pharm review Flashcards
Ventolin - classification, generic name, primary effect and use
SABA (short acting beta2 agonist), aka Salbutamol.
effect: bronchodilation for COPD bronchoconstriction and dyspnea
Ventolin onset, peak effect, duration
onset = 5 - 14 min
peak effect = 30-60 min
duration = 4 - 6 hrs
Ventolin dosing for MDI (intubated vs. nonintubated), diskus and nebule
MDI = 100ug/puff (2-4 puffs nonintubated QID, 8 puffs intubated) Diskus = 200ug 1-2 puffs QID Nebule = 2.5mg
Atrovent generic name, category and effect
Ipratropium Bromide - type of SAMA (short acting muscarinic antagonist)
Effect = bronchodilating
Atrovent MDI dose
20ug, 2-4 puffs QID for COPD
T/F atrovent is often used to treat asthma
false - not a mainstay therapy but may be used in combo with ventolin (SABA) for acute asthma exacerbation. Typically mainly used for COPD
T/F atrovent is preferred over SABA for COPD
true
Spiriva generic name, category, and 2 devices
type of LAMA/LAAC; Tiotropium
devices = handihaler (DPI), Respimat (SMI)
main effect spiriva
mainstay COPD therapy - used monotherapy or in combo with LABA with higher severity
Flovent generic name, category
Flovent = Fluticasone propionate, type of ICS
Flovent main effect
anti-inflammatory to reduce airway inflammation and mucus production. Used in asthma as first line controller monotherapy + used in COPD in combo with a LABA.
devices for flovent
MDI or diskus
prednisone generic name, dose, category, duration of action and use
systemic CS called Deltasone
-used to manage uncontrolled severe asthma/asthma exacerbations; anti-inflammatory
dose = 50mg PO
-action = intermediate 12 - 36 hrs
dexamethasone category, use, route of administration, duration of action
systemic CS used for anti-inflammatory effects in AECOPD and asthma exaacerbation for kids and adults, or glottic edema for upper a/w trauma. IV administration.
action = long 24 - 72 hours
hydrocortisone category, generic name, use, route of admin, action duration
systemic CS called Solu-Cortef; used to treat inflammatory processes via topical cream (e.g. eczema, rash, inflammatory skin conditions)
action duration = short acting (8-12 hrs)
BLES - describe this type of therapy, the dose, the delivery
BLES = surfactant replacement therapy for neonates with RDS to improve gas exchange + decrease alveolar surface tension.
dose = 5ml/lg
delivery method = INSURE (intubation, surfactant, extubation with a regular ETT and multi access catheter) or LISA/MIST (less invasive surfactant administration) using OG or angio cath to avoid intubating and reduce airway injuries
caffeine therapy drug class, effect, use for neonates, loading and maintenanace doses
caffeine therapy = methylxanthine that stimulates CNS and cardiac muscles.
-commonly used to stimulate baby to breathe (+ increased diaphragm activity, Ve, chemoreceptor sensitivity to CO2 changes, reduce periodic breathing or hypoxic resp depression)
Loading dose = 20mg/kg; maintenance dose = 10mg/kg daily
rocuronium trade name, drug class and use
Zemuron
- non depolarizing neuromuscular blocker/paralytic
- used for intubation as pre-treatment for de-fasciculating agent as a subparalyzing dose or used as paralyzing agent during induction/intubation and during maintenance of paralysis in anesthesia
succinylcholine use and trade name
Anectine
-depolarizing neuromuscular blocker (D-NMB) use in main intubation algorithm - it follows administration of the induction agent
reversal agent for succinylcholine?
none
reversal agent/antidote for rocuronium?
