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FINAL EXAM MEDS Flashcards

1
Q

Thiazide and Thiazide-Like Diuretics:
Hydrochlorothiazide

A

Therapeutic Actions:
-adjunctive therapy for edema w HF, cirrhosis, corticosteroid/estrogen therapy
Tx of HTN
-inhibits reabsorption of sodium and chloride in distal renal tubules, increasing excretion of sodium, chloride, and water by kidneys

Adverse Effects:
-dizzy/ vertigo
-ortho hypotension
-nausea
-anorexia
-dry mouth
-diarrhea
-polyuria/nocturia
-muscle cramps/spasms

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2
Q

Block Testosterone Production:
Dutasteride/finasteride

A

Therapeutic Actions:
-long term tx of symptomatic BPH to shrink prostate and relieve symptoms of hyperplasia
-inhibit intracellular enzyme that converts testosterone to DHT, which the prostate gland depends on for its development

Pharmacokinetics:
PO/ excreted in feces and urine

Contraindications:
-allergic to drug
-caution w hepatic/renal dysfunction
-caution w HF or known CAD

Adverse Effects:
-loss of libido
-breast enlargement or tenderness (gynecomastia)
-decreased DHT levels
-cannot donate blood or have a child for 6 months after last dose

Drug Interactions:
-do not use with saw palmetto

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3
Q

Urinary Tract Antiinfectives:
Fosfomycin
Methenamine
Nitrofurantoin
Trimethoprim

A

Therapeutic Actions:
-treatment of women with uncomplicated UTIs caused by susceptible strains of bacteria
-interferes with cell wall formation of gram-negative bacteria, leading to cell death

Pharmacokinetics:
Fosfomycin-PO one time dose
Nitrofurantoin-PO
Methenamine-PO
Fosfomycin and Methenamine CROSS PLACENTA
Take with food

Contraindications:
-allergy to medication
-caution with renal dysfunction

Adverse Effects:
-n+v
-diarrhea
-anorexia
-bladder irritation
-dysuria
-pruritus
-urticaria
-frequency, urgency, pain

Drug Interactions:
-avoid citrus juices and antacids (which promote alkaline urine and increase bacteria growth)

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4
Q

Nonselective Beta-Blocking Agents:
Propranolol

A

Therapeutic Actions:
Tx of HTN, angina, SVT, tremors.
Prevention of reinfarction after MI
-competitively blocks beta-adrenergic receptors in the heart and juxtaglomerular apparatus
-reduces vascular tone in the CNS

Pharmacokinetics:
PO/IV

Contraindications:
-caution w DM and hypoglycemia
-thyrotoxicosis
-renal/hepatic dysfunction

Adverse Effects:
-bradycardia
-HF
-cardiac arrhythmias
-CVA
-pulmonary edema
-gastric pain
-decreased exercise tolerance
-bronchospasms
-dizzy/drowsy

Drug Interactions:
-decreased antihypertensive effect if given w NSAIDs
-increase rebound HTN with clonidine withdrawal
-peripheral ischemia if combo with ergot alkaloids

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5
Q

Proton Pump Inhibitor - Drugs to treat GERD and ULCER DISEASE:
Esomeprazole

A

Therapeutic Actions:
-gastric acid pump suppresses gastric acid secretion by inhibiting H+, K+ —ATPase enzyme system on the secretory surface of gastric parietal cells
-blocks final step of acid production, lowering acid levels in the stomach
-tx of GERD, erosive esophagitis, gastric ulcers

Pharmacokinetics:
-combo with amoxicillin and clarithromycin for tx of H.Pylori infection
-IV

Contraindications:
-caution in pregnant/lactating women
-not for patients <18 , except for lansoprazole
-lansoprazole = PPI for children

Adverse Effects:
-dizzy, headache
-asthenia (loss of strength)
-vertigo
-insomnia
-dream abnormalities
-upper respiratory tract symptoms, cough, epistaxis
-increase bone loss
-C.Diff diarrhea

Drug Interactions:
-increased toxicity of:
—benzodiazepines
—phenytoin
—warfarin
-decreased ketoconazole and theophylline in combo w these drugs
-sucralfate not absorbed well
-CV events if PPI combo with clopidogrel

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6
Q

Prostaglandin
Drugs to treat GERD and ULCER DISEASE:
Misoprostol

A

Therapeutic Actions:
-used to protect stomach lining
-inhibit gastric secretion and increases bicarbonate and mucus production in stomach
-prevent NSAID-induced gastric ulcers

Pharmacokinetics:
-PO
-CROSS PLACENTA

Contraindications:
-women of childbearing age should have a negative pregnancy test within 2 weeks of beginning tx
-use barrier contraceptives during therapy
-caution with hepatic/renal impairments

Adverse Effects:
-nausea +vomiting
-diarrhea
-abdominal pain
-excessive bleeding
-hypermenorrhea
-dysmenorrhea
-miscarriage

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7
Q

Antiemetics:
Prochlorperazine
Chlorpromazine

A

Therapeutic Actions:
-change responsiveness of CTZ in the medulla
-treatment of n+v, intractable hiccoughs

Pharmacokinetics:
-PO/IM/IV
-CROSS PLACENTA

Contraindications:
-dont use with CNS depression/ brain damage
-hypotension/HTN
-liver dysfunction
-active peptic ulcers

