Meds/ Drugs for Midterm Flashcards
(210 cards)
1
Q
Morphine
A
-opioid
- first pass extensive
2
Q
Meperidine
A
(Demerol)
- opioid
-first pass extensive
3
Q
Diazepam
A
(Valium)
-benzodiazepine
-first pass extensive
-extensively bound drug
4
Q
Midazolam
A
- benzodiazepine
- first pass extensive
-extensively bound drug
5
Q
Lidocaine
A
- local anesthetic
-first pass extensive
6
Q
Nitroglycerin
A
-vasodilator
-first pass extensive
7
Q
Propranolol
A
- beta blocker & vasodilator
-first pass extensive
8
Q
ETOH- ethyl alcohol
A
-first pass extensive
9
Q
THC: active ingredient in cannabis
A
first pass extensive
- only 5-20% reach systemic circulation
10
Q
Narrow Therapeutic Index Meds:
A
High number= good
Low number= need careful monitoring
11
Q
Digitoxin (Lanoxin)
A
(Lanoxin)
-Narrow TI
- extensively bound drug
12
Q
Warfarin
A
(Coumadin)
-Narrow TI
- extensively bound drug
13
Q
Phenytoin
A
(Dilantin)
- Narrow TI
14
Q
Tacrolimus
A
(Prograf, Astagraf)
- Narrow TI
15
Q
6 rights of administration +1 most important
A
- right reason*
- right patient
-right medication - right dose
- right time
- right route
- right documentation
16
Q
Main CYP 450 Enzyme
A
- CYP 3A4/5
2A6
2B6
2C8/9/19
2D6
2E1
1A2
17
Q
Anticoagulant
A
- inhibits clotting
- a beta blocker
18
Q
Antihypertensive
A
- lowers BP
- calcium channel blocker
19
Q
Anti-inflammatory
A
- decreases inflammation
20
Q
Anti-emetic
A
- decreases vomiting
21
Q
IM Injection is not recommended at the?
A
Dorsogluteal; too close to the sciatic nerve
ALLOWED ON:
- deltoid muscle
- vastus lateralis
- rectus femoris
- ventrogluteal
22
Q
TI Calculation?
A
TD 50/ ED 50
23
Q
Volume of Distribution
A
Drug dose/ Drug plasma concentration
- High Vd: more drug is getting into tissues
- Low Vd: less drug is going into tissues but tons in the bloodstream
24
Q
Cockgroft Gault Formula (CrCl)=
A
((140-age x Lean Body Weight (kg)/ (serum creatinine x 72)
= x 1 if male
= x 0.85 if female
25
Warfarin
- anticoagulant
- extensively bound drug
26
Ibuprofen
- NSAID
- extensively bound drug
27
Naproxen
- NSAID
- extensively bound drug
28
Furosemide
-loop diuretics
-extensively bound drug
29
Digotoxin
- cardiac
- extensively bound drug
30
Diazepam
- benzodiazepine
- extensively bound drug
31
Midazolam
- benzodiazepine
- extensively bound drug
32
ac
before meals
33
ad-lib
as desired/ directed
34
AM
morning
35
bid
twice per day
36
cap
capsule
37
/d
per day
38
gtt
drop
39
h or hr
hour
40
hs
bed time
hour of sleep
41
no
number
42
pc
after meals; after eating
43
PM
afternoon
44
PO
by mouth; orally
45
PRN or Prn
when needed; as necessary
46
q
every
47
qd
every day
48
qh
every hour
49
qhs
every night/ every bed time
50
qid
4x per day
51
qod
every other day
52
q2h
every 2hrs
53
q4h
every 4 hrs
54
q6h
every 6hrs
55
q8h
every 8 hrs
56
q12h
every 12 hrs
57
STAT
immediate; at once
58
tab
tablet
59
tid
3x per day
60
Gravol
- for mild nausea (motion sickness)
61
Ondansetron
- chemo tx nausea (severe nausea)
62
Morphine
- a primary agonist for opioid receptor
- mimics the endogenous substance (endorphins)
63
Buprenorphrine
- a partial agonist for opioid receptor
- good if we don't want the cell to get used to that receptor
64
Naloxone
- Narcan
- an opioid antagonist
- work to displace the amount of opioid receptor
65
Lidocaine
- anesthetic
- closes ion channels= no action potential= no cellular depolarization= no pain transduction (no pain sensation)
66
Which meds are not recommended during breastfeeding?
