N365 Exam 3

Question 1

Mucolytic; breaks up mucus & makes it more soluble
ADRs: Fever, some N/V, Stomatitis, Rhinorrhea
Bronchospasm in asthmatics
Rotten egg odor; wash face after use
ANTIDOTE FOR ACETAMINOPHEN OVERDOSE

Answer 1

Acetylcysteine (Mucomyst)

Question 2

Expectorant, bronchomucotropic; increases volume but decreases viscosity of mucus
ADRs: Rare. Occasional GI irritation
HYDRATION is very important

Answer 2

Guaifenesin (Robitussin, Mucinex)

Question 3

Sympathomimetic (non-selective); BRONCHODILATOR; vasoconstriction to dec. mucosal edema, stimulates HR and force of contraction, bronchial smooth muscle relaxation
ADR: Nervousness, insomnia, FEAR, tremors, TACHYCARDIA, headache, dyspnea
Use caution with CAD, HTN, and hyperthyroid
USE WITH MAOIs = SEVERE HTN

Answer 3

Epinephrine (Adrenalin)

Question 4

Sympathomimetic (non-selective beta stimulant); BRONCHODILATOR; b1 & b2 stim.
ADRs: tachycardia, palpitation, headache, nausea, tremor, insomnia; MORE USED, LESS EFFECTIVE
MOST POWERFUL BRONCHODILATOR

Answer 4

Isoproterenol (Isuprel)

Question 5

Sympathomimetic; BRONCHODILATOR (selective B2 stimulant)
Relaxation of bronchial smooth muscles (some B1 action at high doses)
ADR: Few; peripheral dilation = dec. BP & tachycardia; Tremors, nervousness, palpitations, N/V, lethargy, tinnitus
SABA = rescue inhaler
Use caution with diabetes, HTN, cardiac arrhythmias

Answer 5

Albuterol (Proventil, Ventolin)

Question 6

Anticholinergic BRONCHODILATOR, Short-acting muscarinic antagonist (SAMA); blocks cholinergic receptors to dec. bronchial tone
ADRs: Few. Dry mouth, pharyngeal irritation
Combivent and Spiriva in same class

Answer 6

Ipratropium (Atrovent)

Question 7

BRONCHODILATOR, Methylated Xanthine; relaxes bronchial smooth muscle, stim. heart, CNS, & medullary resp. center
ACTS LIKE CAFFEINE
ADRs: GI (anorexia, N/V, abd. discomfort); CNS (insomnia, irritability, SEVERE CONVULSIONS); CV (tachycardia, severe hypotension, arrhythmias); Renal (urinary freq.)
Dec. 1/2 life in smokers; Take with food
THERAPEUTIC LEVEL: 8-15

Answer 7

Aminophylline (Theophylline)

Question 8

Antiallergic (histamine inhibitor); stabilizes mast cell membranes
ADRs: THROAT IRRITATION
Used for ASTHMA PROPHYLAXIS; comes in MDI or Turbo inhaler, nasal spray, & ophthalmic sol’n
RINSE MOUTH AFTER USE
Useful for children and with Exercise Induced Asthma (EIA)

Answer 8

Cromolyn sodium (Intal)

Question 9

Leukotriene receptor antagonist; blocks inflammatory response by leukotrienes
ADRs: GI, headache, ELEVATED LIVER FUNCTION TESTS
MAINT. THERAPY & prophylaxis of asthma; not good for acute attack
With warfarin –> inc warfarin levels
In combo with aspirin –> inc. ____ levels
Take 1hr before or 2hrs after meals

Answer 9

Zafirlukast (Accolate)

Question 10

Inhaled CORTICOSTEROID; blocks inflammatory enzymes
ADRs: Hoarseness, dry mouth, THRUSH
Can have systemic steroid response; LONG- TERM TX of asthma; RINSE MOUTH
Also: Advair, Dulera, Breo

Answer 10

Beclomethasone (Vanceril)

Question 11

Antitussive, non-opioid; suppresses cough center; NO analgesic or addictive properties
ADRs: Infrequent; GI distress and drowsiness
Synthetic opiate derivative w/o analgesic and resp. depressant effects

Answer 11

Dextromethorphan (DM)

Question 12

Decongestant; alpha & beta stimulation releases norepi
Vasoconstriction, bronchial muscle relaxation, dec. uterine activity, shrink mucous membranes
ADRs: Minimal; CV (tachycardia, flushing)
AVOID TAKING NEAR BEDTIME d/t stim. effects

