EXAM 2 Flashcards

Question

Beta-Blockers

Answer 1

An antianginal Decreases the heart’s need for oxygen and the heart work more efficiently ; which in turn decreases angina. / Decrease workload, decrease O2 demands / Beta-blockers as antianginal decrease heart rate and myocardial contractility, reducing O2 demands and reducing angina. Most useful in stable angina Taper dose to avoid reflex tachycardia and recurrent angina pain Remember it lower HR, if someone has heart block and we give them a beta-blocker, it can slow the conduction even more, so we need to be careful. / Avoid in 2nd and 3rd degree AV block

Answer 2

An antianginal Help decrease the workload and oxygen demand. Dilate those coronary arteries a lil bit to ease the angina / Used to treat both variant and stable angina Calcium blockers would dialate those arteries to prevent those spasms in variant angina. Prevent spams help decrease oxygen cardiac demand Decrease contractility Decrease after load Decrease PVR (peripheral vascular resistance) basically decreasing BP Decrease workload of the heart *Remember the two groups of calcium channel blockers. But Remember all of them will help with angina.

Answer 3

An antianginal Reduce venous tone, increase vasodilation, decrease workload. / Increase vasodilation and also lower blood pressure and lower preload; helps the heart work more efficiently *Keep in mind that nitrates are potent dilators, so someone can have a rapid drop in their blood pressure More info: dilate those coronary arteries on the heart and also dilate the arteries around the body and drop bp and decrease the work of the heart. / cause generalized vascular and coronary vasodilation increasing blood flow to coronary arteries, reducing ischemia Forms of Nitrates: sublingual (SL), IV, ointment, patch, PO

Answer 4

A type of nitrate An antianginal. Sublingual Nitroglycerin (SL) its 0.4mg and it is inserted underneath the tongue wait 5mins and if the pain doesnt relieve in 5 mins, can take another pill, and if it doesnt relieve in 5mins, can take a third pill. If the angina still there after 5mins, call 911. Patients should NOT swallow it because GI will deactivate it. The tablets should be kept in the dark and not exposed to the light This is NOT in a child proof container (if a child take this can significantly reduce their bp and kill them) / Nitroglycerin (SL) 0.4mg or 1/150 gr Take on q 5mins x 3 no relief call 911 Tablets will decompose when exposed to light and heat Keep in dark, glass, airtight jar. Not a child proof jar for decreased elder dexterity DO NOT SWALLOW UNDER GOES 1ST PASS METABOLISM AND WILL BE INEFFECTIVE Transdermal is absorbed slowly. You dont want to put the patches where you put the defibrillator because it will cause burns / SL absorbed directly and rapidly into the internal jugular vein and right atrium. (40- 50% absorbed through GI are inactivated by liver metabolism) Nitro-bid ointment (you dont want to get it on your hands because its a potent dialator and can pass out) and transdermal patch absorbed slowly through the skin Excreted primarily in the urine Pharmacodynamics: Causes the blood vessels of the blood vessels to relax and dialate Decreases preload and after load, so the heart doesnt have to work as hard Reduces myocardial oxygen demand Onset action SL and IV: 1-3mins Transdermal patches onset: 30-60 mins duration 24hrs Sometimes pts can develop nitroglycerin tolerance. To help prevent this sometimes we would Remove patch for 8-12 hours to help pts not to become tolerance/ Remove patch 8-12hrs for nitrate free interval Side effects: headache (very common; because of the potent dilation), hypotension, dizziness, weakness and faintness Adverse reactions: taper dose to avoid REBOUND effect of severe pain due to myocardial ischemia, reflex tachycardia if given RAPIDLY. Drug interactions: Remember, any medications that is going to lower bp, any other meds that also lower bp can cause a problem. Such as Betablockers, CA+ blockers, vasodialation and ETOH (alcohol) may cause hypotension We want to make sure we are careful when we are utilizing these meds together

Answer 5

-Monitor vital signs *Check orthostatic hypotension (all antianginals lower blood pressure) -offer a sip of water with the nitroglycerin; dont use fingers to apply ointment because it’ll cause a significant drop in blood pressure - taper dose down; at risk of vasospasm and at risk of MI Rotate patches, avoid dirty areas Keep in storage containers / Monitor vital signs Check orthostatic hypotension Offer sips of H2O prior to SL NTG to wet mouth and increase absorption DO NOT USE FINGERS TO APPLY OINTMENT DO NOT APPLY NITRI-BID OINMENT or Patch IN AREA OF DEFIBRILLATOR PAD PLACEMENT AS EXPLOSION OR SKIN BURNS MAY OCCUR Do not discontinue meds abruptly Rotate skin locations for patches and ointment, avoid hairy areas Keep in storage container

Answer 6

Basically slows down the conduction within the heart. We look at the ECG When we have any interruptions in the p-wave, QRS, T, etc., thats when we see dysrhythmia

Answer 7

MI (after someone has had an MI, leads to dysrhythmias), Hypoxia, hypercapnia, Thyroid dx, CAD (blockages or plaques in the coronary vessels, leads to dysrhythmias), electrolytes imbalances (ex: potassium is conductor of the heart)

Answer 8

(Dont worry about what are the differences btwn the classes for example, the difference btwn class 1C and 1B) Class I Class II Class III Class IV

Answer 9

Class I are Sodium channel blockers They decrease the sodium rush into the cells, which decreases conduction, which **slows the heart and decreases ectopy There are different types of class 1

Answer 10

Class IA ClassIB ClassIC

Answer 11

A type of antidysrhythmic that Slows conduction and PROLONGS repolarization (PAT, SVT) (Dont have to. Knoww these.. just to give you an idea what it is used for): PAT= paraschsmal atrial tachycardia …use it for atrial tachycardia/ rapid beating SVT= regular rhythm, but beating over 150bpm Meds: Quinidine, procainamide, disopyramide

Answer 12

A type of antidysrhythmic that Slows conduction and SHORTENS repolarization (VT, fib) Medications: lidocaine, mexitiletine HCL (Extra info for better understanding: use for ventricular dysrhythmias /tachycardia) Just focus on what rhythm each class is use for.

Answer 13

A type of dysrhythmias that Prolonged conduction (VT, fib) Medication: flecainide

Answer 14

A type of antidysrhythmic These are your BETA BLOCKERS. Notice that they end in ‘olol’ Slows down the conduction speed (velocity) of the heart, help improve automaticity ; help decrease afibs, tachycardia, dysrhythmias Meds: propranolol (Inderal), acebutolol (Sectral), esmolol (Brevibloc), sotalol (Betapace)

Answer 15

Automaticity is the property of cardiac cells to generate spontaneous action potentials

Answer 16

Is a betablocker use for antidysrhythmias (keep in mind most beta-blockers are used for dysrhythmias) Drug class: beta-1 blocker Contraindications: anyone with heart block, severe bradycardia, severe HF, cariogenic shock We know that taking a beta blocker will further decrease their hr and vasodilation Interactions: anyone who is on meds that decrease their hr or bp ex: diuretics, prolonged hypoglycemia, antagonist effect with albuterol (albuterol causes tachycardia; have to look out for that), terbutaline, metaproterenol

Answer 17

Treatment for dyshrythmias, angina, HTN

Answer 18

Dizziness, nausea, headache, hypotension, diaphoresis, fatigue Remember if anyone on beta-blocker, have them taper down the dose. Adverse: bradycardia, life threatening agranulocytosis (low WBCs) and bronchospasm at higher doses (remember, even in cardio selective meds, the lungs have a lil bit of beta-1)

Answer 19

At type of antidysrhythmics Increase refractory period and prolong action potential Indications: mostly used in atrial fibrillation (afib)

Answer 20

Is a class III antiadysrhytmic Increase refractory period and prolong action potential Indications: mostly used in atrial fibrillation (afib) Make sure to monitor thyroid function by doing tests, because thyroid may decline. It can also cause pulmonary fibrosis, so do pulmonary function tests.

