Pharmacology - Exam 3 Flashcards

Question

Intrinsic factor's role in cyanocobalamin (B-12) administration

Answer 1

Oral vitamin B12 formations are available primarily as vitamin supplementation, although they are only effective in patients who have sufficient amounts of intrinsic factor.

Answer 2

Ferrous sulfate (iron) is an iron supplement and anti-anemic drug.

Answer 3

nonintentional overdoses of iron-containing products are a leading cause of fatal poisoning in children.

Answer 4

food, especially dairy products, will inhibit absorption of ferrous sulfate. Foods high in vitamin C, such as orange juice and strawberries, can increase the absorption of iron.

Answer 5

when administering via IV, be careful to prevent infiltration because iron is highly irritating to tissues. Use the z-track method (deep muscle) when giving IM. Do not crush tablets or empty contents of capsules when administrating. Do not give tablets or capsules within 1 hour of bedtime.

Answer 6

give ibuprofen on an empty stomach as tolerated. If nausea, vomiting, or abdominal pain occurs, give with food. Be aware that patients with asthma or who have allergies to aspirin are more likely to exhibit a hypersensitivity reaction to ibuprofen.

Answer 7

when used intermittently at low-moderate doses, the adverse effects of ibuprofen are generally mild and include nausea, heartburn, epigastric pain, and dizziness. GI ulceration with occult or gross bleeding may occur, especially in patients who are taking high doses for prolonged periods. Chronic use of ibuprofen may lead to CKD.

Answer 8

NSAIDs may cause an increased risk of serious thrombotic events, MI, and stroke, which can be fatal. This risk may increase with duration of use. Patients with CV disease or risk factors for CV disease may be at greater risk. NSAIDs are contraindicated for the treatment of perioperative pain in those undergoing coronary artery bypass graft surgery. NSAIDs increase the risk of serious GI adverse events, including bleeding, ulceration, and the perforation of the stomach or intestines - which can be fatal.

Answer 9

Max daily dose is 3200/mg/day, or 400-800 TID-QID

Answer 10

Prednisone is a corticosteroid

Answer 11

LT therapy may result in cushing syndrome, a condition that includes hyperglycemia, fat redistribution to the shoulders and face, muscle weakness, bruising, and bones that easily fracture. Because gastric ulcers may occur with LT therapy, an antiulcer medication may be prescribed prophylactically. Use with caution in patients with peptic ulcer, ulcerative colitis, or diverticulitis.

Answer 12

Patients with active viral, bacterial, fungal, or protozoan infections should not take prednisone.

Answer 13

Acetaminophen is an antipyretic

Answer 14

Lots of OTC medications have acetaminophen in them, so it easy to overdose and should be reviewed in a med rec.

Answer 15

liquid forms are available in varying concentrations. Use the appropriate-strength product in children to avoid toxicity. Never administer to patients who consume alcohol regularly due to the potential for drug-induced hepatotoxicity. Advise patients that acetaminophen is found in many OTC products and that extreme care must be taken to not duplicate doses by taking several of these products concurrently.

Answer 16

acetaminophen is generally safe, and adverse effects are uncommon at therapeutic doses. The risk of adverse effects is dose related and increases with LT use. Acute acetaminophen poisoning is very serious. Symptoms include anorexia, nausea, vomiting, dizziness, lethargy, diaphoresis, chills, abdominal pain, and diarrhea. Excessive acetaminophen use is the nuber one cause of acute liver failure in the US.

Answer 17

Acetaminophen has the potential to cause severe and even fatal liver injury and may cause serious allergic reactions with symptoms of angioedema, difficulty breathing, itching, or rash. Because of FDA recommendations, drug manufacturers now limit the strength of acetaminophen in prescription combination products to 325 mg/tablet to lower the potential for acetaminophen induced hepatotoxicity.

Answer 18

Given to children: at birth, 1-4 months, and 6-18 months later.

Answer 19

HBV is a highly effective vaccine that provides active immunity for 99-100% of patients. indications include all infants at birth, children <19yo who have not been vaccinated, healthcare workers or caregivers who are at risk for contact with Hep B, individuals with high risk sexual practices etc. HBV doesn't provide against exposure to other non-B hep viruses. HBV is produced through recombinant DNA tech, using yeast cells. It is not prepared from human blood.

