meds midterm Flashcards
1
Q
what class is Ondansetron
A
Serotonin antagonist
2
Q
what is the action of ondansetron
A
Blocks effect of serotonin @ 5-HT3 receptor sites located in the vagal nerve terminals & CTZ
3
Q
pathway that ondansetron works on
A
CTZ & GI
4
Q
uses of ondansetron
A
CINV, PONV, radiation, HG after other options first.
5
Q
Cation for ondansetron
A
Hepatic impairment, congenital long QT, electrolyte imbalances, bradyarrythmias or HF
6
Q
Side effects of Ondansetron
A
WORST: Prolonged QT –> Fainting & palpitations
Headache, Diarrhea & rash
7
Q
Extrea info about ondansetron
A
No extra pyramidal effects
GOLD STANDARD!! most common & best
Risk of torsades de points - life threatening dysrhythmia
8
Q
What class is dimenhydrinate
A
antihistamine & anticholinergic
9
Q
what is the action of dimenhydrinate
A
blocks histaminergic & muscarinic cholinergic receptors in neuronal path that connects ear to vomit centre
10
Q
what pathway does dimenhydrinate work on
A
Vestibular
11
Q
use of dimenhydrinate
A
motion sickness & vertigo
12
Q
cation of dimenhydrinate
A
Angle closure glaucoma, seizure, pro strategic hyperplasia
13
Q
side effects of dimenhydrinate
A
sedation (blocking H1), Dry mouth, Blurry vision, urinary retention form muscarinic receptors
14
Q
Extra information about dimenhydrinate
A
not our first choice b/c its les effective than scopolamine
15
Q
what class is scholamine
A
Anticholinergic
16
Q
What is scopolamine known for
A
MOST EFFECTIVE DRUG FOR PREVENTION & TX of MOTION SICKNESS
17
Q
Action of scopolamine
A
Effects on the vestibular muscle b/c muscarinic antagonist. Suppresses nerve traffic in neuronal pathway that connects the vestibular apparatus of inner ear to vomiting centre.
18
Q
Caution for scopolamine
A
prostatic hyperplasia, pyloric obstrictioon, tachycardia or glaucoma
19
Q
Pathway of scopolamine
A
vestibular
20
Q
side effects of scopolamine
A
Sedation, dry mouth, constipation, difficulty urinating, blurry vision, disorientation. Hard on elderly…
less effects if transdermal behind the ear
21
Q
what class is prochlorperazine
A
Phenothiazines
Dopamine (D2 Receptor) Antagonist
22
Q
Action of prochlorperazine
A
Blocks dopamine in CTZ, may also block ACh and calms CNS
23
Q
PAth of prochlorperazine
A
CTZ & GI
24
Q
use of prochlorperazine
A
chemo, radiation, PONV, Anxiety & intractable hiccups
25
Side effects of prochlorperazine
Orthostatic hypertension
EXTRAPYRAMIDAL SYMPTOMS - Tardive dyskineae
headaceh, dry mouth, eyes, constipation, urinary retention
26
cation for prochlorperazine
do not use if hypersensitive to phenothiazines, coma, seizures, encephalopathy or bone marrow depression.
27
Nursing considerations of prochlorperazine
Extrapyramidal symptoms (akathisia - restlessness) and tar dive dyskinesia mvmd of jaw suck chew, blink etc.
28
What class is Metoclopramide
PRokinetic
| Dopamine antagonist
29
Action of metoclopramide
Suppresses emesis through blockade of dopamine and serotonin receptors in CTZ.
Can suppress post op N/V or from chemo, anticancer, opioids or toxins.
It is a pro kinetic agent which means it increases upper GI motility by enhancing gAcetylcholine action. So be ware in Gi reflux & diabetic gastroparesis
30
Patho of metoclopramide
CTZ, GI
31
side effects of metoclopramiede
```
hypotension
sedation
headache
dystonia
dry mouth & diarrhea
```
32
CONTRAINDICATIONS OF METOCLOPRAMIDE
GI OBSTRUCTION.
| PERFORATION OR HEMORRHAGE OR CROHNS OR ALREADY OPEN ULCER
33
nursing considerations for metoclopramide
give 30 mins before meal
ok for pregnancy
can cause extrapyramidal symptoms - do not use with others which will also call this
Can cause dystonia which is involuntary msk. contract
34
what class is diphenoxylate with atropine
```
Diphenoxylate = opiod
Atropine = anticholinergic
```
35
action of diphenoxylate with atropine
Opiods help to slow peristalsis & reduce gastric secretions. Activates the Opiod receptors in the GI tract. Presents the large intestine with less H20 to reduce fluidity & volume of stools which can release cramping.
Atropine also slows peristalsis by inhibiting Ach & it drys up secretions.
