N398 Post Midterm Flashcards Preview

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Flashcards in N398 Post Midterm Deck (39):
1

Metformin

Class: insulin sensitizer
*does not stimulate insulin secretion from pancreas

Action: inhibits glucose production in liver
-reduces glucose absorption in gut
-sensitizes insulin receptors in target tissues

AE: GI: decreased appetite, nausea, diarrhea
*does not cause hypoglycemia, contraindicated within 48 hours of IV contrast

2

Thiazoloidinediones

Class: Glitazones

Action: Reduce insulin resistance and decrease glucose production; usually used in combo with other agents, "turning on your genes"

AE: fluid retention, hypoglycemia
CYP450

3

Glipizide (is a 2nd generation sulfonyrea)

Class: 2nd generation sulfonyrea

Action: Stimulates release of insulin from pancreatic islets
*if pancreas doesn’t work, this doesn’t work!

AE: hypoglycemia

4

Lispro

Class: Fast acting insulin

Onset 15-30 minutes
Peaks 0.5-2.5 minutes
AE: hypoglycemia

5

Regular Insulin

Class: regular insulin

30-60 minutes onset
Peak 1-5 hours

6

NPH Insulin

Class: long acting insulin

1-2 hour onset
Duration is more than 12 hours

7

Repaglinide

Class: meglitinides

Action:
Stimulates insulin release from the pancreas

AE: hypoglycemia

8


Sitagliptin (DPP4 inhibitors)

Class: oral anti hyperglycemic agents

Action: enhances the effects of incretin hormones
*incretin hormones: stimulate glucose dependent release of insulin and suppress postprandial release of glucagon

DPP-4 INACTIVATES incretin hormones, so by inhibiting DPP-4, sitagliptin thus enhances incretin

AE: upper respiratory tract infections, headace, inflammation in nasal passages and throats
-hypoglycemia, pancreatitis, anaphalazis

9

Liraglutide

Class: anti diabetic medication

Action: Incretin mimetic (suppress appetite and inhibit glucagon secretion)
bind to GLP-1 receptors and stimulate glucose dependent insulin release

Note: only SQ

10

Pioglitazone

Action: decreases insulin resistance

11

Carbamazepine

Class: AED-used for partial seizures and tonic-clonic seizures

Action: Suppresses high-frequency neuronal discharge in and around seizure focci

AE: CNS- nystagmus, blurred vision, ataxia, vertigo, unsteadiness, Hematologic- bone marrow suppression, anemia, aplastic anemia

KNOWN TERATOGEN; promotes ADH secretion and water retention

12

Phenytoin
*IV option

Class: traditional AED

Action: Used for many diff types of seizures; selective inhibition of sodium channels
-slows recover of sodium channels from the inactive state to the active state
-entry of sodium into neurons is inhibited; suppression of action potentials

AE: gingival hyperplasia, dermatologic effects, rash
-pregnancy teratogenic!
-With IV admin; dysrhythmia, hypotension, purple glove syndrome

exhibits saturable kinetics; lower dose, SMALLER half life! 1st order kinetics
-minimal changes in dose, large changes in concentration

13

Fosphenytoin

Class: AED

Action: Converted to phenytoin in the body; easier to administer and less adverse effects

*does not cause purple glove
*decreased incidence of hypotension
*may be infused faster vs. phenytoin

14

Valproic acid

Class: anticonvulsant

AE: GI upset

15

Divalproex

Class: AED

Action: Suppressions of high-frequency neuronal firing through sodium channel blockade
-suppresses calcium influx through T-type calcium channels
-augment inhibitory influence of GABA

AE: nausea, vom
Hepatotoxicity- can be fatal (avoid in less than 2 yari of age)
Pancreatitis, hyperammonemia, teratogenic

16

Levetiracetam

Class: AED

Action: actually, we don't even know! used for many different types of seizure disorders

-Minimally metabolized
-KEPPRA!

AE: Mild to moderate side effects *compared to the other older ones which have lots of SE

17

Mannitol

Class: osmotic diuretic

Action: raises serum osmolarity

AE: dehydration, decrease BP, electrolytes, watch your serum osmolarity

18


Albuterol

Class: Short acting beta 2 agonist

Action: rescue inhaler for asthma and COPD
-relieves acute bronchospasm and prevention of exercise induced bronchospasm

AE: tachycardia, tremor, hypokalemia
*immediate benefit lasts 30-60 minutes
*there is no MAX of albuterol

19

Ipratropium

Class: Anticholinergic

Action: Anticholinergic (blocks the action of acetylcholine)
block muscarinic receptors in bronchi (bronchodilation)

short acting, used to relieve bronchospasm

20

Montelukast

Class: oral leukotriene receptor antagonist

anti-inflammatory treatment of asthma

Action:
Suppress effects of leukotrienes (reduce inflammation, bronchoconstriction, airway edema)

Metabolized by CYPP450

21

Beclomethasone (inhaled)

Class: Inhaled corticosteroid
*controller medications

Action: *anti inflammatory treatment

AE:
-Oropharyngeal candidiasis (thrush)
-dysphonia (crackly voice)
-can promote bone loss

