Exam 2 Drug Classes Flashcards
(340 cards)
1
Q
MOA of antacids
A
- neutralize gastric acidity
- increases stomach pH from 1.3-3.5
- symptomatic relief and some ulcer healing
2
Q
antacids medications
A
calcium carbonate (Tums)
3
Q
AE of antacids
A
- motility of gastric system
- DDI, increased pH reduces absorption of acidic groups
- electrolyte imbalance
- do not take within 2 hours of other oral meds
- take with foods
4
Q
MOA of H2 receptor antagonists
A
reduce the secretion of stimulated acid
5
Q
indication for H2 receptor agonist
A
treats acid reflux and heal ulcers
6
Q
H2 receptor agonist medications
A
ranitidine (Zantac)
famotidine (Pepcid)
7
Q
AE of H2 receptor agonists
A
- diarrhea
- muscle pain
- rashes
- cimetidine inhibits P450 enzymes and can cause gynecomastia
- take on empty stomach
8
Q
MOA of PPI
A
irreversibly inhibits ATPase pump and blocks final steps in acid secretion into stomach
9
Q
indication of PPI
A
treat acid reflux and heal ulcers (most effective)
10
Q
PPI medications
A
omeprazole (Prilosec)
esomeprazole (Nexium)
11
Q
AE of PPIs
A
- generally well tolerated
- long term use gastric polyps, altered calcium reabsorption, cvd abnormalities
- take on empty stomach
12
Q
what are the 3 mucosal protectors
A
- bismuth chelate
- sucralfate
- misoprost
13
Q
MOA of bismuth chelate
A
- coat ulcers
- increase gastric mucous
- protects against H. pylori induced ulcers
14
Q
MOA of sucralfate
A
- aluminum salt that coats the ulcer
15
Q
indication of sucralfate
A
high-risk cases
- trauma
- burns
- ARDS
- major surgery
16
Q
MOA of misoprostol
A
PGE2 that inhibits acid secretion
17
Q
indication of misoprostol
A
prevent NSAID induced ulcers
18
Q
what is the combo therapy used to treat H. plylori infection
A
acid controlling drug + antibiotic
(usually PPI + 2 antibiotics)
- can eliminate bacterium within one week
- if NSAID ulcer use GI friendly COX2 inhibitor)
19
Q
MOA anticholinergics
A
binds to ACh receptor on vestibular nuclei and blocks communication
20
Q
indication of anticholinergics
A
motion sickness related vomiting
21
Q
AE of anticholinergics
A
- dizziness
- drowsiness
- dry mouth
- blurred vision
- dilated pupils
- cant see, spit, pee or poo
22
Q
anticolinergic antiemetic medication
A
scopolamine (Transderm Scop)
23
Q
MOA antiemetic antihistamines
A
inhibit vestibular input to CTZ
24
Q
indication antiemetic antihistamines
A
motion-sickness related vomiting
25
antiemetic antihistamine medications
meclizine
26
AE antiemetic antihistamines
dizziness and sedation
27
MOA neuroleptic drugs
block dopamine receptors in CTZ
28
indication for neuroleptic drugs
post op N/V and chemo-induced vomiting
29
AE of neuroleptic drugs
- OH
- tachycardia
- blurred vision
- dry eyes
- urinary retension
- long term use can lead to extrapyramidal sx
TONS
30
MOA of prokinetic drugs
- block dopamine in CTZ
| - produce central and peripheral antiemetic effects
31
indicator of prokinetic drugs
nausea and vomiting
32
AE of prokinetic drugs
- diarrhea, weakness, prolactin release
- prolonged use causes extrapyramidal signs, motor restlessness
- hypo- and hypertension, tachycardia
33
MOA of serotonin blockers
block serotonin receptors in GI tract, CTZ, and vomiting center
34
Indication of serotonin blockers
used to prevent vomiting
35
prokinetic medications
metoclopramide
36
serotonin blockers medications
ondansetron
37
AE of serotonin blockers
- HA
- dizziness
- diarrhea
- no extrapyramidal signs
38
what may be used in combo with serotonin blockers to control chemo-induced emesis
corticosteroids
39
neurokin - 1 receptor blockers MOA
blocks substance p from binding, prevents both central and peripheral
40
indication for neurokinin-1 receptor blockers
used to prevent emesis from chemotherapy
41
AE of neurokinin-1 receptor blockers
- sedation
- GI issues
- stevens johnson syndrome (life threatening rash)
42
MOA of cannabinoids
is unclear
43
indication for cannabinoids
- used to block acute and delayed emesis
| - used for chemo-induced n/v
44
AE of cannabinoids
- ataxia
- light headedness
- blurred vision
- dry mouth
- weakness
- tachycardia or bradycardia
- CNS sx (being stoned)
45
indication of phosphorated carbohydrate solution (Emetrol)
used for mild cases of intestinal flu or food-borne causes
46
MOA of phosphorated carbohydrate solution (Emetrol)
relaxes GI tract smooth muscle
47
Drug classes used to treat Nausea and vomiting
- anticholinergics
- antihistamines
- neuropletic drugs
- pro kinetic drugs
