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pharm review Flashcards

1
Q

Ventolin - classification, generic name, primary effect and use

A

SABA (short acting beta2 agonist), aka Salbutamol.

effect: bronchodilation for COPD bronchoconstriction and dyspnea

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2
Q

Ventolin onset, peak effect, duration

A

onset = 5 - 14 min
peak effect = 30-60 min
duration = 4 - 6 hrs

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3
Q

Ventolin dosing for MDI (intubated vs. nonintubated), diskus and nebule

A 
MDI = 100ug/puff (2-4 puffs nonintubated QID, 8 puffs intubated) 
Diskus = 200ug 1-2 puffs QID
Nebule = 2.5mg
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4
Q

Atrovent generic name, category and effect

A

Ipratropium Bromide - type of SAMA (short acting muscarinic antagonist)
Effect = bronchodilating

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5
Q

Atrovent MDI dose

A

20ug, 2-4 puffs QID for COPD

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6
Q

T/F atrovent is often used to treat asthma

A

false - not a mainstay therapy but may be used in combo with ventolin (SABA) for acute asthma exacerbation. Typically mainly used for COPD

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7
Q

T/F atrovent is preferred over SABA for COPD

A

true

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8
Q

Spiriva generic name, category, and 2 devices

A

type of LAMA/LAAC; Tiotropium

devices = handihaler (DPI), Respimat (SMI)

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9
Q

main effect spiriva

A

mainstay COPD therapy - used monotherapy or in combo with LABA with higher severity

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10
Q

Flovent generic name, category

A

Flovent = Fluticasone propionate, type of ICS

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11
Q

Flovent main effect

A

anti-inflammatory to reduce airway inflammation and mucus production. Used in asthma as first line controller monotherapy + used in COPD in combo with a LABA.

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12
Q

devices for flovent

A

MDI or diskus

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13
Q

prednisone generic name, dose, category, duration of action and use

A

systemic CS called Deltasone
-used to manage uncontrolled severe asthma/asthma exacerbations; anti-inflammatory
dose = 50mg PO
-action = intermediate 12 - 36 hrs

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14
Q

dexamethasone category, use, route of administration, duration of action

A

systemic CS used for anti-inflammatory effects in AECOPD and asthma exaacerbation for kids and adults, or glottic edema for upper a/w trauma. IV administration.
action = long 24 - 72 hours

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15
Q

hydrocortisone category, generic name, use, route of admin, action duration

A

systemic CS called Solu-Cortef; used to treat inflammatory processes via topical cream (e.g. eczema, rash, inflammatory skin conditions)
action duration = short acting (8-12 hrs)

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16
Q

BLES - describe this type of therapy, the dose, the delivery

A

BLES = surfactant replacement therapy for neonates with RDS to improve gas exchange + decrease alveolar surface tension.
dose = 5ml/lg
delivery method = INSURE (intubation, surfactant, extubation with a regular ETT and multi access catheter) or LISA/MIST (less invasive surfactant administration) using OG or angio cath to avoid intubating and reduce airway injuries

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17
Q

caffeine therapy drug class, effect, use for neonates, loading and maintenanace doses

A

caffeine therapy = methylxanthine that stimulates CNS and cardiac muscles.
-commonly used to stimulate baby to breathe (+ increased diaphragm activity, Ve, chemoreceptor sensitivity to CO2 changes, reduce periodic breathing or hypoxic resp depression)
Loading dose = 20mg/kg; maintenance dose = 10mg/kg daily

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18
Q

rocuronium trade name, drug class and use

A

Zemuron

  • non depolarizing neuromuscular blocker/paralytic
  • used for intubation as pre-treatment for de-fasciculating agent as a subparalyzing dose or used as paralyzing agent during induction/intubation and during maintenance of paralysis in anesthesia
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19
Q

succinylcholine use and trade name

A

Anectine
-depolarizing neuromuscular blocker (D-NMB) use in main intubation algorithm - it follows administration of the induction agent

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20
Q

reversal agent for succinylcholine?

A

none

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21
Q

reversal agent/antidote for rocuronium?

