Pharm Final Flashcards
These drugs can cause histamine release
Atracurium, dilaudid and morphine
Giving reglan with this medication can cause dysrhythmias
Zofran
For who is reglan contraindicated?
Bowel obstruction
Parkinson’s
Seizure disorders
What can we give to reverse gastric cramping from reglan
An anticholinergic (glycopyrrolate)
Rapid administration of reglan can cause ____ while rapid admin of zofran can cause
Cramping
HA
This medication may cause out of body experiences
Droperidol
Thioamines take 1-2 weeks to take effect due to thyroid stores in the body. We can take these meds in the meantime to decrease symptoms
Beta blockers.
These block the hyper-adrenergic effects of hyperthyroidism.
Also, these block the peripheral conversion of T4 to T3.
We use this med in thyroid storm
Esmolol
How do corticosteroids work in treating hyperthyroidism?
1) Suppresses TSIs in Grave’s disease (remember steroids are immunosuppressants!). Also decreases inflammation.
2) Blocks the peripheral conversion of T4 to T3
We use prednisone or methylprednisolone
Drugs that can alter thyroid status
Amiodarone (resembles thyroid hormone and contains iodine– can cause hypo or hyperthyroidism)
Lithium (body can mistake it for iodine–> hypothyroidism)
Reglan (can increase TSH production and release)
Why choose methimazole over PTU?
More potent than PTU, longer half-life allows for QD dosing (PTU is TID), and has fewer SE than PTU
How does lugol’s solution treat hyperthyroidism?
1) Blocks peripheral T4 to T3 conversion
2) Decreases the vascularity of the thyroid
3) Temporary block of T4 release (the thyroid is so busy taking up iodine that it doesn’t have time to focus on releasing hormone. This effect is only temporary!!!)
This is a short-term solution to decrease thyroid activity before thyroid surgery
IV T3 is called ____ and can be given emergently for _____
Cytomel
Myxedema coma
How are sulfonylureas metabolized?
Via the liver! They are 99% protein-bound, so the liver is gonna have to deal with those before they can be excreted via the kidneys. Avoid in ESLD.
These sulfonylureas should be used if the pt has renal disease
Glipizide or Tolbutamine (because these will be completely metabolized to inactive or weakly active products)
sulfonylureas should be avoided in these patients
ESLD and those with sulfa allergies
How do sulfonylureas work?
1) block the ATP sensitive K+ pump
2) Increases sensitivity of the tissues to insulin
How to biguinides like Metformin work?
1) Shifts into anaerobic metabolism, decreasing glucose production in the liver and kidneys (less gluconeogenesis and glycogenolysis)*******
Also:
a) Enhances insulin binding (decreases insulin resistance)
b) Increases glucose utilization
Who are biguanides contraindicated in
ESRD, ESLD, CHF, pulm disease, shock
All related to buildup of anaerobic metabolites
These two oral hypoglycemic meds require insulin to work
Biguanides (like metformin)
Thiazolidinediones (TZDs like Pioglitazone)
These antiepileptics are CP450 inducers
Phenytoin
Barbiturates (phenobarb)
Carbamazepime (tegretol)
These antiepileptics are CP450 inhibitors
Valproic acid
Felbamate
Many anti-epileptics are associated with these life-threatening complications
Hepatotoxicity
Bone marrow suppression
We want to test for LFTs and get a CBC
These are the major considerations with phenytoin (Dilantin)
1) Infuse no faster than 50mg/min!! Could cause cardiac collapse
2) Enzyme inducer
3) CNS toxicity (nystagmus, double vision, vertigo, peripheral neuropathies)
4) Stevens Johnson Syndrome
5) Precipitates in solutions with a pH<7.8
What is fosphenytoin?
Pro-drug of phenytoin
Reasons nitrates are good for the heart
1) Preferentially dilate collateral vessels service ischemic areas
2) Decrease preload
3) SLIGHT decrease of afterload
4) Attenuates coronary vasospasm
5) Increases rate of relaxation during diastole**
Why aren’t nitrates used for chronic BP control?
Because people develop tolerance to them
How do we prevent tolerance with nitrates?
Tell people to remove their patches at night
What would we use to treat the profound hypotension caused by taking nitrates with a PDE?
Phenylephrine
Main SE of nitrates
HA
Orthostatin hypotension/fainting
These medications have been shown to reduce M&M in patients with CHF
Aldosterone antagonists
ACE Inhibitors
ARBs
BBs
These medications have NOT been shown to reduce M&M in patients with CHF
Thiazide or loop diuretics (symptom relief only)
Digoxin (again-symptom relief only–> may worsen long-term outcomes)
Do we hold ACEIs and ARBs before surgery?
Yes, or else the patient will be too dry
A patient with CHF should be on these 3 meds
Spironolactone, BB, and ACEI
All ACEIs have this suffix
pril
As in “captopril”
ARBS have this suffix
artan
Ex- Losartan or Valsartan
Weuse this med for BP control in pregnancy
Methyldopa
How do CCBs help fight HTN?
1) Reducing heart rate and contractility
2) Reducing SVR (arteriodilation)
