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NS 128 > Final - Meds > Flashcards

Final - Meds Flashcards

1
Q

HTN: CCBs

A
  • Calcium Channel Blockers
    • Dihydropyridines (end with -pine)
    • Non-dihydropyridines
      • diltiazem (Cardizem) & verapamil (Calan)
  • blocks SA and AV node
  • watch for bradychardia
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2
Q

HTN: ACE Inhibitors

A
  • end with -pril
  • good for kidney and DM patients
  • watch for cough
  • watch for angioedema
  • watch for HYPERkalemia
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3
Q

HTN: Adrenergic Agents–> Beta Blockers

A
  • end with -olol
  • Cardioselective and non (carve- and prop-)
  • Blocks AV node
  • take apical pulse before admin
  • can tx glaucoma and migraine
  • watch for decrease resp in non-selective
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4
Q

HTN: Adrenergic Agents –> Alpha Blockers

A
  • end with -zosin
  • syncope on 1st dose
  • Tx obstructive BPH
  • Takes 2 weeks to work
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5
Q

HTN: Adrenergic Agents –> Central Acting alpha 2 adrenergics

A
  • clonidine
  • methyldopa
  • can tx nicotine and opiod withdrawals
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6
Q

HTN: Angiotensin 2 Receptor Blockers (ARBs)

A
  • end with -sartan
  • same s/e as ACE but no cough
  • watch for angioedema
  • contraindicated in 2nd and 3rd trimester
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7
Q

HTN: Vasodilators

A
  • hydralazine (Apresoline)
  • nitrates
  • uesd in htn crises/emergency
  • nitroprusside
  • diazoxide
  • minoxidil
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8
Q

HTN: Diuretics–>Loop diuretics

A
  • end in -mide/nide
  • may need K supplement
  • blocks Na and Cl reabsorption
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9
Q

HTN: Diuretics–>Thiazide

A
  • Hydrochlorothiazide
  • metaloze
  • inhibits Na and CL reabsorption
  • Watch for hypokalemia
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10
Q

HTN: Diuretics–> potassium sparing

A
  • spironolactone
  • good for asthma pts and african americans
  • watch for HYPERkalemia
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11
Q

HTN: Potassium Replacment

A
  • potassium chloride (Kaon, K-Dur, K-Lyte)
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12
Q

Surg: Sedative-Hypnotics–>benzodiazepine

A
  • end in -pam and -lam
    • diazepam (Valium)
    • lorezepam (Ativan)
    • midazolam (Versed)
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13
Q

Surg: Sedative-Hyptontics–>non-benzodiazepine

A

zolpidem (Ambien)

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14
Q

Surg: Anticholinergics

A
  • glycopyrrolate (Robinul)
  • atropine
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15
Q

Surg: Anesthesia

A
  • general
    • inhalation
    • intravenous
  • regional
    • topical/surface
    • infiltration/local
    • peripheral nerve block
    • spinal
    • epidural
  • procedural sedation (aka moderate or conscious sedation)
    • propofol (Diprivan)
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16
Q

Surg: Anesthesia Adjuncts

A
  • sedative-hypnotics
    • benzodiaepines
      • end in -pam and -lam
  • neuro-muscular blocking agents
    • succinylcholine (Anectine)
    • panacuronium (Pavulon)
    • awake but can’t move or breath
  • opioids
    • fentanyl (Duragesic)
    • morphine
    • watch for resp depression
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17
Q

Surg: Antimicrobial/Anti-infective–> Penicillins

A

end in -cillin

  • assess for allergy
  • penicillin g and v
  • nafcillin
  • amoxicillin (Amoxil)
  • ticarcillin (Ticar)
  • piperacillin/tazobactam (Zosyn)
  • amoxicillin/clavulanate (Augmentin)
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18
Q

Surg: Antimicrobial/Anti-infective–>Trycyclic Glycopeptide

A
  • vancomycin (Vancocin)
  • can caues 8th CN damage
  • give slowly
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19
Q

Surg: Antimicrobial/Anti-infective–>Cephalosporin

A
  • start with cef- or ceph-
  • assess for pcn allergies
  • watch for super infection
  • monitor renal and hepatic
  • cefazolin (Ancef, Kefzol)
  • ceftriaxone (Rocephin)
  • cefoxtoxine sodium (Claforan)
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20
Q

