Exam 4 Flashcards by Sara Clements

do bronchodilators help with inflammation?

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what are the two primary indications for inhaled bronchodilators?

acute bronchospasm and COPD

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what are the two classes of bronchodilators?

beta agonists and anticholinergics

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what type of medications are used to relieve acute bronchospasm or treat COPD?

bronchodilators

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what general class of medication is used to treat COPD?

inhaled anticholinergics

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do inhaled anticholinergics help with inflammation?

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do inhaled beta agonists help with inflammation?

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do albuterol or ventolin help with underlying inflammation?

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what class of medication helps with underlying inflammation?

inhaled corticosteroids

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SABA stands for?

short acting beta agonist

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SAMA stands for?

short acting muscarinic antagonist

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LABA stands for?

long acting beta agonist

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LAMA stands for?

long acting muscarinic antagonist

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generic name for Proair?

albuterol

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generic name for ventolin?

albuterol

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generic name for proventil?

albuterol

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what type of medication is albuterol?

short acting beta agonist

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what type of medication is proair?

(albuterol) short acting beta agonist

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what type of medication is ventolin?

(albuterol) short acting beta agonist

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what type of medication is proventil?

(albuterol) short acting beta agonist

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brand name for levalbuterol?

xopenex

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what is the generic name for xopenex?

levalbuterol

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what type of medication is xopenex?

(levalbuterol) short acting beta agonist

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what type of medication is levalbuterol?

short acting beta agonist

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what is the generic name for serevent?

salmeterol

what type of medication is salmeterol?

long acting beta agonist

what type of medication is serevent?

long acting beta agonist

generic name for foradil?

fomoterol

brand name for fomoterol?

foradil

generic name for brovana?

arfomoterol

brand name for arformoterol?

brovana

what type of medication is fomoterol?

long acting beta agonist

what type of medication is foradil?

(fomoterol) long acting beta agonist

what type of medication is arfomoterol?

long acting beta agonist

what type of medication is brovana?

(arfomoterol) long acting beta agonist

brand name for tiotropium bromide?

spiriva

generic name for spiriva?

tiotropium bromide

what type of medication is spiriva?

(tiotropium bromide) long acting muscarinic antagonist

what type of medication is tiotropium bromide?

long acting muscarinic antagonist

albuterol and levalbuterol are what type of medications?

short acting beta agonist

salmeterol, fomoterol, and arfomoterol are what type of medication?

long acting beta agonist

two examples of SABAs?

albuterol and levalbuterol

three examples of LABAs?

salmeterol, fomoterol, arfomoterol

example of LAMA?

tiotropium bromide

what general class of medication treats acute episodes of asthma?

beta 2 agonists

can you treat acute episodes of asthma with LABAs?

what specific class of medication is used to treat acute asthma attacks?

SABAs

how do you treat initial episodes of asthma exacerbation?

increasing frequency of SABAs

increasing the frequency of SABAs is the initial treatment of what?

asthma exacerbation

how do you treat asthma exacerbation if patient is on SABA and beta blocker?

add a SAMA

why do we add a SAMA if patient on SABA and beta blocker?

to help with bronchodilation

what class of medication should be added if acute asthma exacerbation and patient on SABA and beta blocker?

short acting muscarinic antagonist

can LABAs be used as monotherapy for asthma?

what is the black box warning for LABAs re asthma?

should not be used as monotherapy; increase mortality

what must LABAs be used with?

inhaled corticosteroids

why must LABAs be used with inhaled corticosteroids?

to address the underlying inflammation

do beta agonists address underlying inflammatory process?

what kind of regulation happens when patients on long-term beta 2 agonists?

downregulation of the beta receptors

what is the result of downregulation of beta receptors in asthma?

do not respond as well to SABA to help with acute bronchospasm

is inflammation treated when a patient is only on a LABA?

what isn't being treated if a patient is only on a LABA?

inflammation (only being bronchodilated)

should patient ever just be taking salmeterol for asthma?

broad class of LAMAs?

inhaled anticholinergics

what do LAMAs do to sputum volume?

decrease sputum volume

what specific class of medication reduces sputum volume?

LAMAs

what specific class of medication results in reduced acetylcholine stimulation of goblet cells in the airway?

LAMAs

what is the MOA of LAMAs?

reduced sputum volume leads to reduced acetylcholine stimulation of goblet cells in the airway

what kind of side effects can occur with LAMAs?

anticholinergic side effects

what kind of cells experience reduced acetylcholine stimulation in the airway with LAMAs?

goblet cells

do LAMAs cause bronchodilation?

yes

what do LAMAs do in addition to bronchodilation?

reduce sputum volume

what condition are inhaled anticholinergics generally used for?

COPD

what general class of medication are used to reduce sputum volume and bronchodilate in COPD?

inhaled anticholinergics

what are the two effects of inhaled anticholinergics in COPD?

reduce sputum volume and bronchodilation

anticholinergic side effects are particularly problematic in what population?

older adults

what general class of medication is used to inhibit airway inflammation?

inhaled corticosteroids

adverse effects of what general class? Xerostomia, hoarseness, mouth irritation, dysgeusia, oral candidiasis

inhaled corticosteroids

how must inhaled corticosteroids be taken?

routinely

what is key in preventing adverse effects of inhaled corticosteroids?

patient education

what should patients do after each use of inhaled corticosteroids?

rinse mouth with water and spit

patients on which general class of medications should rinse mouth with water and spit after each use?

inhaled corticosteroids

what is a strategy for decreasing adverse effects of inhaled corticosteroids?

using a spacing device

using a spacing device is a strategy to decrease adverse effects of what general class?

inhaled corticosteroids

what is the MOA of inhaled corticosteroids?

inhibit airway inflammation

oral candidiasis is associated with what general class of medication?

inhaled corticosteroids

what are five adverse effects of inhaled corticosteroids?

xerostomia, hoarseness, mouth irritation, dysgeusia, oral candidiasis

using a spacing device allows for what?

much more of drug to be inhaled and delivered to the lungs rather than deposited on tongue & buccal mucosa

specific class? Montelukast

leukotriene antagonist

specific class? Singulair

leukotriene antagonist

what is the generic name for singulair?

montelukast

what is the brand name for montelukast?

singulair

what is the example of a leukotriene antagonist?

montelukast (singulair)

dyspepsia can be seen with what specific respiratory medication?

montelukast (singulair)

possible side effect of montelukast?

dyspepsia

what is an example of a drug of monoclonal antibodies?

xolair

specific class? Xolair

monoclonal antibodies

drug? Binds to IgE preventing it from attaching to receptors on mast cells and basophils

xolair

what two cell types are involved with xolair?

mast cells and basophils

mast cells and basophils are involved in MOA of what drug?

xolair

what is the approved indication for xolair?

severe persistent asthma

what drug is only approved for severe persistent asthma?

xolair

what immunoglobulin is involved with xolair?

IgE

what are the two routes of administration for decongestants?

oral and intranasal

what is the brand name of pseudoephedrine?

sudafed

what is the generic name of sudafed?

pseudoephedrine

what kind of drug is pseudoephedrine?

oral decongestant

example of oral decongestant?

pseudoephedrine

example of intranasal decongestant?

oxymetazoline (Afrin)

what is the generic name of afrin?

oxymetazoline

what is the brand name of oxymetazoline?

afrin

what kind of drug is oxymetazoline?

intranasal decongestant

how is xolair administered?

subcutaneous injection

what asthma medication is administered by subcutaneous injection?

xolair

what kind of asthma is xolair indicated for?

severe persistent asthma only

should toddlers and infants take decongestants?

how long can you used intranasal decongestants?

should not be used more than three days (maybe 5)

what is the problem with intransal decongestants?

rebound congestion

what is rhinitis medicamentosa?

rebound congestion

what is the medical term for rebound congestion?

rhinitis medicamentosa

what do intranasal decongestants work well for?

opening up eustachian tubes

what is the brand name of guaifenesin?

mucinex

what is the generic name of mucinex?

guaifenesin

what kind of medication is guaifenesin?

expectorant

what is kind of medication is mucinex?

expectorant

example of expectorant medication?

guaifenesin

example of antitussive medication?

benzonatate

what is the brand name of benzonatate?

tessalon perle

what is the generic name of tessalon perle?

benzonatate

what age group should not be treated with decongestants or cough medicine?

less than 4 years old

what age group should not be treated with decongestants?

less than 4 years old

what age group should not be treated with cough medications?

less than 4 years old

what age group should use caution with cough medications?

less than 6 years old

what age group should use caution with decongestants?

less than 6 years old

what age group should use caution with decongestants and cough medications?

less than 6 years old

children less than 6 years old should use caution with what two classes of medication?

cough medication and decongestants

what type of medication is benzonatate?

antitussive

what type of medication is dextromethorphan?

antitussive

how to treat cough/congestion in young children?

nonpharmacologic treatment

what are the three med classes used to treat GERD?

PPIs, H2 blockers, antacids

PPIs, H2 blockers, and antacids are used to treat what condition?

GERD

example of a PPI medication?

omeprazole

What kind of med is Pepcid?

