Exam 4: Bullet Point Flashcards
rhythmic contractions that moves contents through the intestines
peristalsis
moving _____________ results in EXCESS water being reabsorbed from the stool and leads to hard stools
slowly
moving _____________ leads to lack of water being reabsorbed from the stool and results in watery stools
quickly
bulk forming laxative
DRUG CLASS:
o bulk forming laxatives
DRUGS:
o psyllium (Metamucil)
o methylcellulose (Citrucel)
MOA:
o actions of fiber
INDICATIONS:
o treatment and prevention of constipation
ONSET:
o 1+ days
NOTES:
o can be taken long term
o first line treatment for constipation
surfactant laxatives (stool softener)
DRUG CLASS:
o surfactant laxatives (stool softener)
DRUGS:
o docusate sodium (Colace)
MOA:
o helps water enter stool to soften stool
INDICATIONS:
o treatment and prevention of constipation
ONSET:
o 1+ days
NOTES:
o often used in hospitals w/patients who are immobile for extended periods of time to prevent constipation (going to surgery or post-op)
stimulant laxatives
DRUG CLASS:
o stimulant laxatives
DRUGS:
o bisacodyl (Dulcolax)
MOA:
o stimulates peristalsis
o moves contents through intestines quicker
o less water reabsorbed and stools wont as hard
INDICATIONS:
o constipation related to slow peristalsis (opioid induced constipation)
osmotic laxatives
DRUG CLASS:
o osmotic laxatives
DRUGS:
o magnesium hydroxide (milk of magnesia)
o polyethylene glycol (miralax)
o lactulose
MOA:
o retains water in the stool increasing softness and promoting peristalsis
INDICATIONS:
o constipation
______________ oil can be used orally for constipation and rectally for fecal impaction
mineral oil
_____________ oil is used for rapid and complete bowel evacuation
castor oil
only drug that works on the small intestine
castor oil (laxatives)
if abused for weight loss, may cause the body to become dependent on them for BMs
laxatives
nonpharmacological interventions include __________________ fiber and fluid intake and __________________ activity
increasing
increasing
opioids
DRUG CLASS:
o opioids
DRUGS:
o diphenoxylate (lomotil)
o loperamide (imodium)
MOA:
o slows down peristalsis
o not necessarily causing constipation but taking us away from diarrhea towards normal
INDICATIONS:
o diarrhea
NOTES:
o diphenoxylate is mixed with atropine to prevent abuse (controlled substance - schedule V)
o loperamide is available OTC
bismuth subsalicylate (pepto-bismol)
MOA:
o direct action against viral and bacterial GI pathogens
INDICATIONS:
o dyspepsia
o treatment and prevention of diarrhea
dicyclomine (bentyl)
MOA:
o anticholinergic
INDICATIONS:
o irritable bowel syndrome (IBS)
SE/AE:
o anticholinergic effects
NOTES:
o also considered an antispasmodic
assess for ___________ and _______________ imbalances in diarrhea patients, especially with prolonged diarrhea in children and elderly
o fluid
o electrolyte
5 aminosalicylates
DRUG:
o sulfasalazine
MOA:
o reduces inflammation
INDICATIONS:
o ulcerative colitis
o rheumatoid arthritis
other agents for IBD
o glucocorticoids
o immunosuppressants
o monoclonal antibodies
IBS-D drug approved specifically for women
alosetron (lotronex)
disease where the lining of the esophagus is exposed to acidity from the stomach contents
gastroesophageal reflux disease (GERD)
GERD is also referred to as ________ ________
heart burn
disease where there is an ulceration in the lining of the stomach or duodenum
peptic ulcer disease (PUD)
two primary causes of PUD
o NSAIDs
o H. pylori bacteria
proton pump inhibitors (PPI)
DRUG CLASS:
o proton pump inhibitors
DRUGS:
o omeprazole (prilosec)
o pantoprazole (protonix)
MOA:
o inhibits the enzyme that generates gastric acid
INDICATIONS:
o GERD
OFF-LABEL USE:
o PUD
NOTES:
o rebound issues can occur with cessation after long term
o ideally should not be used for mor than 4-8 weeks
o more potent than H2 receptor antagonists
o available OTC
