Exam 3 Drugs

Question 1

Carvedilol (Coreg)

AE= 1

Answer 1

• Class: beta blocker
• MOA: decrease the heart rate and myocardial contractility reducing cardiac output
• AE: orthostatic hypotension

Question 2

Prazosin (Minipress)

AE= 1

Answer 2

• Class: Selective Alpha 1 Adrenergic antagonist
• MOA: inhibit sympathetic activation causing vasodilation
• AE: orthostatic hypotension

Question 3

Hydralazine (Apresoline)

Answer 3

• Class: Direct arterial vasodilator
• MOA: Directly relax vascular smooth muscle causing vasodilation and decreasing BP
• AE: MI, severe hypotension, blood dyscrasias, lupus erythematosus (SLE)
• Teach: Take the initial dose at bedtime to minimize the increased 1st dose ADE response, Consult with physician before taking OTC meds

Question 4

Nifedipine (Adalat CC, Procardia XL)

Answer 4

Class: dihydropyridine CCB
MOA: Inhibits calcium ion influx into vascular smooth muscle and myocardium
AE: CHF, severe hypotension, arrhythmia

no grapefruit juice

Question 5

Furosemide (Lasix)

and Monitoring

AE=2

Answer 5

• Class: loop diuretic
• MOA: inhibits loop of Henle and proximal and distal convoluted tubule sodium and chloride resorption
• AE: Severe hypokalemia/electrolyte imbalance
• Monitor: BUN/Cr/GFR, serum CO2, electrolytes frequently early in tx, CBC, weight, ototoxicity

Question 6

Diltiazem (Cardizem)

Answer 6

• Class: nondihydropyridine CCB
• MOA: Decreased preload, afterload, workload with decreased vasospasm and increased O2 supply.
• AE: severe bradycardia, heart failure and hypotension

no grapefruit juice

Question 7

Lisinopril (Zestril)

and monitoring

Answer 7

• Class: Angiotension-Concerting enzymeinhibitor (ACEi)
• MOA: act in the lungs to prevent ACE conversion from angiotensin I to angiotensin II.
• AE: Angioedema, hyperkalemia, renal impairment
• Monitor: kidney function, potassium

Question 8

Losartan (Cozaar)

and monitoring

Answer 8

• Class: Angiotension 2 receptor blocker (ARB)
• MOA: selectively antagonizes angiotensin II angiotensin 1 (AT1) receptors thereby preventing the effect of angiotensin II
• AE: hypotension, hyperkalemia, renal failure
• Monitor: potassium, kidney function

Question 9

Atorvastatin (lipitor)

3 teach

Answer 9

• Class: Statin- HMG-CoA reductase inhibitor
• MOA: Inhibits HMG-CoA reductase (a key enzyme for cholesterol synthesis); thus, inhibiting the liver’s cholesterol synthesis.
• AE: Rhabdomyolysis, acute renal failure, hepatotoxicity
• Teach: take in the evening, may cause constipation and bloating, never give during pregnancy

Question 10

Colesevelam (Welchol)

and teaching

Answer 10

• Class: bile acid sequestrants
• MOA: Increase cholesterol excretion in the stool by binding cholesterol containing bile acids; DM MOA unknown
• AE: esophageal/intestinal obstruction, dysphagia, pancreatitis
• Teach: Administer just before a meal. Give oral drugs at least 4 h before colesevelam

Question 11

Gemfibrozil (Lopid)

Teach instead of AE

Answer 11

• Class: fibric acid drug
• MOA: inhibits triglyceride synthesis and stimulates catabolism of triglyceride-rich lipoproteins (fibric acid derivative).
• Teaching: taken bid before breakfast and dinner

Question 12

Ezetimibe (Zetia)

Answer 12

• Class: cholesterol absorbing inhibitors
• MOA: blocks small intestine cholesterol absorption
• AE: rhabdomyolysis, hepatitis, pancreatitis

Question 13

Nitroglycerin (Nitrostat)

Answer 13

• Class: Organic Nitrates
• MOA: The body converts nitroglycerin (NTG) to the vasodilator nitric oxide (NO), which ultimately stimulating smooth muscle relaxation
• AE: Severe hypotension, syncope,
• headache
• Teach: call 911 after 3 tabs each 5 min apart with no chest pain relief

Question 14

metoprolol (Lopressor, Toprol)

1 AE

Answer 14

• Class: beta adrenergic antagonist
• MOA: decrease the heart rate and myocardial contractility reducing cardiac output
• AE: orthostatic hypotension

Question 15

hydrochlorothiazide (Microzide)

Answer 15

• Class: thiazide and thiazide like diuretic
• MOA: inhibits distal convoluted tubule sodium and chloride resorption. Because most Na+ was reabsorbed before reaching the distal tubule, thiazides diuresis less than loop diuretics.
• AE: Electrolyte imbalances: hypokalemia, hyponatremia, impaired renal function

Question 16

spironolactone (Aldactone)

1 DDI

Answer 16

• Class: potassium sparing diuretic, aldosterone receptor antagonist
• MOA: antagonizes aldosterone-specific mineralocorticoid receptors primarily in the distal convoluted tubule, decreasing Na and water reabsorption and increasing K retention
• AE: renal failure, severe hyperkalemia, arrhythmia
• DDI: potassium rich foods

Question 17

digoxin (Lanoxin)

Answer 17

• Class: cardiac glycoside
• MOA: Inhibits sodium-potassium ATPase resulting in calcium ion release which causes a positive inotropic effect. Suppresses SA node and slows AV node conduction to lower ventricular rate.

