Exam 4 Medications Flashcards
1
Q
Ranitidine (Zantac)
A
- Indication: GERD
- mostly replaced by PPIs for PUD, chronic GERD
- MOA: H2 receptor antagonist
- Elimination: hepatic, renal
- Side Effects:
- headache, fatigue, dizziness, N/V/D/C
- dry mouth
- confusion, delirium, hallucination
- Interactions:
- antacids have small effect on absorption
2
Q
Omeprazole (Prilosec)
A
- Indication: GERD, PUD
- MOA: PPI
- Elimination: hepatic metabolism, renal excretion
- Side Effects:
- headache, hypergastrinemia, B12 deficiency, rebound hypersecretion
- Interactions:
- decrease ketoconaozole
- increase digoxin absorption, toxicity
- clopidogrel (inhibits CYP2C19 which converts to active form)
- Key points:
- prodrug that converts in acidic environment in STOMACH
- active form rapidly forms covalent bond with H/K pump
- active form metabolized by liver
- formulated in enteric-coated granules that remain intact until they reach alkaline environment of duodenum for absorption
- never open, crush, chew tablet
- taper med because of rebound hypersecretion
3
Q
Sucralfate (Carafate)
A
- Indication: GERD, PUD
- MOA: mucosal surface proteciton
- Advantage: mostly non-absorbed (90% eliminated in feces)
- Disadvantage: aluminum absorption possible
- Dosing: empty stomach
- Side Effects: dry mouth, N/C
- Interactions:
- impede absorption of phenytoin, digoxin, fluoroquinolones, warfarin
- 2 hrs before/after these meds
4
Q
Ferrous Sulfate (Feosol, FeroSul, others)
A
- Indication: iron deficiency anemia. Not for dialysis
- MOA: increases iron stores for hemoglobin
- Onset: 6-8 weeks for anemia amelioration, 6 mo for repletion of iron stores
- Elimination: small amounts through hair, nails, skin, feces
- Side Effects:
- teeth staining (liquid form)
- GI, N/C
- Administration
- food may decrease GI effects, but also absorption
- Vitamin C/orange juice may increase absorption, but increases GI effects
- Adverse rxns:
- toxicity in pediatric patients
- Interactions:
- anatacids (decrease absoprtion)
- tetracycline (decrease absorption of both)
5
Q
Iron Dextran (InFeD, DexFerrum)
A
- Indication: iron deficiency anemia in certain patients (hemodialysis, intestinal disease, post-bariatric surgery)
- MOA: increases iron stores for hemoglobin
- Dose: PARENTERAL only (IV)
- Onset: 1 wk. Duration: months
- Elimination: dextran metabolized/excreted, trace iron excreted via urine
- Adverse Effects:
- hypotension, headache, fever, urticaria
- fatal anaphylactic rxns (slow IV, small doses, test dose required)
- Interactions: oral iron products (decreases absorption)
6
Q
Epoetin alfa (Procrit, Epogen, Eprex)
A
- Indication: anemia of CKD, chemotherapy, elective surgery
- MOA: like endogenous erythropoietin
- Correct iron, B12, folate deficiencies before treatment
- Onset: 7-10 days.
- Duration: 2 wks
- Elimination: mainly in feces, 10% unchanged in urine
- Adverse Effects:
- hypertension, stroke, MI, HF, cardiac arrest, DVT
- black box warning when Hgb > 11
- rare autoimmune pure red cell aplasia
- Interactions: estrogens, oral contraceptives - thrombosis
7
Q
Sevelamer HCl (Renagel)
A
- Indication: hyperphosphatemia in hemodialysis patients
- MOA: binds phosphate in intestine to decrease serum phosphate
- Dose: depends on serum phosphate level, intial and mainteance. take with food. tablet or powder for oral suspension
- Onset: reduction in serum phosphate 1-2 wks
- Absorption: not systemic
- Elimination: unchanged in feces. drug is non-absorbed polymer
- Adverse Effects: N/V/D/C, dyspepsia, abdominal pain
- fecal impaction (polymer absorbs water)
- metabolic acidosis
- Interactions: quinolone antibiotics (2 hrs before or 6 hrs after sevelamer) - reductions in Vit. E, K, folic acid absorption
- Note: tablets should be swallowed WHOLE. will rapidly expand in water and could be a choking hazard
- Note:
- can reduce LDL cholesterol
8
Q
Vitamin D replacement
A
- calcium and phosphorus homeostatis
- bone health
- early use may prevent secondary hyperparathyroidism
- ergocalciferol (Vit. D2 -plant) and cholecalciferol (Vit. D3-human)
- kidney converts both to biologically active form
9
Q
Fluoextine (Prozac)
A
- Indication: depression, OCD, panic, premenstrual dysphoric disorder, bulimia nervosa, bipolar
