PHARM FINAL Flashcards
1
Q
Difference between pharmacologic vs therapeutic drug classification?
A
Pharmacologic: grouping based on how they work–MOA, essentially. (Ex: beta blockers)
Therapeutic: grouping based on what they’re intended to treat. (Ex: antidepressants)
2
Q
Controlled Substance C-1 and C-2 drugs (give examples, name abuse potential)
A
C-1: heroin, marijuana, LSD, psilocybin, meth (‘abuse potential high’, no medical use lol)
C-2: Codeine, cocaine, most opiates (AP high)
3
Q
C-3 and C-4 drugs (name examples, abuse potential)
A
C-3: Codeine combined w/ other drugs like acetaminophen (AP less than C2)
C-4: Phenobarbital, benzos (“-pams”, tramadol (AP less than C3)
3
Q
A
4
Q
C-5 drugs (name examples, abuse potential)
A
C-5: OTC meds for cough relief, diarrhea control–contain small amounts of opioids (AP less than C4)
5
Q
FDA phases of approval
A
I: cell/animal studies
II: few people
III: more people
IV: ‘post market’ (“after 10 years of use…”)
6
Q
Black Box Warnings (3 classes)
A
Class 1: severe side effect will occur
Class 2: treatable side effect may occur
Class 3: possibility of side effect, esp for certain populations
7
Q
“5 Rights” of med admin
A
Right…
-Medication
-Patient
-Dose
-Route/form
-Time
+DOCUMENTATION
8
Q
3 Checks of med admin
A
-check the drug in MAR
-check drug when preparing
-check before administering (2 identifiers)
9
Q
Polypharmacy
A
A patient with multiple prescriptions that might conflict each other
10
Q
Aspirin MOA, dose, use, side effects
A
-COX blockers (lol)
-analgesic, anti-inflamm, antipyretic, AND antiplatelet
-(81 - 324 mg) treats MI, headache, arthritis, lupus…
-side effects: GI bleed, tinnitus, Reye’s (in peds)
11
Q
ibuprofen, ketoprofen, and naproxen: MOA, use, side effects
A
-nonspecific COX inhibitors (propionic acid drug)
-analgesic, anti-inflammatory, antipyretic: for many things incl; headache, arthritis, cramps, gout, ankylosing spondylitis
-side effects: GI bleed/upset/ulcer, renal function
12
Q
What labs might one check before giving an NSAID?
A
Kidney/renal function:
-Creatinine (0.6 - 1.3)
-BUN (7-20)
13
Q
Ketorolac (toradol) is primarly used as a powerful ______, and can only be given for (how long?)
A
Analgesic, 5 days (severe side effects on kidney, GI)
14
Q
ibuprofen, ketoprofen, and naproxen rec. doses
A
-ibuprofen: 3200mg/day (800 QID)
-naproxen: 1000mg/day (500 BID)
-ketoprofen: 800 mg/day (200 QID)
15
Q
T/F: Corticosteroids mimic hormones already made in the body
A
True! (glucocorticoids, mineralocorticoids, sex hormones)
16
Q
Corticosteroid MOA
A
Modifying enzyme activity–suppress immune response + therefore, inflammation
17
Q
Common corticosteroids
A
dexamethasone, methylprednisone (IV), prednisone (PO)
18
Q
Corticosteroid side effects
A
mood changes, hyperglycemia, osteoporosis, ulcers, bloating, muscle weakness
19
Q
1st line gout therapy?
A
NSAIDS
20
Q
Allopurinol MOA, use, side effects
A
-inhibits xanthine oxidase (prevents uric acid production), treats gout
-side effects: anemia, skin stuff; exfoliative dermatitis/agranulocytosis
21
Q
Colchicine MOA, use, side effects + contraindications
A
-anti-inflammatory, treats gout
-side effects: leukopenia (low WBCs), GI/urinary bleeding
-CAN’T TAKE if severe kidney, liver, GI, heart issues
22
Q
Probenecid MOA, use + considerations
A
-inhibits uric acid reabsorption (promotes excretion), treats gout
-take w/ food/milk
23
Q
Sulfonamides MOA
A
bacteriostatic: interfere w/ FOLIC ACID production
fuck w/ G+ and G- bacteria
24
Sulfonamides are often given for:
-UTIs
-staph
as SMV-TMP (Bactrim)
25
Sulfonamide side effects, contraindications, interactions
-skin issues (photosensitive), agranulocytosis, anemia
-common allergy
-NO: pregnant, under 2mo, warfarin, phenytoin, cyclosporin
26
Sulfonamides should be avoided if you take:
-warfarin
-phenytoin
-cyclosporin
or if you're pregnant or under 2mo old!
27
Tetracycline is often given for:
-acne
-STIs (chlamydia, syphilis)
-Lyme's
-Rickettsia
28
What should you avoid on tetracyclines?
-Dairy
-Antacids
-Supplements w/ Ca, Fe, Mg
(can prevent drug from acting in body)
29
What antibiotic class has the potential to stain teeth?
Tetracyclines
30
Tetracycline MOA
-Bacteriostatic
-bind to 30s ribosome (messes up protein synthesis)
-Fuck up both G+/- bacteria
31
Macrolide antibiotics end in "m____"
-mycin!
32
Macrolide used for C. diff?
Fidaxomycin (fartaxomycin)
33
What macrolide is put in newborn's eyes to prevent gonorrhea?
Erythromycin
34
Common uses for macrolides include:
-strep
-respiratory infections
-spirochetal infections
-STIs
35
Macrolide side effects:
-GI (take w/ food, especially erythromycin!)
