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N233 > meds midterm > Flashcards

meds midterm Flashcards

1
Q

what class is Ondansetron

A

Serotonin antagonist

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2
Q

what is the action of ondansetron

A

Blocks effect of serotonin @ 5-HT3 receptor sites located in the vagal nerve terminals & CTZ

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3
Q

pathway that ondansetron works on

A

CTZ & GI

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4
Q

uses of ondansetron

A

CINV, PONV, radiation, HG after other options first.

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5
Q

Cation for ondansetron

A

Hepatic impairment, congenital long QT, electrolyte imbalances, bradyarrythmias or HF

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6
Q

Side effects of Ondansetron

A

WORST: Prolonged QT –> Fainting & palpitations

Headache, Diarrhea & rash

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7
Q

Extrea info about ondansetron

A

No extra pyramidal effects
GOLD STANDARD!! most common & best
Risk of torsades de points - life threatening dysrhythmia

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8
Q

What class is dimenhydrinate

A

antihistamine & anticholinergic

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9
Q

what is the action of dimenhydrinate

A

blocks histaminergic & muscarinic cholinergic receptors in neuronal path that connects ear to vomit centre

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10
Q

what pathway does dimenhydrinate work on

A

Vestibular

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11
Q

use of dimenhydrinate

A

motion sickness & vertigo

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12
Q

cation of dimenhydrinate

A

Angle closure glaucoma, seizure, pro strategic hyperplasia

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13
Q

side effects of dimenhydrinate

A

sedation (blocking H1), Dry mouth, Blurry vision, urinary retention form muscarinic receptors

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14
Q

Extra information about dimenhydrinate

A

not our first choice b/c its les effective than scopolamine

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15
Q

what class is scholamine

A

Anticholinergic

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16
Q

What is scopolamine known for

A

MOST EFFECTIVE DRUG FOR PREVENTION & TX of MOTION SICKNESS

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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.

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18
Q

Caution for scopolamine

A

prostatic hyperplasia, pyloric obstrictioon, tachycardia or glaucoma

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19
Q

Pathway of scopolamine

A

vestibular

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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

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21
Q

what class is prochlorperazine

A

Phenothiazines

Dopamine (D2 Receptor) Antagonist

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22
Q

Action of prochlorperazine

A

Blocks dopamine in CTZ, may also block ACh and calms CNS

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23
Q

PAth of prochlorperazine

A

CTZ & GI

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24
Q

use of prochlorperazine

A

chemo, radiation, PONV, Anxiety & intractable hiccups

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25
Q

Side effects of prochlorperazine

A

Orthostatic hypertension
EXTRAPYRAMIDAL SYMPTOMS - Tardive dyskineae
headaceh, dry mouth, eyes, constipation, urinary retention

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26
Q

cation for prochlorperazine

A

do not use if hypersensitive to phenothiazines, coma, seizures, encephalopathy or bone marrow depression.

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27
Q

Nursing considerations of prochlorperazine

A

Extrapyramidal symptoms (akathisia - restlessness) and tar dive dyskinesia mvmd of jaw suck chew, blink etc.

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28
Q

What class is Metoclopramide

A

PRokinetic

Dopamine antagonist

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29
Q

Action of metoclopramide

A

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

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30
Q

Patho of metoclopramide

A

CTZ, GI

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31
Q

side effects of metoclopramiede

A 
hypotension
sedation 
headache 
dystonia 
dry mouth & diarrhea
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32
Q

CONTRAINDICATIONS OF METOCLOPRAMIDE

A

GI OBSTRUCTION.

PERFORATION OR HEMORRHAGE OR CROHNS OR ALREADY OPEN ULCER

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33
Q

nursing considerations for metoclopramide

A

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

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34
Q

what class is diphenoxylate with atropine

A 
Diphenoxylate = opiod 
Atropine = anticholinergic
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35
Q

action of diphenoxylate with atropine

A

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.

