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Pharm N317 - UW Madison Fall 2023 > PHARM FINAL > Flashcards

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)

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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)

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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)

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3
Q
A
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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)

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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…”)

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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

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7
Q

“5 Rights” of med admin

A

Right…
-Medication
-Patient
-Dose
-Route/form
-Time
+DOCUMENTATION

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8
Q

3 Checks of med admin

A

-check the drug in MAR
-check drug when preparing
-check before administering (2 identifiers)

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9
Q

Polypharmacy

A

A patient with multiple prescriptions that might conflict each other

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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)

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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

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12
Q

What labs might one check before giving an NSAID?

A

Kidney/renal function:
-Creatinine (0.6 - 1.3)
-BUN (7-20)

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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)

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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)

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15
Q

T/F: Corticosteroids mimic hormones already made in the body

A

True! (glucocorticoids, mineralocorticoids, sex hormones)

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16
Q

Corticosteroid MOA

A

Modifying enzyme activity–suppress immune response + therefore, inflammation

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17
Q

Common corticosteroids

A

dexamethasone, methylprednisone (IV), prednisone (PO)

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18
Q

Corticosteroid side effects

A

mood changes, hyperglycemia, osteoporosis, ulcers, bloating, muscle weakness

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19
Q

1st line gout therapy?

A

NSAIDS

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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

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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

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22
Q

Probenecid MOA, use + considerations

A

-inhibits uric acid reabsorption (promotes excretion), treats gout
-take w/ food/milk

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23
Q

Sulfonamides MOA

A

bacteriostatic: interfere w/ FOLIC ACID production
fuck w/ G+ and G- bacteria

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24
Q

Sulfonamides are often given for:

A

-UTIs
-staph
as SMV-TMP (Bactrim)

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25
Q

Sulfonamide side effects, contraindications, interactions

A

-skin issues (photosensitive), agranulocytosis, anemia
-common allergy
-NO: pregnant, under 2mo, warfarin, phenytoin, cyclosporin

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26
Q

Sulfonamides should be avoided if you take:

A

-warfarin
-phenytoin
-cyclosporin
or if you’re pregnant or under 2mo old!

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27
Q

Tetracycline is often given for:

A

-acne
-STIs (chlamydia, syphilis)
-Lyme’s
-Rickettsia

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28
Q

What should you avoid on tetracyclines?

A

-Dairy
-Antacids
-Supplements w/ Ca, Fe, Mg
(can prevent drug from acting in body)

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29
Q

What antibiotic class has the potential to stain teeth?

A

Tetracyclines

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30
Q

Tetracycline MOA

A

-Bacteriostatic
-bind to 30s ribosome (messes up protein synthesis)
-Fuck up both G+/- bacteria

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31
Q

Macrolide antibiotics end in “m____”

A

-mycin!

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32
Q

Macrolide used for C. diff?

A

Fidaxomycin (fartaxomycin)

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33
Q

What macrolide is put in newborn’s eyes to prevent gonorrhea?

A

Erythromycin

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34
Q

Common uses for macrolides include:

A

-strep
-respiratory infections
-spirochetal infections
-STIs

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35
Q

Macrolide side effects:

A

-GI (take w/ food, especially erythromycin!)

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36
Q

Name the 3 aminoglycosides that ALSO end in mycin (Bruh)

A

-gentamycin
-tobromycin
-neomycin (oral)

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37
Q

What antibiotics attack mostly G- bacteria?

A

-Aminoglycosides
-Fluroquinolones

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38
Q

Tetracyclines and fluroquinolones shouldn’t be taken with what?

A

-antacids, zinc, supplements w/ Ca, Al, Fe, Mg
(+tetra: no dairy)

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39
Q

Fluroquinolone side effects

A

BLACK BOX WARNING: tenditinis/tendon rupture possible in older adults

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40
Q

Vanomycin is a (macrolide/aminoglycoside?)

A

NEITHER! Lone wolf that causes “red man syndrome”

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41
Q

Vancomycin is used to treat:
But monitor for ___ and ____ toxicity

A

MRSA
oto, nephro

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42
Q

Fluroquinolone MOA

A

-alter DNA :0
-bactericidal and BROAD SPECTRUM (but mostly G-)

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43
Q

Ticonazole (Vagistat), miconazole, and clotrimazole are all ______ antifungals and can are common ___ meds.

A

topical, OTC

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44
Q

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?

A

“amphoterrible”
-fever, chills, nausea/vomiting, low BP, tachycardia
-nephrotoxicity
-premedicate w/ antihistamine, antipyretic, anti-nausea meds
-monitor renal labs like BUN/creatinine

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45
Q

Nystatin is used to treat _____

A

thrush (oral candidiasis), athletes foot, jock itch…

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46
Q

What are HSV1/2 treated with? Can these viruses be cured?

A

-acyclovir/valacylovir
-no, just managed/treated

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47
Q

How many times per day would you take acyclovir? How many times would you take valacyclovir per day?

