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NURS 424 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Albuterol: classification

A

Short acting beta2 receptor agonist

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2
Q

Albuterol: indications

A

Asthma, COPD

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3
Q

Albuterol: MOA

A

Acts on smooth muscle of the bronchi to reverse bronchospasm –> decreases airway resistance and residual volume –> increases vital capacity and airflow

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4
Q

Albuterol: onset

A

Within 5 minutes

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5
Q

Albuterol: caution and contraindications

A

Should be avoided in arrhythmias that cause tachycardia and pheochromocytoma (severe HTN)

Caution w/ CVD, DM, glaucoma, hyperthyroidism

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6
Q

Can albuterol be used in pregnancy and lactation?

A

Benefits outweigh risks in pregnancy (approved in peds)

Compatible w/ lactation

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7
Q

Albuterol: adverse effects

A

Tachycardia, dizziness, palpitations, tremors, nervousness, HA

Mild effect on beta1 receptors –> heart effects

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8
Q

Salmeterol (Serevent): classification

A

Long-acting beta2 receptor agonist

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9
Q

Salmeterol (Serevent): indications

A

Asthma, COPD

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10
Q

Salmeterol (Serevent): MOA

A

Relaxes bronchial smooth muscle by selective action on beta2 receptors

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11
Q

Can salmeterol (Serevent) be used without an asthma controller medication?

A

NO - need to be used along with asthma controller medication such as inhaled steroid

Used alone could cause respiratory asthma related death

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12
Q

Salmeterol (Serevent): caution and contraindications

A

Caution in patients with CVD, DM, hyperthyroidism, glaucoma

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13
Q

Can salmeterol (Serevent) be used in pregnancy and lactation?

A

Benefits outweigh the risks in pregnancy, safe in lactation

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14
Q

Salmeterol (Serevent): adverse effects

A

Tachycardia, palpitations, tremors, nervousness, HA

Overuse may lead to increase adverse effects and paradoxical effects

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15
Q

Theophylline: classification

A

Xanthine derivative

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16
Q

Theophylline: indications

A

Asthma (NOT first line), COPD

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17
Q

Theophylline: MOA

A

Inhibits specific phosphodiesterase –> increase cAMP –> relaxation of bronchial smooth muscle and pulmonary vessel relaxation

Increases force of diaphragmatic muscle

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18
Q

Theophylline: caution and contraindications

A

Avoid in patients with hypersensitivity to any xanthine, PUD, underlying seizure disorder

Closely monitor with CVD

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19
Q

Can theophylline be used in pregnancy and lactation?

A

Asses risks and benefits in pregnancy

Approved in pediatrics

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20
Q

Theophylline: adverse effects

A

Tachycardia, palpitations, irritability, gastric irritation, HA

If blood levels are >20, may see N/V/D, insomnia, greater irritability

If >30, seizures, arrhythmias, death

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21
Q

Theophylline TI

A

10-20 mcg/mL

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22
Q

Theophylline: patient education

A

Similar structure to caffeine and smoking increases excretion –> avoid smoking and caffeine

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23
Q

Ipratropium bromide (Atrovent): classification

A

Short acting anticholinergics

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24
Q

Ipratropium bromide (Atrovent): indications

A

Asthma exacerbation, COPD

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25
Q

Ipratropium bromide (Atrovent): MOA

A

Blocks action of ACTH at muscarinic cholinergic receptors in bronchial smooth muscle –> bronchodilation

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26
Q

Ipratropium bromide (Atrovent): onset

A

15 minutes

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27
Q 
True/False
Ipratropium bromide (Atrovent) is given in combination with albuterol
A

True - ONLY used for asthma exacerbation if combined with albuterol

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28
Q

Ipratropium bromide (Atrovent): caution and contraindications

A

Avoid in patients with urinary retention, BPH, closed-angle glaucoma

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29
Q

Is ipratropium bromide (Atrovent) compatible with pregnancy and lactation?

