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101a Vocab > Pharm 103 Test 2 > Flashcards

Pharm 103 Test 2 Flashcards

1
Q

Initial 4 drug combo for TB

A 
Reduces MDRTB:
isoniazid 
rifampin
pyrazinamide
ethambutal
not as common-streptomycin
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2
Q

prophylaxis drugs for TB for ppd + HCWs

A

isoniazid or rifampin

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3
Q

INH action

A

inhibit cell wall synthesis

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4
Q

some lack liver enzyme to metabolize

A

isoniazid

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5
Q

AEs of isoniazid

A 
hepatotoxicity (monitor liver function)
peripheral neuritis
B6 deficiency (take supplement)
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6
Q

rifampin action

A

inhibit protein synthesis

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7
Q

causes orange/brown discoloration of body fluids

A

rifampin

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8
Q

General TB med AEs

A

Hepatotoxicity (INH, PZA, rifampin)
Kidney issues (INH, Rif, esp streptomycin)
GI upset (take with snack)
eye problems (ethambutol especially: optic neuritis and decreased visual acuity, red-green color
INH)

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9
Q

non-opioid antitussive

A

dextromethorphan

potential for abuse

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10
Q

antitussive action

A

suppress cough reflex in medulla to reduce annoying, nonproductive cough

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11
Q

AE of high dose of dextromethorphan

A

dizziness and sedation

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12
Q

opioid antitussive

A

codeine

very effective but can be habit forming

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13
Q

AEs of codiene

A

constipation, sedation, hypotension

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14
Q

antihistamine and antitussive

A

diphenhydramine

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15
Q

AEs of diphenhydramine

A

drowsiness, dry mouth, anorexia

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16
Q

alpha 1 adrenergic receptors-location and function

A

mostly in peripheral arteries and veins; cause vasoconstriction when stimulated

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17
Q

alpha 2 adrenergic receptors-location and function

A

located on nerve membranes; modulate NE release to prevent overstimulation

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18
Q

beta 1 adrenergic receptors-location and function

A

mostly heart,some kidney; increase HR, contractility, automaticity, AV conduction and renin release from kidneys

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19
Q

beta 2 adrenergic receptors-location and function

A

lungs; cause bronchiole smooth muscle relaxation, resulting in bronchodilation

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20
Q

Decongestants-Action

A

sympathomimetic; shrink engorged nasal mucosa by stimulating alpha receptors of bvs in nasal mucosa causing vasoconstriction, reducing swelling and secretions

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21
Q

systemic effects of decongestants

A

especially in fragile pts.
cardiac stimulation-irregular rhythm, increased HR
CNS stimulation-DZNS, HA, irritable
Increase BS in DM
decreased sphincter contraction, decreased voiding

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22
Q

Avoid decongestant use in these pts

A

heart disease, HTN
Hyperthyroid
DM

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23
Q

to avoid systemic effects of decongestants, use

A

topical nasal spray to avoid cardiac stimulation; steroid nasal spray or mast cell stabilizers to avoid all

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24
Q

nonselective adrenergic agonist

A

epinephrine
very effective bronchodilator but multiple AEs since stimulates alpha, B1 and B2: jittery, increased HR, increased BP, HA, HTN
only used in acutely ill pt-anaphylaxis

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25
Q

B2 adrenergic agonists-action

A

mostly stimulate B2 receptors in lungs causing bronchodilation by increasing cAMP; in lg frequent dose can stimulate B1 (increase HR)

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26
Q

AE of B2 agonists

A

tremors, anxiety, minimal tachycardia and increased bp, arrhythmia in some pts.

