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NS373—Pharmacology > Exam 4 Drug Info > Flashcards

Exam 4 Drug Info Flashcards

1
Q

somatrem indications

A

GH deficiency
growth failure in children
dwarfism

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2
Q

somatrem action

A

stimulates skeletal & organ growth

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3
Q

somatrem adverse effects (7)

A
  • *Neuro—**h/a
  • *GI/endo—**insulin resistance; hyperglycemia
  • *F & E—**edema
  • *MS—**arthralgia
  • *Imm—**antibodies to GH
  • *Other—**injection site pain
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4
Q

when is somatrem effective?

A

before epiphyses close

start early in life

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5
Q

caution for somatrem (1)

A

DM

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6
Q

octreotide indication

A

GH excess (often pituitary tumor)
gigantism (children)
acromegaly (after puberty)

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7
Q

octreotide action

A

GH antagonist

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8
Q

octreotide route

A

SQ

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9
Q

somatrem route

A

IM

SQ

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10
Q

octreotide adverse effects (8)

A
  • *Neuro—**h/a; fatigue
  • *GI/endo—**gallbladder disease; hyperglycemia; abd pain; cholelithiasis; nvd
  • *MS**—back pain
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11
Q

somatrem - what to monitor (3)

A

glucose

thyroid function

nutritional needs

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12
Q

octreotide - what to monitor

A

glucose

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13
Q

octreotide caution (2)

A

DM

gallbladder issues

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14
Q

octreotide used in combo with…

when…

A

surgery, radiation

when there is a tumor

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15
Q

desmopressin & vasopressin indication

A

ADH deficiency
diabetes insipidus
↑ thirst & voiding

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16
Q

desmopressin & vasopressin action (4)

A

↑ water reabsorption
hemostatic—shortens clotting time
↑ cardiac output
peripheral vasoconstriction

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17
Q

desmopressin route

A

PO

nasal

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18
Q

vasopressin route

A

IV

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19
Q

desmopressin & vasopressin adverse effects (9)

A
  • *Neuro—**h/a
  • *CV—**↑ BP
  • *GI/endo—**nausea
  • *F & E—**fluid retention; electrolyte imbalance; hyponatremia
  • *Other**—facial flushing; reaction at injection site; water intoxication
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20
Q

somatrem effect on glucose levels

A

raises

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21
Q

desmopressin & vasopressin effect on sodium

A

hyponatremia

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22
Q

vasopressin & desmopressin effect on BP

A

raises

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23
Q

vasopressin & desmopressin - monitor (4)

A

VS, esp BP
I&O
electrolytes (Na+)
thirst

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24
Q

desmopressin & vasopression caution

A

HTN

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25
Q

short term tx for ADH deficiency

A

vasopressin IV

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26
Q

GH is from the…

A

anterior pituitary

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27
Q

ADH is from the…

A

posterior pituitary

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28
Q

steroids indications (3)

A

Addison’s (adrenal insufficiency)
severe inflammation (short term)
may be given c amphotericin B

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29
Q

steroids route

A

IM

IV

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30
Q

steroids adverse effects (16)

A

Neuro—mood changes/irritability; euphoria;
nervousness; insomnia; personality change; cataracts
GI/endo—hyperglycemia; peptic ulcers; ↑ appetite
F & E—electrolyte imbalance
MS—osteoporosis/bone changes
Integ—delayed wound healing; acne; facial hair
Rep—menstrual changes
Other—Cushing’s syndrome

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31
Q

how do steroids effect sleep?

A

insomnia

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32
Q

how can steroid affect eyes?

A

cataracts

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33
Q

how can steroids affect glucose

A

hyperglycemia

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34
Q

how can steroids affect appetite?

