Final Exam Flashcards
Drug for Motion Sickness
Scopolamine: Prevents nausea stimuli at CTZ, decreases GI secretions, slows smooth muscle contraction
Adverse Effects: Anticholinergic, Impaired cognition
Dopamine Antagonists
promethazine (Phenergan): Blocks dopamine2 receptors
Adverse Effects: Anticholinergic effects, extrapyramidal reactions, drowsiness, photosensitivity
Serotonin Receptor Antagonists
Ondansetron (Zofran): Blocks serotonin receptors in the GI tract, CTZ, and the vomiting center
Adverse Effects: Headache, Diarrhea, Dizziness, Constipation, Fever,
Serotonin syndrome
Opioids Used for Diarrhea
loperamide (Imodium): Decreases intestinal motility; Decreases fluid secretion into the intestine.
Adverse Effects: Dizziness
Osmotic Laxatives
Sodium salts, Magnesium salts, Polyethylene glycol: Draws water into the intestinal lumen. Fecal mass softens and swells.
Adverse Effects: Dehydration, sodium retention.
Stimulant Laxatives
Bisacodyl (Dulcolax), Senna (Senokot): Stimulate intestinal motility and increase water in the intestine.
Adverse Effects: Cramping/nausea, Red/brown urine (Senna), Fluid/electrolyte imbalances.
Bulk-forming Laxatives
Psyllium (Metamucil):Similar to dietary fiber
Adverse Effects: Esophageal obstruction, Intestinal obstruction.
Surfactant Laxatives
Docusate (Colace): Alter surface tension of stool. Allows increased water to enter feces.
Histamine2-Receptor Antagonists
famotidine (Pepcid): Block H2 receptors. It decreases the volume of gastric juices and decreases ion concentration.
Proton Pump Inhibitors
Omeprazole (Prilosec), Pantoprazole (Protonix): Bind to the hydrogen-potassium ATPase enzyme system of the parietal cell. Inhibit the secretion of hydrochloric acid.
Adverse Effects: Interfere with the liver metabolism of other meds. Can potentially exacerbate zinc deficiency. Hypomagnesemia.
Other Antiulcer Drugs
Sucralfate (Carafate): Promotes ulcer healing.
Adverse Effects: Almost none; constipation.
Narrow-Spectrum Penicillins
Penicillin G: Effective against gram-positive and a few gram-negative bacteria.
Least toxic of all antibiotics; Few side effects, Allergic reactions.
Penicillinase-Resistant Penicillins
Methicillin: Effective against gram-positive bacteria
Treats: Endocarditis, Meningitis, Bacteremia, Skin, and respiratory infections.
Broad-Spectrum Penicillins
Amoxicillin: Same antimicrobial spectrum as Penicillin G + increased activity against certain gram-negative bacilli
Treats: Haemophilus influenzae, Escherichia coli, Salmonella
Penicillins (Combined with Beta-Lactamase Inhibitors)
Amoxicillin/clavulanic acid (Augmentin), Piperacillin/tazobactam (Zosyn): Beta-lactamases are enzymes produced by bacteria that break open the beta-lactam ring, inactivating the beta-lactam antibiotic.
Therapeutic Uses of Cephalosporins
First Generation: Cephalexin (Keflex), Cefazolin (Ancef).
Second Generation: Cefoxitin (Mefoxin)
Third Generation: Ceftriaxone (Rocephin)
Fourth Generation: Cefepime (Maxipime)
Glycopeptide
Vancomycin: Inhibits cell wall synthesis, Effective against gram-positive MRSA.
Tetracyclines
Bacteriostatic Inhibitor of Protein Synthesis. Inhibit protein synthesis. Prevents bacterial growth & replication. Does not cause outright death. Broad-spectrum antibiotics
Aminoglycosides
Gentamicin: Bactericidal Inhibitors of Protein Synthesis. Effects limited to gram-negative bacilli. Parenteral Therapy.