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27
Q

fast acting B2 agonists–rescue meds in MDI or neb

A

albuterol (duration 3-4h) and levalbuterol (longer duration-8h)

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28
Q

long-acting B2 agonists (bid)

A

Brovana (neb)
salmeterol (Serevent)
formoterol (Foradil)

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29
Q

B2 agonist that can be used to stop preterm labor

A

terbutaline (Brethine)

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30
Q

Advair diskus

A

Dry powder inhaler-B2 agonist and steroid
salmeterol (Serevent) and fluticasone
daily use-bid

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31
Q

Combivent inhaler

A

ipratropium (Atrovent) and albuterol
used in COPD
DuoNeb in nebulizer

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32
Q

Symbicort

A

budesonide and formaterol

similar to Advair- steroid and long acting B2 agonist

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33
Q

two MDIs that combine a steroid and a long-acting B2 agonist

A

Advair diskus and Symbicort

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34
Q

PSNS stimulation in lungs causes

A

bronchoconstriction–need anticholinergic med

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35
Q

anticholinergic bronchodilators

A

ipratropium (Atrovent)–short acting and duration

tiotropium (Spiriva)–longer acting (qid)

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36
Q

Leukotriene receptor antagonists-action and examples

A

leukotrienes cause bronchoconstriction–these meds stop that part of the inflammatory process
Long term preventative of acute asthma problems
montelukast (Singular)
many interactions, not 1st choice

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37
Q

Xanthine bronchodilators-action and examples

A

stop cAMP from breaking down, promoting bronchodilation
oral theophylline/aminophylline
related to caffeine, AEs: tachycardia, nervousness
monitor blood levels, can become toxic

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38
Q

Inhaled Corticosteroids used for long term prevention in asthma and COPD (not rescue)

A

fluticasone (Flo-vent)
budesonide (Pulmicort)
triamcinolone (Asmacort)
beclomethasone (Beclonase)

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39
Q

inhaled steroids used for asthma instead of oral/IV because

A

less systemic AE

may use oral or IV in acute situation

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40
Q

Mast cell stabilizers-action and examples

A

prevent mast cells from releasing inflammatory mediators
cromolyn (Intal)
nedocromil (Tilade)

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41
Q

three functions of respiratory aerosols

A

Decongest, liquify secretions
Bronchodilate, topical med admin
moisten, heat or cool resp mucosa

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42
Q

DPIs

A

dry powder inhalers

Advair and Spiriva

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43
Q

Effects of histamine release in inflammation

A

dilates and increases permeability of nasal capillaries causing edema
constricts smooth muscle in lungs
increases GI secretions

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44
Q

anti histamines action

A

block histamine receptors so histamine can’t bind-don’t effect already bound histamine

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45
Q

1st vs 2nd generation antihistamines

A

1st gen-Benadryl AEs:drowsiness, decreased coordination, allergic rxns, n/v
2nd gen-nonsedating antihistamines

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46
Q

Secondary uses for diphenhydramine

A

n/v, vertigo, sleep aid

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47
Q

muco-kinetic vs. muco-lytic

A

muco-kinetic: thins mucus for better ciliary action (ex. aerosolized saline, water)

muco-lytic: chemically breaks down mucus
guanifenesin, Mucomyst

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48
Q

3 uses for acetylcysteine (Mucomyst)

A
  1. To reduce tenacity and viscosity of thick secretions, esp. in CF
  2. Antidote for tylenol OD-blocks livery toxicity from tylenol
  3. Protects kidneys from damage when IV contrast is used in pt with renal dysfunction
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49
Q

Quick relief agent bronchodilators

A

albuterol MDI/neb
ipratropium (Atrovent) MDI
oral prednisone (not as much)

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50
Q

anticholinergic bronchodilators (2)

A

ipratropium (Atrovent)

tiotropium (Spiriva)

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51
Q

alpha adrenergic blockers-action

A

HTN med; block alpha 1 receptors in peripheral arteries and veins that cause vasoconstriction; preventing stimulation dilates arteries and veins, decreasing arterial pressure and venous return to the heart, decreasing CO and bp
there are selective and nonselective

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52
Q

selective alpha adrenergic blockers

A 
HTN med; block only alpha 1 receptors
-sin
prazosin (Minipress)
terazosin (Hytrin)
doxazosin (Cardura)
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53
Q

alpha adrenergic blocker that can be used in treatment of BPH

A

terazosin (Hytrin)

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54
Q

nonselective alpha adrenergic blockers

A 
block E and NE, alpha 1 and alpha 2
used to treat HTN d/t pheochromocytoma tumor of adrenal medulla in which too much E and NE are released
phenoxybenzamine (Dibenzyline)
phentolomine (Regitine)
used in treat
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55
Q

nonselective alpha blocker used to treat increased alpha activity disorders (Raynauds, frostbite) where there is too much vasoconstriction