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36
Q

Side effects of Diphenoxylate with atropine

A

Dizziness, headache, dry mouth, constipation, blurry vision, N/V, interacts with other CNS depressants & MAO inhibitor

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37
Q

when is diphenoxylate with atropine contraindicated

A

IBD b/c toxic megacolon
Not for severe liver disease or infectious diarrhea
not for alcohol intolerant

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38
Q

Nursing considerations for Diphenoxylate with atropine

A

monitor liver function, skin turgor, lyse balances

opiod on its own does not change the consistency

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39
Q

Class of bismuth subsalicylate / active charcoal

A

Absorbant

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40
Q

Use of bismuth subsalicylate

A

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
Q

what class is methycellulose

A

Bulk forming agent

42
Q

what does methycellulose do

A

Stools less water
doesnt effect volume
can also be a laxative

43
Q

What class is Atropin

A

Anticholinergic / antispasmodics

44
Q

What does atropine do

A

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
Q

What is H1 for

A

H1 - Antihistmine - Moslty for allergic reactions, also very sedative (Dimenhydrinate)

46
Q

What is H2 for

A

Gastric reflux disease indic because it causes decreased production of acid reversibly by blocking H2 at parietal cells

47
Q

what do omeprazole & pantoprazole class

A

PPI (Proton pump inhibitor)

48
Q

PPI vs. H2RA

A

PPI has stronger effect & faster onset

49
Q

Indication of omeprazole

A

Gastric & duodenal ulcers & GERD

50
Q

Mechanism of omeprazole

A

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
Q

Common side effects of omeprazole

A

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
Q

Nursing considerations of omeprazole

A

MOST effective gastric acid suppression.
Gan decrease drug absorption…
Give 30 minutes before a meal
used wit hclopidogrel to decrease risk of bleeding

53
Q

What class is ranitidine

A

H2 Receptor Antagonist

54
Q

Indication of ranitidine

A

Surgical treatment of gastric/ duodenum ulcer, prophylaxis for GERD

55
Q

Mechanism of Ranitidine

A

suppresses secretion of gastric acid by blocking H2 receptors on gastric parietal cells.
Does not interact with H1

56
Q

Side effects of ranitideine

A

increased gastric ph , increasespneumoniarisk

Weak inhibition of hepatic enzymes but does not decreases Metabolism

57
Q

Nursing consideration of ranititde

A

Can accumulate with renal impair.

Half life is 2-3 hours

58
Q

What class is aluminum hydroxide

A

antacid

59
Q

what is the mechanisms of aluminum hydroxide

A

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
Q

Side effects of aluminum hydroxide

A

Constripation & diarrhea
Sodium loading –> HTN & HF
contraindicated in RENAL FAILURE CANNOT GIVE.
Hypophosphatemia

61
Q

Nursing considerations of aluminum hydroxide

A

Doesnt affect systemic ph
slow acting but long
contraindicated i renal failure

62
Q

what class is prednisone

A

Corticosteroid

63
Q

What is the mechanism of prednisone

A

suppresses inflammation & normal immune response

64
Q

side effects of prednisone

A

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
Q

Nursing considerations for prednison

A 
FOR IBD. 
Daily weights & lung assessment 
Glucose & electrolytes 
may need more surgery 
monitorin input & output for edema
66
Q

what class if infliximab

A

monoclonal AB (GI anti-inflm

67
Q

what is the mechanism of infliximab

A

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
Q

Common side effects of infliximab

A 
TB infection 
Chills 
fever 
prurutiis, urticaria, cardio rections 
Increased risk lymphoma, Infections, infusion, reaction, opportunitistc infection, chest pain
Hypotension, Hypertension & dyspnea
69
Q

Nursing considerations for Infliximab

A

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
Q

What class is sulfasalazine

A

5-Aminosalicyclic acid (anti-inflm)

