Classifications

Question 0

Opioid Partial Agonist

Answer 0

-block mu receptors and compete with agonists
-POTENT synthetic analgesics
-potential for misuse and abuse is less
-Antagonistic activity can produce withdraw symptoms in opioid dependent patients
Example: Nubain

Question 1

Opioid agonists

Answer 1

Narcotics
MOA: achieve beneficial effects by their action in the CNS. When they act outside CNS that is where unwanted effects occur.

Indications: alleviate severe to moderate pain; cough suppressant-codeine,hydrocodene; anti diarrheal preparations.

Contraindications: allergy, severe asthma, respiratory insufficiency, increased ICP, pregnancy

SE: sedation, constipation, respiratory depression

Question 2

Opioid antagonist

Answer 2

NARCAN
Reversal agent
-Blocks opioid receptors; does not produce sedation or respiratory depression.
-drug of choice : complete or partial reversal of opioid induced respiratory depression OR diagnosis of suspected opioid overdose
-short half life—must monitor patient

Question 3

Non-Narcotic Analgesics

Answer 3

Tylenol (acetaminophen)

• analgesic, antipyretic (fever, pain)
• NOT an anti inflammatory
• indications: fever or mild to moderate pain
• will kill liver with overdose, one of most harmful drugs to overdose on

Antidote: acetylcysteine (Mucomyst)
Smells like rotten eggs, oral

Question 4

NDAIDS

Answer 4

Very common. Potential major toxicity=GI intolerance, bleeding, kidney impairment with long term therapy.
MOA: “prostaglandin” inhibitor
Indications: pain, gout, inflammation, fever, vascular headaches, rheumatoid arthritis, osteoarthritis, inflammatory syndromes.

SE: GI distress, could precipitate in acute or chronic renal failure

Contraindications: conditions that increase risk of bleeding: peptic ulcer disease, 3rd stage of pregnancy because risk of bleeding

No antidote. Activated charcoal is used in tx of overdose of NSAIDs

Aspirin, ibuprofen, Celebrex

Question 5

Salicylates

Answer 5

NSAID example
Aspirin
First ever NSAID
Only NSAID with anti-platelet abilities

Question 6

COX-2 inhibitors

Answer 6

NSAID example
Celebrex (celecoxib)
-block what we think may have been causing a GI bleed, less GI upset, prevents GI bleeding, need to be monitored closely for heart issues, increases cardiac issues why there aren’t other cox-2 on market…way pros and cons

Question 7

Triptans

Answer 7

Agent to treat migraines: oral, sc, intranasal
Serotonin agonist
Drug of choice
Thought to act by constricting certain intracranial vessels
SE: dizziness, drowsiness, rarely severe
Contraindications: recent MI, HTN, angina, diabetes…don’t want to increase BP more than it already is

Question 8

Ergot alkaloids

Answer 8

Agent to treat migraines, don’t see a lot, used for those who are unresponsive to Triptans

Question 9

Antineurolgics

Answer 9

Micellaneous Analgesic
Action: work differently in the CNS to decrease excitatory neurotransmitter release
Indication: nerve pain, peripheral neuropathy, fibromyalgia
SE: dizziness, ataxia, drowsiness, fatigue, peripheral edema

Question 10

Benzodiazepines

Answer 10

Anxiety and insomnia ; Most commonly prescribed
Indications: anxiety, insomnia, skeletal muscle spasm, EMERGENT seizure control, tx of alcohol addiction
SE: usually mild, involve CNS: headache, drowsy, nervousness, vertigo, lethargy, HANGOVER
Contraindications: allergy, pregnancy, narrow angle glaucoma, caution with geriatric patients d/t falls

Question 11

Reversal Agents Benzodiazepines

Answer 11

Flumazenil (Romazicon)
Symptoms include drowsiness, sedation, respiratory depression
Reverses CNS depressant symptoms

Question 12

Non-Benzodiazepine Hypnotic Agent

Answer 12

Short half life
Less lethargy or grogginess in the morning
Less abuse potential
For sleep, not anxiety, help getting you to sleep and keeping you asleep