Adverse Effects:
-drowsy/dizzy
-photosensitivity
-tremors
-headache
-cardiac arrhythmias
-dry mouth
-sweating
-urinary retention
-urine pink to red-brown
-gynecomastia

Drug Interactions:
-additive CNS depression if combo with other CNS depressants, like alcohol
-avoid OTC preparations

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8
Q

Prochlorperazine (antiemetic) chemotherapy patient teaching

A

common effects of this drug:
-dizziness, weakness (change positions slowly)
-photosensitivity
-dehydration (avoid excessive heat exposure, encourage fluids d/t increased risk for heat stroke)

Report these conditions to HCP:
-fever
-rash,
yellowing of eyes/skin
-dark urine
-pale stools
-easy bruising
-vision changes

Avoid OTC meds

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9
Q

Antiemetics:
Phenothiazine Patient Teaching

A

Dizziness, weakness:
-change positions slowly
-avoid driving, dangerous activities for at least 24hrs after last dose (using heavy machinery)

Sensitivity to sun: avoid sun exposure

Dehydration: drink fluids because increased risk for heat stroke

-avoid OTC meds

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10
Q

Treatment for Graves Disease
(Autoimmune hyperthyroidism)

A

Antithyroid Agents:
Thioamides
Iodine Solutions

Thioamides:
-lower thyroid hormone
-partially inhibit T4 to T3 at the cellular level
-tx of hyperthyroidism
-PTU and methimazole
-CROSSES PLACENTA

Iodine Solutions:
-tx of hyperthyroidism
-radioactive iodide

Contraindications:
-propylthiouracil (PTU) is drug of choice if mom is at risk of certinism in the infant!!

Adverse Effects:
Thioamides:
-drowsiness/lethargy
-bradycardia
-skin rash
-GI complains/ liver toxicity

Iodine Solutions:
-hypothyroidism
-iodism (metallic taste and burning in mouth, sore teeth and gums, cold symptoms)
-staining of teeth
-goiter

Drug Interactions:
Thioamides:
-increase risk of bleeding when PTU given w anticoagulants
-changes in levels of theophylline, metoprolol, propranolol, and digitalis

Iodine Solutions:
-hyperthyroid to hypothyroid
-a change in thyroid function should be monitored closely with anticoagulants, theophylline, digoxin, metoprolol, propranolol

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11
Q

Adrenocortical Agents: Glucocorticoids

A

Therapeutic Actions:
-enter target cells and bind to cytoplasmic receptors
-short-term treatment of inflammatory disorders
-block action of arachidonic acid

Pharmacokinetics:
-CROSS PLACENTA
-Methylprednisome available in PO/IV

Contraindications:
-DM
-acute peptic ulcers
-endocrine disorders

Adverse Effects:
-Methylprednisone associated with increased toxicity in African Americans
-child growth retardation r/t suppression of hypothalamic-pituitary system

Drug Interactions:
-toxic effects if corticosteroids are given w erythromycin, ketoconazole, or troleandomycin
-decreased effectiveness if corticosteroids are combo with salicylates, barbituates, phenytoin, or rifampin

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12
Q

Glucocorticoid: Prednisone

A

Therapeutic Actions:
-replacement therapy in adrenal cortical insufficiency
-short-term management of inflammatory/allergic disorders
-hypercalcemia
-hematologic disorders
-ulcerative colitis
-enters target cells and binds to intracellular corticosteroid receptors

Adverse effects:
-vertico
-hypotension
-shock
-sodium and fluid retention
-amenorrhea
-immunosuppression
-impaired wound healing

Drug Interactions:
-toxic effects increase if corticosteroids are given w erythomycin, ketoconazole, or troleandomycin
-serum levels and effectiveness may decreasev if corticosteroids are cobmo with salicylates, barbiturates, phenytoin, or rifampin

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13
Q

Thyroid Hormones:
Levothyroxine

A

Therapeutic Actions:
-replacement therapy in hypothyroid states
-tx of myxedema coma
-supporession of TSH in tx and prevention of goiters
-management of thyroid cancer
-increases metabolic rate of body tissues, increasing oxygen consumption, respiration, and HR

Pharmacokinetics:
PO/IV

Contraindications:
-during acute thyrotoxicosis
-during acute MI
-with Addisons disease

Adverse Effects:
-tremors
-palpitation/tachycardia
-loss of hair in first few months of therapy in children
-n+v

Nursing Considerations:
-give once a day before breakfast with full glass of water
-avoid calcium at same time of med administration

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14
Q

Antifungal Agents: Azole Antifungal-
Fluconazole
Ketoconazole

A

Therapeutic Actions:
-tx of oropharyngeal, esophageal, and vaginal candidiasis, cryptococcal meningitis, systemic fungal infections
-binds to sterols in fungal cell membrane, changing membrane permeability
-fungicidal or fungistatic

Pharmacokinetics:
-PO/IV

Contraindications:
-Ketoconazole: severe hepatic toxicity
-fluconazole: caution in presence of liver/renal impairment

Adverse Effects:
-headache
-n+v
-diarrhea
-abdominal pain
-rash

Drug Interactions:
-ketoconazole and fluconazole inhibit CYP450 enzyme in liver
-increased levels of drug with cyclosporine, digoxin, oral hypoglycemics, warfarin, anticoagulants, phenytoin

