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PHARM EXAMS 3, 4 & 5 > PHARM EXAM 4 > Flashcards

PHARM EXAM 4 Flashcards

1
Q

Sympathetic Fight or Flight

A

(ANTI- SLUDGE)

  • Pupils dilate
  • Saliva is inhibited
  • Heart accelerates/ Blood vessel constrict
  • Bronchioles dilate
  • Digestion is inhibited
  • Liver glycogen breakdown promoted
  • Adrenal gland releases epinephrine and norepinephrine
  • Sex organs inhibited
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2
Q

Sympathetic Nervous System

A
  • Adrenergic Receptors : Aplha (Blood/Brain/ Postate) / Beta (Heart/ lungs/ kidney)
  • Norepinephrine is the neurotransmitter.
  • Sympathomimetic
  • Parasympathetolytic
  • Adrenergic
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3
Q

Sympathomimetics AdrenergicAgonists

A

Alpha Agonists: treat nasal congestion and hypotension, dilate pupils during eye exams.

Beta Agonists: treat asthma

  • Oxymetazoline
  • Pseudoephedrine
  • Albuterol
  • epi-pen
  • dopamine
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4
Q

Sympatholytic Anti-adrenergicAntagonistsBlockers

A

Alpha Blockers: treat hypertension (Doxazosin)

Beta Blockers: treat hypertension and heart failure (metropolol)

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5
Q

Parasympathetic Nervous System

A
  • Muscarinic Receptors: Muscarinic
  • Acetocholine is the neurotransmitter
  • Parasympathomimetic
  • Muscarinic Agonist
  • Cholinergic
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6
Q

Parasympathetic Rest and Digest

A

( SLUDGE)

  • Eyes constrict
  • Saliva is stimulated
  • Heart slows/ Blood vessel dilate
  • Bronchioles constrict
  • Digestion is stimulated
  • Gallbladder is stimulated
  • Bladder contracts
  • Sex organs are stimulated
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7
Q

Cholinergic (Muscarinic Agonist) (SLUDGE)

Bethanechol

A
  • Oral or SQ
  • Used for nonobstructive urinary retention by acting on muscarinic receptors of the GU tract.
  • Side effects are cholinergic.
  • Avoid in conditions such as asthma or bradycardia
  • Reversal of a cholinergic agent is atropine*
  • *Avoid PT w/ BPH-asthma-GI obstruction**
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8
Q

Anticholinergics (ANTI- SLUDGE side effects)

or parasympatholytics - similar response

A
  1. Atropine
  2. Atrovent
  3. Dicyclomine
  4. Oxybutynin
  5. Glycopyrrolate

AVOID PT w/ BPH- Tachy- increased BP- CHF- kidney problems

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9
Q

Anticholinergics (Muscarinic Antagonists)

Atropine

A
  • IM or IV
  • Atropine –treatment of cholinergic overdose and increases HR.
  • Used as an antidote to cholinergic crisis (plant poisons, overtreatment with cholinergic medications)
  • Used as part of ACLS protocol for symptomatic bradycardia.- when pt is awake but not able to completely converse & have low BP

-Contraindicated in obstruction of bowel or bladder, BPH, myasthenia gravis

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10
Q

Somatic Nervous System

A

Controls Voluntary Movement
Skeletal Muscles
Acetocholine is the neurotransmitter
Cholinergic

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11
Q

Myasthenia Gravis

A
  • Autoimmune disease that leads to the breakdown of nicotinic receptors on the muscle.
  • The nerve operates normally, there is not enough receptors available leading to a weak/ easily fatigued muscle contraction.
  • Symptoms include: when there are less ach receptor = decreased muscle strength/ contraction, easy muscle fatigue. Can also affect other muscles leading to difficulty breathing, difficulty swallowing.
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12
Q

Myasthenia Gravis meds

A
  • Medications block acetocholinesterase so ACH is in the synapse longer and can produce a better, stronger muscle contraction
  • Cholinestraise Inhibitor ** increase strength less fatigue
  • Fast acting for diagnosis: endonorphium* (TESTER & will make muscle stronger if they have Myasthenia Gravis)
  • Long acting for treatment: pyridostigmine*
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13
Q

Pyridostigmine

A

(SLUDGE)- cholinergics
PO medication
-Used to effect activity at the nicotinic (skeletal muscle) but could effect the muscarinic (smooth muscle) leading to parasympathetic side effects.
-Contraindicated in intestinal and urinary obstruction.
Reversal is atropine. for muscle weakness respiratory paralysis that occurs within 1 hr of admin = serum level too high.

