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NRS 155 Pharmacology > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Erythropoiesis Stimulating Agents Drugs

A

Anemia

Epoetin Alfa
Darbepoetin Alfa

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2
Q

Epoetin Alfa
Darbepoetin Alfa
Class

A

Erythropoiesis Stimulating Agents

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3
Q

Erythropoiesis Stimulating Agents MOA

A

Anemia

Act like erythropoietin to stimulate production RBC in bone marrow

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4
Q

Erythropoiesis Stimulating Agents Indication

A

Anemia

Rx anemia associated with chronic renal failure or kidney disease

Epoetin Alfa: associated AIDS and decreased need for blood transfusions

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5
Q

Erythropoiesis Stimulating Agents

A

Anemia

Epoetin Alfa
Darbepoetin Alfa

Act like erythropoietin to stimulate production RBC in bone marrow

Rx anemia associated with chronic renal failure or kidney disease

Epoetin Alfa: associated AIDS and decreased need for blood transfusions

Absolute: uncontrolled HTN
Relative: P/L
Caution: some cancers, nL renal function (cause rebound anemia)

Seizures
Increase risk of DVT when Hgb is greater than 11 g/dL

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6
Q

Erythropoiesis Stimulating Agents Unique ADE

A

Anemia

Seizures
Increase risk of DVT when Hgb is greater than 11 g/dL

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7
Q

Erythropoiesis Stimulating Agents C/C

A

Anemia

Absolute: uncontrolled HTN
Relative: P/L
Caution: some cancers, nL renal function (cause rebound anemia)

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8
Q

Anti-Anemia Lifespan Considerations

A

Children:
iron prep through straw because stain teeth
nutrition
Epoetin alfa not establish

Adult:
comfort constipation for iron replacement
increase supplementation in P/L
Epoetin alfa/Darbepoetin no in P/L

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9
Q

Iron Deficient Anemia

A

Anemia

Ferrous Asparate, Ferrous Fumarate, Ferrous Gluconate, Ferrous Sulfate, Iron Dextran, Iron Sucrose

MOA: increase serum iron levels

Indication: rx iron deficient anemia; adjunct therapy when receiving epoetin alfa

Absolute: hemochromatosis; anemia not iron deficient toxic
Relative: peptic ulcer, colitis, regional enteritis
D-D: numerous
D-F: eggs, milk, tea, coffee; encourage vitamin C

ADE: staining teeth

Antidote: de-fer

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10
Q

Iron Deficient Anemia Drugs

A

Anemia

Ferrous Asparate, Ferrous Fumarate, Ferrous Gluconate, Ferrous Sulfate, Iron Dextran, Iron Sucrose

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11
Q

Iron Deficient Anemia MOA

A

Anemia

MOA: increase serum iron levels

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12
Q

Iron Deficient Anemia Indication

A

Anemia

Indication: rx iron deficient anemia; adjunct therapy when receiving epoetin alfa

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13
Q

Iron Deficient Anemia Antidote

A

Anemia

Antidote: de-fer

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14
Q

Iron Deficient Anemia C/C

A

Anemia

Absolute: hemochromatosis; anemia not iron deficient toxic
Relative: peptic ulcer, colitis, regional enteritis
D-D: numerous
D-F: eggs, milk, tea, coffee; encourage vitamin C

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15
Q

Iron Deficient Anemia Unique ADE

A

Staining teeth

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16
Q

Megaloblastic Anemia

A

Anemia

Folic Acid: Leucovorin; Levoleucovorin
Vitamin B12: Hydroxocobalamin; Cyanocobalamin

MOA: essential for cell growth and division of RBC
B12: maintenance of myelin sheath

Indication:
Megaloblastic anemia
replacement therapy for dietary deficiencies and high demand states
Folic acid used rescue drug for cells exposed toxic chemotherapy agents

Give both types drug in pernicious anemia

Vitamin B12 deficiency: beefy red tongue
Secondary folate deficiency cause by alcoholism

Parenteral B12 given IM each day for 5-10 days and then once a month for life for pernicious anemia

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17
Q

Megaloblastic Anemia Drugs

A

Anemia

Folic Acid: Leucovorin; Levoleucovorin
Vitamin B12: Hydroxocobalamin; Cyanocobalamin

MOA: essential for cell growth and division of RBC
B12: maintenance of myelin sheath

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18
Q

Megaloblastic Anemia MOA

A

MOA: essential for cell growth and division of RBC
B12: maintenance of myelin sheath

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19
Q

Megaloblastic Anemia Indications

A

Indication:
Megaloblastic anemia
replacement therapy for dietary deficiencies and high demand states
Folic acid used rescue drug for cells exposed toxic chemotherapy agents

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20
Q

Megaloblastic Anemia ADPIE

A

Give both types drug in pernicious anemia

Vitamin B12 deficiency: beefy red tongue
Secondary folate deficiency cause by alcoholism

Parenteral B12 given IM each day for 5-10 days and then once a month for life for pernicious anemia

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21
Q

Ferrous Asparate, Ferrous Fumarate, Ferrous Gluconate, Ferrous Sulfate, Iron Dextran, Iron Sucrose
Class

A

Iron Deficient Anemia

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22
Q

Sickle Cell Anemia

A

Anemia

Hydroxyurea

Increase amount of fetal hemoglobin produced in bone marrow and dilutes formation of abnormal hemoglobin S

Relative: severe anemia or leukopenia

D-D: Uricosuric agents

Rare ADE: increase risk of cancer

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23
Q

Hydroxyurea Class

A

Sickle Cell Anemia

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24
Q

Opioid Agonist

A

Analgesics

Morphine, Hydromorphone, Codeine, Oxycodone, Fentanyl, Hydrocodone

MOA: acts at specific opioid receptor sites in CNS to produce analgesia, sedation, euphoria

Indication: relief of severe acute or chronic pain; analgesia during anesthesia

Absolute: diarrhea caused by poisons

Cautions:
respiratory dysfunction, asthma, emphysema
P/L
GI or GU surgery; Acute abdomen or ulcerative colitis
Head injury, alcoholism, CVA, delirium tremens

Antidote: opioid antagonist

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25
Q

Opioid Agonist Drug

A

Morphine, Hydromorphone, Codeine, Oxycodone, Fentanyl, Hydrocodone

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26
Q

Opioid Agonist MOA

A

Acts at specific opioid receptor sites in CNS to produce analgesia, sedation, euphoria

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27
Q

Opioid Agonist Indication

A

Relief of severe acute or chronic pain; analgesia during anesthesia

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28
Q

Opioid Agonist Antidote

A

opioid antagonist

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29
Q

Opioid Agonist C/C

A

Absolute: diarrhea caused by poisons

Cautions:
respiratory dysfunction, asthma, emphysema
P/L
GI or GU surgery; Acute abdomen or ulcerative colitis
Head injury, alcoholism, CVA, delirium tremens

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30
Q

Morphine, Hydromorphone, Codeine, Oxycodone, Fentanyl, Hydrocodone Class

A

Opioid Agonist

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31
Q

Opioid Agonist-Antagonist

A

Analgesic

Buprenorphine, Butorphanol, Nalbuphine

MOA: act as partial agonist at mu receptor and antagonist at kappa receptor in CNS to produce analgesia, sedation, euphoria, hallucination

Indication: moderate to severe pain; some can be used to treat opioid use disorder

Absolute:
Nalbuphine: sulfite allergy

Cautions:
physical dependence on narcotic
COPD and respiratory tract disease
Acute MI or hx CAD, HTN
P/L

D-D: Barbiturate general anesthetic or narcotic agent

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32
Q

Opioid Agonist-Antagonist Drugs

A

Buprenorphine, Butorphanol, Nalbuphine

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33
Q

Buprenorphine, Butorphanol, Nalbuphine Class

A

Opioid Agonist-Antagonist

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34
Q

Opioid Agonist-Antagonist MOA

A

act as partial agonist at mu receptor and antagonist at kappa receptor in CNS to produce analgesia, sedation, euphoria, hallucination

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35
Q

Opioid Agonist-Antagonist Indication

A

Moderate to severe pain; some can be used to treat opioid use disorder

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36
Q

Opioid Agonist-Antagonist C/C & D-D

A

Absolute:
Nalbuphine: sulfite allergy

Cautions:
physical dependence on narcotic
COPD and respiratory tract disease
Acute MI or hx CAD, HTN
P/L

D-D: Barbiturate general anesthetic or narcotic agent

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37
Q

Opioid Antagonist

A

Analgesic

Naloxone
Naltrexone

MOA: bind strongly to opioid receptor but do not activate

Indication
Naloxone: reverse adverse effect opioid; dx suspected acute opioid OD
Naltrexone: oral manage alcohol or opioid dependence

D-D: larger dose to reverse effects opioid agonist-antagonist

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38
Q

Antimigraine Ergot Derivatives

A

Dihydroergotamine and Ergotamine

MOA: block alpha adrenergic and serotonin receptor sites in brain cause constriction cranial vessels, decrease cranial artery pulsation, and decrease hyper-perfusion of basilar artery bed

Indication: prevention of migraine (aura)