A

phenoxybenzamine (Dibenzyline)

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56
Q

nonselective alpha blocker used to reverse tissue necrosis when drugs extravasate

A

phentolomine (Regitine)

57
Q

AEs of alpha blockade

A

most important: orthostatic HoTN
can go away eventually, get OOB slowly

S=syncope and dizziness (OHoTN), sexual dysfunction
I=Increased HR, weakness,
N=nasal congestion

58
Q

Centrally-acting alpha 2 stimulators-action and examples

A

suppress SNS outflow in brainstem to heart and bvs and decrease renin from kidneys (alpha 2 receptors modulate NE release to prevent overstimulation)
clonidine (Catapres)
methyldopa (Aldomet)

59
Q

centrally-acting alpha 2 stimulators and direct-acting vasodilators are usually given with a diuretic because they can cause

A

Na and water retention

60
Q

centrally-acting alpha 2 stimulator AEs

A

drowsiness, sedation
decreased concentration depression
dry mouth

61
Q

This centrally-acting alpha 2 stimulator can cause severe rebound HTN if stopped abruptly

A

clonidine (Catapres)

62
Q

This centrally-acting alpha 2 stimulator can cause hemolytic anemia, liver toxicity, and dark urine

A

methyldopa (Aldomet)

63
Q

Direct-acting Vasodilators-action and examples

A

decrease bp by dilating arterioles (not veins)
hydralazine (Apresoline)
minoxidil (Loniten)
often given with diuretics, can cause Na and fluid retention

64
Q

Beta Blockers-action

A

nonselective and cardioselective
decrease O2 demand of heart by blocking SNS response
decrease HR (increases filling time of ca’s)
and contractility, resulting in decreased CO and myocardial O2 demand
decreased AV conduction
prevent renin release from kidneys
decrease PVR long term
-olols

65
Q

mostly widely used drug for HTN

A

Beta Blockers

66
Q

two types of Beta Blockers

A

nonselective (block B1 and B2)
cardioselective (block B1 only)
cardioselective don’t cause bronchospasm like nonselective can

67
Q

nonselective Beta Blockers

A

propanolol (Inderol)
nadolol (Corgard)
Timolol (Blocadren)

68
Q

cardioselective Beta Blockers

A

atenolol (Tenormin)

metoprolol (Lopressor)

69
Q

danger in cardioselective Beta Blockers for DM pts

A

may mask “jitters” and effects of hypoglycemia

70
Q

don’t use nonselective Beta Blocker in asthma pt because

A

may cause bronchospasm

71
Q

Newest Beta Blocker, blocks B1 and vasodilates with endothelium derived NO

A

nebivolol (Bystolic)

72
Q

Beta Blockers can treat tachyarrythmias because they

A

decrease rate of AV conduction

73
Q

Beta Blockers are less effective in

A

blacks

74
Q

B1 adrenergic receptor stimulation increases (5)

A 
HR
contractility
automaticity
AV conduction
Renin from kidneys (activation of RAAS)
75
Q

B2 adrenergic receptor stimulation causes (2)

A

Bronchodilation

Increased breakdown of glycogen into glucose

76
Q

do not stop Beta Blocker use abruptly because

A

sudden withdrawal can exacerbate angina by rebound vasoconstriction

77
Q

Combined alpha and beta blocker-action and examples

A

Block A1: promote vasodilation
Bock B1: decrease HR and contractility, decrease renin release in kidney
labetalol (Normodyne)
carvedilol (Coreg)

78
Q

Major AE of combined alpha and beta blocker

A

Orthostatic Hypotension and Bradycardia

79
Q

AEs of Beta Blockers

A

Bradycardia, worsening HF
weakness, lethargy
sexual dysfunction
depression, insomnia, bizarre dreams
may delay recovery from hypoglycemia in Type 1 DM
nonselective only: may promote bronchospasm and bronchoconstriction

80
Q

Calcium channel blockers-action and types

A

prevent Ca from entering myocardial cells, decreasing force of myocardial contraction
results in: coronary artery dilation and peripheral artery dilation; some decrease conduction
Anti-HTN: nifedipine (Procardia) and amlodipine (Norvasc)