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14
Q

Cenntrally acting muscle relaxers

Cyclobenzoprine

A
  • Suppression of muscle activity in the brain stem, no effect on the actual muscle function. Enhance inhibitory effects of GABA
  • Max effect in 1-2 weeks
  • Side effects: drowsiness, blurred vision, dry mouth, rash, and tachycardia.
  • Use with caution in the elderly.
  • Avoid with other sedatives
  • Contraindicated in MI
    • can not stop right away & start with low dose/ Withdrawal symptoms**
  • Anxiety
  • Restlessness
  • Visual hallucinations
  • Seizures
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15
Q

Muscle Spasms & Muscle Spasticity

A

Muscle Spasms: Involuntary contractions of a muscle, tightened and fixed causing pain and potential impairment of joint function.

Muscle Spasticity: Muscle groups in a continuous state of contraction due to neuromuscular disorder (like spinal injury)

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16
Q

Peripherally acting muscle relaxers

Dantrolene

A
  • Direct acting
  • Blocks release of calcium in the muscle cells blocking contraction
  • IV (irritating to tissue) or oral suspension
  • Side effects: weakness, drowsiness, dizziness, nausea, diarrhea, photosensitivity, urinary retention.
  • Avoid in patients with impaired cardiac or lung function
  • Avoid in patients with liver disease 35 yrs and older, can cause hepatotoxicity
    • IV emergency med that is used to reverse malignant hyperthermia**
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17
Q

Anticholinergics (Muscarinic Antagonists)

Atrovent

A

Parasympatholytic/ Medications that block ACH on cholinergic receptors. This action has a similar effect as sympathomimetics.

-Atrovent- relaxation of bronchioles (asthma)- COPD

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18
Q

Anticholinergics (Muscarinic Antagonists)

Oxybutynin

A

Parasympatholytic/ Medications that block ACH on cholinergic receptors. This action has a similar effect as sympathomimetics.

-Oxybutynin- treatment of incontinence (over active bladder)

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19
Q

Anticholinergics (Muscarinic Antagonists)

Glycopyrrolate

A

Parasympatholytic/ Medications that block ACH on cholinergic receptors. This action has a similar effect as sympathomimetics.

-Glycopyrrolate (Robinul)-dry up secretions for surgery* IV- so there is no aspiration during SX

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20
Q

Anticholinergics (Muscarinic Antagonists)

Dicyclomine

A

Parasympatholytic/ Medications that block ACH on cholinergic receptors. This action has a similar effect as sympathomimetics.

-Dicyclomine (Bentyl)-IBS, decrease crampy pain*

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21
Q

Adrenergic agonists: afrin (Oxymetazoline) and albuterol

A

afrin (Oxymetazoline)- vaso constriction

lbuterol- bronco dilate

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22
Q

Anti-Adrenergic: doxazocin and metoprolol

A
  • Drugs that manipulate the sympathetic nervous system*

- Blocks Beta/ alpha

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23
Q

Admin Eye drops

A

-take out contacts
-Lie supine or tilt head back
-With non-dominant hand pull down lower lid.
Look up
-Hold ¼ above conjunctival sac, instill required drops. Do not touch dropper to eye.
If ointment, thin line from inner to outer canthus.
-Close eye, apply gentle pressure to nasolacrimal duct. (decreased systemic absorption)
Gently blot eye
Replace dropper, do not rinse.

24
Q

Glaucoma

A

Pressure has increased.

  • To decrease the pressure inside the eye then decrease the amount of aqueous humor or increase the outflow of aqueous humor.
  • Dilated pupil, means a smaller thinner iris and decreased aqueous outflow increasing pressure.

