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Pharm 2 Exam 3 Flashcards

1
Q

Causes of Hypokalemia

A
  • Diuretics (e.g., furosemide, HCTZ)
  • Insufficient dietary intake
  • Alkalosis and excessive insulin
  • Vomiting, diarrhea, and laxative abuse
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2
Q

Potassium Chloride

A

Potassium supplement

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3
Q

Notable problems with potassium supplements

A
  • Very irritating to GI tract (must take with food or a full glass of water)
  • Very irritating to veins (must dilute)
  • IV potassium must be infused with a pump (never ever ever pushed by hand (lethal injection))
  • Watch for hyperkalemia (bradycardia, EKG changes- prolonged PRT interval)
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4
Q

Potassium supplement high yield concepts

A
  • Serum potassium should be 3.5 to 5 mEq/L
  • If your client’s potassium is low or high, put them on a cardiac monitor
  • Never push IV potassium by hand
  • Hyperkalemia can be treated with insulin, sodium bicarbonate, and sodium polystyrene sulfonate
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5
Q

Major symptoms of overactive bladder

A
  • Urgency (sudden urge to go)
  • Frequency (8+ times/day)
  • Nocturia (2+ times/night)
  • Urge incontinence (didn’t make it)
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6
Q

Treatment for overactive bladder

A
  • Behavior therapy: Planning times to void, what you drink, limiting caffeine use, and kegel exercises
  • Medications
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7
Q

oxybutynin

A

Bladder medication

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8
Q

oxybutynin mechanism of action

A

Oxybutynin is an anticholinergic medication that selectively blocks M3 receptors in the bladder, decreasing contractions and the urge to void

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9
Q

Oxybutynin notable problems

A
  • Tachycardia
  • Anticholinergic effects
  • Contraindicated in clients who have glaucoma and myasthenia gravis
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10
Q

Common uses for oral contraceptives

A
  • Acne (girls who also what a contraceptive)
  • Contraception
  • Dysfunctional uterine bleeding
  • Menopausal hormone therapy
  • Premenstrual dysphoric disorder (PMDD)
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11
Q

Ethinyl estradiol/norethindrone

A

Combination (progestin and estrogen) oral contraceptive

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12
Q

Norethindrone

A

Progestin-only oral contraceptive

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13
Q

oral contraception mechanism of action

A

Estrogen suppresses the release of follicle stimulating hormone. Progestin suppresses the release of luteinizing hormone. This prevents ovulation, thins the lining of the uterus, and thickens cervical mucus

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14
Q

Combination oral contraception administration

A
  • 3 weeks active drug; 1 week inactive tablets
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15
Q

Problem with oral contraceptives

A
  • Thromboembolic events
  • Breast cancer
  • Drug interactions
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16
Q

Thromboembolic events from oral contraceptives

A
  • DVT, PE, MI, thrombotic stroke (progestin only would be better)
  • Risk factors: heavy smoking, history of thromboembolism, thrombophilias, older than 35 years and a smoker
  • lower doses today = lower risk
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17
Q

Breast cancer from oral contraceptives

A
  • Do not increase risk of breast cancer

- Can increase the rate of growth

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18
Q

Drug interactions from oral contraceptives

A
  • St. John’s wort
  • Antiseizure medication (e.g., phenytoin, carbamazepine, phenobarbital)
  • Antibiotics (e.g., penicillins, cephalosporins, rifampin)
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19
Q

Novel delivery systems for contraception

A
  • Transdermal patch (once a week for 3 weeks, no patch the 4th week)
  • Vaginal contraceptive ring (wear for 3 weeks, no ring the 4th week, rinse with warm water and put back in if it falls out)
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20
Q

Medication options for Benign Prostate Hypertrophy

A
  • Alpha-1 blockers
  • 5-alpha-reductase inhibitors
  • Saw palmetto (not effective)
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21
Q

Tamsulosin

A

Alpha-1 blocker (BPH)

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22
Q

Doxazosin

A

Alpha-1 blocker (BPH)

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23
Q

Alpha-1 blockers mechanism of action

A

Alpha-1 blockers relax smooth muscle in the neck of the bladder, allowing urine to flow more freely through the urethra. Alpha-1 blockers also block receptors in the vasculature, decreasing blood pressure