Question 13

Pituitary Agents

Answer 13

Action: augment the natural effects of pituitary hormones

Indications:
Corticotropin (ACTH): diagnosis and treatment of adrenalcortical insufficiency. Treatment of MS
Somatotropin (GH): stimulates skeletal muscle growth in pts with inadequate secretion
Vasopressin (ADH) : antidiuretic hormone. Symptom management of diabetes insipidus

SE:
Corticotropin: convulsions, dizziness, insomnia
Somatotropin: HA, hyperglycemia, ketosis
Vasopressin: increased BP, drowsiness, HA

Question 14

Thyroid agents

Answer 14

Action: replacement of thyroid hormone
Indications: hypothyroidism from any cause–> (Myxedema) –sluggish, cold, puffy face
Contraindications: recent MI, adrenal insufficiency, hyperthyroidism
SE: result of overdose=overstimulation of metabolism
Ex: Synthroid

Question 15

Antithyroid Agents

Answer 15

Action: inhibit formation of thyroid hormone, DOES NOT inactivate already existing hormone

Indication: hyperthyroidism (Graves disease)

SE: most serious: liver and bone marrow toxicity

Contraindications: avoid in pregnancy unless the hyperthyroidism is induced by pregnancy
Ex: PTU

Question 16

Glucocorticoids

Answer 16

Action: inhibition of inflammatory and immune responses
Indications: many! Management of head or spinal cord injuries , itis, collagen diseases
SE: hypertension, mood swings, hyperglycemia, ecchymosis and poor wound healing, muscle weakness

Question 17

Mineralocorticoids

Answer 17

Aldosterone: natural hormone excreted by adrenal cortex
Action: Deals with fluid and electrolyte balance
Indications: replacement therapy for patients with adrenal insufficiency; Addison’s disease..sometimes used to increase BP in pts suffering from chronic severe postural hypotension
SE: sodium and fluid retention, impaired wound healing
Contraindications: serious infections like septicemia, systemic fungal infections

Question 18

Insulin

Answer 18

Action: exogenous insulin functions as a substitute for the endogenous hormone
Indications: type 1 and type 2 Diabetes, emergency treatment of Ketoacidosis
SE: hypoglycemia!! If severe=convulsions! coma, death

Question 19

Sulfonylureas

Answer 19

Antidiabetic drug
Action: stimulate insulin secretion from beta cells of pancreas. Increase sensitivity of insulin receptors on target cells.
SE: hypoglycemia!!! GI effects, moderate weight gain d/t fluid retention

Question 20

Biguanides

Answer 20

Deal with insulin resistance. Do not get hypoglycemia as a side effect of med.
Action: decreases hepatic production of glucose. Decreases insulin resistance. Takes 3-4 months for optimal control.
SE: mostly GI: anorexia, nausea, bloating, diarrhea
Contraindications: cardiac insufficiency, liver dysfunction

Question 21

Thiazolidinediones

Answer 21

Deal with insulin resistance. Do not get hypoglycemia as a side effect of med.
Action: decreases hepatic production of glucose. Decreases insulin resistance. Takes 3-4 months for optimal control.
SE: fluid retention, headaches, weight gain, exacerbation of heart failure
Contraindications: cardiac insufficiency, liver dysfunction

Question 22

Alpha-glucosidase inhibitors

Answer 22

Action: block enzymes in the small intestine responsible for breaking down complex carbohydrates into monosaccharides. Delays digestion of glucose.
**must be taken with first bite of meal
SE: minimal GI: abdominal cramping, flatulence, diarrhea

Question 23

GLP-Agonist

Answer 23

Incretin enhancer. Incretins are hormones secreted by the intestines following a meal that signal the pancreas to increase insulin production and the liver to decrease glucose production .

