Exam 2 Meds Flashcards

Question

Montelukast (Singulair)

Answer 1

Leukotriene Modifiers Chronic asthma, allergic rhinitis Inhibits the cysteinyl leukotriene (CysLT1) receptor, which is correlated with the pathophysiology of asthma, including airway edema and smooth muscle contraction Notto be used for asthma exacerbation•May be used in pregnancy and caution in lactation

Answer 2

Leukotriene Modifiers Chronic asthma Inhibits 5-lipoxygenase, the enzyme that catalyzes the formation of leukotrienes from arachidonic acid Not recommended in pregnancy and lactation Should not be used in active liver disease

Answer 3

Corticosteroids Extremely potent vasoconstrictive and anti-inflammatory activity do not use for asthma exacerbation, can cause oral candida

Answer 4

Inhaled Anti-Inflammatory Agent Asthma, bronchospasm prophylaxis, allergic rhinitis Inhibits antigen-induced bronchospasm and blocks the release of histamine by inhibiting mast cell degranulation not for asthma exacerbation-

Answer 5

Inhaled Antihistamines Seasonal allergic rhinitis and vasomotor rhinitis Inhibit the release of histamine by competing with histamine at H1 receptor sites Not to be combined with CNS depressants•Avoid driving or operating heavy machinery Somnolence (greater with azelastine)

Answer 6

First-Generation Antihistamines Allergic rhinitis, hypersensitivity reactions, urticaria and angioedema, insomnia, motion sickness antiemetic Competitively antagonizes the effects of histamine at the peripheral H1 receptor sites at the GI tract, blood vessels, and respiratory tract Caution in elderly patients and young children Alternative agents recommended in pregnancy- avoid in lactation Sedation, dizziness, confusion, ataxia, urinary retention, paradoxical excitation, dry mouth, tremor, blurred vision

Answer 7

Second-generation antihistamines Respiratory allergies, urticaria Competitively antagonize the effects of histamine at the peripheral H1 receptor sites at the GI tract, blood vessels, and respiratory tract AE= headache, drowsiness, nervousness

Answer 8

Sudafed, Afrin Avoid in severe hypertension and coronary artery disease (oral)•Not recommended for children younger than four years (oral)•Not recommended in pregnancy and lactation•Avoid in combination with beta blockers Anxiety, restlessness, headache, insomnia, psychological disturbances, tremors, hypertension, tachycardia

Answer 9

Antitussive Acts centrally in the medulla to elevate the threshold for coughing; structurally related to codeine Avoid in persistent or chronic cough caused by smoking, asthma, or emphysema drowsiness, dizziness, and GI upset

Answer 10

Antitussive Direct effect on cough receptors in the medulla Avoid in persistent or chronic cough caused by smoking, asthma, or emphysema risk of abuse; drowsiness, dizziness, and GI upset

Answer 11

Antitussive Related to anesthetic tetracaine and thought to anesthetize the stretch receptors in the respiratory passages, calming the cough Avoid in persistent or chronic cough caused by smoking, asthma, or emphysema chest numbness, dizziness, GI upset, headache, and “chilly” sensation

Answer 12

Expectorant

Answer 13

Aluminum hydroxide, magnesium hydroxide, calcium carbonate Indications: Hyperacidity, peptic ulcer disease, GERD Antacids are weak bases that interact with hydrochloric acid in your stomach to reduce gastric acidity and increase pH Avoid aluminum-and magnesium-based in renal impairment Avoid calcium-based in hypercalcemia Caution in patients who are on sodium restriction calcium and aluminum cause constipation while mag causes diarrhea Take at least 2 hours before or after other meds

Answer 14

cytoprotective agents Prophylaxis and treatment of duodenal ulcers associated with NSAID use and treatment for duodenal ulcers from other causes Selectively binds to necrotic ulcer tissue, covering it and acting as a barrier for outside stimuli such as acids Compatible with pregnancy and lactation•Limited data in children•Caution in geriatric patients with CrCl less than 30 mL/minute AE= constipation, GI upset

Answer 15

Cytoprotective Agents Prophylaxis and treatment of duodenal ulcers associated with NSAID use Inhibition of gastric secretion through inhibition of histamine stimulated cAMP•Mucosal protective qualities by increasing mucus and bicarbonate Avoid in pregnancy and lactation Diarrhea, abdominal pain, nausea, postmenopausal bleeding, headache