Surg: Antimicrobial/Anti-infective –> Aminoglycosides

A
  • end in -myocin
  • gentomycin (Geramycin)
  • tobramycin (Nebcin)
  • do NOT use with other antibiotics
  • oto and nephro toxic
  • assess peak and trough
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21
Q

Surg: Antimicrobial/Anti-infective–>Floroquinolones/Quinolones

A
  • end in -floxin
  • ciprofloxacin (Cipro)
  • levofloxacin (Lefoquin)
  • moxifloxacin (Avelos)
  • can cause 8th CN damage (Hearing)
  • caution for renal and hearing impaired
  • monitor bowel sounds
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22
Q

Surg: Antimicrobial/Anti-infective–>Antitrichomonal & Amebicides

A
  • metronidazole (Flagyl)
  • female infections (trichomonas)
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23
Q

Surg: Antimicrobial/Anti-infective–> Lincosamides

A
  • clindamycin (Cleocin)
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24
Q

Surg: Antimicrobial/Anti-infective–>Macrolides

A
  • erythromycin
  • azitrhromycin (Zithromax, Z-pak)
  • do not used in liver impaired pt
  • interferes with other hepatic-metabolic drugs
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25
Q

Surg: Antimicrobial/Anti-infective–>Tetracyclines

A
  • tetracycline (Achromycin)
  • doxycycline (Vibramycin)
  • broad spectrum
  • stains teeth
  • causes photosensitivity
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26
Q

Surg: Antimicrobial/Anti-infective–>Sulfonamides Combination Agents

A
  • sulfamethoxazole/trimethoprim, SMX-TMP, SMZ, TMP (Bactrim, Spectra)
  • can cause Stevens-Johnson
  • do not give to kids < 2 yo
  • brain damage possible s/e
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27
Q

Surg: Antimicrobial/Anti-infective–>Antivirals

A
  • acyclovir (Zovirax)
  • valacyclovir (Valtrax)
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28
Q

Surg: Antimicrobial/Anti-infective–>Antifungals

A
  • nystatin (Mycostatin)
  • fluconazole (Diflucan)
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29
Q

Resp: Decongestants

A
  • oxymetazoline (Afrin)
  • pseudoephedrine (Sudafed, Dimetapp)

– phenylephrine is prototype

– topical nasal sprays and oral

– many are OTC

– stimulate alpha adergenic receptors

– decongests by reduces nasal inflammation

– for non–allergic rhinitis

decongestants contraindicated in

glaucoma pts

extreme caution in htn

teaching re decongestants

– stand up / change position slowly

– report HA, dizziness, difficulty breathing

– monitor BP at home

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30
Q

Resp: Antihistamines

A
  • diphenhydramine (Benadryl)
  • cetirizine (Zyrtec)
  • loratadine (Claratin)
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31
Q

Resp: Expectorants

A
  • guaifenesin (Robitussin)
    prototypes: guaifenesin (Robitussin)
    action: increases cough by increasing and thinning mucus secretions

used for: tx of colds by decreasing chest secretions

expectorants: route: nsg considerations:

Route: PO tab or liquid

nsg considerations:

– increase fluids to promote liquifying secretions

– look for contraindications with other drugs

– report if cough lasts longer than 1 wk

– do not take if pregnant

– take with food if GI upset occurs

expectorants teaching:

– don’t take prior to driving, etc

– sit or lie down if lightheaded

– change position slowly

– avoid if breastfeeding or child less than 4 yo

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32
Q

Resp: Anti-tussives

A
  • codeine
  • codeine containing drugs
  • dextromethorphan containing drugs

prototypes: – opioid: codeine

– non–opioid: dextromethorphan

action: suppress cough reflex in brain

used for: suppress chronic and non–productive cough

anti–tussive admin

– only for short–term use

– only when needed

– use lowest effective dose

anti–tussive nsg considerations:

opioid/codeine: beware of other opioids pt is taking//PO

non–opioid//dextromethorphan: do not give fluids immediately after to avoid dilution

anti–tussive teaching:

– avoid acty that require alertness

– avoid etoh and other CNS depressants

– avoid smoking

– sit upright

– take several deep breaths before attempting to cough

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33
Q

Resp: Mucolytic Agents

A
  • acetylycystein (Mucomyst)

