Pharm Final Flashcards

Terms Definitions
Urispas
antispasmotic
Brevibloc
Andtidysrythmic
Adrenergics blocker
Class II
Slow rate of ventricular contractions,block sympathetic NS,>increase blood flow,decrease BP,pupil constrict, increase GI motility
mannitol
osmotic diuretic
Thorocolumnar
SNS stimulating
Beta-Andrenergic Blocker
sotalol
Betapace
Available: Tablets:80,120,160,240mg
Use: Dysrythmias
Dosage Range: PO Initial 80mg bid. Maint. up to 320mg daily
Demecarium
Anticholinesterase
chronic open-angle glaucoma
closed- angle glaucoma
Dx & Tx of accommodative esotropia
imdur
antianginal organic nitrate
Ibutilide
Andtidysrythmic
K++ channel blocker
Class III
Slows repolarization>prolongs refactory period in atria & ventricles
Risk of hypokalemia
Xerostoma
(no saliva)
artifical saliva

gravies, sauces

casseroles

dairy, creams

avoid dry foods

humidify the room
Tricyclics
Amitriptyline (Elavil), Amoxapine, Clomipramine (Anafranil), Desipramine (Norpramin), Imipramine (Tofranil)
Pronestyl
Andtidysrythmic
Na++ channel blocker
Class 1a
For heart rythems faster than normal-
Lopid
Dyslipidemia
Co q reductase inhibitor
Increase HDL decrease LDL
inderal
antianginal
decrease severity of attacks
verapamil (calan)
- antiarrhythmics, antihypertensives
- side effects- drowsy, dizzy, arrhythmias, CHF, abnormal liver function, muscle cramps
- WATCH BP AND LIVER ENZYMES 
Dopaminergic receptors
adrenergic (sympathetic) stimulation increases urine output due to better renal perfusion and improves symptoms r/t Parkinsons.
Imipramine
Tricyclics (reuptake inhibitor of serotonin & NE)
B&O suppository
Belladona and opium- anticholinergic
bladder antispasmotic
narcotic
Stomatitis
(also called mucositis; mouth sores)
give liquids/soft foods

use a straw to get past the site

avoid acid

cool foods

use lidocane at meals
additive chemical in tobacco plants
nicotine
Nadolol (corgard)
- beta blocker (antihypertensive)
- manages hypertension, angina, arrhythmias
- Side effects- fatigue, weakness, impotence, decreased libido, arrhythmias, bradycardia
- MOnitor BP and pulse frequently as well as I's & O's
- hold if BP under 60 
Anaphylaxis
an allergic reaction between an allergic antigen (drug) and immunoglobulins
Tubocurarine- drug class
Nicotonic: Neuromuscular Blocking DrugsAntagonists (Non-depolarizing type): Competition with Ach to binding site = flaccid paralysis
Serotonin not inhibited by endproducts so can give
tryptophan
Antidepressant effect
Inhibition of reuptake transporters for norepinephrine or serotonin
captopril
1st line drug Ace inhibitors
Antihypertensive
Causes vasodialation, reduces Na and H2o retention,
May be used in combo for diabetics
Dysphagia
(trouble swallowing; picture having a sore throat)
cool, non acidic foods

straws

no rough/textured foods
known as the date rape drug
'roofies'
clarithromycin (biaxin)
- anti-infective, used to treat respitory tract infections
- side effects- headache, arrythmias, abdominal discomfort
- monitor for diarrhea and superinfection 
doxazosin (cardura)
- adrenergic antagonist
- used to cause vasodilation, lower BP 
Synergism
Occurs when two drugs together produce an effect greater than the 2 drugs alone could produce.
Scopolamine - drug class
cholinergic antagonists/ cholinergic blockersnopposed sympathetic stimulationblock muscarinic receptorsdo not block nicotinic receptors
Neostigmine - drug class
Indirect Cholinergic AgosistSynthetic inhibitor of acetylcholinesterase - more Ach available
Serotonin selective uptake inhibitors
fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft)
Drugs for hypotention and shock
adrenergic
increase peripheral vascular resistance and increase BP
Preop screening
Vitamin K, r/t clotting issues
Vitamin E (excess increases clotting time)

Herbs ginko, ginseng, garlic (change blood clotting)

Valerian, kava kava and St. John's wart can make patients more succeptable to anesthesia.
Which insulin should be given at bedtime?
Glargine
What are the side effects of coumadin?
Hemorrhage
Put the following in order according to speed of absorption fastest to slowest
a. capsules
b. enteric coated tablets
c. elixirs
d. powders
Elixers
powders
capsules
enteric-coated tablets
Vistaril and Ativan
Antianxiety, sedative hypnotic
 
Hydroxyzine (Vistaril)-Preop and post op sedation. can be given IM or PO.
You will feel relaxed and then sleepy.
Watch for headache, hypotension, dry mouth, dizzey, hives.
Lorazepam (Ativan)-Pre op sedatin, seizures, anxiety. can be given PO, IM or IV push. You will feel calmer and then become more sedated
When using Ativan, watch for retrograde amnesia, unsteadiness, drowsiness, and abd discomfort.
Assess Motor response, vs, I & O's, electrolytes
 
