Exam 4 Meds

Question 1

Prednisone

Answer 1

Corticosteroids/Glucocorticoids

For
* Short-term treatment of many inflammatory disorders. To relieve discomfort. To give the body a chance to heal from the effects of inflammation. In illnesses like cancer, ulcerative colitis, asthma, anaphylaxis/allergies.

MOA
* Enter target cells and bind to cytoplasmic receptors. Initiate many complex reactions responsible for anti-inflammatory and immunosuppressive effects, Hydrocortisone, cortisone, and prednisone have some mineralocorticoid activity

AE
* Related to route of administration. Systemic use is associated with endocrine disorders. HA, HTN, agitation, weight gain, can induce DM, Na/H20 retention, immunosuppression, impaired wound healing

CI: Known allergy, Acute infection, Lactation
Caution: Diabetes, Acute peptic ulcer, infection

Drug
* Increase in drug when given with erythromycin, ketoconazole, or troleandomycin. Decrease in drug when given with salicylates, barbiturates, phenytoin, or rifampin.

Question 2

Cortisone

Answer 2

Mineralocorticoid

For
* Replacement therapy in primary and secondary adrenal
insufficiency

MOA
* Holds sodium, and with it, water in the body. Causes the excretion of potassium & hydrogen by acting on the renal tubule

AE
* Increase fluid volumes. Allergic reactions. Headaches, arthralgias. Heart failure

CI: Known allergy. HTN. CHF. Cardiac disease
Caution: Pregnancy. Presence of any infection. High sodium intake

Drug
* Decrease effectiveness with salicylates, barbiturates, hydantoins, rifampin, and anticholinesterases

Question 3

7 S’s of Steroid Precautions

Answer 3

1. Swollen: water gain = weight gain, report 1lb in 1 day or 2-3lbs in a few days
2. Sepsis: low WBC, fever is priority
3. Sugar: increases, hyperglycemia
4. Skinny: muscles and bones - osteoporosis
5. Sight: cataract risk - refer to optometrist
6. Slowly taper off: prevent adisonian crisis
7. Stress and surgery: increase the dose

Question 4

Levothyroxine

Answer 4

Thyroid Replacement Hormones

For
* Replacement therapy in hypothyroidism; pituitary TSH suppression in the treatment of euthyroid goiters, management of thyroid cancer; thyrotoxicosis in conjunction with other therapy; myxedema coma
* “Leaves T3 and T4 in the body”
* L = life long drug; long, slow onset (3-4 wks)
* E = early morning on empty stomach (30-60 min before eating)
* V = very hyper, high HR/BP/temp, report agitation and confusion

MOA
* Increases the metabolic rate of body tissues, increasing oxygen consumption, respiration, and heart rate; the rate of fat, protein, and carbohydrate metabolism; and growth and maturation

AE
* Skin reactions, Symptoms of hyperthyroidism, Cardiac stimulation, CNS effects, Nervousness, palpitations, NVD, HA, tachycardia, loss of hair (children)
* Assess for MI, Addison’s disease, VS, hormone levels, Thyrotoxicosis, thyroid storm

CI: Known allergy, Thyrotoxicosis, Acute MI
Caution: Lactation, Hypoadrenal conditions such as Addison’s
* preg safe!

Drug
* Cholestyramine, Oral anticoagulants, Digitalis, Theophylline

Question 5

Propylthiouracil / Sodium Iodine

Answer 5

Antithyroid Agents

For
* hyperthyroidism
* PTU = puts the thyroid underground

MOA
* Thioamides: prevent formation of thyroid hormone within the thyroid cells, lowering the serum level, partially inhibit conversion of T4 to T3
* Iodine Solutions: high doses block thyroid function

AE
* Thioamides: Thyroid suppression
* Iodine Solutions: Hypothyroidism - resp failure

