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Flashcards in Final - Meds Deck (112):
1

HTN: CCBs

  • Calcium Channel Blockers
    • Dihydropyridines (end with -pine)
    • Non-dihydropyridines
      • diltiazem (Cardizem) & verapamil (Calan)
  • blocks SA and AV node
  • watch for bradychardia

2

HTN: ACE Inhibitors

 

  • end with -pril
  • good for kidney and DM patients
  • watch for cough
  • watch for angioedema
  • watch for HYPERkalemia

3

HTN: Adrenergic Agents--> Beta Blockers

  • end with -olol
  • Cardioselective and non (carve- and prop-)
  • Blocks AV node
  • take apical pulse before admin
  • can tx glaucoma and migraine
  • watch for decrease resp in non-selective

4

HTN: Adrenergic Agents --> Alpha Blockers

  • end with -zosin
  • syncope on 1st dose
  • Tx obstructive BPH
  • Takes 2 weeks to work

5

HTN: Adrenergic Agents --> Central Acting alpha 2 adrenergics

  • clonidine
  • methyldopa
  • can tx nicotine and opiod withdrawals

6

HTN: Angiotensin 2 Receptor Blockers (ARBs)

 

  • end with -sartan
  • same s/e as ACE but no cough
  • watch for angioedema
  • contraindicated in 2nd and 3rd trimester

7

HTN: Vasodilators

  • hydralazine (Apresoline)
  • nitrates
  • uesd in htn crises/emergency
  • nitroprusside
  • diazoxide
  • minoxidil

8

HTN: Diuretics-->Loop diuretics

  • end in -mide/nide
  • may need K supplement
  • blocks Na and Cl reabsorption

9

HTN: Diuretics-->Thiazide

  • Hydrochlorothiazide
  • metaloze
  • inhibits Na and CL reabsorption
  • Watch for hypokalemia

10

HTN: Diuretics--> potassium sparing

  • spironolactone
  • good for asthma pts and african americans
  • watch for HYPERkalemia

11

HTN: Potassium Replacment

  • potassium chloride (Kaon, K-Dur, K-Lyte)

12

Surg: Sedative-Hypnotics-->benzodiazepine

  • end in -pam and -lam
    • diazepam (Valium)
    • lorezepam (Ativan)
    • midazolam (Versed)

13

Surg: Sedative-Hyptontics-->non-benzodiazepine

zolpidem (Ambien)

14

Surg: Anticholinergics

  • glycopyrrolate (Robinul)
  • atropine

15

Surg: Anesthesia

  • general
    • inhalation
    • intravenous
  • regional
    • topical/surface
    • infiltration/local
    • peripheral nerve block
    • spinal
    • epidural
  • procedural sedation (aka moderate or conscious sedation)
    • propofol (Diprivan)

16

Surg: Anesthesia Adjuncts

  • sedative-hypnotics
    • benzodiaepines
      • end in -pam and -lam
  • neuro-muscular blocking agents
    • succinylcholine (Anectine)
    • panacuronium (Pavulon)
    • awake but can't move or breath
  • opioids
    • fentanyl (Duragesic)
    • morphine
    • watch for resp depression

17

Surg: Antimicrobial/Anti-infective--> Penicillins

end in -cillin

  • assess for allergy
  • penicillin g and v
  • nafcillin
  • amoxicillin (Amoxil)
  • ticarcillin (Ticar)
  • piperacillin/tazobactam (Zosyn)
  • amoxicillin/clavulanate (Augmentin)

18

Surg: Antimicrobial/Anti-infective-->Trycyclic Glycopeptide

  • vancomycin (Vancocin)
  • can caues 8th CN damage
  • give slowly

19

Surg: Antimicrobial/Anti-infective-->Cephalosporin

  • start with cef- or ceph-
  • assess for pcn allergies
  • watch for super infection
  • monitor renal and hepatic
  • cefazolin (Ancef, Kefzol)
  • ceftriaxone (Rocephin)
  • cefoxtoxine sodium (Claforan)

 

20

Surg: Antimicrobial/Anti-infective --> Aminoglycosides

  • end in -myocin
  • gentomycin (Geramycin)
  • tobramycin (Nebcin)
  • do NOT use with other antibiotics
  • oto and nephro toxic
  • assess peak and trough

