pharm medication exam 3

Question 1

fentanyl (common opioid analgesics) (opioid agonist)

Answer 1

MOA: bind to the opioid receptors in the CNS and alter perception of pain, producing CNS depression
indication: treat breakthrough pain
SE: sedation, confusion, drowsiness, dizziness, nausea and vomiting, urinary retention, pupillary constriction, and respiratory depression
NI/CE: caution with liver and renal impairment
CI: assess for adverse effects
(given IV)

Question 2

morphine (common opioid analgesics)

Answer 2

MOA:The stimulatory effects of opioids are the result of ‘disinhibition’ as the release of inhibitory neurotransmitters such as GABA and acetylcholine is blocked.
indication:treatment of persistent, severe pain that requires an extended treatment period with a daily opioid and for which alternative treatments are inadequate.
SE: central nervous system depression, nausea, vomiting, and urinary retention.
NI/CE: monitor blood pressure, Morphine can cause shallow breathing, difficulty or noisy breathing, confusion, more than usual sleepiness,
CI:heart failure secondary to chronic lung disease; cardiac arrhythmias; increased intracranial or cerebrospinal pressure; head injuries; brain tumor; acute alcoholism; and delirium tremens

Question 3

oxycodone (common opioid analgesics)

Answer 3

MOA: differential susceptibility of the opioid receptor to desensitization or activation of more than one G-protein system or subunit (one excitatory and one inhibitory) by an opioid receptor.Clinically, stimulation of µ-receptors
indication:For the treatment of severe pain where treatment with an opioid is appropriate and for which alternative treatments are inadequate.
SE:asthenia, constipation, dizziness, dry mouth, headache, nausea, pruritus, somnolence, sweating, and vomiting.
NI/CE: Their blood pressure, heart rate, and respiratory rate should also be monitored, especially for the first 24 to 72 hours after initiating therapy or increasing dosage.
CI:hepatic and renal impairment

Question 4

tylenol with codeine (common opioid analgesics)

Answer 4

MOA: ithin the CNS to increase the pain threshold by inhibiting central cyclooxygenase, an enzyme involved in prostaglandin (PG) synthesis.
indication:For the treatment of mild pain to moderate pain where treatment with an opioid is appropriate and for which alternative treatments are inadequate. Oral dosage (tablets containing acetaminophen 300 mg and codeine 15 to 60 mg) Adults
SE: unusual dizziness, lightheadedness, extreme sleepiness, slowed or difficult breathing, or unresponsiveness.
NI/CE: Routinely monitor serum acetaminophen levels for patients receiving frequent or large doses of any form of acetaminophen to avoid toxicity.
CI:Significant respiratory depression

Question 5

naxolone

Answer 5

MOA: Reverses opioid agonist, and analgesic and CNS depression caused by opioid agonist
indication: reverses adverse effects of narcotics; diagnoses suspected acute narcotic overdose
SE: agitation, tremors, drowsy, sweating, hypertension, decreased respirations
NI/CE: to make sure breathing does not slow or stop, every 2 hours monitored
CI: known allergy

Question 6

acetaminophen

Answer 6

MOA: inhibits prostaglandins
indication: used to treat pain and fever, relief of musculoskeletal pain associated with arthritis
SE: rash, hemolytic anemia, liver damage
usually associated with chronic use and overdose
NI/CE: regular monitor liver, not exceed 3,000 mg in 24 hours (geriatric), not exceed 2,000 mg in 24 hours (alcoholics)
CI: known allergy, hepatic dysfunction or chronic alcoholism

Question 7

non-steroidal anti-inflammatories (NSAIDS)

Answer 7

MOA: Inhibits prostaglandin synthesis, block two enzymes
(COX-1 and COX-2)
indication: antipyretic, anti-inflammatory and analgesic effects
SE: nausea, dyspepsia, GI bleed, renal failure, platelet inhibition, allergy alert: hives, facial swelling, skin redness, rash, increase risk for heart attack and stroke with long-term use
NI/CE: administer with food, monitor kidneys
CI: allergy to any NSAID or salicylate, CV dysfunction or hypertension, peptic ulcer, GI bleeding, coronary artery bypass graft, renal and hepatic dysfunction

Question 8

aspirin (non-steroidal anti-inflammatories (NSAIDS))

