Term 7 PDP

Question 1

Insulin Glargine

Answer 1

MOA: Lowers blood glucose by: stimulating glucose uptake in skeletal muscles and fat, inhibiting hepatic glucose production
Pharmacokinetics: Prolonged absorption over 24 hrs (onset 3-4 hours, duration 24hrs)
Monitor: Blood Glucose, Potassium, signs for hyper/hypoglycemia

Question 2

Insulin Regular

Answer 2

Lowers blood glucose by: stimulating glucose uptake in skeletal muscles and fat, inhibiting hepatic glucose production
Subq: (onset 30-60min, duration 5-7 hrs)
Monitor: Blood Glucose, Potassium, signs for hyper/hypoglycemia

Question 3

Ipratropium

Answer 3

Class: bronchodialator, anitcholinergic
MOA: Inhibits cholinergic receptors in bronchial smooth muscle, resulting in decreased concentrations fo cGMP. Produces bronchdialation
O/P/D: Inhalation - 1-3min/1-2hr/4-6hr
Assessment - Respiratory

Question 4

Salbutamol

Answer 4

Class: bronchodialator, adrendergic
MOA: Binds to Beta-2 receptors leading to increase in cAMP, decreasing intracellular calcium - resulting in bronchodialation
O/P/D: Inhalation 5-15min/60-90min/3-6hr)
Assesment: Lungs, HR, BP, Potassium

Question 5

Clopidogrel

Answer 5

Class: Antiplatelet
MOA: Inhibits platelet aggregation by irreversibly inhibiting the binding of ATP to platelet receptors
O/P/D: PO - within 24hrs/3-7days/5days
Contraindications: pathological bleeding
Monitor: inappropriate bleeding, bleeding time, neutrophils, platelets

Question 6

Pantoprazole

Answer 6

Class: Proton Pump Inhibitor/Anti Ulcer
MOA: binds to an enzyme in the presence of acidic gastric pH preventing final transport of hydrogen ions into the gastric lumen
O/P/D: PO - 2.5 hr/unknown/1 wk
Assessment: GI, blood in stool, monitor magnesium

Question 7

Ceftriaxone

Answer 7

Class: anti-infective/3rd gen cephalosporin
MOA: Binds to bacterial cell wall membranes causing cell death
O/P/D: IV - rapid/endofinfusion/12-24 hr
Assess: Hepatic and Renal Impairment, infection, bowel function (c-diff)

Question 8

Fluticasone

Answer 8

Class: Corticosteroid
MOA: Potent, locally acting anti-inflammatory and immune modifer
O/P/D: within 24hr/1-4wk/several days after discontinuation
Monitor: Respiratory

Question 9

Amlodipine

Answer 9

Class: Antianginal/calcium channel blocker
MOA: inhibits transport of calcium into myocardial and vascular smooth muscle resulting in inhibition of excitation-contraction coupling and subsequen contraction
Therapeutic Effect: reduction in BP, decreased angina attacks
O/P/D: PO - unknown/6-9hr/24hr
Monitor/Assess: Hepatic Impairment, BP, Pulse, ECG, Inputs/Outputs, signs of HF

Question 10

Candesartan

Answer 10

Class: anithypertensives/ARB/Angiotensin II receptor antagonist
MOA: Blocks he vasconstrictor and aldosterone secreting effects of angiotensin II at various receptor sites including vascular smooth muscle and the adrenal glands
Therapeutic Effect: Lowers BP in hypertensive patients
O/P/D: PO - within 2 wk/4-6wk/unknown
Assess: HR, BP, perfusion

Question 11

Linagliptin

Answer 11

Class:antidiabetic/DPP-4 inhibitors
MOA: Inhibits DPP-4 which results in increased insulin release and decreased glucagon levels
O/P/D: PO - unknown/ 1.5 hr/ 24 hr
Assess: blood glucose, signs of hypoclycemia, pancreatitis, joint pain

Question 12

Signs of Hypoglycemia

Answer 12

abdominal pain, sweating, hunger, weakness, dizziness, headache, tremor, tachycardia, anxiety