36
Name the 3 aminoglycosides that ALSO end in mycin (Bruh)
-gentamycin
-tobromycin
-neomycin (oral)
37
What antibiotics attack mostly G- bacteria?
-Aminoglycosides
-Fluroquinolones
38
Tetracyclines and fluroquinolones shouldn't be taken with what?
-antacids, zinc, supplements w/ Ca, Al, Fe, Mg
(+tetra: no dairy)
39
Fluroquinolone side effects
BLACK BOX WARNING: tenditinis/tendon rupture possible in older adults
40
Vanomycin is a (macrolide/aminoglycoside?)
NEITHER! Lone wolf that causes "red man syndrome"
41
Vancomycin is used to treat:
But monitor for ___ and ____ toxicity
MRSA
oto, nephro
42
Fluroquinolone MOA
-alter DNA :0
-bactericidal and BROAD SPECTRUM (but mostly G-)
43
Ticonazole (Vagistat), miconazole, and clotrimazole are all ______ antifungals and can are common ___ meds.
topical, OTC
44
Amphotericin B (AKA ________) will cause what side effects (including what organ toxicity? What would you give in anticipation of these effects? What labs would you monitor?
"amphoterrible"
-fever, chills, nausea/vomiting, low BP, tachycardia
-nephrotoxicity
-premedicate w/ antihistamine, antipyretic, anti-nausea meds
-monitor renal labs like BUN/creatinine
45
Nystatin is used to treat _____
thrush (oral candidiasis), athletes foot, jock itch...
46
What are HSV1/2 treated with? Can these viruses be cured?
-acyclovir/valacylovir
-no, just managed/treated
47
How many times per day would you take acyclovir? How many times would you take valacyclovir per day?
-acyclovir: 5x day
-valacyclovir: 1x day
48
HSV3, or varicella zoster (chickenpox), can be prevented with:
the childhood varicella vaccine
49
What patients are at risk for HS5 (CMV)?
Severely immunocompromised patients (i.e., organ transplant recipients)
50
There are 3 types of hepatitis. Which ones have a preventative vaccine?
Hep A and Hep B have a vaccine, Hep C does not.
51
How is Hep C spread? How is it treated (+ who cannot have that med)?
-sexual contact--blood, fluid
-Ribavirin--which is a teratogen, so pregnant people can't have it!
52
Name the Hep B preventative vaccine and post exposure treatment
-HBV vaccine (x3)
-immunoglobulins w/in 3 weeks of exposure
53
Name the Hep A preventative vaccine and post exposure treatment
-HAV vaccine
-immunoglobulin GamaSTAN
54
How is Hep A spread vs Hep B/C?
A: oral-fecal route
B/C: blood, body fluids
55
Oseltamivir treats what if taken w/in 48 hours of symptom onset?
It has what side effect?
-Influenza A, B
-Nausea, vomiting
56
Ganciclovir and valganciclovir treat...
CMV
57
Folate and pyrimidine antagonists are all __________ ______________, meaning they are cell cycle ___________.
antimetabolite atineoplasts, specific
58
________ blocks estrogen receptors on breast cancer cells.
-Tamoxifen
59
Define 'nadir'. When does it occur?
-Lowest WBC count after chemo
-10-28 days after treatment
60
What is neutropenia?
Low neutrophils (type of WBC)
61
What is thrombocytopenia?
Low platelets in the blood
62
Anemia, leukopenia, neutropenia, thrombocytopenia, alopecia, emetic, stomatitis, and nadir are all side effects of...
myelosupression
63
Methotrexate is a ________ antagonist and an anti-_________.
folate, anti-metabolite
64
Cytarabine is a _________ antagonist and ____-_______.
pyridimine, anti-metabolite
65
Cytoxan is a _____________ cell cycle antimetabolite.
nonspecific
66
Loop diuretics MOA, and what's special about them
-block K+, chloride and hence sodium reabsorption in LOH
-reduce resistance via blood vessel dilation
-they can act rapidly, for a long time, even w/ poorly functioning kidneys
67
Loop diuretic adverse effects
-fluid loss, BP reduced too much
-hypokalemia, nausea, vomiting, dizziness, headaches, BS and electrolyte loss
68
_______ _______ are used to manage edema associated w/ heart failure/hepatic disease/renal disease and pts w/ hypercalcemia
Loop diuretics
69
Furosemide MOA, class, adverse effects (+pregnancy category), uses
-loop diuretic (K+ wasting)
-BLACK BOX: fluid/electrolyte loss
-pregnancy category C
-used for heart failure, edema (pulmonary)
70
Potassium sparing diuretics MOA (+ site of action)
-blocks sodium/water reabsorption
-in collecting duct and distal tubule
-competitively bind to aldosterone binding sites
71
Potassium sparing diuretics (spironolactone, amiloride) use, adverse effects, pregnancy category
-use: hypertension, HF
-SFX: hyperkalemia, amenorrhea, postmenopausal bleeding, gynecomastia in XY, lithium toxicity
-pregnancy category C (decreases fetal testosterone)
72
Potassium sparing drugs interact w/:
-ACE inhibitors + other K sparing drugs
-NSAIDS
73
Thiazides MOA, use
-inhibit reabsorption of electrolytes in distal tubule--> diuresis
-dilates arterioles
Use: hypertension treatment, heart failure, edema
74
Thiazides adverse effects, considerations (K wasting or sparing?)
Electrolyte imbalance -K wasting (hypokalemia/hyponatrimia)
-dizziness, vertigo, headache, decreased libido
-Consider: dizziness/urination--so don't give at night
75
Labs to assess before giving diuretics
-vitals + fluid volume status (BP)
-BUN, creatinine, LDH, AST, ALP
-serum electrolytes
-CAIs: Na and K
76
Torsemide, a _______ type diuretic, can affect what?
loop, WBC and platelet count
77
Which diuretics are K sparing? Which are K wasting?
