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pharm 2 > test 3 > Flashcards

test 3 Flashcards

1
Q

rapid insulin (insulin aspart, insulin lispro, insulin glulisine) onset, peak and duration

A

onset- 10-30 mins
peak- 1/2 hour to hour and a half
duration- 3-5 hours

give 5-10 mins before meal

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2
Q

short insulin (regular) onset, peak, duration

A

onset- 30-60 mins
peak- 2- 4 hours
duration- 5-8 hours

admin 30-60 mins before meal

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3
Q

intermediate insulin (Insulin Isophane) onset, peak, duration

A

onset- 1-2 hours
peak- 4-12 hours
duration- 18-24 hours

give 30 mins before first meal of day

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4
Q

long insulin (insulin degludec, insulin detemir, insulin glargine) onset, peak action

A

onset- 1.5-1.6 hours
no peak
duration- 24 hours

give at the same time daily

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5
Q

only insulin that can be given IV

A

Insulin regular (short acting)

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6
Q

what insulin can not be mixed with other insulins

A

long (insulin degludec, insulin detemir, insulin glargine)

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7
Q

type I diabetes

A

cells are no longer responsive to insulin. Insulin resistance

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8
Q

type II diabetes

A

beta cells don’t have insulin to release

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9
Q

what is glucagon and what secretes it

A

secreted by alpha cell, raises blood glucose level

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10
Q

what is insulin and what secretes it

A

secreted by beta cell, lowers blood glucose level

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11
Q

diabetes symptoms

A

fasting glucose above 126, polyuria, polyphagia, polydipsia, glucosuria, fatigue, weight loss (Type I)

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12
Q

Regular insulin (Humulin R, Novolin R)

A

Ther class-Parenteral drug for diabetes; pancreatic hormone
pharm class- short acting insulin
preg cat B

Promote cellular uptake of glucose, amino acids, and potassium; to promote protein synthesis, glycogen formation and storage, and fatty acid storage as triglyceride

adverse- hypoglycemia

may decrease serum potassium, calcium, magnesium

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13
Q

drug interactions and diabetes

A

furosemide or thiazide diuretics may increase glucose levels
beta blockers may mask effects of hypoglycemic reactions

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14
Q

hypoglycemia symptoms

A

tachycardia, confusion, sweating, drowsiness, convulsions, coma, death

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15
Q

hyperglycemia symptoms

A

polyuria, polydipsia, polyphagia, glucosuria, weight gain/loss. fatigue

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16
Q

insulin shots

A

insulin special syringe

To avoid multiple shots; can draw together: Draw up clear first (usually regular), then cloudy looking insulin, which could be intermediate
Long action cannot be mixed!!

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17
Q

treatment goals for type II DM

A

preprandial (before eating) blood sugar below 110
HbA1C< 6.5%

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18
Q

Oral hypoglycemic drugs

A

not effective for type I DM, they need insulin

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19
Q

oral hypoglycemic drug that has adverse effect for hypoglycemia

A

sulfonylureas, , meglitinides

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20
Q

oral hypoglycemia drug that can help treat obesity

A

increntin enhancers

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21
Q

metformin (fortamet, glucophage, glumetza)

A

ther- antidiabetic
pharm- biguanide

Preferred oral antidiabetic drug due to effectiveness and safety
Decreases hepatic production of glucose and reducing insulin resistance. A major advantage of this drug is that it doesn’t cause hypoglycemia

does not promote insulin release.
Does not cause hypoglycemia

adverse- GI related. Black box- lactic acidosis

contraindicated when using IV radiation

May decrease B12 and folic acid absorption

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22
Q

progressive loss of brain function characterized by memory loss, confusion and dementia

A

alzheimer’s disease

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23
Q

demyelination of neurons in the CNS resulting in weakness

A

multiple sclerosis

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24
Q

progressive loss of dopamine in CNS causing tremor, muscle rigidity, and abnormal movements

A

parkinson’s disease

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25
Q

degenerative disease of motor nuerons

A

ALS

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26
Q

levodopa, carbidopa, and entacapone (stalevo)

A

ther- antiparkinson
pharm- dopamine precursor; dopamine-enhancing drug combination

action- Restores neuromuscular dopamine in extrapyramidal areas of the brain, relieving some Parkinson’s symptoms such as tremor, bradykinesia, and muscle rigidity, combined with drugs to prevent enzymatic breakdown.