A

ONLY if clearly indicated in pregnancy

Compatible with lactation

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30
Q

Ipratropium bromide (Atrovent): adverse effects

A

Cough, dry mouth, mouth and throat irritation, dyspepsia, N/V

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31
Q

Tiotropium bromide (Spiriva): classification

A

Long-acting anticholinergic

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32
Q

Tiotropium bromide (Spiriva): indications

A

Asthma, COPD

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33
Q

Tiotropium bromide (Spiriva): MOA

A

Inhibits muscarinic M3 receptors in the lungs –> smooth muscle bronchodilation

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34
Q

Tiotropium bromide (Spiriva): caution and contraindications

A

Avoid in patients with urinary retention, BPH, closed-angle glaucoma

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35
Q

Can tiotropium bromide (Spiriva) be used during asthma exacerbations?

A

NO

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36
Q

Can tiotropium bromide (Spiriva) be used with pregnancy and lactation?

A

Use ONLY if clearly indicated in pregnancy

Compatible with lactation

Approved for kids >6 years old

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37
Q

Tiotropium bromide (Spiriva): adverse effects

A

Dry mouth, pharyngitis, URI, HA, mouth irritation

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38
Q

What should providers monitor for in children who take leukotriene modifiers?

A

Neuropsychiatric events

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39
Q

Montelukast (Singulair): classification

A

Leukotriene modifier

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40
Q

Montelukast (Singulair): indications

A

Chronic asthma, allergic rhinitis

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41
Q

Montelukast (Singulair): MOA

A

Inhibits the CysLT1 receptor (correlated with pathophysiology of asthma) –> decrease airway edema, smooth muscle contraction

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42
Q

Can montelukast (Singulair) be used for asthma exacerbations?

A

NO

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43
Q

Montelukast (Singulair): caution and contraindications

A

Zafirlukast should NOT be used in active liver disease

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44
Q

Can montelukast (Singulair) be used with pregnancy and lactation?

A

Pregnancy - yes
Lactation - NO

Montelukast can be used in children >1 years, Zafirlukast >5 years

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45
Q

Montelukast (Singulair): adverse effects

A

HA, GI upset, myalgia

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46
Q

Zileuton (Zyflo): classification

A

Leukotriene modifier

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47
Q

Zileuton (Zyflo): indications

A

Chronic asthma

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48
Q

Zileuton (Zyflo): MOA

A

Inhibits 5-lipoxygenase which catabolizes formation of leukotrienes from arachidonic acid

Decreases inflammation, edema, mucous secretion, bronchoconstriction

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49
Q

Zileuton (Zyflo): caution and contraindications

A

Should NOT be used in active liver disease

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50
Q

Can zileuton (Zyflo) by used for asthma exacerbations?

A

NO

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51
Q

Can zileuton (Zyflo) be used in pregnancy and lactation?

A

NO - use montelukast

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52
Q

Zileuton (Zyflo): adverse effects

A

HA, dyspepsia, increased serum ALT, myalgia, URI

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53
Q

Fluticasone (Flovent or Flonase): classification

A

Corticosteroid

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54
Q

Fluticasone (Flovent or Flonase): indications

A

Asthma, COPD, allergic rhinitis

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55
Q

Fluticasone (Flovent or Flonase): MOA

A

Extremely potent vasoconstrictive and anti-inflammatory activity

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56
Q

Flovent: MOA

A

Inhaled; inhibits IgE in mast cell migration of inflammatory cells into the bronchioles

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57
Q

Flonase: MOA

A

Intranasal; decreases inflammation of nasal mucosa alone

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58
Q

Fluticasone (Flovent or Flonase): onset

A

3-7 days

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59
Q

Fluticasone (Flovent or Flonase): caution and contraindications

A

Caution in those with active infection

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60
Q

Can fluticasone (Flovent or Flonase) be used during pregnancy and lactation?

A

Pregnancy and lactation: compatible

Evaluate age of ped patient in relation to drug used

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61
Q

Can fluticasone (Flovent or Flonase) be used for asthma exacerbations?