71
Q

what is the mechanism of sulfasalazine

A 
locally acting anti-inflm in colon inhibition of prostaglandin synthesis. 
Decreases symptoms (Fever, pain, diarrhea, bleed(
72
Q

what are side effects of sulfaalazine

A

Headache, Andreia, Diarrhea, nausea, vomiting, rash & fever

73
Q

Nursing consdierations for sulfasalazine

A

Safe for preg& lactating
Most effective against UC
For those who cannot have steroids
similar to aspirin

74
Q

what class is beclomethasone

A

Steroidal anti-inflm (inhaled glucocortiocids)

75
Q

mechanism fo action of beclomethasone

A

steroid so it acts potent locally to cause anti-inflammation & modify the immune system
USED WITH A BETA AGONIST TO IMPROVE RESPONSIVENESS

76
Q

what are the indications for beclomethosone

A

Maintain/prophylaxis for asthma

Moderate to severe COPD

77
Q

Side effects of beclomethasone

A

Headache, no serious toxicity or adrenal suppression.
Growth delay in children
Long term bone loss
ORAL PHARYNGEAL YEAST

78
Q

Nursing implications of beclomethasone

A

Resp & pulmonary function tests
signs of adrenal insufficiency
Withdrawal symptoms
Monitor growth rate in children

79
Q

What class is Albuterol/Salbuterol

A

SHORT ACTING BETA 2 AGONIST

Bronchodilator, Adrenergic

80
Q

What is the mechanism of albuterol/salbuterol

A

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
Q

Side effects of Albuterol

A

NEvous, Restless, Tremor, Chestpain, PALPATIONGINS

Cannot be used with MAO inhibitor, Digoxin, Beta blockers will negate the effect

82
Q

Nursing implications of Salbuteral

A

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
Q

What class is ipantropium 1

A

Anticholinergics

84
Q

What mechanism is ipantropium

A

Blocks muscarinec receptors in the bronchi – reduces bronchoconstriction
SLOWER ONSET THAN BETA AGONSITS

85
Q

when is ipantropium used

A

to prevent prochospasm of COPD

Off label use for asthma

86
Q

side effects of ipantroprium

A

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
Q

Nursing implicite of ipantropium

A

Resp assessment

is there wheezing

88
Q

what class is Aminophylline

A

Methylxanthines

89
Q

What is the mechanism of action of aminophylline

A

Bronchodilation by relaxing smooth muscle in the bronchi, likely from blocking adenosine receptors

90
Q

when is aminophylline used

A

NOT FOR COPD.
Chronic, stable asthma, will decrease the frequency & severity of attacks
Oral or IV

91
Q

Side effects of aminphylline

A

Toxicity (N/v, nausea, diarrhea, insomnia, restlessness)

Interacts with caffeine, tobacco, weed (antagonism)

92
Q

Nursing implications of aminophylline

A

Not an inhaler

Allergies, Breast fed caution

93
Q

Zafirlukast class

A

leyukotrine receptor antagonist

94
Q

Zafirlukast mechanism

A 
Suppress leukorines (Which promotes smooth muscle constriction, vessel permeability & inflammatory response) 
Leads to decreased bronchoconstrition
95
Q

use of Zafirlukast

A

Maintinext treatment in chronic asthma
Second line treatment (if inhaled glucocorticoid cannot be used) Adults & children 5+
ORAL

96
Q

Side effects of Zafirlukast

A

Headache, GI, arthralgia, myalgia, neuropsych effects, depression, suicidal
NOT GOOD FOR PSYCH ISSUES
interacts with aspirin, erythmycin and warfarin

97
Q

What class is Salmeterol

A

Adrenergic bronchodilator

LONG ACTING BETA-2 Receptor ANTAGOIST

98
Q

What is the mechanism of salmeterol

A

Produces accumulation of cyclic adenosine monophosphate at beta 2-andrenergic receptors which leads to bronchodilation

99
Q

what are nursing implications for salmeterol

A

ALWAYS GIVEN WITH A GLUCOCORTICOID FOR ASTHMA
heart symptoms with oral
COPD inhaled
2+ ok

N233 (11 decks)

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