anti-.... cholenergics, n/v,Oxytocin, octreotide Flashcards Preview

Pharm Oral > anti-.... cholenergics, n/v,Oxytocin, octreotide > Flashcards

Flashcards in anti-.... cholenergics, n/v,Oxytocin, octreotide Deck (52):
1

MOA for Anticholinergics

Aromatic esters that competitively inhibit the effects of ACh at the muscarinic receptors thereby decreasing PNS activity (prevent c AMP and cGMP effects); used for symptomatic brady, anti-sialagogue, Gi spasms and decreases GI secretions, bronchodilation, pea, systole, promotes AW relaxation by inhibing the M2 and M3 causing bronchial SM relaxation and increase HR by blocking the ACh effects at SA node; use with NMB reversal agent

2

Atropine PK

40%PB to alpha-1-glycoprotein, Vd=1.6L/KG, onset 1 min, peak 1-2min, Do a 30-60min, e1/2 2 hours, hydrolyzed in the liver to tropine and tropic acid and excreted 18% unchanged in the urine

3

Atropine Se

sedation bc crosses bbb, increases HR, CO, IOP, arrhythmias, blurry vision, decrease secretions and GI motility, bronchodilation

4

Atropine class

tertiary amine anticholinergic

5

Atropine CI

glaucoma, patients that tachycardia would be harmful- such as-CAD, hyperpyrexia pts, mobitz type 2
avoid other sympathomimetics

6

Atropine Dose

0.01mg/kg for reversal; 0.4-0.6 preop antisialagogue, 0.4-1mg for bradycardia; 1mg q3-5min for systole/PEA

7

Glycopyrrolate class

synthetic quaternary ammonium anticholinergic

8

Glycopyrrolate Pk

onset 2-3 min, peak 3-5min, DOA 2-4 hours, e1/2 1hour, liver metabolism and 85% excreted unchanged in the urine, poorly lipid soluble

9

Glycopyrrolate SE

increase HR, CO, IOP, arrhythmias, H/A, blurry vision, decrease secretions and go motility, bronchodilation, MH, decreases sweating, anaphylactic reaction

10

Glycopyrrolate CI

MH, neonates, CAD, HTN, CHF, glaucoma, hyperpyrexia pts

11

Glycopyrrolate dose

reversal 0.01-0.02mg/kg IV
anti-sialagogue and bradycardia 0.1-0.2mg

12

Scopolamine- class

tertiary amine anticholinergic
used for motion sickness, PONV, sedation, bronchodilation; biliary and ureteral SM relaxation, NOT USED FOR REVERSAL NMB

13

Scopolamine Pk

lipid soluble, onset 10 min, DOA 2 hours, e1/2 4 hours, may last 3-7 days, metabolized by the liver with <1% excreted unchanged in the urine

14

Scopolamine SE

increase HR, CO, IOP, OH. sedation, arrhythmias, blurry vision. decreases secretions and GI motility

15

Scopolamine CI

glaucoma liver disease, GI/GU obstruction

16

Scopolamine dose

0.3-0.6mg IV q4-6 hours

17

Metoproclamide/reglan

antiemetic, dopamine receptor antagonist and serotonin receptor agonist

18

Metoproclamide/reglan MOA

blocks the DA2 receptors in the chemo receptor trigger zone of the medullar preventing N/V; also a pro kinetic increasing gastric motility via serotonin increasing peristalsis and increases ACh at the muscarinic receptors post synaptically

19

Metoproclamide/reglan PK

onset 1-3 min, DOA 1-2 HR, e1/2 2-4hours, metabolized in the liver and 40% excreted unchanged in the urine

20

Metoproclamide/reglan SE

increase gastric motility, LES tone, decrease N/V, extrapyramidal SE, abd cramping, sedation, prolactin secretion, dry mouth, good for RSI

21

Metoproclamide/reglan CI

Parkinsons, bowel obstruction, GI hemorrhage, sz, arrhythmias esp if administered with zofran, no phenothiazides