A

-acyclovir: 5x day
-valacyclovir: 1x day

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48
Q

HSV3, or varicella zoster (chickenpox), can be prevented with:

A

the childhood varicella vaccine

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49
Q

What patients are at risk for HS5 (CMV)?

A

Severely immunocompromised patients (i.e., organ transplant recipients)

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50
Q

There are 3 types of hepatitis. Which ones have a preventative vaccine?

A

Hep A and Hep B have a vaccine, Hep C does not.

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51
Q

How is Hep C spread? How is it treated (+ who cannot have that med)?

A

-sexual contact–blood, fluid
-Ribavirin–which is a teratogen, so pregnant people can’t have it!

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52
Q

Name the Hep B preventative vaccine and post exposure treatment

A

-HBV vaccine (x3)
-immunoglobulins w/in 3 weeks of exposure

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53
Q

Name the Hep A preventative vaccine and post exposure treatment

A

-HAV vaccine
-immunoglobulin GamaSTAN

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54
Q

How is Hep A spread vs Hep B/C?

A

A: oral-fecal route
B/C: blood, body fluids

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55
Q

Oseltamivir treats what if taken w/in 48 hours of symptom onset?
It has what side effect?

A

-Influenza A, B
-Nausea, vomiting

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56
Q

Ganciclovir and valganciclovir treat…

A

CMV

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57
Q

Folate and pyrimidine antagonists are all __________ ______________, meaning they are cell cycle ___________.

A

antimetabolite atineoplasts, specific

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58
Q

________ blocks estrogen receptors on breast cancer cells.

A

-Tamoxifen

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59
Q

Define ‘nadir’. When does it occur?

A

-Lowest WBC count after chemo
-10-28 days after treatment

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60
Q

What is neutropenia?

A

Low neutrophils (type of WBC)

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61
Q

What is thrombocytopenia?

A

Low platelets in the blood

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62
Q

Anemia, leukopenia, neutropenia, thrombocytopenia, alopecia, emetic, stomatitis, and nadir are all side effects of…

A

myelosupression

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63
Q

Methotrexate is a ________ antagonist and an anti-_________.

A

folate, anti-metabolite

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64
Q

Cytarabine is a _________ antagonist and ____-_______.

A

pyridimine, anti-metabolite

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65
Q

Cytoxan is a _____________ cell cycle antimetabolite.

A

nonspecific

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66
Q

Loop diuretics MOA, and what’s special about them

A

-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

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67
Q

Loop diuretic adverse effects

A

-fluid loss, BP reduced too much
-hypokalemia, nausea, vomiting, dizziness, headaches, BS and electrolyte loss

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68
Q

_______ _______ are used to manage edema associated w/ heart failure/hepatic disease/renal disease and pts w/ hypercalcemia

A

Loop diuretics

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69
Q

Furosemide MOA, class, adverse effects (+pregnancy category), uses

A

-loop diuretic (K+ wasting)
-BLACK BOX: fluid/electrolyte loss
-pregnancy category C
-used for heart failure, edema (pulmonary)

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70
Q

Potassium sparing diuretics MOA (+ site of action)

A

-blocks sodium/water reabsorption
-in collecting duct and distal tubule
-competitively bind to aldosterone binding sites

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71
Q

Potassium sparing diuretics (spironolactone, amiloride) use, adverse effects, pregnancy category

A

-use: hypertension, HF
-SFX: hyperkalemia, amenorrhea, postmenopausal bleeding, gynecomastia in XY, lithium toxicity
-pregnancy category C (decreases fetal testosterone)

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72
Q

Potassium sparing drugs interact w/:

A

-ACE inhibitors + other K sparing drugs
-NSAIDS

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73
Q

Thiazides MOA, use

A

-inhibit reabsorption of electrolytes in distal tubule–> diuresis
-dilates arterioles
Use: hypertension treatment, heart failure, edema

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74
Q

Thiazides adverse effects, considerations (K wasting or sparing?)

A

Electrolyte imbalance -K wasting (hypokalemia/hyponatrimia)
-dizziness, vertigo, headache, decreased libido
-Consider: dizziness/urination–so don’t give at night

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75
Q

Labs to assess before giving diuretics

A

-vitals + fluid volume status (BP)
-BUN, creatinine, LDH, AST, ALP
-serum electrolytes
-CAIs: Na and K

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76
Q

Torsemide, a _______ type diuretic, can affect what?

A

loop, WBC and platelet count

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77
Q

Which diuretics are K sparing? Which are K wasting?

A

Sparing:
-spironolactone
-amiloride
Wasting:
-loop (ex: furosemide)
-osmotics (ex: mannitol)
-thiazides and thiazide-like (ex: hydrochlorothiazide)

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78
Q

Main difference btwn spironolactone and amiloride:

A

spiro = long term, amiloride = shorter term

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79
Q

What diuretic should be avoided if a patient has a sulfa allergy?