Absolute: CAD, HTN, PVD

Caution: pruritus, malnutrition

D-D: Beta blocker and Triptans

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39
Q

Antimigraine Ergot Derivatives Drugs

A

Dihydroergotamine and Ergotamine

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40
Q

Dihydroergotamine and Ergotamine Class

A

Antimigraine Ergot Derivatives

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41
Q

Antimigraine Ergot Derivatives MOA

A

block alpha adrenergic and serotonin receptor sites in brain cause constriction cranial vessels, decrease cranial artery pulsation, and decrease hyper-perfusion of basilar artery bed

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42
Q

Antimigraine Ergot Derivatives Indications

A

prevention of migraine (aura)

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43
Q

Antimigraine Ergot Derivatives C/C & D-D

A

Absolute: CAD, HTN, PVD

Caution: pruritus, malnutrition

D-D: Beta blocker and Triptans

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44
Q

Antimigraine Triptans

A

Eletriptan, Sumatriptan, Zolmitriptan

MOA: Bind to selective serotonin receptors to cause vasoconstriction of cranial vessels

Indication: treat acute migraine

Absolute: pregnancy and CAD

Caution: elderly, risk factors for CAD, lactation

D-D: ergot-containing drugs

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45
Q

Antimigraine Triptans Drugs

A

Eletriptan, Sumatriptan, Zolmitriptan

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46
Q

Eletriptan, Sumatriptan, Zolmitriptan Class

A

Antimigraine Triptans

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47
Q

Antimigraine Triptans MOA

A

Bind to selective serotonin receptors to cause vasoconstriction of cranial vessels

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48
Q

Antimigraine Triptans Indications

A

treat acute migraine

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49
Q

Antimigraine Triptans C/C & D-D

A

Absolute: pregnancy and CAD

Caution: elderly, risk factors for CAD, lactation

D-D: ergot-containing drugs

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50
Q

Antimigraine CGRP Inhibitors & Serotonin Agonist

A

CGRP Inhibitors: Rimegepant
MOA: inhibits a potent vasodilator chemical released during migraine HA
Indication: acute migraine HA
Only migraine drug taken on a schedule to prevent or decrease the number of migraines

Serotonin Agonist: Lasmiditan
MOA: selective serotonin agonist leading to vasoconstriction
Indication: acute migraine with or without aura in adults

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51
Q

Antimigraine CGRP Inhibitors & Serotonin Agonist Drugs

A

CGRP Inhibitors: Rimegepant
Serotonin Agonist: Lasmiditan

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52
Q

CGRP Inhibitors: Rimegepant
Serotonin Agonist: Lasmiditan

A

Antimigraine CGRP Inhibitors & Serotonin Agonist

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53
Q

Antimigraine CGRP Inhibitors & Serotonin Agonist MOA

A

CGRP Inhibitors: Rimegepant
MOA: inhibits a potent vasodilator chemical released during migraine HA

Serotonin Agonist: Lasmiditan
MOA: selective serotonin agonist leading to vasoconstriction

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54
Q

Antimigraine CGRP Inhibitors & Serotonin Agonist Incations

A

CGRP Inhibitors: Rimegepant
Indication: acute migraine HA
Only migraine drug taken on a schedule to prevent or decrease the number of migraines

Serotonin Agonist: Lasmiditan
Indication: acute migraine with or without aura in adults

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55
Q

Which antimigraine drug is the only one take on a schedule to prevent migraine

A

Rimegepant - CGRP Inhibitor

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56
Q

Aminoglycoside

A

Antibiotic

Gentamicin, Neomycin, Streptomycin, Tobramycin

Bactericidal

Treat serious bacterial infections

Relative: renal/hepatic dz, P/L, hearing loss, Myasthenia Graves and Parkinson Disease

ADE: ototoxicity, nephrotoxicity, bone marrow depression

D-D:
Penicillin and cephalosporin (synergy)
Loop diuretic: ototoxicity risk
Parenteral penicillin

Patient teaching
know signs of allergic reaction
decrease urine output is indicated of nephrotoxicity
changes in hearing

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57
Q

Aminoglycoside Drugs

A

Antibiotic

Gentamicin, Neomycin, Streptomycin, Tobramycin

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58
Q

Gentamicin, Neomycin, Streptomycin, Tobramycin Class

A

Aminoglycoside

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59
Q

Aminoglycoside MOA

A

Antibiotic

Bactericidal

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60
Q

Aminoglycoside Indication

A

Antibiotic

Treat serious bacterial infections

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61
Q

Aminoglycoside Relative Contraindication

A

Antibiotic

Relative: renal/hepatic dz, P/L, hearing loss, Myasthenia Graves and Parkinson Disease

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62
Q

Aminoglycoside ADE

A

Antibiotic

ADE: ototoxicity, nephrotoxicity, bone marrow depression

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63
Q

Aminoglycoside Drug to Drug

A

Antibiotic

D-D:
Penicillin and cephalosporin (synergy)
Loop diuretic: ototoxicity risk
Parenteral penicillin

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64
Q

Aminoglycoside Patient Teaching

A

Antibiotic

Patient teaching
know signs of allergic reaction
decrease urine output is indicated of nephrotoxicity
changes in hearing

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65
Q

Carbapenem

A

Antibiotic

Doripenem
Ertapenem
Imipenem-cilastatin
Imipenem-cillastatin-relebactam
Meropenem
Meropenem-Vaborbactam

Bactericidal

Treat serious bacterial infections

Relative: allergy to beta-lactam; kidney disease

D-D: increase risk of seizure when combined with other drugs

ADE:
Toxic GI effects leading to dehydration and electrolyte imbalance from pseudomembranous colitis, Clostridium difficile diarrhea, and N/V
Superinfection
CNS effect

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66
Q

Carbapenem Drugs

A

Antibiotic

Doripenem
Ertapenem
Imipenem-cilastatin
Imipenem-cillastatin-relebactam
Meropenem
Meropenem-Vaborbactam

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67
Q

Doripenem
Ertapenem
Imipenem-cilastatin
Imipenem-cillastatin-relebactam
Meropenem
Meropenem-Vaborbactam

A

Carbapenem

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68
Q

Carbapenem MOA

A

Antibiotic

Bactericidal

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69
Q

Carbapenem Indication

A

Antibiotic

Treat serious bacterial infections

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70
Q

Carbapenem Relative Contraindication

A

Antibiotic

Relative: allergy to beta-lactam; kidney disease

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71
Q

Carbapenem ADE

A

Antibiotic

ADE:
Toxic GI effects leading to dehydration and electrolyte imbalance from pseudomembranous colitis, Clostridium difficile diarrhea, and N/V
Superinfection
CNS effect

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72
Q

Carbapenem D-D

A

Antibiotic

D-D: increase risk of seizure when combined with other drugs

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73
Q

Cephalosporins

A

Antibiotic

Cephalexin
Cefaclor, Cefoxitin, Cefuroxime,
Cefdinir, Cefotaxime, Cefpodoxime, Ceftriaxone, Cefazoline

Bactericidal or bacteriostatic

Treat bacterial infections

Relative: allergies to penicillin and renal impairment

D-D:
aminoglycosides: increase risk of nephrotoxicity
Warfarin: increase risk of bleeding

ADE:
N/V/D/F
abdominal pain
Pseudomembranous colitis
C. diff
Superinfection
Nephrotoxicity
CNS
Injection site inflammation, irritation, infection

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74
Q

Cephalosporins Drugs

A

Antibiotic

Cephalexin
Cefaclor, Cefoxitin, Cefuroxime,
Cefdinir, Cefotaxime, Cefpodoxime, Ceftriaxone, Cefazoline

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75
Q

Cephalexin
Cefaclor, Cefoxitin, Cefuroxime,
Cefdinir, Cefotaxime, Cefpodoxime, Ceftriaxone, Cefazoline
Class

A

Cephalosporins

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76
Q

Cephalosporins MOA

A

Antibiotic

Bactericidal or bacteriostatic

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77
Q

Cephalosporins Indications

A

Antibiotic

Treat bacterial infections

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78
Q

Cephalosporins Relative Contraindication

A

Antibiotic

Relative: allergies to penicillin and renal impairment

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79
Q

Cephalosporins D-D

A

Antibiotic

D-D:
aminoglycosides: increase risk of nephrotoxicity
Warfarin: increase risk of bleeding

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80
Q

Cephalosporins ADE

A

Antibiotic

ADE:
N/V/D/F
abdominal pain
Pseudomembranous colitis
C. diff
Superinfection
Nephrotoxicity
CNS
Injection site inflammation, irritation, infection

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81
Q

Fluoroquinolones

A

Antibiotic

Ciprofloxacin
Levofloxacin
Moxifloxacin
Ofloxacin

Bacteriostatic

Treat bacterial infection

Relative:
renal dysfunction, liver impairment, Myasthenia Graves, seizure disorder

D-D:
iron salt, sucralfate, mineral supplement, antiacids
other drugs increase QT interval
Theophylline
NSAIDs

ADE:
bone arrow depression, photosensitivity, liver toxicity

Black Box Warning: risk for tendinitis and tendon rupture; CNS effects including hallucinations

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82
Q

Fluoroquinolones Drugs

A

Antibiotic

Ciprofloxacin
Levofloxacin
Moxifloxacin
Ofloxacin

Black Box Warning: risk for tendinitis and tendon rupture; CNS effects including hallucinations