Answer 16

Histamine 2Receptor Antagonists Mild intermittent GERD, peptic ulcer disease, heartburn Reversible competitive inhibition of histamine at H2 receptors of the gastric parietal cells, thus inhibiting gastric acid secretion Caution in renal impairment•Compatible with pregnancy and lactation•Approved in pediatrics AE: Headache, dizziness, confusion

Answer 17

Proton Pump Inhibitor Duodenal and gastric ulcers, erosive gastritis, Zollinger-Ellison syndrome, GERD Inhibit gastric proton pumps specifically, the H+/K+-ATPase pump, located on the parietal cells to suppress acid secretion Black box warning for omeprazole and clopidrogel Compatible in pregnancy and lactation Approved in pediatrics

Answer 18

antimotility agent Inhibits excessive GI motility and GI propulsion. Atropine is added to this agent, which provides anticholinergic effects that decrease secretion in the bowel and slow peristalsis

Answer 19

antimotility agent Acts through opioid receptors to inhibit peristalsis and prolong gastric time. It also reduces fecal volume and diminishes loss of fluid and electrolytes

Answer 20

Exhibits both antisecretory and antimicrobial action and may have some anti-inflammatory action as well

Answer 21

Kaolin is a clay-like powder that attracts and holds bacteria, and pectin thickens the stool by absorbing moisture

Answer 22

Can provide bulk to your stools by absorbing water in the GI tract

Answer 23

5HT3 Receptor Antagonists Blocks serotonin both peripherally on vagal nerve terminals and centrally in the CTZ Caution in QT prolongation•Caution with other serotonin medications•Caution in pregnancy and lactation AE: headache, constipation, fatigue

Answer 24

Antihistamines In addition to competing with histamine for H1 receptor sites, they also block the CTZ, diminish vestibular stimulation, and depress labyrinthine function through its central anticholinergic activity Drowsiness, dry mouth, blurred vision, urinary retention, and paradoxical excitation in children may occur Avoid in elderly patients included in Beers list. In elderly patients, you can have an increased risk for confusion and CNS depression- compatible with pregnancy, avoid in lactation

Answer 25

Anticholinergics Blocks the action of acetylcholine at the parasympathetic sites in smooth muscle, CNS, and secretory glands AE: Drowsiness, dry mouth, blurred vision, urinary retention, dilated pupils Avoid in pregnancy and lactation and peds Avoid in elderly patients

Answer 26

Phenothiazines Block dopamine receptors in the CTZ as well as cholinergic, alpha 1 adrenergic, and histamine 1 receptors Sedation, extrapyramidal reactions, agranulocytosis, dry mouth, blurred vision, constipation, bradycardia, hypotension Avoid in elderly patients Other agents preferred in pregnancy; avoid in lactation

Answer 27

Cannabinoids Activates CB1 receptors in the brain, which prevents the pro-emetic effects of endogenous compounds such as dopamine and serotonin Depression, dizziness, paranoid thoughts, somnolence, palpitations, tachycardia, hypotension High potential for abuse•Avoid in pregnancy and lactation Caution in patients with seizure disorder- do not use for kids under 12

Answer 28

Prokinetic Agent Dopamine receptor antagonist in the CNS leading to prevention of nausea; also stimulates motility in the upper GI tract AE: Black box warning for extrapyramidal side effects, depression, drowsiness, dizziness, diarrhea, and hypoglycemia Can prolong QTc•High potential for abuse; can be used in pregnancy/peds, avoid in lactation

Answer 29

Stimulants Stimulates the myenteric plexus, which results in prostaglandin release and increase cAMP concentration May be used in pregnancy and lactation

Answer 30

Bulk Laxatives Soluble fiber that absorbs water in the intestine to form a viscous liquid that promotes peristalsis and reduces transit time Caution in narrowed esophageal or intestinal lumen

Answer 31

Osmotic Draw water into the intestinal lumen to increase intraluminal pressure, which distends the colon and increases peristalsis Caution with lactulose in diabetic patients•Caution with magnesium-based preparations and renal impairment•All may be used in pregnancy and lactation

Answer 32

Stool Softener Reduces the surface tension of the oil–water interface on the stool and facilitates admixture of fat and water into the stool, producing an emollient action Compatible with pregnancy and lactation