CI: Known allergy, pregnancy
Caution: Lactation

Drug
* Thioamides: Oral anticoagulants, theophylline, metoptolol, propranolol, digitalis
* Iodine Solutions: Anticoagulants, theophylline, digoxin, metoprolol, propranolol

Question 6

Alendronate (Fosamax) / ibandronate (Boniva)

Answer 6

Bisphosphonates

For
* Osteoporosis, Padget’s disease, Steroid induced osteoporosis

MOA
* Slow or block bone resorption; by doing this, they help to lower serum calcium levels, but they do not inhibit normal bone formation and mineralization

AE
* headache, NVD; bone pain with Paget’s disease

CI: Bisphosphonates- Hypocalcemia, pregnancy and lactation, renal dysfunction, GI disease

Drug
* antacids, calcium products, iron, or multiple vitamins and aspirin

Question 7

Insulin

Answer 7

For
* Treatment of type 1 diabetes mellitus
* Treatment of type 2 diabetes mellitus in patients whose diabetes cannot be controlled by diet or other agents

MOA
* Hormone that promotes the storage of the body’s fuels, Facilitates the transport of various metabolites and ions across cell membranes, Simulates the synthesis of glycogen from glucose, Reacts with specific receptor sites on the cells.

AE
* hypoglycemia, ketoacidosis

Caution: Pregnancy and lactation

Drug
* When given with any drug that decreases glucose levels; Beta blockers

Question 8

Glyburide

Answer 8

Sulfonylureas

For
* T1DM
* T2DM where diabetes cannot be controlled by diet and other agents
* Adjunct to diet and exercise to lower blood glucose in T2

MOA
* Bind to potassium channels on pancreatic beta cells, may improve insulin binding to insulin receptors and increase number of insulin recep tors
* Stimulate insulin release from beta cells in the pancreas; they improve binding to insulin receptors

AE
* NVD , skin reactions, hypoglycemia

CI: T1, diabetic complications, allergy
Caution: preg and lactation

Drug
* do not intereact with as many protein bound drugs
* drugs that acidifies the urine, Beta Blockers, alcohol

Question 9

Glucagon

Answer 9

Glucose Elevating Agent

For
* Treatment of hypoglycemia
* Raise the blood level of glucose when severe hypoglycemia occurs (<40 mg/dL)

MOA
* Increase the blood glucose levels by decreasing insulin release and accelerating the breakdown of glycogen in the liver to release glucose

AE
* GI upset; Vascular effects

CI: Known allergy; Pregnancy and lactation
Caution: Hepatic dysfunction or cardiovascular disease

Drug
* Thiazide diuretics; Anticoagulants

Question 10

Glargine (Lantus)

Answer 10

Long Acting Insulin
* no peak
* no mix
* “old guys”
* duration: 24 hrs
* “large lasting”

Question 11

NPH

Answer 11

Intermediate Acting Insulin
* never IV
* mix clear to cloudy
* given 2x a day
* duration 14 hrs
* Peak: 4-12 hrs

Question 12

Regular Insulin

Answer 12

Short-Acting Insulin
* Ready to go IV
* the ONLY IV insulin
* Duration: 5-8 hrs
* Peak: 2-4 hrs

Question 13

Lispro / Aspart

Answer 13

Rapid Acting Insulin
* Most Deadly - 15 min onset
* Must be given during meals
* Duration 2-5 hrs
* Peak 30-90 min
* Always monitor for hypoglycemia

Question 14

Metformin

Answer 14

Biguanide
* reduce output of glucose through liver and increase insulin sensitivity
* minimal chance of low sugar
* major liver and kidney toxic
* Hold 48 hrs before cath lab: lactic acidosis

Question 15

Cimetidine

Answer 15

Histamine-2 Antagonist
“-tidine”

