test 4 Flashcards
phenytoin (dilatin, phenytek)
ther-Antiseizure; antidysrhythmic
pharm -Hydantoin; sodium influx-suppressing drug
Acts by desensitizing sodium channels in the CNS, Preventing the spread of abnormal electrical charge in the brain that produces seizures. Also has antidysrhythmic activity
adverse- May cause dysrhythmias like bradycardia or v-fib, severe hypotension, hypoglycemia, headache, nystagmus, ataxia, confusion, twitching, insomnia, peripheral neuropathy with long time use, skin reactions such as steven Johnson. Black box- IV shouldn’t achieve 50mg/min due to risk of dysrhythmias and hypotension
IV max - 50mg/min
Always prime or flush before giving
Don’t use hand veins
monitor kidney and liver functions
similar drugs- fosphenytoin, zonisamide
Valproic acid (depakene)
ther-Antiseizure drug
pharm-valproate
Preferred for treating epilepsy. Many names Valproic acid (standard), valproate sodium (sodium salt), divalproex sodium (SR of valproic acid and sodium salt). All 3 form the chemical valproate. For seizures. Off label- behavioral disturbances
adverse- Sedation, drowsiness, GI upset, prolonged bleeding time, visual disturbances, muscle weakness, tremor, bone marrow suppression, weight gain, fetal hepatotoxicity, alopecia. Black box- hepatic failure
ethosuximide (zarotonin)
ther- antiseizure
pharm- succinimide
Preferred drug for absence seizures. Depresses activity of neurons in the motor cortex by elevating the neuronal threshold. Usually ineffective for psychomotor or tonic clonic seizures
adverse-May impair mental and physical abilities. Psychosis, mood swings. Headaches, dizziness, lethargy, fatigue, ataxia, sleep disturbances
Don’t abruptly withdrawal- could cause tonic clonic seizure
phenobarbital (luminal)
ther-Antiseizure drug; sedative
pharm- Antiseizure drug; sedative
Long acting barbiturate used for management of a variety of seizures. Also for sedation
Acts biochemically by enhancing the action of the GABA neurotransmitter, suppressing abnormal neuronal discharges
schedule IV drug
adverse-May cause dependance. Common side effects are drowsiness, vitamin deficiency (D, B12, folate) and laryngospasms. OD may cause resp depression, CNS depression, coma, death
report bleeding and bone pain
similar drug- primidone (mysoline)
diazepam (valium)
ther-Antiseizure drug
pharm-Benzodiazepine; GABA receptor agonist
for Status epilectus, or prevention in patients who had toxic substances
action-Binds to GABA receptor chloride channels through out the CNS. Suppresses neuronal activity in the limbic system and subsequent impulses that might be transmitted to the reticular activating system. For short term use only
adverse- IV- hypotension, muscular weakness, tachycardia, resp depression
Effects may take 1-2 weeks
Tolerance may develop after 4 weeks
When IV- monitor RR
no alcohol, OTC drugs, nicotine, driving
take with food
end in -pam
chlorpromazine
ther-First generation antipsychotic
pharm-D2 dopamine receptor antagonist; phenothiazine
Provides symptomatic relief of positive symptoms of schizophrenia and controls manic symptoms
adverse- Dizziness, drowsiness, orthostatic hypotension, EPS
Black box- older patients with dementia related psychosis increased risk for death
May take 7-8 weeks for improvements
Give IM in buttocks
Drug must be gradually withdrawn over 2-3 weeks
IV only in surgery or severe hiccups
EPS
muscle spasms of face, tongue, neck or back
inability to rest: pacing
worm like movements of tongue
haloperidol (haldol)
ther-Conventional antipsychotic; schizophrenia drug
pharm-D2 dopamine receptor antagonist; nonphenothiazine
For management of acute and chronic psychotic disorders. May help with Tourette’s. 50X more potent than chlorpromazine
adverse- EPS, possible sedation and hypotension
Black box- older patients with dementia related psychosis increased risk for death
do not abruptly stop
Risperidone (Risperdal)
ther- Atypical antipsychotic; schizophrenia drug
pharm- D2 dopamine receptor antagonist
First line drug for treatment of schizophrenia and acute mania from bipolar. Also for irritability in autistic kids. Effects occur from blockade of dopamine type 2, serotonin type 2, and alpha 2 adrenergic receptors located in the CNS
adverse- EPS (involuntary shaking of head, arms, neck) hyperactivity, fatigue, nausea, dizziness, visual disturbances, fever, orthostatic hypotension. Black box- older patients with dementia related psychosis increased risk for death
May take weeks to produce effectiveness
monitor RBC and WBC
OD- activated charcoal
hydrocortisone (cortef, hydrocortone)
ther- adrenal hormone
pharm- corticosteroid
Structurally identical with natural hormone cortisol, this is a synthetic corticosteroid that’s the drug of choice for adrenocortical insufficiency. Also available for inflammation and allergic disorders. Available in 6 different salts.
