Exam 3 drugs Flashcards

Question

Heparin

Answer 1

Category Class: **anticoag** MOA: **Inhibits activation vit K (factor X)** Indication: **Prophylactic, therapeutic (waiting for warfarin onset 3-5 days)** SE: **Heparin-induced thrombocytopenia, bleeding with OD** Route: IV/SQ-vial (units). **Onset 20 mins, duration 8 hrs parenteral** NI: **Monitor aPTT, platelet count Antidote: _FFP, protamine sulfate IV, or wait 6-8 hrs_**

Answer 2

Category Class: **Anticoagulant Low molecular weight heparin** MOA Inhibits activation of vit K (factor X) Indication: Prophylactic, therapeutic CI: SE: **Stinging for few minutes after injection** Route: **SUB Q in mg (avoid massaging area, use prefilled syringe)** parenteral NI: No labs **Duration of action: 12 hrs Antidote: FFP, protamine sulfate IV, or wait 12-24 hrs**

Answer 3

Category Class: anticoagulant Inhibits vit K (factor X) Indication: Embolism/thrombus/dysrhythmia CI: **PG (switch to hep), thrombocytopenia, chronic liver disease, ETOH abuse** SE: bleeding Route: PO. enteral NI: Frequent monitoring **PT** (ther 18-24 sec) **INR**: ther 2-3 (normal \<1)( \>3=hyperther) (takes 3-5 days to reach therapeutic so bridge with heparin) Loneg1/2 life- takes 5 days to return to normal **Antidote: phytonadione (vit K), FFP, tranfusion** PE: **Consistent amount green leafy (high vit K)** Frequent PT/INR Keep diet/dose log Interactions **Avoid ETOH, inc INR**

Answer 4

**Aspirin/Clodipigrol & eptifbatide** Category Class: Antiplatelet MOA: Prevents platelet aggregation Indication: **Prophylactic for risk of thromboembolism** CI: **PG, hx bleeding disorder, retinal/cerebral hemorrhage, thrombocytopenia, PUD, aneurysm, uncontrolled HTN** SE: AE: hemorrhage/ GI bleed Route: PO NI: Hx GIB,PUD- **use enteric coated aspirin, buffered aspirin** Reversal: platelet infusion PE: **Take w/ food** Interactions **Avoid NSAIDS/ETOH (GI)**

Answer 5

Antiplatelet Takes 7 days to clear CI: NEVER children \<19, Lactation

Answer 6

Antiplatelet Duration: 4 hrs

Answer 7

Category Class: **Thrombolytic** MOA: **dissolve clots by fibrinolysis** Indication: **w/I 4 hrs MI/CVA symptoms** PE, DVT, restore patency of IV catheters CI: **BP\>180/110 Hemorrhagic disease (PUD), neoplasm, recent CNS trauma, aneurism Recent CVA, AC use, thrombocytopenia, ASA, NSAIDs, PG** SE: Bleeding, hemorrhagic CVA, spinal cord infarction **NV, fever, angioedema, anaphylactic, rhabdomyolysis, dysrhyth, PE** Route: **IV bolus, drip for 60 mins. Taper.** NI: Goal: resultution. T1/2= 35 mins. In ICU/ED Avoid all AC/antiplatelet until thrombolytic is cleared **Antidote: aminocaproic acid PO/IV, FFP, PRBC** Monitor VS, resolution of symptoms (CP, neuro), active bleeding, allergic rxn Cardiac monitoring (risk of reperfusion dysrhythmia- treat with lols) Avoid venipuncture, arterial sticks, injections (SQ/IM) Hold pressure for 30 mins

Answer 8

Category Class: antihyperlipidemia MOA Inhibit cholesteral synth in liver Indication: CI: PG, lactation SE: **Liver failure** (elevated LFT, check baseline q 8 wks) , **myopathy** (hold with muscle aches), **rhabdomyolysis** (check baseline CK q 8 wks) Route: PO NI: Taper (orr **rebound** effect and acute MI) Take at **night** May cause **cataracts** ( annual eye exam) PE: Interactions Grapefruit juice