A

Loop diuretics

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80
Q

Lisinopril class/MOA, use, warnings

A

-ACE inhibitor (vasodilator)
-hypertension, HF, MI
-Pregnancy class C and later
-Side effects: cough, hyperkalemia, renal disfunction (all ACE inhibitors)

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81
Q

Valsartan class/MOA, use, warnings

A

-ARB (angiotensin receptor blocker), vasodilator
-uses: hypertension, HF
-Pregnancy category D
-SFX: hyperkalemia, renal disfunction (all ARBs)

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82
Q

Valsartin-sacubitril (“Entresto”) class/MOA, use, warnings

A

-ARNis (apprvd 2015), inhibits neprilysin enzyme and reduces vaso-peptides, plus valsartin’s vasodilation
-BLACK BOX for pregnancy

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83
Q

Alpha1 receptor blockers (examples, class, MOA, side effects)

A

-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

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84
Q

Beta blockers (examples, class, MOA, side effects)

A

-adrenergic
-“lols”: propranolol, atenonol, metaprolol
-MOA: reduce HR/renin
-SFX: bradycardia, dizziness
!Don’t stop suddenly

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85
Q

ACE inhibitors for hypertension (examples, MOA, side effects/interactions/antidote)

A

-“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

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86
Q

Most ACE inhibitors are prodrugs. What does this mean? Which 2 are NOT prodrugs?

A

-prodrugs: must be metabolized by liver to work
-Lisonopril and captopril are Not prodrugs

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87
Q

ARBs for hypertension (examples, MOA, side effects–signs of overdose)

A

-“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)

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88
Q

Hydralazine, nitroprusside, minoxidil, and diazoxide are ______. Name their MOA/side effects

A

Vasodilators for hypertension
-cause peripheral dilation directly
-SFX: bradycardia, low platelet aggregation

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89
Q

What diuretics are typically used for hypertension? Are they considered “first line” treatment? Do they decrease pre/afterload?

A

-thiazides
-Yes
-decrease preload

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90
Q

Calcium channel blockers (examples, MOA/use, side effects)

A

-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)

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91
Q

ARNiS (example, MOA, SFX)

A

-“Entresto” (valsartan/sacubitril)
-MOA: blocks neprilysin (enzyme that degrades vasoactive peptide) + an ARB (valsartan)
-SFX: preg cat D, hyptoension, hyperkalemia, renal issues

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92
Q

Which beta blockers are nonselective? which are selective? What’s the main difference?

A

-nonselective: Propranolol
-selective: metoprolol, atenolol
Nonselective also interfere w/ respiratory system

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93
Q

Digoxin class, MOA, signs of toxicity/considerations

A

-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

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94
Q

Digoxin contraindications

A

NO:
-high fiber diet
-amiodarone, verapamil, St. John’s wort

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95
Q

Nitrates and nitrites treat many different types of ______.

A

angina

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96
Q

Nitrate/Nitrite example, MOA, use, side effects, contraindications

A

-Isosorbide dinitrate (nitrATE)
-MOA: vasodilates sm muscle, treats angina acutely/prophylactically
-SFX/Contras: (low BP) KA, anemia, hypotension, ED meds (“-fils”)

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97
Q

IR nitrate/nitrate tabs “rule of 3”

A

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

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98
Q

3 types of lipids

A

-LDL (“bad” cholesterol)
-HDL (“good”/recycling cholesterol)
-VLDL

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99
Q

Statins examples, MOA, considerations/contraindications/side effects

A

-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

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100
Q

Bile acid sequestrants (examples, MOA, side effects, considerations)

A

-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

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101
Q

Niacin (B3) MOA, considerations/side effects

A

MOA: increases lipase function (breaks down lipids), increases HDLs
SFX: redness/flushing (take NSAID beforehand), pruritus, hepatotoxicity

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102
Q

Fibric acid derivates examples, MOA, side effects

A

-gemifibrozil, fenofibrate
-MOA: lower triglycerides by activating lipase enzyme
-side effects: GI, gallstones, increased liver enzymes, enhances anticoagulants

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103
Q

Normal triglyceride lab values

A

<150 mg

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104
Q

Normal HDL/LDL lab values

A

HDL: >40 mg
LDL: <100 mg

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105
Q

Normal cholesterol lab values

A

<200mg

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106
Q

Sublingual nitrates expire how long after they are opened?

A

3 months

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107
Q

Enoxaparin (lovenox) and dalteparin MOA, side effects + considerations

A

-MOA: LMWH (factor X)
-Side effects: bleeding, anemia, bruising, nothing life threatening
-Check: HCT, HgB, platelets–bleeding

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108
Q

Heparin (MOA, use, side effects–considerations/antidote?)

