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NUR 334: Pharmacology > Exam 4: Bullet Point > Flashcards

Exam 4: Bullet Point Flashcards

1
Q

rhythmic contractions that moves contents through the intestines

A

peristalsis

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2
Q

moving _____________ results in EXCESS water being reabsorbed from the stool and leads to hard stools

A

slowly

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3
Q

moving _____________ leads to lack of water being reabsorbed from the stool and results in watery stools

A

quickly

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4
Q

bulk forming laxative

A

DRUG CLASS:
o bulk forming laxatives

DRUGS:
o psyllium (Metamucil)
o methylcellulose (Citrucel)
MOA:
o actions of fiber

INDICATIONS:
o treatment and prevention of constipation

ONSET:
o 1+ days

NOTES:
o can be taken long term
o first line treatment for constipation

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5
Q

surfactant laxatives (stool softener)

A

DRUG CLASS:
o surfactant laxatives (stool softener)

DRUGS:
o docusate sodium (Colace)

MOA:
o helps water enter stool to soften stool

INDICATIONS:
o treatment and prevention of constipation

ONSET:
o 1+ days

NOTES:
o often used in hospitals w/patients who are immobile for extended periods of time to prevent constipation (going to surgery or post-op)

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6
Q

stimulant laxatives

A

DRUG CLASS:
o stimulant laxatives

DRUGS:
o bisacodyl (Dulcolax)

MOA:
o stimulates peristalsis
o moves contents through intestines quicker
o less water reabsorbed and stools wont as hard

INDICATIONS:
o constipation related to slow peristalsis (opioid induced constipation)

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7
Q

osmotic laxatives

A

DRUG CLASS:
o osmotic laxatives

DRUGS:
o magnesium hydroxide (milk of magnesia)
o polyethylene glycol (miralax)
o lactulose

MOA:
o retains water in the stool increasing softness and promoting peristalsis

INDICATIONS:
o constipation

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8
Q

______________ oil can be used orally for constipation and rectally for fecal impaction

A

mineral oil

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9
Q

_____________ oil is used for rapid and complete bowel evacuation

A

castor oil

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10
Q

only drug that works on the small intestine

A

castor oil (laxatives)

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11
Q

if abused for weight loss, may cause the body to become dependent on them for BMs

A

laxatives

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12
Q

nonpharmacological interventions include __________________ fiber and fluid intake and __________________ activity

A

increasing
increasing

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13
Q

opioids

A

DRUG CLASS:
o opioids

DRUGS:
o diphenoxylate (lomotil)
o loperamide (imodium)

MOA:
o slows down peristalsis
o not necessarily causing constipation but taking us away from diarrhea towards normal

INDICATIONS:
o diarrhea

NOTES:
o diphenoxylate is mixed with atropine to prevent abuse (controlled substance - schedule V)
o loperamide is available OTC

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14
Q

bismuth subsalicylate (pepto-bismol)

A

MOA:
o direct action against viral and bacterial GI pathogens

INDICATIONS:
o dyspepsia
o treatment and prevention of diarrhea

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15
Q

dicyclomine (bentyl)

A

MOA:
o anticholinergic

INDICATIONS:
o irritable bowel syndrome (IBS)

SE/AE:
o anticholinergic effects

NOTES:
o also considered an antispasmodic

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16
Q

assess for ___________ and _______________ imbalances in diarrhea patients, especially with prolonged diarrhea in children and elderly

A

o fluid
o electrolyte

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17
Q

5 aminosalicylates

A

DRUG:
o sulfasalazine

MOA:
o reduces inflammation

INDICATIONS:
o ulcerative colitis
o rheumatoid arthritis

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18
Q

other agents for IBD

A

o glucocorticoids
o immunosuppressants
o monoclonal antibodies

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19
Q

IBS-D drug approved specifically for women

A

alosetron (lotronex)

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20
Q

disease where the lining of the esophagus is exposed to acidity from the stomach contents

A

gastroesophageal reflux disease (GERD)

