Pharmacology Final Flashcards
1
Q
What are dietary supplements?
A
Products intended to enhance a or supplement the diet such as botanicals, vitamins, or minerals
2
Q
Explain the Dietary supplement Health and Education Act of 1994 and 2000 update (DSHEA)
A
- Regulatory act for dietary supplements
- Requires all products to be clearly labeled as “dietary supplements”
- Product must state “not intended to diagnose, treat, cure, or prevent any disease.”
3
Q
Explain the Dietary Supplement and Nonprescription Drug Consumer Protection Act of 2007
A
Must now include contact info so consumers can report AE
Manufacturers must evaluate identity, purity, potency, and consumption of products with labels that reflect accurately
4
Q
What are the 4 phases of pharmacokinetics?
A
Absorption
Distribution
Metabolism (biotransformation)
Excretion
5
Q
Explain absorption.
A
- moving a drug from the site of admin to the bloodstream.
- The primary factor to determine the onset of the drug action and the intensity of the drug action
6
Q
Explain distribution.
A
- Movement of medication to the body’s tissues
- Key factors that influence circulation, permeability of cell membrane, plasma binding protein, Blood brain barrier
7
Q
Explain metabolism.
A
Drugs are changed into new, less active chemicals
Aka biotransformation
Primary site is the liver
P450 system: determine the speed at which a drug is metabolized. Contributes to drug-drug interactions
8
Q
Explain excretion.
A
Removing the drug from the body
Primary site is the kidney
9
Q
Nursing Process: What should you obtain during assessment?
A
Obtain a thorough medication hx, allergies, and past medical conditions
Physical exam: weight, age, anything r/t the disease state or known drug effects
Level of education
Social supports
Financial support
Pattern of health care
10
Q
Nursing Process: What is done during planning?
A
Set goals and desired patient outcomes
Minimize factors that contribute to medication errors
11
Q
Nursing Process: Implementation
A
Focus entirely on the task of med admin
Rights of med admin
Provide comfort measures/coping with effects of drug therapy
Patient education
12
Q
Nursing Process: Evaluation
A
Assess the patient for expected therapeutic outcomes and determine if any AE occurred
13
Q
What is a half-life?
A
The length of time required for the plasma concentration to decrease by one half after administration
14
Q
Why is a narrow therapeutic index important to be aware of?
A
Therapeutic drug monitoring used when drugs have a low safety margin (aka narrow therapeutic index/window)
Plasma concentration levels need to be monitored (via labs)
Peak, trough, random drug level
15
Q
List anticholinergic effects.
A
s/s: dry mouth, constipation, urinary retention, blurred vision, palpitations, tachycardia
16
Q
What is the MOA and routes for Aspirin (Salicylates)?
A
irreversible inhibition of COX-1 and COX-2, PO and rectal
17
Q
What are salicylates used for?
A
Reduce mild to moderate pain and inflammation
Fever
Prevention of thromboembolic events
Off label: colorectal cancer prevention
18
Q
What are the AE of salicylates/ASA?
A
GI: n/v, dyspepsia, heartburn, epigastric discomfort
Clotting: bleeding (increases w/ dose)
Renal impairment
Salicylism
Reye’s syndrome
19
Q
List salicylate/ASA interactions.
A
Other salicylates
Other drugs that’s cause bleeding
Alcohol
20
Q
List nursing considerations for salicylates/ASA.
A
Monitor s/s bleeding
Take with food/milk and 8oz water
Recommend PPI w/ long term therapy
Monitor: I&Os, BUN, and creatinine
Monitor for salicylism
Discontinue 1 week before surgery
21
Q
What is the MOA and route for NSAIDs (ibuprofen)?
A
reversible inhibition of COX 1&2, PO
22
Q
What are the uses for ibuprofen?
A
Reduce mild-moderate pain and inflammation
Fever
Dysmenorrhea
23
Q
What are the AE of ibuprofen/NSAIDs?
A
GI (common)
Renal impairment w/ chronic use
BBW
24
Q
List contraindications of ibuprofen/NSAIDs.
A
Allergy
Bleeding
Corticosteroids
25
List interactions for ibuprofen/NSAIDs.
Anticoagulants (bleeding)
NSAIDS
Alcohol
Corticosteroids
26
Drug Schedule Law: Explain the Controlled Substance Act of 1970.
Ranks drugs for abuse potential in categories 1-5.
Drugs w/ abuse potential
Hospitals, pharmacies, and prescribers have to register with the DEA and use registration numbers to purchase prescribed drugs
They must maintain records of all quantities purchases and sold
27
What is the MOA and route for morphine (opioid agonist)?
reacts with MU and Kappa receptors, po, iv, im, sc, sl, rectal, epidural, intrathecal
28
What are the uses for opioid agonists like morphine?
Relief of acute or chronic severe pain
Suppress cough
Slow GI motility with severe diarrhea
Sedation
Part of general anesthesia
Euphoria and intense relaxation (reason for abuse)
29
What are the AE of opioid agonists (morphine)?
Respiratory depression w/ apnea
(Monitor RR before admin and hold if less than 12. Admin antagonist if RR falls below 10 (naloxone)
CNS depression
GI: constipation and n/v
Urinary retention
Hypotension
Cough suppression
Pruritus
BBW: abuse
Tolerance
Pupil constriction
30
List contraindications for morphine (opioid agonist).
allergy and premature infants
31
For morphine/opioid agonists use caution in those with?
Respiratory dysfunction
GI/GU surgery
GI issue that slow motility
32
List interactions of opioid agonists.
other CNS depressants
33
What is the OD treatment?
Naloxone
34
What are nursing considerations when administering opioid agonists like morphine?
Monitor full set of v/s
Assist w/ ambulation to prevent falls and injury
Encourage fluid and fiber. Patient may need laxative
Monitor for urinary retention
Admin IV push slowly
Give on a fixed schedule not PRN
Administer before pain become severe
35
What is the MOA and route for opioid antagonist naloxone?
binds to MU and KAPPA but does NOT activate them, IV, IM, SC, nasal .
36
What are the uses for naloxone?
OD
Reversal of post op effects
Opioid addiction
Reversing neonatal depression
37
Opioid antagonists like Naloxone reverse these 4 things.