Answer 33

Lubricants Eases passage of stool by decreasing water absorption and lubricating the intestine Avoid in pregnancy and lactation•Avoid in elderly per Beers Criteria AE: Abdominal cramping, diarrhea, nausea, oily rectal leakage, vomiting

Answer 34

Chloride Channel Activators Activates chloride channels in the GI epithelial lining, producing chloride-rich secretions that soften the stool and increase motility Not recommended in pediatrics and pregnancy

Answer 35

Opioid-Receptor Antagonists Antagonist at mu receptors in the GI tract Known or suspected bowel obstruction•Caution in pregnancy•Not recommended in pediatrics

Answer 36

ACE Inhibitors Hypertension, hypertensive proteinuric diabetes, angina and ischemic heart disease, post-MI, heart failure Lower blood pressure by inhibiting the conversion of angiotensin I to angiotensin II, which is a potent vasoconstrictor. They also inhibit the degradation of bradykinin and increase the synthesis of vasodilating prostaglandins Avoid in pregnancy and lactation Approved in >6 y/o

Answer 37

ARBs Hypertension, hypertensive proteinuric diabetes, angina and ischemic heart disease, post-MI, heart failure Block the angiotensin II receptors, which is a potent vasoconstrictor. By reducing the levels of angiotensin II, there is also a reduction in aldosterone secretion, which reduces the retention of sodium and water Avoid in pregnancy and lactation Caution with other medications that can cause hyperkalemia Dizziness, hypotension, hyperkalemia, fatigue, URI

Answer 38

Dihydropyridines Hypertension and angina Inhibit calcium ions from crossing the cell membrane, resulting in a marked decrease in transmembrane calcium content and prolonged vascular smooth muscle relaxation Avoid in patients with significant peripheral edema Approved in pediatrics >6 y/o

Answer 39

Non-Dihydropyridines Angina, hypertension, atrial fibrillation, SVT Inhibit calcium ions from crossing the cell membrane, resulting in a decrease of calcium content, leading to vascular smooth muscle relaxation and coronary vasodilation Avoid if SBP is below 90 mmHg, Avoid in HF with ejection fraction of less than 40%, ventric dysfunction, pregnancy and lactation Edema, headache, gingival hyperplasia, constipation

Answer 40

Thiazide Diuretics Hypertension, mild fluid retention Act on the distal renal tubule to inhibit sodium reabsorption Caution in elderly•Compatible with pregnancy

Answer 41

Loop Diuretics Edema associated with congestive heart failure, hepatic cirrhosis, and renal disease Inhibits sodium reabsorption in the ascending loop of Henle Avoid in patients who are anuric

Answer 42

Potassium-Sparing Diuretics Edema related to CHF Competes with aldosterone for receptor sites in the distal renal tubules, increasing sodium and water excretion and maintaining potassium AE: Gynecomastia, hyperkalemia, rash, hyperuricemia, hyponatremia

Answer 43

Atrial fibrillation, atrial flutter Class III antiarrhythmic agent that inhibits adrenergic stimulation, affects sodium, potassium, and calcium channels, and prolongs the action potential and refractory period in the myocardium Prescribing in pregnancy and lactation via cardiologist Increased risk of development of pulmonary fibrosis Increased risk for hypothyroidism or hyperthyroidism Extrapyramidal syndrome, hepatic dysfunction, corneal deposits, peripheral neuropathy, and extreme burning photosensitivity which can result in blue-gray skin tone Need to monitor w/ Monitoring•Chest x-ray, pulmonary function tests•Thyroid stimulating hormone (TSH), free T4•Ophthalmic exam•Liver function tests

Answer 44

Atrial fibrillation, supraventricular tachycardia, heart failure inhibits the sodium potassium (ATPase) pump in myocardial cells, which results in a transient increase in intracellular sodium, which promotes calcium influx leading to increased contractility•Decreases positive inotropic effect, enhances vagal tone, and decreases ventricular rate Fatigue, anorexia, nausea and vomiting, diarrhea, visual disturbances

Answer 45

increases nitric oxide and cGMP...desphorylation of myosin light chain...vascular smooth muscle relaxation