Fluoroquinolones
ciprofloxacin (Cipro), levofloxacin (Levaquin): Broad-spectrum agent, Inhibit bacterial DNA gyrase (the enzyme needed for DNA supercoiling)
Adverse Effects:
MILD; GI problems, Nausea, Vomiting, Diarrhea
CNS effects; Dizziness, Headache, Confusion
Tendon rupture; May cause Candida infections as a result of treatment
Sulfonamides
sulfamethoxazole with trimethoprim (Bactrim or Septra): First drugs available for systemic treatment of bacterial infections. Inhibit the bacterial synthesis of folic acid. Used for UTIs
Adverse Effects: Hypersensitivity Reactions, Hematologic Effects, Kernicterus, Renal Damage
Nitroimidazoles
Metronidazole (Flagyl): Disrupts DNA and protein syntheses in bacteria and protozoa, Bacteriocidal
Adverse Effects: Anaphylaxis, GI distress, Disulfiram-like reaction.
Drugs for Hypothyroidism
Levothyroxine (Synthroid): Synthetic preparation of thyroxine (T4). Conversion to T3.
Adverse Effects: Rare! Acute overdose = thyrotoxicosis may develop. Educate patient about s/sx of overtreatment. Symptom diary.
Drugs for Hyperthyroidism
Propylthiouracil (PTU); Methimazole (Tapazole): Inhibits production of new thyroid hormone. Inhibits the conversion of T4 to T3.
Adverse Effects: Agranulocytosis, Hypothyroidism, Acute Liver Injury
Types of Insulin
Rapid Acting: Insulin Lispro
Short Duration: Regular Insulin
Intermediate Duration: NPH Insulin
Long-acting: Insulin Glargine
Combination Insulin: Humulin 70/30
Inhalation of Insulin
Afreeza: Technosphere insulin-inhalation system. Fine powder of regular insulin inhaled by lungs. Replaces mealtime insulin.
Adverse Effects: Hypoglycemia, Decreased lung function, Increased risk of lung cancer, Cough/Sore Throat.
Oral Hypoglycemics
Sulfonylureas
Glinides
Biguanides- Metformin
SGLT2 Inhibitors-Gliflozins
Sulfonylureas
Glipizide (Glucotrol), Glyburide (DiaBeta): These medications are sencond generation. They work by promoting insulin release by the pancreas.
Adverse Effects: Hypoglycemia, Cardiovascular Toxicity.
Glinides
Repaglinide (Prandin): Stimulate pancreatic insulin release. They bind to the Glucagon Like Peptide-1 receptor and stimulate glucose-dependent insulin release from the pancreatic islets, as described above. They do not usually cause hypoglycemia
Adverse Effects: Hypoglycemia
Especially with liver dysfunction patients. Headache, Dizziness, Jitteriness, GI distress
Biguanides
Metformin (Glucophage): ○ Decrease hepatic production of glucose from stored glycogen. Use for type 2 diabetes.
Adverse Effects: Decreases appetite, Nausea/Diarrhea, Vitamin Deficiencies, and Lactic Acidosis.
SGLT2 Inhibitors (Gliflozins)
Empagliflozin (Jardiance): Decreases blood glucose by causing the kidneys to remove sugar from the body through urine.
Adverse Effects: Urinary tract infections, Increased urination, Elevated LDL, Increased risk of bone fractures, Should be held before surgery to decrease the risk of DKA.
GLP-1 Agonists
Exenatide (Byetta): Slows gastric emptying, and stimulates the glucose-dependent release of insulin. Inhibits postprandial release of glucagon, and suppresses appetite
Adverse Effects: Hypoglycemia, Pancreatitis, Rick of Thyroid C cell tumors
Hyperglycemics
Glucagon: Increase blood glucose by stimulating glycogenolysis
***IV/PO glucose is preferred for the treatment of hypoglycemia if available and able to deliver
Medications that Stimulate Alpha1 Receptors
Epinephrine
Norepinephrine
Dopamine
Medications that Stimulate Beta1 Receptors
Epinephrine
Norepinephrine
Dopamine
Dobutamine
Medications that stimulate Beta2
Albuterol
Adrenergic Agonists #1
Epinephrine: Stimulates Alpha1+2, Beta1+2. Restore cardiac function following cardiac arrest, and bronchodilation for asthmatics. Elevate blood pressure, and overcome AV block
Treatment of choice for anaphylactic shock (IM)
Adverse Effects: Hypertensive Crisis, Dysrhythmias, Angina Pectoris, Tissue necrosis with extravasation, Hyperglycemia
Adrenergic Agonists #2
Dopamine: Beta1; Alpha1. Receptor specificity. Used for shock, heart failure, and acute renal failure.