Answer 8

MOA: inhibits production of prostaglandins and decreases platelet aggregation
indication: treats mild pain (analgesic) and fever (antipyretic) and reduces risk of heart attack and stoke
SE: effects on stomach, GI bleed, tinnitus, shock, hives, facial swelling
NI/CE: monitor bleeding, drink adequate fluids while taking aspirin, advise patient to avoid alcohol when prescribed high doses of aspirin
CI: known allergy, bleeding abnormalities, impaired renal function, bleeding disorder

Question 9

ibuprofen (non-steroidal anti-inflammatories (NSAIDS))

Answer 9

MOA: Ibuprofen competitively inhibits both COX-1 and COX-2 by blocking arachidonate binding resulting in analgesic, antipyretic, and anti-inflammatory pharmacologic effects.
indication:For the treatment of rheumatoid arthritis (RA) and juvenile rheumatoid arthritis (JRA)/juvenile idiopathic arthritis (JIA). Oral dosage (tablets or suspension) Adults
SE: stomach pain, heartburn, vomit that is bloody or looks like coffee grounds, blood in the stool, or black and tarry stools
NI/CE:Assess patients for pain relief effectiveness by monitoring for any signs of adverse effects or toxicity related to acetaminophen.
CI: known hypersensitivity or idiosyncratic reaction to ibuprofen

Question 10

ketorolac (non-steroidal anti-inflammatories (NSAIDS))

Answer 10

MOA: Inhibit prostaglandin v synthesis and platelet function
indication: moderately severe pain, usually after a procedure or surgery
SE: same as NSAIDS but also: increased risk for serious CV events or stroke, renal risk
NI/CE: monitor signs of kidney toxicity, including blood or pus in urine, increased urinary frequency, decreased urine output, weight gain from fluid retention, and fatigue
CI: renal disease or renal failure
(given IV or IM)

Question 11

celecoxib (non-steroidal anti-inflammatories (NSAIDS))

Answer 11

MOA: Inhibits the enzyme COX- 2 within the prostaglandins
indication: osteoarthritis, rheumatoid arthritis
SE: dyspepsia, diarrhea, abdominal pain, nausea, vomiting
NI/CE: assess range of motion, degree of swelling, and pain in affected joints before and periodically during therapy
CI: ischemic heart disease, cerebrovascular disease, peripheral artery disease, mild to severe heart failure, active gastrointestinal ulceration or bleeding or IBS

Question 12

baclofen

Answer 12

MOA: Baclofen inhibits both monosynaptic and polysynaptic reflexes at the spinal level, possibly by decreasing excitatory neurotransmitter release from primary afferent terminals, although actions at supraspinal sites may also occur and contribute to its clinical effect
indication: For the treatment of spasticity, muscle spasm (not due to rheumatic conditions), myoclonus, and muscle rigidity in multiple sclerosis and spinal cord injury or other spinal cord diseases.
SE: dizziness, drowsiness, vision problems, or clumsiness or unsteadiness in some people. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are not alert, well-coordinated, and able to see well.
NI/CE: e alert for new seizures or increased seizure activity, especially during intrathecal (spinal) administration. …
Assess patient’s spasticity, ROM, functional ability, and posture (e.g., head control and trunk stability), especially when beginning baclofen treatment or during dose adjustments.
CI: hepatic and renal impairment

Question 13

cyclobenzaprine

Answer 13

MOA:ince cyclobenzaprine is so closely similar to amitriptyline in chemical structure, some of its effects are similar to the tricyclic antidepressants, including anticholinergic activity, potentiation of norepinephrine, and antagonism of reserpine
indication:For the treatment of muscle spasm associated with acute, painful musculoskeletal conditions as an adjunct to rest and physical therapy. Oral dosage (immediate-release) Adults
SE:lurred vision or to become drowsy, dizzy, or less alert than they are normally.
NI/CE: focus on the client’s assessment, monitoring for side effects, and pain and discomfort from spasticity.
CI: hepatic and renal impairments

Question 14

tizanidine

Answer 14

MOA:izanidine is a central-acting alpha2-adrenergic agonist which acts at presynaptic receptors. It is structurally and pharmacologically related to clonidine, but has only 2—10% of clonidine’s antihypertensive potency.
indication:For the treatment of spasticity.
NOTE: Because of its short duration, reserve tizanidine for activities and times when spasticity control is most important. Use tizanidine with caution when spasticity is beneficial to obtain increased function or to sustain posture and balance during movement.
Oral dosage Adults
SE: dry mouth, tiredness, and low energy. Dizziness and low blood pressure are also possible. Rare but serious tizanidine side effects include liver damage and hallucinations.
NI/CE: can affect your alertness or coordination. Do not drive or do other activities that require alertness or coordination until you know how tizanidine affects you. People who are ages 65 years and older can be at greater risk for some side effects from tizanidine.
CI: hepatic and renal impairment, hemodialysis