Answer 9

Category Class: Nicotinic acid (B3) Antihyperlipidemia MOA: **Inhibits breakdown of triglycerides to free fatty acids, synth of LDL, breakdown HDL** Indication: **Vit: 25 mg Anticholesterol: 2500 mg/day (rx)** CI: PG, liver disease, gout SE: * *Flushing face/neck, feeling warm, paresthesia** * *Hyperglycemia** (caution DM) * *AE: hepatotox (NO acetaminophen), hyperuricemia (gout/RF)**

Answer 10

=choles Category Class: Antihyperlipidemic MOA: Bind bile acid and inc excretion of cholesterol and LDL CI: **Ab pain (possible small bowel obstruction)**- V Serious SE: * *Constipation**, SBO, flatulence, cramping (inc giber, activity, water) * *Poor absorption fat soluble vitamins** (take 4 hrs apart from vitamins/other drugs) Route: NI: **Take 30 mins before meal, w/ \<8 oz water (avoid impaction in esoph)**

Answer 11

omeg 3: rx- fish oilL OTC Category Class: Antihyperlipidemia MOA: Inhibits triglyceride production in liver Indication: **Preventative/treat hyperlipidemia Off label: HTN, RA** SE: **GI distress (acid), N, aftertaste, rash Take with food**

Answer 12

Category Class: antiemitic MOA: Adsorbs bacteria/toxins causing nausea Indication: N/V 2\* diarrhea/indigestion CI: **\<19 \*reyes syndrome Allergy to ASA/NSAIDS** PG SE: Slurred speech, hearing loss, vision problems AMS, muscle spasm, black discoloration of stools/tongue (harmless) Route: OTC: liquid/chewable tabs ## Footnote **Stop having visions about my brother tom** **Nausea Hearburn indigestion upset stomach diarrhea**

Answer 13

diphenhydramine/promethazine Category Class: Antihistamines (1st gen) MOA: Prev histamine release in small BV/nerves Indication: Rhinitis (relieves itch, sneeze, allergy, anaphylaxis, motion sickness, insomnia) 2nd indication: **Insomnia/motion sick** CI: **PG, lactation, new borns, children, elderly** Anti chol: BPH/glaucoma/HTN SE: Cross BBB, **CNS dep**: drowsy/dizzy/fatigue, coordination, FALL **Antichol effects (PNS)** AE: Toxicity: paradoxical: excitation, hallucination, seizure Route: PO/IV/IM NI: Watch breathing. (CNS dep, resp dep) VS (antichol effects) I/Os- dec output PE: Interactions Avoid other CNS depressants No combo meds- decongestants, A1 agonists

Answer 14

Category Class: Anticholinergic (to CNS) MOA: Inhibit vest stim inner ear Indication: **Antiemetic: N/W, menieres disease, allergies** CI: **Caution: elderly, chronic resp** SE: **CNS depressants: drowsiness** Memory impairment Route: Patch, PO, IM, IV

Answer 15

Category Class: **Antihist, Antichol, Dopamine antagonist** MOA: **Inhibit vest stim inner ear Block dopaminergic receptors in intesting CTZ** Indication: **Antiemetic: N/W, menieres disease, allergies -antipsychotic (lg dose), antiemetic (small) Nausea assoc w. chemo, opioids, anesthesia** CI: Caution: elderly, chronic resp BPH, urinary ret, glaucoma, HTN, tachy SE: CNS depressants: drowsiness Memory impairment CNS: Seizure/**EPS** (high risk peds/geri) **Antichol** **CNS dep** (avoid driving, hangover, avoid other CNS dep Route: Patch, PO, IM, IV NI: Monitor VS, I/Os ## Footnote ***EPS: give diphenhydramine/benztropine (central antichol)***

