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Flashcards in Exam 3 Deck (112)
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1

acarbose

-blocks glucose absorption in intestines
s/e diarrhea, foul flatus

2

actos (pioglitazone)

thiazolinedione (TZD) derivative
• enhances insulin activity
-not often used anymore due to HF and bladder CA, CV effects
-may have elderly that use it

3

acetaminophen

fever and mild pain, safe in pregnancy
-overdose is toxic to liver, don't use with alcohol

4

acetazolamide (Diamox)

diuretic and carbonic anhydrase inhibitor
-promotes excretion of bicarb
• Treats glaucoma, HTN, CHF, altitude sickness, epilepsy

5

s/e caution and interactions of acetazolamide

• s/e fatigue, abdominal pain, N/V, parasthesia, Stevens-johnson
• don’t use for patients with renal or hepatic dysfunction
• interacts with abx, sodium bicarb, amphetamines and salicylates

6

Acetylsalicylic acid (ASA)

• reduced inflammation, low dose can be safe in pregnancy
-decreases platelet aggregation
-risk of Reyes syndrome in kids

7

Aldosterone antagonist- spironolactone

-blocks Na and water resorption, k sparing
• treat HTN and HF, no androgen effects

8

s/e and caution with aldosterone antagonists (ex: epelernone)

• s/e hyperkalemia, hypotension, dizzy, impaired renal fxn
• avoid azole antifungals and macrolide antibiotics
-monitor K, watch out for salt supplements and k sources

9

Alpha adrenergic antagonist- prazosin (minipres)

• blocks vasoconstriction
• not first line drug for elderly (inc risk orthostatic hypotension)

10

amicar

antifibrinolytic agent
-prevents clot breakdown
-treats acute bleeding syndromes, leaking cerebral aneurysm

11

amiodarone

k channel blocker (blocks repolarization phase), iodine based
-regulate atrial and ventricular rhythms
• monitor QT interval, monitor thyroid levels
-risk of fibrosis alveolitis, need f/u cxrays
-can get yellow vision or blue skin, use sunscreen.
• can treat chronic stable angina or Prinzmetals

12

drug/drug with amiodarone

• don’t give with dantrolene, Cardizem, simvastain

13

Angiotensin II receptor antagonist- ex valsartan

• first tx for HTN in CKD
• decrease BP and afterload, some natriuretic and diuretic properties
• decreases cardiac myocyte hypertrophy
• promotes vasodilation, reduces vasopressin, reduce aldosterone
• renal protective in DM

14

can you give ARB in pregnancy?

nope

15

If allergic to ___ then allergic to ___

ACE, ARB

16

angiotensin converting enzyme inhibitor (ex: vasotec)

• first tx for HTN in CKD
• can also delay progression of diabetic nephropathy by blocking breakdown of bradykinin and substance P

17

ACEi s/e

• s/e is cough, angioedema

18

Aquamephyton

vit K replacement
• reverses coumadin, monitor INR

19

beta adrenergic antagonists (ex: propanolol, nadalol, metoprolol)

-membrane stabilizing effect, decrease excitability (PVCs and atrial rhythms)
-for exercise induced angina
-reduces CNS activity

20

c/i for beta blockers

COPD/Asthma, Reynauds, bradycardia, HF, DM, pregnancy, lactation
-don't give with Verapamil or Adenosine, decreased effect when given with NSAIDs

21

s/e with beta blockers

• s/e bradycardia, HF, fatigue, depression, sleep disturbance, N/V

22

propanolol

non-specific Beta

23

nadalol

a and B action

24

metoprolol

B1 specific blocker

25

Ca channel blocker (ex diltiazem and nifedipine)

prevent inward movement of calcium
• for Prinzmetals, migraine, reynauds, HTN, post infarction to preserve muscle
• dilate peripheral and coronary arteries- reduces systemic vascular resistance

26

c/i for ca channel blockers

• c/i in heart block, sick sinus syndrome, renal and hepatic dysfunction
• inhibits metabolism of many drugs like b adrenergics

