Exam 4 Drug Info Flashcards
1
Q
somatrem indications
A
GH deficiency
growth failure in children
dwarfism
2
Q
somatrem action
A
stimulates skeletal & organ growth
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
4
Q
when is somatrem effective?
A
before epiphyses close
start early in life
5
Q
caution for somatrem (1)
A
DM
6
Q
octreotide indication
A
GH excess (often pituitary tumor)
gigantism (children)
acromegaly (after puberty)
7
Q
octreotide action
A
GH antagonist
8
Q
octreotide route
A
SQ
9
Q
somatrem route
A
IM
SQ
10
Q
octreotide adverse effects (8)
A
- *Neuro—**h/a; fatigue
- *GI/endo—**gallbladder disease; hyperglycemia; abd pain; cholelithiasis; nvd
- *MS**—back pain
11
Q
somatrem - what to monitor (3)
A
glucose
thyroid function
nutritional needs
12
Q
octreotide - what to monitor
A
glucose
13
Q
octreotide caution (2)
A
DM
gallbladder issues
14
Q
octreotide used in combo with…
when…
A
surgery, radiation
when there is a tumor
15
Q
desmopressin & vasopressin indication
A
ADH deficiency
diabetes insipidus
↑ thirst & voiding
16
Q
desmopressin & vasopressin action (4)
A
↑ water reabsorption
hemostatic—shortens clotting time
↑ cardiac output
peripheral vasoconstriction
17
Q
desmopressin route
A
PO
nasal
18
Q
vasopressin route
A
IV
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
20
Q
somatrem effect on glucose levels
A
raises
21
Q
desmopressin & vasopressin effect on sodium
A
hyponatremia
22
Q
vasopressin & desmopressin effect on BP
A
raises
23
Q
vasopressin & desmopressin - monitor (4)
A
VS, esp BP
I&O
electrolytes (Na+)
thirst
24
Q
desmopressin & vasopression caution
A
HTN
25
short term tx for ADH deficiency
vasopressin IV
26
GH is from the…
anterior pituitary
27
ADH is from the…
posterior pituitary
28
steroids indications (3)
**Addison's (adrenal insufficiency)**
severe inflammation (short term)
may be given c amphotericin B
29
steroids route
IM
IV
30
steroids adverse effects (16)
**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
31
how do steroids effect sleep?
insomnia
32
how can steroid affect eyes?
cataracts
33
how can steroids affect glucose
hyperglycemia
34
how can steroids affect appetite?
increase
35
syndrome that can be caused by steroids
Cushing's
36
how to administer first dose of steroids
start with large dose, then decrease
37
steroids - monitor (2)
glucose
s/s of infection
38
steroids pregnancy category
C
39
steroids contraindication
active infection
40
steroids caution (3)
DM
peptic ulcer disease
infection
41
levothyroxine indication
**hypothyroidism**
myxedema (adults)
cretinism (children)
42
levothyroxine action
synthetic thyroxine (T4) replacement
43
levothyroxine adverse effects (10)
* *Neuro—**tremors; h/a; nervousness; insomnia
* *CV—**palpitations; angina; tachycardia
* *GI/endo—**n/v/d; wt loss
* *Integ**—hair loss
44
how can levothyroxine affect HR?
tachycardia
palpitations
45
when should you take levothyroxine?
in the morning on an empty stomach
46
thyroid drugs - monitor (4)
VS, EKG
wt
TH levels
glucose levels
47
don't switch brands and discontinue slowly
thyroid drugs
48
propylthiouracil & methimazole indications
hyperthyroidism
Graves
49
propylthiouracil & methimazole action
decrease TH
50
propylthiouracil & methimazole adverse effects (6)
* *Neuro**—bradykinesia; emotional dullness
* *CV**—bradycardia; anemia
* *GI/endo**—wt gain; constipation
51
how do propylthiouracil & methimazole affect HR?
bradycardia
52
propylthiouracil & methimazole may be used with…
radiation on thyroid
53
insulin indications
DM
gestational DM
steroid use
54
insulin action
↓ blood glucose
55
insulin adverse effect
**GI/endo**—hypoglycemia
56
which insulin should you only give with food present?
lispro (rapid acting)
57
when should you eat after taking regular insulin?