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15
Q

Topical Antifungals:
Clotrimazole

A

Therapeutic Actions:
-tx of oropharyngeal candidiasis and prevention for patients receiving radiation/chemotherapy
-toical tx for tinea pedis/tinea cruris
-binds to sterols in fungal cell membrane, changing membrane permeability and allowing leakage of intracellular components, causing cell death

Contraindications:
-Econazole causes local burning/irritation

Adverse Effects:
-topical: stinging, redness, urticaria, edema
-vaginal: lower abdo pain, urinary frequency, burning or irritation in sexual partner

Nursing Considerations:
-vag supp: remain recumbent for at least 10-15 mins after insertion
-avoid occlusive dressing

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16
Q

Oral Contraceptive Contraindications:
Estrogen

A

-idiopathic vaginal bleeding
-breast cancer
-hx of thromboembolic disorder
-CVA
-heavy smoker
hepatic dysfunction
-PREGNANCY
-metabolic bone disease
-renal insufficiency

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17
Q

Oral Contraceptive Contraindications:
Progestins

A

-similar to estrogens
-pelvic inflammatory disease (PID)
-STI
-endometriosis
-drospirenone is contraindicated in patients at risk for hyperkalemia d/t renal disorders, liver disease, adrenal dysfunction
-epilepsy
-migraine headache
-asthma
-cardiac or renal dysfunction

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18
Q

Creatine supplement therapy

A

-occurs in red meats
-interacts with NSAIDs, cimetidine, probenecid, and trimethoprim
-serious effects on kidney function
-drink ++ fluids while taking drug
-monitor for swelling, muscle cramps, dizziness
-short-term use

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19
Q

Drugs Affecting Male Reproductive System-Anabolic Steroids:
Oxandrolone

A

Therapeutic Action:
-adjunctive therapy to promote weight gain after chronic infections, or trauma
-to offset protein catabolism associated with prolonged corticosteroids use
-short-stature syndrome
-HIV-related cachexia and wasting
-testosterone analogue with andogenic and anabolic activity, promotes tissue-building, reverses catabolic processes, increases RBC mass

Pharmacokinetics:
-PO

Contraindications:
-PREGNANCY
-liver dysfunction
-prostate/breast CA in males

Adverse Effects:
-excitation
-insomnia
-hepatitis
-sodium retention
-acne
-masculinization of females
-inhibition of testicular function
-loss of libido postpubertal males

Assess for:
-CAD, concurrent use of insulin or oral anticoagulants

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20
Q

Antipsychotic/Neuroleptic Drugs:
chlorpromazine

A

Therapeutic Actions:
-established pediatric regimens
-management of manifestations of psychotic disorders
-relief of pre-op restlessness
-adjunctive tx of tetanus
-control of hiccups
-blocks postsynapatic dopamine receptors in the brain
-depresses part of brain involved in wakefulness and emesis, anticholinergic, antihistaminic, alpha-adrenergic blocking

Pharmacokinetics:
-PO/IM

Adverse Effects:
-drowsy
-insomnia
-vertigo
-extrapyramidal symptoms
-ortho hypotension
-photophobia
-blurred vision
-dry mouth
-urinary retention
-photosensitivity

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21
Q

Opioid Agonists:
codeine

A

Therapeutic Actions:
-pediatric dose available
-produce analgesia, sedation, and a sense of well-being
-relief of severe acute/chronic pain, pre-op medication, anaglesia during anesthesia
-some African americans have a decreased sensitivity to pain-relieving qualities of some opioids

Pharmacokinetics:
-IV/IM
-CROSS PLACENTA

Contraindications:
-diarrhea caused by toxic poisons
-after biliary sx
-caution w resp. dysfunction
-GU surgery and acute abdomen or ulcerative colitis
-liver/renal dysfunction

Adverse Effects:
-respiratory depression with apnea
-cardiac arrest
-shock
-n+v , constipation
-biliary spams occur as a result of CTZ stimulation and negative effects on GI motility
-hallucinations
-urinary retention
-loss of libido

Drug Interactions:
-when given w barbiturates or phenothiazines and MAOIs, increased resp. depression, hypotension, sedation, or comaclon

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22
Q

Alpha-Specific Adrenergic Agonists:
clonidine

A

Therapeutic Actions:
-stimulates CNS alphas-receptors
-control HTN

Pharmacokinetics:
-PO/IV

Contraindications:
-severe HTN or tachycardia
-narrow-angle glaucoma
-caution in presence of CV disease or vasomotor spasm
-thyrotoxicosis
-DM

Adverse Effects:
-CNS effects (bad dreams, sedation, drowsiness, fatigue, headache)
-hypotension, HF, bradycardia d/t decreased sympathetic outflow from CNS

Drug Interactions:
-decreased antihypertensive effects if taken with TCAs
-paradoxical HTN if combo with propranolol

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23
Q

Cholinergic Agonists:
bethanechol

A

Therapeutic Actions:
-acute post-op or postpartum nonobstructive urinary retention, neurogenic atony of the bladder with retention
-acts directly on cholinergic receptors to mimic effects of ACh, increases tone of detrusor muscles and causes emptying of bladder

Pharmacokinetics:
-PO

Contraindications:
-hypersensitivity to any component of the drug
-bradycardia, hypotension, vasomotor instability, CAD
-Peptic ulcer , intestinal obstruction
-asthma
-bladder obstruction
-PREGNANCY