Adverse Effects: Tachycardia, Dysrhythmias, Anginal pain
Adrenergic Agonists #3
Dobutamine: Selective activation of beta1 receptors. Used for heart failure.
Adverse Effects: Tachycardia, Dysrhythmia, Angina
Anticholinergic Side Effects
Hot as a Hare
Dry as a bone
Blind as a bat
Red as a beet
Mad as a hatter
“Can’t see can’t pee, Can’t spit can’t shit”
The Five Rights to Medication Administration
Right patient
Right medications
Right dose
Right route
Right time
Medication Interaction
Medication can interact with other medications, drugs, alcohol, food, and other drinks.
Medication-induced Photosensitivity
Skin reaction by taking a medication that increases sensitivity to the sun while taking those particular medications.
Idiosyncratic effect
Uncommon drug response resulting from a genetic predisposition
Teratogenic
Drug-induced birth defects
Carcinogenic
The ability of medication to cause cancer
Complementary and Alternative Therapies
Herbal supplements. Supplements cannot be claimed to prevent, treat, or cure disease. Standardization remains a concern without full FDA regulation
Commonly Used Herbal Supplements
Saw palmetto: Prostate disease, testosterone enhancement
Garlic: hypercholesterolemia, hypertension
Gingko biloba: Memory, cognition
Echinacea: immunostimulant
Ginseng: boosts energy, enhances physical and mental performance, treats erectile dysfunction, strengthens the immune response
Hawthorn: supportive treatment for angina, atherosclerosis, heart failure, angina, atherosclerosis, high blood pressure
Goldenseal: antiseptic qualities
Adolescent Consideration for Medication Administration
Physical changes
Cognitive level and abilities
Social, reasoning, and decision-making skill development
Emotional development
Independence from parents
Self-care behaviors
Impact of chronic illness
Pediatric Consideration for Medication Administration
Consider developmental and cognitive differences
Maintain safety while ensuring comfort
Family-centered, atraumatic care
Utilize, honesty, respect, explanations, least amount of restraint
Older Adult Consideration for Medication Administration
Polypharmacy
Changes in metabolism
Adverse drug events
Adherence
Anti-Inflammatory Medication Groups
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Corticosteroids
Disease-modifying antirheumatic drugs (DMARDs)
Antigout drugs
Acetylsalicylic Acid
Aspirin Non-selective anti-inflammatory. COX-1: Protects vs. stroke and heart attack.
COX-2: Decreases pain, inflammation & fever.
Adverse Effects: GI upset, increased bleeding, salicylism, Reye’s syndrome.
Cyclooxygenase Inhibitors
Inhibition of COX-1:Protection against MI, stroke, Gastric erosion, Bleeding, and Renal impairment
Inhibition of COX-2: Suppression of inflammation, Alleviation of pain, Fever reduction, Renal impairment, and Promotion of MI and stroke
Ibuprofen
Non-selective cox inhibitor, used to treat mild to moderate pain.
Adverse Effects: Headaches, GI bleeding, GI upset, Steven-Johnson Syndrome
Ketorolac
Toradol: non-selective cox inhibitor, used to treat short-term moderate to severe breakthrough pain.
Adverse Effects: Drowsiness, headaches, GI bleeding, SJS, and Renal failure
Naproxen
Naprosyn: non-selective cox inhibitor, used to treat mild to moderate pain. It has a longer half-life and is a OTC medication
NSAIDs
Non
Steroidal
Anti
Inflammatory
Drugs
Celecoxib
Celebrex: Slective Cox-2 inhibitor, used for pain from arthritis and suppresses inflammation.
Adverse Effects: Hypertension, Peripheral edema, Increased liver enzymes, GI distress
Corticosteroids
Prednisone: Controla inflammation by suppressing or preventing many of the components of the inflammatory process at the injured site
Adverse Effects: Hyperglycemia, Abnormal fat deposits, Adrenal insufficiency, Osteoporosis, Infection, Glucose Intolerance, Cataracts/Glaucoma
DMARDs
Disease
Modifying
Antirheumatic
Drugs
Acetaminophen
Tylenol: Inhibits prostaglandin synthesis, used to treat muscular aches, pain, and fever
Toxic Effect (overdose): Hepatotoxicity, renal failure, Blood dyscrasias, hearing loss, acetylcysteine (antidote)
Opioid Agonists
Morphine
Fentanyl citrate (Duragesic)
Hydromorphone (Dilaudid): Less specific pharmacokinetics but similar to morphine.
