Drugs for Final (-: Flashcards
(149 cards)
1
Q
Class of Ibuprofen
A
NSAID, anti-inflm, analgesic, antipyretic
2
Q
availability of Ibuprofen
A
200-400mg
3
Q
indications of ibuprofen
A
Inflammatory disorders, pain, fever arthritis
SUPERIOR To all NSAIDs for dysmenorrhea
less bleeding than aspirin & less platelet aggregation (less implications for stroke & MI)
4
Q
Action of ibuprofen
A
Inhibit prostaglandin synthesis
5
Q
1/2 life of ibuprofen
A
1-2 hr for kids, 2-4 hr for adults
6
Q
onset of ibuprofen
A
0.5-2.5 hours for fever
30 minutes for pain
7 days for inflame
7
Q
contraindications for ibuprofen
A
NOT GIVEN WITH KIDNEY DISEASE
active GI bleed or ulcer.
Caution with cardiovascular or hepatic impair
8
Q
side effects of ibuprofen
A
nausea, GI bleed, HF, MI, Stroke
9
Q
dose of ibuprofen
A
anti-infm: MAX is 3200mg
otherwise the max is 1200mg
10
Q
Assessments for ibuprofen
A
Allergy, pain, Hx, Gi bleed, renal insufficiency, people with asthma have increased sensitivity
11
Q
what to teach for ibuprofen
A
W/ H20 & food
do not take with alcohol
12
Q
What class is ASA
A
NSAID, antipyretic
13
Q
What is the availability of ASA
A
Tablet or suppository, enteric coated. 81-975mg
14
Q
what is the indication of ASA
A
Arthritis, pain, fever, prophylaxis of TIA & MI
15
Q
what is the action of ASA
A
inhibit prostaglandin synthesis (COX-2) decreases platelet aggregation (COX-1)
16
Q
metabolism of ASA
A
excreted via kidneys (goes into breast milk & passes blood brain barrier)
17
Q
side effects of ASA
A
Heartburn, nausea, tinnitus, ulceration & bleeding
18
Q
assessments for ASA
A
pain, not for under 19 with viral infection, look for bleeding
19
Q
teaching for ASA
A
bleeding, do not take enteric coated with milk
20
Q
What is Acetaminophen for, why may it be better than other analgesics/ antipyretic
A
Not Anti-Inflm so not for arthritis
Doesn’t suppress platelet aggregation
doesn’t causes gastric ulceration or decrease blood flow to kidneys or cause renal impairment
21
Q
what class is acetaminophen
A
non-narcotic analgesic/antipyretic
22
Q
what is the mechanism of acetaminophen
A
inhibit enzyme cyclooxyrgenase needed to make prostaglandins in the CNS
23
Q
what is the pharmacokinetics of acetaminophen
A
absorbed well orally. 1/2 life is 2 hr
24
Q
what is the indication of acetaminophen
A
mild fever, pain
25
what is the onset of acetaminophen
rapid. Peak 0.5-2 hr.
26
duration of acetaminophen
3-4 hour
27
what is the side effects of acetaminophen
HEPATOTOXICITY (<4000mg a day) - there's an antidote
-if they drink 3x than no more than 200mg (you just reduce the dose...)
