The Motherload 732 - Pharm Test 2

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732 questions. CV, CNS, and renal meds, pharmacokinetics, and pharmacodynamics, including indications, side-effects, and antidotes.

What do diuretics do for CHF patients?

Reduce pre-load and afterload

What do diuretics fo for HTN patients?

Reduce BP

What are diuretics used for?

CHF, HTN, head trauma, pulmonary edema, renal failure, glaucoma, edema, weight loss

What are thiazide diuretics used for?

HTN, mild CHF, edema

What are side effects of thiazide diuretics?

Hypokalemia, hyperuricemia, hyperglycemia, hypercalcemia. May cause hypotension

What class of diuretics have increased toxic reactions to digoxin and lithium?

Thiazides

Chlorothiazide (Diuril) belong to what group of drugs?

Thiazide Diuretic

Hydrochlorothiazide (HydroDiuril) belong to what group of drugs?

Thiazide Diuretics

What are loop diuretics used for?

CHF, renal disease, hypertensive crisis

What class of diuretics cause a great amount of potassium loss and therefore require a K supplement in conjunction with the prescription?

Loop Diuretics

What class of diuretics can have a side effect of ototoxicity?

Loop Diuretics

Furosemide (Lasix) belongs to what group of drugs?

Loop Diuretics

What class of diuretics are used in combination with other diuretics (especially thiazides) to treat HTN?

Potassium-Sparing Diuretics

If used alone, what can potassium-sparing diuretics put a patient at risk for?

Hyperkalemia

What group of drugs does Spironolactone (Aldactone) belong to?

Potassium-Sparing Diuretics

What might Spironolactone be used for?

Hyperaldosteronism

What diuretic drug may cause an endocrine balance like hirsutism or gynecomastia?

Spironolactone (Aldactone)

What group of drugs does Triamterene (Dyrenium) belong to?

Potassium-Sparing Diuretics

What drug and class of drug may cause a patient's urine to turn blue?

Triamterene (Dyrenium)-- Potassium-Sparing Diuretic

What are Osmotic Diuretics used for?

Renal failure, increased drug excretion, decrease ICP and IOP.

What class of diuretics may be used for glaucoma?

Osmotic Diuretics

Which class of diuretics can only be given IV and may increase venous BP initially and could induce heart failure?

Osmotic Diuretics

What group of drugs does Mannitol (Resectisol) belong to?

Osmotic Diuretics

What are some side effects of Osmotic Diuretics?

Headache, NVD (nausea/vomiting/diarrhea).

What class of diuretics will potassium supplements absolutely be necessary for?

Loop Diuretics

What class of diuretics may or may not require potassium supplements?

Thiazide Diuretics

What are some examples of potassium-rich foods?

Citrus fruits, nuts, spinach, bananas, tomatoes, salt substitutes

When should diuretics be administered?

early a.m.

What signs and symptoms should be monitored in a patient taking diuretics?

s/s of loss of electrolytes: dehydration, hypokalemia, muscle cramps, fatigue, anorexia

What should the nurse record daily for a patient taking diuretics?

Weight

What side effects can diuretics cause?

Drop in BP-- postural hypotension

What should the nurse warn the patient of before starting diuretics?

They will produce a copious flow of urine.

-dipine

Calcium channel blocker

-olol

Beta blocker

-sartan

ARB

-pine

ACE inhibitor

-thiazide

Diuretic

-semide

Diuretic

-lactone

Diuretic

-dogril

Anticoagulant

-farin

Anticoagulant

-statin

HMG-CoA reductase inhibitor (statin)

-terol

Beta 2 agonist

-afil

Erectile dysfunction drug

Morphine

Opiate - full agonist
11 dosing formulations including PCA
Schedule II

Fentanyl

Opiate - full agonist
100x more potent than Morphine
Duragesic transdermal
palliative
Schedule II

Oxycodone (OxyContin/Percocet)

Opiate - full agonist
PO for pain
abuse-proof formulations now
Schedule II

Hydrocodone (Lortab/Vicodin)

Opiate - full agonist
PO for pain
Schedule III

Oxymorphone

Opiate - full agonist
newer, PO, potent, do now chew/crush/dissolve
Schedule II

Meperidine (Demerol)

Opiate - full agonist
accumulates - don't use more than 48hrs, with MAOI, or in seizure pts
Schedule II

Pentazocine

Opiate - partial agonist
Good if opiate naive, only moderate pain
Schedule IV

Naloxone

Opiate - antagonist
treatment of narcotic OD; will induce withdrawal

Ritalin

CNS stimulant
ADHD, narcolepsy
alertness, mood elevation, less fatigue
SE: MI, HTN, Stroke, Psychosis, Hallucinations

Strattera

CNS non-stimulant
ADHD - results take about a week to be seen; less potential for abuse
ADR: suicidal ideation