Acetylcysteine (Mucomyst) also have hypertonic saline inhalation

breaks down mucus and enhances flow of secretions

Mucolytics/acetylcysteine routes of admin:

nebuelizer via facemask

Mucolytics/acetylcysteine nsg considerations:

– assess resp fx, lung sounds, amount and consistency of secretions before and after admin

– monitor for bronchospasms

– rinse pt’s mouth and face after for sticky residue

Mucolytics/acetylcystein teaching points

– stop medication and notify hcp if bronchospasms/aspiration

– avoid acty that require alertness

– change positions slowly

– rotten egg odor– be prepared to suction pt if aspirates

– use caution in pt’s with asthma

– monitor liver, kidney, and electrolytes

– monitor for bleeding

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34
Q

Resp: Bronchodilaters–>Adrenergics

A
  • albuterol (Proventil)
  • epinephrine (Adernalin, Bronkaid)

Prototype: albuterol

Action: bronchodilator

Used for:– prevention of exercise induced asthma and asthma

– tx of bronchospasms

– long–term control of asthma

Beta 2 Adrenergic routes:

PO tablet and inhalation

Beta 2 Adrenergic nsg considerations:

– pt may use both forms together

– monitor for toxicity

– may cause paradoxical bronchospasm

– use caution in pt with DM, heart disease, Htn

– contraindicated in: tachydysrhtmia, preg cat C

Beta 2 adrenergic teaching:

– may cause unusual or bad taste

– avoid smoking

– rinse mouth with water to tx dry mouth

– instruct on proper inhaler/nebuelizer use

Beta 2 adrenergic s/e:

– NVD

– dizziness

– HA

– upset stomach

– sore throat

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35
Q

Resp: Bronchodilators–>Xanthine

A
  • theophylline
    • short acting: Aminopylline
    • long acting: Theo-Dur

Theophylline

action: bronchodilation

used for: COPD, asthma

xanthines admin:

oral or IV (emergency only)

– if dose missed, do NOT double u

– do not crush, chew

Teaching point for xanthines:

– take as prescribed

– do not double doses

– avoid caffeine as this can increase CNS and cardiac adverse effects

– monitor theophylline serum levels

– high doses can cause dysrhythmias and seizures

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36
Q

Resp: Bronchodilators–>combination

A
  • albuterol and ipratropium (Combivent)
  • fluticasone and salmeterol (Advair)

action of both types of combo bronchos

  1. albuterol– broncho dilate

ipratopium– reduces secretions

  1. flutacasone– decrease inflammation

salmetrol– broncho dilate

considerations for albuterol/ipratopium broncho–combos:

– tacchycaria/arrythmias (can cause)

–considerations for fluticasone/salmertrol broncho combos

– avoid in pt’s with milk allergies

teaching with combo–bronchos:

– notify hcp if SOB not improved in 1 wk

– not for sudden COPD attack

– may casue dizziness, drowsiness, difficulty seeing

– prime new unit with 4 sprays before use

– clean mouthpeice weekly

– rinse mouth after admin

– do not drive, etc until response known

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37
Q

Resp: Anti-Inflammatory agents

A
  • Intranasal/inhaled steroids
    • prednisone triamcinolone (Azmacort)
    • budesonide (Pulmocort)
  • Systemic Steroids
    • prednisone
    • methylyprednisolone (Solu-Medrol)
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38
Q

Resp: Mast Cell stabilizers

A
  • cromolyn (Intal)
  • nedocromil (Tilade)

prototype: Cromolyn (ital) - also have nedocromil (Tilade)
action: decreases release of substances that contribute to bronchspasms

used for: manage acute and chronic episodes of reversible bronchoconstriction

Mast Cell stabilizers route of admin

nebeulizer

Mast cell stabilizers nsg considerations:

– assess lung sounds before and after

– assess CV status

Mast cell stabilizers teaching:

– rinse mouth before and after to prevent infection

– keep inhaler clean and unobstructed

– may cause dizziness

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39
Q

Resp: Leukotrine modifiers

A
  • montelukast (Singulair)
  • zafirlukast (Accolate)
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40
Q