Action: acts like incretins
SE: significant nausea, vomiting and diarrhea in some clients
Contraindications: severe GI disease, gastroparesis

Question 24

DPP-4 Inhibitor

Answer 24

Action: inhibit breakdown of incretins SE: N/V/D, flu like symptoms, URI, back pain Use with caution: severe renal disease DPP-4 is a enzyme that breaks down incretins

Question 25

Glucose Elevators

Answer 25

Used to increase blood sugar levels, many times in emergent situations. 1. Oral glucose 2. High dose Dextrose solutions such as 50% Dextrose --- add glucose directly to blood stream 3. Glucagon- natural hormone, can be given orally or IV when rapid response to hypoglycemia is needed

Question 26

Sulfonamides

Answer 26

``` One of first groups of ATBs MOA: inhibit growth=prevent synthesis of folic acid. Achieves very high concentration in the kidney. Indications: UTI, URI Contraindications: allergies to Sulfa SE: common cause of allergic reactions *increase fluid intake 1500-3000 ml/day Ex: Bactrim ```

Question 27

Penicillins

Answer 27

Synthesized from molds; lots of allergic reactions MOA: inhibition of cell wall synthesis Indications: strep, staph, enterococcus SE: pretty frequent allergy *always check allergy! caution with neonates and pregnancy, caution with history of asthma and multiple allergens

Question 28

Cephalosporins

Answer 28

Developed for those who couldn't take PCN die to allergies, and have a broader spectrum MOA: inhibition of cell wall synthesis Indications: 4 generations, cover different spectrums SE: GI distress *caution with neonates and pregnancy! caution if history of asthma and multiple allergens

Question 29

Macrolides

Answer 29

MOA: prohibits bacterial protein synthesis Indications: Strep, respiratory infections, syphilis and Lyme disease, STDs, diabetic gastroparesis, helicobacter pylori SE: basically GI , alteration in vaginal flora=yeast infections *caution with neonates and pregnancy, caution if history of asthma and multiple allergens Mycin=Macrolides

Question 30

Tetracyclines

Answer 30

Indications: STDs, Lyme disease, helicobacter pylori, pneumothorax, acne Contraindications: avoided in pregnancy and children less than 8 years old SE: teeth discoloration in children still developing, photosensitivity *not used in children under 8, caution with renal or hepatic disease, do not give with dairy products

Question 31

Aminoglycosides

Answer 31

Not given orally=poor GI absorption Serious toxicities=renal failure, hearing loss All IV antibiotics SE: ototoxicity, renal toxicity, BOTH reversible if caught early Contraindications: allergy, renal disease **monitor BUN and Creatinine, increase fluid intake, peak and trough levels regularly used

Question 32

Fluoroquinoloness

Answer 32

Excellent oral absorption; can give once or twice a day Indications: respiratory, skin, and and urinary tract infections, Anthrax (post exposure) Contraindications: not used with pts receiving certain anti-arrhythmic drugs=altered cardiac fx SE: CNS=headache, dizziness, restlessness GI = nausea, vomiting, constipation **Cipro not recommended in children under 18 Don't take with multivitamins or mineral supplements because Ca, Mg, iron, and zinc absorption up to 90%

Question 33

GLP-Agonist

Answer 33

Incretin enhancer. Incretins are hormones secreted by the intestines following a meal that signal the pancreas to increase insulin production and the liver to decrease glucose production . Action: acts like incretins SE: significant nausea, vomiting and diarrhea in some clients Contraindications: severe GI disease, gastroparesis

Question 34

DPP-4 Inhibitor

Answer 34

Action: inhibit breakdown of incretins SE: N/V/D, flu like symptoms, URI, back pain Use with caution: severe renal disease DPP-4 is a enzyme that breaks down incretins

Question 35

Glucose Elevators

Answer 35

Used to increase blood sugar levels, many times in emergent situations. 1. Oral glucose 2. High dose Dextrose solutions such as 50% Dextrose --- add glucose directly to blood stream 3. Glucagon- natural hormone, can be given orally or IV when rapid response to hypoglycemia is needed

Question 36

Sulfonamides

Answer 36

``` One of first groups of ATBs MOA: inhibit growth=prevent synthesis of folic acid. Achieves very high concentration in the kidney. Indications: UTI, URI Contraindications: allergies to Sulfa SE: common cause of allergic reactions *increase fluid intake 1500-3000 ml/day Ex: Bactrim ```

Question 37

Penicillins

Answer 37

Synthesized from molds; lots of allergic reactions MOA: inhibition of cell wall synthesis Indications: strep, staph, enterococcus SE: pretty frequent allergy *always check allergy! caution with neonates and pregnancy, caution with history of asthma and multiple allergens