H2 blocker

what is the brand name of omeprazole?

prilosec

what is the generic name of prilosec?

omeprazole

what is the brand name of metoclopramide?

reglan

what is the generic name of reglan?

metoclopramide

example of prokinetic therapy drug?

metoclopramide

what is metoclopramide associated with?

serious adverse effects

is metoclopramide first line therapy for GERD?

when should PPIs be taken?

first thing in the morning before eating or drinking

what is a cause for treatment failure with PUD?

microbial resistance

what is the brand name of bismuth subsalicylate?

pepto-bismol

what is the generic name for pepto-bismol?

bismuth subsalicylate

why should young children not take bismuth subsalicylate?

contains aspirin

why should pts allergic to aspirin not take bismuth subsalicylate?

contains aspirin

is bismuth subsalicylate a cytoprotective agent?

yes

is misoprostol a cytoprotective agent?

yes

what is the brand name of misoprostol?

cytotec

what is the generic name of cytotec?

misoprostol

aspirin allergies tend to coexist with what other condition?

asthma

what is a contraindication to misoprostol?

pregnancy

example of antidiarrheal?

loperamide

what is the generic name for imodium?

loperamide

what is the brand name for loperamide?

imodium

what drug is used for chronic constipation in children?

polyethylene glycol (osmotic laxative)

where do beta 2 agonists bind?

smooth muscle cells in the airway

what are the two classes of bronchodilators?

inhaled beta 2 agonists and inhaled anticholinergics

where do bronchodilators act to reverse bronchospasm?

smooth muscle of the bronchial tree

what effect do bronchodilators have on airway resistance?

decreased

what effect do bronchodilators have on residual volume?

decreased

what effect do bronchodilators have on vital capacity?

increased

what effect do bronchodilators have on airflow?

increased

airway resistance- increased or decreased with bronchodilators?

decreased

residual volume- increased or decreased with bronchodilators?

decreased

vital capacity- increased or decreased with bronchodilators?

increased

air flow- increased or decreased with bronchodilators?

increased

specific class? Bind to beta 2 smooth muscle cells in the airway- stimulates smooth muscle cell relaxation leading to bronchodilation via the cyclic AMP pathway

inhaled beta 2 agonists

what pathway is involved with beta 2 agonists?

cyclic AMP pathway

what do inhaled beta 2 agonists inhibit the release of?

hypersensitivity mediators

release of hypersensitivity mediators from what cells are inhibited by inhaled beta 2 agonists?

mast cells

do all inhaled beta 2 agonists have some beta 1 receptor activity?

yes

are inhaled beta 2 agonists used to relieve acute bronchospasm?

yes

three causes of acute bronchospasm?

asthma; reactive airway disease; COPD

can inhaled beta 2 agonists be used in COPD?

yes

do inhaled beta 2 agonists affect inflammation?

what cause many of the side effects with inhaled beta 2 agonists?

some degree of beta 1 receptor activity

what does SABA stand for?

short-acting beta agonists

how long do SABAs last?

4-6 hours

which class of inhaled beta 2 agonists last for 4-6 hours?

short-acting beta agonists

which class of inhaled beta 2 agonists are the 'rescue' inhalers?

short-acting beta agonists

two generic examples of SABAs?

albuterol, levalbuterol

what are three brand names associated with albuterol?

proair, ventolin, and proventil

what is the brand name of levalbuterol?

xopenex

what is the generic name of xopenex?

levalbuterol

what is the generic name of proair?

albuterol

what is the generic name of ventolin?

albuterol

what is the generic name of proventil?

albuterol

what type of drug is albuterol?

short-acting beta agonists

what type of drug is levalbuterol?

short-acting beta agonists

specific class? Proair

short-acting beta agonists

specific class? Ventolin

short-acting beta agonists

specific class? Proventil

short-acting beta agonists

specific class? Xopenex

short-acting beta agonists

specific class? Albuterol

short-acting beta agonists

specific class? Levalbuterol

short-acting beta agonists

when are SABAs used?

acute episodes of asthma

how do you treat initial episodes of asthma exacerbation?

increasing the frequency of SABAs

what do you add if a patient is on a SABA and a beta blocker?

add a SAMA

why do you add a SAMA if a patient is on a SABA and a beta blocker?

to help with bronchodilation

describe the adverse effects of SABAs?

usually transient

how can you reduce the adverse effects of SABAs?

temporarily decrease the dose

adverse effect of SABAs re: heart rate?

tachycardia

how often does insomnia occur with SABAs?

rare

palpitations, tremors, tachycardia, dizziness, shakiness, nervousness, restlessness, HA, & insomnia- associated with what specific class of respiratory medication?

short-acting beta agonists

because of effects on CV system, patients with what five conditions require close monitoring with SABAs?

HTN; ischemic heart disease; coronary insufficiency; hx of a CVA; cardiac arrhythmias

can you give SABAs to patients with cardiac arrhythmias associated with tachycardia?

can you give SABAs to patients with heart block due to digitalis intoxication?

can you give SABAs to patients with angina?

what type of glaucoma is a contraindication for SABA therapy?

narrow-angle glaucoma

can you give SABAs to patients with narrow-angle glaucoma?

patients with what thyroid dysfunction require close monitoring with SABAs?

hyperthyroidism

what does LABA stand for?

long-acting beta agonists

how long do LABAs last?

12 hours

how often are LABAs dosed?

twice daily

which specific class of inhaled beta agonists lasts for 12 hours?

long-acting beta agonists

three generic examples of LABAs?

salmeterol; fomoterol; arfomoterol

specific class? Salmeterol

long-acting beta agonists

specific class? Fomoterol

long-acting beta agonists

specific class? Arfomoterol

long-acting beta agonists

brand name for salmeterol?

serevent

brand name for fomoterol?

foradil

brand name for arfomoterol?

brovana

generic name for serevent?

salmeterol

generic name for foradil?

fomoterol

generic name for brovana?

arfomoterol

how long does salmeterol last?

12 hours

how long does serevent last?

12 hours

how long does fomoterol last?

12 hours

how long does foradil last?

12 hours

how long does arfomoterol last?

12 hours

how long does brovana last?

12 hours

can LABAs be used as monotherapy for asthma?

use of LABAs for asthma is contraindicated without the use of what?

an asthma controller medication

what is an example (class) of an asthma controller medication that can be used with LABAs?

inhaled corticosteroid

what class of drugs is the most potent and effective antiinflammatory medication currently availabile?

inhaled corticosteroids

what class of drugs inhibits airway inflammation?

inhaled corticosteroids

what immunoglobulin is involved with inhaled corticosteroids?

IgE

what mediates migration of inflammatory cells with inhaled corticosteroids?

mast cells

what phase of allergic reaction is involved with inhaled corticosteroids?

late phase allergic reaction

the late phase allergic reaction is involved in the MOA of what class of respiratory medication?

inhaled corticosteroids

exact mechanism by which inhaled corticosteroids inhibit bronchoconstrictor mechanisms and produce smooth muscle relaxation?

unknown

what class of respiratory medication helps prevent airway remodeling and disease progression?

inhaled corticosteroids

what effect do ICS have on the severity of asthma symptoms?

decreased

what effect do ICS have on peak flow readings?

increased

what effect do ICS have on airway hyperresponsiveness?

decreased

what is the highest potency ICS?

fluticasone

what is the lowest potency ICS?

budesonide

can bronchospasm occur with ICS?

yes

which ICS can cause bronchospasm?

any of them

why can patients experience oral candidiasis with ICS?

due to local immunosuppression

local immunosuppression with ICS can cause what adverse effect?

oral candidiasis

cataracts can occur with what class of respiratory medication?

inhaled corticosteroids

can you give inhaled corticosteroids in status asthmaticus?

should you give inhaled corticosteroids in cushing syndrome?

how should inhaled corticosteroids be taken?

routinely, even if not having symptoms

use of WHAT can reduce the adverse effects of inhaled corticosteroids?

spacer device

use of a spacer device with inhaled corticosteroids can decrease what?

adverse effects

what should patients do after each use of inhaled corticosteroids?

rinse mouth with water and spit

patients taking what class of medication should rinse mouth with water and spit after each use?

inhaled corticosteroids

patients with cushing sydrome = precaution for what class of respiratory medication?

inhaled corticosteroids

patients with status asthmaticus = contraindication for what class of respiratory medication?

inhaled corticosteroids

should inhaled corticosteroids be used to relieve acute bronchospasm?

are inhaled corticosteroids a rescue medication?

what are the preferred long-term meds (class) for managing the inflammatory processes associated with asthma?

inhaled corticosteroids

what are the two options for persistent asthma?

ICS (or) ICS/LABA

ICS or ICS/LABA= treatment for what?

persistent asthma

HPA suppression can occur with which class of respiratory medications?

inhaled corticosteroids

xerostomia, hoarseness, mouth irritation, dysgeusia, oral candidiasis, HPA suppression, and cataracts- adverse effects of what class of medication?

inhaled corticosteroids

what does SAMA stand for?

short-acting muscarinic antagonists

how long do SAMAs last?

4-6 hours

example of SAMA?

ipratropium bromide

what is the generic name for atrovent?

ipratropium bromide

what is the brand name for ipratropium bromide?

atrovent

specific class? Ipratropium bromide

short-acting muscarinic antagonists

specific class? Atrovent

short-acting muscarinic antagonists

how long does ipratropium bromide last?

4-6 hours

how long does atrovent last?

4-6 hours

what is the general class of SAMAs?

inhaled anticholinergics

should inhaled anticholinergics be used for acute bronchospasm (monotherapy)?

what must you combine an inhaled anticholinergic with in order to use for acute bronchospasm?

beta 2 receptor agonist

what general class of medications blocks muscarinic cholinergic receptors?

inhaled anticholinergics

how to inhaled anticholinergics block muscarinic cholinergic receptors?

by antagonizing acetylcholine

the MOA of what general class of respiratory medication involves cyclic GMP?

inhaled anticholinergics

what do inhaled anticholinergics do to contractility of smooth muscle in the lungs?

decreased

what general class of respiratory medication blocks muscarinic cholinergic receptors by antagonizing acetylcholine?

inhaled anticholinergics

what should ipratropium bromide be combined with for emergent treatment of an asthma exacerbation?

albuterol

when can you use SAMAs in children < 6 years old?

as an adjunct to beta agonist therapy in acute exacerbations of asthma

what specific class of medication can be used in children < 6 years old as an adjunct to beta agonist therapy in acute exacerbations of asthma?

short-acting muscarinic antagonists

describe the adverse effects of SAMAs?

anticholinergic side effects

cough, xerostomia, HA, hoarseness, throat irritation, dysgeusia, N/V/dyspepsia- adverse effects of what specific class of respiratory medication?

short-acting muscarinic antagonists

how long do LAMAs last?

24 hours

what specific class of respiratory medication lasts 24 hours?

long-acting muscarinic antagonists

what does LAMA stand for?

long-acting muscarinic antagonists

example of a LAMA?

tiotropium bromide

specific class? Tiotropium bromide

long-acting muscarinic antagonists

specific class? Spiriva

long-acting muscarinic antagonists

brand name of tiotropium bromide?

spiriva

generic name of spiriva?

tiotropium bromide

specific class? Inhibits the muscarinic M3 receptors in the lungs

long-acting muscarinic antagonists

how long does spiriva last?

24 hours

how long does ipratropium bromide last?