Ibuprofen, Opioids (codeine, oxycodone, morphine)
67
*ASA (Aspirin)
A common pain reliever and fever reducer.
- Toxic effects:
Can cause stomach bleeding, ringing in the ears (tinnitus), breathing problems, confusion, and even kidney failure.
-Severe cases:
Can lead to seizures, coma, or death.
68
*Benzodiazepines (Anti-anxiety medication & sedatives)
ie.) Xanax (alprazolam), Valium (diazepam)
-Toxic effects:
Can cause drowsiness, confusion, slow breathing, and unconsciousness.
*Dangerous when mixed with alcohol or opioids—increases risk of overdose.
69
*Tylenol (Acetaminophen)
Used for pain relief and fever reduction.
-Toxic effects:
Too much can damage the liver, causing nausea, vomiting, abdominal pain, and jaundice (yellowing of the skin/eyes).
-Severe cases:
Can lead to liver failure and death without treatment.
70
*Opioids (strong painkillers)
ie.) Oxycodone, Fentanyl
- Toxic effects:
Can slow or stop breathing, cause extreme drowsiness, pinpoint pupils, and unconsciousness.
-Severe cases:
Overdose can be fatal without quick treatment (Narcan/Naloxone can reverse effects).
71
*Alcohol (ETOH)
Found in beer, wine, liquor, and some medications.
-Toxic effects:
Can cause slurred speech, confusion, vomiting, breathing problems, and unconsciousness.
-Severe cases:
Can slow or stop breathing, cause coma, or lead to death.
72
*THC (Tetrahydrocannabinol) -> cannabis, marijuana
The active ingredient in marijuana (weed, edibles, vapes, etc.).
-Toxic effects:
Can cause anxiety, paranoia, hallucinations, nausea, vomiting, and an increased heart rate.
- Severe cases:
Rare, but some people experience extreme agitation or prolonged vomiting (cannabinoid hyperemesis syndrome).
73
*Cocaine (stimulating drug)
A highly addictive stimulant drug that increases energy and alertness.
Toxic effects: Can cause a fast heart rate, high blood pressure, severe sweating, confusion, and seizures.
Severe cases:
Can lead to a heart attack, stroke, or sudden death.
74
Activated Charcoal
prevents further absorption in the bloodstream;
- binds to drugs at the small intestine & stomach
75
Metadoxine
- Speeds up alcohol metabolism
-Induces alcohol dehydrogenase metabolism
76
Tx drug for Opioid?
- Narcan (Naloxone)
77
Tx for Alcohol Overdose?
- Metadoxine: to induce alcohol dehydrogenase
- IV fluids: help with dehydration + electrolyte imbalances
78
Tx Narcan:
- only blocks to prevent drug-receptor activity from happening; but does not alter anything--> it is safe to give.
79
Tx: benzodiazepine toxicity
- GABA receptor antagonist
Tx Drug: Flumazenil, IV
80
Glutamate
an excitatory neurotransmitter that makes the brain more active.
81
GABA (gamma-aminobutyric acid)
GABA is the brain’s calming neurotransmitter.
82
1st Generation Antihistamine
ie.) Dipenhydramine (Benadryl, Allerdryl)
Chlorpherinamine (ingridient in Beylin)
83
2nd Generation Histamine
*fexofenadine (Allegra)
*loratadine (Claritin)
*cetirizine (Reactine) e.g. fast melt tabs
* desloratadine (Aerius)
84
What is special about Cetirizine?
- non-drowsy
-On set: 10-20 mins and duration is 24hrs
85
Suffixes with - dine, - mine
Antihistamines (but these meds are not just limited to Histamines)
86
Olopatidine (Patanol)
- topical
- eye drops that treat eye - allergies
87
Benadryl cream
- reduce itching and swelling
88
fexofenadine (Allegra)
2nd generation antihistamine
89
*loratadine (Claritin)
2nd generation antihistamine
90
cetirizine (Reactine)
2nd generation antihistamine
91
desloratadine (Aerius)
2nd generation antihistamine
92
S&S: localized urticaria (hives), pruritus (itching at the contact site); no change to VS; no other deficits noted
Localized or Systemic Allergy? What is your tx?