A

-MOA: anti factors IIA, IX, and X –> anticoagulant
-side effects: HIT (heparin induced thrombosis), bleeding
-consider: check aPTT, protamine sulfate is antidote

109
Q

Rivaroxaban and apixaban (class/MOA, considerations, reversal agent)

A

-anticoagulant
-MOA: inhibits clotting factor Xa
-considerations: don’t stop abruptly, dose carefully, in
-reversal agent: andexanet alfa

110
Q

Warfarin MOA, use, side effects, considerations/antidote

A

-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
Q

Clopidogrel (use, MOA, side effects)

A

-MOA: ADP receptor blocker, anti platelet
-side effects: bleeding
interactions w/ Ca channel blockers, NSAIDs

112
Q

Thrombolytic drugs are the only anti-clotting drugs that do what?

A

Lyse clots that are already formed

113
Q

Thrombolytic drug examples, MOA, side effects

A

-alteplase
-reteplase
-streptokinase
-MOA: activates plasminogen
-Side Effs: ecchymoses, bleeding, toxicity

114
Q

NO-NOs w/ anti coagulants

A

Grapefruit juice, cranberry juice, ginko/ginger/st John’s wort, green tea (vit K)

115
Q

Don’t take what on heparin?

A

Potassium (salt-replacements in diet foods)

116
Q

Aspirin class, MOA

A

-class/MOA: antiplatelet (prevents clots, binds to COX-1 and COX-2)

117
Q

Anticoagulants have what effect on blood clots?

A

NO effect

118
Q

Short-acting bronchodilators (examples, MOA, side effects)

A

-albuterol, levalbuterol (rescue inhalers)
-MOA: binds to beta 2 receptors in lungs –> bronchodilation
-SFX: tachycardia, headache, tremor

119
Q

The ‘nursing consideration’ for almost all respiratory drugs

A

-make sure med is appropriate for symptoms (long vs short acting)
-make sure technique is appropriate if using inhaler
-respiratory assessment, maybe cardiac

120
Q

Long-acting bronchodilators (examples, MOA, side effects)

A

-salmeterol, formoterol, arformoterol
-MOA: binds to beta 2 receptors in lungs –> bronchodilation
-SFX: hypertension, headache

121
Q

Anticholinergic drugs (examples, MOA, side effects)

A

-ipratropiums, tiotropium, combivent
-MOA: Ach agonist –> bronchodilation
-SFX: dry mouth (reduces secretions), congestion, palpitations, GI distress

122
Q

Xanthine derivates (examples, MOA, side effects, considerations)

A

-theophylline, aminophylline
-MOA: stimulates cAMP production –> bronchodilation + respiratory drive
-SFX: nervousness, tremors, insomnia, GI distress
-Consider: AVOID other sources of caffeine!

123
Q

Corticosteroid examples, MOA, SFX/considerations,
+systemic?

A

-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
Q

You should always take _______ before taking _____ for asthma, if taking both. Why? What med has both of those meds?

A

-bronchodilators, corticosteroids
-Allows anti-inflamm steroids to reach more of airway
-Combo med: fluticasone/salmeterol

125
Q

Cough and cold products shouldn’t be given to children under ___ due to side effects like…

A

-2
-oversedation, tachy, seizure, death

126
Q

Sudafed class, MOA, considerations

A

adrenergic decongestant
-MOA: vasoconstriction
-SFX: CNS stim: jitters, insomnia, palpatations, tremor
-considerations: hypertension, abuse potential

127
Q

Opiod antitussives: example, MOA, side effects

A

-codeine (S5 drug), hydrocodone
-MOA: pain relief, dry secretions, dull cough reflex in medulla
-SFX: sedation, N/V, constipation, lightheaded

128
Q

Opioids are the ______ effective cough supressant

A

most

129
Q

Non-opiod antitussive examples and their MOAs, SFX

A

-Benzonatate: numbs stretch receptors in respiratory
-Robatussin: dries mucosa of res system (prevents post nasal drip)
SFX (both): drowsy, dizzy, nausea

130
Q

Expectorants example/use, MOA, side effects

A

-for productive coughs
-SFX: NV, drink fluids!

131
Q

Epinephrine class, MOA

A

-nonselective adrenergic med
-MOA: stimulates B1, B2 (cardiac and respiratory receptors) and alpha receptors –> relaxes sm muscle, increases HR

132
Q

Anticholinergic examples, MOA/use/route, side effects

A

-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
Q

Antihistamine examples, MOA, side effects

A

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
Q

Antidopaminergics examples, MOA, route/use, SFX

A

-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
Q

What is NMS, and what antiemetic class(/es) can cause it?

A

-Neuroleptic Malignant Syndrome: life threatening fever, altered mental status, rigidity, autonomic function loss
-Antidopaminergics, prokinetics

136
Q

What antidopaminergic can cause agranulocytosis (low neutrophil count)? What would that put the pt at risk for?