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21
Q

GERD is also referred to as ________ ________

A

heart burn

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22
Q

disease where there is an ulceration in the lining of the stomach or duodenum

A

peptic ulcer disease (PUD)

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23
Q

two primary causes of PUD

A

o NSAIDs
o H. pylori bacteria

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24
Q

proton pump inhibitors (PPI)

A

DRUG CLASS:
o proton pump inhibitors

DRUGS:
o omeprazole (prilosec)
o pantoprazole (protonix)

MOA:
o inhibits the enzyme that generates gastric acid

INDICATIONS:
o GERD

OFF-LABEL USE:
o PUD

NOTES:
o rebound issues can occur with cessation after long term
o ideally should not be used for mor than 4-8 weeks
o more potent than H2 receptor antagonists
o available OTC
o longer term use increases risk of developing fractures
(advise patient to take calcium and vitamin D)
o often used for prevention of ulcers in hospitalized patients

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25
Q

most potent drugs available to lower acidity in stomach

A

o omeprazole
o pantoprazole

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26
Q

histamine 2 receptor antagonists
(h3 antagonists or H2RA)

A

DRUGS:
o famotidine (pepcid)
o ranitidine (zantac)

MOA:
o reduces gastric juices and acidity of it

INDICATIONS:
o GERD

NOTES:
o can be used daily or PRN
o available OTC
o if no relief, consider switching to PPI

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27
Q

sucralfate

A

DRUG NAME:
o sucralfate

MOA:
o creates a coating or prevention over the ulcer

INDICATIONS:
o duodenal ulcer

NOTES:
o Rx only
o must be taken 4x/day

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28
Q

misoprostol

A

DRUG NAME:
o misoprostol

MOA:
o a synthetic prostaglandin that replaces those consumed by NSAIDs

INDICATIONS:
o prevention of ulcers in patients taking long-term NSAIDs and termination of pregnancy
(used along with miphroprostein steroid to induce abortion

NOTES:
o teratogenic
o can’t be used in pregnancy (used to induce abortion)

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29
Q

Anatacids

A

DRUG CLASS:
a antacids

DRUGS:
o calcium carbonate (tums)
o sodium bicarbonate (alka-seltzer)

MOA:
o neutralizes the pH in the stomach

INDICATIONS:
o symptom relief in PUD and GERD (do not heal)

ONSET:
o rapid onset and relief
o usually 5 - 15 min

SE/AE:
o depending on which drug used, they can cause diarrhea or constipation

NOTES:
o available OTC
o should not be taken at the same time as other medications
o OD can cause acid base imbalances

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30
Q

PUD due to H. pylori requires what type of treatment

A

ABX (antibiotic) treatment

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31
Q

nausea can be related to conditions such as:

A

o bowel obstruction
o myocardial infarction
o pregnancy

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32
Q

serotonin receptor antagonist

A

DRUG CLASS:
o serotonin receptor antagonist

DRUGS:
o ondansetron (zofran)

MOA:
o blocks 5-HT3-receptors in the chemoreceptor trigger zone

INDICATIONS:
o nausea

SE/AE:
o headache
o QT prolongation

NOTES:
o first line agent for nausea
o available PO, IV, IM, ODT
o often given ODT (oral disintegrating tablet- place on tongue to dissolve)
o if pt is also vomiting w/nausea, PO route should not be used due to risk of vomiting up med, so use ODT

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33
Q

phenothiazines

A

DRUG CLASS:
o phenothiazines

DRUGS:
o prochlorperazine (compazine)
o promethazine (phenergan)

MOA:
o blocking dopamine in the chemoreceptor trigger zone

INDICATIONS:
o nausea

BLACK BOX:
o extrapyramidal effects (EPS)

SE/AE:
o anticholinergic effects
o hypotension
o sedation

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34
Q

metoclopramide (reglan)

A

DRUG NAME:
o metoclopramide (reglan)

MOA:
o blocking dopamine in the chemoreceptor trigger zone

INDICATIONS:
o nausea

OFF-LABEL USE:
o migraines
o tension headaches

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35
Q

anticholinergics

A

DRUG CLASS:
o anticholinergics

DRUGS:
o scopolamine (transderm scop)