D-amphetamine

CNS stimulant
more potent than Ritalin, more SE

Phenobarbital

Anticonvulsant/AED - traditional
sedation / RED FLAG

Diazepam

Anticonvulsant/AED - traditional; also sedative, muscle relaxant
IV for status epilepticus (30 min seizure)

Ethosuximide

Anticonvulsant/AED - traditional
sedation, RED FLAG, rash

Valproic acid

Anticonvulsant/AED - traditional (also for BPAD)
sedation, RED FLAG, hepatoxicity

Carbamazepine

Anticonvulsant/AED - traditional
sedation, RED FLAG, Stevens-Johnson syndrome

Gabapentin (Neurontin)

Anticonvulsant/AED - newer
adjunct for seizures
also migraines, peripheral neuropathies

Topiramate (Topamax)

Anticonvulsant/AED - newer
adjunct for seizures
also migraines, alcohol/cocaine addiction, weight loss

Levetiracetam

Anticonvulsant/AED - newer
not a red flag drug - does not metabolize at all

Haloperidol

Antipsychotic - older
chemical restraint; best with positive symptoms
extrapyramidal SE, anti-cholinergic, big weight gain

Compazine

Antipsychotic - older
good for nausea/vomiting

Olanzepine

Antipsychotic - atypical
long-acting (2-4 week) IM injection
better for negative syptoms
SE: weight gain, headache, CNS stimulation

Aripiprazole

Antipsychotic - atypical (Abilify)
better for negative syptoms
SE: weight gain, headache, CNS stimulation

Clozapine

Antipsychotic - atypical
most effective drug for schizophrenia
better for negative syptoms
SE: weight gain, headache, CNS stimulation
ADR: agranulocytosis (fatal destruction of WBCs) - requires MONITORING (1m, 2m, 6m, q6m)

Secobarbital

Sedative (barbiturate)
short-acting - 3-6hrs - night before surgery

Alprazolam (Xanax)

Sedative - BZD
pt. cooperation for a procedure
top 20 in US / highly abused

Midazolam (Versed)

Sedative - BZD
sedation, induction for anesthesia, pt. cooperation for procedure

Zolpidem (Ambien)

Sedative - BZD-like
SE: sleep-driving, eating, hangover

Amitriptyline

Antidepressant - tricyclic
blocks reuptake of NE and 5-HT
used for depression, panic, agoraphobia, OCD, pain, migraine
SE: sedation, anticholinergic
2-3 weeks to see effect

Fluoxetine (Prozac)

Antidepressant - SSRI
used for depression, OCD, PMDD, anxiety, etc.
SE: nausea, nervousness, headache, anorexia, suicide, sexual dysfunction

Citalopram (Celexa)

Antidepressant - SSRI
used for depression, OCD, PMDD, anxiety, etc.
SE: nausea, nervousness, headache, anorexia, suicide, sexual dysfunction

Paroxetine (Paxil)

Antidepressant - SSRI
used for depression, OCD, PMDD, anxiety, etc.
SE: nausea, nervousness, headache, anorexia, suicide, sexual dysfunction

Wellbutrin

Antidepressant - atypical
may affect 5-HT and DA
SE: rash, seizures, weight loss, lower sexual SE than others

Lithium

DOC for BPAD
Goal is to control the mania - even it out
Narrow TI - may cause DM and toxicity: vomiting, muscle weakness, seizures, coma
SE: GI upset, polyuria, fine tremor

Halothane

Anesthetic
Most widely used used general anesthetic
Not good for muscle relaxation; may cause arrhythmia

Lidocaine

local anesthetic
Fast onset (< 1min) longer duration (~2hrs)
May cause heart block or arrhythmias

Bupivicaine

local anesthetic
Slow onset (>10min) long duration (3+hrs)
Used for spinal, epidural, infiltration and nerve block
May cause arrhythmias

Propofol

general anesthetic
General CNS depressant
SE: Causes respiratory depression
"purposeful sedation" for shorter things

Scopolamine

Anticholinergic
used as an adjunct to anesthesia

Clonidine

HTN
Centrally-acting sympathetic agonist (alpha-2)
SE: low mood, energy (decreased sympathetic outflow)
Do not d/c abruptly d/t rebound HTN
Not our first choice
also a new drug for ADHD

Reserpine

HTN
Peripherally-acting sympathetic antagonist
Over 50 yrs old
Now our 4th/5th choice in a cocktail
Some suicides
SE: sedation, depression, GI motility

Propranolol

HTN, Angina, STEMI, CHF, Dysrhythmia
Beta-Blocker (B1 & B2)
Do not d/c abruptly d/t rebound HTN
SE: exercise intolerance, tiredness
Contraindications: asthma, diabetes (may mask signs of hypoglycemia)
Good for digoxin induced arr's—Atrial arr's
Angina - decreases work of heart; not used for variant angina

