Pharm Exam 3 Flashcards
Isoniazid
ANTI TUBERCULAR
Action:
-disrupts cell wall synthesis (inhibits mycotic acid which is the causative agent for TB) and blocks pyridoxine (B6)
-bactericidal
Uses:
-most useful for antitubercular drug
-may be used alone for prophylaxis (preventative measure)
-always included in the treatment plan
Pharmacokinetics:
-well absorbed after oral administration
-rate of acetylation differs among populations
-slow metabolism (less likely to build up)
ADRs:
-peripheral neuropathy (give vitamin B6)
-blood dyscrasias
-hepatitis
-allergic reactions
-GI upset
Implications:
-assess for peripheral neuropathy
-monitor CBC and WBC
-stress importance of completing entire course of drug therapy and taking pyridoxine (B6)
-avoid alcohol
Rifampin
ANTI TUBERCULAR
Action:
-inhibits RNA polymerase = no protein synthesis = metabolic activity in bacteria is stopped
-bactericidal, broad spectrum
-synergistic in combination with Isoniazid (INH)
ADRs
-may turn body fluids orange (salive, urine, teras, sputum)
-flu-like symptoms
-hepatitis (no alcohol)
-allergic reactions
-GI upset
Implications:
-take on empty stomach with full glass of water
-warn patient about change in body fluids
-stress importance of completing entire course
-oral contraceptive may not be effective
Zidovudine
ANTIVIRAL FOR HIV
Action:
-inhibits reverse transcriptase
-NRTIs
-RNA cannot convert to DNA
-no incorporation in host DNA
P. kinetics:
-short-acting
-high fast-pass effect
-fatty meals decrease absorption
ADR:
-GI distress (take w/ food, not fatty food)
-peripheral neuropathy
-hepatotoxicity (check for yellowing, liver size)
-bone marrow suppression (low neutrophils)
-lactic acidosis
TENOFORIR
-new Nuke
-less ADRs
-more potent
Efavirenz
ANTIVIRAL FOR HIV
Action:
-inhibit reverse transcriptase = inhibit viral replication
-NNRTI
-different mechanism to NRTIs -> additive or synergistic effects
-resistance develops rapidly
P. Kinetics:
-oral, 12 hour half life
ADRs:
-GI distress
-CNS (sleep disorders)
-skin rashes
Atazanavir
ANTIVIRAL FOR HIV
Action:
-inhibit protease enzymes that are important for replication
-large precursor proteins are cleaved to shorter, mature protein by an enzymes
-block the enzyme = precursor proteins are not convert to mature proteins
-> immature non-effective virus
-resistance develops rapidly
ADRs:
-GI distress (do not take w/ food)
-hepatoxic
-Metabolic effects
1.hyperglycemia/diabetes
2.fat maldistribution
3.hyperlipidemia
-osteoporosis
-drug to drug interactions (inhibit liver enzymes)
Acyclovir
ANTIVIRAL FOR HERPES
Action:
-activated by viral enzymes (selective action)
-inhibits DNA polymerase = halts viral production
Pharmacokinetics:
-iv, oral, topical
ADR:
-NV
-phlebitis at injection site
-renal damage, nephrotoxicity
Implications:
-teach client to complete full course of therapy
-avoid sexual intercourse if genital herpes are being treated
Oseltamivir
ANTIVIRAL FOR INFLUENZA
Action:
-neuraminidase inhibitor
1.stops viral entry/spread (mucus barrier stays in tact)
2.stops viral release from infected host cell
Pharmacokinetics:
-dosing must begin early (reduces the duration of illness)
ADR:
-NVD
Amphotericin B
ANTI-FUNGAL
Action:
-targets ergosterol of fungal cell membrane (vs host cholesterol)
-fungistatic or fungicidal (depends on concentration)
Use:
-only used in treating progressive and potentially fatal systemic infections due to severe adverse effects (very limited drug, dangerous reactions)