Hydrocodone: mixed with acetaminophen or ibuprofen.
Oxycodone: combined or alone for
faster release. Similar pharmacodynamics to hydrocodone.
Adverse Effects of Opioids
Respiratory Depression
Constipation
Orthostatic Hypotension
Urinary Retention
Nausea
Elevation of Intracranial Pressure
Sedation
Impairment of mental or physical abilities needed to perform potentially hazardous activities
Opioid Antagonists
Naloxone: Blocks receptors and displaces any present opioid.
Adverse Effects: Sweating, tachycardia, Hypo/hypertension, Nausea, vomiting, Reversal of analgesia
Nitroglycerin #1
Nitrates: Improves the balance of myocardial oxygen supply and demand. Leads to: Venous vasodilation, Coronary vasodilation, Arterial vasodilation.
Adverse Effects: Headache, Orthostatic Hypotension
Nitroglycerin #2
Nitrostate: Same as Nitrates but is given sublingual and has an extensive first-pass effect
Nitroglycerin #3
Ntg (Nitro-dur) Transdmeral: Same as Nitrates but it is a patch you can place on the skin
HMG CoA Reductase Inhibitors
Statins: Inhibit the enzyme HMG CoA reductase in cholesterol biosynthesis. Decreases LDL, VLDL, & triglycerides. Promote plaque stability and reduce the risk of thrombosis
Adverse Effects: Headache, fatigue, GI distress, abdominal pain, Hepatotoxicity, Cataracts, hyperglycemia, Rhabdomyolysis, muscle cramps.
Bile-Acid Sequestrants
Cholestyramine (Questran); Colesevelam (Welchol): Reduce LDL cholesterol levels by binding with bile acids in the intestine. Often used as an adjunct to statin.
Side Effects: Anorexia, nausea, vomiting, Cramping, steatorrhea - fatty stool, GI bleeding/obstruction
Folate deficiency.
Fibric Acid
Gemfibrozil (Lopid): Most effective for lowering VLDL and triglycerides.
Adverse Effects: GI upset, rashes, gallstones, dizziness, blurred vision.
Niacin
Nicotinic Acid: Reduces VLDL, LDL. Most effective at increasing HDL.
Side Effects: Dizziness, headache, Hypotension, weakness, GI distress, liver damage, Hyperglycemia, hyperuricemia, FLUSHING
Cholesterol Absorption Inhibitor
Ezetimibe (Zetia): Acts on the cells in the small intestine to inhibit cholesterol absorption.
Side Effects: Fatigue, myalgia, arthralgia, Diarrhea, cholelithiasis.
Heparin
Prevents thrombosis associated with PE, MI, unstable angina, prosthetic heart valves, and DVT. Inhibits thrombin, preventing fibrinogen to fibrin. Given SubQ or IV.
Low-Molecular-Weight Heparin
Enoxaparin (Lovenox): Inactivates Factor Xa. Prevent venous thromboembolism – used prophylactically for DVT and acute PE. Lower risk of bleeding
Warfarin
Coumadin: Prevents thromboembolic conditions – thrombophlebitis, PE, embolism formation from Atrial Fibrillation. Inhibits hepatic synthesis of vitamin K, affecting clotting factors II, VII, IX & X
Adverse Effects: Hemorrhage, Headache, GI distress, Alopecia, Weakness, Priapism.
Direct Thrombin Inhibitors
dabigatran (Pradaxa): Prevention of blood clots and strokes. Decrease risk of DVT/PE. Higher rates of GI bleeding (compared with Coumadin). More effective for stroke prevention
Antidote: idarucizumab (Praxbind)
Selective Factor Xa Inhibitors
Apixaban (Eliquis), Rivaroxaban (Xarelto): Non-valvular atrial fibrillation. Treatment of DVT and PE. Reduce the risk of recurrent DVT and PE.
Adverse Reactions: Blood thinning effects are quickly gained and lost (within 24 hours). The risk for GI bleed is HIGHER than Coumadin.