adverse- Rare. Cushing syndrome, CNS effects such as insomnia, anxiety, headache, vertigo, confusion. May also cause HTN and tachycardia
Admin at same time daily
Discontinue gradually if token longer then 2 weeks
methimazole (Tapazole)
ther- Drug for hyperthyroidism
pharm- antithyroid drug
For hyperthyroidism. Acts by interfering with the synthesis of T3 and T4 in the thyroid gland. Effects are return to normal thyroid function: weight gain, reduction in anxiety, less insomnia, slower HR
adverse-Could be hepatotoxic. Possible blood dyscrasias such as agranulocytosis, aplastic anemia, thrombocytopenia
Talk to DR if pregnancy suspected
Monitor liver lab values
levothyroxine (levothroid, Synthroid)
ther- thyroid hormone
pharm- thyroid replacement hormone
Synthetic form of T4 that is a drug of choice for replacement therapy. Actions are weight loss, improved tolerance to environmental temps, increased activity, increased pulse
adverse- Rare at therapeutic doses. Hyperthyroidism, palpitations, dysrhythmias, anxiety, insomnia, weight loss, menstrual irregularities. Black box- not for treatment of obesity
Admin at same time daily
Monitor TSH levels
Monitor for hyperthyroidism
Calcium, and iron supplements can interact
desmopressin (DDAVP, noctiva)
ther-Drug for diabetes insipidus and nocturia
pharm-ADH analog
Synthetic form of ADH that acts on kidneys to increase the reabsorption of water. Causes contraction of smooth muscle in the vascular system, uterus, and GI tract. Lowers production of urine at night
adverse- Water intoxication- Drowsiness, headache, listlessness, convulsions, coma. Other adverse could be headache, facial flushing, abdominal cramping. Black box- may cause hyponatremia
ensure sodium is normal before starting
Restrict fluids if given IV
Overdose- water restriction, osmotic diuretic
similar drug: vasopressin
metronidazole (flagyl)
ther-Anti-infective, antiprotozoal
pharm-Drugs that disrupt nucleic acid synthesis
For giardiasis and trichomoniasis.
Acts as antiprotozoal drug that has antibiotic activity against anaerobic bacteria
adverse-Anorexia, nausea, diarrhea, dizziness, headache, dry mouth, unpleasant metallic taste
no alcohol
nystatin (Nystop)
ther- Superficial antifungal
pharm- polyene
for Candida infections, typically topical, vagina or in mouth
action: Binds to sterols in fungal cell membrane, allowing leakage in intracellular components
adverse- Skin irritation, N/V/D
May swallow if yeast possibly in esophagus
Amphotericin B (fungizone)
ther-
pharm-
For systemic fungal infections, given in ICU typically
action: Binds to ergosterol in fungal cell membranes, causes them to become leaky
adverse-Fever, chills, vomiting, headache in beginning. Phlebitis possible for IV, nephrotoxicity, dysrhythmias, cardiac arrest, ototoxicity
Admin IV slowly
May cause decreased K, Ca, Mg
Tylenol/antihistamine may be given for early adverse
One of last choice drugs due to danger
fluconazole (Diflucan)
ther-
pharm-
Treats fungal infection inside the body, such as in intestine
action: Interfering with synthesis of ergosterol
adverse- N/V/D
Look at liver test
No alcohol
Monitor BG
omeprazole (Prilosec)
ther- antiulcer drug
pharm-Proton pump inhibitor
Available prescription or OTC for PUD. Reduces acid in stomach by binding irreversibly to the enzyme H+K+ -ATPase. Can take up to 2 hours to reach effect but last 72 hours. Used short term 4-8 week therapy for peptic ulcers or GERD
adverse- Headache, nausea, diarrhea, abdominal pain. Rare- blood disorders
Take before breakfast on empty stomach
Interacts with anti seizures, more bleeding with warfarin
ranitidine (zantac)
ther- antiulcer
pharm- H2 receptor antagonist
Acts by blocking H2 receptors in the stomach to decrease acid production. Healing of ulcer takes 4-8 weeks, gastric requires longer healing. Available IV and IM as well as PO
adverse- Headache is most common. Rare- decrease in RBC, WBC
Admin after meals and monitor liver and kidney function
Aluminum hydroxide (alternaGEL)
ther- anti heartburn drug
pharm- antacid
Inorganic drug used alone or in combination of antacids. Giving these with magnesium increase effectiveness. These are minimally absorbed. Action is to neutralize stomach acid by raising the pH of the stomach contents, doesn’t reduce volume of acid secretions.