Answer 20

in adults, use the deltoid muscle for the injection site, unless contraindicated. Because none of the formulas of Recomivax HB contain a preservative, once the single dose vial has been penetrated, withdrawn vaccine should be used promptly and the vial discarded. Epinephrine (1:1000) should be immediately available to treat a possible anaphylactic reaction.

Answer 21

Interferons are secreted by lymphocytes and macrophages that have been infected with a virus. They slow the spread of viral infections and enhance the activity of leukocytes.

Answer 22

used to treat multiple sclerosis, granulomatous disease, and severe osteoporosis

Answer 23

interferon alfa 2b is a biologic response modifier prepared by recombinant DNA technology that is approved to treat cancers and viral infections (HPV, chronic hepatitis virus B&C)

Answer 24

inhibit the patient's immune system; used to prevent tissue rejection following organ transplantation.

Answer 25

type of immunosuppressant

Answer 26

Cyclosporine is less toxic to bone marrow cells. When prescribed for transplant recipients, it is often used in combination with high doses of a corticosteroid such as prednisone. Cyclosporine is approved for the prophylaxis of kidney, heart, and liver transplant rejection.

Answer 27

the primary adverse effect of cyclosporine occurs in the kidneys, with up to 75% of patients experiencing reduction in urine output. Over half the patients taking the drug will experience HTN and tremor. Other common side effects are headache, gingival hyperplasia, and elevated hepatic enzymes. Periodic blood counts are necessary to ensure that WBCs do not fall below 4000 or platelets below 75000.

Answer 28

hives, rash, fever, difficulties breathing, increased pulse / HR, confusion/anxiety, collapsing, losing consciousness

Answer 29

Penicillin --> kills bacteria by disrupting their cell walls. Human cells don't have cell walls. Pencillins work best on gram+ bacteria.

Answer 30

Penicillin G may decrease the effectiveness of oral contraceptives.

Answer 31

cephalosporin --> binds to bacterial cell walls and inhibits cell wall synthesis. Acts with broad-spectrum activity against gram negative organisms.

Answer 32

Cefazolin is sometimes used for infection prophylaxis in patients who are undergoing surgical procedures. Cefazolin has a longer half-life than other first generation cephalosporins, which allows for frequent dosing.

Answer 33

tetracyclines class. Effective against broad range of gram+ and gram (-) organisms. Newer tetracyclines are used for drug-resistant intra-abdominal infections and complicated skin structure infections, especially those caused by MRSA.

Answer 34

Has increased use over the past due to Tetracycline's effectiveness against H Pylori in the treatment of peptic ulcer disease

Answer 35

administer oral drug with a full glass of water to decrease esophageal and GI irritation. Administer antacids and tetracycline 1-3 hours apart.

Answer 36

macrolide inhibits protein synthesis by binding to the bacterial ribosome. It's effective against most gram+ and gram (-) bacteria. Primary use is for whooping cough, legionnaire dsiease, infections by strep, influenza, and pneumonia.

Answer 37

administer oral drug on an empty stomach with a full glass of water. for suspensions of erythromycin, shake the bottle thoroughly to ensure that the drug is well mixed. Do not give with or immediately before or after fruit juices.

Answer 38

aminoglycosides Inhibits bacterial protein synthesis. Primary use is for the treatment of serious systemic infections caused by aerobic gram-negative bacteria, mycobacteria, and some protozoans.

Answer 39

neurotoxicity may manifest as ototoxicity and produce a los of hearing or balance, which may become permanent with continued use. Tinnitus, vertigo, and persistent headaches are early signs of ototoxicity. The risk of neurologic effects is higher in patients with CKD. Other signs of neurotoxicity include paresthesias, muscle twitching, and seizures. Concurrent use with other neurotoxic drugs should be avoided.

Answer 40

ciprofloxacin is a fluoroquinolone. Fluoroquinolones inhibit bacterial DNA synthesis by inhibiting DNA gyras and topoisomerase IV. Used for respiratory infections, GI & GU tract infections, some skin and soft tissue infections, uncomplicated UTIs, prophylaxis of anthrax infection.