21

Surg: Antimicrobial/Anti-infective-->Floroquinolones/Quinolones

  • end in -floxin
  • ciprofloxacin (Cipro)
  • levofloxacin (Lefoquin)
  • moxifloxacin (Avelos)
  • can cause 8th CN damage (Hearing)
  • caution for renal and hearing impaired
  • monitor bowel sounds

22

Surg: Antimicrobial/Anti-infective-->Antitrichomonal & Amebicides

  • metronidazole (Flagyl)
  • female infections (trichomonas)

23

Surg: Antimicrobial/Anti-infective--> Lincosamides

  • clindamycin (Cleocin)

24

Surg: Antimicrobial/Anti-infective-->Macrolides

  • erythromycin
  • azitrhromycin (Zithromax, Z-pak)
  • do not used in liver impaired pt
  • interferes with other hepatic-metabolic drugs

25

Surg: Antimicrobial/Anti-infective-->Tetracyclines

  • tetracycline (Achromycin)
  • doxycycline (Vibramycin)
  • broad spectrum
  • stains teeth
  • causes photosensitivity

26

Surg: Antimicrobial/Anti-infective-->Sulfonamides Combination Agents

  • sulfamethoxazole/trimethoprim, SMX-TMP, SMZ, TMP (Bactrim, Spectra)
  • can cause Stevens-Johnson
  • do not give to kids < 2 yo
  • brain damage possible s/e

27

Surg: Antimicrobial/Anti-infective-->Antivirals

  • acyclovir (Zovirax)
  • valacyclovir (Valtrax)

28

Surg: Antimicrobial/Anti-infective-->Antifungals

  • nystatin (Mycostatin)
  • fluconazole (Diflucan)

29

Resp: Decongestants

  • oxymetazoline (Afrin)
  • pseudoephedrine (Sudafed, Dimetapp)

– phenylephrine is prototype

– topical nasal sprays and oral

– many are OTC

– stimulate alpha adergenic receptors

– decongests by reduces nasal inflammation

– for non–allergic rhinitis

decongestants contraindicated in        

glaucoma pts

extreme caution in htn

teaching re decongestants       

– stand up / change position slowly

– report HA, dizziness, difficulty breathing

– monitor BP at home

30

Resp: Antihistamines

  • diphenhydramine (Benadryl)
  • cetirizine (Zyrtec)
  • loratadine (Claratin)

31

Resp: Expectorants

  • guaifenesin (Robitussin)

prototypes: guaifenesin (Robitussin)

action:  increases cough by increasing and thinning mucus secretions

used for:  tx of colds by decreasing chest secretions

expectorants:  route:  nsg considerations:       

Route:  PO tab or liquid

nsg considerations:

– increase fluids to promote liquifying secretions

– look for contraindications with other drugs

– report if cough lasts longer than 1 wk

– do not take if pregnant

– take with food if GI upset occurs

expectorants teaching:

– don't take prior to driving, etc

– sit or lie down if lightheaded

– change position slowly

– avoid if breastfeeding or child less than 4 yo

32

Resp: Anti-tussives

  • codeine
  • codeine containing drugs
  • dextromethorphan containing drugs

prototypes: – opioid:  codeine

                         – non–opioid: dextromethorphan

action:  suppress cough reflex in brain

used for:  suppress chronic and non–productive cough

anti–tussive admin      

– only for short–term use

– only when needed

– use lowest effective dose

anti–tussive nsg considerations:          

opioid/codeine:  beware of other opioids pt is taking//PO

non–opioid//dextromethorphan:  do not give fluids immediately after to avoid dilution

anti–tussive teaching: 

– avoid acty that require alertness

– avoid etoh and other CNS depressants

– avoid smoking

– sit upright

take several deep breaths before attempting to cough

33

Resp: Mucolytic Agents

  • acetylycystein (Mucomyst)

Acetylcysteine (Mucomyst)  also have hypertonic saline inhalation

breaks down mucus and enhances flow of secretions

Mucolytics/acetylcysteine routes of admin:    

nebuelizer via facemask

Mucolytics/acetylcysteine nsg considerations:

– assess resp fx, lung sounds, amount and consistency of secretions before and after admin

– monitor for bronchospasms

– rinse pt's mouth and face after for sticky residue

Mucolytics/acetylcystein teaching points        

– stop medication and notify hcp if bronchospasms/aspiration

– avoid acty that require alertness

– change positions slowly

– rotten egg odor– be prepared to suction pt if aspirates

– use caution in pt's with asthma

– monitor liver, kidney, and electrolytes

– monitor for bleeding

34

Resp: Bronchodilaters-->Adrenergics

  • albuterol (Proventil)
  • epinephrine (Adernalin, Bronkaid)

Prototype: albuterol

Action: bronchodilator

Used for:– prevention of exercise induced asthma and asthma

– tx of bronchospasms

– long–term control of asthma

Beta 2 Adrenergic routes:       

PO tablet and inhalation

Beta 2 Adrenergic nsg considerations: 

– pt may use both forms together

– monitor for toxicity

– may cause paradoxical bronchospasm

– use caution in pt with DM, heart disease, Htn

– contraindicated in:  tachydysrhtmia, preg cat C

Beta 2 adrenergic teaching:     

– may cause unusual or bad taste

– avoid smoking

– rinse mouth with water to tx dry mouth

– instruct on proper inhaler/nebuelizer use

Beta 2 adrenergic s/e

– NVD

– dizziness

– HA

– upset stomach

– sore throat

35

Resp: Bronchodilators-->Xanthine

  • theophylline
    • short acting: Aminopylline
    • long acting: Theo-Dur

Theophylline

action: bronchodilation

used for: COPD, asthma

xanthines admin:         

oral or IV (emergency only)

– if dose missed, do NOT double u

– do not crush, chew

Teaching point for xanthines:   

– take as prescribed

– do not double doses

– avoid caffeine as this can increase CNS and cardiac adverse effects

– monitor theophylline serum levels

– high doses can cause dysrhythmias and seizures

36

Resp: Bronchodilators-->combination

  • albuterol and ipratropium (Combivent)
  • fluticasone and salmeterol (Advair)

action of both types of combo bronchos

1.  albuterol– broncho dilate   

 ipratopium– reduces secretions

2.  flutacasone– decrease inflammation

    salmetrol– broncho dilate

considerations for albuterol/ipratopium broncho–combos:     

– tacchycaria/arrythmias (can cause)

–considerations for fluticasone/salmertrol broncho combos     

– avoid in pt's with milk allergies

teaching with combo–bronchos:         

– notify hcp if SOB not improved in 1 wk

– not for sudden COPD attack

– may casue dizziness, drowsiness, difficulty seeing

– prime new unit with 4 sprays before use

– clean mouthpeice weekly

– rinse mouth after admin

– do not drive, etc until response known

37

Resp: Anti-Inflammatory agents

 

  • Intranasal/inhaled steroids
    • prednisone triamcinolone (Azmacort)
    • budesonide (Pulmocort)
  • Systemic Steroids
    • prednisone
    • methylyprednisolone (Solu-Medrol)

38

Resp: Mast Cell stabilizers

  • cromolyn (Intal)
  • nedocromil (Tilade)

prototype:  Cromolyn (ital)   - also have nedocromil (Tilade)

action:  decreases release of substances that contribute to bronchspasms

used for:  manage acute and chronic episodes of reversible bronchoconstriction

Mast Cell stabilizers route of admin     

nebeulizer

Mast cell stabilizers nsg considerations:           

– assess lung sounds before and after

– assess CV status

Mast cell stabilizers teaching:  

– rinse mouth before and after to prevent infection

– keep inhaler clean and unobstructed

– may cause dizziness

39

Resp: Leukotrine modifiers

  • montelukast (Singulair)
  • zafirlukast (Accolate)

 

40

Resp: Antituberculars

 