A

increase

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35
Q

syndrome that can be caused by steroids

A

Cushing’s

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36
Q

how to administer first dose of steroids

A

start with large dose, then decrease

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37
Q

steroids - monitor (2)

A

glucose

s/s of infection

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38
Q

steroids pregnancy category

A

C

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39
Q

steroids contraindication

A

active infection

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40
Q

steroids caution (3)

A

DM

peptic ulcer disease

infection

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41
Q

levothyroxine indication

A

hypothyroidism
myxedema (adults)
cretinism (children)

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42
Q

levothyroxine action

A

synthetic thyroxine (T4) replacement

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43
Q

levothyroxine adverse effects (10)

A
  • *Neuro—**tremors; h/a; nervousness; insomnia
  • *CV—**palpitations; angina; tachycardia
  • *GI/endo—**n/v/d; wt loss
  • *Integ**—hair loss
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44
Q

how can levothyroxine affect HR?

A

tachycardia

palpitations

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45
Q

when should you take levothyroxine?

A

in the morning on an empty stomach

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46
Q

thyroid drugs - monitor (4)

A

VS, EKG
wt
TH levels

glucose levels

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47
Q

don’t switch brands and discontinue slowly

A

thyroid drugs

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48
Q

propylthiouracil & methimazole indications

A

hyperthyroidism

Graves

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49
Q

propylthiouracil & methimazole action

A

decrease TH

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50
Q

propylthiouracil & methimazole adverse effects (6)

A
  • *Neuro**—bradykinesia; emotional dullness
  • *CV**—bradycardia; anemia
  • *GI/endo**—wt gain; constipation
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51
Q

how do propylthiouracil & methimazole affect HR?

A

bradycardia

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52
Q

propylthiouracil & methimazole may be used with…

A

radiation on thyroid

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53
Q

insulin indications

A

DM
gestational DM
steroid use

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54
Q

insulin action

A

↓ blood glucose

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55
Q

insulin adverse effect

A

GI/endo—hypoglycemia

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56
Q

which insulin should you only give with food present?

A

lispro (rapid acting)

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57
Q

when should you eat after taking regular insulin?

A

2-4 hours later

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58
Q

insulin - monitor (1)

A

glucose

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59
Q

antidote to insulin

A

50% dextrose IV

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60
Q

lispro

onset, peak, duration

A

o. <15 min; p. 30-90 min; d. 3-5hr

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61
Q

regular insulin

onset, peak, duration

A

o. 30-60 min; p. 2-4 hr; d. 6-12 hr

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62
Q

NPH

onset, peak, duration

A

o. 1-1.5 hr; p. 4-12 hr; d. 18-24 hr

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63
Q

glargine

onset, duration

A

o. 1-2 hr; d. 24 hr

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64
Q

glipizide & glyburide indication

A

DM

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65
Q

glipizide & glyburide action

A

stimulate beta cells to release insulin

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66
Q

glipizide & glyburide adverse effects (6)

A

GI/endo—hypoglycemia; wt gain; nvd; heartburn;
hepatotoxicity
Imm—hypersensitivity reactions

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67
Q

glipizide & glyburide - monitor (1)

A

glucose

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68
Q

glipizide & glyburide caution

A

alcohol causes disulfiram-like reaction

(flushing, palpitations, nausea)

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69
Q

advantages of 2nd generation sulfonylureas

A

2nd generation effective at lower doses; longer duration; fewer side effects

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70
Q

metformin indication

A

DM

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71
Q

metformin action (5)

A

↓ hepatic glucose production
↓ insulin resistance
alters glucose absorption
↓ triglycerides & LDL
promotes wt loss

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72
Q

metformin adverse effects (2)

A
  • *GI/endo**—severe nvd
  • *Other—**lactic acidosis (rare)
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73
Q

metformin - monitor (1)

A

liver function tests

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74
Q

which oral DM drugs do NOT cause hypoglycemia?

A

biguanides

alpha-glucosidase inhibitors

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75
Q

acarbose action

A

delays glucose digestion

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76
Q

acarbose adverse effects (4)

A

GI/endo—cramping; distension; diarhhea; flatulence

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77
Q

which patients are prescribed acarbose?