4-6 hrs

what is the result of inhibition of the muscarinic M3 receptors in the lungs by LAMAs?

smooth muscle bronchodilation

effect of LAMAs on sputum volume?

decreased

why do LAMAs cause decreased sputum volume?

decreased acetylcholine stimulation of goblet cells in the airway

what specific class of respiratory medication can be added to an ICS/LABA combination?

long-acting muscarinic antagonists

when would you add a LAMA to an ICS/LABA combination?

patients whose asthma is not well-controlled

describe the adverse effects of LAMAs?

anticholinergic side effects

adverse effects of specific class? Xerostomia, cough, HA, mouth irritation, pharyngitis, nasal congestion, sinusitis, upper respiratory infections

long-acting muscarinic antagonists

pharyngitis, nasal congestion, sinusitis, upper respiratory infection- can be seen with what specific class of respiratory medication?

long-acting muscarinic antagonists

SAMAs and LAMAs are what?

second-line bronchodilators in the treatment of asthma and COPD

which kind of glaucoma is a contraindication for inhaled anticholinergics?

closed-angle glaucoma

why is closed-angle glaucoma a contraindication for inhaled anticholinergics?

can increased IOP

urinary retention, BPH, closed-angle glaucoma- contraindications for what general class of respiratory medications?

inhaled anticholinergics

what receptors are involved with LAMAs?

M3 muscarinic receptors

where are M3 muscarinic receptors located?

in the lungs

what cells experience decreased acetylcholine stimulation in the airway?

goblet cells

what three conditions are contraindications for inhaled anticholinergics?

urinary retention, BPH, closed-angle glaucoma

what broad class of medications are the mainstay for treatment of COPD?

bronchodilators

what are the two goals of COPD treatment?

slow disease process & maintain quality of life

what type of medications treat the reversible component of COPD?

bronchodilators

how do bronchodilators maximize airflow?

relaxing airway smooth muscles and improving lung emptying

what effect do bronchodilators have on airway smooth muscle?

relax

what effect do bronchodilators have on lung emptying?

improved

what are the three classes of bronchodilators?

beta2 agonists, muscarinic antagonists/inhaled anticholinergics; methylxanthines

are inhaled beta 2 agonists useful in acute episodes?

yes

are inhaled beta 2 agonists useful in only occasional dyspnea?

yes

is regular use of a SABA with persistent symptoms recommended?

what specific class of medication is preferred over SABAs for routine bronchodilator therapy?

LABAs

why do LABAs provide longer bronchodilator effects than SABAs?

higher affinity for the lipid bilayer of the cell compared with the more hydrophilic SABA molecule

LABAs have a higher affinity for what part of the cell?

lipid bilayer of the cell

are SAMAs first-line therapy for COPD?

general class of medication? Nonspecific anti-inflammatory activity at multiple points in the inflammatory process

corticosteroids

can corticosteroids be used in stable COPD?

yes

can corticosteroids be used in COPD exacerbations?

yes

in pts who have frequent or severe exacerbations, addition of a WHAT to LABA/LAMA therapy can be beneficial?

inhaled corticosteroid

what specific class of medication can help to prevent symptom breakthrough in COPD?

long-acting beta agonists

in asthma, what specific class of medication is associated with increased risk for exacerbations and death when airway inflammation is not addressed along with bronchodilation?

Long acting beta agonists

what are the two categories of asthma medications?

quick-relief meds & controlled meds

what two factors determine dosing and frequency re: asthma medication?

asthma severity; level of control

what are the three specific classes used for asthma controller medication?

inhaled corticosteroids; long-acting beta2 agonists; long-acting muscarinic antagonists

ICS, LABAs, and LAMAs are what type of medications re: asthma?

controller medications

what three specific medication classes can be used re: asthma quick relief?

SABAs, SAMAs, and oral corticosteroid bursts

what specific class of medication is an add-on medication to ICS in asthma treatment?

long-acting beta agonists

when might you use LAMAs in asthma?

add-on therapy for pts requiring additional controller medications

what class of medication is montelukast?

leukotriene receptor antagonist

what class of medication is singulair?

leukotriene receptor antagonist

what is the brand name of montelukast?

singulair

what is the generic name of singulair?

montelukast (singulair)

what two types of leukotrienes are involved in pathophysiology of airway stimulation from allergens?

C4 and D4

what two effects do leukotrienes have on respiratory system?

contraction of airway smooth muscle (airway hyperresponsiveness); increased permeability of the airway vasculature

another way to say increased permeability of the airway vascular?

vascular leakage

another way to say contraction of the airway smooth muscle?

airway hyperresponsiveness

describe vascular leakage?

increased permeability of the airway vasculature

describe airway hyperresponsiveness?

contraction of the airway smooth muscle

what two types of cells produce leukotrienes?

eosinophils and mast cells

eosinophils and mast cells produce what?

leukotrienes

what receptor is inhibited with leukotriene receptor antagonists?

cysteinyl leukotriene receptor

the cysteinyl leukotriene receptor is inhibited with what class of medication?

leukotriene receptor antagonists

specific class? Blocks the action of LTD4 (a component of SRS-A)

leukotriene receptor antagonists

what is the component of the SRS-A blocked with leukotriene receptor antagonists?

LTD4

what does SRS-A stand for?

slow-reacting substance of anaphylaxis

LTD4 is involved in the MOA of what class of medications?

leukotriene receptor antagonists

how long must asthma persist for use of leukotriene receptor antagonists?

greater than or equal to 12 months

prevention of exercise-induced bronchoconstriction is an indication for what specific class of medication?

leukotriene receptor antagonists

can leukotriene receptor antagonists be used for the primary treatment of an acute asthma attack?

what two types of allergic rhinitis are indications for leukotriene receptor antagonists?

seasonal and perennial allergic rhinits

adverse effects of what specific class? Dyspepsia, HA, sore throat, neuropsychiatric

leukotriene receptor antagonists

neuropsychiatric effects are associated with what class of medication?

leukotriene receptor antagonists

four adverse effects of leukotriene receptor antagonists?

dyspepsia, headache, sore throat, neuropsychiatric

children less than 4 years old should not be treated with what two classes of medications?

decongestants or cough medications

decongestants/cough medications should be used cautiously in children less than what age?

6 years old

what two drugs are examples of non-opioid antitussives?

benzonatate and dextromethorphan

benzonatate and dextromethorphan are what type of medication?

non-opioid antitussives

what kind of drug is benzonatate?

non-opioid antitussives

what kind of drug is dextromethorphan?

non-opioid antitussives

what is the brand name of benzonatate?

tessalon perle

what is the generic name of tessalon perle?

benzonatate

what kind of drug is codeine?

opioid antitussive

what antitussive is chemically related to tetracaine?

benzonatate

benzonatate is chemically related to what?

tetracaine

what drug acts by anesthetizing the cough receptors in the lungs?

benzonatate

what is the MOA of benzonatate?

acts by anesthetizing the cough receptors in the lungs

what receptors does benzonatate anesthetize?

cough receptors in the lungs

drug? D-isomer of codeine analog levorphanol

dextromethorphan

what is the name of the codeine analog involved with dextromethorphan?

levorphanol

where does dextromethorphan act?

centrally in the cough center in the medulla

where is the cough center located?

in the medulla

dextromethorphan acts centrally in the cough center in the medulla to do what?

increase the threshold for coughing

dextromethorphan increases/decreases the threshold for coughing?

increases

drug that acts as an antitussive in the medulla at lower doses than is required for analgesia?

codeine

five examples of intranasal corticosteroids?

fluticasone, budesonide, triamcinolone, ciclesonide, mometasone

what is the brand name of fluticasone?

flonase

what is the brand name of budesonide?

rhinocort aqua

what is the brand name of triamcinolone?

nasacort aq

what is the brand name of ciclesonide?

omnaris

what is the brand name of mometasone?

nasonex

what kind of drug is intranasal fluticasone?

intranasal corticosteroid

what kind of drug is intranasal budesonide?

intranasal corticosteroid

what kind of drug is intranasal triamcinolone?

intranasal corticosteroid

what kind of drug is intranasal ciclesonide?

intranasal corticosteroid

what kind of drug is intranasal mometasone?

intranasal corticosteroid

do intranasal corticosteroids have any systemic glucocorticoid effects?

what causes epistaxis with intranasal corticosteroids?

dryness

side effects of what class of medication? Nasal irritation, itching, sneezing, dryness, epistaxis

intranasal corticosteroid

what are three examples of first generation antihistamines?

diphenhydramine, chlorphiramine, hydroxyzine

specific class? Diphenhydramine, chlorpheneramine, hydroxyzine

first generation antihistamines

specific class? Diphenhydramine

first generation antihistamines

specific class? Chlorpheniramine

first generation antihistamines

specific class? Hydroxyzine

first generation antihistamines

what is the brand name for diphenhydramine?

benadryl

what is the brand name for chlorpheniramine?

chlor-trimeton

what is the brand name for hydroxyzine?

atarax

specific class? Chlor-trimeton

first generation antihistamines

what receptors do antihistamines generally bind to?

what three muscles are affected by antihistamines?

respiratory, vascular, GI smooth muscle

specific class? Bind non-selectively to central H1 receptors

first generation antihistamines

do first generation antihistamines bind selectively or non-selectively?

non-selectively

do first generation antihistamines bind to central or peripheral H1 receptors?

central

which generation of antihistamines are all on the beers criteria list?

first generation antihistamines

what effect do antihistamines have on capillary permeability?

decreased

constriction of what three muscle groups is reduced by antihistamines?

respiratory, vascular, GI smooth muscle

what generation of antihistamines can cause paradoxical CNS stimulation in young children?

first generation antihistamines

which generation of antihistamines requires caution re: anticholinergic effects?

first generation antihistamines

should first generation antihistamines be given with urinary retention?

should first generation antihistamines be given with a history of bronchial asthma?

should first generation antihistamines be given with increased IOP?

should first generation antihistamines be given with hyperthyroidism?

should first generation antihistamines be given with CV disease?

should first generation antihistamines be given with hypertension?

which glaucoma is a contraindication for first generation antihistamines?

narrow-angle glaucoma

what are the two urinary contraindications for first generation antihistamines?