A

sugameddex

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22
Q

Hydrochlorothiazide trade name, drug class, mode action, strength, when to use, route admin

A

Type of thiazides diuretic, Apo-Hydro

  • strength: low ceiling diuretic, moderate natriuretic
  • action: inhibits NaCl reabsorption @ early DCT (but promotes Na/K exchange, hypokalemia)
  • use: HT, edema w/ heart failure, nephrolithiasis, diabetes insipidus, used for neonates
  • admin: oral
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23
Q

Lasix drug class, generic name, strength, mode action, use, route of admin, adverse effects

A

Type of loop diuretic, furosemide

  • most POTENT diuretic + high ceiling
  • admin: oral or IV
  • action: inhibits NaCl reabsorption via Na/K/2Cl symporter @ loop of H + increases Ca2+ and Mg2+ secretion
  • use: acute pulm edema, hypercalcemia, renal impairment
  • adverse effects: hypokalemia, metabolic alkalosis, hypotension, hypomanesemia, hypocalcemia + others
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24
Q

Spironolactone trade name + drug class, route admin, mode action, use

A

Aldactone, type of potassium-sparing diuretic

  • aldosterone receptor antagonist that prevents activation + expression of Na channel proteins = prevents Na reabsorption @ late DT and collecting duct via inhibiting Na/K exchange = K+ sparing
  • use: excess aldosterone and severe heart failure
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25
Q

Diamox generic name + drug class, strength, mode action, use, side effect, route admin

A

Acetazolamide, carbonic anhydrase inhibitor

  • weak strength, rarely used
  • action: inhibits carbonic anhydrase from converting H2O +CO2 -> HCO3- = prevents NaHCO3 reabsorption in proximal tubule
  • admin: oral
  • use: Glaucoma, acute mountain sickness (counteracts met alkalosis from hyperventilating), treats met alkalosis
  • side effect: met acidosis
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26
Q

Mannitol drug class, route admin, mode action, use

A

Osmotic diuretic

  • admin: IV
  • mode action: drug freely passes into filtrate and not reabsorbed, increases filtrate osmolarity so H2O stays in filtrate + dilutes sodium in filtrate = decreased chemical gradient for Na reabsorption in DCT and CD
  • use: decrease ICP, glaucoma, cerebral edema, increase urine volume, acute renal failure
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27
Q

3 crystalloid soln used for fluid resuscitation and compare each to normal physiologic plasma concentrations

A

Normal saline (0.9% NaCl; not physiologically normal), Ringer’s lactate (RL- more normal than NS and used for large volume replacement in short time & contains lower Na and higher pH than NS + electrolytes lactate, K, Ca2+), PlasmaLyte (mimics normal but more expensive)

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28
Q

Give example if colloid soln used in fluid resuscitation and its appropriate use

A

Albumin- naturally occurring plasma protein that increases on Otis pressure in blood to increase blood volume
Use: only for Pt proven to be hypoproteinemic or hypoalbuminemic
note: can result in allergic rxn

29
Q

aspirin mode action as an anticoagulant

A

inhibits TXA2, sometimes used prophylactically for clot formation

30
Q

heparin mode action + onset action as an anticoagulant

A

inhibits thrombin formation (which results in prevention of fibrin formation); onset is immediate

31
Q

Coumadin (Warfarin) mode action as anticoagulant and onset action

A

interferes with action of Vitamin K - cofactor for coagulation factor activation, therefore prevents clot creation; onset 3 - 5 days to start

32
Q

streptokinase mode action as anticoagulant

A

enzyme that lyses fibrin clot

33
Q

TPA mode action as anticoagulant and trade name, adverse effect

A

tissue plasminogen activator AKA alteplase - activates plasminogen –> plasmin which degrades fibrin clot
-adverse effect: can result in inadvertent bleeding

34
Q

Piptazo drug class, 2 other drug names, and mode action

A

Beta-lactam AB, a penicillin.
Other names: Piperacillin / Tazobactam
Mode Action: inhibits bacterial cell wall synthesis