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83
Q

Ciprofloxacin
Levofloxacin
Moxifloxacin
Ofloxacin
Class

A

Fluoroquinolones

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84
Q

Fluoroquinolones MOA

A

Antibiotic

Bacteriostatic

Black Box Warning: risk for tendinitis and tendon rupture; CNS effects including hallucinations

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85
Q

Fluoroquinolones Indication

A

Treat bacterial infection

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86
Q

Fluoroquinolones Relative Contraindication

A

Antibiotic

Relative:
renal dysfunction, liver impairment, Myasthenia Graves, seizure disorder

Black Box Warning: risk for tendinitis and tendon rupture; CNS effects including hallucinations

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87
Q

Fluoroquinolones D-D

A

Antibiotic

D-D:
iron salt, sucralfate, mineral supplement, antiacids
other drugs increase QT interval
Theophylline
NSAIDs

Black Box Warning: risk for tendinitis and tendon rupture; CNS effects including hallucinations

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88
Q

Fluoroquinolones ADE

A

Antibiotic

ADE:
bone arrow depression, photosensitivity, liver toxicity

Black Box Warning: risk for tendinitis and tendon rupture; CNS effects including hallucinations

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89
Q

Fluoroquinolones BBW

A

Antibiotic

Black Box Warning: risk for tendinitis and tendon rupture; CNS effects including hallucinations

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90
Q

Penicillin and Penicillinase Resistant

A

Antibiotic

Penicillin G Benzathine
Penicillin G Potassium
Penicillin G Procaine
Penicillin V
Amoxicillin
Ampicillin

Bactericidal - Broad Spectrum

Treat bacterial infections

Relative Contra:
allergy to cephalosporins
renal dz

D-D: parenteral aminoglycosides

ADE:
GI tract irritation
infection at injection site
superinfection

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91
Q

Penicillin and Penicillinase Resistant Drugs

A

Antibiotic

Penicillin G Benzathine
Penicillin G Potassium
Penicillin G Procaine
Penicillin V
Amoxicillin
Ampicillin

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92
Q

Penicillin and Penicillinase Resistant MOA

A

Antibiotic

Bactericidal - Broad Spectrum

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93
Q

Penicillin and Penicillinase Resistant Indication

A

Antibiotic

Treat bacterial infections

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94
Q

Penicillin and Penicillinase Resistant Relative Contraindication & D-D

A

Antibiotic

Relative Contra:
allergy to cephalosporins
renal dz

D-D: parenteral aminoglycosides

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95
Q

Penicillin and Penicillinase Resistant ADE

A

Antibiotic

ADE:
GI tract irritation
infection at injection site
superinfection

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96
Q

Penicillin G Benzathine
Penicillin G Potassium
Penicillin G Procaine
Penicillin V
Amoxicillin
Ampicillin
Class

A

Penicillin and Penicillinase Resistant

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97
Q

Sulfonamides

A

Antibiotic

Sulfadiazine
Sulfasalazine
Trimethoprim-Sulfamethoxazole

Bacteriostatic by inhibiting folic acid synthesis (prevent reproduction of bacteria)

Treat bacterial infections

Relative Contra:
Allergy to thiazide diuretic
Pregnancy: possible teratogenic

Caution: renal dz and kidney stones

D-D:
Sulfonylurea (antidiabetic: glyburide, glipizide)
Cyclosporine: increase risk of nephrotoxic

ADE:
GI: N/V/D, stomatitis, abdominal pain
Renal: hematuria, crystalluria, proteinuria, hyperkalemia
CNS: HA & dizziness
Skin: Stevens-Johnson syndrome
Bone marrow depression

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98
Q

Sulfonamides Drugs

A

Antibiotic

Sulfadiazine
Sulfasalazine
Trimethoprim-Sulfamethoxazole

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99
Q

Sulfonamides MOA

A

Antibiotic

Bacteriostatic by inhibiting folic acid synthesis (prevent reproduction of bacteria)

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100
Q

Sulfonamides Indication

A

Antibiotic

Treat bacterial infections

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101
Q

Sulfonamides Relative Contraindication, Cautions, D-D

A

Antibiotic

Relative Contra:
Allergy to thiazide diuretic
Pregnancy: possible teratogenic

Caution: renal dz and kidney stones

D-D:
Sulfonylurea (antidiabetic: glyburide, glipizide)
Cyclosporine: increase risk of nephrotoxic

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102
Q

Sulfonamides ADE

A

Antibiotic

ADE:
GI: N/V/D, stomatitis, abdominal pain
Renal: hematuria, crystalluria, proteinuria, hyperkalemia
CNS: HA & dizziness
Skin: Stevens-Johnson syndrome
Bone marrow depression

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103
Q

Sulfadiazine
Sulfasalazine
Trimethoprim-Sulfamethoxazole
Class

A

Sulfonamides

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104
Q

Tetracyclines

A

Antibiotic

Tetracycline, Doxycycline, Minocycline

MOA: Bacteriostatic

Indication: Treat bacterial infections; substitute when PCN is contraindicated

Relative Contra:
P/L; hepatic impairment

Caution:
children under 8 YO

D-D: Digoxin
D-F: administer on empty stomach

ADE:
Hepatotoxicity
Photosensitivity
Damage to teeth and bones
Superinfection

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105
Q

Tetracyclines Drugs

A

Antibiotic

Tetracycline, Doxycycline, Minocycline

106
Q

Tetracyclines MOA

A

Antibiotic

MOA: Bacteriostatic

107
Q

Tetracyclines Indications

A

Antibiotic

Indication: Treat bacterial infections; substitute when PCN is contraindicated

108
Q

Tetracyclines Relative Contraindication, Caution, Drug Interactions

A

Antibiotic

Relative Contra:
P/L; hepatic impairment

Caution:
children under 8 YO

D-D: Digoxin
D-F: administer on empty stomach

109
Q

Tetracyclines ADE

A

ADE:
Hepatotoxicity
Photosensitivity
Damage to teeth and bones
Superinfection

110
Q

Tetracycline, Doxycycline, Minocycline Class

A

Tetracyclines

111
Q

Antimycobacterial & Antituberculosis

A

Antibiotics

RIPE
Rifampin
Isoniazid (INH)
Pyrazinamide
Ethambutol

MOA: Bactericidal

Indications: Treat tuberculosis

Relative Contraindications:
renal or hepatic failure P/L

D-D:
Rifampin and Isoniazid together cause liver toxicity

ADE:
interferes with hormonal birth control

Rifampin: RED-fampin
discolor bodily fluids red or orange
problems with contact lenses
liver toxicity

Isoniazid:
interferes with absorption B6
liver toxicity

Ethambutol: e = eye
baseline and periodic eye exam because report blurred vision or color change

112
Q

Antimycobacterial & Antituberculosis Drugs

A

Antibiotics

RIPE
Rifampin
Isoniazid (INH)
Pyrazinamide
Ethambutol

113
Q

Antimycobacterial & Antituberculosis MOA

A

Antibiotics

MOA: Bactericidal

114
Q

Antimycobacterial & Antituberculosis Indications

A

Antibiotics

Indications: Treat tuberculosis

115
Q

Antimycobacterial & Antituberculosis Relative Contraindication, D-D

A

Antibiotic

Relative Contraindications:
renal or hepatic failure P/L

D-D:
Rifampin and Isoniazid together cause liver toxicity

116
Q

Antimycobacterial & Antituberculosis ADE

A

Antibiotics

ADE:
interferes with hormonal birth control

Rifampin: RED-fampin
discolor bodily fluids red or orange
problems with contact lenses
liver toxicity

Isoniazid:
interferes with absorption B6
liver toxicity

Ethambutol: e = eye
baseline and periodic eye exam because report blurred vision or color change

117
Q

RIPE
Rifampin
Isoniazid (INH)
Pyrazinamide
Ethambutol
Class

A

Antimycobacterial & Antituberculosis

118
Q

Other Antibiotic

A

Lincosamides: Clindamycin; lincomycin
Treat serious infection because risk of Pseudomembranous colitis

Lipoglycopeptides: Telavancin; Dalbavancin; Oritavancin (IV) Vancomycin (IV or oral; oral treat c. diff)
ADE: risk of nephrotoxicity, prolonged QT interval, foamy urine

Macrolides: Erythromycin, Azithromycin, Clarithromycin, Fidaxomicin

Oxazolidinones: Tedizolid; Linezolid;
ADE: HTN

Monobactam: Aztreonam (IV or IM)

119
Q

Lincosamides: Clindamycin; Lincomycin

Lipoglycopeptides: Telavancin; Dalbavancin; Oritavancin Vancomycin

Macrolides: Erythromycin, Azithromycin, Clarithromycin, Fidaxomicin

Oxazolidinones: Tedizolid; Linezolid;

Monobactam: Aztreonam

Class

A

Other antibiotics

120
Q

Systemic Antifungal

A

Antifungal

Azole: Fluconazole, Itraconazole, Ketoconazole, Voriconazole

Echinocandin: Anidulafungin, Caspofungin, Micafungin

Other: Amphotericin, Griseofulvin, Nystatin

Azole MOA:
Binds to sterols causing cell death; inhibits glucan synthesis

Echinocandin MOA: inhibit glucan synthesis

Indications: fungal infections
Griseofulvin: nail and scalp infections
Nystatin: oral candida (thrush)