Hydralazine

HTN
Peripheral Arterial Vasodilator
Directly relax arterioles via decreased Ca+2 flux in smooth muscle cells; decreases BP (afterload)
reflex increased HR, decreased Na/H20 retention; drug-induced SLE; safe in pregnancy

Minoxidil

HTN
Peripheral Arterial Vasodilator
Directly relax arterioles via decreased Ca+2 flux in smooth muscle cells; decreases BP (afterload)
also Rogaine - refractory HTN only - 4th/5th choice in cocktail

Nitroprusside

HTN - IV in Crisis
Arterial-Venous Vasodilator
Converted to nitric oxide which is a vasodilator (preload and afterload)
OD - cyanide poisoning

Prazosin

HTN
Alpha 1 blocker (vasodilation)
First dose syncope - take at night
Mild-moderate HTN

Verapamil

HTN (low dose), Angina (med dose), Dysrhythmia (high dose)
Calcium-Channel Blocker
May cause AV node block, constipation (offset with fiber and water), dizziness
decreased AV nodal conduction for Atrial arrhythimas
For Angina - dilates coronary arteries - good for all 3 types

Amlodipine

HTN (low dose), Angina (med dose), Dysrhythmia (high dose)
Calcium-Channel Blocker
May cause AV node block, constipation (offset with fiber and water), dizziness
top 20 in USA
For Angina - dilates coronary arteries - good for all 3 types

Lisinopril

HTN, HF, post-MI
ACE Inhibitor
Lowers BP, Na+, H20 by inhibiting ACE
Longer t ½; q day dosing
Causes first-dose syncope, dizziness, GI SE
Begin within 24hrs of MI, continue at least 6wks
Monitor for cough, K levels

Losartan

HTN, HF
ARB
Lowers BP, Na+, H20 by inhibiting ACE
Longer t ½; q day dosing
Causes first-dose syncope, dizziness, GI SE

Hydrochlorothiazide

Diuretic (Thiazide)
Causes Na+ and H20 Loss
SE: dizziness, electrolyte imbalance, hypotension
First step for HTN
1-2 extra trips to pee per day

Furosemide

Diuretic (Loop)
Causes Na+ and H20 Loss
SE: dizziness, electrolyte imbalance
ADR: ototoxicity (balance/hearing)
Requires K+ supplement
2-3 extra trips to pee per day

Quinidine

Antidysrhythmic
Na+ channel blocker (decreases automaticity of ectopic foci)
Atrial & vent. Arr.; can cause cinchonism (headache, blurred vision, tinnitus)

Flecainide

Antidysrhythmic
Na+ channel blocker (decreases automaticity of ectopic foci)
Vent. Arr. - good for chronic management

Lidocaine

Antidysrhythmic
Na+ channel blocker (decreases automaticity of ectopic foci)
IV only; vent. arrs following MI or surgery

Bretylium

Antidysrhythmic
Given IV
For life-threatening vent arr; vent fibrillation

Amiodarone

Antidysrhythmic
Given PO
For life-threatening vent arr; vent fibrillation

Dobutamine

Antidysrhythmic
Sympathetic agonist
DOC for cardiac stimulation; B1: HR, contractility

Atropine

Antidysrhythmic
Parasympathetic antagonist / anticholinergic
ER Codes

Nitroglycerin

Angina, STEMI
Venous Vasodilator (decreases afterload and preload)
Lots of dosage forms
Have to take a break or tolerance will develop
For all 3 types of angina
Contraindicated with tachycardia, bradycardia, systolic hypotension, right ventricular infarction, viagra/cyalis, tadalafil

Isosorbide dinitrate

Angina
Vasodilator
Decreases preload
Daily PO prophy for unstable/vasospastic angina

Heparin

Anticoagulant
IV/SC - blocks free thrombin
Monitor: APTT (activated partial thromboplastin time), blood in stool or urine; CBC/platelet count
ADR: Hemorrhage
Antidote: protamine sulfate

Enoxaparin

Anticoagulant
SC-abdominal; blocks free thrombin
DVT & PE prevention post-op
APTT monitoring not reqd

Bivalrudin

Anticoagulant
IV - during angioplasty

Warfarin

Anticoagulant
PO - antagonizes Vitamin K
Monitor PT/INR - clotting time - LOTS of follow-up
Lots of drug/diet interactions
ADR: Hemorrhage
Antidote: phytonadione

Alteplase

Fibrinolytic
Dissolve clots - best within 4-6 hrs of MI and 2-3 hrs of stroke
Cost-benefit: very expensive ($4000+), but when given within 30 minutes of arrival at ED - really good results
Bleeds are the major risk of use

Tenecteplase

Fibrinolytic
Dissolve clots - best within 4-6 hrs of MI and 2-3 hrs of stroke
Cost-benefit: very expensive ($4000+), but when given within 30 minutes of arrival at ED - really good results
Bleeds are the major risk of use

Aspirin

Antiplatelet
unstable angina, MI, stroke
80-325mg/day
risk for bleeds, esp. GI, so not for all

Clopidogrel (Plavix)

Antiplatelet
decreases platelet aggregation

Ticlopidine (Ticlid)

Antiplatelet
decreases platelet aggregation

Dabigatran

Direct Thrombin Inhibitor
stroke, DVT prophy, etc.