- serotonin blockers
- neuokinin-1 receptor blockers
- cannabinoids
- phosphorated carbohydrate solution (Emetrol)
48
indication for absorbents
diarrhea
49
MOA of absorbents
binds to bacteria causing diarrhea to carry them out with feces
50
absorbent medications
bismuth subsalicylate (Pepto-Bismol)
51
AE of absorbents
- aspirin products: so use with caution in children recovering from the flu/chickenpox bc of Reye's syndrome
- increased bleeding time
- GI bleed
- tinnitus
- decrease effectiveness of many drugs
52
MOA antidiarrheal anticholinergics
reduce peristalsis of GI tract, inhibits the PNS
53
AE of antidiarrheal anticholinergics
tons of anticholinergic AEs
54
MOA of intestinal flora modifiers
resides in intestines to keep "bad" bacteria in check . helps restore normal gut balance
55
indications of intestine flora modifiers
good to use while taking antibiotics for diarrhea
56
MOA of opiates
- decrease GI motility and propulsion
| - slows transit time in intestines
57
indication of opiates
- can be used to reduce pain
| - diarrhea
58
opiates for antidiarrheal - medications
dipenoxylate (Lomotil)
| - has added atropine to prevent recreational opioid use
59
AE of opiates
- sedation
- dizziness
- constipation
- nausea
- vomiting
- respiratory depression
- bradycardia
- hypotension
- urinary retention
60
classes of antidiarrheal agents
- absorbents
- anticholinergics
- intestinal flora modifiers
- opiates
61
classes of medications for constipations
- bulk forming laxatives
- hyperosmotic laxatives
- saline laxatives
- emollient laxatives
- stimulant laxatives
62
MOA of bulk forming laxatives
increases water absorption to soften and increase bulk of intestinal contents
63
bulk forming laxatives medications
- methycellulose (Citrucel)
64
hyperosmotic laxatives MOA
draws fluid into the colon to increase stool fluid content
65
hyperosmotic medications
- lactulose
| - polyethylene glycol 3350 (Miralax)
66
AE of hyperosmotic medications
- abdominal bloating
- rectal irritation
- electrolyte imbalance: dont use with heart issues
67
MOA of saline laxatives
pushes water/electrolytes into intestines
68
AE of saline laxatives
salts may cause issues with individuals with diminished cardiac or renal failure
69
MOA of emollient laxatives
facilitate water and fat absorption into the stool, lubricates
70
emollient laxative medications
decussate sodium (Colace)
71
AE of emollient laxatives
- skin rash
- decreased vitamin absorption
- electrolyte imbalance
72
MOA of stimulant laxatives
stimulates peristalsis through enteric nervous system
73
Stimulant laxative medications
Senna
74
AE of stimulant laxative medications
dependence with long term use and damage to intestinal cells/loss of colon function
NOT best for long term constipation issues
75
what nervous system are anticholinergics associated with?
PNS
76
what neurotransmitter bings cholinergic receptors?
acetylecholine
77
what are the two types of cholinergic receptors?
- muscarinic
| - nicotinic
78
what are the AEs of anticholinergic drugs
```
- cant see, spit, pee, shit
ABCDs
- agitation
- blurred vision
- constipation and confusion
- dry mouth
- stasis of urine and sweat
```
79
what are contraindications to taking an anticholinergic drug
avoid (esp systemic use) if history of urinary retention, narrow angle closure glaucoma
80
Indication of atropine
- pre-surgery or end of life care of decrease saliva and secretions
- mydriasis for eye exams
- treat poisoning from muscarinic-containing mushrooms, organophosphates, insecticides, or nerve agents
81
MOA inhaled anticholinergic (aka antimuscarinics)
primarily bind M3 in airway smooth muscle to bronchodilate
82
indication of an inhaled anticholinergic
asthma and COPD
83
anticholinergic medications
- SAMA
| - LAMA or LAAC
84
AE of inhaled anticholinergics
dry mouth, but generally well tolerated
85
MOA of anticholinergics used to treat overactive bladder (patch)
antagonize muscarinic receptors on bladder smooth muscle = decrease contraction
86
what are the uses for anticholinergic drugs
COPD, asthma, parkinson's disease, OAB, motion sickness, decreasing saliva/secretions pre-surgery, treating poisonings, ophthalmic exams
87
AE of anticholinerics for Parkinson's
may produce extrapyramidal sx
| - aka drug induced movement disorders
88
moa of anticholinergics for parkinson's
block M1 receptors in CNS, may also increase dopamine which plays a role in PD
89
what receptor types do antihistamines act on?
