| Terms |
Definitions |
|
Imitrex
|
sumatriptan
|
|
necro-
|
death
|
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alendronate
|
Fosamax
|
|
|
|
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Aldomet
|
Methyldopa
|
|
Vicodin
|
Analgesic
|
|
meloxicam
|
mobicox
|
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paroxetine
|
paxil
|
|
amitriptyline
|
elavil
|
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timidolol
|
beta nonselective antagonist
|
|
Allegra
|
fexofenadine/ pseudoephedrine
|
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Autonomic drugs
|
p302
|
|
Digoxin
|
Cardiac Glycosides
|
|
servent
|
salmeterol xinaforte
|
|
acebutalol
|
sectral, monitan
|
|
Primaquine
|
MalariaMOA: Synthetic 8-aminiquinolineMET: Absorbed GI Half-life: 3-8 hoursSE: GI, methemoglobinemia Hemolysis in G6PD Cardiac & blood dyscrasias OTH: Only agent active against dormant hypnozoite liver form (P. vivax & P. ovale)TX: Malaria
|
|
Lincomycin
|
AntiinfectivesLincosaminesNarrow, gm+, bac.static, toxic in g.pigs, horses,hamsters, rabbits, good w/anaerobic bac.
|
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Diuretics
|
reduce volume overload
|
|
Antipsychotics (neuroleptics)
|
p. 310
|
|
class risperidone
|
atypical antipsych
|
|
Haloperidol
|
Antipsychotic butyrophenone
blocks brain dopamine D2 receptors.
Tox-
marked EPS dysfunction, hyperprolactinemia; less ANS adverse effects than phenothiazines
|
|
MIC
|
Minimum Inhibitory Concentration
|
|
chlorpheniramine
|
H1 selective antagonist
|
|
Pilocarpine
|
Mechanism: cholinomimetic alkaloid, tertiary amine (well-absorbed, penetrates CNS); excreted by kidney; not an ester so not hydrolyzed by acetylcholinesterase
Treatment: sialogogue (increases salivation), miotic agent; Sjogren's syndrome and after radiation therapy
Side effects: parasympathetic action
|
|
common glucocorticosteroid:
|
fluticasone (Flovent)
ADVAIR DISCUS: (fluticasone + salmeterol)
combined glucocortico. & B agonist
use for long-term control
|
|
non-cardiac symptoms of Digoxin:
|
anorexia
nausea
vomiting
fatigue
|
|
St. John's Wart
|
Mild depression
|
|
Reversal agent for precedex
|
atipamezole
|
|
uses of somatostatin
|
acromegaly
carcinoid
gastrinoma
glucagonoma
|
|
Clozapine
|
Atypical antipsychotic
low affinity for dopamine D2 receptors, higher for D4 and 5−HT2A receptors; less EPS adverse effects than other antipsychotic drugs.
Tox-
ANS effects, agranulocytosis (infrequent but significant)
|
|
Isoniazid
|
Antimycobacterial
primary drug in combination regimens for tuberculosis; used as sole agent in prophylaxis. Metabolic clearance via N−acetyltransferases (genetic variability).
Tox-
hepatotoxicity (age−dependent), peripheral neuropathy (reversed by pyridoxine), hemolysis (in G6PD deficiency)
|
|
Lidocaine Indications
|
ventriculare dysrythmias only
|
|
fluticasone
|
nasal flonase, inh flovent
|
|
Asprin
|
acteylated salicyclic, irreversably inhibits cox-1,2,weak acid, absorbed in upper GI and stomach. Low dose short half life, binds to serum protein, enterohepatic circulation.
|
|
Carbachol
|
Mechanism: choline ester with quaternary ammonium group (poorly absorbed, low penetration of CNS); muscarinic receptor agonist; parasympathetic effects (contraction of ciliary muscle which lowers intraocular pressure)
Treatment: used topically as miotic agent for glaucoma
Side effects:nausea, vomiting, diarrhea, salivation, sweating, cutaneous vasodilation bronchial constriction
Antidote: atropine
|
|
CYP
|
What abbreviation stands for Cytochrome P450?
|
|
TCA S/E
|
Orthostatic Hypotension, sedation, anticholinergic, seizures, sexual dysfuntion
|
|
neostigmeine
|
use in urinary retension
myasthenia
ileus (no cross BBB)
|
|
Anaphylaxis
|
severe, potentially fatal allergic reaction
|
|
Chief side effect of antihistaines
|
Sedation
|
|
Drug
skeletal muscle resistant
blocks Ca release from SR
used with pts with spasticity
also treats malignant hyperthemia
no effect on Ach release
|
Dantrolene
|
|
Drug
skeletal muscle resistant
blocks Ca release from SR
used with pts with spasticity
also treats malignant hyperthemia
no effect on Ach release
|
unique MOA
|
|
toxicityy of selegeliene
|
enhances l-dopa toxicity
|
|
What drug causes:
Acute cholestatic hepatitis
|
Macrolides
|
|
Aminoglutethimide
|
Nonsteroid inhibitor of steroid synthesis
reduces conversion of cholesterol to the hormone precursor, pregnenolone. Used in metastatic breast cancer
|
|
what is extra pyramidal symptoms
|
parkinsons
|
|
phentermine
|
amphetamine parent, monoamine reuptake inhibitor anti-obesity
|
|
Phenoxybenzamine
|
Treats pheochromocytoma & Reynaud’s disease; short-term control of hypertension
Irreversible blockade. Alpha 1 and 2 antagonist.
|
|
Tamsulosin
|
is an antagonist of alpha-1A adrenoceptors in the prostate, leading to relaxation of the smooth muscle. Used to treat benign prostatic hyperplasia.
|
|
Bismuth subsalicylate
|
GI Drug (Mucosal Protectant/Antacid) MOA: React w/proteins in acid medium → protective barrier in ulcer crater SE: Black stools, black tongue Don't use in renal disease May have ABX activity against H. pylori TX: Gastric/duodenal ulcers
|
|
Components of the nephron
(6)
|
glomerulus
bowman's capsule
proximal convoluted tubule
loop of henle
distal convoluted tubule
collecting tubule/duct
|
|
Antiadrenergic Drugs:
|
alpha blockers, and beta blockers
|
|
Clinical use?
|
pain, cough supression (dex), diarrhea (loperamide), acute pulmonary edema, methadone maintenance programs
|
|
Which drugs causes cardiotoxicity, alopecia, and myelosuppression?
|
Doxorubicin (adriamycin)
|
|
Generic Name
|
Identitifies the active ingredient. Derived from the chemical name. Assigned by the drug manu. who first dev. drug.
|
|
Diaxepam, lorazepam and phenobarbital are ecamples of __________________ ____ drugs.
|
Schedule IV
|
|
propofol: facts + pros
|
non-barbiturate sedative-hypnotic agent
used for induction &/or maintenance of anesthesia, to produce prolonged sedation of patients in ICU
pros: rapidly metabolized & redistributed --> very rapid recovery
does NOT accumulate in body w/ chronic dosing
|
|
which epileptic drug --> aplastic anemia, liver toxicity, and teratogenesis?
|
carbamazepine
|
|
receptor selectivity for epi?
|
all are equal
|
|
Type of drug?