BPH, bladder neck obstruction

newborns and premature infants should not receive which generation of antihistamines?

first generation antihistamines

what is the problem with giving newborns and premature infants first generation antihistamines?

can cause convulsions

MAOI use within 2 weeks is a contraindication for which generation of antihistamines?

first generation antihistamines

why are first generation antihistamines contraindicated with lower respiratory tract symptoms?

thicken secretions and impair expectoration

which generation of antihistamines thickens secretions and impairs expectoration?

first generation antihistamines

dry mouth, urinary retention, and dysuria are more likely with which generation of antihistamines?

first generation antihistamines

which generation of antihistamines is more likely to cause sedation/drowsiness?

first generation antihistamines

what are the GI adverse effects of oral antihistamines?

increased/decreased appetite; N/V/D; constipation; epigastric distress

what are the visual adverse effects of oral antihistamines?

blurred vision, diplopia

can tremors and nervousness occur with oral antihistamines?

yes

can lassitude or fatigue occur with oral antihistamines?

yes

specific class? Ceterizine

second generation antihistamine

specific class? Levocetirizine

second generation antihistamine

specific class? Loratadine

second generation antihistamine

specific class? Desloratadine

second generation antihistamine

specific class? Fexofenadine

second generation antihistamine

brand name? cetirizine

zyrtec

brand name? levocetirizine

xyzal

brand name? loratidine

claritin

brand name? desloratidine

clarinex

brand name? fexofenadine

allegra

generic name? zyrtec

ceterizine

generic name? xyzal

levocetirizine

generic name? claritin

loratidine

generic name? clarinex

desloratidine

generic name? allegra

fexofenadine

specific class? Selective for peripheral H1 receptors only

second generation antihistamine

do second generation antihistamines act on central or peripheral H1 receptors?

peripheral

are second generation antihistamines selective or non-selective?

selective

what is the MOA of second generation antihistamines?

selective for peripheral H1 receptors only

what is the MOA of first generation antihistamines?

bind non-selectively to the central H1 receptors

if patients have adverse reactions to the first generation antihistamines, what can you do?

switching to 2nd gen can alleviate the problem

general class? Dimenhydrinate

antiemetic

what are the four antihistamine antiemetics?

dimenhydrinate, diphenhydramine, hydroxyzine, meclizine

what are the two first generation antihistamines that can be used as antiemetics?

diphenhydramine and hydroxyzine

dimenhydrinate, diphenhydramine, hydroxyzine, meclizine- specific class?

antihistamine antiemetic

what are the two characteristics of antihistamines that are associated with antiemetic activity?

strong anticholinergic effects; histamine-blocking effects

what receptors do antihistamine antiemetics bind to?

histamine 1 receptors

binding of antihistamine antiemetics to histamine receptors does what?

decreases secretion in the mouth and eyes

in addition to H1 receptors, what receptors do antihistamine antiemetics bind to?

central cholinergic receptors

what two types of receptors are involved with antihistamine antiemetics?

histamine 1 and central cholinergic

what are antihistamine antiemetics most useful for?

motion sickness N/V

why are antihistamine antiemetics most useful for motion sickness N/V?

because of slowing of neural communication in the vestibulocerebellar areas

where do antihistamine antiemetics slow neural communication?

in the vestibulocerebellar areas

describe, generally, the adverse effects of antihistamine antiemetics?

anticholinergic side effects

why should antihistamine antiemetics be avoided in the older adult population?

anticholinergic side effects

which type of glaucoma is a contraindication for antihistamine antiemetics?

narrow-angle glaucoma

seizure disorder is a contraindication for which class of antiemetics?

antihistamine antiemetic

pyloric obstruction is a contraindication for which class of antiemetics?

antihistamine antiemetic

hyperthyroidism is a contraindication for which class of antiemetics?

antihistamine antiemetic

BPH is a contraindication for which class of antiemetics?

antihistamine antiemetic

should antihistamine antiemetics be given with CV disease?

should antihistamine antiemetics be given with hepatic dysfunction?

should antihistamine antiemetics be given to patients with severe liver disease?

no- contraindicated

which class of antiemetics can cause paradoxical excitation/agitation in children?

antihistamine antiemetic

what are the three examples of phenothiazine antiemetics?

prochlorperazine, periphenazine, promethazine

specific class? Prochlorperazine

phenothiazine antiemetic

specific class? Periphenazine

phenothiazine antiemetic

specific class? Promethazine

phenothiazine antiemetic

general class? Prochlorperazine

antiemetic

general class? Periphenazine

antiemetic

general class? Promethazine

antiemetic

specific class? Prochlorperazine, periphenazine, promethazine

phenothiazine antiemetic

specific class? Block (antagonize) dopamine receptors in the chemoreceptor trigger zone

phenothiazine antiemetic

what receptors are blocked with phenothiazine antiemetics?

dopamine

where are the dopamine receptors antagonized with phenothiazine antiemetics?

chemoreceptor trigger zone

what does CTZ stand for?

chemoreceptor trigger zone

in addition to dopamine, what three other receptors are affected by phenothiazine antiemetics?

cholinergic, alpha-1 adrenergic, histamine-1 receptors

are cholinergic receptors affected by phenothiazine antiemetics?

yes

are alpha-1 adrenergic receptors affected by phenothiazine antiemetics?

yes

are histamine-1 receptors affected by phenothiazine antiemetics?

yes

are dopamine receptors affected by phenothiazine antiemetics?

yes

is it recommended to administer phenothiazine antiemetics long-term?

should phenothiazine antiemetics be given long-term?

what limits the use of phenothiazine antiemetics?

sedating and extrapyramidal side effects

which class of antiemetics is associated with sedating and extrapyramidal side effects?

phenothiazine antiemetic

do anticholinergic effects happen with phenothiazine antiemetics?

yes

do extrapyramidal effects happen with phenothiazine antiemetics?

yes

do extrapyramidal effects happen with antihistamine antiemetics?

do extrapyramidal effects happen with 5HT3 receptor antiemetics?

what is the black box warning for phenothiazine antiemetics?

respiratory depression in the pediatric population that can be fatal

specific class of antiemetic? Black box warning for respiratory depression in the pediatric population that can be fatal

phenothiazine antiemetic

which specific class of antiemetic is associated with agranulocytosis with longer term use?

phenothiazine antiemetic

after how many months can agranulocytosis occur with phenothiazine antiemetics?

>= 4 months

which specific class of antiemetic can change color of the urine?

phenothiazine antiemetic

what colors can phenothiazine antiemetics change the urine?

pink to reddish brown

why should patients taking phenothiazine antiemetics be told about urine color changes?

so they know it is not hematuria

should phenothiazine antiemetics be given in pregnancy?

no (avoid)

should phenothiazine antiemetics be given in parkinson disease?

should phenothiazine antiemetics be given in narrow-angle glaucoma?

which glaucoma is a contraindication for phenothiazine antiemetics?

narrow-angle glaucoma

should phenothiazine antiemetics be given with bone marrow depression?

should phenothiazine antiemetics be given with CV disease?

what do phenothiazines do to cough reflex?

decreased

what two types of patients can have respiratory problems with phenothiazines?

lung disease and those prone to aspiration

what kind of COPD is problematic with phenothiazines?

chronic bronchitis-caused COPD

patients prone to aspiration are problematic with which class of antiemetics?

phenothiazine antiemetic

silent pneumonia can happen with which class of antiemetics?

phenothiazine antiemetic

which class of antiemetics can decrease cough reflex?

phenothiazine antiemetic

four examples of 5HT3 receptor antiemetic drugs?

ondansetron, palonosetron, dolasetron mesylate, granisetron

specific class? Ondansetron

5-HT3 receptor antiemetics

what is the most commonly prescribed 5HT3 antiemetic?

ondansetron

specific class? Palonosetron

5-HT3 receptor antiemetics

specific class? Dolasetron mesylate

5-HT3 receptor antiemetics

specific class? Granisetron

5-HT3 receptor antiemetics

specific class? Ondansetron, palonosetron, dolasetron mesylate, granisetron

5-HT3 receptor antiemetics

which class of antiemetics blocks serotonin?

5-HT3 receptor antiemetics

where do 5HT3 antiemetics block serotonin on vagal nerve terminals?

peripherally

where do 5HT3 antiemetics block serotonin on CTZ?

centrally

specific class? Block serotonin both peripherally in the vagal nerve terminals and centrally in the CTZ

5-HT3 receptor antiemetics

chemotherapy causes a release of what?

serotonin

what cells release serotonin with chemotherapy?

enterochromaffin cells

specific class? Pretreatment with these drugs decreases emesis (chemotherapy)

5-HT3 receptor antiemetics

specific class? Used for pretreatment to prevent chemotherapy-induced nausea and vomiting

5-HT3 receptor antiemetics

what two anatomic areas are involved with 5HT3 antiemetics?

vagal nerve terminals and CTZ

what do enterochromaffin cells release?

serotonin

which class of antiemetic can mask progressive ileus?

5-HT3 receptor antiemetics

which class of antiemetic can make progressive ileus asymptomatic?

5-HT3 receptor antiemetics

what are the three rare CV adverse effects with 5HT3 antiemetics?

tachycardia/bradycardia; hypotension; QTc prolongation

tachycardia/bradycardia; hypotension; QTc prolongation- rare ADEs with which antiemetic class?

5-HT3 receptor antiemetics

why should ODTs of 5HT3 antiemetics be avoided in PKU?

because they contain aspartame

can 5HT3 antiemetics be used in pregnancy?

yes

which class of antiemetics (ODT form) should not be given to patients with PKU?

5-HT3 receptor antiemetics

what happens if 5HT3 antiemetics mask progressive ileus?

becomes more serious and life-threatening

two stool changes that can happen with 5HT3 antiemetics?

constipation; diarrhea

can 5HT3 antiemetics cause headache?

yes

can 5HT3 antiemetics cause fatigue?

yes

can 5HT3 antiemetics cause dizziness?

yes

example of an opioid antidiarrhea?

loperamide

specific class? Loperamide

opioid antidiarrheal

drug? Slowing of peristalsis by binding of drug to opioid receptors in the intestines

loperamide

what effect does loperamide have on stool?

bulking and increased thickness

what does loperamide do to fecal volume?

decreased

why does loperamide have limited CNS effects?

does not cross BBB

does loperamide cross the BBB?

loperamide prevents loss of WHAT two things in the GI tract?

fluid and electrolyte loss

what drug can be given for traveler's diarrhea?

loperamide

what is the only drug indicated for IBS?

loperamide

when is loperamide used for Crohn's disease?

mild cases without any serious complication

what drug can be used in mild cases of Crohn's disease without any serious complication?

loperamide

general class? Loperamide

antidiarrheal

what are the two indications for loperamide?

traveler's diarrhea and mild IBS

what can rebound constipation progress to?

serious impaction

what population is prone to progression of rebound constipation to serious impaction?

older adults

why can loperamide cause toxic megacolon?

decreased intestinal motility/delayed intestinal transit

patients with what condition are especially prone to toxic megacolon?