o longer term use increases risk of developing fractures
(advise patient to take calcium and vitamin D)
o often used for prevention of ulcers in hospitalized patients
most potent drugs available to lower acidity in stomach
o omeprazole
o pantoprazole
histamine 2 receptor antagonists
(h3 antagonists or H2RA)
DRUGS:
o famotidine (pepcid)
o ranitidine (zantac)
MOA:
o reduces gastric juices and acidity of it
INDICATIONS:
o GERD
NOTES:
o can be used daily or PRN
o available OTC
o if no relief, consider switching to PPI
sucralfate
DRUG NAME:
o sucralfate
MOA:
o creates a coating or prevention over the ulcer
INDICATIONS:
o duodenal ulcer
NOTES:
o Rx only
o must be taken 4x/day
misoprostol
DRUG NAME:
o misoprostol
MOA:
o a synthetic prostaglandin that replaces those consumed by NSAIDs
INDICATIONS:
o prevention of ulcers in patients taking long-term NSAIDs and termination of pregnancy
(used along with miphroprostein steroid to induce abortion
NOTES:
o teratogenic
o can’t be used in pregnancy (used to induce abortion)
Anatacids
DRUG CLASS:
a antacids
DRUGS:
o calcium carbonate (tums)
o sodium bicarbonate (alka-seltzer)
MOA:
o neutralizes the pH in the stomach
INDICATIONS:
o symptom relief in PUD and GERD (do not heal)
ONSET:
o rapid onset and relief
o usually 5 - 15 min
SE/AE:
o depending on which drug used, they can cause diarrhea or constipation
NOTES:
o available OTC
o should not be taken at the same time as other medications
o OD can cause acid base imbalances
PUD due to H. pylori requires what type of treatment
ABX (antibiotic) treatment
nausea can be related to conditions such as:
o bowel obstruction
o myocardial infarction
o pregnancy
serotonin receptor antagonist
DRUG CLASS:
o serotonin receptor antagonist
DRUGS:
o ondansetron (zofran)
MOA:
o blocks 5-HT3-receptors in the chemoreceptor trigger zone
INDICATIONS:
o nausea
SE/AE:
o headache
o QT prolongation
NOTES:
o first line agent for nausea
o available PO, IV, IM, ODT
o often given ODT (oral disintegrating tablet- place on tongue to dissolve)
o if pt is also vomiting w/nausea, PO route should not be used due to risk of vomiting up med, so use ODT
phenothiazines
DRUG CLASS:
o phenothiazines
DRUGS:
o prochlorperazine (compazine)
o promethazine (phenergan)
MOA:
o blocking dopamine in the chemoreceptor trigger zone
INDICATIONS:
o nausea
BLACK BOX:
o extrapyramidal effects (EPS)
SE/AE:
o anticholinergic effects
o hypotension
o sedation
metoclopramide (reglan)
DRUG NAME:
o metoclopramide (reglan)
MOA:
o blocking dopamine in the chemoreceptor trigger zone
INDICATIONS:
o nausea
OFF-LABEL USE:
o migraines
o tension headaches
anticholinergics
DRUG CLASS:
o anticholinergics
DRUGS:
o scopolamine (transderm scop)
MOA:
o anticholinergic action
INDICATIONS:
o motion sickness
o nausea
SE/AE:
o dry mouth
glucocorticoids (corticosteroids)
DRUG CLASS:
o glucocorticoids (corticosteroids)
DRUGS:
o dexamethasone
MOA:
o unknown antiemetic activity
INDICATIONS:
o nausea (most common is chemotherapy nausea)
inflammation
o immunosuppression
SE/AE:
o adrenal suppression
o hyperglycemia
o increased risk of infection
NOTES:
o must be tapered when discontinuing
off-label use for nausea in pregnancy
doxylamine (unisom)
recommended for nausea relief in pregnancy
pyridoxine (B6)
given prior to chemotherapy treatment
nausea medication
cannabinoids are approved for what treatment to induce nausea
chemotherapy treatment
vitamins are separated into what two categories
- lipid or fat soluble vitamins (stored in body longer)
- water soluble vitamins
Vitamin A (retinol)
SOURCES:
o dairy products
o cantaloupe
o carrots
o mangos
o pumpkins
o sweet potatoes
INDICATIONS:
o vitamin A deficiency
ROLE:
o eye health and more
NOTES:
o deficiency can cause night blindness
o teratogenic
o fat soluble
Vitamin D
SOURCES:
o supplements
o sunlight
o fortified foods
INDICATIONS:
o vitamin D deficiency
o prevention of osteoporosis
ROLE:
o increases level of calcium an phosphorous
FORMS OF VITAMIN D:
o ergocalciferol
o cholecalciferol
NOTES:
o someone who is deficient in vitamin D can present as HYPOcalcemic
o deficiency causes rickets in children
o deficiency causes osteomalacia in adults
o fat soluble
Vitamin E
SOURCES:
o vegetable oils
INDICATIONS:
o Vitamin E deficiency
ROLE:
o antioxidant
NOTES:
o fat soluble
Vitamin K
SOURCES:
o spinach
o broccoli
INDICATIONS:
o vitamin K deficiency
o reversal of warfarin
ROLE:
o required for the synthesis of prothrombin and clotting
factors VII, IX, X
BLACK BOX WARNING:
o parenteral administration can cause adverse reactions including DEATH
NOTES:
o deficiency can cause bleeding (vitamin K needed for clotting factors, so if deficient in vitamin K, you will bleed)
o fat soluble
Vitamin C (ascorbid acid)
SOURCES:
o citrus fruits
o juices
INDICATIONS:
o deficiency in vitamin C causing Scurvy
ROLE:
o collogen synthesis
o multiple other roles
NOTES:
o deficiency causes scurvy (bruising, gingivitis, arthralgias, impaired wound healing)
o water soluble
Vitamin B1 (thiamine)
SOURCES:
o fortified grains
INDICATIONS:
o thiamine deficiency
ROLE:
o carbohydrate metabolism
NOTES:
o deficiency causes Beriberi
o water soluble
Vitamin B3 (Niacin)
SOURCES:
o plant and animal foods
INDICATIONS:
o niacin deficiency
ROLE:
o coenzyme necessary for cellular respiration
NOTES:
o deficiency causes Pellagra
o also a medication for hyperlipidemia that is no longer recommended
o water soluble
Vitamin B6 (pyridoxine)
SOURCES:
o fortified grains
o meat
o fish
o poultry
INDICATIONS:
o pyridoxine deficiency
ROLE:
o metabolism of amino acids and proteins
NOTES:
o deficiency can be caused by isoniazide (INH)
o deficiency can be caused by alcohol use disorder
o water soluble
Vitamin B9 (Folic acid)
SOURCES:
o liver
o spinach
o green leafy vegetables
INDICATIONS:
o anemia
o prevent neural tube defects in the fetus
o decrease toxicity from certain chemotherapeutic agents such as methyltrexate
ROLE:
o synthesis of DNA
NOTES:
o deficiency can cause neural tube defects very early in pregnancy
o folic acid supplementation is recommended to start one month prior to conception (recommended to be supplemented in females of child baring age that are attempting conception)
o water soluble
Vitamin B12 (cyanocobalamin)
SOURCES:
o only available from animal products such as eggs, dairy, and meat
INDICATIONS:
o megaloblastic anemia
ROLE:
o DNA synthesis
o blood cell formation
NOTES:
o deficiency can cause anemia (common symptom is glossitis)
Ferrous Sulfate (iron)
SOURCES:
o meat
o poultry
o beans
o green leafy vegetables
INDICATIONS:
o anemia (specifically iron deficiency anemia)
ROLE:
RBC formation
NOTES:
o deficiency can cause iron deficiency anemia
Total parenteral nutrition (TPN)
o contains amino acids, lipids, carbohydrates, vitamins, minerals
INDICATIONS:
o patients that are unable to receive oral nutrition for extended periods of time
NOTES:
o TPN is not preferred over enteral supplements for long term nutrition
Lipase Inhibitors
DRUG CLASS:
o lipase inhibitors
DRUGS:
o orlistat (alli)
MOA:
o reduces absorption of fat
INDICATIONS:
o weight loss
SE/AE:
o GI effects
GLP-1 agonists
DRUG CLASS:
o GLP-1 agonist
DRUGS:
o liraglutide (saxenda, victoza)
MOA:
o slows gastric emptying which increases fullness sensation
INDICATIONS:
o weight loss
o DM
BLACK BOX:
o thyroid tumor risk
SE/AE:
o increased heart rate
Phentermine
DRUG NAME:
o Phentermine
MOA:
o decreases appetite
INDICATIONS:
o weight loss
SE/AE:
o cardiac and CNS effects
o increase heart rate
o increase BP
NOTES:
o controlled substance (schedule IV)
2 types of combination drugs for weight loss
o phentermine w/ topiramate
o naltrexone w/ bupropion
what is RDA
recommended dietary allowance
o average daily intake required for most healthy adults
alcohol use disorder often coexists with deficiencies in vitamins _____, _____, and _____.