Sparing:
-spironolactone
-amiloride
Wasting:
-loop (ex: furosemide)
-osmotics (ex: mannitol)
-thiazides and thiazide-like (ex: hydrochlorothiazide)
78
Main difference btwn spironolactone and amiloride:
spiro = long term, amiloride = shorter term
79
What diuretic should be avoided if a patient has a sulfa allergy?
Loop diuretics
80
Lisinopril class/MOA, use, warnings
-ACE inhibitor (vasodilator)
-hypertension, HF, MI
-Pregnancy class C and later
-Side effects: cough, hyperkalemia, renal disfunction (all ACE inhibitors)
81
Valsartan class/MOA, use, warnings
-ARB (angiotensin receptor blocker), vasodilator
-uses: hypertension, HF
-Pregnancy category D
-SFX: hyperkalemia, renal disfunction (all ARBs)
82
Valsartin-sacubitril ("Entresto") class/MOA, use, warnings
-ARNis (apprvd 2015), inhibits neprilysin enzyme and reduces vaso-peptides, plus valsartin's vasodilation
-BLACK BOX for pregnancy
83
Alpha1 receptor blockers (examples, class, MOA, side effects)
-adrenergic
-"sins": doxasin, prazosin, tarazosin
-MOA: block norepinephrine receptors, decreasing BP and causing vasodilation
-SFX: orthostatic hypertension, fatigue, dizziness
!Don't stop suddenly, get up slowly
84
Beta blockers (examples, class, MOA, side effects)
-adrenergic
-"lols": propranolol, atenonol, metaprolol
-MOA: reduce HR/renin
-SFX: bradycardia, dizziness
!Don't stop suddenly
85
ACE inhibitors for hypertension (examples, MOA, side effects/interactions/antidote)
-"prils" CELF: captopril, enalapril, lisonopril, fosinopril
-MOA: inhibit A-II and aldosterone, reduces BP and vasodilates
-SFX: dry cough, hyperkalemia, fatigue, dizziness
-interacts w/ NSAIDs, pregnancy category C/D (BLACK BOX)
-antidote: Hemodialysis
86
Most ACE inhibitors are prodrugs. What does this mean? Which 2 are NOT prodrugs?
-prodrugs: must be metabolized by liver to work
-Lisonopril and captopril are Not prodrugs
87
ARBs for hypertension (examples, MOA, side effects--signs of overdose)
-"sartans": losartan, valsartan, irbesartan, candesartan
-MOA: blocks conversion of A-I to A-II, reduces BP and vasodilates
-SFX: chest pain, fatigue, diarrhea, pregnancy category C (BLACK BOX)
-Overdose: tachycardia, hypotension (treat w/ fluids)
88
Hydralazine, nitroprusside, minoxidil, and diazoxide are ______. Name their MOA/side effects
Vasodilators for hypertension
-cause peripheral dilation directly
-SFX: bradycardia, low platelet aggregation
89
What diuretics are typically used for hypertension? Are they considered "first line" treatment? Do they decrease pre/afterload?
-thiazides
-Yes
-decrease preload
90
Calcium channel blockers (examples, MOA/use, side effects)
-amlodipine, nifedipine, nimodipine
-MOA: block calcium binding and prevent contraction (negative inotropic)
-use: hypertension, angina, migraines
-SFX: hypotension, peripheral edema
-NO: grapefruit juice, ED meds (hypotension)
91
ARNiS (example, MOA, SFX)
-"Entresto" (valsartan/sacubitril)
-MOA: blocks neprilysin (enzyme that degrades vasoactive peptide) + an ARB (valsartan)
-SFX: preg cat D, hyptoension, hyperkalemia, renal issues
92
Which beta blockers are nonselective? which are selective? What's the main difference?
-nonselective: Propranolol
-selective: metoprolol, atenolol
Nonselective also interfere w/ respiratory system
93
Digoxin class, MOA, signs of toxicity/considerations
-class: cardiac glycoside
-MOA: Na/K pump inhibition --> increase contractility + stroke volume, reduces heart size
-Consider: narrow therapeutic window (0.5-2), monitor electrolytes
-Toxicity: bradycardia, visual disturbances (flickering), confusion/headache/dizziness
low potassium makes this worse!
antidote: digoxin immune fab
94
Digoxin contraindications
NO:
-high fiber diet
-amiodarone, verapamil, St. John's wort
95
Nitrates and nitrites treat many different types of ______.
angina
96
Nitrate/Nitrite example, MOA, use, side effects, contraindications
-Isosorbide dinitrate (nitrATE)
-MOA: vasodilates sm muscle, treats angina acutely/prophylactically
-SFX/Contras: (low BP) KA, anemia, hypotension, ED meds ("-fils")
97
IR nitrate/nitrate tabs "rule of 3"
at sign of chest pain:
-take tab stat, then lie down
-3 pills can be taken at 5 minute intervals
-if these do not relieve pain, go to hospital ASAP
98
3 types of lipids
-LDL ("bad" cholesterol)
-HDL ("good"/recycling cholesterol)
-VLDL
99
Statins examples, MOA, considerations/contraindications/side effects
-atorvastatin, simvastatin, pravastatin, rosuvastatin
-MOA: HMG-CoA reductase inhibitors cause liver to produce less cholesterol--lowers LDLs
-considerations: take HS, GI issues, elevated liver enzymes, rhabdomyolysis
-interacts w: grapefruit juice, erythromycin, systemic antifungals, warfarin
100
Bile acid sequestrants (examples, MOA, side effects, considerations)
-cholestyramine powder, colesevelam
-MOA: bind to bile acids to prevent absorption into bloodstream (in SI), slightly lower LDLs
-SFX/consider: GI side effects, binds to other meds, so take 1-2 hours before or 4-6 hours after other medications
101
Niacin (B3) MOA, considerations/side effects
MOA: increases lipase function (breaks down lipids), increases HDLs
SFX: redness/flushing (take NSAID beforehand), pruritus, hepatotoxicity
102
Fibric acid derivates examples, MOA, side effects
-gemifibrozil, fenofibrate
-MOA: lower triglycerides by activating lipase enzyme
-side effects: GI, gallstones, increased liver enzymes, enhances anticoagulants
103
Normal triglyceride lab values
<150 mg
104
Normal HDL/LDL lab values
HDL: >40 mg
LDL: <100 mg
105
Normal cholesterol lab values
<200mg
106
Sublingual nitrates expire how long after they are opened?