35
Q

Vancomycin drug class, mode action, and use

A

Antibiotic, inhibits bacterial cell wall synthesis

use: MRSA/methicillin resistant staph aureus

36
Q

Versed generic name, drug class, mode of action, advantages (2), onset + duration and route admin

A

Midazolam

  • drug class: BZ, sedative, hypnotic, anxiolytic, induction
  • mode action: GABA receptor agonist binds to BZ receptors to increase GABA Cl- influx = hyperpolarization of neuron
  • advantage: strong amnesia with little hangover effect + minimal resp and CV depression
  • onset + duration and route: <5 mins, 1 hr duration (Rapid and short acting), IV route
37
Q

Ativan generic name, drug class, mode action, adverse effect, onset + duration and route admin

A

Lorazepam

  • drug class: BZ, sedative, hypnotic, anxiolytic
  • mode action: GABA receptor agonist
  • adverse effect: associated with dependence
  • route admin, onset and duration: oral or IV, onset < 5 mins, duration 10 hours (long acting)
38
Q

Diprivan generic name, drug class, mode action, adverse effects (3) and benefit (1), onset and duration action

A

Propofol

  • drug class: IV anesthetic, sedative, hypnotic, induction agent
  • mode action: GABA receptor agonist = hyperpolarization of neuron
  • adverse effects (3): hypotension, decreased HR + SVR, and PRIS (propofol infusion syndrome)
  • benefit: decreases ICP, use for head injury Pt
  • onset and duration: 15-30sec, 5-10 min duration
39
Q

Amidate generic name, drug class, mode action, adverse effects (2), benefits (2), onset and duration action

A

Etomidate

  • drug class: IV anesthetic, sedative, hypnotic, induction agent
  • mode action: GABA receptor agonist = hyperpolarizes + inhibits neuron
  • adverse effects: suppresses cortisol production, N&V
  • benefits: decreases ICP, stable CVS (use for CV Pts)
  • onset + duration: 30 sec, 10 min duration
40
Q

Ketalar generic name, drug class, common use, mode action, adverse effect, benefits (3), onset and duration

A

Ketamine

  • drug class: dissociative IV anesthetic, sedative, hypnotic, induction agent
  • use: children & intubating asthmatics
  • mode action: NMDA receptor antagonist (reduces excitatory/glutamate transmission)
  • adverse: increases ICP
  • benefits: dissociative amnesia = analgesia, increases BP, bronchodilator
  • onset + duration: 30 sec, 30 min
41
Q

Precedex generic name, drug class, mode action, 2 adverse effects

A

Dexmedetomidine

  • drug class: sedative
  • mode action: short acting alpha 2 adrenergic agonist inhibits release of NE; used for sedation of intubated Pt during/post-surgery in critical care
  • adverse effects (2): affects BP, lacks resp depression
42
Q

Haldol generic name, drug class, mode action

A

Haloperidol

  • drug class: antipsychotic, neuroleptic
  • mode action: blocks dopamine receptors, used in crit care to treat acute psychosis when hallucinations + delirious symptoms present
43
Q

Nozinan generic name, drug class, mode action

A

Methotrimeprazine

  • drug class: antipsychotic, neuroleptic
  • omde action: blocks dopamine + serotonin receptors, used in crit care to treat acute psychosis when hallucinations + delirium present
44
Q

atropine drug class, mode action, use, adverse effects

A
  • drug class: antimuscarinic, chronotrope
  • mode action: blocks M2 receptors on heart (M2 receptors = bradycardia), increases HR
  • use: first line therapy treating symptomatic bradycardia <50bpm with pulse (ACLS bradycardia algorithm)
  • adverse effects: dry mouth, blurred vision, nausea
45
Q

dobutamine trade name, drug class, mode action, adverse effects

A

Dobutrex
-drug class: positive inotrope, chronotrope, Beta adrenergic/B1 agonist/catecholamine (adrenergic agonist)
(B1 = increases HR and contractility), “inodilator” = inotrope + vasodilation
-mode action: strong B1 activation, minimal B2 activation and very minimal A1 activation = increases contractility, mild increase HR, increased CO and mild vasodilation