Resp: Antituberculars

A
  • isoniazid (INH)
  • rifampin (RIF, Rifadin)
  • pyrazinaminde (PNZ)
  • sterptomycin
  • ethambutol (Myambutol)

protoypes: isonazid/rifampin drugs also incl: pyraziamide (PNZ), streptomycin, ethambutol (Myambutol)
action: inhibit cell wall synthesis and interfere with metabolism of microbe/used in combo to prevent antibiotic resistance

used for: against mycobacteria

Anti–TB routes:

– isonazid: PO, IM

– rifampin: PO, IV

Anti–tb nsg considerations:

– isonazid:

– if IM, warm up to room temp

– if PO, take 1 hr before or 2 hrs after meals; can take with meals if GI upset

– monitor for: – periph neuropathy

– hepatoxicity

– hyperglycemia in DM pts

Rifampin:

– expect red/orange body fluids

– monitor liver fx

– may cause mild GI discomfor

– may cause pseudomembranous colitis

anti–tb teaching:

– avoid etoh as could cause liver toxicity

– avoid foods containing tyramine (aged cheese, meats)

– may have to take 2 months to 6 year

– report any visual changes

– monitor for s/s of hepatitis (yellow skin/eyes, N/V, anorexia, dark urine, incr fatigue)

– need regular physical and eye exams

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41
Q

Resp: Antivirals

A
  • amantadine (Symmetrel)
  • ribavirin (Virazole)

prototype: amantadine - also includes: ribavirin (Virazole)
action: – prevents influenza A for entering celln

– increases dopamine action in CNS

used for: – prevention/symptom relief in influenza A

– relief from Parkinsons

Anti–virals admin and nsg considerations

– do not take last dose at bed time

– dividing doses may decrease CNS s/e

– check for allergic reaction

– check for renal impairment

– seizure

– liver diseases

anti–viral effects

– decrease in akinesia and rigidity

– decrease/alleviate influenza A symptoms

anti–virals teaching:

– may cuase dizziness, blurred vision,

– practice good oral hygiene

– notify hcp if symptoms d/n improve

– contraindicated if HTN

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42
Q

Resp: Antifungals

A
  • amphotericin B
  • fluconazole (Diflucan)

Prototype: amphoteracin B and fluconazole (Diflucan)

action: kills or stops growth of fungi

used for: fungal infections in lungs and respiratory tract

safety re antifungals

– aseptic technique

– monitor VS every 15 mins

– monitor BUN, CBC, Creatnine, K, Mg

teaching for amphoteracin

inform pt of side effects and to report

teaching for fluconazole:

– notify MD if abdo pain, fever, diarrhea, or signs of liver dysfunction

– avoid OTC antacids and alcohol within 2 hrs after admin

antifungal routes:

IV and PO

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43
Q

Resp: CF drugs

A
  • dornase alpha (Pulmozyme)
  • pancreatic enzymes (Pancrease, Viokase)

prototype: pancrelipase drugs include: - dornase alpha (Pulmozyme) – pancreatic enzymes (Pancrease, Viokase)
action: assists in digestion of protein, starch, fats

used for: pancreatic insufficiency associated with CF

pancreatic enzyme supplements admin:

– PO; swallow whole with full glass of water

– do not give with alkaline foods; can sprinkle on soft, acidic foods (applesauce)

pancreatic enzyme supplements nsg considerations:

– monitor I&O and watch for increased urinary output & fecal fat

– labs: increased uric acid

– pt may be more sensitive if allergic to pork

pancreatic enzyme supplements teaching:

– notify hcp if allergic reaction

– abdo pain, cramping, blood in urine

– take with full glass of water

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44
Q

Resp: Smoking Cessation Drugs

A
  • nicotine spray
  • buproprion (Wellbutrin)
  • vareniciline (Chantix)

– PO, patch, nasal spray, inhaler

– tx can last 12 wks (and up to 12 more wks)

– black box warning for suicidal thoughts and worsening of bipolar

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45
Q

Resp: Anticholinergics (not in highlighted list ?)