Localized; since there is no change to VS, system involved is only skin
Tx: Benadryl cream
93
Patient comes to a friend’s house, the friend has a cat.
*Within 15 minutes, starts to have s&s:
Watery eyes (epiphora)
Itchy eyes (allergic conjunctivitis)
Runny nose (rhinorrhea)
Sneezing
Slightly itchy skin throughout (pruritus)
Localized or Systemic?, What is your tx?
- We see more systems involved (eyes, nose, skin)
- Systemic, non-life threatening
- Tx: Anti-histamine & monitor
94
The same situation with a cat and other systems involved but now we see diffused urticaria throughout, difficulty breathing (bronchocnstriction) and tachycardia?
- There is VS change!
- Diagnosis: Anaphylaxis
Tx: Antihistamine + life saving drugs
- Systemic allergic reaction is life threatening
95
Localized Allergy; usually in one area. What is your tx?
Benadryl Cream
96
More systems involved in allergies, eyes red, urticaria, but no VS change. What is your tx?
- Anti-histamine and monitor (we monitor because allergies can progress)
97
Other systems involved, bronchoconstriction and tachycardia., What is your tx?
Dx: Anaphylaxis
-
Tx: Anti- histamine and life saving drugs (Epinephrine esp if going to shock)
98
99
COX 1(at rest)
- increase platelet aggregation
100
101
COX 2 (at rest)
( increase pain and inflammation)
102
Non- Selective Inhibitors COX- 1
- decrease platelet aggregation (does the opposite of what it does at rest)
103
Non-Selective Inhibitors COX-2
- decrease pain and inflammation ( does the opposite of what it does at rest))
104
Selective COX-2 Inhibitors:
-only inhibit COX 2 (pain and inflammation) but it spares COX-1 hence; we are at risk for clots
105
Celecoxib
- selective COX-2 inhibitor
- very good with pain and inflammation but risk for clots
106
Aside from COX 1 and COX 2 working along with AA; what else does it do?
-Aside from synthesizing prostaglandins
- It also plays a role in further prostaglandin differentiation
107
COX 1 location and function (platelet aggregation)
- present in all tissues
- protects:
gastric mucosa supports kidney function, and promotes platelet aggregation
108
COX 2 location and function (pain and inflammation)
- present at sites of tissue injury
(normally inactive-->activated during inflammation)
- mediates inflammation,
- sensitizes pain receptors
- mediates fever in the brain
109
What drug class does Non- Selective COX Inhibitors and Selective COX iInhibitors fall under?
NSAID
- Non- Steroidal Anti- Inflammatory Drugs
110
NSAID effects:
-Anti inflammatory
- Analgesic
- Anti pyretic
111
Celecoxib (Celebrex)
- only prescription
- "black box" bc of CV warning
- since its a selective COX 2 inhibitor; there is a risk for clots
112
Why is Celecoxib (Celebrex), a COX 2 inhibitor is not the first choice of NSAID when treating pain?
- risk forc clots since it is a Selective COX 2 inhibitor
113
Non- Selective Cox Inhibitors Drugs:
Acetylsalicylic acid (Aspirin aka ASA)
*+ Enteric-coated ASA (ECASA)
*Ibuprofen (Advil, Motrin)
*Ibuprofen-like:
*Voltaren (Diclofenac)
*Naproxen (Aleve, Naprosyn)
*Ketorolac (Toradol)
*Indomethacin
114
Acetylsalicylic acid (Aspirin aka ASA)
Non-selective COX Inhibitor (NSAID)
115
Enteric-coated ASA (ECASA)
Non-selective COX Inhibitor (NSAID)
116
*Ibuprofen (Advil, Motrin)
Non-selective COX Inhibitor (NSAID)
117
Voltaren (Diclofenac)
Non-selective COX Inhibitor (NSAID)
118
Naproxen (Aleve, Naprosyn)
Non-selective COX Inhibitor (NSAID)
119
Ketorolac (Toradol)
Non-selective COX Inhibitor (NSAID)
120
*Indomethacin
Non-selective COX Inhibitor (NSAID)
121
How to treat Aspirin overdose?