  • isoniazid (INH)
  • rifampin (RIF, Rifadin)
  • pyrazinaminde (PNZ)
  • sterptomycin
  • ethambutol (Myambutol)

protoypes:  isonazid/rifampin  drugs also incl:  pyraziamide (PNZ), streptomycin, ethambutol (Myambutol)

action: inhibit cell wall synthesis and interfere with metabolism of microbe/used in combo to prevent antibiotic resistance

used for: against mycobacteria

Anti–TB routes:

– isonazid:  PO, IM

– rifampin:  PO, IV

Anti–tb nsg considerations:     

– isonazid:

– if IM, warm up to room temp

– if PO, take 1 hr before or 2 hrs after meals; can take with meals if GI upset

– monitor for: – periph neuropathy

– hepatoxicity

– hyperglycemia in DM pts

Rifampin:

– expect red/orange body fluids

– monitor liver fx

– may cause mild GI discomfor

– may cause pseudomembranous colitis

anti–tb teaching:         

– avoid etoh as could cause liver toxicity

– avoid foods containing tyramine (aged cheese, meats)

– may have to take 2 months to 6 year

– report any visual changes

– monitor for s/s of hepatitis (yellow skin/eyes, N/V, anorexia, dark urine, incr fatigue)

– need regular physical and eye exams

41

Resp: Antivirals

  • amantadine (Symmetrel)
  • ribavirin (Virazole)

prototype:  amantadine  - also includes: ribavirin (Virazole)

action: – prevents influenza A for entering celln

              – increases dopamine action in CNS

used for: – prevention/symptom relief in influenza A

              – relief from Parkinsons

Anti–virals admin and nsg considerations        

– do not take last dose at bed time

– dividing doses may decrease CNS s/e

– check for allergic reaction

– check for renal impairment

– seizure

– liver diseases

anti–viral effects         

– decrease in akinesia and rigidity

– decrease/alleviate influenza A symptoms

anti–virals teaching:    

– may cuase dizziness, blurred vision,

– practice good oral hygiene

– notify hcp if symptoms d/n improve

– contraindicated if HTN

42

Resp: Antifungals

  • amphotericin B
  • fluconazole (Diflucan)

Prototype: amphoteracin B and fluconazole (Diflucan)

action:  kills or stops growth of fungi

used for:  fungal infections in lungs and respiratory tract

safety re antifungals    

– aseptic technique

– monitor VS every 15 mins

– monitor BUN, CBC, Creatnine, K, Mg

teaching for amphoteracin      

inform pt of side effects and to report

teaching for fluconazole:         

– notify MD if abdo pain, fever, diarrhea, or signs of liver dysfunction

– avoid OTC antacids and alcohol within 2 hrs after admin

antifungal routes:        

IV and PO

43

Resp: CF drugs

  • dornase alpha (Pulmozyme)
  • pancreatic enzymes (Pancrease, Viokase)

prototype: pancrelipase  drugs include: - dornase alpha (Pulmozyme) – pancreatic enzymes (Pancrease, Viokase)

action:  assists in digestion of protein, starch, fats

used for: pancreatic insufficiency associated with CF

pancreatic enzyme supplements admin:          

– PO; swallow whole with full glass of water

– do not give with alkaline foods; can sprinkle on soft, acidic foods (applesauce)

pancreatic enzyme supplements nsg considerations:   

– monitor I&O and watch for increased urinary output & fecal fat

– labs:  increased uric acid

– pt may be more sensitive if allergic to pork

pancreatic enzyme supplements teaching:      

– notify hcp if allergic reaction

– abdo pain, cramping, blood in urine

– take with full glass of water

44

Resp: Smoking Cessation Drugs

  • nicotine spray
  • buproprion (Wellbutrin)
  • vareniciline (Chantix)

– PO, patch, nasal spray, inhaler

– tx can last 12 wks (and up to 12 more wks)

– black box warning for suicidal thoughts and worsening of bipolar

45

Resp: Anticholinergics (not in highlighted list ?)