2-4 hours later
58
insulin - monitor (1)
glucose
59
antidote to insulin
50% dextrose IV
60
lispro
onset, peak, duration
o. \<15 min; p. 30-90 min; d. 3-5hr
61
regular insulin
onset, peak, duration
o. 30-60 min; p. 2-4 hr; d. 6-12 hr
62
NPH
onset, peak, duration
o. 1-1.5 hr; p. 4-12 hr; d. 18-24 hr
63
glargine
onset, duration
o. 1-2 hr; d. 24 hr
64
glipizide & glyburide indication
DM
65
glipizide & glyburide action
stimulate beta cells to release insulin
66
glipizide & glyburide adverse effects (6)
**GI/endo**—hypoglycemia; wt gain; nvd; heartburn;
hepatotoxicity
**Imm—**hypersensitivity reactions
67
glipizide & glyburide - monitor (1)
glucose
68
glipizide & glyburide caution
alcohol causes disulfiram-like reaction
| (flushing, palpitations, nausea)
69
advantages of 2nd generation sulfonylureas
2nd generation effective at lower doses; longer duration; fewer side effects
70
metformin indication
DM
71
metformin action (5)
↓ hepatic glucose production
↓ insulin resistance
alters glucose absorption
↓ triglycerides & LDL
promotes wt loss
72
metformin adverse effects (2)
* *GI/endo**—severe nvd
* *Other—**lactic acidosis (rare)
73
metformin - monitor (1)
liver function tests
74
which oral DM drugs do NOT cause hypoglycemia?
biguanides
alpha-glucosidase inhibitors
75
acarbose action
delays glucose digestion
76
acarbose adverse effects (4)
**GI/endo**—cramping; distension; diarhhea; flatulence
77
which patients are prescribed acarbose?
who can't achieve control of glucose levels with diet alone
78
acarbose indication
DM
79
rosiglitazone indication
DM
80
rosiglitazone action
↓ insulin resistance
81
rosiglitazone adverse effects (2)
* *CV—**↑ risk for adverse events
* *F & E—**fluid retention
82
rosiglitazone contraindications (2)
symtomatic heart disease
CHF
83
repaglinine indication
DM
84
repaglinine action
stimulates beta cells to release insulin
85
repaglinine adverse effect (1)
**GI/endo**—hypoglycemia
86
repaglinine - monitor (2)
liver function tests
glucose
87
short acting oral DM drug
repaglinine
88
exenatide, liraglutide & sitagliptin indication
DM
89
exenatide, liraglutide & sitagliptin action (4)
↑ incretin hormone causes ↑ insulin release
↓ glucagon production
↑ fullness - ↓ food intake
slow gastric emptying
90
captopril, enalapril & lisinopril indication
HTN
91
captopril, enalapril & lisinopril action (5)
what is excreted & what is retained?
**inhibits angiotensin II formation**
blocks vasoconstriction
blocks aldosterone release
Na+ & water excreted
K+ retained
92
captopril, enalapril & lisinopril adverse effects (12)
**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
captopril, enalapril & lisinopril caution (2)
first dose reaction—ortho hypotension
with K-sparing diuretics (hyperkalemia)
94
captopril, enalapril & lisinopril interventions (2)
start with low dose
monitor for first dose reaction (orthostatic hypotension)
95
losartan & valsartan indication
HTN
96
losartan & valsartan action (3)
prevents angiotensin II from reaching receptors
vasodilation
↓ peripheral resistance
97
losartan & valsartan adverse effects (5)
* *Neuro**—dizzyness; h/a
* *CV**—hypotension
* *GI/endo**—diarrhea; abd pain
98
how can ACE inhibitors affect HR?
tachycardia
arrhythmias
99
how can ACE inhibitors affect K+?
hyperkalemia
100
prazosin & doxazosin indication
HTN
101
prazosin & doxazosin action (2)
block alpha-1 receptors
vasodilation
102
prazosin & doxazosin adverse effects (10)
* *Neuro**—dizzyness; h/a
* *CV—**hypotension; tachycardia; flushing
* *Resp—**nasal congestion
* *GI/endo—**n/d; dyspepsia
* *F & E**—edema
* *Rep—**priapism (prolonged erection)
103
how can alpha-1 inhibitors affect HR?
tachycardia
104
how can alpha-1 inhibitors affect the reproductive system?
priapism
105
atenolol, metoprolol & nebivolol indication
HTN
106
atenolol, metoprolol & nebivolol action (3)
block beta receptors in kidney to inhibit renin
↓ HR, myocardial contraction, CO
↑ renal perfusion
107
atenolol, metoprolol & nebivolol adverse effects (12)
* *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
how can beta blockers affect the reproductive system
decrease libido
109
how can beta blockers affect the cardiovascular system? (6)
bradycardia
decreased CO
AV block
rebound myocardium
heart failure
arrhythmias
110
beta blockers intervention
assess HR & BP before giving
111
beta blockers can mask…
sx of hypoglycemia
112
beta blockers caution
do not give with Ca+ channel blockers
113
nifedipine & diltiazem indications (4)
chronic HTN
angina
dysrhythmias
premature labor contractions
114
nifedipine & diltiazem action (3)
block Ca+ channel in vascular smooth muscle
vasodilation
uterine relaxation
115
nifedipine & diltiazem adverse effects (5)
* *Neuro**—dizzyness; h/a
* *CV**—bradycardia; flushing
* *F & E**—peripheral edema
116
how can nifedipine & diltiazem affect HR
bradycardia
117
nifedipine & diltiazem caution (2)
NO grapefruit juice
do NOT give with beta blockers
118
hydralazine & nitroprusside indication
severe HTN
**nitroprusside**—hypertensive emergency
119
nitroprusside & hydralazine action (2)
relax smooth muscle of arteries
vasodilation
120
nitroprusside & hydralazine adverse effects (3)
* *CV—**reflex tachycardia
* *F & E**—Na+ & water retention; peripheral edema
121
how can nitroprusside & hydralazine affect HR?