27

s/e for ca channel blockers

• s/e dizziness, H/A, fatigue, hypotension, bradycardia, edema

28

L calcium channel

muscle, neurons (verapamil and nifedipine)

29

first HTN meds for blacks

thiazide and ca channel blockers

30

Carbonic Anhydrase inhibiter- ex acetazolamide (Diamox)

• reduces the activity of carbonic anhydrase (enzyme which catalyzes the reaction between carbon dioxide and water into carbonic acid and then bicarbonate)
• will see increased bicarb excretion and mild increase in Na and K excretion

31

Chlorothiazide- thiazide diuretic

• inhibit the na/cl resorption
-good for salt sensitive HTN (elderly and black pts)

32

clonidine

centrally acting alpha agonist
-dec sympathetic outflow
-used HTN, withdrawal, ADHD

33

Clopidogrel (plavix)

• anti-platelet, dec risk of stroke and MI
-don't need frequent bloodwork
-no reversal
-risk of bleeding into spinal cord when spinal taps
• don’t give with Tagamet and azole, grapefruit

34

coumadin

• anti-coagulant, inhibits vitamin K clotting factors
• need to monitor INR
• levothyroxine increases breakdown of vit k thus enhancing coumadin, may need to reduce dose

35

Digoxin- cardiac glycoside

• blocks Na/K atpase- increase in intracellular Ca for stronger contraction
• vagatonic- slows SA nodal rate of fire (afib and atrial rhythms)
*monitor labs, esp K, narrow therapeutic window
-need to dig load cuz long half life

36

antidote to digoxin

digibind

37

Entresto

• Combo of neprilysin inhibitor, sacubitril and valsartan (ARB)
-will have elevated BNP to promote diuresis

38

s/e Entresto and monitor

• s/e hypotension, hyperkalemia, cough, dizzy, renal failure
-monitor with pro-nBNP, cxray

39

neprilysin

breaks down naturietic peptides and other vasoactive compounds

40

Epinephrine

• neurotransmitter
-B adrenergic effects, mobilizes glucose stores

41

Exenatide (Byetta)- synthetic Incretin peptide

• Secreted by Gi at meals to delay emptying and reduce appetite
• Enhanced insulin secretion, prevents glucagon release
• Given 30 min before meals

42

s/e of exenatide (Byetta)

• s/e hypoglycemia, N/D, HA, dizzy

43

Furosemide (Lasix)-

loop diuretic, will lose K
-used in HF
• monitor BMP, K levels

44

Glipizide

a sulfonylurea
-stimulates insulin release from pancreas (****risk for hypoglycemia*** )
-risk of allergy to other sulfa drugs

45

Glucagon

rapidly elevates BG
• Naturally is a peptide hormone produced by alpha cells of the pancreas
• Causes liver to perform glycogenolysis which converts stored glycogen into glucose which is released into the bloodstream

46

Glucocorticoids/Cortisol

• secreted from adrenal cortex
-negative feedback response
-secreted as it is produced--need to taper med
-diurnal rhythm- highest in AM

47

Growth Hormone

- normally produced in the ant pituitary gland, can be used for doping
-secreted as you sleep
-important for wound healing
-counter regulatory hormone- at risk for hyperglycemia

48

H2 Receptor Antagonist examples

• cimetidine (Tagamet)- interferes with many drugs
• famotidine (Pepcid)- more potent, less adverse effects, less drug-drug interactions
-OTC meds

49

Helicobacter pylori Treatment

• Supress acid (PPI, H2, bismuth subsalicylate)
• And at least 2 abx (flagyl and tetracycline) or (flagyl and amoxicillin)
**can give tagamet
-diagnose by carbonurea breath test, endoscopy

50

Hydrochlorothiazide- thiazide diuretic

• blocks Na/Cl transporter in distal convoluted tubule
• reduce volume and decrease peripheral vascular resistance

51

s/e and caution with hydrochlorothiazide

• s/e hypokalemia, inc uric acid, impaired carb intolerance, hyponatremia
• allergy- sulfonamides, photosensitivity, hemolytic anemia