adverse- Uncontrolled and purposeless movements, loss of appetite, nausea, orthostatic hypotension.
Psychosis develops in 20% patients taking levodopa

considerations- discontinue gradually; liver function test may be elevated
encourage increase in fiber and fluids

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27
Q

Benztropine (Cogentin)

A

ther-Antiparkinsonian drug
pharm- Centrally acting cholinergic receptor blocker

action- Blocks excessive cholinergic stimulation of neurons. Used for relief of Parkinson like symptoms

adverse-dry mouth, constipation, tachycardia

avoid alcohol

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28
Q

donepezil (Aricept)

A

ther- Alzheimer disease drug
pharm- Cholinesterase inhibitor

action- AChE inhibitor improves memory by enhancing acetylcholine in neurons

adverse-Vomiting, diarrhea, dark urine, CNS side effects such as depression, headache, musculoskeletal such as cramps, arthritis

overdose- anticholinergic like atropine

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29
Q

memantine (namenda)

A

approved for treatment of moderate to severe alzheimer’s
-reduces abnormally high levels of glutamine

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30
Q

drugs for MS

A

interferon beta
glatiramer

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31
Q

what to watch for with immunosuppressants

A

infection

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32
Q

non-pharm treatments of muscle spasms

A

RICE, pain management, surgery, PT, message

33
Q

cyclobenzaprine (Amrix)

A

ther- Centrally acting skeletal muscle relaxant
pharm- Catecholamine reuptake inhibitor

action- Relieves muscle spasms by depressing motor activity primarily in brainstem. This drug also increases circulating levels of norepinephrine, blocking presynaptic uptake.

adverse- Drowsiness, blurred vision, dry mouth, rash. tachycardia

nursing considerations- Only meant for 2-3 weeks
no alcohol

skeletal muscle relaxant

34
Q

neuromuscular junction drug

A

has -toxin at end

direct acting antispasmodic

35
Q

Dantrolene sodium (Dantrium, revonto)

A

ther- skeletal muscle relaxant
pharm- direct acting antispasmodic, calcium release blocker

Often used for spasticity
action- It directly relaxes muscle spasms by interfering with the release of calcium ions from storage areas inside skeletal muscle cells

adverse- Muscle weakness, drowsiness, dry mouth, dizziness, diarrhea, tachycardia
Black box- hepatitis and death due to liver failure

36
Q

neuromuscular blockers

A

used to relax muscles during surgical procedures- Diaphragm is paralyzed, need to vent or ambu bag

patients still feel pain, they need to be sedated as well

37
Q

Somatic pain

A

sharp, localized sensation

38
Q

visceral pain

A

dull, throbbing, aching

39
Q

nerve cords received pain impulse through A fibers (sharp) or C fibers (dull)

A

nociceptor stimulation

40
Q

endogenous opioids

A

in our body naturally; interrupts pain
ex- endorphins, dynorphins, enkephalins

41
Q

stimulates mu and kappa

A

opioid agonist drugs

42
Q

block mu and kappa receptors

A

opioid antagonist

43
Q

what does mu do

A

analgesia, decreased GI motility, resp depression, sedation, physical dependance

44
Q

what does kappa do

A

analgesia, decreased GI motility, sedation

45
Q

morphine (Astramorph PF, duramorph)

A

ther- opioid analgesic
pharm- opioid analgesic receptor

action- Morphine binds with mu and kappa receptor sites to produce profound analgesia. It causes euphoria, constriction of the pupils, and stimulation of cardiac muscle. Used for symptomatic relief of serious and acute chronic pain

causes peripheral vasodilation

adverse- Orthostatic hypotension, hallucinations, nausea, dizziness, itching. OD may result in resp depression or cardiac arrest. Black box- when given epidural, 24 hour watch

schedule II drug

monitor o2 stat and respirations
monitor liver and kidney functions

OD treatment- naloxone

46
Q

naloxone (evzio, Narcan)

A

ther-Drug for treatment of acute opioid od and misuse
pharm- Opioid receptor antagonist

action- Pure opioid antagonist, blocking both mu and kappa receptors. Used for complete or partial reversal of opioid effects in emergency situations when acute opioid overdose is suspected

adverse- not many, relates to withdrawal of opioids like increased BP, temor, hyperventilation

admin for a resp rate lower than 10 breaths/min

47
Q

treatment for opioid dependency

A

no cure but avoids withdrawal- methadone drug

48
Q

NSAIDs

A

nonopioid analgesic
-used for fever, inflammation and analgesia

49
Q

aspirin (acetylsalicylic acid, ASA)

