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Pharm > Exam 2 Review sheet > Flashcards

Exam 2 Review sheet Flashcards

1
Q

Antiepileptics

A 
Hydantoins	
Succinimides	
Barbiturates 	
Adjunct Therapy	
Benzodiazepines
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2
Q

Hydrantoins Prototype

A

phenytoin (Dilantin)

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3
Q

Other drugs in the same class as phenytoin (Dliantin)

A

ethotoin
fosphenytoin
mephytoin

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4
Q

Indications for phenytoin (Dilantin)

A

Treats tonic-chronic (grand-mal) & complete-partial seizures

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5
Q

Mechanism of action of phenytoin (Dilantin)

A
  • enhancement of GABA
  • inhibition of glutamate
  • prolonging inactiveation period of Na Channels (Slows channels down)
  • inactivation of Ca channels
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6
Q

Absorption of phenytoin (Dilantin)

A

slow with PO and IM

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7
Q

Distribution of phenytoin (Dliantin)

A

Highly protein bound
T1/2 increases as dose increases
Low dose = 6-24 hours T 1/2
Thera peutic dose = 20-60 hr T 1/2

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8
Q

Metabolism of phenytoin (Dilantin)

A

Liver

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9
Q

Elimination of phenytoin (Dilantin)

A

Kidney

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10
Q

Therapeutic level of phenytoin (Dilantin)

A

10-20 mcg/mL (narrow therapeutic range)

Steady state at 7-10 days

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11
Q

Drug interactions with phenytoin (Dilantin)

A

CYP450 inducer = increase metabolism of other meds

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12
Q

Adverse effects of phenytoin (Dilantin)

A

CNS: dizziness, ataxia, blurred vision, slurred speech, tremor, confusion
Nausea
gingival hyperplasia
derm reaction (infiltrate steven johnson syndrome)
Liver damage
CV collapse (IVP slow)
hypotension

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13
Q

Contraindications of phenytoin (Dilantin)

A

CV: sinus bradycardia, sinoatrial block, 2nd and 3rd degree heart block
DM: Increase blood sugars
PG: class D
co-admin with tube feedings (Increase protein levels)
ETOH use & other drug interactions

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14
Q

Education of phenytoin (Dilantin)

A

Do not stop suddenly (will cause seizures)
Monitor levels (small change in dose = large change in serum level
must shake thoroughly
Good dental hygiene
take with food
DM: Check blood sugar
May decrease effectiveness of birth control

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15
Q

True or false: Always dilute in NS

A

True

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16
Q

True or false: Compatible w/ D5W (will cause precipitate)

A

False: NOT compatible with D5W

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17
Q

True or false: Can increase BS

A

True

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18
Q

What is the prototype of Succinimides?

A

ethosuximide (Zarontin)

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19
Q

Indications for ethosuximide (Zarontin)

A

Treat absence (petite mal seizures)

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20
Q

Mechanism of action of ethosuximide (Zarontin)

A

Delays influx of Ca ions

1 week to see results

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21
Q

Absorption of ethosuximde (Zarontin)

A

Only oral admin

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22
Q

Distribution of ethosuximide (Zarontin)

A

Peak: 3-7 hours

Half life: 30-60 hours

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23
Q

Metabolism of ethosuximide (Zarontin)

A

Liver

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24
Q

Elimination of ethosuximide (Zarontin)

A

Kidneys

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25
Q

Drug interactions with ethosuximide (Zarontin)

A

interacts with some other anti-epileptic drugs

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26
Q

Adverse effect of ethosuximide (Zarontin)

A 
Increased suicidal thoughts
Drowsiness
lethargy
nausea
blood dyscrasias
rash, joint pain, fever, sore throat, blurred vision, PG
Unusual bleeding or bruising
Notify MD
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27
Q

What is dyscrasias?

A

Any disease condition, especially in hematology, as in “blood dyscrasias.” The term “dyscrasia” was borrowed from the Greek meaning “a bad mixture” referring to the ancient belief that an imbalance between the four humors - blood, phlegm, yellow bile, and black bile- which caused disease.

