Exam 4 Meds Flashcards
Prednisone
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.
Cortisone
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
7 S’s of Steroid Precautions
- Swollen: water gain = weight gain, report 1lb in 1 day or 2-3lbs in a few days
- Sepsis: low WBC, fever is priority
- Sugar: increases, hyperglycemia
- Skinny: muscles and bones - osteoporosis
- Sight: cataract risk - refer to optometrist
- Slowly taper off: prevent adisonian crisis
- Stress and surgery: increase the dose
Levothyroxine
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
Propylthiouracil / Sodium Iodine
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
Alendronate (Fosamax) / ibandronate (Boniva)
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
Insulin
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
Glyburide
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
Glucagon
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
Glargine (Lantus)
Long Acting Insulin
* no peak
* no mix
* “old guys”
* duration: 24 hrs
* “large lasting”
NPH
Intermediate Acting Insulin
* never IV
* mix clear to cloudy
* given 2x a day
* duration 14 hrs
* Peak: 4-12 hrs
Regular Insulin
Short-Acting Insulin
* Ready to go IV
* the ONLY IV insulin
* Duration: 5-8 hrs
* Peak: 2-4 hrs
Lispro / Aspart
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
Metformin
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
Cimetidine
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
Sodium Bicarbonate
Aluminum salts, Magnesium salts, Calcium salts
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
Omeprazole
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
Sucralfate
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
Misoprostol
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
Pancrelipase
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
Castor Oil
Bisacodyl, Senna
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
Psyllium / Methylcellulose
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
Magnesium Citrate
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
Sodium Docusate
Stool Softener
* Increases water content in the stools to soften bowels
Mineral Oil
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
Metoclopramide
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
Loperamide
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
Prochlorperazine
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
Ondansetron
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
Lactulose
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
Sulfasalzine
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
Baclofen
Cyclobenzaprine, Tizanidine
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
Dantrolene
Botox
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
Methotrexate
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
Infliximab
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
Hydroxychloroquine
DMARD
For
* inflammatory disorders, lupus
MOA
* decreases the inflammatory response on skin and joints
AE
* retinal damage and vision problems: get eye appts
Allopurinol & Colchicine
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
