Exam 3 Flashcards
acarbose
-blocks glucose absorption in intestines
s/e diarrhea, foul flatus
actos (pioglitazone)
thiazolinedione (TZD) derivative
• enhances insulin activity
-not often used anymore due to HF and bladder CA, CV effects
-may have elderly that use it
acetaminophen
fever and mild pain, safe in pregnancy
-overdose is toxic to liver, don’t use with alcohol
acetazolamide (Diamox)
diuretic and carbonic anhydrase inhibitor
-promotes excretion of bicarb
• Treats glaucoma, HTN, CHF, altitude sickness, epilepsy
s/e caution and interactions of acetazolamide
- s/e fatigue, abdominal pain, N/V, parasthesia, Stevens-johnson
- don’t use for patients with renal or hepatic dysfunction
- interacts with abx, sodium bicarb, amphetamines and salicylates
Acetylsalicylic acid (ASA)
• reduced inflammation, low dose can be safe in pregnancy
- decreases platelet aggregation
- risk of Reyes syndrome in kids
Aldosterone antagonist- spironolactone
-blocks Na and water resorption, k sparing
• treat HTN and HF, no androgen effects
s/e and caution with aldosterone antagonists (ex: epelernone)
• s/e hyperkalemia, hypotension, dizzy, impaired renal fxn
• avoid azole antifungals and macrolide antibiotics
-monitor K, watch out for salt supplements and k sources
Alpha adrenergic antagonist- prazosin (minipres)
- blocks vasoconstriction
* not first line drug for elderly (inc risk orthostatic hypotension)
amicar
antifibrinolytic agent
- prevents clot breakdown
- treats acute bleeding syndromes, leaking cerebral aneurysm
amiodarone
k channel blocker (blocks repolarization phase), iodine based
-regulate atrial and ventricular rhythms
• monitor QT interval, monitor thyroid levels
-risk of fibrosis alveolitis, need f/u cxrays
-can get yellow vision or blue skin, use sunscreen.
• can treat chronic stable angina or Prinzmetals
drug/drug with amiodarone
• don’t give with dantrolene, Cardizem, simvastain
Angiotensin II receptor antagonist- ex valsartan
- first tx for HTN in CKD
- decrease BP and afterload, some natriuretic and diuretic properties
- decreases cardiac myocyte hypertrophy
- promotes vasodilation, reduces vasopressin, reduce aldosterone
- renal protective in DM
can you give ARB in pregnancy?
nope
If allergic to ___ then allergic to ___
ACE, ARB
angiotensin converting enzyme inhibitor (ex: vasotec)
- first tx for HTN in CKD
* can also delay progression of diabetic nephropathy by blocking breakdown of bradykinin and substance P
ACEi s/e
• s/e is cough, angioedema
Aquamephyton
vit K replacement
• reverses coumadin, monitor INR
beta adrenergic antagonists (ex: propanolol, nadalol, metoprolol)
- membrane stabilizing effect, decrease excitability (PVCs and atrial rhythms)
- for exercise induced angina
- reduces CNS activity
c/i for beta blockers
COPD/Asthma, Reynauds, bradycardia, HF, DM, pregnancy, lactation
-don’t give with Verapamil or Adenosine, decreased effect when given with NSAIDs
s/e with beta blockers
• s/e bradycardia, HF, fatigue, depression, sleep disturbance, N/V
propanolol
non-specific Beta
nadalol
a and B action
metoprolol
B1 specific blocker
Ca channel blocker (ex diltiazem and nifedipine)
prevent inward movement of calcium
• for Prinzmetals, migraine, reynauds, HTN, post infarction to preserve muscle
• dilate peripheral and coronary arteries- reduces systemic vascular resistance
c/i for ca channel blockers
- c/i in heart block, sick sinus syndrome, renal and hepatic dysfunction
- inhibits metabolism of many drugs like b adrenergics
s/e for ca channel blockers
• s/e dizziness, H/A, fatigue, hypotension, bradycardia, edema
L calcium channel
muscle, neurons (verapamil and nifedipine)
first HTN meds for blacks
thiazide and ca channel blockers
Carbonic Anhydrase inhibiter- ex acetazolamide (Diamox)
- reduces the activity of carbonic anhydrase (enzyme which catalyzes the reaction between carbon dioxide and water into carbonic acid and then bicarbonate)
- will see increased bicarb excretion and mild increase in Na and K excretion
Chlorothiazide- thiazide diuretic
• inhibit the na/cl resorption
-good for salt sensitive HTN (elderly and black pts)
clonidine
centrally acting alpha agonist
- dec sympathetic outflow
- used HTN, withdrawal, ADHD
Clopidogrel (plavix)
• anti-platelet, dec risk of stroke and MI
-don’t need frequent bloodwork
-no reversal
-risk of bleeding into spinal cord when spinal taps
• don’t give with Tagamet and azole, grapefruit
coumadin
- anti-coagulant, inhibits vitamin K clotting factors
- need to monitor INR
- levothyroxine increases breakdown of vit k thus enhancing coumadin, may need to reduce dose
Digoxin- cardiac glycoside
• blocks Na/K atpase- increase in intracellular Ca for stronger contraction
• vagatonic- slows SA nodal rate of fire (afib and atrial rhythms)
*monitor labs, esp K, narrow therapeutic window
-need to dig load cuz long half life
antidote to digoxin
digibind
Entresto
• Combo of neprilysin inhibitor, sacubitril and valsartan (ARB)