Analgesia
Sedation
Euphoria
Respiratory depression
38
Corticosteroids (prednisone) uses.
RA, SLE, IBD< inflammatory disorders, allergic conditions, asthma, derm disorders, suppression of allograft rejection
39
What are the AE of corticosteroids/prednisone?
Adrenal insufficiency
Infection
Peptic ulcers
Osteoporosis
Behavioral changes
Hyperglycemia
Cushing syndrome
Sodium/water retention
diminished growth in children
40
List interactions for corticosteroids/prednisone.
Hypoglycemic
Nsaids
Alcohol
Diuretics
Vaccines
41
List contraindications for corticosteroids/prednisone.
Allergy
Systemic fungal infections and infections not controlled by meds
Diabetes
Peptic ulcers
Children, pregnancy, lactation
42
Explain the nurse's role in anesthesia (what to monitor, assessment preop).
Preop assessment :
Contraindications and cautions
Known allergies
Family hx or personal hx of malignant hyperthermia
Weight
Vitals
ECG
Skin assessment
Bowel sounds
Have emergency equipment available
Monitor temperature
Monitor: HR, RR, BP, ECG, cardiac output and AE
Institute safety precautions
Provide comfort measures
Provide pain relief
Skin care and turning
Offer support and encouragement
Provide education
43
What is the therapeutic use for the prostaglandin inhibitor misoprostol?
GI indication is prevention of gastric ulcers caused by long term NSAID therapy.
44
What is the MOA and route for misoprostol? Keep in mind when to give this medication.
inhibits gastric acid secretion and increases bicarb and mucus production in the stomach (protects the stomach lining) , PO x4/day w/ meals and at bedtime while on NSAIDS
45
What are the AE of misoprostol?
GI: most common id diarrhea. And abd pain, n/, dyspepsia
GU: miscarriages, excessive bleeding, spotting, cramping
46
List contraindications for misoprostol. (only 1).
pregnancy category x
47
What is the MOA of antacids (sodium bicarb)?
Inorganic chemicals that neutralize stomach acid
48
Why are antacids not recommended as a primary drug?
Not recommended as primary drug class because they do not promote ulcer healing
49
What are AE of antacids?
Acid rebound
Constipation
Diarrhea
Fluid retention and heart failure
50
List contraindications for antacids.
Allergy
Renal impairment
51
List interactions/instructions specific to antacids.
Need to separate antacids from other drugs by two hours
52
Explain H. Pylori treatment (how is it treated, barriers to compliance).
Antibiotics should be given. Usually, a combination of antibiotics is used concurrently to eradicate and decrease resistance.
Use a minimum of two antibiotics perferably 3 and an antisecretory agent (PPI, H2 antag)
Barriers to compliance :
- Can require up to 12 pill/day for 14 days
- GI AE
- Expensive
53
Explain issues with laxative use. (why does misuse occur, causes, consequences).
Misuse occurs from misconceptions of what constitutes normal bowel function
Causes:
-Misconception that bowel movements must occur daily
-Can perpetuate their own use
-Bowel replenishment after evacuation can be 2-5 days; often mistakes for constipation
Consequences: cathartic dependence
-Diminished defecatory reflexes leading to further reliance on laxatives
-Electrolyte imbalance, dehydration, and impaction
54
What is the MOA for lubricant laxatives (docusate)?
used to make defecation easier without stimulating the GI tract.
55
Lubricant laxatives like docusate are expected to produce a soft stool in _____ to _____ hours after onset of treatment.
Produces a soft stool 24-48 hours after onset of treatment
56
What is the treatment for IBS-C? (constipation predominant IBS)
lubiprostone
57
What is the treatment for IBS-D? (diarrhea predominant IBS)
aloesetron
58
What is the MOA for lubiprostone (IBS-C treatment).
activates chloride channels in the intestinal luminal cells (this increases fluid and motility)
59
What is the MOA for aloestron (IBS-D treatment).
inhibits serotonin receptors in the GI tract leading to decreased perception of abdominal pain and discomfort and decreased motility, BBW.
60
What is the MOA and routes for Hydantoins (phenytoin)?
stabilize nerve membranes by influencing ionic channels in the cell membrane (decrease excitability and hyperexcitability). Reduce the tonic-colonic muscular and emotional response to stimulation , PO/IV
61
What are the AE of Hydantoins (phenytoin)?
CNS depression: drowsiness, confusion, fatigue
Increased r/f suicide ideation
GI: gingival hyperplasia, constipation, dry mouth
Bone marrow suppression
Skin reactions (could be serious)
Sever liver toxicity
BBW
Toxicity: nystagmus, ataxia, sedation, blurred/double vision
62
What is the therapeutic serum level for hydantoins (phenytoin)?
10-20
63
List contraindications of hydantoins (phenytoin).
Allery
Pregnancy/lactation
Coma, depression, psychosis
Older adults
Impaired liver or renal function
64
List interactions for hydantoins (phenytoin).
Alcohol or other CNS depressants
Oral contraceptives
Primrose and gingko
IV phenytoin is incompatible with dextrose solutions
65
What are some nursing considerations when administering hydantoins?
Educate not to drive or preform hazardous activity if experiencing CNS effects
Obtain regular dental check ups
Brush teeth with soft bristles
Do not stop taking abruptly
Monitor: CNS and rash
66
What are 4 treatment goals for status epilepticus?
- maintain ventilation
- correct hypoglycemia
- terminate seizures: IV benzos
- initiate or continue long term suppression drugs
67
What are the uses for carabmazepine?
- management of generalized and focal seizures
- monotherapy or in combination with another AED
- off label: neuropathic pain
- take several weeks to achieve optimal effects
68
What is the MOA for carabmazepine?
inhibits polysynaptic responses and blocks sodium channels to prevent the formation of repetitive action potential in the abnormal focus
69
What are the AE of carbamazepine?
CNS: double vision, vertigo, HA< ataxia, drowsiness, dizziness
GI: n/v
Elevated liver enzymes
Dermatologic: rash, photosensitivity, alopecia
BBW: dermatologic reactions.
Association of congenital abnormalities
70
List contraindications for carbamazepine.
Allergy to drug or tricyclic antidepressants
Liver disease
HLA-B*1502 gene
Pregnancy and lactation
71
List interactions for carbamazepine.