A

who can’t achieve control of glucose levels with diet alone

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78
Q

acarbose indication

A

DM

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79
Q

rosiglitazone indication

A

DM

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80
Q

rosiglitazone action

A

↓ insulin resistance

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81
Q

rosiglitazone adverse effects (2)

A
  • *CV—**↑ risk for adverse events
  • *F & E—**fluid retention
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82
Q

rosiglitazone contraindications (2)

A

symtomatic heart disease

CHF

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83
Q

repaglinine indication

A

DM

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84
Q

repaglinine action

A

stimulates beta cells to release insulin

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85
Q

repaglinine adverse effect (1)

A

GI/endo—hypoglycemia

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86
Q

repaglinine - monitor (2)

A

liver function tests

glucose

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87
Q

short acting oral DM drug

A

repaglinine

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88
Q

exenatide, liraglutide & sitagliptin indication

A

DM

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89
Q

exenatide, liraglutide & sitagliptin action (4)

A

↑ incretin hormone causes ↑ insulin release
↓ glucagon production
↑ fullness - ↓ food intake
slow gastric emptying

90
Q

captopril, enalapril & lisinopril indication

A

HTN

91
Q

captopril, enalapril & lisinopril action (5)

what is excreted & what is retained?

A

inhibits angiotensin II formation
blocks vasoconstriction
blocks aldosterone release
Na+ & water excreted
K+ retained

92
Q

captopril, enalapril & lisinopril adverse effects (12)

A

CV—tachycardia; arrhythmias; hypotension;
severe ortho hypotension (first dose)
Resp—persistent dry cough (ACE cough, ↑ bradykinin)
GI/endo—n/d; irritation; peptic ulcers
F & E—hyperkalemia; angioedema
MS—bone marrow suppression
Integ—rash

93
Q

captopril, enalapril & lisinopril caution (2)

A

first dose reaction—ortho hypotension

with K-sparing diuretics (hyperkalemia)

94
Q

captopril, enalapril & lisinopril interventions (2)

A

start with low dose
monitor for first dose reaction (orthostatic hypotension)

95
Q

losartan & valsartan indication

A

HTN

96
Q

losartan & valsartan action (3)

A

prevents angiotensin II from reaching receptors
vasodilation
↓ peripheral resistance

97
Q

losartan & valsartan adverse effects (5)

A
  • *Neuro**—dizzyness; h/a
  • *CV**—hypotension
  • *GI/endo**—diarrhea; abd pain
98
Q

how can ACE inhibitors affect HR?

A

tachycardia

arrhythmias

99
Q

how can ACE inhibitors affect K+?

A

hyperkalemia

100
Q

prazosin & doxazosin indication

A

HTN

101
Q

prazosin & doxazosin action (2)

A

block alpha-1 receptors
vasodilation

102
Q

prazosin & doxazosin adverse effects (10)

A
  • *Neuro**—dizzyness; h/a
  • *CV—**hypotension; tachycardia; flushing
  • *Resp—**nasal congestion
  • *GI/endo—**n/d; dyspepsia
  • *F & E**—edema
  • *Rep—**priapism (prolonged erection)
103
Q

how can alpha-1 inhibitors affect HR?

A

tachycardia

104
Q

how can alpha-1 inhibitors affect the reproductive system?

A

priapism

105
Q

atenolol, metoprolol & nebivolol indication

A

HTN

106
Q

atenolol, metoprolol & nebivolol action (3)

A

block beta receptors in kidney to inhibit renin
↓ HR, myocardial contraction, CO
↑ renal perfusion

107
Q

atenolol, metoprolol & nebivolol adverse effects (12)

A
  • *Neuro—**depression
  • *CV—**bradycardia; ↓ CO; AV block; ortho hypotension; rebound myocardium; HF; arrhythmia
  • *Resp—**bronchospasm
  • *GI/endo—**n/v/d; hypoglycemia masking
  • *Rep—**↓ libido
108
Q

how can beta blockers affect the reproductive system

A

decrease libido

109
Q

how can beta blockers affect the cardiovascular system? (6)