Antianginals and antiarrythmics (cardiosuppresive): verapamil (Calan)

Intermediate acting: diltiazem (Cardizem)

81
Q

anti-HTN CCBs

A

nifedipine (Procardia)

amlodipine (Norvasc)

82
Q

antianginal and antiarrythmic (cardiosuppressive) CCBs

A

verapamil (Calan): most conduction reducing b/t SA and AV; some vasodilation
diltiazem (Cardizem): intermediate acting bt conduction reducing and vasodilation, reducing HTN

83
Q

Use diltiazem or verapamil cautiously with

A

bradycardia, HF, AV block

bc both decrease donduction

84
Q

AEs of CCBs

A 
constipation
HoTN
dizziness, HA
skin flushing 
edema
85
Q

ACE inhibitors-action and examples

A

blocks conversion of Ag I to Ag II, a potent vasoconstrictor. Promotes relaxation of arteries and excretion of Na and H20. Drug of choice for HTN and CHF.
captopril (Capoten)
enalapril (Vasotec)
lisinopril (Zestril)

86
Q

AEs of ACE inhibitors

A

first dose HoTN
persistent dry cough
hyperkalemia (watch for gradual increase)
Danger of angioedema

87
Q

angioedema-definition and what drugs can cause it

A

ACE inhibitors
histamine response causing edema of mucus membranes of lips, tongue, and glottis.
Stop drug immediately and give epinephrine

88
Q

Angiotensin II Antagonists (Angiotensin Receptor Blockers)-action and examples

A

newer, similar to ACE I but don’t cause cough
Block AG II from binding to receptors on bvs and kidneys, promoting vasodilation and reduced bp, promoting excretion of Na and H20
losartan (Cozaar)
irbesartan (Avapro)

89
Q

AE of ARB’s

A

URI and HA

90
Q

ARBs can help HF because

A

decreased bp makes it easier for the heart to pump

91
Q

3 meds used to treat angina

A

CCBs
BBs
nitrates

92
Q

no grapefruit juice with

A

CCBs

93
Q

If there are no written parameters, hold a BB for

A

SBP < 120

HR < 60

94
Q

closely watch BS in DM pts on

A

Beta Blockers

oral diabetic meds and insulin can delay effects also

95
Q

first choice in acute angina attack

A

nitroglycerine

rapid and long term treatment of angina; treats HF also

96
Q

nitroglycerin-action

A

relax smooth muscle cells around arteries and veins to dilate them; this decreases BP and cardiac workload
dilate ca’s -decrease angina
dilate peripheral a’s - decrease afterload
dilate veins-decrease venous return and preload

97
Q

Hypertensive crisis can result if using erectile dysfunction med with

A

nitroglycerin

98
Q

when giving SL nitro, assess BP and HR when

A

before giving and 5 minutes after

99
Q

AEs of nitroglycerin

A

orthostatic HoTN
flushing
dzns, weakness
HA-expected, give tylenol

100
Q

Inotropes alter

A

force of heart contraction

101
Q

chonotropes alter

A

rate of heart contraction

102
Q

dromotropes alter

A

rate of conduction SA to AV

103
Q

Digoxin (Lanoxin) action

A

alters ion movement across myocardial PM
positive inotropic (increase strength of contraction) which increases emptying
negative chono and dromotropic (decreased rate of contraction and conduction) which increases filling

Overall: increased CO, perfusion, blood to kidneys and excretion
decreased pulmonary and systemic congestion

104
Q

Digitalization

A

pt given loading dose of dig to saturate body tissues with med and get high blood levels. Followed by maintenence dose until pt is at therapeutic level.