B1
B6
B9
vitamins are what type of compounds
organic compounds
minerals such as calcium and sodium are what type of compounds
inorganic compounds
postmenopausal women need an increased intake of what?
o calcium
o vitamin D
rheumatoid arthritis (RA) is in a group called what?
autoimmune diseases
build up of uric crystals in the joint
(also considered a type of arthritis)
Gout
most common type of arthritis
osteoarthritis (OA)
what is the first thing we address for bone and joint diseases.
first treatment?
o inflammation
o NSAIDs
caused by a decrease in bone mass
osteoporosis
common recommendations to prevent osteoporosis
calcium
vitamin D
Methotrexate
DRUG NAME:
o methotrexate
MOA:
o unknown for RA.
o blocks folate acid thereby inhibiting DNA synthesis
INDICATIONS:
o anti-tumor/anti-cancer
o autoimmune disease (psoriasis, SLE, RA, etc.)
o induction of abortion
ONSET:
o several weeks for RA
SE/AE:
o can cause adverse effects across many systems
NOTES:
o for cancer - blocks folic acid which is required for DNA synthesis
o teratogenic
o often used as first line for RA after NSAIDs
5 Aminosalicylates
DRUG CLASS:
o 5 aminosalicylates
DRUGS:
o sulfasalazine
MOA:
o reduces inflammation (anti-inflammatory agent)
INDICATIONS:
o ulcerative colitis
o rheumatoid arthritis
ONSET:
o several weeks for RA
SE/AE:
o GI effects
o blood dyscrasias
Hydroxychloroquine
DRUG NAME:
o Hydroxychloroquine
MOA:
o unknown
INDICATIONS:
o autoimmune disease
o malaria
ONSET:
o several weeks for RA
Monoclonal antibodies
(largest class of drug: 100+)
DRUG CLASS:
o Monoclonal Antibodies
DRUGS:
o etanercept (enbrel)
o adalimumab (humira)
MOA:
o biologic agent
o varies by medication
INDICATIONS:
o autoimmune disease (RA, UC)
o tumors
o hyperlipidemia
o asthma
o IBD
o Infections
o Covid-19
BLACK BOX:
o malignancy
o serious infections
ROUTE:
o Parenteral ONLY (must be given by injection)
ONSET:
o several months
NOTES:
o also used to reverse DIGOXIN and DIABIGATRAN TOXICITY
o also referred to as a disease modifying anti-rheumatic agent (DMARD)
Clochicine
DRUG NAME:
o colchicine
MOA:
o blocks action of neutrophils associated with gout symptoms
INDICATIONS:
o gout
SE/AE:
o GI symptoms
FIRST LINE AGENTS FOR GOUT FLARES:
o steroids
o NSAIDs
o colchicine
NOTES:
o narrow therapeutic index
o toxicity can lead to adverse effects such as hepatic and renal issues
Xanthine Oxidase Inhibitors
DRUG CLASS:
o Xanthine Oxidase Inhibitors
DRUGS:
o allopurinol
MOA:
o reduces uric acid levels
INDICATIONS:
o gout prevention
o nephrolithiasis
ONSET:
o several days
o peak effects are in 1-3 weeks
NOTES:
o may exacerbate gout upon initial pharmacotherapy
Uricosurics
DRUG CLASS:
o Uricosurics
DRUG:
o probenecid
MOA:
o reduces uric acid levels
INDICATIONS:
o gout prevention
NOTES:
o may exacerbate gout upon initial pharmacotherapy (treatment)
Bisphosphonates
DRUG CLASS:
o Bisphosphonates
DRUGS:
o alendronate (fosamax) - PO meds
o Zoledronic acid / Zoledronate (Reclast) - IV ONLY
MOA:
o decreases bone turnover
INDICATIONS:
o osteoporosis
o Paget disease
NOTES:
o Bisphosphonates are first line for osteoporosis
o Zoledronate is first line for Paget disease
o Teratogenic
PATIENT EDUCATION:
o alendronate should be taken before first meal of the day with a full glass of water
o remain sitting or upright for 30 minutes following administration
o ensure the patient has adequate intake of calcium and vitamin D
Selective Estrogen Receptor Modulators
DRUG CLASS:
o Selective Estrogen Receptor Modulators
DRUG:
o Raloxifene (Evista)
MOA:
o Similar to estrogen
INDICATIONS:
o prevent and treat osteoporosis in post-menopausal women
BLACK BOX WARNING:
o increased risk of embolic events
NOTES:
o teratogenic
PATIENT EDUCATION:
o ensure patient has adequate intake of calcium and vitamin D
Calcitonin
DRUG NAME:
o calcitonin
MOA:
o increases calcium excretion