325-600mg every 4-6 hours
28
What is the therapeutic effect of Morphine
reduces pain
29
what class if morphine
opiod analgesic
30
What is the availability of morphine
Tab, cap, parenteral, sup, extended release
31
what is the mechanism of morphine
bind to opiate receptor in CNS. Alters perception & response to painful stimuli w/ generalized CNS depression
32
what are the side effects of morphine
respiratory depression & constipations
33
assessments for morphine
RR, BP, PAIN, URINARY RETENTION, cranial pressure, constipation, tolerance & physical dependence can occur
34
when to hold opioids or give narcan
If rr 8 or under GIVE NARCAN
| if rr 12 or less, HOLD MEDICATION
35
what class is hydromorphone
Opiod analgesic
36
what mechanism is hydromorphone
bind to opiate receptors in CNS. Generalized CNS depression w/ altered perception & response to stimuli
37
what is the indication of hydromorphone
Moderate to severe pain, mod/severe chronic pain in opiod tolerant patient
38
what is the side effects of hydromorphone
Resp depression, constipation
39
what is fentanyl transdermal indicated for
cancer & chronic pain
40
what class is fentanyl
Opiod analgesic
41
How is fentanyl available
parenteral / transdermal
42
what is the mechanism of fentanyl
bind to opiod receptors in the CNS alters the perception & response to painful stimuli while producing generalize dCNS depression
43
wha tis the indication of fentanyl
severe chronic 24 hour pain
44
what are the side effects of fentanyl
CNS depression/ constipation - Assses RR, BP, Renal, hepatic
45
what is vancomycin toxic too?
THE KIDNEYS !!!! (RENAL FAILURE ESPECIALLY IF YOU ALREADY FOR IT)
46
what is the most widely used antibiotic
vancomycin
47
what is vancomycin used for
for severe CDiff, MRSA & Staph & people who are allergic to penicillin
48
what is the action of vancomycin
inhibit cell wall synthesis of bacteria q
49
what is the absorption of vancomycin
Poor in GI. Willl be IV unless its for CDIFF
50
what are the side effects of vancomycin
Renal failure, infusion less than 60 minutes can cause pruritus, urticaria, tachycardia & hypotension.
Thrombophlebitis may occur
51
What is the indication for cephazolin
skin & skin structure infections including BURN, PNEUMONIA, UTI & Bone & joint infections.
NOT FOR MENINGITIS
52
what is the action of cephazolin
bind to bacterial cell wall
53
what is the pharmacology of cephazolin
1/2 life 90-150 minutes. RAPID onset
54
when is cephazolin contraindicated
hypersensitivity to cephalosporins or serious hypersensitivity to PENICILLIN. Caution in renal impairment
55
what are the side effects of cephazolin
seizures, colitis, diarrhea, anaphylaxis, serum sickness, N/V, very nephrotoxic, assess for infection, C&S, WBC, Renal FX,
56
What is the therapeutic effect of morphine
reduce pain
57
what is the class of morphine
opiod analgesic
58
what is the mechanism of morphine
bind to opioid receptors in the CNS. Alters perception & response to painful stimuli with generalized CNS depression
59
what are the side effects of morphine
resp. Depression & consitipation
60
what should you assess for with morphine
RR, BP, PAin, Narcan if 8 or under RR, 12 RR hold, urinary retention, cranial pressure, orthostatic hypotension, tolerance & psychical dependence
61
what is the trade name of atorvastatin
lipitor
62
what is the Therapeutic class & pharmacological class of atorvastatin
Lipid lower agent, HMG-CoA Reductase inhibitors
63
what is the indications for Atorvastatin
Hypercholestemia, Prevent CAD
64
benefits of atorvastatin
```
Lower LDL within 2 weeks (20-40%)
Must be taken life long
increases HDL, Lowers TG
Stabilizes Atherosclerotic plaques
Decreases inflammation, slows calcification, improve abnormal endothelial function