A

ther-Nonopioid analgesic; non-steroid anti-inflammatory drug (NSAID); antipyretic
pharm- Salicylate; cyclooxygenase (COX) inhibitor

action- Inhibits prostaglandin synthesis involved in the processes of pain and inflammation and produces mild to moderate relief of fever. Also causing vasodilation, significant anticoagulant ability

platelet inhibition caused by this is irreversible

adverse- Gastric discomfort and bleeding; salicylism may occur

50
Q

act by constricting certain intracranial vessels; serotonin agents

A

triptans

51
Q

acts as vasoconstrictors; interacts with adrenergic, dopaminergic, and serotonin receptors; terminates ongoing migraines

A

ergot alkaloids

52
Q

sumatriptan (Imitrex, onzetra)

A

ther- antimigraine drug
pharm- Triptan, 5-HT (serotonin) receptor drug, vasoconstrictor of intracranial arteries

action- Causes vasoconstriction of cranial arteries. Moderately selective and doesn’t usually affect all of blood pressure

adverse- Dizziness, drowsiness, warming sensation

May produce cardiac ischemia (due to vasoconstriction), or HTN

53
Q

Ergot alkaloids adverse effects

A

GI upset, tachycardia, angina like pain, numbness/tingling in fingers and toes

54
Q

contains injury, destroys microorganisms

A

inflammation

55
Q

signs of inflammation and basic steps

A

redness, warmth (vasodilation)
swelling(vascular permeability)
pus (cellular infiltration)
clots (thrombosis)
pain (stimulation of nerve endings)

56
Q

histamine

A

responsible for symptoms of anaphylaxis

produces vasodilation- capillaries become leaky and tissue swells

h1 receptors found in vascular smooth muscle, in bronchi, and on sensory nerves

57
Q

ibuprofen (Advil, Motrin)

A

ther-Analgesic, anti-inflammatory, antipyretic
pharm- NSAID

Action- For treatment of mild to moderate pain, fever and inflammation. Its actions are primary due to inhibition of prostaglandin synthesis

adverse- Nausea, heartburn, epigastric pain, dizziness. Rare- peripheral edema, anaphylaxis, aplastic anemia, GI ulcer. Black box- may cause increase risk of thrombotic event

best with food to prevent stomach pain

MONITOR hydration (kidneys), cardio events, GI bleeds

58
Q

cyclooxygenase-1 (COX-1)

A

present in all tissues
- reduces gastric acid secretion, promotes renal blood flow, promotes platelet aggression

inhibiting this can cause bleeding, GI upset, reduced renal function

59
Q

cyclooxygenase-2 (COX-2)

A

formed only after tissue injury
- promotes inflammation, sensitizes pain receptors, mediated fever in brain

inhibiting this results in suppression of inflammation

60
Q

salicysm

A

tinnitus, dizziness, headache, excessive perspiration

61
Q

prednisone (meticorten)

A

ther-Anti-inflammatory
pharm- corticosteroids

action-Synthetic corticosteroid. When used for inflammation, only used for 4-10 days

adverse- Long term- Cushing’s disease

gradually stop-I f you don’t gradually stop, adrenals become atrophy, we need to wake them up slightly

62
Q

Tylenol (acetaminophen)

A

ther-Antipyretic and analgesic
pharm-Centrally acting COX inhibitor

action- Reduces fever by direct action at the level of the hypothalamus and dilation of peripheral blood vessels. Has no anti-inflammatory properties
- enables sweating

adverse-Uncommon. high, long uses can cause acetaminophen poisoning like vomiting, dizziness, abdominal pain. Black box- can cause fatal liver injury

63
Q

sedatives

A

gives ability to sedate or relax a patient

64
Q

hypnotics

A

ability to induce sleep

65
Q

sedative-hypnotics

A

calming effect at lower doses; sleep at higher doses

66
Q

sedative-hypnotics

A

calming effect at lower doses; sleep at higher doses

67
Q

EEG

A

sleep study; seizure study

68
Q

escitalopram (lexapro) or sentraline (zoloft)

A

ther- Antidepressant; anxiolytic
pharm- Selective serotonin reuptake inhibitor (SSR)

action- SSRI that increases the availability of serotonin at specific post-synaptic receptor sites located within the CNS. Selective inhibition of serotonin uptake results in antidepressive activity without symptoms of sympathomimetic or anticholinergic activity
-Keeps serotonin recirculating, instead of reuptake

adverse- Dizziness, nausea, insomnia, weight gain, confusion, seizures, sexual dysfunction
Black Box- antidepressants increase risk of suicidal ideation

