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Pharmacology > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

What are the types of diarrhea? What are the treatment goals? Types of medications?

A

acute: caused by bacteria, virus, parasite, nutritional change. self limiting

chronic: caused by IBS, tumors, diabetes, lasts more than 3-4 weeks

symptom management, treat cause if can; absorbents, antimotility, probiotics

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2
Q

What is the usage for absorbaents? MOA? Examples? Side effects?

A

for mild cases of diarrhea; coats the wall of the GI tract to bind to bacteria or toxin so it can be eliminated through stool; bismuth subsalicylate (also used for H. pylori treatment) and cholestyramine (bile acid sequesterant); affects drug absorption, GI side effects of cholestyramine and asprins, darkening of tongue and stool (when taking bismuth subsalicylate)

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3
Q

When are anticholinergics used for diarrhea? MOA? Example? Side effects?

A

severe forms; decrease muscle tone and slow peristalsis of GI to allow for more water reabsorption; belladonna alkaloid combos; drying effect, urinary retention, headache, hypotension, bradycardia, confusion, drowsiness

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4
Q

How are opiates-related antidiarrheals used for diarrhea? MOA? Examples? Side effects?

A

for symptoms or for those with IBS; decreases peristalsis to allow for more water reabsorption and reduce pain of rectal spasms; loperamide, diphenoxylate (has anticholinergic effect to prevent recreational use), codeine; hypotension, urinary retention, dizziness, N&V, constipation (long term side effect)

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5
Q

What are probiotics useage? MOA? Examples?

A

antibiotic induced diarrheal; aka intestinal flora modifiers and bacterial drugs supply missing bacteria to GI and suppress growth of diarrhea-causing bacteria; Lactobacillus acidophilus

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6
Q

What is the MOA for bulk forming laxatives? Examples?Nursing consideration?

A

high in fiber to absorb water and increase bulk, distends bowel to initiate reflex bowel activity; methylcellulose, psyllium; only laxative one can take daily, increase water intake

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7
Q

What are laxative different MOAs? Examples?

A

hypoerosmotic: increase fecal water content resulting in bowel reflex (distension, peristalsis, evacuation). polyethylene glycol, sorbitol, lactulose, glycerin

saline: increase osmotic pressure within intestinal tract causing more water to enter intestines resulting in bowel reflex. magnesium hydroxide (milk of magnesia) and magnesium citrate

stimulant: increases peristalsis via intestinal nerve stimulation. senna and bisacodyl

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8
Q

When are peripherally acting opioid antagonist used for? MOA? Examples?

A

treatment of constipation related to opioid use and bowel resection therapy; blocks entrance of opioid into bowel to allow for normal function with continued opioid use; methylnaltrexone, alvimopan

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9
Q

What are some water-soluble vitamins and their nursing considerations? What are some fat-soluble vitamins and their nursing considerations?

A

vitamin B and C, must be taken every day, excess cannot be stored it’s excreted; vitamins d, a, k, and e, found in abundance in food and can be stored in liver and adipose

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10
Q

What is thiamine? Where is it found? Usage? What happens if there’s a deficiency?

A

vitamin b1; plants and animals; carbohydrate metabolism; werneck’s encephalopathy (causing brain lesions and memory loss)

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11
Q

What is riboflavin? Where is it found? Usage?

A

vitamin b2; dairy products, enriched flour, nuts, meats, fish, green leafy greens; needed for normal RBC function

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12
Q

What is pyridoxine? Usage? What causes deficiency?

A

vitamin b6; amino acids, carbohydrate and lipid metabolism; isoniazid usage

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13
Q

What is folic acid? Usage? What happens if there’s a deficiency?

A

B9; fetal developmetna and folate-deficiency anemia; spina bifida and neurocephaly

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14
Q

What is B12 for?

A

fat, carbohydrate metabolism and protein synthesis

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15
Q

What is ascorbic acid? Usage? What happens if there’s a deficiency?