Answer 12

Pseudoephedrine (Sudafed)

Question 13

Antihistamine; bronchodilation, vasodilation
Inhibits release of acetylcholine
Sedative effects –> used as a HYPNOTIC
ADRs: *SEDATION, dizziness, LASSITUDE, blurred vision, EUPHORIA; dec. appetite, N/V/D, dry mouth; urinary freq., palpitations, TINGLING/WEAKNESS OF HANDS)
May cause allergic DERMATITIS
Do NOT take with alcohol; tolerance can occur; used as a hypnotic for kids and adults

Answer 13

Diphenhydramine (Benadryl)

Question 14

Anti-lipid; prevents formation of cholesterol
ADRs: mild, transient GI disturbances, headache, sleep disturbances, Inc. transaminase levels, peripheral neuropathy, lupus-like syndrome, SEVERE MYALGIA, muscle weakness, RHABDOMYOLYSIS
CAUTION IN ALCOHOLICS & LIVER DISEASE
Monitor liver function tests; contraindicated in pregnancy, enhance effects of anticoagulants
GRAPEFRUIT JUICE INHIBITS METABOLISM–> toxic levels of drug

Answer 14

Atorvastatin (Lipitor)

Question 15

Sympatholytic, antihypertensive, a2 adrenergic agonist; reduces NE; dec. peripheral resistance
ADRs: ORTHO HYPOTENSION, sedation, DEPRESSION, dry mouth, dec. WBC & PLT, sexual dysfunction; Na & water retention (unless on diuretic)
CONTRAINDICATED IN LIVER Dx and MAJOR DEPRESSION
Can be used for pregnancy induced HTN (PIH)

Answer 15

Methyldopa (Aldomet)

Question 16

Antihypertensive, a1 adrenergic antagonist; prevents constriction (vasodilation & dec. PVR)
ADRs: ORTHO HYPOTENSION; dizziness, SYNCOPE, tachycardia, peripheral edema, impotence
FIRST DOSE PHENOMENON (severe drop in BP!)

Answer 16

Prazosin (Minipress)

Question 17

Beta blocker; antihypertensive effect, antianginal, antiarrhythmic
ADRs: bradycardia, INTENSIFY AV BLOCK, hypotension, BRONCHOSPASM IN COPD/ASTHMA, cramps, allergic response
CHECK APICAL & RADIAL PULSE AND BP
Use w/ vasodilator and thiazide diuretic
BLACK BOX: do NOT stop abruptly, TAPER!
Caution w/ CHF, asthma, diabetes
Used for migraine & MI prophylaxis, panic attacks, benign essential tremor & PTSD

Answer 17

Atenolol (Tenormin)

Question 18

Antihypertensive, vasodilator
ADRs: hypotension, palpitations, tachycardia, anxiety, UNPLEASANT TASTE IN MOUTH, N/V
FREQUENT MONITORING d/t differences in metabolism

Answer 18

Hydralazine (Apresoline)

Question 19

Calcium antagonist, antianginal, antiarrhythmic
Inc. in coronary perfusion d/t arteriolar dilation
Inhibits renin release
ADRs: bradycardia, hypotension, SEVERE TACHYCARDIA, abd. discomfort, flushing
CONTRAINDICATED in AV BLOCK, SEVERE HYPOTENSION, & SEVERE CHF
Grapefruit juice INCREASES drug levels!

Answer 19

Verapamil (Calan, Isoptin)

Question 20

Angiotensin II inhibitor (ACE inhibitor); reduced vascular tone and lowering of BP; dec. aldosterone release and less Na retention
ADRs: hypotension, pruritus; poss. HYPERKALEMIA; Rare (NEUTROPENIA, AGRANULOCYTOSIS, HEPATOTOXICITY)
BLACK BOX: fetal injury & death during pregnancy
Used for heart failure

Answer 20

Lisinopril (Prinivil, Zestril)

Question 21

Angiotensin II antagonist, Antihypertensive; inhibits RAAS (more than ACE inhibitors)
ADRs: insomnia, GI, MUSCLE PAIN, cramps, occasionally inc. LFTs
BLACK BOX: should not use in pregnancy
Max effect seen w/in 3-6 weeks

Answer 21

Losartan (Cozaar)

Question 22

Antianginal; dec. myocardial oxygen consumption (doesn’t work for CAD)
ADRs: headache, dizziness, SYNCOPE, REFLEX TACHYCARDIA, flushing, hypotension
USE WITH SILDENAFIL = LIFE-THREATENING HYPOTENSION AND CARDIAC COLLAPSE!