histamine and muscarinic
90
1st generation antihistamines (H1 antagonists) AEs
- bind to histamine receptors in periphery and CNS (more sedation)
- bind muscarinic receptors (anticholinergic AE)
(Crosses BBB)
91
indication of 1st gen H1 antagonists (antihistamines)
used for allergies, sleep aid, motion sickness, N/V
92
2nd generation antihistamines AE
Does not cross BBB so not as many sedative effects. generally well tolerated
93
indication of anticholinergic - antidepressants
TCAs (tricyclic antidepressants)
| - used for depression, OCD, bulimia, neuropathy and more
94
MOA anticholinergic antidepressants
varies by product
- primarily act by increasing serotonin and NE
```
H1 antagonists (sedating)
muscarinic antagonists
```
95
AE anticholinergic antidepressants
- can have anticholinergic AEs
| - prolong QTc (deadly in overdose)
96
MOA anticholinergic muscle relaxers
serotonin antagonism, also binds muscarinic receptors
97
MOA anticholinergic antipsychotics
antagonize alpha adrenergic, serotonin, dopamine, histamine, and muscarinic receptors to varying degrees
98
MOA anticholinergic anti arrhythmics
primary action is to inhibit sodium channels but also binds muscarinic receptors
99
when to avoid anticholinergics in elderly
- be aware all the time!!
| - avoid in delirium, dementia, cognitive impairment, urinary retention, lower urinary tract sx, BPH
100
MOA direct acting cholinergic drugs
act directly on muscarinic receptors
101
MOA indirect acting cholinergic drugs
inhibit acetylcholinesterase (AChE)
102
uses of cholinergic drugs
glaucoma, GI disorders, urinary retention, alzheimer's disease, diagnosis of myasthenia graves
103
MOA cholinergic drugs for glaucoma
meds stimulate muscarinic receptors in the eye
- miosis
- constrict ciliary muscle
- decrease resistance to aqueous humor outflow
104
when to use cholinergic drugs for urinary retention
- neurogenic bladder
| - post surgery (potentially due to atropine given before surgery)
105
why take cholinergic drugs for alzheimers?
alzheimer's is associated with decreased levels of ACh
106
MOA cholinergic drugs for Alzheimer's
reversibly bind AChE so it does not break down ACh
| - overtime may be less effective bc of disease progression (decrease in cholinergic receptors)
107
AE of cholinergic drugs from alzheimers
- varies some by product
- GI (n/v/d)
- less AEs with patch
108
what are the off-label uses for alzheimer's disease medication
Lewy-Body dementia
| traumatic brain injury cognitive impairment
109
what is myasthenia gravis
antibodies bind nicotinic ACh receptors in neuromuscular junction = inability to maintain muscular contractions
110
how to cholinergic drugs help dx of myasthenia gravis
edrophonium is administered and if muscle strength temp improves this assist dx
111
cholinergic AEs
SLUDGE
- sweating, lacrimation, urination, diarrhea, GI cramping, emesis
DUMBELLS
- diarrhea, urination, mitosis, bradychardia, emesis, lacrimation, lethargy, salvation/sweating
112
contraindications to cholinergic medications
- hx of COPD or asthma
- urinary tract obstruction
- PD
- PUD
113
therapeutic concerns with direct and indirect acting muscarinic agents (cholinerginic drugs)
- significant CVD effects
- decreased CO
- hypotension
- GI issues
- lungs
- frequent urination
- increase secretions
- cholinesterase inhibitors - syncope - pacemaker placement
114
therapeutic effects of anticholinergic drugs
atropine
- dry mouth in low doses
- blurred vision in higher doses
- blocked vagal effects
- constipation, urinary retention
- high doses have CNS effects
tachycardia and hyperthermia
115
what nervous system to adrenergic drugs act on
SNS
116
adrenergic agonists =
sympathomimetic
117
adrenergic antagonists =
sympatholytic
118
amphetamine MOA
- sympathomimetic indirect acting adrenergic drug
| - taken up by NE receptors which leaves more NE available to have effect
119
indications of amphetamine
used for ADHD and narcolepsy
| - increases alertness and decreases fatigue
120
amphetamine AE
- increased BP and HR
- decreased appetite
- enters the CNS and stimulates dopamine receptors = euphoria = abuse potential
121
cocaine MOA
sympathomimetic indirect acting adrenergic drugs
| - inhibits reuptake of NE
122
indication of cocaine
used topically during nasal surgeries
123
cocaine AEs
significant vasoconstriction = hypertensive crisis
- MI
- stroke
124
ephedrine MOA
sympathomimetic indirect acting adrenergic drugs
- stimulates adrenergic receptors, facilitates NE release, enters CNS - similar impact to amphetamine
- synthetic in chinese herbal remedies
125
indication of ephedrine
marketed for increased energy, not regulated by FDA
126
classes of antihypertensive drugs
- diuretics
- calcium channel blockers
- beta blockers
- ACE inhibitors
- ARBs
- central acting alpha agonist
- nitrates
127
MOA diuretics
act directly on the nephron to limit water and sodium reabsorption
- increase excretion of NA and water by kidneys
- increases amount of urine formed
- decreases blood volume
128
what is the recommended initial therapy for all HTN pts
diuretics
129
loop diuretics MOA
act primarily on ascending loop of Henle and inhibit reabsorption of Na/K/Cl which prevents reabsorption of water
- increases urine production
130
loop diuretic classification
moderate antihypertensive, strong diuretic
131
thiazide diuretic classification
powerful antihypertensive, moderate diuretics
132
what are the 3 major classifications of diuretics
- loop
- thiazide
- potassium-sparing
133
examples of loop diuretics
furosemide (Lasix)
134
AE loop diuretics
dehydration, hypokalemia, hyponatremia, hypocalcemia, toxicity, hyperglycemia, increased LDLs
135
thiazide diuretics MOA
- act on early part of distal convoluted tubule
| - Na and K excretion and reabsorption of Ca
136
what type of diuretic is the primary choice for HTN
thiazide diuretics
| - lowers systolic BP more than other classes of antihypertensive drugs
137
in what populations are thiazide diuretics especially indicated?