3 months
107
Enoxaparin (lovenox) and dalteparin MOA, side effects + considerations
-MOA: LMWH (factor X)
-Side effects: bleeding, anemia, bruising, nothing life threatening
-Check: HCT, HgB, platelets--bleeding
108
Heparin (MOA, use, side effects--considerations/antidote?)
-MOA: anti factors IIA, IX, and X --> anticoagulant
-side effects: HIT (heparin induced thrombosis), bleeding
-consider: check aPTT, protamine sulfate is antidote
109
Rivaroxaban and apixaban (class/MOA, considerations, reversal agent)
-anticoagulant
-MOA: inhibits clotting factor Xa
-considerations: don't stop abruptly, dose carefully, in
-reversal agent: andexanet alfa
110
Warfarin MOA, use, side effects, considerations/antidote
-MOA: inhibits vit K dependent clotting factors
-Use: in afib, prevent clotting in heart
-Side effects: bleeding, muscle pain
-Consider: antidote = Vit K, (watch for too much vit K intake) interacts with erythromycin/sulfa/amiodarone, check INR (therapeutically, 2-3.5)
111
Clopidogrel (use, MOA, side effects)
-MOA: ADP receptor blocker, anti platelet
-side effects: bleeding
interactions w/ Ca channel blockers, NSAIDs
112
Thrombolytic drugs are the only anti-clotting drugs that do what?
Lyse clots that are already formed
113
Thrombolytic drug examples, MOA, side effects
-alteplase
-reteplase
-streptokinase
-MOA: activates plasminogen
-Side Effs: ecchymoses, bleeding, toxicity
114
NO-NOs w/ anti coagulants
Grapefruit juice, cranberry juice, ginko/ginger/st John's wort, green tea (vit K)
115
Don't take what on heparin?
Potassium (salt-replacements in diet foods)
116
Aspirin class, MOA
-class/MOA: antiplatelet (prevents clots, binds to COX-1 and COX-2)
117
Anticoagulants have what effect on blood clots?
NO effect
118
Short-acting bronchodilators (examples, MOA, side effects)
-albuterol, levalbuterol (rescue inhalers)
-MOA: binds to beta 2 receptors in lungs --> bronchodilation
-SFX: tachycardia, headache, tremor
119
The 'nursing consideration' for almost all respiratory drugs
-make sure med is appropriate for symptoms (long vs short acting)
-make sure technique is appropriate if using inhaler
-respiratory assessment, maybe cardiac
120
Long-acting bronchodilators (examples, MOA, side effects)
-salmeterol, formoterol, arformoterol
-MOA: binds to beta 2 receptors in lungs --> bronchodilation
-SFX: hypertension, headache
121
Anticholinergic drugs (examples, MOA, side effects)
-ipratropiums, tiotropium, combivent
-MOA: Ach agonist --> bronchodilation
-SFX: dry mouth (reduces secretions), congestion, palpitations, GI distress
122
Xanthine derivates (examples, MOA, side effects, considerations)
-theophylline, aminophylline
-MOA: stimulates cAMP production --> bronchodilation + respiratory drive
-SFX: nervousness, tremors, insomnia, GI distress
-Consider: AVOID other sources of caffeine!
123
Corticosteroid examples, MOA, SFX/considerations,
+systemic?
-fluticasone, budensonide, belcomethasone
-MOA: anti-inflammatory (mostly used for chronic asthma)
-SFX/consider: thrush--rinse mouth after use, take a week to work
Systemic: prednisone/prednisolone--work thru whole body, must taper, makes you Hangry
124
You should always take _______ before taking _____ for asthma, if taking both. Why? What med has both of those meds?
-bronchodilators, corticosteroids
-Allows anti-inflamm steroids to reach more of airway
-Combo med: fluticasone/salmeterol
125
Cough and cold products shouldn't be given to children under ___ due to side effects like...
-2
-oversedation, tachy, seizure, death
126
Sudafed class, MOA, considerations
adrenergic decongestant
-MOA: vasoconstriction
-SFX: CNS stim: jitters, insomnia, palpatations, tremor
-considerations: hypertension, abuse potential
127
Opiod antitussives: example, MOA, side effects
-codeine (S5 drug), hydrocodone
-MOA: pain relief, dry secretions, dull cough reflex in medulla
-SFX: sedation, N/V, constipation, lightheaded
128
Opioids are the ______ effective cough supressant
most
129
Non-opiod antitussive examples and their MOAs, SFX
-Benzonatate: numbs stretch receptors in respiratory
-Robatussin: dries mucosa of res system (prevents post nasal drip)
SFX (both): drowsy, dizzy, nausea
130
Expectorants example/use, MOA, side effects
-for productive coughs
-SFX: NV, drink fluids!