A

-Prochlorperazine
-Infection

137
Q

Prokinetic (metoclopramide) examples, MOA, route/use, SFX

A

-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
Q

Signs and symptoms of TD (tardive dyskinesia)

A

-stooped posture, forward tilted trunk
-rigidity
-flexed elbows/wrists
-reduce arm swinging
-trembling in extremities

139
Q

Serotonin blockers examples, MOA, route/use, SFX

A

-“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
Q

Describe serotonin syndrome and Torsades de Pointes–what classes of drugs can cause these?

A

-Serotonin syndrome: polypharmacy of serotonin blockers
-TDP: widening QT interval
-Serotonin blockers can cause these

141
Q

Vitamin B1 use

A

THIAMINE
-needed for carb metabolism
-deficiency –> wernicke’s encephalopathy (effects short term memory)

142
Q

Vitamin B2

A

RIBOFLAVIN
-necessary for RBC function
-deficiency caused by poor nutrition
-found in: dairy, flours, green leafy veg, nuts, meat…

143
Q

Vitamin B3

A

NIACIN
-coenzyme for metabolizing lipids
-deficiency caused by alcohol abuse, nutritional/absorption deficiency

144
Q

Vitamin B6

A

PYRIDOXINE
-necessary for amino acid/carb/lipid metabolism
-deficiency from poor nutrition, isoniazide–causes anemia, neurological issues

145
Q

Vit B9

A

FOLIC ACID
-necessary for fetal dev (spina bifida), RBCs

146
Q

Vit B12

A

-needed for RBC and DNA development
-helps brain and nerve cell development

147
Q

Vitamin C

A

ASCORBIC ACID
-collagen formation/tissue repair, antioxidant
-deficiency –> scurvy, and bleeding gums, gingivitis, wound healing
-no evidence for helping/preventing colds

148
Q

Vit D2/D3

A

-fat soluble
-helps w/ bones, teeth

149
Q

Vitamin A

A

Retinol
-growth of bones, teeth
-from beta-carotenes (green/yellow plants)

150
Q

Vitamin K

A

-clotting
-Given to newborns to prevent dangerous bleeding (into brain)

151
Q

Vitamin E

A

-antioxidant
-protects body from free radicals
-can be low in preemies–supplemented here

152
Q

What can you not take w/ Calcium?

A

Tetracycline (hypercalcemia)

153
Q

What can cause Mg deficiency?

A

-alcohol abuse
-don’t supplement w/ impaired kidneys

154
Q

1st line treatment of H pylori

A

-10-14 days of PPI, clarithromycin, amoxicillin, metronidazole OR
-PPI, bismuth, tetracycline, metronidazole

155
Q

Stress related mucosal damage is prevented with:

A

-histamine receptor blockers
-PPI

156
Q

Antacids are made up of…

A

Al, Ca, Mg, Na salts

157
Q

Antacid MOA, interactions

A

-neutralize acid
-stim mucus
-stim prostaglandins
-stim bicarb
interacts w/: quinolones, cipro, levofloxacin (certain antibiotics)
NO for kidney disesase

158
Q

H2 receptor antagonists (suffix, MOA, SFX)

A

-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
Q

PPI (suffix, use, MOA, considerations/SFX)

A

-“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
Q

Sucralfate MOA, use, consids

A

-ulcers
-binds to base of ulcers and forms protective barrier
-give hour before meals, not at same time as PPIs (2hrs before/after)

161
Q

Misoprostol MOA, use

A

-inhibits acid secretion, protects mucus
-prostaglandin analogue
-acid controlling drug
-NO w pregnancy

162
Q

Simethicone use

A

increase fartin n burpin, reduces gas pain

163
Q

Chronic diarrhea lasts for

A

2-4 weeks

164
Q

Adsorbants (ex, MOA, consids)

A

-bismuth, cholestyramine
-MOA: bind to toxic agent
-can affect drug absorption, darkening of tongue/stool, platelet aggregation

165
Q

Loperamide, diphenoxylate, codeine are _______ ________ opioid like drugs. How do they work?

A

-anti diarrheal
-MOA: sloowwww: decrease motility, reduce pain, increase transit time through bowel

166
Q

Docusate and mineral oil are ______ laxatives contraindicated with ________ ________. They work by bringing water and ____ into stool

A

-emollient laxatives
-intestinal obstruction
-fat

167
Q

Mg hydroxide, Mg citrate are ______ laxatives. They draw ______ into the ______ and are contraindicated for kidney failure.

A

-saline
-draw water into intestines

168
Q

Stimulant laxatives ex, MOA

A

-senna, bisacodyl
-MOA: increase peristalsis via intestinal nerve stimulation

169
Q

Most psych meds take (how long?) to work.

A

4-6

170
Q

xanax, ativan, valium, and buspirone are all benzodiazepines and anti-anxiety drugs. Which one is unique and why?

A

-buspirone: doesn’t have sedative side effects, reduce CNS activity

171
Q

If you’re giving someone lithium carbonate for ______, what labs would you check? What would you advise your patient?