A

vitamin C; collagen formation and tissue repair, powerful antioxident; scurvy, bleeding gums, gingivitis, poor wound healing

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16
Q

What is vitamin D and D3 for? What happens if there’s a deficiency?

A

D2 is from the diet and D3 is sunshine both are needed for use of calcium and phosphorus to calcify bone and teeth to prevent osteoporosis; rickets

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17
Q

What is retinol? Where is it found? Usage?

A

vitamin A from carotenes in plants; needed for vision and growth of bones and teeth

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18
Q

What is vitamin K for?

A

blood clotting, antidote to warfin

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19
Q

What is vitamin E for?

A

antioxidant

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20
Q

What is magnesium needed for? Where is it found?

A

nerve and muscle contractions; green leafy vegetables, milk, meats, nuts

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21
Q

What is zinc for? Where is it found?

A

tissue growth and repair; red meat, liver, milk

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22
Q

What are enternal nutritional supplements? Side effects?

A

supplements administered orally or through a feeding tube through the GI tract; diarrhea

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23
Q

What is parenteral nutritional supplements? Nursing consideratison?

A

supplements administered through the circulation through a vein or central line, bypassing the GI tract; monitor blood sugar levels

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24
Q

What is phentermine? MOA? Side effects?

A

short term usage anorexiant; stimulates the CNS to suppress appetite control centers (related to amphetamines with a lower abuse potential); hypertension, heart palpitations, headache,

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25
Q

What is orlistat and alli? MOA? Side effects?

A

anorexiants; binds to gastric and pancreatic enzymes to reduce fat absorptions; oily spotting, flatulence

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26
Q

What are the goals of antiepileptic drugs? Nursing consideration? MOA?

A

control or prevent seizures while maintaining a resonable quality of live and minimize adverse effects and drug-induced toxicity; lifelong therapy with tapering, constant serum drug monitoring; not known but may change movement of electrolytes to make cell membranes of nerves less excitable

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27
Q

What is primidone and phenobarbitol? MOA? What are they and how are they related? Side effects? Contraindications? Nursing considerations?

A

barbiturate antiepiletpic drug; reduce nerve impulses of brainstem; phenobarbitol (PO or IV) for different types of seizures and primidone (PO) metabolized in liver to phenobarbitol thereby lowering phenobarbitol serum levels and decreasing side effects, long half life; sedation (over time tolerance), GI upset; contraindicated for liver or kidney disease, (medications that induce liver enzymes to increase metabolism such as) beta-blockers - “olol”, Ca channel blockers - “dipines”, contraceptives; therapeutic serum levels 10-40 mcg/mL

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28
Q

What is phenytonin and fosphenytonin? What are they and how are they related? MOA? Side effects? Contraindications? Nursing considerations?

A

hydantoins antieplieptic; phenytoin (PO or IV) is a common first line that must be diluted
fosphenytoin (IV) is converted to phenytoin to overcome serious side effects of phenytoin; increase liver to produce cytochrome p-450 enzymes; highly bound protein, sedation and letahrgy, gingival hyperplasia (good oral care to prevent), dilantin facies (hypertrophy of subcutaneous cells), hirsutism (abnormal hair growth); medications that reduce hydantonin clearance: proton pump inhibitors - “prazoles”, azoles, sulfa drugs; therapeutic drug level 10-20 mcg/mL, careful IV administration, albumin level monitoring

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29
Q

What does highly protein bound mean for a medication?

A

medication has a strong affinity for albumin meaning less free drug but if the medication is given with other drugs with high protein bound characteristics they will compete for the site on the protein. This results in an increase in free drug and a toxicity of either of the medications

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30
Q

What is carbamazepine and oxcarbazepine? What are they and how are they related? Side effects? Contraindications? Nursing implications?

A

iminostilbene antiepileptic drug used for partial seizures and generalized tonic-clonic seizures; carbamazepine is a hepatic enzyme inducer that will stimulate enzymes in the liver to metabolize it faster
oxcarbazepine is not a hepatic enzyme inducer and is an analog of carbamezepine; headache, dissiness, nausea; no grapefruit juice, can make seizures worse if mixed with other antieplictic drugs that treat a different type of seizure; therapeutic levels are 4-12 mcg/mL

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31
Q

What is gabapentin? Usage? MOA? Side effects?