Aspirin
Can also be used for suppressing platelet aggregation. Inhibits cyclooxygenase (COX enzyme)
Clopidogrel
Plavix: Similar to aspirin, generally well tolerated
Thrombolytic Drugs
Alteplase or Tissue plasminogen activator (tPA) & Tenecteplase (TNK tPA): Converts plasminogen to plasmin, which destroys the fibrin in the blood clot – Clot Buster! Used for PE, DVT, Thrombotic Strokes, Arterial Occlusion
Adverse Effects: Intracranial bleeding, Hemorrhage, Anaphylaxis, Bleeding, Hematoma
Antihistamines
First Generation:Diphenhydramine (Benadryl)
Second Generation: Loratadine (Claritin)
Decongestants
Oxymetazoline (Afrin), Pseudoephedrine (Sudafed): Treat nasal congestion caused by allergic rhinitis, and nasal mucosa inflammation.
Side Effects: CNS excitation: Restlessness, irritability, anxiety, insomnia, Cardiovascular effects: Widespread vasoconstriction, Drowsiness, Dizziness, Rebound congestion, Abuse; Effects similar to amphetamine.
Combination
Montelukast (Singulair): Antihistamine/Sympathomimetics
Intranasal Glucocosrticoids
Fluticasone (Flonase): Decrease rhinorrhea (runny nose), sneezing, and congestion through anti-inflammatory action
Side effects: Headache, nasal irritation, pharyngitis, fatigue, insomnia, candidiasis.
Antitussives
Opioid: codeine
Non-opioid: dextromethorphan
Acts on the cough-control center of the medulla
Side Effects: Dizziness, drowsiness, confusion, fatigue, ataxia, nausea, vomiting, restlessness
Expectorants
Guaifenesin (Mucinex): Loosens bronchial secretions by reducing the surface tension of secretions, and allows elimination by coughing.
Side Effects: Drowsiness, dizziness, headache, nausea.
Bronchodilators: Sympathomimetics
Epinephrine: Causes bronchodilation, restores circulation, and increases airway patency.
Side Effects: Dizziness, nervousness, tremors, hypertension, angina, palpitations, tachycardia, dysrhythmias, restlessness.
Selective Beta-Agonists
Albuterol: Causes bronchodilation and has a rapid onset of action. Longer duration of action.
Side Effects: Headache, rhinitis, excitability, tremors, bronchospasm, palpitations, tachycardia, hyperglycemia.
Anticholinergics
Tiotropium (Spiriva): Maintenance treatment of bronchospasms associated with COPD
Ipratropium (Atrovent): Asthma
DuoNeb: Albuterol and anticholinergics
Methylxanthines
Methylxanthine derivatives (Theophylline): Relaxes smooth muscle of bronchi and bronchioles increasing cAMP and promoting bronchodilator. Used for Asthma
Leukotriene Receptor Antagonists
montelukast (Singulair): Reduce inflammatory process and decrease bronchoconstriction. Used for Asthma, prophylaxis of exercise-induced bronchospasm
Side Effects: distress, depression, weakness, infection
Glucocorticoids (Steroids)
Prednisone, Solumedrol: Anti-inflammatory effect.
Side Effects: Dry mouth, throat irritation, hoarseness, thrush (MDI), Immune suppression, Headache, euphoria, confusion, depression, Hyperglycemia, GI distress, hypertension, insomnia, Electrolyte imbalance, fluid retention, diaphoresis, Osteoporosis, psychosis, superinfections , Menstrual irregularities
Cromolyn
Action: Inhibit the release of histamine and leukotrienes from the mast cell.
Use: Bronchial asthma prophylaxis
Common side effects: Cough, postnasal drip
Adverse effect: Rebound bronchospasm
Mild Intermittent Asthma
Treated on PRN basis. Long-term control meds not needed. Beta2 agonist manages occasional attacks. If Beta2 more than twice/week, move up.
Mild Persistent Asthma
Combination of long-term control meds plus quick relief. Daily inhalation of anti-inflammatory. If using Beta2 every day, move up
Moderate Persistent Asthma
Inhaled glucocorticoid - low dose. Add long-acting beta2 agonist (Serevent). Better control & less systemic effects. If still using beta2 agonist every day, move up.
Severe Persistent Asthma
Daily inhalation of high-dose glucocorticoid, plus long-acting beta2 agonist.
Severe Asthma Exacerbations
Relieve obstruction and hypoxemia. Normalize lung function. Repetitive inhalation of beta2 agonist. Give oxygen to keep oxygen saturation up. Oral glucocorticoids x 1 week after discharge.
Am I going to pass this Final
YES!!!