Answer 22

Nitroglycerin

Question 23

Thiazide diuretic; promotes excretion of Na, Cl, and water, also K
ADRs: HYPOKALEMIA, anorexia, cramping, JAUNDICE, vertigo, paresthesia
ALLERGIC RXNs IF SENSITIVE TO SULFA (bc sulfonamide derivatives)

Answer 23

Hydrocholorthiazide (HCTZ, Hydrodiuril)

Question 24

Loop diuretic; inhibits passive Na transport
ADRs: N/V/D, dermatitis, pruritus, blurred vision, ortho hypotension, HYPOKALEMIA, OTOTOXICITY
SULFONAMIDE derivative (potential allergy!)
Contraindicated: pregnancy and nursing moms, anuria, hepatic coma, and F&E depletion
MORE POTENT THAN THIAZIDES (good for CHF)

Answer 24

Furosemide (Lasix)

Question 25

Diuretic, Potassium SPARING; antagonizes aldosterone
ADRs: anorexia, N/V/D, occasional headache, ATAXIA, MENTAL CONFUSION, in males (GYNECOMASTIA w/ tender lumps in breasts), in females (breast soreness and menstrual irreg.)
MOST SERIOUS ADR: HYPERKALEMIA
Often used in combo w/ other diuretics

Answer 25

Spironolactone (Aldactone)

Question 26

Osmotic diuretic; high osmolality dec. reabsorption
ADRs: DEPENDS ON AMT OF DRUG AND EFFECT; headache, nausea, chills, mild CHEST PAIN, electrolyte imbalance
DO NOT give to pts w/ severe CHF, HTN, chronic edema
MAY CRYSTALLIZE –> USE A FILTER

Answer 26

Mannitol

Question 27

Cardiac glycoside; useful for HF, afib/flutter; + inotropic, - chronotropic, - dromotropic action
ADRs: anorexia, N/V/D, VISUAL DISTURBANCE, nervous irritability, GYNECOMASTIA, DYSRHYTHMIAS (w/ dig toxicity)
MUST CHECK APICAL PULSE before giving
Arrhythmias = sign of LATE toxicity
W/ diuretics = potassium loss –> dig. toxicity
W/ antacids = interfere w/ dig. absorption
ANTIDOTE = DIGOXIN IMMUNE FAB

Answer 27

Digoxin (Lanoxin)

Question 28

Electrolyte; plays role in muscle contraction, nerve impulse, cell membrane function
ADRs: HYPERKALEMIA, GI pain, distension, abd. cramps, diarrhea, weakness, PARALYSIS
Oral K+ is used for prophylaxis w/ diuretics
GIVE WITH FULL GLASS OF WATER
Unpleasant taste if liquid/elixir

Answer 28

Potassium chloride (K-dur)

Question 29

Antiarrhythmic; direct action on cardiac cell membrane, decreases conduction
ADRs: N/V/D, tinnitus, vertigo, visual disturbances, THROMBOCYTOPENIC PURPURA, urticaria, hypotension; CV (complete heart block & Vfib)
Used with ATRIAL dysrhythmias
Many drug interactions

Answer 29

Quinidine- Class 1A

Question 30

Antiarrhythmic; similar properties to quinidine; depresses automaticity of ectopic pacemakers
ADRs: Drowsiness, CNS (agitation, muscle twitching) HEART BLOCK, blurred vision, PARESTHESIAS, tinnitus, euphoria, RESPIRATORY DEPRESSION
Used for VENTRICULAR dysrhythmias
Caution with liver disease

Answer 30

Lidocaine- Class 1B (Xylocaine)

Question 31

Iron replacement; used for nL oxygen carrying of RBCs
ADRs: headache, loss of appetite, gastric pain, N/V, constipation
ALWAYS GIVEN ORALLY (take sol’ns w/ a straw)
Black/green stools
Overdose can be lethal (keep away from kids!)
Do NOT take with antacids
Antidote = deferoxamine (Desferal)

Answer 31

Ferrous sulfate (Feosol)

Question 32

Vitamin; needed for RBC formation
ADRs: Rare. Possible dec. potassium
Evaluate pt q4-6 months to be sure of effectiveness
If pt lacks intrinsic factor –> must use large oral dose