105
Q

Digoxin given to treat

A

Afib, Aflutter, CHF (4th line tx, used to be 1st)

106
Q

Therapeutic level for Digoxin

A

0.8-2.0 ng/mL (less in renal pts)

small therapeutic index, and some pts can be toxic at therapeutic level

107
Q

most common cause of dig toxicity

A

hypokalemia

108
Q

s/s digoxin toxicity

A

fatigue
blurred vision
disturbed color vision (yellow/green halos around objects)
GI disturbance-n/v, anorexia, abd pain diarrhea
CNS-DZNS, confusion, delerium, depression
change in HR, arrythmias
Hyperkalemia

109
Q

Times to measure dig level

A 
digitization
post op
renal failure
pt showing s/s toxicity
intervals in treatment
110
Q

pt teaching about dig

A

always take apical HR before taking med
inform MD of GI or visual complaints
eat food high in K

111
Q

Dig antidote

A

Digibind–antibody that binds digoxin and inactivates it

112
Q

drugs that increase risk of digoxin toxicity

A

antacids, calcium preps

K wasting diuretics, steroids, some abx–all these 3 can cause hypokalemia

113
Q

AEs of digoxin are related to

A

dose; continnum of s/s toxicity
fatal arrythmias
bradycardia
GI, CNS (can go to seizures and hallucinations)

114
Q

conditions that may predispose to digoxin toxicity

A

hepatic/renal impairment
MI/heart disease
electrolyte imbalances (low K)
hypothyroid (decreased metabolism)

115
Q

Don’t give Digoxin with

A

antacids, high fiber, or food (one hour before or two hours after meals)

116
Q

Assess before giving digoxin

A

electrolytes, renal function

apical and radial HR and rhythm for 1 minute

117
Q

Short term tx for CHF pt unresponsive to dig

A 
Phosphodiesterase inhibitors (PDI)
Inamrinone (Inocor)
milrinone (Primacor)
118
Q

Direct renin inhibitors

A

block activity of renin enzyme converting Ag I to Ag II

aliskiren

119
Q

pt teaching about vasodilators includes avoiding (3)

A

exercise for 3 hours after taking
hot tubs
alcohol

120
Q

pt teaching about HTN meds includes (4)

A

low Na diet
OOB slowly
don’t d/c abruptly
contact MD for sexual dysfunction

121
Q

when giving a HTN med, assess BP

A

prior to dose (w/in 30 min)

recheck at peak effect time

122
Q

nifedipine, amlodipine

A

Procardia, Norvasc

CCBs with no antiarrythmic action, only vasodilation

123
Q

diltiazem, verapamil

A

Cardizem and Calan
CCBs with antiarrythmic effects
block Ca channels in heart to decrease conduction

124
Q

CCBs that treat angina

A

diltiazem, verapamil, and nifedipine

block Ca channels in bvs, causing coronary artery and peripheral artery dilation

125
Q

advantage of ARBs over ACE inhibitors

A

no dry cough, less risk of hyperkalemia

126
Q

BBs used for angina

A

atenolol, metoprolol
decrease myocardial O2 demand and workload
decreased HR increases diastole, increases filling time of coronary arteries.s

127
Q

NO sudden withdrawal from BBs or CCBs because

A

could cause rebound HTN

128
Q

oral antidiabetic agents and insulin can delay effects of

A

BBs and CCBs

129
Q

used for rapid and long term treatment of angina; vasodilate arteries and veins by relaxing smooth muscle

A

nitrates

130
Q

chemical tourniquet

A

nitrates

131
Q

organic nitrates, similar to nitroglycerin

A

isosorbide dinitrate-acute and exertional relief

isosorbide mononitrate-stable angina

131
Q

Direct Acting vasodilator that can cause lupus-like syndrome (butterfly rash, sore throat, fever, joint pain

A

hydralazine (Apresoline)

132
Q

Direct acting vasodilator that can cause pericardial effusion

A

minoxidil (Loniten)

133
Q

These meds can increase BS in DM pts

A

Decongestants

134
Q

Digoxin is used to treaty

A

A fib, Aflutter, CHF

135
Q

Monitor glucose level closely for a DM pt on these meds

A

BB

136
Q

Danger of sympathomimetic decongestants in fragile pts

A

Epinephrine-like effects

Increased HR, irregular rhythm, anxiety, HA, increased BS

138
Q

Avoid decongestants in pt with

A

Arrhythmia, HTN, hyperthyroid, DM

139
Q

Orthostatic HoTN is considered significant if (3)

A

bp decreases by 20 mm Hg OR
pulse increases by 20 OR
pt c/o dizziness

101a Vocab (9 decks)

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