MOA:
o anticholinergic action

INDICATIONS:
o motion sickness
o nausea

SE/AE:
o dry mouth

36
Q

glucocorticoids (corticosteroids)

A

DRUG CLASS:
o glucocorticoids (corticosteroids)

DRUGS:
o dexamethasone

MOA:
o unknown antiemetic activity

INDICATIONS:
o nausea (most common is chemotherapy nausea)
inflammation
o immunosuppression

SE/AE:
o adrenal suppression
o hyperglycemia
o increased risk of infection

NOTES:
o must be tapered when discontinuing

37
Q

off-label use for nausea in pregnancy

A

doxylamine (unisom)

38
Q

recommended for nausea relief in pregnancy

A

pyridoxine (B6)

39
Q

given prior to chemotherapy treatment

A

nausea medication

40
Q

cannabinoids are approved for what treatment to induce nausea

A

chemotherapy treatment

41
Q

vitamins are separated into what two categories

A
  1. lipid or fat soluble vitamins (stored in body longer)
  2. water soluble vitamins
42
Q

Vitamin A (retinol)

A

SOURCES:
o dairy products
o cantaloupe
o carrots
o mangos
o pumpkins
o sweet potatoes

INDICATIONS:
o vitamin A deficiency

ROLE:
o eye health and more

NOTES:
o deficiency can cause night blindness
o teratogenic
o fat soluble

43
Q

Vitamin D

A

SOURCES:
o supplements
o sunlight
o fortified foods

INDICATIONS:
o vitamin D deficiency
o prevention of osteoporosis

ROLE:
o increases level of calcium an phosphorous

FORMS OF VITAMIN D:
o ergocalciferol
o cholecalciferol

NOTES:
o someone who is deficient in vitamin D can present as HYPOcalcemic
o deficiency causes rickets in children
o deficiency causes osteomalacia in adults
o fat soluble

44
Q

Vitamin E

A

SOURCES:
o vegetable oils

INDICATIONS:
o Vitamin E deficiency

ROLE:
o antioxidant

NOTES:
o fat soluble

45
Q

Vitamin K

A

SOURCES:
o spinach
o broccoli

INDICATIONS:
o vitamin K deficiency
o reversal of warfarin

ROLE:
o required for the synthesis of prothrombin and clotting
factors VII, IX, X

BLACK BOX WARNING:
o parenteral administration can cause adverse reactions including DEATH

NOTES:
o deficiency can cause bleeding (vitamin K needed for clotting factors, so if deficient in vitamin K, you will bleed)
o fat soluble

46
Q

Vitamin C (ascorbid acid)

A

SOURCES:
o citrus fruits
o juices

INDICATIONS:
o deficiency in vitamin C causing Scurvy

ROLE:
o collogen synthesis
o multiple other roles

NOTES:
o deficiency causes scurvy (bruising, gingivitis, arthralgias, impaired wound healing)
o water soluble

47
Q

Vitamin B1 (thiamine)

A

SOURCES:
o fortified grains

INDICATIONS:
o thiamine deficiency

ROLE:
o carbohydrate metabolism

NOTES:
o deficiency causes Beriberi
o water soluble

48
Q

Vitamin B3 (Niacin)

A

SOURCES:
o plant and animal foods

INDICATIONS:
o niacin deficiency

ROLE:
o coenzyme necessary for cellular respiration

NOTES:
o deficiency causes Pellagra
o also a medication for hyperlipidemia that is no longer recommended
o water soluble

49
Q

Vitamin B6 (pyridoxine)

A

SOURCES:
o fortified grains
o meat
o fish
o poultry

INDICATIONS:
o pyridoxine deficiency

ROLE:
o metabolism of amino acids and proteins

NOTES:
o deficiency can be caused by isoniazide (INH)
o deficiency can be caused by alcohol use disorder
o water soluble

50
Q

Vitamin B9 (Folic acid)

