Pharm Exam 3 Flashcards

(51 cards)

1
Q

Isoniazid

A

ANTI TUBERCULAR
Action:
-disrupts cell wall synthesis (inhibits mycotic acid which is the causative agent for TB) and blocks pyridoxine (B6)
-bactericidal

Uses:
-most useful for antitubercular drug
-may be used alone for prophylaxis (preventative measure)
-always included in the treatment plan

Pharmacokinetics:
-well absorbed after oral administration
-rate of acetylation differs among populations
-slow metabolism (less likely to build up)

ADRs:
-peripheral neuropathy (give vitamin B6)
-blood dyscrasias
-hepatitis
-allergic reactions
-GI upset

Implications:
-assess for peripheral neuropathy
-monitor CBC and WBC
-stress importance of completing entire course of drug therapy and taking pyridoxine (B6)
-avoid alcohol

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2
Q

Rifampin

A

ANTI TUBERCULAR
Action:
-inhibits RNA polymerase = no protein synthesis = metabolic activity in bacteria is stopped
-bactericidal, broad spectrum
-synergistic in combination with Isoniazid (INH)

ADRs
-may turn body fluids orange (salive, urine, teras, sputum)
-flu-like symptoms
-hepatitis (no alcohol)
-allergic reactions
-GI upset

Implications:
-take on empty stomach with full glass of water
-warn patient about change in body fluids
-stress importance of completing entire course
-oral contraceptive may not be effective

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3
Q

Zidovudine

A

ANTIVIRAL FOR HIV
Action:
-inhibits reverse transcriptase
-NRTIs
-RNA cannot convert to DNA
-no incorporation in host DNA

P. kinetics:
-short-acting
-high fast-pass effect
-fatty meals decrease absorption

ADR:
-GI distress (take w/ food, not fatty food)
-peripheral neuropathy
-hepatotoxicity (check for yellowing, liver size)
-bone marrow suppression (low neutrophils)
-lactic acidosis

TENOFORIR
-new Nuke
-less ADRs
-more potent

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4
Q

Efavirenz

A

ANTIVIRAL FOR HIV
Action:
-inhibit reverse transcriptase = inhibit viral replication
-NNRTI
-different mechanism to NRTIs -> additive or synergistic effects
-resistance develops rapidly

P. Kinetics:
-oral, 12 hour half life

ADRs:
-GI distress
-CNS (sleep disorders)
-skin rashes

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5
Q

Atazanavir

A

ANTIVIRAL FOR HIV
Action:
-inhibit protease enzymes that are important for replication
-large precursor proteins are cleaved to shorter, mature protein by an enzymes
-block the enzyme = precursor proteins are not convert to mature proteins
-> immature non-effective virus
-resistance develops rapidly

ADRs:
-GI distress (do not take w/ food)
-hepatoxic
-Metabolic effects
1.hyperglycemia/diabetes
2.fat maldistribution
3.hyperlipidemia
-osteoporosis
-drug to drug interactions (inhibit liver enzymes)

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6
Q

Acyclovir

A

ANTIVIRAL FOR HERPES
Action:
-activated by viral enzymes (selective action)
-inhibits DNA polymerase = halts viral production

Pharmacokinetics:
-iv, oral, topical

ADR:
-NV
-phlebitis at injection site
-renal damage, nephrotoxicity

Implications:
-teach client to complete full course of therapy
-avoid sexual intercourse if genital herpes are being treated

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7
Q

Oseltamivir

A

ANTIVIRAL FOR INFLUENZA
Action:
-neuraminidase inhibitor
1.stops viral entry/spread (mucus barrier stays in tact)
2.stops viral release from infected host cell

Pharmacokinetics:
-dosing must begin early (reduces the duration of illness)

ADR:
-NVD

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8
Q

Amphotericin B

A

ANTI-FUNGAL
Action:
-targets ergosterol of fungal cell membrane (vs host cholesterol)
-fungistatic or fungicidal (depends on concentration)