GOAL= stop dilation & decrease fluid productions

25
Q

Prostaglandin Analogs: Latanoprost (Xalatan)

A

-Decreases IOP by increase in outflow of aqueous humor metabolized in the cornea
Instill eye drop, wait 5 minutes before instilling another drop in same eye.
-Cannot wear contacts for 15 minutes.
-Increased length of lashes, darkening of iris, sensation of FB in eye, ocular symptoms (edema, itching, dryness)
Systemic Absorption: respiratory infection, angina, muscle/joint pain)
- hold inner corner of eye to avoid systematic effect

26
Q

Beta Adrenergic Blockers: Timolol (Betimol)

A

Decreased formation of aqueous humor & decrease pressure & blood vessel constrict
Given 1-2x per day.
Takes 2-4 weeks to work.
Can be combined with other medication

27
Q

Diagnostic Exams

A

Mydriatic drugs dilate pupil for better assessment

Cycloplegic drugs paralyze the ciliary muscle and prevent the lens from moving during assessment.

28
Q

Common Ear complaints

A

Cerumen Impaction: Carbamide peroxide (Debrox)
4 gtts, 3-4x per day
Otitis Externa: Ciprofloxacin/ Hydrocortisone
Otitis Media: oral antibiotics
Mastoiditis: IV/ oral ABX gentamicin, ticarcillin (14 days)

29
Q

Instillation of ear drops

A

Side lying, head tilted
Clean if necessary
Hold dropper ¼ inch above ear canal, instill drops into side of canal
Apply pressure to the tragus 3-4 times
Stay in position for 10 minutes
If cotton ball ordered soak in medication and insert into outer most ear canal.
Wipe ear with tissue.
Adults: UPWARD and backward
Children under Age 3: DOWNWARD and backward

30
Q

Risk of Peptic Ulcers

A 
Family history
Blood group O
Smoking tobacco
Caffeine
NSAIDS and platelet inhibitors
Stress
H. Pylori Infection: Bacteria that breaks up mucus that protects the stomach and lets acid destroy the stomach
31
Q

Proton Pump Inhibitors
Omeprazole (Prilosec)*
FOR GERD/PUD

A

Omeprazole (Prilosec)*
Irreversibly binding to proton pumps
Give before breakfast on an empty stomach. Do not open capsules, no chewing or crushing
irreversible for 7 days

32
Q

Proton Pump Inhibitors
Omeprazole (Prilosec)* SIDE EFFECTS
FOR GERD/PUD

A

HA, diarrhea, nausea, rash, dizziness
Increased risk of osteoporosis, hypomagnesium, C.diff
Rare blood disorders with fatigue and weakness

33
Q

H2 Receptor Antagonist
Ranitidine (Zantac)*
FOR GERD/PUD

A

Administer nightly, PO
IV for acute stress induced bleeding ulcer
Monitor liver and kidney function

34
Q

H2 Receptor Antagonist
Ranitidine (Zantac)* SIDE EFFECTS
FOR GERD/PUD

A

Diarrhea, constipation, HA, fatigue, nausea, gynecomastia.

Rare(Adverse effect) : blood dyscrasia (Bone marrow supression), blurred vision, tachycardia.

35
Q

Antacids: Aluminum hydroxide

FOR GERD/PUD

A 
Aluminum hydroxide (minimal absorption, aluminum reduces constipation)
Calcium carbonate (more systemic absorption)
*coat the stomach to protect the stomach *
36
Q

Antacids: Aluminum hydroxide
SIDE EFFECTS
FOR GERD/PUD

A

SE: constipation, nausea, stomach cramps,
Adverse: fecal impaction, electrolyte imbalance

37
Q

Constipation

A

Freq + consistency

- is it different? Does it feel bad

38
Q

Bulk Forming-psyllium

For Constipation

A

Bulk Forming-psyllium abdominal fullness, cramping, fainting, esophageal/GI obstruction if taken with insufficient fluid. (need full 8oz of water or will lose benefit of med)

