Med Summary St. B Flashcards
1
Q
ASA administration
A
Chewed
2
Q
ASA cautions (3)
A
Do not administer with salicylate allergy, GI bleed, thrombocytopenia
3
Q
Calcium Chloride uses
A
Cardiac Resuscitation
Hyperkalemia
Hypocalcemia
Calcium channel blocker overdose
4
Q
Calcium chloride administration
A
IV push - central route preferred
5
Q
Dextrose 50% administration
A
IV push (central preferred)
6
Q
Dextrose cautions
A
Local pain and vein irritation if infused rapidly
7
Q
Diazepam use (4) - SAAS mnemonic
A
Sedation
Agitation
Alcohol withdrawal
Status epilepticus
8
Q
Diazepam admin
A
Slow IV push into large vein, flush afterwards
9
Q
Diazepam cautions
A
- thrombophlebitis
- drowsiness
- ataxia
- resp depression
- hypotension
10
Q
Diphenhydramine use
A
Anaphylaxis
11
Q
Diphenhydramine admin
A
IV push
12
Q
Diphenhydramine cautions
A
- CNS effects
- urinary retention
13
Q
Epinephrine use
A
Anaphylaxis and cardiac arrest
14
Q
Epinephrine admin
A
IV push, if given peripherally, flush with 20ml to ensure complete drug delivery
15
Q
Epinephrine cautions
A
- hypertension
- tachycardia
- palpitations
- angina
- arrhythmias
- anxiety
- swearing
- headache
- hyperglycaemia
16
Q
Furosemide admin
A
IV push into infusing IV solution
17
Q
Furosemide cautions
A
- electrolyte depletion
- hypovolemia
- thrombophlebitis
- ototoxicity
- caution in patients allergic to sulfa drugs
18
Q
Hydralazine use
A
Hypertension, heart failure
19
Q
Hydralazine admin
A
IV push
20
Q
Hydralazine cautions
A
- hypotension
- palpitations
- tachycardia
- angina
- dizziness
21
Q
Hydrocortisone use
A
Anaphylaxis
Sepsis
Refractory hypotension
Adrenal insufficiency
22
Q
Hydrocortisone admin
A
IV push - only up to 500mg
23
Q
Hydrocortisone cautions
A
- Sodium retention, edema
- hypokalemia, hyperglycaemia
- hypertension
- CNS side effects
24
Q
Naloxone cautions
A
Opioid withdrawal symptoms
25
Nitro spray (use, admin, cautions
- use: opioid antagonist
- admin: sublingual
- cautions: hypotension, dizziness
26
Phenytoin use
Seizures
27
Phenytoin route
Max rate 50mg/min, DO NOT COMBINE WITH DEXTROSE, Infuse with fluids into large vein, big flush
28
Phenytoin cautions
- Bradycardia
- hypotension
- arrhythmias
- resp depression
29
Sodium Bicarbonate use
Hyperkalemia, acidosis
30
Sodium bicarbonate cautions
- CNS effects
- electrolyte disturbances
31
Adenosine use
SVT
32
Adenosine admin (2)
- Fast push (worse sx with slow push)
- Continuous EKG monitoring required
33
Adenosine cautions
- sx common but short term
- contraindications: AV block, sick sinus, symptomatic brady, asthma/COPD (wheezing occurs)
- sx: AV block, transient arrhythmias, hypotension, tachycardia
34
Amiodarone use
Atrial/ventricular arrhythmias
35
Amiodarone admin (2)
Push in cardiac arrest only (dilute in 20ml D5W)
36
Amiodarone cautions (2)
- Hypotension
- bradyarrhythmias
37
Atropine use
Symptomatic bradycardia
38
Atropine admin
IV push
39
Atropine cautions (5)
- palpitation
- tachycardia
- dilated pupils
- blurred vision
- urinary retention
40
Lidocaine use
Ventricular arrhythmias
41
Lidocaine admin
IV push
42
Lidocaine cautions (4)
- CNS effects
- seizures
- resp arrest
- hypotension
43
Vasopressin use
Cardiac arrest
Shock
44
Vasopressin admin
IV push in cardiac arrest
45
Vasopressin cautions (3)
Bradycardia
Arrhythmias
Angina
46
Indication for use of antipsychotics
- Severe/disabling hallucinations, paranoia, delusions
- aggression poses safety risk to self/others
47
Contraindication for antipsychotics
Not effective for wandering/calling out
48
How does antipsychotic use for agitation impact mortality
Increased risk of mortality
49
Side effects of antipsychotics (8)
- somnolence
- increased confusion
- postural hypotension
- falls
- Parkinsonian symptoms, akathisias
- metabolic disorders
- arrhythmias
- neuroleptic malignant syndrome
50
How often should patients on antipsychotics for dementia be re-evaluated
- minimum q3 months
51
List three common atypical antipsychotics
- risperidone
- quetiapibe
- olanzapine
52
Risperidone cautions