P. kinetics:
-iv, or by slow infusion
ADR:
-patient must start on low doses (build up slow b/c of toxicity)
-fever (give acetaminophen 30 mins prior)
-headache
-NV (give antiemetic 30 mins prior to keep it down)
-renal damage- nephrotoxicity (occurs in 80% of patients)
-anemia, leukopenia
-electrolyte imbalances
Ketoconazole (fungarest)
ANTI-FUNGAL (skin, nails)
Action:
-inhibits the synthesis of ergosterol (component of fungal cell membranes)
-may be fungistatic or fungicidal
P. kinetics:
-iv, oral, topically, pessary (vagina)
ADRs:
-GI upset
-hepatotoxicity
-allergy
Miconazole
ANTI-FUNGAL (superficial like athletes foot, ringworm)
Action:
-inhibits the synthesis of ergosterol (component of fungal cell membranes)
-may be fungistatic or fungicidal
P. kinetics:
-iv, oral, topically, pessary (vagina)
ADRs:
-GI upset
-hepatotoxicity
-allergy
Clotrimazole
ANTI-FUNGAL (superficial like yeast infection)
Action:
-inhibits the synthesis of ergosterol (component of fungal cell membranes)
-may be fungistatic or fungicidal
-can be used during pregnancy
P. kinetics:
-iv, oral, topically, pessary (vagina)
ADRs:
-GI upset
-hepatotoxicity
-allergy
Chloroquine
ANTI-MALARIA
Action:
-causes build up of heme within parasitized erythrocytes = parasite death
-can be used for prophylaxis
P. kinetics:
-orally active
-start 1 week before and continue 4 weeks after
ADRs:
-gastric distress
-loss of appetite
-skin rash
-diarrhea
-neurological and psychiatric reactions (headaches, agitation, excitement that can be psychotic/paranoia)
Quinine
ANTI-MALARIA
-used if there is chloroquine-resistant strains
-older drug
ADR
-cinchonism (tinnitus, headache, NV, cardiac irregularities/abnormalities)
Poliomyelitis
KILLED/INACTIVATED VACCINE
Action:
-inactivated -> not virulent but still antigenic
-advantages: very safe, no risk of mutating to virulent form, no need to refrigerate (attenuated = safe)
-disadvantages: weaker response, need larger doses, boosters
P. Kinetics:
-series of shots (2,4,6 mo, 4-6 y)
-pathogen is artificially introduced in modified for to prime immune system -> future protection
-practically eliminated globally
ADRs associated w/ vaccines:
-slight fever
-sore at injection site
-local redness
-swelling, pain
Severe (vvv rare)
-hypersensitivity reaction
-anaphylaxis (give epi)
-encephalitis (brain inflammation)
-convulsions (seizures)
MMR
LIVE ATTENUATED VACCINE (LAV)
Action:
-live (still has ability to reproduce), attenuated (weakened)
-low or no virulence but still antigenic
-good immune response since it is still alive -> increased virulence = enhanced immunity
-B and T cell immunity, few boosters needed
Disadvantages:
-risk for reversion to virulent form (mutation = virus is back)
-not suitable for weak immune system (care in corticosteroids, cancer chemotherapy, leukemias, lymphomas, advanced HIV)
-not in pregnancy
-need for refrigeration (to maintain ability to reproduce)
-CI for immunocompromised
P. Kinetics:
-at 12-15 months, second dose 4-6 years
-CI for immunocompromised
-does NOT cause autism
-check for allergies to eggs, gelatin, neomycin
ADRs associated w/ vaccines:
-slight fever
-sore at injection site
-local redness
-swelling, pain
Severe (vvv rare)
-hypersensitivity reaction
-anaphylaxis (give epi)
-encephalitis (brain inflammation)
-convulsions (seizures)
Hep B
SUBUNIT VACCINE
Action:
-newer
-only use antigenic part of microbe, eg. proteins in the viral envelope (take sub-unit of pathogen)