Adverse Effects:
-CV effects - bradycardia, heart blood, hypotension
-n+v, increased salivation, involuntary defecation
-swallowing difficulties leading to aspiration
-dehydration
-bladder muscles and sphincter relaxation
-flushing/ sweating

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24
Q

Anticholinergics/Parasympatholytics:
Atropine

A

Therapeutic Actions:
-inhibit vagal responses in the heart, to relax the GI and GU tracts, to inhibit GI secretions, to cause mydriasis or relaxation of the pupil of the eye, and to cause cycloplegia or inhibition of the ability of the lens in the eye to accommodate to near vision
-block only the muscarinic effectors in the PNS
-used to depress salivation and bronchial secretions to dilate the bronchi, but it can thicken respiratory secretions

Pharmacokinetics:
-PO/IM/IV/SQ/transdermal

Contraindications:
-blockade of the PNS
-glaucoma
-peptic ulcer, intestinal atony, paralytic ileus, GI obstruction, severe ulcerative colitis, toxic megacolon
-heart arrhythmias, MI
-impaired liver/kidney function

Adverse Effects:
-the more the drug is in the system, the greater are the systemic effects
-CNS effects (blurred vision, pupil dilation, resultant photophobia, cycloplegia, increased IOP r/t blocking of parasympathetic effects in the eye
-sweating

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25
Q

Tumor Necrosis Factor (TNF) BLockers:
infliximab

A

Therapeutic Actions:
-act to decrease the local effects of TNF, a locally released cytokine that can cause the death of tumor cells and stimulate a range of pro-inflammatory activities
-tx of rheumatoid arthritis, polyarticular juvenile arthritis
-used in Crohn disease and ulcerative colitis

Pharmacokinetics:
-the only TNF given IV

Contraindications:
-cannot be used in anyone with an acute infection, cancer, sepsis, TB, hepatitis, myelosuppression or demyelinating disorders
-caution in renal or hepatic disorders, HF, or latex alelrgies

Adverse Effects:
-risk of serious-fatal infections and development of lymphomas and other cancers
-MS
-MI, HF, hypotension
-irritation at injection site

Drug Interactions:
-any other immune suppressant drugs with TNF blockers increases risk of serious infections and cancer
-live vaccines should not be given while on these drugs

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26
Q

Immune Modulators- Interleukin Receptor Antagonist:
anakinra

A

Therapeutic Actions:
-used to reduce s/s of moderate to severe active rheumatoid arthritis who have not responded to traditional antirheumatic drugs

Pharmacokinetics:
-100 mg/d by SQ injection

Contraindications:
-contraindicated with allergy to E.Coli
-caution in patients with renal impairment, immunosuppression, or any active infection
-immunizations cannot be give while patient is on drug

Adverse Effects:
-headache
-sinusitis, n+v
-URI
-injection site rxn

Drug Interactions:
-patients also receiving etanercept must be monitored closed d/t life-threatening infections
-should not be combo with abatacept d/t potential serious infections

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27
Q

NSAIDs:
naproxen

A

Therapeutic Actions:
-relief of s/s of rheumatoid arthritis and osteoarthritis
-for relief of mild to moderate pain
-for tx of primary dysmenorrhea
-fever reduction

Pharmacokinetics:
-CROSS PLACENTA

Contraindications:
-CV dysfunction
-HTN
-peptic ulcer or known GI bleeding
-pregnancy/lactation
-caution with renal/hepatic dysfunction

Adverse Effects:
-n+v
-dyspepsia, GI pain, constipation, diarrhea, flatulence
-headache, dizziness
-bleeding, platelet inhibition, HTN, bone marrow depression r/t blocking of prostaglandin activity
-rash/mouth sores
-heartburn

Drug Interactions:
-decreased diuretic effect when these drugs with loop diuretics
-potential for decreased antiHTN effect of beta-blockers if these drugs are combined
-lithium toxicity especially if combo with ibuprofen

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28
Q

Muscle Relaxants- centrally acting skeletal muscle relaxants:
methocarbamol (Skelaxin)
cyclobenzaprine

A

Methocarbamol is the drug of choice if a child needs to be treated for tetanus

Therapeutic Actions:
-works in the CNS to interfere with the reflexes that are causing muscle spasm
-action in upper or spinal interneurons
-relief of discomfort associated with acute, painful musculoskeletal conditions

Pharmacokinetics:
-PO / parenteral

Contraindications:
-hx of epilepsy
-hepatic/renal dysfunction

Adverse Effects:
-drowsiness, weakness, confusion
-hypotension, arrhythmias
-urinary frequency, enuresis, urine orange to purple
-dry mouth, anorexia, constipation

Drug Interactions:
-if taken with other CNS depressants or alcohol, CNS depression may increase
-avoid alcohol if taking these muscle relaxants

29
Q

Tetracycline

A

Therapeutic Actions:
-inhibiting protein synthesis in a wide range of bacteria, leading to inability of bacteria to multiply
-tx of acne, uncomplicated GU infections caused by C.trachomatis
-used as adjuncts in tx of certain protozoal infections

Pharmacokinetics:
-absorption is affected by food, iron, calcium
-CROSS PLACENTA

Contraindications:
-known allergy to tetracycline or tartrazine
-ophthalmic preparation is contraindicated in patients who have fungal, mycobacterial, or viral ocular infections
-caution in children younger than 8 years
-hepatic/renal dysfunction

