Pharmacology review Flashcards
Acetylcysteine (Mucomyst)
antedote for poisoning [hepatotoxic OD] with acetaminophen (PO w/I 24 hrs)
Prevents or lessens liver damage
Dilute in fruit juice or other beverage
Will make nasal and bronchial secretions watery and facilitate coughing
antiemics
Hormones
Darepoetin
epoetin
antiemics
Iron Supplements
Ferros fumarate, gluconate, sulfate, iron dextran, iron polysaccharide, iron sucrose, sodium ferric gluconate complex
w/OJ, not milk, tarry stools, constipation, stains teeth.
antianginals
Nitrates
Prevent and treat attacks
Dilate coronary arteries, cause systemic vasodilation
End in –ate except nitroglycerin
Many forms, including sublingual
antianginals
Calcium Channel Blockers
prophylactic
Dilate coronary arteries, some also slow HR
End in –ine; except diltiazem and verapamil
antianginals
Beta Blockers-
prophylactic
Decrease myocardial oxygen consumption via decrease in heart rate
End in -olol
Benzodiazepenes
anti-anxiety
End in –am Alprazolam (Xanax) Diazepam (Valium) Lorazepam (Ativan) Midazolam (versed) Depress CNS Daytime drowsiness/ alcohol potentiates Tolerance/potential for physical dependence
antiarrhythmics
Advise to take pulse before and hold for pulse <50 Don’t crush, open, break or chew Lidocaine Amiodorone Fosphenytoin Diltiazem Phenytoin Verampamil Propafenone Atropine Esmolol Digoxin
bronchodilators - acute
albuterol
epi
levalbuteral (Xopenex)
bronchodilaters - chronic
Metaproterenol [Alupent] Pirbuterol [Maxair] Salmeterol (long) Terbutaline [po, SC, IV] Theophylline Formoterol (long) Aminophylline [po/IV]
how to use bronchodilators
Always use bronchodilator FIRST and allow 5 minutes before other medications
antiasthmatics - corticosteroids
Beclomethasone (Qvar) Betamethasone (Celestone) Budesonide (Pulmicort) Cortisone Dexamethasone Flunisolide (Aerobid) Fluticasone (Flovent) Hydrocortisone Methylprednisolone Mometasone Prednisolone Prednisone Triamcinolone ALL DECREASE INFLAMMATION PROPHYLACTIC- NOT FOR ACUTE ATTACKS
anticholinergics - action, outcomes
dry things up.
May give prior to intubation
^ HR, Decrease N/V, Dry mouth, Dilation pupils, Decrease GI motility, Resolution of signs of Parkinson’s
Atropine-anticholinergics
Bradyrythmias- given for slow heart rate, will ^ HR.
Ipratropium- anticholinergics
Bronchospasm (inhalation) and rhinorrhea (nasal)
Scopolomine - anticholinergics
apply patch at least 4 hours before travel. PO 30 min before meal.
Heparin
Monitor aPTT with full-dose heparin therapy and HCT and other clotting factors through treatment
Overdose antidote is protamine sulfate
Enoxaprin (lovenox)- SC
- low molecular weight
Coumadins
Warfarin
Monitor PT/ INR- 2-3
Antidote for overdose is Vitamin K
warfarin - diet
Review foods high in Vitamin K with pts. On warfarin. Consistent intake is necessary- fluctuation will cause fluctuation in PT and dose adjustment necessary.
Miglitol - antidiabetic
delays digestion of ingested carbs, thus lowering blood glucose and may be combined with sulfonylureas.