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28
Q

Education of ethosuximide (Zarontin)

A 
Monitor levels at the start and when changing doses
Assess CBC, UA, and LFT
Taper gradually to discontinue
Take with milk or food if GI upset
Use birth control beyond the pill
Urine may change color (pinkish)
NO ETOH due to drowsiness
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29
Q

Drug prototype for barbituates

A

phenobarbital

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30
Q

Indications for phenobarbital

A

Last resort for extended seizures

Tonic clonic and focus seizure treatment

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31
Q

Mechanism of Action of phenobarbital

A

Stimulates GABA receptors

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32
Q

What is GABA again??

A

Gamma-Amino Butyric acid (GABA) is an amino acid which acts as a neurotransmitter in the central nervous system. It inhibits nerve transmission in the brain, calming nervous activity

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33
Q

Therapeutic level of phenobarbital

A

20-40 mcg/mL (narrow therapeutic range)

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34
Q

Drug interaction with phenobarbital

A

Interacts with many different drugs

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35
Q

Adverse effects of phenobarbital

A

CNS, respiratory depressant
Sedation
Increased potential for abuse/addiction
Increase tolerance (sedative) with/LT use and dependence

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36
Q

Contraindications with phenobarbital

A

PG: Class D

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37
Q

Education for phenobarbital

A

Wean slowly

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38
Q

True or false: phenobarbital is used mostly after other seizure meds have failed

A

True

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39
Q

Drug prototype for Adjunct therapy

A

levetiracetam (Keppra)

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40
Q

Indications for use of levetiracetam (Keppra)

A

Used more now as primary drug for seizure treatment than Dilantin due to less side effects

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41
Q

Mechanism of action of levetiracetam (Keppra)

A

Unknown

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42
Q

Metabolism of levetiracetam (Keppra)

A

1/3 in liver (ok for liver patients)

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43
Q

Elimination of levetiracetam (Keppra)

A

Kidneys (unchanged)

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44
Q

Drug interactions with levetiracetam (Keppra)

A

no significant

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45
Q

Adverse effects with levetiracetam (Keppra)

A

Drowsiness, dizziness, headache, infection

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46
Q

Education for levetiracetam (Keppra)

A
  • caution d/t ↑ accidental injuries

- PEDS = ↑ behavioral changes (nervous, hostile, agitated, depressed)

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47
Q

Prototype for Benzodiazepines

A

lorazepam

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48
Q

Other drugs in the same class as lorazepam

A

clonazepam
diazepam
midazolam

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49
Q

carbamazepine (Tegretol)

A
  • partial seizure tx
  • off label uses for psych disorders
  • Decrease sodium into cells
  • Do not give with other drugs
  • Black box warning - anemia
  • IVP = Steven Johnson syndrome (Asians)
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50
Q

valproic acids (Depakote)

A
  • most used world wide
  • block influx of sodium and stim GABA
  • hard on liver (monitor LFT’s)
  • caution with PEDS
  • off-label use for psych (migraines)
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51
Q

gabapentin (Neurontin)

A
  • originally neuropathy treatment
  • used in PEDS for seizure tx
  • unknown MOA
  • Not metabolized in liver (ok for liver patients)
  • No drug interactions
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52
Q

Anxiety/Sleep meds

A 
Benzodiazepines
Barbituates
Non-Benzodiazepam hypnotic
Melatonin receptor agonist
Hypnotic
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53
Q

What is the prototype for Benzodiazepine as an anxiety/sleep med?

A

lorazepam (Ativan)

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54
Q

Other drugs in the same class as lorazepam (Ativan) that are considered anxiety/sleep meds?

A 
alprazolam (Xanax)
chlordiazepoxide (Librium)
chlorazepate (Traxene)
diazepam (Valium)
midazolam (Versed)
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55
Q

Hypnotic drugs that are under the same class as lorazepam (Ativan)?