-very safe (only protein is being injected)
Disadvantages:
-difficult to develop
-usually weaker response
-low immunological memory, need boosters
P. Kinetics:
-protein from viral envelope
-at birth and boosters (0, 2, 4 mo)
-baker’s yeast (be careful if allergic to yeast)
ADRs associated w/ vaccines:
-slight fever
-sore at injection site
-local redness
-swelling, pain
Severe (vvv rare)
-hypersensitivity reaction
-anaphylaxis (give epi)
-encephalitis (brain inflammation)
-convulsions (seizures)
COVID-19
mRNA VACCINE
P. Kinetics:
-mRNA that codes for the spike protein, nucleotides/sequence is reversed -> immunity
-need boosters
ADRs associated w/ vaccines:
-slight fever
-sore at injection site
-local redness
-swelling, pain
Severe (vvv rare)
-hypersensitivity reaction
-anaphylaxis (give epi)
-encephalitis (brain inflammation)
-convulsions (seizures)
DTap
TOXOID VACCINE
Action:
-some bacteria release a toxin that creates a problem, rather than the bacteria being the problem
-toxoids take toxins and alter them, so that they are no longer toxic but still antigenic
-diphtheria toxoid: creates covering of throat -> difficulty breathing
-tetanus toxoid (paralyzes jaw -> lock jaw)
-acellular pertussis vaccine (whooping cough)
P. Kinetics:
-series of shots (2,4,6,18 mo, 4-6 yrs)
-then tetanus booster every 10 years
ADRs associated w/ vaccines:
-slight fever
-sore at injection site
-local redness
-swelling, pain
Severe (vvv rare)
-hypersensitivity reaction
-anaphylaxis (give epi)
-encephalitis (brain inflammation)
-convulsions (seizures)
Hydrochlorothiazide
ANTI-HYPERTENSIVE and HEART FAILURE
Action:
-thiazide diuretic (promotes urine)
-inhibits reabsorption of sodium, so it gets excreted
-for hypertension and edema
-decreased BV = decreased BP/afterload/work
-inhibits tubular reabsorption of sodium
-sodium excreted, water follows, causing dieresis
-monotherapy
-also used in combination with other antihypertensives to prevent rebound fluid retention
ADRs:
-hypotension/postural hypotension
-hyponatremia, hypokalemia, dehydration
-hyperglycemia, hyperuricemia, hypercholesterolemia
-take in morning for easy urination throughout day
-GI upset (take with food)
Captopril
ANTI-HYPERTENSIVE and HEART FAILURE
Action:
-acts on RAAS (ACEI)
-no angiotensin II
ADRs:
-hypotension/postural hypotension
-angioedema
-persistent dry cough
-renal impairment/failure
-hyperkalemia (avoid potassium)
Enalapril
ANTI-HYPERTENSIVE and HEART FAILURE
Action:
-acts on RAAS (ACEI)
-no angiotensin II
-longer acting than captopril
ADRs:
-hypotension/postural hypotension
-angioedema
-persistent dry cough
-renal impairment/failure
-hyperkalemia (avoid potassium)
Losartan
ANTI-HYPERTENSIVE and HEART FAILURE
Action:
-blocks angiotensin II receptors = blocked vasoconstriction and blocked aldosterone release
ADRs:
Hypotension/postural hypotension
Aliskiren
ANTI-HYPERTENSIVE
Action:
-direct renin inhibitors (blocks angiotensinogen from converting to angiotensin I)
-PO, do not take with food
ADRs:
-generally well tolerated but hypotension/postural hypotension
Propranolol
ANTI-HYPERTENSIVE
Action:
-non-selective beta blocker
-act on BOTH lungs and heart
CI:
-asthma, COPD, smokers b/c of the bronchoconstriction
ADRs:
-hypotension/postural hypotension
-bradycardia (HR<60, report! decrease dose, increase interval)
-impaired exercise tolerance
-edema, monitor weight (fluid retention) +thiazide
-NVD, take w/ food
