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CPR Final > Rx Final > Flashcards

Rx Final Flashcards

1
Q

B2 Adrenergic Agonists (sympathomimetics)

A

ASTHMA: Bronchodilators
“short term relievers”
activates B2 receptor= inc cAMP= SM relaxes.
Dec mast cell mediator release, exudate. inc mucocillary clearance and surfactant.

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2
Q

epinephrine

isoproterenol

A 
ASTHMA: Bronchodilators
Nonselective B2 Adrenergic Agonists (sympathomimetics)
use: rapid, emergency use
inject/inhale
side effects: cardiac/GI
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3
Q

albuterol

terbutaline

A 
ASTHMA: Bronchodilators
Short acting B2 Adrenergic Agonists (sympathomimetics)
first line for acute exacerbation
1-4 hours
use: acute asthma, COPD 
side effect: tachycardia, tremor
toxicity and interactions with MAOi
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4
Q

salmeterol

formoterol

A 
COPD/ASTHMA: Bronchodilators
Long acting B2 Adrenergic Agonists (sympathomimetics)
>12hrs, lipid soluble
slow onset
side effect: CYP3A4 interactions
headache, cough
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5
Q

Symbicort
Advair
Dulera

A

ASTHMA: Bronchodilators
Combination drugs: B2 adrenergic+ anti-inflamm

Symbicort: budesonide+formoterol
Advair: fluticasone+salmeterol
Dulera: formoterol+mometasone

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6
Q

Atropine
ipratropium
tiotropium

A

ASTHMA: Bronchodilators
Muscarinic antagonists (anticholinergics)
blocks acetylcholine M3= bronchodilation and dries secretions
tx for COPD
side effects: mouth drying, tachycardia

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7
Q

theophylline

theobromine

A

ASTHMA: Bronchodilators
Methylxanthines
blocks adenosine A2 receptor (stops constriction) and PDE (inc cAMP)
use: maintenance therapy for moderate asthma
side effects: ess effective
caffeine-like sleep prodlems, tachycardia, diuretic, nervous,sz

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8
Q

corticosteroids

A

ASTHMA: Anti-inflammatory- “long term controllers”
most potent and effective
used in combo +B2 agonist
dec cytokines, arachidonic acid, prostaglandin, leukotriene, NF-kB
binds intracellular glucocorticoid receptors

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9
Q

prednisone

A 
ASTHMA: Anti-inflammatory
corticosteroids
use: acute exacerbation and chronic severe asthma
oral
chronic use= adverse effects
cushings, weight gain, mood alteration
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10
Q

beclomethasone
fluticasone
budesonide

A 
ASTHMA: Anti-inflammatory
corticosteroids
inhaled
long half life
side effects: 
cataracts, dec bone desity/growth rate, oral candidiasis, dysphonia
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11
Q

leukotriene pathway modifiers

A

ASTHMA: Anti-inflammatory
inhibits receptor or synthesis of LTBr, LTC4 and LTD4
use: mild and persistent asthma (requires less steroid use)

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12
Q

zileuton

A

ASTHMA: Anti-inflammatory
leukotriene pathway modifiers:
inhibits leukotriene (5-lipoxygenase) synthesis
oral
prophylaxis
long lasting
use: intrinsic asthma (asa-induced and exercise)
less effective
side effects: hepatic injury and CYP1A2 inhibition, GI, headaches

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13
Q

zafirlukast

montelukast

A 
ASTHMA: Anti-inflammatory
leukotriene pathway modifiers:
antagonize leukotriene (LTD4) receptor
oral
prophylaxis
long lasting
use: intrinsic asthma (asa-induced and exercise)
less effective
side effects: hepatic injury and CYP1A2 inhibition, GI, headaches
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14
Q

omalizumab (xolair)