Answer 46

Vasodilators Hypertension, heart failure Acts by direct relaxation and dilation of arteriolar smooth muscle, leading to a decrease in peripheral vascular resistance Avoid in patients who have CAD Caution in pregnancy•Compatible with lactation

Answer 47

HMG CoA Reductase Inhibitors Block the conversion of HMG-CoA to mevalonate, which is the rate-limiting step in the production of cholesterol in the liver. Blocking cholesterol production leads to an increase in the number of LDL receptors in the liver, allowing for a larger amount of LDL and VLDL to be taken up by the liver Avoid in pregnancy and lactation Myalgia, arthralgia, diarrhea, nausea, abdominal pain, headache

Answer 48

This is a naturally-occurring B vitamin with the MOA uncertain. It appears to reduce VLDL synthesis, inhibits lipolysis in adipose tissue, and increase lipoprotein lipase activity Avoid with active peptic ulcers•Avoid in pregnancy and lactation Pruritus, flushing, rash, diarrhea, hepatotoxicity (rare)

Answer 49

Fibrates Increase lipolysis of triglycerides via lipoprotein lipase, resulting in a large decrease in triglyceride, thus increasing HDL Increased serum transaminases, dyspepsia, abdominal pain, diarrhea Avoid in pregnancy and lactation

Answer 50

Bile Acid Sequestrants Forms a nonabsorbable complex with bile acids in the intestine; inhibits enterohepatic reuptake of intestinal bile salts, resulting in increase fecal removal of LDL cholesterol Flatulence, bloating, abdominal pain, constipation Avoid in patients with triglyceride levels of greater than or equal to 300 mg/dL Recommended in pregnancy and lactation when treatment is needed

Answer 51

Cholesterol Absorption Inhibitors Blocks the absorption of cholesterol across the intestinal border AE= Fatigue, diarrhea, increased serum transaminases, arthralgia Avoid in pregnancy and lactation

Answer 52

PCSK9 Inhibitors Human monoclonal antibody that binds to PCSK9 and inhibits the binding of PCSK9 to LDL receptors allowing for increased LDL receptors on the cell surface, decreasing LDL in the blood stream Avoid in pregnancy and lactation • Evolocumab may be used in children older than 13 years

Answer 53

Stimulates glucose entry into cells • Increases storage of glucose as glycogen in muscle and liver cells • Inhibits glucose production in liver and muscle cells • Promotes protein synthesis by increasing amino acid transport into cells • Enhances fat storage and prevents mobilization of fat for energy Close monitoring in patients with: Hepatic dysfunction • Renal impairment • Pregnancy • Hypo- and hyperthyroidism

Answer 54

It accelerates liver glucogenolysis, which results in increased breakdown of glycogen to glucose and inhibition of glycogen synthesis. This leads to elevated blood glucose levels Contraindicated if there is a hypersensitivity to glucagon or lactose • Avoid in patients with insulinoma or pheochromocytoma

Answer 55

Rapid: onset of 15 minutes, peak 30-90 minutes, lasts for 5 hours. Have meal at bedside Regular: onset of 30 minutes, peak of 1-2 hours, lasts 3-7 hours MPH (intermediate acting): onset 1.5 hours, peak 4-12 hours, duration of 10-16 hours Determir: glargine- onset 3-6 hours, NO PEAK, lasts about 24 hours

Answer 56

Biguanides Increases peripheral glucose uptake and utilization, thus improving insulin sensitivity; decreases hepatic glucose production and intestinal absorption of glucose ``` Avoid with eGFR less than 30 • Caution: with eGFR between 30–45, would require close monitoring • Hold 48 hours before to 48 hours after radiologic studies with contrast • Avoid in liver disease • Insulin first-line therapy in pregnancy, though metformin may be considered by OB ``` AE: Lactic acidosis (rare), diarrhea, bloating, nausea, flatulence, headache, vitamin B12 deficiency

Answer 57

Thiazolidinediones (TZDs) Enhances insulin sensitivity by improving insulin action in the cell. This leads to increased utilization of available insulin by the liver and muscle cells as well as adipose tissue. Also decreases hepatic glucose production Avoid in patients with NYHA class III and IV heart failure • Avoid in patients with ALT levels greater than 2.5 times above normal limit • Avoid in active or history of bladder cancer • Increase risk for bone fractures • Avoid in pregnancy, lactation, and children younger than 18 years of age AE: Fluid retention, weight gain, headache, myalgia, hypertension, URI