Bretylium
|
Class III antiarrhythmic
Potassium channel blocker
|
|
Paraquat
|
Toxic herbicide
very small oral (but not inhaled) doses cause lethal pulmonary fibrosis
|
|
ALPRAZOLAM
|
Mechanism: Increase the frequency of Cl channel opening. No GABA mimetic activity. BZ1 mediates sedation, hypnotic while BZ2 mediates antianxiety, impairment of cognitive functions, muscle relaxant, etc.
Uses: anxiety, panic, phobias
Most widely used BZ
|
|
nifedipine
|
L-type Ca channel blocker vascular selective
|
|
Ipratropium
|
Reduces bronchospasms by blocking M3 receptors. (causes brochodilation and reduces bronchial secretions)
|
|
...induce synthesis of renal prostaglandins and improve renal blood flow
|
Loop diuretics
|
|
Memantine
|
is used in the treatment of Alzheimer’s disease. It is an NDMA receptor antagonist, which may help prevent excitotoxicity and neuronal cell death.
|
|
Aspirin
|
RA (COX1 & COX2 Irreversible inh) Duration: Low = 15 min High = 4 h ↑ High = 13 h OTH: 1) binds serum proteins (depends on dose) 2) irreversibly acetylates COX-1&2, 3) irreversibly inhibits platelet aggregation SE: 1) salicylism, respirary alkalosis, met. acid 2) NSAID-asthma 3) Reyes syndome TX: Rheumatoid Arthritis, Inflammation
|
|
Trough
|
lowest serum level, taken 30 mins before next dose - used to determine drug accumulation & toxicity
|
|
GER
regurgitation
emesis
|
GER: passage of gastric contents into the esophagus
regurgitation: passage of gastric contents into the oropharynx
emesis: expulsion of gastric contents from the mouth
|
|
S/E hydrlazine
|
SLE like syndrome
edema
no cause CNS depreesion
or postural Hypotesion
reflex tachycardia
|
|
What type of drug administration is usually used for CSF?
|
Intrathecal
|
|
inhibit NT release
|
-inhibit uptake of precursor-inhibit synthesis-inhibit uptake/storage in vesicle-inhibit release into cleft-increase destruction
|
|
What drug is made of Valproic acid?
|
Depakote
|
|
Cholinergics anatagonists that block the effects of ACh almost exclusivley at muscarinic receptors
|
Muscarinic Cholinergic Antagonist
|
|
pH of all narcotics and local anesthetics
|
basic
|
|
strategies to study pharmacology
|
concentrate on therapeutic classifications
keep a reference handy
use own words in notes/cards
understand how drug works in body - applies to rest of class
|
|
Clinical uses of Ivermectin.
|
Onchocerciasis "rIVER blindness treated with IVERmectin".
|
|
MOA nitroprusside
|
vasodilation of arteries and veins
contact with RBC --> decomposition of drug and release of NO
NO, via activation of guanylate cyclase --> vasodilation
|
|
Type of drug?
Mexiletine
|
Class Ib antiarrhythmic
Na channel blocker
|
|
What is another name for vitamin B12?
|
cyanocobalamin
|
|
Aminophyllin OD S/S
|
first signs: insomina, tachycardia, arrhythmias, seizures; then anorexia, N, V, stomach cramps, restlessness, confusion, headache, flushing, increased urination,
|
|
what types of drugs affect the parasympathetic nervous system?
|
cholinergics
anticholinergics
|
|
Lignocaine
|
used for local anasthesia, has epi mixed with it for slower removal coz of its vasoconstrictive effect, dental work.
|
|
Thiopental
|
IV or bolus anesthetic, rapid onset, 10 min. anesthesia, slowly metab. by liver but out of brain quickly, get hangover, decreases cerebral blood flow so good for head injuries and grain tumors, reduces hepatic blood flow and GFR, NOT AN ANALGESIC.
|
|
L-Asparaginase
|
"I am going to eat ALL ASParagus"
Mechanism: enzyme that depletes asparagine (many tumors cannot synthesize their own)
Treatment: ALL
Side-effects: Allergic reactions, decreased protein synthesis (hypoinsulinemia/hyperglycemia, reduced clotting factors/inhibitors), ASP (allergies, spare GI and bone marrow, and protein deficiency), cerebral dysfunction, pancreatitis
|
|
All sedative/hypnotics except for ______ are general CNS _________ capable of producing _________ that can progress to _________
|
1. Benzodiazepines2. depressants3. dose-dependant CNS depression4. medulla oblongata depression, coma, death
|
|
antifungal agents:
terbinafine (Lamisil)
|
similar spectrum as Griseofulvin
PO & topical administration
drug of choice for fingernal (8 wks PO) & toenail (12 wks PO) fungi - "onycomycosis"
|
|
MAOIs THERAPEUTIC USES
|
for persons allergic or NOT responding to TCAs
those w/low psychomotor actvity
those w/strong anxiety
ATYPICAL depression:
labile moods, rejection sensitivity,eating disorders
|
|
As the dosage administered to a single subject or isolated tissure is increased, the pharmacologic effect will also increase until at certain dose, the effect reaches a maximum. What is this called?
|
Graded responses
|
|
This drug used to treat testicular cancer and lymphomas may cayse pulmonary fibrosis, skin chnages, and myelosuppression
|
Bleomycin, Dactinomycin
|
|
propagation of a seizure
|
-recruitment of normal neurons-local or distant-gradual or instantaneous
|
|
Tricycli Antideressants (TCA)
|
Antidepressants act by blocking the reuptake of norepi and seretonin, extending the duration of their actions
|
|
Beta 2 receptors
|
-Cause broncho and vasodilation when stimulated.