 

prototype: ipratopium

action:  blocks acetlycholine receptors to stimulate bronchodilation

used for:  – bronchospasm with COPD

– allergen–induced bronchospasm

– exercise–induced bronchospasm

Anticholinergeric route:          

inhaled

Anticholinergeric nsg considerations:  

– rinse mouth after

– usual dose 2 puffs

– if using 2 diff inhalers, wait 5 mins in between

– do not swallow capsule, put in inhalation device

– do not exceed 12 doses in 24 hours

anticholinergeric teaching       

– if missed dose, take ASAP but do not double

– notify hcp if:

– stomatitis

– dry mouth x2weeks

– symptoms do not improve/worsen within 30 mins

– do not spray in eyes– blurred vision

–pulmonary fx test to monitor effectiveness

– withhold if bronchospasm (wheezing) occurs

46

Resp: inhaled glucocorticoids (not in highlighted list ? )

mometasone, beclomethasone

action:  decrease inflammation, suppress immune system, decrease edema of airway mucosa, decrease bronchial hyperactivity, decrease mucus production

inhaled glucocorticoids  route:  nsg considerations:     

Route:  MDI

nsg considerations:

– use daily, not just for symptoms

– may take up to 1 week for relief

– clear blocked nasal passages with topical decongestant prior to admin

inhaled glucocorticoids teaching:        

– avoid smoking, known allergens, and known respiratory irritants

– notify hcp if sore throat/mouth occurs

– notify hcp if pregnancy expected

47

Diabetes: Insulin--> Rapid Acting

  • insulin lispro (Humalog)
  • insulin aspart (Novalog)
  • insulin glulisine (not on highlighted list)
  • onsent: 15 mins
  • peak: 30 min - 3 hrs
  • duration: 3 - 5 hrs

48

Diabetes: Insulin-->Short Acting

 

  • regular insulin (Humulin R, Novolin R)
  • onset: 30 mins
  • peak: 2 - 4 hrs
  • duration 5 - 7 hrs

49

Diabetes: Insulin-->Intermediate

 

NPH insulin (Humalin N, Novolin N)

  • onset: 1.5 hrs
  • peak: 4 - 12 hrs
  • duration: 16 - 24 hrs

insulin determir (Levemir) sometimes considered long, sometimes intermediate

  • onset: 1 hr
  • peak: 6 - 8 hrs
  • duration: 5 - 24 hrs

50

Diabetes: Insulin-->long acting

  • insuline glargine (Lantus)
    • onset: 2- 4 hrs
    • peak: none
    • diuration: 24 hrs
  • insuline degludac (Tresiba)
    • once daily
    • up to 42 hours

51

Diabetes: Insulin-->insulin mixtures

  • NPH and regular (Humaline 70/30)
  • 70% NPH and 30% regular

52

Diabetes: GLP-1 agonists

incretin mimetics

  • exenatide (Byetta)
    • admin 60 min b/f breakfast and dinner
    • peak: 2 hours
    • s/e: hypoglycemia, N/V/D, pancreatitis (rare)
    • consume adequate calories
  • liraglutide (Victoza)

53

Diabetes: Oral hypoglycemics-->Sulfonylureas

 

  • glimepiried (Amaryl)
  • glipizide (Glucotrol)
  • glyburide (DiaBeta, Micronase, Glynase)
  • admin: 30 mins ac
  • SR: do not crush or chew
  • s/e: hypoglycemia, n/d
  • contra: pregnancy, DKA, avoid alcohol

54

Diabetes: Oral hypoglycemics-->Alpha-glucosidase inhibitors

  • acarbose (Precose)
  • miglitol (Glyset)
  • admin: w/ 1st bite of meal TID
  • skip meal, skip a dose
  • s/e: GI effects, hypoglycemia, liver dysfx, anemai
  • use dextrose for hypglycemia
  • conta: GI disorders, hepa impair, GI distress

55

Diabetes: Oral hypoglycemics-->Biguanide

  • metformin immediate release (Glucophage)
  • metformin extended release (Fortamet)
  • @ bfast and dinner or @ dinner (XR)
  • s/e: N/D, vit def, lactic acidosis
  • first drug for new DM
  • avoid alchol and contrast studies
  • contra: DKA, alcholism, heart failure, AMI, lactic acidosis, shock