reflex tachycardia
122
how can nitroprusside & hydralazine affect sodium?
retention
123
tx for reflex tachycardia
beta blocker
124
what might nitroprusside & hydralazine be given with and why? (2)
beta blockers for reflex tachycardia
diuretics for fluid retention
125
furosemide indications
HTN
pulmonary edema
126
furosemide action (2)
act on loop of Henle
↓ Na+, Cl-, water
127
furosemide adverse effects (5)
* *Neuro—**ototoxicity
* *CV—**dysrhythmias (hypokalemia); hypotension
* *F & E**—severe F & E losses; dehydration
128
furosemide - monitor for…(4)
dehydration
↓ electrolytes
hyperglycemia
↑ uric acid
129
furosemide caution
hot climates (dehydration, vasodilation)
130
very strong diuretic
furosemide
131
hydrochlorothiazide indications
HTN
mild/moderate HF
132
hydrochlorothiazide action (2)
act on distal convoluted tubule
Ca+ reabsorption
133
hydrochlorothiazide adverse effect
**MS**—gout (uric acid)
134
hydrochlorothiazide - monitor (4)
dehydration
hypokalemia
hyperglycemia
↑ uric acid
135
how can hydrochlorothiazide effect K+?
hypokalemia
136
which diuretic can cause gout?
hydrochlorothiazide
137
slow acting diuretic
hydrochlorothiazide
138
spironolactone indication
HTN
139
spironolactone action (3)
act on collecting duct & late distal tubules
Na+ excretion
K+ retention
140
spironolactone adverse effect (1)
**F & E**—hyperkalemia
141
spironolactone - monitor (1)
what may pts need?
K+ levels
a K+ supplement
142
spironolactone caution
with ACE inhibitors
| (hyperkalemia)
143
weaker diuretic used with other diuretics
spironolactone
144
digoxin action (7)
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
digoxin indication
HF
146
digoxin sx of toxicity (5)
* *Neuro**—vision changes (green/yellow halos, blur, double)
* *CV**—bradycardia
* *GI/endo**—n/v; abd pain; anorexia
147
digoxin - monitor (3)
drug level
puls
K+ levels
148
digoxin interventions (4)
hold if \<60bpm
take drug same time each day
follow-up exams important
avoid OTC meds w/o asking PCP
149
digoxin caution
hypokalemia—↑ risk toxicity
150
digoxin TR
0.5-1.8 ng/mL
151
antidote to digoxin
digoxin immune fab (DigiFab; Digibind)
152
what slows absorption of digoxin?
antacids
antidiarrheals
153
hydralazine, isosorbine dinitrate & BiDil indications
HF, especially in African Americans
154
hydralazine, isosorbine dinitrate & BiDil action (5)
↓ cardiac workload
vasodilation
↓ preload
↓ BP
Na+ & water retained
155
hydralazine, isosorbine dinitrate & BiDil adverse effect
* *CV—**reflex tachycardia
* *F & E**—peripheral edema
156
milrinone indication
severe HF
157
milrinone action
↑ CO
↑ force myocardial contraction
↑ available Ca+
vasodilation
158
milrinone adverse effects (4)
* *CV**—arrhythmias; hypotension; thrombocytopenia
* *GI/endo**—n/v
159
use milrinone for…
| (time period)
no more than 2-3 days
160
procainamide indications
a-fib
PACs
PCVs
V-tach
161
propanolol indications
a-flutter
a-fib
tachydysrhythmias
ventricular dysrhythmias
162
amiodorone indication
severe dysrhythmias (atrial & vent)
163
verapamil indications (2)
paroxysmal SVT
supraventricular tachycardia
164
beta blockers contraindication
asthma
165
may be given with Ca+ channel blockers for peripheral edema
diuretics
166
beta blockers used to treat HTN vs arrhythmias vs angina
**HTN** — atenolol; metoprolol; nebivolol
**arrhythmias** — propanolol
**angina** — metoprolol; carvidolol
167
nitroglycerin indication
acute angina
168
nitroglycerin action (5)
**vasodilator**
dilates veins & capillaries
↓ vascular resistance
dilate coronary arteries
↓ cardiac workload
169
nitroglycerin routes (5)
nasal spray
IV
topical
PO
sublingual
170
nitroglycerin adverse effects (6)
* *Neuro—**severe h/a; dizzyness
* *CV—**hypotension; reflex tachycardia; flushing
* *GI/endo—**n/v
171
how can nitroglycerin affect HR and BP?