IBS

what GI medication is associated with toxic megacolon?

loperamide

what should you do if patient on loperamide has abdominal distention?

promptly discontinue it

what is the concern if a patient on loperamide has abdominal distention?

toxic megacolon

can loperamide cause anticholinergic effects?

yes

what population is especially prone to urinary retention with opiate antidiarrheals?

children

children are especially prone to what adverse effect with loperamide?

urinary retention

three anticholinergic side effects of loperamide?

dry mucus membranes; flushing; tachycardia

what can anticholinergic side effect can happen to HR with loperamide?

tachycardia

why should loperamide be used cautiously in older adult population?

risk for impaction

should loperamide be given with urinary obstruction?

should loperamide be given with BPH?

should children with down syndrome be given loperamide?

what condition can influence younger children's response to opiate antidiarrheals?

dehydration

dehydration in children is problematic with what GI medication?

loperamide

at what age is there NO SAFE USE of any antidiarrheal?

<2 years old

what is the standard of care for children with diarrhea?

oral rehydration therapy

what is the only class of laxative that does not have abuse/dependency potential?

bulk producing laxatives

is there risk for abuse/dependence with bulk producing laxatives?

is there risk for abuse/dependence with osmotic laxatives?

yes

is there risk for abuse/dependence with stimulant laxatives?

yes

what 5 conditions can be caused by laxative abuse?

electrolyte alterations; fluid alterations; steatorrhea; osteomalacia; vitamin and nutrient deficiencies

electrolyte alterations; fluid alterations; steatorrhea; osteomalacia; vitamin and nutrient deficiencies- potential consequences of what?

laxative abuse

what general class of medication is contraindicated with nausea/vomiting/abdominal pain of unknown cause?

laxatives

if bowel obstruction is suspected, what general class of medication should NOT be given?

laxatives

what general class of medication can cause tartrazine sensitivity?

laxatives

tartrazine sensitivity is associated with sensitivity to what?

aspirin

what is an example of a tartrazine reaction?

bronchospasm

laxatives are associated with sensitivity to what?

tartrazine

4 examples of stimulant laxatives?

cascara, senna, bisacodyl, castor oil

specific class? Cascara, senna, bisacodyl, castor oil

stimulant laxatives

specific class? Cascara

stimulant laxatives

general class? Cascara

laxatives

specific class? Senna

stimulant laxatives

general class? Senna

laxatives

specific class? Bisacodyl

stimulant laxatives

general class? Bisacodyl

laxatives

specific class? Castor oil

stimulant laxatives

general class? Castor oil

laxatives

specific class? Thought to possibly cause direct action/stimulation/irritation of the myenteric nerve plexus (intestinal mucosa) along with irritation of intestinal smooth muscle

stimulant laxatives

what anatomical structure is stimulated by stimulant laxatives?

myenteric nerve plexus

where is the myenteric nerve plexus located?

intestinal mucosa

what class of laxatives affects the myenteric nerve plexus?

stimulant laxatives

which stimulant laxative can cause diarrhea in lactating infants?

cascara

what can happen if lactating infants breastfeed with mom on cascara?

diarrhea

which stimulant laxative contains ETOH?

cascara

which laxative medication should not be used if a patient cannot ingest ETOH?

cascara

can bisacodyl be used in pregnancy?

yes

which stimulant laxative can be used in pregnancy?

bisacodyl

which stimulant laxative is specifically contraindicated in pregnancy?

castor oil

why is castor oil contraindicated in pregnancy?

can induce uterine contractions

which laxative drug can induce uterine contractions?

castor oil

what effect do stimulant laxatives have on peristalsis?

increased

what effect do stimulant laxatives have on prostaglandins?

increased

what effect do stimulant laxatives have on c AMP concentration?

increased

what is a relative contraindication for bisacodyl?

CV disease

CV disease is a relative contraindication for which stimulant laxative?

bisacodyl

what two things does increased c AMP cause with stimulant laxatives?

increased secretion of electrolytes and increased peristalsis

which laxative class facilitates the release of prostaglandins?

stimulant laxatives

which laxative class is drug of choice when a rapid response is needed?

stimulant laxatives

should stimulant laxatives be used long-term?

how long should stimulant laxatives be used?

short-term

which laxative class is used for constipation r/t prolonged immobility?

stimulant laxatives

which laxative class is used for drug-induced constipation?

stimulant laxatives

example of causative drug class re: drug-induced constipation?

opioids

which laxative class is indicated for conditions causing decreased motility of the GI tract?

stimulant laxatives

which laxative class is indicated for neurogenic bowel?

stimulant laxatives

which laxative class may be indicated in spinal cord injury?

stimulant laxatives

which laxative class is indicated in constipation-predominant IBS?

stimulant laxatives

what two laxative classes are used for bowel prep?

osmotic and stimulant laxatives

which type of IBS is an indication for stimulant laxatives?

constipation-predominant

four adverse effects of stimulant laxatives?

diarrhea, flatulence, abdominal cramping, bloating

how can patients take a stimulant laxative for a more rapid response?

on an empty stomach with a full glass of water

taking a stimulant laxative on an empty stomach with a full glass of water leads to what?

more rapid response

specific class? Magnesium hydroxide

osmotic laxative

specific class? Magnesium citrate

osmotic laxative

specific class? Sodium phosphate

osmotic laxative

specific class? Polyethylene glycol 3350

osmotic laxative

general class? Magnesium hydroxide

laxative

general class? Magnesium citrate

laxative

general class? Sodium phosphate

laxative

general class? PEG 3350

laxative

can PEG 3350 be used in pediatric population?

yes, cautiously

specific class? Exert effects mainly by drawing water into the intestinal lumen

osmotic laxative

what effect does more water in the intestinal lumen have with osmotic laxatives?

increased intraluminal pressure

what effect do osmotic laxatives have on peristalsis?

increased

specific class? Hypertonic salt-based solutions that cause the diffusion of fluid from plasma into the intestine

osmotic laxative

are osmotic laxatives hypotonic or hypertonic?

hypertonic

osmotic laxatives are WHAT-based solutions?

salt

which type of osmotic laxative salts also cause an increase in the release of cholecystokinin by the duodenum?

magnesium salts

magnesium salts cause an increase in the release of cholecystokinin by what anatomical structure?

duodenum

which laxative drug can be used to treat chronic constipation in children?

PEG 3350

PEG 3350 can be used to treat WHAT in children?

chronic constipation

can osmotic laxatives be used for bowel prep?

yes

can stimulant laxatives be used for bowel prep?

yes

four adverse effects of osmotic laxatives?

diarrhea, flatulence, abdominal cramping, bloating

osmotic laxatives in pregnancy?

weigh risk/benefit

osmotic laxatives in lactation?

weigh risk/benefit

laxatives containing WHAT should be avoided in the setting of renal dysfunction?

magnesium salts

what magnesium imbalance can occur if you give magnesium-containing laxatives to patients with renal dysfunction?

hypermagnesemia

hypermagnesemia in setting of renal dysfunction is a concern with which class of laxatives?

osmotic laxative

can magnesium-containing laxatives be given with hypocalcemia?

can magnesium-containing laxatives be given with heart arrhythmias?

can magnesium-containing laxatives be given to patients with conduction disturbances?

should patients with bowel obstruction be given osmotic laxatives?

should patients with ileus be given osmotic laxatives?

can magnesium-containing laxatives be given to patients with heart block?

three examples of bulk producing laxatives?

psyllium, methylcellulose, polycarbophil

specific class? Psyllium, methylcellulose, polycarbophil

bulk producing laxatives

specific class? Psyllium

bulk producing laxatives

specific class? Methylcellulose

bulk producing laxatives

specific class? Polycarbophil

bulk producing laxatives

general class? Psyllium

bulk producing laxatives

general class? Methylcellulose

bulk producing laxatives

general class? Polycarbophil

bulk producing laxatives

what class of laxatives consists of natural and semi-synthetic polysaccharides and cellulose?

bulk producing laxatives

what class of laxatives acts physiologically like increased dietary fiber would?

bulk producing laxatives

what do bulk producing laxatives combine with in the intestines?

water

what do bulk producing laxatives do to the intestinal wall?

mechanical distention

what effect do bulk producing laxatives have on peristalsis?

increased

what is the safest class of laxatives?

bulk producing laxatives

what is the physiologically easiest class of laxatives?

bulk producing laxatives

what class of laxatives works like increased fiber in the diet?

bulk producing laxatives

can bulk producing laxatives be given in pregnancy?

yes

can bulk producing laxatives be given in lactation?

yes

which class of laxatives is the class of choice when rapid response is NOT needed?

bulk producing laxatives

which class of laxatives should be used for long-term management with the least adverse reactions?

bulk producing laxatives

which class of laxatives is especially useful if constipation is r/t low dietary fiber?

bulk producing laxatives

which class of laxatives is especially useful in situations where straining at stool should be avoided?

bulk producing laxatives

what is the use for bulk producing laxatives in chronic watery diarrhea?

to bulk the stool

for what type of diarrhea can bulk producing laxatives be used?

chronic, watery diarrhea

which class of laxatives can be used for long-term therapy for simple, chronic constipation?

bulk producing laxatives

do side effects of bulk producing laxatives usually dissipate with time?

yes

four adverse effects of bulk producing laxatives?

diarrhea, flatulence, abdominal cramping, bloating

which class of laxatives should be used cautiously in situations with strictures or other narrowing of the esophagus/intestine?

bulk producing laxatives

which class of laxatives can be contraindicated if patient has salt or sugar restriction?

bulk producing laxatives

restrictions of what two dietary substances can be problematic with bulk producing laxatives?

salt or sugar

which class of laxatives has some preparations that may contain salt or sugar?

bulk producing laxatives

can you give bulk producing laxatives in bowel obstruction?

why are bulk producing laxatives contraindicated in bowel obstruction?