A

-mania/BPD
-lithium (0.5-1.6) and Na labs
-don’t change fluid intake

172
Q

Signs of lithium toxicity include:

A

slurred speech, cardiac dysrhythmia, issues w/ movement and coordination

173
Q

What class of medications has a black box for suicidal ideation?

A

antidepressants

174
Q

MAOI examples, MOA, use, side effects/considerations

A

-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
Q

You can’t have what food/drink while on MAOIs?

A

-fermented/preserved foods with tyramine–cheese, wine, kimchi, pickles

176
Q

SSRIs examples and uses

A

-celexa, lexapro, paxil, prozac, zoloft
-use: anxiety, EDs, depression, PMDD

177
Q

SSRI MOA and side effects/considerations

A

-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
Q

1st gen antipsychotics examples, use, MOA, side effects

A

-pro/chlorpromazine, haldol
MOA: reduces dopamine in CNS, block Ach receptors
use: “calm pts down”, schizophrenia
SFX: anticholinergic (drying), EPS, NMS

179
Q

Anticholinergic effects include

A

drying: dry mouth, cough, constipation, sedation/drowsy/dizzy

180
Q

2nd gen antipyschotics–examples, use, MOA, side effects

A

-“one-pines”: quetiapine, risperidone, olanzapine
MOA: block D2 and serotonin re-uptake
use: MDD, BPD, schizophrenia
SFX: weight gain, agranularcytosis, sedation, EPS, NMS

181
Q

Haldol is a more _____-_____ medication as opposed to other 1st gen antipsychotics

A

long-term

182
Q

3rd gen antipsychotics: examples, MOA, side effects

A

-“azoles”: brexpiprazole (rexulti), aripiprazole (abilify)
-MOA: D2 and serotonin agonists
-SFX: akathisia (jitters), weight gain, suicide, NMS

183
Q

Kids over ___ can take lexapro, for _______ and ______.

A

12, anxiety, depression

184
Q

Children over age __ can take prozac for depression, OCD, and other off-label disorders (bulimia, social anxiety, PTSD)

A

10

185
Q

codeine and hydrocodone are _______ opiate _______. Name the “strong” versions of these drugs

A

-mild, agonists
strong opioid agonists:
-morphine
-oxycodone
-fentanyl
-methlydone
-hydromorphone

186
Q

Opioid agonists are sometimes combined with…

A

tylenol: i.e., percocet/vicodin

187
Q

Common symptoms of opioid agonists and antagonists include:

A

-constipation
-sedation, drowsy, dizzy
-hypotension
-respiratory depression

188
Q

What interacts with opioid agonists?

A

-sedatives (alcohol, other sedatives like barbiturates/antihistamines)

189
Q

Morphine is 7x ________ than hydromorphone (Dilaudid)

A

weaker

190
Q

Subutex, stadol, and nubain are ______ _________ -________. What are they used for?

A

mixed agonist-antagonists; used for opioid withdrawal/detox

191
Q

Subutex, stadol, and nubain are used for what? Why is it unique compared to some other similar meds?

A

-opioid withdrawal/detox
-provides no high/euphoria, just pain relief

192
Q

T/F: mixed/partial opioid agonists have no life threatening symptoms.

A

T

193
Q

Alcohol abuse can cause deficiency of what vitamin? What conditions can this deficiency lead to?

A

Thiamin, Wernicke’s encephalopathy and eventually Korsakoff’s psychosis

194
Q

Name the strong opioid agonists (hint: MOFHM)

A

-morphine
-oxycodone
-fentanyl
-methlydone
-hydromorphone

195
Q

Long acting benzodiazepines (hint: LAKV)

A

-klonopin
-valium

196
Q

Intermediate acting benzos (hint: XAR)

A

-xanax
-ativan
-restoril

197
Q

Short acting benzos

A

-versed

198
Q

Benzodiazepine, suffix, MOA side effects, interactions

A
  • “pams”
  • MOA: depress CNS (GABA-like)
  • SFX: ‘hangover effect’, fall risk–esp for older, drowsy/dizzy/vertigo
  • Interactions: grapefruit juice, azoles (antifungals), alcohol
199
Q

Barbituate suffix, MOA, use, side effects

A

-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
Q

_________ are habit forming, have a narrow therapeutic window, and carry the side affect of respiratory depression.

A

Barbituates

201
Q

Atomoxetine is a unique drug used to treat ADHD, in that it…

A

-is not a stimulant (carries less side effects than other ADHD meds)
-takes longer to work than stimulants

202
Q

Dexmethylphenidate, amphetamines, and dextroamphetamine are examples of CNS _________ used to treat ______. Side effects include what? What schedule are these drugs?

A

stimulants, ADHD
-insomnia, tachycardia, rhabdomylosis
-schedule II

203
Q

Muscle relaxants have “____” in their name and are CNS ______.