Answer 16

Category Class: **Serotonin antagonist** MOA: **Blocks CTZ center in brain and visceral stim** Indication: **N/V (drug of choice for chemo/opioid/anesthesia)** CI: SE: **Overall, few SE** (no EPS) HA, diarrhea, dizzy, fatigue AE: Dysrhyth Route: IV/IM/**ODT** NI: Monitor for dysrhyth ## Footnote **Frick, Dan had diarrhea daily**

Answer 17

I: N/V (chemo/anesthetic) MOA: cns dep SE: lethargy, loss of balance, resp suppression, fall ## Footnote **Lets Play real football**

Answer 18

**corticosteroid** antiemitic **I: premed for chemo nausea** SE: (long term): inc BG, immunosuppress, na/h2o ret, paper skin, adrenal dec, osteoporosis meth- meth lab (IV) - chemo

Answer 19

**N/V (2\* to chemo) Appetite stim for AIDs, failure to thrive** CI: Psychiatric disorders SE: THC related: mood change, euphoria, drowsiness, diziness, HA, depersonalizaiton, nightmares, confusion, uncoord, mem lapse dry mouth, ortho, tachy fall Route: **PO (sched III)**

Answer 20

emetic MOA: **Stimulates CTZ and acts on gastric mucosa** Indication: **If \<60 mins after ingestion (v short) If no antidote (contact poison control) If no risk of aspiration If ingested substance is NOT caustic/erosive to mucus membrane** Route: OTC NI: **Risk abuse: anorexia**

Answer 21

MOA: **Adsorbent**. SE: **Constipation Bowel obstruction** Route: PO via NG tube (may be given gastric lavage is ingestion \<60 mins)

Answer 22

MOA: **Dec peristasis by activating opioid rec in GI** Indication: diarrhea CI: Atropine: glaucoma/bph **-longer than 2 days -unknown fever -unknown etiology** SE: **CNS and resp depr (high dose)- esp w. children/polypharm** Physical dependence Route: NI: Otc/rx

Answer 23

Category Class: probiotic MOA: Replacing normal flora Reduces colonization of pathogenic bacteria Indication: Antibiotic use (give 2 hrs after abx) IBS, US, C. diff

Answer 24

Category Class: Somatostatin MOA: Inhibits growth hormone Dec GI motility Dec portal vein pressure Indication: diarrhea Route: Subq (diarrhea) IV (upper gi blees, esoph varices rt portal HTN)

Answer 25

MOA: Hyperosmolar saline Indication: Colonosopy prep ``` CI: Renal pt (electrolytes) ``` SE: Hypovolemia (monitor VS/BP) NI: **Quick treatment. W/in 2 hrs**

Answer 26

osmotic lax PO drink **CI: \>1 wk use**

Answer 27

osmotic lax **bowel prep (colonoscopy) PE: adherence!**

Answer 28

**osmotic lax PO drink (also antacid)** **Hypermg-\> cardiac arrest (monitor Mg**

Answer 29

osmotic lax * *hyperosmolar** saline (not NS) * *CI: renal pts, children \<2**

Answer 30

Class: stimulant/irritant MOA: **Inc peristalsis by irritating sensory nerve endings in intestinal mucosa** Indication: constipation SE: **Anorexia, n/v, cramps, weakness, reddish brown urine, dependence** Suppository: **proctitis**: pt on left side. Extra lubricant: finger and suppos. Route: OTC PO NI: **Quick: PO: 6-12 hrs, PR: 15-60 mins** PE: **Avoid milk/antacid w/ PO form (gt least 1 hr)**

Answer 31

stimulant/irritant Castile=milk soap MOA: suds irritate bowels, emollient, lg water volume **I: other med are ineffective** NI: PR PE: hold as long as possible