56

Diabetes: Oral hypoglycemics-->Thiazolidinediones

  • pioglitazone (Actos)
  • rosiglitazone (Avandia)
  • once daily w/wo food
  • Not w/ heart failure or CV disease
  • s/e: fluid retention, hepa-tox, incr lipids
  • watch s/s of fluid overload
  • labs (LFT, lipids)
  • report edema, SOB, chest pain
  • contra: heart failure, CV, hepatic disease

57

Diabetes: Oral hypoglycemics-->Meglitinides

  • nateglinide (Starlix)
  • repaglinide (Prandin)
  • 30 min ac TID
  • skip meal, skip dose
  • add meal, add dose
  • max 4x/day
  • s/e: hypoglycemia, N/V/D
  • Adequate carb IV consumption

58

Diabetes: Oral hypoglycemics-->DPP-4 Inhibitors

  • sitagliptin (Januvia)
  • w or wo food
  • s/e: pancreatitis, URI, HA
  • generally well tolerated

59

Diabetes: Oral hypoglycemics-->SGLT2 inhibitors

  • canagliflozin (Invokana)
  • dapagliflozin (Farxiga)
  • empagliflozin (Jardiance)
  • work with kidneys to remove glucose from blood and excrete in urine
  • new drugs

60

Diabetes: Oral hypoglycemics-->combination drugs

glyburide/metformin (Glucovance)

61

Diabetes: Inhaled insulin

insulin powder (Afrezza)

 

62

Diabetes: Anti-hypoglycemic agents

  • glucagon
  • 50% dextrose

63

Diabetes: Amylin Mimetics

  • pramlintide (Symlin)
    • for type 1 and type 2
    • risk of severe hypoglycemia
    • GI upset
    • do not mix with regular insulin (in same syringe)
    • reduces post-prandial blood glucose levels
    • Peak: 20 min
    • slows gastric emptying

 

64

Pain and Sleep: Non-narcotic

  • acetminophen (Tylenol)
  • aspirin
  • ibuprofen (Motrin, Advil)
  • gabapentin (Neurontin)
  • pregabalin (Lyrica)

65

Pain and Sleep: Narcotic (Opioid) analgesics

  • morphine sulfate (immediate and sustained release)
  • oxycodone (immediate and sustained release)
  • hydrocodone
  • hydromorphone (Dilauded)
  • codeine
  • fentanyl (parenteral and transdermal)
  • meperidine (Demerol) - maternity use

66

Pain and Sleep: Narcotic (Opioid) analgesics-->Morphine

  • morphine sulfate (immediate and sustained relief)
  • hydrophilliic
  • slow onset, long duration
  • available in a wide variety of formulations

67

Pain and Sleep: Narcotic (Opiod) analgesics-->oxycodone

  • oral only
  • intermediate onset and duraiton

68

Pain and Sleep: Narcotic (Opioid) analgesics-->hydrocodone

  • often in combo with non-opioids which limits use for moderate pain
  • frequently used in US

69

Pain and Sleep: Narcotic (Opioid) analgesics-->hydromorphone (Dilaudid)

  • less hydrophillic than morphine
  • less lipophillic than fentanyl
  • available in a wide variety of  formulations

70

Pain and Sleep: Narcotic (Opioid) analgesics-->fentanyl

  • parenteral and transdermal
  • lipophillic
  • fast onset, short duration
  • no metabolites so good for organ fail
    • ideal as transdermal patch

71

Pain and Sleep: Topical

  • lidocaine (Lidoderm)
    • IV, IM, patch
    • quick onset and duration
    • s/e: confusion, drowsiness, stinging

72

Pain and Sleep: Narcotic antagonists

  • naloxone (Narcan)
  • romazicon (Flumazenil)
    • IV to reverse effects of benzos used as gen anesth or for benzo overdose
    • s/e: dizziness, N/V
    • improves LOC
    • decreases resp depression

73

Pain and Sleep: Agonist/Antagonist

  • burenorphine HCA (Buprenex)
  • butorphanol tartrate (Stadol)
  • nalbuphine HCA (Nubain)

74

Pain and Sleep: Agonist/Antagonist-->butophalol tartrate

  • Stadol
  • management of mod-severe pain
  • analgesia in labor
  • sedation pre-op
  • s/e: confusion, dysphoria, hallucinations, sedation, nausea, sweating
  • interacts with etoh, antidepressants, antihistamines
  • avail in IV, IM, and intranasal