Typically first line drug, tends to be safest

Watch for weight gain, sexual dysfunction, serotonin syndrome, suicidal idea, steven Johnson’s syndrome (painful rash)

69
Q

duloxetine (cymbalta)

A

serotonin norepinephrine reuptake inhibitors

second line-Not as safe as SSRI- acting on 2 neurotransmitters now

adverse- abnormal dreams, sweating, constipation, dry mouth, weight loss, loss of appetite, tremor, N/V. abnormal vision, loss of sexual desire, dizziness

70
Q

amitriptyline (elavil)
or
imipramine (Tofranil)

A

ther- Antidepressant; treatment for nocturnal enuresis in children
pharm-TCA- tricyclic antidepressant

Blocks the reuptake of serotonin and norepinephrine into nerve terminals. It is used mainly for major depression, and sometimes used for treatment of nocturnal enuresis (bed wetting) in children

dont use with cardio issues; dont discontinue disruptly

side effects- drowsiness, sedation, orthostatic hypotension, dry mouth, constipation, weight gain, urine retention, mydriasis, dysrhythmias, blurred vision
Black box- may increase risk for suicidal thinking

71
Q

phenelzine (nardil)

A

ther-antidepressant
pharm-Monoamine oxidase inhibitor (MAO)

action-Produces its effects by irreversible inhibition of MAO; therefore, it intensifies the effects of norepinephrine in adrenergic synapses. It is used to manage symptoms of depression that are not responsive to safer meds

adverse- Dry mouth, orthostatic hypotension, insomnia, nausea, loss of appetite. May increase HR and neural activity- leading to delirium, mania, convulsions.
Black box- increase risk of suicidal thinking

Abrupt stop could cause rebound HTN

avoid foods with tyramine

72
Q

lorazepam (Ativan)

A

ther-Sedative-hypnotic; anxiolytic; anesthetic adjunct
pharm-Benzodiazepine; GABA receptor agonist

action-Benzodiazepine that acts by potentiating the effects of GABA, an inhibitory neurotransmitter, in the thalamic, hypothalamic, and limbic levels of the CNS. Also used as a preanesthetic medication to provide sedation and for management of status epilectus. Unlabeled uses include the treatment of chemo induced nausea/vomiting

adverse-Drowsiness and sedation is most common. IV route may cause amnesia, weakness, disorientation, ataxia, sleep disturbance BP changes, vision changes

Monitor respirations every 5-15 mins

73
Q

nembutal, seconal

A

barbiturates
action- binds with GABA receptor chloride channel molecules; inhibits brain impulses

used as sedative, hypnotic, and anti-seizure effects

adverse-tolerance, resp depression, dependance

rarely used for anxiety and insomnia!

74
Q

zolpidem (Ambien, edluar, intermezzo)

A

ther-Sedative hypnotic
pharm-Nonbenzodiazepine GABA receptor agonist, Nonbarbiturate CNS depressant

action-Acts in a similar fashion to facilitate GABA mediated CNS depression in the limbic, thalamic and hypothalamic regions. It preserves stage 3 of sleep and has only minor effects on REM sleep. For short term insomnia management

adverse-Daytime sedation, confusion, amnesia, dizziness, depression w suicidal thoughts, nausea, vomiting, hallucinations, sleep walking (and eating while doing), sensory distortion
Black box- schedule IV controlled substance that can lead to abuse and dependency

monitor for CNS depression

75
Q

what’s needed for depression diagnosis

A

5 symptoms ongoing for 2 weeks

76
Q

Lithium carbonate (eskalith)

A

mood stabilizer for bipolar disorder

affects sodium transport across cell membranes

adverse- sodium loss
Take lithium all the time, do blood checks of levels and check sodium

77
Q

methylphenidate (concerta, Ritalin)

A

ther-Attention deficit/hyperactivity disorder drug
pharm- CNS stimulant

action-Activates the reticular activating system, causing heightened alertness in various regions of brain, particularly those centers associated with focus and attention. Activation is partially achieved by release of neurotransmitters

adverse-Irregular heartbeat, HTN, liver toxicity, loss of appetite
Black box- schedule II, high abuse potential

drug holidays are recommended
Amphetamine- will show up in drug test.

78
Q

foods that contain tyramine

A

avocado
cheese
salami
yogurt
bananas

pharm 2 (4 decks)

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