Beta and Alpha Combo Blocker Side Effects
Ortho HTN
Dizziness
Nausea
Bradycardia
Dry Mouth
Impotence
Bronchospasm,wheezing
Teratogens
Drugs that are known to cause birth defects
Physostigmine -Uses
Treatment of overdoses of drugs with anticholinergic actions (reversal of CNS effects of atropine)↑


Multiple uses of dyphenhydramine? (pg 383)


Diphenhydramine, a potent antihistamine, also has been approved for use as an antitussive. Because of its anticholinergic properties it must be used with caution in clients with glaucoma, prostatic hypertrophy, or obstructive pulmonary disease. When used with alcohol or other CNS depressants, excessive sedation may occur. The client should therefore be made aware of possible impairment of physical or mental capabilities, or both, while taking this drug. Also, in the main drug in most sleepaids.
cacogeusia
a general bad taste in the mouth;fix by taking in fluids w/foods.
Data is collected during what phase of nursing process?
assessment
Benemid (Probenecid)-block renal uptake uric acid
Colchicine-Inhibit inflam & reduce pain & swelling
Zyloprin (Allopurinol)-decrease uric acid
 
We work together or alone to reverse symptoms
Side effects: blood dyscrasias, GI upset, Abd pain
Colchicine: Nausea
Probenecid: Vomiting, Headache
Allopurinal: Rash
Antigout agents can be given with food to decrease GI discomfort, avoid beer, may cause sudden gout attack. Increase fluid intake to increase secretion of uric acid.
 
 
Scopolamine - Actions
One of the most effective anti-motion sickness drugs


Other uses for anorectic drugs


Anorectic and/or anorexiants are drugs that reduce appetite. They cause CNS & cardiovascular stimulation. Other uses for anorectics are the tx of narcolepsy, & ADHD.  
To decrease respiratory quotent
increase fat calories, and decrease carbohydrate calories
What drug class do we use for arterial thrombosis and what is the prototype of that class?
Adrenergic Agent 
dopamine
Inotropin
Dose: IV: 40, 80, 160mg/mL in 5, 10, 20mL ampule
Adrenergic Recptr: Alpha, Beta-1, Dopaminergic
Action: Vasopressor(stimulates contraction of smooth muscle in arteries)
Use: Shock, hypotension, inotropic agent


Adverse effects of prophylthiouracid (PTU)


• Not very common, some clients develop a mild skin rash that often subsides spontaneously or an changing drugs the development of agraneously has been reported in a small number of clients. This condition develops rapidly should report signs of sore throat or fever immediately, as they often precede adverse effects.
What is significant about Histamine 1?
They vasodilate when activated, especially in the skin and face, they increase capillary permeability, bronchoconstriction and help with itching, pain, and an increase in mucus secretion.
There is first and second generation
1st is sedating (benadryl), 2nd is not but can be sedating (allegra, claritin)


How is propanolol (lindoral) used for treatment of hyperthyroidism?


Have been used successfully in suppression some of the signs and symptoms of hyperthyroidism. Although, these agents do not inhibit the functioning of the thyroid gland, their ability to clock the tachycardia, tremor, and anxiety often associated with hyperthyroidism makes them useful adjunct to other forms of therapy, particularly before the other measures have begun exerting their effects. 
Most drug references recommend that pediatric dosages be based on ___________.
milligrams per kg of body weight
Median Lethal Dose (LD50)
The dose at which 50% of the test animals die
modification of diet and medications for levodopa 
it has been suggested that food, particularly high-protein food, may decrease or delay absorption of this drug. The drug may be taken with a low-protein snack such as fruit or juice. high-protein meals have been associated with decreased mobility in persons with Parkinson's disease. Multivitamin preparations and fortified cereals may contain pyridoxine (vitamin B6), which can decrease the effects of levodopa
What are the nursing implications for atropine?
monitor vitals and check for tachycardia
What impacts an indivuals response to to a drug?

   Age- the young and elderly- often exhibit great variation in drug absorption, distribution,          biotransformation, and elimination.
    Sex- the proportion of fat to lean body mass may the action and distribution of drugs

    Body weight- increased body weight may require increased drug doses


    Body surface area- Body surface area (BSA) has been shown to be a useful measure of what dosage should be used for a specific client.

    Basal Metabolic Rate- (BMR) clients with a high BMR may metabolize or eliminate drugs more rapidly
    Disease states- underlying disease states may affect and individual's absorption, distribution, biotransformation and excretion (eg hypo/hyperthroidism, diarrhea)
    Genetic factors- variation in response to drugs may ccur because of genetic differences between two individuals. Ex: some clients may metabolize drugs more slowly because of a gentically induced enzyme deficiency

    Placebo effect- This effect can result from a variety of factors, including the relationship of the client with those providing treatment, belief in the ultimate success of of their therapy, and the client's cultural and ethnic background. In treating subjective symptoms, such as pain, the placebo response may be as important as the actual pharmacological actions produced by potent drugs.