Question 15

allopurinol

Answer 15

MOA: which increase the urinary excretion of uric acid, allopurinol interferes with the catabolism of purines. It reduces the production of uric acid by inhibiting the biochemical reactions immediately preceding uric acid formation
indication: For the treatment of primary or secondary gout (i.e., acute attacks, tophi, gouty arthritis or joint destruction, uric acid lithiasis, and/or uric acid nephropathy). Oral dosage Adults
SE:nausea, diarrhea, and drowsiness. Allopurinol can also temporarily cause gout flares in the months after you first start taking
NI/CE: onitor intake and output ratios frequently; this drug is excreted in the urine and decreased kidney function can cause drug accumulation and toxic effects. …
Continuously assess the patient for rash or more severe hypersensitivity reactions. …
Monitor continuously for joint pain and swelling.
CI: Avoid red meat, kidneys, liver, or seafood.
sugary drinks and snacks.
fatty foods.
alcohol.

Question 16

lidocaine (local anesthetic)

Answer 16

MOA: temporary interruption in the conduction of nerve impulses
indication: for local anesthesia, infiltrative anesthesia, peripheral nerve block and spinal anesthesia
SE: Light-headedness, anxiety, blurred vision, bradycardia, nausea, respiratory depression, skin erythema (skin), with epidural: backache, urinary retention, malignant hyperthermia (MH)
NI/CE: check BP and cardiac monitor prior to administration of lidocaine
CI: known allergy

Question 17

nitrous oxide (inhaled anesthesia)

Answer 17

MOA: gas enters the bronchi and alveoli, rapidly
passes into the capillary system and depresses CNS
to produce anesthesia and analgesia
indication: inhaled anesthesia
SE: delirium, anxiety, CV depression, respiratory depression, apnea, hiccups, middle ear pain
NI/CE: monitor all vital signs
CI: pneumothorax, small bowel obstruction, middle ear surgery, and retinal surgeries involving the creation of an intraocular gas bubble

Question 18

propofol (IV Non-Barbiturates)

Answer 18

MOA: rapid acting sedative-hypnotic
indication: used for induction and maintenance
of anesthesia and sedation
SE: hypotension, bradycardia and respiratory
depression
NI/CE: monitored without interruption to assess level of consciousness and identify early signs of hypotension, bradycardia, apnea, airway obstruction and/or oxygen desaturation
CI: allergy to eggs, respiratory depression

Question 19

methohexital (IV Barbiturates)

Answer 19

MOA: increase the inhibitory effects of gamma-aminobutyric acid (GABA) on neurons in the brain
indication: used an adjunct to induce
anesthesia and a hypnotic state
SE: CNS depression, CV depression, respiratory depression
NI/CE: do not drive for at least 8 to 12 hours after you are treated with this medicine, stand up to fast
CI: respiratory depression and apnea, CNS- depressive

Question 20

midazolam (Benzodiazepine)

Answer 20

MOA: binding to the gamma-aminobutyric acid (GABA) receptor and increasing the frequency of chloride ionophore opening
indication: amnesiac and sedation
SE: hiccoughs, cough, nausea, and vomiting, thrombophlebitis, thrombosis, and pain on injection
NI/CE: monitoring mood changes, uncontrollable movements, vision changes and heartbeat
CI: respiratory depression

Question 21

flumazenil (reversal agent for midazolam)

Answer 21

MOA: Flumazenil antagonizes the actions of benzodiazepines on the central nervous system. Flumazenil has a high affinity for the GABA/benzodiazepine-receptor complex, the specific binding site of benzodiazepines. Flumazenil competes with benzodiazepines at this receptor for binding
indication:For sedation reversal when sedation is secondary to benzodiazepine therapy. Intravenous dosage Adults
SE:ain or irritation where the medicine was injected,agitation or tremors (shaking), flushing (warmth, redness, or tingly feeling under your skin), dizziness,sweating or shivering
NI/CE: signs of resedation or recurrent respiratory depression.
CI: patients must be carefully observed for signs of resedation and respiratory depression for at least 2 hours.

