Unit 4 Flashcards
Nonabsorbable compound that retains water in intestinal lumen, causing fecal mass to swell and soften
Osmotic laxatives- polyethylene glycol
Most effective for men with mild prostatic enlargement
Tamsulosin
AEs:
*Very well tolerated
Hypoglycemia
Meglitinides
Indications:
Tonic-clonic, simple partial, complex partial seizures
• Drug of choice for partial seizures
• Best for treating tonic-clonic seizures in young children
Bipolar disorder
Trigeminal and glossopharyngeal neuralgias (stabbing pain that occurs along a nerve)
Carbamazepine (Tegretol)
AEs:- Nausea/vomiting -Dyskinesias -Cardiovascular effects -Psychosis -CNS effects
Levodopa
Contraindications:
Don’t use in patients with preexisting liver dysfunction
Stop if pancreatitis is diagnosed during treatment
Pregnancy category D but HIGHLY teratogenic when taken in 1st trimester (neural tube defects, congenital malformations, cognitive dysfunction)
Valproic Acid (Depakene)
Stimulate intestinal motility and increase amount of water and electrolytes within the intestinal lumen by increasing secretion of water and ions into the intestine
Stimulant laxatives
Starting dose for levothyroxine:
1.6mcg/kg/day
AEs:
• Rarely causes side effects
• Acute overdose- thyrotoxicosis can result
o Tachycardia, angina, tremor, nervousness, insomnia, hyperthermia, heat intolerance, sweating
o Can accelerate bone loss and increase risk of AF
Levothyroxine
Advanced nursing implications:
PO sucrose cannot help during hypoglycemia episodes because the medications will impede the absorption in the intestines, must use PO glucose itself.
Check LFT every 3 months r/t potential Liver dysfunction
Alpha-glucosidase inhibitors
Poorly absorbed and cannot be digested by intestinal enzymes and is converted into lactic acid, formic acid, and acetic acid, which exerts a mild osmotic action
Osmotic laxatives- lactulose
Most effective in men who have highly enlarged prostates
Finasteride
MOA:
• Suppression of high-frequency neuronal firing through blockade of sodium channels
• Suppresses calcium influx through T-type calcium channels
• May augment inhibitory influence of GABA
Valproic Acid (Depakene)
MOA:
Prevents breakdown of acetylcholine by acetylcholinesterase- increasing availability of acetylcholine at cholinergic synapses
Donepezil (aricept)
AEs:
GI effects- N/V/indigestion- transient usually (avoid by administering with food and with enteric coated tablet)
Hepatotoxicity- rare but can cause fatal liver failure- usually within first months of therapy
• Don’t use in conjunction with other drugs in children under 2
• Monitor LFTs, use lowest effective dose
Pancreatitis- can be fatal
Hyperammonemia- can occur with or without encephalopathy
Others- rash, weight gain, hair loss, tremor, blood dyscrasias
Valproic Acid (Depakene)
MOA:
• Enhances the action of incretin hormones, which helps blood sugars not elevate as high
• Incretin hormones 1. stimulate glucose-dependent release of insulin. 2. Suppress post-prandial release of glucagon.
• It inhibits DPP-4 enzymes that inactive the incretin hormone action
DPP-4 inhibitors- sitagliptin, “gliptins”
AEs:
Constipation or diarrhea, depending on the agent:
• Aluminum and calcium compounds- constipation
• Magnesium compounds- diarrhea
Sodium compounds raise BP, affect patients with HF
• Also causes eructation and flatulence (liberates CO2)
Aluminum compounds- can bind to tetracyclines, warfarin and digoxin, reducing effects
• Also high in sodium
Antacids
MOA:
binds to base of ulcers and erosions, forming a protective barrier over these areas
o Protects these areas from pepsin, which breaks down proteins, making ulcers worse
Sucralfate
AEs:
Female genitalia fungal infections (Candida infections, yeast infections) *lots of glucose in urine, bacteria breeding ground.