- better for individuals prone to renal calculi
| - favored for older adults to reduce Ca loss and maintain bone mass
138
examples of thiazide diuretic drugs
hydrochlorothiazide (Microzide)
| HCTZ
139
AE of thiazide diuretics
- dehydration
- hyponatremia
- hypercalcemia
- significant K loss
- increased LDLs
140
MOA potassium sparing diretics
- interferes with the sodium-potassium exchange in distal convoluted tubules
- limits reabsorption of Na
- reabsorbes more K
141
indication for potassium sparing diuretics
- someone with electrolyte imbalance
142
AE of potassium sparing diuretics
- hyperkalemia
- lethargy, mental confusion
- gynecomastia in males
- menstrual irregularities in females
143
potassium sparing diuretic medications
spironolactone
144
indication of direct vasodilators
used to treat hypertensive crisis
| ex. diastolic over 120
145
MOA of direct vasodilators
directly vasodilates the peripheral vasculature
| - inhibits smooth muscle contraction in the arterioles
146
AE of direct vasodilators
dizziness, OH
147
MOA of calcium channel blockers
block Ca entrance into vascular smooth muscles
- reduces smooth muscle tone which allows for vasodilation
- decreases contractility, CO, and energy demands on the heart
148
indication for calcium channel blockers
HTN, angina, arrhythmias
| - useful when beta blockers are contraindicated (asthma, DM, PVD)
149
AE of calcium channel blockers
- HA
- dizziness
- hypotension
- bradycardia
- reflex tachycardia
- sweating
- tremor
- flushing
- constipation
150
what are the three classes of calcium channel blockers
1. dihydropyridines
- reduce arterial tone
2. phenylklylamines
- affects the heart
3. benzodiazepines
- affects heart and vasculature
151
calcium channel blocker medications
- amlopdipine
| - diltiazem
152
indication for b blockers
HTN, angina, arrhythmia, post-MI survival
153
b blocker effects on the heart
- reduced contractility
- reduced HR
- reduced peripheral vascular resistance
and in return reduced BP!
154
non selective b blockers act on....
block b1 and b2 adrenoceptors
155
selective b blockers act on....
block only b1 receptors
- selectivity is lost at high doses
- use if pt has pulmonary issues
156
b blocker MOA
- lol
- reduce sympathetic influences
- prevents normal ligand from binding to receptor by competing for the site
157
non selective b blocker medication
propranolol (Inderal)
158
selective b blocker medications
metoprolol (Lopressor)
| carvedilol (Coreg)
159
non selective b blocker AEs
related to receptor blocking action
- peripheral vasoconstriction
- bronchoconstriction
- bradycardia
- reduce exercise capacity
- abrupt withdrawal drug triggers arrythmia, angina, MI
- dizziness
- OH
- depression
- fatigue
- sexual disfunction
160
cardoselective b blockers AEs
related to receptor blocking action
- peripheral vasoconstriction
- bradycardia
- reduce exercise capacity
- abrupt withdrawal drug triggers arrythmia, angina, MI
- dizziness
- OH
- depression
- fatigue
- sexual disfunction
161
a-adrenoceptor blockers MOA
- azosin
- reduce sympathetic tone of blood vessels to decrease peripheral vascular resistance
- shown to lower LDL and triglyceride levels
162
indication of a-adrenoceptor blockers
used as add-on drugs to reduce BP, never used first
163
AE of a-adrenoceptor blockers
- OH
- nasal stuffiness
- reflex tachycardia
- arrhythmia
164
indication for dual a and b blockers
used for individuals who have increased PVR with pure b-blockers
165
dual a and b blocker medication
carvedilol
| 4:1 beta to alpha blockade
166
central acting a2 agonists for HTN
- clonidine
| - methyldopa
167
central acting a2 agonists MOA
a2 receptor on presynaptic neurons, stimulates CNS, decreases NE production to decrease peripheral resistance, renal vascular resistance, HR and BP
168
AE of central acting a2 agonist
- dizziness
- drowsiness
- fatigue
- headache
169
indication for central acting a2 agonist - clonidine
- used for resistant HTN
| - ADHD, vasomotor menopausal sx, tourettes syndrome, adjust pain control
170
AE specific to central acting a2 agonist - clonidine
- dry mouth
| - rash with patch but patch typically decreases AEs
171
indication for central acting a2 agonist - methyldopa
first line option for HTN in pregnancy
172
ACEi indication
HTN, rEF HF, post MI, post stroke, kidney disease
173
MOA ACEi
- pril
- block conversation of angiotensin I to angiotensin II to increase blood vessel vasodinaltion to ultimately decrease Na and H2O retention
ONLY blocks angiotensin II by RAAS pathway
174
AEs of ACEi
- dry cough
- angioedema
- hypotension
- hyperkalemia
- acute renal failure
175
ARB MOA
- sartan
| - antagonist at AT1 receptor to block binding of angiotensin II
176
ACEi medications
lisinopril
enalapril
ramipril
177
indication of ARBs
use as alternative if ACEi-intolerant in HTN, kidney disease, HF
178
AE of ARBs
- similar to ACEi but no dry cough
- hypotension
- hyperkalemia
- acute renal failure
179
ARB medications
losartan
| valsartan
180
what are the sympathomimetics - indirect acting adrenergic drugs?