52

Hydralazine and s/e

• smooth muscle relaxer, arterial vasodilator, need to maintain fluid volume status
• s/e tachycardia, edema, H/A, GI, Lupus

53

can hydralazine be given in pregnancy

yes

54

can ibuprofen be given in pregnancy

no, increases bleeding

55

parenteral insulin

from animal sources, no longer used, hard to know what is consists of

56

Humulin

- recombinant DNA tech, less antigenic

57

inhaled insulin

- rapid, T1DM, lung function tests

58

Invokana- Sodium glucose transport 2 inhibitor

• Resorption of glucose in renal proximal tubules
• Increased excretion of glucose in urine
**doesn't interact with incretins

59

caution and s/e with invokana

• s/e KETOACIDOSIS, dehydration
• *don’t give in renal insufficiency, or frequent UTI/yeast infection
• Caution with ACE, ARBS, K sparin diuretics

60

Lantus (insulin glargine)

• Long acting, cannot be mixed with other insulins, once daily, initial dose 10 u per day
• Given with lispro for basal/bolus approach

61

Lispro- insulin analogue

• ultra short acting, give 15 min prior to meal, peak seen in 30 min
• Used with lantus for basal/bolus approach

62

Maalox

contains aluminum hydroxide, mag hydroxide, and simethicone (don't give with other meds)
• Antacid treatment, can be combined with PPI and H2 inhibitors
-s/e diarrhea

63

is maalox safe in pregnancy

yes

64

Metformin/Biguanides

• increase sensitivity of tissues to insulin, reduce hepatic gluconeogenesis
-T2DM and pre-diabetes, pregnancy, polycystic ovarian syndrome

65

s/e and caution of metformin/biguanidea

-need to be paused before contrast dye
-cant give if altered renal fxn
• Monitor BUN/Creat, LFTs

66

methyldopa (antihypertensive)

• a false neurotransmitter that replaces norepi
treats HTN in pregnancy
• alpha 2 agonist, reduction of sympathetic outflow

67

is methyldopa safe in pregnancy

yes, first med approved for this

68

Nifedipine

calcium channel blocker
• prinzmetals angina, severe HTN

69

Nitrates (nitroglycerin-short half life or isosorbide-long half life)

• promotes endothelial relaxing factor (EDRF)
o Low dose large veins, high dose arteriolar dilation (dec afterload)
***prinzmetals

70

hemodynamic effects of nitrates

o Vasodilation- reduced BP
o Have a short half life- throw away after 3 months

71

s/e and caution with nitrates

• s/e H/A dizziness, orthostatic hypotension, tachycardia, tachyphylaxis (need higher and higher dose to get response), ETOH potentiates effects
• large doses associated with methemoglobinemia (pseudocyanosis and tissue hypoxia)

72

NPH Insulin

- intermediate acting insulin for T1DM and T2DM
• commonly used in gestational diabetes
• good for elderly
-70/30 combo (7 units NPH and 3 of regular)

73

Penicillin

beta lactam abx
• treats staphylococci and streptococci
• don’t give with cephalosporins, aminoglycosides, tetracyclines, macrolides, fluoroquinolones

74

Pradaxa

• direct thrombin inhibitor
-has an antidote!
• for stroke reduction in afib, reduce risk or reoccurrence of DVT or PE

75

black box warning pradaxa

: increased risk of clot when stopped, increased risk of hematoma during spinal procedures

76

reverses pradaxa

-praxbind

77

Propranolol (inderal)

beta 1 and 2 adrenergic antagonist, crosses BBB, s/e depression and fatigue
•don't give with asthma

78

omeprazole (Prilosec)- PPI

blocks movement of hydrochloric acid
o inhibits H/K atpase, use only short term
• long term use is associated with gastric cell hypertrophy and cancer
• do not crush or mix with food (granules)

79

Quinidine

Na and K channel blocker
• used with digoxin to treat atrial arrhythmias
-seen in elderly or from other countries