CNS depressants and alcohol
Grapefruit juice
St john's wort
Decrease effectiveness of contraceptives and gives false negatives on pregnancy tests
72
What are nursing considerations for carbamazepine?
Begin with low dose and gradually increase
Give at bedtime if possible
Give with meals for GI s/s
Educate about not doing hazardous activity
Use sunscreen
Fall precautions
Monitor: WBC, CBC, skin, edema
73
Neurotransmitters affected with Alzheimer's Disease (Hallmark of AD).
Beta-amyloid and neuritic plaques
Neurofibrillary tangles
74
Pharmacotherapy of Alzheimer's. (what is the main goal of pharmacotherapy for AD, which 2 drug classes are used, name prototypes).
Drugs are used to slow memory loss
2 drug classes used:
1. Reversable indirect acting cholinesterase inhibitors
(donepezil, galantamine, rivastigmine)
2. Neuronal receptor blocker (NMDA receptor antagonist)
(memantine)
75
Indirect acting cholinesterase inhibitors: donepezil, what is the goal of this medication, MOA, and route.
Goal: improve ADLS and improve behaviors and cognition
May delay or slow progression... not treat!
MOA: blocks acetylcholinesterase
Route: PO
76
What are AE for donepezil?
cholinergic side effects, CNS effects, CV (bradycardia, hypotension, heart block)
77
List the only contraindication for donepezil.
allergy
78
Use caution for donepezil in cases of:
pregnancy/lactation/renal and hepatic dysfunction
79
List interactions for donepezil.
anticholinergic drugs, drugs that can reduce response to cholinesterase inhibitors
80
Centrally acting muscle relaxants: baclofen. What is the MOA/routes?
works in the CNS to interfere with the reflexes that are causing the muscle spasms. Possibly by increasing gamma aminobutyric
take PO dose with food/milk, available PO or intrathecal pump
81
List contraindications of baclofen.
allergy, caution in patients older than 65
82
What are the AE of baclofen (centrally acting muscle relaxants)?
CNS depression
GI/GU: nausea, dry mouth, constipation, urinary retention
CV: hypotension and arrhythmias
Tapered slowly
Physical dependence
83
Regular Insulin is also recognized as short-acting. What is the MOA? What are appropriate routes?
identical to insulin produced by the beta cells of the pancreas. Promotes cellular utake and use of glucose. Promotes glucose storage. Promotes uptake of potassium into cells.
SQ injection, regular can be given IV
84
What are AE of regular insulin?
Hypoglycemia
Injection reactions
lipodystrophy
Hypokalemia
Cough and throat pain (inhaled route only)
85
When mixing insulin, explain how it should be mixed.
short before intermediate (clear before cloudy)
86
Biguanides: metformin. What is the MOA and routes? Why is this the preferred drug for Type II DM?
Preferred drug for type II DM because safety and effectiveness
decreases hepatic glucose production. Increases uptake of glucose. Improves insulin sensitivity of peripheral cells.
PO (regular or sustained release), solution.
87
What are biguanides like metformin used for?
Maintain blood sugar levels WNL in patients with type II dm where diet and exercise are ineffective.
Off label: PCOS
88
What are AE of metformin?
GI
Allergic skin reactions
BBW: lactic acidosis
Lactic acidosis s/s: malaise, myalgia, hyperventilation, severe abd pain.
89
List contraindications for metformin.
Allergy
Impaired renal function
Metabolic acidosis
2 days prior and 2 days after IV contrast
90
List interactions for metformin. (only 2).
Alcohol
Iv contrast
91
Explain treatment of hypoglycemia. (prototype, what it is used for, moa, AE, contraindications, interactions).
Glucagon
Uses:
Emergency treatment of severe hypoglycemia in patients who are unable to swallow or are unconscious
MOA: increases blood glucose levels. Decreases insulin releases. Accelerates breakdown of glycogen in the liver.
AE:
GI upset and n/v
Hyperglycemia
Contraindications:
Depleted glycogen stores
Interactions
Antagonizes effects of antidiabetic drugs
92
What is the MOA and routes for Levothyroxine?
synthetic form of T4, increases metabolic rate. PO/IV
93
What is levothyroxine used for?
hyperthyroidism, goiters, thyroid cancer, myxedema coma
94
What are the AE of levothyroxine?
Rare at therapeutic doses
Hyperthyroidism
BBW: not for weight loss use
Esophageal atresia
95
List contraindications of levothyroxine.
Allergy
Thyrotoxicosis
Acute MI
96
Antithyroid agent: Thioamides. What are the 2 prototypes and MOA?
MOA: lowers thyroid hormone by preventing formation of thyroid hormone, inhibit conversion of t3 to t4.
Prototypes: propylthiouracil (PTU) and methimazole.
96
List interactions of levothyroxine.
Take in the am on an empty stomach
Many drugs decrease absorption and serum levels of levothyroxine
97
What are the AE of thioamides like PTU and methimazole?
n/v, liver toxicity. Arthralgia. Hypothyroidism. Bone marrow suppression.
98
List contraindications for PTU/methimazole.
allergy, pregnancy, lactation
99
List interactions for PTU/methimazole.
increases actions of anticoagulants
100
What do iodine solutions do to thyroid cells? List route and 2 main AE.
- cause thyroid cells to become oversaturated with iodine and stop producing thyroid hormone.
- route: po
- ae: iodism, stained teeth
101
What is the MOA and route for radioactive iodine? State the main AE overall.
MOA: taken up by thyroid cells which are then destroyed by the beta radiation
Route: PO
AE: hypothyroidism
102
When is radioactive iodine contraindicated?
hypersensitivity, pregnancy (cat. x), lactation
103
The patient asks the nurse, "when will I see the full effects of radioactive iodine?" the nurse knows that effects will take __-___ months and the patient should take radiation precautions.
2-3 months.
104
List 5 drug classes used for dyslipidemia. Including other lipid lowering agents (there are 3 others).
HMG-CoA reductase inhibitors (statins)
Bile acid sequestrants
Cholesterol absorption inhibitors
PCSK9 inhibitors
Other lipid lowering agents: Niacin, omega 3, fibrates
105
HMG-CoA reductase inhibitors (statins): atorvastatin. What are the uses, MOA, and PO (any special instructions?)