feces cannot get around the impacted stool

do bulk producing laxatives hinder the absorption of nutrients?

which class of laxatives is especially suited for older adults?

bulk producing laxatives

what three properties does bismuth subsalicylate possess?

antisecretory, antiinflammatory, antimicrobial

what drug has antisecretory, antiinflammatory, and antimicrobial properties?

bismuth subsalicylate

what portion of bismuth subsalicylate is antisecretory?

salicylate

what function does the salicylate portion of bismuth subsalicylate have?

antisecretory

which portion of bismuth subsalicylate is antimicrobial?

bismuth portion

the bismuth portion of bismuth subsalicylate has what function?

antimicrobial

what two types of pathogens can bismuth affect?

bacterial and viral

what drug has action on bacterial and viral enteropathogens?

bismuth subsalicylate

part of what drug may exert direct antimicrobial effects against bacterial and viral enteropathogens?

bismuth subsalicylate

bismuth subsalicylate can be used as part of a multidrug regimen for what?

h pylori

bismuth subsalicylate in pregnancy?

no significant data for safe use

bismuth subsalicylate in lactation?

no significant data for safe use

bismuth subsalicylate in children < 2 years old?

extreme caution

should children be given antidiarrheals?

no- avoid; use oral rehydration therapy

which drug should be avoided in febrile viral conditions?

bismuth subsalicylate

what is the concern with giving bismuth subsalicylate in febrile viral conditions?

reye syndrome

reye syndrome can happen with administration of what drug?

bismuth subsalicylate

what portion of bismuth subsalicylate can cause reye syndrome?

salicylate

what is an example of a condition in which bismuth subsalicylate can cause reye syndrome?

influenza

a patient with influenza should not be given which medication?

bismuth subsalicylate

what population is especially prone to reye syndrome with bismuth subsalicylate?

pediatric population

can reye syndrome be life-threatening?

yes

can patients that are allergic to aspirin take bismuth subsalicylate?

patients that are allergic to WHAT should not take bismuth subsalicylate?

aspirin

example of a drug used for prokinetic therapy?

metoclopramide

drug? Stimulates motility in the upper GI tract

metoclopramide

where does metoclopramide stimulate motility?

upper GI tract

drug? Action of sensitizing tissues to the action of acetylcholine

metoclopramide

what neurotransmitter is effected primarily with metoclopramide?

acetylcholine

what happens to gastric contractions with metoclopramide?

increased tone and amplitude

what does metoclopramide do to tone of gastric contractions?

increased

what does metoclopramide do to amplitude of gastric contractions?

increased

what does metoclopramide do to pyloric sphincter?

relaxes

what does metoclopramide do to duodenal bulb?

relaxes

what two structures does metaclopramide relax?

pyloric sphincter and duodenal bulb

what effect does metoclopramide have on peristalsis?

increased

does metoclopramide increase peristalsis?

yes

what kind of drug is metoclopramide in the CNS?

dopamine receptor antagonist

what does metoclopramide anatagonize in the CNS?

dopamine

what does metoclopramide do at the CTZ?

antagonizes dopamine

drug? Induces release of prolactin

metoclopramide

drug? Transiently increases circulating aldosterone levels

metoclopramide

metoclopramide induces the release of what hormone?

prolactin

metoclopramide transiently increases circulating levels of what hormone?

aldosterone

what drug can impact both prolactin and aldosterone?

metoclopramide

what is the boxed warning for metoclopramide?

tardive dyskinesia

what GI drug has a boxed warning re: tardive dyskinesia?

metoclopramide

what should you do if a patient on metoclopramide shows signs of movement disorder?

discontinue it

the risk for tardive dyskinesia with metoclopramide increase with what?

length of treatment

the longer a patient is on metoclopramide, the greater the changes they will experience what?

tardive dyskinesia

extrapydramidal symptoms can occur with which prokinetic medication?

metoclopramide

three examples of EPS reactions with metoclopramide?

tardive dyskinesia, acute dystonic reaction, parkinsonian symptoms

tardive dyskinesia, acute dystonic reaction, parkinsonian symptoms- can happen with what GI medication?

metoclopramide

what two populations are more prone to EPS with metoclopramide?

children and young adults

children and young adults taking metoclopramide are more prone to what?

EPS

can metoclopramide cause sedation?

yes

sedation re: metoclopramide is similar to what class of antiemetic?

phenothiazine antiemetic

what drug is associated (rare) with neuroleptic malignant syndrome?

metoclopramide

three uncommon side effects of metoclopramide?

galactorrhea, amenorrhea, gynecomastic

galactorrhea, amenorrhea, and gynecomastia- associated with what drug?

metoclopramide

when should metoclopramide be taken?

30 minutes before each meal and at bedtime

should you double doses of metoclopramide?

can metoclopramide be used as monotherapy?

why is metoclopramide used for lower tiers of therapy?

due to serious adverse effects

does metoclopramide have prokinetic properties?

yes

does metoclopramide heal esophageal lesions?

what medication is mostly used for gastroparesis therapy of GI disorders?

metoclopramide

what is metoclopramide mostly used for?

gastroparesis

the action of metoclopramide WHERE prevents nausea and vomiting?

chemoreceptor trigger zone

what is the principal effect of metoclopramide in GERD?

relief of postprandial and daytime heartburn

the primary use of what drug in GERD is to relieve postprandial and daytime heartburn?

metoclopramide

metoclopramide in pregnancy?

no adequate studies

metaclopramide in lactation?

no adequate studies

treatment with metoclopramide should not exceed how long?

12 weeks

dopamine-associated activity that affects the CNS with metoclopramide can cause what problem?

depression

why can depression happen with metoclopramide?

dopamine-associated activity that affects the CNS

metoclopramide in renal impairment?

caution

what can happen if you take an MAOI with metoclopramide?

hypertensive crisis

a hypertensive crisis can happen if you what WHAT with metoclopramide?

MAOI

MAOI use and metoclopramide?

contraindication

metoclopramide with GI hemorrhage?

metoclopramide with mechanical obstruction?

metoclopramide with new surgery on GI tract?

metoclopramide with perforation?

pheochromocytoma + metoclopramide can lead to what?

hypertensive crisis

what two situations with metoclopramide can cause hypertensive crisis?

pheochromocytoma and MAOI use

what is the main cause of PUD?

h pylori

three potential complications of PUD?

bleeding, perforation, carcinoma

what is the primary class of antisecretory medication used in PUD?

proton pump inhibitors

what is used over H2RAs in PUD?

proton pump inhibitors

which is more effective at gastric acid suppression? H2RAs or PPIs

proton pump inhibitors

can clarithromycin be used for h pylori?

yes

can amoxicillin be used for h pylori?

yes

can metronidazole be used for h pylori?

yes

can tetracycline be used for h pylori?

yes

can doxycycline be used for h pylori?

yes

can nitazoxanide be used for h pylori?

yes

can levofloxacin be used for h pylori?

yes

can bismuth subsalicylate be used for h pylori?

yes

example of cytoprotective agent used in h pylori?

misoprostol

what is a primary cause of treatment failure re: h pylori?

microbial resistance to antibiotics

what kind of drug is misoprostol?

cytoprotective agent

drug? Methyl analog of prostaglandin E1

misoprostol

misoprostol is a methyl analog of what?

prostaglandin E1

drug? Inhibition of gastric secretion through inhibition of histamine-stimulated production of c AMP

misoprostol

drug? Inhibits basal and nocturnal gastric acid secretion in response to a variety of stimuli

misoprostol

how does misoprostol inhibit basasl and nocturnal gastric acid secretion in response to stimuli?

binding to prostaglandin receptors

three examples of stimuli that can be affected by misoprostol?

meals, histamine, coffee

does misoprostol have cytoprotective properties?

yes

prostaglandin E receptors have a high affinity for WHAT and its active metabolite?

misoprostol

drug? Primarily used for prevention of NSAID-induced PUD

misoprostol

drug? Provides mucosal protection from h pylori

misoprostol

what GI drug can cause induction of uterine contractions?

misoprostol

post-menopausal bleeding can occur with what GI drug?

misoprostol

what is the #1 adverse effect with misoprostol?

diarrhea

can misoprostol cause abdominal pain?

yes

can misoprostol cause diarrhea?

yes

can misoprostol cause nausea?

yes

can misoprostol cause flatulence?

yes

can misoprostol cause post-menopausal bleeding?

yes

what GI med is absolutely contraindicated in pregnancy?

misoprostol

can misoprostol cause abortion?

yes

can misoprostol cause premature birth?

yes

can misoprostol cause birth defects?

yes

misoprostol in lactation?

is excreted in breast milk but not expected to cause adverse effects

misoprostol in children <18 years old?

safety not established

misoprostol in renal impairment?

caution

what can happen if you combine misoprostol with magnesium-based antacids?

diarrhea

diarrhea can happen if you combine misoprostol with WHAT?

magnesium-based antacids

for what two conditions are diuretics 1st line therapy?

HTN and HF

what class of medication is considered first line therapy for HTN and HF?

diuretics

specific class? Esomeprazole

proton pump inhibitors

specific class? Lansoprazole

proton pump inhibitors

specific class? Omeprazole

proton pump inhibitors

specific class? Pantoprazole

proton pump inhibitors

specific class? Rabeprazole

proton pump inhibitors

specific class? Dexlansoprazole

proton pump inhibitors

specific class? Suppression of gastric acid secretion by parietal cells by preventing the H+/K+atpase enzyme system from secreting hydrogen ion needed to form hydrochloric acid

proton pump inhibitors

what cells are affected by PPIs?

gastric parietal cells

what enzyme system is inhibited with PPIs?