Sulfonylureas, nateglinide, repaglinide, and metformin - antidiabetics
lower blood glucose by stimulating endogenous insulin secretion by beta cells of pancreas and increasing sensitivity to insulin at receptor sites
Pioglitizone and rosiglitazone - antidiabetics
increase insulin sensitivity
ace inhibitors - anti hypertensives
teaching
Teach how to take BP Change position slowly Watch OTC cold meds Not advised during pregnancy Take even when not feeling well to avoid rebound hypertension Always tell MD if side effects > outcome
ace inhibitors do what
convert angiotension 1 to angiotension 2. it is an antihypertension
beta blockers do what
help lower bp, lower pule rate and lower cardiac output
benzodiazepines are used for what
anticonvulsants and anitanxiet
nursing interventions for working with beta blockers
monitor lab values (protein, BUN, creatinine), monitor bp, heart rate and rhytm and monitor for signs of edema
nursing interventions for anti-infectives
obtain a history of allergies, monitor i and o. monitor v/s, monitor for s/s of nephrotoxicity and monitor for s/s of ototoxictiy
nursing interventions for ace inhibirtors
monitor v/s, monitor wbc count, monitor electrolyte count
nursing interventions for benzodiazepines
monitor respirations, monitor liver and kidney function. monitor bone marrow function and monitor for signs of chemical abuse
phenothiazines are for what
antiemetics or neuroleptics. used to tx in clients with schizophrenia
glucocorticoids used to treat what
conditions requiring suppression of the immune system and in addisons disease. they have anti inflammatory anti-allergenic and anti stress effects. used for replacement therapy for adrenal insufficiency . also to reduce cerebral edema associated with head trauma, neurosurgery and brain tumors
antivirals
used to treat herpes, chicken pox,shingles, herpes simplex, cytomegalovirus (cmv), respirator syncytical virus (rsv)
nursing interventions for antivirals
tell client to report a rash, watch for signs of infection, monitor creatinine level, monitor liver profile, monitor bowel pattern before and during tx
cholesterol lowering agents
help lower cholesterol and triglyceride levels and decrease potential for heart disease
interventions for cholesterol lowering agents
a deit low in cholesterol and fat, monitor cholesterol, monitor liver and renal, tell client to report visual changes, and monitor for muscle weakenss and pain
angiotensin receptor blockers
block vasoconstrictor and aldosterone-secreting angiotension 2. used to treat primary or secondary hypertension. these drugs lower bp and increase cardiac output
nursing interventions for angiotensin receptor blockers
monitor bp and pulse, monitor bun, monitor creatinine and electrolyte, tell client to report edema in feet and legs daily and monitor hydration status
cox 2 enzyme blockers
used to tx osteoarthritis and rheumatoid arthritis. this drug category considered to be nsaid
nursing interventions for cox 2 enzymes
tell client to report changes in bowel habits thatt indicate gi bleeding, monitor platelet count and tell client to report easy bruisin
histamine 2 antagonists
used to tx gerd, acid reflux and gastric ulcers. they inhibit histamine 2 release in gastric parietal cells therefore inhibit gastric acids
nursing interventions for histamine 2 antagonists
monitor bun, administer wit meals, if taking med with antacids, take antacids 1 hour before or after taking drugs. cimietidine may be prescribed in one large dose at bedtime. sucralfate decreases the effects of histamine 2 receptor blockers
proton pump inhibitors
suppress gastric secretion by inhibit the hydrogen/potassium ATPase enzyme system. they are used in tx of gastric ulcers, indigestion and gerd
interventions for proton pump inhibitors
do NOT crush pantoprazole (protonix) use a filter when administering IV pantoprazole. may take before meals for best absorption and monitor liver function
anticoagulants
used in tx of thrombolytic disease. used to tx pulmonary emboli, myocardial infarction, dvt, after coronary bypass surgery
nursing intervention for anticoagulants
blood studies (hematocrit and occult blood in stool should be checked every 3 months) monitor ptt (therapeutic levels are 1.5-2 times the control) monitor platelet count, monitor for s/s of bleeding monitor for signs of infection
HERBAL. feverfew
used to tx migraines, arthritis and fever. should not be taken wit coumadin, aspirin, nsaids, thrombolytics or anitplatet meds b/c it will prolong bleeding time
HERBAL. ginseng
used as an anti-inflammatory. it has estrogen effects, enhances immune system and physical abilities. this herbal decreases anticoagulants and nsaids. should not be taken wit clients who are taken corticosteriods
HERBAL. gingko
used to improve memory and depression. improves peripheral circulation, should not be taken with MAO inhibitors, anticoagulants or anti-platelets
HERBAL. echinacea
used to tx colds, fever and utis. may interfere with immmunosuppressive agents, methotrexate and ketoconizole
HERBAL. kave-kava
tx insomnia and mild muscle aches and pains. increases effects of cns suppressants and decreases effects of levodopa. can increase effect of maoi
HERBAL. st johns wort
to tx mild to moderate depresssion. increases adverses cns effects when used with etoh or antidepressant medications
HERBAL. ma huang
used to tx asthma and hay fever, for wt loss and to increase energy levels. may increase effect of maois, sympathomimetic, theophyllline and cardiac glycosides
pregnancy category. category a
no risk to fetus
pregnancy category category b
insufficient data to use in pregnancy
pregnancy category. category c
benefits of med could outweigh the risks
pregnancy category. category d
risk to fetus exist, but the benefits of the med could outweigh the probable risks
pregnancy category. category x
avoid use in pregnancy or those who may become pregnant. potential risks to fetus outweigh the potential benefits
OD
Right eye
OS
Left eye
OU
Both eyes
Injection into the fatty layer under the skin. Sites include upper abdomen, upper thigh, or lateral upper arm. Amounts are usually 0.5-1.5 Medication is to be absorbed slowly with prolonged effect.