-will have elevated BNP to promote diuresis
s/e Entresto and monitor
• s/e hypotension, hyperkalemia, cough, dizzy, renal failure
-monitor with pro-nBNP, cxray
neprilysin
breaks down naturietic peptides and other vasoactive compounds
Epinephrine
• neurotransmitter
-B adrenergic effects, mobilizes glucose stores
Exenatide (Byetta)- synthetic Incretin peptide
- Secreted by Gi at meals to delay emptying and reduce appetite
- Enhanced insulin secretion, prevents glucagon release
- Given 30 min before meals
s/e of exenatide (Byetta)
• s/e hypoglycemia, N/D, HA, dizzy
Furosemide (Lasix)-
loop diuretic, will lose K
-used in HF
• monitor BMP, K levels
Glipizide
a sulfonylurea
- stimulates insulin release from pancreas (*risk for hypoglycemia )
- risk of allergy to other sulfa drugs
Glucagon
rapidly elevates BG
• Naturally is a peptide hormone produced by alpha cells of the pancreas
• Causes liver to perform glycogenolysis which converts stored glycogen into glucose which is released into the bloodstream
Glucocorticoids/Cortisol
• secreted from adrenal cortex
- negative feedback response
- secreted as it is produced–need to taper med
- diurnal rhythm- highest in AM
Growth Hormone
- normally produced in the ant pituitary gland, can be used for doping
- secreted as you sleep
- important for wound healing
- counter regulatory hormone- at risk for hyperglycemia
H2 Receptor Antagonist examples
• cimetidine (Tagamet)- interferes with many drugs
• famotidine (Pepcid)- more potent, less adverse effects, less drug-drug interactions
-OTC meds
Helicobacter pylori Treatment
• Supress acid (PPI, H2, bismuth subsalicylate)
• And at least 2 abx (flagyl and tetracycline) or (flagyl and amoxicillin)
**can give tagamet
-diagnose by carbonurea breath test, endoscopy
Hydrochlorothiazide- thiazide diuretic
- blocks Na/Cl transporter in distal convoluted tubule
* reduce volume and decrease peripheral vascular resistance
s/e and caution with hydrochlorothiazide
- s/e hypokalemia, inc uric acid, impaired carb intolerance, hyponatremia
- allergy- sulfonamides, photosensitivity, hemolytic anemia
Hydralazine and s/e
- smooth muscle relaxer, arterial vasodilator, need to maintain fluid volume status
- s/e tachycardia, edema, H/A, GI, Lupus
can hydralazine be given in pregnancy
yes
can ibuprofen be given in pregnancy
no, increases bleeding
parenteral insulin
from animal sources, no longer used, hard to know what is consists of
Humulin
- recombinant DNA tech, less antigenic
inhaled insulin
- rapid, T1DM, lung function tests
Invokana- Sodium glucose transport 2 inhibitor
• Resorption of glucose in renal proximal tubules
• Increased excretion of glucose in urine
**doesn’t interact with incretins
caution and s/e with invokana
- s/e KETOACIDOSIS, dehydration
- *don’t give in renal insufficiency, or frequent UTI/yeast infection
- Caution with ACE, ARBS, K sparin diuretics
Lantus (insulin glargine)
- Long acting, cannot be mixed with other insulins, once daily, initial dose 10 u per day
- Given with lispro for basal/bolus approach
Lispro- insulin analogue
- ultra short acting, give 15 min prior to meal, peak seen in 30 min
- Used with lantus for basal/bolus approach
Maalox
contains aluminum hydroxide, mag hydroxide, and simethicone (don’t give with other meds)
• Antacid treatment, can be combined with PPI and H2 inhibitors
-s/e diarrhea
is maalox safe in pregnancy
yes
Metformin/Biguanides
• increase sensitivity of tissues to insulin, reduce hepatic gluconeogenesis
-T2DM and pre-diabetes, pregnancy, polycystic ovarian syndrome
s/e and caution of metformin/biguanidea
-need to be paused before contrast dye
-cant give if altered renal fxn
• Monitor BUN/Creat, LFTs
methyldopa (antihypertensive)
• a false neurotransmitter that replaces norepi
treats HTN in pregnancy
• alpha 2 agonist, reduction of sympathetic outflow
is methyldopa safe in pregnancy
yes, first med approved for this
Nifedipine
calcium channel blocker
• prinzmetals angina, severe HTN
Nitrates (nitroglycerin-short half life or isosorbide-long half life)
• promotes endothelial relaxing factor (EDRF)
o Low dose large veins, high dose arteriolar dilation (dec afterload)
***prinzmetals
hemodynamic effects of nitrates
o Vasodilation- reduced BP
o Have a short half life- throw away after 3 months
s/e and caution with nitrates
- s/e H/A dizziness, orthostatic hypotension, tachycardia, tachyphylaxis (need higher and higher dose to get response), ETOH potentiates effects
- large doses associated with methemoglobinemia (pseudocyanosis and tissue hypoxia)
NPH Insulin
- intermediate acting insulin for T1DM and T2DM
• commonly used in gestational diabetes
• good for elderly
-70/30 combo (7 units NPH and 3 of regular)
Penicillin
beta lactam abx
• treats staphylococci and streptococci
• don’t give with cephalosporins, aminoglycosides, tetracyclines, macrolides, fluoroquinolones
Pradaxa
• direct thrombin inhibitor
-has an antidote!