Most likely atypical antipsychotic to cause Parkinsonian symptoms
53
Risperidone benefits
Least likely atypical antipsychotic to cause drowsiness
54
Quetiapine cautions
Most likely atypical antipsychotic to cause drowsiness
55
Quetiapine benefit and preferred population
Least likely atypical antipsychotic to cause Parkinsonian symptoms (choice for Parkinson’s disease/Louis body dementia
56
Olanzapine caution
Most likely atypical antipsychotic to cause postural hypotension
57
What is a typical antipsychotic
Haldol
58
Haldol cautions (2)
Avoid in patients with Parkinson’s/Lewis body dementia
QT prolongation - caution with patients on anti-arrhythmic meds
59
Beta blocker examples
All end with ‘olol’ except carvedilol
- most common: metoprolol, atenolol, bisoprolol, labetolol
60
Beta blockers secondary uses
- rate control for a. Fib
- prophylaxis against variceal bleed, migraine
- hyperthyroidism
- eye drop for glaucoma
61
Beta blocker side effects
- Fatigue
- insomnia
- decreased libido
- bronchospasm
62
Calcium channel blocker (non-dihydropyridine) examples
- Diltiazem
- Verapamil
63
Calcium channel blocker
(dihydropyridine) example
Nifepidine
Felopidine
Amlodipine
64
Calcium channel blocker (dihydropyridine) cautions
- only amplodipine can be chewed
- nifepidine appears undigested in stool
- sx: dizziness, headache, constipation, fatigue
65
ACE-inhibitor examples
All end with PRIL
Common: Ramipril
66
ACE-inhibitor side effects
- hyperkalemia
- cough
- initial worsening of renal function (renal protective long term)
- rare: Angioedema
67
Angiotensin receptor blocker examples
End with ‘sartan’
Common: irbesartan
68
Angiotensin receptor blocker considerations
- consider for patients with cough from ace inhibitors
- sx include hyperkalemia, initial worsening of renal function, angioedema
69
Alpha blocker examples
End with ‘zosin’
- terazosin
- prazosin
- doxazosin
70
Alpha blocker side effects
- Postural hypotension (intense, consider HS dosing)
- dizziness
- headache
- muscle weakness
- peripheral edema
71
Central acting vasodilator example
Clonidine
72
Central acting vasodilator side effects
Dizziness
Drowsiness
Dry mouth
Weakness
Constipation
73
Venous vasodilator example
Nitroglycerin
74
Venous vasodilator considerations
- sx: hypotension, dizziness, headache, patchy skin reactions
- nitro patch tolerance develops within 72 hours - need vacations
75
Arterial vasodilator examples
- Hydralazine
- Minoxidil
76
Hydralazine considerations
May cause reflex tachycardia and lupus-like syndrome
77
Minoxidil considerations
MY cause excess hair growth
78
Thiazide diuretic examples (4)
Hydroclorothiazide
Metolazone
Chlorthalidone
Indapamide
79
Thiazide diuretic indications
Treats hypertension and synergizes with loop diuretics in treatment of CHF
80
Thiazide considerations
- give in AM (++HS elimination)
- sx: low k, Na, Mg, elevated Ca+, dehydration, hypotension, photosensitivity, anorexia, gout
- low glomerular filtration = ineffective
81
Loop diuretic examples
Furosemide
Ethacrynic Acid
82
Loop diuretic considerations
- admin AM
- sx: low K, Na, Mg, Ava
- dehydration, bad renal function, hypotension, photosensitivity, gout, *hearing impairment with high IV dose*
- Ethacrynic acid used for furosemide allergy
83
Potassium sparing diuretic examples
Spironolactone
Amiloride
Triamterene
84
Potassium sparing diuretic secondary uses
Hyperaldosteronism (spironolactone)
85
K sparing diuretic considerations
- Give in AM
- Spironolactone sx hyperkalemia, gynecomastia, dehydration, worsening renal function
86
Cardiac glycosides example
Digoxin
87
Digoxin use
- CHF
- A. Fib (rate control)
88
Digoxin considerations
- sx: NV, visual disturbances, bradycardia, anorexia, arrhythmias
- hypokalemia predisposes to Brady
89
Which anti-arrhythmic drug has the lowest potential to cause new arrhythmias and is safest for heart failure
Amiodarone
90
Unfractioned Heparin/Dalteparin indication (very specific)
Used for patients unable to ambulate 50m 3x day
91
Dalteparin alternative name?