cocaine
amphetamine
ephedrine
181
MOA of sympathomimetics - indirect acting adrenergic drugs
release store NE or inhibit reuptake
182
drug classes used for angina treatment
- nitrates
- b blockers
- calcium channel blockers
183
Nitrates MOA
unknown BUT thought to vasodilate by acting on smooth muscle
| - decrease preload and after load to reduce the workload of the heart and lower O2 demands
184
what forms can nitrate be given
- IV
- sublingual spray, chewable, oral tablets
- topical transdermal
185
what is the drug of choice for acute angina attacks
sublingual nitrates
- immediate sx releif
- can be administered before activity to prevent sx
186
nitrate medications
nitroglycerin
| isosorbide mononitrate
187
how to store nitrates
- limit light exposure
- short shelf life (6 mo unopened, 3 mo once opened)
- tingling sensation to know it is active
188
dosing of nitrates
- after 1 dose, relief should onset w/ in 1-2 mins
- 2nd dose if sx still present after 5 mins
- up to 3 doses in a 15 min period
189
AE of nitrates
- reflex tachycardia
- dizziness
- OH
- weakness
190
what drug classes are used to predict angina (not used when angina occurs)
- b blockers
| - calcium channel blockers
191
when a cardiac event is suspected immediately take...
chew 325mg non-enteric coated aspirin
| - will prevent clots from forming
192
what are the three classes of antithrombotics
- antiplatelets
- anticoagulants
- fibrinolytics
193
antiplatelets...
prevent thrombus from happening
194
anticoagulants...
prevent initial thrombus and prevent extension of current thrombus
195
fibrinolytics...
lyse active thrombus
| - clot busters
196
antiplatelet classes
- aspirin
- ADP receptor inhibitors (irreversible)
- ADP receptor inhibitors (reversible)
197
aspirin MOA
inhibits COX 1 and 2 to inhibit platelet aggregation
| - at low doses (81mg) primarily inhibits COX 1 for cardiovascular protection
198
aspirin AE
BLEEDING RISK
199
ADP receptor inhibitors (irreversible) MOA
- P2Y12 inhibitors
- prevents platelet aggregation by blocking ADP binding
- irreversibly blocks P2Y12 receptor on platelets
- decreases platelet aggregation for lifespan of platelet (7-10 days)
200
indication for ADP receptor inhibitors (irreversible)
used after acute coronary syndrome with PCI (stent placement)
201
ADP receptor inhibitors (irreversible) AEs
- generally well tolerated
- BLEEDING RISK
- decreased efficacy in 50% of asians, 30% AA, 25% caucasians
202
ADP receptor inhibitors (irreversible) medications
clopidorgrel (Plavix)
| - pro drug!! CYP2C19 to active metabolite
203
ADP receptor inhibitors (reversible) MOA
- blocks ADP mediated activation to decrease platelet aggregation
- reversibly binds P2Y12 receptor on platelet surface
204
ADP receptor inhibitors (reversible) indication
used with acute coronary syndrome
| - up to 1 year or more after NSTEMI or STEMI
205
ADP receptor inhibitors (reversible) AEs
BLEEDING RISK
206
classes of anticoagulants
- heparin
- LMWH
- fondaparinux
- direct thrombin inhibitors
- vitamin K antagonist
- factor XA inhibitors
207
what are the DOAC drugs
all really eliminated
direct oral anticoagulant
- direct thrombin inhibitor
- factor XA inhibitor
208
heparin MOA
increases action of antithrombin which prevents conversion of fibrinogen to fibrin
209
heparin routes
IV or subut
210
heparin AEs
- requires platelet monitoring except when using for prophylaxis
- heparin induced thrombocytopenia
211
heparin reversal agent
protamine sulfate
| - binds to inactivate heparin
212
LMWH
| low molecular weight heparin MOA
- increases antithrombin but has a greater effect on inhibiting FXa than thrombin
213
LMWH medications
enoxaparin (Lovenox)
214
LMWH routes
IV or subut
215
LMWH compared to heparin
- shorter drug molecule
| - preferred bc more simple dosing, no monitoring required, decreased HIT risk
216
LMWH reversal agent
- protamine sulfate (less effective)
| - new agent: andexanet alfa (Andexxa), structurally similar to FXa so acts as a decoy
217
fondaparinux (Atrixtra) MOA
causes antithrombin-mediated selective inhibition of FXa
218
fondaparinux (Atrixtra) advantages
- once daily dosing
| - no hit risk
219
fondaparinux (Atrixtra) routes
IV or subut
220
vitamin K antagonist medications
warfarin (Coumadin)
221
vitamin K antagonist MOA
depletes vitamin K stores to inhibit synthesis of factors VII, IX, X, and II and protein C and S
222
vitamin K antagonist reversal agent
vitamin K
223
vitamin K antagonist AEs
- NTI drug
- frequent INR monitoring
- genetic variants can increase bleeding risk
- MANY DDI and food interactions
- cannot eat too many vitamin K foods
224
INR too low... what is the risk?