Adverse Effects:
-n+v, diarrhea, abdo pain, glossitis, dysphagia
-fatal hepatotoxicity
-damage to teeth and bones
-photosensitivity
-rash
-yeast infections
-hemolytic anemia and bone marrow depression

Drug Interactions:
-when penicillin G and tetracycline taken concurrently, effectiveness of penicillin G decreases
-if this combo is used, the dose of the penicillin should be increased

30
Q

Tetracycline Patient Teaching

A

-abx specific for your infection
-taken on EMPTY STOMACH 1hr before or 2-3hr after meals with a full glass of water
-do not take this drug with food, dairy products, iron, or antacids
-can experience stomach upset/diarrhea
-can develop infections in mouth/vagina
-report to provider: colour of urine/stool, severe cramps, difficulty breathing, rash or itching, yellowing of skin/eyes
-digoxin toxicity rises when tetracycline are taken concurrently
-monitor digoxin levels during treatment and after tetracycline therapy is d/c
-decreased absorption of tetracycline results from oral combo with calcium salts, bismuth salts, iron, urinary alkalinizers, and charcoal

31
Q

Diuretic of choice for essential HTN

A

Thiazide diuretic

32
Q

Adverse Effects and Patient Teaching for Antibiotics

A

-ocular damage
-auditory damage
-superinfection
-dermatological rxns
-allergic rxns
-renal damage
-GI effects
-bone marrow depression

33
Q

Antacid Considerations

A

assess for:
-allergy
-renal dysfunction
-electrolyte disturbance
-pregnancy

Implement:
-give drug apart from others 1hr before or 2hrs after
-chew tabs and follow w water
-obtain specimens for electrolyte monitoring
-monitor nutritional status
-monitor for AE (GI effects, imbalances in electrolytes, acid-base status)

34
Q

Laxative Considerations

A

Assess for:
-allergy to laxatives
-fecal impaction or intestinal obstruction
-acute abdominal pain, nausea, vomiting
-pregnancy
-rash
-CNS effects
-bowel elimination patterns, frequency
-nutritional intake
-abdominal assessment

Implement:
-temporary measure
-give oral form with a full glass of water
-do not chew tablets
-encourage fluid intake t/o day
-give bulk laxatives w plenty of water
-insert rectal supps HIGH into rectum
-DO NOT give w acute abdo pain, nausea, vomiting
-if diarrhea or cramping, d/c drug
-possible leaking/ staining when mineral oil is used

Monitor for AE:
-dizzy, confusion, GI alterations, sweating, electrolyte imbalance, cathartic dependence

35
Q

Drugs That Act on Lower Respiratory Tract - Bronchodilators/Antiasthmatics:
Theophylline

A

Therapeutic Actions:
-symptomatic relief or prevention of bronchial asthma and reversible bronchospasm associated w chronic bronchitis and emphysema
-directly relaxes bronchial smooth muscle, causing bronchodilation and increasing vital capacity
-increases force of diaphragmatic muscle

Pharmacokinetics:
-PO/IV

Adverse Effects:
-irritability
-restlessness
-dizzy
-palpitation
-life-threatening arrhythmias
-decreased appetite
-proteinuria
-respiratory arrest
-fever
-flushing

Implement:
-give drug with meals
-do not chew EC or time release tabs
-provide quiet environment
-avoid caffeine
-consult HCP on changes of cig smoking

36
Q

Antineoplastic Agents - Hormone Modulators:
Tamoxifen

A

Therapeutic Actions:
-tx of metastatic breast CA
-competes with estrogen for binding sites in target tissues (like breast)
-a potent antiestrogenic agent

Pharmacokinetics:
-PO

Adverse Effects:
-virilization (female develops characteristics of male hormones)
-hot flashes
-rash
-nausea/vomiting
-vaginal bleeding/ menstrual irregularities
-edema
-pain
-cerebrovascular accident
-PE

Assess for:
-hypercalcemia and hypercholesterolemia
-bone marrow suppression
-pregnancy
-CNS effects

Implement:
-stay in cool environment
-perform hygiene and skin care to reduce stress to come w menopausal effects

37
Q

Antiseizure Agents:
Phenytoin (Dilantin)

A

Therapeutic Actions:
-control of tonic-clonic and psychomotor seizures
-prevention of seizures during neurosurgery
-control of status epilepticus
-stabilizes neuronal membranes and prevents hyperexcitability caused by excessive stimulation
-limits spread of seizure activity from an active focus
-has cardiac antiarrhythmic effects similar to lidocaine

Pharmacokinetics:
-PO/IV

Adverse Effects:
-Ataxia
-dysarthria
-slurred speech
-mental confusion
-fatigue
-tremors
-headache
-gingival hyperplasia
-liver damage
-hematopoietic complications
-nystagmus with toxicity

Drug Interactions:
-CNS depression increases if taken w alcohol
-when being treated for epilepsy, DO NOT use herbal/alternative therapies

Use barrier contraceptives

38
Q

Effects of Androgens

A

-Responsible for the growth and development of male sex organs and maintenance of secondary male sex characteristics
-increase retention of nitrogen, sodium, potassium, phosphorus, and decrease urinary excretion of calcium

Adverse Effects:
-acne
-edema
-hirsutism (increased hair distribution)
-deepening of voice
-oily skin and hair
-weight gain
-decrease in breast size and testicular atrophy
-headache