increases dilation
decreases AFIB
suppresses thrombin
```
65
what is the worst outcome for Atorvastatin
Liver dysfunction can occur (LFT tests prior & 3 months post)
Must pain, tender, weakness -> check CPK (indicates muscle injury)
N/V, heartburn, abdominal cramping, diarrhea, memory loss
given with evening meal
MEMORY LOSS - CANNOT BE GIVEN WITH LIVER DEASES
CAN CAUSE OVERWEIGHT FETUS
66
what is atorvastatin mechanism of cholesterol reduction
increase LDL receptors of hepatocytes
| inhibits HMG coa reductase (rate limiting enzyme in cholesterol biosynthesis) = hepatocytes better able to remove LDLS
67
what class is metoprolol
Beta-blockers (antianginal & antiHTN)
68
What is the indication of metoprolol
HTN, Angina pectoris, Prevent MI, decrease morality, mgmt of HF
(Unlabelled for: ventricular arrhythmia, tremor, anxiety & migraine)
69
what is the mechanism of metoprolol
blocks beta1 (myocardial) - adrenergic receptors. Doesn't usually affect Beta2 (blocking norepinephrine, epinephrine from increasing HR)
70
what are the adverse effects of Metoprolol
decrease BP, decrease HR, pulmonary edema, HF
71
what are the nursing considerations for metoprolol
Baseline BP, HR
72
when is metoprolol contraindicated
decreased BP, decreased HR, pulmonary edema, heart block, cariogenic shock
DO NOT GIVE IF HR less than 50
73
what is the teaching for metoprolol
abrupt withdrawal -> arrhythmia
| HTN, ischemia, drowsiness, orthostatic HTN
74
What is special about hydrochlorothiazide
Ineffective with a lowGFR
75
what class if Hydrocholorthiazide
AntiHTN, Thiazide diuretics
76
what is the indication for Hydrocholorthiazide
HTN, EDEMA
77
what is the mechanism of hydrochlorothiazide
Urine prod. Via block reabsorption of Na+ & Chlorine in early distal convoluted tubule (smaller urine amt than loop diuretics)
Dependent on kidney fx - effective with GFR 15-20)
78
when does Hydrocholorthiazide start working
diuresis 2hr, peak 4-6hr, duration 10 hr
79
what are the therapeutic indications of hydrocholorthizide
HTN, edema, Diabetes insipidus, osteoporossis b/c reabsorb calcium
80
what are the adverse effects of hydrocholorthiide
Hyponatremia, hypocholermia, dehydration, hypokalemia
| hyperuricemia, Increased LDL, Increased excretion of magnesium
81
when should you give hydrocholorthizide
later in the day
82
what type of diuretic is furosemide
loop diuretic
83
what is the mechanism of furosemide
acts on hence's loop to block reabsorption of Na+ & CL-
prevents passive reabsorption of H2O
Oral onset = 60 minutes for 8 hrs or IV within 5 minutes for 2 hours
84
what is the indication of furosemide
pulmonary edema, edema, HTN
| -Thiazide diuretic is added if furosemide is not enough
85
what are the adverse effects of furosemide
hyponatremia, hypochloremia, dehydration, hypotension, hypokalemia, ototoxicity (deafness), hyperglycemia, hyperuricemia, reduces LDL, raises HDL
NOT SAFE FOR PREGNAT
86
what type of insulin is lispro/humalog
Rapid acting analogue of regular insulin
87
when do you give lispro/humalog
food must be in front -> immediately b4 meals
88
what is the onset of lispro/humalog
10-15 minutes
89
what is the peak of lipro/humalog
60-90 minutes
90
what is the duration of lispro/humalog
3-5hr
91
why does lispro/humalog work faster
aggregates less than normal insulin
92
what type of insulin is glargine/lantus
long acting basal insulin analogue
93
what is the onset of lantus/glargine
90 minutes & duration is 24 hours
94
what should you know about glargine/lantus
DO NOT GIVE IV
do not MIX WITH OTHER INSULINS
Dosing can occur at any time
- low solubility, clear
95
what is warfarin
Anticoagulant - VITAMIN K ANTAGONISTS
96
is warfarin for emergencies?