• for stroke reduction in afib, reduce risk or reoccurrence of DVT or PE
black box warning pradaxa
: increased risk of clot when stopped, increased risk of hematoma during spinal procedures
reverses pradaxa
-praxbind
Propranolol (inderal)
beta 1 and 2 adrenergic antagonist, crosses BBB, s/e depression and fatigue
•don’t give with asthma
omeprazole (Prilosec)- PPI
blocks movement of hydrochloric acid
o inhibits H/K atpase, use only short term
• long term use is associated with gastric cell hypertrophy and cancer
• do not crush or mix with food (granules)
Quinidine
Na and K channel blocker
• used with digoxin to treat atrial arrhythmias
-seen in elderly or from other countries
s/e quinidine
s/e chiconism (vertigo/dizziness), diarrhea, vagolytic
-need to monitor QT interval, highly protein bound
Regular Insulin
Humulin R, Novolin R
• short acting that moves glucose from the blood into the body’s cells
Rosiglitazone (TZD)
(another example is actos)
-monitor LFTs
• banned in US due to reports of cardiac problems
Saxagliptin (Onglyza)
DPP4 inhibitor- block breakdown of incretins
• less hypoglycemia
• s/e runny hose, HA, N/V, bloating, hives, rash, swelling, hoarseness
Sitagliptin (januvia)
DPP4 inhibitor
• reduce inactivation of incretin, inc insulin levels and dec glucagon, promotes satiety, less chance of hypoglycemia
s/e januvia (sitagliptin)
• s/e HA, upper resp infection, angioedema, pancreatitis, anaphylaxis, Stephen-johnson
Spironolactone
aldosterone antagonist, K sparing
• prevents remodeling in HF, edema
s/e spironolactone
• s/e hyperkalemia, nausea, lethargy, androgen effects- resembles sex steroids (irregular periods, gynecomastia)
Sulfonylureas
increase insulin release from pancreas
• pts need to have functioning pancreatic B cells
• Ex: glipizide, glimepride, glyburide
caution with sulfonylureas
- *cross reactivity with sulfa drugs
- *disulfiram rxn and hypotension with EtOH
- High risk for hypoglycemia, pancreas can be overworked
Tagamet (cimetidine)
• h2 receptor antagonist, OTC for heartburn
-many drug interactions
s/e tagamet
• s/e diarrhea, HA, fatigue, seizure, depression, anti-androgen (reversible gynecomastia), dec libido
**many drug/drug interactions
Tetracycline
protein synthesis inhibitor abx, broad spectrum
• don’t give in pregnancy or children due to bone/teeth effects
-h pylori
Thiazide diuretic
first line for HTN in non-hispanic blacks
• mild to moderate HTN
TZD (thiazolidinedione)
for DM
• not first line treatment, inc risk of CV disease
• ex: actos
Vasotec (enalapril)- ACEi
• works by reducing cardiac myocyte hypertrophy and L vent hypertrophy
s/e and c/i with vasotec
- c/I with history of angioedema, pregnancy, renal artery stenosis
- check kidney function, K, etc at 2 wks, 6 wks, 6 mos
- s/e postural hypotension, hyperkalemia, cough
Verapamil
calcium channel blocker
-dec SA nodal rate of fire
• for atrial rhythms
• slight peripheral vasodilation, suppresses early and delayed after depolarization
don’t give verapamil with___
beta blockers
vit K
give for high INR, reverses coumadin
adenosine
- for rapid atrial arrhythmias
- can have long pause before pt converts to NSR
- short half life
amlodipine (Norvasc)
ca channel blocker
- HTN
- s/e pedal edema
- good for elderly, and 2nd line for blacks
4 classes of drugs for HTN
ACE, ARB, thiazide diuretics, ca channel blocks
HTN treat for blacks
thiazide and ca channel blockers
many blacks are low in
aldosterone, renin
-ACE isn’t going to make a big difference
why use ACE or ARB?
decreases myocyte hypertrophy
-less likely to develop LVH, less HF risk
incretins
- intestinal hormones secreted from small intestines as you eat
- stimulate insulin release, promotes sense of fullness, decrease glucagon
ibuprofen
antiplatelet, antifever
-given often in kids cuz no risk Reyes syndrome
sulfonamide
- sulfa abx
- cross reactivity to sulfa allergy
heparin
monitor aptt
-antidote is protamine
verapamil can treat which rhythm
SVT
Cardizem
slows sa nodal rate of fire, also HTN
drug trial phases
1- safety
2-small group effective
3- adverse effects
4- nurse eval in practice
