Exam 2

Question 1

Bronchodilators

Answer 1

SABA, LABA, Short acting anticholinergic, Methylxanthines

Question 2

Albuterol

Answer 2

SABA - Rescue therapy
PK: inhaled formulations generally exert their effect locally
MOA: beta-adrenergic agonist - stimulation of beta 2 receptors in the smooth muscle leading to bronchodilation; also improves mucociliary transport
AE: paradoxical bronchospasm, tachycardia, palpitations, tremors, dry mouth

Question 3

Salmeterol

Answer 3

LABA - used in treatment of asthma and COPD

• Use on a regular basis
• Best when used with anti-inflammatory agents
• NOT used to treat acute symptoms

Question 4

Ipratropium (Atrovent)

Answer 4

Short Acting Inhaled Anticholinergic
PK: inhaled, local effects
MOA: blocks parasympathetic NS - blocks muscarinic receptors resulting in bronchodilation and decreased mucus secretion
AE: tachycardia, constipation, blurred vision, dizziness, headache, dry mouth, metallic taste, urinary retention
DO NOT USE TO TREAT ACUTE SX
***Always give bronchodilator first

Question 5

Theophylline (Theolair)

Answer 5

Methylxanthines
PK: oral solution or tablet, absorbed rapidly and converted to active form
MOA: Smooth muscle relaxation, decreased inflammatory mediators — monitor blood serum levels to prevent toxicity
AE: severe – not used commonly AVOID caffeine cardiac: tachy, palpitations, dysrhythmias, neuro: HA, dizziness, irritability, insomnia, GI: abdominal discomfort, N/V

Question 6

Glucocorticoids (ICS)

Answer 6

Prototypes: beclomethasone (QVar), budesonide (pulmocort), ruticsone (Rovent Diskus)

Decreases exaverbations in COPD stages C & D
Not used alone - in combo with bronchodilators
***Helps reduce inflammation in airways
AE: oral thrush (rinse mouth), dysphonia, reflex cough/bronchospasm
There are many combination preparations with SABAs and LABAs

Question 7

budesonide

Answer 7

Glucocorticoid - inhaled

Anti-inflammatory for respiratory disorders

Question 8

budesonide

Answer 8

Glucocorticoid - inhaled

Anti-inflammatory for respiratory disorders

Question 9

montelukast (Singular)

Answer 9

Leukotriene inhibitor
Anti-inflammatory for respiratory disorders
Not for acute attacks

Monitor patient’s mood/behavior changes (suicide precautions)

Question 10

cromolyn

Answer 10

Mast cell stabilizer
Anti-inflammatory for respiratory disorders
Not for acute attacks
Prophylactic therapy - occasional pulmonary function tests

Question 11

dextromethorphan

Answer 11

Suppressant /anti-tussive

AE: Central nervous system: Confusion, excitement, irritability, nervousness, serotonin syndrome

Question 12

guaifenesin

Answer 12

Expectorant
used for cough
AE: dizziness, headache, decreased uric acid, kidney stone formation (high doses)

Question 13

phenylephrine

Answer 13

Decongestant
Alpha1 receptor agonist
AE: CNS - Anxiety, dizziness, excitability, headache, insomnia, nervousness, restlessness

Question 14

diphenhydramine (1st gen)

loratadine (2nd gen)

Answer 14

Histamine1 receptor antagonist

Anti-histamine

Question 15

ondansetron (Zofran)

Answer 15

Anti-emetic Drug
5-HT3 (serotonin) receptor antagonist
AE: headache, malaise, fatigue

Question 16

promethazine (Phenergan)

Answer 16

Anti-emetic Drug
Dopamine2 receptor antagonist
AE: tinnitus, decreased HR

Question 17

aprepitant

Answer 17

Anti-emetic Drug
Neurokinin antagonist
AE: fatigue, hiccups, weakness, dizziness
**Use with caution for pts. with renal impairment
Monitor for fatigue, weakness, constipation, low blood pressure, and dizziness

Question 18

aluminum hydroxide, magnesium hydroxide, calcium

carbonate, etc.

Answer 18

Drugs for gastric ulcer / GERD
Antacid
Take after meals and at bedtime for the temporary relief of heartburn, acid indigestion, and sour stomach
AE: Constipation, discoloration of feces (white speckles), fecal impaction, nausea, stomach cramps, vomiting

Monitor calcium and phosphorus levels

Question 19

ranitidine

Answer 19

Drugs for gastric ulcer / GERD 
Histamine2 receptor antagonist 
Uses: ulcers, heartburn, GERD
AE: a little bit of everything
Monitor AST, ALT, creatinine, s/s of gastric ulcer, signs of confusion

Use in caution with pt. who has renal impairment

Question 20

omeprazole

Answer 20

Drugs for gastric ulcer / GERD
Proton pump inhibitor
AE: headache, dizziness

Question 21

misoprostol (Cytotec)

Answer 21

Drugs for gastric ulcer / GERD
Prostaglandin
Preg. test for women prior to use

Question 22

sucralfate

Answer 22

Drugs for gastric ulcer / GERD 
Mucosal barrier 
Prevention of mucositis 
AE: constipation
Use caution in presence of renal failure. Teach patient proper timing of other medications. May cause constipation.