    Time of administration- the time of day or month that a drug is administered has been shown to effect the pharmacological response of clients to a specific drug.  Ex: corticosteroids may be more effective if given in the morning. Some cancer thereapies in females may be more effective during certain parts of the menstrual cycle.
    Environmental factors- Exposure to very hot or cold temps may influence the response to drug therapy
    Indiosyncratic response-
How do you taper doses of steroids?
Taper the dosage over 7 days 
Switch from multiple to single dosing
 
Pramlintide
Decreased glucagon
benzylisoquinolines(Atacurium)
no analgesiac/sed/anestesia
hoffman elimination-no organ or enzymes for metabolism (so great for liver or kidney disease)
forms laudaosine-cross bb at high concentration
metformin
biguanide, diabetes
Glyburide
2nd gen sulfonylurea
triazolam
benzodiazepine sedative
notes: short-acting; tolerance/withdrawal
prehypertension
SBP 120-139

DBP 80-89
digoxin OAR
retina
Y-B axis
Cocaine
Indirect sympathomimetic, uptake inhibitor. Causes vasoconstriction, local anesthesia.
Epinepherine
EpiPen. Antihistamine. (Indirect antagonist). Bronchodilator, vasoconstrictor, use in anaphylaxis.
Trimethaphan
Indirec antag, ganglionic blocker
Methotrexate
Antimetabolite competitively inhibits enzyme that changes FA into its active form, 4hf, disrupting synth of thymidylate, purines, serosine and methionine. Blocks DNA, RNA and protein synth.LymphomaImmunosuppressiveS phaseStronger binding than FA, but can be reversed with leucovorin
7.35-7.45 (slighty basic)
Normal pH
lansoprazole
GERD
proton pump inhibitor
Acyclovir
Phosphorylated by HSV/VZV thymidine kinase. Guanosine analog. Triphosphate formed by cellular enzymes. Preferentially inhibits viral DNA polymerase by chain termination.
Streptomycin*
B-cidal for extracellular* TB; toxicity is ototoxicity and nephrotoxicity
Bupivicaine
Local Anesthetic. Infiltration, Field block, nerve block, spinal anesthesia, and epidural block. As an infiltrative, has longer effects, so used for more prolonged surgical procedures. Is an amide, can make toxic intermediates. Tox: Especially Cardiotoxic! Also CNS.
o 2nd generation antihistamines
lower adverse effects
isoproternol
direct acting selective agonist B1,B2Effect: chronotropic, ionotropic effects, increase in CO w/ decrease in diastolic and mean BP, slight increase in systolic BPToxic: palpitations, tachycardia, flushing, cardiac ischemia, arrhythmias therapy: increase HR in bradycardia or heart block
Opioid partial agonist
nalbuphine Nubain
butorphanol Stadol
Sodium salicylate
reversibly inh COX I/II
clarithromycin
block h. pylori in GERD
Edrophonium';
AChE I; Diagnosis MG, PAT
Pyridostigmine
Anti-AChE. ↑ endogenous ACh; ↑ strength. Used for myasthenia gravis (long acting); does not penetrate CNS.
Raloxifene
SERM (bone liver agonist) (uterus brain antagonist); strong bones, good LDL, hot flashes, procoagulant
ACS: Transmural Myocardial Infarction (AMI)Will see ______ on EKG__ waves present
ST elevationQ
Valproate
Depakote, alone is effective as lithium in Rx of acutemania; is somewhat effective in maintenance; valproate + lithium effective in acute and in maintenance.
Type II hypersensitivitycomplement-mediate lysisCb3
-increases opsonization-increases the capacity of the system to allow lysis by other effector cells or by complement itself.
MSpotential interactions
Increased effect with alcohol, sedatives, muscle relaxants.
what else can blunt baroreceptors
opiods
beta blockers
the drug of choice for mania
Lithium
datura (jimsen weed; anti-ACh) OAR
dry eyes
mydriasis
Tolterodine';
CholinoR blocker; urgency in mild cystitis, reduce bladder spasm, ulcer
For ____ other than midazolam, the intramuscular route gives slow, erratic, and unpredictable results.
benzodiazepines
Psyllium, methyl-cellulose, bran
Bulk forming laxatives (increase water) and least SEs
H2 receptor blockers
 
