Pharm part 4 Flashcards
Common indications of H2 blockers
Short-term tx of active duodenal ulcer, GERD, erosive esophagitis, gastritis
MOA of H2 blockers
Competitively and reversibly inhibits histamine at H2 receptors on gastric cells
Common AEs of H2 blockers
Abd pain
Constipation
Diarrhea
HA
Clinically sig drug interactions of H2 blockers
May decrease warfarin clearance
Major counseling points of H2 blockers
May be taken with food if GI upset occurs
Prolonged tx greater than or equal to 2 yrs may lead to vitamin B12 malabsorption
Monitoring parameters of H2 blockers
Improvement in GI S/sx
Common indications for alpha blockers
HTN
BPH
MOA of alpha blockers
HTN: Competitively inhibits postsynaptic alpha-adrenergic receptors which results in vasodilation of veins and arterioles and a decrease in total peripheral resistance and blood pressure
BPH: Competitively inhibits postsynaptic alpha-adrenergic receptors in prostatic stromal and bladder neck tissues. This reduces the sympathetic tone-induced urethral stricture causing BPH sx
Common AEs of alpha blockers
Dizziness
Fatigue
Orthostatic hypotension
HA
Renal or hepatic dose adjustments for alpha blockers
Use with caution in mild-to-moderate hepatic dysfunction
Do not use with severe impairment
Clinically sig drug interactions with alpha blockers
PDE-5 inhibitors
Monitoring parameters of alpha blockers
Decrease in BP
Urinary retention
Common indications of duloxetine
MDD
Neuropathic pain associated with diabetic peripheral neuropathy
GAD
MOA of duloxetine
Inhibits neuronal reuptake of serotonin and norepinephrine primarily, and dopamine to a slight extent
Common AEs of duloxetine
Nausea Dry mouth Constipation Insomnia Dizziness
Renal or hepatic dose adjustments of duloxetine
CrCl <30: use not recommended
Mild-mod renal impairment use low dosing
Not recommended in hepatic impairment
BBW for duloxetine
Antidepressants increase risk of suicidal thinking and behavior in children, adolescents, and young adults with MDD and other psychiatric d/os
Clinically significant drug interactions of duloxetine
CI-ed with MAOIs, inhibitors of CYP1A2 and CYP2DC increase levels of duloxetine. Chronic use of NSAIDs increases risk of GI bleeds.
Major counseling points of duloxetine
Pay close attention to mood or behavioral changes- this drug may increase suicidal thoughts or actions.
Benefits may not be seen before 2 wks of continued drug therapy;
May cause drowsiness; Avoid alcohol while taking this medication
Do not abruptly d/c
Store in a cool, dry place…
If a dose is missed, skip it and return to nl dosing schedule
Monitoring parameters of duloxetine
Improvement in S/sx of anxiety/depression/pain
Abrupt changes in mood
Common indications for risperidone
Bipolar mania Bipolar I maintenance Shizophrenia PTSD Tourette's syndrome Agitation
MOA of risperidone
Dopamine and serotonin antagonism
Common AEs of risperidone
EPS Tachycardia Priapism Rash Somnolence Agitation/anxiety
Renal or hepatic dose adjustments for risperidone
Recommended
BBW for risperidone
Increased mortality in elderly pts with dementia-related psychosis
Clinically significant drug interactions of risperidone
Fluoxetine, carbamazepine, and clozapine may increase risperidone
Major counseling points of ripseridone
May cause fainting during initial doses,
May impair judgement
Avoid EtOH
Avoid excessive exposure to sunlight and heat during therapy
Monitoring parameters of risperidone
Decrease of S/sx of bipolar, schizophrenia, PTSD and Tourette’s syndrome
Common indications for bupropion
Depression
Anxiety
Aid in smoking cessation
MOA of bupropion
Weak inhibitor of neuronal uptake or norepinephrine, serotonin, and dopamine
Common AEs of bupropion
Tremor
Wt loss
Insomnia
Renal or hepatic dose adjustments of bupropion
Hepatic/renal: consider reducing dose and frequency
BBW for bupropion
Suicidality
Clinically sig drug interactions of bupropion
EtOH may lower seizure threshold
Toxicity is increased by monoamine oxidase inhibitors
Chronic use with NSAIDs increases risk of GI bleeds
Major counseling points of bupropion`
Swallow XL and SR tabs whole
Avoid EtOH
Wt loss or gain may be temporary
May need up to 2 wks to show noticeable improvement
Pay attention to sudden mood/thought change
Do not abruptly d/c
Monitoring parameters for bupropion
Improvement in mood/smoking frequency
Unusual changes in behavior/suicidality
Common indications for diazepam
Acute EtOH withdrawal Anticonvulsant Anxiety Muscle spasm Sedation Status epilepticus
MOA of diazepam
Enhances the inhibitory effect of GABA
Common AEs of diazepam
Drowsiness Ataxia Fatigue Sedation Cognitive impairment
Renal or hepatic dose adjustments for diazepam
Daily 50% reduction of dose for cirrhosis pts
Clinically sig drug interactions with diazepam
Additive effect with other CNS depressants
Cimetidine delays clearance
Grapefruit juice may increase plasma level
Major counseling points of diazepam
May cause drowsiness
May be habit forming
Avoid EtOH while taking this medication
Do not abruptly d/c
Monitoring parameters for diazepam
Improvement in S/sx of anxiety
Muscle spasticity
Seizure control
Abuse, misuse
Common indications for methylprednisolone
Allergic or inflammatory dz
MS
MOA of methylprednisolone
Regulate gene expression subsequent to binding specific intracellular receptors and translocation into the nucleus
Modulate carbs, protein, and lipid metabolism and maintenance of fluid and electrolyte homeostasis
CV, immunologic, musculoskeletal, endocrine, and neurologic physiology are influenced
Decreases inflammation by suppression of PMN leukocytes and reversal of increased capillary permeability
Common AEs of methylprednisolone
Blurred vision Upset stomach Nausea Vomiting Fluid and electrolyte disturbances Agitation Insomnia Long-term Cushings Osteoporosis
BBWs for methylprednisolone
Epidural corticosteroid injection may cause neurologic complications
Clinically significant drug interactions with methylprednisolone
Anticholinesterase
Barbiturates
Estrogens
Ketoconazole
Major counseling points of methylprednisolone
Take with or without food
Do not d/c on your own
DM pts could see an increase in BG readings
Monitoring parameters of methylprednisolone
S/sx of inflammation
BG
