Pharm part 1 Flashcards
Common indications for HCTZ
Adjunctive therapy in edema associated with CHF, hepatic cirrhosis, forms of renal dysfunction, or control of HTN
MOA of HCTZ
Inhibits reabsorption of sodium and chloride at the distal renal tubule
Common adverse effects of HCTZ
Dry mouth Muscle cramps Weakness Orthostasis Photosensitivity
Renal or hepatic dosage adjustments for HCTZ
CrCl <10 mL/min- use not recommended
Contraindicated with anuria
Clinically significant drug interactions: HCTZ
Decreases effect of sulfonylureas
May cause digitalis-induced arrhythmias with digoxin
Major counseling points for HCTZ
Take in the AM
Avoid excessive sunlight exposure
Store in cool, dry place away from sunlight
If dose is missed, skip it and return to normal schedule
Monitoring parameters for HCTZ
BP
Potassium
Hemodynamic status
Edema in fluid overload pts
Common indications for tramadol
Management of moderate to moderately severe pain
MOA of tramadol
Mu-opioid agonist
Inhibits reuptake of serotonin and norepinephrine
Common adverse effects of tramadol
Dizziness/vertigo
Nausea
HA
Drowsiness
Renal or hepatic dosage adjustments for tramadol
IR: CrCl <30 mL/min: 50-100 mg every 12 hrs, max 200 mg/day ER: should be avoided if CrCL <30 mL/min Cirrhosis: 50 mg every 12 hrs, should be avoided in pts with severe (Child-Pugh class C) hepatic dysfunction
Clinically significant drug interactions for tramadol
May potentiate effects of MAOIs, TCAs
Increased risk of seizure when given with SSRIs, TCAs, and opioids
Carbamazepine decreases levels of tramadol
Major counselling points for tramadol
May cause drowsiness- use caution when operating machinery/driving
Avoid alcohol while taking this medication
May take with food or milk to avoid GI upset
Do not split, crush or chew ER tabs
Take only as directed
Store in cool dry place away from kids and sunlight
If dose is missed, skip and return to nl dosing schedule
May produce psychological and physical dependence with continuous use
Could potentially lower the seizure threshold
Use with caution in pts with h/o seizures
Monitoring parameters of tramadol
Pain control
Misuse
Abuse
Common indications of Tylenol #3
Relief of mild-to-moderate pain
MOA of Tylenol #3
Acetaminophen: Believed to inhibit the synthesis of prostaglandins in the CNS and peripherally block pain impulse generation; produces antipyresis from inhibition of hypothalmic heat-regulating center
Codeine: Binds to opiate receptors in the CNS, causing inhibition of ascending pain pathways, altering the perception of and responses to pain, causes cough suppression by direct central action in the medulla; produces generalized CNS depression
Common adverse effects of Tylenol #3
Hepatotoxicity SJS Constipation Dizziness/drowsiness HA Lightheadedness
Renal or hepatic dosage adjustments for Tylenol #3
Hepatic: use with caution may cause hepatotoxicity
Black box warnings for Tylenol #3
Hepatotoxicity and ultra-rapid metabolism of codeine to morphine
Clinically significant drug interactions for Tylenol #3
Alcohol
Major counseling points for Tylenol #3
Do not use any other product including OTC with APAP
Avoid alcohol
Do not exceed 3-4 gm/day of APAP
Common indications for gabapentin
Adjunctive therapy for partial seizures
Tx of postherpetic neuralgia, bipolar, peripheral neuropathies
MOA of gabapentin
The exact MOA is unknown
Common adverse effects of gabapentin
Somnolence Dizziness/drowsiness Sedation Confusion Ataxia
Renal or hepatic dosage adjustments for gabapentin
400 mg 3x/day when CrCl >60 mL/min
300 mg 2x/day when CrCl 30-60 mL/min
300 mg once per day when CrCl 15-30 mL/min
300 mg every other day when CrCl <15 mL/min
Clinically significant drug interactions with gabapentin
Antacids reduce bioavailability of gabapentin
Major counseling points for gabapentin
Avoid taking with alcohol
Given at least 2 hrs after antacids
Avoid abruptly discontinuing medication
Monitoring parameters of gabapentin
Unusual behavior or mood changes
Improvement in pain or psych sx as appropriate
MoA of prednisone
Stimulate/inhibits transcription of mRNA, resulting in synthesis of specific enzym es that carry out its antiallergy and anti-inflammatory effects
Common adverse effects of prednisone
Blurred vision Upset stomach N/V Cushing's syndrome Peptic ulceration Increased susceptibility to infection Osteoporosis (chronic use)
Clinically significant drug interactions with prednisone
May antagonize effects of anticholinesterases, barbiturates, rifampin Phenytoin may increase metabolism Estrogens may decrease metabolism Ketoconazole may increase effects May decrease salicylate effectiveness
Major counseling points of prednisone
Take medication only as prescribed
Do not d/c use without consulting a physician
May take with food or milk if GI upset occurs
Store in a cool dry place away from kids and sunlight
If a dose is missed, take it as soon as possible
May see an increase in BG readings in diabetics while on this medication
Monitoring parameters of prednisone
BG BP Decrease in inflammation where appropriate Long-term osteoporosis Kyphosis Cushings
MOA of metoprolol
Selective inhibitor of beta1-adrenergic receptors
Competitively blocks beta1- receptors, with little or no effect on beta2-receptors
Common indications for metoprolol
Mangement of HTN
Long-term tx of angina pectoris
Tx of stable, symptomatic heart failure of ischemic, hypertensive, or cardiomyopathic origin
Common adverse effects of metoprolol
Dizziness
Hypotension
Bradycardia
Fatigue
Major counseling points in metoprolol
Pts with heaert failure should contact their physician if their sx worsen
Take with food
Do not abruptly d/c
Take whole or halved tablets without chewing or crushing
Use caution while operating machinery
Can mask hypoglycemic sc in diabetics
BBW in metoprolol
Ischemic heart dz
When stopping, gradually decrease doses over a 1-2 wk period
Drug interactions with metoprolol
Toxic effects may be increased with verapamil
Monitoring for metoprolol
BP
HR
EKG is used for dysrhythmias