75

Pain and Sleep: Agonist/Antagonist-->nalbuphine HCL

  • Nubain
  • mod to severe pain
  • prevent or treat opioid itching
  • s/e: dizziness, HA, sedation, dry mouth, N/V, clammy, sweat
  • IM, IV, subq
  • don't use in opioid addicts
  • may trigger withdrawal

76

Pain and Sleep: NSAID --> ketorolac

  • Toradol
  • short tem mgmt of pain (not > 5 days)
  • s/e: drowsiness, anaphylaxis
  • PO, IV, IM, intranasal
  • assess for rhinitis, aspirin allergies, nasal polyps before giving

77

Pain and Sleep: Complementary and alternative medicine

  • feverfew
    • migrain prophylaxis
  • devil's claw
    • often used for back pain and OA

78

Pain and Sleep: Benzo-receptor like agents-->eszopiclone

  • Lunesta
    • used to treat insomnia
    • short-term memory impairment
    • hallucinations
    • impaired coordination
    • dizziness

79

Pain and Sleep: Benzo-receptor like agents-->zolpidem

  • Ambien
    • used to treat insomnia
    • daytime sleepiness
    • dizziness
    • abnormal thinking
    • drugged feeling
    • sleep driving
    • hallucinations

80

Pain and Sleep: Amphetamines: dextroamphetamine

  • Dexedrine
  • used to treat narcolepsy
  • s/e: hyperactivity, resltessness, insomnia, tremors, palpitations, tachycardia, anorexiea

81

Pain and Sleep: Non amphetamine wake promotion

  • modafinil (Provigil)
  • used to treat narcolepsy
  • contra in people with heart issues
  • s/e: HA
  • rhinitis
  • increased liver enzymes
  • nausea
  • can cause angioedema

82

Mobility: NSAIDS

  • aspirin (ASA)
  • celecoxib (Celebrex)
  • diclofenac sodium (Voltaren)
  • ibuprofen (Advil, Motrin, PediaCare)
  • ketorolac (toradol)
  • naproxen (Napyrosyn, Aleve, Anaprox)

83

Mobility: Corticosteroids

  • prednison
  • S/E
    • CNS: steroid induced psychosis (often in high doses but not always)
    • Sensory: Cataract devel (rare), glaucoma devel (rare)
    • Endocrine: inc appetite, inc caloric intake, diabetes (steroid-induced)
    • Urinary: Na and H20 renention, K excretion (Hypokalemia)
    • Musculo-skeletal: calcium loss, osteoporosis, muscle weakness, loss of musle mass
    •  

84

Moblility: S/E of NSAIDS

  • increases chance of GI bleed
  • can worsen or cause HTN
  • increased risk of thromboembolic events including stroke and MI
  • CNS: mental confusion, drowsiness, dizziness, HA (more common with elderly)
  • Sensory: tinnitus (aspirin in higher doses), vertigo, visual changes, reversible hearing loss
  • Hematologic: prolonged bleed time, thrombocytopenia, bruising, bleeding gums
  • Ingeument: Uticaria (hives), pruritis (itching), skin erruptions
  • GI: N/V/D, GI bleed, GI ulcers, abdominal pain
  • Urinary: NA retention, H20 retention, hyperkalemia, nephrotic toxicity

85

Mobility: Which NSAID is associated with Reye syndrome

aspiring

86

Mobility: What is Reyes syndrome

Can cause liver damage and encephalopathy

87

Mobility: Why do NSAIDs cause GI problems?

Because prostaglandins protect stomach

88

Mobility: Supplement needed if taking NSAIDs or corticosteroids long-term?

