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semester 4 > pharmacology 3 > Flashcards

pharmacology 3 Flashcards

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1
Q

HMG-CoA Reductase Inhibitors

A

the Statins!
pravastatin (Pravachol)
simvastatin (Zocor)
atorvastatin (Lipitor)
fluvastatin (Lescol)
rosuvastatin (Crestor)
pitavastatin (Livalo)

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2
Q

HMG-CoA Reductase Inhibitors

A

Mild, transient GI disturbances
Rash
Headache
Myopathy (muscle pain), possibly leading to the serious condition rhabdomyolysis
Elevations in liver enzymes or liver disease

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3
Q

rhabdomyolysis

A

breakdown of muscle, enzymes are released and it can lead to kidney damage and failure

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4
Q

HMG-CoA Reductase Inhibitors

A

oral anticoagulants
drugs metabolized by CYP3A4
(erythromycin
Azole antifungals
verapamil
diltiazem
HIV protease inhibitors
amiodarone)
Grapefruit juice

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5
Q

Bile Acid Sequestrants

A

sequester bile acid - Prevent resorption of bile acids from small intestine - Bile acids are necessary for absorption of cholesterol

cholestyramine (Questran)
colestipol (Colestid)
colesevelam (Welchol)

cannot be taken with other meds. either an hour before or 4-6 hours after

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6
Q

Bile Acid Sequestrants: Adverse Effects

A

Constipation

Heartburn, nausea, belching, bloating
These adverse effects tend to disappear over time

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7
Q

Bile Acid Sequestrants: Indications

A

Type II hyperlipoproteinemia

Relief of pruritus associated with partial biliary obstruction (cholestyramine)

May be used along with statins

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8
Q

Bile Acid Sequestrants Contraindications

A

PKU

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9
Q

Niacin (Nicotinic Acid)

A

Vitamin B3 - higher dose than normal vitamins

Effective, inexpensive, often used in combination with other lipid-lowering drugs

start with a low dose and gradually increase to prevent puritis and flushing

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10
Q

Niacin: Indications

A

Effective in lowering triglyceride, total serum cholesterol, and LDL levels

Increases HDL levels

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11
Q

Niacin: Adverse Effects

A

Flushing (caused by histamine release)

Pruritus

GI distress

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12
Q

Fibric Acid Derivatives Examples

A

Also known as fibrates
gemfibrozil (Lopid)
fenofibrate (Tricor)

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13
Q

Fibric Acid Derivatives: Indications

A

hyperlipidemia

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14
Q

Fibric Acid Derivatives: Adverse Effects

A

Abdominal discomfort, diarrhea, nausea
Blurred vision, headache
Increased risk of gallstones - unique to this set
Prolonged prothrombin time
Liver studies may show increased enzyme levels

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15
Q

Fibric Acid Derivatives: Interactions

A

oral anticoagulants
statins (risk for myositis, myalgias, and rhabdomyolysis is increased)

Decreased hemoglobin level, hematocrit value, and white blood cell count
Increased activated clotting time, lactate dehydrogenase level, and bilirubin level

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16
Q

Cholesterol Absorption Inhibitor

A

ezetimibe (Zetia)

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17
Q

ezetimibe (Zetia)

A

Inhibits absorption of cholesterol and related sterols from the small intestine
Results in reduced total cholesterol, LDL, and triglyceride levels
Also increases HDL levels
Often combined with a statin drug

Clinical trials continue >Currently recommended only when patients have not responded to other therapy

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18
Q

Herbal Product: Garlic

A

Used as an antispasmodic, antihypertensive, antiplatelet, lipid reducer

Possible interactions with warfarin, diazepam

May enhance bleeding when taken with NSAIDs
» stop taking prior to surgery

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19
Q

Garlic Adverse Effects

A

dermatitis, vomiting, diarrhea, flatulence, antiplatelet activity

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20
Q

Herbal Product: Flax

A

Both the seed and oil of the plant are used

Uses: atherosclerosis, hypercholesterolemia, GI distress, menopausal symptoms

May cause diarrhea and allergic reactions. Not recommended during pregnancy

Possible interactions: antidiabetic drugs, anticoagulant drugs

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21
Q

Herbal Product: Omega-3 Fatty Acids

A

Fish oil products

Used to reduce cholesterol

May cause rash, belching, allergic reactions

Potential interactions with anticoagulant drugs

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22
Q

Nursing Implications for Lipid Lowering Meds

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A

health and medication history

Assess dietary patterns, exercise level, weight, height, vital signs, tobacco and alcohol use, family history

Assess for contraindications, conditions that require cautious use, and drug interactions

Obtain baseline liver function studies

23
Q

Contraindications for Lipid Lowering Meds

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A

Contraindications include biliary obstruction, liver dysfunction, active liver disease