UTI
Increase urination
Hypoglycemia if used in combination of other diabetic medications
In Elderly: can cause postural hypotension and dizziness especially if used with diuretics. Both increase urination and cause dehydration
SLGT-2 inhibitors
MOA:
• Stimulate the pancreas to make insulin (Actively lower blood glucose levels) by binding and inactivating ATP-sensitive potassium channels in the cell membrane = membrane depolarization = calcium influx = insulin excretion
• Long-term use: can target cell sensitivity to insulin
Sulfonylureas- glyburide
AEs:
• Cholinergic effects- N/V/D, dizziness, HA, bronchoconstriction
• CV effects uncommon but can cause bradycardia, fainting, falls (and fractures from falls), requirement of pacemaker placement
Donepezil (Aricept)
AEs:
CNS effects- sedation
Gingival hyperplasia (excessive growth of gum)
Dermatologic effects- morbilliform (measles-like rash) can progress to Stevens-Johnson syndrome or toxic epidermal necrolysis (TEN) (worse with gene variation- HLA-B*1502)
Effects in pregnancy- category D- can lead to cleft palate, heart malformations, fetal hydantoin syndrome (growth deficiency, motor/mental deficiency, microcephaly, craniofacial distortion, etc)
CV effects- if administered IV for status epilepticus- dysrhythmias and hypotension may result
Purple glove syndrome- IV- painful swelling/discoloration in hands and arms
Others- hirsutism, interference with vitamin D- can cause rickets and osteomalacia, interference with vitamin K-dependent clotting factors- can cause bleeding in newborns, liver damage from drug allergy
Phenytoin (Dilantin)
Contraindications:
Don’t use in patients with preexisting hematologic abnormalities
Pregnancy category D
Use caution in patients with HF- monitor sodium levels (hypoosmolarity
Carbamezepine (Tegretol)
MOA:
Selective inhibition of sodium channels
• Causes slow recovery of sodium channels from inactive state back to the active state
• Suppresses action potential- decreasing neuronal firing
• Limited to neurons that are hyperactive, leaving healthy neurons unaffected
Phenytoin (Dilantin)
Contraindications:
Renal impairment or renal insufficiency: excreted unchanged in the kidneys so bad kidneys means toxic levels
Not for individuals with HF
ETOH r/t inhibiting breakdown of lactic acid = increase risk of Lactic acidosis
No cimetidine (h2 blocker for GERD or acid reflux) r/t increase risk of Lactic acidosis
Iodinated Radiocontrast Media: can lead to renal impairment, then increase risk of lactic acidosis
Metformin
Alter stool consistency by lowering surface tension, which facilitates penetration of water into the feces
o Also act on intestinal wall to inhibit fluid absorption and stimulate secretion of water and electrolytes into the intestinal lumen
Surfactant laxatives (Colace)
Starting dose for levothyroxine in elderly patients
25mcg/day
MOA:
• do not prevent overproduction of acid, but does neutralize the acid once in the stomach
o Helps relieve pain by raising gastric pH
• If pH rises >5, can reduce pepsin activity as well
• May also stimulate production of prostaglandins to enhance mucosal protection
Antacids
Once plasma levels reach therapeutic range, small changes in doses produce large changes in plasma levels- small increases in doses can cause toxicity
Sensitive to hepatic metabolism- if too much dose is given, liver’s capacity to metabolize becomes overwhelmed and plasma levels can quickly rise
• Makes it difficult to establish and maintain a dosage that’s safe and effective
Use caution with other CNS depressants- barbiturates, alcohol, other CNS depressants
Phenytoin (Dilantin)
AEs: Upper respiratory infections Headache Sinusitis Inflammation of nasal passage and throat
Pancreatitis (rare)
Potential relationship with hypersensitivity reactions (anaphylaxis, angioedema, and steven’s Johnson syndrome (rare)
DPP-4 inhibitors
Contraindications:
Diuretics can cause dehydration if mixed (*elderly)
Rifampin, phenytoin, phenobarbital will decrease Canagliflozin levels
SLGT-2 inhibitors
Suppresses release of follicle-stimulating hormone from the pituitary gland and suppresses mid cycle luteinizing hormone surge, inhibiting ovulation while also thickening cervical mucus and making the endometrium less hospitable for implantation
Combination OC (estrogen and progesterone)
Short-acting = need to be taken with meals
To avoid hypoglycemia patient needs to eat within 0-30 minutes of taking medication
Meglitinides
MOA:
• Stimulate the pancreas to make insulin (Actively lower blood glucose levels) by binding and inactivating ATP-sensitive potassium channels in the cell membrane = membrane depolarization = calcium influx = insulin excretion (like sulfonylureas)
SHORT-ACTING (sulfonylureas are long-acting)
Meglitinides- repaglinide and nateglinide