Uses:
Adjuncts with diet and exercise for the treatment of increased cholesterol and LDL levels that are unresponsive to diet alone
MOA:
Liver responds to the loss of LDL by making more receptors wihc removes the LDL from the blood
Route: PO. Should be given at night because cholesterol biosynthesis is higher.
106
What are the AE of atorvastatin?
Generally, well tolerated
GI most common
Increased liver enzymes and liver failure
Myopathy
Rhabdomyolysis
107
List contraindications of atorvastatin.
pregnancy (cat. x), allergy, liver disease, breastfeeding
108
Antihistamines. Name the prototype for 1st gen and 2nd gen.
1st: diphenhydramine
2nd: cetirizine
109
What is the MOA of anthistamines?
h1 receptor antagonists. They block histamine from reaching its receptor, thus relieving allergy s/s.
110
List contraindications of antihistamines.
allergy, pregnancy/lactation
111
What are AE of antihistamines?
CNS: drowsiness (more common w/ gen 1), dizziness. Young children may experience CNS stimulation instead of depression.
GI: n/v
Anticholinergic effects (more common w/ gen 1)
112
List interactions for antihistamines. (only 2)
CNs depressants, alcohol
113
Beta2 adrenergic agonists: albuterol (SABA). They are most effective and preferred for relieving acute bronchospasms. What is their MOA/routes?
activate the sympathetic nervous system which relaxes the smooth muscle, resulting in bronchodilation
po, inhaled, parenteral
114
What are the AE of albuterol?
CV: tachycardia, palpitations, tremors
CNS stimulations, nervousness, sweating, flushing
Paradoxical bronchospasm
LABA BBW
115
List contraindications for albuterol (beta 2 agonist only has 2)
Allergy
Tachydysrhythmias
116
List interactions for albuterol. (only 2).
beta blockers, caffeine
117
2 key education points for albuterol are?
- LABA not for relief of an acute attack
- if taking a glucocorticoid use this beta first
118
Inhaled corticosteroids: budesonide. Why are they used? What is the MOA?
Use:
Preferred drug for long term management of asthma in children and adults
Not for acute attack use! need to be used on a daily schedule.
MOA: decreases inflammation in the airways
119
List contraindications of budesonide. (2 only)
allergy, emergency use (not for emergencies)
120
What are AE of budesonide?
Hoarseness, sore throat, coughing, dry mouth, oral fungal infection
Long term has potential to affect bone physiology. Decreased growth in children and osteoporosis in adults.
121
What are the interactions for budesonide? (trick question)
no known
122
Smoking cessation: varenicline. How long is this medication given. What is the MOA and route.
- given for 12-24 weeks
- MOA: activates nicotinic acetylcholine receptors in the brain and blocks nicotine from reaching the brain
- route: PO
123
What are AE of varenicline?
n/v, dry mouth, strange dreams, HTN
Seizures and neuropsychiatric events
124
List contraindications and interactions of varenicline.
- contraindicated in allergies
- interactions: increased effects of alcohol
125
Define withdrawal, tolerance, addiction, and physical dependence.
Withdrawal: s/s that occur in physically dependent individuals when they discontinue drug use
Tolerance: a state in which a dose of a drug elicits a smaller response than it did initially
Addiction: a chronic, relapsing brain disease
Physical dependence: a state in which abstinence syndrome will occur if drug use is discontinued
126
Alcohol deterrent: disulfiram. List uses. (3).
Taking disulfiram with alcohol results in a syndrome named disulfiram-alcohol reaction
Can only be given to patients who fully understand and are motivated to maintain sobriety
Prevents impulse drinking does not cure alcohol abuse
127
MOA and route for disulfiram.
MOA: irreversibly inhibits the enzyme acetaldehyde dehydrogenase causing toxic acetaldehyde to build up in the blood
Route: PO
128
AE of disulfiram.
Extreme doses can cause neurological toxicity, psychosis, and hepatotoxicity
129
Interactions for disulfiram.
Interactions: alcohol. s/s begin 5-10 min after alcohol ingestion. All alcohol products must be strictly avoided (cough syrups, mouthwash, vitamins, etc...)
130
Uses of potassium sparing diuretics like spironolactone.
Mild diuretics
Useful in patients who are high risk for hypokalemia
Used as adjuvants for the management of edema and sodium retention associated with HF, nephrotic syndrome, and liver disease
131
MOA of spironolactone and route.
MOA:
Inhibit the actions of aldosterone in the distal tubule and collecting ducts
Route: PO
132
AE of spironolactone.
Hyperkalemia
Gynecomastia, impotence, diminished libido- males
Menstrual irregularities, hirsutism, breast tenderness- females
Decreased fertility
BBW
133
Contraindications of sprironolactone.
Allergy
Anuria, severe renal impairment, pregnancy, and hyperkalemia
134
Interactions for spironolactone.
Potassium supplements, ACE inhibitors, ARBs
Avoid foods high in potassium
135
Thiazide diuretics: hydrochlorothiazide (HCTZ). Why are they used? 3 listed.
Mild diuretics
1st line treatment of mild to moderate HTN
Edema r/t heart, liver, and renal failure
136
MOA of HCTZ (thiazide diuretics) and the routes.
MOA: block the chloride pump which keeps chloride and sodium in the distal tubule to be excreted in the urine
Route: PO and one is available IV
137
AE of HCTZ.
GI upset
Hypotension
Fluid and electrolyte imbalances: hypokalemia, hypercalcemia
Uremia: possible gout attack
Hyperglycemia w/ long term use
138
Contraindications for HCTZ.
Allergy to thiazides and sulfonamides
Fluid and electrolyte imbalance and severe renal disease
139
Interactions for HCTZ.
Other antihypertensive drugs
Digoxin
140
ACE inhibitors are first line treatment for HTN. What is their MOA and routes? What 3 things are they used for?
MOA: works in the lungs to block conversion of angiotensin 1 to angiotensin 2
Routes: PO (enapril also IV)
Uses:
HTN
HF
Acute MI
141
AE of ACE Inhibitors.
CV: hypotension, reflex tachycardia, angina
GI: irritation
Hyperkalemia
Persistent dry cough
Angioedema
BBW: r/f congenital effects if taken during pregnancy
142
Interactions for ACE inhibitors.