A

bradycardia

decreased CO

AV block

rebound myocardium

heart failure

arrhythmias

110
Q

beta blockers intervention

A

assess HR & BP before giving

111
Q

beta blockers can mask…

A

sx of hypoglycemia

112
Q

beta blockers caution

A

do not give with Ca+ channel blockers

113
Q

nifedipine & diltiazem indications (4)

A

chronic HTN
angina
dysrhythmias
premature labor contractions

114
Q

nifedipine & diltiazem action (3)

A

block Ca+ channel in vascular smooth muscle
vasodilation
uterine relaxation

115
Q

nifedipine & diltiazem adverse effects (5)

A
  • *Neuro**—dizzyness; h/a
  • *CV**—bradycardia; flushing
  • *F & E**—peripheral edema
116
Q

how can nifedipine & diltiazem affect HR

A

bradycardia

117
Q

nifedipine & diltiazem caution (2)

A

NO grapefruit juice

do NOT give with beta blockers

118
Q

hydralazine & nitroprusside indication

A

severe HTN
nitroprusside—hypertensive emergency

119
Q

nitroprusside & hydralazine action (2)

A

relax smooth muscle of arteries
vasodilation

120
Q

nitroprusside & hydralazine adverse effects (3)

A
  • *CV—**reflex tachycardia
  • *F & E**—Na+ & water retention; peripheral edema
121
Q

how can nitroprusside & hydralazine affect HR?

A

reflex tachycardia

122
Q

how can nitroprusside & hydralazine affect sodium?

A

retention

123
Q

tx for reflex tachycardia

A

beta blocker

124
Q

what might nitroprusside & hydralazine be given with and why? (2)

A

beta blockers for reflex tachycardia

diuretics for fluid retention

125
Q

furosemide indications

A

HTN
pulmonary edema

126
Q

furosemide action (2)

A

act on loop of Henle
↓ Na+, Cl-, water

127
Q

furosemide adverse effects (5)

A
  • *Neuro—**ototoxicity
  • *CV—**dysrhythmias (hypokalemia); hypotension
  • *F & E**—severe F & E losses; dehydration
128
Q

furosemide - monitor for…(4)

A

dehydration
↓ electrolytes
hyperglycemia
↑ uric acid

129
Q

furosemide caution

A

hot climates (dehydration, vasodilation)

130
Q

very strong diuretic

A

furosemide

131
Q

hydrochlorothiazide indications

A

HTN
mild/moderate HF

132
Q

hydrochlorothiazide action (2)

A

act on distal convoluted tubule
Ca+ reabsorption

133
Q

hydrochlorothiazide adverse effect

A

MS—gout (uric acid)

134
Q

hydrochlorothiazide - monitor (4)

A

dehydration
hypokalemia
hyperglycemia
↑ uric acid

135
Q

how can hydrochlorothiazide effect K+?

A

hypokalemia

136
Q

which diuretic can cause gout?

A

hydrochlorothiazide

137
Q

slow acting diuretic

A

hydrochlorothiazide

138
Q

spironolactone indication

A

HTN

139
Q

spironolactone action (3)

A

act on collecting duct & late distal tubules
Na+ excretion
K+ retention

140
Q

spironolactone adverse effect (1)

A

F & E—hyperkalemia

141
Q

spironolactone - monitor (1)

what may pts need?

A

K+ levels

a K+ supplement

142
Q

spironolactone caution

A

with ACE inhibitors

(hyperkalemia)

143
Q

weaker diuretic used with other diuretics

A

spironolactone

144
Q

digoxin action (7)

A

inhibits Na+/K+ pump
influx of Ca+ into cardiac cells
↑ efficiency of muscle fiber contraction
improves pumping ability
slows HR & rate of conduction
↑ CO, force of contraction
↑ renal perfusion

145
Q

digoxin indication

A

HF

146
Q

digoxin sx of toxicity (5)

