pharm medications exam 1

Aspirin
mechanism of action
uses
side effects
adverse effects
antidote/duration etc.
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Terms in this set (22)
Aspirin
mechanism of action
uses
side effects
adverse effects
antidote/duration etc.
-Discovered in the 1800s. Antiplatelet properties was known in 1960s

1. Mechanism of Action: Inhibits platelet aggregation by interfering with thromboxane A2

2. Uses: MI (bite and chew), CVA (tx or prophylaxis), CAD prophylaxis.
-Maybe used within 48 hours of stroke, recommended before and after endarterectomy

3. Side Effects: tinnitus, bleeding

4. Adverse Effects: nausea, dyspepsia, heartburn, GI bleed, tinnitus, toxicity, headache, anaphylactoid reaction.

5. No Antidote. Discontinue 1wk before surgery
Rapidly absorbed in the GI tract (onset: 5-30 minutes)
-Inhibits platelets within 60 minutes (Peak: 25 min to two hours)

-Duration: 3-6
Benzodiazepines
uses
Uses:
Anticonvulsants
Sedative-hypnotics
Pre-op drugs
Anxiolytics
Manage alcohol withdrawal

-treat NMS, TD

lorazepam, valium
Lorazepam (Ativan)
Actions
type?
side
adverse
withdrawal?
Benzodiazepines
Actions:
-Enhances gamma-aminobutyrate (GABA) effects
-Binds to specific benzodiazepine receptors
-Postsynaptic receptor becomes more sensitive to GABA
-Results in inhibition of rapid neurotransmissions
-Decreases signs and symptoms of anxiety

-Rapid GI absorption
-High PB 91%
-T ½ : 12-14 hours
-Excreted in urine

Side effects:
-Drowsiness, dizziness (risk for fall)
-Weakness, confusion, blurred vision
-N/V, anorexia
-Sleep disturbance
-Restlessness
-Hallucinations

Adverse effects:
-Hypertension
-Hypotension

Do not D/C benzodiazepines abruptly
-Withdrawal symptoms: agitation, muscle tremors, cramps, nausea, sweating; drug is tapered over time
Metoprolol (lopressor) & atenolol
type?
mechanism of action?
side effects?
-Cardioselective selective** beta blockers, Sympatholytics
-selective, only works for beta 1 and wont constrict bronchioles
-Decrease in rhythm disturbance
-Decreased incidence of angina
-↓ CO
-↓ systemic vascular resistance
-Lower BP***
-↓ HR, contractility, & renin release

side effects:
-Dizziness
-Fatigue, weakness
-N/V, diarrhea
-Nasal stuffiness
-Impotence
-Decreased libido
-Depression
-Mental changes
-Bradycardia/heart block
-Thrombocytopenia
-Agranulocytosis
Fluoxetine (prozac)
mechanism of action?
side effects?
SSRI
-Block reuptake of serotonin & enhance transmission
-Do not block uptake of dopamine or norepinephrine
-Do not block cholinergic & alpha1 adrenergic receptors
-Mostly used for major depressive disorders
-Also used for anxiety disorders & migraines

Hepatically metabolized
> commonly used for depression than TCAs
> costly than TCAs

< side effects than TCAs
-Dry mouth
-Blurred vision
-Insomnia, nervousness*
-Headache
-Nausea, anorexia, diarrhea
-Suicidal ideation
-Sexual dysfunction*
Diphenhydramine (Benadryl)
antihistamine
action
use
contraindications/cautions
administration
interactions
side effects
***first generation
Action
-Competes with histamine for receptor sites preventing a histamine response
-Reduces nasopharyngeal secretions, itching, sneezing

Use
-Treats acute and allergic rhinitis, antitussive
-Other uses: as pre-med prior to blood transfusion in some cases

Contraindications/cautions
-Severe liver disease, narrow-angle glaucoma, urinary retention

Administration: oral, IM, IV

Interactions
-Increases CNS depression with alcohol and other CNS depressants
-Avoid use of MAOIs

Side effects
-Drowsiness, dry mouth, dizziness, blurred vision, wheezing, photosensitivity, urinary retention, constipation, GI distress, blood dyscrasias

****Elderly at > risk
-These side effects
-Plus ↓ BP & confusion
-Give lower dosage
-Consider 2nd generation
Albuterol
-Selective Beta2 Receptor Agonists-

-Action: Works specifically with beta 2 receptors in the bronchi causing bronchodilation
-Systemic effects - increased BP/HR, decreased GI/renal blood flow

-Rapid onset of action
-Longer duration of action
-Few side effects
Nitroglycerin
mechanism of actin
adult dosage
IV
topical
PO
emergencies
-nitrate for angina
1. Reduces myocardial oxygen demand
2. Increases cyclic guanosine monophosphate
-Smooth muscle relaxation and vasodilation
3. Decreases preload
-Amount of blood in RV at end of diastole
-dilated smooth muscle, increases capacity of blood
4. Decreases afterload
-Peripheral vascular resistance

Cause generalized vascular & coronary vasodilation
-↑ blood flow through coronary arteries to myocardial cells
-↓ myocardial ischemia but causes ↓ BP