131
Epinephrine class, MOA
-nonselective adrenergic med
-MOA: stimulates B1, B2 (cardiac and respiratory receptors) and alpha receptors --> relaxes sm muscle, increases HR
132
Anticholinergic examples, MOA/use/route, side effects
-Ex: scopolamine
-MOA: blocks Ach in inner ear, dry out GI secretions
-ROUTE/USE: patch often used for motion sickness
-SFX: dry you out--blurred vision, dry mouth, urinary hesitancy, drowsiness. Used CAUTION w/ older adults
133
Antihistamine examples, MOA, side effects
ex: diphen, meclinzine, dimenhydrinate (dramamine)
-MOA: blocks H1 receptors in vestibular/reticular formations
-R/U: oral--motion sickness
-SFX: dizziness, drowsiness, dry mouth, constipation--use w/ caution in older adults
134
Antidopaminergics examples, MOA, route/use, SFX
-prochlorperazine (Compazine), promethazine, droperidol
-MOA: block dopamine receptors in the CTZ
-R/U: oral/suppository/IV, general N/V
-SFX: drying, sedative, constipation. Can cause NMS
135
What is NMS, and what antiemetic class(/es) can cause it?
-Neuroleptic Malignant Syndrome: life threatening fever, altered mental status, rigidity, autonomic function loss
-Antidopaminergics, prokinetics
136
What antidopaminergic can cause agranulocytosis (low neutrophil count)? What would that put the pt at risk for?
-Prochlorperazine
-Infection
137
Prokinetic (metoclopramide) examples, MOA, route/use, SFX
-metoclopramide
-MOA: block dopamine in CTZ and stimulates Ach receptors in GI
-R/U: more commonly used for motility issues like GERD
-SFX: drying and drowsy, long term use = tardive dyskniesia (on BEERS), NMS
138
Signs and symptoms of TD (tardive dyskinesia)
-stooped posture, forward tilted trunk
-rigidity
-flexed elbows/wrists
-reduce arm swinging
-trembling in extremities
139
Serotonin blockers examples, MOA, route/use, SFX
-"trons": ondansetron (Zofran), dolasetron, granisetron, palonosetron
-MOA: block serotonin receptors in GI, CTZ
-R/U: tabs, SL tabs, IV... for chemo/post-op N/V
-SFX: headache, diarrhea, RARELY: serotonin syndrome, Torsades de Pointes
140
Describe serotonin syndrome and Torsades de Pointes--what classes of drugs can cause these?
-Serotonin syndrome: polypharmacy of serotonin blockers
-TDP: widening QT interval
-Serotonin blockers can cause these
141
Vitamin B1 use
THIAMINE
-needed for carb metabolism
-deficiency --> wernicke's encephalopathy (effects short term memory)
142
Vitamin B2
RIBOFLAVIN
-necessary for RBC function
-deficiency caused by poor nutrition
-found in: dairy, flours, green leafy veg, nuts, meat...
143
Vitamin B3
NIACIN
-coenzyme for metabolizing lipids
-deficiency caused by alcohol abuse, nutritional/absorption deficiency
144
Vitamin B6
PYRIDOXINE
-necessary for amino acid/carb/lipid metabolism
-deficiency from poor nutrition, isoniazide--causes anemia, neurological issues
145
Vit B9
FOLIC ACID
-necessary for fetal dev (spina bifida), RBCs
146
Vit B12
-needed for RBC and DNA development
-helps brain and nerve cell development
147
Vitamin C
ASCORBIC ACID
-collagen formation/tissue repair, antioxidant
-deficiency --> scurvy, and bleeding gums, gingivitis, wound healing
-no evidence for helping/preventing colds
148
Vit D2/D3
-fat soluble
-helps w/ bones, teeth
149
Vitamin A
Retinol
-growth of bones, teeth
-from beta-carotenes (green/yellow plants)
150
Vitamin K
-clotting
-Given to newborns to prevent dangerous bleeding (into brain)
151
Vitamin E
-antioxidant
-protects body from free radicals
-can be low in preemies--supplemented here
152
What can you not take w/ Calcium?
Tetracycline (hypercalcemia)
153
What can cause Mg deficiency?
-alcohol abuse
-don't supplement w/ impaired kidneys
154
1st line treatment of H pylori
-10-14 days of PPI, clarithromycin, amoxicillin, metronidazole OR
-PPI, bismuth, tetracycline, metronidazole
155
Stress related mucosal damage is prevented with:
-histamine receptor blockers
-PPI
156
Antacids are made up of...
Al, Ca, Mg, Na salts
157
Antacid MOA, interactions
-neutralize acid
-stim mucus
-stim prostaglandins
-stim bicarb
interacts w/: quinolones, cipro, levofloxacin (certain antibiotics)
NO for kidney disesase
158
H2 receptor antagonists (suffix, MOA, SFX)
-famotidine, cimetidine (ranitidine)
-MOA: block H2 receptors
-SFX: CNS adverse for elderly, cime = impotence, gynecomastia
-take hour before meals, 2 hours before after PPI
159
PPI (suffix, use, MOA, considerations/SFX)
-"prazoles"
-use: GERD, esophagitis, ulcers, H pylori (w/ antibiotic)
-MOA: bind to H-K-ATPase pump, block acid secretion
-Consid: take daily, take on empty stomach before eating, -SFX: long term --> osteoporosis, increases warfarin effects
160
Sucralfate MOA, use, consids
-ulcers
-binds to base of ulcers and forms protective barrier
-give hour before meals, not at same time as PPIs (2hrs before/after)
161
Misoprostol MOA, use
-inhibits acid secretion, protects mucus
-prostaglandin analogue
-acid controlling drug
-NO w pregnancy
162
Simethicone use
increase fartin n burpin, reduces gas pain
163
Chronic diarrhea lasts for
2-4 weeks
164
Adsorbants (ex, MOA, consids)
-bismuth, cholestyramine
-MOA: bind to toxic agent
-can affect drug absorption, darkening of tongue/stool, platelet aggregation
165
Loperamide, diphenoxylate, codeine are _______ ________ opioid like drugs. How do they work?