no because delayed onset 2-3 days
97
what is the effect of warfarin
long term prophylaxis and prevention of THROMBOSIS with a significant hemorrhage risk
98
what is the mechanism of warfarin
Decreased clotting factor production (by inhibiting an enzyme needed to convert K+ to its active from)
NO EFFECT ON CLOTTING FACTOR SALREADY IN CIRCULATION
99
what is the duration of warfarin
2-5 days
100
what is the therapetuic use of warfarin
Prevent VT, PE, thromboembolism with prostatic valve, thrombosis with fib, decrease TIA & MI risk
101
what do you need to monitor with warfarin
PROTHROMBIN TIME- meant to prolong (12s as a baseline)
| PT INR 2-3 for most warfarin (if below you need to increase dose) THIS IS PT-INR THE EXTRINSIC PATHWAY
102
what are the side effects of warfarin
hemorrhage, skin necrosis, weak bones, fever, GI disturbances
103
when is warfarin contraindicated
Thrombocytopenia (not many platelets) (lumbar puncture, CNS surgery)
High risk bleeders (hemophilia, aneurysm, GI ulcer, HTN, Abortion)
Vitamin K deficiency, Liver Disease, Alcoholism, Pregnant & lactating
*KEEP VITAMIN K INTAKE STABLE
104
what class is ramipril
Ace inhibitor
105
what does ramipril do (mechanism of action)
Lowers bp b/c no angiotensin 2 -> systemic vasodilation and decreased cardiac workload.
Treats HTN, HF & prevents MI
106
what are the side effects of ramipril
hypotension, Increased K+, cough, fetal death, reduce dosage if kidney issues are present
107
what are the assessments for ramipril
BP (HR not very important), Electrolytes, K+, dry cough
108
what type of a drug is digoxin
cardiac Glycoside, positive isotrope
109
what is the indication of digoxin
HF, Dysrhythmias,
110
what is the effect of Digoxin
effects both mechanical & electrical
increased myocardial contractility & effects neurohormonal
SYMPTOM RELEIVE ONLY - doesn't prolong life
increases exercise tolerance & decreases hospitalization
111
what is the mechanism of digoxin
Positive inotrope -> Increases force of ventricle contraction -> Increases CO
INHIBITS NA+/KATPASE -> promotes calcium accumulation within the myocytes -> augments contractile force
K+ IONS compete to bind NA+/K+ATPASE so when K+ is low excessive inhibition occurs AND LEADS to TOXICITY
*K+ MUST BE MONITORED
FOR ANTI-ARRYTHMIA: increased automaticity of SA node, increased refractory period for AV nodes
112
what ae the benefits go digoxin
Increases CO, decreases sympathetic tone, increases urine, decreases renin, decreases heart size, fatigues reduced,
increased automaticity of SA node, increased refractory period for AV nodes
113
what are the side effects of digoxin
arrhythmias b/c hypokalemia or Overdose (0.5-0.8 is ideal)
| anorexia, n/v, fatigue, visual disturbance, Hold if HR IS BELOW 60, avoid IM
114
What is the class of codeine
opiod
115
what is the indication of codeine
mgmt of mild -> moderate pain
116
what is the action of codeine
bind to opiate receptors in the CNS alters the perception of & response to painful stimuli with general CNS depression
117
what are the side effects of Codeine
confusion, sedation, hypotension, constipation, nausea, vomiting
118
pre/post assessments for codeine
Bp, Pulse, RR, allergies, pain, bowel function
119
what class is nitroglycerine
Antianginals, Nitrates
120
what is the indication of nitroglycerine
acute & LT prophylactic mngmt of agina pectorals
121
Action
Relac vascular smooth muscle (arteries - coronary) but particularly VEINS & Consequently reducing cardiac workload
-Decreases Left ventricle EDV & EDP
reduces myocardial O2 consumption
122
what are the effects of nitroglycerine
relief of prevention of anginas attacks - reduces O2 consumption to decrease ischemia, increase CO & decrease BP
123
what are the side effects of nitroglycerine