A

NO

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62
Q

Fluticasone (Flovent or Flonase): adverse effects

A

Xerostomia, hoarseness, mouth and throat irritation, flushing, bad taste, oral candidiasis, rash and urticaria (rare)

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63
Q

Cromolyn sodium: classification

A

Inhaled anti-inflammatory agent

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64
Q

Cromolyn sodium: indications

A

Asthma, bronchospasm prophylaxis, allergic rhinitis

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65
Q

Cromolyn sodium: MOA

A

Inhibits antigen-induced bronchospasm and blocks release of histamine by inhibiting mast cell degranulation

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66
Q

Can cromolyn sodium be used during pregnancy and lactation?

A

Other inhaled agents preferred in pregnancy and lactation (e.g. intranasal formulations)

Approved in children >2 years old

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67
Q

Can cromolyn sodium be used for asthma exacerbations?

A

NO

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68
Q

Azelastine (Astepro) and Olopatadine (Patanase): classification

A

Inhaled antihistamine

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69
Q

Azelastine (Astepro) and Olopatadine (Patanase): indications

A

Seasonal allergic rhinitis, vasomotor rhinitis

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70
Q

Azelastine (Astepro) and Olopatadine (Patanase): MOA

A

Inhibits release of histamine by competing with histamine at H1 receptor sites

Improves mucous transport

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71
Q

Azelastine (Astepro) and Olopatadine (Patanase): caution and contraindications

A

DO NOT combine with CNS depressants

Avoid driving or operating heavy machinery while using

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72
Q

Can Azelastine (Astepro) and Olopatadine (Patanase) be used in pregnancy and lactation?

A

NO but approved in pediatrics (but not first option d/t somnolence)

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73
Q

Azelastine (Astepro) and Olopatadine (Patanase): adverse effects

A

Somnolence (greater with azelastine), bitter taste, HA, nasal irritation

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74
Q

Diphenhydramine (Benadryl): classification

A

First-generation antihistamine (causes drowsiness)

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75
Q

Diphenhydramine (Benadryl): indications

A

Allergic rhinitis, hypersensitivity reactions, urticaria and angioedema, insomnia, motion sickness, antiemetics

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76
Q

Diphenhydramine (Benadryl): MOA

A

Competitively antagonizes the effects of histamine at the peripheral H1 receptor sites at the GI tract, blood vessels, and respiratory tract

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77
Q

Diphenhydramine (Benadryl): onset

A

15-30 minutes

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78
Q

Diphenhydramine (Benadryl): caution and contraindications

A

Not to be combined with CNS depressants

Avoid in patients with narrow angle glaucoma, BPH, those with thickened respiratory secretions

Caution in elderly (BEERS criteria)

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79
Q

Can diphenhydramine (Benadryl) be used in pregnancy, pediatrics, and lactation?

A

Avoid premature infants, newborns, and young children –> paradoxical effects

Use alternative agents for pregnancy and lactation

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80
Q

Diphenhydramine (Benadryl): adverse effects

A

Sedation, dizziness, confusion, ataxia, urinary retention, paradoxical excitation, dry mouth, tremor, blurred vision

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81
Q

First vs second generation antihistamines

A

Second gens cause no drowsiness (avoids crossing BBB), longer acting

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82
Q

Cetirizine, Loratadine, Fexofenadine: classification

A

Second generation antihistamines

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83
Q

Cetirizine, Loratadine, Fexofenadine: indications

A

Respiratory allergies, urticaria

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84
Q

Cetirizine, Loratadine, Fexofenadine: MOA

A

Competitively antagonizes the effects of histamine at peripheral H1 receptor sites at the GI tract, blood vessels, respiratory tract

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85
Q

Which second generation antihistamine has the fastest onset and least metabolized by the P450 system?

A

Cetirizine –> avoid in patients with chronic liver disease

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86
Q

Cetirizine, Loratadine, Fexofenadine: caution and contraindications

A

Additive drowsiness when combined with CNS depressants

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87
Q

Can Cetirizine, Loratadine, and Fexofenadine be used in pregnancy and lactation?