NSAIDS, other antihypertensives.
143
ARBS: losartan (-sartan). What is the MOA, route, and what are they used for?
MOA: binds w/ angiotensin II receptors in vascular smooth muscle and the adrenal gland results in vasodilation and prevents secretion of aldosterone
Uses:
HTN, stroke prophylaxis, prevention of type II diabetic neuropathy
Off label: HF
Route: PO
144
AE of losartan.
HA, dizzy, syncope
Gi irritation
Nasal congestion and s/s of respiratory tract infection
Angioedema and acute renal failure
145
Contraindications for losartan.
allergy, pregnancy
146
Interactions for losartan.
NSAIDs, other antihypertensives.
147
Calcium Channel Blockers: amlodipine. What is the MOA and routes.
Moa: selectively blocks calcium channels in vascular smooth muscle
Route: PO and IV
148
Contraindications for amlodipine (CCB).
Allergy
Heart block, HF, brady dysrhythmias
Renal or hepatic dysfunction
Pregnancy and lactation
149
AE of amlodipine (CCBs).
CNS: dizzy, lightheaded, HA
GI: nausea, constipation, hepatotoxicity
CV: hypotension, bradycardia, edema, heart block
Skin flushing
150
Interactions for amlodipine.
Other antihypertensives
Alcohol
Grapefruit juice
151
Beta blockers: (-lol). What is the MOA. Why is it used. What are the routes.
Moa: diminished myocardial contractility (decreases cardiac output). Prevents release of renin by the kidneys
Uses: HTN, angina, dysrhythmias, glaucoma, HF, MI, migraine prophylaxis
Off label: stage fright and PTSD
Routes: PO and IV
152
AE of beta blockers.
n/v, diarrhea
Fatigue and insomnia, confusion
bronchospasm, stevens Johnson syndrome, anaphylaxis
Hypotension and bradycardia
Hypoglycemia
BBW: withdrawal treatment gradually over several weeks
Loss of libido and erectile dysfunction
153
Contraindications for beta blockers.
COPD and asthma, bradycardia, severe HF
154
What are the treatment goals for Parkinson's Disease?
To increase the ability of the patient to perform normal ADL and decrease the chance of falls that could cause injury.
Therapy is aimed at management of s/s to provide optimal functioning for as long as possible.
Drugs do not offer a cure but significantly reduce s/s for a time in many patients
155
Dopaminergic agents: levodopa and carbidopa. Why is it used? What is the MOA? What is the only contraindication?
Uses:
Relieve s/s of idiopathic and secondary Parkinson's disease
MOA: taken up by dopaminergic nerves to be converted to dopamine
Contraindications: allergy
156
Interactions of levodopa and carbidopa.
Interactions:
Dopamine antagonists, iron salts, high protein meals
MAOIs
157
AE of levidopa/carbidopa.
GI: n/v, anorexia
CNS: muscle twitching, tremors, ataxia. Psychosis, hallucinations, paranoia
CV: orthostatic hypotension
Anticholinergic effects
BBW
158
Other information r/t levolevoddopa/carbidopa. (3 key points).
2-3 weeks of therapy needed before improvement is observed
Beneficial effects tend to diminish
Amantadine can help with the involuntary movement, tremors, and twitching
159
Immune modulators: interferon beta-1b. Why is it used? What is the MOA? What is the route (any special instructions?).
Uses:
Treatment of relapsing forms of MS
MOA: unknown. May inhibit the movement of leukocytes across the blood brain barrier
Route: Subq every other day
160
Contraindications of interferon beta-1b?
allergy, pregnancy, caution in people with suicidal tendencies/other mental health disorders.
161
AE of interferon beta- 1b.
Flu like s/s
Bone marrow suppression
Injection site reactions
Increased liver enzymes and toxicity
162
Interactions of interferon beta 1b.
Do not administer with any other drugs that may suppress the immune system
163
Other info for interferon beta 1b ( what do nurses monitor?)
Monitor for depression and suicidal ideations
Monitor CBS and LFTs before treatment and periodically
164
Calcitriol. What are the uses. What is the MOA and routes?
Use:
Hypocalcemia, chronic kidney disease, hypoparathyroidism
MOA: elevates serum calcium levels, decreases elevated blood levels of phosphorus and decreases bone resorption
Route: po and IV
165
Contraindications for calcitriol.
Hypercalcemia
Vit. D toxicity
166
AE of calcitriol.
GI: n/v, dry mouth, constipations, metallic taste
Hypercalcemia
167
Calcium supplements: Calcium carbonate. What are the uses? What is the MOA?
Uses:
Prevention and treatment of hypocalcemia
Osteoporosis
Pregnancy, lactation
Gastric hyperacidity
MOA: restore normal serum levels of calcium
168
Contraindications for calcium carbonate.
Cardiac dysrhythmias, renal calculi, hypercalcemia, low phosphate levels
169
AE of calcium bicabonate.
Hypercalcemia
Constipation
Kidney stones
IV: pain at site, hypotension, heat wave, fainting, dysrhythmias
170
Interactions for calcium bicarbonate.
Calcium decreases absorption of thyroid hormones, and some antibiotics
Zinc rich foods decrease absorption
171
Recommended dietary allowance for calcium supplements, what else is this supplement usually given with?
RDA: 1000-1200 mg/day
Often given w/ vit. D
172
Calcitonin. What are the uses, what is the MOA, what are the 3 routes?
Uses:
Does NOT prevent osteoporosis
Postmenopausal osteoporosis
Paget's disease and hypercalcemia secondary to hyperparathyroidism
Antihypercalcemic agent
MOA: acts similar to calcitonin produced by the thyroid glands. Inhibits bone resorption, decreases serum CA levels, increases excretion of phosphate, calcium, and sodium from the kidneys
Route: SC, IM, intranasal
173
Contraindications of calcitonin.
lactation, allergy to med/fish
174
AE of calcitonin.
Flushing of face and hands, n/v, rash
Hypocalcemia
Nasal dryness
Hypersensitivity
Decreased therapeutic effects over time
175
Bisphosphonates: alendronate. What are the uses. What is the MOA.
Uses:
Osteoporosis prevention and treatment in post-menopausal people
Age related osteoporosis in males
Glucocorticoids related osteoporosis
MOA: decreases bone resorption
176
What are the contraindications for alendronate.