46
Q

Epinephrine/adrenaline drug class, mode action, use, additional advantage

A
  • drug class: adrenergic/catecholamine (direct acting), chronotrope, inotrope, vasopressor
  • mode action: stimulates all alpha and beta receptors = increased contractility, HR, CO and vasoconstriction
  • use: first line therapy in cardiac arrest resuscitation, alternate therapy for adult bradycardia with pulse algorithm
  • benefit: bronchodilates
47
Q

Milrinone trade name, drug class, mode action, additional advantage

A

Primacor

  • drug class: phosphodiesterase inhibitor, inotrope = inodilator
  • mode action: inhibits phosphodiesterase + prevents cAMP breakdown = Ca2+ influx myocytes, decrease Ca2+ in vascular smooth muscle = increased myocardial contractility + decreased SVR
48
Q

Labetalol drug class, use, and mode action

A
  • drug class: non-selective B blocker/Class 2 antiarrhythmic
  • mode action: slows conduction speed, negative chronotropic + neg inotropic effects
  • use: treats tachycardia and hypertension
49
Q

Nitroglycerin trade name, mode action

A

Nitrostat

-mode action: vasodilator used to treat angina + hypertension

50
Q

Amiodarone trade name, drug class, mode action, side effects

A

Cordarone

  • drug class: Class 3 antiarrhythmic, potassium channel blocker
  • mode action: potent K+ blocker (but also blocks Na+, Ca2+, B-receptors) resulting in slowed HR + conduction speed
  • use: second-line therapy to epinephrine for cardiac arrest algorithm, treats tachycardia with pulse
  • side effects: fibrosis with long term use, hepatotoxicity, bradycardia, skin discolouration
51
Q

Vasopressin trade name, drug class, mode action, considerations

A

Pitressin

  • drug class: direct acting vasoconstriction and ADH/ antidiuretic hormone
  • mode action: vasoconstriction, increases water reabsorption in kidneys
  • use: given after Levophed, treats hypotension and extreme water excretion e.g. diabetes insipidus
    note: if Vasopressin + Levophed given, usually indicates suffering from severe sepsis
52
Q

Norepinephrine trade name, drug class, mode action, adverse effect

A

Levophed

  • drug class: vasopressor, catecholamine (direct adrenergic agonist)
  • mode action: stimulates all alpha and beta receptors, higher affinity for a1 = significant vasoconstriction + increased contractility, HR, BP and coronary blood flow
  • adverse effect: increase chance of peripheral necrosis at high doses
53
Q

Neo-synephrine generic name, drug class, mode action, adverse effect and benefit

A

Phenylephrine

  • drug class: noncatecholamine pure a1 agonist , vasopressor
  • mode action: a1 agonist = vasoconstriction, increases MAP and used also as decongestant/for rhinitis
  • adverse effect: very potent + quick acting –> can increase SVR at expense of organ perfusion
54
Q

epinephrine drug class, mode action and use

A
  • drug class: vasopressor (+ adrenergic, chronotrope, inotrope)
  • mode action: stimulates all alpha + beta receptors, vasoconstriction
  • use: alternate therapy to atropine for adult bradycardia with pulse, first line therapy for cardiac arrest
55
Q

hydralazine drug class, use

A

drug class: direct acting vasodilator

use: treat heart failure if antiogensin inhibitors contraindicated/not tolerated

56
Q

iNO / inhaled nitric oxide drug class, mode action/use, dose to start, adverse effect, onset and duration action

A
  • drug class: selective pulmonary vasodilator
  • NO increases cGMP = decrease intracellular Ca2+ = pulmonary vasodilation
  • use: treat pulmonary hypertension
  • adverse: continuously delivered as gas into vent circuit + expensive! side effects = rebound hypoxemia, methemoglobinemia, NO2 formation, bleeding
  • dose: start 20 - 40ppm
  • onset: intermediate, < 5 sec
  • note: for neo use, should see positive response/increase in SpO2 within 5 mins of use, if not move onto alternative therapy
57
Q