Question 23

psyllium (Metamucil)

Answer 23

Laxative
Bulk forming
Dietary fiber laxative

Question 24

docusate (colace)

Answer 24

Laxative
Surfactant-stool softener
AE: throat irritation

Question 25

bisacodyl

Answer 25

Laxative stimulant Tx of constipation AE: abdominal cramps, nausea, vertigo, electrolyte imbalance

Question 26

polyethylene glycol

Answer 26

Laxative - osmotic | AE: Abdominal bloating, cramping, diarrhea, flatulence, nausea

Question 27

loperamide (Imodium)

Answer 27

Anti-diarrheal Opioid-type May cause drowsiness or dizziness, which may impair physical or mental abilities; patients must be cautioned about performing tasks which require mental alertness AE: dizziness, constipation

Question 28

mesalamine

Answer 28

``` Inflammatory bowel disease drugs - UC 5-Aminosalicylates AE: headache, abdominal pain Monitor: renal function, CBC, hepatic function Adequate hydration important ```

Question 29

azathioprine

Answer 29

Inflammatory bowel disease drugs - Crohns disease (off label) immunosuppressant AE: N/V, diarrhea, hepatotoxicity Monitor for opportunistic infection, and signs/symptoms of malignancy

Question 30

infliximab

Answer 30

Inflammatory bowel disease drugs Immunomodulator (TNF inhibitor) Premedication with antihistamines, acetaminophen, and/or corticosteroids may be considered to prevent and/or manage infusion-related reactions. AE: headache, N/V, diarrhea, abdominal pain Do not use with live vaccines

Question 31

alendronate (Fosamax)

Answer 31

Osteoporosis Bisphosphonate **Patients should receive supplemental calcium and vitamin D if dietary intake is inadequate Monitor serum calcium and vitamin D 25 levels.

Question 32

raloxifene

Answer 32

Osteoporosis SERM May increase risk for DVT or PE Contraindicated for those with hx of DVT, pregnant/bfeeding women AE: peripheral edema, hot flashes, leg cramps, flu syndrome **Evaluate lipid profile and BMD. Monitor for DVT, PE, chest pain, migraine, and rash on a regular basis during therapy.

Question 33

denosumab

Answer 33

Osteoporosis RANKL antagonist ***Administer calcium and vitamin D as necessary to prevent or treat hypocalcemia AE: htn, CV issues, preg. class X

Question 34

teriparatide

Answer 34

Osteoporosis PTH analog AE: orthostatic hypotension, dizziness, headache, N/V Monitor for chest pain, hypotension, nausea, vomiting, arthralgia, leg cramps, and dyspnea at beginning of and regular intervals during therapy.

Question 35

Ibuprofen, naproxen

Answer 35

NSAID Uses: Arthritis, acute gout attack AE: ulcers

Question 36

methotrexate

Answer 36

Arthritis Disease Modifying Antirheumatic Drugs (DMARD), Nonbiologic AE: neurotoxicity - seizures, headache Close monitoring of CBC with differential, liver function tests, and renal function is important. Monitor for acute neurotoxicity. Signs include drowsiness, blurred vision, headaches, or stroke-like symptoms. Restrict alcohol intake to decrease hepatic toxicity

Question 37

etanercept (enbrel)

Answer 37

Rheumatoid Arthritis - SubQ injection anti-TNF alpha DMARD, biological Monitor for signs of respiratory infections, liver function test

Question 38

colchicine

Answer 38

Acute gout attack AE: diarrhea, N/V, fatigue, headache, abdominal pain Monitor LFT, BUN/creatinine

Question 39

allopurinol

Answer 39

Prevention - Xanthine oxidase inhibitor Obtain renal function; dosage adjustments may be needed. Monitor uric acid levels, CBC, liver function tests, and renal function tests. Monitor for therapeutic response; frequency and severity of gouty attacks. Observe for signs of hypersensitivity

Question 40

heparin

Answer 40

DVT - anticoagulants Hemoglobin, hematocrit, signs of bleeding; fecal occult blood test; aPTT (or antifactor Xa activity levels) or ACT depending upon indication

Question 41

enoxaparin (Lovenox)

Answer 41

DVT - anticoagulants | LMW heparin

Question 42

dabigatran

Answer 42

DVT - anticoagulants Direct thrombin inhibitor Take with full glass of water

Question 43

rivaroxaban (Xarelto)

Answer 43

DVT - anticoagulants Direct Xa inhibitor Avoid abrupt discontinuation in patients with atrial fibrillation; increased risk of stroke Monitor aPTT, PT

Question 44

warfarin (Coumadin)

Answer 44

DVT - anticoagulants Vit K antagonist Monitor INR

Question 45

morphine

Answer 45

Pain (mod-severe) Opioid AE: respiratory depression

Question 46

dantrolene

Answer 46

Malignant Hyperthermia Skeletal muscle relaxant AE: flushing, tachycardia Monitor vital signs, IV site, cardiac function

Question 47

dantrolene

Answer 47

Malignant Hyperthermia | Skeletal muscle relaxant