-anti diarrheal
-MOA: sloowwww: decrease motility, reduce pain, increase transit time through bowel
166
Docusate and mineral oil are ______ laxatives contraindicated with ________ ________. They work by bringing water and ____ into stool
-emollient laxatives
-intestinal obstruction
-fat
167
Mg hydroxide, Mg citrate are ______ laxatives. They draw ______ into the ______ and are contraindicated for kidney failure.
-saline
-draw water into intestines
168
Stimulant laxatives ex, MOA
-senna, bisacodyl
-MOA: increase peristalsis via intestinal nerve stimulation
169
Most psych meds take (how long?) to work.
4-6
170
xanax, ativan, valium, and buspirone are all benzodiazepines and anti-anxiety drugs. Which one is unique and why?
-buspirone: doesn't have sedative side effects, reduce CNS activity
171
If you're giving someone lithium carbonate for ______, what labs would you check? What would you advise your patient?
-mania/BPD
-lithium (0.5-1.6) and Na labs
-don't change fluid intake
172
Signs of lithium toxicity include:
slurred speech, cardiac dysrhythmia, issues w/ movement and coordination
173
What class of medications has a black box for suicidal ideation?
antidepressants
174
MAOI examples, MOA, use, side effects/considerations
-NPMs (no popular meds): Nardil, Parmate, Marplan, Selegiline
-MOA: monoamine oxidase inhibitor (block serotonin re-uptake)
-use: mostly Parkinson's
-SFX: siezure, HT crisis
175
You can't have what food/drink while on MAOIs?
-fermented/preserved foods with tyramine--cheese, wine, kimchi, pickles
176
SSRIs examples and uses
-celexa, lexapro, paxil, prozac, zoloft
-use: anxiety, EDs, depression, PMDD
177
SSRI MOA and side effects/considerations
-MOA: block serotonin re-uptake (selective serotonin re-uptake inhibitor)
-SFX: insomnia, weight gain, impotence, serotonin syndrome, suicide
-consider: don't take w/ other protein bound drugs (warfarin, phenytoin) as there will be too much free drug in the body, consider "washout period" for switching drugs
178
1st gen antipsychotics examples, use, MOA, side effects
-pro/chlorpromazine, haldol
MOA: reduces dopamine in CNS, block Ach receptors
use: "calm pts down", schizophrenia
SFX: anticholinergic (drying), EPS, NMS
179
Anticholinergic effects include
drying: dry mouth, cough, constipation, sedation/drowsy/dizzy
180
2nd gen antipyschotics--examples, use, MOA, side effects
-"one-pines": quetiapine, risperidone, olanzapine
MOA: block D2 and serotonin re-uptake
use: MDD, BPD, schizophrenia
SFX: weight gain, agranularcytosis, sedation, EPS, NMS
181
Haldol is a more _____-_____ medication as opposed to other 1st gen antipsychotics
long-term
182
3rd gen antipsychotics: examples, MOA, side effects
-"azoles": brexpiprazole (rexulti), aripiprazole (abilify)
-MOA: D2 and serotonin agonists
-SFX: akathisia (jitters), weight gain, suicide, NMS
183
Kids over ___ can take lexapro, for _______ and ______.
12, anxiety, depression
184
Children over age __ can take prozac for depression, OCD, and other off-label disorders (bulimia, social anxiety, PTSD)
10
185
codeine and hydrocodone are _______ opiate _______. Name the "strong" versions of these drugs
-mild, agonists
strong opioid agonists:
-morphine
-oxycodone
-fentanyl
-methlydone
-hydromorphone
186
Opioid agonists are sometimes combined with...
tylenol: i.e., percocet/vicodin
187
Common symptoms of opioid agonists and antagonists include:
-constipation
-sedation, drowsy, dizzy
-hypotension
-respiratory depression
188
What interacts with opioid agonists?
-sedatives (alcohol, other sedatives like barbiturates/antihistamines)
189
Morphine is 7x ________ than hydromorphone (Dilaudid)
weaker
190
Subutex, stadol, and nubain are ______ _________ -________. What are they used for?
mixed agonist-antagonists; used for opioid withdrawal/detox
191
Subutex, stadol, and nubain are used for what? Why is it unique compared to some other similar meds?
-opioid withdrawal/detox
-provides no high/euphoria, just pain relief
192
T/F: mixed/partial opioid agonists have no life threatening symptoms.
T
193
Alcohol abuse can cause deficiency of what vitamin? What conditions can this deficiency lead to?
Thiamin, Wernicke's encephalopathy and eventually Korsakoff's psychosis
194
Name the strong opioid agonists (hint: MOFHM)
-morphine
-oxycodone
-fentanyl
-methlydone
-hydromorphone
195
Long acting benzodiazepines (hint: LAKV)
-klonopin
-valium
196
Intermediate acting benzos (hint: XAR)
-xanax
-ativan
-restoril
197
Short acting benzos
-versed
198
Benzodiazepine, suffix, MOA side effects, interactions
* "pams"
* MOA: depress CNS (GABA-like)
* SFX: 'hangover effect', fall risk--esp for older, drowsy/dizzy/vertigo
* Interactions: grapefruit juice, azoles (antifungals), alcohol
199
Barbituate suffix, MOA, use, side effects
-pentobarbital
-phenobarbitol
-MOA: reduce nerve impulses at brainstem
-use: pre-op relaxation, recurrent seizure, and pheno: withdrawal
-SFX: narrow therapeutic window, habit forming, drowsy/dizzy, respiratory depression, N/V, decreased REM sleep
200
_________ are habit forming, have a narrow therapeutic window, and carry the side affect of respiratory depression.
Barbituates
201
Atomoxetine is a unique drug used to treat ADHD, in that it...