adverse- Constipation, could cause phosphate depletion
Admin 2 hours before or after drugs
Could inhibit iron
Don’t use if patient has bowel obstruction
psyllium
(Metamucil)
ther- bulk type laxative
pharm- herbal agent
Derived from seeds of plantain plant, a insoluble fiber that is indigestible and not absorbed thru GI tract, when taking with enough water, swells and increases size of fecal mass, promoting passage of stool
adverse- Typically none, if not enough water-obstruction
Could cause small reduction in blood cholesterol
Reduction in warfarin, seizure drugs, antidepressants
May lower blood glucose in type II diabetes
Mix with 8oz liquid
Diphenoxylate with atropine(Lomotil)
ther- antidiarrheal
pharm- opioid
Slows peristalsis, allowing additional time for water reabsorption. Acts within 45-60 mins. High doses could cause anticholinergic effects
adverse-Typically well tolerated. May cause dizziness
Don’t stop diarrhea that needs to occur, like c diff
Assess fluid and electrolytes
OD- narcan
sulfasalazine (Azulfidine)
ther- drug for iBS
pharm-5 aminosalicyte, sulfonamide
Oral sulfonamide with anti-inflammatory properties that is approved to treat mild to moderate symptoms of ulcerative colitis. Off label is treating crohns. Approved as a alternate drug of RA classified as DMARD
adverse- GI related, headache, blood dyscrasias, skin rashes. Impairs men fertility but reverses when discontinued. Can cause photosensitivity
Don’t admin if allergy to furosemide, sulfa
May decrease iron and folic acid
ondansetron (Zofran, zuplenz)
ther- antiemetic
pharm-Serotonin (5 ht3) receptor antagonist
Blocks serotonin receptors in the GI tract, as well as the chemoreceptor trigger zone in the brain. Started 30 mins prior to chemotherapy to prevent N/V. off label can be for pruritus
adverse- Usually well tolerated. Headache, dizziness, drowsiness, constipation or diarrhea
Admin on schedule not prn
pancrelipase (Creon, pancreaze)
ther- pancreatic enzyme
pharm- none
Contains lipase, protease and amylase of pork origin and is used as replacement therapy for patients with insufficient pancreatic exocrine secretions such as CF, pancreatitis. The enzymes act locally in the GI tract
adverse-Uncommon because enzymes are not absorbed. Most frequent are N/V/D. High doses have risk for hyperuricemia
Give with meals or 1-2 hours before
prochlorperazine (Compazine)
ther- antiemetic
pharm- Phenothiazine antipsychotic
Can be for psychoses or for severe nausea or vomiting. Acts by blocking dopamine receptors in brain, signaling to the vomiting receptor in the medulla. Frequently given the rectal route as absorption is rapid
adverse- Anticholinergic side effects such as dry mouth, sedation, constipation, orthostatic hypotension, tachycardia, extrapyramidal effects when prolonged. Black box–increased risk of death in dementia patients
Admin 2 hours before of after antacids or antidiarrheals
No alcohol
prochlorperazine (Compazine)
ther- antiemetic
pharm- Phenothiazine antipsychotic
Can be for psychoses or for severe nausea or vomiting. Acts by blocking dopamine receptors in brain, signaling to the vomiting receptor in the medulla. Frequently given the rectal route as absorption is rapid
adverse- Anticholinergic side effects such as dry mouth, sedation, constipation, orthostatic hypotension, tachycardia, extrapyramidal effects when prolonged. Black box–increased risk of death in dementia patients
Admin 2 hours before of after antacids or antidiarrheals
No alcohol
drugs for peptic ulcers
sucralfate (carafate)- coats and protects from father erosion
misoprostol (cytotec)- inhibits acid and stimulates production of mucosa
metoclopramide (reglan)- causes muscle in upper extremity to contract, antinausea
bacteriostatic antibiotic
slows growth of bacteria
bactericidal antibiotics
kills bacteria
penicillin G
ther- Antibacterial
pharm- Cell wall inhibitor, natural penicillin
Drug of choice against streptococci, pneumococci, and staphylococcus organism that do not produce beta-lactamase and are shown to be susceptible by C&S testing. May also be drug of choice for gonorrhea and syphilis.