-Can inhibit uterine contractions when stimulated.
-Side effects of muscle tremors possible with over stimulation.
|
|
What does the abbreviation stand for: VO
|
verbal order
|
|
Most common resistance mechanism for Chlorampenicol.
|
Modification via acetylation.
|
|
Type of drug?
Propanthaline
|
Blocks M1 receptors on ECL cells(↓Histamine) & M3 receptors on parietal cells (↓acid)
|
|
what is the duration of ipratropium bromide?
|
4-6 hour
|
|
signs of drug diversion
|
arriving early/staying late; comming in on off days; signing out large quanity; volunteering to give meds to other nurses patients; frequent bathroom breaks, discrepencies in documentation, meds being signed out for patients who are not at the unit
|
|
selegiline
|
MAOB i, reduces DA metabolism in CNS, parkinsons
|
|
Two prototypical TCA drugs
|
Imipramine and amitriptyline. (both are tertiary compounds and both inhibit NE and 5-HT uptake ) They are metabolized to secondary compounds that are also antidepressants (desipramine and nortriptyline). Tertiary have more prominent side effects.
|
|
Drugs for the treatment of TB?
|
isoniazid, rifampin, pyrazinamide, ethambutal. American Thoracic Society recommends 3 drug regimen of isoniazid, rifampin, and pyrazinamide
|
|
There are 3 types of interindividual genetic variations that influence pharmacotherapy, which are?
|
Pharmacokinetic variation, pharmacodynamic variation & genetic asso. w/ idiosyncratic drug effect
|
|
3rd generation quinolones/2nd generation fluoroquinolones
|
broad spectrum (not good for atypicals)
gram-neg coverage as above
greater gram-pos coverage
|
|
Therapeutic uses of Mannitol [Osmitrol]
|
Prophylaxis of renal failure
Reduction of intracranial pressure
Reduction of intraocular pressure
|
|
What biological item may be used as a model for drug-receptor interactions?
|
Enzymes
|
|
how to modify synaptic function
|
-inhibit NT release-facilitate NT release-decrease NT in cleft-increase Nt in cleft-mimic action of NT on post-block access of NT to receptor on post-decrease action of NT-increase action of NT
|
|
Extended Spectrum
|
Gram + and -. Also good against pseudomones and proteins (everything).
|
|
What are two big respiratory depressants?
|
Opium and barbiturate groups
|
|
antidote for anticholinesterates & organophosphates (too much ACh) =
|
atropine & pralidoxime (which regenerates cholinesterASE)
|
|
Fluoxetine, sertraline, paroxetine, citalopram are what class of drugs?
|
pg 311 SSRI's for endogenous depression
|
|
what 2 cholesterol drugs, if taken concurrently, will cause rhabdomyolysis
|
statins and fibrates
|
|
What is the problem with Ephedra?
|
-relative of amphetamine
-myocardial infarct
|
|
ETOH abuse - frequent complications
|
cirrhosis of the liver, cardiomyopathy, vitamin B deficiency (wernicke's encephalopathy, korsakoff's psychosis, polyneuritis, nicotinic acid deficiency, encephalopathy
|
|
Efficacy
|
Max response that can be achieved by a drug.
|
|
Maternal intake of...may cause neurobehavioral deficits.
|
Enter your back text here.
|
|
Loading dose
|
What type of dosage would be used if it is clinically important to acheive therapeutic concentrations immediately?
|
|
other agents affecting the cell wall:
vancomycin (Vancocin)
|
effective against all gram-pos organisms
presently reserved for tx of severe infections caused by MRSA or serious gram-pos infection in PCN-allergic pts (b/c not safe)
also used to treat C.diff-induced pseudomembranous colitis & for prophylaxis in pts w/ prostatic valves who are undergoing oral surgery
adminstered IV, except when treating pseudomembranous colitis, then POadmin IV over 90+ min to avoid Red Man's Syndrome (regardless of dose)
|
|
What do class I drugs target?
What states do they work on?
What phase in the action potential does it affect?
Why?
|
Sodium channel blockers
Open & inactive state
Phase 0
Because that is when sodium channels are open to enter the cell
|
|
Scopalamine: Class of drug, use.
|
Muscarinic Blocker - to prevent motion sickness and insomnia *puts you to sleep so you don’t puke on the Scope boat
|
|
Site of action
|
location within the body where a drug exerts its therapeutic effect, often a type of receptor
|
|
Once dug has FDA official name it is listed where and will have what next to name of drug
|
Pharmocpeia, USP
|
|
Disulfiram-like reaction can be due to which drugs?
|
- metronidazole
- cephalosporins w/methylthiotetrazole group
- procarbazine (Hodgekin's)
- sulfonylureas (insulin release for type 1 diabetes)
|
|
which beta blockers are used to treat glaucoma
|
timolol, betxolol, carteolol
|
|
What is the triple therapy for H. pylori ulcers?
|
Metronidazole
Bismuth or sucralfate
Amoxicillin(or tetracycline)
|
|
Tyroid replacement therapy action
|
is to achieve normal thyroid levels (euythroid)
|
|
Levofloxacin, moxifloxacin, and gemifloxacin have good antibiotic effects on... And their adverse side effects.
|
Gram-neg. and gram pos (strep., staph, and respiratory pathogens). Prolong QT interval and should not be given to patients being receiving class I or III antirrhythmics.
|
|
What is presumptive antibiotic therapy?
|
Given when there is a strong possibility of an established infection. (acute cholecystitis or pancreatitis of less that 24 hour duration)
|
|
Pharmacodynamics of Fibric Acid Derivatives:
|
mech. of action is not well understood
believed that fibric acid derivatives increase the activity of lipoprotein lipase, a plasma enzyme that degrades chylomicrons & VLDL
|
|
How do you properly measure BP?
|
Arm should be at level of heart
|
|
What is the normal function of Beta-2 receptors?