Increased sedative effects of Cns depressants

22

Metoproclamide/reglan dose

10-20mg iv over 3-5min 15 min before induction
10mg preinduction pt with gastroparesis
0.15/kg mom ponv and kid

23

Ondansetron/Zofran class

antiemetic, serotonin antagonist

24

Ondansetron/Zofran MOA

blocks the serotonin receptors peripherally and in the CRTz- coupled to fast sodium channels and k channels

25

Ondansetron/Zofran PK

onset 30min, DOA 4-8hours, e1/2 3-4 hours, metabolized in the liver with renal excretion 5% unchanged

26

Ondansetron/Zofran SE

HA with rapid administration, sedation, arrhythmias, constipation, diarrhea, fatigue

27

Ondansetron/Zofran CI

hypersensitivity, liver disease, SSRIs, MAOis

28

Ondansetron/Zofran dose

4-8mg IV over 2-5min

29

Promethazine/Phenergan class

antiemetic, H1 and Dopamine 2 antagonist.

30

Promethazine/Phenergan MOA

blocks DA receptors and antagonizes H1 @ receptor. response decreases histamine mediated release in respiratory tract, GI and blood vessels

31

Promethazine/Phenergan Pk

93%PB, onset 3-5min, DOA 2-4 hours, e1/2 9-16hours, metabolized in the liver by CYP450 and excreted in the urine

32

Promethazine/Phenergan SE

extrapyramidal effects, anticholinergic effects, sedation, arrhythmias, neuroleptic malignant syndrome

33

Promethazine/Phenergan CI

hypersensitivity, parkinson's on levodopa, rena/hepatic/pulmonary diseases, peds <2yrs

34

Promethazine/Phenergan dose

6.25-25mg IB

35

Omeprazole/Prilosec class

Antiemetic/ PPI

36

Omeprazole/Prilosec MOA

prodrug that irreversibly inhibits H=/K= ATPase proton pump in the parietal cells decreasing gastric secretion

37

Omeprazole/Prilosec PK

95% PB, onset 1hr, DOA 72 hr, metabolized in the liver by CYP 2C19 to inactive metabolites

38

Omeprazole/Prilosec SE

HA, confusion, agitation, dizziness, N/V/D, abd pain

39

Omeprazole/Prilosec CI

hyprsensitivity, prolongs metabolism of diazepam, warfarin, dilantin

40

Omeprazole/Prilosec dose

40mg IV

41

Octreotide class

somatostatin analog

42

Octreotide MOA

binds to somatostatin receptor on carcinoid tumors to decrease the amount of serotonin released from tumors and decrease vasoactive amides; inhibits the production and release of GH, glucagon and insulin

43

Octreotide pk

65% PB, onset rapid, peak 2 hours; E1/2 2 hours; liver metabolism and excreted 32% unchanged in the urine

44

Octreotide SE

decrease glucose tolerance, hyperglycemia, N/V/C, decreases GI motility, gallstones, bradycardia, AV block

45

Octreotide CI

hypersensitivity, decreases effects of codeine and cyclosporine

46

Octreotide dose

50-100mcg/hr; 25-200mcg prn; 25-50mcg/hr for varices

47

Oxytocin class

endogenous posterior pituitary hormone

48

Oxytocin MOA

binds to oxytocin receptors on the uterus= SM contraction; used to induce or augment labor and contract the uterus post delivery and decrease chance of hemorrhage

49

Oxytocin PK

onset 1 min, DOA 1hour, E1/2 3-5min; metabolized by the liver and kidney; broken down by plasma oxytocinase and metabolism in mammary gland

50

Oxytocin SE

mom- anaphylaxis, N/V, PP hemorrhage, uterine rupture, arrhythmias and PVCs; baby- bradycardia, problematic fetal positioning, fetal distress

51

Oxytocin CI

fetal distress, hypertonic contractions, hypersensitivity

52

Oxytocin dose

10-40 units in 1L at 0.5-2mU/min ( increase gtt q15 min by 0.5-2mU/min until contractions are 2-3 min apart)