Drug-Lab Test Interferences:
-when taking androgens, there may be decreased thyroid function and increased creatinine and creatinine clearance
-these effects can last up to 2 weeks after d/c of therapy

39
Q

Spironolactone

A

Therapeutic Actions:
-primary hyperaldosteronism
-adjunctive therapy in tx of edema associated with HF
-tx of hypokalemia
-essential HTN
-competitively blocks effects of aldosterone in renal tubule, causing loss of sodium and water and retention of potassium

Pharmacokinetics:
-PO

Contraindications:
-hyperkalemia
-renal disease
-anuria

Adverse Effects:
-hyperkalemia
-cardiac arrhythmias
-dizzy, headache
-drowsy
-rash
-cramping
-diarrhea
-hirsutism
-gynecomastia, deepening of voice
-irregular menses

Drug Interactions:
-diuretic effect decreases if potassium-sparing diuretic is combo with salicylates

40
Q

What are beta2-specific adrenergic agonists prescribed for?

A

-asthma
-bronchospasms
-obstructive pulmonary diseases

41
Q

Beta blocker:
Metoprolol

A

Therapeutic Actions:
-tx of stable angina pectoris
-tx of HTN, prevention of reinfarction
-tx of stable, symptomatic HF
-competitively blocks beta-adrenergic receptors in heart and kidneys, decreasing the influence of the SNS on tissues and the excitability of the heart
-decreases CO = lowered BP and decreased cardiac workload

Pharmacokinetics:
-PO/IV

Contraindications:
-bradycardia
-heart block
-cardiogenic shock
-diabetes
-PVD
-asthma
-COPD
-thyrotoxicosis

Adverse Effects:
-dizzy/vertigo
-HF
-arrhythmias
-gastric pain
-flatulence
-diarrhea
-vomiting
-decreased exercise tolerance

Drug Interactions:
-decreased antiHTN effects when given w NSAIDs
-changes in blood glucose if given with insulin - pt will not have usual s/s of hypo/hyperglycemia

42
Q

Cholinergic Agonists- Agents for Myasthenia Gravis:
edrophonium

A

A reversible acetylcholinesterase inhibitor that is used as a diagnostic agents to distinguish:

-> if the patient improves immediately after the edrophonium injection, the problem is a myasthemic crisis (which is improved by cholinergic drug)

->if the patient gets worse, the problem is a cholinergic crisis, and withdrawal of the patients cholinergic drug along with intense medical support is indicated

43
Q

Salicylates in pediatrics

A

Salicylates = antiinflammatory, antipyretics, analgesics, block prostaglandins

-children are more susceptible to GI and CNS effects of these drugs
-parents need to be taught to read the label to find ingredients/dose they are giving the child
-choline magnesium trisalicylate and aspirin are the ONLY salicylates recommended for children
-should NOT be used when at risk of Reye syndrome exists, who have a viral infection, who become febrile, lethargic, who have personality changes

44
Q

Salicylate Adverse Effects

A

Contraindicated:
-w NSAIDs
-bleeding abnormalities
-impaired renal function
-chickenpox or influenza

Adverse Effects:
-salicylism = occurs with high levels of aspirin, dizziness, ringing in ears, difficulty hearing, n+v, diarrhea, mental confusion, lassitude
-salicylate toxicity = hyperpnea, tachypnea, hemorrhage, excitement, confusion, pulmonary edema, convulsions, tetany, metabolic acidosis, fever, coma, CV, renal, respiratory collapse

45
Q

Muscle Relaxants:
Baclofen

A

Therapeutic Actions:
-alleviate s/s of spasticity
-use in spinal cord injuries or spinal cord disease
-inhibits monosynaptic and polysynaptic spinal reflexes, CNS depressant

Pharmacokinetics:
-PO / Intrathecal (peak serum levels in 4hrs)

Adverse Effects:
-transient drowsiness, dizzy
-weak, fatigue
-constipation
-headache
-insomnia
-hypotension
-nausea
-urinary frequency

Implement:
-additional measures to relieve discomfort
-d/c drugs at any sign of hypersensitivity rxn/liver dysfunction
-taper drug over 1-2 weeks
-use drug cautiously in patients whose spasticity contributes to mobility, posture, or balance

Drug Interactions:
-if taken with other CNS depressants or alcohol, CNS depression can increase
-avoid alcohol with muscle relaxants

Carisoprodol safer to use in older patients with renal or hepatic dysfunction

46
Q

Dantrolene (muscle relaxant) and hepatotoxicity

A

-associated with potentially fatal hepatocellular injury
-when liver damage begins, patients experience a warning syndrome (anorexia, nausea, fatigue)
-greater in women and pt’s older than 35 y/o

-in women, combo of dantrolene and estrogen = big risk of affecting liver
-higher risk taking HT
-baclofen is a safer option

Contraindications:
-spasticity that contributes to locomotion, upright position, or increased function
-active hepatic disease
-botulinum toxins with any peripheral neuropathic disease
-active infection at site of injection
-respiratory depression
-cardiac disease

47
Q

Cephalosporins for gram-POSITIVE infections

A

FIRST-GENERATION CEPHALOSPORINS
-cefadroxil
-cephalexin

Bacteria susceptible to 1st-gen cephalosporins: PEcK
P. mirabilis
E. coli
K. pneumoniae

48
Q

Anthelmintics:
albendazole

A

-don’t give to children or pregnant women
-monitor hydration and nutrition in older adults