36
Side effects of Diphenoxylate with atropine
Dizziness, headache, dry mouth, constipation, blurry vision, N/V, interacts with other CNS depressants & MAO inhibitor
37
when is diphenoxylate with atropine contraindicated
IBD b/c toxic megacolon
Not for severe liver disease or infectious diarrhea
not for alcohol intolerant
38
Nursing considerations for Diphenoxylate with atropine
monitor liver function, skin turgor, lyse balances
| opiod on its own does not change the consistency
39
Class of bismuth subsalicylate / active charcoal
Absorbant
40
Use of bismuth subsalicylate
Mild cases, can blacken stool & tongue. Binds to the toxins that cause diarrhea but does not prevent dehydration.
Intestinal absorption fluid & electrolytes. Decreases prostaglandins
41
what class is methycellulose
Bulk forming agent
42
what does methycellulose do
Stools less water
doesnt effect volume
can also be a laxative
43
What class is Atropin
Anticholinergic / antispasmodics
44
What does atropine do
Does not change consistency or volume. But relieves cramping.
Causes dizziness, tachycardia, dry mouth & urinary hesitancy.
Inhibits Ach in smokt muscle which leads to an antimuscarinic effects
45
What is H1 for
H1 - Antihistmine - Moslty for allergic reactions, also very sedative (Dimenhydrinate)
46
What is H2 for
Gastric reflux disease indic because it causes decreased production of acid reversibly by blocking H2 at parietal cells
47
what do omeprazole & pantoprazole class
PPI (Proton pump inhibitor)
48
PPI vs. H2RA
PPI has stronger effect & faster onset
49
Indication of omeprazole
Gastric & duodenal ulcers & GERD
50
Mechanism of omeprazole
Prodrug that undergoes conversion by parietal cells, causes irreversible inhibition of H+,K+Atpase enzyme that generates gastric acid. Both basal & stimulated release. 97% gone on first dose
51
Common side effects of omeprazole
Pneumonia - b/c altered upper GI flora & WBC fx
Fractures - Osteroporossis b/c decreased calcium absorb
Rebound acid hyper secretion - Use PPI for low dose & taper
Hypomagnesemia - decreased absorb, can cause arrhythmia
Diarrhea - B/c C.Dff
Gastric cancer - B/c hyperplasia of gastric epithelial
52
Nursing considerations of omeprazole
MOST effective gastric acid suppression.
Gan decrease drug absorption...
Give 30 minutes before a meal
used wit hclopidogrel to decrease risk of bleeding
53
What class is ranitidine
H2 Receptor Antagonist
54
Indication of ranitidine
Surgical treatment of gastric/ duodenum ulcer, prophylaxis for GERD
55
Mechanism of Ranitidine
suppresses secretion of gastric acid by blocking H2 receptors on gastric parietal cells.
Does not interact with H1
56
Side effects of ranitideine
increased gastric ph , increasespneumoniarisk
| Weak inhibition of hepatic enzymes but does not decreases Metabolism
57
Nursing consideration of ranititde
Can accumulate with renal impair.
| Half life is 2-3 hours
58
What class is aluminum hydroxide
antacid
59
what is the mechanisms of aluminum hydroxide
alkaline compound that neutralizes stomach acid. Reacts with gastric acid to produce neutral salts. Decreases destruction of gut wall, decreases pepsin activity, enhances mucosal protection by increasing stimulation of prostaglandins
60
Side effects of aluminum hydroxide
Constripation & diarrhea
Sodium loading --> HTN & HF
contraindicated in RENAL FAILURE CANNOT GIVE.
Hypophosphatemia
61
Nursing considerations of aluminum hydroxide
Doesnt affect systemic ph
slow acting but long
contraindicated i renal failure
62
what class is prednisone
Corticosteroid
63
What is the mechanism of prednisone
suppresses inflammation & normal immune response
64
side effects of prednisone
depressed CNS, eurphoria , HTN, anorexia, nausea, decreased wound healing, ecchymosis, adrenal sup, muscle wasting, osteoporosis, cushingoeid appearance
Adrenal insuf -> Hypotension, weight loss, weakness, N/V anorexia, confusion & restlessness
65
Nursing considerations for prednison
```
FOR IBD.
Daily weights & lung assessment
Glucose & electrolytes
may need more surgery
monitorin input & output for edema
```
66
what class if infliximab
monoclonal AB (GI anti-inflm
67
what is the mechanism of infliximab
form of immunotherapy. Monocolonal ABs bind to specific target cells or proteins & stimulate the bodies immune system to attack those cells. Designed to neutralize TNF which restyles in anti-inflmataotry & anti prolific activity.
Decreases swelling & pain.