H+K+ATPase

what type of ion is needed to form hydrochloric acid?

hydrogen

describe efficacy of PPIs?

very effective

what class of GI medication can cause achlorhydria?

proton pump inhibitors

what is the term for no gastric acid?

achlorhydria

definition of achlorhydria?

no gastric acid

what three structures experience decreased blood flow with Ppis?

gastric antrum; pylorus; duodenal bulb

what happens to blood flow to gastric antrum with PPIs?

decreased

what happens to blood flow to pylorus with PPIs?

decreased

what happens to blood flow to duodenal bulb with PPIs?

decreased

what happens to pepsinogen levels with PPIs?

increased

what happens to pepsin activity with PPIs?

decreased

what happens to gastrin levels with PPIs?

compensatory increase

do PPIs have anticholinergic effects?

do PPIs have histamine2 blockade?

what class is considered 1st line therapy for most patients with frequent GERD sx or other serious complications?

proton pump inhibitors

would a PPI be given with esophagitis?

yes

can PPIs be used in PUD?

yes

can PPIs be used in hypersecretory states?

yes

what is an example of a hypersecretory state for which a PPI may be used?

zollinger-ellison syndrome

describe adverse effect profile of PPIs?

usually well tolerated in the short term

four GI adverse effects of PPIs?

nausea, abdominal pain, flatulence, constipation/diarrhea

can PPIs cause nausea?

yes

can PPIs cause abdominal pain?

yes

can PPIs cause flatulence?

yes

can PPIs cause constipation?

yes

can PPIs cause diarrhea?

yes

can PPIs cause drowsiness?

yes

can PPIs cause dizziness?

yes

what class of GI medication can cause acute interstitial nephritis?

proton pump inhibitors

short-term PPI use can lead to increased risk for what respiratory condition?

pneumonia

why can PPI use cause pneumonia?

stomach acid provides a natural defense against microbial pathogens

what three infections can happen with long-term use of PPIs?

c diff; salmonella; campylobacter

can c diff happen with long-term use of PPIs?

yes

can salmonella happen with long-term use of PPIs?

yes

can campylobacter happen with long-term use of PPIs?

yes

concern that PPIs increase the risk for what type of cancer?

gastric cancer

what is the association re: risk for PPIs and gastric cancer?

chronic atrophic gastritis

chronic atrophic gastritis is a concern with what class of GI medication?

proton pump inhibitors

what cognitive condition is potentially associated with PPIs?

dementia

dementia may be linked to what class of GI medication?

proton pump inhibitors

what class of GI medication potentially increases overall mortality?

proton pump inhibitors

are PPIs linked with acute kidney injury?

yes

are PPIs linked with chronic kidney disease?

yes

what four nutrients/minerals can be deficient with long-term PPI use?

iron, magnesium, vitamin B12, calcium

can PPIs affect iron?

yes

can PPIs affect magnesium?

yes

can PPIs affect vitamin B12?

yes

can PPIs affect calcium?

yes

why can PPIs affect iron?

need an acidic environment for optimal absorption

why can PPIs affect magesium?

need an acidic environment for optimal absorption

why can PPIs affect vitamin B12?

need an acidic environment for optimal absorption

why can PPIs affect calcium?

need an acidic environment for optimal absorption

what are two skeletal complications that can happen with long-term PPI use?

osteoporosis; hip fracture

hip fracture is associated with what class of GI med?

proton pump inhibitors

osteoporosis is associated with what class of GI med?

proton pump inhibitors

PPIs in lactation?

caution

PPIs in pregnancy?

only if benefit > risk

can PPIs be used in children?

some drugs in class have shown efficacy in the pediatric population

PPIs in hepatic dysfunction?

caution (CYP450)

PPIs in older patients?

caution

PPIs in lactation?

caution

should patients continue PPIs if they are feeling better?

yes

should PPI doses be doubled?

when should PPIs be taken?

before a meal- morning preferred

any drug therapy for GERD must be combined with what?

lifestyle modification

what should I do if response to PPI therapy is inadequate?

check for compliance with medication and lifestyle modifications

what does H2RA stand for?

histamine-2 receptor antagonist

specific class? Cimetidine

histamine-2 receptor antagonist

specific class? Famotidine

histamine-2 receptor antagonist

specific class? Nizatidine

histamine-2 receptor antagonist

specific class? Blockade of the histamine-2 receptor on gastric parietal cells

histamine-2 receptor antagonist

what receptor is affected by H2RAs?

histamine 2

what happens to ph of gastric juices with H2RAs?

increased

on H2RAs does gastric juice become more alkaline or more acidic?

more alkaline

can H2RAs affect volume of gastric secretion?

yes

can H2RAs affect hydrogen ion concentration?

yes

can H2RAs affect speed of gastric emptying?

yes

can H2RAs affect LES pressure?

yes

can H2RAs affect level of postprandial gastrin?

yes

can H2RAs affect level of fasting gastrin?

yes

are H2RAs anticholinergic?

do H2RAs have anticholinergic effects?

why do H2RAs not have anticholinergic effects?

Because they don’t block histamine 1 receptors

what are 2 antiandrogenic adverse effects of H2RAs?

gynecomastia and erectile dysfunction

gynecomastia and erectile dysfunction can occur with what GI class of medication?

histamine-2 receptor antagonist

erectile dysfunction is known to occur with which specific H2RA?

cimetidine

how to address erectile dysfunction with H2RAs?

switch to another medication in the class

can oral H2RAs cause rhythm and conduction abnormalities?

yes

can IV H2RAs cause rhythm and conduction abnormalities?

yes

what two situations make CNS adverse effects more likely with H2RAs?

renal and hepatic dysfunction

what is an example of a CNS adverse effect with H2RAs?

cognitive dysfunction

why should H2RAs be avoided in older adult population?

risk for cognitive dysfunction

can agitation occur with H2RAs?

yes

can depression occur with H2RAs?

yes

can psychosis occur with H2RAs?

yes

can seizures happen with H2RAs?

yes

can headache happen with H2RAs?

yes

what GI class can cause individual cell line deficiencies?

histamine-2 receptor antagonist

what GI class can cause pancytopenia?

histamine-2 receptor antagonist

why should H2RAs have monitoring with CBC?

individual cell line deficiencies to pancytopenia

when should liver function be monitored with H2RAs?

more than short-term use or higher doses

is there a risk for hepatocellular damage with H2RAs?

yes

when should renal function be monitored with H2RAs?

more than short-term use or higher doses

can older adults need dosage adjustment with H2RAs?

yes

deficiency of what can occur with long-term use of H2RAs?

vitamin B12

two consequences of vitamin B12 deficiency?

anemia; neuro deficits

anemia and neuro deficits can be a consequence of what?

vitamin B12 deficiency

when are PPIs preferred over H2RAs?

almost all instances

when are H2RAs most effective?

if used as on-demand treatment for relief of GERD

can H2RAs be used in PUD?

yes

can H2RAs be used in hypersecretory states?

yes

can H2RAs be used in GERD without erosive esophagitis?

yes

can H2RAs be used in GERD with erosive esophagitis?

yes

can H2RAs be used for heart burn?

yes

can H2RAs be used for acid indigestion?

yes

can H2RAs be used for sour stomach?

yes

for what 3 conditions can H2RAs be used as prophylaxis for in patients that are NPO?

duodenal ulcer; gastric acid; GERD

when can H2RAs be used as maintenance therapy after PPI treatment?

if no esophageal erosive disease is present

are any H2RAs preferred over other H2RAs?

when have H2RA treatment failures occurred?

with each drug in class

can treatment failure with one H2RA be corrected by changing drugs within the class?

doubtful

can tachyphylaxis happen with H2RAs?

yes

when can a dose of H2RA for patients on PPIs be helpful for nighttime reflux?

before bed

is once-daily dosing of H2RAs effective in treating GERD?

H2RAs in pregnancy?

not well-studied- avoid use; weigh risk/benefit

H2RAs in lactation?

avoid use/ weigh risk/benefit

H2RAs in pediatrics?

yes- as young as neonates

can H2RAs be used in neonates?

yes

why do H2RAs have many drug interactions?

CYP450 metabolism

which of the H2RAs is the most problematic re: drug interactions?

cimetidine

should patients continue taking H2RAs if they feel better?

yes

should patients double doses of H2RAs?

when should H2RAs be taken relative to meals?

with meals or immediately afterward

should H2RAs be taken at bedtime?

yes

when should H2RAs be taken?

with meals or immediately afterward and at bedtime

if patient on a once daily dose of H2RA, what time of day should it be taken?

at bedtime

what behavior interferes with the absorption of H2RAs?

smoking

smoking increases the secretion of what?

gastric acid

how long should antacids be separated from H2RAs?

at least 30 min to 1 hour

how long should sucralfate be taken after H2RA?

2 hours

sucralfate should be taken when relative to an H2RA?

2 hours after

what is an example of a life-threatening GERD complication?

esophageal carcinoma

what three activities should be avoided for 3 hours after eating/drinking anything?

bending over; strenuous exercise; lying supine

can smoking cessation help GERD?

yes

can NOT overeating help GERD?

yes

can elevating the HOB when lying down help GERD?

yes

can weight loss to ideal body weight help GERD?

yes

effect of bethanechol on LES tone?

increased

effect of metoclopramide on LES tone?

increased

effect of histamine on LES tone?

increased

effect of pentobarbital on LES tone?

increased

effect of antacids on LES tone?

increased

effect of anticholinergics on LES tone?

decreased

effect of theophylline on LES tone?

decreased

effect of meperidine on LES tone?

decreased

effect of calcium channel blockers on LES tone?

decreased

when are drugs used that improve LES tone re: GERD?

used adjunctively with a drug that is suppressing the production of HCL

what general class of GERD medication has serious adverse effects?

prokinetic agents

what general class of medication is reserved for use in patients who still experience symptoms after maximal acid suppression and maximal lifestyle modification?

prokinetic agents

when are cytoprotective agents usually used?

only in PUD

why are cytoprotective agents usually only used in PUD?

since they affect the gastric mucosa

what class of medication decreases the exposure of gastric mucosa to acid?

cytoprotective agent

what are the three types of antacids?

calcium-based; aluminum-based; magnesium-based

class? Weak bases that form salt and water when they interact with hydrochloric acid

antacids

what two things are formed when antacids interact with HCL?

salt and water

are antacids weak acids or weak bases?

weak bases

what effect do antacids have on HCL?

neutralize

what effect do antacids have on gastric ph?

increase

what effect do antacids have on duodenal bulb ph?

increase

antacids include a metallic cation plus what?

basic anion

antacids include a basic anion plus what?

metallic cation

what do antacids do to pepsin's proteolytic activity?

inhibit

what do antacids do to LES tone?

improve

which type of antacids slow gastric motility?

aluminum-based antacids

how do aluminum-based antacids slow gastric motility?

inhibition of smooth muscle locally in the stomach

which two types of antacids cause constipation?

calcium-based and aluminum-based

which type of antacids can cause diarrhea?

magnesium-based antacids

patients with what condition can have alkalosis when taking antacids?

renal failure

what three labs should be monitored with chronic use of antacids?

phosphate, potassium, calcium

chronic use of antacids can do what to calcium?

increase calcium

chronic antacid use can do what to phosphate levels?

decrease

can you use antacids if unknown cause of GI symptoms?

can you use antacids if severe abdominal pain of unknown cause?

which type of antacids is contraindicated if hx of renal stones?

calcium-based antacids

which type of antacids are contraindicated if hypercalcemia?

calcium-based antacids

what can happen if you give magnesium-based antacids in renal failure?

hypermagnesemia

when should high sodium-containing antacids be avoided?

when fluid overload will exacerbate a condition

high sodium-containing antacids should be avoided in what three medical conditions?