Ribaroxaban

Direct Factor Xa Inhibitor
PO
No need for INR monitoring
Only approved as anticoagulant following knee/hip replacement, to prevent stroke in afib patients, DVT, PE; being tested in MI patients
Lower risk for fatal bleeds than Warfarin, but no antidote

Atorvastatin (Lipitor)

Statin
inhibits cholesterol synthesis in the liver
Significant LDL decrease
Monitor liver function
Decreased risk of MI and mortality after 2 years
SE: "fogginess"/dementia
top 20 in USA

Rosuvastatin (Crestor)

Statin
inhibits cholesterol synthesis in the liver
Significant LDL decrease
Monitor liver function
Decreased risk of MI and mortality after 2 years
SE: "fogginess"/dementia
top 20 in USA

Gemfibrozil

for cholesterol - esp. triglycerides
monitor Liver function like Statins

Fenofibrate

for cholesterol - esp. triglycerides
monitor liver function like Statins

Nicotinic Acid

for cholesterol
Most effective with lowering triglycerides and raising HDL
SE: hot flashes from vasodilation for 30 mins after taking

Iron

Most often d/t blood loss - need to correct this
Oral iron - constipating; elixir will stain teeth
Parenteral iron (iron dextran) given by Z track technique subQ to prevent pooling (watch for anaphylaxis with test dose)

Cyanocobalamin

B-12 supplement
IM - q day for 1-2 weeks
d/t decreased intrinsic factor, gastrectomy (d/t stomach CA, perhaps), or vegetarian diet

Epoetin alpha (Procrit)

Hematopoetic
stimulates RBC production in bone marrow
In profound anemia from renal disease, HIV, CA, wasting syndromes

Filgrastim (Neupogen)

Hemapoetic
WBC stimulation, especially for chemo pts.
SE: bone pain

Potassium-sparing diurectics

Used in combination with other diuretics (esp. thiazides) to make K neutral

Mannitol

Osmotic diuretic
Very acute - IV
Can flush nephrotoxic drugs
Lose a lot of fluid very quickly

Lanoxin (digoxin)

Increases cardiac contractility. Treatment of CHF.

Diuretics

Increases sodium and water excretion. Treatment of CHF.

ACE inhibitors

Decrease BP and blood volume. Treatment of CHF.

Vasodilators

Decreases BP. Treatment of CHF.

Dobutamine

Increases ventricular contractility. Treatment of CHF.

Dopamine

Increases ventricular contractility. Treatment of CHF.

PDE (phosphodiesterase) inhibitors

Increases ventricular contractility. Treatment of CHF.

Lanoxin (digoxin)

In the hospital setting, always ask patients whether they take tablets or capsules of this drug at home, since capsular absorption is greater than tablet absorption and sudden change in dosage format may result in toxicity or physiologic side effects/adverse reactions.

Lanoxin (digoxin)

This drug is 70% renally excreted. Therefore, good renal function is important.

Lanoxin (digoxin)

Cardiac glycoside. Increased cardiac contractility, positive inotropic effect by inhibiting Na-K ATPase, leading to increased cardiac output. Decreased heart rate. Decreased AV nodal conduction.

Lanoxin (digoxin)

Adverse drug reactions include anorexia; nausea, vomiting, diarrhea (NVD); confusion; blurred vision (halos); and arrhythmias.

Lanoxin (digoxin)

Toxicity of this drug is made worse by hypokalemia or any factor affecting drug clearance.

Lanoxin (digoxin)

Treatment for toxicity of this drug may include administration of potassium.

Lanoxin (digoxin)

Treatment for toxicity of this drug may include administration of Digibind.

Lanoxin (digoxin)

Quinidine displaces this drug from tissues and decreases its secretion.

Lanoxin (digoxin)

Decrease the dose of this drug when using quinidine.

Lanoxin (digoxin)

Antacids bind this drug, decreasing its absorption.

Lanoxin (digoxin)

Diuretics increase toxicity of this drug.

Diuretics

May cause hypokalemia.

ACE

"Angiotensin-converting enzyme"

ACE

Converts angiotensin I to angiotensin II in the lungs.

Renin

Converts angiotensinogen (a plasma protein) to angiotensin I.

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