Question 18

digoxin antidote called?

Answer 18

Digibind

Question 19

fluconazole (diflucan)

2 DDI,

Answer 19

• Class: azoles
• MOA: Azoles interfere with the biosynthesis of ergosterol, which is essential for the construction of fungal cell membranes
• AE: Hepatotoxicity, anaphylaxis, blood dyscrasias.
• Nursing Implications:
  DDI-antidiabetic drugs, inhibitor of CYP
  Monitor AST/ALT
  teratogenic

Question 20

nystatin (Nystop)

1 key point

Answer 20

• Class: polyene
• MOA: Binds to cell membrane sterols, increasing permeability
• AE: hypersensitivity
• Key point: not absorbed well orally

Question 21

metronidazole (Flagyl

2 DDIs

Answer 21

• Class: nitromidazole
• MOA: Binds to DNA, RNA, and intracellular proteins within the cell causing cell death
• AE: Seizures, peripheral neuropathy, bone marrow suppression
• DDI: warfarin, ETOH

Question 22

acyclovir (Zovirax)

2 AE

Answer 22

• Class: synthetic nucleoside analogues
• MOA: Inhibits DNA polymerase; incorporates into viral DNA
• AE: nephro and neuro toxicity

Question 23

oseltamivir (Tamiflu)

2 teach points

Answer 23

• Class: neuraminidase inhibitors
• MOA: inhibits influenza neuraminidase enzyme
• AE: Bronchitis, bronchospasm, serious skin hypersensitivity reactions
• Teach: give within 48 hours of onset of sx’s. Shortens sx’s from 7 to 5 days.

Question 24

Penicillin G

no class

Answer 24

• MOA: binds to bacterial cell wall, inhibiting bacterial cell wall
  synthesis
• allergy/anaphylaxis; dermatologic reactions (SJS/TENs/DRESS, etc.); clostridium difficile

Question 25

Cefazolin (Ancef) | 1 contraindication

Answer 25

* Class: 1st gen cephalosporins * MOA: bind to the penicillin-binding proteins (PBPs) on bacterial cell wall & inhibit synthesis of the bacterial cell wall, causing cell lysis * AE: allergy/anaphylaxis; dermatologic reactions; seizure * Contra: PCN allergy (due to cross sensitivity)

Question 26

vancomycin (Vancocin) | 1 nursing implication

Answer 26

* Class: misc cell wall inhibitor-glycopeptide * MOA: bactericidal; inhibits cell wall synthesis and RNA synthesis * AE: nephrotoxicity, ototoxicity, red man syndrome * Nursing Implications: GIVE SLOW IV to prevent red man syndrome | red man: flushing, hypotension, tachycardia, & rash on the upper body

Question 27

tetracycline (Achromycin) | 2 teach

Answer 27

* Class: tetracycline * MOA: broad spectrum bacteriostatic inhibitors of protein synthesis * AE: superinfections, hepatotoxicity, lupus * Teach: take on empty stomach, use sunscreen and protective clothing

Question 28

erythromycin, azithromycin

Answer 28

* Class: macrolides * MOA: Macrolides are bacteriostatic inhibitors of protein synthesis. * AE: hepatotoxicity/cholestatic hepatitis, dysrhythmias(QT), pseudomembranous colitis (PMC)

Question 29

gentamicin (Pred-G) | 1 AE, 3 implications

Answer 29

* Class: aminoglycosides * MOA: bactericidal inhibitors of protein synthesis * AE: ototoxicity * Nurse Implications: tinnitus and headache= 1st sign of ototoxicity, not metabolized, narrow therapeutic range

Question 30

linezolid (Zyvox) | No AE, 1 Important fact

Answer 30

* Class: oxazolidinones * MOA: Inhibits the 1st step in protein synthesis * Important: it is effective against infections that are resistant to most other antibiotics, including MRSA and VRE

Question 31

ciproflaxacin (Cipro) | 1 teach

Answer 31

* Class: fluoroquinolones * MOA: inhibits bacterial DNA replication * AE: Hepatotoxicity, CNS toxicity, Tendon rupture * Teach: stop after first signs of joint pain or swelling

Question 32

trimethoprim- sulfamethoxazole (Bactrim) | 2 contras

Answer 32

* Class: sulfonamides * MOA: Both SMZ and TMP are inhibitors of the bacterial metabolism of folic acid * AE: SJS/TEN; myelosuppression (aplastic anemia, acute hemolytic anemia, and agranulocytosis), fulminant hepatic necrosis Contra: pregnancy, infants