Relative Contraindications: hepatic and renal dysfunction; P/L

D-D:
Azole: numerous
Echinocandin: cyclosporine-caspofungin cause liver injury

ADE:
Azole: liver toxicity, teratogenic effects
Echinocandin: liver toxicity, teratogenic effects, bone marrow suppression
Amphotericin B: renal toxicity, bone marrow suppression, GI effects

121
Q

Systemic Antifungal Drugs

A

Azole: Fluconazole, Itraconazole, Ketoconazole, Voriconazole

Echinocandin: Anidulafungin, Caspofungin, Micafungin

Other: Amphotericin, Griseofulvin, Nystatin

122
Q

Azole: Fluconazole, Itraconazole, Ketoconazole, Voriconazole

Echinocandin: Anidulafungin, Caspofungin, Micafungin

Other: Amphotericin, Griseofulvin, Nystatin

Class

A

Systemic Antifungal

123
Q

Topical Antifungal

A

Antifungal

Azole: Clotrimazole, Ketoconazole, Miconazole, Tioconazole
Terbinafine, Tolnaftate

MOA: prevent replication causing fungal death

Indication: local dermatophytes including ringworm infections

Relative contraindication: open areas

124
Q

Azole: Clotrimazole, Ketoconazole, Miconazole, Tioconazole
Terbinafine, Tolnaftate
Class

A

Topical Antifungal

125
Q

Topical Antifungal Drugs

A

Azole: Clotrimazole, Ketoconazole, Miconazole, Tioconazole
Terbinafine, Tolnaftate

126
Q

Agents for Influenza A and Respiratory Viruses

A

Antiviral

Amantadine
Oseltamivir
Peramivir
Rimantadine
Zanamivir

MOA: prevent viral replication

Indication: treat respiratory virus

Relative Contraindication: P/L; renal impairment (lower dose)

ADE:
Dizziness
Insomnia
Nausea
Orthostatic hypotension
Urinary retention

Peramivir associated with Stevens Johnson Syndrome

Nursing Process:
start ASAP after exposure usually within 2 days of starting symptoms
Administer the full course

127
Q

Agents for Influenza A and Respiratory Viruses Drugs

A

Antiviral

Amantadine
Oseltamivir
Peramivir
Rimantadine
Zanamivir

128
Q

Agents for Influenza A and Respiratory Viruses MOA, Indications & Relative Contraindications

A

MOA: prevent viral replication

Indication: treat respiratory virus

Relative Contraindication: P/L; renal impairment (lower dose)

129
Q

Agents for Influenza A and Respiratory Viruses ADE & Nursing Process

A

ADE:
Dizziness
Insomnia
Nausea
Orthostatic hypotension
Urinary retention

Peramivir associated with Stevens Johnson Syndrome

Nursing Process:
start ASAP after exposure usually within 2 days of starting symptoms
Administer the full course

130
Q

Amantadine
Oseltamivir
Peramivir
Rimantadine
Zanamivir
Class

A

Agents for Influenza A and Respiratory Viruses

131
Q

Agents for Herpes and Cytomegalovirus

A

Antivirals

Acyclovir
Ganciclovir
Valacyclovir
Valganciclovir

MOA: inhibit viral DNA replication

Indication: treat HSV and CMV

Absolute: highly toxic in pregnancy

Relative: lactation, renal dz, severe CNS disorders

D-D:
nephrotoxic drug will increase risk of nephrotoxicity
Zidovudine: increase drowsiness

ADE:
N/V
HA
Rash
Hair loss
Paresthesia
Neuropathy
Renal Dysfunction

Patient teaching:
good hydration to decrease risk of renal toxicity
complete full course
wear protective gloves if applying topically
Does not cure and they can still transmit the virus

132
Q

Agents for Herpes and Cytomegalovirus Drugs

A

Antivirals

Acyclovir
Ganciclovir
Valacyclovir
Valganciclovir

133
Q

Acyclovir
Ganciclovir
Valacyclovir
Valganciclovir
Class

A

Agents for Herpes and Cytomegalovirus

134
Q

Agents for Herpes and Cytomegalovirus MOA, Indications, ADE

A

MOA: inhibit viral DNA replication

Indication: treat HSV and CMV

ADE:
N/V
HA
Rash
Hair loss
Paresthesia
Neuropathy
Renal Dysfunction

135
Q

Agents for Herpes and Cytomegalovirus Contraindications & D-D

A

Absolute: highly toxic in pregnancy

Relative: lactation, renal dz, severe CNS disorders

D-D:
nephrotoxic drug will increase risk of nephrotoxicity
Zidovudine: increase drowsiness

136
Q

Agents for Herpes and Cytomegalovirus Patient Teaching

A

Patient teaching:
good hydration to decrease risk of renal toxicity
complete full course
wear protective gloves if applying topically
Does not cure and they can still transmit the virus

137
Q

Agents for HIV/AIDS
Nucleoside Reverse Transcriptase Inhibitors

A

Antiviral

Abacavir
Emtricitabine
Lamivudine
Tenofovir
Zidovudine

MOA: competes with naturally occurring nucleosides within the cell that the virus would use to build DNA (interferes with viral replication)

Relative Contraindication: Lactation

Caution:
Hepatic dysfunction, renal impairment, bone marrow suppression

ADE:
hypersensitivity
pancreatitis
hepatomegaly
neurologic problems
bone marrow suppression

138
Q

Agents for HIV/AIDS
Nucleoside Reverse Transcriptase Inhibitors MOA

A

Antiviral

MOA: competes with naturally occurring nucleosides within the cell that the virus would use to build DNA (interferes with viral replication)

139
Q

Agents for HIV/AIDS
Nucleoside Reverse Transcriptase Inhibitors C/C

A

Relative Contraindication: Lactation

Caution:
Hepatic dysfunction, renal impairment, bone marrow suppression

140
Q

Agents for HIV/AIDS
Nucleoside Reverse Transcriptase Inhibitors ADE

A

ADE:
hypersensitivity
pancreatitis
hepatomegaly
neurologic problems
bone marrow suppression

141
Q

Agents for HIV/AIDS
Nucleoside Reverse Transcriptase Inhibitors Drugs

A

Abacavir
Emtricitabine
Lamivudine
Tenofovir
Zidovudine

142
Q

Abacavir
Emtricitabine
Lamivudine
Tenofovir
Zidovudine

Class

A

Agents for HIV/AIDS
Nucleoside Reverse Transcriptase Inhibitors

143
Q

Agents for HIV/AIDS
Nonnucleoside Reverse Transcriptase Inhibitors

A

Antivirals

Delavirdine
Efavirenz
Nevirapine

MOA: bind directly to HIV reverse transcriptase blocking both RNA and DNA-dependent DNA polymerase activities

Relative Contraindication: P/L

ADE:
N/V/D/C
Dizziness
Blurred vision
HA
flu-like symptoms

144
Q

Agents for HIV/AIDS
Nonnucleoside Reverse Transcriptase Inhibitors Drugs

A

Antivirals

Delavirdine
Efavirenz
Nevirapine

145
Q

Delavirdine
Efavirenz
Nevirapine
Class

A

Agents for HIV/AIDS
Nonnucleoside Reverse Transcriptase Inhibitors

146
Q

Agents for HIV/AIDS
Nonnucleoside Reverse Transcriptase Inhibitors MOA

A

MOA: bind directly to HIV reverse transcriptase blocking both RNA and DNA-dependent DNA polymerase activities

147
Q

Agents for HIV/AIDS
Nonnucleoside Reverse Transcriptase Inhibitors Contraindication and ADE

A

Relative Contraindication: P/L

ADE:
N/V/D/C
Dizziness
Blurred vision
HA
flu-like symptoms

148
Q

Agents for HIV/AIDS
Fusion Inhibitor

A

Antiviral

Enfuvirtide

MOA: prevent the fusion of virus with human cellular membrane (interferes with viral replication)

Relative Contraindication: Lactation
Caution: lung dz and pregnancy

ADE:
Insomnia
Depression
Peripheral neuropathy
Nausea
Diarrhea
Pneumonia
Injection site reaction

149
Q

Agents for HIV/AIDS
Fusion Inhibitor Drug

A

Antiviral

Enfuvirtide

150
Q

Enfuvirtide
Class

A

Agents for HIV/AIDS
Fusion Inhibitor

151
Q

Agents for HIV/AIDS
Fusion Inhibitor MOA

A

MOA: prevent the fusion of virus with human cellular membrane (interferes with viral replication)

152
Q

Agents for HIV/AIDS
Fusion Inhibitor C/C & ADE

A

Relative Contraindication: Lactation
Caution: lung dz and pregnancy

ADE:
Insomnia
Depression
Peripheral neuropathy
Nausea
Diarrhea
Pneumonia
Injection site reaction

153
Q

Agents for HIV/AIDS
Protease Inhibitors

A

Antivirals

Darunavir
Fosamprenavir
Lopinavir
Ritonavir
Tipranavir

MOA: block protease activity within HIV virus (interferes with viral replication)