Question 22

succinylcholine (Muscle relaxant)

Answer 22

MOA: binds with acetylcholine receptors causing
stimulation of muscles and muscle contractions
indication: adjunct to general anesthesia, to
facility endotracheal intubation, to induce skeletal
muscle relaxation during surgery or mechanical
ventilation
SE: muscle pain related to the contraception of the muscles, flaccid paralysis, respiratory depression, apnea, malignant hyperthermia
NI/CE: continuous cardiac monitoring in conjunction with end-tidal carbon dioxide and pulse oximetry monitoring
CI: decreased plasma cholinesterase activity, recent burns or trauma within 24 to 72 hours, and muscle myopathies

Question 23

diphenhydramine (1st gen)

Answer 23

MOA: competitively blocks the effects pf histamine at histamine-1 receptors sites, has atropine-like-antipuritic sedative effects
indication: urticaria, nighttime sleep aid sleep, allergic rhinitis, allergic conjunctivitis, and angioedema
SE: sedating, drowsy, anticholinergic effects (dry),
in children may cause paradoxical effects (excitation)
NI/CE: monitor blood count
CI: large doses can cause mild CNS depression,
avoid with alcohol

Question 24

cetirizine (2nd gen)

Answer 24

MOA:
indication: allergic rhinitis, allergic conjunctivitis, and
uncomplicated urticaria
SE: non-sedating, anticholinergic effects
NI/CE:
CI: large doses can cause mild CNS depression

Question 25

pseudoephedrine

Answer 25

MOA: Shrink the nasal mucous membrane by stimulating the alpha-adrenergic receptors in the nasal mucous membranes indication: Decrease nasal congestion related to the common cold, sinusitis, and allergic rhinitis SE: Rebound congestion, Hypertension, Sympathetic effects NI/CE: CI:

Question 26

dextromethorphan

Answer 26

MOA: This antihistamine-antitussive combination acts synergistically for the temporary relief of cough, rhinorrhea, and sneezing associated with the common cold. indication: For the relief of cough, rhinorrhea, and sneezing due to the common cold. Oral dosage (tablets containing chlorpheniramine 4 mg and dextromethorphan 30 mg [e.g., Coricidin HBP Cough and Cold] OR tablets containing chlorpheniramine 4 mg and dextromethorphan 20 mg [e.g. Maxichlor DM]) Adults, Adolescents, and Children 12 years and older SE:dizziness,lightheadedness.drowsiness.nervousness.restlessness.nausea. vomiting.stomach pain. NI/CE: Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, assess cough CI: Caution patient to avoid taking more than the recommended dose or taking alcohol or other CNS depressants concurrently with this medication

Question 27

guaifenesin

Answer 27

MOA: Reduce viscosity of cough secretions making it easier for patient to cough them up indication: Productive cough and to loosen mucus within respiratory tract SE: Drowsiness, GI symptoms, Prolonged use may result in masking a serious underlying disorder NI/CE: No eating/drinking for 30 minutes, encourage coughing and deep breathing, stay hydrated CI:

Question 28

fluticasone nasal spray

Answer 28

MOA: antiinflmatory action indication: Seasonal allergic rhinitis SE: Local burning, irritation, stinging, dryness of the mucosa, and headache NI/CE: CI:

Question 29

albuterol (short acting beta-2 agonist)

Answer 29

MOA: reacts as an agonist at beta-receptor sites in the sympathetic nervous system to cause bronchodilation via smooth muscle relaxation indication: asthma, exercise induced asthma SE: fear, anxiety, restlessness, headache, sore throat, dizziness, nausea, palpitation, tachycardia NI/CE: monitor respiratory rate, oxygen saturation, and lungs sounds before and after administration CI: hypersensitivy

Question 30

ipratropium (short acting anticholinerg ics)

Answer 30

MOA: anticholinergic that blocks vagally mediated reflexes by antagoniizing the action of acetychloine indication: maintenance treatment of bronchospasm associated with COPD, seasonal allergies SE: nervousness, dizzy, headache, nausea, GI distress, cough, palpations NI/CE: CI:

Question 31

montelukast

Answer 31

MOA: Block leukotriene receptors and decrease inflammation indication: Long-term preventative treatment of asthma in adults and in patients younger than 12 years of age SE: Headache, cough, nasal congestion, nausea NI/CE: Take daily, Not a rescue medicine, Takes 7 days to begin to work CI:

Question 32

theophylline

Answer 32

MOA: Relaxes bronchial smooth muscles indication: For symptomatic relief or prevention of asthma or COPD that is unresponsive to beta agonist or inhaled corticosteroids SE: Related to theophylline levels in the blood, GI upset, nausea, irritability, and tachycardia to seizure, brain damage, and even death, Theophylline therapeutic range 10-20 mcg/mL Note: At the higher the therapeutic range there are more side NI/CE: Patients need serum blood levels tested every 6-12 months CI: Avoid caffeine

Question 33

salmeterol (long-acting beta-2 agonist)

Answer 33

MOA: Fluticasone is an antiinflammatory corticosteroid; salmeterol is a long-acting, selective beta-agonist; when used together, the combination is more effective than either drug alone. indication:For asthma maintenance treatment. Respiratory (Inhalation) dosage (inhalation aerosol; e.g., Advair HFA) Adults SE:urticaria, rash, angioedema, bronchospasm, headache, tremor, or anaphylaxis NI/CE: monitor respiratory rate, oxygen saturation, and lung sounds before and after administration. CI:Advise patient not to exceed the recommended dose or frequency of inhalations.

Question 34

tiotropium (long acting anticholinerg ics)

Answer 34

MOA: he action of acetylcholine by blocking muscarinic cholinergic receptors. The parasympathetic nervous system has an important role in the automatic control of the airways and is responsible for resting bronchomotor tone. indication:For asthma maintenance treatment. SE:pharyngitis, bronchitis, sinusitis, dry mouth, cough, and headaches. NI/CE: Monitor signs of paradoxical bronchospasm (wheezing, cough, dyspnea, tightness in chest and throat), especially at higher or excessive doses. CI:Check with your doctor right away if you develop a skin rash, itching, trouble breathing, or large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs after using this medicine.

Question 35

fluticasone inhaler (inhaled corticosteroids, ICS)

Answer 35

MOA: Decrease the inflammatory response in the airway indication: Prevention and treatment of asthma SE: Oral thursh (fungus), Sore throat, Hoarseness, Dry mouth NI/CE: CI: Not used for emergency during an acute attack or status asthmaticus

Question 36

prednisone (oral steroids (corticosteroids))

Answer 36

MOA: binds to cytoplasmic receptors and inhibits DNA synthesis indication: multiple inflammatory disorders (asthma, rheumatoid arthritis, lupus, inflammatory bowel disease) SE: fluid retention and hypertension, mood swings and euphoria, hyperglycemia, weight gain, suppress immune system NI/CE: longer than 10 days needs taper, CI: hypersensitivity

Question 37

epinephrine (nonselective adrenergic agonist drug)

Answer 37

MOA: induces increased vascular smooth muscle contraction, pupillary dilator muscle contraction, and intestinal sphincter muscle contraction indication: anaphylactic shock, cardiac stimulant SE: stroke, MI, apnea, oliguria NI/CE: monitored for heart rate, cardiac rhythm, and blood pressure frequently if an IV drip is to be infused CI: hypersensitivity to sympathomimetic drugs, closed-angle glaucoma, anesthesia with halothane

Question 38

quinidine (class I: sodium channel blocker)

Answer 38

MOA: Slow conduction by decreasing sodium into the cardiac cells indication: life threatening ventricular tachycardia, or to treat atrial fibrillation that did not respond to other drugs SE: abnormal ECG, dizziness, nausea NI/CE:avoid grapefruit juice, maintain consistent sodium intake CI: hypersensitivity

Question 39

sotalol (class II: beta blockers)

Answer 39

MOA: non-selective b-blocker that decrease cardiac conduction indication: treatment of life-threatening arrhythmias such ventricular tachycardia or atrial fibrillation SE: chest pain, palpitation, hypotension, bradycardia, dizziness, bronchospasm, hypoglycemia NI/CE: monitor blood pressure and ECG CI: diabetes, asthma, sinus bradycardia

Question 40

amiodarone (class III: potassium channel blocker)

Answer 40

MOA: block potassium channels and slow the outward movement of potassium to control heart rhythm indication: emergency treatment of ventricular tachycardia SE: fatigue, heart failure, dizziness, cardiac arrest and arrhythmias, hepatotoxicity NI/CE: CI:

Question 41

nitrate (antianginal)

Answer 41

MOA:onverting to nitric oxide (NO) in the body, which then relaxes blood vessels: indication:angina pectoris, acute coronary syndrome, arterial hypertension, and heart failure. SE:headaches, dizziness or light-headedness, flushing or a warm feeling in the face. NI/CE: Monitor the vital signs of the patient.With IV nitroglycerin therapy, monitor the pulse and blood pressure every 5 to 15 minutes. Make the necessary dosage adjustments accordingly. Observe for adverse drug reactions. Monitor the effectiveness of the drug. CI:Sit/lie down before taking your fast-acting form of nitrates, because they can lower your blood pressure, which can result in dizziness or fainting.