A

SOURCES:
o liver
o spinach
o green leafy vegetables

INDICATIONS:
o anemia
o prevent neural tube defects in the fetus
o decrease toxicity from certain chemotherapeutic agents such as methyltrexate

ROLE:
o synthesis of DNA

NOTES:
o deficiency can cause neural tube defects very early in pregnancy
o folic acid supplementation is recommended to start one month prior to conception (recommended to be supplemented in females of child baring age that are attempting conception)
o water soluble

51
Q

Vitamin B12 (cyanocobalamin)

A

SOURCES:
o only available from animal products such as eggs, dairy, and meat

INDICATIONS:
o megaloblastic anemia

ROLE:
o DNA synthesis
o blood cell formation

NOTES:
o deficiency can cause anemia (common symptom is glossitis)

52
Q

Ferrous Sulfate (iron)

A

SOURCES:
o meat
o poultry
o beans
o green leafy vegetables

INDICATIONS:
o anemia (specifically iron deficiency anemia)

ROLE:
RBC formation

NOTES:
o deficiency can cause iron deficiency anemia

53
Q

Total parenteral nutrition (TPN)

A

o contains amino acids, lipids, carbohydrates, vitamins, minerals

INDICATIONS:
o patients that are unable to receive oral nutrition for extended periods of time

NOTES:
o TPN is not preferred over enteral supplements for long term nutrition

54
Q

Lipase Inhibitors

A

DRUG CLASS:
o lipase inhibitors

DRUGS:
o orlistat (alli)

MOA:
o reduces absorption of fat

INDICATIONS:
o weight loss

SE/AE:
o GI effects

55
Q

GLP-1 agonists

A

DRUG CLASS:
o GLP-1 agonist

DRUGS:
o liraglutide (saxenda, victoza)

MOA:
o slows gastric emptying which increases fullness sensation

INDICATIONS:
o weight loss
o DM

BLACK BOX:
o thyroid tumor risk

SE/AE:
o increased heart rate

56
Q

Phentermine

A

DRUG NAME:
o Phentermine

MOA:
o decreases appetite

INDICATIONS:
o weight loss

SE/AE:
o cardiac and CNS effects
o increase heart rate
o increase BP

NOTES:
o controlled substance (schedule IV)

57
Q

2 types of combination drugs for weight loss

A

o phentermine w/ topiramate
o naltrexone w/ bupropion

58
Q

what is RDA

A

recommended dietary allowance
o average daily intake required for most healthy adults

59
Q

alcohol use disorder often coexists with deficiencies in vitamins _____, _____, and _____.

A

B1
B6
B9

60
Q

vitamins are what type of compounds

A

organic compounds

61
Q

minerals such as calcium and sodium are what type of compounds

A

inorganic compounds

62
Q

postmenopausal women need an increased intake of what?

A

o calcium
o vitamin D

63
Q

rheumatoid arthritis (RA) is in a group called what?

A

autoimmune diseases

64
Q

build up of uric crystals in the joint
(also considered a type of arthritis)

A

Gout

65
Q

most common type of arthritis

A

osteoarthritis (OA)

66
Q

what is the first thing we address for bone and joint diseases.
first treatment?

A

o inflammation

o NSAIDs

67
Q

caused by a decrease in bone mass

A

osteoporosis

68
Q

common recommendations to prevent osteoporosis

A

calcium
vitamin D

69
Q

Methotrexate

A

DRUG NAME:
o methotrexate

MOA:
o unknown for RA.
o blocks folate acid thereby inhibiting DNA synthesis

INDICATIONS:
o anti-tumor/anti-cancer
o autoimmune disease (psoriasis, SLE, RA, etc.)
o induction of abortion

ONSET:
o several weeks for RA

SE/AE:
o can cause adverse effects across many systems

NOTES:
o for cancer - blocks folic acid which is required for DNA synthesis
o teratogenic
o often used as first line for RA after NSAIDs

70
Q

5 Aminosalicylates

A

DRUG CLASS:
o 5 aminosalicylates

DRUGS:
o sulfasalazine

MOA:
o reduces inflammation (anti-inflammatory agent)