sugameddex
Hydrochlorothiazide trade name, drug class, mode action, strength, when to use, route admin
Type of thiazides diuretic, Apo-Hydro
- strength: low ceiling diuretic, moderate natriuretic
- action: inhibits NaCl reabsorption @ early DCT (but promotes Na/K exchange, hypokalemia)
- use: HT, edema w/ heart failure, nephrolithiasis, diabetes insipidus, used for neonates
- admin: oral
Lasix drug class, generic name, strength, mode action, use, route of admin, adverse effects
Type of loop diuretic, furosemide
- most POTENT diuretic + high ceiling
- admin: oral or IV
- action: inhibits NaCl reabsorption via Na/K/2Cl symporter @ loop of H + increases Ca2+ and Mg2+ secretion
- use: acute pulm edema, hypercalcemia, renal impairment
- adverse effects: hypokalemia, metabolic alkalosis, hypotension, hypomanesemia, hypocalcemia + others
Spironolactone trade name + drug class, route admin, mode action, use
Aldactone, type of potassium-sparing diuretic
- aldosterone receptor antagonist that prevents activation + expression of Na channel proteins = prevents Na reabsorption @ late DT and collecting duct via inhibiting Na/K exchange = K+ sparing
- use: excess aldosterone and severe heart failure
Diamox generic name + drug class, strength, mode action, use, side effect, route admin
Acetazolamide, carbonic anhydrase inhibitor
- weak strength, rarely used
- action: inhibits carbonic anhydrase from converting H2O +CO2 -> HCO3- = prevents NaHCO3 reabsorption in proximal tubule
- admin: oral
- use: Glaucoma, acute mountain sickness (counteracts met alkalosis from hyperventilating), treats met alkalosis
- side effect: met acidosis
Mannitol drug class, route admin, mode action, use
Osmotic diuretic
- admin: IV
- mode action: drug freely passes into filtrate and not reabsorbed, increases filtrate osmolarity so H2O stays in filtrate + dilutes sodium in filtrate = decreased chemical gradient for Na reabsorption in DCT and CD
- use: decrease ICP, glaucoma, cerebral edema, increase urine volume, acute renal failure
3 crystalloid soln used for fluid resuscitation and compare each to normal physiologic plasma concentrations
Normal saline (0.9% NaCl; not physiologically normal), Ringer’s lactate (RL- more normal than NS and used for large volume replacement in short time & contains lower Na and higher pH than NS + electrolytes lactate, K, Ca2+), PlasmaLyte (mimics normal but more expensive)
Give example if colloid soln used in fluid resuscitation and its appropriate use
Albumin- naturally occurring plasma protein that increases on Otis pressure in blood to increase blood volume
Use: only for Pt proven to be hypoproteinemic or hypoalbuminemic
note: can result in allergic rxn
aspirin mode action as an anticoagulant
inhibits TXA2, sometimes used prophylactically for clot formation
heparin mode action + onset action as an anticoagulant
inhibits thrombin formation (which results in prevention of fibrin formation); onset is immediate
Coumadin (Warfarin) mode action as anticoagulant and onset action
interferes with action of Vitamin K - cofactor for coagulation factor activation, therefore prevents clot creation; onset 3 - 5 days to start
streptokinase mode action as anticoagulant
enzyme that lyses fibrin clot
TPA mode action as anticoagulant and trade name, adverse effect
tissue plasminogen activator AKA alteplase - activates plasminogen –> plasmin which degrades fibrin clot
-adverse effect: can result in inadvertent bleeding
Piptazo drug class, 2 other drug names, and mode action
Beta-lactam AB, a penicillin.
Other names: Piperacillin / Tazobactam
Mode Action: inhibits bacterial cell wall synthesis
Vancomycin drug class, mode action, and use
Antibiotic, inhibits bacterial cell wall synthesis
use: MRSA/methicillin resistant staph aureus
Versed generic name, drug class, mode of action, advantages (2), onset + duration and route admin
Midazolam
- drug class: BZ, sedative, hypnotic, anxiolytic, induction
- mode action: GABA receptor agonist binds to BZ receptors to increase GABA Cl- influx = hyperpolarization of neuron
- advantage: strong amnesia with little hangover effect + minimal resp and CV depression
- onset + duration and route: <5 mins, 1 hr duration (Rapid and short acting), IV route
Ativan generic name, drug class, mode action, adverse effect, onset + duration and route admin
Lorazepam
- drug class: BZ, sedative, hypnotic, anxiolytic
- mode action: GABA receptor agonist
- adverse effect: associated with dependence
- route admin, onset and duration: oral or IV, onset < 5 mins, duration 10 hours (long acting)
Diprivan generic name, drug class, mode action, adverse effects (3) and benefit (1), onset and duration action
Propofol
- drug class: IV anesthetic, sedative, hypnotic, induction agent
- mode action: GABA receptor agonist = hyperpolarization of neuron
- adverse effects (3): hypotension, decreased HR + SVR, and PRIS (propofol infusion syndrome)
- benefit: decreases ICP, use for head injury Pt
- onset and duration: 15-30sec, 5-10 min duration