For
* Short-term treatment of active duodenal ulcer or benign gastric ulcer. Treatment of pathological hypersecretory conditions such as Zollinger–Ellison syndrome. Prophylaxis of stress-induced ulcers and acute upper GI bleeding in critical patients. Treatment of erosive gastroesophageal reflux. Relief of symptoms of heartburn, acid indigestion, and sour stomach (OTC preparations)

MOA
* Block the release of hydrochloric acid in response to gastrin
* Selectively block histamine-2 receptor sites. This blocking leads to a reduction in gastric acid secretion and reduction in overall pepsin production

AE
* GI effects (diarrhea), CNS effects (dizzy, somnolence, HA), Cardiac arrhythmias and hypotension

CI: Known allergy
Caution: Pregnancy, lactation, renal/liver impairment

Drug
* Warfarin, phenytoin, beta blockers, alcohol, quinidine, lidocaine, theophylline, chloroquine, benzodiazepines, nifedipine, pentoxifylline, tricyclics, procainamide, and carbamazepine

Question 16

Sodium Bicarbonate

Aluminum salts, Magnesium salts, Calcium salts

Answer 16

Antacids

For
* Symptomatic relief of upset stomach associated with hyperacidity, as well as hyperactivity

MOA
* A group of inorganic chemicals that neutralize stomach acid
* Neutralize stomach acid by direct chemical reaction

AE
* Relate to their effects on acid-base levels and electrolytes, Rebound acidity, Alkalosis, Hypercalcemia, Constipation or diarrhea, Hypophosphatemia
* Hypokalemia – intracellular K+ shift.

CI: Known allergy
Caution: Any condition that can be exacerbated by electrolyte imbalance
GI obstruction

Drug
* many drugs - affects the absorption

Question 17

Omeprazole

Answer 17

PPI
“-prazole”

For
* Short-term treatment of active duodenal ulcers, GERD, erosive esophagitis, and benign active gastric disease.
* Long-term treatment of pathological hypersecretory conditions

MOA
* Suppress the secretion of hydrochloric acid into the lumen of the stomach
* Act at specific secretory surface receptors to prevent the final step of acid production and thereby decrease the level of acid in the stomach

AE
* CNS effects: Dizziness, headache, asthenia, vertigo, insomnia, apathy.
* GI Effects: Diarrhea, abdominal pain, and tongue atrophy.
* Upper respiratory tract symptoms: Cough, stuff nose, hoarseness, and epistaxis.
* Other: Rash, alopecia, pruritis, dry skin, back pain, and fever

CI: Known allergy
Caution: pregnancy/lactation

Drug
* Benzodiazepines, phenytoin, warfarin. Ketoconazole, theophylline. Sucralfate, Clopidogrel

Question 18

Sucralfate

Answer 18

GI Protectant

For
* Ulcer healing
* Take on an empty stomach: 1-2 hrs before or after food or meds
* Best at bedtime

MOA
* Coat any injured area in the stomach to prevent further injury from acid
* Forms an ulcer-adherent complex at duodenal ulcer sites, protecting the sites against acid, pepsin, and bile salts

AE
* GI effects – Constipation, diarrhea, nausea, indigestion, gastric discomfort, dry mouth, Dizziness, Sleepiness. Vertigo. Skin rash. Back pain

CI: Known allergy, renal failure
Caution: pregnancy/lactation

Drug
* Aluminum salts
* Phenytoin, fluoroquinolone, or penicillamine

Question 19

Misoprostol

Answer 19

Prostaglandin

For
* Protect the stomach lining
* Prevention of NSAID-induced gastric ulcers: on an NSAID therapy
* Treatment of duodenal ulcers

MOA
* Inhibits gastric acid secretion and increases bicarbonate and mucous production in the stomach

AE
* GI effects – Nausea, diarrhea, abdominal pain, flatulence, vomiting, dyspepsia, and constipation; GU effects – Miscarriages, excessive bleeding, spotting, cramping, hypermenorrhea, dysmenorrhea, and other menstrual disorders, increases cervical ripening