Subcutaneous
Good for poorly soluble drugs, irritating drugs, provides systemic effect
Intramuscular
Provides rapid onset. Gives option of larger fluid volume therefore diluting irritating drugs, Amounts are usually over 5 ml
Intravenous
Patient should lie on left side for insertion and water-soluble lubricant should be used.
suppositories
Suspension of fat globules in water
emulsion
Drugs dissolved in alcohol
tincture
Drug coated with substance that delays release of drug until it reaches the intestine (should not be crushed)
enteric coated
Reactive site on the surface or inside of a cell.
Receptor
The length of time the body takes to reduce the plasma level of a drug to 50% of its peak value. Duration of action for most drugs.
Half-life
Drugs that bind to a receptor and cause effects that mimic normal cell activities.
Agonists
Drugs that bind to a receptor and inhibit normal cell activities
Antagonists
Enzymatic alteration of drug structure, also known as biotransformation
Metabolism
Sympathetic NS mimics the “fight or flight” response selectively stimulating alpha & beta adrenergic receptors Includes vasoconstrictors (Norepinephrine) & Inotropes (Dopamine & Dobutrex)Increase HR and B/P
Adrenergic
Dopamine involvement in CNS regulation, having a major effect on the akinesia of Parkinson’s (Sinemet & Levodopa)
Dopaminergic
Drugs that stimulate the PSNS by mimicking ACh. Promote muscle contraction & bladder emptying treating urinary retention. Side effects: abdominal cramps, salivation, N/V & diarrhea
Cholinergic drugs
Drugs that block or impede the activity of the neurotransmitter acetylcholine (ACh) at cholinergic receptors in the brain. Relax smooth muscles
Anticholinergic drugs
Antibiotic: broad spectrum, gram +, first choice for meningitis, syphillis
Penicillin’s
Chemically very similar to Penicillin. If have allergic reaction to Penicillin can also have a reaction to this
Cephalosporin’s
Used to treat MRSA, adverse reaction includes ototoxicity, administer slowly, poorly absorbed orally
Vancomycin
Used to treat GI infections, Rocky Mountain Spotted Fever. Take on empty stomach, no milk products. Decrease the effectiveness of oral contraceptives.
Tetracycline
Dilation of arteries and veins. Treat dopamine infiltration sites. Side effect: orthostatic hypotension. A-blocker
Regitine
Vasoconstriction
Alpha
Muscle activity
Beta
Mycoardium, increased HR, increased contraction
B1
Bronchial & Vascular smooth muscles: Bronchial relaxation and arterial dilation to skeletal muscles
B2
The main clinical usage of calcium channel blockers
Decrease blood pressure
Calcium channel blockers work by
blocking voltage-gated calcium channels (VGCCs) in muscle cells of the heart and blood vessels. When Ca+ decreases, Blood pressure decreases
Reduce arterial pressure by preventing generation of angiotensin II from angiotensin I
Ace Inhibitors
Cause decrease in B/P and increased renal perfusion. A persistent dry cough is a relatively common adverse effect.
Ace Inhibitors
End in pril, captopril, enalapril, lisinopril
Ace Inhibitors
End in olol, propanolol, labetalol. Decrease heart rate and force of contraction.
Beta adrenergic antagonist-Beta blockers
A common mnemonic used to describe the physiologic manifestations of atropine overdose is
“hot as a hare, blind as a bat, dry as a bone, red as a beet, and mad as a hatter”.
Reverse cholinergic (parasympathetic) effects. Blocks ACh at receptor sites in smooth muscles, secretory glands, SA & AV nodes & cardiac muscle Ex: Scopolamine-motion sickness, Atropine- treatment for bradycardia
Anticholinergics
CNS neurotransmitter, Action: Inhibits excitatory signals produced by ACh. Decrease levels cause tremors (pill rolling) rigidity, bradykinesia, akinesia
Dopamine
Extensive deterioration of neurons at basal ganglia.
Parkinson’s Disease
Major effects of Opioids
Decreased level of consciousness, respiratory depression, orthostatic hypotension, decreased muscle tone, urinary retention
Opioid antagonist: Drug used to counter the effects of opioid overdose ex. heroin or morphine overdose
Narcan
Produce maximal response (schedule II drugs)Ex: codeine, morphine, demerol, oxycodone
Opioid agonist
Supress gastric acid secretion by irreversibly binding with proton pump system that controls hydrogen ion secretion. Use on high risk patients ex: Prevacid, Prilosec
Proton Pump Inhibitors
Used for Asthma, COPD, Anti-inflammatory effect-reduced mucus secretion in respiratory conditions
Corticosteroids
Side effects of Corticosteroids
Mask infections, hyperglycemia, slow wound healing
Side effects of Beta Agonists
Tachycardia, headache, angina, muscle tremors
Relieve bronchoconstriction, open airway ex: alupent, serevent proventil (inhalers)
Beta Agonists