-blurry
-halos
-red eyes
-dilated pupil – nonreactive to light
-cloudy cornea
closed glaucoma
___________ jaundice is from increased RBC breakdown
- Hemolytic
s/e
- Bladder irritation
- Systemic infection
- UTI type s/s
BCG vaccine: intravesical therapy
- monitor K+ = _______
- Has been associated with increased risk of C diff – monitor = ________
cirrhosis treatment
Lactulose or Rifaximin?
- Lactulose2. rifaximin
types of kidney stones
UTIs are associated with _______
calcium is associated with ________
gout is associated with ________
stuvite
calcium oxalate and calcium phosphate
uric acid
Kidney cancer
Renal cell carcinoma
risk factors
- smoking
- female
- obese
- high fat diet
- OA
- Genetics
which is the most significant risk factor?
- smoking
X - male - obese
X- high fat diet - OA
- Genetics
SMOKING = kidney cancer
Calcitriol
Calcium carbonate
Sodium bicarbonate
treats ___________
- specifically treats metabolic acidosis
- specifically Treats hyperphosphatemia
- specifically treats renal osteodystrophy
CKD
- specifically treats metabolic acidosis - Sodium bicarbonate
- specifically Treats hyperphosphatemia - Calcium carbonate
- specifically treats renal osteodystrophy - Calcitriol
male reproductive drugs
MOA
- Blocks conversion of testosterone to DHT
finasteride - alpha 1 receptors
dutasteride - alpha 1 and 2 receptors
H
A
R
P
what are the manifestations and which issue is it associated with
-Hematuria
-Azotemia – build-up of waste products
-Retention – Na and water retention + oliguria = edema and high BP
-Proteinuria
Glomerulonephritis
MOA
Reduces blood ammonia levels by converting ammonia to ammonium (gets excreted via stool)
cirrhosis treatment
Lactulose or Rifaximin?
Lactulose
BCG vaccine: intravesical therapy
treats _____
Stage 1 bladder cancer
Direct acting antiviral therapy
Interferon based regiments
Some require treatment along with a nucleoside analogue med as well
which viral hep gets this treatment?
Hep C
_________ jaundice is from decreased or obstructed flow of bile, bilirubin can’t get out of liver (r/t gallstones)
- Obstructive
Lactulose
Rifaximin
treats _______
cirrhosis
Lactulose 1st line
Rifaximin 2nd line
pancreatic enzymes
4 =
3 =
1 =
1 =
1 =
- kallikrein = edema, vascular permeability (fluid seeps into pancreas), smooth muscle contraction, shock
- trypsin = edema, necrosis, hemorrhage
- elastase = hemorrhage
- phospholipase A = fat necrosis
- lipase = fat necrosis
forms of alcoholic liver disease stages
o Precursor to cirrhosis
o Inflammation
o Degeneration of hepatocytes
o Irreversible
- Alcoholic steatohepatitis
prostate cancer risk factors
- male
- black men
- Asians and native American men
- white men
- OA
- Familial tendency
- High fat diet
- male
- black men
X- Asians and native American men
X- white men - OA
- Familial tendency
- High fat diet
Finasteride ___creases prostate specific antigen (PSA) levels
- measure PSA _____ and _______
- If PSA hasn’t __creased = eval for________
- measure PSA before starting drug and 6 mos after starting drug
- If PSA isn’t low = eval for prostate cancer
sildenafil
treats
1.
2.
3.
- Relief of ED
- Pulmonary arterial HTN
- BPH
Interferons
Nucleoside analogs
treatment for which viral hep A, B, or C?
Chronic Hep B treatment is for these high risk pts only
- Increased AST levels
- Hepatic inflammation
- Advanced fibrosis
finasteride
dutasteride
tamsulosin
combination drug for treating BPH?
Prototype = dutasteride + tamsulosin
forms of alcoholic liver disease stages
o Mild
o Asymptomatic
o Reversible
- Alcoholic fatty liver
male reproductive drugs
MOA
- Blocks alpha 1 receptors – relaxes smooth muscle cells in bladder, neck, prostate, and urethra
- Selective for alpha receptors in prostate – will not have systemic effects
for BPH
tamsulosin
MOA
Inhibitis bacterial RNA synthesis by binding to bacterial DNA
cirrhosis treatment
Lactulose or Rifaximin?