A

flex, depressants

204
Q

Symptoms of DM-I

A

3 p’s:
-polyuria (peeing)
-polydypsia (thirst)
-polyphagia (hunger)

205
Q

Aspart, lispro, and glulisme are _____-______ insulins. Name their onset, peak, and how long they last.

A

rapid-acting
5-15 minute onset
peak at 1-2 hours
last 3-5 hours

206
Q

Humulin-R is a ______ _______ medication–name the onset, peak, and duration

A

short-acting
-1/2 hour-1 hour onset
-peaks at 2.5 hours
-lasts 6-10 hours

207
Q

NPH is _______ acting insulin. Name onset, peak, and duration

A

intermediate acting
-1-2 hour onset
-peaks at 4-8 hours
-lasts for 10-18 hours

208
Q

Long acting insulin, like _______, has an onset of ___ hours, a peak of _____ hours, and it lasts ____ hours.

A

glargine
-1-2 hour onset
-has no peak
-lasts 24 hours

209
Q

Metformin decreases _______ ________ production, and carries a rare but serious side effect of…

A

-Metformin decreases hepatic glucose production
-lactic acidosis

210
Q

Sulfa “-ide” drugs for diabetes stimulate release of ________, carry what side effect, and what cross allergic affect?

A

-insulin release
-risk of hypoglycemia
-sulfa cross allergy potential

211
Q

“-glinides” are like sulfa diabetes drugs, but w/o what consideration?

A

-like sulfas: increase insulin release from pancreas, hypoglycemia risk
-NO cross allergy potential

212
Q

Acarbose and miglitol are _______-______ inhibitors that delay glucose absorption, and carry ___ side effects

A

Alpha-glucosidase inhibitors, GI side effects

213
Q

“flozins” are ______-______- transport inhibitors. Name considerations and side effects

A

-sodium-glucose
-Flozins –> kidney function, rifampin increases effects

214
Q

Flozin MOA

A

Inhibit glucose reabsorption in the proximal renal tubules

215
Q

The depo provera is a _______ shot dosed every ___ months

A

-progestin
-3mo

216
Q

Mirena lasts __ years, skyla lasts __ years, and paragard lasts up to __ years

A

mirena: 3 yrs
sklya: 5 yrs
paragard: 10 yrs

217
Q

Plan B side effects include…

A

nausea, lower
abdominal cramps, breast tenderness

218
Q

Mifepristone vs misoprostol

A

mife: anti-progesterone
miso: cervical ripening/labor induction–take 36-48 hours after mifepristone

219
Q

Instructions for missing a dose of an oral contraceptive

A

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
Q

Progesterone/estrogen BC are of reduce effectiveness when taken w/…

A

-rifampin/isoniazide
-antibiotics
-anticoagulants

221
Q

What do indomethacin, nifedipine, and Mg sulfate do (used when)? Side effects?

A

-stop preterm labor
-Indo: inhibits prostaglandins
-Nife: Ca channel blocker
-mg sulfate: sfx include hypotension, bradycardia, arrythmias

222
Q

Clomiphene use, MOA, SFX

A

-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
Q

Osteoporosis is much more common in _____

A

women–40% of women over 50 years of age will develop
osteoporotic fracture

224
Q

“-dronates” (alendronate and risedronate) inhibit ______________, preventing osteoporotic fractures. Name nursing considerations.

A

-osteoclast bone reabsorption.
-consids: irritates esophagus, take w/ 8oz water and DON’T lie down!

225
Q

Evista is used to treat X by Y. Name the side effects

A

-X: osteoporosis
-Y: stimming estrogen receptors–increases bone density
-SFX: hot flashes, leg cramps, VTE, luekopenia

226
Q

Calcitonin is a nasal spray used for what? Side effects?

A

-inhibits osteoclastic bone resorption
-SFX: facial flushing, rhinitis, hypocalcemia, malignant tumor

227
Q

“-sterides” (finasteride, dutasteride) are androgen _________. Side effects include…

A

-androgen inhibitors
-SFX: hair growth, reduced libido, hypotension, drowzy/dizzy
-use gloves to apply!!
-takes 6mo to work

228
Q

Alpha5-ad blockers (“-osins”) are used for relief from what?

A

BPH

229
Q

Tamsulosin (what type of drug) interacts with…

A

-“osin”: BPH symptom relief
-interacts w/ azoles, erythromycin and
clarithromycin

230
Q

“-fils” are used to treat __. MOA? Considerations?

A

-ED
-MOA: inhibit phosphodiesterase enzyme
-SFX: unexplained vision loss, sever hypotension when used w/ nitrates
-take 1hr before sex, only 1x day

231
Q

1st line of treatment for RA

A

can’t be cured, only treated
-NSAIDs
-non-biologic DMARDs

232
Q

Abacept, Humira, Etanercept are biologics used to treat RA. Name MOA, considerations, SFX

A

-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
Q

Abatacept considerations

A

-give w/ filter
-caution for patients w/ COPD, recurrent infections

234
Q

Methotrexate, used for ___, is dosed weekly. It should be taken with what type of supplement and has how long of an onset?