Adult
-PO/SL: comes in various dosages
-SL most common → readily absorbed
-Onset 1-3min; effects last 10min
-SL tabs decompose when exposed to heat & light
-Keep in original container
-give under tongue

IV
-Dose usually titrated to relieve angina or manage acute CHF exacerbation

Topical
-Ointment 2%: Apply ½ to 2inches chest or thigh
-Ointment or patch should be removed after 12 hrs to avoid tolerance (8-12hr nitrate free interval)
-Transdermal patch: pre-measured dose to chest or thigh

PO: oral extended release capsule or tablet

Take one NTG, call 911 if pain is unrelieved or worsening (2012 ACCF/AHA)
Do not discontinue drugs without notifying provider
Furosemide
(lasix)
mechanism of action
side effects
-loop diuretic
Inhibit exchange of Cl-Na-K in the thick segment of the ascending loop of Henle
-reduce high BP

-Promote Na+ and water depletion
-↓ extracellular fluid volume

-Side Effects: Nausea, diarrhea, electrolyte imbalances (*hypokalemia)
Hydrochlorothiazide
mechanism of action
side effects
lithium?
Thiazides, diuretic
Promote Na+ and water depletion
-↓ extracellular fluid volume
-Inhibit active exchange of Cl-Na in the cortical diluting segment of the ascending loop of Henle