24
Q

Niacin contraindications

25
Lipid lowering meds: how long does it take for these drugs to take effect?
several weeks
26
Niacin and NSAIDs
Small doses of aspirin or NSAIDs may be taken 30 minutes before niacin to minimize cutaneous flushing
27
Lipid Lowering Agents: what to report
persistent GI upset, constipation, abnormal or unusual bleeding, and yellow discoloration of the skin
28
Low TSH
hyperthyroid
29
High TSH
hypothyroid
30
Hyperthyroid s/s
Tachycardia, heat intolerance, tremors, agitation, high BP
31
Hypothyroid
cold intolerant, low BP and heart rate
32
Cretinism
low thyroid in youth Low metabolism, delayed growth and sexual development, possible retardation. Testing at birth to identify & treat!
33
Myxedema
low thyroid as an adult Low metabolism, decrease mental, physical stamina, weight gain, hair loss, firm edema
34
Levothyroxine
(synthroid, levoxyl, synthetic T4) 25-200mcg./day; chemically pure; more predictable results; adults and children take in the morning to avoid sleep disturbances
35
Dessicated thyroid shit
Animal source; “natural”; consists of pulverized cow or pig thyroid. Results variable 60-65 mg. (1 gr.) Armour Thyroid
36
Thyroid Replacement: Adverse Reaction
Usually the result of overdose; is essentially an induced state of hyperthyroidism! Cardiac: dysrhythmia, tachycardia, hypertension, Recent MI is contraindication CNS: insomnia, tremor, headache, anxiety GI: nausea, diarrhea, appetite change Other: menstrual irregularity, wt. loss, heat intolerance
37
Thyroid Replacement: Interactions
anticoagulants With digitalis, may decrease levels Cholestyramine binds in gut reducing absorption of both May increase need for insulin in diabetes Cardiac patient using epinephrine may induce coronary insufficiency Inappropriate/overuse associated with osteoporosis
38
when to take levothyroxine
Best taken in AM: 30-60 minutes before food
39
Hashimoto’s Thyroiditis
Test for anti-thyroid antibodies Important cause of hypothyroidism Autoimmune process; destruction of thyroid Initially presents with symptoms of hyperthyroidism; may include Hashimoto’s psychosis!
40
Radioactive Iodine
Destroys the thyroid gland through ablation Emits beta rays which destroy the tissue when taken up
41
Antithyroid drugs
tapazole (methimazole), PTU (propylthiouracil) Inhibits iodine uptake preventing the formation of active T3, T4; dietary restrictions of iodine!
42
pregnancy and antithyroid
PTU first trimester, MMI, remainder of pregnancy
43
Tapazole(methimazole):
QD dosing; typically result in suppression in 6 weeks can rarely cause agranulocytosis
44
PTU (propylthiouracil):
preferred for use in 1st trimester if indicated; takes 8 weeks or longer for suppression; BID-TID dosing rarely cause agranulocytosis
45
Radioactive Iodine Testing/Ablation
Frequently used post thyroidectomy if further suppression indicated Usually out-patient unless high doses anticipated (↑30 mci) Stop synthroid 6 weeks before scan; begin cytomel Stop cytomel 2 weeks before scan; need thyroid suppression Low iodine diet 1 week before scan; low salt diet, no fish, shellfish, limit dairy to 8oz/day 2 days before scan check TSH to assure hypothyroid, pregnancy test
46
Radioactive Iodine Testing: Patient Teaching
Radioactive iodine is largely taken up by the thyroid. Residual amounts excreted over 2-3 days in urine, feces, saliva, sweat Hand washing, personal towel, separate linens Double flush toilet No one closer than 3 feet for more than 1 hr/day No pregnant women, minimize infant exposure
47
Side effect og magnesium containing antacid
diarrhea (milk of mag makes people poop)
48
Aluminum containing drugs can cause
constipation
49
Antidiarrheals carry a risk for
dependence (lomotoal)
50
Medications for Aids patients to stimulate appetites
Marinol
51
Helicobacter pylori (H. pylori)
PPI & Antibiotics are used together to eradicate H. pylori * First-line therapy includes a 10- to 14-day course of a proton pump inhibitor (PPI) and the antibiotics clarithromycin and either amoxicillin or metronidazole or a combination of a PPI, bismuth subsalicylate, and the antibiotics tetracycline and metronidazole.
52
Testing for H. Pylori
blood: looks for antibodies and can test positive for years after initial infection even if the patient is over it. best for young people stool: best for older people or those previously treated. no ppi for 2 weeks before test, no bismuth for 1 month before test breath: not always available, great at any point in treatment and you just need to be NPO for 6 hours before test
53
Histamine blockers: Adverse Effects
**confusion** CV: hypotension with IV use CNS: headache, confusion, agitation Endocrine: ↑ prolactin, gynecomastia (tagamet) GI: diarrhea, nausea Hepatobiliary: ↑ LFT, jaundice Hematologic: numerous Skin: urticaria, rash

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