INDICATIONS:
o ulcerative colitis
o rheumatoid arthritis

ONSET:
o several weeks for RA

SE/AE:
o GI effects
o blood dyscrasias

71
Q

Hydroxychloroquine

A

DRUG NAME:
o Hydroxychloroquine

MOA:
o unknown

INDICATIONS:
o autoimmune disease
o malaria

ONSET:
o several weeks for RA

72
Q

Monoclonal antibodies
(largest class of drug: 100+)

A

DRUG CLASS:
o Monoclonal Antibodies

DRUGS:
o etanercept (enbrel)
o adalimumab (humira)

MOA:
o biologic agent
o varies by medication

INDICATIONS:
o autoimmune disease (RA, UC)
o tumors
o hyperlipidemia
o asthma
o IBD
o Infections
o Covid-19

BLACK BOX:
o malignancy
o serious infections

ROUTE:
o Parenteral ONLY (must be given by injection)

ONSET:
o several months

NOTES:
o also used to reverse DIGOXIN and DIABIGATRAN TOXICITY
o also referred to as a disease modifying anti-rheumatic agent (DMARD)

73
Q

Clochicine

A

DRUG NAME:
o colchicine

MOA:
o blocks action of neutrophils associated with gout symptoms

INDICATIONS:
o gout

SE/AE:
o GI symptoms

FIRST LINE AGENTS FOR GOUT FLARES:
o steroids
o NSAIDs
o colchicine

NOTES:
o narrow therapeutic index
o toxicity can lead to adverse effects such as hepatic and renal issues

74
Q

Xanthine Oxidase Inhibitors

A

DRUG CLASS:
o Xanthine Oxidase Inhibitors

DRUGS:
o allopurinol

MOA:
o reduces uric acid levels

INDICATIONS:
o gout prevention
o nephrolithiasis

ONSET:
o several days
o peak effects are in 1-3 weeks

NOTES:
o may exacerbate gout upon initial pharmacotherapy

75
Q

Uricosurics

A

DRUG CLASS:
o Uricosurics

DRUG:
o probenecid

MOA:
o reduces uric acid levels

INDICATIONS:
o gout prevention

NOTES:
o may exacerbate gout upon initial pharmacotherapy (treatment)

76
Q

Bisphosphonates

A

DRUG CLASS:
o Bisphosphonates

DRUGS:
o alendronate (fosamax) - PO meds
o Zoledronic acid / Zoledronate (Reclast) - IV ONLY

MOA:
o decreases bone turnover

INDICATIONS:
o osteoporosis
o Paget disease

NOTES:
o Bisphosphonates are first line for osteoporosis
o Zoledronate is first line for Paget disease
o Teratogenic

PATIENT EDUCATION:
o alendronate should be taken before first meal of the day with a full glass of water
o remain sitting or upright for 30 minutes following administration
o ensure the patient has adequate intake of calcium and vitamin D

77
Q

Selective Estrogen Receptor Modulators

A

DRUG CLASS:
o Selective Estrogen Receptor Modulators

DRUG:
o Raloxifene (Evista)

MOA:
o Similar to estrogen

INDICATIONS:
o prevent and treat osteoporosis in post-menopausal women

BLACK BOX WARNING:
o increased risk of embolic events

NOTES:
o teratogenic

PATIENT EDUCATION:
o ensure patient has adequate intake of calcium and vitamin D

78
Q

Calcitonin

A

DRUG NAME:
o calcitonin

MOA:
o increases calcium excretion
o decreases calcium loss from the bones

INDICATIONS:
o hypercalcemia
o post-menopausal osteoporosis
o Paget disease

ROUTES:
o parenteral
o intranasal

79
Q

Oral Contraceptive (OCP)

A

DRUG CLASS:
o Oral Contraceptive (OCP)

DRUGS:
o most common type is a combination of estrogen & progesterone
o Norethindrone and Ethinyl Estradiol
o Many generic and brand/trade names for OCP (nearly all include an estrogen and progesterone)