Relative Contraindication: lactation and hepatic dysfunction

ADE:
GI effects
Change in liver function
Elevated cholesterol and triglyceride levels
Redistribution of fate to face, neck, and upper back
Stevens-Johnson Syndrome

154
Q

Agents for HIV/AIDS
Protease Inhibitors Drugs

A

Antivirals

Darunavir
Fosamprenavir
Lopinavir
Ritonavir
Tipranavir

155
Q

Darunavir
Fosamprenavir
Lopinavir
Ritonavir
Tipranavir
Class

A

Agents for HIV/AIDS
Protease Inhibitors

156
Q

Agents for HIV/AIDS
Protease Inhibitors MOA

A

MOA: block protease activity within HIV virus (interferes with viral replication)

157
Q

Agents for HIV/AIDS
Protease Inhibitors Contraindication & ADE

A

Relative Contraindication: lactation and hepatic dysfunction

ADE:
GI effects
Change in liver function
Elevated cholesterol and triglyceride levels
Redistribution of fate to face, neck, and upper back
Stevens-Johnson Syndrome

158
Q

Agent for AIDS/HIV
Integrase Strand Transfer Inhibitors

A

Antiviral

Dolutegravir
Raltegravir

MOA: Inhibits the activity of virus-specific enzyme

Caution:
Rhabdomyolysis, Myopathy, Pregnancy

D-D: decrease serum level is combined with Rifampin

ADE:
HA, dizziness, insomnia
Weight gain
Liver failure
Renal impairment
Suicidal ideation

159
Q

Agent for AIDS/HIV
Integrase Strand Transfer Inhibitors Drugs

A

Antiviral

Dolutegravir
Raltegravir

160
Q

Dolutegravir
Raltegravir
Class

A

Agent for AIDS/HIV
Integrase Strand Transfer Inhibitors

161
Q

Agent for AIDS/HIV
Integrase Strand Transfer Inhibitors MOA

A

MOA: Inhibits the activity of virus-specific enzyme

162
Q

Agent for AIDS/HIV
Integrase Strand Transfer Inhibitors Caution, D-D, ADE

A

Caution:
Rhabdomyolysis, Myopathy, Pregnancy

D-D: decrease serum level is combined with Rifampin

ADE:
HA, dizziness, insomnia
Weight gain
Liver failure
Renal impairment
Suicidal ideation

163
Q

Agents HIV/AIDS

CCR5 Coreceptor Antagonist

A

Antiviral

Maraviroc

MOA: bock the receptor site on the cell membrane to which HIV needs to interact to enter the cell (disrupt viral replication)

Relative Contraindication: lactation and liver dz

ADE:
Dizziness and changes in consciousness
URI

BBW: severe hepatotoxicity

164
Q

Agents HIV/AIDS

CCR5 Coreceptor Antagonist Drug

A

Antiviral

Maraviroc

165
Q

Agents HIV/AIDS

CCR5 Coreceptor Antagonist

A

MOA: bock the receptor site on the cell membrane to which HIV needs to interact to enter the cell (disrupt viral replication)

166
Q

Agents HIV/AIDS

CCR5 Coreceptor Antagonist Contraindication & ADE & BBW

A

Relative Contraindication: lactation and liver dz

ADE:
Dizziness and changes in consciousness
URI

BBW: severe hepatotoxicity

167
Q

Maraviroc
Class

A

Agents HIV/AIDS

CCR5 Coreceptor Antagonist

168
Q

Anti-Hepatitis B Agents

A

Antiviral

Adefovir
Entecavir

MOA: inhibit reverse transcriptase in Hep B virus and cause DNA chain termination (interferes with viral replication)

Absolute: lactation

D-D: increase risk renal toxicity if taken with other nephrotoxic drugs

ADE:
HA
Dizziness
Nausea
Diarrhea
Elevated liver enzymes
Renal impairment

Patient Teaching:
Caution to not run out of drug because it can cause acute exacerbation
Advise women to use barrier contraceptives
Find alternative feeding method for baby
Patient is still at risk of transferring disease

169
Q

Anti-Hepatitis B Agents Drugs

A

Antiviral

Adefovir
Entecavir

170
Q

Adefovir
Entecavir
Class

A

Anti-Hepatitis B Agents

171
Q

Anti-Hepatitis B Agents MOA

A

MOA: inhibit reverse transcriptase in Hep B virus and cause DNA chain termination (interferes with viral replication)

172
Q

Anti-Hepatitis B Agents Contraindication, D-D, ADE

A

Absolute: lactation

D-D: increase risk renal toxicity if taken with other nephrotoxic drugs

ADE:
HA
Dizziness
Nausea
Diarrhea
Elevated liver enzymes
Renal impairment

173
Q

Anti-Hepatitis B Agents Patient Education

A

Patient Teaching:
Caution to not run out of drug because it can cause acute exacerbation
Advise women to use barrier contraceptives
Find alternative feeding method for baby
Patient is still at risk of transferring disease

174
Q

Anti-Hepatitis C Agents

A

Antiviral

Velpatasvir-Sofosbuvir
Ledipasvir-Sofosbuvir
Glecaprevir-Pibrentasvir
Elbasvir-Grazoprevir

MOA: alter viral replication

Indication: used in combination for treatment of chronic hepatitis C

Relative: P/L

Caution: severe liver dz

D-D: protease inhibitors and St. John’s wort

ADE:
HA
Fatigue
Nausea
Diarrhea
Rash
Severe skin reaction

Does not immediately cure disease

175
Q

Anti-Hepatitis C Agents Drugs

A

Antiviral

Velpatasvir-Sofosbuvir
Ledipasvir-Sofosbuvir
Glecaprevir-Pibrentasvir
Elbasvir-Grazoprevir

176
Q

Velpatasvir-Sofosbuvir
Ledipasvir-Sofosbuvir
Glecaprevir-Pibrentasvir
Elbasvir-Grazoprevir
Class

A

Anti-Hepatitis C Agents

177
Q

Anti-Hepatitis C Agents MOA & Indication

A

MOA: alter viral replication

Indication: used in combination for treatment of chronic hepatitis C

178
Q

Anti-Hepatitis C Agents C/C, D-D, ADE

A

Relative: P/L

Caution: severe liver dz

D-D: protease inhibitors and St. John’s wort

ADE:
HA
Fatigue
Nausea
Diarrhea
Rash
Severe skin reaction

Does not immediately cure disease

179
Q

Locally Active Antivirals

A

Docosanol
Ganciclovir
Penciclovir
Acyclovir

MOA: act on viruses by interfering with normal viral replication and metabolic processes

Indication: specific load viral infection

ADE: local stinging, burning, discomfort (topical agent)

180
Q

Locally Active Antivirals Drugs

A

Docosanol
Ganciclovir
Penciclovir
Acyclovir

181
Q

Docosanol
Ganciclovir
Penciclovir
Acyclovir
Class

A

Locally Active Antivirals

182
Q

Locally Active Antivirals MOA, Indications, ADE

A

MOA: act on viruses by interfering with normal viral replication and metabolic processes

Indication: specific load viral infection

ADE: local stinging, burning, discomfort (topical agent)

183
Q

Antimalarials

A

Antiprotozoal

Quinine
Chloroquine
Hydroxychloroquine
Mefloquine
Primaquine

MOA: prevent malaria replication or cause malaria cell death

Relative: P/L

Caution: liver dz, alcoholism
Retinal disease or damage, psoriasis, porphyria

D-D:
combination of quinine derivative and quinine are at risk of cardiac toxicity and convulsion
Anti-fungal drugs: increase bone marrow suppression

ADE:
HA, dizziness
N/G
Hepatic dysfunction
rash, hair loss, blindness, ototoxicity

184
Q

Antimalarials Drugs

A

Antiprotozoal

Quinine
Chloroquine
Hydroxychloroquine
Mefloquine
Primaquine

185
Q

Quinine
Chloroquine
Hydroxychloroquine
Mefloquine
Primaquine
Class

A

Antimalarials

186
Q

Antimalarials MOA

A

MOA: prevent malaria replication or cause malaria cell death

187
Q

Antimalarials C/C, D-D, ADE

A

Relative: P/L

Caution: liver dz, alcoholism
Retinal disease or damage, psoriasis, porphyria

D-D:
combination of quinine derivative and quinine are at risk of cardiac toxicity and convulsion
Anti-fungal drugs: increase bone marrow suppression

ADE:
HA, dizziness
N/G
Hepatic dysfunction
rash, hair loss, blindness, ototoxicity