hypotension
reflex tachycardia
172
nitroglycerin - monitor (1)
BP before and after giving
173
how to take nitroglycerin tablets
take 1 tablet q 5 mins - max 3 tablets
if pain not relieved in 10-15 mins, call 911
174
carvidolol indication
angina
175
statins indication
HLD
176
statins action (3)
inhibit HMG CoA reductase
↓ LDL
↑ HDL
177
statins adverse effects (9)
* *Neuro**—h/a
* *GI/endo—**↑ liver enzymes; abd pain; flatulence; cramps; constipation
* *F & E**—acute renal failure
* *MS—**rhabdomylysis
* *Integ—**rash
178
statins caution (3)
NO grapefruit or citrus
NO alcohol
do not take during pregnancy
179
when do we see effects of statins?
effect in 2 weeks
therapeutic effect 2-4 weeks
180
what kind of supplement may be given with statins?
CoQ10
181
not systemically absorbed
excreted in feces
often combined with statins
cholestyramine
182
cholestyramine indication
HLD
183
cholestyramine action (2)
binds with bile acids in intestine
↓ LDL
184
cholestyramine adverse effects (7)
* *CV—**↑ bleeding time
* *F & E—**hypokalemia
* *GI/endo—**bloating; constipation; flatulence; hemorrhoids; interference c vitamin & mineral absorption
185
how can cholestyramine affect K+?
what can result?
hypokalemia
increased bleeding time
186
cholestyramine often combined with…
statins
187
gemfibrozil indications
HLD
extremely high tryglyceride levels
188
gemfibrozil action (2)
↓ triglycerides
↓ VLDL
189
gemfibrozil adverse effects (4)
* *GI/endo**—dyspepsia; n/v/d; abd pain
* *MS**—muscle pain
190
how to take gemfibrozil
with meals
191
do not use with statins because it increases risk of rhabdo
gemfibrozil
| (fibric acid agents)
192
gemfibrozil contraindications
gallbladder disease
liver disease
193
niacin indication
HLD
194
niacin action (2)
↓ VLDL & LDL
inhibits release of fatty acids
195
niacin adverse effects (6)
* *CV**—severe flushing; palpitations
* *GI/endo**—hyperglycemia; n/d; bloating
* *Integ**—pruritus
196
can cause severe flushing
interventions?
niacin
use brand that doesn't cause flushing
take aspirin 30 mins prior
197
niacin contraindication
DM
198
niacin typical dose & maximum dose
usually 2-3 g/day
do not exceed 6 g/day
199
ezetimibe indication
HLD
200
ezetimibe action (3)
works in sm intestine
inhibits cholesterol absorption
↓ LDL & triglycerides
201
ezetimibe adverse effects (6)
* *Resp**—URIs
* *GI/endo**—abd pain; hepatitis; diarrhea
* *MS**—muscle pain; arthralgia
202
which lipid lowering drugs are combined with statins?
ezetimibe (cholesterol absorption inhibitor)
cholestyramine (bile acid sequestrant)
203
drug causing cholelithiasis & gallbladder disease
octreotide
204
drugs causing water intoxication
desmopressin
vasopressin
205
drugs causing mood changes, hyperglycemia, osteoporosis, and Cushing's
steroids
206
drug causing hair loss
levothyroxine
207
drugs causing emotional dullness
propylthiouracil
methIMAzole
208
drug causing lactic acidosis (in rare cases)
metformin
209
drugs causing persistant dry cough
ACE inhibitors
“-pril"s
210
drugs causing priapism
alpha-1 blockers
“zosin”s
211
drugs causing depression, bronchospasm, many heart issues and decreased libido
beta blockers
“olol”s
212
drugs causing peripheral edema and bradycardia
Ca+ channel blockers
213
drug causing ototoxiciy & dehydration
furosemide
214
drug causing gout
hydrochlorothiazide
215
drug causing green halos, blurred vision, double vision when toxic
digoxin
216
drug causing thrombocytopenia
milrinone
217
drug causing severe h/a, even for nurses who handle it
nitroglycerin
218
drugs causing rhabdo & acute renal failure
statins
219
drug causing worsened hemorrhoids & malabsorption of vitamins & minerals
cholestyramine
220
drug causing severe flushing and hyperglycemia
niacin
221
drug causing URIs
ezetimibe
222
what effect does niacin have on glucose?
hyperglycemia