Answer 21

Class IV are calcium channel blockers (Remember there are only two calcium channel blockers that lower hr; and use as antiadysrhythmcs ) Meds: verapamil (Calan,Isoptin) diltiazem (Cardizem) They work by blocking calcium influx, which decreases the cardiac response and conduction & put them back in normal sinus rhythm. Contraindication: someone who has AV block, HF and severe bradycardia (Dont want to decrease hr even more)

Answer 22

Bile acid sequestrants HMG-CoA inhibitors Fibrates Niacin Cholesterol absorption inhibitors The goal is to put them on the highest tolerable dose without side effects, if we can’t do that we usually add these other medications

Answer 23

To treat hyperlipidemia They are usually added to statin (HMG-CoA inhibitors) to reach their goal cholesterol level Indications: reduce elevated serum cholesterol in patients with hypercholesterolemia

Answer 24

Headache, fatigue, and drowsiness Direct GI irritation: nausea and constipation Increased bleeding times Vitamin A and E deficiencies

Answer 25

Malabsorption of fat-soluble vitamins Thiazide diuretics, digoxin, warfarin, thyroid hormones and corticosteroids

Answer 26

Aka ‘statin’ .. HCPs call them this Utilize to lower cholesterol levels Inhibits HMG-CoA, decrease serum cholesterol levels, LDLs, ad triglycerides and increase HDL levels These are the best, best lowering Indications: hyperlipidemia, prevention MI, CVA Medications: atorvastatin (Lipitor), rosuvastatin (Crestor), Simvastatin (Zocor), Lovastatin (Mevacor), Pravastatin (Pravachol) *notice that they all end in ‘statin’*

Answer 27

Through the main pathway in the liver , So if someone is an alcoholic, liver toxicity, taking other meds that are metabolize through that,..typically try not to use that statin.

Answer 28

Allergy, active liver disease and hxs of alcoholic liver disease, pregancy and lactation Caution in impaired endocrine function because they can develop hyperglycemia.

Answer 29

Because babies need fat and cholesterol to have normal brain development, so we should never never ever put a woman who is pregnant or breast feeding on any cholesterol lowering medications.

Answer 30

Myopathy (complain in muscle pain) Liver failure Rhabdomyolysis (break down of all the muscle tissue and lead to organ failure; deadly) Do liver function tests to monitor

Answer 31

Erythromycin Cyclosporine Gemfibrozil *Niacin Grapefruit juice (also metabolize in the same pathway) Acetaminophen: It takes the same pathway as the satin, so pt should limit use of taking acetaminophen

Answer 32

Class: A HMG-CoA inhibitor Which decreases lipid levels (especially LDL and triglycerides) Commonly use Side effects: HA, constipation, diahreah, myalgia (muscle pain) Adverse reactions: rhabdomyolysis (break down of muscle tissue; lead to death), photosensitivity, hyperglycemia, elevated LFTs Contraindicated: pregnant, lactation, liver dx Caution with ETOH use, Tylenol use, hxs of liver disease Monitor LFTs at 6-8wks, then 6 months and then yearly

Answer 33

Used to treat hyperlipidemia Work in the small intestines to inhibit the absorb of cholesterol This is typically an additive treatment, (for example, if someone cant get to their LDL goal on a highest tolerated dose of statin or they cant tolerate statin, we put them on cholesterol absorption inhibitor) Med: Zetia (ezetimbe)

Answer 34

To lower serum cholesterol levels, Treat homozygous familia hypercholesterolemia

Answer 35

Absorbed in the GI tract,metabolized in the liver, excreted in urine and feces

Answer 36

Abdominal pain and diarrhea Headache Dizziness Fatigue URI (upper respiratory infection) Back pain Muscle aches and pain

Answer 37

Not significant but soemthing to keep in mind Cholestyramine Fenofibrate Gemfibrozil Antacids Cyclosporine Vibrates Warfarin

Answer 38

Allergy And remebr pts who are pregnant or breast feeding if combined with a statin.

Answer 39

Another lipid lowering agent Vitamin B3, inhibits release of free fatty acids from adipose tissue. Increase rate of triglyceride removal from plasma. With this, they sometimes develop redness in chest or head; NOT an allergic reaction; its a known reaction

Answer 40

Used to treat hyperlipidemia An additive to statin Inhibits triglyceride synthesis in the liver, which decreases LDL Increase Uric acid secretion and may stimulate triglyceride breakdown

Answer 41

Another lipid lowering agent Inhibits peripheral breakdown of lipids Reduces production of triglycerides and LDL Increases HDL If combine with statin, we need to watch the LFT because both goes through same metabolic pathway. Think of the gem’FIBR’ozil in FenoFIBRates

Answer 42

Help reduce LDLs and triglycerides Not metabolized by the liver, and does not cause muscle aches and pains Meds: alirocumab (Praluent) Evolocumab (repatha) “PSK9 Ihibits CUM”

Answer 43

When patients CANNOT tolerate statins Or Pts not at a goal at highest tolerable statin dose (ex: still had muscle aches and pains) Or They have liver toxicity and cannot be put on a statin Can also use as a Addive

Answer 44

Kept in the refrigerator take out fridge 30mins before taking dose Make sure to hold down pen until windows fills with yellow tube.

Answer 45

Class: peripheral vasodilator For those who have peripheral vascular disease. Dilates those lil arteries in the extremities to improve blood flow to the tissue. Indications: pts who have clottictaion/ angina in the legs / Increase blood flow to the extremities in older adults with PAD and PVD Also effective in Raynaud’s disease, and Buergers disease Meds: cilostanzol (Pletal) Trental (Think of petals from roses look like platelets 🌹…”tal” ending in peripheral vasodilators)

Answer 46

Class: peripheral vasodilator Trade name: cilostazol Therapeutic effects: Prevent platelets from sticking together/ Inhibits platelet aggregation and causes vasodialation Use for peripheral vascular disease; it increases circulation. Treats Raynaud’s disease, and cerebral vascular insufficiency. PO Interactions: hypotension, with anti-hypertensives

Answer 47

For patients who have. Stents

Answer 48

Pts that have heart failure, arterial bleeding (you’re increasing secretions/ increase blood loss), severe hypotension, postpartum, tachycardia Caution: bleeding disorder & tachycardia.

Answer 49

N/V Dizziness Syncope(fainting) Blood in the eye HA Abdominal pain Abnormal stools Peripheral edema Adverse: tachycardia, palpitations

Answer 50

Obtain baseline vitals Asses their extremities and observe for signs of inadequate blood flow to the extremities: pallor, coldness, and pain …see any improvement Monitor for tachycardia & hypotension.

Answer 51

Formation of a clot

Answer 52

Arterial (WBC & RBC) Blood stasis (the blood is not moving; form clots ; thats why we have compression stockings on) Platelet aggregation (if there’s plaque on the arteries; platelets can build up and form a clot) Blood coagulation Venous (RBC and PLT) happens in the veins Blood stasis of slow flow Occur rapidly Can cause DVT and can lead to a Pulmonary embolism

Answer 53

Help prevent blood clots form forming Ex: if someone is just sitting around, and the blood is just sitting there, it will help the blood clot from forming. If someone already HAS a blood clot, it will prevent the clot form getting bigger. (It does not break up the clots; thrombolytics does) Alow THE BODY to break down the clot.