CI: Pregnancy - have to give preg test before taking this
Caution: Lactation

Drug
* Aluminum salts, antacids
* Phenytoin, fluoroquinolone, or penicillamine

Question 20

Pancrelipase

Answer 20

Digestive Enzymes

For
* Substances produced in the GI tract to break down foods into usable nutrients
* Replacement therapy for CF patients
* Must be eaten with every meal and snack
* Open capsule and sprinkle contents on food without chewing

MOA
* Saliva substitute – Contains electrolytes and carboxymethylcellulose to act as a thickening agent in dry mouth conditions. Pancreatic enzymes are replacement enzymes that help the digestion and absorption of fats, proteins, and carbohydrates

AE
* Saliva – Complications from abnormal electrolytes – increased levels of magnesium, sodium, or potassium
Pancreatic enzyme – GI irritation, nausea, abdominal cramps, and diarrhea

CI: Saliva – Allergy; Pancreatic enzymes - Allergy
Caution: Saliva – CHF, hypertension, or renal failure; Pancreatic enzyme – Pregnancy and lactation

Drug
* Aluminum salts
* Phenytoin, fluoroquinolone, or penicillamine

Question 21

Castor Oil

Bisacodyl, Senna

Answer 21

Chemical Stimulant

For
* Producing stool

MOA
* Begin working at the beginning of the small intestine and increase motility throughout the rest of the GI tract by irritating the nerve plexus
* Chemically irritate the lining of the GI tract

AE
* GI: diarrhea, abdominal cramping, nausea. CNS: dizziness, headache, weakness. Sweating, palpitations, flushing,
fainting. Cathartic dependence. Castor oil: blocks absorption of fats and fat-soluble vitamins
ASSESS for: Fecal impaction or intestinal obstruction, acute abdominal pain, abdomen and BS, elimination pattern,
nausea, or vomiting

CI: Acute Abdominal Disorder
Caution: Heart block, CAD, debilitation. Pregnancy and lactation

Question 22

Psyllium / Methylcellulose

Answer 22

Laxatives - Bulk Stimulants

For
* Producing stool

MOA
* Increase motility by increasing size of fecal material, which will increase fluid in the GI tract, cause more stretch on GI tract, stimulate local stretch receptors, and activate local GI activity
* Cause the fecal matter to increase in bulk

AE
* *GI: diarrhea, abdominal cramping, nausea. CNS: dizziness, headache, weakness. Sweating,
palpitations, flushing, fainting
ASSESS for: Fecal impaction or intestinal obstruction, acute abdominal pain, abdomen and BS, elimination pattern, nausea, or vomiting

CI: Acute Abdominal Disorder
Caution: Heart block, CAD, debilitation. Pregnancy and lactation

Drug
* other prescribed meds

Question 23

Magnesium Citrate

Answer 23

Saline Laxatives

For
* Producing Stool

MOA
* Draw more water into GI tract and stimulate increased GI motility

AE
* GI: diarrhea, abdominal cramping, abdominal bloating, nausea; dehydration: dry mouth, dizziness, light-
headedness. CNS: dizziness, headache, weakness. Sweating, palpitations, flushing, fainting. Rectal irritation
* ASSESS for: Fecal impaction or intestinal obstruction, acute abdominal pain, abdomen and BS, elimination pattern, nausea, or vomiting

CI: Lactulose: appendicitis, acute surgical abdomen, fecal impaction, intestinal obstruction
Caution: Lactulose: Diabetes. Magnesium: Renal insufficiency. Polyethylene glycol: seizures

Drug
* Other prescriptions. Magnesium: neuromuscular junction blockers

Question 24

Sodium Docusate

Answer 24

Stool Softener
* Increases water content in the stools to soften bowels

Question 25

Mineral Oil

Answer 25

Lubricant

For
* Producing Stool

MOA
* Forms a slippery coat on the contents of the intestinal tract

AE
* GI: diarrhea, abdominal cramping, nausea; leakage and staining with mineral oil. CNS: dizziness, headache, weakness. Sweating, palpitations, flushing, fainting
* ASSESS for: Fecal impaction or intestinal obstruction, acute abdominal pain, abdomen and BS, elimination pattern, nausea, or vomiting