Therapeutic Actions:
-tx of infections by susceptible worms
-blocks tubule formation
-poorly absorbed from GI tract
-reaches peak level in 5hrs

Contraindications:
-don’t breastfeed while on drug
-use barrier contraceptives
only use after causative worm has been identified
-renal/hepatic disease

Adverse Effects:
-renal failure/ severe bone marrow depression
-headache/dizzy
-fever/ shaking/ chills
-rash/ pruritis/ loss of hair

Drug Interactions:
-negative effects increased if combo with dexamethasone, praziquantel, cimetidine

Implement:
-C+S test before beginning therapy
-give complete drug WITH FOOD
-avoid high-fat meals, provide small frequent meals
-change positions slowly and avoid driving
-ready access to bathroom (CNS effects/falls)
-report fever or severe diarrhea

49
Q

Contrast dyes can cause …?

A

Nephrotoxicity

50
Q

Erythropoietin

A

a glycoprotein produced by the kidneys, released in response to decreased blood flow or low oxygen tension in the kidneys

stimulates RBC production in the bone marrow

RBCs are produced in the myeloid tissue of the bone marrow in response to the hormone erythropoietin

51
Q

Acetaminophen overdose

A

-acetaminophen is the most used analgesic/antipyretic for children
-overdose can cause severe hepatotoxicity
-hepatotoxicity when combo with barbiturates, carbamazepine, hydantoins, or rifampin

Antidote: acetylcysteine

52
Q

Miscellaneous Antiemetics:
Dronabinol

A

-contain active ingredients of cannabis
-only approved for use in managing nausea and vomiting associated with CA chemotherapy in cases that have not responded to other treatment
-controlled substances (C-III)
-possible altered mental status

53
Q

Estradiol: (Estrace, Climara)

A

Therapeutic Actions:
-palliation of moderate to severe vasomotor symptoms associated w menopause
-prevention of postmenopausal osteoporosis
-tx of female hypogonadism, female castration, ovarian failure
-the most potent endogenous female sex hormone
-responsible for estrogen effects on the body

Pharmacokinetics:
-PO

Adverse Effects:
-corneal changes/ photosensitivity
-peripheral edema
-choasma
-hepatic adenoma
-n+v
-abdominal cramps/ bloating
-breakthrough bleeding / changes in menstrual flow
-dysmenorrhea
-premenstrual-like syndrome

54
Q

Antianxiety Agent:
Buspirone

A

does not cause sedation or muscle relaxation
-absense of CNS effects
-preferred in certain circumstances (when a person needs to drive, go to work, or maintain alertness)

55
Q

Anxiolytics: Benzodiazepines (-pam’s)
Dosing Considerations

A

-prevent anxiety without causing too much sedation

Dosing Considerations:
-DO NOT give intra-arterially d/t arteriospasms that can lead to gangrene
-DO NOT mix IV drugs in solution with any other drugs
-give parenteral form ONLY if oral forms are not available - switch to oral form ASAP
-give IV drugs SLOWLY
-reduce dose and monitor closely
-maintain patients receiving parenteral benzo’s in bed for at least 3 hours - do not ambulate or operate motor vehicle after injection
-taper dose gradually after long-term therapy ,especially with epileptic patients
-have pt void before dosing
-monitor for adverse effects (sedation, hypotension, cardiac arrhythmias, hepatic/renal dysfunction, blood dyscrasias)

56
Q

Tricyclic Antidepressants (TCAs):
Amitriptyline

A

Therapeutic Actions:
-inhibit presynaptic reuptake of neurotrasmitters 5HT and NE
-relief of symptoms of depression
-anticholinergic effects (block action of acetylcholine)

Pharmacokinetics:
-peak levels 2-4hrs
-CROSS PLACENTA

Contraindications:
-recent MI/ pre-existing CV disorders
-concurrent use of an MAOI
-angle-closure glaucoma
-urinary retention / prostate hypertrophy
-hx of seizures

Adverse Effects:
-CNS: sedation, sleep disturbances, fatigue, suicidal
-visual disturbances
-CV effects: BP changes
-GI: dry mouth, constipation
-fetal toxicity
-GU: urinary retention, loss of libido

Drug Interactions:
-increased TCA levels if combo with cimetidine, fluoxetine, or ranitidine
-combo with sympathomimetics/clonidine increases risk of arrhythmias and HTN
-hyperpyretic crisis with combo of MAOIs

Maintain initial dose for 4-8 weeks
Give at bedtime

57
Q

Lithium

A

NOT FOR CHILDREN

Therapeutic Actions:
-tx of manic episodes of bipolar disorder
-alters sodium transport in nerve and muscle cells
-inhibits release of norepinephrine and dopamine (but not serotonin) from stimulated neurons

Pharmacokinetics:
-PO
-PO, extended release

Adverse Effects:
-CNS problems: lethargy, slurred speech
-muscle weakness, fine tremors
-polyuria, gastric toxicity, n+v, diarrhea
-CV collapse, coma
-hyponatremia leads to lithium retention and toxicity
-AE are directly r/t serum levels of the drug

Drug Interactions:
-lithium-haloperidol combo can result in encephalopathic syndrome (weakness, lethargy, confusion, tremors, extrapyramidal symptoms, leukocytosis, irreversible brain damage)
-DO NOT use with psyllium
-increased CNS toxicity if combo with carbamazepine
-lithium-iodide salt combo increases risk of hypothyroidism
-thiazide diuretic-lithium combo increases risk of lithium toxicity d/t loss of sodium and increased retention of lithium
-lithium combo w indomethacin/NSAIDs, higher plasma levels of lithium