Calcium

89

Mobility: Signs of adrenal suppression associated with corticosteroids

weakness, fatigue, weight loss

90

Mobility: What happens if you just stop taking corticosteroids?

depression, need to taper off

91

Mobility: DMARDS

  • hydroxychloroquine (Plaquenil) & penicillamine (Cuprimine, Depen)
  • disease modifying anti-rheumatic drug
  • slow disease progession
  • 1st line of treatment for RA

92

Mobility: DMARDs -->hydroxychloroquine

  • Plaquenil
  • need baseline eye exam
  • may cause retinal damage
  • need f/u exam q6-12 mos
  • can cause blod discresia (blood abnormality similar to leukemia/aplastic anemia)
  • hepatotoxic
  • renal toxic

93

Mobility: Muscle Relaxants

  • baclofen (Lioresal)
  • carisoprodol (Soma)
  • cyclobenzaprine (Flexeril)
  • metaxalone (Skelaxin)
  • methocarbamol (Robaxin)

94

Mobility: Immunosupressants

  • etanercept (Enbrel)
  • infliziman (Remicade)
  • leflunomide (Arava)
  • methotrexate (Rheumatrex)

95

Mobility: Immunosupressants-->leflonomide

  • Arava
  • slow acting
  • can cuase birth defects
  • questeren reverses action of leflunomide if pregnant

96

Mobility: Immunosupressants-->inflizimab

  • Remicade
  • very effective
  • often given with methotrexate
  • very expensive $3-5K

97

Mobility: Immunosupressants--> methotrexates

  • Rheumatrex
  • give low doses fro msuculo skeletal probs
  • high doses for cancer
  • slow acting-takes 4 - 6 weeks for therapeutic effect
  • given with certolizumab (fast acting within 1 -2 weeks)
  • very liver toxic***
  • no alchol***
  • can cause stomatitis
  • monitor CBC (can cause bone marrow supression)
  • monitor renal function
  • increase fluids when taking***
  • can cause alopecia (ususally with high doses)
  • can cause sterility

98

Mobility: What is gout?

increased uric acid production that cannot be secreted

99

Mobility: Anti-gout agents

  • allopurinol (Zyloprim)
  • colchicines
  • probenecid (Benemid)

100

Mobility: Anti-gout agenets-->colchicines

  • drug of choice for gout
  • relieves pain
  • in combo with NSAIDs
  • give on empty stomach
  • increase fluids
  • no alcohol

101

Mobility: Anit-gout-->allopurinal

  • Zyloprim
  • prevents uric acid formation
  • need 2 - 3 K mL to prevent kidney stones

102

Mobility: Osteoporosis drugs-->biphosphonates

  • alendronate (Fosamax)
  • pamidronate (Aredia)
  • risedronate (Actonel)
  • ibandronate (Boniva)
  • drink with water
  • take 30 min before meals
  • don't like down for 30 mins
  • give IV biphosphonates with osteopenia
    • need baseline creatinine
    • PT will feel like they are getting the flu
    • increases risk of a-fib

103

Mobility: Osteoporsis drugs-->calcitonin-salmon

  • Calcimar
  • nasal spray??

104

Mobility: Osteoporosis Drugs-->selective estrogen receptor modulaters

  • raloxifene (Evista)
  • teriparaxide (Fortec)

105

Mobility: Osteporosis drugs --> vit D preparations

ergocalciferol (Calciferol)

106

Mobility: Osteoporosis --> Denosumab

  • subq shot 2x/yr for osteoporosis
  • monitor for signs of hypocalcemia **

107

Cancer: Antineoplastics

  • mutli drug protocol may be used
  • alkylating agents
  • antibetabolites
  • antitumor antibiotics
  • antimitotics

108

Cancer: Cytoprotective agents

  • leucovorin (Wellcovorin)
  • mesna (Mesnex)

109

Cancer: Drugs used to treat bone marrow suppression

  • colony stimutalating factor (WBC's)
    • filgrastim (Neupogen)
    • sargramostim (Leukine)
  • hemotopoietic (RBS's)
    • epoetin alfa (Epogen or Procrit)
  • thrombopoetic growth factor (platelets)
    • oprelvekin (Neumega)

110

Cancer: Metotrexate

  • very toxic to kidney
  • neutrophils
  • usually givenn with bolus of IV fluid before and after admin
  • inhibits DNA synthesis

111

Cancer: Side effect management

  • viscous lidocain (Swish and Swallow) MD Anderson

112

Cancer: Other drugs that limit tumor growth

  • vaccines
  • biotherapy
  • immunotherapy
  • targeted therapy