Allergy
Hypocalcemia
177
AE of alendronate.
Hypocalcemia
GI: n/v, pain, constipation, diarrhea, esophagitis, ulceration
Osteonecrosis of the jaw
178
Interactions of alendronate.
Empty stomach
Take on full glass of water
Remain upright 30 min after taking
Diet needs adequate amount of vit d, calcium, and phosphates
179
SERMS: raloxifene. What are the uses. What is the MOA. What are some contraindications.
Uses:
Prevention and treatment of osteoporosis in postmenopausal people
Breast cancer prophylaxis of estrogen dependent or receptor positive breast cancers
MOA: activates estrogen receptors in endometrial tissue and bones. Decreases bone resorption and bone loss. Blocks access to estrogen receptors in breast tissues.
Contraindications:
Pregnancy (cat. X)
Lactation
Hx of thromboembolism
Allergy
180
What are AE of raloxifene (SERMS).
Increased risk of thromboembolic events
Hot flashes
Endometrial cancer
BBW: thromboembolism
181
DMARDS I: methotrexate. They are antimetabolite drugs and work by interfering with a normal metabolic process. What is their MOA and uses.
Uses:
RA
SLE
Malaria
Cancer
MOA: immunosuppression
182
Contraindications for methotrexate.
Allergy
Liver or renal insufficiency
Visual field damage
183
AE of methotrexate.
Liver damage
Bone marrow suppression
GI ulcers
Pulmonary fibrosis
Eye damage
184
Interactions for methotrexate.
Antacids
Hepatotoxic drugs
Alcohol
185
Other information for someone taking methotrexate.
Need routine eye exams
Drink 8-12 8oz glasses of water per day
Cat. X drug
If on methotrexate they need a weekly folic acid supplement
186
Heparin. What is the MOA, routes, and uses.
MOA: factor Xa thrombin inhibitor. Binds with antithrombin. Blocks the formation of prothrombin. Prevents formation of fibrin clots within minutes of IV admin.
Uses:
IV is 1st line for acute thromboembolic disorders
Also used to maintain line patency in heparin locks and arterial lines
Route: SQ and Iv
187
Labs for heparin. (which labs, how often are they measured, what's normal, what is the therapeutic range?)
Aptt or ptt is used to measure heparin
Meausred daily and 6-8 hours after dosage change
Normal: 25-40 seconds
Therapeutic: 1.5-2 x baseline (60-80 sec)
188
AE of heparin.
Bleeding
BBW
Heparin induced thrombocytopenia (HIT)
Hypersensitivity reactions
189
Antidote for heparin.
protamine sulfate.
190
Contraindications for heparin.
Active bleeding
Severe HTN
Recent trauma
Intracranial hemorrhage
191
Interactions of heparin.
Other anticoagulants and antiplatelet
Several herbs
192
Warfarin. Why is it used? MOA, route, and main AE.
Uses:
Long term prophylaxis of arterial thromboembolism
MI
Stroke
A fib
Prosthetic valves
MOA: inhibits 2 enzymes involved in Vit. K formation
Route: PO
Pregnancy cat: X
AE:
Bleeding
BBW
Toxicity
193
What is the antidote for warfarin?
Vit. K
194
Contraindications for warfarin.
Recent trauma
Active internal bleeding
Bleeding disorders
Intracranial hemorrhage
Sever HTN
195
Interactions for warfarin.
Numerous drugs, several herbs, foods high in vit. K
196
Nitrates: isosorbide dinitrate and nitroglycerin. What is the MOA.
Moa: relaxes and dilates veins, arteries, and capillaries. Allows for increased blood flow. Lowers BP. Decreases vasospasms of the arteries.
197
Nitrates: short-acting and long-acting. Name prototype for each.
Short acting: nitroglycerine
Long acting: isosorbide dinitrate
198
AE of nitrates.
CNS: HA, dizzy, weakness
GI: n/v
Skin: flushing, contact dermatitis
CV: hypotension, orthostatic hypotension, syncope, reflex tachycardia
Tolerance with long actings
199
Contraindications for nitrates.
Phosphodiesterase-5 inhibitors
Alcohol
200
Beta blockers: propranolol. What is it used for. MOA/routes.
Used for angina prophylaxis
Moa: decreases cardiac workload by lowering BP, slowing HR, and reducing contractility
Not effective in vasospastic angina
Uses:
HTN, HF, stable angina, post-acute MMI
Off label: migraine prophylaxis and unstable angina
MOA: selectively blocks beta
Route: PO and IV
201
AE of propranolol.
CV: bradycardia, hypotension
CNS: fatigue, dizziness
GI: n/v
Respiratory: bronchospasm
BBW
202
Contraindications for propranolol.
Severe bradycardia, heart block, shock
203
Interactions of propranolol.
other antihypertensives.
204
Cardiac glycosides: digoxin. What are the uses. What is the MOA. What are the routes.
Uses:
Alleviates s/s
Increases exercise tolerance
MOA: inhibits enzyme responsible for sodium and potassium ion exchange. This increases intracellular calcium and allows more Ca to enter myocardial cells
Increased force of myocardial contraction
Increased CO and renal perfusion
Slowed HR decreased conduction velocity through the AV node
Route: PO and IC
205
Digoxin has a narrow margin of safety. What is the therapeutic range, how often should digoxin levels be drawn after a dose?
range: 0.5-2
levels drawn 6-12 hours after a dose
206
Antidote for digoxin toxicity.
digoxin immune fab
207
AE of digoxin.
CV: arrhythmias, bradycardia
CNS: drowsiness, HA< weakness, vision changes
GI: n/v, anorexia
Digoxin toxicity: anorexia, n/v, malaise, depression, arrhythmias.
208
Contraindications of digoxin.
Allergy
Heart block
Acute MI
Ventricular dysrhythmias
Renal insufficiency
Caution in pregnancy and lactation
209
Interactions for digoxin.
St john's wort and psyllium
Ginseng, hawthorn, black licorice
Potassium losing diuretics
Refer to pharmacist because many meds increase digoxin levels
210
Other info. Hold digoxin if pulse is less than ___.
Hold if apical pulse less than 60
Bioavailability can differ
211
Phosphodiesterase III inhibitors: milrinone. What are the uses? What is the MOA? What is the route?