|
Relax bronchial smooth muscles
|
|
specific mechanisms of AED: enhance GABA inhibition
|
-Gaba facilitation (drug binds and helps gaba bind)-increase gaba synthesis/release (increase GAD-glu acid decarboxylase, decrease Gaba-T- gaba tranaminase, SSA- succininc semi-aldehyde)-decrease gaba metabolism-decrease gaba reuptake
|
|
What does the abbreviation stand for: SOS
|
si opus sit, if necessary
|
|
what are the side effects of antipsychotics
|
extrapyramidal side effects (EPS), sedation, endocrine, muscarinic blockade, alpha blockade, histamine blockade
|
|
which drugs cause SLE like syndrome
|
"it's not HIPP to have lupus"
hydralazine
inh
procainamide
phenytoin
|
|
What is sick sinus syndrome?
|
SA node is damaged, fibrotic or infected causing a lack of firing
|
|
Histamine neurons found where in the brain?
|
Tuberomammillary nucleus in the hypothalamus (neuroendocrine control, thermoreg., and arousal.)
|
|
examples of combinations of PCNs + B-lactamase inhibitors
|
amoxicillin + clavulanic acid = augmentin
piperacillin + tazobactam = zosyn
|
|
What equation is used to calculate half-life? What equation is used to estimate amount of a drug in the body at some point after it is given?
|
Half life = kt=0.693. Concentration at time t = Amount of drug at time zero/2^number of half lives that have gone by since time zero
|
|
Thiazide Diuretics - MOA, Uses, and S/E
|
Most widely used; the first choice.
MOA: Blocks reabsorption of Na and Cl in the distal convoluted tubule. (won't reabsorb water, blood volume decreases)
Uses: Hypertension and edema
S/E: Lyte/H2O imbalance, increases uric acid (which causes gout), hypokalemia, increased blood sugar, (hyperglycemia inhibits release of insulin).
|
|
Also, mediators elicit a ________ response is which leads to bronchial __________ and is treated with __________.
|
mediators elicit a late response and this leads to bronchial hyperactivity. This is best treated with steroids.
|
|
what is the process of absorption done by most drugs?
|
Passive Diffusion
(there is also active trans and carrier mediated)
|
|
Bethanechol (and other main drug in this group and group function)
|
Ach/choline ester mimetic (M-3 agonist (cevimeline also one)) for stomach and bladder-detrusor muscle, relaxes trigone, and external sphincter) Carbachol (broader effects).
|
|
What are special considerations (5) in patients that you should consider in drug metabolism?
|
- Age- Induction of drug metabolizing enzymes- First pass effect- Nutrition- Drug competition
|
|
Name the four places that Nicotinic receptors are found.
|
1 Autonomic ganglia 2 Adrenal medulla 3 CNS 4 Skeletal muscle
|
|
T or F: penicillin is effective against gram pos and gram neg rods
|
False: penicillin is used to treat common streptococci (but not staph), meningococci, gram pos bacilli and spirochetes (i.e. syphilis, treponema). Not used to treat gram neg rods.
|
|
What is the formula for augmentin?
|
250 or 500 mg amoxicillin + 125 clavulonic acid
|
|
What does angiotensis II do to SM cells?
|
Causes them to contract & proliferate -> ↑ strength of vascular wall (↑ tone) -> ↓ compliance (not able to relax as easy)
|
|
Which of these is not a mechanism of penicillin action: (1) binds penicillin-binding protein, (2) blocks peptidoglycan synthesis, (3) blocks transpeptidase catalyzed cross-linking of cell wall and (4) activates autolytic enzymes
|
Penicillin does not block peptioglycan synthesis, bacitracin, vancomycin and cycloserine do that
|
|
What lab work would be ordered for a patient to evaluate lipid levels?
|
A total cholesterol level, an LDL level, and HDL level.
|
|
What do the following drugs inhibit: 1. MAO inhibitors, 2. Desipramine/maprotilline, 3. Mirtazapine and 4. Fluoxetine/trazodone?
|
1. MAO 2. NE reuptake 3. Alpha 2-R 4. 5HT reuptake
|
|
os
|
mouth
|
|
amp
|
ampule
|
|
amp
|
a small glass vial containing solutions for hypodermic injection
|
|
Eprosartan
|
Teveten
ARB
|
|
1cc
|
1milliliter (ml)
|
|
tobramycin (Nebcin)*
|
Aminoglycoside
|
|
Antipyretic
|
Fever reducer
|
|
sol, soln
|
solution
|
|
Captopril
|
Capoten
-ACE inhibitor
|
|
Potential drug interactions
|
additive
potentiation
antagonistic
slower or faster absorption
slower or faster metabolism
slower or faster excretion
|
|
Nursing Process
1. Assess
|
History
Physical
|
|
Ends in "ase"
|
Enzyme
|
|
metipranolol (Optipranolol)
|
Beta-Adrenergic Blockers
|
|
Bactericidal
|
drugs kill bacteria
|
|
Cerumenolytics
|
hydrogen peroxidemineral oilCerumenexDebrox
|
|
Rifampin uses
|
M. tuberculosis
|
|
gt, GT
|
gastrostomy tube
|
|
gt, GT
|
gt is not the same as gtt!
|
|
Phenoxygenzamine
|
-Dibenzyline
-peripherally acting alpha adrenergic blocker
|
|
Amitriptyline(elavil)
|
drugTherapeutic uses: depression, bipolar disorder, neuropathy painadverse effects: ortostatic hypotension, anticholinergic effects (cant see, pee spit, poop)sedation, cardiac toxicity.Drug interactions: CNS depressants*huge issues with overdose/toxicity, these drugs can be tough to reverse!
|
|
DRUGS AFFECTING GOUT
URICOSURIC
|
PROBENECID (BENEMID)
|
|
1 gallon (gal)
|
4 quarts
|
|
Antihypertensives: Vasodilators
Indications
|
Severe HTN
Parenteral form is generally reserved for treatment of severe or malignant HTN
|
|
prototype for sulfonamides
|
sulfamethoxazole-trimethoprim (bactrim)
|
|
levothyroxine (Synthroid)
|
Classification: Thyroid hormone
Action: increases metabolic rate, controls protein synthesis, increases cardiac output, body temp, renal blood flow, O2 consumption, blood volume, growth, and development at cellular level.
SE: anxiety, insomnia, tremors, thyroid storm, tachycardia, palpitations, angina, dysrhythmias, cardiac arrest.
Contraindicated: adrenal insufficiency, recent MI, throtoxicosis, hypersensitivity to beef.