A

PO, antiepiletic chemical analog of GABA; partial seizures and treatment of neuropathy; will increase syntehsis and coagulation of gaba at the synaptic clef; CNS depression and GI

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32
Q

What is pregabalin? Usage? MOA? Side effects?

A

PO antiepiletic; neuropathic pain, postherapeutic neuroalgia, fibromyalgia, adjunct therapy for partial seizures; thought to bind to Ca channels in CNS to reduce neurotransmitter relsease; suicidal thoughs, drowsiness and dizziness

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33
Q

What is valporic acid? Usage? Side effects? Nursing consideratison?

A

antiepiletic; generalized seizures, bipolar disorder, partial seizures; drowsiness, GI, weight gain, tremor; therapeutic levels 50-125 mcg/mL, highly protein bound, cannot take with carbonated beverages, should be taken with food or water

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34
Q

What is parkinson’s disease? Symptoms? Treatment?

A

chronic, progresive dengerative disorder affecting dopamine-producing neurons causing an imbalance of dopamine (too little) and acetylcholine (too much); TRAP: tremor, rigidity, akinesia (slow in movement), postural instability; PT and medications (which only slow the symptoms), drug therapies that aim in increasing levels of dopamine and antagonizing the effects of acetylcholine

35
Q

What are monoamine oxidase inhibitors? Example? MOA? Side effects?

A

antiepiletic; “giline” selegine and rasagiline; inhibits monoamine oxidase B enzyme to increase levels of dopamine timulation in brain; headache, insomina, dizziness, GI

36
Q

What is the cheese effect? Treatment?

A

interaction between non-selective MOAIs and tyrosine containing foods (cheese) leading to severe hypertension; low dosage of MOAI B specific

37
Q

What is levodopa? Usage? MOA? Side effects? Contraindications?

A

dopamine replacement; main treatment of parkinsons; precursor of dopamine that will cross the blood brain barrier and be converted into dopamine; GI, low bp, involuntary movements; if used by itself or in large dosages it can lead to an increase of side effects, do not eat too much protein or it will slow down or prevent absorption, take 30 minutes before or 1 hour after eating

38
Q

What is carbidopa?

A

used to prevent levodopa breakdown before it reaches the brain, does not cross the blood brain barrier

39
Q

What are benzodiazepines? Examples? Side effect? Nursing considerations?

A

CNS depressant; “pam” diazepam, midazolam, temazepam; “hangover effect”; grapefurit juice, azoles, and alcohol

40
Q

What is eszopiclone? Zolpidem?

A

non-benzodiazepam CNS depressants; eszopicloze is the first hypnotic approved for long term use and zolpidem: is a short acting depressant also good for long-term use

41
Q

What are examples of muscle relaxants? and OTC CNS depressants?

A

cyclobenzaprine, tizanidine; doxylamine, diphenhydramine; acetaminophen/diphenhydramine

42
Q

What are the stages of alcohol withdrawal?

A

mild, moderate, severe with increasing BP, HR and agitation

43
Q

What is disulfiram? MOA?

A

last resort for alcohol withdrawal; alters metabolism of alcohol to induce acetaldehyde syndrome to induce vomiting, hypotension, blurred vision, and headache if they drink alcohol which will last a couple of days

44
Q

What is bupropion?

A

first nicoteine-free medication to treat nicotine dependence that may be prescribed to aid in smoking cessation, considered an antidepressent

45
Q

What is varenicline? MOA? Side effect?

A

typically a 12 week course of medication to treat nicotine withdrawal symptoms; stimulating nicotine receptor; GI and insomnia

46
Q

How is vomiting stimulated?

A

chemoreceptors in the cerebral cortex stimulate the medulla, the vomiting center

47
Q

What is the MOA for antiemetics?