Answer 41

administer at least 4 hours before antacids and ferrous sulfate

Answer 42

tendinitis and tendon rupture may occur in patients of all ages. Risk is especially high in patients over age 60 in kidney, heart, and lung transplant recipitients, and in those receiving concurrent corticosteroid therapy.

Answer 43

Trimethoprim-sulfamethoxazole is a sulfonamide and urinary antiseptic. It suppresses bacterial growth by inhibiting bacterial synthesis of folic acid. Primary use is for UTIs, pneumocystis carinii pneumonia, and shigella infections of the small bowel.

Answer 44

the fixed dose combo of SMZ (sulfamethoxazole) with TMP (trimethoprim) is most frequently prescribed for the pharmacotherapy of UTIs. It's also approved for the treatment of pneumonia, shigella infections of the small bowel, and for acute episodes of chronic bronchitis. SMZ&TMP are inhibitors of the bacterial metabolism of folic acid.

Answer 45

TMP-SMZ should be administered with a full glass of water. This medication should be used cautiously in patients with CKD because crystalluria, oliguria, and renal failure have been reported.

Answer 46

Tuberculosis (TB) is a highly contagious infection caused by the organism Mycobacterium tuberculosis. The incidence is staggering: Worldwide, about 2 billion people are infected. TB is treated with multiple anti-infectives for a prolonged period.

Answer 47

antituberculosis drug

Answer 48

The most common adverse effects of INH or isoniazid are numbness of the hands and feet, rash, and fever. Neurotoxicity is a concern during therapy, and patients may exhibit paresthesia of the feet and hands, convulsions, optic neuritis, dizziness, coma, memory loss, and various psychoses.

Answer 49

hepatotoxicity is a serious and sometimes fatal adverse effect. While rare, the patient should be monitored carefully for jaundice, fatigue, elevated hepatic enzymes, or loss of appetite. Liver enzyme tests are usually performed monthly during therapy to identify early hepatotoxicity. Hepatotoxicity usually appears in the first 1-3 months of therpay, but may occur at any time during treatment. Older adults and those with daily alcohol consumption are at greater risk of developing hepatotoxicity.

Answer 50

antifungal drug. Azoles interfere with biosynthesis of ergosterol, which is essential for fungal cell membranes.

Answer 51

azole antifungal drug Acts by interfering with the synthesis of ergosterol. The primary use is to treat fungal infections in the CNS, bone, eyes, urinary tract, and respiratory tract. It's not effective against non-albicans candida species, but it's particularly effective against the Candida Albicans species.

Answer 52

used for superficial fungal infections

Answer 53

nystatin binds to sterols in the fungal cell membrane, causing leakage of intracellular contents as the membrane becomes weakened. Nystatin is available in a cream, ointment, powder, tablet, and lozenge. Too toxic for parenteral administration, nystatin is primarily used topically for Candida infections of the vagina, skin, and mouth. It may also be administered PO to treat candidiasis of the intestine because it travels through the GI tract without being absorbed.

Answer 54

for oral candidiasis, apply with a swab to the affected area in infants and children because swishing is difficult or impossible. For adults with oral candidiasis, the drug should be swished in the mouth for at least two minutes.

Answer 55

antimalarial drug Acts as an anti-protozoal agent

Answer 56

Metronidazole is effective against both the intestinal and hepatic stages of the disease. Resistant forms of E. histolytica have not yet emerged as a clinical problem with metronidazole therapy. Metronidazole is a preferred drug for giardiasis and trichomoniasis.

Answer 57

metronidazole may elicit a disulfiram reaction if taken in combination with alcohol or other medications that may contain alcohol.

Answer 58

Drug for HIV. (Called AZT) AZT or Zidovudine is a nucleoside reverse transcriptase inhibitor. The virus mistakensly uses zidovudine as the nucleoside, thus creating a defective DNA strand. Used to treat HIV infection in combination with other anti-retrovirals, as well as for prevention of the transmission of HIB from mother to fetus or neonate.

Answer 59

nucleoside reverse transcriptase inhibitor

Answer 60

Zidovudine was one of the first drugs used for HIV infection. Zidovudine resembles thymidine, one of the 4 nucleoside building blocks of DNA. As the reverse transcriptase enzyme begins to synthesize viral DNA, it mistakensly uses zidovudine as one of the nucleosides, thus creating a defective DNA strand. This medication is sometimes abbreviated as AZT.