Considerations: take in am at same time daily on empty stomach; report excitability, irritability, anxiety -- OD; avoid foods high in iodine - iodized salt, soybeans, tofu, turnips, high-iodine seafood.
|
|
Rheumatoid arthritis meds
|
NSAIDsCorticosteroidsdexamethasone (Decadron)prednisone (Sterapred)triamcinolone (Kenalog)Disease modifying antirheumatic drugs (DMARDs)
|
|
Diflucan (Flucanazole)
|
Class: Anti-fungals
Side effects:
nausea, headache, abdominal pain, diarrhea, pain distortion
Nursing care:
used to treat candidiasis
reduces metabolism of tolbutamide, glyburide, glypizide so blood glucose should be monitored closely- hyperglycemia
|
|
t.i.d., tid
|
three times a day
|
|
t.i.d., tid
|
tres in dia
|
|
Terazosin
|
Hytrin
-peripherally acting alpha adrenergic blocker
|
|
Calcium supplements are contraindicated in pts who have
|
hypercalcemia
bone tumors
hyperparathyroidism
|
|
DRUGS AFFECTING CHOLINERGIC FUNCTION
AGONISTS
DIRECT-ACTING MUSCARINIC
|
PILOCARPINE (AKARPINE)
|
|
1 quart (qt)
|
1 liter (L)
|
|
POTENTIATE
|
(INCRESES THERAPUTIC AFFECT)
A DRUG THAT MAKES ANOTHER STRONGER WHEN GIVEN TOGETHER.
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amiodarone (Cordarone)
Type, Mechanism of Action, Uses
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Type: antidysrhythmic
Mechanism of Action: Class III - principal effect on myocardial tissue is to increase action potential duration
Uses: Treatment of V-tach, V-fib, V flutter and A fib
Treats only ventricular dysrhythmias
*Proarhythmic properties
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Vancomycin- RN responsibilities
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Infection-focused physical examinationMonitor blood pressure and heart rate during IV administration; take at least 60 minutesMonitor for red man syndromeMonitor urinalysis and renal and hepatic functions; do hematologic studiesMonitor blood levels in certain patientsAssess baseline and periodic hearingMonitor fluid balance; report changes in intake and output ratio and patternNote oliguria or cloudy or pink urine
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Raloxifene (Evista)
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Classification: hormone modifier, selective estrogen receptor modulator (SERM)
Action: reduces resorption of bone and decreases bone turnover; mediated through estrogen receptor binding.
SE: CVA, nausea, hot flashes, leg cramps, pulmonary embolism.
Contraindicated in pregnancy (X) & women c active hx of DVT
Considerations: B/P, weight gain, BDT baseline & during treatment. D/C drug 72hrs to prolonged immobilization.
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Meperidine (Demerol) produces what metabolite?
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normeperidine
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ARDS And Asthma
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Symptoms of ARDS:
Anxiety
restlessness
crackles
rhonchi
decreased breath sounds
dyspnea
tachypnea
Symptoms of Asthma:
Dyspnea
Wheezing on expiration
Non productive cough
Tachypnea
Tachycardia
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Examples of Endogenous Ligands:
Neurotransmitters bind to ________________.
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Neurotransmitter receptors
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anaphylaxis
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acute allergic response to an antigen that results in severe hypotension and may lead to life-threatening shock if untreated
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anaphylaxis
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hypotension & may be life-threatening
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Pharmacological Class groups drugs by
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shared characteristics
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DRUGS FOR UPPER RESPIRATORY SYSTEM
ANTIHISTAMINE
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FEXOFENADINE (ALLEGRA)
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Receptors that bind to acetylcholine are called?
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cholinergic
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Nursing Process
2.Diagnose
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1. Primary medical problem
2. Secondary medical problems
3.Social, psychological, educational,environmental, safety,nutritional problems
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cardiac glycosides help patients manage
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systolic HF
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Beta-adrenergic agonists stimulate
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Beta-1 receptors: cardiac stimulation
Beta-2 receptors: bronchodilation
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cromolyn sodium (Intal)
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* anti-allergic, anti-inflammatory properties. mast cell stabilizer, not a bronchodilator! stabilizes mast cell membrane, decreasing the release of histamine & other mediators
- inhibits eosinophils, macrophages and other inflammatory cells
* do not use to abort an acute attack
* safest antiasthmatic med!* especially effective for seasonal allergy attacks; e.g. 15min before mowing the lawn!* ADR's: cough, bronchospasm (low incidence)
* works in 15min; 1-2 weeks to get maximum benefits!
* allergic rhinnitis: Nasalcrom (intranasally)
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What types of injections should patients avoid for 3 months after completeing therapy with aldesleukin (Proleukin)?
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Vaccinations
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nursing responsibilities
diuretics
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-weigh daily
-I/O
-monitor BP and ortho hypo
-monitor elecrolytes (Na+, K+, Ca+)
-Hypo K+ <3.5: muscle weakness, abdominal distention, leg cramps, dysrythmias
-Hyper K+ >5.5: nausea, diarrhea, abdominal cramps, bradycardia, ecg change, oliguria
-Hypo Na+: LOC, headache, irritability,neurochanges, seizures, hallucinations
-take in AM
-drink!
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Electrodesication
Verruca Vulgaris (Warts)
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cautery / laser
note: wart can also be removed by surgical excision
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Beta-Adrenergic Blockers
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Decrease production of aqueous humor
|
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Clindamycin (Cleocin) Can induce antibiotic-associated
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pseudomembranous colitis
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Rubs & Liniments
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temporary relief muscular aches
|
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Montelukast (Singulair)Zafirlukast (Accolate)
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ActionsSelective and competitive receptor antagonist of cysteinyl leukotriene receptor. Leukotrienes are part of the inflammatory pathway that causes bronchoconstriction.reduce inflammatory process and decrease bronchoconstrictionUsesprophylactic and maintenance for chronic asthma NOT acute asthma attacks. Used in combination with other drugs to treat asthmaNot bronchodilators; given orally. Should not be used to treat acute episodes of asthma.The cysteinyl leukotriene receptor is the one that leukotriene D4 and E4 stimulates to trigger asthma symptoms.