Vessels dilate too much & blood pool in the periphery which reduces CO -> give isotonic fluid to increase volume
-headache
124
what is so special about nitroglycerine
Use up to 3 times (every 5 minutes) for angina & if it doesn't work in 15 call 9111
metabolism is 5-7 mintes & most are destroyed in first pass
cannot be used with erectile dysfunction medications
beta blockers suppress tachycardia reflex
Relief is via PERIPHERAL DILATION
125
what class is Atleplase (tPA)
Thrombolytic, fibrinolytic, plasminogen activators
| Identical to naturally occurring human Tea
126
what is the Action of Atleplase
Directly converts plasminogen to plasmin which degrades clot bound fibrin -> increases risk of hemorrhage
127
what is the indications for Atleplase
MI, ISchemic, Stroke, PE
128
Explain Atleplase for Use in MI
For stem if it is within 6 hr of 1st symptom & angioplastyy with a stent (percutaneous coronary intervention) is not aavail within the first 90 minutes of medical contact
-47-75% reduction in mortality if delivered within the 1st hour of onset of symptoms
DIAGNOSIS MUST BE RIGHT
129
what is the pharmacology of ATLEPLASE
INR must be above 1.7, bp must be above 185/110, 1/2 life if 5 minutes
130
explain Atleplase for use in CVA
within first 4.5 hours (3-15%) - Door to needle should be 1 hour or less
PATIENT REQUIREMENTS: Normal CT, No bleeding tendency, Bp <180/100
decreases morbidity by 30%, hemorrhaging occurs in 6%
DO NOT GIVE WITH UNCONTROLLED HYPERTENSION
131
explain bleeding with atleplase
Can destroy clots & healed injuries
| D/c if severe bleed. Give blood products or AMINCAPROIC ACID
132
how to minimize risk of bleeding on atleplase
Decrease physicial manipulation
avoid SubQ & MI's
Decrease invasive procedures
minimize anticoage/ anti platelet
133
what class is metformin
biguanides
134
what is the mechanism of action of metformin
1) Decreased hepatic glucose production
2) decreased interstitial glucose absorption
3) increased sensitivity to insulin - more permeability
DOES not work on pancrease
DO NOT USE WITH LIVER FAILURE OR A GFR OF LESS THAN 30
135
what are the adverse effects & contraindicationsns
Contraindicated with renal impair, HF & Recent MI
| CONTRAINDICATED WITH HF b/c ALREADY PREDISPOSED TO LACTIC ACIDOSIS & METFORMIN CAUSES LACTIC ACIDOSIS
136
how does metformin cause lactic acidosis
inhibits mitochondrial oxidation of lactic acid.
| Ppl with HF are already predisposed to lactic acidosis because its associated with poor perfusion
137
what glass are glipizide
sulfonylureas
138
what side is aspiration pneumonia more common
right
139
what is glipizide mechanism of action
stimulate the pancreas to secrete insulin
improves action @ receptor site
may decrease hepatic metabolism
WORKS DIRECTLY ON THE PANCREAS
140
what should you assess for glipize
hypoglycaemia, bg
141
what are the adverse effects of glipizie
hypoglycaemia
NAUSEA & DIARRHEA
constipation
Dizziness, skin rash, red & itchy
142
what class is phenytoin/ Dilantin
Antiarrythmia, Anticonvulsants, Hydratoins
143
How is phenytoin available
IV PO
144
what are the side effect of phenytoin
dizzy, lethargy, confusion, suicidal thoughts, hypotension, nausea& vomiting, diplopia, nystagmus
145
what is the indication of phenytoin
tx/prevent of tonic/clonic seizures & complex partial seizures
146
what is the action of phenytoin
limit seizure propagation by altering ion transport
| Shortens AP's
147
what is the assessments for phenytoin
mental status
seizure
BP, EEG, Resp, CBC, Calcium FX
YOU NEED TO TEST FOR PHENYTOIN LVL & ALBUMIN LVL
148
what are the s&S of phenytoin toxicity
nystagmus (mvmd eyes), ataxia (abnormalities gains, speech, eye mints) confusion, slurred speech dizzy
149
considerations for phenytoin
many interactions
MUST BY EMPTY STOMCH
USE WITH CAUTION IN HEPATIC OR RENAL PATIENTS