A
  • *Neuro**—vision changes (green/yellow halos, blur, double)
  • *CV**—bradycardia
  • *GI/endo**—n/v; abd pain; anorexia
147
Q

digoxin - monitor (3)

A

drug level

puls

K+ levels

148
Q

digoxin interventions (4)

A

hold if <60bpm
take drug same time each day
follow-up exams important
avoid OTC meds w/o asking PCP

149
Q

digoxin caution

A

hypokalemia—↑ risk toxicity

150
Q

digoxin TR

A

0.5-1.8 ng/mL

151
Q

antidote to digoxin

A

digoxin immune fab (DigiFab; Digibind)

152
Q

what slows absorption of digoxin?

A

antacids

antidiarrheals

153
Q

hydralazine, isosorbine dinitrate & BiDil indications

A

HF, especially in African Americans

154
Q

hydralazine, isosorbine dinitrate & BiDil action (5)

A

↓ cardiac workload
vasodilation
↓ preload
↓ BP
Na+ & water retained

155
Q

hydralazine, isosorbine dinitrate & BiDil adverse effect

A
  • *CV—**reflex tachycardia
  • *F & E**—peripheral edema
156
Q

milrinone indication

A

severe HF

157
Q

milrinone action

A

↑ CO
↑ force myocardial contraction
↑ available Ca+
vasodilation

158
Q

milrinone adverse effects (4)

A
  • *CV**—arrhythmias; hypotension; thrombocytopenia
  • *GI/endo**—n/v
159
Q

use milrinone for…

(time period)

A

no more than 2-3 days

160
Q

procainamide indications

A

a-fib
PACs
PCVs
V-tach

161
Q

propanolol indications

A

a-flutter
a-fib
tachydysrhythmias
ventricular dysrhythmias

162
Q

amiodorone indication

A

severe dysrhythmias (atrial & vent)

163
Q

verapamil indications (2)

A

paroxysmal SVT
supraventricular tachycardia

164
Q

beta blockers contraindication

A

asthma

165
Q

may be given with Ca+ channel blockers for peripheral edema

A

diuretics

166
Q

beta blockers used to treat HTN vs arrhythmias vs angina

A

HTN — atenolol; metoprolol; nebivolol

arrhythmias — propanolol

angina — metoprolol; carvidolol

167
Q

nitroglycerin indication

A

acute angina

168
Q

nitroglycerin action (5)

A

vasodilator
dilates veins & capillaries
↓ vascular resistance
dilate coronary arteries
↓ cardiac workload

169
Q

nitroglycerin routes (5)

A

nasal spray
IV
topical
PO
sublingual

170
Q

nitroglycerin adverse effects (6)

A
  • *Neuro—**severe h/a; dizzyness
  • *CV—**hypotension; reflex tachycardia; flushing
  • *GI/endo—**n/v
171
Q

how can nitroglycerin affect HR and BP?

A

hypotension

reflex tachycardia

172
Q

nitroglycerin - monitor (1)

A

BP before and after giving

173
Q

how to take nitroglycerin tablets

A

take 1 tablet q 5 mins - max 3 tablets
if pain not relieved in 10-15 mins, call 911

174
Q

carvidolol indication

A

angina

175
Q

statins indication

A

HLD

176
Q

statins action (3)

A

inhibit HMG CoA reductase
↓ LDL
↑ HDL

177
Q

statins adverse effects (9)

A
  • *Neuro**—h/a
  • *GI/endo—**↑ liver enzymes; abd pain; flatulence; cramps; constipation
  • *F & E**—acute renal failure
  • *MS—**rhabdomylysis
  • *Integ—**rash
178
Q

statins caution (3)

A

NO grapefruit or citrus
NO alcohol
do not take during pregnancy

179
Q

when do we see effects of statins?

A

effect in 2 weeks
therapeutic effect 2-4 weeks

180
Q

what kind of supplement may be given with statins?