Use:
-only used in treating progressive and potentially fatal systemic infections due to severe adverse effects (very limited drug, dangerous reactions)

P. kinetics:
-iv, or by slow infusion

ADR:
-patient must start on low doses (build up slow b/c of toxicity)
-fever (give acetaminophen 30 mins prior)
-headache
-NV (give antiemetic 30 mins prior to keep it down)
-renal damage- nephrotoxicity (occurs in 80% of patients)
-anemia, leukopenia
-electrolyte imbalances

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9
Q

Ketoconazole (fungarest)

A

ANTI-FUNGAL (skin, nails)
Action:
-inhibits the synthesis of ergosterol (component of fungal cell membranes)
-may be fungistatic or fungicidal

P. kinetics:
-iv, oral, topically, pessary (vagina)

ADRs:
-GI upset
-hepatotoxicity
-allergy

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10
Q

Miconazole

A

ANTI-FUNGAL (superficial like athletes foot, ringworm)
Action:
-inhibits the synthesis of ergosterol (component of fungal cell membranes)
-may be fungistatic or fungicidal

P. kinetics:
-iv, oral, topically, pessary (vagina)

ADRs:
-GI upset
-hepatotoxicity
-allergy

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10
Q

Clotrimazole

A

ANTI-FUNGAL (superficial like yeast infection)
Action:
-inhibits the synthesis of ergosterol (component of fungal cell membranes)
-may be fungistatic or fungicidal
-can be used during pregnancy

P. kinetics:
-iv, oral, topically, pessary (vagina)

ADRs:
-GI upset
-hepatotoxicity
-allergy

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11
Q

Chloroquine

A

ANTI-MALARIA
Action:
-causes build up of heme within parasitized erythrocytes = parasite death
-can be used for prophylaxis

P. kinetics:
-orally active
-start 1 week before and continue 4 weeks after

ADRs:
-gastric distress
-loss of appetite
-skin rash
-diarrhea
-neurological and psychiatric reactions (headaches, agitation, excitement that can be psychotic/paranoia)

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12
Q

Quinine

A

ANTI-MALARIA
-used if there is chloroquine-resistant strains
-older drug

ADR
-cinchonism (tinnitus, headache, NV, cardiac irregularities/abnormalities)

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13
Q

Poliomyelitis

A

KILLED/INACTIVATED VACCINE
Action:
-inactivated -> not virulent but still antigenic
-advantages: very safe, no risk of mutating to virulent form, no need to refrigerate (attenuated = safe)
-disadvantages: weaker response, need larger doses, boosters

P. Kinetics:
-series of shots (2,4,6 mo, 4-6 y)
-pathogen is artificially introduced in modified for to prime immune system -> future protection
-practically eliminated globally

ADRs associated w/ vaccines:
-slight fever
-sore at injection site
-local redness
-swelling, pain
Severe (vvv rare)
-hypersensitivity reaction
-anaphylaxis (give epi)
-encephalitis (brain inflammation)
-convulsions (seizures)

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14
Q

MMR

A

LIVE ATTENUATED VACCINE (LAV)
Action:
-live (still has ability to reproduce), attenuated (weakened)
-low or no virulence but still antigenic
-good immune response since it is still alive -> increased virulence = enhanced immunity
-B and T cell immunity, few boosters needed

Disadvantages:
-risk for reversion to virulent form (mutation = virus is back)
-not suitable for weak immune system (care in corticosteroids, cancer chemotherapy, leukemias, lymphomas, advanced HIV)
-not in pregnancy
-need for refrigeration (to maintain ability to reproduce)
-CI for immunocompromised

P. Kinetics:
-at 12-15 months, second dose 4-6 years
-CI for immunocompromised
-does NOT cause autism
-check for allergies to eggs, gelatin, neomycin

ADRs associated w/ vaccines:
-slight fever
-sore at injection site
-local redness
-swelling, pain
Severe (vvv rare)
-hypersensitivity reaction
-anaphylaxis (give epi)
-encephalitis (brain inflammation)
-convulsions (seizures)

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15
Q

Hep B

A

SUBUNIT VACCINE
Action:
-newer
-only use antigenic part of microbe, eg. proteins in the viral envelope (take sub-unit of pathogen)
-very safe (only protein is being injected)

Disadvantages:
-difficult to develop
-usually weaker response
-low immunological memory, need boosters

P. Kinetics:
-protein from viral envelope
-at birth and boosters (0, 2, 4 mo)
-baker’s yeast (be careful if allergic to yeast)

ADRs associated w/ vaccines:
-slight fever
-sore at injection site
-local redness
-swelling, pain
Severe (vvv rare)
-hypersensitivity reaction
-anaphylaxis (give epi)
-encephalitis (brain inflammation)
-convulsions (seizures)

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16
Q

COVID-19

A

mRNA VACCINE
P. Kinetics:
-mRNA that codes for the spike protein, nucleotides/sequence is reversed -> immunity
-need boosters

ADRs associated w/ vaccines:
-slight fever
-sore at injection site
-local redness
-swelling, pain
Severe (vvv rare)
-hypersensitivity reaction
-anaphylaxis (give epi)
-encephalitis (brain inflammation)
-convulsions (seizures)

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17
Q

DTap

A

TOXOID VACCINE
Action:
-some bacteria release a toxin that creates a problem, rather than the bacteria being the problem
-toxoids take toxins and alter them, so that they are no longer toxic but still antigenic
-diphtheria toxoid: creates covering of throat -> difficulty breathing
-tetanus toxoid (paralyzes jaw -> lock jaw)
-acellular pertussis vaccine (whooping cough)

P. Kinetics:
-series of shots (2,4,6,18 mo, 4-6 yrs)
-then tetanus booster every 10 years

ADRs associated w/ vaccines:
-slight fever
-sore at injection site
-local redness
-swelling, pain
Severe (vvv rare)
-hypersensitivity reaction
-anaphylaxis (give epi)
-encephalitis (brain inflammation)
-convulsions (seizures)

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18
Q

Hydrochlorothiazide

A

ANTI-HYPERTENSIVE and HEART FAILURE
Action:
-thiazide diuretic (promotes urine)
-inhibits reabsorption of sodium, so it gets excreted
-for hypertension and edema
-decreased BV = decreased BP/afterload/work
-inhibits tubular reabsorption of sodium
-sodium excreted, water follows, causing dieresis
-monotherapy
-also used in combination with other antihypertensives to prevent rebound fluid retention

ADRs:
-hypotension/postural hypotension
-hyponatremia, hypokalemia, dehydration
-hyperglycemia, hyperuricemia, hypercholesterolemia
-take in morning for easy urination throughout day
-GI upset (take with food)

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19
Q

Captopril

A

ANTI-HYPERTENSIVE and HEART FAILURE
Action:
-acts on RAAS (ACEI)
-no angiotensin II

ADRs:
-hypotension/postural hypotension
-angioedema
-persistent dry cough
-renal impairment/failure
-hyperkalemia (avoid potassium)

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20
Q

Enalapril

A

ANTI-HYPERTENSIVE and HEART FAILURE
Action:
-acts on RAAS (ACEI)
-no angiotensin II
-longer acting than captopril

ADRs:
-hypotension/postural hypotension
-angioedema
-persistent dry cough
-renal impairment/failure
-hyperkalemia (avoid potassium)

21
Q

Losartan

A

ANTI-HYPERTENSIVE and HEART FAILURE
Action:
-blocks angiotensin II receptors = blocked vasoconstriction and blocked aldosterone release

ADRs:
Hypotension/postural hypotension

22
Q

Aliskiren

A

ANTI-HYPERTENSIVE
Action:
-direct renin inhibitors (blocks angiotensinogen from converting to angiotensin I)

-PO, do not take with food

ADRs:
-generally well tolerated but hypotension/postural hypotension

23
Q

Propranolol

A

ANTI-HYPERTENSIVE
Action:
-non-selective beta blocker
-act on BOTH lungs and heart

CI:
-asthma, COPD, smokers b/c of the bronchoconstriction

ADRs:
-hypotension/postural hypotension
-bradycardia (HR<60, report! decrease dose, increase interval)
-impaired exercise tolerance
-edema, monitor weight (fluid retention) +thiazide
-NVD, take w/ food
-CNS (fatigue, depression, nightmares, sexual dysfunction)
-bronchospasm (narrowed airways)
-diabetes
-allergic reactions

24
Atenolol
ANTI-HYPERTENSIVE Action: -cardioselective beta 1 blocker, vasodilation -**acts only on heart** -decrease HR, BP, and contractility ADRs: -hypotension/postural hypotension -bradycardia (HR<60, report! decrease dose, increase interval) -impaired exercise tolerance -edema, monitor weight (fluid retention) +thiazide -NVD, take w/ food -CNS (fatigue, depression, nightmares, sexual dysfunction) -diabetes -allergic reactions
25
Doxazosin
ANTI-HYPERTENSIVE Action: block alpha receptors on arterioles and veins = vasodilation = lower BP ADRs: -orthostatic hypotension (extreme, massive vasodilation, can lead to fainting) -headache, dizziness, flushing -edema (nasal congestion from opened vessels, fluid leaks) -reflex tachycardia (vasodilation, BP drops, body responds by speeding up heart) -NVD
26
Nifedipine
ANTI-HYPERTENSIVE Action: -calcium channel blocker -muscle relaxation = vasodilation -heart rate and force of contraction decreases ADRs: -hypotension/orthostatic hypotension -headaches, dizziness, flushing -edema -cardiac suppression; bradycardia, SOB -constipation -leg/muscle cramps -allergic reactions
27
Verapamil
ANTI-HYPERTENSIVE and ANGINA Action: -calcium channel blocker -muscle relaxation = vasodilation -decrease HR and contractility ADRs: -hypotension/orthostatic hypotension -headaches, dizziness, flushing -edema -cardiac suppression; bradycardia, SOB -constipation -leg/muscle cramps -allergic reactions
28
Hydralazine
ANTI-HYPERTENSIVE and HEART FAILURE Action: -act on arterioles and/or veins for direct vasodilation -decrease TPR, BP ADRs: -hypotension -headaches, dizziness, flushing -edema -reflex tachycardia
29
Minoxidil
ANTI-HYPERTENSIVE Action: -act on arterioles and/or veins for direct vasodilation ADRs: -hypotension -headaches, dizziness, flushing -edema -reflex tachycardia -**hypertrichosis (hair growth on face or chest)**
30
Nitroprusside
ANTI-HYPERTENSIVE Action: -act on arterioles and/or veins for direct vasodilation ADRs: -hypotension -headaches, dizziness, flushing -edema -reflex tachycardia Implications: -**iv (hypertensive crisis)**
31
Clonidine
ANTI-HYPERTENSIVE Uses: **HT crisis, PO** Action: -act in CNS to decrease activity -effects resemble alpha and beta blockade 1.blood vessels (vasodilation) 2.heart (cardio suppression) ADRs: -depression -trouble sleeping -sedation
32
Methyldopa
ANTI-HYPERTENSIVE **Uses: pregnancy** Action: -act in CNS to decrease activity -effects resemble alpha and beta blockade 1.blood vessels (vasodilation) 2.heart (cardio suppression) ADRs: -depression -trouble sleeping -sedation
33
Glyceryl Trinitrate
ANGINA Action: -vasodilation 1.dilate veins = decreased preload 2.higher doses = arterial dilation = decreased after-load -decreased work of heart = decreased myocardial oxygen demand -very rapid acting, acute relief during attack -prophylactically (protection before precipitating activity) P. Kinetics: -highly soluble - readily available to cross membranes -rapid onset of action -allow for alternative routes (SL, buccual, transdermal) -rapidly degraded by liver = short acting -extensive first pass effect ADRs: -hypotension -headaches, dizziness, flushing -reflex tachycardia Tolerance: -body gets use to drug -need to increase the dose -try drug holidays or mini holidays Toxicity: -hypotension and reflex tachycardia -exacerbated by alcohol, anti-hypertensives, viagra Implications: ● Review storage directions with patient (GTN is explosive/reaction, store in cool, dark, dry area) ● Review method of administration ● Take before engaging in activity ● How to avoid tolerance ● Assess vital signs (BP and HR) ● If dizzy lie down before taking medication ● Avoid alcohol & care with other drugs ● Assess pain ● Instruct family members Emergency: ● One tablet every 5 min x3 ● If pain is not relieved, go to ER (possibly MI)
34
Metoprolol
HEART FAILURE and ANGINA -beta blocker (vasodilation) -decreased HR, contraction, work -controlled suppression -long action -do not chew ADRs: -hypertension -bradycardia -NV -CNS, fatigue
35
Digoxin
HEART FAILURE Action: -inhibit enzyme (Na/K ATPase) which causes accumulation of calcium -increased calcium = increased contractility (positive inotropic action = more force of contraction) -increased stroke volume, cardiac output, improves blood flow to the kidneys and periphery, clears edema ADRs: -neurological: weakness, fatigue, fainting -visual: dimness, double vision, flashing lights, changes in color vision -cardiac: bradycardia, arrhythmias (tachycardia, fibrillations) -GI: abdominal discomfort (take with food), anorexia, nausea -psychiatric: mood alterations, hallucinations Toxicity: -narrow therapeutic index -long half-life (4-5 days, increases blood levels) -measures to minimize toxicity (dont change brands) -toxicity is exacerbated by hypokalemia (thiazide and loop diuretics) -antidote: digoxin immune fab Implications: -Take apical and radial pulse for 1 minute. -Teach patient to monitor apical pulse for 1 min -Do not administer and notify prescriber if apical pulse rate is <60 BPM or >100 BPM -Assess patient for toxicity and monitor blood levels -Assess diet -weight daily -take with meals -medical ID tag -take missed dose as soon as remembered, but do not “double up” -Regular follow up appointments
36
Furosemide
HEART FAILURE -loop diuretic -**for severe heart failure** -diuretic that removes edema -decrease BP, after load, work of heart -care for those with hypokalemia
37
Spirinilactone
HEART FAILURE -potassium-sparing -diuretic that removes edema -decrease BP, after load, work of heart
38
Atorvastatin
ANTILIPEMIC Action: -inhibit enzyme (HMGG-CoA reducatase) needed for cholesterol synthesis ADRs: -myalgia (muscle pain) -liver damage CI: -liver disease -pregnancy Implications: -monitor liver function -ID at bed time (chronopharmacology, stops cholesterol)
39
Niacin
ANTILIPEMIC Action: -B complex vitamin -MOA is unclear (anti lipid effect) ADRs: -intense flushing and itching from increased prostaglandin release (manage with aspirin to stop prostaglandin release, give 30 mins prior) -hepatoxic, especially slow release forms -GI distress -orthostatic hypotension
40
Cholestyramine resin
ANTILIPEMIC Action: -bind with bile acids in GI tract -prevents reabsorption so it is eliminated by stool Bile acids emulsify fats and carry free acids to wall to be absorbed ADRs: -very few side effects, no systemic action (only stays in gut) -GI (steatorrhea: fatty stools) Implications: -decreased absorption of drugs/food = take on empty stomach -sprinkle over 2oz of fluid
41
Colesevelam
ANTILIPEMIC Action: -bind with bile acids in GI tract -prevents reabsorption so it is eliminated by stool Bile acids emulsify fats and carry free acids to wall to be absorbed ADRs: -very few side effects, no systemic action (only stays in gut) -GI (steatorrhea: fatty stools) Implications: -decreased absorption of drugs/food = take on empty stomach -sprinkle over 2oz of fluid
42
Ezetimibe
ANTILIPEMIC Action: -blocks cholesterol absorption -well tolerated
43
Gemfibrozil
ANTILIPEMIC Action: -complicated -decreased triglyceride levels ADRs: -GI upset -rash -myopathy -hepatotoxicity, gallstones
44
Heparin Sodium - Enoxaprin
ANTICOAGULANT -sulfated mucopolysaccharide polymer Action: -activate antithrombin = stop fibrin formation -antithrombin -> inactivates thrombin and other clotting factors -low molecular weight heparin -less lab monitoring needed -less ADRs -longer half-life, id dosing -DOC for post op Use: -prevent formation of new clots -prevent the extension of existing clots -used for DVT, PE, preventing clots during surgery/hemodialysis, coagulation after blood has left body P. kinetics: -parenteral (highly charged) -rapid acting -iv, sc -units (40,000 units/mL) -risk of hemorrhage if blood is too thin Anti-dote: Protamine sulfate ADRs: -bleeding, minimize risk (hemorrhage) -monitor closely, blood work (aPTT) -check for: bruises, hematomas, red/black stools, cloudy/discolored urine, pelvic pain, headache/faintness, lumbar pain -CI: eye, brain, spinal order surgery -allergic reactions -heparin-induced thrombocytopenia
45
Warfarin
ANTICOAGULANT Action: -blocks vitamin K = no clotting factors (no fibrin formation) -slow onset Use: -prophylaxis and treatment of thrombosis P. kinetics: -oral (long term therapy) -highly (99%) protein bound -takes 48-72 hours to see peak effect ADRs: -bleeding (decreased BP) -abdominal cramps/nausea/anorexia (take w/ food) -alopecia (hair loss, lower dose) Anti-dote: Vitamin K Implications: -monitor bleeding, decreased BP, check for bruises, bloody/black stools, cloudy urine -strategize to minimize bleeding -schedule INR testing -dosage size and timing -wear MedicAlert bracelet -care with drug and food (vitamin K) -category X in pregnancy (use LMW heparin instead)
46
Dabigatran
ANTICOAGULANT Action: -direct oral thrombin inhibitor (blocks factor 10) -alternative to warfarin (safer, faster, and easier to use)
47
Aspirin
ANTIPLATELET Use: -prevention of arterial thrombus formation (stop platelet plug) -reduce risk of fatal IM and stroke Action: -irreversible inhibition of COX enzyme -inhibits the formation of a PG (thromboxane A2) involved in platelet aggregation -anti-platelet effect at low doses ADRs: -bleeding -monitor, strategize, report
48
Abciximab
ANTIPLATELET Use: -prevention of arterial thrombus formation (stop platelet plug) -reduce risk of fatal IM and stroke Action: -glycoprotein (GP) receptor antagonist -GP receptor on platelets needed for platelet aggregation -given IV (usually in combination with aspirin and heparin) ADRs: -bleeding -monitor, strategize, report
49
Clopidogrel
ANTIPLATELET Use: -prevention of arterial thrombus formation (stop platelet plug) -reduce risk of fatal IM and stroke Action: -adenosine diphosphate (ADP) receptor antagonist = no aggregation ADRs: -bleeding -monitor, strategize, report
50
Alteplase
THROMBOLYTIC Action: “Clot busters” remove thrombi that have already formed -prevent formation -degrades fibrin networks in clots Uses: -in **medical emergencies** to treat adverse thromboembolic events (MI; 6h window, PE, arterial occlusions, DVT) -restore potency to occluded central venous catheters ADRs: -bleeding (especially observe for LOC- intracranial bleeding) -NV Implications: -cardiac and vital signs monitoring -education -**antidote: aminocaproic acid**