A

prototype: ipratopium
action: blocks acetlycholine receptors to stimulate bronchodilation

used for: – bronchospasm with COPD

– allergen–induced bronchospasm

– exercise–induced bronchospasm

Anticholinergeric route:

inhaled

Anticholinergeric nsg considerations:

– rinse mouth after

– usual dose 2 puffs

– if using 2 diff inhalers, wait 5 mins in between

– do not swallow capsule, put in inhalation device

– do not exceed 12 doses in 24 hours

anticholinergeric teaching

– if missed dose, take ASAP but do not double

– notify hcp if:

– stomatitis

– dry mouth x2weeks

– symptoms do not improve/worsen within 30 mins

– do not spray in eyes– blurred vision

–pulmonary fx test to monitor effectiveness

– withhold if bronchospasm (wheezing) occurs

46
Q

Resp: inhaled glucocorticoids (not in highlighted list ? )

A

mometasone, beclomethasone

action: decrease inflammation, suppress immune system, decrease edema of airway mucosa, decrease bronchial hyperactivity, decrease mucus production

inhaled glucocorticoids route: nsg considerations:

Route: MDI

nsg considerations:

– use daily, not just for symptoms

– may take up to 1 week for relief

– clear blocked nasal passages with topical decongestant prior to admin

inhaled glucocorticoids teaching:

– avoid smoking, known allergens, and known respiratory irritants

– notify hcp if sore throat/mouth occurs

– notify hcp if pregnancy expected

47
Q

Diabetes: Insulin–> Rapid Acting

A
  • insulin lispro (Humalog)
  • insulin aspart (Novalog)
  • insulin glulisine (not on highlighted list)
  • onsent: 15 mins
  • peak: 30 min - 3 hrs
  • duration: 3 - 5 hrs
48
Q

Diabetes: Insulin–>Short Acting

A
  • regular insulin (Humulin R, Novolin R)
  • onset: 30 mins
  • peak: 2 - 4 hrs
  • duration 5 - 7 hrs
49
Q

Diabetes: Insulin–>Intermediate

A

NPH insulin (Humalin N, Novolin N)

  • onset: 1.5 hrs
  • peak: 4 - 12 hrs
  • duration: 16 - 24 hrs

insulin determir (Levemir) sometimes considered long, sometimes intermediate

  • onset: 1 hr
  • peak: 6 - 8 hrs
  • duration: 5 - 24 hrs
50
Q

Diabetes: Insulin–>long acting

A
  • insuline glargine (Lantus)
    • onset: 2- 4 hrs
    • peak: none
    • diuration: 24 hrs
  • insuline degludac (Tresiba)
    • once daily
    • up to 42 hours
51
Q

Diabetes: Insulin–>insulin mixtures

A
  • NPH and regular (Humaline 70/30)
  • 70% NPH and 30% regular
52
Q

Diabetes: GLP-1 agonists

A

incretin mimetics

  • exenatide (Byetta)
    • admin 60 min b/f breakfast and dinner
    • peak: 2 hours
    • s/e: hypoglycemia, N/V/D, pancreatitis (rare)
    • consume adequate calories
  • liraglutide (Victoza)
53
Q

Diabetes: Oral hypoglycemics–>Sulfonylureas

A
  • glimepiried (Amaryl)
  • glipizide (Glucotrol)
  • glyburide (DiaBeta, Micronase, Glynase)
  • admin: 30 mins ac
  • SR: do not crush or chew
  • s/e: hypoglycemia, n/d
  • contra: pregnancy, DKA, avoid alcohol
54
Q

Diabetes: Oral hypoglycemics–>Alpha-glucosidase inhibitors

A
  • acarbose (Precose)
  • miglitol (Glyset)
  • admin: w/ 1st bite of meal TID
  • skip meal, skip a dose
  • s/e: GI effects, hypoglycemia, liver dysfx, anemai
  • use dextrose for hypglycemia
  • conta: GI disorders, hepa impair, GI distress
55
Q

Diabetes: Oral hypoglycemics–>Biguanide

A
  • metformin immediate release (Glucophage)
  • metformin extended release (Fortamet)
  • @ bfast and dinner or @ dinner (XR)
  • s/e: N/D, vit def, lactic acidosis
  • first drug for new DM
  • avoid alchol and contrast studies
  • contra: DKA, alcholism, heart failure, AMI, lactic acidosis, shock
56
Q

Diabetes: Oral hypoglycemics–>Thiazolidinediones

A
  • pioglitazone (Actos)
  • rosiglitazone (Avandia)
  • once daily w/wo food
  • Not w/ heart failure or CV disease
  • s/e: fluid retention, hepa-tox, incr lipids
  • watch s/s of fluid overload
  • labs (LFT, lipids)
  • report edema, SOB, chest pain
  • contra: heart failure, CV, hepatic disease
57
Q