Names (4)
MOA
Use
Cimetidine, Ranitidine, Famotidine, Nizatidine
 
MOA: REVERSIBLE block of H2 rec-> dec H+ secretion by parietal cells
 
Use: Peptic Ulcer, Gastritis, mild GERD
Nephrotoxicity
toxicity is related to NSAID effects on renal prostaglandins that help to increase renal blood flow & maintain renal function
• Will not work for rescue inhaler
leukotriene antagonists
Tamsulosin (FLOMAX)
competitive a1 antagonist, t1/2= 9-15 hrsgreater effect in inhibiting prostrate smooth muscle contraction since it involves a1therapy: treat benign prostatic hypertrophy
carafate
adheres to ulcers to protect and promote healing;do not take within 2 hours of certain drugseat high fiber diet and lots of fluids
treatment goal for classical angina
reduce heart work
resistance
determined by radius or size of airways
dopamine receptor
causes increased blood flow by dilating the blood vessels:
renal
mesenteric
coronary
cerebral
Amantadine produces a rapid reduction in parkinsonism symptoms but its effects begin to diminsh after ____ ____ of therapy.
several months
Codeine, Oxycodone and propoxyphene are all part of what drug class?
Opioid Analgesics: Moderate Agonists
The harder the myocardium works the more oxygen it requires.When the oxygen supply cannot keep up with the energy requirements of the heart then ___ and maybe cardiac ___ can occur.
angina damage
Typical Neuroleptics block what type of schizophrenic symptoms?
Positive/active symptoms includingthought disturbances, delusions, hallucinations
16. An overdose of antihistamines can result in:
a. hallucinations and convulsions
corticosteroids effects onglucosesodium/waterfatimmune systemWHAT SHOULD PT BE TAUGHT?
g: raises blood glucoses/w: retention caused by higher BPf: deposits are mobilizedis: suppresses immune response and inflammationTEACH: increased risk of infection, monitor blood glucose
Drug effect
The physiological reaction of the body to the drug
Cyclophosphamide
Prodrug, needs to be activated by Cyto P450 to 4-Hydroxycyclophosphamide <--> Aldophosphamide. Aldophosphamide produces Inactive metabs and Toxic metabolites Phosphoramide (active agent) and Acrolein (bladder toxicity, get hemorragic cystitis). Cleared through bladder, never give before bed. Give with MESNA to blunt Acrolein toxicity. Broad general activity.

Most potent (cytotoxic) immunosuppressor, related to Nit mustard. Acts by cross-linking DNA. Used for severe inflamma diseases and transplantation. Excreted in urine and damages bladder cells. ADR: Cardiotoxicity (Type A)
ipecac
a drug consisting of the dried roots of this plant, used as an emetic, purgative, etc., and as the source of emetine.
This is an HIV/AID drug that was the first drug available for HIV in 1987. It causes bone marrow suppression/anemia/neutropenia. It increases toxicity with drugs requiring glucuronidation.
Zidovudine
Doxorubicin
Used to treat cancer, but the does is limited by its Cardiotoxicity. Can cause reversible EKG changes and arrythmias followed by severe conduction probs and heart failure.
Serevent (Salmeterol) admin guideline
- bronchodilator- take 30-60 min before exercise AND NOT FOR ACUTE BRONCHOSPASMS- hold in breath 10 sec for inhaler use
 
What environment is ginger best cultivated?
In the tropical areas
How is solubility related to uptake
inversely
high solubility= slow equlibration
low solubility= fast equilibration
Drug of choice for prophylaxis of meningococcal infections Alternative?
Rifampin, Minocyclin
Enter your front text here.
Enter your back text here.
Pts w/ heart failure should use ____ or ____ loop diuretics -> something about fluid retention b/c absorption is not as inhibited
torsemide & bumetanide
protease inhibitors used to treat HIV
• Reversible inhibitors of HIV protease (involved with essential enzymes)• This inhibition results decreased production of virions
decongestant - drug and MOA
reduce nasal congestion by activating alpha 1 adrenergic receptors on nasal blood vessels - vasoconstriction
to decrease the possibility of a headache after spinal anesthesia you should instruct the pt to
lie flat in bed
Example of a drug target that is unique to pathologic cells and not present in host cells
cell wall in bacteria
• Inhibits the final step in integration of strand transfer of the viral DNA to the host cell
integrase inhibitors used to treat HIV
unortriptyline is used for depression in elderly why?
less confusion - less anticholinergic effects
What are the 4 signal transduction mechanisms?
1. G-protein coupled receptor systems
- half of all known drugs work through GPCR's
2. Ion-channel receptors
3. Enzymes
4. Nuclear receptors (receptor is in nucleus of cell)
What do hormones do to help regulate the GI tract?
Gastrin, secretin and cholecystokinin are released from intestinal cells and control many functions such as gastric secretions, gastric and gall bladder emptying.
Half – Life
The time that it takes for ½ of the given amount to be eliminated
- the time for ½ to reach peak level
54. The following statement by your client makes you believe that she understands your teaching about diuretics:
a. “I will weight myself once a week and report significant changes.”
What are the advers effects of Amantadine?
they are primarily CNS related and include confusion, dizziness, irritability, and headache
What is Bupropion (Zyban) used for?
This drug is used to aid in smoking cessation.-it is nicotine free
Prednisone
oral glucocorticoid
Ticarcillin-clavulanate (Timentin),
1
isoniazide administration
??
Contraindication of terbutaline
hypertension
TMP/SMZ (Bactrim, Septra)
1
Blood colloids
AlbuminPlasma Proteins
Opioids
Analgesia, euphoria, drowsiness, detachment from environment, relaxation, constricted of pupils, constipation, nausea, decreased respiratory rate, slurred speech, imparied judgment, decreased sexual and aggressive drives
Theophylline
Anti-asthmatic Drug Class: Methylxanthine
Macrolides
Side effects/adverse reactionsGI distress, tinnitusSuperinfectionOtotoxicity, hepatotoxicity (especially if taken with other hepatotoxic drugs such as acetaminophen)Nursing interventionsCulture and sensitivity before therapyMonitor liver enzymesAdvise client to take full regimenAdminister antacids 2 hrs before or 2 hrs after macrolidesGive azithromycin 1 hr before or 2 hrs after meals with full glass of water
Antitubercular Agents
Drug: ethambutol (Myambutol)ActionsAlter cellular RNA synthesis and phosphate metabolismUsesTreat tuberculosisCommon adverse effectsNausea, vomiting, anorexia, abdominal crampsSerious adverse effectsConfusion, hallucination, blurred vision, red-green vision changes
Antihypertensive
Angiotensin Converting Enzyme (ACE)
Contraindications
Allergies
impaired renal function
pregnancy and lactation
 