A

Caution in pregnancy and lactation

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88
Q

Cetirizine, Loratadine, Fexofenadine: adverse effects

A

HA, drowsiness, nervousness

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89
Q

What classification of medication are decongestants?

A

Alpha adrenergic agonists (sympathomimetic)

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90
Q

What is the most commonly used systemic decongestant?

A

Pseudoephedrine

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91
Q

Systemic decongestant MOA

A

Vasoconstriction by stimulating alpha receptors within mucosa of respiratory tract and mucus membranes

92
Q

True/False

Pseudoephedrine has mild CNS stimulant effects

A

True - increased HR, force of contraction, cardiac output

93
Q

Topical decongestant MOA

A

Intense vasoconstriction when applied directly to swollen mucous membranes of nasal passage

94
Q

Decongestant: caution and contraindications

A

Avoid in severe HTN and CAD (oral)

Avoid in combination with beta blockers

95
Q

Can decongestants be used in pregnancy and lactation?

A

Not recommended for children <4 years (oral), pregnancy, and lactation

96
Q

Decongestant: adverse effects

A

Anxiety, restlessness, HA, insomnia, psychological disturbances, tremors, HTN, tachycardia

97
Q

Dexotromethorphan, codeine, benzonatate: classification

A

Antitussives (cough meds)

98
Q

Dexotromethorphan: MOA

A

Acts centrally in the medulla to elevate the threshold for coughing (structurally related to codeine)

Okay with pregnancy and lactation

99
Q

Codeine: MOA

A

Direct effect on cough receptors in the medulla

100
Q

Benzonatate: MOA

A

Related to anesthetic tetracaine and thought to anesthetize the stretch receptors in the respiratory passages (calms cough)

101
Q

Benzonatate: patient education

A

Not recommended in pregnancy and lactation

Swallow tablet whole, don’t chew

102
Q

Antitussive: caution and contraindication

A

Avoid in persistent or chronic cough caused by smoking, asthma, or emphysema

Avoid benzonatate in allergies to tetracaine or related compounds

Risk of abuse with codeine and dextromethorphan

CNS depressants when combined with codeine and dextromethorphan can cause additive CNS depression

103
Q

Antitussive: adverse effects

A

Dextromethorphan and codeine: drowsiness, dizziness, GI upset

Benzonatate: chest numbness, dizziness, GI upset, HA, “chilly” sensation

104
Q

Guaifenesin: classification

A

Expectorant

105
Q

Guaifenesin: MOA

A

Increase output of respiratory tract by decreasing adhesiveness and surface tension –> productive cough

106
Q

Antacid formulations

A

Aluminum hydroxide, magnesium hydroxide, calcium carbonate

107
Q

Antacid: indications

A

Hyperacidity, PUD, mild GERD

108
Q

Antacid: MOA

A

Weak bases that react with HCl acid to form salt and water, reduce gastric acidity and increase pH

109
Q

Antacid: caution and contraindications

A

Should not be used in abdominal pain of unknown etiology

Avoid aluminum and magnesium based antacids in renal impairment

Avoid calcium based in hypercalcemia

Caution in patients who are on sodium restriction (e.g. HF)

110
Q

Can antacids be used with pregnancy and lactation?

A

Yes

111
Q

Antacid: adverse effects

A

Aluminum and calcium based: constipation

Magnesium based: diarrhea

112
Q

Antacid: drug interactions

A

Antacids should be separated from other meds by at least TWO hours

113
Q

Sucralfate (Carafate): classification

A

Cytoprotective agents

114
Q

Sucralfate (Carafate): indications

A

Prophylaxis and treatment of duodenal ulcers associated with NSAID use and treatment for duodenal ulcers from other causes

115
Q

Sucralfate (Carafate): MOA

A

Selectively binds to necrotic ulcer tissue, covering it and acting as a barrier for outside stimuli (such as acids)

116
Q

Sucralfate (Carafate): caution and contraindications

A

Caution in geriatric patients with creatinine clearance less than 30 mL/min

117
Q

Can sucralfate (Carafate) be used in pregnancy and lactation?