Low molecular weight heparin
92
Dalteparin dosing
<50kg = 2500
50-100kg = 5000
100-150kg = 7500
93
Heparin dosing
<100kg = 5000 q12h
>100kg = 5000 q8h
94
Dalteparin contraindications
- Caution in renal dysfunction (eGFR <30), particular caution if used more than 7 days
- HIT
95
Factor XA Inhibitor example
Fondaparinux
96
Fonxaparinux use
Patients with history of HIT
97
Fondaparinux contraindications
May accumulate with renal dysfunction.
98
SABA examples
Salbutamol (ventolin)
Terbutaline
99
SABA secondary uses
Anaphylaxis
Hyperkalemia
100
Respiratory anticholinergic examples
Ipatropium (atrovent)
Tiotropium (spiriva)
101
Anticholinergic uses
- Reduces airway secretions/bronchodilates
- Asthma (acute and chronic)
102
Anticholinergic considerations
Ipatropium therapy must fail in order to try other types
103
LABA examples (2)
- salmeterol (serevent)
- formoterol
104
Salmeterol onset of action
30min-2hrs
105
Salmeterol considerations
Should not be used as mono therapy - use with steroid
106
Corticosteroid examples
Fluticasone (Flovent)
Budesonide (pulmicort)
Ciclesonide
Beclomethasone
107
Corticosteroid considerations
Rinse mouth after each use to reduce risk of thrush
108
Resp Combination product examples
Advair (salmeterol/fluticasone)
Symbiocort (formeterol/budesonide)
Combivent (Salbutamol/ipatropium)
Zenhale (folmeterol/mometasone)
109
Advair considerations
Salmeterol content is different in MDI vs. Diskus
110
Classes of oral resp meds (4)
- corticosteroids
- leukotriene receptor antagonist
- phosphodiesterase 3+4 inhibitor
- phosphodiesterase 5 inhibitor
111
Corticosteroid sx
GI upset
Mood changes/insomnia
Hyperglycaemia
Fluid retention
HTN
Osteoporosis
Cataracts
112
Leukotriene receptor antagonist example
End with Lukast
Example: montelukas
113
Leukotriene receptor antagonist uses
- Asthma
- Allergic rhinitis
114
Leukotriene receptor antagonist considerations
Sx: headache and behavioural changes
115
Phosphodiesterase III + IV inhibitor examples
Theophylline
116
Phosphodiesterase III + IV inhibitor use
Asthma
117
Phosphodiesterase III + IV inhibitor sx
- lots of drug interactions
- sx: GI, insomnia, Tachy, urinary retention
118
Phosphodiesterase IV inhibitor example
Roflumilast
119
Phosphodiesterase IV inhibitor use
Severe COPD
120
Phosphodiesterase IV inhibitor considerations
- Not covered by pharmacare, expensive
- considered when people have maxed out on puffers
- sx: depression, insomnia, suicidal thoughts, NVD
121
Classes of acid suppressing meds (3)
Antacids
H2 blockers
PPIs
122
Antacid examples
Diovol (aluminum/magnesium)
Alugel (aluminum hydroxide)
123
Antacid considerations
- Sx: diarrhea, constipation
- Binds with floxacin, cycline abx
124
H2 blocker examples
- Ranitidine
- Famotidine
125
PPI Inhibitor examples
- Pantoprazole
- Esomeorazole
- Omeprazole
- Lansoprazole
126
Describe the PPI auto sun policy
All patients get switched to panto, esomeprazole on admission
- eso more likely for tube feeds
127
When is panto IV used?