HFrEF, HTN, renal failure

prolonged use of which type of antacids can cause osteomalacia in renal failure?

aluminum-based antacids

can aluminum-based antacids cause or worsen osteomalacia of dialysis?

yes

what are the two pieces of antacids' dual purpose?

improve LES tone; increase gastric ph

which type of antacid can be used in malnutrition?

magnesium-based antacids

which type of antacid can be used in alcoholism?

magnesium-based antacids

which type of antacid can be used with magnesium-depleting drugs?

magnesium-based antacids

can antacids be used PRN in GERD?

yes

can antacids be used PRN for non-frequent symptoms in GERD?

yes

can antacids be used in concert with an acid suppressive drug in GERD?

yes

can antacids be used as monotherapy for significant GERD disease?

can antacids be used as monotherapy for esophagitis?

can antacids be used as monotherapy for frequent GERD symptoms?

can antacids be used as adjunctive therapy for frequent GERD symptoms?

yes

can antacids be used in PUD?

yes

can antacids be used in hypersecretory states?

yes

can antacids be used in calcium deficiency?

yes

can antacids be used in menopause?

yes

menopause reflects what type of state?

calcium-deficiency

chronic renal failure reflects what type of state?

calcium-deficiency

can antacids be used in chronic renal failure?

yes

can antacids be used in hyperphosphatemia?

yes

when are antacids used in renal failure?

to bind phosphates and lower blood phosphate levels

what two types of antacids can be used in renal failure to lower phosphate levels?

calcium and aluminum-based antacids

when should antacids be taken?

1-3 hours after meals and at bedtime

what should you do to prevent chewable tabs from entering the small intestine in undissolved form?

chew thoroughly and then drink 1/2 a glass of water

chewing antacids thoroughly and then drinking a 1/2 glass of water does what?

prevents chewable tabs from entering the small intestine in undissolved form

can calcium-based antacids be administered with foods high in oxalic acid?

what type of antacid should not be administered with foods high in oxalic acid?

calcium-based antacids

what type of antacid should not be given with foods high in phytic acid?

calcium-based antacids

two foods high in oxalic acid?

spinach, rhubarb

two foods high in phytic acid?

bran; cereal

is aluminum easily removed by dialysis?

why is aluminum hard to remove during dialysis?

because it is bound to albumin and transferrin

can albumin and transferrin cross the dialysis membrane?

where is aluminum deposited?

into the bone

deposition of WHAT into the bone cause osteomalacia?

aluminum

many of the antacid drug interactions have to do with what?

absorption

separation of admin of the antacid and interacting drug should occur by how long?

2 hours

specific class? Spironolactone

aldosterone antagonist

specific class? Triamterene

aldosterone antagonist

specific class? Amiloride

aldosterone antagonist

specific class? Eplerenone

aldosterone antagonist

describe the diuretic effect of aldosterone antagonists?

weak

where do aldosterone antagonists act?

distal tubule of the kidney

MOA of aldosterone antagonists?

inhibit excretion in the distal tubule of the kidney

specific class? Inhibit excretion in the distal tubule of the kidney

aldosterone antagonist

aldosterone antagonists are most often used in combination with what class?

thiazide diuretics

why are aldosterone antagonists most often used in combination with thiazide diuretics?

to decrease potassium loss

gynecomastia occurs in what percentage of patients taking spironolactone?

0.5

gynecomastia is associated with what diuretic medication?

spironolactone

impotence is associated with which diuretic class?

aldosterone antagonist

older adults are at increased risk for what adverse effect with diuretics?

hypotension

what is the cause of hypotension with diuretics?

fluid volume deficit

fluid volume deficit with diuretics can cause what?

hypotension

which aldosterone antagonist can cause high levels of uric acid?

spironolactone

when is hyperkalemia more likely with aldosterone antagonists?

when combined with an ACE or ARB

what are the two classes of medications that make hyperkalemia more likely with aldosterone antagonists?

ACE or ARB

taking an ACE or an ARB with an aldosterone antagonist makes WHAT more likely?

hyperkalemia

which diuretic medication is the best choice for a pregnant patient if a diuretic must be used?

spironolactone

furosemide in pediatric patients?

safe

specific class? Furosemide

loop diuretic

specific class? Bumetanide

loop diuretic

describe speed of loop diuretics?

short-acting

describe diuretic effect of loop diuretics?

powerful, large natriuresis

are loop diuretics long or short acting?

short-acting

MOA of loop diuretics?

inhibit sodium reabsorption in the ascending loop of henle

where do loop diuretics inhibit sodium reabsorption?

in the ascending loop of henle

what do loop diuretics inhibit in the ascending loop of henle?

sodium reabsorption

with loop diuretics, older adults are at increased risk for what two complications?

falls and hypotension

what three diuretic classes/drugs have the greatest risk for high uric acid?

loop; thiazide; spironolactone

can loop diuretics cause high uric acid levels?

yes

can thiazide diuretics cause high uric acid levels?

yes

can spironolactone cause high uric acid levels?

yes

calcium imbalance seen with loop diuretics?

hypercalcemia

sodium imbalance seen with loop diuretics?

hyponatremia

magnesium imbalance seen with loop diuretics?

hypomagnesemia

potassium imbalance seen with loop diuretics?

hypokalemia

what electrolyte imbalance must be treated before treating hypokalemia?

hypomagnesemia

what electrolyte imbalance can lead to metabolic alkalosis with diuretics?

hypokalemia

high dietary intake of what can exacerbate potassium loss re: diuretics?

sodium

high dietary intake of sodium can worsen what?

hypokalemia

what two classes of diuretics are most likely to cause glucose intolerance?

thiazide and loop diuretics

glucose intolerance is directly linked to what re: diuretics?

serum potassium level

what electrolyte imbalance should you correct in order to address glucose intolerance with diuretics?

hypokalemia

effect of loop diuretics on placental perfusion?

can decrease

loop diuretics in pregnancy?

only if benefit > risk

specific class? Chlorthalidone

thiazide diuretics

specific class? Hydrochlorothiazide

thiazide diuretics

specific class? Indapamide

thiazide diuretics

specific class? Metolazone

thiazide diuretics

HCTZ in pediatrics?

safe

which thiazide diuretic is safe in pediatric patients?

hydrochlorothiazide

are thiazide diuretics longer or shorter lasting?

longer lasting with less diuresis

which class of diuretic? Longer lasting with less diuresis

thiazide diuretics

which class of diuretic? Short-acting but powerful, large natriuresis

loop diuretic

which class of diuretic? Weak diuretics

aldosterone antagonist

which class of diuretic can cause transient increase in lipids?

thiazide diuretics

hyperlipidemia (Transient) can be seen with which diuretic class?

thiazide diuretics

MOA of thiazide diuretics?

inhibit sodium reabsorption in the distal renal tubule

where do thiazide diuretics inhibit sodium reabsorption?

distal renal tubule

what do thiazide diuretics inhibit in the distal renal tubule?

sodium reabsorption

what effect do thiazide diuretics have on potassium excretion?

increased

can thiazide diuretics cause hypokalemia?

yes

which class of diuretics enters the intracellular spaces?

thiazide diuretics

why can thiazide diuretics be useful in refractory edema?

they enter intracellular spaces

which class of diuretics can be useful in refractory edema?

thiazide diuretics

which class of diuretics can cause long-term photosensitivity reactions?

thiazide diuretics

how long can photosensitivity persist after stopping thiazide diuretics?

years

do thiazide diuretics increase the risk for falls in older adults?

yes

do thiazide diuretics increase risk for hypotension in older adults?

yes

electrolyte imbalance of calcium in thiazide diuretics?

hypercalcemia

electrolyte imbalance of sodium in thiazide diuretics?

hyponatremia

electrolyte imbalance of magnesium in thiazide diuretics?

hypomagnesemia

electrolyte imbalance of potassium in thiazide diuretics?

hypokalemia

hypokalemia may lead to what condition with thiazide diuretics?

metabolic alkalosis

what two classes of diuretics can cause metabolic alkaloisis?

loop and thiazide diuretics

what can exacerbate hypokalemia with thiazide diuretics?

high dietary sodium

can glucose intolerance happen with thiazide diuretics?

yes

glucose intolerance is directly linked to what re: thiazide diuretics?

potassium level

which diuretic drug is the least likely to cause high levels of uric acid?

indapamide

there is a possible link between what class of diuretics and development of squamous cell lip cancer?

thiazide diuretics

thiazide diuretics may have a link to what kind of cancer?

squamous cell lip cancer

what effect can thiazide diuretics have on placental perfusion?

decrease

thiazide diuretics in pregnancy?

only if benefit > risk

retention of sodium and water lead to increase in what?

ECF volume

what effect do diuretics have on cardiac output?

decreased

how do diuretics decrease cardiac output?

by decreasing plasma volume

initially, diuretics do what to natriuresis?

promote

initially, diuretics do what to plasma volume?

decrease it

initially, diuretics do what to cardiac output?

decrease it

what is the lasting effect of diuretics, even after time?

decreased total peripheral resistance

metabolic alkalosis with diuretics is associated with what electrolyte imbalance?

hypokalemia

what sodium imbalance can happen with diuretics?

hyponatremia

what magnesium imbalance can happen with diuretics?

hypomagnesemia

what calcium imbalance can happen with diuretics?

hypercalcemia

drug interactions with diuretics?

multiple

what are the two classes of diuretics that increase excretion of potassium?

loop and thiazide diuretics

where must thiazide diuretics reach in order to work?

lumen of the renal tubule

what happens to efficacy of diuretics with renal impairment?

less effective

Exam 4 Flashcards

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