Amidate generic name, drug class, mode action, adverse effects (2), benefits (2), onset and duration action
Etomidate
- drug class: IV anesthetic, sedative, hypnotic, induction agent
- mode action: GABA receptor agonist = hyperpolarizes + inhibits neuron
- adverse effects: suppresses cortisol production, N&V
- benefits: decreases ICP, stable CVS (use for CV Pts)
- onset + duration: 30 sec, 10 min duration
Ketalar generic name, drug class, common use, mode action, adverse effect, benefits (3), onset and duration
Ketamine
- drug class: dissociative IV anesthetic, sedative, hypnotic, induction agent
- use: children & intubating asthmatics
- mode action: NMDA receptor antagonist (reduces excitatory/glutamate transmission)
- adverse: increases ICP
- benefits: dissociative amnesia = analgesia, increases BP, bronchodilator
- onset + duration: 30 sec, 30 min
Precedex generic name, drug class, mode action, 2 adverse effects
Dexmedetomidine
- drug class: sedative
- mode action: short acting alpha 2 adrenergic agonist inhibits release of NE; used for sedation of intubated Pt during/post-surgery in critical care
- adverse effects (2): affects BP, lacks resp depression
Haldol generic name, drug class, mode action
Haloperidol
- drug class: antipsychotic, neuroleptic
- mode action: blocks dopamine receptors, used in crit care to treat acute psychosis when hallucinations + delirious symptoms present
Nozinan generic name, drug class, mode action
Methotrimeprazine
- drug class: antipsychotic, neuroleptic
- omde action: blocks dopamine + serotonin receptors, used in crit care to treat acute psychosis when hallucinations + delirium present
atropine drug class, mode action, use, adverse effects
- drug class: antimuscarinic, chronotrope
- mode action: blocks M2 receptors on heart (M2 receptors = bradycardia), increases HR
- use: first line therapy treating symptomatic bradycardia <50bpm with pulse (ACLS bradycardia algorithm)
- adverse effects: dry mouth, blurred vision, nausea
dobutamine trade name, drug class, mode action, adverse effects
Dobutrex
-drug class: positive inotrope, chronotrope, Beta adrenergic/B1 agonist/catecholamine (adrenergic agonist)
(B1 = increases HR and contractility), “inodilator” = inotrope + vasodilation
-mode action: strong B1 activation, minimal B2 activation and very minimal A1 activation = increases contractility, mild increase HR, increased CO and mild vasodilation
Epinephrine/adrenaline drug class, mode action, use, additional advantage
- drug class: adrenergic/catecholamine (direct acting), chronotrope, inotrope, vasopressor
- mode action: stimulates all alpha and beta receptors = increased contractility, HR, CO and vasoconstriction
- use: first line therapy in cardiac arrest resuscitation, alternate therapy for adult bradycardia with pulse algorithm
- benefit: bronchodilates
Milrinone trade name, drug class, mode action, additional advantage
Primacor
- drug class: phosphodiesterase inhibitor, inotrope = inodilator
- mode action: inhibits phosphodiesterase + prevents cAMP breakdown = Ca2+ influx myocytes, decrease Ca2+ in vascular smooth muscle = increased myocardial contractility + decreased SVR
Labetalol drug class, use, and mode action
- drug class: non-selective B blocker/Class 2 antiarrhythmic
- mode action: slows conduction speed, negative chronotropic + neg inotropic effects
- use: treats tachycardia and hypertension
Nitroglycerin trade name, mode action
Nitrostat
-mode action: vasodilator used to treat angina + hypertension
Amiodarone trade name, drug class, mode action, side effects
Cordarone
- drug class: Class 3 antiarrhythmic, potassium channel blocker
- mode action: potent K+ blocker (but also blocks Na+, Ca2+, B-receptors) resulting in slowed HR + conduction speed
- use: second-line therapy to epinephrine for cardiac arrest algorithm, treats tachycardia with pulse
- side effects: fibrosis with long term use, hepatotoxicity, bradycardia, skin discolouration
Vasopressin trade name, drug class, mode action, considerations
Pitressin
- drug class: direct acting vasoconstriction and ADH/ antidiuretic hormone
- mode action: vasoconstriction, increases water reabsorption in kidneys
- use: given after Levophed, treats hypotension and extreme water excretion e.g. diabetes insipidus
note: if Vasopressin + Levophed given, usually indicates suffering from severe sepsis
Norepinephrine trade name, drug class, mode action, adverse effect
Levophed
- drug class: vasopressor, catecholamine (direct adrenergic agonist)
- mode action: stimulates all alpha and beta receptors, higher affinity for a1 = significant vasoconstriction + increased contractility, HR, BP and coronary blood flow
- adverse effect: increase chance of peripheral necrosis at high doses
Neo-synephrine generic name, drug class, mode action, adverse effect and benefit
Phenylephrine
- drug class: noncatecholamine pure a1 agonist , vasopressor
- mode action: a1 agonist = vasoconstriction, increases MAP and used also as decongestant/for rhinitis