188
Q

Other Antiprotozoal Agents

A

Atovaquone: prevent and rx PCP

Metronidazole: rx amebiasis, trichomoniasis, giardiasis

Pentamidine: rx PCP, trypanosomiasis, leishmaniasis

Tinidazole: rx trichomoniasis, giardiasis, amebiasis

Benznidazole 9: pediatric pt with Chargas

Pyrimethamine: rx toxoplasmosis

MOA: inhibit DNA synthesis if susceptible protozoa

Caution: P/L; CNS dz; hepatic dz

D-D: alcohol, anticoagulant, disulfiram

ADE:
HA, dizziness, ataxia
peripheral neuropathies
loss of coordination
N/V/D

189
Q

Other Antiprotozoal Drugs

A

Atovaquone: prevent and rx PCP

Metronidazole: rx amebiasis, trichomoniasis, giardiasis

Pentamidine: rx PCP, trypanosomiasis, leishmaniasis

Tinidazole: rx trichomoniasis, giardiasis, amebiasis

Benznidazole 9: pediatric pt with Chargas

Pyrimethamine: rx toxoplasmosis

190
Q

Atovaquone

Metronidazole

Pentamidine

Tinidazole

Benznidazole 9

Pyrimethamine

Class

A

Other Antiprotozoal Agents

191
Q

Other Antiprotozoal Agents MOA

A

MOA: inhibit DNA synthesis if susceptible protozoa

192
Q

Other Antiprotozoal Agents Indications

A

Atovaquone: prevent and rx PCP

Metronidazole: rx amebiasis, trichomoniasis, giardiasis

Pentamidine: rx PCP, trypanosomiasis, leishmaniasis

Tinidazole: rx trichomoniasis, giardiasis, amebiasis

Benznidazole 9: pediatric pt with Chargas

Pyrimethamine: rx toxoplasmosis

193
Q

Other Antiprotozoal Agents Caution, D-D, ADE

A

Caution: P/L; CNS dz; hepatic dz

D-D: alcohol, anticoagulant, disulfiram

ADE:
HA, dizziness, ataxia
peripheral neuropathies
loss of coordination
N/V/D

194
Q

Vaccines

A

Routine childhood vaccines
Diphtheria, pertussis, tetanus
Haemophiles B
Hep B/ Hep A
Chickenpox
Poliovirus
Meningitis
Measles, mumps, rubella
Rotavirus

MOA: artificially stimulate active immunity with goal to cause immune response without the patient suffering the full course of the disease

Absolute:
severe to life threatening allergic reaction to any component in vaccines (many are made with egg)

Relative:
presence of immune deficiency (live virus in MMR & Chickenpox)
Pregnancy
Mild or moderate allergic reaction to any component
Patient receiving immune globulin or received blood products within 3 months

Caution:
Febrile convulsion or cerebral injury
Condition where high fever is dangerous
Acute infection

ADE:
fever, chills, malaise, irritability, anorexia, vomiting, rash, pain, redness, swelling at injection site

D-D:
immunosuppressant

195
Q

Vaccines Names

A

Routine childhood vaccines
Diphtheria, pertussis, tetanus
Haemophiles B
Hep B/ Hep A
Chickenpox
Poliovirus
Meningitis
Measles, mumps, rubella
Rotavirus

196
Q

Routine childhood vaccines
Diphtheria, pertussis, tetanus
Haemophiles B
Hep B/ Hep A
Chickenpox
Poliovirus
Meningitis
Measles, mumps, rubella
Rotavirus
Class

197
Q

Vaccines MOA

A

MOA: artificially stimulate active immunity with goal to cause immune response without the patient suffering the full course of the disease

198
Q

Vaccines C/C

A

Absolute:
severe to life threatening allergic reaction to any component in vaccines (many are made with egg)

Relative:
presence of immune deficiency (live virus in MMR & Chickenpox)
Pregnancy
Mild or moderate allergic reaction to any component
Patient receiving immune globulin or received blood products within 3 months

Caution:
Febrile convulsion or cerebral injury
Condition where high fever is dangerous
Acute infection

199
Q

Vaccines ADE & D-D

A

ADE:
fever, chills, malaise, irritability, anorexia, vomiting, rash, pain, redness, swelling at injection site

D-D:
immunosuppressant

200
Q

Immune Sera

A

Antitoxin
Antivenom

MOA: sera that contains antibodies to specific bacteria or virus

Indication: prophylaxis against specific disease after exposure

Relative: history of severe reaction to any immune sera

Caution:
pregnancy
coagulation defects
previous exposure to immune sera

ADE:
rash, N/V, chills, feber
allergic reaction: chest tightness, drop in BP, difficulty breathing
Local reaction: swelling, tenderness, pain, muscles stiffness at injection site

D-D: immunosuppressant drugs

201
Q

Immune Sera Agents

A

Antitoxin
Antivenom

202
Q

Antitoxin
Antivenom
Class

A

Immune Sera

203
Q

Immune Sera MOA & Indication

A

MOA: sera that contains antibodies to specific bacteria or virus

Indication: prophylaxis against specific disease after exposure

204
Q

Immune Sera C/C & D-D

A

Relative: history of severe reaction to any immune sera

Caution:
pregnancy
coagulation defects
previous exposure to immune sera

D-D: immunosuppressant drugs

205
Q

Immune Sera ADE

A

ADE:
rash, N/V, chills, feber
allergic reaction: chest tightness, drop in BP, difficulty breathing
Local reaction: swelling, tenderness, pain, muscles stiffness at injection site

206
Q

Antithyroid Thioamides

A

Propylthiouracil (PTU)
Methimazole

MOA: prevent formation of thyroid hormone within the thyroid cell

Indications: hyperthyroidism

Caution: PTU and liver impairment

ADE: hypothyroidism
Methimazole: bone marrow suppression
PTU: severe liver toxicity

D-D:
oral anticoagulant
theophylline
beta blockers
digoxin

207
Q

Antithyroid Iodine Solutions

A

Sodium I 131 and Sodium I 123

MOA: enter thyroid cells and destroy them by giving off radiation

Indication:
low dose: dx and evaluate thyroid function
high dose: hyperthyroidism; radiation emergencies

Strong sodium solutions; potassium iodine

MOA: high dose saturate thyroid cell preventing thyroid hormone function

Indication:
hyperthyroidism; radiation emergencies
suppression of thyroid gland before surgery
acute thyrotoxicosis

ADE:
hypothyroidism
iodism: iodine toxicity

D-D:
anti-coagulant
theophylline
beta blockers
digoxin

Nursing Considerations:
give iodine solution through straw because stain teeth

208
Q

Thyroid Hormones

A

Levothyroxine: T4
Liothyronine: T3
Liotrix: T3/T4
Thyroid Desiccated (pig)

MOA: increases cellular metabolism

Indication:
Hypothyroidism
Myxedema coma: severe hypothyroidism
Pituitary TSH suppression in treatment of euthyroid goiter
Management of thyroid cancer
Thyrotoxicosis in conjunction with other therapy

Relative:
acute MI
Thyrotoxicosis: s/sx hyperthyroidism

Caution: hypo adrenal conditions like Addison’s dz

D-D:
oral anticoagulants
digoxin
theophylline

ADE:
skin rash; hair loss at the beginning
sx hyperthyroidism
cardiac stimulation
CNS effect

Nursing Considerations:
single dose daily 30-60 minutes before breakfast
administer with full glass of water
do not administer other drugs at the same time
Takes several weeks to improve

209
Q

Thyroid Hormones Drugs

A

Levothyroxine: T4
Liothyronine: T3
Liotrix: T3/T4
Thyroid Desiccated (pig)

210
Q

Levothyroxine: T4
Liothyronine: T3
Liotrix: T3/T4
Thyroid Desiccated (pig)
Class

A

Thyroid Hormones

211
Q

Thyroid Hormones MOA & Indications

A

MOA: increases cellular metabolism

Indication:
Hypothyroidism
Myxedema coma: severe hypothyroidism
Pituitary TSH suppression in treatment of euthyroid goiter
Management of thyroid cancer
Thyrotoxicosis in conjunction with other therapy

212
Q

Thyroid Hormones C/C, D-D. ADE

A

Relative:
acute MI
Thyrotoxicosis: s/sx hyperthyroidism

Caution: hypo adrenal conditions like Addison’s dz

D-D:
oral anticoagulants
digoxin
theophylline

ADE:
skin rash; hair loss at the beginning
sx hyperthyroidism
cardiac stimulation
CNS effect

213
Q

Thyroid Hormones Nursing Considerations

A

Nursing Considerations:
single dose daily 30-60 minutes before breakfast
administer with full glass of water
do not administer other drugs at the same time
Takes several weeks to improve

214
Q

Anti-hypocalcemia Agents

A

Teriparatide
Parathyroid hormone
Calcitriol (vitamin D)

MOA
stimulate osteoclasts to release calcium from bone.
Increase intestinal absorption of calcium
Increase calcium resorption from kidneys
Stimulate kidney cells to produce calcitriol

Indications
low calcium in blood
management of hypocalcemia in patients undergoing chronic renal dialysis
treat hypoparathyroidism

Teriparatide: stimulate new bone formation to treat osteoporosis

Relative: hypercalcemia
Caution: history of renal stones

D-D: magnesium containing antiacid
Digoxin

ADE:
GI: metallic taste; N/V/C
CNS: weakness, HA< somnolence

215
Q

Anti-hypocalcemia Agents Drugs

A

Teriparatide
Parathyroid hormone
Calcitriol (vitamin D)

216
Q

Teriparatide
Parathyroid hormone
Calcitriol (vitamin D)
Class

A

Anti-hypocalcemia Agents

217
Q

Anti-hypocalcemia Agents MOA & Indications

A

MOA
stimulate osteoclasts to release calcium from bone.
Increase intestinal absorption of calcium
Increase calcium resorption from kidneys
Stimulate kidney cells to produce calcitriol