Rifaximin
- Hep _____ vaccine
- 2 doses, 6 months apart
- Recommendations
- All kids 12 months +
- Special high risk populations - Hep ________ vaccine
- 3 doses, 4 months apart
- Recommendation
- All newborns
- Hep A
- Hep B
LFT – liver function tests
indicating liver dysfunction
increase or decrease
1. liver enzymes ALT, AST, Alk Phos
2. Bilirubin
3. Ammonia
4. Protein and albumin
5. PTT prothrombin time
- increase
- increase
- increase
- decrease
- increase
s/e
- Impotence
- Decreased libido
- Gynecomastia – abnormal growth breast tissue
s/e
- Well tolerated
- Abnormal ejaculation – doesn’t decrease PSA
which BPH drug(s)?
finasteride
dutasteride
tamsulosin
- Alcoholic fatty liver
- Alcoholic cirrhosis
- Alcoholic steatohepatitis
rank from mild to severe forms of alcoholic liver disease stages
- Alcoholic fatty liver
- Alcoholic steatohepatitis
- Alcoholic cirrhosis
- Live vaccine
- Stimulates inflammatory response in bladder
- Goal is for immune system to recognize cancerous cells and attack
BCG vaccine: intravesical therapy
treats bladder cancer
Hyperosmotic laxative
treats cirrhosis
Lactulose
Rifaximin
Lactulose
which issue is associated with
fat
female
forty
Cholelithiasis
- Obesity
- Female
- Middle aged
- Use of oral contraceptives
- Rapid weight loss
- Native American
- Genetics
- Pancreatic or ileal disease
BCG vaccine: intravesical therapy
Pt instructions
1. Empty bladder
2. Instill BCG vaccine into bladder – dwell time ___ hours
3. Change position q ___ mins
- ______ for 6 hours post treatment
- watch for infection
- Take weekly for 6-12 weeks
- Live vaccine – don’t give to _______
Pt instructions
1. Empty bladder
2. Instill BCG vaccine into bladder – dwell time 2 hours
3. Change position q 15 mins
- Disinfect urine for 6 hours post treatment
- watch for infection
- Take weekly for 6-12 weeks
- Live vaccine – don’t give to compromised immunity
Manifestations of AKI
- Oliguria (goal is >30ml/hr or <400ml/24hr)
- begins 1 day after hypotensive event and lasts 1-3 weeks
- FVE
- Metabolic acidosis and waste product accumulation (azotemia/uremia) – no excretion, build up of waste
- Hyponatremia – no excretion, dilution issue
- Hyperkalemia – no excretion, accumulation issue
- Neurologic disorders – r/t hyponatremia
so treatment could be
1.
2.
3.
- diuretic = for FVE and associated accumulations
- dextrose and insulin = for hyperkalemia
- sodium polystyrene sulfonate = for hyperkalemia
timolol or betaxolol contraindications:
- same as oral beta blockers
- asthma
- COPD
- Sinus bradycardia
- Heart failure
timolol
Disadvantage of ___________ treatment
- Prolonged
- Costs
- s/e
- high relapse
chronic hep B
Interferons
Nucleoside analogs
__________________Glomerulonephritis
- This type of glomerulonephritis is caused by a direct insult to the glomeruli themselves.
Secondary Glomerulonephritis, Primary Glomerulonephritis
Primary Glomerulonephritis
cirrhosis treatment
Lactulose
T/F
- Reduction of ammonia absorption in hepatic encephalopathy
- high ammonia levels alone is an indication
- must have s/s of hepatic encephalopathy and high ammonia levels to be an indication
- Reduction of ammonia absorption in hepatic encephalopathy
- Not just given for high ammonia levels – must have s/s of hepatic encephalopathy
- Females caution in handling – tetragenic for preg. Women, may cause birth defect in male fetus
finasteride
___________ jaundice is from liver is unable to take up bilirubin from blood, or unable to conjugate it
- Hepatocellular
sildenafil safety teaching:
- don’t take with _______ – will pass out b/c of drop in BP
- what do you do if you have chest pain or signs of heart attack during sex?
- _________ is a rare side effect that would require patient to seek emergency care
- don’t take more than ___ per day
- priapism – erection is painful or lasts >___ hours = medical emergency
safety teaching:
- don’t take with nitrates – will pass out b/c of drop in BP
- chest pain or signs of heart attack during sex = call 911
- sudden loss of vision in eye(s) or hearing
- don’t take more than 1 per day
- priapism – erection is painful or lasts >4 hours = medical emergency
- Males can’t donate blood while taking this med
finasteride