-CNS (fatigue, depression, nightmares, sexual dysfunction)
-bronchospasm (narrowed airways)
-diabetes
-allergic reactions
Atenolol
ANTI-HYPERTENSIVE
Action:
-cardioselective beta 1 blocker, vasodilation
-acts only on heart
-decrease HR, BP, and contractility
ADRs:
-hypotension/postural hypotension
-bradycardia (HR<60, report! decrease dose, increase interval)
-impaired exercise tolerance
-edema, monitor weight (fluid retention) +thiazide
-NVD, take w/ food
-CNS (fatigue, depression, nightmares, sexual dysfunction)
-diabetes
-allergic reactions
Doxazosin
ANTI-HYPERTENSIVE
Action: block alpha receptors on arterioles and veins = vasodilation = lower BP
ADRs:
-orthostatic hypotension (extreme, massive vasodilation, can lead to fainting)
-headache, dizziness, flushing
-edema (nasal congestion from opened vessels, fluid leaks)
-reflex tachycardia (vasodilation, BP drops, body responds by speeding up heart)
-NVD
Nifedipine
ANTI-HYPERTENSIVE
Action:
-calcium channel blocker
-muscle relaxation = vasodilation
-heart rate and force of contraction decreases
ADRs:
-hypotension/orthostatic hypotension
-headaches, dizziness, flushing
-edema
-cardiac suppression; bradycardia, SOB
-constipation
-leg/muscle cramps
-allergic reactions
Verapamil
ANTI-HYPERTENSIVE and ANGINA
Action:
-calcium channel blocker
-muscle relaxation = vasodilation
-decrease HR and contractility
ADRs:
-hypotension/orthostatic hypotension
-headaches, dizziness, flushing
-edema
-cardiac suppression; bradycardia, SOB
-constipation
-leg/muscle cramps
-allergic reactions
Hydralazine
ANTI-HYPERTENSIVE and HEART FAILURE
Action:
-act on arterioles and/or veins for direct vasodilation
-decrease TPR, BP
ADRs:
-hypotension
-headaches, dizziness, flushing
-edema
-reflex tachycardia
Minoxidil
ANTI-HYPERTENSIVE
Action:
-act on arterioles and/or veins for direct vasodilation
ADRs:
-hypotension
-headaches, dizziness, flushing
-edema
-reflex tachycardia
-hypertrichosis (hair growth on face or chest)
Nitroprusside
ANTI-HYPERTENSIVE
Action:
-act on arterioles and/or veins for direct vasodilation
ADRs:
-hypotension
-headaches, dizziness, flushing
-edema
-reflex tachycardia
Implications:
-iv (hypertensive crisis)
Clonidine
ANTI-HYPERTENSIVE
Uses: HT crisis, PO
Action:
-act in CNS to decrease activity
-effects resemble alpha and beta blockade
1.blood vessels (vasodilation)
2.heart (cardio suppression)
ADRs:
-depression
-trouble sleeping
-sedation
Methyldopa
ANTI-HYPERTENSIVE
Uses: pregnancy
Action:
-act in CNS to decrease activity
-effects resemble alpha and beta blockade
1.blood vessels (vasodilation)
2.heart (cardio suppression)
ADRs:
-depression
-trouble sleeping
-sedation
Glyceryl Trinitrate
ANGINA
Action:
-vasodilation
1.dilate veins = decreased preload
2.higher doses = arterial dilation = decreased after-load
-decreased work of heart = decreased myocardial oxygen demand
-very rapid acting, acute relief during attack
-prophylactically (protection before precipitating activity)
P. Kinetics:
-highly soluble - readily available to cross membranes
-rapid onset of action
-allow for alternative routes (SL, buccual, transdermal)
-rapidly degraded by liver = short acting
-extensive first pass effect
ADRs:
-hypotension
-headaches, dizziness, flushing
-reflex tachycardia
Tolerance:
-body gets use to drug
-need to increase the dose
-try drug holidays or mini holidays
Toxicity:
-hypotension and reflex tachycardia
-exacerbated by alcohol, anti-hypertensives, viagra
Implications:
● Review storage directions with patient (GTN is explosive/reaction, store in cool, dark, dry area)
● Review method of administration
● Take before engaging in activity
● How to avoid tolerance
● Assess vital signs (BP and HR)
● If dizzy lie down before taking medication
● Avoid alcohol & care with other drugs
● Assess pain
● Instruct family members
Emergency:
● One tablet every 5 min x3
● If pain is not relieved, go to ER (possibly MI)
Metoprolol
HEART FAILURE and ANGINA
-beta blocker (vasodilation)
-decreased HR, contraction, work
-controlled suppression
-long action
-do not chew
ADRs:
-hypertension
-bradycardia
-NV
-CNS, fatigue
Digoxin
HEART FAILURE
Action:
-inhibit enzyme (Na/K ATPase) which causes accumulation of calcium
-increased calcium = increased contractility (positive inotropic action = more force of contraction)
-increased stroke volume, cardiac output, improves blood flow to the kidneys and periphery, clears edema
ADRs:
-neurological: weakness, fatigue, fainting
-visual: dimness, double vision, flashing lights, changes in color vision
-cardiac: bradycardia, arrhythmias (tachycardia, fibrillations)
-GI: abdominal discomfort (take with food), anorexia, nausea
-psychiatric: mood alterations, hallucinations
Toxicity:
-narrow therapeutic index
-long half-life (4-5 days, increases blood levels)
-measures to minimize toxicity (dont change brands)
-toxicity is exacerbated by hypokalemia (thiazide and loop diuretics)
-antidote: digoxin immune fab
Implications:
-Take apical and radial pulse for 1 minute.
-Teach patient to monitor apical pulse for 1 min
-Do not administer and notify prescriber if apical pulse rate is <60 BPM or >100 BPM
-Assess patient for toxicity and monitor blood levels
-Assess diet
-weight daily
-take with meals
-medical ID tag
-take missed dose as soon as remembered, but do not “double up”
-Regular follow up appointments
Furosemide
HEART FAILURE
-loop diuretic
-for severe heart failure
-diuretic that removes edema
-decrease BP, after load, work of heart
-care for those with hypokalemia
Spirinilactone
HEART FAILURE
-potassium-sparing
-diuretic that removes edema
-decrease BP, after load, work of heart
Atorvastatin
ANTILIPEMIC
Action:
-inhibit enzyme (HMGG-CoA reducatase) needed for cholesterol synthesis
ADRs:
-myalgia (muscle pain)
-liver damage
CI:
-liver disease
-pregnancy
Implications:
-monitor liver function
-ID at bed time (chronopharmacology, stops cholesterol)
Niacin
ANTILIPEMIC
Action:
-B complex vitamin
-MOA is unclear (anti lipid effect)
ADRs:
-intense flushing and itching from increased prostaglandin release (manage with aspirin to stop prostaglandin release, give 30 mins prior)
-hepatoxic, especially slow release forms
-GI distress
-orthostatic hypotension
Cholestyramine resin
ANTILIPEMIC
Action:
-bind with bile acids in GI tract
-prevents reabsorption so it is eliminated by stool
Bile acids emulsify fats and carry free acids to wall to be absorbed
ADRs:
-very few side effects, no systemic action (only stays in gut)
-GI (steatorrhea: fatty stools)
Implications:
-decreased absorption of drugs/food = take on empty stomach
-sprinkle over 2oz of fluid
Colesevelam
ANTILIPEMIC
Action:
-bind with bile acids in GI tract
-prevents reabsorption so it is eliminated by stool
Bile acids emulsify fats and carry free acids to wall to be absorbed
ADRs:
-very few side effects, no systemic action (only stays in gut)
-GI (steatorrhea: fatty stools)
Implications:
-decreased absorption of drugs/food = take on empty stomach
-sprinkle over 2oz of fluid
Ezetimibe
ANTILIPEMIC
Action:
-blocks cholesterol absorption
-well tolerated
Gemfibrozil
ANTILIPEMIC
Action:
-complicated
-decreased triglyceride levels
ADRs:
-GI upset
-rash
-myopathy
-hepatotoxicity, gallstones
Heparin Sodium - Enoxaprin
ANTICOAGULANT
-sulfated mucopolysaccharide polymer
Action:
-activate antithrombin = stop fibrin formation
-antithrombin -> inactivates thrombin and other clotting factors
-low molecular weight heparin
-less lab monitoring needed
-less ADRs
-longer half-life, id dosing
-DOC for post op
Use:
-prevent formation of new clots
-prevent the extension of existing clots
-used for DVT, PE, preventing clots during surgery/hemodialysis, coagulation after blood has left body
P. kinetics:
-parenteral (highly charged)
-rapid acting
-iv, sc
-units (40,000 units/mL)
-risk of hemorrhage if blood is too thin
Anti-dote: Protamine sulfate
ADRs:
-bleeding, minimize risk (hemorrhage)
-monitor closely, blood work (aPTT)
-check for: bruises, hematomas, red/black stools, cloudy/discolored urine, pelvic pain, headache/faintness, lumbar pain
-CI: eye, brain, spinal order surgery
-allergic reactions
-heparin-induced thrombocytopenia
Warfarin
ANTICOAGULANT
Action:
-blocks vitamin K = no clotting factors (no fibrin formation)
-slow onset
Use:
-prophylaxis and treatment of thrombosis
P. kinetics:
-oral (long term therapy)
-highly (99%) protein bound
-takes 48-72 hours to see peak effect
ADRs:
-bleeding (decreased BP)
-abdominal cramps/nausea/anorexia (take w/ food)
-alopecia (hair loss, lower dose)
Anti-dote: Vitamin K
Implications:
-monitor bleeding, decreased BP, check for bruises, bloody/black stools, cloudy urine
-strategize to minimize bleeding
-schedule INR testing
-dosage size and timing
-wear MedicAlert bracelet
-care with drug and food (vitamin K)
-category X in pregnancy (use LMW heparin instead)
Dabigatran
ANTICOAGULANT
Action:
-direct oral thrombin inhibitor (blocks factor 10)
-alternative to warfarin (safer, faster, and easier to use)
Aspirin
ANTIPLATELET
Use:
-prevention of arterial thrombus formation (stop platelet plug)
-reduce risk of fatal IM and stroke
Action:
-irreversible inhibition of COX enzyme
-inhibits the formation of a PG (thromboxane A2) involved in platelet aggregation
-anti-platelet effect at low doses
ADRs:
-bleeding
-monitor, strategize, report
Abciximab
ANTIPLATELET
Use:
-prevention of arterial thrombus formation (stop platelet plug)
-reduce risk of fatal IM and stroke
Action:
-glycoprotein (GP) receptor antagonist
-GP receptor on platelets needed for platelet aggregation
-given IV (usually in combination with aspirin and heparin)
ADRs:
-bleeding
-monitor, strategize, report
Clopidogrel
ANTIPLATELET
Use:
-prevention of arterial thrombus formation (stop platelet plug)
-reduce risk of fatal IM and stroke
Action:
-adenosine diphosphate (ADP) receptor antagonist = no aggregation
ADRs:
-bleeding
-monitor, strategize, report
Alteplase
THROMBOLYTIC
Action:
“Clot busters” remove thrombi that have already formed
-prevent formation
-degrades fibrin networks in clots
Uses:
-in medical emergencies to treat adverse thromboembolic events (MI; 6h window, PE, arterial occlusions, DVT)
-restore potency to occluded central venous catheters
ADRs:
-bleeding (especially observe for LOC- intracranial bleeding)
-NV
Implications:
-cardiac and vital signs monitoring
-education
-antidote: aminocaproic acid