Answer 54

Pts with both arterial and venous clots or pts who are at risk for clot formation DVT Pulmonary embolisms MI (can be caused by blood clots Artificial valves(the body doesnt recognize that surgery is good; the body see it as an injury; increase risk of forming clots; thats why its ideal to give Heparin during surgery) CVA (stroke;

Answer 55

Heparin Lovenox (LMWH) Coumadin (LMWH) Fragmin(LMWH) Innohep (LMWH)

Answer 56

used for RAPID anticoagulation for thrombosis such as DVT, PE, CVA (cerebral vascular accident) Mostly used via IV Used during surgery it is given to prevent thrombosis. We use it as a bridge (ex: if someone is using another agent such as Coumadin and coming into a hospital for a procedure, we would take them off and then put them on heparin)

Answer 57

Combines with antithrombin III and *prevents thrombin formation Inhibits the conversion of fibrinogen to fibrin *prevents fibrin clot formation Prolongs clotting time Partial thromboplastin time (PTT)

Answer 58

By looking at the PTT (partial thromboplastin time) Ex: if the levels are too high, i need to lower dose of heparin)

Answer 59

Because heparin is poorly absorb through the GI mucosa It is destroyed by heparinase in the Liver Poor oral absorption Not given IM due to pain and hematoma formation

Answer 60

2 inches away from umbilical Maintain air bubble

Answer 61

Bruising Itching Burning Adverse Effects: Beeding Ecchymosis (bleeding under skin ) Thrombocytopenia (having an allergy to heparin; HIT: heparin induce thrombocytopenia)Increase risk of blood. Clot Hemorrhage (can be life-threatening)

Answer 62

Bleeding disorder Peptic ulcer (increase risk of GI bleed) Severe hepatic or Renal disease Hemophilia Hemorrhagic CVA/stroke: means they are already bleeding;it’ll increase tremendously with heparin)

Answer 63

Taking another drug that is also an anticoagulant, there is going to be a higher increase of bleeding. Increase effect with ASA (aspirin), NSAIDS, thrombolytics and probenecid Decresed effect of nitroglycerin and protamine (antidote)

Answer 64

Obtain hxs of possible abnormal clotting or health problems affect clotting (i.e. ETOH, severe renal or liver disease) PTT should be checked (usually we start them on heparin and check the PTT 4 hours later or anytime we change the dose check 4 hours later) Check stool for melena (dark starry blood stool) and occult blood (do a guiac) to see if there is any GI bleed

Answer 65

An anticoagulant Same indications as heparin Only given PO Inhibits vitamin K, which decreases the clotting of blood Its given at home We need to worry about what they are eating; vitamin K will counter interact with Warfin.

Answer 66

Foods with vitamin K: dark leafy greens Decreases the effectiveness of Coumadin and lower INR Pts on Coumadin, they need to eat the same amount of dark green veggies every week (ex: if they normally eat it 3xs a week, you can do so and be consistent ) & adjust the Coumadin based on how much dark green leafy veggies they eat and according to their Pt/INR If someone has HIGH INR, the antidote is vitamin K Antibiotics often increase INR; monitor closely

Answer 67

Pt is at increase risk of bleeding

Answer 68

To adjust the Coumadin dose. If INR is too low, and they are at risk for blood clots, will need to increase the dose of Coumadin If their INR is too high an increase of bleeding; would lower the dose of Coumadin.

Answer 69

Therapeutic range means that the Coumadin is preventing the blood form clotting Normal INR range (someone who is not taking Coumadin): <1.2 *AFIB (therapeutic range): 2-3 *DVT/PE (therapeutic range): 2.5-3.5

Answer 70

MEANS INCREASE RISK OF BLEEDING

Answer 71

INCREASE RISK OF CLOTTING

Answer 72

What the disease process is and what we know that will prevent blood clots from working

Answer 73

Aka NOax New to the market No INR monitor (no blood tests) No antidotes yet Increased risk for bleeding but less than warfarin Most dose adjusted for renal insufficiency Utilize for pt that have atrial fibrillation, DVT /PE BUT NOT USED FOR PTS THAT HAVE a MECHANICAL VALVE Oral Medications: Eliquis (apixaban), Xarelto (rivaroxaban), Pradaxa (dabigatran) “Novel AN!”

Answer 74

A NOax aka Novel anticoagulant Think of “NO’axa’” These help prevent blood clots from forming Treatment for DVT/PE and prophylaxis, stroke prophylaxis (non-valvular atrial fibrillation) We need to worry about if they have chronic kidney disease; have to adjust dose; because it is mostly excreted by the kidneys Avoid in hemodialysis

Answer 75

Side effects: bleeding, bruising, gastritis Adverse effects: hemorrhage, hematoma, thrombocytopenia

Answer 76

If pts are taking off this medication they have an increase risk of a blood clot forming If they are on this medication, they cannnot get epidural because it will cause a spinal hematoma risk

Answer 77

Class: Novel Anticoagulants Therapeutic use: thromboembolism (DVT/PE) treatment and prophylaxis, stroke prophylaxis (non-valvular artrial fibrillation) It blocks one of the clotting factors “Xa” Excreted by kidneys;; decrease dose in CKD; avoid hemodialysis Side effects: bleeding, bruising, gastritis, anemia Adverse effects: hemorrhaging, hematoma, thrombocytopenia Black Box Warning: increase thrombotic event and stroke risk when discontinued prematurely, epidural and spinal hematoma risk

Answer 78

Increase risk to form a blood clot and pt cant get epidural it is a hematoma risk

Answer 79

Are a lil different Help to prevent platelets from sticking together or aggregating together Indications: use for pts who have MI or CVA(blockage in coronary arteries) , Stroke (not hemological stroke)

Answer 80

ASA (aspirin), *Ticagrelor (Brilinta) must use with 100mg ASA or less (usually 81) Effient (prasugrel) Clopidogrel (Plavix) *Pletal (remeber use it for peripheral vascular disease NOT CVA) Agrylin Reopro Integrillin

Answer 81

Its an antiplate It doesnt work if a person is on aspirin for more than 100 mg a day . The aspirin has to be less than 100mg. (Or just 81mg)

Answer 82

Class: Antiplatelet Helps to prevent blood clots from sticking together Indication: prevent recurrence of MI or stroke, and prevent vascular death

Answer 83

Need to start off with loading dose in order for it to work. Its either 300 or 600 mg they would have to take all at once.. then taken 75mg everyday

Answer 84

We do not use it in someone who is bleeding (intracranial bleed or hemorrhage) Peptic ulcer you do NOT keep them on an antiplatlet medication if the had BRAIN or SPINAL surgery Caution: anyone who is undergoing surgery going to be careful with; Liver disease GI bleeding Bleeding from trauma

Answer 85

Side: URI (upper respiratory infection) Flulike symptoms Dizziness, HA , fatigue, CP (cerebral palsy), diahrea, *Bleeding, *bruising Adverse reactions: HTN, bronchitis

Answer 86

May increase bleeding with NSAIDs (like ibuprofen, Motrin; any anticoagulants) Interferes the metabolism of: Warfin Phenytoin Fluvastatin Tamoxifen Tolbutamide Torsemide Ginger, garlic, ginkgo, feverfew increase risk of bleeding Remember meds that are anticoagulants increase risk of bleeding

Answer 87

Anticouagulatnts prevent BLOOD CLOTS from forming they are only utilize for pts who has ATRIALFIBILLATION, DVTs or PEs Antiplatlets medications prevent PATLETS from sticking together and use for pts who have HEART DISEASE or hxs of STROKE or PERIPHERAL VASCULAR DISEASE Summary: Anticoagulants, such as heparin or warfarin (also called Coumadin), slow down your body's process of making clots. Antiplatelets, such as aspirin and clopidogrel, prevent blood cells called platelets from clumping together to form a clot In general, -Anticoagulants are used for conditions that involve stasis. Stasis can cause blot clots (thrombosis) to form. That’s why PCDs are used for DVT prophylaxis. -Antiplatelets are used for conditions that involve endothelial damage and platelets sticking to the injured site. For example, in the heart, ischemia and MI are usually not due to stasis but to plaque formation with coronary vessels. So you use antiplatelets.

Answer 88

“These are clot busters” Used to promote the fibrinOLYYTIC mechanism /ACTUCALLY BREAK UP THE CLOT indications: Utilize it pts who are having a STROKE (remember, we have to make sure it’s a embolic stroke and not a hemorrhagic stroke), MASSIVE MI MASSIVE PE MASSIVE DVT CVA (embolic stroke only; not hemorrhagic) Having an acute MI Breaks up the clot and and open up the arteries Or If someone has a very big PE, use a thrombolytic to break up the clot The most potent and powerful; so the. HIGHEST risk of bleeding is with these medications

Answer 89

Usually the thrombus or clot disintegrates Within 4hours of the disease process

Answer 90

Streptokinase, Urokinase, Altepase Reteplase (retevase) Tenecteplase (THKnase) “ pASE give me a thrombolytic!!!!)