A

Yes

Limited data in children

118
Q

Sucralfate (Carafate): adverse effects

A

Constipation, dizziness, gastric discomfort

Separate meds by at least two hours

119
Q

Misoprostol (Cytotec): classification

A

Cytoprotective agent

120
Q

Misoprostol (Cytotec): indications

A

Prophylaxis and treatment of duodenal ulcers associated with NSAID use

121
Q

Misoprostol (Cytotec): MOA

A

Inhibition of gastric secretion through inhibition of histamine stimulated cAMP

Mucosal protective qualities by increasing mucus and bicarbonate

122
Q

Misoprostol (Cytotec): caution and contraindications

A

Caution in renal impairment

123
Q

Can misoprostol (Cytotec) be used in pregnancy and lactation?

A

AVOID in pregnancy and lactation (can cause abortion birth defects)

Safety and efficacy not established in peds

124
Q

Misoprostol (Cytotec): adverse effects

A

Diarrhea, abdominal pain, nausea, postmenopausal bleeding, HA

125
Q

Ranitidine and Famotidine (Pepcid): classification

A

Histamine 2 receptor antagonist

126
Q

Ranitidine and Famotidine (Pepcid): indications

A

Mild intermittent GERD, PUD, heartburn

127
Q

Ranitidine and Famotidine (Pepcid): onset

A

30 minutes

128
Q

Ranitidine and Famotidine (Pepcid): MOA

A

Reversible competitive inhibition of histamine at H2 receptors of gastric parietal cells –> inhibits gastric acid secretion

Parietal cells = acetylcholine, gastrin, histamine

129
Q

Ranitidine and Famotidine (Pepcid): caution and contraindications

A

Caution in renal impairment

130
Q

Can Ranitidine and Famotidine (Pepcid) be used in pregnancy and lactation?

A

Yes and in peds

131
Q

Ranitidine and Famotidine (Pepcid): adverse effects

A

HA, dizziness, confusion

132
Q

Omeprazole, Pantoprazole, Esomeprazole: classification

A

PPI

133
Q

Omeprazole, Pantoprazole, Esomeprazole: indications

A

Duodenal and gastric ulcers, erosive gastritis, Zollinger-Ellison syndrome, GERD

134
Q

Omeprazole, Pantoprazole, Esomeprazole: MOA

A

Inhibits gastric proton pumps (H+/K+ ATPase) on parietal cells to suppress acid secretion

135
Q

Omeprazole, Pantoprazole, Esomeprazole: caution and contraindications

A

BLACK BOX WARNING: don’t combine omeprazole and clopidrogel (increases effectiveness of clopidrogel)

Caution in elderly and those with hepatic dysfunction

136
Q

Can Omeprazole, Pantoprazole, Esomeprazole be used in pregnancy and lactation?

A

Yes and for peds

137
Q

Omeprazole, Pantoprazole, Esomeprazole: adverse effects

A

Nausea, diarrhea, HA, GI disturbances, bone fractures

Increased risk for c. diff infection, hypomagnesemia, vitamin B12 deficiency

138
Q

Omeprazole, Pantoprazole, Esomeprazole: patient education

A

Take 30-60 minutes before meals (preferably in the morning)

Slower onset than histamine 2 receptor antagonists

139
Q

First line therapy for h. pylori infection

A

Triple therapy -

PPI once or twice daily
Amoxicillin 1 g bid
Clarithromycin 500 mg bid

140
Q

Triple therapy for h. pylori infection for patients with amoxicillin in penicillin allergy

A

PPI once or twice daily
Metronidazole 500 mg bid
Clarithromycin 500 mg bid

141
Q

Examples of anti motility agents

A

Diphenoxylate/atropine

Loperamide

142
Q

Diphenoxylate/atropine: MOA

A

Inhibits excessive GI motility and GI propulsion

143
Q

Why is atropine added to diphenoxylate (anti motility agent)?

