Metabolic Alterations Meds (DETAILED)

Question 1

Ammonium Chloride

Answer 1

Trade Name(s): (OFF THE MARKET IN US)

Class: Electrolyte Modifiers (Acidifying Agents)

Indication(s): Treatment of hyperchloremic states and metabolic alkalosis

Action: Ammonium ion (NH₄⁺) is converted to urea in the liver, liberating H⁺ and Cl^-

Side Effects: Drowsiness, HA, ammonia toxicity

Adverse Effects: N/A

Question 2

Sodium Bicarbonate

Answer 2

Trade Name(s): Baking Soda

Class: Antiulcer Agents (Alkalinizing Agents)

Indication(s): Management of metabolic acidosis; antacid

Action: Alkalinizes by releasing HCO₃^-

Side Effects: Metabolic alkalosis, F&E imbalances

Adverse Effects: N/A

Question 3

Potassium Chloride

Answer 3

Trade Name(s): Klor-Con

Class: Mineral and Electrolyte Replacements/Supplements

Indication(s): Treatment/prevention of K⁺ depletion

Action: Maintains acid-base balance and isotonicity

Side Effects: Abdominal pain, N/V/D, flatulence

Adverse Effects: Arrhythmias

Question 4

Sodium Chloride

Answer 4

Trade Name(s): NSS, ½NSS

Class: Mineral and Electrolyte Replacements/Supplements

Indication(s): Hydration, fluid replacement (½NSS, NSS); treatment of metabolic alkalosis (NSS); treatment of hyperosmolar DM (½NSS)

Action: Na⁺ is a major cation in ECF and helps maintain H₂O distribution, F&E, acid-base equilibrium, and osmotic pressure; Cl^- is the major anion in ECF and is involved in maintaining acid-base balance

Side Effects: Edema, hypernatremia, hypokalemia, hypervolemia, extravasation (IV), irritation (IV)

Adverse Effects: HF, pulmonary edema

Question 5

Albuterol

Answer 5

Trade Name(s): ProAir, Proventil, Proventil

Class: Bronchodilators (Adrenergics)

Indication(s): Treatment/prevention of bronchospasm in asthma or COPD, prevention of exercise-induced bronchospasm

Action: Binds to β₂-adrenergic receptors in airway smooth muscle → activation of adenyl cyclase and ↑levels of cAMP → ↓intracellular Ca²⁺ → relaxation of smooth airway muscle with subsequent bronchodilation

Side Effects: Chest pain, palpitations, nervousness, restlessness, tremor

Adverse Effects: Paradoxical bronchospasm

Question 6

Furosemide

Answer 6

Trade Name(s): Lasix

Class: Diuretics (Loop Diuretics)

Indication(s): Edema due to heart failure, hepatic disease, or renal impairment; HTN

Action: Inhibits reabsorption of Na⁺ and Cl^- from the loop of Henle & distal renal tubule; ↑renal excretion of H₂O, Na⁺, Cl^-, Mg²⁺, K⁺, and Ca²⁺

Side Effects: Dehydration, hypocalcemia, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia, hypovolemia, metabolic alkalosis,

Adverse Effects: Erythema multiforme, Steven-Johnsons Syndrome (SJS), toxic epidermal necrolysis (TEN), aplastic anemia, agranulocytosis

Question 7

Bumetanide

Answer 7

Trade Name(s): Bumex

Class: Diuretics (Loop Diuretics)

Indication(s): Edema due to heart failure, hepatic disease, or renal impairment

Action: Inhibits reabsorption of Na⁺ and Cl^- from the loop of Henle & distal renal tubule; ↑renal excretion of H₂O, Na⁺, Cl^-, Mg²⁺, K⁺, and Ca²⁺

Side Effects: Dehydration, hypocalcemia, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia, hypovolemia, metabolic alkalosis

Adverse Effects: Steven-Johnsons Syndrome (SJS), toxic epidermal necrolysis (TEN)

Question 8

Hydrochlorothiazide

Answer 8

Trade Name(s): Microzide

Class: Antihypertensives/Diuretics (Thiazide Diuretics)

Indication(s): Management of mild to moderate HTN; treatment of edema associated with heart failure, renal dysfunction, cirrhosis, glucocorticoid therapy, and estrogen therapy

Action: ↑excretion of Na⁺ and H₂O by inhibiting Na⁺ reabsorption in the distal tubule; ↑excretion of Cl^-, H⁺, PO₄^3-, Ca²⁺, K⁺, Mg⁺, and HCO₃^-; may also promote arteriolar dilation

Side Effects: Hypokalemia, headache, dehydration,

Adverse Effects: Skin cancer, Steven-Johnsons Syndrome (SJS), pancreatitis

Question 9

Naloxone

Answer 9

Trade Name(s): Narcan

Class: Opioid Antidotes (Opioid Antagonists)

Indication(s): Reversal of CNS depression and respiratory depression associated with suspected opioid overdose

Action: Competitively blocks effects of opioids, including CNS & respiratory depression, without opioid-like effects

Side Effects: N/V

Adverse Effects: Ventricular arrhythmias

Question 10

Naltrexone

Answer 10

Trade Name(s): Vivitrol

Class: Opioid Antidotes (Opioid Antagonists)