Reduction & closure of fistulas, decreased symptoms, maintain resission & mucosal healing with decreased corticosteroid use in UC
68
Common side effects of infliximab
```
TB infection
Chills
fever
prurutiis, urticaria, cardio rections
Increased risk lymphoma, Infections, infusion, reaction, opportunitistc infection, chest pain
Hypotension, Hypertension & dyspnea
```
69
Nursing considerations for Infliximab
Infusion related reaction *fever, chills, urticaria, pruritus up to 2 hours after
Monitor for infection (fever, malaise, weight loss, cough, sweat, dyspnea, pulmonary infiltrates & shock)
Can develop TB
70
What class is sulfasalazine
5-Aminosalicyclic acid (anti-inflm)
71
what is the mechanism of sulfasalazine
```
locally acting anti-inflm in colon inhibition of prostaglandin synthesis.
Decreases symptoms (Fever, pain, diarrhea, bleed(
```
72
what are side effects of sulfaalazine
Headache, Andreia, Diarrhea, nausea, vomiting, rash & fever
73
Nursing consdierations for sulfasalazine
Safe for preg& lactating
Most effective against UC
For those who cannot have steroids
similar to aspirin
74
what class is beclomethasone
Steroidal anti-inflm (inhaled glucocortiocids)
75
mechanism fo action of beclomethasone
steroid so it acts potent locally to cause anti-inflammation & modify the immune system
USED WITH A BETA AGONIST TO IMPROVE RESPONSIVENESS
76
what are the indications for beclomethosone
Maintain/prophylaxis for asthma
| Moderate to severe COPD
77
Side effects of beclomethasone
Headache, no serious toxicity or adrenal suppression.
Growth delay in children
Long term bone loss
ORAL PHARYNGEAL YEAST
78
Nursing implications of beclomethasone
Resp & pulmonary function tests
signs of adrenal insufficiency
Withdrawal symptoms
Monitor growth rate in children
79
What class is Albuterol/Salbuterol
SHORT ACTING BETA 2 AGONIST
| Bronchodilator, Adrenergic
80
What is the mechanism of albuterol/salbuterol
Binds to beta2-andrenergic receptors in the airway smooth muscle, leading to activation of adenyl cyclanse nd increased levels of cyclic-3,Adenosine mono-phosphate.Increased cAMP activates kinases which inhibit the phosphylatin of myosin & decrease intracellular calcium --> relaxation of the airway & Bronchodilation.
81
Side effects of Albuterol
NEvous, Restless, Tremor, Chestpain, PALPATIONGINS
| Cannot be used with MAO inhibitor, Digoxin, Beta blockers will negate the effect
82
Nursing implications of Salbuteral
Assess lung sounds, pulse & bp before and during peak.
Note sputum, pulmonary function,
Note bronchospasm of wheezing, may decrease K+.
Pediatrics 2+ only
Cation with breast feeding
TACHYCARDIA IS NORMAL FIRST DOSE
83
What class is ipantropium 1
Anticholinergics
84
What mechanism is ipantropium
Blocks muscarinec receptors in the bronchi -- reduces bronchoconstriction
SLOWER ONSET THAN BETA AGONSITS
85
when is ipantropium used
to prevent prochospasm of COPD
| Off label use for asthma
86
side effects of ipantroprium
dry mouth, throat & nasal congestion
deos not absorb systemically but could increase Intraoccular pressure. Caution with glaucoma or prostate enlargement
TOXIC WITH OTHER ANTICHOLINERGICS
87
Nursing implicite of ipantropium
Resp assessment
| is there wheezing
88
what class is Aminophylline
Methylxanthines
89
What is the mechanism of action of aminophylline
Bronchodilation by relaxing smooth muscle in the bronchi, likely from blocking adenosine receptors
90
when is aminophylline used
NOT FOR COPD.
Chronic, stable asthma, will decrease the frequency & severity of attacks
Oral or IV
91
Side effects of aminphylline
Toxicity (N/v, nausea, diarrhea, insomnia, restlessness)
| Interacts with caffeine, tobacco, weed (antagonism)
92
Nursing implications of aminophylline
Not an inhaler
| Allergies, Breast fed caution
93
Zafirlukast class
leyukotrine receptor antagonist
94
Zafirlukast mechanism
```
Suppress leukorines (Which promotes smooth muscle constriction, vessel permeability & inflammatory response)
Leads to decreased bronchoconstrition
```
95
use of Zafirlukast
Maintinext treatment in chronic asthma
Second line treatment (if inhaled glucocorticoid cannot be used) Adults & children 5+
ORAL
96
Side effects of Zafirlukast
Headache, GI, arthralgia, myalgia, neuropsych effects, depression, suicidal
NOT GOOD FOR PSYCH ISSUES
interacts with aspirin, erythmycin and warfarin
97
What class is Salmeterol
Adrenergic bronchodilator
| LONG ACTING BETA-2 Receptor ANTAGOIST
98
What is the mechanism of salmeterol
Produces accumulation of cyclic adenosine monophosphate at beta 2-andrenergic receptors which leads to bronchodilation
99
what are nursing implications for salmeterol
ALWAYS GIVEN WITH A GLUCOCORTICOID FOR ASTHMA
heart symptoms with oral
COPD inhaled
2+ ok