Answer 58

Sulfonylureas Cause an increase in endogenous insulin secretion by the beta cells of the pancreas. Reduce glucose release from the liver avoid in elderly, children, pregnancy, lactation AE: Hypoglycemia, weight gain, nausea, epigastric fullness, heartburn, rashes, pruritus, urticaria, agranulocytosis (rare)

Answer 59

Meglitinides Block ATP-dependent potassium channels, depolarizing the membrane and facilitating calcium entry through calcium channels. Increased calcium stimulates insulin release from pancreatic beta cells • Short-acting insulin secretagogues that are most effective at reducing postprandial blood glucose levels avoid in elderly, pregnancy, lactation AE: Hypoglycemia, weight gain, headache, diarrhea, arthralgias, chest or back pain

Answer 60

Alpha-Glucosidase Inhibitors used for diabetes- poop out the glucose Competitively inhibits the absorption of complex carbohydrates from the small bowel Flatulence, diarrhea, abdominal pain, elevated serum transaminases Avoid in bowel diseases • Caution in renal and hepatic impairment • Avoid in patients predisposed to intestinal obstruction • Avoid in pregnancy and lactation

Answer 61

Selective Sodium-Glucose Cotransporter 2 Inhibitors (SGLT-2) Inhibit renal SGLT-2 in the proximal tubule, blocking the reabsorption of glucose in the kidneys. This leads to increased urinary glucose excretion and reduction of plasma glucose AE: Hyperkalemia, GU fungal infections, UTI, renal insufficiency, urinary frequency, hypotension, urticaria Black box warning: risk of Fournier’s gangrene • Avoid with eGFR less than 30 • Increased risk for bone fractures • Avoid in pregnancy and lactation

Answer 62

Dipeptidyl Peptidase-4 Inhibitors (DPP-4) ``` Inhibit DPP-4 enzyme, resulting in prolonged incretin (GLP-1 and GIP) hormone levels *incretin is part of the insulin secretory response to food ``` Caution in renal impairment (except for linagliptin) • Avoid in pregnancy and lactation AE: Hypersensitivity reactions (rare), acute pancreatitis (rare), arthralgias, hypoglycemia

Answer 63

``` Glucagon-Like Peptide 1 Receptor Agonists (GLP-1) ``` Analog of the incretin hormone GLP-1, which increases glucose-dependent insulin secretion, decreases inappropriate glucagon secretion, and slows gastric emptying AE: Nausea and vomiting, diarrhea, injection site reaction, headache Avoid in moderate- to end-stage renal disease • Avoid in patients with severe GI disease • Black box warning: risk of thyroid c-cell tumors • Limited data in pregnancy and lactation

Answer 64

Synthetic form of T4, which is an endogenous hormone secreted by the thyroid gland. T4 is converted to its active metabolite T3. These hormones then bind to thyroid receptor proteins in the cell nucleus and exert metabolic effects through control of DNA transcription and protein synthesis Avoid after recent MI • Caution in patients with cardiovascular disease • Caution in patients with adrenal insufficiency • Compatible in pregnancy and lactation avoid in peds AE: Increased heart rate, increased blood pressure, anxiety, nervousness, insomnia, weight loss

Answer 65

Inhibits the synthesis of thyroid hormones by blocking the oxidation of iodine in the thyroid gland; does not inactivate circulating T3 and T4 AE: Drowsiness, headache, arthralgia, skin rash, urticaria, fever, agranulocytosis (rare), hepatitis (rare) Avoid in first trimester of pregnancy • Use lowest dose in lactation • Approved in pediatrics • Use with caution with other medications that can suppress bone marrow

Answer 66

Inhibits the synthesis of thyroid hormones by blocking the oxidation of iodine in the thyroid gland; also blocks conversion of T4 to T3 in the peripheral tissues. Does not inactivate circulating T3 and T4 AE: Drowsiness, headache, arthralgia, skin rash, urticaria, fever, agranulocytosis (rare), hepatitis (rare) ``` Black box warning: hepatotoxicity • Use lowest dose in lactation • Avoid in pediatrics • Increased bleeding risk • Use with caution with other medications that can suppress bone marrow ```

Exam 2 Meds Flashcards

(90 cards)