-is not a stimulant (carries less side effects than other ADHD meds)
-takes longer to work than stimulants
202
Dexmethylphenidate, amphetamines, and dextroamphetamine are examples of CNS _________ used to treat ______. Side effects include what? What schedule are these drugs?
stimulants, ADHD
-insomnia, tachycardia, rhabdomylosis
-schedule II
203
Muscle relaxants have "____" in their name and are CNS ______.
flex, depressants
204
Symptoms of DM-I
3 p's:
-polyuria (peeing)
-polydypsia (thirst)
-polyphagia (hunger)
205
Aspart, lispro, and glulisme are _____-______ insulins. Name their onset, peak, and how long they last.
rapid-acting
5-15 minute onset
peak at 1-2 hours
last 3-5 hours
206
Humulin-R is a ______ _______ medication--name the onset, peak, and duration
short-acting
-1/2 hour-1 hour onset
-peaks at 2.5 hours
-lasts 6-10 hours
207
NPH is _______ acting insulin. Name onset, peak, and duration
intermediate acting
-1-2 hour onset
-peaks at 4-8 hours
-lasts for 10-18 hours
208
Long acting insulin, like _______, has an onset of ___ hours, a peak of _____ hours, and it lasts ____ hours.
glargine
-1-2 hour onset
-has no peak
-lasts 24 hours
209
Metformin decreases _______ ________ production, and carries a rare but serious side effect of...
-Metformin decreases hepatic glucose production
-lactic acidosis
210
Sulfa "-ide" drugs for diabetes stimulate release of ________, carry what side effect, and what cross allergic affect?
-insulin release
-risk of hypoglycemia
-sulfa cross allergy potential
211
"-glinides" are like sulfa diabetes drugs, but w/o what consideration?
-like sulfas: increase insulin release from pancreas, hypoglycemia risk
-NO cross allergy potential
212
Acarbose and miglitol are _______-______ inhibitors that delay glucose absorption, and carry ___ side effects
Alpha-glucosidase inhibitors, GI side effects
213
"flozins" are ______-______- transport inhibitors. Name considerations and side effects
-sodium-glucose
-Flozins --> kidney function, rifampin increases effects
214
Flozin MOA
Inhibit glucose reabsorption in the proximal renal tubules
215
The depo provera is a _______ shot dosed every ___ months
-progestin
-3mo
216
Mirena lasts __ years, skyla lasts __ years, and paragard lasts up to __ years
mirena: 3 yrs
sklya: 5 yrs
paragard: 10 yrs
217
Plan B side effects include...
nausea, lower
abdominal cramps, breast tenderness
218
Mifepristone vs misoprostol
mife: anti-progesterone
miso: cervical ripening/labor induction--take 36-48 hours after mifepristone
219
Instructions for missing a dose of an oral contraceptive
1 dose missed: take 2 pills next day
2 doses missed: take 2 pills next day and 2 day after
3 doses missed: use backup BC
220
Progesterone/estrogen BC are of reduce effectiveness when taken w/...
-rifampin/isoniazide
-antibiotics
-anticoagulants
221
What do indomethacin, nifedipine, and Mg sulfate do (used when)? Side effects?
-stop preterm labor
-Indo: inhibits prostaglandins
-Nife: Ca channel blocker
-mg sulfate: sfx include hypotension, bradycardia, arrythmias
222
Clomiphene use, MOA, SFX
-fertility drug
-MOA: blocks estrogen receptors in brain, --> 'false low estrogen signal', --> more estrogen/FSH/LH produced
-SFX: GI stuff (N/V, constipation, anorexia), heart stuff (tachy, DVT, hypovolemia), itching, nervousness, and TWINS!
223
Osteoporosis is much more common in _____
women--40% of women over 50 years of age will develop
osteoporotic fracture
224
"-dronates" (alendronate and risedronate) inhibit ______________, preventing osteoporotic fractures. Name nursing considerations.
-osteoclast bone reabsorption.
-consids: irritates esophagus, take w/ 8oz water and DON'T lie down!
225
Evista is used to treat X by Y. Name the side effects
-X: osteoporosis
-Y: stimming estrogen receptors--increases bone density
-SFX: hot flashes, leg cramps, VTE, luekopenia
226
Calcitonin is a nasal spray used for what? Side effects?
-inhibits osteoclastic bone resorption
-SFX: facial flushing, rhinitis, hypocalcemia, malignant tumor
227
"-sterides" (finasteride, dutasteride) are androgen _________. Side effects include...
-androgen inhibitors
-SFX: hair growth, reduced libido, hypotension, drowzy/dizzy
-use gloves to apply!!
-takes 6mo to work
228
Alpha5-ad blockers ("-osins") are used for relief from what?
BPH
229
Tamsulosin (what type of drug) interacts with...
-"osin": BPH symptom relief
-interacts w/ azoles, erythromycin and
clarithromycin
230
"-fils" are used to treat __. MOA? Considerations?