A

flurazepam (Dalmane)
temazepam (Restoril)
triazolam (Halcion)

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56
Q

Indications for use of lorazepam (Ativan)

A 
anxiety
sleep
antiepileptic
ETOH withdrawl
induction of gen. antesthesia
pre-op sedation
continuous sedation
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57
Q

Mechanism of action lorazepam (Ativan)

A

bind to BZ1 (sleep) and BZ2 (memory, motor, sensory, cognitive) receptors
Increase effects of GABA

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58
Q

Distribution of lorazepam (Ativan)

A

highly protein bound

Onset: fast/medium

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59
Q

Absorption of lorazepam (Ativan)

A

easliy absorbed from GI tract

some readily absorbed when given IM

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60
Q

Metabolism of lorazepam (Ativan)

A

Liver

lorazepam and oxazepam metab to inactive substances (ok for liver patients)

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61
Q

Excretion of lorazepam (Ativan)

A

Kidneys

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62
Q

Contraindications of lorazepam (Ativan)

A 
Resp depression or with other CNS depressants
acute angle glaucoma
psychoses
ETOH, narcotics, barbituates
PG: Class X
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63
Q

Adverse effects of lorazepam (Ativan)

A

well tolerated
mild drowsiness
ataxia and confusion (esp elderly)
rare: CNS depression

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64
Q

Education with lorazepam (Ativan)

A

do not stop abruptly (esp for seizure management)

elderly may need half dose due to toxicity

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65
Q

Other drugs in the same class at phenobarbital used for anxiety/sleep meds

A 
chloral hydrate
mephobarbital
phenobarbital
secobarbital
tuinal
thiopental
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66
Q

Adverse effects of phenobarbital

A 
low safety
CNS depressant
resp depressant
suicidal potential
physical dependence
tolerance
abuse potential
induce hepatic drug metabolism
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67
Q

What is the prototype of a barbituate?

A

phenobarbital

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68
Q

What is the prototype of a non-benzodiazepam hypnotic?

A

eszopiclone (Lunesta)

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69
Q

Indications for use of eszopiclone (Lunesta)

A

induce sleep

ok for LT use

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70
Q

Mechanism of action of eszopiclone (Lunesta)

A

induces sleep quickly

prevents waking up in the middle of the night

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71
Q

Distribution of eszopiclone (Lunesta)

A

long half life

rapid onset: 1 hr

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72
Q

Adverse effects of eszopiclone (Lunesta)

A

AM headache
Prolonged drowsiness
Bitter aftertaste

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73
Q

What is the prototype for Melatonin receptor agonist

A

ramelteon (Rozerem)

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74
Q

Indications for ramelteon (Rozerem)

A

Induces sleep

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75
Q

Mechanism of action of ramelteon (Rozerem)

A

high affinity for melatonin receptors

no effect on GABA

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76
Q

Contraindications for ramelteon (Rozerem)

A

Pregnancy: Category X

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77
Q

Education of ramelteon (Rozerem)

A

No risk of abuse or tolerance

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78
Q

True or false: ramelteon (Rozerem) is a controlled substance?

A

False: It is not a controlled substance

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79
Q

What is the prototype for Hypnotics?

A

zolpidem (Ambien)

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80
Q

Indications for use of zolpidem (Ambien)

A

Insomnia

Short term use: 7-10 days only

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81
Q

Adverse effects of zolpidem (Ambiem)

A

Tolerance possible

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82
Q

Education on zolpidem (Ambiem)

A

no residual effects next day

no insomnia rebound effects when discontinued

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83
Q

What are different types of Adrenergic Agonist (SNS)

A

Non-selective adrenergic agonist
Alpha-1 adrenergic agonist (Selective)
Alpha-2 Agonist
Beta adrenergic agonist

84
Q

What is the prototype for the non-selective adrenergic agonist?

A

epinephrine

85
Q

Other drugs in the same class as epinephrine

A

ephedrine (FenFen)
norepinephrine (Levophed)
vasopressin

86
Q

Mechanism of action of epinephrine

A 
Stim all (alpha and beta) adrenergic receptors in body. Greatest effect on Cv and CNS
Fight or flight
87
Q

Indications for epinephrine

A

Shock, CPR (code), v-fib, asthma, cluster headache, simple glaucoma/cataracts, GI hemorrhage, hyperkalemia, wheezing in infants.