- Aspirin is an acidic drug
- IN excretion: Acidic drug in basic environment
- We will need to alkanize the urine to better enhance excretion of Aspirin
122
Tx for soft tissue injury (due to twisted sprained ankle)?
NSAIDS:
- ibuprofen (PO), Voltaren cream
- and ICE, ELEVATE, REST
123
Hydrocortisone
Glucocorticoid
124
Glucocorticoid Drugs:
*Hydrocortisone, Cortisone
*Prednisone, Prednisolone
*Methylprednisolone
*Dexamethasone
125
Glucocorticoid as a drug
- HIGH EFFICACY FOR TISSUE INFLAMMATION.
- think how it inhibits COX2
- suppress Histamine
- lowers immune system (suppression of phagocytes/ lymphocytes)
126
Cortisone
Glucocorticoid
127
Prednisolone
Glucocorticoid
128
Methylprednisolone
Glucocorticoid
129
Dexamethasone
Glucocorticoid
130
Local allergy, contact dermatitis Tx:
Antihistamine- Topical
ie.) Benadryl (diphenhydramine) cream
131
known allergen, systemic exposure Tx:
Antihistamine- non-drowsy preferred
ie.) Reactin (cetirizine
132
eye symptoms allergy:
Antihistamine- topical to eye
ie.) Patanol (olopatadine)
133
If allergen exposure is anticipated in high doses: (local/ systemic)
Leukotriene modifiers
ie.)Singulair (1 tab x 2 days pre-exposure)
134
Anaphylaxis:
high histamine => systemic inflammatory response => severe inflammation & vasodilation
135
Signs and Symptoms of Anaphylaxis"
- evidence of allergy
- bronchoconstriction (tight airways-> wheezing, difficulty breathing) &
-hypotension (low BP due to vasodilation-> dizziness, fainting)
136
What are we most concerned of during Anaphylaxis:
- Bronchoconstriction and Hypotension (due to vasodilation)
137
Tx of Anaphylaxis:
- focuses on ABC's
- Epinephrine, IM; IV (sympathomimetic effect)
-Dexamethasone, IV (glucocorticoid; suppresses histamine release)
-antihistamines, IV
- IV fluids (for Cardiac Output)
138
Signs and Symptoms of Anaphylaxis (more info)
-Coughing
Shortness of breath
Wheezing
Chest pain/tightness
Tightening of throat
Difficulty swallowing
-Hives
Swelling
Itchiness
Widespread redness
Warmth
(skin may feel hot due to increased blood flow)
- Anxiety
Confusion
Headache
Feeling that something is about the happen
- Faint
Pale
Blue color : Lack of O2 in the bloodstream
Dizziness: sign of hypotension
Weak pulse
Shock
Loss of consciousness
139
topical - Voltaren PRN
- glucocorticoid, less/ almost no side effect
- used for localized pain and inflammation
140
intranasal - Avamys PRN
- glucocorticoid, less/ almost no side effect
-Used for nasal allergies
141
Allergic Rhinitis Tx:
Glucocorticoid- Intranasal
ie.) fluticasone (Flonase, Avamys)
ie.) mometasone (Nasonex)
ie.) budenoside (Rhinocort)
142
Fluticasone (Flonase, Avamys)
Glucocorticoid- Intranasal
143
Flonase
Glucocorticoid- Intranasal
144
Avamys
Glucocorticoid- Intranasal
145
mometasone (Nasonex)
Glucocorticoid- Intranasal
146
Nasonex
Glucocorticoid- Intranasal
147
budenoside (Rhinocort)
Glucocorticoid- Intranasal
148
Rhinocort
Glucocorticoid- Intranasal
149
Suffixes ending in - one, -ide
Glucocorticoids
150
Suffixes ending in - dine, -mine
Antihistamines
151
Psoriasis Tx:
- Glucocorticoids
- DMARD's
- UV light
152
Atopic Dermatitis Tx:
moisturize +
- topical glucocorticoids
-Antihistamines
-antibiotics/antivirals if infection
153
Tx of Rheumatoid Arthritis:
- NSAID's
- Glucocorticoids (PO route)
- DMARD's
- Biologic Response Modifiers (BRM's) --> IV, SC Route
154
What are BRMs (biologic response modifiers)?