Diabetes: Oral hypoglycemics–>Meglitinides

A
  • nateglinide (Starlix)
  • repaglinide (Prandin)
  • 30 min ac TID
  • skip meal, skip dose
  • add meal, add dose
  • max 4x/day
  • s/e: hypoglycemia, N/V/D
  • Adequate carb IV consumption
58
Q

Diabetes: Oral hypoglycemics–>DPP-4 Inhibitors

A
  • sitagliptin (Januvia)
  • w or wo food
  • s/e: pancreatitis, URI, HA
  • generally well tolerated
59
Q

Diabetes: Oral hypoglycemics–>SGLT2 inhibitors

A
  • canagliflozin (Invokana)
  • dapagliflozin (Farxiga)
  • empagliflozin (Jardiance)
  • work with kidneys to remove glucose from blood and excrete in urine
  • new drugs
60
Q

Diabetes: Oral hypoglycemics–>combination drugs

A

glyburide/metformin (Glucovance)

61
Q

Diabetes: Inhaled insulin

A

insulin powder (Afrezza)

62
Q

Diabetes: Anti-hypoglycemic agents

A
  • glucagon
  • 50% dextrose
63
Q

Diabetes: Amylin Mimetics

A
  • pramlintide (Symlin)
    • for type 1 and type 2
    • risk of severe hypoglycemia
    • GI upset
    • do not mix with regular insulin (in same syringe)
    • reduces post-prandial blood glucose levels
    • Peak: 20 min
    • slows gastric emptying
64
Q

Pain and Sleep: Non-narcotic

A
  • acetminophen (Tylenol)
  • aspirin
  • ibuprofen (Motrin, Advil)
  • gabapentin (Neurontin)
  • pregabalin (Lyrica)
65
Q

Pain and Sleep: Narcotic (Opioid) analgesics

A
  • morphine sulfate (immediate and sustained release)
  • oxycodone (immediate and sustained release)
  • hydrocodone
  • hydromorphone (Dilauded)
  • codeine
  • fentanyl (parenteral and transdermal)
  • meperidine (Demerol) - maternity use
66
Q

Pain and Sleep: Narcotic (Opioid) analgesics–>Morphine

A
  • morphine sulfate (immediate and sustained relief)
  • hydrophilliic
  • slow onset, long duration
  • available in a wide variety of formulations
67
Q

Pain and Sleep: Narcotic (Opiod) analgesics–>oxycodone

A
  • oral only
  • intermediate onset and duraiton
68
Q

Pain and Sleep: Narcotic (Opioid) analgesics–>hydrocodone

A
  • often in combo with non-opioids which limits use for moderate pain
  • frequently used in US
69
Q

Pain and Sleep: Narcotic (Opioid) analgesics–>hydromorphone (Dilaudid)

A
  • less hydrophillic than morphine
  • less lipophillic than fentanyl
  • available in a wide variety of formulations
70
Q

Pain and Sleep: Narcotic (Opioid) analgesics–>fentanyl

A
  • parenteral and transdermal
  • lipophillic
  • fast onset, short duration
  • no metabolites so good for organ fail
    • ideal as transdermal patch
71
Q

Pain and Sleep: Topical

A
  • lidocaine (Lidoderm)
    • IV, IM, patch
    • quick onset and duration
    • s/e: confusion, drowsiness, stinging
72
Q

Pain and Sleep: Narcotic antagonists

A
  • naloxone (Narcan)
  • romazicon (Flumazenil)
    • IV to reverse effects of benzos used as gen anesth or for benzo overdose
    • s/e: dizziness, N/V
    • improves LOC
    • decreases resp depression
73
Q

Pain and Sleep: Agonist/Antagonist

A
  • burenorphine HCA (Buprenex)
  • butorphanol tartrate (Stadol)
  • nalbuphine HCA (Nubain)
74
Q

Pain and Sleep: Agonist/Antagonist–>butophalol tartrate

A
  • Stadol
  • management of mod-severe pain
  • analgesia in labor
  • sedation pre-op
  • s/e: confusion, dysphoria, hallucinations, sedation, nausea, sweating
  • interacts with etoh, antidepressants, antihistamines
  • avail in IV, IM, and intranasal
75
Q