Question 42

diltiazem (class IV: calcium channel blocker)

Answer 42

MOA: Block the movement of calcium ions across the cell membrane to decrease firing rate and slow conduction through AV node indication: Supra ventricular tachycardia or Atrial fibrillation, Hypertension SE: Peripheral edema, bradycardia, hypotension, dizziness NI/CE: CI: grapefruit juice

Question 43

adenosine (IV)

Answer 43

MOA: Used to convert supraventricular tachycardia (SVT) to sinus rhythm when vagal maneuver have been ineffective indication: as a pharmacologic stress agent for myocardial perfusion scintigraphy in patients unable to undergo adequate exercise stress. SE:flushing, chest discomfort, dyspnea, facial flushing, headache, throat/neck/jaw discomfort, gastrointestinal discomfort, and lightheadedness/dizziness NI/CE: Monitor blood pressure and apical pulse prior to administration. Cardiac monitor should be used on patients receiving adenosine IV boluses. Flush IV port with flush solution (e.g., normal saline) immediately after IV bolus. Use only clear solutions; discard unused medication. CI:

Question 44

digoxin (V)

Answer 44

MOA: Inhibits sodium and potassium, slowing conduction and heart rate with atrial fibrillation and improving contractility indication: Heart failure and atrial fibrillation SE: Digoxin toxicity (nausea, vomiting, arrythmia, visual changes), bradycardia, headache, dizziness, confusion NI/CE: Assess apical heart rate (hold with pulse <60), Serum digoxin and potassium (hypokalemia bad), Signs of digoxin toxicity CI:

Question 45

furosemide (loop diuretic)

Answer 45

MOA: Loop diuretic that inhibits absorption of sodium and chloride, causing fluid loss, along with sodium and potassium loss. Very potent indication: edema and hypertension SE: dehydration, hypotension, electrolyte imbalance (hypokalemia) NI/CE: give slowly (risk of ototoxicity), monitor blood pressure, monitor potassium, assess for dehydration CI:

Question 46

hydrochlorothiazide (thiazide diuretic)

Answer 46

MOA: Works near distal tubule to promotion excretion of sodium and water. Not effective for immediate diuresis indication: edema and hypertension SE: dehydration, hypotension NI/CE: education to take daily CI:

Question 47

spironolactone (potassium sparing diuretics)

Answer 47

MOA: Binds to aldosterone reception in distal convoluted renal tubule. Causes increased amounts of sodium and water to be excreted, while potassium is retained indication: Hypertension, acne SE: hyperkalemia, dehydration, hypotension NI/CE: monitor potassium, education to take daily, avoid potassium rich diet CI:

Question 48

clonidine (alpha-2 agonist)

Answer 48

MOA: reduces sympathetic outflow from CNS and decreases peripheral resistance indication: hypertension and ADHD SE: hypotension, bradycardia, sedation, rebound hypertension if stopped abruptly NI/CE: orthostatic blood pressure changes CI: avoid alcohol

Question 49

metoprolol (beta blocker) (beta-1 antagonist)

Answer 49

MOA: Selectively block beta-1 receptors in the SNS indication: high blood pressure, angina, abnormal heart rate SE: bradycardia, hypotension, drowsiness, stroke NI/CE: monitor BP, ECG, and pulse frequently during dose adjustment and periodically during therapy CI: Sinus bradycardia, heart block, cardiogenic shock, CHF, and hypotension, COPD, diabetes, thyroid disease

Question 50

captopril (ACE inhibitors)

Answer 50

MOA: Blocks ACE from converting angiotensin I to angiotensin II, leading to a decrease in blood pressure, a decrease in aldosterone production, and a small increase in serum potassium levels along with sodium and fluid lo indication: Treatment of hypertension, congestive heart failure (CHF), diabetic nephropathy, left ventricular dysfunction following an SE: Cough, hypotension and renal insufficiency,Life threatening: Angioedema NI/CE: CI:

Question 51

losartan (ARBs) Angiotensin II Receptor Blockers

Answer 51

MOA: Selectively bind with the angiotensin II receptors in vascular smooth muscle and in the adrenal cortex to block vasoconstriction and the release of aldosterone indication: Hypertension and diabetic nephropathy SE: Hypotension, Headache, dizziness, syncope, weakness NI/CE: CI:

Question 52

atorvastatin (class: statin)

Answer 52

MOA: Inhibits HMG-CoA, decreases serum cholesterol levels, LDLs, and triglycerides, increases HDL levels indication: Adjunct to diet in the treatment of elevated cholesterol, lower LDL and triglycerides, increase HDL SE: Muscle symptoms (myalgias to rhabdomyolysis) * Increase liver enzymes and liver injury * Nausea, vomiting, indigestion NI/CE: assess liver CI: liver disease

Question 53

heparin (anticoagulants) reversal agent: Protamine sulfate

Answer 53

MOA: Inhibits activated coagulation factors involved in clotting process (it will not break existing clot) indication: deep venous thromboembolism (DVT), or pulmonary embolism SE: Bleeding * Cerebral hemorrhage * Heparin-Induced Thrombocytopenia (HIT) or Heparin- Induced Thrombocytopenia and Thrombosis (HITT) NI/CE: Given IV or Injection (subq) * Monitor prothrombin time (PTT) CI: Heparin-Induced Thrombocytopenia (HIT) or Heparin-Induced Thrombocytopenia and Thrombosis (HITT), Avoid: Aspirin or Ibuprofen

Question 54

enoxaparin (anticoagulants)

Answer 54

MOA: inhibits thrombus and clot formation, with higher ratio of anti-Factor Xa to anti- Factor IIa activity than heparin indication: Prevention of blood clots and emboli formation after surgeries or during bedrest SE: bleeding, HIT NI/CE: CI: Caution: kidney disease * Avoid: Aspirin or Ibuprofen

Question 55

warfarin (anticoagulant) reversal agent: vitamin K

Answer 55

MOA: Inhibits synthesis of vitamin K- dependent clotting factor indication: prevention of DVT and PE, prevention of atrial fibrillation and cardiac valve replacement SE: NI/CE: Monitor prothrombin time (PTT) and international normalized ratio (INR). INR range: 2-3.5 CI: no alochol, risk for bleeding

Question 56

aspirin (anti-platelet)

Answer 56

MOA: inhibits production of prostaglandins and decreases platelet aggregation indication: treats mild pain (analgesic) and fever (antipyretic) and reduces risk of heart attack and stoke SE: effects on stomach, GI bleed, tinnitus, shock, hives, facial swelling NI/CE: monitor bleeding, drink adequate fluids while taking aspirin, advise patient to avoid alcohol when prescribed high doses of aspirin CI: known allergy, bleeding abnormalities, impaired renal function, bleeding disorder

Question 57

finasteride

Answer 57

MOA:DHT is the primary androgen that stimulates the development of prostate tissue. When used for the treatment of benign prostatic hyperplasia, as the enzymatic conversion from testosterone to DHT is inhibited, a desirable reduction in prostate hypertrophy is achieved, and urine flow should be improved indication: For the treatment of benign prostatic hyperplasia (BPH). Oral dosage (e.g., Proscar and generic equivalents) Adults SE: inability to have or maintain an erection.decreased sexual desire. problems with ejaculation (including decreased volume of ejaculate) pain in the testicles.depression. NI/CE: decreased libido, erectile dysfunction, ejaculation disorders, and reductions in sperm count CI:Men should report any changes in their breast tissue such as lumps, pain, tenderness, enlargement, or nipple discharge.

Question 58

tamsulosin (alpha-1 antagonist)

Answer 58

MOA: block alpha 1- receptor in the prostate, this causes relaxation of bladder and prostate and improves urine flow indication: Benign Prostatic Hyperplasia SE: orthostatic hypotension and syncope (30-90 minutes after first dose) NI/CE: 30 mins after meal, swallow whole, monitor BP CI: kidney and liver problems, low BP

Question 59

sildenafil

Answer 59

MOA: Causes muscle relaxation, vasodilation, Inhibits phosphodiesterase-5 indication: erectile dysfunction SE: Orthostatic hypotension, urinary frequency and bladder pain NI/CE: CI: