Pharm 103 Test 2 Flashcards
(139 cards)
1
Q
Initial 4 drug combo for TB
A
Reduces MDRTB: isoniazid rifampin pyrazinamide ethambutal not as common-streptomycin
2
Q
prophylaxis drugs for TB for ppd + HCWs
A
isoniazid or rifampin
3
Q
INH action
A
inhibit cell wall synthesis
4
Q
some lack liver enzyme to metabolize
A
isoniazid
5
Q
AEs of isoniazid
A
hepatotoxicity (monitor liver function) peripheral neuritis B6 deficiency (take supplement)
6
Q
rifampin action
A
inhibit protein synthesis
7
Q
causes orange/brown discoloration of body fluids
A
rifampin
8
Q
General TB med AEs
A
Hepatotoxicity (INH, PZA, rifampin)
Kidney issues (INH, Rif, esp streptomycin)
GI upset (take with snack)
eye problems (ethambutol especially: optic neuritis and decreased visual acuity, red-green color
INH)
9
Q
non-opioid antitussive
A
dextromethorphan
potential for abuse
10
Q
antitussive action
A
suppress cough reflex in medulla to reduce annoying, nonproductive cough
11
Q
AE of high dose of dextromethorphan
A
dizziness and sedation
12
Q
opioid antitussive
A
codeine
very effective but can be habit forming
13
Q
AEs of codiene
A
constipation, sedation, hypotension
14
Q
antihistamine and antitussive
A
diphenhydramine
15
Q
AEs of diphenhydramine
A
drowsiness, dry mouth, anorexia
16
Q
alpha 1 adrenergic receptors-location and function
A
mostly in peripheral arteries and veins; cause vasoconstriction when stimulated
17
Q
alpha 2 adrenergic receptors-location and function
A
located on nerve membranes; modulate NE release to prevent overstimulation
18
Q
beta 1 adrenergic receptors-location and function
A
mostly heart,some kidney; increase HR, contractility, automaticity, AV conduction and renin release from kidneys
19
Q
beta 2 adrenergic receptors-location and function
A
lungs; cause bronchiole smooth muscle relaxation, resulting in bronchodilation
20
Q
Decongestants-Action
A
sympathomimetic; shrink engorged nasal mucosa by stimulating alpha receptors of bvs in nasal mucosa causing vasoconstriction, reducing swelling and secretions
21
Q
systemic effects of decongestants
A
especially in fragile pts.
cardiac stimulation-irregular rhythm, increased HR
CNS stimulation-DZNS, HA, irritable
Increase BS in DM
decreased sphincter contraction, decreased voiding
22
Q
Avoid decongestant use in these pts
A
heart disease, HTN
Hyperthyroid
DM
23
Q
to avoid systemic effects of decongestants, use
A
topical nasal spray to avoid cardiac stimulation; steroid nasal spray or mast cell stabilizers to avoid all
24
Q
nonselective adrenergic agonist
A
epinephrine
very effective bronchodilator but multiple AEs since stimulates alpha, B1 and B2: jittery, increased HR, increased BP, HA, HTN
only used in acutely ill pt-anaphylaxis
25
B2 adrenergic agonists-action
mostly stimulate B2 receptors in lungs causing bronchodilation by increasing cAMP; in lg frequent dose can stimulate B1 (increase HR)
26
AE of B2 agonists
tremors, anxiety, minimal tachycardia and increased bp, arrhythmia in some pts.
27
fast acting B2 agonists--rescue meds in MDI or neb
albuterol (duration 3-4h) and levalbuterol (longer duration-8h)
28
long-acting B2 agonists (bid)
Brovana (neb)
salmeterol (Serevent)
formoterol (Foradil)
29
B2 agonist that can be used to stop preterm labor
terbutaline (Brethine)
30
Advair diskus
Dry powder inhaler-B2 agonist and steroid
salmeterol (Serevent) and fluticasone
daily use-bid
31
Combivent inhaler
ipratropium (Atrovent) and albuterol
used in COPD
DuoNeb in nebulizer
32
Symbicort
budesonide and formaterol
| similar to Advair- steroid and long acting B2 agonist
33
two MDIs that combine a steroid and a long-acting B2 agonist
Advair diskus and Symbicort
34
PSNS stimulation in lungs causes
bronchoconstriction--need anticholinergic med
35
anticholinergic bronchodilators
ipratropium (Atrovent)--short acting and duration
| tiotropium (Spiriva)--longer acting (qid)
36
Leukotriene receptor antagonists-action and examples
leukotrienes cause bronchoconstriction--these meds stop that part of the inflammatory process
Long term preventative of acute asthma problems
montelukast (Singular)
many interactions, not 1st choice
37
Xanthine bronchodilators-action and examples
stop cAMP from breaking down, promoting bronchodilation
oral theophylline/aminophylline
related to caffeine, AEs: tachycardia, nervousness
monitor blood levels, can become toxic
38
Inhaled Corticosteroids used for long term prevention in asthma and COPD (not rescue)
fluticasone (Flo-vent)
budesonide (Pulmicort)
triamcinolone (Asmacort)
beclomethasone (Beclonase)
39
inhaled steroids used for asthma instead of oral/IV because
less systemic AE
| may use oral or IV in acute situation
40
Mast cell stabilizers-action and examples
prevent mast cells from releasing inflammatory mediators
cromolyn (Intal)
nedocromil (Tilade)
41
three functions of respiratory aerosols
Decongest, liquify secretions
Bronchodilate, topical med admin
moisten, heat or cool resp mucosa
42
DPIs
dry powder inhalers
| Advair and Spiriva
43
Effects of histamine release in inflammation
dilates and increases permeability of nasal capillaries causing edema
constricts smooth muscle in lungs
increases GI secretions
44
anti histamines action
block histamine receptors so histamine can't bind-don't effect already bound histamine
45
1st vs 2nd generation antihistamines
1st gen-Benadryl AEs:drowsiness, decreased coordination, allergic rxns, n/v
2nd gen-nonsedating antihistamines
46
Secondary uses for diphenhydramine
n/v, vertigo, sleep aid
47
muco-kinetic vs. muco-lytic
muco-kinetic: thins mucus for better ciliary action (ex. aerosolized saline, water)
muco-lytic: chemically breaks down mucus
guanifenesin, Mucomyst
48
3 uses for acetylcysteine (Mucomyst)
1. To reduce tenacity and viscosity of thick secretions, esp. in CF
2. Antidote for tylenol OD-blocks livery toxicity from tylenol
3. Protects kidneys from damage when IV contrast is used in pt with renal dysfunction
49
Quick relief agent bronchodilators
albuterol MDI/neb
ipratropium (Atrovent) MDI
oral prednisone (not as much)
50
anticholinergic bronchodilators (2)
ipratropium (Atrovent)
| tiotropium (Spiriva)
51
alpha adrenergic blockers-action
HTN med; block alpha 1 receptors in peripheral arteries and veins that cause vasoconstriction; preventing stimulation dilates arteries and veins, decreasing arterial pressure and venous return to the heart, decreasing CO and bp
there are selective and nonselective
52
selective alpha adrenergic blockers
```
HTN med; block only alpha 1 receptors
-sin
prazosin (Minipress)
terazosin (Hytrin)
doxazosin (Cardura)
```
53
alpha adrenergic blocker that can be used in treatment of BPH
terazosin (Hytrin)
54
nonselective alpha adrenergic blockers
```
block E and NE, alpha 1 and alpha 2
used to treat HTN d/t pheochromocytoma tumor of adrenal medulla in which too much E and NE are released
phenoxybenzamine (Dibenzyline)
phentolomine (Regitine)
used in treat
```
55
nonselective alpha blocker used to treat increased alpha activity disorders (Raynauds, frostbite) where there is too much vasoconstriction
phenoxybenzamine (Dibenzyline)
56
nonselective alpha blocker used to reverse tissue necrosis when drugs extravasate
phentolomine (Regitine)
57
AEs of alpha blockade
most important: orthostatic HoTN
can go away eventually, get OOB slowly
S=syncope and dizziness (OHoTN), sexual dysfunction
I=Increased HR, weakness,
N=nasal congestion
58
Centrally-acting alpha 2 stimulators-action and examples
suppress SNS outflow in brainstem to heart and bvs and decrease renin from kidneys (alpha 2 receptors modulate NE release to prevent overstimulation)
clonidine (Catapres)
methyldopa (Aldomet)
59
centrally-acting alpha 2 stimulators and direct-acting vasodilators are usually given with a diuretic because they can cause
Na and water retention
60
centrally-acting alpha 2 stimulator AEs
drowsiness, sedation
decreased concentration depression
dry mouth
61
This centrally-acting alpha 2 stimulator can cause severe rebound HTN if stopped abruptly
clonidine (Catapres)
62
This centrally-acting alpha 2 stimulator can cause hemolytic anemia, liver toxicity, and dark urine
methyldopa (Aldomet)
63
Direct-acting Vasodilators-action and examples
decrease bp by dilating arterioles (not veins)
hydralazine (Apresoline)
minoxidil (Loniten)
often given with diuretics, can cause Na and fluid retention
64
Beta Blockers-action
nonselective and cardioselective
decrease O2 demand of heart by blocking SNS response
decrease HR (increases filling time of ca's)
and contractility, resulting in decreased CO and myocardial O2 demand
decreased AV conduction
prevent renin release from kidneys
decrease PVR long term
-olols
65
mostly widely used drug for HTN
Beta Blockers
66
two types of Beta Blockers
nonselective (block B1 and B2)
cardioselective (block B1 only)
cardioselective don't cause bronchospasm like nonselective can
67
nonselective Beta Blockers
propanolol (Inderol)
nadolol (Corgard)
Timolol (Blocadren)
68
cardioselective Beta Blockers
atenolol (Tenormin)
| metoprolol (Lopressor)
69
danger in cardioselective Beta Blockers for DM pts
may mask "jitters" and effects of hypoglycemia
70
don't use nonselective Beta Blocker in asthma pt because
may cause bronchospasm
71
Newest Beta Blocker, blocks B1 and vasodilates with endothelium derived NO
nebivolol (Bystolic)
72
Beta Blockers can treat tachyarrythmias because they
decrease rate of AV conduction
73
Beta Blockers are less effective in
blacks
74
B1 adrenergic receptor stimulation increases (5)
```
HR
contractility
automaticity
AV conduction
Renin from kidneys (activation of RAAS)
```
75
B2 adrenergic receptor stimulation causes (2)
Bronchodilation
| Increased breakdown of glycogen into glucose
76
do not stop Beta Blocker use abruptly because
sudden withdrawal can exacerbate angina by rebound vasoconstriction
77
Combined alpha and beta blocker-action and examples
Block A1: promote vasodilation
Bock B1: decrease HR and contractility, decrease renin release in kidney
labetalol (Normodyne)
carvedilol (Coreg)
78
Major AE of combined alpha and beta blocker
Orthostatic Hypotension and Bradycardia
79
AEs of Beta Blockers
Bradycardia, worsening HF
weakness, lethargy
sexual dysfunction
depression, insomnia, bizarre dreams
may delay recovery from hypoglycemia in Type 1 DM
nonselective only: may promote bronchospasm and bronchoconstriction
80
Calcium channel blockers-action and types
prevent Ca from entering myocardial cells, decreasing force of myocardial contraction
results in: coronary artery dilation and peripheral artery dilation; some decrease conduction
Anti-HTN: nifedipine (Procardia) and amlodipine (Norvasc)
Antianginals and antiarrythmics (cardiosuppresive): verapamil (Calan)
Intermediate acting: diltiazem (Cardizem)
81
anti-HTN CCBs
nifedipine (Procardia)
| amlodipine (Norvasc)
82
antianginal and antiarrythmic (cardiosuppressive) CCBs
verapamil (Calan): most conduction reducing b/t SA and AV; some vasodilation
diltiazem (Cardizem): intermediate acting bt conduction reducing and vasodilation, reducing HTN
83
Use diltiazem or verapamil cautiously with
bradycardia, HF, AV block
| bc both decrease donduction
84
AEs of CCBs
```
constipation
HoTN
dizziness, HA
skin flushing
edema
```
85
ACE inhibitors-action and examples
blocks conversion of Ag I to Ag II, a potent vasoconstrictor. Promotes relaxation of arteries and excretion of Na and H20. Drug of choice for HTN and CHF.
captopril (Capoten)
enalapril (Vasotec)
lisinopril (Zestril)
86
AEs of ACE inhibitors
first dose HoTN
persistent dry cough
hyperkalemia (watch for gradual increase)
Danger of angioedema
87
angioedema-definition and what drugs can cause it
ACE inhibitors
histamine response causing edema of mucus membranes of lips, tongue, and glottis.
Stop drug immediately and give epinephrine
88
Angiotensin II Antagonists (Angiotensin Receptor Blockers)-action and examples
newer, similar to ACE I but don't cause cough
Block AG II from binding to receptors on bvs and kidneys, promoting vasodilation and reduced bp, promoting excretion of Na and H20
losartan (Cozaar)
irbesartan (Avapro)
89
AE of ARB's
URI and HA
90
ARBs can help HF because
decreased bp makes it easier for the heart to pump
91
3 meds used to treat angina
CCBs
BBs
nitrates
92
no grapefruit juice with
CCBs
93
If there are no written parameters, hold a BB for
SBP < 120
| HR < 60
94
closely watch BS in DM pts on
Beta Blockers
| oral diabetic meds and insulin can delay effects also
95
first choice in acute angina attack
nitroglycerine
| rapid and long term treatment of angina; treats HF also
96
nitroglycerin-action
relax smooth muscle cells around arteries and veins to dilate them; this decreases BP and cardiac workload
dilate ca's -decrease angina
dilate peripheral a's - decrease afterload
dilate veins-decrease venous return and preload
97
Hypertensive crisis can result if using erectile dysfunction med with
nitroglycerin
98
when giving SL nitro, assess BP and HR when
before giving and 5 minutes after
99
AEs of nitroglycerin
orthostatic HoTN
flushing
dzns, weakness
HA-expected, give tylenol
100
Inotropes alter
force of heart contraction
101
chonotropes alter
rate of heart contraction
102
dromotropes alter
rate of conduction SA to AV
103
Digoxin (Lanoxin) action
alters ion movement across myocardial PM
positive inotropic (increase strength of contraction) which increases emptying
negative chono and dromotropic (decreased rate of contraction and conduction) which increases filling
Overall: increased CO, perfusion, blood to kidneys and excretion
decreased pulmonary and systemic congestion
104
Digitalization
pt given loading dose of dig to saturate body tissues with med and get high blood levels. Followed by maintenence dose until pt is at therapeutic level.
105
Digoxin given to treat
Afib, Aflutter, CHF (4th line tx, used to be 1st)
106
Therapeutic level for Digoxin
0.8-2.0 ng/mL (less in renal pts)
| small therapeutic index, and some pts can be toxic at therapeutic level
107
most common cause of dig toxicity
hypokalemia
108
s/s digoxin toxicity
fatigue
blurred vision
disturbed color vision (yellow/green halos around objects)
GI disturbance-n/v, anorexia, abd pain diarrhea
CNS-DZNS, confusion, delerium, depression
change in HR, arrythmias
Hyperkalemia
109
Times to measure dig level
```
digitization
post op
renal failure
pt showing s/s toxicity
intervals in treatment
```
110
pt teaching about dig
always take apical HR before taking med
inform MD of GI or visual complaints
eat food high in K
111
Dig antidote
Digibind--antibody that binds digoxin and inactivates it
112
drugs that increase risk of digoxin toxicity
antacids, calcium preps
| K wasting diuretics, steroids, some abx--all these 3 can cause hypokalemia
113
AEs of digoxin are related to
dose; continnum of s/s toxicity
fatal arrythmias
bradycardia
GI, CNS (can go to seizures and hallucinations)
114
conditions that may predispose to digoxin toxicity
hepatic/renal impairment
MI/heart disease
electrolyte imbalances (low K)
hypothyroid (decreased metabolism)
115
Don't give Digoxin with
antacids, high fiber, or food (one hour before or two hours after meals)
116
Assess before giving digoxin
electrolytes, renal function
| apical and radial HR and rhythm for 1 minute
117
Short term tx for CHF pt unresponsive to dig
```
Phosphodiesterase inhibitors (PDI)
Inamrinone (Inocor)
milrinone (Primacor)
```
118
Direct renin inhibitors
block activity of renin enzyme converting Ag I to Ag II
| aliskiren
119
pt teaching about vasodilators includes avoiding (3)
exercise for 3 hours after taking
hot tubs
alcohol
120
pt teaching about HTN meds includes (4)
low Na diet
OOB slowly
don't d/c abruptly
contact MD for sexual dysfunction
121
when giving a HTN med, assess BP
prior to dose (w/in 30 min)
| recheck at peak effect time
122
nifedipine, amlodipine
Procardia, Norvasc
| CCBs with no antiarrythmic action, only vasodilation
123
diltiazem, verapamil
Cardizem and Calan
CCBs with antiarrythmic effects
block Ca channels in heart to decrease conduction
124
CCBs that treat angina
diltiazem, verapamil, and nifedipine
| block Ca channels in bvs, causing coronary artery and peripheral artery dilation
125
advantage of ARBs over ACE inhibitors
no dry cough, less risk of hyperkalemia
126
BBs used for angina
atenolol, metoprolol
decrease myocardial O2 demand and workload
decreased HR increases diastole, increases filling time of coronary arteries.s
127
NO sudden withdrawal from BBs or CCBs because
could cause rebound HTN
128
oral antidiabetic agents and insulin can delay effects of
BBs and CCBs
129
used for rapid and long term treatment of angina; vasodilate arteries and veins by relaxing smooth muscle
nitrates
130
chemical tourniquet
nitrates
131
organic nitrates, similar to nitroglycerin
isosorbide dinitrate-acute and exertional relief
| isosorbide mononitrate-stable angina
131
Direct Acting vasodilator that can cause lupus-like syndrome (butterfly rash, sore throat, fever, joint pain
hydralazine (Apresoline)
132
Direct acting vasodilator that can cause pericardial effusion
minoxidil (Loniten)
133
These meds can increase BS in DM pts
Decongestants
134
Digoxin is used to treaty
A fib, Aflutter, CHF
135
Monitor glucose level closely for a DM pt on these meds
BB
136
Danger of sympathomimetic decongestants in fragile pts
Epinephrine-like effects
| Increased HR, irregular rhythm, anxiety, HA, increased BS
138
Avoid decongestants in pt with
Arrhythmia, HTN, hyperthyroid, DM
139
Orthostatic HoTN is considered significant if (3)
bp decreases by 20 mm Hg OR
pulse increases by 20 OR
pt c/o dizziness