Indications
low calcium in blood
management of hypocalcemia in patients undergoing chronic renal dialysis
treat hypoparathyroidism

Teriparatide: stimulate new bone formation to treat osteoporosis

218
Q

Anti-hypocalcemia Agents C/C, D-D, ADE

A

Relative: hypercalcemia
Caution: history of renal stones

D-D: magnesium containing antiacid
Digoxin

ADE:
GI: metallic taste; N/V/C
CNS: weakness, HA< somnolence

219
Q

Anti-hypercalcemia Agents
Bisphosphonates:

A

Bisphosphonates:

Etidronate
Ibandronate
Pamidronate
Risedronate
Alendronate

MOA:
act on serum calcium levels and not directly on parathyroid gland or PTH. Inhibits bone resorption

Indications:
osteoporosis
Paget’s dz
hypercalcemia in cancer

Absolute: hypocalcemia
Relative: renal dysfunction, GI dz, prolonged use

D-D: other drugs; aspirin

ADE:
GI: abdominal pain, nausea, D/C
Esophageal erosion
Bone pain with Paget’s disease

220
Q

Anti-hypercalcemia Agents
Bisphosphonates: Drugs

A

Etidronate
Ibandronate
Pamidronate
Risedronate
Alendronate

221
Q

Etidronate
Ibandronate
Pamidronate
Risedronate
Alendronate
Class

A

Anti-hypercalcemia Agents
Bisphosphonates:

222
Q

Anti-hypercalcemia Agents
Calcitonin

A

Calcitonin:
Calcitonin salmon

MOA:
hormones secreted by thyroid gland to balance effects of PTH; inhibits bone resorption

Indication:
osteoporosis
Paget’s dz
emergency treatment of hypercalcemia

Absolute: allergy to fish
Relative: pregnancy, renal dysfunction, pernicious anemia

ADE:
flushing face and hands
skin rash
N/V
urinary frequency
local inflammation at injection site

223
Q

Anti-hypercalcemia Agents
Calcitonin Drugs

A

Calcitonin salmon

224
Q

Calcitonin salmon
Class

A

Anti-hypercalcemia Agents
Calcitonin

225
Q

Antiseizure Hydantoins

A

Phenytoin

MOA: stabilize nerve membranes by blocking channels in the cell membrane or altering receptor site. Decreases excitability to stimulation

Indication: seizures

Cautions: elderly and debilitated
impaired renal or liver
depression or psychosis

ADE:
CNS depression
Cardiac arrhythmia and hypotension
severe liver toxicity
bone marrow suppression
urinary retention
loss of libido

D-D: alcohol

226
Q

Antiseizure Barbiturates and Benzodiazepine

A

Barbiturates: Phenobarbital, Primidone

Benzodiazepine: Clonazepam, Diazepam

MOA: stabilize nerve membranes by blocking channels in the cell membrane or altering receptor site. Decreases excitability to stimulation ‘

Indication: status epileptic seizures

Cautions: elderly and debilitated
impaired renal or liver
depression or psychosis

ADE:
CNS depression
cardiac arrhythmia and change in BP
urinary retention, loss of libido
Physical dependence and withdrawal

BBW: Benzo + opioid = profound sedation

D-D: alcohol

227
Q

Antiseizure Succinimides

A

Ethosuximide
Methsuximide

MOA: suppress abnormal electrical activity in brain

Indication: absence seizures

Caution: renal and hepatic dz

ADE:
CNS depressant
Bone marrow suppression
SJS

D-D: primidone

228
Q

Antiseizure GABA modulators

A

Valproic acid
Divalproex

MOA: reduce abnormal electrical activity in the brain; increase GABA levels in brain

Caution: hepatic and renal impairment

ADE:
CNS depression
liver toxicity
pancreatitis
DRESS: drug reaction with eosinophils and systemic symptoms (skin and organ failure)

D-D: other antiseizure

229
Q

Antiseizure: Other

A

Carbamazepine: BBW serious skin reaction
ADE: agranulocytosis, aplastic anemia, bloody dyscrasias

Lamotrigine: BBW serious skin reactions

Levetiracetam

Topiramate: ADE serious skin reaction

All ADE CNS depression
All D-D: CNS depressant, alcohol, and hormonal birth control

230
Q

Antidepressant Other

A

Bupropion:
low dose = smoking cessation
available extended and sustained release formulas

Mirtazapine: atypical
many anticholinergic effects

Trazodone: many CNS effects
BBW: suicidality, hypotension, priapism

Esketamine: nasal spray
CNS effects and increase in BP

231
Q

Tricyclic Antidepressant

A

Amitriptyline
Nortriptyline
Clomipramine
Desipramine
Imipramine
Trimipramine
Doxepin

MOA: reduce reuptake of serotonin and norepinephrine into nerves

Indications:
depression
sleep disorders
enuresis
anxiety
chronic pain

Relative: recent MI

Caution:
CV disease, anticholinergic conditions
manic-depression or bipolar d/p
seizure d/o

D-D:
MAOI
Cimetidine
Fluoxetine

ADE:
CNS: sedation, sleep disturbances, hallucinations, ataxia
GI: dry mouth, C/N/V, anorexia, decrease salivation
CV: tachycardia, HTN, arrhythmias

May take 4 weeks

232
Q

Amitriptyline
Nortriptyline
Clomipramine
Desipramine
Imipramine
Trimipramine
Doxepin
Class

A

Tricyclic Antidepressant

233
Q

Monoamine Oxidase Inhibitor Antidepressant

A

Isocarboxazid
Phenelzine
Tranylcypromine
Selegiline

MOA: irreversibly inhibit MAO allowing NE, 5HT, DA to accumulate in synaptic cleft

Indication: depression but not the first line

Absolutes pheochromocytoma
Relative: CV dz, HA, renal or hepatic impairment

Caution: bipolar d/o, seizure d/o, hyperthyroidism

ADE
CNS: dizziness, excitement, nervousness, mania, hyperreflexia, tremors, confusion, insomnia, agitation
CV: HTN, tachycardia, arrhythmias

BBW: suicidal ideation especially in children and young adults

D-D:
other antidepressants: coma, hypertensive crisis, convulsions, serotonin syndrome
Sympathomimetic
Antidiabetic: increase risk of hypoglycemia

D-F: tyramine - hypertensive crisis

Antidote: Phentolamine or adrenergic blocker

Takes several weeks to be effective

234
Q

Isocarboxazid
Phenelzine
Tranylcypromine
Selegiline
Class

A

Monoamine Oxidase Inhibitor Antidepressant

235
Q

Antidepressant: Serotonin Norepinephrine Inhibitors (SNRI)

A

Desvenlafaxine
Duloxetine
Venlafaxine

MOA: decrease in neuronal reuptake of both 5HT and NE

Indication: depression, neuropathy pain, fibromyalgia, anxiety

Absolute: MAOI use

Caution: severe depression; suicidality (BBW); bipolar and seizure d/o

ADE:
hyperhidrosis
Erective dysfunction
Cardiac: tachycardia, palpitation, HTN
abnormal bleeding
Anticholinergic: glaucoma and urinary retention
Serotonin syndrome

D-D:
MAOI
SSRI, TCA, serotonergic drugs including St. John Worts

Takes 4 weeks to work

236
Q

Desvenlafaxine
Duloxetine
Venlafaxine
Class

A

Antidepressant: Serotonin Norepinephrine Inhibitors (SNRI)

237
Q

Antidepressant: Selective Serotonin Receptor Inhibitors

A

Citalopram
Escitalopram
Fluoxetine
Paroxetine
Sertraline

MOA: specifically block reuptake of 5HT

Indications:
depression, OCD, panic attacks, bulimia, premenstrual dysphoric d/o, PTSD, social phobias, social anxiety d/o

Caution: impaired renal and hepatic function; P/L

ADE:
CNS: HA, drowsiness, dizziness, insomnia, anxiety, tremors, agitation
GU: painful menstruation, sexual dysfunction, impotence, urgency
serotonin syndrome

D-D:
MAOI, TCA, SNRI, St. John’s Wort

Takes 4 weeks to work

238
Q

Citalopram
Escitalopram
Fluoxetine
Paroxetine
Sertraline
Class

A

Antidepressant: Selective Serotonin Receptor Inhibitors

239
Q

Serotonin Syndrome

A

Agitation
Confusion
Elevated HR/BP
Muscle Rigidity
Diaphoresis
Diarrhea
HA
High fever
Death

240
Q

Bipolar Disorder Drugs

A

Lithium
Aripiprazole
Olanzapine
Quetiapine
Ziprasidone

241
Q

Lithium
Aripiprazole
Olanzapine
Quetiapine
Ziprasidone
Class

A

Bipolar Disorder

242
Q

Bipolar Disorder: Lithium

A

MOA: unknown how affect mania
Alter sodium transport in nerve and muscle cells. Influences reuptake of NE and DA

Relative: significant renal and cardiac dz
Dehydration and risk of dehydration
Hyponatremia

ADE: LITH
leukocytosis
Insipidus
Tremors, teratogenic, thyroid issue
Hypothyroidism

D-D:
haloperidol
Carbamazepine
Diuretic
Herbal psyllium

Pharmacokinetics: 0.6-1.2 mEq/L
kidney reabsorbs more lithium during dehydrated and hyponatremia states