Pain and Sleep: Agonist/Antagonist–>nalbuphine HCL

A
  • Nubain
  • mod to severe pain
  • prevent or treat opioid itching
  • s/e: dizziness, HA, sedation, dry mouth, N/V, clammy, sweat
  • IM, IV, subq
  • don’t use in opioid addicts
  • may trigger withdrawal
76
Q

Pain and Sleep: NSAID –> ketorolac

A
  • Toradol
  • short tem mgmt of pain (not > 5 days)
  • s/e: drowsiness, anaphylaxis
  • PO, IV, IM, intranasal
  • assess for rhinitis, aspirin allergies, nasal polyps before giving
77
Q

Pain and Sleep: Complementary and alternative medicine

A
  • feverfew
    • migrain prophylaxis
  • devil’s claw
    • often used for back pain and OA
78
Q

Pain and Sleep: Benzo-receptor like agents–>eszopiclone

A
  • Lunesta
    • used to treat insomnia
    • short-term memory impairment
    • hallucinations
    • impaired coordination
    • dizziness
79
Q

Pain and Sleep: Benzo-receptor like agents–>zolpidem

A
  • Ambien
    • used to treat insomnia
    • daytime sleepiness
    • dizziness
    • abnormal thinking
    • drugged feeling
    • sleep driving
    • hallucinations
80
Q

Pain and Sleep: Amphetamines: dextroamphetamine

A
  • Dexedrine
  • used to treat narcolepsy
  • s/e: hyperactivity, resltessness, insomnia, tremors, palpitations, tachycardia, anorexiea
81
Q

Pain and Sleep: Non amphetamine wake promotion

A
  • modafinil (Provigil)
  • used to treat narcolepsy
  • contra in people with heart issues
  • s/e: HA
  • rhinitis
  • increased liver enzymes
  • nausea
  • can cause angioedema
82
Q

Mobility: NSAIDS

A
  • aspirin (ASA)
  • celecoxib (Celebrex)
  • diclofenac sodium (Voltaren)
  • ibuprofen (Advil, Motrin, PediaCare)
  • ketorolac (toradol)
  • naproxen (Napyrosyn, Aleve, Anaprox)
83
Q

Mobility: Corticosteroids

A
  • prednison
  • S/E
    • CNS: steroid induced psychosis (often in high doses but not always)
    • Sensory: Cataract devel (rare), glaucoma devel (rare)
    • Endocrine: inc appetite, inc caloric intake, diabetes (steroid-induced)
    • Urinary: Na and H20 renention, K excretion (Hypokalemia)
    • Musculo-skeletal: calcium loss, osteoporosis, muscle weakness, loss of musle mass
      *
84
Q

Moblility: S/E of NSAIDS

A
  • increases chance of GI bleed
  • can worsen or cause HTN
  • increased risk of thromboembolic events including stroke and MI
  • CNS: mental confusion, drowsiness, dizziness, HA (more common with elderly)
  • Sensory: tinnitus (aspirin in higher doses), vertigo, visual changes, reversible hearing loss
  • Hematologic: prolonged bleed time, thrombocytopenia, bruising, bleeding gums
  • Ingeument: Uticaria (hives), pruritis (itching), skin erruptions
  • GI: N/V/D, GI bleed, GI ulcers, abdominal pain
  • Urinary: NA retention, H20 retention, hyperkalemia, nephrotic toxicity
85
Q

Mobility: Which NSAID is associated with Reye syndrome

A

aspiring

86
Q

Mobility: What is Reyes syndrome

A

Can cause liver damage and encephalopathy

87
Q

Mobility: Why do NSAIDs cause GI problems?

A

Because prostaglandins protect stomach

88
Q

Mobility: Supplement needed if taking NSAIDs or corticosteroids long-term?

A

Calcium

89
Q

Mobility: Signs of adrenal suppression associated with corticosteroids

A

weakness, fatigue, weight loss

90
Q

Mobility: What happens if you just stop taking corticosteroids?

