Flashcards in Pharm Final Deck (38)
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1
These drugs can cause histamine release
Atracurium, dilaudid and morphine
2
Giving reglan with this medication can cause dysrhythmias
Zofran
3
For who is reglan contraindicated?
Bowel obstruction
Parkinson's
Seizure disorders
4
What can we give to reverse gastric cramping from reglan
An anticholinergic (glycopyrrolate)
5
Rapid administration of reglan can cause ____ while rapid admin of zofran can cause
Cramping
HA
6
This medication may cause out of body experiences
Droperidol
7
Thioamines take 1-2 weeks to take effect due to thyroid stores in the body. We can take these meds in the meantime to decrease symptoms
Beta blockers.
These block the hyper-adrenergic effects of hyperthyroidism.
Also, these block the peripheral conversion of T4 to T3.
8
We use this med in thyroid storm
Esmolol
9
How do corticosteroids work in treating hyperthyroidism?
1) Suppresses TSIs in Grave's disease (remember steroids are immunosuppressants!). Also decreases inflammation.
2) Blocks the peripheral conversion of T4 to T3
We use prednisone or methylprednisolone
10
Drugs that can alter thyroid status
Amiodarone (resembles thyroid hormone and contains iodine-- can cause hypo or hyperthyroidism)
Lithium (body can mistake it for iodine--> hypothyroidism)
Reglan (can increase TSH production and release)
11
Why choose methimazole over PTU?
More potent than PTU, longer half-life allows for QD dosing (PTU is TID), and has fewer SE than PTU
12
How does lugol's solution treat hyperthyroidism?
1) Blocks peripheral T4 to T3 conversion
2) Decreases the vascularity of the thyroid
3) Temporary block of T4 release (the thyroid is so busy taking up iodine that it doesn't have time to focus on releasing hormone. This effect is only temporary!!!)
This is a short-term solution to decrease thyroid activity before thyroid surgery
13
IV T3 is called ____ and can be given emergently for _____
Cytomel
Myxedema coma
14
How are sulfonylureas metabolized?
Via the liver! They are 99% protein-bound, so the liver is gonna have to deal with those before they can be excreted via the kidneys. Avoid in ESLD.
15
These sulfonylureas should be used if the pt has renal disease
Glipizide or Tolbutamine (because these will be completely metabolized to inactive or weakly active products)
16
sulfonylureas should be avoided in these patients
ESLD and those with sulfa allergies
17
How do sulfonylureas work?
1) block the ATP sensitive K+ pump
2) Increases sensitivity of the tissues to insulin
18
How to biguinides like Metformin work?
1) Shifts into anaerobic metabolism, decreasing glucose production in the liver and kidneys (less gluconeogenesis and glycogenolysis)*********
Also:
a) Enhances insulin binding (decreases insulin resistance)
b) Increases glucose utilization
19
Who are biguanides contraindicated in
ESRD, ESLD, CHF, pulm disease, shock
All related to buildup of anaerobic metabolites
20
These two oral hypoglycemic meds require insulin to work
Biguanides (like metformin)
Thiazolidinediones (TZDs like Pioglitazone)
21
These antiepileptics are CP450 inducers
Phenytoin
Barbiturates (phenobarb)
Carbamazepime (tegretol)
22
These antiepileptics are CP450 inhibitors
Valproic acid
Felbamate
23
Many anti-epileptics are associated with these life-threatening complications
Hepatotoxicity
Bone marrow suppression
We want to test for LFTs and get a CBC
24
These are the major considerations with phenytoin (Dilantin)
1) Infuse no faster than 50mg/min!! Could cause cardiac collapse
2) Enzyme inducer
3) CNS toxicity (nystagmus, double vision, vertigo, peripheral neuropathies)
4) Stevens Johnson Syndrome
5) Precipitates in solutions with a pH<7.8
25
What is fosphenytoin?
Pro-drug of phenytoin
26
Reasons nitrates are good for the heart
1) Preferentially dilate collateral vessels service ischemic areas
2) Decrease preload
3) SLIGHT decrease of afterload
4) Attenuates coronary vasospasm
5) Increases rate of relaxation during diastole**
27
Why aren't nitrates used for chronic BP control?
Because people develop tolerance to them
28
How do we prevent tolerance with nitrates?
Tell people to remove their patches at night
29
What would we use to treat the profound hypotension caused by taking nitrates with a PDE?
Phenylephrine
30
Main SE of nitrates
HA
Orthostatin hypotension/fainting
31
These medications have been shown to reduce M&M in patients with CHF
Aldosterone antagonists
ACE Inhibitors
ARBs
BBs
32
These medications have NOT been shown to reduce M&M in patients with CHF
Thiazide or loop diuretics (symptom relief only)
Digoxin (again-symptom relief only--> may worsen long-term outcomes)
33
Do we hold ACEIs and ARBs before surgery?
Yes, or else the patient will be too dry
34
A patient with CHF should be on these 3 meds
Spironolactone, BB, and ACEI
35
All ACEIs have this suffix
pril
As in "captopril"
36
ARBS have this suffix
artan
Ex- Losartan or Valsartan
37
Weuse this med for BP control in pregnancy
Methyldopa
38