-ED
-MOA: inhibit phosphodiesterase enzyme
-SFX: unexplained vision loss, sever hypotension when used w/ nitrates
-take 1hr before sex, only 1x day
231
1st line of treatment for RA
can't be cured, only treated
-NSAIDs
-non-biologic DMARDs
232
Abacept, Humira, Etanercept are biologics used to treat RA. Name MOA, considerations, SFX
-MOA: binds to TNF and blocks it's action
-Considerations: caution for pts w/ active infections, COPD, past hepatitis and TB
-SFX: headache, dizziness, weakness, injection site reaction, infection (URIs), malignancy
233
Abatacept considerations
-give w/ filter
-caution for patients w/ COPD, recurrent infections
234
Methotrexate, used for ___, is dosed weekly. It should be taken with what type of supplement and has how long of an onset?
-folic acid supplement to reduce bone marrow suppression
-6-12 week onset
235
MOA of immunosupressants
Suppress T-lymphocyte cells, preventing immune response
236
Nursing considerations for Immunosupressants
-take same time each day, w/ food, don't skip doses
-draw kidney function/drug function labs regularly
-reduce infection risk
-take precautions in sunlight
-interactions w/ antibiotics and antifungals
-no Gfruit juice
237
Cellcept has a carries a black box warning for _______. use/MOA?
-pregnancy
-immunosupressant
-MOA: inhibit purine synthesis --> prevent T cell proliferation
238
Tacrolimus use, MOA
-immunosupressant
-MOA: prevent T cell activation/proliferation
239
Corticosteriods are used to treat adrenal _________, but not _________
-undersecretion (Addison's)
-not oversecretion (Cushing's)
240
Corticosteroid considerations/SFX
-werewolf SFX (moon face, hirsutism, weight gain/muscle wasting)
-monitor for electrolyte imbalances, hyperglycemia
-can impact mood
-give at same time each day w. food/milk
-rinse if inhaling
241
Methylprednisolone is the only ______-_______ corticosteroid
long-acting
242
Causes of anemia
-Maturation defects (iron/B12/folic acid deficiency, thalassemia)
-Hemolytic--RBC lysis (sickle cell, extrinsic factors)
243
"-poetins" for anemia would be given in what types of anemia? What's a big side effect?
chemo, renal disease--need functioning bone marrow and iron
SFX: uncontrolled hypertension
244
"-stim" anemia drugs (fligrastim, pegfilgrastim) MOA, serious side effects
-MOA: neutrophil stimulators
-SFX: splenic rupture, hypersensitivity, bone pain
245
Iron for iron-deficient anemia: SFX, considerations
-GI issues, abdominal cramps, iron toxicity
-can turn feces tarry, liquid iron supplements can stain teeth
246
Folic acid is a _____-soluble vitamin essential for _______
-water
-erythropoiesis
247
Iron ______ is not commonly used because of the risk for anaphylaxis?
-dextran
248
Pegfilgrastim is a ________-_______ anemia drug, often given 1x after ______.
-long-acting
-chemo
249
antacids, milk, and other food (should/shouldn't) be taken at the same time as iron
Should NOT, decreases absorption
250
Name where Alpha 1, alpha 2, beta 1, and beta 2 receptors are located
-alpha 1: sm muscle
-alpha 2: brain
-beta 1: heart
-beta 2: lungs
251
When activated, a1/2 and b1 receptors cause _______. Beta 2 receptors cause _______.
-vasoconstriction
-bronchodilation
252
Chronotropes affect heart _____, while inotropes affect...
-rate
-strength of heart muscle contraction
253
Drugs that work ONLY on Alpha 1
-phenylephrine
-dopamine
-midodrine
254
Drug that works on Alpha 1 and alpha 2 receptors (plus a little beta 1)
norepinephrine
255
Epinephrine activates what receptors?
-Beta 1, beta 2, alpha 1
256
dobutamine affects _____ __ receptors ONLY
Beta 1
257
dopamine works only on _____ __ receptors
alpha 1
258
Alpha-adrenergic drugs (EX) side effects
HYPERTENSION, chest pain, bradycardia, N/V, anorexia, palpitations
259
Epinephrine SFX
-hypertension, tachycardia, hyperglycemia
260
dobutamine and epinephrine can both cause...
tachycardia
261
Midodrine is a ___drug that works on the _____-__ receptors. It's given for __________ hypotension, so it shouldn't be given before lying down to prevent ________ ___________.
Midodrine is a prodrug that works on the alpha-1 receptors. It's given for orthostatic hypotension, so it shouldn't be given before lying down to prevent supine hypertension.
262
Acetylcholine (Miochol-E) use, MOA
-produce miosis during eye surgery
-immediate onset, duration of 10 min
263
CAIs for glaucoma/IOP before surgery
-"-zolamides"
-MOA: inhibit CAI --> reduces aqueous humor formation
264
Prostaglandin agonists
Suffix, MOA/use, side effects
"-oprosts"
-MOA: increase outflow of aqueous fluid
-SFX/nursing considerations: burning, CAN CHANGE EYE COLOR PERMANENTLY! (light --> brown)
265
Ocular anti-inflammatory NSAIDs and corticosteroids
NSAID: flurbiprofen, ketoralac
Corticosteroids: dexamethasone, prednisolone
266
Tetracaine and proparacaine are _______ ________, and can't be self-administered
Ophthalmic anesthetics
267
When using eye drops, have the patient look at the ______ and place the drop (where?)
-ceiling
-conjuctival sac
268
Considerations for giving eardrops
-give at ROOM TEMPERATURE!!!!!!
-remove earwax
-children: hold pinna down/back
-adults: hold pinna up/back
-lie on opposite side for 5 min, massage tragus
269
Bacitracin, neosporin, and Mupirocin are what kind of drug
topical antibacterials, Muprocin used for MRSA, staph, and strep
270
Silver Sulfadiazine is used to prevent infection in what situation? What pts should not use this drug?
burns--no for those w/ sulfa allergies