Answer 91

Class: Trhombolytic argent It breaks up the clot To help improve blood flow Indications: dissolve clot following AMI (acute myocardial infraction), PE, acute ischemic stroke Side effects: bleeding Adverse: biggest risk is intracranial bleeding, stroke, atrial or ventricular dysrhythmias This medication is short term

Answer 92

Internal bleeding, bleeding disorders, recent CVA/Stroke (even if is is an embolic stroke, a lot of times it can lead to a hemmoragic/bleeding stroke) Surgery or Trauma Bacterial endocarditis Sever liver dysfunction Severe uncontrolled HTN

Answer 93

Increase bleeding when taken with oral anticoagulants, NSAIDS, cefotetan, pilcamycin

Answer 94

Aka “SOG2” Class: Antidiabetic medication Decrease blood glucose levels; cause body to get rid of glucose through urine. Have to be careful because can increase fungal infections and UTIs Use in pts who has HF and protect the heart from getting damaged,, while getting rid of glucose (especially those who has HF and diabetes) Dont use it to treat type 1 diabetes; insulin would be the one to use for that Medications: Empagliflozin (Jardiance), Canagliflozin (Invokana), Dapagliflozin (Farxiga) Ending in “gliflozin”

Answer 95

A/E: Hyperkalemia, fungal infections, UTI, renal insufficiency and could potentially develop Hypotension (because when the glucose is leaving the body by urine, sometimes increasing urine production, and cause pt to become dehydrated; leads to hypotension)

Answer 96

“Sartan” is an ARB Also used for pts who have HF, help to reduce the morbidity and mortality of HF Indications: heart failure with reduced ejection fraction Side effects: hypotension, dizziness, cough, Hyperkalemia, real failure Adverse effects: hypersensitivity, angio edema, severe hypotension, renal failure Black box warning: fetal toxicity

Answer 97

Bronchodialators (sympathomimetics, Beta-2 adrenergic agonist) Methylxanthines (xathines) Leukotriene antagonists Glucocorticoids Cromolyn Anticholinergics Mucolytics

Answer 98

It is a sympathomimetic Alpha and beta2 adrenergic agonists They STOP the bronchoconstriction and help to relieve Sxs of asthma or COPD exacerbation Examples: albuterol (Proventil), Ventolin, Metaproterenol

Answer 99

Class: Beta-2 Adrenergic Indication: used for acute asthma attack, control asthma, exercise induced asthma (when exercise triggers their asthma) Rapid onset; thats why we can use it as a rescue medication

Answer 100

Can potentially affect Beta 1 as well.. remember the heart has a bit of beta-2.. thats why they can have heart palpitations, tachycardia hen on this medication

Answer 101

Xopenex Less heart rate, and good for pts with afib or tachycardia

Answer 102

Always test spray inhaler that hasn’t been used recently Insert medication canister into plastic mouthpiece Shake inhaler before using, remove cap from mouthpiece Breath out through mouth, place mouthpiece 1-2 inches from mouth or in mouth Take slow deep breath while pressing top of medication canister once Hold breath for few secs, exhale slowly through pursed lips Wait two minutes repeat starting from shaking again Administer bronchodilator 1st, wait 5mins then steroid inhaler (the steroid can actually get into the lungs)

Answer 103

Class: Anticholinergic Indications: for maintance treatment of bronchospasm associate with COPD To relax the bronchotubes and prevent bronchoconstriction Administer this before administering the steroid, because we want to dilate the airway, so the steroid can get in.

Answer 104

Administer Spiriva 5 minutes before steroid or cromolyn (this allows the bronchioles to dilate so the steroids or cromolyn can be deposited in the bronchioles

Answer 105

Side effects: dry mouth, hoarseness Adverse effects: angioedema (allergic reaction), dehydration, hyperglycemia

Answer 106

Cannot use during pregnancy If someone is allergic to peanuts or lactose Glaucoma (remember increasing ocular pressure) Breastfeeding

Answer 107

Used for treatment of asthma Stimulated the CNS (think of sedative effect) and respiration Examples are aminophylline, theophylline and caffeine They all have “ine” endings *Therapeutic range: 10-20 mcg/ml ; the higher above that 20, the more side effects they have

Answer 108

Prototype is Theophylline GI problems Coronary artery disease Respiratory dysfunction Renal or hepatic disease Alcoholism Hyperthyroidism Adverse: related to theophylline lvls in the blood if >20mcg/ml, more side effects Range from GI upset, nausea, irritability, and tachycardia to seizure, brain damage and even death

Answer 109

A chemical that causes inflammation in the lungs migrating the eosinophil (see this in asthma attacks; allergic reaction so we basically want to move the eosinophils away from lungs to decrease lung inflammation), mucous production, and airway wall edema resulting bronchoconstriction.

Answer 110

Blocking that Leukotriene from causing the inflammation in the lungs Help decrease inflammatory response NOT used for asthma attacks (albuterol is the true rescue inhaler) Used for exercise induced asthma Medications: Zafirlust (Accolate), Zileuton (Zyflo CR) Montelukast sodium (singular)

Answer 111

Class: Leukotriene receptor agonist Trade name: Singilair Think of “LUK” in LeUKotriene inhibitor Indications: to prevent and maintain treatment of asthma PO (a pill) Side effect: fatigue, fever, dizziness , nasal congestions, sore throat, cough, HA Contraindications: hypersensitivity, severe asthma attack, status asthmaticus (prolonged asthma attack that nothing is making it better) Caution: severe liver disease BLACKBOX warning: suicidal thoughts and psychosis

Answer 112

Used to treat respiratory disorders, particularly asthma Anti-inflammatory action Used if asthma is unresponsive to bronchodilator, or asthma attack on maximum does of theophylline or adrenergic drug Has a synergic effect hen given with Beta2 agonist they work very well together

Answer 113

Inhaled route (preferred; because not getting a full systemic reaction) PO route (for exacerbation) IV route (significant exacerbation; rapidly reduce inflammation in lungs)

Answer 114

1-4 weeks for full effect, not ideal for severe asthma attack

Answer 115

Inhaled glucocorticoids help improve symptom control, and decrease attacks Inhaled is the current preferred treatment Inhale reduced risk of adrenal suppression associated with systemic glucocorticoid *Inhaled is preferred over oral, unless inhaled doesn’t work Make sure they take it with food when PO because risk of ulcers Adair (fluticaspone propionate and salmeterol) combination used to alleviate constriction

Answer 116

Can develop thrush* (rinse mouth out with water after each dose, wash the apparatus daily with warm water) Throat irritation, hoarseness, dry mouth

Answer 117

Class: Glucocorticoid It is only for prophylactic treatment of asthma Need to be taken everyday for it to do their job and that goes for all the other medications (albuterol only acute asthma attacks) Inhalation Inhibits the release of histamine to prevent asthma reaction Side effects: bad taste (decrease by drinking water after dose), rebound bronchospasm DO NOT DISCONTINUE ABRUPTLY can cause rebound asthma attack

Answer 118

Class: Glucocorticoid Similar to Cromolyn Think of the “CROM” in “CROMolyn: Helps the stop of histamine Indication: prophylactic treatment of bronchial asthma Believe to be more effective than Cromolyn

Answer 119

Utilize to make the secretions in the airway thinner; so it’ll be easy to cough out Indication: hen pts with asthma or active airway disease, produce excess secretions, used as adjunct to bronchodilators Medication: Mucomyst (acetylcysteine)

Answer 120

Mucolytics if given within 12-24 hrs ex: mucomyst (acetylcysteine)

Answer 121

Utilize to liquify and loosen thick mucous secretions in airways, so it can be coughed out Administered by neubilizer, or orally diluted by after or juice. Take 5 minutes after bronchodialtors Side effects: N/V, stomatitis (oral ulcers), and runny nose

Answer 122

Acute inflammation of mucous membranes of nasal passages , secretions; common cold.