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Another great comparison of Somatic Nervous System and Autonomic Nervous System
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s(with a line above the letter)
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without
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beta-adrenergic blockers
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inhibit beta adrenergic stimulation decreasing CO
-block the release of catecholamines, epinephrine, and norepinephrine decreasing HR and BP-used for angina, dysrhythmias, HTN, migranes, MI prevention, glaucoma
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Ergotamine
|
The drug of choice for stopping ongoing migraine attacks; also used for cluster headaches
|
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With administration of epinephrine and similar drugs (used for cardiac, bronchial, antiallergic, ophthalmic and vasopressor effects), assessment should focus on:
|
Vital signs
Breath sounds
Arteriole blood gas levels (ABGs)
ECG findings
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DRUG
|
ANY CHEMICAL AGENT THAT AFFECTS THE PHYSIOLOGI PROCESS OF A LIVING ORGANISM.
|
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Antidysrhythmics: 3 key drugs
|
lidocaine (Xylocaine)
amiodarone (Cordarone)
adenosine (Adenocard)
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Allergy or hypersensitivity to PCN, what is given?
|
Erythromycin (macrolide)
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RAAS
|
* ↓ (renal) BP - kidneys secrete renin
* converts angiotensinogen to angiotensin I
* angiotensin I is converted to angiotensin II via ACE (angiotensin converting enzyme) from the lungs
* angiotensin II → strong vasoconstrictor! Stimulates the release of aldosterone (saves Na+ and water (and secretes K+) which in the end ↑ blood volume, which ↑BP!
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what is the onset of pyridium
|
30 min
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APAP poisoning s/s
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anorexia, nausea, vomiting, dizziness, lethargy, diaphoresis, chills, epigastric or abd pain, diarrhea
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Protein Binding
|
Binding of drugs to Plasma Proteins:
- Albumin- major carrier for acidic drugs
- Alpha-1 acid glycoprotein- major carrier for basic drugs (alkaline drugs)
- Sex hormone binding globulin
- Thyroxin binding globulin
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Storage of Insulin
|
unopened vial is refrigerated
opened vials 4 weeks at room temp., 12 weeks refrigerator
less irritating to tissues injected at room temp.
DO NOT FREEZE
do not place in heat / direct sunlight
prefilled syringes in refrigerator and used in 1-2 weeks (at home)
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prednisone (Deltasone, Orasone)
glucocorticoid (adrenal cortex)
|
decreases inflammatory occurrence; as an immunosuppressant; to treat dermatologic disorders
mode: suppression of inflammation and adrenal function
Dose: 5-60 mg/day; may taper dose to avoid severe adrenal insufficiency
SE: N/D, increased appetitie, headache, weight gain, depression, mood changes, euphoria, hyperglycemia, abnormal fat deposits
Adverse: HTN, tachycardia, osteoporosis, muscle wasting, IOP, thin skin with purpurs, growth retardation, GI hemorrhage, thrombophlebitis.
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Alpha-Glucosidase Inhibitors
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acarbose (Precose): inhibits enzyme in the small intestine responsible for the release of glucose from complex carbs in the diet; cannot absorb carbs and are passed through to large intestine; not significantly absorbe, no systemic effects; used in conjuction with diet; does not cause hypoglycemia; may combine with sulfonylurea
Dose: 25 mg with meals
miglitol(Glyset): is absorbed from GI tract ; does not cause hypoglycemia unless taken with insulin or sulfonylurea
Dose: 25-100 mg with meals
SE: GI
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Somogyi Syndrome
|
hypoglycemia at 2-4 am
reduce bedtime insulin
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Equianalgesic Opioid Doses codiene
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O:180-200 mg parentral:130 mg
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Tetracyclines used to treat
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Rickettsiae, Mycoplasma, ChlamydiaN. meningitidis, N. gonorrhoeae, Lyme disease, anthrax (doxycycline), helicobacter pylorii, acne
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theophylline (Theo-Dur)
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LOW THERAPEUTIC INDEX: must monitor serum levelsAction: relaxes smooth muscle of bronchi, bronchiolesUse: maintenance therapy for chronic stable asthmaTheophyllineTherapeutic range: 10-20 mcg/ml (toxicity greater than 20) MUST KNOW THIS VALUE!!!!
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Toxicity
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An undesirable or dangerous effect of a drug brought about by high drug levels
|
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What is the medication route of administration that involves a needle?
|
parental
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Inamrinone lactate
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-used for short-term management of congestive heart failure in those who have not responded adequately to cardiac glycosides, diuretics, ad vasodilators
|
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Name of Drug: Hydrochlorothiazide(HCTZ) Trade Name: Aquazide H, HydroDIURIL, Microzide, Apo-Hydro, othersClassification: thiazide diuretic, antihypertensive
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Actions/Uses: diuretic, reduces the kidneys’ ability to absorb sodium, which in turn reduces the ability to reabsorb water, causing increased urinary output. The decreased levels of fluid in the blood help the heart pump more efficiently and decrease cardiac output. Used to treat a variety of conditions including: hypertension, congestive heart failure, symptomatic edema, the prevention of kidney stones and multiple other disorders. This drug has also been found helpful in treating diabetes insipidus(excessive urine production), although this mechanism is unknown.
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Adverse effects of beta-adrengergic agents
|
Adversely effect CNS, causing:
Mild tremor
HA
Nervousness
Dizziness
Cardiovascular effects:
Increased HR (positive chronotrophy)
Palpitations (dysrhythmias)
Fluctuations in BP
Other significant effects:
Sweating
Nausea
Vomiting
Muscle cramps
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Implementing Teaching Plan
|
Role of pt stress and anxiety
Planning and timing of sessions
Learning capacity
Variety of teaching methods
Verbal education
group settings
Written information
pt teaching resources
Audiovisual resources
internet & navigating the web
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AEs of cardiac glycosides
|
Very narrow therapeutic window: normal level is 0.8-2 ng/ml
Bradycardia, A/N/V, colored vision, halo vision are classic!
CV - Any type of dysrhythmia, including bradycardia or tachycardia
CNS - HA, fatigue, malaise, confusion, convulsions
Eye - Colored vision (i.e., green, yellow or purple), halo vision or flickering lights
GI - Anorexia, nausea, vomiting, diarrhea
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variant angina-prinzmetal's/vasospastic
|
* coronary vasospasm
* you can wake up in the middle of the night with this one!
* treatment is symptomatic only: nitrates and CCBs
|
|
seasonal rhinnitis, cont.
|
* Nasalcrom - intranasal cromolyn sodium.
- works in 1-2 weeks.
* sympathomimetrics (PO and intranasal decongestants used adjunctively)
- relieves stuffiness, not sneezing, runny nose or itching
- limit use to 3-5 days or else will REBOUND (all symptoms will reappear!)