- off label: social phobia, PTSD
- MOA: SSRI
- Absorption: well absored w/w/o food
- Elimination: hepatic metabolism
- Long half life (7 days) makes it a good med for patients who forget to take medications
- Adverse Effects:
- sexual dysfxn, nausea, headache, nervousness, insomnia, anxiety, weight gain
- extrapyramidal (motor) Sx, bruxism, bleeding disorders, hyponatremia, serotonin syndrome, suicide risk, withdrawal
- Caution: pts w/ liver disease, pregnancy
- Interactions:
- MAOIs - increase serotonin syndrome risk
- TCAs and lithium - elevated levels
- antiplatelet drugs - bleeding
- substrates for/inhibitors of CYPD2D6
10
Q
Venlafazine (Effexor)
A
- Indication: depression, gen. anxiety, social anxiety, panic
- MOA: SNRI
- Absorption: well absorbed orally, ER formulation w/ food (swallow whole)
- Elimination: hepatic metabolism
- Adverse Effects:
- nausea, headache, anorexia, nervousness, sweating, somnolence, insomnia, sexual dysfxn, diastolic HTN
- sustained mydriasis, hyponatremia, serotonin sydrome, suicide risk, intense withdrawal, neonatal abstinence syndrome
- Interactions:
- MAOIs, SNRIs, SSRIs
11
Q
Bupropion (Wellbutrin)
A
- Drug Class: atypical
- Indication: depression, SAD, smoking cessation
- off label: neuropathic pain, ADHD
- MOA: unclear
- likely blocks DA and/or NE reputake, not 5HT
- Absorption: low bioavailability
- Elimination: hepatic metabolism
- Adverse Effects:
- agitation, headache, dry mouth, constipation, weight loss, GI upset, dizziness, tremor, insomnia, blurred vision, tachycardia
- increase in sexual desire
- may increase anxiety
- seizures, psychotic symptoms, suicide risk, withdrawal
- Interactions:
- drugs that inhibit CYP2B6
- MAOIs
12
Q
Mirtazapine (Remeron)
A
- Drug Class: atypical
- Indication: major depression esp. w/ insomnia
- MOA: tetracyclic
- increases 5-HT, NE release via blocking presynpatic a2-adrenergic receptors
- blocks some 5-HT and histamine receptors
- promotes sedation and appetite
- Absoprtion: well absorbed orally
- Elimination: hepatic
- excretion in urine and feces
- Adverse Effects:
- somnolence, weight gain, increased appetite, increased cholersterol
- minimal sexual dysfxn, mild anticholinergic effects
- suicide risk, withdrawal
- Interactions:
- MAOIs
- alcohol, benzodiazepines, CNS depressants - increase somnolence
13
Q
Alprazolam (Xanax)
A
- Drug Class: benzodiazepine
- Indication: generalized anxiety/panic
- MOA: potentiates action of GABA at GABAA receptor-chloride channel complex
- Dose: titrate slowly, taper to discontinue. extended release for panic disorders
- Absorption: well absorbed PO
- Onset: rapid. 90% of peak effects w/in 1 hr
- Elimination: hepatic
- excreted in urine
- Adverse Effects:
- sedation, drowsiness, fatigue, dizziness, amnesia, rash, dry mouth
- respiratory depression, seizures, hypotension, syncope, paradoxical CNS stimulation, angioedema
- Interactions:
- alcohol
- CNS depressants
- CPY3A4 inhibitors
14
Q
Buspiron (BuSpar)
A
- Drug Class: other anxiolytic
- Indication: generalized anxiety
- MOA: exact is unknown
- binds w/ high affinity to 5-HT receptors and low affinity to DA receptors
- does NOT bind to GABA or benzodiazepines
- Onset: slow. intial response = 1 wk, full effect several weeks. NOT PRN
- Elimination: hepatic
- food delays absorption, but enhances bioavailability
- Adverse Effects:
- dizziness, nausea, headaches, nervousness, lightheadedness, excitement
- serotonin syndrome, EPS, hostility, depression
- Interactions:
- CYP450 3A4 inhibitors/inducers
- Erythromycin, ketoconazole. grapefruit (increase buspirone)
15
Q
Phenytoin (Dilantin)
A
- Drug Class: AED
- Indication: partial, tonic/clonic seizure
- MOA: Na channel inhibition
- Absorption: saturates with high PO
- Duration: varies with dose
- Elimination: saturable hepatic metabolism; highly protein bound
- Administration: w/ food
- Effects:
- acute: cognitive impairment, slurred speech
- chronic: gingival hyperplasia, hirsutism, skin thickening, folate deficiency, acne, bone disease
- adverse: hepatitis, photosensitivity, rash, SJS, TEN
- Interactons:
- CYP3A4, 2C drugs
- decreased effect of oral contraceptives, warfarin, glucocorticoids
- increased levels of diazepam, isoniazid, cimetidine, alcohol, valproic acid