Answer 123

Help alleviate of symptoms of common colds, rhinitis, acute rhinitis or pharyngitis, sinusitis H1 blockers or H1 antagonist; blocks nasal secretions There are two types of histamine receptors H1: when stimulated, extravascular smooth muscle in the nasal cavity are constricted H2: when stimulated, increase gastric secretions

Answer 124

1st generation (older) 2nd generation (newer is better; less side effects)

Answer 125

Can cause dry mouth, drowsiness and other anticholinergic symptoms. OTC Ex: Benadryl

Answer 126

Non-sedating antihistamines, fewer anticholinergic effects. Examples: Loratadine (Claritan) Zyrtec (cetirizine) Allegra (fexofenadine)

Answer 127

Class: antihistamine Indications: to treat allergic rhinitis (decrease secretions, and inflammations by inhibiting histamines) and itching, prevent motion sickness Use as a sleep aid Help prevent coughing by preventing post nasal drip (drying up the secretions)

Answer 128

Cannot use during acute asthma attack (because it can cause constriction) Lower respiratory disease (because we do not want to have dried up secretions it will make them thicker, and it’ll be harder to expel) Severe liver disease Neonate (babies that ar <1 years old) MAOIs

Answer 129

Anyone who is using another CNS depression (alcohol,sleeping pill ect.) not the best choice; Narcotics and hypnotics Barbiturates Avoid MAOI

Answer 130

Drowsiness, dizziness, fatigue, urinary retention (not good for pts with BPH), constipation, dry mouth and throat. Decreased secretions and excitation in children (paradoxical effect) Its like a anticholinergic. Adverse: life-threatening agranulocytosis, hemolytic anemia, thrombocytopenia (basically breaking down the blood)

Answer 131

To control nonproductive cough. (We dont want to always prevent the cough because coughing can be a good thing; but if they have abdominal surgery or intracranial pressure or trachs wont be good) Antitussive work in the cough center in the brain; decreases the cough reflexes

Answer 132

Pts who NEED to cough to maintain the airway (ex: so they wont develop pneumonia) Head injury and impaired CNS (because the med causes sedatition; so if someone already has a decreased CNS, its not ideal for them to take an Antitussive) Caution: in those who has hxs of narcotic diction (ex: if a cough med has codeine in it, not used alcohol for the drug abuser to use) Hypersensitivity

Answer 133

Drying effect on the mucous membranes (because of the decreased secretions) CNS effects: drowsiness and sedation GI upset (ex: codeine causing constipation)

Answer 134

Trade names: Robitussin, Benylin Sucrets cough control Vicks 44 Inhibits the cough center PO Therapeutic effects: temporary suppression of non-productive cough

Answer 135

Keep in mind, Robitussin work by constricting blood vessels; which decrease secretions. So pts who have HTN or cardiovascular disease shouldn’t take this OFC Pts who have COPD (if holding on to those secretions, increase of risk of developing pneumonia) Chronic productive cough Hypersensitivity MAOIs Children <2

Answer 136

Side: Nausea Dizziness Drowsiness Sedation Adverse: hallucinations at high doses

Answer 137

Increased toxicity/effect with MAO, narcotics, sedative hypnotics, sedative hypnotics, barbiturates, antidepressants and ETOH

Answer 138

These are nasal sprays They work by constriction of blood vessels in the nose and decrease secretions. Relieve the discomfort that accompanies the common cold, sinusitis, and allergic rhinitis Sympathomimetic (not really gonna have sympathetic effects, but still use with caution) Adverse effects: local stinging and burning, rebound congestion, sympathomimetic effects Medication: Ephedrine

Answer 139

If a pt has lesion or erosion (cuts) in the mucous membranes Caution: may cause stroke, HTN, renal failure

Answer 140

Get re-bound congestion (rebound vasodilation)

Answer 141

Topical nasal decongestion Think about DRaINE in EphiDRINE, but with EPHInphrine (constricting blood vessels)

Answer 142

Indication: Someone who has significant secretions in the sinus Same action as topical/Oral decongestion work by constricting blood vessels and decrease secretions and inflammation to alow sinuses to drain better. The contraindications are the same as topical nasal decongestion Adverse effects are the same as topical

Answer 143

OTC oral decongestion ma contain pseudoephedrine An cause serious Sid effects.

Answer 144

Indications: used for seasonal allergic rhinitis Inflammation after the removal of nasal polyps We use this short term Generally not absorbed systemically because its in the nose Contraindication: acute infections Cautions: active infection, avoid exposure to airborne infections

Answer 145

Steroids decreases the immune response

Answer 146

Local burning, irritation, stinging, dryness of the mucosa, and headache Suppression of healing can occur in pt who has had a nasal surgery or trauma.

Answer 147

A topical nasal steroid decongestant Think of “flu…slide in nose” “S” for steroid

Answer 148

Indications: relief of respiratory conditions conditions characterized by a dry, non-production cough Decrease the thickness of the mucous; make it easier to cough up. To clear their lung Hydration is the best natural expectorant

Answer 149

A type of expectorant medication Think about “Guafin up mucus”

Answer 150

Work to break down mucous & Causes bronchospasm to cough up mucous

Answer 151

Pts who have difficulty coughing up secretions Patients who develop atelectasis (collapsed lungs) Patients undergoing diagnostic bronchoscopy (to be able to see through the mucous when its thin out by the Mucolytics ) Postoperative patients (we dont want them to have a huge cough reflex to avoid using abdominal muscles) Patients with tracheostomies tend to have thicker secretions; use mucolytics to thin them out

Answer 152

Nebulization Direct installation into the trachea

Answer 153

GI upset Stomatitis Rhinorrhea (runny nose) Bronchospasm Caution: acute bronchospasm (ex: asthma), Peptic ulcer, and esophageal varices (abnormal dilated vessels in throat)

Answer 154

A type of mucolytic

Answer 155

Medications that Causes vomiting (No longer reccomeded for at-home poison control) Dont want to use if they are unconscious; would se an absorbent (ex: charcoal) think about “emesis”

Answer 156

Medications that decrease or prevent n/v These meds are centrally acting (sedation occurs)

Answer 157

Antihistamines Dopamine agonists Anticholinergics Serotonin antagonists Benzodiazepines Glucocorticoids Cannabinoids Miscellaneous

Answer 158

Class: antiemetic Trade name: Phenergan Indication: used to treat and prevent motion sickness and nausea and diarrhea Blocks H1 receptor sites. Meds: chlorpromazine (Thorazine) Prochlorperazine edisylate (comparing), Promethazine (Phenergan) They all end in “azine” Think of “AZINE (Iseen) antiemetics, i need it”

Answer 159

It causes CNS depression, so you will mostly see confusion, dizziness, sedation as a side effects & anticholinergic-like side effects

Answer 160

Decreased GIMotility (constipation) , dry mouth, urinary retention, orthostatic hypotension,

Answer 161

Side effect: drowsiness, constipation, urine retention, confusion, anorexia, dry mouth and eyes, blurred vision, photosensitivity, hypertension, transient leukopenia

Answer 162

Hypersensitivity, narrow-angle glaucoma, severe liver disease, intestinal obstruction, bone marrow depression Caution: cardiovascular disease, liver dysfunction, asthma, respiratory dysfunction, HTN, older adults and debilitated (weak) pts. Adverse effects: parkinson-like-reactions

Answer 163

Drugs that increases CNS depression and anticholinergic effects (ex: ETOH and other CNS depressants)

Answer 164

Pregancy tests

Answer 165

Weak tea (non-dark) Flattened carbonated beverage (not too bubbly) Gelatin Gatorade (half Gatorade, half water; want to limit the consumption of sugar Pedialyte Crackers dry toast IV fluids with severe hydration Cool rag on forehead or neck Lemon ice Ginger

Answer 166

These are mostly used for motion sickness Dimenhydrinate (Dramamine) Meclizine hydrochloride (Antivert): mostly used for vertigo Diphenhydramine hydrochloride (Benadryl)

Answer 167

Used to prevent motion sickness, n/v and dizziness (vertigo) (not effective treatment for severe vomiting R/T anticancer agents, radiation or toxins) Also used to prevent or alleviate of allergic reaction to insect bite, allergens or foods Blocks H1 receptors/ histamine receptors Stabilizes the inner ear that causes motion sickness

Answer 168

Drowsiness, dry mouth, and constipation (think of anticholinergic effect) Cant use during pregnancy

Answer 169

Trimethobenzoamide (Tigan) Use if severe vomiting threatens mother or fetus Think of “TRIMEster antihistamine”

Answer 170

Help withh n/v Acts directly on gastric mucosa to suppress vomiting, diarrhea Pink solution Chewable tabs Has subsalicylate (asprin) If someone has an allergy to subsalicylate, not ideal to use Can give a false pos guiac test.