A

Provides anticholinergic effect that decreases secretion in the bowel and slows peristalsis

144
Q

Diphenoxylate/atropine: adverse effect

A

Euphoria and dependence

145
Q

Loperamide: MOA

A

Acts through opioid receptors to inhibit peristalsis and prolongs gastric time

Reduces fecal volume and diminishes loss of fluid and electrolytes

146
Q

Loperamide: contraindication

A

Active bacterial bowel infection

147
Q

Examples of anti secretory meds

A

Bismuth subsalicylate, kaolin and pectin, polycarbophil (FiberCon)

148
Q

Bismuth subsalicylate, kaolin and pectin, polycarbophil (FiberCon): indications

A

Acute diarrhea, IBS with diarrhea predominance

149
Q

Bismuth subsalicylate: MOA

A

Exhibits both anti secretory and antimicrobial action and may have some anti-inflammatory action as well

150
Q

Kaolin and pectin: MOA

A

Kaolin - clay like powder that attracts and holds bacteria

Pectin - thicken stool by absorbing moisture

151
Q

Polycarbophil (FiberCon): MOA

A

Provides bulk to stools by absorbing water in GI tract

152
Q

Diphenoxylate/atropine (Lomotil): adverse effects

A

Dry mouth, dry eyes, urinary retention, blurred vision, drowsiness, dizziness

153
Q

Diphenoxylate/atropine (Lomotil): contraindications

A

Patients with liver disease, fever, bloody stool, fecal leukocytes

Scheduled V substance

154
Q

Loperamide (Imodium): adverse effects

A

Abdominal discomfort, constipation, drowsiness, dry mouth

155
Q

Loperamide (Imodium): contraindications

A

Patients with fever, blood stools, fecal leukocytes

May cause drowsiness (avoid driving or other activities that require alertness)

156
Q

Bismuth subsalicylate: adverse effects

A

Black stools, darkening of tongue, tinnitus

157
Q

Bismuth subsalicylate: contraindications

A

Aspirin sensitive or taking medications that interact with warfarin

NOT recommended for peds d/t presence of salicylate component (Reye syndrome)

158
Q

Polycarbophil (FiberCon): adverse effects

A

Stomach upset, bloating, gas

159
Q

Polycarbophil (FiberCon): contraindications

A

Potential for drug interactions with tetracycline or quinolones

160
Q

Kaolin and pectin: adverse effects

A

Constipation, feeling of fullness, stomach bloating, gas

161
Q

Kaolin and pectin: contraindications

A

DO NOT use with children

162
Q

Ondansetron (Zofran): classification

A

5HT3 receptor antagonist

163
Q

Ondansetron (Zofran): MOA

A

Blocks serotonin both peripherally on vagal nerve terminals and centrally in CTZ

164
Q

Ondansetron (Zofran): caution and contraindications

A

Caution in QT prolongation, concurrent use with other serotonin meds, pregnancy and lactation

Okay in children >6 months

165
Q

Ondansetron (Zofran): adverse effects

A

HA, constipation, fatigue

166
Q

Dramamine, Meclizine: classification

A

Antihistamines

167
Q

Dramamine, Meclizine: MOA

A

Competes with histamine for H1 receptor sites, black CTZ, diminish vestibular stimulation, depress labyrinthine function through central anticholinergic activity

168
Q

Dramamine, Meclizine: adverse effects

A

Drowsiness, dry mouth, blurred vision, urinary retention, paradoxical excitation in children may occur

169
Q

Dramamine, Meclizine: caution and contraindications

A

NOT combined with CNS depressants

Avoid in patients with narrow angle glaucoma, BPH, those with thickened respiratory secretions

Avoid in elderly patients (increased risk for confusion and CNS depression)

170
Q

Can Dramamine and Meclizine be used with pregnancy and lactation?