Answer 61

antiviral for herpesviruses

Answer 62

Nucleoside Analog

Answer 63

When given via IV, the drug may cause painful inflammation of vessels at the site of infusion. Administer around the clock, even if sleep is interrupted. Administer with food. The nurse should monitor the patient's condition, provide education, obtain medical/surgical/drug history, assess lifestyle and dietary habits, obtain description of symptomology and current therapies.

Answer 64

1st generation antihistamine -- histamine H1 receptor blocker. Primary use is to treat minor symptoms of allergy and common cold.

Answer 65

diphenhydramine is a 1st generation H1 receptor antagonist whose primary use is to treat minor symptoms of allergy and the common cold such as sneezing, runny nose, and tearing of the eyes.

Answer 66

can cause significant drowsiness, although this diminishes with LT use. Occasionally, paradoxical CNS stimulation and excitability will be observed, rather than drowsiness. Excitation is more frequent in children than in adults. Anticholinergic effects such as dry mouth, tachycardia, and mild hypotension occur in some patients. Diphenhydramine may cause photosensitivity.

Answer 67

drug of choice in treating allergic rhinitis. High efficacy and wide margin of safety. Must be administered 2-3 weeks prior to allergen exposure. Decreases the secretion of inflammatory mediators. They reduce tissue edema and cause mild vasoconstriction.

Answer 68

intranasal corticosteroid. Decreases local inflammation in nasal passages, thus reducing nasal stuffiness.

Answer 69

Fluticasone is typical of the intranasal corticosteroids used to treat seasonal allergic rhinitis. Therapy usually begins with 2 sprays in each nostril twice daily and decreases to one dose per day. Fluticasone acts to decrease local inflammation in the nasal passages, thus reducing nasal stuffiness. Veramyst is approved for the treatment of both seasonal and perennial allergic rhinitis.

Answer 70

alleviate nasal congestion of allergic rhinitis and common cold

Answer 71

Decongestant. Stimulates alpha-adrenergic receptors in the sympathetic nervous system. Causes arterioles in the nasal passages to constrict and dries mucous membranes.

Answer 72

intranasal preparations are more efficacious, but should only be used for 3-5 days due to rebound congestions. Available in OTC sprays and drops. Have local action within minutes and few systemic side effects, slower response time, are less effective at relieving congestion, and are often combined with antihistamine preparations. Wash hands carefully after administration to prevent anisocoria (blurred vision and inequality of pupil size).

Answer 73

Rebound congestion is common when oxymetazoline is used for longer than 3-5 days. Minor stinging and dryness in nasal mucosa may be experienced. Systemic adverse effects are unlikely unless a large amount of the medicine is swallowed.

Answer 74

antitussive. Acts in the medulla to inhibit the cough reflex. Primary use is as a component in most OTC severe cold and flu preparations.

Answer 75

Dextromethorphan is a nonopioid drug that is a component in many OTC severe cold and flu preparations. It is available in a large variety of formations, uincluding tablets, liquid-filled capsules, lozenges, and liquids. It has a rapid onset of action, usually within 15-30 minutes. Like codeine, it acts in the medulla, although it lacks the analgesic and euphoric effects of the opioids and does not produce dependence. Patients whose cough is not relieved by dextromethorphan after several days of therapy should notify their healthcare provider.

Answer 76

dextromethorphan is contraindicated in the treatment of chronic cough due to excessive bronchial secretions, such as asthma, smoking, and emphysema. Suppressing the cough reflex is not desirable in those patients. the FDA has issued advisories that nonRx cough and cold products (like those containing dextromethorphan) not be used in children under 6 yo and that they be used with extreme caution in all children.

Answer 77

most effective drugs for relieving acute bronchospasm. The beta-adrenergic agonists activate beta2 receptors in bronchial smooth muscle to cause bronchodilation. Fewer cardiac side effects than the older non-selective beta-adrenergics. They range from ultrashort to long-acting.

Answer 78

Beta-adrenergic agonist. Primary use is for the termination of acute bronchospasm.

Answer 79

Albuteral is a SABA that is used to relieve the bronchospasm of asthma. Its rapid onset and excellent safety profile have made inhaled albuterol a preferred drug for the termination of acute bronchospasm. In addition to relieving bronchospasm, the drug facilitates mucus drainage and can inhibit the release of inflammatory chemicals from mast cells. When inhaled 15-30 minutes prior to physical activity, it can prevent exercise-induced bronchospasm.