80

s/e quinidine

s/e chiconism (vertigo/dizziness), diarrhea, vagolytic
-need to monitor QT interval, highly protein bound

81

Regular Insulin

Humulin R, Novolin R
• short acting that moves glucose from the blood into the body’s cells

82

Rosiglitazone (TZD)

(another example is actos)
-monitor LFTs
• banned in US due to reports of cardiac problems

83

Saxagliptin (Onglyza)

DPP4 inhibitor- block breakdown of incretins
• less hypoglycemia
• s/e runny hose, HA, N/V, bloating, hives, rash, swelling, hoarseness

84

Sitagliptin (januvia)

DPP4 inhibitor
• reduce inactivation of incretin, inc insulin levels and dec glucagon, promotes satiety, less chance of hypoglycemia

85

s/e januvia (sitagliptin)

• s/e HA, upper resp infection, angioedema, pancreatitis, anaphylaxis, Stephen-johnson

86

Spironolactone

aldosterone antagonist, K sparing
• prevents remodeling in HF, edema

87

s/e spironolactone

• s/e hyperkalemia, nausea, lethargy, androgen effects- resembles sex steroids (irregular periods, gynecomastia)

88

Sulfonylureas

increase insulin release from pancreas
• pts need to have functioning pancreatic B cells
• Ex: glipizide, glimepride, glyburide

89

caution with sulfonylureas

• *cross reactivity with sulfa drugs
• *disulfiram rxn and hypotension with EtOH
• High risk for hypoglycemia, pancreas can be overworked

90

Tagamet (cimetidine)

• h2 receptor antagonist, OTC for heartburn
-many drug interactions

91

s/e tagamet

• s/e diarrhea, HA, fatigue, seizure, depression, anti-androgen (reversible gynecomastia), dec libido
**many drug/drug interactions

92

Tetracycline

protein synthesis inhibitor abx, broad spectrum
• don’t give in pregnancy or children due to bone/teeth effects
-h pylori

93

Thiazide diuretic

first line for HTN in non-hispanic blacks
• mild to moderate HTN

94

TZD (thiazolidinedione)

for DM
• not first line treatment, inc risk of CV disease
• ex: actos

95

Vasotec (enalapril)- ACEi

• works by reducing cardiac myocyte hypertrophy and L vent hypertrophy

96

s/e and c/i with vasotec

• c/I with history of angioedema, pregnancy, renal artery stenosis
• check kidney function, K, etc at 2 wks, 6 wks, 6 mos
• s/e postural hypotension, hyperkalemia, cough

97

Verapamil

calcium channel blocker
-dec SA nodal rate of fire
• for atrial rhythms
• slight peripheral vasodilation, suppresses early and delayed after depolarization

98

don't give verapamil with___

beta blockers

99

vit K

give for high INR, reverses coumadin

100

adenosine

-for rapid atrial arrhythmias
-can have long pause before pt converts to NSR
-short half life

101

amlodipine (Norvasc)

ca channel blocker
-HTN
-s/e pedal edema
-good for elderly, and 2nd line for blacks

102

4 classes of drugs for HTN

ACE, ARB, thiazide diuretics, ca channel blocks

103

HTN treat for blacks

thiazide and ca channel blockers

104

many blacks are low in

aldosterone, renin
-ACE isn't going to make a big difference

105

why use ACE or ARB?

decreases myocyte hypertrophy
-less likely to develop LVH, less HF risk

106

incretins

-intestinal hormones secreted from small intestines as you eat
-stimulate insulin release, promotes sense of fullness, decrease glucagon

107

ibuprofen

antiplatelet, antifever
-given often in kids cuz no risk Reyes syndrome

108

sulfonamide

-sulfa abx
-cross reactivity to sulfa allergy

109

heparin

monitor aptt
-antidote is protamine

110

verapamil can treat which rhythm

SVT

111

Cardizem

slows sa nodal rate of fire, also HTN

112

drug trial phases

1- safety
2-small group effective
3- adverse effects
4- nurse eval in practice