A

Dramamine can be used in children older than 2 years; Meclizine in children >12 years

Compatible with pregnancy, avoid in lactation

171
Q

Scopolamine (Transderm Scop): classification

A

Anticholinergic

172
Q

Scopolamine (Transderm Scop): MOA

A

Blocks the action of acetylcholine at the parasympathetic sites in smooth muscle, CNS, and secretory glands (decreased GI motility)

173
Q

When should scopolamine (Transderm Scop) patches be applied?

A

Administer four hours before desired onset (can stay on for 72 hours)

174
Q

Scopolamine (Transderm Scop): adverse effects

A

Drowsiness, dry mouth, blurred vision, urinary retention, dilated pupils

175
Q

Scopolamine (Transderm Scop): caution and contraindications

A

Avoid in patients with narrow angle glaucoma, BPH, thickened respiratory secretions

Caution in renal impairment

Avoid in elderly patients (increased risk for confusion and CNS depression)

176
Q

Can scopolamine (Transderm Scop) be used with pregnancy and lactation?

A

Avoid in pregnancy and lactation; no use in peds

177
Q

Promethazine, Prochlorperazine: classification

A

Phenothiazine

178
Q

Promethazine, Prochlorperazine: MOA

A

Blocks dopamine receptors in the CTZ as well as cholinergic, alpha 1 adrenergic, and histamine 1 receptors

179
Q

Promethazine, Prochlorperazine: adverse effects

A

Sedation, EPS reactions, agranulocytosis, dry mouth, blurred vision, constipation, bradycardia, hypotension,

180
Q

Promethazine: adverse effects

A

Fatal respiratory depression in children younger than 2 years

181
Q

Prochlorperazine: contraindications

A

Patients with leukopenia, neutropenia, agranulocytosis

182
Q

Promethazine, Prochlorperazine: caution and contraindications

A

Not combined with CNS depressants

Avoid in patients with narrow angle glaucoma, BPH, thickened respiratory secretions

Avoid in elderly patients (increased risk for confusion and CNS depression)

183
Q

Can Promethazine and Prochlorperazine be used in pregnancy and lactation?

A

Other agents preferred in pregnancy, AVOID in lactation

184
Q

Dronabinol (Marinol): classification

A

Cannabinoids

185
Q

Dronabinol (Marinol): MOA

A

Activates CB1 receptors in the brain –> prevents pro-emetic effects of endogenous compounds such as dopamine and serotonin

186
Q

Dronabinol (Marinol): adverse effects

A

Depression, dizziness, paranoid thoughts, somnolence, palpitations, tachycardia, hypotension

187
Q

Dronabinol (Marinol): caution and contraindications

A

Caution in patients with seizure disorder, cardiac disorder, high potential for abuse

188
Q

Can dronabinol (Marinol) be used with pregnancy and lactation?

A

Avoid in pregnancy and lactation

Caution in pediatric patients younger than 12 years; not recommended for use younger than 6 years

189
Q

Metoclopramide (Reglan): classification

A

Prokinetic agent

190
Q

Metoclopramide (Reglan): MOA

A

Dopamine receptor antagonist in the CNS leading to prevention of nausea

Stimulates motility in the upper GI tract

191
Q

Metoclopramide (Reglan): adverse effects

A

BLACK BOX WARNING: EPS effects, depression, drowsiness, dizziness, diarrhea, hypoglycemia

192
Q

Metoclopramide (Reglan): caution and contraindications

A

Caution in renal impairment, prolongs QT prolongation

High potential for abuse

Avoid use in Parkinson’s disease, if bowel obstruction is suspected/active

193
Q

Can Metoclopramide (Reglan) be used with pregnancy and lactation?