A

blocks the vomiting pathway in the brain, inner ear, or GI

48
Q

How are anticholinergics used as antiemetics? MOA? Example? Side effects? Contraindication?

A

used for motion sickness, effects the vestibular area of the brain and blocks acetylcholine from binding to receptors in inner ear thereby blocking signals sent to chemoreceptor trigger zone to indicate nausea, will also dry out GI secretions and slow down smooth muscle spasms; scopolamine (patch); drowsiness; narrow angle glaucoma and caution with older adults

49
Q

How are antihistamines used as antiemetics? MOA? Example? Side effects?

A

inhibits acetylcholine by binding to H1 receptors; stop vestibular and reticular signaling to chemoreceptor trigger zone; dimenhydrinate, meclizine; dizziness, dry mouth

50
Q

How are antidopaminergics used as antiemetics? Routes? Example? Side effects? Nursing consideration?

A

block dopamine receptors in chemoreceptor trigger zone of the brain with a slight affect to acetylcholine; IV, PR; prochlorperazine, promethazine; dry mouth, constipation; promethazine needs to be diluted if given IV

51
Q

What are prokinetics? MOA? Examples? Side effects?

A

for motion issues and assisting in peristalsis; blocks dopamine receptors in the chemoreceptor trigger zone; metoclopramide; fatigue, sedation, dry mouth, if used long term: tardive dyskinesia (involuntary movement of face or body

52
Q

How are serotonin blocker (5HT-3) used as antiemetics? MOA? Routes? Example? Side effects? Nursing consideration?

A

given for chemotherapy and post-operative induced N&V; block serotonin receptors in chemoreceptive trigger zone, and works in GI and medualla; IV or PO (oral disintegrating tablets); ondansetron; headache, diarrhea, rare arrhythmia; give 30 to 60 minutes prior to chemo

53
Q

What are tetrahydrocannaboinoid? MOA? Example? Side effects? Nursing considerations?

A

synthetic THC, second line medication for antinausea and antiemetics; inhibits cerebral cortex and thalamus effecting the chemoreceptive trigger zone; dronabinol (PO); appetite stimulant; considered control 2 substance and can have withdrawal if used long term

54
Q

What are the cell types you can find in the gastric zone of the stomach?

A

parietal cells: produce and secrete HCL (many antiacid medications work here)

chief cells: secrete pepsinogen which will be activated into pepsin when exposed to acid to aid in protein breakdown

muscous cells: provide a coating to protect from self-digestion

55
Q

What is peptic ulcer disease? Cause? Treatment?

A

gastric or duodenal ulcers that involve digestion of the GI mucosa by pepsin; helicobacter pylori; 10-14 days of proton pump inhibitors, clarithromycin and amoxicillin or metronizadole, or bismuth and tetracycline and metronidazole

56
Q

What are in antacids? MOA? Side effects? Interactions?

A

Al, Ca, Mg, and/or Na salts; neutralize stomach acid and reduces pain but will not prevent acid production, stimulates mucus, prostablands, and bicarbonate; Mg can cause diarrhear and cannot be used if pt is in renal failure. Ca can cause kidney stones; antibiotics, cannot be taken together usually 2 hours before or after

57
Q

What are examples of H2 receptor antagonist antiacids? MOA? Usage? Side effects? Nursing considerations?

A

“tidine”; blocks H2 receptors in acid parietal cells to reduce acid secretion; GERD and peptic ulcer disease; confusion, disorientation, affects drug absorption, cimetidine can lead to impotence and gynecomastia (blocks enzyme in liver that breaks down medication); smoking can reduce effectiveness, can be taken with antacids if taken about an our before the antacid

58
Q

What are examples of proton pump inhibitors? MOA? Use? Side effects? Nursing considerations? Interactions?

A

“prazole”; binds to hydrogen-potassium ATPase pump and blocks all acid secretion; GERD and erosive esophagitis and ulcers (in combination with antibiotics); long term use can increase risk of osteoporosis and fractures; takes a bit to work and should be taken on an empty stomach 30-60 minutes before food to be most effective; produce toxicity levels of diazepam, phenytoin, and warfarin

59
Q

What is sucralfate? MOA? Nursing considerations?