A

depression, need to taper off

91
Q

Mobility: DMARDS

A
  • hydroxychloroquine (Plaquenil) & penicillamine (Cuprimine, Depen)
  • disease modifying anti-rheumatic drug
  • slow disease progession
  • 1st line of treatment for RA
92
Q

Mobility: DMARDs –>hydroxychloroquine

A
  • Plaquenil
  • need baseline eye exam
  • may cause retinal damage
  • need f/u exam q6-12 mos
  • can cause blod discresia (blood abnormality similar to leukemia/aplastic anemia)
  • hepatotoxic
  • renal toxic
93
Q

Mobility: Muscle Relaxants

A
  • baclofen (Lioresal)
  • carisoprodol (Soma)
  • cyclobenzaprine (Flexeril)
  • metaxalone (Skelaxin)
  • methocarbamol (Robaxin)
94
Q

Mobility: Immunosupressants

A
  • etanercept (Enbrel)
  • infliziman (Remicade)
  • leflunomide (Arava)
  • methotrexate (Rheumatrex)
95
Q

Mobility: Immunosupressants–>leflonomide

A
  • Arava
  • slow acting
  • can cuase birth defects
  • questeren reverses action of leflunomide if pregnant
96
Q

Mobility: Immunosupressants–>inflizimab

A
  • Remicade
  • very effective
  • often given with methotrexate
  • very expensive $3-5K
97
Q

Mobility: Immunosupressants–> methotrexates

A
  • Rheumatrex
  • give low doses fro msuculo skeletal probs
  • high doses for cancer
  • slow acting-takes 4 - 6 weeks for therapeutic effect
  • given with certolizumab (fast acting within 1 -2 weeks)
  • very liver toxic***
  • no alchol***
  • can cause stomatitis
  • monitor CBC (can cause bone marrow supression)
  • monitor renal function
  • increase fluids when taking***
  • can cause alopecia (ususally with high doses)
  • can cause sterility
98
Q

Mobility: What is gout?

A

increased uric acid production that cannot be secreted

99
Q

Mobility: Anti-gout agents

A
  • allopurinol (Zyloprim)
  • colchicines
  • probenecid (Benemid)
100
Q

Mobility: Anti-gout agenets–>colchicines

A
  • drug of choice for gout
  • relieves pain
  • in combo with NSAIDs
  • give on empty stomach
  • increase fluids
  • no alcohol
101
Q

Mobility: Anit-gout–>allopurinal

A
  • Zyloprim
  • prevents uric acid formation
  • need 2 - 3 K mL to prevent kidney stones
102
Q

Mobility: Osteoporosis drugs–>biphosphonates

A
  • alendronate (Fosamax)
  • pamidronate (Aredia)
  • risedronate (Actonel)
  • ibandronate (Boniva)
  • drink with water
  • take 30 min before meals
  • don’t like down for 30 mins
  • give IV biphosphonates with osteopenia
    • need baseline creatinine
    • PT will feel like they are getting the flu
    • increases risk of a-fib
103
Q

Mobility: Osteoporsis drugs–>calcitonin-salmon

A
  • Calcimar
  • nasal spray??
104
Q

Mobility: Osteoporosis Drugs–>selective estrogen receptor modulaters

A
  • raloxifene (Evista)
  • teriparaxide (Fortec)
105
Q

Mobility: Osteporosis drugs –> vit D preparations

A

ergocalciferol (Calciferol)

106
Q

Mobility: Osteoporosis –> Denosumab

A
  • subq shot 2x/yr for osteoporosis
  • monitor for signs of hypocalcemia **
107
Q

Cancer: Antineoplastics

A
  • mutli drug protocol may be used
  • alkylating agents
  • antibetabolites
  • antitumor antibiotics
  • antimitotics
108
Q

Cancer: Cytoprotective agents

A
  • leucovorin (Wellcovorin)
  • mesna (Mesnex)
109
Q

Cancer: Drugs used to treat bone marrow suppression

A
  • colony stimutalating factor (WBC’s)
    • filgrastim (Neupogen)
    • sargramostim (Leukine)
  • hemotopoietic (RBS’s)
    • epoetin alfa (Epogen or Procrit)
  • thrombopoetic growth factor (platelets)
    • oprelvekin (Neumega)
110
Q

Cancer: Metotrexate

A
  • very toxic to kidney
  • neutrophils
  • usually givenn with bolus of IV fluid before and after admin
  • inhibits DNA synthesis
111
Q

Cancer: Side effect management

A
  • viscous lidocain (Swish and Swallow) MD Anderson
112
Q

Cancer: Other drugs that limit tumor growth

A
  • vaccines
  • biotherapy
  • immunotherapy
  • targeted therapy

NS 128 (2 decks)

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