- decrease T & B cell response
- prevent autoimmune attack on joints
- ie.) Infliximab, Adalimumab, Ustekinumab
155
Infliximab
BRMs - biologic response modifiers
156
Adalimumab
BRMs - biologic response modifiers
157
Ustekinumab
BRMs - biologic response modifiers
158
What are DMARD's- disease-modifying anti-rheumatic drugs?
- inhibits nucleotide synthesis
-inhibits WBC synthesis & fx: reduce immune overactivity
159
Methotrexate
DMARD
160
Tx for OA:
- NSAIDs,
-Glucocorticoids (intra articular injection) ie.) Betamethasone (Celestone)
161
Betamethasone (Celestone)
Glucocorticoid (IA)
- intrarticular because it contains large molecules that'll stay
- half life is 2-3 wks; then pt gets repeated doses
162
IBD Tx:
- ●Glucocorticoids
- ●Aminosalicylate (help control inflammation in the intestines)
- ●DMARDs (Methotrexate)
- stem cell research (mesenchymal stem cells)
163
Drug class: Aminosalicylates
anti- inflammatory drugs used to treat IBD
- they are PO administered
- prodrug (gets metabolized in the colon)
- 2 products: 5-ASA: salicylate (NSAID) + Sulfapyridine (DMARD)
ie.) Sulfasalazine (Azulfidine, Salazopyrin)
164
Aminosalicylate when metabolized in the colon produced 2 drugs; what are they?
salicylate (NSAID): reduce gut inflammation
AND
Sulfapyridine (DMARD): helps control immune system overactivity
165
Sulfasalazine
Aminosalicylates (contains NSAID's and DMARD's)
166
Azulfidine
Aminosalicylates (contains NSAID's and DMARD's)
167
Salazopyrin
Aminosalicylates (contains NSAID's and DMARD's)
168
Asacol
5-ASA: salicylate (NSAID's)
PO:rectal
169
Teva
5-ASA: salicylate (NSAID's)
PO: rectal
170
Mesalamine
5-ASA: salicylate (NSAID's)
ROA: PO, rectal
171
(Asacol, Teva, Mesalamine)
Drug: 5-ASA (NSAID's)
172
Ulcerative Colitis first line of tx:
Aminosalicylates
ie.) Sulfsalazine (Azulfidine, Salazopyrin)
173
Crohn's Disease first line of Tx:
- Glucocorticoid (if long term)
- But if flare up is present--> aminosalicylates
174
Prevnar
immunization to decrease respiratory infection risk
175
Drug class: Aminosalicylates
anti- inflammatory drugs used to treat IBD
- they are PO administered
- prodrug (gets metabolized in the colon)
- 2 products: 5-ASA: salicylate (NSAID) + Sulfapyridine (DMARD)
ie.) Sulfasalazine (Azulfidine, Salazopyrin)
176
Asthma Line of Treatments: (3)
1.) ●Tx: ‘controllers’ -> long term Anti-inflammatory drugs
2.) Tx: rescue
3.) Severe attack "drugs"
177
Tx: ‘controllers’
- prevention against attacks
Drug class: Glucocorticoids
ie.) Pulmicort (Budenoside), Qvar (Beclomethasone), Flovent (Fluticasone)
178
Tx: "controllers" - Glucocorticoids, what are the adjunct tx?
- Mast cell stabilizers
ie.) Cromolyn (cromoglicic acid)
- Leukotriene modifiers: blocks leukotrienes, reducing infammation. ie.) Singulair (montelukast)
179
Pulmicort (Budenoside)
- Glucocorticoid, tx- asthma controller
180
Flovent (Fluticasone)
Glucocorticoid, tx- asthma controller
181
Cromolyn (cromoglicic acid)
- Mast cell stabilizers
- Adjunct tx for "asthma controller"
182
Singulair (montelukast)
- Leukotriene modifier
-Adjunct tx for "asthma controller"
183
Drug class for tx for asthma controller?
- Glucocorticoids
184
long term maintenance for severe asthma and allergic conditions?