CI: Allergy. Acute abdominal disorders
Caution: Heart block, CAD, debilitation. Pregnancy and lactation

Drug
* Frequent use of mineral oil can interfere with absorption of the fat-soluble vitamins A, D, E, and K

Question 26

Metoclopramide

Answer 26

Gastrointestinal Stimulant

For
* Rapid movement of GI contents

MOA
* Blocks dopamine receptors and makes the GI cells more sensitive to acetylcholine. Leads to increased GI activity and rapid movement of food through the upper GI tract
* Stimulate parasympathetic activity within the GI tract. Increase GI secretions and motility

AE
* Nausea, vomiting, diarrhea, intestinal spasms, cramping, decreased blood pressure and heart rate, weakness, and
fatigue
* ASSESS for: Fecal impaction or intestinal obstruction, acute abdominal pain, abdomen and BS, elimination pattern, nausea, or vomiting

CI: Allergy. GI obstruction
Caution: Pregnancy. Lactation

Drug
* Digoxin. Cyclosporine. Alcohol

Question 27

Loperamide

Answer 27

Antidiarrheal Drugs - an Opioid

For
* Relief of symptoms of acute or chronic diarrhea
* Reduction of volume of discharge from ileostomies
* Prevention and treatment of travelerʼs diarrhea

MOA
* Slow the motility of the GI tract through direct action on the lining of the GI tract
* Allows increased time for absorption of fluid and electrolytes

AE
* Abdominal distension. Abdominal discomfort. Nausea. Dry mouth. Toxic megacolon. Fatigue. Weakness. Dizziness
* ASSESS for: intestinal obstruction, acute abdominal pain, abdomen and BS, elimination pattern, nausea, or vomiting

CI: Allergy.
Caution: Pregnancy. Lactation. History of GI obstruction History of acute abdominal conditions. Diarrhea due to poisonings

Drug
* depends

Question 28

Prochlorperazine

Answer 28

Phenothiazines - Antiemetics

For
* Antianxiety drug that blocks the responsiveness of the CTZ to stimuli, leading to a decrease in nausea and vomiting

MOA
* Depresses various areas of the central nervous system (CNS)

AE
* Drowsiness, dizziness, weakness, tremor, headache. Hypotension, hypertension, cardiac arrhythmias. Dry mouth, nasal congestion, anorexia, pallor, sweating, urinary retention. Menstrual disorders, galactorrhea, and gynecomastia. Photosensitivity

CI:Coma, severe CNS depression, brain damage or injury. Severe hypotension or hypertension. Severe liver dysfunction
Caution: Renal dysfunction. Moderate liver impairment. Active peptic ulcer. Pregnancy and lactation

Drug
* Other CNS depressants, including alcohol

Question 29

Ondansetron

Answer 29

Serotonin (5-HT3) Receptor Blockers - Antiemetic

For
* Prevention of nausea and vomiting associated with emetogenic cancer chemotherapy, prevention of postoperative nausea and vomiting
* Give before chemo and before/with pain meds

MOA
* Acts to reduce the responsiveness of the nerve cells in the CTZ to circulating chemicals that induce vomiting

AE
* Drowsiness. Fatigue. Restlessness. Extrapyramidal symptoms
* Serotonin Syndrome: agitation, tachycardia, high BP, muscle rigidity

CI: Coma, severe CNS depression, brain damage or injury. Severe hypotension or hypertension. Severe liver dysfunction
Caution: Renal dysfunction. Moderate liver impairment. Active peptic ulcer. Pregnancy and lactation.