88
Q

Effects of epinephrine

A

Increased BP/HR, relax broncial and smooth muscle, vasoconstrictor in periph. blood vessels, inhibit insulin secretions = Increased Blood sugar

89
Q

Route of admin of epinephrine

A

SQ, IV, IM, Inhalation, topical, opthlalmic

NOT PO

90
Q

Absorption of epinephrine

91
Q

Duration of epinephrine

92
Q

Metabolization of epinephrine

A

Liver (quick, T1/2 = 2 min, MAO/COMT destroys, may need to give mult. doses.

93
Q

Epinephrine is excreted through the ______________

94
Q

Epinephrine contraindications are:

A 
Hypersensitivity
Active labor
close angle Glaucoma
Sulfite sensitivity
dysrhythmias
CAD
HTN of hyperthyroidism
95
Q

Adverse effects of epinephrine

A 
Fatigue
Increase blood glucose
Sleep disturbances
tremors
weakness
dizziness
CV stim
Cerebral hemorrhage
96
Q

Drug interactions with epinephrine

A 
MAO inhibitors
tricyclic antidepressants
general anesthesics
alpha adrenergic blockers
beta adrenergic blockers
97
Q

Nursing management of epinephrine

A 
Establish baseline vitals
Monitor resp status and BP closely
Use cardiac monitor/resuscitation equip
monitor for hyperglycemia
monitor for change in I&O
examine ocular and nasal mucosa
98
Q

What is the prototype of Alpha-1 adrenergic agonist (selective)?

A

phenylephrine (Neo-synephrine)

99
Q

What is another drug in the same class as phenylephedrine

A

naphazoline HCL (Allerest, Clear eyes)

100
Q

Indications for use of phenylephedrine (Neo-synephrine)

A

Shock, relief of nasal/pharyngeal mucous congestions, dilation of pupils for eye procedures.

101
Q

Adverse effects of phenylephedrine (Neo-synephrine)

A

Blurred vision

102
Q

What is the prototype of Alpha-2 Agonist

A

clonidine (Catapress, patch form)

103
Q

Other drugs in the same class as clonidine (Catapress, patch form)

A

methyldopa (Aldomet)

104
Q

Mechanism of action of clonidine (Catapress, patch form)

A

stim. Alpha-2 receptors which inhibit SNS

105
Q

Indications for use of clonidine (Catapress, patch form)

106
Q

Excretion of clonidine (Catapress, patch form)

A

40-60% excreted unchanged

107
Q

Adverse effects of clonidine (Catapress, patch form)

A

dizziness and drowsiness (give at night)

108
Q

What is the off label use for clonidine (Catapress, patch form)?

109
Q

What is the prototype for Beta adrenergic agonists?

110
Q

What other drugs are in the same class as dopamine?

A

albuterol
isoproterenol
dobutamine

111
Q

Mechanism of action of dopamine

A

Stim alpha 1 and beta 1 receptors

112
Q

Indications for use of dopamine

A

early shock (increased BP)

113
Q

Effects of dopamine

A

beta-1 stim = increased Cardiac output by increased force of contractions and HR
leads to increased O2 need for myocardium
dilates renal and mesenteric arteries at low doses

114
Q

Adverse effects of dopamine

A 
ectopic beats
n/v
tachy
angina
palpitations
hypotension (vasodilation at low doses)
vasoconstrictor at high doses
115
Q

Nursing management of dopamine

A

patient on monitors and frequent vital signs

116
Q

What is the prototype drug for Alpha Adrenergic antagonist?

A

prazosin (Minipress - HTN tx)

117
Q

Other drugs in the same class as prazosin (Minipress - HTN tx)

A

doxazosin (Cardura - not 1st line tx for HTN)
tamsulosin (Flomax - BPH tx)
terazosin (Hytrin - not 1st line tx for HTN

118
Q

Mechanism of Action for prazosin (Minipress - HTN tx)

A

blocks post synaptic alpha-1 adrenergic receptors

119
Q

Indications for prazosin (Minipress - HTN tx)

A

HTN
BPH
Raynaud’s

120
Q

Effects of prazosin (Minipress - HTN tx)

A

Lowers supine and standing BP

121
Q

Route of prazosin (Minipress - HTN tx)

122
Q

Absorption of prazosin (Minipress - HTN tx)