Question 13

Metoprolol

Answer 13

Class: antianginal/antiypertensive/beta blocker
MOA: blocks stimulation of beta-1 adrenergic receptors
Therapeutic Effect: Decreased BP and HR, decreased angina
O/P/D: PO: 15min/unknown/6-12 hours
Assess: BP (withold if <50bpm), HR, ECG, Intake/Output, daily weights, S&S of HF
Record: Apical Pulse in MAR

Question 14

Polyethylene glycol 3350

Answer 14

Class: laxatives/osmotics
MOA: acts as an osmotic agent, drawing water into the lumen of the GI tract
O/P/D: PO unknown/1-3 days/unknown
Assessment: Abdominal/GI

Question 15

Vitamin B12

Answer 15

Class: Vitamin
Therapeutic effect: healthy development, myelination and function of CNS, healthy RBC formation, and DNA synthesis

Question 16

allopurinol

Answer 16

Class: antigout/anithyperuricemics
MOA: Inhibits production of uric acid by inhibiting action of xanthine oxidase
Therapeutic Effects: Lowering of serum uric acid levels
O/P/D: PO - 1-2 days/1-2wks/1-3wks
Assess: Renal function, fluid intake, serum and urine uric acid levels

Question 17

budesonide/formoterol/glycopyrrolate (Bresti Aerosphere)

Answer 17

Class: corticosteroid+bronchodialator
MOA: Budenoside - antiinflammatory, formoterol - beta 2 agonist, bronchodialation, glycoprrolate - anticholinergic resulting in bronchodialation
Therapeutic effects: bronchodialation with decreased airflow obstruction
O/P/D: Inhalation - within 5 min/4wks/unknown
Assess: Lungs sounds, BP, HR, glucose and potassium

Question 18

enoxaparin

Answer 18

Class: anticoagulant, antithrombotic, Low molecular weight heparins
MOA: Potentiates the inhibitory effect of antithrombin on factor Xa and thrombin
Therpeutic Effects: prevention of thrombus formation
O/P/D: - Subq - unknown/3-5 hour/12 hours
Assess: signs of bleeding, falling hematocrit, evidence of thrombosis, hypersensitive to pork products, BP, platelet count

Question 19

methylprednisolone

Answer 19

Class: corticosteroid
MOA: Suppresses inflammation and normal immune response
Therapeutic Effects: suppression of inflammation and modification of the normal immune response.
O/P/D: PO - unknown/1-2hr/1.25-1.5days
Assessment: adrenal insufficiency, blood glucose (if diabetic), WBC counts, potassium and calcium

Question 20

piperacillin-tazobactam

Answer 20

Class: anti-infectives/extened spectrum penicillins
MOA: Piperacillin - binds to bacterial wall membrane causing cell death (extended spectrum compared with other penicillins). Tazobactam - inhibits beta-lactamase, an enzyme that can destroy penicillins
Therapeutic Effect: Death of susceptible bacteria
O/P/D: IV - rapid/end of infusion/4-6 hour
Assessment: infection, bowel function (C-diff), renal/hepatic function

Question 21

signs of adrenal insufficiency

Answer 21

hypotension, weight loss, weakness, nausea, vomiting, anorexia, lethargy, confusion

Question 22

levodopa/carbidopa

Answer 22

Class: dopamine agonist/antiparkinson agents
Indications: Parkinson’s disease
MOA: Levodopa converted to dopamine in the CNS (increased neurotransmitter). Carbidopa prevents peripheral destruction of levodopa.
Therapeutic Effect: Relief of tremor and rigidity in Parkinson’s syndrome
O/P/D: 10-15 min/unknown/5-24 hr or more
Assess: orthostatic hypotension constipation, GI COMPLICATIONS, uncontrolled movements
Education: Food after meds may decrease GI irritation, high protein diet makes therapy less effective.
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Question 23

hydromorphone

Answer 23

Class: Opioid Analgesic
Indications: Moderate to Severe Pain
MOA: Binds to opiate receptors in CNS and alters perception and response to painful stimuli while producing CNS depression
Therapeutic Effect: Decrease in moderate to severe pain
O/P/D: PO: 30 min/30-90min/4-5 hr
Assess: pain, hypotension, constipation,confusion, sedation, RESPIRATORY DEPRESSION
Document: RR in MAR