A

used for ulcers; binds to base of ulcers and forms a protective barrier; should be given an hour before meals and cannot be taken at the same exact time as PPI

60
Q

What is misoprostol? MOA? Nursing consideration?

A

prostaglandin analogue; prostaglandin can inhibit gastric acid secretion and protects mucosa; can induce labor and therefore should never be given to a pregnant person

61
Q

What is simethicone?

A

reduces gas pain by making the gas bubbles smaller and increase expulsion through the mouth or rectum (does not reduce amount of gas)

62
Q

What is anxiety?

A

unpleasant state of mind characterized by sense of dread and fear, could be based on anticipatory experiences or past experiences, or an exaggerated response to imaginary negative situations

63
Q

What are affective disorders?

A

changes in mood that range from mania to depression or the experience of both (bipolar)

64
Q

What is psychoses?

A

severe emotional disorder that impairs of mental function to the point that they cannot participate in daily life due to a loss of contact with reality

65
Q

What is St. John’s wart?

A

herbal therapy for depression, anxiety, and sleep disorders that should not be taken with any other psychotherapy drugs

66
Q

What are the types of psychotherapeutic drugs?

A

Anxiolytic drugs
Mood-stabilizing drugs
Antidepressant drugs
Antipsychotic drugs

67
Q

What is an example of anxiolytics? MOA? Usage? Side effects?

A

benzodiazepines, “pam”; reduce anxiety by reducing CNS over acitvity; largest and most most commonly prescribed for anxiety, alcohol withdrawal, insomnia, muscle spasms, and adjunct treatment for depression; sedation, drowsiness, loss of coordination, dizziness, headaches

68
Q

What are mood-stabilizing drugs used for? Example? MOA? Side effects? Nursing considerations?

A

used to treat bipolar illness and mania; lithium carbonate and lithium citrate; increases serotonin neurotransmission and alter how sodium is released; cardiac dysrhythmias, drowsiness, slurred speech, epilepsy-type seizures, problem with movement and coordination; narrow therapeutic range 0.6-1.2 mEq/L, monitor sodium levels, no drastic change to intake of sodium and water, avoid thaizides, ACE inhibitors, and NSAIDs

69
Q

What are antidepressant drugs used for? MOA? Side effect? Nursing considerations? Classes?

A

major depressive disorders, chronic depression, adjunct with schizophrenia, eating disorders, and personality disorder, treatment of migraines, chronic pain, and sleep disorders; Increase neurotransmitters (serotonin, dopamine, norepinephrine) levels in CNS; high risk of suicide; requires at least 6 weeks of therapy to see results, used in conjunction with psychotherapy; tricyclic antidepressants, monoamine oxidase inhibitors, second generation antidepressants (SSRIs and SNRIs)

70
Q

What is amitriptyline? Usage?MOA? Side effects? Nursing consideration?

A

tricyclic antidepressant; second line antidepressants or used in adjunct with SSRIs for neuropathic pain and insomnia; blocks reuptake of neurotransmitter: serotonin and norepinephrine; sedation, orthostatic hypotension, impotence, dry mouth, constipation; any overdose is lethal, no antidote

71
Q

What are selective serotonin reuptake inhibitor examples? MOA? Side effects? Nursing considerations?

A

citalopram: most commonly used for depression and OCD, short half life and therefore commonly assoicated with discontinuation syndrome (antidepressant withdrawal syndrome)

duloxetine: selective serotonin norepinephinrine reuptake inhibitor for depression, generalized anxiety, diabetic neuropathy, fibromyalgia

Fluoxetine: depression, bulimia, OCD, panic disorder

SSRI and SSNI; insomnia, weight gain, sexual dysfunction; highly protein bound, washout period of 2-5 weeks if changing from MAOIs

72
Q

What are positive symptoms of schizophrenia? How are they effected by antipsychotics?