Caution
CHF
Define legend drugs
prescription drugs
haloperidol (Haldol)
Antipsychotics, first generation (FGA)butyrophenone family
bacteriostatic
drugs that slow microbe reproduction
Pharmodynamics
How drug acts/interacts with macromolecule components of body tissue
Antiviral Agents
Drug: lamivudine (Epivir)Zidovudine (Retrovir): used alone during pregnancyActionsNRTI that inhibits replication of virusesUsesEpivir used in combination with zidovudine to treat HIV-1 infection; chronic hepatitis B associated with active liver inflammationSerious adverse effectsAnemia, granulocytopenia, lactic acidosis, hepatotoxicity
Antianginal Agent
Nitroglycerin (Nitrostat)
Adverse Effect
Headache -most common
Types of Angina
1. Stable/Predictable2. Prinzmetal's/Vasospasm3. Silent/No s/s4. Unstable/pain/unpredictable
Glipizide (Glucotrol) use
type 2 diabetes
Nutrition
includes concepts related to common foods, eating rituals, limitations in obtaining nutritious foods, enzyme deficiencies, and how foods are used for health promotion and wellness.
Indications for vincristine
-Hodgkins disease, leukemias, neuroblastomas, malignant lymphomas, rhabdomyosarcoma, Wilms’ tumor, other tumors -ideal combination drug d/t little toxicity to bone marrow
Indications for chloral hydrate
Induction of sleep
ZANTAC
H2 RECEPTOR AGONIST: DECREASES ACID PRODUCTIONADR'S: HA, DIZZY, HALLUCINATION, RESTLESS, B12 ANEMIA, DRUG INTERACTIONS
tacyphylaxis
quick developing tolerance that occurs after repeated admin of drug
Quinolone Antibiotics
Cipro & LevaquinActionsInhibit DNA gyrase enzymes needed for DNA replication in bacteria UsesTreat recurrent UTIs caused by E. coli, P. mirabilis, and othersCommon adverse effectsNausea, vomiting, anorexia, abdominal cramps, flatulence, drowsiness, visual disturbance, photosensitivitySerious adverse effectsHematuria, perineal burning, urticaria, hives, headache, dizziness, photophobia, tinnitus
What is the MAC of iso?
1.15%
Loop/High Ceiling Drug to treat
Hypertension
Furosemide (Lasix)
what type of drug influences myocardial contractility
inotropic
intraderamal administration
5-15 degree angle
do not aspirate
 
Bismuth salts (Pepto-bismol)
 
 
drugs that are sonsidered adsorbents because they adsorb bacterial toxins.
-can be used as antacids for gastric discomfort
- commonly used to treat acute diarrhea.
MOA of fluoxetine
selective inhibition of serotonin reuptake; intensifies serotonin transmission at serotonergic synapses
Side effects of phenobarbital
Respiratory depression, suicide, exacerbation of intermittent porphyria, hangover, paradoxical excitement, hyperalgesia -Toxicity: respiratory depression, coma, pinpoint pupils, hypotension, hypothermia
Pain threshold- Factors
Raise- sleep, rest, diversion, drugs
 
Lower- Anxiety, tiredness, anger, pain
SulfonamidesTMp/SMZ
Side effects: mild to moderate rash, photosensitivity, GI distress, stomatitis, crystalluria,fatigue, depression, H/A, dizzinessAdverse reactions: bloody dyscrasias, renal failure, steven-johnson syndrome
Moderate: (stage AD)
increasing difficulty with activities of daily living, increases of items from early stage, increased behavior problems/issues (wandering/pacing/agitation/screaming) (sundowning: symptoms worsen of an evening and at night).
Antihypertensive
Vasodilator
Nitroprusside (Nitropress)
IV use for the treatment of hypertensive crisis and to maintain controlled hypotension during surgery
how selctive aldosterone blockers help treat HF
decreases preload
What type of diuretics are contraindicated in HF?
Osmotic diuretics.
Cardizem (antianginal):action
a calcium channel blocker that inhibits calcium ions influx across cardiac and smooth-muscle cells, decreasing oxygen demand. drug also dilates coronary arteries and arterioles.
(Naphazoline) Decongestants:define
drugs that reduce congestion or swelling, especially of the upper and lower respiratory tract
Drug Misuse
Indiscriminate use of a drug for purpose other than those for which it is intended.
MOA of mercaptopurine
Cell-cycle S-phase specific (when DNA synthesis occurs)-Prodrug that undergoes conversion to active form within cells.-Once activated, disrupts biochemical processes: purine biosynthesis, nucleotide interconversion, biosynthesis of nucleic acids
Side effects of rifampin
hepatotoxicity, discoloration of body fluids (red-orange color to urine, sweat, tears, saliva)
Orphan Drug Act
offered tax compensation to companies to produce Drug to treat rare diseases