Answer 32

**docusate sodium, mineral oil enema** MOA: **Lower surface tension (like surfactant)- + water penetration to stool** Emulsifies and lubricates feces Indication: **Maintenance laxative: slow acting. For RF**

Answer 33

**emmolient +irritant, stim peristalsis**

Answer 34

Category Class: **Bulk forming (laxative)** ``` MOA: Natural fibers (nonabsorbable) made from plant (same as fiber, inc/soften fecal mass) ``` Indication: constipation **Maintenance: results in 8-24 hrs** PE: **Drink a lot of water to prev obstruction**

Answer 35

Indication: antiulcer SE: **OD electrolytes (Mg, Ca, Al)** Caution: RF NI: **Take up to 7 dose/day (1 and 3 hrs after meals, ad HS)** Give body chance to digest a bit **Take other drugs \<1 hr before or 4 hrs after antacids** Monitor for diarrhea (S/S infection (opportunistic) Chewable (must chew), suspension (must shake well) **Take w/ 8 oz water**

Answer 36

**No constipation/diarrhea bc: Mg/Al** antiulcer antacid

Answer 37

antiulcer Category Class: **Histamine 2 blocker** MOA: **Red gastric acid** by blocking H2 Promote healing of ulcer by red hydrochloric acid Indication: ulcer CI: Caution: geri (cns depre) RF SE: **B-12 deficiency (take supplement) Block androgen receptors: ED/libido/gynecomastia** CNS: Lethargy, dep, confusion (give at **bedtime**) Low gastric acidity (may cause bacterial colonizaiton) Route: IV/PO NI: Right before meals/at HS (bc CNS dep) Monitor I/Os (RF) Give 1-2 hrs after antacids Geri need smaller dose PE: Interactions May cause tox w/ warfarin/phenytoin/theophylline/lidocaine ## Footnote **FAM: thomac lucy peter white witch** **famished**

Answer 38

Category Class: **Proton pump inh** MOA: Red gastric acid **Oral peak effect after several days** Indication: Ulcer SE: Diarrhea, insomnia, dizziness, dry mouth, flatulence, liver fail, C-diff. Long term-\> osteoporosis Route: NI: Take 1 hr before meal/drugs (to avoid poor digestion) Taper off ## Footnote **praise FIDDLCOD**

Answer 39

Category Class: **Mucosal protective drugs (pepsin inh)** MOA: Rxn w.gastric acidand forms thick paste Selectively adheres to ulcer protecting it from acid/pepsin Indication: ulcer SE: **Constipation, inc BG** Route: PO NI: **Given 30 mins AC/HS (qid) Avoid taking w. other drugs (give 2 hrs) Finish course even if feeling better** Inc activity/water/fiber to avoid constripation

Answer 40

herparin/enoxaparin antidote

Answer 41

vit K. warfarin OD

Answer 42

reversal TPA

Answer 43

**MONA** **Some Block Potass channels, adenosine, dig, mg, atropine** NI: Monitor heart **Always use antiCoAg** Cont IV -\> PO **IV push SLOW** PE: VS, adherence Interactions Grapefruit, caffeine, etoh, nic

Answer 44

antidysrhythmic push fast, flush fast

Answer 45

**opiate related, probiotics, adsorbents** NI: assess BM consistency, freq, quantity. Listen to sounds Prior: r/o: C diff, OB, C&S, O&P Monitor VS trend for hypovolemia and shock PE: Short term (\<48 hrs) Inc fluid intake (PO/IV)

Answer 46

**osmotic lax, stim/irritants, emmolients, bulk forming** Indication: **Opioid use (prohylactic)** PG **Prevent painful BM w. hemorrhoid** **Prev straining (aneurysm/MI)** **Evac bowel (colonoscopy/poison)** CI: w/ other enteral med (give 2 hrs) Ab pain/cramping, n/v Fecal impaction, bowel obstruction, ischemic bowel Biliary obstriction, appendicitis, divertic, GI bleed