A

Onset = 1 hr

123
Q

Duration of prazosin (Minipress - HTN tx)

124
Q

Metabolization of prazosin (Minipress - HTN tx)

125
Q

Excretion of prazosin (Minipress - HTN tx)

A

Bile, feces, and urine

126
Q

Contraindications of prazosin (Minipress - HTN tx)

A

Hypersensitivity

Angina pt b/c hypotension may worsen condition

127
Q

Adverse effects of prazosin (Minipress - HTN tx)

A

Orthostatic hypotension, light headedness, dizziness, headache, drowsiness, weakness, lethargy, nausea, palpitations

128
Q

Drug interactions with prazosin (Minipress - HTN tx)

A

other HTN meds

129
Q

True or False: prazosin (Minipress - HTN tx) has first dose phenomenon

A

True: Causes extreme drop in BP and goes away with time.

130
Q

When should prazosin (Minipress - HTN tx) be given - morning or night?

A

Give at night

131
Q

What is the prototype for Beta adrenergic antagonists (beta blockers)?

A

propranolol

132
Q

What other drugs are in the same class as propranolol?

A 
They all end in -olol
atenolol
metoprolol
nadolol
timolol
133
Q

Indications for use of propranolol

A

Cardiac, glaucoma, migraines

Off label: PTSD, sweating, and anxiety

134
Q

propranolol is contraindicated for:

A

COPD, resp, and asthma patients

135
Q

Adverse effects of propranolol:

A 
slow HR (SA/AV node slows)
Bronchoconstriction (NOT for COPD/asthma/resp pts)
hypoglycemia (masks s/s, increase insulin production = Decrease blood sugar)
alters lipids
136
Q

Cholinergic Agonist (PSNS)

A

Direct acting muscarinic agonist
Direct acting nicotinic agonist
Indirect acting cholinergic agonist

137
Q

What is the prototype drug for direct acting muscarinic agonist

A

pilocarpine (eye drops, constriction, glaucoma tx)

138
Q

Other drugs in the same class as pilocarpine

A

acetylecholine
bethanecol (urinary ret tx post op)
carbachol (miosis = decreased intraocular pressure)

139
Q

Mechanism of action of pilocarpine

A

stim receptors to produce miosis

140
Q

Indications for use of pilocarpine

A

Open angle glaucoma
alngle closure glaucoma
induction of miosis

141
Q

Effects of pilocarpine

A

miosis

secretory gland effect = increased salivary flow

142
Q

Route of pilocarpine

A

topical

oral

143
Q

Absorption of pilocarpine

A

onset depend on route

144
Q

Excretion of pilocarpine

145
Q

Contraindications of pilocarpine

A

hypersensitivity
retinal detatchment
airway disease

146
Q

Adverse effects of pilocarpine

A

Ocular: burning and stinging, tearing, and ciliary spasm
Oral: tachy, HTN, bronchospasms, pulmonary edema, N/V, salvation and sweating.

147
Q

Prototype of Direct acting nicotinic agonists

A

Nicotine (smoking cessation tx)

148
Q

Route of direct acting nicotinic agonists

A

gum, spray, pills, patch

149
Q

Prototype of indirect acting cholinergic agonists (cholinesterase inhibitors)

A

neostigmine (Prostigmin/Neostigmin)

rarely used, Myasthenia Gravis tx

150
Q

Other drugs in the same class as cholinergic agonist

A 
ambenonium
edrophonium
physostigmine
pyridostigmine
tacrine (Cognex)
donepezil (Aricept)
151
Q

Mechanism of action of cholinergic agonist

A

inhibit acetylcholinesterase
Decrease destruction of ACH = increase ACH
Increase cholinergic action

152
Q

Indications of cholinergic agonist

A 
Alzheimer's (Increase ACH = Increased memory
myasthenia gravis
glaucoma
reverse NM blocks
nerve gas prophylaxis
skeletal muscle contractions
153
Q

Prototype drug for cholinergic antagonist

154
Q

Other drugs in the same class as atropine

A

benztropine (Parkinson’s)
hyoscyamine (Cystospaz - relaz smooth muscle in gut)
ipratropium bromide (Atrovent - inhaler, bronchodilator)
propantheline
scopolamine (motion sickness)
trihexphenidyl (Parkinson’s)