A 
ASTHMA: Anti-inflammatory
Anti-IgE antibody:
monoclonal antibody blocks IgE mast cell activation
use: extrinsic asthma (allergic) 
subQ q3weeks
expensive
side effect: URI’s, headache, cancer
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15
Q

cromolyn

nedocromil

A 
ASTHMA: Anti-inflammatory
Anti-IgE antibody:
reduces mast cell degranulation
inhalation
prophylaxis
not used today
less effective
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16
Q

bupropion

A

SMOKING CESSATION
dopaminergic-noradrenergic reuptake inhibitor
tricyclic antidepressant
also nicotinic acetylcholine receptor antagonist

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17
Q

varenicline

A

SMOKING CESSATION

nicotine receptor agonist

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18
Q

roflumilast

cilomilast

A

COPD: PDE4 inhibitor
inc cAMP= relax SM and dec inflamm
improved FEV1

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19
Q

azithromycin

A

COPD:
prophylactic antibiotic
side effect: hearing loss

20
Q

Tx for COPD

A

COPD tx:

  • short/long acting anticholinergic
  • inhaled short/long-acting B2 agonist
  • inhaled corticosteroid
  • PDE4 inhibitor
  • prophylactic antibiotic
21
Q

Tx for ASTHMA

A
  • Bronchodilators- “short term relievers”
  • Anti-inflammatory- “long term controllers”
  • Combination drugs: B2 adrenergic+ anti-inflamm
22
Q

IV FLUIDS: isotonic fluid

A

concentration of solutes= plasma
isosmotic volume expansion
no change in osmolarity of ECF or ICF

23
Q

IV FLUIDS: Hypotonic fluid

A

will swell the RBC’s
lower tonicity or solute concentration
lowers serum osmolarity in vascular space, fluid shift to intracellular/interstitial space

24
Q

IV FLUIDS: Hypertonic fluid

A

will shrink the RBC’s
higher tonicity or solute concentration
increases serum osmolarity and draws water out of intercellular space
volume expanders: increases extracellular volume

25
Q

IV FLUIDS: Crystalloids

A

solution of small molecules that flow easily across cell membranes: interstitial and intravascular

26
Q

saline: isotonic (normal) 0.9%

A

IV FLUIDS: Crystalloids
NaCl
pH=5
osmolarity=300
distribution: extracellular fluid (250 in intravascular and 750 in interstitial)
will raise ECF volume and BP
use: fluid depletion (hypovolemia), low extracellular fluid:
shock, hemorrhage, n/v, wound drainage, mild hyponatremia, metabolic acidosis
risk: hyperchloremia, metabolic acidosis, dec renin/aldosterone, impaired coagulation, renal vasoconstriction and dec GFR, volume overload

27
Q

saline:

Hypotonic .45%, .25%

A

IV FLUIDS: Crystalloids
shift fluid into cells
use: hypernatremia, DKA, hyperosmolar hyperglycemic state
risk of hyponatremia in extracellular volume depletion pts (post surgical, trauma, burns); increased cerebral edema, hypotension, hypovolemia

28
Q

saline: Hypertonic

A

IV FLUIDS: Crystalloids
rarely used
use: severe hyponatremia, cerebral edema
risk: fluid volume overload and pulmonary edema

29
Q

Dextrose

A

IV FLUIDS: Crystalloids
glucose, can be metabolized to intracellular/extracellular
pH=4
osmolarity=250, isotonic
distribution: free diffusion (60 in intravascular, 240 in interstitial, 700 in cells)
use: NPO pt’s
risk of osmotic diuresis and extracellular volume depletion in diabetics; volume overload and renal failure, cerebral edema

30
Q

Lactated Ringer’s

A

IV FLUIDS: Crystalloids
(K, HCO3, Mg, Ca)
pH= 6.5
osmolarity= 275 (close to serum)
use: fluid replacement:
burn patients, n/v/d, fistula drainage, acute blood loss, third-space shifts
pro’s:lower incidence of imbalance, improved gastric perfusion
risk for hyperkalemia in renal failure pts
do not use in liver disease, lactic acidosis, or pH>7.5

31
Q

IV FLUIDS: Colloids

A

solution with large molecules that don’t pass the cell membrane (stay intravascular).
increase oncotic pressure and draw fluids in from extravascular space
pro’s: long duration, less volume