243
Q

Antipsychotic/Neuroleptic

A

Typical:
Prochlorperazine
Thioridazine
Chlorpromazine
Haloperidol

MOA: block dopamine receptor preventing stimulation of postsynaptic neurons by dopamine to depress RAS

Atypical
Aripiprazole
Brexipiprazole
Quetiapine
Olanzapine
Clozapine
Risperidone
Ziprasidone
Iloperidone

MOA: block dopamine and serotonin receptors

Indications:
schizophrenia
hyperactivity
combative and agitated behaviors
severe behavioral problems in children
adjunct therapy to major depressive d/o

Relative:
CNS depression
blood dyscrasias
PD
prolonged QT intervals
BBW: serious CV events including death can occur patient with dementia

Caution: condition worsened by anticholinergic effects
seizure d/o
liver, renal, cardiac dz

ADE:
CNS:
drowsiness & sedation
weakness
tremors
extrapyramidal effects including pseudo-parkinsonism, akathisia, dystonia, tardive dyskinesia
Neuroleptic malignant syndrome
Anticholinergic effects
Gynecomastia
CV: prolonged QT intervals, hypotension, orthostatic hypotension
Bone marrow suppression

D-D: CNS depressant including alcohol; Anticholinergics

244
Q

Anti-parkinsonism: Dopaminergic Agents

A

Amantadine
Carbidopa-levodopa
Levodopa
Rasagiline
Ropinirole

MOA: increase dopamine or increase stimulation of dopamine receptor

Absolute: lactation
Relative: angle closure glaucoma

Caution:
CV dz, bronchial asthma, history of peptic ulcer, urinary tract obstruction, psychiatric d/o, pregnancy

ADE:
CNS: anxiety, nervousness
Peripheral: anorexia, nausea, dysphagia, urinary retention
Cardiac: arrhythmia, orthostatic hypotension

D-D:
MAOI: increase risk HTN crisis
Vitamin B6: decrease levodopa
carbidopa-levodopa: iron salt
Rasagiline: tyramine-containing food, St. John wort
Acetaminophen

245
Q

Anti-parkinsonism
Anticholinergic Agents

A

Benztropine
Diphenhydramine (children)

MOA: synthetic drug with greater affinity for cholinergic receptor site in CNS than PNS. Block overexcited cholinergic neurons.

Indication: rx PD
Relief of sx of extrapyramidal d/o associated with use of some drugs

Relative: condition exacerbated by blocking PNS

Caution: tachycardia; HTN; P/L; individual at risk for heat exhaustion

ADE:
CNS and peripheral anticholinergic effects
decrease ability to sweat

D-D:
other anticholinergic
Antipsychotics

246
Q

Adjunctive Antiparkinsonism

A

Improve patient response to traditional therapy

Entacapone: used with carbidopa-levodopa to increase plasma concentration and duration of action of levodopa

Tolcapone: works in similar way with carbidopa-levodopa to increase plasma concentration of levodopa

Safinamide: word with carbidopa-levodopa in patient with PD that are having off episodes (normal treatment regimen stops working)

Selegiline: used with carbidopa-levodopa after patient shown sx of deteriorating response with this treatment

247
Q

Other Anxiolytic and Hypnotic Drugs

A

Antihistamine (Promethazine; Diphenhydramine) : preoperative medication and postoperative to decrease the need for opioid

Buspirone: reduce s/sx anxiety without severe CNS and ADE

Eszopiclone: insomnia

Ramelteon: melatonin receptor agonist; treat insomnia characterized by difficulty with sleep onset

Suvorexant: insomnia

Zaleplon and Zolpidem: short-term treatment of insomnia

248
Q

CNS Stimulants

A

Amphetamine
Armodafinil
Atomoxetine
Dexmethylphenidate
Dextroamphetamine
Lisdexamfetamine
Methylphenidate
Modafinil

MOA: increase the release of catecholamines from presynaptic neurons leading to increase stimulatory postsynaptic neurons

Indications: ADHD; narcolepsy and various sleep d/o

Relative: marked anxiety, agitation, tension, severe fatigue, glaucoma, cardiac dz

Caution: history of seizures, history of drug dependence including alcoholism (controlled substance), HTN, P/L

ADE:
nervousness, insomnia, dizziness, HA, blurred vision, anorexia, nausea, weight loss

D-D:
MAOI/TCA
some OTC medication
Caffeine

249
Q

CNS Stimulants MOA and Indications

A

MOA: increase the release of catecholamines from presynaptic neurons leading to increase stimulatory postsynaptic neurons

Indications: ADHD; narcolepsy and various sleep d/o

250
Q

CNS Stimulants C/C, ADE, D-D

A

Relative: marked anxiety, agitation, tension, severe fatigue, glaucoma, cardiac dz

Caution: history of seizures, history of drug dependence including alcoholism (controlled substance), HTN, P/L

ADE:
nervousness, insomnia, dizziness, HA, blurred vision, anorexia, nausea, weight loss

D-D:
MAOI/TCA
some OTC medication
Caffeine

251
Q

CNS Stimulants Drugs

A

Amphetamine
Armodafinil
Atomoxetine
Dexmethylphenidate
Dextroamphetamine
Lisdexamfetamine
Methylphenidate
Modafinil

252
Q

Amphetamine
Armodafinil
Atomoxetine
Dexmethylphenidate
Dextroamphetamine
Lisdexamfetamine
Methylphenidate
Modafinil
Class

A

CNS Stimulants

253
Q

Muscle Relaxant: Centrally Acting Skeletal Muscle Relaxant

A

Baclofen,
Carisoprodol
Cyclobenzaprine
Metaxalone
Methocarbamol
Tizanidine

MOA: work in upper levels of CNS to interfere with reflexes causing muscle spasms (spasmolytic)

Indication:
relief of discomfort associated with acute painful musculoskeletal conditions
Adjunct to rest, PT/OT

Absolute: rheumatic d/o

Caution:
epilepsy, P/L, cardiac dysfunction, condition marked by muscle weakness, hepatic/renal impairment

ADE:
drowsiness, fatigue, weakness, confusion, HA
Nausea, dry mouth, hypotension, urinary frequency

D-D: CNS depressant; alcohol

254
Q

Muscle Relaxant: Centrally Acting Skeletal Muscle Relaxant MOA & Indication

A

MOA: work in upper levels of CNS to interfere with reflexes causing muscle spasms (spasmolytic)

Indication:
relief of discomfort associated with acute painful musculoskeletal conditions
Adjunct to rest, PT/OT

255
Q

Muscle Relaxant: Centrally Acting Skeletal Muscle Relaxant C/C, ADE, D-D

A

Absolute: rheumatic d/o

Caution:
epilepsy, P/L, cardiac dysfunction, condition marked by muscle weakness, hepatic/renal impairment

ADE:
drowsiness, fatigue, weakness, confusion, HA
Nausea, dry mouth, hypotension, urinary frequency

D-D: CNS depressant; alcohol

256
Q

Muscle Relaxant: Centrally Acting Skeletal Muscle Relaxant Drugs

A

Baclofen,
Carisoprodol
Cyclobenzaprine
Metaxalone
Methocarbamol
Tizanidine

257
Q

Baclofen,
Carisoprodol
Cyclobenzaprine
Metaxalone
Methocarbamol
Tizanidine
Class

A

Muscle Relaxant: Centrally Acting Skeletal Muscle Relaxant

258
Q

Muscle Relaxant: Direct-Acting Skeletal Muscle Relaxant

A

Dantrolene
Incobotulinumtoxin A
Onabotulmumtoxin A
Rimabotulinumtoxin B

MOA: enter muscle to prevent muscle contraction directly

Indication: treat spasticity directly affecting peripheral muscle contraction. Management spasticity associated with neuromuscular dz

Absolute: lactation
Relative: spasticity contributes locomotion. upright position, hepatic dz

Caution:
women, patient over 35 Y, liver dz, cardiac dz, respiratory depression, pregnancy

ADE:
fatigue, weakness, confusion, GI irritation, enuresis

D-D: estrogen: increase risk fetal hepatocellular dz
NMJ blockers interfere with neuromuscular transmission

259
Q

Anxiolytic & Hypnotic Benzodiazepines

A

Alprazolam
Clonazepam
Diazepam
Lorazepam
Midazolam
Temazepam

MOA:
act in limbic system and RAS by making GABA more effective and interferes with neurons
Lower dose: anxiety
Higher dose: sedation and hypnosis

Indication:
anxiety d/o
alcohol withdrawal prevent alcohol withdrawal seizure
panic d/o
restless leg syndrome
seizure d/o
insomnia

Relative:
P/L
psychosis, shock, coma, acute narrow angle glaucoma, acute alcohol intoxication

Caution:
OA and debilitate patient
renal or hepatic dysfunction

ADE:
dry mouth, constipation, N/V
hypotension
urinary retention
sedation, drowsiness, depression, lethargy, blurred vision, confusion

D-D:
increase CNS depression when taken with alcohol or other CNS depressant
increase effects with cimetidine, oral contraceptives, and disulfiram
decrease effect with theophylline

Antidote: Flumazenil

NRS 155 Pharmacology (9 decks)

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