Answer 32

Vitamin B12 (cyanocobalamin)

Question 33

Vitamin; development of enzymes for DNA production; if inadequate –> macrocytic anemia
ADRs: NONTOXIC but allergic rxns can occur
Take for deficiency then dietary sources adequate
IMPORTANT FOR PREVENTING NEURAL TUBE DEFECTS IN FETUS DURING PREGNANCY

Answer 33

Folic acid (Folvite)

Question 34

Enhances production of RBCs
ADRs: Hypertension (ENCEPHALOPATHY & seizures), headache, paresthesia, fatigue, SOB, inc. clotting of AV grafts, limb pain and sweating
BLACK BOX- TIAs, MIs, CVAs (THROMBOEMBOLI)
Watch for rapid inc. in hematocrit (>4 points in 2 weeks)
>500U/L: won’t respond; <500U/L: will respond
Adequate iron supplementation is necessary
Increased appetite and wellbeing

Answer 34

Erythropoietin (Epogen, Procrit)

Question 35

Anticoagulant; inhibits thrombin mediated conversion of fibrinogen to fibrin
ADRs: HEMORRHAGE; minor bleeding (GI tract, GU tract, PETECHIAE, ecchymosis); major bleeding (CNS or GI tract); hypersensitivity (chills, fever, urticaria, anaphylaxis)
Mild thrombocytopenia
Dose & effectiveness determined by PPT/APTT
Should not be given IM bc risk of hematoma
BLACK BOX: SPINAL HEMATOMAS W/ SPINAL ANESTHESIA
Elderly women more sensitive
Does not decrease PLT aggregation
HEPARIN-INDUCED THROMBOCYTOPENIA (HIT) –> potentially fatal
Antidote = Protamine Sulfate

Answer 35

Heparin (unfractionated)

Question 36

Low molecular-weight heparin; inactivates factor Xa
ADRs: bleeding, heparin-induced thrombocytopenia (HIT), edema, injection site pain, angioedema
Avoid in pts with increased risk of hemorrhage
Used for prophylaxis and tx of DVT after hip/knee procedures

Answer 36

Enoxaparin (Lovenox)

Question 37

Heparin Antidote; combines with heparin and neutralizes it
ADRs: dyspnea, flushing, bradycardia, hypotension (w/ rapid injection); overdose = anticoagulation, leading to hemorrhage
Hypersensitivity can occur ESP. WITH FISH ALLERGY (drug comes from fish sperm)

Answer 37

Protamine Sulfate

Question 38

Anticoagulant, direct factor Xa inhibitor; prevents production of thrombin
ADRs: Hemorrhage (minor to life-threatening), spinal/epidural hematoma), NOT safe in pregnancy
Approved for DVT & PE prevention and stroke prevention in Afib
NO BLOOD MONITORING NEEDED
Antidote = factor Xa (Andexxa)

Answer 38

Rivaroxaban (Xarelto)

Question 39

Thrombolytic agent; initiates fibrinolysis
ADRs: bleeding (internal –> GI, GU, retroperitonal, intracranial; superficial –> venipuncture sites); Dysrhythmias, fever, N/V
Higher stroke incidence
Contraindicated in active internal bleeding, CVA, known bleeding problems, severe uncontrolled HTN, pregnancy
Can cause dysrhythmias d/t reperfusion
Electrical instability in ~80% of patients
Give with heparin to reduce risk of rethrombosis
Mix with sterile water then dilute with D5W
EXTREMELY EXPENSIVE

Answer 39

Tissue Plasminogen Activator (TPA) (Activase, Alteplase)

Question 40

Antidote, hemostatic agent-antifibrinolytic; prevents formation of plasmin
ADRs: headache, dizziness, nausea, abd. pain, tinnitus, malaise, THROMBOPHLEBITIS, GRAND MAL SEIZURE
Hypotension, bradycardia, arrhythmias (if given too rapidly IV)

Answer 40

Aminocaproic acid (Amicar)

Question 41

Granulocyte colony stimulating factor; increases production of neutrophils
ADRs: mainly BONE PAIN; inc. uric acid, lactate dehydrogenase, and alkaline phosphatase
Only 1 dose per vial
Long acting form = pegfilgrastim (Neulasta)
Used for cancer patients during chemo therapy sessions

Answer 41

Filgrastim (Neupogen)