Xolair (omalizumab)
- Xoliari has high affiinity for igE- thus preventing it from attaching to mast cells = reduction in mast cell response
185
Impaired gas exchange secondary to asthma
- As the inflammatory process continues, the bronchioles narrow due to cytokine release, and goblet cells increase mucus production-> trapping CO2 in the alveoli
186
What are Tx: rescue drugs during Asthma:
- medications used during an asthma attack to quickly open the airways (bronchodilation) and improve breathing
187
Tx "rescue drugs" in Asthma
bronchodilator drugs, inhaled
-Drug Class: Beta 2- adrenergic agonists: very potent, stimulates SNS, fast-acting
- Drug Class: Anticholinergics: antagonize PNS--> allow more air flow; synergy with Beta-2 Adrenergic agonists
188
How does Beta -2 adrenergic agonists differ from Anticholinergics?
- Beta-2 agonists :open airways quickly
- Anticholinergics: provide longer-lasting bronchodilation
189
Beta -2 adrenergic Agonists
- potent, stimulate SNS, fast-acting.
ie.) Salbutamol (Ventolin)
○Albuterol (Ventolin)
○Formoterol (Oxeze, Turbohaler)
190
Salbutamol (Ventolin)
Beta-2 adrenergic Agonists
191
Albuterol (Ventolin)
Beta-2 adrenergic Agonists
192
Formoterol (Oxeze, Turbohaler)
Beta-2 adrenergic Agonists
193
Anticholinergics
-less potent, synergy with Beta 2- adrenergic agonist
ie.) Atrovent (Ipratropium)
194
Atrovent (Ipratropium)
Anticholinergics
195
Asthma Tx in severe attack:
- Oxygen (O₂) therapy is given immediately to correct low oxygen levels (hypoxemia)
- Beta2 adrenergic agonists, inhalation (nebulizer-> continuous mist inhalation. ie.) Ventolin
- Calcium channel blocker(smooth muscle)
- Anticholinergics, inhalation (nebulizer)
- Adrenergics/Sympathomimetics, IV ie.) Epinephrine (Adrenalin)
- Glucocorticoids, IV ie.) Dexamethasone
196
Adjunct tx in Asthma severe attack:
Antihistamines, IV (e.g. Benadryl)
197
Ventolin
- used in severe asthma attack
- Beta2 adrenergic agonists, inhalation (nebulizer-> continuous mist inhalation
198
Magnesium sulfate (MgSO4), IV
- used in severe asthma attack
- calcium channel blocker (targets smooth muscle to relax--> stabilization of mast cells + t-cells)
Side effect: hypotension (although, we are concerned, it's okay because right now the problem is the airway)
199
Anticholinergics, inhalation (nebulizer)
-used in severe asthma attack
- Synergy tx-> with Beta-2 agonists
200
●Adrenergics/SympathomimeticsIV
-used in severe asthma attack
- ○Epinephrine (Adrenalin)
201
Dexamethasone
- used in severe asthma attack
- a glucocorticoid
202
Magnesium Sulfate (MgSO4)
- Drug classes: electrolyte; enzymatic activator; Calcium channel blocker
- ●inhibition of Ca channels in smooth muscle => reduced cellular excitability => bronchodilation
- ●stabilization of mast cells & T-cells => decreased pro/inflammatory mediators
- ●enhanced release of NO => vasodilation (relaxes blood vessels), pulmonary vasodilation = improved gas exchange
○side effects:
hypotension
203
Do we titrate MgSO4 for severe bronchoconstriction?
Yes we do! Adjust the dose carefully base don how well the pt respomse
204
Nitric Oxide
rescue drug to pt’s with angina to allow vasodilation (better O2 perfusion)
Side effect: hypotension
205
How do we differentiate Asthma to Anaphylaxis?
- Asthma: focus is to bronchodilate (open up airway to make breathing easier)
- Anaphylaxis: focus is to vasoconstrict to maintain BP (maintain blood pressure and ensure adequate blood flow)
206
Asthma vs Anaphylaxis Tx
ASTHMA:
- Bronchodilators
- Anti-inflammatory meds
- Long acting bronchodilators
- Leukotriene modifiers
- Allergen immunotherapy
Anaphylaxis:
- Epinephrine (Adrenaline)
- Antihistamines
- Corticosteroids
- Beta-agonists
207
suffixes such as -lam, -pam
Benzodiazepine
208
Tx for Benzodiazepine OD:
Flumazenil
209
Tx for Alcohol OD:
Methadoxine
210