clotting
225
INR too high... what is the risk?
bleed
226
if a pt on vitamin K antagonist eats too much vitamin K...
INR will go down which will increase clotting risk
227
PO direct thrombin inhibitor MOA
inhibits conversion of fibrinogen to fibrin
228
PO direct thrombin inhibitor AEs
- less intracranial bleeding than warfarin but more GI bleeding
- beers list for increased risk of GI bleed in 75+
- dyspepsia (take w food)
229
PO direct thrombin inhibitor reversal agent
idarucizumab (Praxbind)
230
factor XA inhibitors MOA
- xaban
| - selectively and reversibly binds FXa to prevent fibrinogen from becoming fibrin
231
factor XA inhibitors medications
rivaroxaban (Xarelto)
| apixaban (Eliquis)
232
factor XA inhibitors AEs
- less intracranial bleeding than warfarin, but Xarelto has more GI bleed (on beers list)
- Apixaban has the lowest bleeding risk
- less DDI than warfarin
xarelto must be taken w food
233
factor XA inhibitors indication
usually used with high risk individuals
234
factor XA inhibitors reversal agent
andexanet alfa (Andexxa), structurally similar to FXa so acts as a decoy
235
factor XA inhibitors as a DOAC
shorter duration of action than warfarin so not preferred if pt is noncompliant
- but more convenient if using before a procedure
236
all antithrombotics...
monitor bleeding v clotting
| - understand when med is working "too well" or not enough
237
fibrinolytics MOA
- aka thrombolytics
| - mimic endogenous TPA, plasmin breaks fibrin links in the thrombus
238
fibrinolytics indication
use immediately after a stroke, MI, PE
| - aren't really used long term.. will be transitioned to another drug
239
fibrinolytics route
IV
240
VTE treatment in acute setting at diagnosis
may start with LMWH or heparin and bridge to PO meds
241
VTE long term treatment
1st line: DOAC
2nd: VKA
3rd: LMWH
exceptions
- use LMWH as 1st line in its with cancer
- questionable efficacy of DOACs in its with BMI > 40
242
AF treatment
1st line: DOAC
2nd: VKA
3rd: aspirin
243
HMG Coa Reductase Inhibitors...
"Statins"
244
statin medications
atorvastatin (Lipitor)
rosuvastatin (Crestor)
simvastatin
pravastatin
245
statin MOA
blocks HMG-CoA reductase = blocks cholesterol sysnthesis
246
statin AEs
myalgia
- usually symmetrical
- less likely with lower doses
- less likely with pravastatin and rosuvastatin bc they are hydrophilic
```
myopathy and rhabomyolysis
dyspnea
HA
increase liver function enzymes
tendonopathy
```
247
in what populations is myalgia more likely
- elderly female
- low BMI
- asian descent
- excess alcohol
- high PA level
- trauma
- in combo with other meds
248
what is rhabomyolosis
breakdown of muscle, dies and sends toxins to the kidneys
| - can cause kidney failure
249
cholesterol absorption inhibitor MOA
- ezetimibe (Zetia)
| inhibits absorption of cholesterol in small intestine
250
statin indication
atherosclerosis
251
cholesterol absorption inhibitor indication
atherosclerosis
252
cholesterol absorption inhibitor AEs
generally well tolerated
- not metabolized in CYP enzymes so far less DDIs
- less common than statins though bc has not been proven to reduce MI and stroke risk
253
Fibrates
- for atherosclerosis
| - generally well tolerated but may increase myopathy risk with statins
254
PCSK9 inhibitor
- for atherosclerosis
- subcut injection
- emerging role to reduce mortality in high risk patients .. doesn't yet do this
255
bempedoic acid (Nexletol)
- 1st non-statin PO in 20 yrs
- approved adjunct to statin for those with ASCVD who need additional LDL lowering
- not sure if it decreases risk of MI and stroke yet
- blocks cholesterol synthesis in the liver
- AEs: hyperuricemia and tendon rupture
256
atheroclerosis treatment
1st line: statin
2nd: ezetimibe added on if uncontrolled or cant have statin
3rd: bile acid sequestrates can be added or PCSK9 inhibitor if very high risk
257
what medication class will decrease edema and congestion
diuretics
258
what medication will increase contractility
digoxin
259
what medication class will decrease preload and after load
vasodilators, ACEi, ARB
260
ARNI (angiotensin receptor-neprilysin inhibitor) medication
sacubitril/valsartan (Entresto)
261