A

behaviors or ways of thinking that they didn’t have before they became ill
ex/ Hallucinations, delusions, and conceptual disorganization; All antipsychotics show efficacy in improving the positive symptoms of schizophrenia

73
Q

What are negative symptoms of schizophrenia? How are they effected in antipsychotics?

A

Thoughts or behaviors person used to have before ill but do not have them any more
iel. Apathy, social withdrawal, blunted affect, poverty of speech, and catatonia; Conventional drugs are less effective in managing negative symptoms.
Atypical antipsychotics have improved efficacy in treating both positive and negative symptoms

74
Q

When are antipsychotics used? MOA?

A

for serious mental illness, blocks dopamine receptors in the brain (imbic system and basal ganglia, areas assoicated with emotion, cognitive function, motor function;

75
Q

What is haloperidol? Route? Use? Side effects? Contraindications?

A

antipsychotic drug; PO, IM, IV; pts with schizophrenia who are nonadherent with drug regimen due to long half life; tremors, muscle twitching, extrapyramidal symptoms of tremors and muscle twitching;

76
Q

What are some atypical antipsychotics? What’s the MOA? Side effects?

A

clozapine, risperidone (more of an affinity for serotonin receptors than clorzapine), aripiprazole (quinolone for schizophrenia, bipolar, agitation in those with autism; block dopamine-2 receptors and serotonin receptors; overall much lower than haldol, weight gain, sedative, tardive dyskinesia

77
Q

What is the three step analgesic ladder?

A

nonopioids after pain has been assessed and identified

opioids with or without nonopioids and with or without adjuvants

opioids indicated for moderate to severe pain

78
Q

What are opioids? What are the classifications for opioid drugs?

A

synthetic drugs that bind to opiate receptors to receive pain;
Agonists: bind to opioid pain receptor in brain
Reduce sensation of pain

Mild: codeine & hydrocodone

Strong: morphine, hydromorphone, oxycodone, fentanyl, methadone

79
Q

What are some examples of opioid analgesics? Side effects? Interactions?

A

Fentanyl (IV, patch, po)
IV and PO very strong and works fast
1 mg: 10 mg of morphine
Patch: for chronic pain and will take a bit longer to reach steady pain control
Work for about 72 hours

Hydromorphone (Dilaudid)
Stronger than morphine 1mg:7mg

Methadone (Dolophine) PO
Longer half life

Morphine sulfate PO, IV, ER

Oxycodone
oxycodone/acetaminophen (Percocet)
hydrocodone with acetaminophen (Vicodin)
Cough suppression and diarrhea; CNS depression, constipation, sweating, flushing, itching; alcohol, sntihistamines, barbiturates, and benzodiazepines will promote CNS depression

80
Q

What is the difference between tolerance and physical depeneden and psychologic dependence?

A

Tolerance: where a larger dose is required to maintain same level of analgesia, Not addiction

Physical dependence: the body has adapted to the opioid, Not addiction

Psychologic dependence: compulsive drug use where the person has a continued need and craving for the drug for other reasons than pain relief

81
Q

What is naloxone hydrochloride?

A

pure opioid antagonist and drug of choice for complete or partial reversal of opioid-induced respiratory depression

82
Q

What is an example of nonopioid analgesics? MOA? Nursing consideration?

A

acetaminophen; block pain impulses peripherally by blocking synthesis of prostaglandins; maximum daily dosaeg for healthy adults is 3000 mg/day and for older adults and those with liver disease 2000 mg/day

83
Q

What is tramadol hydrochloride? Usage? MOA? Side effects?

A

analgesic for moderate to moderately severe pain; weak bond to opioid receptors and inhibit norepinephrine and serotonin reuptake; Drowsiness, dizziness, headache
Nausea and constipation
Respiratory depression
Seizures
Increase risk with those on anti-depressants

84
Q

What is lidocaine? Usage? Side effects? Nursing considerations?

A

topical anesthetic; postherapeutic neuralgia; skin irritation may occur; have patch in place no longer than 12 hours

Pharmacology (6 decks)

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