Minimum effective concentration 


plasma drug level below which therapeutic effects will not occur
early stages (AD)
Memory loss and confusion and disorientation at times. Also impaired judgment, personality changes.
Antiarrhythmics
Class II Beta-Blockers
Propranolol (Inderal)
This drug is also an antihypertensive. 
Used to treat supraventricular tachycardia and PVCs
Difference between virus and bacteria
virus needs a host
What is a dromotropic effect?
Conduction of heart cells.
Bulk-forming laxative action:
absorb water into the intestines, which causes bulk and distends the bowel to initiate reflex bowel activity, thus promoting a bowel movement
sublingual administration:
under tongue (allow to dissolve) no water!
lopid teaching
take 30 minutes before breakfast and dinner
teach proper diet management
possible dizziness, and blurred vision
traveler's diarrhea
or acute diarrhea
Lomotil with atropine is frequently prescribed for
Side effects of lithium
Therapeutic level side effects: Early: GI- nausea, diarrhea, bloating, anorexia, polyuria, lethargy, slurred speech, weakness and hand tremor.Later: goiter and hypothyroidism.*Toxic levels: Ataxia, giddiness, ECG changes, extreme polyuria, muscle twitching, blurred vision, tinnitus... seizures, stupors, severe hypotension, coma and death
Contraindications for ramelteon
-Used with caution in pts with moderate hepatic impairment; avoided in pts with severe hepatic impairment-Pregnancy/breast-feeding effects have not yet been studied; high doses are teratogenic in rats
MOA of beclomethasone (QVAR)
• Locally acting in lungs• suppresses inflammation by decreasing synthesis of inflammatory mediators (leukotrienes, histamine, prostaglandins)• decrease infiltration and activity of inflammatory cells (eosinophils, leukocytes)• decrease edema in the airway mucosa (secondary to decrease in vascular permeability)
how do local anesthetics work?
local anesthetics stop axonal conduction by blocking sodium channels in the axonal membrane, thereby bringing conduction to a halt
B/c cannot take blood draw at SOA, you can take plasma draw after administrationthat offer predictive therapeutic responses
Major pathologic findings of AD
are degeneration of cholinergic neurons and the presence of neuritic plaques and neurofibrillary tangles.
Lipid Lowering Agents
Fenofibrates - Tricor
inhibits triglycerides synthesis in the liver, decrease LDL; increase uric acid; frequent side effects
what condition is natrecor used to treat
acute decompensated HF
Lopressor (antihypertensive): administration
PO: give with or immediately following meals
IV: give drug undiluted by direct injection
Store at room temp. and keep away from light
what do insulin needles look like?
orange top
measured in units
indications for salmeterol
long term control of asthma (not for acute episodes, and not to be used as monotherapy)
7 Elements of handwritten prescription
client name, date, Medication name, dosage, route, frequency, prescriber signature
What are the three factors affecting uptake of inhaled anesthetics in the lungs?
blood solubility (blood:gas coefficient)
cardiac output
Partial pressure of the agent in the lungs
 
explain digitalization process
To speed up the onset of therapeutic effects, a dose higher than normal, a loading dose, may be given to raise the level quickly to a therapeutic range to improve HF or a-fib; rapid digitalization is done in the hospital where IV pushes are given then po; slow digitalization is done at home on po doses.
(Robitussin) Expectorants: define
drugs that increase the flow of fluids in the repiratory tract, usually by reducing the viscosity of bronchial and tracheal secretions, and facilitate their removal by coughing and ciliary action
1952: Durham- Humphrey Amendment to the 1938 Act
distinguished between drugs that can be sold with or without prescription and those that should not be refilled with out a new prescription
Nursing considerations for zolpidem
Little or no withdrawal and no rebound insomnia after stopping to take it. Safety in pregnancy not established. Teach sleep hygiene


 
Drug excretion in the kidney 
Tubular Reabsorption (2)
 

 

ü  Lipid soluble drugs move back into the blood.
ü  Polar and ionized drugs remain in the urine
ü  ionization depends upon the pH - change in pH of the urine will affect drug excretion
o   Ie.. ASA in acidic urine is non-ionized & reabsorbed; to rid ASA give NaHC03
o   Ie… Cranberry juice make urine acidic, and would help us excrete basic drug

 
How many half-lives does it take for a drug to essentially be "cleared" from the body?
 roughly 4 half-lives
how do diuretics help treat HF
decrease fluid volume and edema; decreases circulating volume and peripheral resistance, reducing the workload on the failing heart (decreasing preloads)
Heparin is what type of drug?
an anticoagulant; therefore it will not dissolve a blood clot


Orphan Drug Act – 1983


a drug (a drug for a disorder affecting fewer than 200,000 people in the United States) may sell it without competition for seven years. May get Tax incentives
What are progestin only BCPs designed to decrease?
They are designed to decrease circulatory side effects.
Emollient laxative has 2 types: stool softener and lubricant
stool softener: lowers the surface tension of GI fluid, so more water and fat are absorbed into the stool and intestines.
Lubricant: lubricates the fecal material and intestinal wall and prevents absorption of water from the intestines
T or F: The generic BAXTER formulation of propofol contains metbisulfate.
True. Baxter=Bad for patients with SULFITE allergies (sulfites are found in some foods and red wine) NOT THE SAME AS SULFA ALLERGY.
 