Flolan generic name, drug class, mode action, adverse effect, onset action and duration

A

Epoprostenol

  • drug class: selective pulmonary vasodilator
  • mimics prostacyclin (PGI2), binds to PGI2 receptor = vasodilation
  • use: treats pulm HTN
  • adverse effects: continuously nebulized and can interfere with vent circuit + protect from light to prevent breakdown
  • onset action: 1-2 mins, duration 3-5 mins
58
Q

Protamine mode of action

A

reversal / anti-heparin agent
-mode action: heparin has greater affinity for protamine = prevents anticoagulant effects of heparin/used to reverse heparin

59
Q

enoxaparin mode action as anticoagulant + advantages (3)

A

low molecular weight heparin (LMWH)

  • mode action: increases antithrombin 3 activity = inhibits thrombin formation
  • advantages: less potent then heparin therefore good for prophylaxis, longer duration action, reversible
60
Q

morphine drug class, mode action, use, adverse effect

A

synthetic opioid analgesic

  • mode action: binds opioid receptors, greatest effect from u opioid receptor
  • use: less common now bc of drugs with less side effects; but used in end-of-life care to decrease pain + dyspnea
  • adverse: increases histamine release
61
Q

sublimaze trade name, drug class, mode action, relative use

A

Fentanyl

  • drug class: synthetic opioid analgesic
  • mode action: binds opioid receptor, most effect from u receptor, prevents pain signal transmission
  • use: used more than morphine due to fast onset + lower side effects:
    note: 100x more potent than morphine
62
Q

Remifentanil trade name, drug class, mode action, relative potency

A

Ultive

  • drug class: synthetic opioid analgesic
  • mode action: binds opioid receptor, most effect from u receptor, prevents pain signal transmission
  • potency = 200x more potent than morphine; used for mod-severe pain
63
Q

Hydromorphone trade name, drug class, mode action, relative potency

A

Dilaudid

  • drug class: semi-synthetic opioid analgesic
  • mode action: binds opioid receptors, greatest effect from u opioid receptor, prevents pain signal transmission used for mod-severe pain
  • potency: 10x more potent than morphine
64
Q

Naloxone trade name, drug class, use, mode action

A

Narcan

  • drug class: opioid antagonist
  • use: reversal agent for opioid overdose
  • mode action: antagonistic binding to opioid receptors, greatest affinity for u receptor = rapid reversal of opioid
65
Q

Aspirin generic name, drug category, mode action, use

A

Acetylsalicylic acid

  • drug class: NSAID, non-selective irreversible COX inhibitor
  • mode action: irreversibly inhibits COX1 and COX2 enzymes = decreases PG formation = reduce inflammation
  • use: decrease clot formation, reduce heart attacks, used for mild pain relief, fever, mild anti-inflammation
66
Q

advil generic name, drug class, mode action

A

Ibuprofen

  • drug class: NSAID, non-selective irreversible COX inhibitor
  • mode action: reversibly inhibits COX1 and COX2 = decrease PG production = reduce inflammation
  • use: mild pain relief, fever relief, mild anti-inflammatory
67
Q

Tylenol generic name, drug class, mode action, adverse effect

A

Acetaminophen

  • drug class: not an NSAID
  • mode action: not known but not via COX1 or COX2 so no anti-inflammatory effect, rather it targets PAIN
  • adverse: doesnt have anti-inflammatory properties and does not decrease platelet aggregation; can have high OD rate, and liver damage
68
Q

Xylocaine generic name, drug class, mode action, onset and duration, route of admin

A

Lidocaine

  • drug class: amide type local anesthetic
  • mode action: blocks Na+ channel in sensory nerve, prevents depolarization
  • use: short term procedures for loss of local sensation
  • onset + duration: 2- 5 mins, 2 hr duration
  • routes: neb, injected, topical cream, spray
69
Q

Metoprolol

A

(Lopressor) selective b-adrenoceptor antagonist that blocks B1 heart receptors = reduced HR + B1 juxtaglomerular cell receptors = reduced renin activation = vasodilation = treats hypertension + cardiovascular disease Pts

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