155
Q

Mechanism of action of atropine

A

competitive antagonists with NT’s to block receptors (not reversible)
Complete with ACH
Block ACH at muscarinic receptors in PSNS

156
Q

Indications for use of atropine

A

Emergency: bradycardia, PEA (pulseless electrical activity), asystole, CPR (Increased HR and stim heart to pump)
Pre-op: Decrease resp. secretions (prevent aspiration)
Operatively: Block cardiovagal reflexes, arrythmias
GI: duodenal ulcers, IBS
Opthamology: cycloplegia (paralysis of cilliary muscles), Iritis

157
Q

Effects of atropine:

A

small doses = decreased HR
large doses = increased HR
CNS:
Small doses = Decreased muscle rigidity and tremors
Large doses = drowsiness, disorientation and hallucinations
Eye: Dilated pupils (mydriasis)
GI: Decreased mortaility and peristalsis, Decreased intestinal and gastric secretions
Misc: Decreased saliva and sweating

158
Q

Adverse effects of atropine:

A

tachy, urinary retraction, constipation, dry mouth, blurred vision (caution with driving), photosensitivity (wear dark glasses), Increased risk of heat stroke (limit physical exertion and exercise)

159
Q

Contraindications of atropine:

A

hypersensitivity, CHF (Increased workload of heart), hiatal hernia, GI/GU obstruction, BPH, glaucoma, tachy
“Cant’s see, Can’t spit, Can’t pee, Can’t shit”

160
Q

Rapid acting insulin

A

aspart (Novolog)

lispro (Humalog)

161
Q

Short acting insulin

162
Q

Intermediate acting insulin

163
Q

Long acting insulin

A

glargine (Lantus)

Levemir

164
Q

Combination insulin

A

Novolin 70/30 (N/R)

165
Q

Onset, Peak, and Duration of aspart (Novolog)

A

Onset: 5-10min
Peak: 1-3 hrs
Duration: 4 hrs

166
Q

Onset, Peak, and Duration of lispro (Humalog)

A

Onset: 15 min
Peak: 1 hr
Duration: 4 hours

167
Q

Onset, Peak, Duration of Regular insulin

A

Onset: 30 min
Peak: 2-4 hours
Duration: 8 hours

168
Q

Onset, Peak, and Duration of NPH

A

Onset: 2 hours
Peak: 8-10 hours
Duration: 12 hours

169
Q

Onset, Peak, and Duration glargine (Lantus)

A

Onset: 1 hour
Peak: 2-23 hours
Duration: 24 hours

170
Q

Onset, Peak, and Duration Levemir

A

Onset: 1-2 hours
Peak: 3-9 hours
Duration: 17-23 hours

171
Q

Onset, Peak, and Duration Novolin 70/30 (N/R)

A

Onset: 30 min
Peak: 2-12 hours
Duration: 24 hours

172
Q

Oral hypoglycemics

A

Sulfonylureas (SU), Biguanides, Meglitinides (ends in glinide), Alpha-glucose inhibitors

173
Q

What is the prototype of sulfonylureas (SU)

A

glyburide (2nd gen, Micronase, Diabeta)

174
Q

Other drugs in the same class as glyburide (2nd gen, Micronase, Diabeta)

A

glipizide (2nd gen, Glucotrol)
chlorpropamide (1st gen, Diabenese)
tolbutamide (1st gen, Orinase)

175
Q

Mechanism of action of glyburide (2nd gen, Micronase, Diabeta)

A

Stimulate beta cells to secrete insulin (secretagogue)
Decrease glycogenolysis & decrease glycogenesis in liver = decrease glucose
Increase insulin sensitivity (sensitizer)

176
Q

Adverse effects of glyburide (2nd gen., Micronase, Diabeta)

A 
hypoglycemia
cholestasis (bile obstruction)
hyponatremia
weight gain
Skin rash
GI upset
hemolytic anemia
Liver damage and jaundice with LT use
177
Q

Contraindications of glyburide (2nd gen, Micronase, Diabeta)

A

PG: Category C

pts w/sulfa allergies

178
Q

Cautions with glyburide (2nd gen, Micronase, Diabeta)

A

Renal and hepatic disease pts.