adverse- Diarrhea, nausea, vomiting, pain at injection site, anaphylaxis
Only 15% of oral dose is absorbed, often given IV or IM
After IV monitor for reactions 30 minutes after
May decrease effectiveness of oral contraceptive
Cefazolin (Ancef, Kefzol)
ther- Antibacterial
pharm- Cell wall inhibitor; first generation cephalosporin
Beta lactam antibiotic used for the treatment and prophylaxis of bacterial infections, particularly gram positive. Has been used to treat infections of resp tract, urinary tract, skin structures, biliary tract, bones and joints. Can also be used for genital infections, septicemia and endocarditis
adverse- Tolerated well. Most common- rash and diarrhea. Pain and phlebitis and IM sites, rare- seizures
Not effective against MRSA
Typically given IV
Admin IM deep into large muscle mass to avoid injury to surrounding tissue
Don’t use if CKD or allergy to penicillin
Tetracycline (sumycin)
ther-Antibacterial
pharm- Tetracycline, protein synthesis inhibitor
Effective against a broad range of gram pos and gram neg organisms. Also effective against H. pylori for PUD. Given PO, but has short half life so may require 4x daily. Topical can be for acne
adverse- May affect vagina, oral and intestinal flora and cause superinfections. Irritates the GI mucosa cause N/V/D, and epigastric burning. Photosensitivity and discoloration of teeth could occur
Can cause intense pain at injection sites
Give with full glass of water to avoid GI irritation
Admin 1-3 hours before/after antacids
Dairy products interfere with absorption
Don’t give to people under 18 or pregnant woman
Decreases effectiveness of oral contraceptives
Erythrolysin (ERC, erythrocin)
ther- Antibacterial
pharm- Macrolide, protein synthesis inhibitor
Inactivated by stomach acid and is thus formulated as coated, acid resistant tablets or caplets that dissolve in the small intestine. Main application is for people that cant use penicillin. It is effective against most gram pos bacteria
adverse- Nausea, abdominal cramping, vomiting. High doses may cause hearing loss, vertigo and dizziness. High dose IV could pose risk for dysrhythmias
Admin on empty stomach with water
Don’t give immediately before or after fruit juices
Risk of nephrotoxicity
Alcohol can decrease absorption
Gentamicin (garamycin)
ther- Antibacterial
pharm- Aminoglycoside, protein synthesis inhibitor
Broad spectrum , bacterial antibiotic usually prescribed for serious urinary, resp, nervous or GI infections when less toxic antibiotics are contraindicated. Effective against gram pos bacteria, and some strains of MRSA. Drug isn’t absorbed orally
adverse- Rash , nausea, vomiting, fatigue. Black box- neurotoxicity may manifest with ototoxicity, neuromuscular blockade and resp paralysis is possible, nephrotoxicity is possible
IV or IM solutions should be clear and colorless or slightly yellow
Withhold is serum is above range of 5-10mcg
IM- inject deep into large muscle
Nephrotoxicity and ototoxicity possible
May increase liver values, decrease electrolytes
Most toxic antibiotic
Ciprofloxacin (cipro)
ther-Antibacterial
pharm- Fluoroquinolone; bacterial DNA synthesis inhibitor
Most widely prescribed drug in this class; inhibits DNA gyrase, affects DNA replication and DNA repair. More effective against gram neg. Prescribed for UTI, sinusitis, pneumonia, skin/bone infections, eye infections, infectious diarrhea or TB. Drug is rapidly absorbed PO