Answer 171

To induce vomiting when toxic substance have been ingested, prior to absorption

Answer 172

Avoid inducing vomiting when caustic (able to burn or corrode tissues) are absorbed Ex: chlorine bleach, ammonia, Lye, toilet cleaners, battery acid Avoid inducing vomiting to prevent aspiration if petroleum are ingested; because if thrown up they can aspirate on it and die (Gasoline, kerosene, paint thinners, lighter fluid)

Answer 173

Charcoal Activated charcoal is used when emesis is contraindicated.

Answer 174

Is a type of emetic Induces vomiting when pt is alert, conscious and within 60 minutes oof poisoning Thank of “I” for “I”nduce vomiting Acts directly on the gastric mucosa Should be taken with a glass of water Use only the SYURP form of medication. Onset 15-30 minutes, if not successful use absorbent (charcoal)

Answer 175

People who has Anorexia and Bulimia usually abuse this drug because of the induce vomiting Losing electrolytes (particularly potassium ; leading to ventricular dysrhythmias/v fib )

Answer 176

More than 3 BM and loose stools

Answer 177

We use opioids or opiod-related (remember they slow down the GI motility; constipation) Ex: camphorated opium tincture (paregoric), deodorized opium tincture, *Lomotil, Motofen) Somatotatin analogue Ex: *octreotide acetate (Sandostatin) Adsorbents Bismuth Subsalicylate (*Pepto-Bismol, kapectolin, kaopectate) Miscellaneous Rifaximin (Xifaxan)

Answer 178

Class: antidiarrheal Think of “LOwMOTILity is antidiarrhea” Treat diarrhea by slowing intestinal motility Inhibits gastric motility

Answer 179

It is diphenoxylate with atropine Remebr atropine is an anticholinergic ; use it to help slo down GI motility AND DEREASE diarrhea

Answer 180

Depresses the CNS; Think of anticholinergic side effects Drowsiness, dizziness, constipation, dry mouth, weakness, flush, rash, blurred vision, urine retention Adverse: angioneurotic edema Life threatening: Becreful.. can cause paralytic illeus can occur if used too much.

Answer 181

Any med that depresses the CNS (ex: ETOH), Antihistamine, Narcotics, MAOI’s may enhance hTN crisis

Answer 182

Class: Antidiarrheal Antidiarrheal class: Somatatostatin analogue Inhibits gastric secreations Help to. Decrease the diarrhea Used a lot in cancer pts

Answer 183

Class: Antidiarrheal Class of Antidiarrheal: Adsorbent Absorb the toxins that are causing the diarrhea high will help with preventing the diarrhea. Remember it has ASA (aspirin) in it; not ideal for those who as aspirin allergy.

Answer 184

1-3 per day 3 per week

Answer 185

*Osmotics (saline Ex: glycerin, lactulose, magnesium citrate, MOM, sodium biphosphate *Stimulants. (Contacts or irritants) Ex: *biscodyl (Dulcolax), *Caster oil (Neolithic, Purge), Senna (senekot) *Bulk forming Ex: polycarbophil (Fibercon) Methylcellulose (Citrucel) Emollients (stool softeners) Ex: docusate sodium calcium (Colace, Surfak, Dialose)

Answer 186

They pull water into the stool, which increases water into the stool , which increases the size of stool, make them softer, which stimulates peristalsis and the urge to defecate Utilize for pts who undergo a GI procedure (colonoscopy)or GI surgery; want to make sure the bowel is cleaned out Must have good renal function Since it has sodium in it, dont ant to give it to a HF pt; use Goltely.

Answer 187

We can use Golytely in heart failure patients to stimulate bowel movements and clean them out before a procedure.

Answer 188

Class: stimulant Increases peristalsis; it is a short term treatment of constipation and bowel prep for diagnostic tests (ex: colonoscopy ) or after surgery Route: PO, PR (per rectum) Can be abused by anorexics and bulimia pts Think of “—lax” ending for laxative

Answer 189

Someone who has hypersensitivity, fecal impaction, intestinal/biliary obstruction, appendicitis, abdominal pain, N/V, rectal fissure.

Answer 190

Side: N/V/D, cramps Adverse reactions: Dependence, Hypokalemia Adverse: dependence (body will rely on med to stimulate peristalsis) Hypokalemia (risk for losing potassium) Life threatening: tetany Concerned about dysrhythmias

Answer 191

Antacids decreases effect of laxitive and histamine2 blockers, milk

Answer 192

Class: Stimulant It is used to make stool softer aand increase peristalsis

Answer 193

Early pregnancy because it will stimulate uterine contractions & cause spontaneous abortion

Answer 194

Class: Stimulate Increases peristalsis as well Dont want to overuse cause dependence and need it for rest of their life.

Answer 195

Class: Bulk-forming Laxitive To control constipation Acts as a bulk forming laxative by drawing in water into intestine. Has fiber in them

Answer 196

Anorexia, N/V/D, cramps Adverse: we are worried about esophageal or intestinal obstruction, due to not drinking adequate amount of water. Life threatening: bronchospasm, anaphylaxis

Answer 197

• Encourage increased water intake if not contraindicated • Avoid over use of laxatives can lead to electrolyte imbalances, dependence • Encourage exercise to increase peristalsis • Store suppositories in less than 86º F (30 º C) • Take with water to increase absorption • Do not take with in 1 hr of any other drugs • Discontinue if rectal bleeding, N/V or cramping occurs

Answer 198

Aspirin Steroids Advil (NASIDA H.pylori

Answer 199

Class: Anatcids Neutralizes gastric activity Indications: treat hyperacidity, peptic ulcer, reflux esophagitis, ↓ hyperphosphatemia Shouldnt use long term; could cause constipation

Answer 200

Keep in mind that antacids lower the acidity in the stomach and interfere with absorption of most medications ; separate meds an hour or two

Answer 201

Side: constipation Adverse: hypophosphatemia, long term use can cause GI obstruction

Answer 202

• AVOID ADMINSTERING WITH OTHER ORAL DRUGS MAY ANTACID MAY DELAY ABSORPTION • GIVE ANTIACID 1-2 HOURS AFTER OTHER MEDICATIONS • SHAKE SUSPENSION WELL BEFORE ADMINISTERING, DRINK H2O AFTER DOSE • TELL PT TO REPORT PAIN, COUGHING OR VOMITING OF BLOOD • ALERT HEATHCARE PROVIDER IF TAKING > 2 WEEKS (something else is going on and e need to find out) • AVOID TAKING WITH MILK OR FOODS HIGH IN VITAMIN D • STOOLS MAY BECOME SPECKLED WHITE

Answer 203

Class: Histamine 2 blocker To prevent and treat peptic ulcers, GERD, stress ulcers Inhibits gastric acid secretions by inhibiting histamine at H2 receptors. PO “—idine” endings are H2 blockers Think of “IDINE freely”

Answer 204

Side: HA, *costipation, confusion, N/D, *vertigo, depression, rash, blurred vision, malaise, may increase oral anticoagulants. Adverse: hepatotoxicity and blood dyspraxia both can be life threatening

Answer 205

Decrease acidity in the stomach; administer drugs before meals to decrease acid secretions Reduce dose for older adults Instruct client to report pain, coughing, or vomiting blood Avoid smoking because it may decrease effectiveness Separate dose from antacid by 1 hr.

Answer 206

Decreases acidity; interferes with most drug absorption

Answer 207

“PPI” Utilized to treat and prevent gastric ulcers Can be used as a prophylaxis Decreases acidity in stomach

Answer 208

Class: PPI (proton pump inhibitor) Used to treat and prevent gastric ulcers Suppresses gastric acidic secretions “AZOLE” ending “PPI AZOLE!!!”