Drug
* Other CNS depressants, including alcohol

Question 30

Lactulose

Answer 30

Osmotic Laxatives
* Laxative for
* Ammonia levels-decreasing
* Cognition returns - improved mental status

For
* cirrosis patients to decrease ammonia levels
* hepatic encephalopathy

Should See
* 2-3 soft stools per day
* ammonia levels decrease
* cognition improves

Question 31

Sulfasalzine

Answer 31

Pharmacologic Therapies for IBD

MOA
* decreases colon inflammation by inhibiting prostaglandin
* immunosuppresive
* continue even after symptoms subside

Side Effects (normal)
* discoloration of skin and urine

AE
* Sun dried: need sunblock, dry out body
* Urine Crystals - kidney stones
* Low urine output and high gravity - 1.030
* Fluid and folic acid: need these

Contraindicated
* sulfa allergies

Question 32

Baclofen

Cyclobenzaprine, Tizanidine

Answer 32

Centrally Acting Skeletal Muscle Relaxants

For
* Alleviation of signs and symptoms of spasticity; use in spinal cord injuries or diseases

MOA
* Work in upper levels of CNS to interfere with reflexes causing muscle spasm; Possible depression anticipated with their use; Lyse or destroy spasm (spasmolytics); Exact mechanism unknown, thought to involve action in upper or
spinal interneurons

AE
* Drowsiness, Fatigue, Weakness, Confusion, Headache,
Nausea, Dry mouth, Hypotension

CI: Known allergy; Rheumatic disorders
Caution: Epilepsy; Cardiac dysfunction; Conditions marked by muscle weakness

Drug
* CNS depressants, Alcohol

Question 33

Dantrolene

Botox

Answer 33

Direct Acting Skeletal Muscle Relaxants

For
* Treatment of spasticity directly affecting peripheral muscle contraction. Management of spasticity associated with neuromuscular diseases

MOA
* Interfering with the release of calcium from the muscle tubules. This prevents the fibers from contracting. Does not interfere with neuromuscular transmission

AE
* Fatigue. Weakness. Confusion. GI irritation. Enuresis

CI: Known allergy. Spasticity - that contributes to locomotion, upright position, or increased function. Hepatic disease. Lactation
Caution: Women. All patients older than 35 years. Cardiac disease

Drug
* Estrogen. Neuromuscular junction blockers and others that interfere with neuromuscular transmission

Question 34

Methotrexate

Answer 34

DMARD

For
* RA

MOA
* Stops folic acid metabolism, which stops cell reproduction

AE
* Low immunity - infections, suppresses B and T
* Low platelets - serious bleeding
* Fetal death

Caution: preg, crowds, live vaccines, razors, brushing teeth hard

Question 35

Infliximab

Answer 35

TNF Blocker

For
* relieve the symptoms of certain autoimmune disorders
* RA, Crohn’s, UC

MOA
* act to decrease the local effects of TNF, a locally released cytokine that can cause the death of tumor cells and stimulate a wide range of proinflammatory activities

AE
* Demyelinating disorders have occurred, including multiple sclerosis and various neuritis conditions
* Myocardial infarction (MI), heart failure, and hypotension

Drug: other immunosup drugs, live vaccines

Need neg TB test before taking it, may activate TB

Question 36

Hydroxychloroquine

Answer 36

DMARD

For
* inflammatory disorders, lupus

MOA
* decreases the inflammatory response on skin and joints

AE
* retinal damage and vision problems: get eye appts

Question 37

Allopurinol & Colchicine

Answer 37

Xanthine Oxidase Inhibitors / Anti-Gout

For
* Given for Gout - uric acid build up causes inflammation in the joints
* A = prevents gout
* C = acute gout attacks
* not given to reduce pain, just reduce uric acid

MOA
* competitively inhibits reabsorption of uric acid at the proximal convoluted tubule

AE
* Mild rash: report to HCP

Make sure to increase fluid intake