adverse-Typically tolerated well. Nausea, vomiting, diarrhea, phototoxicity, headache, dizziness. Black box- tendonitis and tendon rupture
Admin 4 hours before antacids and ferrous sulfate
Admin w food to diminish GI effects
Restrict caffeine as the drug could increase levels
Don’t take with multivitamins or minerals- Ca, Fe, mg, zinc
Monitor liver and kidney function
Over 60, taking corticosteroids, have risk for Achilles tendon rupture- cartilage toxic
Trimethoprim-sulfamethoxazole (Bactrim, septra)
ther- Antibacterial
pharm- Sulfonamide; folic acid inhibitor
Bacteriostatic drug
Most frequently prescribed for UTIs also approved for pneumocystis pneumonia, shigella, and chronic bronchitis. Inhibitors of bacterial metabolism of folic acid
Nausea and vomiting are most common. Hypersensitivity- rash, fever, itching. Photosensitivity (avoid sunlight), thrombocytopenia.
Use cautiously w CKD bc kidney failure has been reported
Use with caution w diuretics
Increases K+
Don’t use in pregnant woman
Don’t give if allergic to sulfa
Meropenem (merrem)
ther- anti-infective
pharm-carbapenems
binds to bacterial cell wall resulting in death
adverse- GI related, c diff, DRESS, steven johnson, seizures
Isoniazid (INH)
first line Antituberculosis. For latent or active TB.
adverse- GI symptoms. May cause anaphylaxis, peripheral neuropathy, hepatotoxicity, blood dyscrasias
Acyclovir (zovirax)
ther- Antiviral for herpes virus
pharm- Nucleoside analog
Effective against HSV1 and HSV2, only effective at high doses against CMV and varicella zoster. By preventing viral DNA synthesis, acyclovir decreases the decreases the duration and severity of herpes. It doesn’t cure the patient, just helps get virus back into the latent form.
adverse- few adverse effects. IV- Nephrotoxicity and neurotoxicity and possible
IV may cause painful inflammation
Admin around the clock
oseltamivir (tamiflu)
antiviral, neuraminidase inhibitor
flu drug, needs to be taken within 48 hours to be effective. doesn’t kill flu just shortens duration
adverse effects are nausea, vomiting, diarrhea, dizziness
other similar flu drugs are rimantadine, and amantadine
Zidovudine (Retrovir, ZVD)
ther- Antiretroviral
pharm- Nucleoside reverse transcriptase inhibitor (NRTI)
Drug resembles thymidine (of DNA). As the reverse transcriptase enzyme begins to synthesize viral DNA, it mistakenly uses zidovudine as one of the nucleosides, thus creating a defective DNA strand. Used for HIV
adverse- Fatigue, generalized weakness, anorexia, nausea, diarrhea, headache
Black box- lactic acidosis with hepatomegaly, bone marrow suppression
Admin on empty stomach
Avoid fruit juices
Efavirenz (sustiva)
ther- Antiretroviral
pharm- Nonnucleoside reverse transcriptase inhibitor (NNRTI)
Given PO with other antiretroviral for HIV. Acts by inhibiting reverse transcriptase . Resistance can develop rapidly
adverse- CNS effects- sleep disorders, nightmares, dizziness, delusions. Rash is common
Admin on empty stomach
Admin at bedtime to limit CNS effective
Dolutegravir (DTG, tivicay)
ther- Antiretroviral
pharm- Integrase stand transfer inhibitor
Inhibits HIV integrase, thus blocking the stand transfer of retroviral DNA, which interrupts the HIV replication cycle. It is become a preferred drug. Effective in both adults and peds
adverse- Insomnia, fatigue, headache. Less frequent include hypersensitivity and headache
Increased risk of neural tube defects in babies born to mothers taking this