Question 38

Cephalosporins

Answer 38

Developed for those who couldn't take PCN die to allergies, and have a broader spectrum MOA: inhibition of cell wall synthesis Indications: 4 generations, cover different spectrums SE: GI distress *caution with neonates and pregnancy! caution if history of asthma and multiple allergens

Question 39

Macrolides

Answer 39

MOA: prohibits bacterial protein synthesis Indications: Strep, respiratory infections, syphilis and Lyme disease, STDs, diabetic gastroparesis, helicobacter pylori SE: basically GI , alteration in vaginal flora=yeast infections *caution with neonates and pregnancy, caution if history of asthma and multiple allergens Mycin=Macrolides

Question 40

Tetracyclines

Answer 40

Indications: STDs, Lyme disease, helicobacter pylori, pneumothorax, acne Contraindications: avoided in pregnancy and children less than 8 years old SE: teeth discoloration in children still developing, photosensitivity *not used in children under 8, caution with renal or hepatic disease, do not give with dairy products

Question 41

Aminoglycosides

Answer 41

Not given orally=poor GI absorption Serious toxicities=renal failure, hearing loss All IV antibiotics SE: ototoxicity, renal toxicity, BOTH reversible if caught early Contraindications: allergy, renal disease **monitor BUN and Creatinine, increase fluid intake, peak and trough levels regularly used

Question 42

Fluoroquinoloness

Answer 42

Excellent oral absorption; can give once or twice a day Indications: respiratory, skin, and and urinary tract infections, Anthrax (post exposure) Contraindications: not used with pts receiving certain anti-arrhythmic drugs=altered cardiac fx SE: CNS=headache, dizziness, restlessness GI = nausea, vomiting, constipation **Cipro not recommended in children under 18 Don't take with multivitamins or mineral supplements because Ca, Mg, iron, and zinc absorption up to 90%

Question 43

Adrenergic agents

Answer 43

Stimulate sympathetic response Indications: Alpha 1- hypotension, nasal congestion Beta 1- cardiac arrest, heart failure, shock Beta 2- asthma, premature labor Contraindications: severe hypertension SE: hyped up (HA, restlessness, excitement) vasoconstriction that causes hypertension, tachycardia, palpitations, dysrhythmias

Question 44

Adrenergic blocking agents

Answer 44

Blocking sympathetic response, block receptors Alpha blockers Beta blockers

Question 45

Alpha 1 blocker

Answer 45

Adrenergic blocking agent Indication: hypertension, BPH Contraindications: peripheral vascular disease, CAD, renal or liver disease SE: based on effects of vasculature

Question 46

Beta blockers

Answer 46

Adrenergic blocking agent Beta 1&2 Blockers Indications: angina, hypertension, dysrhythmias, migraines, glaucoma Contraindications: uncompensated heart failure, heart block, bradycardia, severe pulmonary disease SE: usually mild. May mask hypoglycemia. Angina may precipitate MI if withdrawn suddenly

Question 47

Cholinergics

Answer 47

Stimulates parasympathetic response Direct=act on receptors Indirect= increase availability of Ach by inhibiting cholinesterase; non-selective MOA= stimulate intestine and bladder constriction of pupil (miosis), decease IOP, constriction of bronchi and airways Indications: reduce IOP, treat various GI and bladder disorders, tx of myasthenia gravis, tx of Alzheimer's disease Contraindications: GI or GU obstruction, bradycardia, COPD, hypotension SE: overstimulation of PSNS

Question 48

Anticholinergics

Answer 48

Blocking parasympathetic response MOA: pupils dilate (inc IOP);decrease in GI motility, GI secretions and salivation; increase HR; decreased bladder contraction= urinary retention; reduce sweating and dry mucous membranes; prevents bronchial constriction Indications: decreasing muscle rigidity and diminish tremors, bradycardia, chronic bronchitis, exercise induced bronchospasm, COPD, irritable bowel disease and diarrhea, incontinence Contraindications: narrow angle glaucoma, acute asthma, myasthenia gravis, acute CV instability, GI or GU obstruction SE: DRYING!!! dry mouth, constipation, urinary retention, decreased bronchial secretions