179
Q

Drug interactions with glyburide

A

Avoid ETOH = extreme flushing, hypoglycemia, Increased half time, nausea and palpations.
Avoid alternative tx, supplements and herbals = hypoglycemia

180
Q

Education with glyburide

A

Take in AM

Take 3-60 min before meals

181
Q

True or false: Need a good functioning liver to take glyberide

A

True because glyburide works in the liver

182
Q

What is the prototype drug for Biguanides?

A

metformin (Glucophage)

183
Q

What other drugs are in the same class as metformin?

A 
None. Only drug in its class
First drug of choice for newly dx. Type 2 overweight pts.
184
Q

Mechanism of action of metformin

A

Sensitizer, No insulin secretion
Decrease hepatic glucose production
Decrease intestinal glucose absorption
Insulin must be present in able to work (must have good functioning pancreas

185
Q

Absorption of metformin

A

orally, slow
bioavailability 50-60%
food delays abosorption

186
Q

Onset of metformin

A

Peak: 2-3 hours

187
Q

Metabolism of metformin:

A

does not undergo hepatic metab (safer for liver patients)

188
Q

Excretion of metformin

A

Excreted unchanged by kidneys

189
Q

Adverse effects of metformin

A

lactic acidosis (hold before/after dye procedures)
anorexia
metalic taste

190
Q

Contraindications of metformin

A 
renal patients (monitor BUN/Creat)
liver patients
alcoholics
acute/chronic metabolism acidosis
CHF
kids <10 yo
191
Q

Drug interactions with metformin

A

cimetidine (Tagamet)
digoxin (Lanoxin)
procainamide
vanco: all increase metformin concentration d/t competition for renal tubular secretion
Iodine contrast materials: increase lactic acidosis
Herbals: increase hypoglycemia

192
Q

Education about metformin

A

takes a wekk or more to see effects
usually given with means
not associated with hypoglycemia at therapeutic doses (not secretagogue)

193
Q

Other effects of metformin

A

decrease total cholesterol, LDL & TGL

possible weight loss

194
Q

What is the drug prototype for Meglitinides?

A

repaglinide (Prandin)

195
Q

Other drugs in the same class as repaglinide (Prandin)

A

-all end in -glinide)
nateglinide (Starlix)
1st choice for newly dx non-obese type 2 patients

196
Q

Mechanism of action of repaglinide (Prandin)

A

stimulate secretion of insulin (secretagogue)

used to lower postprandial glucose levels

197
Q

Absorption of repaglinide (Prandin)

A

absorbed rapidly and works rapidly

quick insulin burst

198
Q

Onset of repaglinide (Prandin)

A

Onset: 20 min
Peak: 1 hr

199
Q

Excretion of repaglinide (Prandin)

A

minimal in kidneys (Prandin ok for renal patients)

200
Q

Education for repaglinide (Prandin)

A

Take with meals (30-60 min before)
Can skip dose if mean skipped
Can add dose if meal added

201
Q

Drug prototype for Alpha-glucose inhibitors

A

acarbose (Precose)

202
Q

Other drugs in the same class as acarbose (Precose)

A

miglitol (Glyset)

203
Q

Mechanism of action of acarbose (Precose)

A 
do not secrete or sensitize
inhibit glucosidase (enzyme in GI that breaks down carbs into sugar) in small intestine
delayed absorption of carbs
Decrease post prandial glucose
204
Q

Adverse effects of acarbose (Precose)

A

flatulance
diarrhea, abd pain and bloating
Increase hepatic enzymes w/ acarcose (Precose)

205
Q

Contraindications for acarbose (Precose)

A

children <18 yo
hiatal hernias (Increase pressure w/ bloating
digestive (GI/Colon) disease

206
Q

Education for acarbose (Precose)

A

administer with 1st bite of meal

full effects at 2-3 mo

207
Q

True or false: Can’t use candy tablets for hypoglycemia because they wont be absorbed with acarbose (Precose)

Pharm (11 decks)

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