- phenylephrine (Neo-synephrine), Sudafed PE, Afrin
- potential for abuse (like amphetamines) - pseudoephedrine, ephedrine
- ADR's: CNS excitation (irritability anxiety, insomnia)
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clinical indications bactrim
|
infections caused by h.influenza and streptococcus pneumonia; pneumocystis carnii (associated with HIV/AIDS); urinary tractinfections; GI infections (caused by shigella and salmonella); otitis media; STDs; burn wound infections (ex. silvadene used topically)
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Teach Family- Hep B
|
Return for all follow-up dosesImmediately report a fever of 39.4°C (103°F) or higher, difficulty breathing, confusion, swelling of eyes or face, irritability, or confusionNotify if known or suspected pregnancy prior to vaccinePrior to vaccination, report use of all vaccines, immunosuppressant drugs, or those to treat or prevent organ transplant rejection or cancerMaintain a current and accurate record of all vaccinationsH
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Contraindications for Intron A:
|
hypersinsitivity to IFN's, autoimmune hepatitis, hepatic decompensation, neonates and infants,
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drug interactions of diflucan
|
oral contraceptives ( decreases effectiveness)
|
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Transdermal absorption
|
Only fat soluble drugs are appropriate for trandermal application
Bypasses the 1st pass effect, abosorbed immediately into the vascular system.
|
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fludrocortisones (Florinef)
mineralocorticoid
|
is an oral mineralocorticoid that can be given with a glucocorticoid. It can cause a negative nitrogen balance; therefore a high-protein diet is usually indicated
potassium excretion occurs with use of mineralocorticoids and glucocorticoids, the serum K+ level should be monitored due to hypokalemia
0.1-0.2 mg/day
|
|
infliximab (Remicade)
|
Tumor Necrosis Factor Blockers used in treatment for RA
|
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Chemotherapy
|
use of chemicals to fight things in your body
|
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Side effects of Beta-2 Antagonist include bronchoconstriction. What does this mean for patients with asthma taking a beta-2 antognists?
|
Could worsen asthma
|
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pharmacodynamics
|
process by which a drug changes the body
|
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c(with a line above the letter)
|
with
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c(with a line above the letter)
|
"con" in Spanish="with" in English
|
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Verapamil and flunarizine
|
are the only two calcium channel blockers that appear useful in relieving migraines
|
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Adrenergic Storm Definition
|
Sudden and dramatic increase in the serum levels of catecholamines epinephrine (increases HR and SV) and norepinephrine (increases HR and BP) with a less significant increase in dopamine (a monoamine and precursor to epinephrine and norepinephrine).
|
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ACE Inhibitors (the "prils"): Renin-Angiotensin-Aldosterone System (RAAS)
|
These drugs block the angiotensin-converting enzyme (ACE) - ultimately prevents vasoconstriction and aldosterone secretion.
(Aldosterone - responsible for reabsorption of salt and water and excretion of potassium in the kidneys)
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|
What is antibiotic trough?
|
indicates how much has been metabolized by the body system, obtained 30 mins before administration
|
|
antibiotics mechanisms of action
(there are 4)
|
1. inhibits cell wall synthesis
2. inhibits protein synthesis
3. disruption of membrane permeability
4. inhibit synthesis of essential metabolites
|
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Nursing responsibilities for patients receiving penicillin G
|
infection-focused exam (VS, WBC); accurate hx; obtain blood, urine, sputum, wound cultures for C&S; evaluate renal, hepatic, and hematologic fxn; monitor for hypersensitivity
|
|
long-term High-doses of aspirin may cause....
|
tinnitus and hearing loss
|
|
Placenta
|
- Fetal pH of 7.0 somewhat more acidic than maternal pH of 7.4, and this can cause trapping of basic drugs
- Drugs that cross placental barrier and which administered to mother immediately before birth may therefore have adverse effect on fetus
- Drugs which are administered during pregnancy and which cross the placental barrier may cause anomolies. These are called teratogenic agents
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Antithyroid
NURSING MEASURES
|
* take meds with meals
*do not stop abruptly; thyroid crisis
S/S hypothyroid
1-3 weeks for improvement
monitor pulse for increase or decrease
SE: rash, hives, alopecia, loss of hair pigment, bruising, weakness
* report fever or sore throat (agranulocytosis); monitor CBC
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|
Fluoroquinolones Interactions
|
antacids, iron or zinc should not be taken within 2 hr, bind makes the antacids ineffective.
|
|
Which of the following terms is defined as "the ability of a drug to activate a receptor upon binding"?
A. Affinity
B. Intrinsic Activity
C. Efficacy
D. Potency
|
B. Intrinsic Activity
|
|
medication interactions
|
occurs when the admin. of one drug before, at the same time as, or after another drug alters the effect of one or both drugs (may be beneficial or harmful)
|
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Schedule V Drugs
|
have the lowest potential for abuse; the only category in which some drugs may be dispensed w/o a prescription because the quantities of the controlled drug are so low that the possibility of causing dependence is extremely low.
|
|
Stimulation of what receptor causes decreased GI motility?
|
Beta2 - decreased GI motility
|
|
Diuretic Agents: Osmotic Diuretics
Mechanism of Action
|
Produces osmotic pressure in the GF >>> pulls fluid into tubules >>> diuresis
|
|
Disease-modifying anti-rheumatic drugs (DMARDs)
|
* reduce joint destruction and retards disease progression in RA
* efficacy in 3wks-6mos depending on the drug
* concurrent use with NSAIDs while waiting for effects
* multiple DMARDs with persistent joint injury progression
|
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Which drug law required a drug to be both safe and effective, set guidelines for clinical trials, and established the Drug Efficacy Study Implementation (DESI)?
|
Kefauver-Harris Amendments
|
|
what is the "three-bag method"?
|
Treatment of APAP overdose; acetadote loading dose: dilute 150mg/kg in 200ml of d5w and administer over 50 minutes second dose: dilute 50mg/kg in 500ml of d5w and administer over 4 hours third dose: dilute 100mg/kg in 1000ml of 5% dextrose and administer over 16 hours
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clinical indications of rifampin
|
treatment of TB; treatment of other mycobacterial infections
|
|
Organs of excretion
|
- Kidney is the most important organ in excretion
- GI tract eliminates unabsorped drugs or metabolites excreted in bile
- Breast milk excretion is important because of potential passage of drugs to the infant
- Lungs excrete gases, ketones, etc.