o decreases calcium loss from the bones
INDICATIONS:
o hypercalcemia
o post-menopausal osteoporosis
o Paget disease
ROUTES:
o parenteral
o intranasal
Oral Contraceptive (OCP)
DRUG CLASS:
o Oral Contraceptive (OCP)
DRUGS:
o most common type is a combination of estrogen & progesterone
o Norethindrone and Ethinyl Estradiol
o Many generic and brand/trade names for OCP (nearly all include an estrogen and progesterone)
MOA:
o prevents ovulation by suppressing LH
INDICATIONS:
o contraception
o treats acne
OFF-LABEL USE:
o dysmenorrhea
o menstrual suppression
o PCOS symptoms
AVAILABLE DOSES:
28 day cycles available as:
o 21 tablets with 7 placebos (most common)
o 24 tablets and 4 placebos
BLACK BOX:
o increased risk for thromboembolic events when combined with smoking
NOTES:
o several medications, such as antiepileptics and antibiotics, can reduce the efficacy of OCP
OCP patient education
o should be started greater than 5 days from onset of bleeding
o usually started on a sunday
o use alternative method of contraception for the first 7 days of starting OCP
o a missed pill should be taken when remembered and can be taken two in one day
o if two or more pills are missed, use an alternative method for contraception
o must be stopped in the event pregnancy occurs
Progesterone Only Pill
DRUG CLASS:
o progesterone only pill
DRUG:
o norethindrone (minipill)
MOA:
o suppresses LH surge
o interferes with sperm and egg movement
o thins endometrium
INDICATIONS:
o contraception
o less effective than combined estrogen - progesterone OCP
NOTES:
o can be started immediately after childbirth
PATIENT EDUCATION:
o must be taken at the same time every day
Emergency Contraception
DRUG CLASS:
o emergency contraception
DRUGS:
o levonorgestrel (Plan B, Plan B One-step)
o ulipristal (Ella)
MOA:
o interferes with ovulation
INDICATIONS:
o emergency contraception
NOTES:
o only effective within the first 5 days after unprotected intercourse
o significantly less effective in patients with a high BMI
o does not abort a fetus
o does not require a prescription
Ovulation Stimulant
DRUG CLASS:
o Ovulation Stimulant
DRUG:
o Clomiphene (Clomid)
MOA:
o causes growth in ovarian follicle by stimulating release of FSH and LH
INDICATION:
o ovulation induction for fertility
ONSET:
o (ovulation) is in 5-10 days
NOTES:
o not recommended to be used for ore than 12 cycles
PATIENT EDUCATION:
o start taking on day 5 of cycle
o have intercourse at least every other day for days 5-10 after final dose
o increases chance of multiple gestation
o hCG may be given IM to induce ovulation
Oxytocin (Pitocin)
DRUG NAME:
o Oxytocin (pitocin)
MOA:
o stimulates uterine contractions
INDICATION:
o induction of labor
o postpartum hemorrhage
ONSET:
o around one minute
BLACK BOX WARNING:
o not labeled for use in elective induction of labor (but it is an off-label use)
Estrogen Replacement
DRUG CLASS:
o estrogen replacement
DRUG:
o conjugated estrogen (premarin)
MOA:
o actions of estrogen
INDICATIONS:
o symptoms of menopause (i.e. hot flashes, vaginal dryness)
o breast cancer
BLACK BOX WARNING:
o endometrial and breast cancer
o CVD
o dementia
Androgen
DRUG CLASS:
o Androgen
DRUG:
o testosterone
MOA:
o produces anabolic and androgenic effects
INDICATIONS:
o delayed puberty
o hypogonadism
BLACK BOX WARNING:
o hypertension
o virilization in women and children
ROUTE:
o parenterally only
NOTE:
o controlled substance (Schedule III)
Alpha One Adrenergic Antagonists
DRUG CLASS:
o alpha one adrenergic antagonists
DRUGS:
o tamsulosin (flomax)
o doxazosin (cardura)
MOA:
o inhibits alpha one receptor causing relaxation of muscle in the bladder neck
INDICATIONS:
o BPH
o HTN
SE/AE:
o orthostatic hypotension
o reflex tachycardia
NOTES:
o first line for BPH (benign prostate hyperplagia)
o other A1 agonists are used only for HTN such as prazosin