A

Okay in pregnancy but caution in lactation

Approved in pediatrics

194
Q

Senna (Senokot): classification

A

GI stimulant

195
Q

Senna (Senokot): MOA

A

Stimulates myenteric plexus –> prostaglandin release –> increase cAMP

196
Q

Senna (Senokot): adverse effects

A

Abdominal cramping, electrolyte imbalance, N/V/D

197
Q

Senna (Senokot): caution and contraindications

A

Caution in severe CVD, bowel obstruction suspected/active

198
Q

Can Senna (Senokot) be used with pregnancy and lactation?

A

May be used in pregnancy and lactation EXCEPT castor oil

199
Q

Which GI stimulant can be used in children older than six years?

A

Bisacodyl

200
Q

Which GI stimulant can be used in children older than two years?

A

Senna and castor oil

201
Q

Psyllium (Metamucil): classification

A

Bulk laxative

202
Q

Psyllium (Metamucil): MOA

A

Soluble fiber that absorbs water in the intestine to form a viscous liquid that promotes peristalsis and reduces transit time

203
Q

Psyllium (Metamucil): caution and contraindications

A

Narrowed esophageal or intestinal lumen

204
Q

Psyllium (Metamucil): adverse effects

A

Abdominal cramping, bloating, esophageal or intestinal obstruction (rare)

205
Q

Which form of laxative is first line for constipation?

A

Psyllium (Metamucil), but has a slow response –> not ideal for acute cases

206
Q

Magnesium hydroxide and polyethylene glycol: classification

A

Osmotic

207
Q

Magnesium hydroxide and polyethylene glycol: MOA

A

Draws water into intestinal lumen to increase intraluminal pressure –> distends colon and increases peristalsis

208
Q

Magnesium hydroxide and polyethylene glycol: adverse effects

A

Abdominal cramping, N/D, bloating

209
Q

Which osmotic laxative has the fastest onset: magnesium hydroxide or polyethylene glycol?

A

Magnesium hydroxide

210
Q

Magnesium hydroxide and polyethylene glycol: caution and contraindications

A

Caution with lactulose in diabetic patients, caution with magnesium based preparations and renal impairment

211
Q

Can Magnesium hydroxide and polyethylene glycol be used with pregnancy and lactation?

A

Okay in pregnancy and lactation

Approved in peds if >2 years

212
Q

Docusate sodium (Colace): classification

A

Stool softener

213
Q

Docusate sodium (Colace): MOA

A

Reduces surface tension of oil-water interface on the stool –> facilitates admixture of fat and water into stool –> emollient action

214
Q

Can docusate sodium (Colace) be used with pregnancy and lactation?

A

Compatible with pregnancy and lactation

Approved in children >2 years

215
Q

Docusate sodium (Colace): adverse effects

A

Overly loose stools

216
Q

Mineral oil: classification

A

Lubricant (laxative class)

217
Q

Mineral oil: MOA

A

Eases passage of stool by decreasing water absorption and lubricating the intestine

218
Q

Mineral oil: caution and contraindications

A

Avoid in pregnancy and lactation; avoid in elderly

219
Q

Mineral oil: adverse drug effects

A

Abdominal cramping, N/V/D, oily rectal leakage

220
Q

Lubiprostone (Amitiza): classification

A

Chloride channel activators

221
Q

Lubiprostone (Amitiza): MOA

A

Activates chloride channels in the GI epithelial lining, producing chloride rich secretions that soften stool and increase motility

222
Q

Lubiprostone (Amitiza): caution and contraindications

A

Known or suspected bowel obstruction

NOT recommended in peds or pregnancy

223
Q

Lubiprostone (Amitiza): adverse effects

A

HA, N/D, abdominal pain and bloating

224
Q

Methylnaltrexone (Relistor): classification

A

Opioid receptor antagonist

225
Q

Methylnaltrexone (Relistor): MOA

A

Antagonist at mu receptors in GI tract

226
Q

Methylnaltrexone (Relistor): caution and contraindications

A

Known or suspected bowel obstruction

Caution in pregnancy and NOT recommended in peds

227
Q

Methylnaltrexone (Relistor): adverse effects

A

Flatulence, N/D, abdominal pain, bloating

NURS 424 (35 decks)

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