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|
Acyclovir routes
|
Topical - apply q3hr x 7 daysAlso may be given PO and IV (renal alert
|
|
What is an autonomic ganglion?
|
- Clusters of neuronal cell bodies and dendrites
- Part of the Postganglionic Neuron
- A junction between autonomic nerves originating from the CNS and autonomic nerves innervating their target organs in the periphery.
|
|
The Nursing Process in Pharmacology:
Planning
|
* Maximize therapeutic effects and minimize adverse effects
* Include the patient & family in the planning
|
|
What is the use of drugs that are used to prevent, dx, and cure disease processes or to relieve s/s?
|
Drug therapy
|
|
DRUGS FOR TREATING THE LOWER GI TRACT
ANTIDIARRHEALS
|
DIPHENOXYLATE HCL WITH ATROPINE SULFATE (LOMOTIL)
|
|
Diuretic Agents: Loop Diuretics
Indications
|
Edema with HF and hepatic or renal disease
HTN
|
|
clinical indications of cephazolin
|
UTI caused by e. coli; surgical wounds (prophylaxis against infection); endocarditis, abdominal and pelvic infections; skin, joint, billiary, genital infections; septicemia
|
|
ASA is contraindicated in this age group:
|
• Contraindicated in children and teens (Reyes Syndrome)
|
|
Elimination of Half-Life
|
A measure of the rate of removal of the drug from the body
|
|
Penicillins are combined with what to extend the spectrum
|
a beta-lactamase inhibitors, the antimicrobial spectrum is extended
|
|
What are Non-Specific Beta Blockers?
|
Block both Beta 1 (heart receptors) and Beta 2 (Lung) receptors
However, they are more likely to cause bronchospasms than cardiovascular beta-1 specific antagonists
Nonspecific Beta Blocker Drugs:
Propanolol
|
|
Sources of drug information
|
1. Pharmacology book (Not a good way for updates; website stays current)
2. Physicians Desk Reference (PDR) for prescription and OTC drugs - comes with the drugs to protect the drug companies
3. Formularies
4. Drug compendiums - useful for dosage, not mechanism of action or class
5. Reputable websites (Mayoclinic, associations (heart, diabetic), advocacy websites
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|
Where are the major sites of action for anticholinergic agents?
|
Muscarinic receptors of the PSNS
|
|
What are the symptoms of pyelonephritis?
|
Symptoms of an upper UTI, would include chills, high fever, flank pain, pain during urination, urinary frequency and urgency, and pyuria.
|
|
if your pt is taking celebrex with diuretics or ACE inhibitors, what may happen?
|
antihypertensitive action of diuretics or ACE inhibitors may be reduced
|
|
Opioid Agonist Antagonist Analgesics general adrs
|
Have a greater risk of dysphoric side effects (spinning, not good)
|
|
Orthostatic Hypotension is an adverse effect of an Alpha-1 Blockade (Antagonist) drug. Explain why.
|
When a person stands up, their sympathetic nervous system is activated and their alpha-1 receptors are stimulated with norepinephrine.
Norephinephrine (an alpha-1 receptor) constrict arteries and veins to increase venous return to the heart and arterial blood pressure and to allow them to maintain full blood flow to the brain
When Alpha-1 Receptors are blocked, this activity does not occur and the person may feel dizzy or faint when standing up
|
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Phase III:
The large clinical trial of hundreds of subjects who have the condition must demonstrate _________ & ____________ of the drug in treating that __________.
|
The large clinical trial of hundreds of subjects who have the condition must demonstrate safety & efficacy of the drug in treating that indication.
|
|
What is PIH? What does it do and what is it treated with?
|
Pregnancy induced hypertension, gestational hypertension: elevated blood pressure without proteinuria after 20 gestational weeks in clients normotensive prior to pregnancy; nonpharmacologic treatments include activity reduction, lying on the left side, increased dietary protein (supplemental 90 g/day), psychosocial therapy and biofeedback; methyldopa (aldomet), hydralazine (apresoline), and Labetalol (trandate) are considered first line therapy for preeclampsia, additional alternatives include beta blockers, prazosin, nifedipine and clonidine; magnesium sulfate and hydralazine are the two most common
|
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Why should infants and neonates not recieve Intron A?
|
it contains benzyl alcohol, which is associated with an increased incidence of neurologic and other serious complications in this age group
|
|
Topical / Systemic preps for Psoriasis
Keratolytics (salicylic acid / sulfer)
|
* psoratic scales may be loosened with keratolytics (salicylic acid/ sulfer)
Topical glucocoritcoids are sometimes used for mild psoriasis.
other topical preps for psoriasis include anthralin (Anthra-Derm, Lasan) and coal tar (Estar, PsoriGel)
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What is the function of the Autonomic Nervous System (ANS)?
|
Regulate, Adjust and Coordinate vital viseral (organ) functions:
* Blood Pressure & Blood Flow
* Body Temperature
* Respiration
* Digestion
* Metabolism
* Elimination
|
|
Patient Specific Factors that may produce what results when taking the drug? (2)
|
1. Alter the drugs ability to produce its therapeutic effects or increase its side effects
2. Might cause an idiosyncratic reaction, like a drug allergy, or other effects particular to the patient
|
|
is urised used in the treatment of UTI
|
No; itis used to prevent reccurence for a pt who has chronic UTIs
|
|
What type of system is the Autonomic Nervous System (ANS)?
|
The ANS is a motor system
It innervates (sends nerve signals to) smooth and cardiac muscles and glands.
|
|
Your pt has overdosed on IBU, what s/s are you looking for and what is the treatment for IBU overdose?
|
• overdose may lead to acute renal failure, apnea, cyanosis, drowsiness, GI bleeding, N/V, sweating. Treatment = charcoal
|
|
What is more important, a more potent drug or a drug that has more efficacy?
|
Efficacy - we want the drug to work.
Some drugs will never create a desired response like others - Example: Morphine for pain will create a needed result for someone going through surgery, where tylenol would not even compare. In this situation, tylenol would have less efficacy and morphine would have more
|
|
How do we overcome the effects of a competitive antagonist?
|
Give an agonist in higher doses to increase the chance that a vacant receptor will be occupied by the agonist instead of the antagonist.
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