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24
Q

Notable problems with Alpha-1 blockers

A
  • Nonselective agents: hypotension, dizziness, nasal congestion, sleepiness
  • Selective agents: abnormal ejaculation
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25
Finasteride
5-alpha-reductase inhibitor (BPH)
26
Dutasteride
5-alpha-reductase inhibitor (BPH)
27
5-alpha-reductase inhibitor (BPH) mechanism of action
Block the enzyme that converts testosterone into DHT - a more potent version of testosterone. Since DHT is what triggers the prostate to grow, this helps halt the growth of the prostate and even shrinks it. Since DHT also plays a role in male-pattern baldness, these drugs also help regrow hair
28
5-alpha-reductase inhibitor (BPH) notable problems
-Pregnancy Category X! - Pregnant women must not handle broken or crushed tablets - Men must not donate blood - Decreased libido, abnormal ejaculation - Falsely decreases PSA levels - Gynecomastia
29
High yield for BPH medications
- Alpha-1 blockers treat BPH but can also treat hypertension - 5-Alpha-reductase inhibitors are extremely teratogenic (wear gloves if handling - 5-Alpha-reductase inhibitors can treat BPH and male pattern baldness
30
Common causes of ED
- Vascular - Neurologic - Hormonal - Drug-induced - Psychogenic
31
Slidenafil
PDE5 (ED med)
32
Tadalafil
PDE5 (ED med) (36 hours)
33
Vardenafil
PDE5 (ED med)
34
Notable problems with ED meds
- Hypotension - Priapism - Sudden hearing loss -PDE5 inhibitors and nitrates increase cGMP levels. IF these drugs are combined, life-threatening hypotension can occur. Wait at least 24 hours
35
ED meds high yield
- PDE5 inhibitors do not cause erections - Take about 1 hour before activity - Do not combine PDE5 inhibitors and nitrates - Be very cautious about combining PDE5 inhibitors and alpha-blockers
36
Preterm labor
- Defined as birth before 37 weeks | - Leading cause of infant mortality and morbidity (75% of neonatal deaths)
37
Induced Labor
- More than 22% of deliveries are induced - When should labor be induced? - Beyond term (42 weeks) - When early delivery reduces morbidity and mortality to infant or mother
38
Oxytocin
Labor and delivery med
39
Methylergonovine
Labor and delivery med
40
Terbutaline
Labor and delivery med
41
Magnesium sulfate
Labor and delivery med
42
Oxytocin specific themes
- Increases the strength, frequency, and length of uterine contractions - Use pump and monitor closely - Stop the infusion if: - Resting uterine pressure > 15-20 mmHg - Contractions last > 1 min. - Contractions frequency every > 2-3 min. - Pronounced alteration of FHR or rhythm
43
Methylergonovine specific themes
- Controls postpartum bleeding - Cause powerful uterine contractions - High risk of hypertension; safer agents such as oxytocin are usually tried first
44
Terbutaline specific themes
- Suppresses preterm labor - Activates beta-2 receptors in the uterus, causing uterine relaxation - Major side effects: - Heart: tachycardia, hypotension - Lungs: pulmonary edema - Hyperglycemia
45
Magnesium sulfate
- Inhibits release of acetylcholine in synapses of skeletal muscle and uterus - No longer used suppress preterm labor (ineffective and dangerous) - Used for preeclampsia (prevent seizures)
46
Magnesium sulfate toxicity
- Signs and symptoms: - RR < 12/min - Loss of deep tendon reflexes - Hypotension - Urinary output <25-30 mL/hr - Antidote: calcium gluconate
47
Bactericidal medications
Kill microbes directly (use for cancer)
48
Bacteriostatic medications
slow the growth of microbes
49
How do prescribers choose the right antibiotic
- infection suspected - specimen collected - empiric therapy started - wait for culture to grow - pathogen identified - possible adjustment made Always collect your specimen(s) before starting antibiotic therapy
50
Broad spectrum antibiotic
Kills all types of bacteria
51
Narrow-spectrum antibiotic
Kills one specific type of bacteria
52
Antibiotic treatment challenges
- Difficult sites/infections to treat: - CNS infections - Endocarditis - Purulent abscesses - Bacterial resistance (e.g., MRSA, VRE) - Superinfection (Broad-spectrum antibiotic, disruption of normal flora, and then new infection)
53
High yield for anitbiotics
- Always collect specimens before starting antibiotic therapy - Narrow-spectrum antibiotics are preferred (match the drug to the bug) - Antibiotics don't kills viruses - Complete the full course - GI disturbances are common