Answer 209

HA/dizziness, fatigue, appetite increased, N/D/C, Adverse: may cause thrombocytopenia

Answer 210

NON-ABSORBABLE AND COMBINE WITH PROTIEN TO FORM A VISCOUS SUBSTANCE THAT COVERS ULCER AND PROTECTS IT FROM ACID AND PEPSIN Puts a coating around the stomach and protect the stomach and ulcer Minimum drug interactions

Answer 211

Class: pepsin inhibitor Coats the stomach, and protects the stomach and the ulcers Indications: prevents gastric mucosal injury from drug induced ulcer; manage ulcers Interfere with absorption of meds

Answer 212

Most medications

Answer 213

Administer on an empty stomach Administer antacids 30mins before or after sucralfate Allow 1-2 hours btwn sulcrafate and other drug Avoid smoking, ETOH Proper diet

Answer 214

Progressive disorder in the brain that causes abnormal movements and activities No cure Use medications are use to slow the progression and symptoms Balance, coordination and locomotion problems

Answer 215

Bradykinesia; slow movement and tremors Rigidigity: increased muscle tone w/increased movement (so they are very stiff) Posture: forward leaning, shuffle gait Also may have flat affect (not really having a face expressions), pill rolling (doing motions) We are worried about risk of falls (especially if taking anticoagulants or Antiplatlets to bleed to death)

Answer 216

We want to balance the dopamine and acetylcholine By decreasing the acetylcholine Dopamine normally maintains control of acetylcholine and inhibits excitatory response, in Parkinson's dopamine production is inhibited, acetylcholine increases and the movement disorder progresses.

Answer 217

We want to keep them mobile; to help them maintain normal movement activities (Therapeutic exercise) Diet with fiber and adequate hydration: a lot of the Sxs of meds will causes constipation and orthostatic hypotension Support groups

Answer 218

Anticholinergic: typically used to treat Parkinson’s but not the slow movements of the disease (Meds: artane, *Cogentin, norflex, parsidol Dominergics: convert to dopamine (Meds: carbidopa-levodopa) Dopamine agonists: stimulate dopamine receptors (Meds: amantadine, bromocriptine, Mirapex requip) “MBA” or “MR. BA is Dope” Mao b inhibitors : (Eldepryl, azilect) Comt inhibitors: (Comtan, Tasmar)

Answer 219

Help to decrease the rigidity and tremors, but it doesnt help with the slow movements (bradykinesia) Inhibits the release of acetylcholine Meds: Cogentin ,artane, akineton, parisdol, norflex, occasionally Benadryl “Yo u caap’n B !”

Answer 220

Dry mouth, dry secretions, urinary retention constipation, blurred vision, increased HR, restlessness, confusion, orthostatic hypotension

Answer 221

Artane Cogentin Akineton Parisdol Norflex Occasionally Benadryl

Answer 222

Class: antiparkinson dopaminergic

Answer 223

Class: antiparkinson dopaminergic Use it to treat Parkinson’s disease; relieve the tremors and rigidity This typically the gold standard Helps block acetylcholine

Answer 224

MAOIs; increase risk of hypertension crisis Anticholinergics decrease the effects if taken with levodopa High protein foods with vitB6 interferes with the medications

Answer 225

*Pts that have skin lesions; need to pay attention, because it might turn cancerous/ activate malignant melanoma, Glaucoma Severe cardiac Renal/ hepatic disease

Answer 226

*Anticholinergic-like side effects (dry mouth, urinary retention, orthostatic hypotension and constipation), *urine can become very dark, *sweat, N/v, HA, twitching, blurry vision, insomnia, palpitations, psychosis, depression with suicidal ideation, hallucinations

Answer 227

Agranulocytosis, hemolytic anemia, thrombocytopenia, cardiac dysrhythmias, neuroleptic malignant syndrome

Answer 228

Not gonna see improvements in symptoms until 1-4weeks Instruct pt to rise slowly to avoid orthostatic hypotension (remeber ALL anticholinergic drugs are all side effects of anticholinergics) Vitamin B6 interfere with the absorption; so decrease the amount of protein intake Avoid taking off med abruptly; rebound Parkinsonism can occur Let the pts know the meds can change THE COLOR OF THEir URINE AND SWEAT

Answer 229

Class: antiparkinson

Answer 230

Class: antiparkinson dopamine agent An antiviral dopamine agonist that help will help with decreasing the abnormal movements of Parkinson’s disease You can either take it alone or with anti cholinergic medication

Answer 231

Pt can develop a tolerance to the medication. The symptoms will return

Answer 232

Well tolerated side effects, but can develop tolerance to drug after awhile; may need to increase the dose, anticholinergic-like symptoms (orthostatic hypotension, urinary retention, constipation), confusion Side effects increase with combination drugs (if taken with anticholinergics meds or carbidopa)

Answer 233

Class: antiparkinson dopamine agonists Less side effects than the older drugs: may cause nausea, dizziness, somnolence, weakness and constpation Intensify hallucinations & dyskinesia (uncontrollable movements)

Answer 234

It can be very sedating; pts can become very very tired Even if dose at night, the pt is sleeping all day the next day

Answer 235

Class: antiparkinson dopamine agonists Acts on the dopamine receptors It is more effective than Symmetrel , but not as effective as carbidopa-levodopa *It is used when pts cant tolerate carbidopa-levodopa Think of “PAR” for PARkinsons in PARlodel

Answer 236

Carbidopa-Levodopa

Answer 237

Similar side effects; anticholinergic-like side effects (orthostatic hypotension, palpitationect.), chest pain. LE edema, nightmares, delusions, confusions

Answer 238

ANTIPARKINSON MEDICATION Help to keep levodopa acting longer; which helps to relieve the symptoms of Parkinson’s disease

Answer 239

Inhibits the metabolism of tyramine; pts need to limit foods that are high i tyramine (red wine, aged cheeses, bananas) Because hypertensive crisis can occur.

Answer 240

Utilize for pts who are JUST been diagnosed with Parkinson’s disease because it is mild

Answer 241

TCA an SSRIs

Answer 242

Selegiline “Selegiline MA” ;)

Answer 243

Used for ADVANCED Parkinson’s disease Increases the amount of levodopa in the brain We are concerned about the liver hepatotoxic; monitor LFT

Answer 244

Class: antiparkinson 1st COMT inhibitor; used for advanced parkinson; monitor LFT *May turn the urine bright yellow

Answer 245

Class: Comt inhibitor antiparkinson NO effect on the liver May turn the urine dark yellow to orange Think of ‘COMT’ in ‘COMTan’ for ‘COMT-inhibitor”

Answer 246

Antiparkinsons “Stalevo” Good dosing flexibility; good side effects; still need to watch out for skin lesions

Answer 247

Similar to parkinson; chronic. Progressive brain disorder, that decreases cognitive function. No cure Meds. Are used to slo the progression and minimize symptoms

Answer 248

With Parkinson’s, e want to decrease the acetylcholine levels, however, with Alzheimer’s, we want to increase the acetylcholine levels “AA” (Alzheimer’sAcetylcholine)

Answer 249

Ergoloid mesylate (hydergine); rare Acetylcholinesterase inhibitors (ACHE): Meds: tacrine (cognex), Donepezil (arciept) *Rivastigmine (exelon)

Answer 250

Remember; the acetylcholinesterase breaks down acetylcholine…. However, the acetylcholinesterase inhibitors allows the acetylcholine lvls to increase; we want that for pts with Alzheimer’s disease.