Uses:
Short term treatment of acute decompensated HF
Therapy is limited to 2-3 days and requires continuous monitoring
MOA: inhibits phosphodiesterase II which increases Ca levels in the cell. Increases contractility and cardiac output
Route: IV.
212
Contraindications for milrinone. Interactions as well.
Contraindications:
Allergy to milrinone or bisulfites
Interactions:
Can not combine milrinone with furosemide
213
Class 1b antidysrhythmic: lidocaine. What are the uses? What is the MOA? What are the routes?
Uses:
Treatment of life-threatening ventricular arrhythmias during MI or cardiac surgery
Treatment of refractory ventricular arrhythmias
MOA: blocks sodium ion channels. Shortens the duration of the action potential.
Route: IM, IV
214
What is the narrow therapeutic range for lidocaine?
1.5-5
215
AE of lidocaine.
CNS: dizzy, drowsiness, fatigue, twitching, mouth numbness, slurred speech
GI: changes in taste, n/v
CV: proarrhythmic, hypotension, vasodilation, cardiac arrest
216
Contraindications of lidocaine.
Allergy
Bradycardia
Heart block
HF
Hypotension
Shock
Electrolyte disturbances
217
Interactions of lidocaine.
Other antiarrhythmics
Beta blockers
Phenytoin
218
Class IV antidysrhythmic: CCB (verapamil). Uses. MOA. Routes.
Uses:
Only effective against atrial dysrhythmias
MOA: blocks movement of calcium ions in the cardiac and smooth muscle cells
Route: PO, IV
219
AE of verapamil.
CNS: dizzy, fatigue, depression, HA
GI: constipations, n/v
CV: hypotension, HF, shock, arrhythmias, edema
220
Contraindications of verapamil.
Allergy
Heart block
Severe HF
Hypotension
221
Interactions for verapmail.
Alcohol
Grapefruit juice
Beta blockers
222
Antimicrobials and cancer. Define difference between bactericidal and bacteriostatic.
Bactericidal: destroys bacteria
Bacteriostatic: prevents growth
223
Cephalosporins: cefazolin. What are the routes, what is the MOA.
Route: PO, IM, IV
MOA: causes bacteria to build weak cell walls when dividing. Bacteriostatic or bactericidal depending on the dose
224
Categories for cefazolin.
5 generations
Increasing activity against gram (-)
Increasing resistance to beta lactamases
Increasing ability to reach CSF
225
AE of cefazolin.
GI s/s
Allergic reactions
Injection site reactions
CNS: HA, dizzy
Nephrotoxicity
Superinfections
226
Contraindications of cefazolin.
Allergy to drug or PCN
227
Interactions for cefazolin. Only 1.
alcohol
228
Metronidazole. What are the routes. What is the MOA. What are the main AE.
Route: PO, IV
MOA: inhibits DNA and RNA synthesis. Bactericidal
AE:
Nausea, dry mouth, HA
Neurotoxicity
BBW: cancer in lab animals
229
Contraindication and interaction for metronidazole.
Contraindications:
Allergy
Interactions:
Alcohol (disulfiram-like reaction)
230
Other information for metronidazole. (what else is it used for, what happens to urine)
Used for protozoal infections, PUD, and infections caused by obligate anaerobic bacteria. Causes harmless darkening of urine
231
Drugs used for tuberculosis. RIPES.
R- rifampin
I- isoniazid
P- pyrazinamide
E- ethambutol
S- streptomycin
232
Alkylating agents: cisplatin and cyclophosphamide. What is the MOA. What are the routes.
MOA: non-cell cycle specific. Kills cancer cells by altering the shape of the DNA double helix and preventing the DNA from duplicating during cell division
They are broad spectrum and used against many types of malignancies
Route: po and IV
233
AE of cisplatin/cyclophosphamides (alkylating agents).
GI
Skin
Hematologic
Secondary cancers, cardiotoxicity, hepatotoxicity, renal toxicity, pulmonary fibrosis
Infertility
Strong vesicants
Cancer cells can develop resistance w/ prolonged treatment
234
Interactions of alkylating agents.
Anticoagulants
Agents that cause: Bone marrow suppression, cardiotoxicity, hepatotoxicity, renal toxicity
St john's wort
235
Nursing considerations for alkylating agents.
Pre medicate with an antiemetic
Monitor: I&Os, labs, s/s infection
Admin mesna (prevent hemorrhagic cystitis) cyclophosphamide
Admin amifostine (prevent renal toxicity) cisplatin
Educate on no live virus vaccines
236
Targeted therapies: monoclonal antibodies. (What do antineoplastic drugs specifically do? what is the MOA of monoclonal antibodies)
Antineoplastic drugs that have been specifically engineered to attack cancer antigens of a specific cancer
Once a MAB binds to the cancer antigen it either directly kills the cancer cell or marks it for the destruction by other immune responses
Example: monoclonal antibodies that target breast cancer with HER2
237
SSRI: fluoxetine. What are the uses. What is the MOA. What is the route.
First choice of drugs for depression
Use:
Depression and anxiety
OCD
Panic attacks
Bulimia
PMDD
PTSD
Social phobias and social anxiety disorder
MOA: blocks reuptake of serotonin
Route: PO
238
Fluoxetine can take up to how many weeks to reach therapeutic effects?
4 weeks for peak effec
239
AE of fluoxetine.
GI: n/v, diarrhea, dry mouth
CNS: HA, dizzy, insomnia, nervousness, anxiety, tremors, agitation, mania
GU: painful menstruation and sexual dysfunction
Weight gain
Bruxism
BBW: suicide
Serotonin syndrome
Withdrawal
240
Contraindications for Fluoxetine.
Allergy
SNRIs, MAOIs, TCAs
241
Interactions for Fluoxetine.
SNRIs, MAOIs, TCAs
St john's wort
Primrose
Grapefruit juice
242
Bupropion. What is the MOA. What are the uses.
Moa: weekly blocks reuptake of norepinephrine and dopamine
Use:
Depression
Prevention of seasonal affective disorder
Smoking cessation
Not used for anxiety
243
What are the benefits of bupropion.
Acts as a stimulant and suppresses appetite
Does not cause weight gain
Increases sex desire and pleasure
Available in ER
244
What are the AE of bupropion?