54
Beta-lactam antibiotic mechanism of action
interfere with an enzyme inside bacteria called penicillin binding protein (PBP). This enzyme helps bacteria build strong cell walls. BY blocking PBP, bacteria cannot build strong cell walls. They swell up with water and burst. BOOM!
55
Amoxicillin/clavulanate
Beta-Lactam antibiotic (Penicillins)
56
Cephalexin
Beta-Lactam antibiotic (Cephalosporin)
57
Imipenem
Beta-Lactam antibiotic (Carbapenems)
58
Allergic reactions from Beta-lactam antibiotics
- Penicillins are the most common cause of drug allergy (0.4% of 7% of clients) - Severity varies (rash to anaphylaxis) - 1% cross sensitivity to cephalosporins - Most likely to occur within 30 minutes
59
Superinfections from Beta-lactam antibiotics
- Cephalosporins can cause C. diff - Advise clients to report water diarrhea - Treat with metronidazole or vancomycin - Stop antibiotic - Swap teh hand foam for soap and water..
60
Beta -lactam antibiotic high yield
- Beta-lactams destroy bacterial walls - Penicillins are the most common cause of drug allergies - If someone is allergic to a penicillin, they may be cross sensitive to a cephalosporin. - Watch out for cephalosporin-induced C. diff (especially in the hospital setting)
61
Protein synthesis inhibitors mechanism of action
Bind to bacteria ribosomes, blocking their ability to make proteins necessary for their survival
62
Tetracyline
Protein synthesis inhibitors (tetracyclines)
63
Erythromycin
Protein synthesis inhibitors (Macrolides)
64
Azithromycin
Protein synthesis inhibitors (Macrolides)
65
Gentamicin
Protein synthesis inhibitors (Aminoglycosides)
66
Neomycin
Protein synthesis inhibitors (Aminoglycosides)
67
Amikacin
Protein synthesis inhibitors (Aminoglycosides)
68
Tobramycin
Protein synthesis inhibitors (Aminoglycosides)
69
Streptomycin
Protein synthesis inhibitors (Aminoglycosides)
70
Tetracycline problems
- Esophageal ulceration (avoid taking at HS) - Many food interactions (e.g., milk products, calcium, iron supplements, magnesium containing laxatives and antacids) - Teeth discoloration (if < 8 years old) - Photsensitivity
71
Macroline problems
- Distorted tasted (e.g., metallic) | - Prolonged QT intervals
72
Aminoglycoside problems
- Nephrotoxicity - Ototoxicity - Inactivated by PCNs if mixed together
73
Peak
30 min after IM or IV dose infuses
74
Trough
Right before next does
75
Fluoroquinolones mechanism of action
Disrupt DNA replication in bacterial cells
76
Ciprofloxacin
Fluoroquinolone
77
Levofloxacin
Fluoroquinolone
78
Moxifloxacin
Fluoroquinolone
79
Norfloxacin
Fluoroquinolone
80
Ofloxacin
Fluoroquinolone
81
Fluoroquinolone notable problems
- Achilles tendon rupture (avoid use in children < 18 years) (organ transplants) (corticoidsteriods) - Photosensitivity - Multiple food interactions (dairy products, aluminum-magnesium antacids, iron)
82
Fluoroquinolone high yield
- Ciprofloxacin treats UTIs, traveller's diarrhea, and anthrax - Instruct clients to report pain, swelling, redness of any tendons or joints
83
Sulfamethoxazole/trimethoprim
UTI medication
84
Nitrofurantoin
UTI medication
85
Phenazopyridine
UTI medication
86
Sulfamethoxazole/trimethoprim mechanism of action
blocks two separate enzymes bacteria need to create their own folic acid
87
Nitrofurantoin mechanism of action
Enters bacteria and is converted into a toxic substances that destroys bacterial DNA
88
Phenazopyridine mechanism of action
An analgesic that works directly on the mucosa of the GU tract
89
Sulfamethoxazole/trimethoprim notable problems
- Hypersensitivity - Crystalluria (Dring 8+ cups of water per day) - Kernicterus (don't give to pregnant women of infants < 2 months old)
90
Nitrofurantoin notable problems
- May turn urine a brownish color - Take with food to increase absorption (40%) and decrease GI discomfort - Peripheral neuropathy (rare) - Contraindicated if renal impairment (increased risk of toxicity)
91
Phenazopyridine notable problems
- turns urine a orang-red color (stains) | - GI discomfort (take with food)
92
UTI med high yield
- SMZ/TMP can precipitate in the urinary tract; drink 8+ cups of water per day - Take nitrofurantoin with food - Phenazopyridine is urinary tract analgesic that turns urine orange-red

Pharm (7 decks)

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