Note: There are two generic forms of propofol. The other generic form (Bedford) contains benzyl alcohol. Therefore, not all generic have metabisulfate.


Federal Pure Food and Drug Act – 1906 


Food must be free of adulterants (unwanted food additive, illicit drug, or poinson)
Under what conditions do you not administer Mannitol?
When crystals are present. To prevent crystallization do not expose vial to low temperatures.
What 4 things do you assess for with oral contraceptives?
1. Drug & herb use.2. Baseline BP & weight.3. Pregnancy status.4. Hx of contraindications, esp. smoking & HTN.
Nitrates action
vasodilation
Normal BP
<120 <80
Symptoms of DM:
Polyuria
Polydipsia
Ketonuria
Rapid weight loss
Elevated blood sugar levels
Stage 1 hypertension
140-159 90-99
Stage 2 hypertension
>160 >100
Pneumocystis pneumonia:
Drug of chioce:
Bactrim/BactrimDS***
Nitrates are used for what?
Angina
Generic name ending in:
-ol
beta-2 agonists
Patients taking NSAID's and anti-hypertensice meds should me instructed to monitor their?
B/P
Insulin glulisine (Apidra)
10-15mins; 1-1.5hrs; 3-5hrs
Generic name ending in:
-dine
H-2 receptor blockers
pulmonary circulation
Delivers blood to the lungs
Aldosterone Antagonists
Drug Interactions:
K+ supps
K+- sparing diuretics
Lithium
Antifungals
**Phenergan; Promethizine
ANTI-EMETICS
Indications/clinical benefits:
Sedation, suppression of anticipatory emesis, and production of anterograde amnesia. May help control extrapyramidal reactions caused by phenothiazine antiemetics.
**Nitroglycerin (Nitrostat, Nitroquick)
Vasodilator
Adverse effects:
Headache, hypotension, reflex tachycardia
Antiplatelet Therapy:
Asprin cyclooxygenase and suppresses platelet aggregation.
Where are most drugs absorbed?
small intestine
describe intrathecal absorption
into CSF, bypassing BBB
toxicity of furosemide
OH DANG! Ototoxicty, Hypokalemia, Dehydration, Allergy, Nephritis (interstitial), Gout
Deficiency Anemias:
Iron preparations & Vitamin B-12 require an acidic pH in the stomach to be properly absorbed when taken orally, therefore antacids or drugs like Pepcid & Zantac must be give 1 hour before or 2 hours after Iron & B-12.DO NOT give with acid lowering drugs.
What diuretic can cause ototoxicty when admin too fast with IV infusion?
Lasix (furosemide)
Long-Term complications of DM:
Macrovascular damage:
Cardiovascular disease-increased risk of HTN, heart disease, and stroke resulting from atherosclerosis, resulting from a combination of hyperglycemia and altered lipid metabolism
Angiotensin II
potent vasoconstrictor - will raise BP
Nitroglycerin
Organic nitrate used to treat anginal pain
Metoptolol (lopressor)
Beta Blocker used to lower BP
ACE Inhibitors (-pril) Uses:
Hypertension (HTN)
Heart Failure (HF)
Diabetic Nephropathy
MI
Prevention of CV events (MI & stroke)
Angiotensin II Receptor Blockers (-sartan)
Drugs to know:
Losartan (Cozaar)
Valsartan (Diovan)
“-sartan drugs”
Can all drugs be properly estimated through pharmacokinetics?
No
What is the standard Creatine clearance?
125 ml/min
What is Distribution
Phase following absorption. Phase following absorption
what is a drug?
Mimics endogenous ligand (usually)
Generic name ending in:
-sartan
Angiotensin II Receptor Blockers (ARB's)
Symptoms of Hypothyroidism:
Fatigue, Weakness, Weight gain, Coarse dry hair, dry pale skin, Hair loss, Cold intolerance, Muscle cramps and frequent muscle aches, Constipation, depression, Irritability, Memory loss, Abnormal menstrual cycles, Decreased libido
Drugs that effect the heart rate are said to be:
Chronotrophic
The primary indications for most vasodilators are:
Essential hypertension
Hypertensive crisis
Angina pectoris
Heart failure &
MI
What group of diuretics is commonly combined with ACE inhibitors?
Thiazide diuretics
What dtugs must must be avoided when taking thrombolytics?
NSAIDs
What are side effects of CCBs?
Hypotension, Palpitations, Tachycardia, rash & flushing, peripheral edema
Flecaindide (Tambocor) and propafenone (Rythmol) are used for what heart rhythms?
life threatening ventricular dysrhythmias
Ferrous sulfate is prescribed for iron deficiency anemia. patient should expect which harmless side effect?
black stool
Heparin is used to treat:
Non-hemorrhagic stroke patients, patients with deep vein thrombosis & pulmonary embolism
describe intra-arterial absorption
into artery, good for local therapy)
Describe 2 compartment Model
Involves both distributive and elimination phases normally.
Do anesthetics have a wide or narrow theraputic window?
Narrow
**Digoxin (Cardiac Glycoside)
Drugs for Heart failure
Actions:
causes increased force of systolic contractions, Slows heartbeat and improves circulation.
The major components of hemodynamics are:
1)Cardiac output &
2)Arterial pressure
Which of the following antibiotics may be used to treat gastric or duodenal ulcers linked to h. pylori infection?
Amoxicillin, clarithromycin, tetracycline, bismuth, and metronidazole
How long does it take for full therapeutic effect take for statins?
2-4 weeks
Flagyl:
Class: Antibacterial & anti-protozooal drug***
Drug Interactions: Alcohol &Disulfiram, Warfarin, Phenytoin, Lithium, Fluorouracil, Cyclosporine, Cholestyramine