A

CoQ10

181
Q

not systemically absorbed
excreted in feces
often combined with statins

A

cholestyramine

182
Q

cholestyramine indication

A

HLD

183
Q

cholestyramine action (2)

A

binds with bile acids in intestine
↓ LDL

184
Q

cholestyramine adverse effects (7)

A
  • *CV—**↑ bleeding time
  • *F & E—**hypokalemia
  • *GI/endo—**bloating; constipation; flatulence; hemorrhoids; interference c vitamin & mineral absorption
185
Q

how can cholestyramine affect K+?

what can result?

A

hypokalemia

increased bleeding time

186
Q

cholestyramine often combined with…

A

statins

187
Q

gemfibrozil indications

A

HLD
extremely high tryglyceride levels

188
Q

gemfibrozil action (2)

A

↓ triglycerides
↓ VLDL

189
Q

gemfibrozil adverse effects (4)

A
  • *GI/endo**—dyspepsia; n/v/d; abd pain
  • *MS**—muscle pain
190
Q

how to take gemfibrozil

A

with meals

191
Q

do not use with statins because it increases risk of rhabdo

A

gemfibrozil

(fibric acid agents)

192
Q

gemfibrozil contraindications

A

gallbladder disease

liver disease

193
Q

niacin indication

A

HLD

194
Q

niacin action (2)

A

↓ VLDL & LDL
inhibits release of fatty acids

195
Q

niacin adverse effects (6)

A
  • *CV**—severe flushing; palpitations
  • *GI/endo**—hyperglycemia; n/d; bloating
  • *Integ**—pruritus
196
Q

can cause severe flushing

interventions?

A

niacin

use brand that doesn’t cause flushing

take aspirin 30 mins prior

197
Q

niacin contraindication

A

DM

198
Q

niacin typical dose & maximum dose

A

usually 2-3 g/day

do not exceed 6 g/day

199
Q

ezetimibe indication

A

HLD

200
Q

ezetimibe action (3)

A

works in sm intestine
inhibits cholesterol absorption
↓ LDL & triglycerides

201
Q

ezetimibe adverse effects (6)

A
  • *Resp**—URIs
  • *GI/endo**—abd pain; hepatitis; diarrhea
  • *MS**—muscle pain; arthralgia
202
Q

which lipid lowering drugs are combined with statins?

A

ezetimibe (cholesterol absorption inhibitor)

cholestyramine (bile acid sequestrant)

203
Q

drug causing cholelithiasis & gallbladder disease

A

octreotide

204
Q

drugs causing water intoxication

A

desmopressin

vasopressin

205
Q

drugs causing mood changes, hyperglycemia, osteoporosis, and Cushing’s

A

steroids

206
Q

drug causing hair loss

A

levothyroxine

207
Q

drugs causing emotional dullness

A

propylthiouracil
methIMAzole

208
Q

drug causing lactic acidosis (in rare cases)

A

metformin

209
Q

drugs causing persistant dry cough

A

ACE inhibitors

“-pril”s

210
Q

drugs causing priapism

A

alpha-1 blockers

“zosin”s

211
Q

drugs causing depression, bronchospasm, many heart issues and decreased libido

A

beta blockers

“olol”s

212
Q

drugs causing peripheral edema and bradycardia

A

Ca+ channel blockers

213
Q

drug causing ototoxiciy & dehydration

A

furosemide

214
Q

drug causing gout

A

hydrochlorothiazide

215
Q

drug causing green halos, blurred vision, double vision when toxic

A

digoxin

216
Q

drug causing thrombocytopenia

A

milrinone

217
Q

drug causing severe h/a, even for nurses who handle it

A

nitroglycerin

218
Q

drugs causing rhabdo & acute renal failure

A

statins

219
Q

drug causing worsened hemorrhoids & malabsorption of vitamins & minerals

A

cholestyramine

220
Q

drug causing severe flushing and hyperglycemia

A

niacin

221
Q

drug causing URIs

A

ezetimibe

222
Q

what effect does niacin have on glucose?

A

hyperglycemia

NS373—Pharmacology (18 decks)

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