58
Q

Antipsychotics:
haloperidol

A

-can give to children

Therapeutic Actions:
-for schizophrenia
-short-term control
-tx of bipolar disorder

Pharmacokinetics:
-IV/ IM / PO
-CROSS PLACENTA

Contraindications:
-CNS depression
-circulatory collapse
-Parkinson disease
-coronary disease
-severe hypotension
-prolonged QTc interval

Adverse Effects:
-sedation
-weakness
-tremors
-drowsiness
-pseudoparkinsonism
-dystonia
-akathisia
-blurred vision
-glucoma
-hypotension
-arrhythmias
-HF
-weight gain
-DM

African Americans respond more rapidly to antipsychotic medications and have a greater risk for developing tardive dyskinesia

59
Q

Antiseizure Agents:
Diazepam

A

Therapeutic Actions:
-tx of recurrent convulsive seizures

Adverse Effects:
-drowsiness/sedation
-depression/ lethargy
-bradycardia, tachycardia
-paradoxical excitatory rxns
-urinary retention / incontinence
-drug dependence with withdrawal syndrome

60
Q

Drugs for treating PARTIAL seizures:
carbamazepine

A

Therapeutic Actions:
-tx of seizure disorders, tonic-clonic seizures, mixed seizures, trigeminal neuralgia
-inhibits polysynaptic responses and blocks posttetanic potentiations

Pharmacokinetics:
-extended release
-boys have faster clearance, so may require higher doses compared to girls

Adverse Effects:
-drowsiness
-ataxia
-dizzy
-CV complications
-hepatitis
-hematological disorders
-stevens-johnson syndrome

Assess for:
-hx of bone marrow suppression or renal stones

D/c drug is skin rash, bone marrow suppression, unusual depression, or personality changes occur

61
Q

Opioid Analgesic:
morphine

A

Therapeutic Actions:
-relief of moderate to severe acute or chronic pain
-pre-op medication
-combination therapy for severe chronic pain
-acts as an agonist at specific opioid receptors in the CNS to produce analgesia, euphoria, and sedation

Pharmacokinetics:
-PO/PR/SQ/IM/IV

Adverse Effects:
-light-headedness
-dizzy
-sedation
-n+v
-dry mouth
-constipation
-ureteral spasms
-respiratory depression/ apnea/ respiratory arrest
-circulatory depression / cardiac arrest
-shock

62
Q

Opioid Analgesics Considerations

A

assess for:
-respiratory dysfunction
-MI or CAD
-renal or hepatic dysfunction

Implement:
-pain assessment
-equipment for assisted ventilation readily available when administering the drug IV
-monitor injection sites for irritation and extravasation
-use additional measures to relieve pain (back rubs/hot packs/ice packs)
-safety measures
-provide support and encouragement
-avoid driving

63
Q

Dopaminergic Agents

A

Therapeutic Actions:
-dopamine DOES NOT cross the BBB ,
-dopaminergic agents are effective as long as enough intact neurons remain in substantia nigra to respond to increased levels of dopamine
-levodopa crosses the BBB and is converted into dopamine

Contraindications:
-dont use during lactation
-levodopa is contraindicated in patients with suspicious skin lesions
-caution w CV disease, MI, arrhythmias, bronchial asthma

Adverse Effects:
-anxiety
-nervousness
-flushing
-sweating
-photophobia
-blurred vision
-hypotension
-arrhythmias
-anorexia, dysphasia
-teratogenicity
-urinary retention

Drug Interactions:
-if combo w MAOIs, risk of hypertensive crisis exists
-combo of levodopa with Vitamind B6 or phenytoin may lead to decreased efficacy of levodopa
-avoid OTC vitamins

Give drug WITH food
Have patient void before each dose

64
Q

COX-2 Inhibitors:
Celecoxib (celebrex)

A

-act only at sites of trauma and injury to more specifically block the inflammatory reaction
-affect only the activity of COX-2
-do not interfere with COX-1 (which is needed for normal functioning of these systems)
-COX-2 inhibitors still have some effect on other functions
-evaluate for GI effects, changes in bleeding time, and water retention

-decreases pain, inflammation
-prevents protective vasodilation
-allows platelet clumping, which can lead to MI, cerebrovascular accident
-myriad of skin rxns, including Stevens-Johnson syndrome

65
Q

Gout Treatment:
Allopurinol and NSAIDS

A

Allopurinol:
-inhibits the enzyme that allows the conversion of purines to uric acid, which is toxic to the body
-lowers level of uric acid to protect kidneys and tissues

66
Q

Aminoglycosides:
amikacin, gentamicin, neomycin, streptomycin, tobramycin

A

Therapeutic Actions:
-abx used to treat infections caused by gram-NEGATIVE aerobic bacilli

Pharmacokinetics:
-poorly absorbed in GI tract
-rapidly absorbed IM, reaching peak levels within 1hr
-CROSS PLACENTA

Monitor for:
-ototoxicity
-renal toxicity
-GI disturbances
-bone marrow depression
-superinfection

67
Q

Antipyretics for prediatrics

A

-acetaminophen is the most used analgesic/antipyretic drug for children

68
Q
A

nurs317 (1 decks)

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