sacubitril/valsartan (Entresto) MOA
valsartan: vasodilation
sacubitril: inhibits neprilysin enzyme to vasodilate
262
sacubitril/valsartan (Entresto) AEs
ARB AEs but higher risk of angioedema
263
Digoxin MOA
inhibits Na/K/ATPase pump to increase contractility
| ionotripic drug
264
digoxin indication
not usually used first bc it does not reduce mortality, but used as an add on in heart failure
265
sacubitril/valsartan (Entresto) indication
heart failure combo product
| - reduced mortality more than ACEi
266
digoxin AEs
NTI
| affects Gi, CV, CNS
267
indication of amiodarone
used for ventricular arrhythmias
268
amiodarone MOA
prolong duration of action potential, blocks K, Na, and Ca channels
- some b blocker activity
269
amiodarone AEs
- VERY long half life
- TONS of side effects
- GI problems
- thyroid disfunction
- blurred vision
- ataxia
- liver toxicity
- neuropathy
- bradycardia
- blue effect
270
classes of drugs used to treat respiratory tract
- decongestants
- antitussives
- antihistamines
- mucolytics and expectorants
271
indication for decongestants
nasal stuffiness, allergies, common cold, respiratory tract infections
272
MOA decongestants
- alpha 1 adrenergic agonists
- cause vasoconstriction
- reduce blood flow and outflow of capillaries
273
decongestant AEs
- HA, dizziness, nervousness, nausea, CV irregularities, can mimic increased SNS activity
274
contraindications to decongestants
HTN
275
indication of antitussives
cough suppression
ONLY for dry cough
- recommended for short term use
276
MOA of antitussives
decrease afferent nerve activity or decrease coughs center sensitivity
- acts centrally
- thicken sputum, reduce clearance
277
antitussive medications
codeine and other opioid derivatives
278
antitussive AEs
sedation, dizziness, GI upset
| - opioid like sx (consultation)
279
antihistamines indication
used to manage respiratory and seasonal allergies
(hay fever, cedar fever)
- may be used in asthma
280
antihistamines MOA
block histamine receptors on respiratory mucosa OR acts as local anesthetic on respiratory epithelium
- acts locally
- reduces sneezing and nasal congestion
281
antihistamines first generation AEs
crosses BBB
| - sedation, fatigue, dizziness, blurred vision, incoordination
282
antihistamines second generation AEs
doesn't easily cross the BBB
| - less side effects, but great amount of variability
283
antihistamines medications
1st gen: benadryl
| 2nd gen: zyrtec, calritin, clarinem, allegra
284
mucolytics indication
difficultly cleaving mucous from airway
| - nasal congestion
285
mucolytics MOA
split disulfide bonds
- decrease the viscosity of mucus
- loosens and clears mucus from the airways
286
MOA of expectorants
thins mucus and lubricates the irritated respiratory tract
287
indication of expectorants
acute and chronic conditions from colds to emphysema or chronic bronchitis
288
inhaled b agonist indication
COPD
289
inhaled b agonist MOA
- terol
| - agonize b2 receptors to bronchodilate
290
two types of inhaled beta agonists
short acting SABAs
| long acting LABAs
291
inhaled b agonist medication
albuterol (Proventil, Pro Air Ventolin)
| SABA
292
SABA
- onset: 5 mins
- 4-6 hours duration
- PRN use for SOB
293
LABA
- 12-14 hour duration
- used for maintenance
- dose once/twice daily
294
inhaled b agonist AEs
- generally well tolerated
| - can cause tachycardia, tremor, hypokalemia, hyperglycemia
295
inhaled antimuscarinics indication
COPD
296
inhaled antimuscarinics MOA
- aka antimuscarinics
| binds M3, antagonizes ACh to bronchodilate
297
two types of inhaled antimuscarinics
short acting SAMA
| long acting LAMA
298
SAMA
short acting muscarinic antagonist
- onset: 15-20 mins
- 6-8 hour duration (longer with neb)
299
inhaled antimuscarinics medications
LAMA
| tiotropium (Spiriva)
300
LAMA
long acting muscarinic antagonist
- used for maintenance
- dosed once/twice daily
301
inhaled corticosteroid medication
fluticasone (Flovent)
302
inhaled corticosteroid indication
COPD, typically used for exacerbations or more severe disease
- unclear safety if used for > 3 years
303
inhaled corticosteroid MOA
anti-inflammatory
304
inhaled corticosteroid AE
- if med is stopped monitor!