32
Q

Albumin

A

IV FLUIDS: Colloids
increase oncotic pressure and draw fluids in from extravascular space
charged
use: shock
side effects: loss of capillary barrier and hyperalbuminema
risk in hypoalbuminemic pts (cirrhosis, neph syndrome)

33
Q

Dextrans

Hetastarch

A

IV FLUIDS: Colloids
increase oncotic pressure and draw fluids in from extravascular space
risk: allergic reactions

34
Q

Blood product

A

IV FLUIDS: Colloids

use: volume replacement, low hematocrit

35
Q 
Chlorothiazide
HCTZ
metolazone
chlorthalidone
indapamide
A

DIURETICS: Thiazides
inhibits distal tubule Na/Cl reabsorption; eliminates H2O
first choice
use: HTN, CHF, nephrotic syndrome, edema, diabetes insipidus
very strong
side effects: electrolyte imbalance (inc loss of K and Mg), inc uric acid, *hyponatremia and hypokalemia

36
Q

Chlorothiazide

HCTZ

A 
DIURETICS: Thiazides
use: inc Ca resorb and vasodilation
side effect: hypercalcemia, hyperuricemia, hyperglycemia,
drug interactions (NSAID)
dec GFR
not in pregnancy (dec placental flow)
37
Q

Furosemide (Lasix)
Ethacrynic Acid
Bumetanide
torsemide

A

DIURETICS: Loop
inhibit thick ascending loop Cl reabsorption
(Na/K+2Cl inhibitor)
side effect: electrolyte imbalance, dehydration
dec effective circulating volume
hypokalemia, hyperuricemia

38
Q

Furosemide (Lasix)

A

DIURETICS: Loop
Use: low GFR pts, HTN emergency, CHF, edema, diabetes, nephrotic syndrome, hyperkalemia, hypercalcemia
also vasodilates
oral or IV
side effects: loss of Ca, Mg, and K in urine, electrolyte imbalance, ototoxicity, dec response over time

39
Q

Amiloride
Spironolactone
Eplerenone
Triamterene

A

DIURETICS: Potassium Sparing
Na/H2O excretion at collecting tubule
retain K
side effects: hyperkalemia

40
Q

Amiloride

A

DIURETICS: Potassium Sparing
increase distal convoluted tubule Na excretion and dec K secretion
**principal cells in collecting duct
use: metabolic alkalosis
rapid onset
side effect: hyperkalemia (EKG changes), Na/water depletion
diabetes= glucose intolerance

41
Q

Spironolactone

A

DIURETICS: Potassium Sparing
aldosterone receptor antagonist (only diuretic that works from outside tubule) =dec Na resorb
use: edema, CHF, HTN, post MI, ascities
side effects: endocrine imbalances, hyperkalemia, gynecomastia
diabetics/renal insufficiency=anuria

42
Q

Eplerenone

A 
DIURETICS: Potassium Sparing
aldosterone receptor antagonist
K sparing diuretic 
use: edema, CHF, HTN
**lower affinity for other steroid hormone receptors than spironolactone = less side effects
43
Q

Triamterene

A 
DIURETICS: Potassium Sparing
inhibits collecting tubule Na reabsorption and K/H secretion
rapid absorbed/excreted
side effect: turns urine blue
dec renal blood flow
not in hyperaldosteronism
highly toxic, renal fail
44
Q

Acetazolamide

A

DIURETICS: Carbonic Anhydrase Inhibitors
blocks proximal tubule’s carbonic anhydrase
(blocks HCO3- resorb)
use: CHF, pulmonary edema, glaucoma, metabolic alkalosis, high altitude
PO/IV
side effect: acidosis, rash, hypersensitivity
metabolic acidosis, inc Cl and NH4+, hepatic cirrhosis, renal stones

45
Q

Mannitol

A

DIURETICS: Osmotic
inhibits H2O reabsorption throughout nephron
use: acute renal fail, glaucoma, brain edema, drug overdose
generates high osmotic pressure to draw in H2O
IV
side effect: initial inc plasma volume and BP, can= HF
headache, n/v, chills, dizziness
hypernatremia

CPR Final (9 decks)

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