MOA:
o prevents ovulation by suppressing LH

INDICATIONS:
o contraception
o treats acne

OFF-LABEL USE:
o dysmenorrhea
o menstrual suppression
o PCOS symptoms

AVAILABLE DOSES:
28 day cycles available as:
o 21 tablets with 7 placebos (most common)
o 24 tablets and 4 placebos

BLACK BOX:
o increased risk for thromboembolic events when combined with smoking

NOTES:
o several medications, such as antiepileptics and antibiotics, can reduce the efficacy of OCP

80
Q

OCP patient education

A

o should be started greater than 5 days from onset of bleeding
o usually started on a sunday
o use alternative method of contraception for the first 7 days of starting OCP
o a missed pill should be taken when remembered and can be taken two in one day
o if two or more pills are missed, use an alternative method for contraception
o must be stopped in the event pregnancy occurs

81
Q

Progesterone Only Pill

A

DRUG CLASS:
o progesterone only pill

DRUG:
o norethindrone (minipill)

MOA:
o suppresses LH surge
o interferes with sperm and egg movement
o thins endometrium

INDICATIONS:
o contraception
o less effective than combined estrogen - progesterone OCP

NOTES:
o can be started immediately after childbirth

PATIENT EDUCATION:
o must be taken at the same time every day

82
Q

Emergency Contraception

A

DRUG CLASS:
o emergency contraception

DRUGS:
o levonorgestrel (Plan B, Plan B One-step)
o ulipristal (Ella)

MOA:
o interferes with ovulation

INDICATIONS:
o emergency contraception

NOTES:
o only effective within the first 5 days after unprotected intercourse
o significantly less effective in patients with a high BMI
o does not abort a fetus
o does not require a prescription

83
Q

Ovulation Stimulant

A

DRUG CLASS:
o Ovulation Stimulant

DRUG:
o Clomiphene (Clomid)

MOA:
o causes growth in ovarian follicle by stimulating release of FSH and LH

INDICATION:
o ovulation induction for fertility

ONSET:
o (ovulation) is in 5-10 days

NOTES:
o not recommended to be used for ore than 12 cycles

PATIENT EDUCATION:
o start taking on day 5 of cycle
o have intercourse at least every other day for days 5-10 after final dose
o increases chance of multiple gestation
o hCG may be given IM to induce ovulation

84
Q

Oxytocin (Pitocin)

A

DRUG NAME:
o Oxytocin (pitocin)

MOA:
o stimulates uterine contractions

INDICATION:
o induction of labor
o postpartum hemorrhage

ONSET:
o around one minute

BLACK BOX WARNING:
o not labeled for use in elective induction of labor (but it is an off-label use)

85
Q

Estrogen Replacement

A

DRUG CLASS:
o estrogen replacement

DRUG:
o conjugated estrogen (premarin)

MOA:
o actions of estrogen

INDICATIONS:
o symptoms of menopause (i.e. hot flashes, vaginal dryness)
o breast cancer

BLACK BOX WARNING:
o endometrial and breast cancer
o CVD
o dementia

86
Q

Androgen

A

DRUG CLASS:
o Androgen

DRUG:
o testosterone

MOA:
o produces anabolic and androgenic effects

INDICATIONS:
o delayed puberty
o hypogonadism

BLACK BOX WARNING:
o hypertension
o virilization in women and children

ROUTE:
o parenterally only

NOTE:
o controlled substance (Schedule III)

87
Q

Alpha One Adrenergic Antagonists

A

DRUG CLASS:
o alpha one adrenergic antagonists

DRUGS:
o tamsulosin (flomax)
o doxazosin (cardura)

MOA:
o inhibits alpha one receptor causing relaxation of muscle in the bladder neck

INDICATIONS:
o BPH
o HTN

SE/AE:
o orthostatic hypotension
o reflex tachycardia

NOTES:
o first line for BPH (benign prostate hyperplagia)
o other A1 agonists are used only for HTN such as prazosin

NUR 334: Pharmacology (13 decks)

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