Continuous infusion for acute GI bleed
128
Prokinetic agent examples (3)
- Metoclopramide
- Domperidone
- Erythromycin
129
Metoclopramide sx
- Crosses blood brain barrier, pseudoparkinson symptoms, myoclonus, drowsiness
- sx more common with older adults, high dose, impaired renal function
130
Domperidone considerations
Does not cross blood brain barrier
131
Erythromycin considerations
Drug interactions frequent, rarely used
132
Antinauseant classes (8)
Antihistamines
Dopamine blockers
Serotinergic agents
Anticholinertics
Neurokinin inhibitor
Corticosteroids
Somatostatin analogues
Cannabinoid receptor binders
133
Antihistamine examples
Gravol and Benadryl
134
Dopamine blocker examples
- Metoclopramide/Domperidone
- haldol
- ‘zine’ drugs, eg. chlorpromazine, promethazine
135
Serotinergic agent examples
Ondansetron, granisetron (subcut)
136
Anticholinergic agent examples
Scopolamine patches
137
Neurokinin inhibitor example and use
Aprepitant (emend) - for chemo associated nausea and vomiting
138
Corticosteroid example and use
Dexamethasone for chemo associated nausea and vomiting
139
Somatostatin analogue example and use
Octerotide for chemo associated NV
140
Cannabinoid receptor binder examples
Dronabinol, nabilone
141
Antidiarrheal drugs (5)
Loperamide
Opioids
Lomotil
Pepto-bismol
Octerotide
142
Loperamide use
Antidiarrheal used in chemo protocols
143
Lomotil drug components
Diphenoxylate - opioid
Atropine - anticholinergic
144
Pepto-bismol considerations
Contraindicated in ASA allergy
145
Octerotide use
Antisecretory agent used in patients with high ostomy output refractory to other agents
146
Laxative/anti-constipation drug classes
Stool softeners
Stimulant laxatives
Osmotic agents
Fibre substances
Opioid antagonists
147
Stool softener example and consideration
Docusate sodium - takes 72h to take full effect, best hard with plenty of fluids
148
Stimulant laxative examples
Sennosides
Bisacodyl
Do not co-administer (not synergistic)
149
Senna + bisacodyl onset of action
Senna: 6-12 hours
Bisacodyl: 6-10
Best given at HS
150
Osmotic agent examples
Lactulose
Milk of magnesium
PEG
PicoSalax
151
Fibre supplement examples
Metamucil
Benefibre (more palatable)
152
Opioid antagonist examples
Methylnaltrexone
153
Drugs for c. Diff (examples)
Metronidazole
Vancomycin
GIVE PO NOT IV
154
Drugs for BPH (examples)
Alpha blockers
5-alpha reductase inhibitors
155
Alpha blocker for BPH examples
Tamulosin (flomax)
Prazosin
156
Alpha blocker MOA
Relax smooth muscle of bladder neck and prostate
- may facilitate passing kidney stones
157
Alpha blocker onset
Slow: 3-7 days, max effect in 4 weeks
158
Alpha blocker sx
Postural hypotension
159
5-alpha reductase inhibitor examples
Finasteride
160
5-alpha reductase inhibitor MOA
Hormonally Reduce the size of prostate (only effective if enlarged)
161
5-alpha reductase inhibitor onset
3-6 months
162
Which drugs work for urinary retention?
Cholinergic drugs
- bethanechol
163
Bethanechol sx
Bradycardia, resp secretions, bronchospasm
164
Drugs for urgency incontinence/overactive bladder (class)
- Anticholinergic agents
- beta 3 agonists
165
Anticholinergics for incontinence - examples
Tolteradine
Oxybutynin
Dicyclomine
166
Anticholinergic for incontinence MOA
Relax detrusor muscles and reduce sensation of urgency
167
Anticholinergic for incontinence sx
- hypotension
- tachycardia
- dry mouth
- constipation
- confusion
168
Beta 3 agonist examples
Mirabegron
169
Beta 3 agonist MOA
- activate receptors in the bladder resulting in relaxation of detrusor smooth muscle during urine storage phase = increase bladder capacity
170
Mirabegron sx
HTN, may impact QT interval