CNS: HA< insomnia, agitation, tremor, seizures, psychosis
CV: tachycardia
GI: N/V, weight loss
BBW: suicide
245
Contraindications for buproprion.
Allergy
Seizure disorders or hx of anorexia nervosa
246
Interactions for bupropion.
SSRIs, SNRIs, MAOIs, TCAs
St john's wort
Other herbal therapies
247
MAOIs: phenelzine. How long might it take to see therapeutic effects? What is the route?
May take 12 weeks for therapeutic effects
Route: PO
248
AE of MAOIs.
CNS: dizzy, nervousness, insomnia, blurred vision, mania
GI: n/v, diarrhea, constipation, weight gain, dry mouth, liver toxicity
GU: sex dysfunction, incontinence, urinary retention
CV: hypotension, palpitations, dysrhythmias, angina, HTN crisis
BBW: suicide
Withdrawal
249
Interactions for MAOIs.
Tyramine
St. John's wort
Other herbs
Check w/ prescriber before taking any other meds
250
Atypical antipsychotics: risperidone. What is the MOA. What are the AE.
Moa: moderate blockade of dopamine receptors. Strong blockade for serotonin
AE:
metabolic effects (weight gain diabetes, dyslipidemia)
GI: n/v, constipation, increased salivation
251
Movement disorders. Acute dystonia. (Manifestations, timeframe, treatment.)
Manifestations: severe painful spasms of muscles in neck and body
Timeframe: early in the course of treatment
Treatment: anticholinergic drugs (diphenhydramine and benztropine)
252
Movement disorders. Parkinsonism. (Manifestations, timeframe, treatment).
Manifestations: bradykinesia, mask like face, drooling, tremor, rigidity, shuffling gait, stooped posture
Timeframe: first month of therapy
Treatments: anticholinergic drugs and amantadine
253
Movement disorders. Akathasia. (Manifestations, timeframe, treatments).
Manifestations: inability to rest and relax. Pacing. Trouble sleeping. Trouble remaining still. Repetitive movements.
Timeframe: first 2 months of therapy
Treatments: benzos and betablockers
254
Movement disorders. Tardive dyskinesia. (Manifestations, timeframe, treatment).
Manifestations: twisting, writing, worm-like movements of the tongue, face, and neck. Lip smacking. Tongue darting
Timeframe: during long term treatment and may persist for years after the drug is discontinued.
Treatment: deutetrabenazine and valbenazine
255
Estrogen. What are the uses.
Hormone replacement therapy
Palliation for menopause discomfort
Hypogonadism and ovarian failure therapy
Contraception
Osteoporosis
Estrogen sensitive cancers
Acne
256
AE of estrogen.
GU: breakthrough bleeding, menstrual irregularities, dysmenorrhea, changes in libido
GI: n/v, abd cramps, bloating, acute pancreatitis, gallbladder disease, jaundice, hepatic adenomas
CNS: HA
Genral: fluid retention, chloasma
257
Contraindications for estrogen.
Estrogen dependent cancers
Hx or thromboembolic disorders
Heavy smokers
Hepatic dysfunction
Pregnancy and lactation
258
BBW for estrogen.
Breast cancer
r/f endometrial cancer
Not used for dementia of CVD treatment
Increase r/f stork and thromboembolic disorders and dementia in those 65+
259
Progestins. What are the uses, what are the AE.
Uses:
Postmenopausal hormone therapy
Contraception
Functional uterine bleeding
Amenorrhea
Infertility
AE:
Similar to estrogens
Teratogenic effects
Vaginal bleeding
Depression/mood swings
Breast tenderness
Bloating
260
Contraindications for progestins.
endometriosis, same as estrogens.
261
BBW for progestins.
Increased r/f stroke, DVT, PE, and MI
Breast cancer
Increase r/f dementia
Not approved for treatment of CVD or dementia
262
IUDs. Hormonal (how long is it good for, when is it placed)
Among the most effective contraceptive available
Placed within 7 days of onset of menses
Good for 3-6 years
263
Nonhormonal IUDs. When is it placed, good for how long? what are AE?
Among most effective contraceptives
Places within 7 days onset of menses
Good for 10 years
Heavy periods and cramping
264
Tocolytics: magnesium sulfate. What are they used for? If combined with glucocorticoids they can accelerate _____?
Uterine relaxants
Suppression of preterm labor
If used in combo with glucocorticoids can accelerate lung development
Also used to buy time to treat infection
265
Testosterone. What are contraindications? Warning r/t drug.
Class III controlled substance
Contraindications
Allergy
Pregnancy and lactation
Breast cancer
Warning
Risk of CV events and need to evaluate the patient carefully for appropriate use of the drug
266
AE of testosterone.
Androgenic effects: acne, edema, hirsutism, deep voice, oily skin and hair, weight gain, penile enlargement, testicular atrophy
Prepubescants: virilization and reduced height
Postpubescents: inhibition of testicular function, gynecomastia, priapism, baldness, prostate issues, changes in libido
Antiestrogen effects: flushing, sweating, menstrual irregularities, no menses, hirsutism, clitoris growth, emotional liability
Other: HA, dizzy, sleep disorders, fatigue, rash
GI: hepatocellular cancer or hepatitis
BBW: topical forms for virilizations in children wo come in contact
Inappropriate use: CV events and prostate issues
267
PDE5 Inhibitors: sildenafil. What is the MOA.
increases nitrous oxide levels in the corpus cavernosum
268
Contraindications and interactions for sildenafil.
Contraindications:
Pregnancy and lactation
Penile implants
Not to be used to increase sexual performance in people with vaginas
Interactions
Nitrates
Alpha blockers
Grapefruit juice
269
AE of sildenafil.
Hypotension
Priapism
Headache, flushing, dyspepsia, UTI, diarrhea, dizzy, rash
Rare: opic neuropathy, sudden hearing loss, risk for melanoma
270
Onset of sildenafil.
Sildenafil: 27 minutes... take one-hour before anticipated sexual stimulation
271
Alpha blockers. What are they used for? what is the MOA.
Use: benign prostatic hyperplasia
Moa: blockade of alpha receptors relaxes smooth muscle in the bladder neck, prostate capsule, and prostatic urethra
all end in -sin.