Indication(s): Management of alcohol dependence and opioid dependence

Action: Competitively blocks effects of opioids, including CNS & respiratory depression, without opioid-like effects

Side Effects: Anxiety, fatigue, HA, insomnia, nervousness

Adverse Effects: SI

Question 11

Prednisone

Answer 11

Trade Name(s): Deltasone, Orasone

Class: Anti-Inflammatories (Steroidal)/Immune Modifiers

Indication(s): Inflammation, allergies, hematologic diseases, neoplastic diseases, autoimmune disorders; off label - adjunct treatment of hypercalcemia

Action: Suppresses inflammation and normal immune responses; suppresses adrenal function at chronic doses of 5mg/day; replaces endogenous cortisol in deficiency states; has mineralocorticoid activity

Side Effects: Depression, euphoria, HTN, anorexia, N, acne, decreased wound healing, ecchymoses, fragility, hirsutism, adrenal suppression, muscle wasting, osteoporosis, cushingoid appearance (moon face, buffalo hump),

Adverse Effects: Peptic ulceration, thromboembolism

Question 12

Acetylcysteine

Answer 12

Trade Name(s): Mucomyst, Acetadote

Class: Acetaminophen Toxicity Antidotes/Mucolytics

Indication(s): PO/IV - Antidote for management of potentially acute hepatotoxic overdose of acetaminophen (APAP); inhalation - mucolytic in management of conditions associated with thick, viscid mucous secretions

Action: PO/IV - ↓buildup of hepatotoxic metabolite in acetaminophen overdose; inhalation - degrades mucus, allows easier mobilizing of secretions

Side Effects: Rash, N/V, bronchospasm, urticaria,

Adverse Effects: Hypersensitivity reactions (anaphylaxis, angioedema)

Question 13

Lorazepam

Answer 13

Trade Name(s): Ativan

Class: Analgesic Adjuncts/Antianxiety Agents/Sedatives/Hypnotics (Benzodiazepines)

Indication(s): Anxiety disorder

Action: Depresses CNS (probably by potentiating GABA)

Side Effects: Dizziness, drowsiness, lethargy, HA

Adverse Effects: Apnea, cardiac arrest

Question 14

Diazepam

Answer 14

Trade Name(s): Valium

Class: Analgesic Adjuncts/ Anticonvulsants/Sedatives/Hypnotics/Centrally-Acting Skeletal Muscle Relaxants (Benzodiazepines)

Indication(s): Anxiety, pre-operative sedation, conscious sedation, uncontrolled seizures, skeletal muscle spasms, ETOH withdrawal

Action: Depresses CNS (probably by potentiating GABA), inhibits spinal polysynaptic afferent pathways for skeletal muscle relaxation, anticonvulsant properties due to presynaptic inhibition

Side Effects: Dizziness, drowsiness, lethargy, headache

Adverse Effects: Respiratory depression

Question 15

Promethazine

Answer 15

Trade Name(s): Phenergan

Class: Antiemetics/Antihistamines/Sedatives/Hypnotics (Phenothiazines)

Indication(s): Treatment of various allergic conditions, motion sickness; pre-operative sedation; treatment/prevention of nausea/vomiting; adjunct to anesthesia and analgesia

Action: Blocks effects of histamine, inhibits effect of chemoreceptor trigger zone in CNS (antiemetic effects), alters effect of dopamine in CNS

Side Effects: Confusion, disorientation, sedation

Adverse Effects: Neuroleptic malignancy syndrome (NMS)

Question 16

Ondansetron

Answer 16

Trade Name(s): Zofran

Class: Antiemetics (5-HT₃ Antagonists)

Indication(s): Prevention of nausea, vomiting

Action: Blocks effects of serotonin at 5-HT₃ receptor sites located in vagal nerve terminals and chemoreceptor trigger zone in CNS

Side Effects: Headache, constipation, dizziness, diarrhea

Adverse Effects: serotonin syndrome, torsades de pointes (TdP), Steven-Johnsons Syndrome (SJS), toxic epidermal necrolysis (TEN)

Question 17

Sodium polystyrene sulfonate

Answer 17

Trade Name(s): Kayexalate

Class: Hypokalemic/Electrolyte Modifiers (Cation Exchange Resins)

Indication(s): Mild to moderate hyperkalemia

Action: Exchanges Na⁺ ions for K⁺ in intestines

Side Effects: Constipation, fecal impaction

Adverse Effects: Intestinal necrosis

Question 18

Phenytoin

Answer 18

Trade Name(s): Dilantin

Class: Antiarrhythmics/Anticonvulsants (Hydantoins)

Indication(s): Treatmentprevention of tonic-clonic (grand mal) seizures and complex partial seizures

Action: Limits seizure propagation by altering ion transport, may also decrease synaptic transmission; antiarrhythmic properties as a result of shortening action potential and decreasing automaticity

Side Effects: Ataxia, HoTN (IV), hypertrichosis, rash, diplopia, gingival hyperplasia, nausea

Adverse Effects: SI, cardiac arrest, acute generalized exanthematous pustulosis (AGEP), drug reaction with eosinophilia and systemic symptoms (DRESS), Steven-Johnsons Syndrome (SJS), toxic epidermal necrolysis (TEN), acute hepatic failure, agranulocytosis, aplastic anemia, angioedema