Question 24

hydrochlorothiazide

Answer 24

Class: antihypertensive/diuretic
Indications: Mild to moderate HTN, edema associated with HF, Renal dysfunction, cirrhosis, glucocorticoid therapy, estrogen therapy.
MOA: Increases excretion of sodium and water by inhibiting sodium reapsorption in the distal tubule. Also promotes excretion of chloride, potassium, hydrogen, magnesium, phosphate, calcium, bicarbonate.
Therapeutic Effect: Lowering of BP, diuresis with mobiliation of edema
O/P/D: PO: 2hr/3-6hr/6-12hr
Assess: BP, edema, hypokalemia, weight, orthostatic hypotension
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Question 25

levothyroxine

Answer 25

Class: hormones/thyroid preparations
Indications: Hypothyroidism, suppression of euthyroid goiters, adjunct treatment for thyropin dependent thyroid cancer
MOA: Synthetic form of T4. Increases metabolic rate: utilizing glucose stores, protein synthesis, cell growth, development of brain and CNS
Therapeutic Effect: restore normal hormonal balance
O/P/D: PO: unknown/1-3wk/1-3wk
Implementation: Take on empty stomach with full glass of water (30-60 min before breakfast)
Assess: BP, Apical pulse, TSH lab value, hyperthyroidism (tachycardia, chest pain, nervousness, insomnia, diaphoresis, tremors, weight loss)
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Question 26

pregabalin

Answer 26

Class: analgesics, anticonvulsants
Indications: neuropathic pain, fibromyalgia, partial-onset seizures
MOA: Binds to calcium channels in CNS tissues with regulates neurotransmitter releases
Therapeutic Effect: Decreased neuropathic or postherpetic pain. Decreased partial onset seizures.
O/P/D: unknown/2-4wk/unknown
Assess: pain, edema, dizziness, drowsiness, increased suicidal thoughts,
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Question 27

diclofenac 2.32% gel

Answer 27

Class: NSAID
Indications: Inflammatory disorers, relief of mild to moderate pain
MOA: inhibits prostaglandin synthesis
Therapeutic Effect: suppresses pain and inflammation
O/P/D: PO (Pain): 30 min/unknown/up to 8 hr
Assess: pain, skin, BP
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Question 28

tamsulosin

Answer 28

Class: alpha-adrenergic blocker
Indications: Benign Prostatic Hyperplasia
MOA: Decreases contractions in smooth muscle of prostatic capsule by binding to Alpha-1 adrenergic receptors
Therapeutic Effect:Decreases symptoms of BPH (urinary urgency, hesitancy, nocturia)
O/P/D: unknown/2 weeks/unknown
Assess:dizziness/headache

Question 29

rosuvastatin

Answer 29

Class: lipid lowering agent
Indications: hypercholesterolemia, dyslipidemia, hypertriglyceremia
MOA: Inhibits protein involved in cholesterol synthesis
Therapeutic Effect: Lowering of total and LDL cholesterol and triglycerides. Slightly increases HDL. Slows progression of coronary atherosclerosis.
O/P/D: unknown/2-4wks/unknown
Assess: Liver function, if muscle tenderness -> CK Levels or myopathy, avoid grapefruit
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Question 30

ramipril

Answer 30

Class: Ace Inhibitor
Indications: Hypertension, HF, Potential for MI/Stroke
MOA: Inhibits angiotensin II - potent vasoconstrictor, prevents degradation of bradykinin (vasodilatory prostaglandin), also increases renin and decreases aldosterone.
Therapeutic Effect: Lowering of BP, decreased risk of MI/stroke, decreased HF progression
O/P/D: 1-2 hours, 3-6 hours, 24 hr
Assess: BP, HR, weight, edema, potassium (increases), Hgb (decreases, rare)
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Question 31

Gabapentin

Answer 31

Class: analgesic, anticonvulsant, mood stabilizer
Indications: partial seizures, postherpetic neuralgia, restless leg syndrome, neuropathic pain, prevention of migraine headache
MOA: Unknown
Therapeutic Effect: Decreased incidence of seizures, decreased postherptic pain, decreaed leg restlessness
O/P/D: rapid/2-4hr/8hr
Assess: suicidal thoughts, respiratory depression, pain, do not take within 2 hrs of antiacid, dizziness, drowsiness,
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