- PO steroids have many AE and no evidence of benefit in stable COPD
- oral candidiasis
- hoarse voice
- skin bruising
- increase risk of pneumonia
in elderly on high doses
- osteoporosis
- cataracts
305
what are the combo products used to treat COPD
- SABA and SAMA
- LABA and LAMA
- LABA/ICS
- LABA/LAMA/ICS
306
SABA/SAMA medication
albuterol/ipratopium (Combivent)
307
LABA/ICS medications
formoterol/budesonide (Symbicort)
| salmeterol/fluticasone (Advair)
308
when are antibiotics used in COPD
- used in acute exacerbations
| - extended treatment only in its prone to exacerbations
309
ICS used in asthma - meds
- in peds it may slow growth rate, but also many be due to asthma
310
LABA used in asthma
- used ONLY in combo with ICS
- helps to lower ICS dose to prevent ICS AEs
- used for sx reduction, improved lung function and to decrease exacerbatins
311
medication classes used to treat asthma
- ICS
- SABA and LABA (inhaled b agonist)
- luekotriene modifiers
- immunomodulators
312
leukotriene modifies - 2 types
- leukotriene receptor antagonist (LTRA)
| - 5-lipoxygenase inhibitor
313
MOA of leukotriene receptor antagonist (LTRA)
competitively antagonize leukotriene receptors
314
leukotriene receptor antagonist (LTRA) medications
montelukast (Singulair)
| - take once daily in the evening for asthma and in the morning for allergies
315
leukotriene receptor antagonist (LTRA) AEs
- very well tolerated
316
leukotriene receptor antagonist (LTRA) indication
used as an alternative agent for kids and adults
| - often used for asthma+allergies
317
5-lipoxygenase inhibitor MOA
inhibits 5-lipoxygenase
318
5-lipoxygenase inhibitor indication
used only as an asthma alternative for adults
319
5-lipoxygenase inhibitor AEs
- rare hepatoxicity (monitor LFTs)
320
Immunomodulators: Anti-IgE medications
omalizumab (Xolair)
321
Immunomodulators: Anti-IgE MOA
- mab
| - binds IgE antibody, limits activation and release of allergic response mediators
322
Immunomodulators: Anti-IgE AEs
injection site reaction
| - rare by anaphylactic allergic reaction may occur, must be administered in doctors office
323
Immunomodulators: Interleukin Antagonists MOA
- mab
| - monoclonal antibodies bind interleukins, decrease eosinophils which are associated with asthma pathologies
324
Immunomodulators: Interleukin Antagonists AEs
injection site reaction
325
drug classes used to treat cystic fibrosis
- inhaled b agonist (SABA and LABA)
- CFTR modulators
- mucolytics
- inhaled/PO antibiotics
326
when will bronchodilators be used in CF
use LABAs for maintenance
SABAs used prior to
- chest physiotherapy
- other inhaled meds that may induce bronchospasm
- exercise
327
CFTR
- transmembrane regulator protein that regulates sodium and water to keep mucus thin
- genetic mutations stop CFTR from getting to cell surface
- ALL over the body
328
MOA of CFTRs
- chloride channels open longer to increase CFTR activity
| - facilitates CFTR to cell membrane which will increase chloride transport
329
CFTR medications
tezacaftor/ivacaftor (Symdeco)
| lumacaftor/ivacaftor (Orkambi)
330
administration of CFTRs
PO twice daily or twice weekly
| - must take with high fat meals to increase absorption
331
CFTR AEs
- HA
- GI (pain, N/D)
- respiratory
okrambi
- dizziness and hypertension
332
mucolytics indication
used to decrease risk of CF exacerbations, increase lung function and quality of life
333
2 types of mucolytics
- hypertonic saline
- dornase alfa (Pulmozyme)
use both if you can afford
334
hypertonic saline
type of mucolytic
- neb 2-4 times daily
- increases hydration of airway mucus
335
dornase alfa (Pulmozyme)
type of mucolytic
- neb daily or twice daily
- cleaves DNA to decrease mucus viscosity to improve airway
- AE: chest pain, cough, voice disorder, skin rash
336
indication of inhaled antibiotics
CF
- to decrease risk of exacerbations and increase function and QOL
- used long term if P. aeruginosa is persistent in cultures
benefit > risk
337
inhaled antibiotics administration
neb twice or three times daily x28 days and then 28 days off
338
PO antibiotics for CF
- used to decrease risk of exacerbations
- can be used w out without P. aeruginosa
- AE: macrolide AEs
339
nutritional support for CF
use fat soluble vitamins that have poor absorption
340
pancreatic enzyme replacement therapy (PERT) for CF
take with H2 blockers or PPI to maintain an alkaline environment in the stomach as it can reach the small intestine where it is broken down
- needed prior to every meal or snack