22

Ranitidine

Class: H2 Receptor Antagonist

Action: Suppresses the secretion of gastric acid by selective blocking H2 receptors in parietal cells lining stomach

AE: -caution in preg
-multiple drug interactions (CYP450)
-doses need to be adjusted in renal insufficiency

23

Sucralfate

Class: mucosal protectant

Action: Acidic environment changes sucralfate into thich substrate that adheres to an ulcer for up to 6 hours- protects the ulcer from further injury

AE:
Constipation
Caution in preg
Use cautiously in renal failure (minimal absorption of aluminum salt)
May interfere w absorption of other meds

24

Antacids (Calcium carbonate & magnesium hydroxide)

Class: antacid

Action: Neutralize gastric acid and inactivate pepsin- potential muscosal protection due to stimulation of production of prostaglandins

AE: Constipation and diarrhea
Caution in pregnancy
Avoid in those with GI perforation or obstruction
Caution in renal dysfunction

25

Sulfasalazine

Class: anti-inflammatory; 5-aminosalicylates

Action: Decreases inflammation by inhibiting prostaglandin synthesis

AE: blood disorders, anemia (contains sulfa)

26

Omeprozol

Class: Proton Pump Inhibitor

Action: Irreversible inhibits H+, K+, ATPase (proton pump), blocks gastrin production

AE: Drug interaction w CYP2C19- Clopidogrel/Plavix
Long term use increases risk of osteoporosis

27

Digoxin

Class: Cardiac Glycosides

Action: Inhibits Na-K-ATPase Pump; alters the electrical activity of the heart
-Favorable effect on neurohormonal systems
-increases Cardiac Output
-increases ionotropy
(often used for afib or cardiac dysrhythmias to correct them)

AE: cardiac dysrhythmias
principal non cardiac toxicities are CNS and GI related
-anorexia, nausea, vom, visual disturbances (halos around objects)

28

Furosemide (Lasix)

Class: Loop Diuretic

Action: inhibit sodium, potassium, and chloride reabsorption in the loop of henle in the kidney to decrease water retention

AE: hypokalemia, hypotension, dehydration
*good for pt with kidney disease

29

Hydrochlorothiazide

Class: Thiazide diuretics

Action: inhibits sodium reabsorption in the distal tubules of the kidneys (decreased water absorption)
mild diuresis

AE: hypokalemia
*ineffective with low GFR

30

Spironolactone

Class: Potassium-sparing diuretic (aldosterone antagonist)

Action: dumps out sodium but allows potassium to stay

AE: hyperkalemia, gynecomastia in men, Monitor potassium

31


Nitroglycerin

Class: Organic nitrate

Action: Dilates veins and decreases venous return (preload) which decreases oxygen demand

AE: drug interactions; phosphodiesterase Type 5 inhibitors
*tolerance can occur rapidly (1 day)
*related to depletion of sulfahydryl groups

32

Lisinopril

Class: ACE inhibitor

Action: angiotensin converting enzyme inhibitor
(no vasoconstriction, body will not hold onto salt, you will diurese)

Adverse Effects:
-persistent cough, hyperkalemia, teratogenic, angioedema (big tongue)

Nursing Considerations:
shown to slow progression of kidney injury in pts with diabetes

33

Losartan

Class: Angiotensin Receptor Blocker

Action: prevents fluid retention, vasodilation, activation of RAAS system

Adverse Effects:
-teratogenic, angioedema, hyperkalemia

Nursing Considerations:
often used in combination therapy

34

Metoprolol

Class: Beta Adrenergic Blocker

Action:
-decreases cardiac output
-suppresses reflex tachycardia caused by vasodilators
-reduces release of renin (in kidneys, reduces the RAAS system input)
-lowers HR
-long term use reduces peripheral vascular resistance

Adverse Reactions:
bradycardia, heart block, bronchoconstriction

Nursing Considerations:
monitor heart rate
-watch for patients with asthma, COPD

35

Hydralazine

Class: vasodilator

Action: Selective dilation of arterioles (little or no venous effects)
in combo w nitrates (isosorbide dinitrate)

AE: hypotension, tachycardia, lupus like syndrome

36

Paroxetine

Class: antidepressant SSRI

Action: inhibits serotonin reuptake from brain synapses and stimulates serotonin activity in the brain

AE:

37

Amitriptyline

Class: Tricyclic antidepressant

Action: Blocks neuronal reuptake of NE and serotonin

AE: orthostatic hypotension, sedation, anticholinergic effect, cardiac toxicity, seizures

38

Bupropion

Class: Atypical antidepressant
(good alternative to SSRIS)

Action: Unclear MOA; DA blockade, NE reuptake

AE: agitation, headache, dry mouth, constipation, weight loss, seizures
can also be used to quit smoking

39

Alprazolam

Class: Benzodiazepine

Action: CNS: depress neuronal function at multiple sites; reduces anxiety, promote sleep, muscle relaxant
CV: IV admin can cause hypotension
Resp: resp depressant

AE: can have abrupt withdrawl sx, CNS depression, resp depression, anterograde amnesia