Answer 251

Class: acetylcholinesterase inhibitor Treat pts with Alzheimer’s PO “It will RIViVE the brain”

Answer 252

Liver/renal disease, urinary tract obstruction , Pts who has orthostatic hypotension, bradycardia

Answer 253

Cant take with food;Food decreases absorption rate; have to take it 4x a day

Answer 254

Dizziness is the most common effect, dry mouth Adverse: orthostatic hypotension

Answer 255

Be careful with hepato-toxicity , sucidal ideation and Stevens-Johnson syndrome can occur

Answer 256

Myasthenia gravis (autoimmune disorder) Multiple sclerosis (autoimmune disorder) Muscle spasms

Answer 257

Affect younger women Break down of acetylcholine recprtor site Change is muscular contractions; its weaker Our biggest concern is depression in respiratory (because diaphragm is a muscle) Difficulty swallowing, respiratory weakness, dysarthria (difficulty speaking) early Sxs: eyelids drooping, double vision,

Answer 258

Class: cholinesterase inhibitor Used to treat & control myasthenia gravis Helps to keep the acetylcholine working and keep those muscle contracts sufficient. Given PO, IM, IV Think of “M” for MyaSTheNIa…MeSTINon

Answer 259

Several times. a day; via PO, IM/IV

Answer 260

GU and GI mechanical Obstruction, severe renal disease. Caution in those with asthma, *hypotension, *bradycardia, peptic ulcer, cardiac dysrhythmias, renal dysfunction, hyperthyroidism and pregnancy (Think about those cholinergic effects and what it does)

Answer 261

N/V/D, HA, dizziness, abdominal cramps, excessive saliva sweating, rash, miosis (constriction of pupils) Adverse: *hypotension, *bradycardia Life threatening: *respiratory depression, bronchospasm, seizures

Answer 262

The big thing to remember is symptoms of cholinergic crises: Muscle weakness (extreme), excessive salvation, tears, sweating, miosis

Answer 263

Autoimmune disease, where you start to see the break down of the myelin sheath in brain and spinal cord; causes. Weakness or spasticity and double vision Typically in Caucasian women 20-40yrs old Treatment is to decrease inflammation and help improve function of the demyelinating axons

Answer 264

H2 blockers Indomethacin Beta-blockers

Answer 265

Relieve muscle spasms and pains associated with traumatic injuries and spasticity from chronic disorders Muscle spasm are typically *Treated with centrally acting muscle relaxants

Answer 266

Class: skeletal muscle relaxant for muscle spasm Short term treatment for muscle spasms. (Tolerance can develop) *Centrally acting PO take its food GI upset; avoid food think of “relaxing the FLEX”

Answer 267

Since its centrally acting: fatigue, drowsiness Alos see anticholinergic effects: dizziness, HA, drymouth, tachycardia, urinary retention

Answer 268

Any drug that increases CNS depression (ETOH, Narcotics, sedative-hypnotics,….)

Answer 269

Pts that has Acute MI , BBB&AV Block (block;That means the conduction in heart is slow, and we dont want to slow the conduction) Paralytic ileus (its an opiod-like med; already slows the GI/cause constipation; not ideal to give them Flexeril) MAOI use (if use within 14 days; high risk of HTN crisis)

Answer 270

Do not stop abruptly, taper over 1 week to avoid rebound spasm • Do not drive or operate machinery • Do not take for longer than 3 weeks • Avoid alcohol and CNS depressants • Contraindicated with nursing or pregnant mothers • Take with food to avoid GI upset

Answer 271

Chronic lifelong seizure disorder

Answer 272

Hydantoins: Phenytoin Long-acting barbiturates: Phenobarbital, mephabarbital, primidone Benzodiazepines: Diazepam, clonazepem Carbamazepine Valproate (valproic acid)

Answer 273

1. Suppressing the influx of sodium; which prevents the neurons from firing, so it decreases the electrical activity 2. Suppresses the calcium influx, which slows the conduction in the brain activity; which will decreases seizure disorders 3. GABA will increase which inhibit neurotransmitter, which will decrease seizure activity

Answer 274

Are the 1st medications to treat seizures Work by INHIBITING the influx of sodium, which will decrease the brain conduction; which will decrease seizure activity conduction Therapeutic range: 10-20mcg/ml for it to be effective

Answer 275

NO It is teratogenic to the baby!! Pregnancy category D Sometimes you will see them on it; but have to see neurologist to outweigh the risk and benefits. But not supposed to be used

Answer 276

If not in between 10-20, too high it will end up having side effects

Answer 277

Class: anticonvulsant that is a Hydantoin Look at ‘toin ending’ Used to treat or prevent seizure Decreases sodium, which decrease s the brain conduction; which help decrease seizure activity PO/IV

Answer 278

*Do not USE IN pregnancy, hypersensitivity, heart block, psychiatric disorders

Answer 279

They all will have the same side effects: Remember it’s SLOWING DOWN brain activity Slurred speech, drowsiness, confusion, dizziness, sedation, decreased coordination Usually after a few months that they are used to it, but will come back again after increasing dose

Answer 280

HA, diplopia (double vision), confusion, dizziness, sluggish, decreased coordination, ataxia (loss of muscle control), slurred speech, rash, anorexia, N/V, hypotension (after given IV form), pink-red/brown color of urine, fevers Think of what happens when someone is drunk Adverse reactions: gingival hyperplasia (overgrowth of gums), reduce WBC, depression because of decrease brain activity

Answer 281

All the GI meds (because of the decresed acidity in the stomach): antihistamines, PPI, Dilantin decreases the efficiency of oral contraceptives

Answer 282

PO: takes longer *7-10days before it can actually work IV: much more quick (1hr); not hat we go for, unless pt is having lots of seizures

Answer 283

Always utilize seizure precautions (pad bed rails, suction that is ready to go, hieight of bed is low, move sharp utensils ou of the way ect.) Advise females to use back up contraception if they are taking oral contraception Monitor CBC Shake suspension well before dispensing Advise pt to avoid driving or other hazardous activities (what if they have. A seizure while driving? Not good) Do not stop drug abruptly, obtain medic alert bracelet Avoid alcohol and other CNS depressants

Answer 284

Class: an anticonvulsant that is a long acting barbiturate Use it for seizures It enhances GABA, which decreases the neuron activity, which will decrease seizures Less side effects than Dilantin, less teratogenic effects (but it still is teratogenic)

Answer 285

Decreases the neuron activity; which decreases seizures

Answer 286

Class: an anticonvulsant that is a succinimide To treat seizures Decreases the CALCIUM influx

Answer 287

40 - 100 mcg/ml

Answer 288

Break down of blood product (blood dyscrasia, renal and liver impairment, and SLE (systemic lupus)

Answer 289

Is an anticonvulsant that treats seizures; tolerance may occur after 6mos Use for less than 6mos Remember it is CNS depressant; for all anti seizure meds, actually Look at “BenzoDIAZEines” Meds: diazepam: DIAZEpam clonazepam: clonaZEpam

Answer 290

Can develop addiction & tolerance

Answer 291

20- 80ng/ml

Answer 292

Class: iminostilbenes anticonvulsants Treatment for seizures ; sometimes used for bipolar or ETOH withdrawal. Metabolized by the main pathway in the liver; cant take grapefruit juice with it.

Answer 293

Grapefruit juice; it will lead to toxicity.

Answer 294

Class: anticonvulsant Use for seizures Monitor LFT *Cant use under 2 yrs and pts with liver disease Always start at low dose and increase slowly

Answer 295

Class: anticonvulsant Commonly used for seizures Can use it in pregnant women and kids Low teratogenic risk

Answer 296

There isn’t a lot of drug-to-drug interactions, and can use during pregnancy.

Answer 297

Aggression; they be extremely angry Have to lower the dose

Answer 298

CNS depression: slurred speech, dizziness, confusion, sedation Remebr we are slowing down the brain conduction.

Answer 299

• 25% of women with epilepsy experience ↑ seizures while pregnant • Hypoxia during seizure cause risk to fetus and mother • Dilantin and tegretol have been linked to cleft-lip and palate • Anticonvulsants inhibit vitamin K can cause hemorrhage in infants, pregnant women usually given vitamin k if on anticonvulsant during last week of pregnancy and then 10 days later, also given to infant after birth

Answer 300

Dilantin and tegretol

Answer 301

Occur when theres a rapid change in the temperature; going from normal and high Occur in children btwn 3mos- 5 years Have higher chances of developing epilepsy later on DONT USE VALPORIC ACID <2 BECAUSE OF LIVER TOXICITY

Answer 302

Think of “DECLINE” or DIP in BP; lowers BP - Amlodipine - Nicardipine - Nifedipine -Felodipine

Answer 303

Think of “ZEN”; getting a FULL treatment of lowering HR & BP Cardizem (Diltiazem)

Answer 304

Just know that it lowers both BP and HR

EXAM 2 Flashcards

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