39
Q

Saline/Osmotic-lactulose

For Constipation

A

Saline/Osmotic-lactulose, polyethylene glycol diarrhea, abd cramping trying to pull water into stool

40
Q

Stimulant- bisacodyl

For Constipation

A

Stimulant- bisacodyl, castor oil abd cramping, nausea, fainting, diarrhea *contraction to bowl *

41
Q

Stool softener- Colace

For Constipation

A

Stool softener –Colace-increases water and fat in stool

Melt onto stool gel like to make it easier

42
Q

Herbal agent- Senna

For Constipation

A

Herbal agent- Senna-irritates bowels

43
Q

Diarrhea : Having multiple watery stool

A

Opioids: (causes slowing of bowl) diphenoxylate with atropine (Lomotil)- addictive potential, drowsy, dizzy, lightheaded, nausea
Anticholinergic effects: constipation, CNS and respiratory depression, toxic megacolon

Miscellaneous:
Bismuth salts-(has ASA)
Lactobacillus-probiotics
Octreotide-severe secretory diarrhea

44
Q

C.Diff Associated Diarrhea

A

Treatment with vancomycin

Fecal Microbiota Transplant (FMT)
Enema, colonoscopy, or NG

45
Q

Anti-Emetics- prevent vomiting / Nausea

A

Antihistimines (scopolamine)
Phenothiazine (prochlorperazine, metoclopramide)
SSRI ondansetron (Zofran)
before SX/ after chemo/ traveling

46
Q

Anti-Emetics

Prochlorperazine- Compizine

A
  • Is part of the phenothiazine antipsychotic family
  • Blocks dopamine
  • Dose related anticholinergic side effects
  • Increased risk for death in patient’s with dementia
47
Q

PancreatitisPancrelipase

A
  • Enzymes stay in pancreas instead of GI tract (lipase, protease, amylase)
  • Can give pancreatic enzymes (1-2 hours prior to meals)
  • Releases in small intestine
  • Side effects are minimal as not systemically absorbed
  • Nausea, vomiting, diarrhea*
48
Q

Malnutrition

A 
Elderly
HIV/AIDS
Alcoholism
Burns
Cancer
IBD
Eating Disorders
Neurologic Disease
Surgery
Trauma
49
Q

Enteral Nutrition

A
  • Polymeric-the GI tract works. Protein, carbs, lipids. Can be used in blenderized diet and replacement supplements.
  • Elemental-malabsorption, decreased fat, individual amino acids.
  • Semi-elemental-direct to intestines, larger protein molecules
  • Modular-disease specific
50
Q

TPN- IV Nutrient

A
  • only central line - infection if given peripherally*
  • At risk for hyperglycemia- so √ BS*

Severe malnourishment
Inability to absorb through the GI tract
Hypertonic: amino acid, lipids, emulsions, carbohydrates, electrolytes, vitamins, and minerals-insulin

Reservoir for infection, central line
Monitor for hyperglycemia, fluid status, renal status

51
Q

Obesity

A

Qualify for medical therapy with a BMI > 30
BMI >27, with HTN, HLD, DM
Lipase inhibitors

52
Q

Orlistat

A 
Lipase inhibitor
TID, during or just prior to a meal. 
Works only when the meal has fat content
GI side effects, oily stools, frequent urgency, flatus with discharge
Can decrease absorption of medications
53
Q

Neurotransmitter

A

Acetylcholine = cholinergic
receptors

Epinephrine = adrenergic receptors

Norepinephrine = adrenergic
receptors

54
Q

Sympathetic avoid Pt with:

A

Avoid pt with:

  • Glc
  • Heart problems
  • increased BP
  • CHF
  • kidney problems

Avoid meds:

  • Beta blockers (Doxasin/ metropolol)
  • CA
55
Q

Parasympathetic avoid Pt with:

A

Avoid pt with:

  • asthma
  • GI obstruction
  • BPH

Avoid meds:
anti-cholinergics ex: Ipratropin(broncho dilator) atropine/ Dicyclomine/ Gyclopyrrolate/ Oxybutin/ Atrovent

PHARM EXAMS 3, 4 & 5 (4 decks)

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