Answer 80

The proper use of the inhaler is important to the effective delivery of the drug. Use only the actuator that comes with the canister Observe and instruct the patient in proper use. Assess vital signs for respiratory and pulse rate, lung sounds, respiratory effort, skin color, O2 saturation. Do not administer if patient has history of dysrhythmia or MI. Use limited in children <6yo. Not recommended for breastfeeding women.

Answer 81

block parasympathetic nervous system with bronchodilator effect. Occasionally used as an alternative to beta-agonists in asthma therapy.

Answer 82

anticholinergic / bronchodilator

Answer 83

Ipratroprium is an anticholinergic drug that is delivered by inhalation and intranasal routes. The inhalation form is approved to relieve and prevent the bronchospasm that is characteristic of asthma and COPD. When combined with albuterol, it is a first line drug for treating bronchospasms due to COPD, including bronchitis and emphysema. It is prescribed off-label for asthma, as it isn't yet FDA approved. The primary role of ipratropium is as an alternative to SABA and for patients experiencing severe asthma exacerbations. It is sometimes combined with beta agonists or corticosteroids to provide additive bronchodilation.

Answer 84

The proper use of the MDI is important to the effective delivery of the drug. Observe and instruct the patient in proper use. Wait 2-3 minutes between dosages. Avoid contact with the eye; otherwise, blurred vision may occur. Assess respiratory rate before and after first dose of MDI. Monitor vital signs: RR, pulse, respiratory effort, skin color, O2 sat, lung sounds. Assess for history of narrow-angle glaucoma, benign prostatic hyperplasia, renal disorders, urinary bladder neck obstruction.

Answer 85

most potent anti-inflammatory drugs. Inhaled corticosteroids are drugs of choice for LT prophylaxis of asthma. They must be taken daily, and systematic side effects are rarely observed. Oral drugs are used for ST therapy of severe, acute asthma. Limit therapy to under 10 days.

Answer 86

Corticosteroid. Used to decrease frequency of asthma attacks, allergic rhinitis. Should not be used to terminate asthma attacks in progress.

Answer 87

Beclomethasone is a corticosteroid available through aerosol inhalation for asthma or as a nasal spray for allergic rhinitis. Beclomethason and corticosteroids are first-line drugs for the LT management of persistent asthma in both children and adults. 3-4 weeks of therapy may be necessary before optimal benefits are obtained. Beclomethasone acts by reducing inflammation, thus decreasing the frequency of asthma attacks. It is not a bronchodilator and should not be used to terminate asthma attacks in progress.

Answer 88

Assess patient for presence/history of conditions such as asthma, allergic rhinitis, HTN, heart disease, blood clots, cushing syndrome, fungal infections, diabetes. Monitor vital signs: RR, pulse, respiratory effort, lung sounds, skin color, O2 saturation, body weight. Assess for signs and symptoms of infection. Primary use is to prevent respiratory distress. Do not use this medication during acute asthma attack. Patients should watch for signs and symptoms of simple infections. Rinse mouth after using steroid inhalers and closely monitor blood glucose levels.

Answer 89

Leukotriene Modifier. Leukotrienes are mediators of the immune response, involved in allergic and asthma reactions. Leukotriene modifiers are primarilty used for asthma prophylaxis to reduce the inflammatory component of asthma.

Answer 90

Montelukast is used for the prophylaxis of persistent, chronic asthma, exercise-induced bronchospasm, and allergic rhinitis. It prevents airway edema and inflammation by blocking leukotriene receptors in the airways. The drug is given PO and acts rapidly, although it is not recommended for termination of acute bronchospasm. Montelukast is available in chewable tablets and as granules that are recommended by the manufacturer to be mixed with applesauce, mashed carrots, or ice cream.

Answer 91

Monitor vital signs: RR, pulse, respiratory effect, lung sounds, skin color, O2 sat level, CBC and liver function tests. Assess for signs and symptoms of infection, especially in older adults. Advise patients not to use leukotriene modifiers during an acute asthma attack. If preventing exercise-induced bronchospasm, take drug at least 2 hours before the activity.