- adverse effect: very potent + quick acting –> can increase SVR at expense of organ perfusion
epinephrine drug class, mode action and use
- drug class: vasopressor (+ adrenergic, chronotrope, inotrope)
- mode action: stimulates all alpha + beta receptors, vasoconstriction
- use: alternate therapy to atropine for adult bradycardia with pulse, first line therapy for cardiac arrest
hydralazine drug class, use
drug class: direct acting vasodilator
use: treat heart failure if antiogensin inhibitors contraindicated/not tolerated
iNO / inhaled nitric oxide drug class, mode action/use, dose to start, adverse effect, onset and duration action
- drug class: selective pulmonary vasodilator
- NO increases cGMP = decrease intracellular Ca2+ = pulmonary vasodilation
- use: treat pulmonary hypertension
- adverse: continuously delivered as gas into vent circuit + expensive! side effects = rebound hypoxemia, methemoglobinemia, NO2 formation, bleeding
- dose: start 20 - 40ppm
- onset: intermediate, < 5 sec
- note: for neo use, should see positive response/increase in SpO2 within 5 mins of use, if not move onto alternative therapy
Flolan generic name, drug class, mode action, adverse effect, onset action and duration
Epoprostenol
- drug class: selective pulmonary vasodilator
- mimics prostacyclin (PGI2), binds to PGI2 receptor = vasodilation
- use: treats pulm HTN
- adverse effects: continuously nebulized and can interfere with vent circuit + protect from light to prevent breakdown
- onset action: 1-2 mins, duration 3-5 mins
Protamine mode of action
reversal / anti-heparin agent
-mode action: heparin has greater affinity for protamine = prevents anticoagulant effects of heparin/used to reverse heparin
enoxaparin mode action as anticoagulant + advantages (3)
low molecular weight heparin (LMWH)
- mode action: increases antithrombin 3 activity = inhibits thrombin formation
- advantages: less potent then heparin therefore good for prophylaxis, longer duration action, reversible
morphine drug class, mode action, use, adverse effect
synthetic opioid analgesic
- mode action: binds opioid receptors, greatest effect from u opioid receptor
- use: less common now bc of drugs with less side effects; but used in end-of-life care to decrease pain + dyspnea
- adverse: increases histamine release
sublimaze trade name, drug class, mode action, relative use
Fentanyl
- drug class: synthetic opioid analgesic
- mode action: binds opioid receptor, most effect from u receptor, prevents pain signal transmission
- use: used more than morphine due to fast onset + lower side effects:
note: 100x more potent than morphine
Remifentanil trade name, drug class, mode action, relative potency
Ultive
- drug class: synthetic opioid analgesic
- mode action: binds opioid receptor, most effect from u receptor, prevents pain signal transmission
- potency = 200x more potent than morphine; used for mod-severe pain
Hydromorphone trade name, drug class, mode action, relative potency
Dilaudid
- drug class: semi-synthetic opioid analgesic
- mode action: binds opioid receptors, greatest effect from u opioid receptor, prevents pain signal transmission used for mod-severe pain
- potency: 10x more potent than morphine
Naloxone trade name, drug class, use, mode action
Narcan
- drug class: opioid antagonist
- use: reversal agent for opioid overdose
- mode action: antagonistic binding to opioid receptors, greatest affinity for u receptor = rapid reversal of opioid
Aspirin generic name, drug category, mode action, use
Acetylsalicylic acid
- drug class: NSAID, non-selective irreversible COX inhibitor
- mode action: irreversibly inhibits COX1 and COX2 enzymes = decreases PG formation = reduce inflammation
- use: decrease clot formation, reduce heart attacks, used for mild pain relief, fever, mild anti-inflammation
advil generic name, drug class, mode action
Ibuprofen
- drug class: NSAID, non-selective irreversible COX inhibitor
- mode action: reversibly inhibits COX1 and COX2 = decrease PG production = reduce inflammation
- use: mild pain relief, fever relief, mild anti-inflammatory
Tylenol generic name, drug class, mode action, adverse effect
Acetaminophen
- drug class: not an NSAID
- mode action: not known but not via COX1 or COX2 so no anti-inflammatory effect, rather it targets PAIN
- adverse: doesnt have anti-inflammatory properties and does not decrease platelet aggregation; can have high OD rate, and liver damage
Xylocaine generic name, drug class, mode action, onset and duration, route of admin
Lidocaine
- drug class: amide type local anesthetic
- mode action: blocks Na+ channel in sensory nerve, prevents depolarization
- use: short term procedures for loss of local sensation
- onset + duration: 2- 5 mins, 2 hr duration
- routes: neb, injected, topical cream, spray
Metoprolol
(Lopressor) selective b-adrenoceptor antagonist that blocks B1 heart receptors = reduced HR + B1 juxtaglomerular cell receptors = reduced renin activation = vasodilation = treats hypertension + cardiovascular disease Pts
