pharm review Flashcards
1
Q
Ventolin - classification, generic name, primary effect and use
A
SABA (short acting beta2 agonist), aka Salbutamol.
effect: bronchodilation for COPD bronchoconstriction and dyspnea
2
Q
Ventolin onset, peak effect, duration
A
onset = 5 - 14 min
peak effect = 30-60 min
duration = 4 - 6 hrs
3
Q
Ventolin dosing for MDI (intubated vs. nonintubated), diskus and nebule
A
MDI = 100ug/puff (2-4 puffs nonintubated QID, 8 puffs intubated) Diskus = 200ug 1-2 puffs QID Nebule = 2.5mg
4
Q
Atrovent generic name, category and effect
A
Ipratropium Bromide - type of SAMA (short acting muscarinic antagonist)
Effect = bronchodilating
5
Q
Atrovent MDI dose
A
20ug, 2-4 puffs QID for COPD
6
Q
T/F atrovent is often used to treat asthma
A
false - not a mainstay therapy but may be used in combo with ventolin (SABA) for acute asthma exacerbation. Typically mainly used for COPD
7
Q
T/F atrovent is preferred over SABA for COPD
A
true
8
Q
Spiriva generic name, category, and 2 devices
A
type of LAMA/LAAC; Tiotropium
devices = handihaler (DPI), Respimat (SMI)
9
Q
main effect spiriva
A
mainstay COPD therapy - used monotherapy or in combo with LABA with higher severity
10
Q
Flovent generic name, category
A
Flovent = Fluticasone propionate, type of ICS
11
Q
Flovent main effect
A
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.
12
Q
devices for flovent
A
MDI or diskus
13
Q
prednisone generic name, dose, category, duration of action and use
A
systemic CS called Deltasone
-used to manage uncontrolled severe asthma/asthma exacerbations; anti-inflammatory
dose = 50mg PO
-action = intermediate 12 - 36 hrs
14
Q
dexamethasone category, use, route of administration, duration of action
A
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
15
Q
hydrocortisone category, generic name, use, route of admin, action duration
A
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)
16
Q
BLES - describe this type of therapy, the dose, the delivery
A
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
17
Q
caffeine therapy drug class, effect, use for neonates, loading and maintenanace doses
A
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
18
Q
rocuronium trade name, drug class and use
A
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
19
Q
succinylcholine use and trade name
A
Anectine
-depolarizing neuromuscular blocker (D-NMB) use in main intubation algorithm - it follows administration of the induction agent
20
Q
reversal agent for succinylcholine?
A
none
21
Q
reversal agent/antidote for rocuronium?
A
sugameddex
22
Q
Hydrochlorothiazide trade name, drug class, mode action, strength, when to use, route admin
A
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
23
Q
Lasix drug class, generic name, strength, mode action, use, route of admin, adverse effects
A
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
24
Q
Spironolactone trade name + drug class, route admin, mode action, use
A
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
25
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
26
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
27
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)
28
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
29
aspirin mode action as an anticoagulant
inhibits TXA2, sometimes used prophylactically for clot formation
30
heparin mode action + onset action as an anticoagulant
inhibits thrombin formation (which results in prevention of fibrin formation); onset is immediate
31
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
32
streptokinase mode action as anticoagulant
enzyme that lyses fibrin clot
33
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
34
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
35
Vancomycin drug class, mode action, and use
Antibiotic, inhibits bacterial cell wall synthesis
| use: MRSA/methicillin resistant staph aureus
36
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
37
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)
38
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
39
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
40
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
41
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
42
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
43
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
44
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
45
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
46
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
47
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
48
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
49
Nitroglycerin trade name, mode action
Nitrostat
| -mode action: vasodilator used to treat angina + hypertension
50
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
51
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
52
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
53
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
54
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
55
hydralazine drug class, use
drug class: direct acting vasodilator
| use: treat heart failure if antiogensin inhibitors contraindicated/not tolerated
56
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
57
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
58
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
59
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
60
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
61
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
62
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
63
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
64
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
65
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
66
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
67
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
68
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
69
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