A

-folic acid supplement to reduce bone marrow suppression
-6-12 week onset

235
Q

MOA of immunosupressants

A

Suppress T-lymphocyte cells, preventing immune response

236
Q

Nursing considerations for Immunosupressants

A

-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
Q

Cellcept has a carries a black box warning for _______. use/MOA?

A

-pregnancy
-immunosupressant
-MOA: inhibit purine synthesis –> prevent T cell proliferation

238
Q

Tacrolimus use, MOA

A

-immunosupressant
-MOA: prevent T cell activation/proliferation

239
Q

Corticosteriods are used to treat adrenal _________, but not _________

A

-undersecretion (Addison’s)
-not oversecretion (Cushing’s)

240
Q

Corticosteroid considerations/SFX

A

-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
Q

Methylprednisolone is the only ______-_______ corticosteroid

A

long-acting

242
Q

Causes of anemia

A

-Maturation defects (iron/B12/folic acid deficiency, thalassemia)
-Hemolytic–RBC lysis (sickle cell, extrinsic factors)

243
Q

“-poetins” for anemia would be given in what types of anemia? What’s a big side effect?

A

chemo, renal disease–need functioning bone marrow and iron
SFX: uncontrolled hypertension

244
Q

“-stim” anemia drugs (fligrastim, pegfilgrastim) MOA, serious side effects

A

-MOA: neutrophil stimulators
-SFX: splenic rupture, hypersensitivity, bone pain

245
Q

Iron for iron-deficient anemia: SFX, considerations

A

-GI issues, abdominal cramps, iron toxicity
-can turn feces tarry, liquid iron supplements can stain teeth

246
Q

Folic acid is a _____-soluble vitamin essential for _______

A

-water
-erythropoiesis

247
Q

Iron ______ is not commonly used because of the risk for anaphylaxis?

A

-dextran

248
Q

Pegfilgrastim is a ________-_______ anemia drug, often given 1x after ______.

A

-long-acting
-chemo

249
Q

antacids, milk, and other food (should/shouldn’t) be taken at the same time as iron

A

Should NOT, decreases absorption

250
Q

Name where Alpha 1, alpha 2, beta 1, and beta 2 receptors are located

A

-alpha 1: sm muscle
-alpha 2: brain
-beta 1: heart
-beta 2: lungs

251
Q

When activated, a1/2 and b1 receptors cause _______. Beta 2 receptors cause _______.

A

-vasoconstriction
-bronchodilation

252
Q

Chronotropes affect heart _____, while inotropes affect…

A

-rate
-strength of heart muscle contraction

253
Q

Drugs that work ONLY on Alpha 1

A

-phenylephrine
-dopamine
-midodrine

254
Q

Drug that works on Alpha 1 and alpha 2 receptors (plus a little beta 1)

A

norepinephrine

255
Q

Epinephrine activates what receptors?

A

-Beta 1, beta 2, alpha 1

256
Q

dobutamine affects _____ __ receptors ONLY

A

Beta 1

257
Q

dopamine works only on _____ __ receptors

A

alpha 1

258
Q

Alpha-adrenergic drugs (EX) side effects

A

HYPERTENSION, chest pain, bradycardia, N/V, anorexia, palpitations

259
Q

Epinephrine SFX

A

-hypertension, tachycardia, hyperglycemia

260
Q

dobutamine and epinephrine can both cause…

A

tachycardia

261
Q

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 ________ ___________.

A

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
Q

Acetylcholine (Miochol-E) use, MOA

A

-produce miosis during eye surgery
-immediate onset, duration of 10 min

263
Q

CAIs for glaucoma/IOP before surgery

A

-“-zolamides”
-MOA: inhibit CAI –> reduces aqueous humor formation

264
Q

Prostaglandin agonists
Suffix, MOA/use, side effects

A

“-oprosts”
-MOA: increase outflow of aqueous fluid
-SFX/nursing considerations: burning, CAN CHANGE EYE COLOR PERMANENTLY! (light –> brown)

265
Q

Ocular anti-inflammatory NSAIDs and corticosteroids

A

NSAID: flurbiprofen, ketoralac
Corticosteroids: dexamethasone, prednisolone

266
Q

Tetracaine and proparacaine are _______ ________, and can’t be self-administered

A

Ophthalmic anesthetics

267
Q

When using eye drops, have the patient look at the ______ and place the drop (where?)

A

-ceiling
-conjuctival sac

268
Q

Considerations for giving eardrops

A

-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
Q

Bacitracin, neosporin, and Mupirocin are what kind of drug

A

topical antibacterials, Muprocin used for MRSA, staph, and strep

270
Q

Silver Sulfadiazine is used to prevent infection in what situation? What pts should not use this drug?

A

burns–no for those w/ sulfa allergies

Pharm N317 - UW Madison Fall 2023 (23 decks)

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