**Diltiazem (Cardizem)
Calcium Channel Blocker (-pine)(Ca)
Adverse effects:
essentially the same as Verapamil, but with less constipation
Generic name ending in:
-parin
Low molecular weight heparins or heparin
True or false Drugs with a t1/2 less than 6 hours require a very wide therapeutic window to use them in repeated doses.
True
For a one compartment model what does the concentration log look like on a graph?
Diagonal line\
What is the most common buffer in the blood?
Bicarb
Define Zero order Kinetics
rate is INDEPENDENT of the concentration. no longer dependant on concentration, but instead becomes constant, at least until concentration falls below saturation.
What is Structure Activity Relationship (SAR)
Understanding the relationship between drug structures and biological activities forms the basis of rational drug design.
What is the #1 drug that proteins bind to?
Albumin
What Phase do you bipass when you give a drug IV?
Absorption
Describe One-Compartment Model
Assumes a single compartment which is in equilibrium which accounts for drug in plasma, and various tissues.
Diagnosis of DM:
Fasting blood sugar: levels of 126 or higher indicative of DM
2hr post-prandial or casual glucose test: levels of 200 or higher indicate DM
Oral glucose tolerance test: If 2hr levels are 200 or higher, DM is indicated
What is a common drug from the IIB IIIA inhibitors?
colpidogrel (Plavix)
systemic circulation (or peripheral circulation
Delivers blood to all other tissues
The primary functions of the circulatory system are:
1)delivery of oxygen, nutrients, hormones, electrolytes, and other essential substances to the cells, &
2)removal of CO2, metabolic wastes, and other debris from cells, as it helps fight infection.
Describe zero Order Kinetics
no matter the concentration the time is still the same. Dependant of time not concentration
Describe the ideal dosing regimen
Determine the maintenance dose which will keep plasma level in therapeutic window
What is a metabphore?
receptor is bonded to an enzymatic system. A metabolic receptor system. (metabolic conversion of one compound to another)
Why is the Octanol coeff used? What is it similar to?
Cell Membrane
Where are 3 receptor locations?
Cell Membrane(inside and out), cell cytoplasm, nuclear envelope
The client with essential hypertension is prescribed the beta blocker, Metoprolol (lopressor). Which assessment data would make the nurse question administering this medication?
the clients apical pulse is 56.
Factors that may affect cardiac preload include:
systemic filling pressure, and total circulating blood volume.
What are side effects of Beta Blockers?
Bradycardia, complete heart block, hypotensin, Raynaud's phenomenon, insomnia
What food must be avoided when taking statins?
Grapefruit and grapefruit juice
What foods must clients taking anticoagulants avoid?
green leafy veggies, fish, liver, coffee, tea (all rich in vitamin K)
Why repeat iv dosing?
Can not maintain a constant Cpss, but instead maintain an average Cpss
What kind of information does pharmacokinetics give you?
quantitative data important to detail fate of the drug, but also to be able to predict doses, routes, etc.
How are receptors usually named?
Usually named for the agonist and antagonist which the interact with
Where are CYP enzymes located?
On the smooth spots of the E.R.
Arterial pressure is regulated by what?
The RAAS, The ANS, and the kidneys.
What is Clearance?
: the removal of a drug in units of volume/time
true or false, elmination does not occur during absorption
false! elimination does occur during absorption
What is a racemic mixture?
A mixture of the D and L form
Can enzymes be drug receptors?
yes, Many enzymes have been shown to be specific drug receptors (ex.- digitalis acts on Na+/K+ ATPase in heart muscles,
What can happen if client abruptly stop taking statins?
3 fold rebound effect on cholesterol; can cause death from AMI
What is the action of ACE inhibitors?
blocks the conversion of angiotensin I to angiotensin II and blocks release of aldosterone
What is the intensity of effect related to?
Intensity of effect related to drug conc. at receptor sites
This lab report is drawn on a patient who is taking an aldosterone antagonist, such as spironolactone (aldactone). What is happening in your patients body?

Na+ - 136
K+ - 6.0 (H)
CI - 97 (L)
CO2 - 30
Electrolytes are being reabsorbed by the kidney causing levels to be too high.
The bestresponse for the thrombolytic therapy occurs when it is:
started within 4-6 hrs of the onset of symptoms.
What is duration of action related to?
Duration of action related to how long drug conc. at receptor site remains high enough to provide response
The major goals of treatment of stage C heart failure would include:
removal of fluid from the lungs and the body, possibly with a thiazide diuretic.
Can Vd be larger than the total plasma volume in the body?
yes, ex:heparin = 5 liters (plasma only)
What 2 compartments do you have in a 2 compartment model?
now have a central compartment (ex.- plasma), and another compartment (ex.- tissue).
/ 304
Term:
Definition:
Definition:

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