-Side Effects: hypokalemia, dehydration

-increased level of lithium with thiazide
Atorvastatin mechanism of action Contraindications: Caution: side adverse drug interactions:Statins, antihyperlipidemics -Hydroxymethylglutaryl-coenzyme A reductase (HMG-CoA) is the precursor for cholesterol synthesis and controls the last step cholesterol production -↓ Cholesterol by inhibiting the enzyme HMG CoA reductase in cholesterol biosynthesis -Slightly ↑ HDL ("good" cholesterol), ↓ LDL -Prototype statin drug -Can be used in children older than 8 years Contraindications: -Active liver disease -Pregnancy Caution: -History of liver disease -Increased alcohol ingestion -Trauma -Severe metabolic endocrine disorders -Uncontrolled seizures side effects: Headache Rash Pruritus Diarrhea or constipation Sinusitis Pharyngitis Lag cramps adverse reactions: Rhabdomyolysis - breakdown of myoglobin = kidney damage* Myalgia Photosensitivity Cataracts *Rare drug interactions: May ↑ digoxin level, oral contraceptives ↑ effects with macrolide antibiotics, antifungals ↓ effect with antacids, propranolol High protein-bindingProcainamide Mechanism of action: uses: abrosption Metabolism & Excretion: half life side effects adverse effectsClass I: Fast (Sodium) Channel Blockers, antidysrhythmic 1. Mechanism of action: -depress the phase 0 of the action potential leading to slow conduction, prolonged repolarization. Decreases automaticity and likelihood of ectopic foci, ↓ conduction velocity in cardiac tissues and increases refractory period. -Slow conduction and prolonged repolarization -blocks rapid contraction, so relaxes heart/slows conduction. given to person with tachycardia 2. Uses: -Wide variety of ventricular & atrial dysrhythmias -Paroxysmal atrial tachycardia, supraventricular dysrhythmia 3. Absorption: Oral extended release - 90 to 120 minutes IM - 15 to 60 minutes 4. Metabolism & Excretion: Converted by liver to N-acetylprocainamide (NAPA), an active antiarrhythmic compound May vary among population 30-60% excreted unchanged by kidney 5. Half-life - 2.5 to 4.7 hours (NAPA - 6 to 8 hours) Prolonged in renal impairment From: Lexicomp, Kee et al., Goodman & Gilman Pharmacology 6. Side effects: Dose-related nausea, anorexia, vomiting, dizziness, drowsiness, heart blocks, hypotension, and CHF -Note: avoid citrus juices and fruits when taking quinidine During long-term therapy -Lupus-like syndrome with rash and small joint pain -Pericarditis with tamponade -Notify prescribing provider immediately as may need to discontinue -look for slow heart rate/bradycardia. can cause hypotension beacuse heart is too relaxed -check BP first!! 7. Adverse effects: Life-threatening: Mainly caused by high concentrations (>10micrograms/ml) -Hypotension -Marked slowing of conduction -Torsade de pointes: Uncommon form of ventricular tachycardia (VT) characterized by changes in QRS complexes. It is associated with a prolonged QT interval. -May evolve into V Fib (cardiac arrest). -Fatal bone marrow collapseAmiodarone Mechanism of action: uses: side effects adverse effects half life drug interactions Nursing Considerations/Patient Education:Class III Antidysrhythmic 1. Mechanism of action: -Unclear mechanism. Blocks potassium and slows the upward movement of potassium during phase 3 of the action potential; prolongs the repolarization and slows the rate and conduction of the heart. - Structurally similar to thyroid hormone. -block phase 3 2. Uses: -Ventricular tachycardia/fibrillation, atrial flutter/fibrillation. -For treatment and maintenance. 3. Side Effects: -Related to size of dose and cumulative dose -nausea, vomiting, GI distress, dizziness, hypotension, arrhythmia -↓ HR can proceed to 2nd or 3rd degree heart block (increases PR interval, QRS duration, and QT intervals 4. Adverse Reactions: -Hypothyroidism or hyperthyroidism -Corneal microdeposits -Hepatic dysfunction -Pulmonary fibrosis -Rarely seen with low dose 200mg/day -Peripheral neuropathy -Proximal muscle weakness Long half-life (weeks to months) 5. Drug interactions: Interacts with multiple drugs such as quinidine or digoxin -Increased risk of QT prolongation with fluoroquinolones, macrolides, and azole antifungals -Increases blood levels of Class I Antidysrhythmics including procainamide -Increases blood level warfarin (Coumadin) Note: Grapefruit juice inhibits enzymes in GI tract that metabolize amiodarone. Avoid concurrent use ↑ levels & risk of toxicity 6. Nursing Considerations/Patient Education: -For IV amiodarone - monitor IV site frequently -Teach patient how to take pulse, monitor vitals -Assess for neurotoxicity, monitor thyroid function, eye exams -Note timing of meds - with or without food Monitor ECG during IV therapy or initiation of PO therapy -Heart rate & rhythm, prolonged PR & QT intervals, QRS widening -Assess for signs of pulmonary toxicity (shortness of breath) Monitor Chest X-Ray & Pulmonary Function TestsClopidogrel (plavix) mechanism of action side adverseThienopyridine - an anti-platelet drug Mechanism of Action: -Prevents platelet aggregation by blocking Adenosine Diphosphate from binding to platelet receptor -3-5 days to work Side effects: -Similar side effects and adverse reactions with ASA. Flu-like symptoms, nose bleed -Patients allergic to Aspirin can take Plavix -Onset of action is several days and drug effects last for 7 days Adverse Reactions: thrombocytopenia, aplastic anemia, agranulocytosisLithium type toxicity interactions side/adverse Nursing interventions:mood stabilizer, Antidepressant -Antidepressant to treat bipolar disorder -Most effective in controlling manic phase -Inexpensive -Must be closely monitored -Narrow therapeutic range (Lithium levels); maintenance range: 0.5 to 1.5 mEq/L (levels >1.5 are toxic) Depletes serum sodium levels -Must monitor sodium level Toxicity: -Nausea -Vomiting -Cardiac dysrhythmias -Cardiac arrest Interactions: -Increased lithium level with thiazides, methyldopa, haloperidol, NSAIDs, antidepressants, theophylline, phenothiazines Side effects/adverse reactions: -Headache, drowsiness, dizziness -Hypotension, dysrhythmias -Restlessness, slurred speech -Dry mouth, metallic taste, GI distress -Tremors, muscle weakness -Edema of hands and ankles -Increased urination, blood dyscrasias, nephrotoxicity Nursing interventions: -Monitor vital signs, sodium levels -Monitor for drug effectiveness, suicidal tendencies -Monitor urine output, renal function tests -Encourage adequate fluid intake (1 to 2 L daily) -Take with food to decrease GI irritation -Monitor lithium levels every 1 to 2 months (0.5 to 1.5 mEq/L); toxic range is greater than 2 mEq/L -Toxic side effects: persistent nausea, vomiting, severe diarrhea, blurred vision, tinnitus, ataxia, increasing tremors, confusion, dysrhythmia, seizuresWarfarin (coumadin) Mechanism of action: uses goals of therapy: PT, INR Atrial fibrillation, artificial valves, dvT and PE-anticoagulant -amiodarone increases coumadin levels Mechanism of action: - Inhibits the hepatic synthesis of coagulation factors dependent on Vitamin K: Factors II, VII, IX and X -Long ½ life & very long duration (2-3 days?) Uses: -mainly to prevent thromboembolic conditions such as embolism caused by atrial fibrillation, which can lead to a stroke (CVA), DVT, PE -The name Warfarin stems from the acronym WARF, for Wisconsin Alumni Research Foundation -Normal PT - 10-12 sec. -Normal INR (International Normalized Ratio) - 0.7-1.7 Goals of Therapy: -Atrial fibrillation - (2-3) -Artificial valves-(2.5-3.5) -DVT and PE- (2-3?) -Starting treatment at 5 mg per day and titrating the dosage every three to seven days to achieve goal -should only take coumadin for 3 monthsHeparin (unfractioned) mechanism of action uses how is it given? SQ, IV side effects Adverse Effects, Highest in patients with any of the following: Interactions, antidote?anticoagulant Mechanism of Action: -Natural substance in liver & prevents clot formation; -Inhibits thrombin (see next slide). -Prevents conversion of fibrinogen to fibrin. Variable effect 1. heparin binds with antithrombin III 2. antithrombin inactivates thrombin 3. thrombin inhibits conversion of fibrinogen to fibrin 4. fibrin is decreased and clot is prevented Uses: -for rapid anticoagulant effect in: -DVT, Pulmonary Embolus (PE), or evolving stroke, DIC, atrial fib/flutter, MI, valve replacement and other thromboembolic states -SQ prophylaxis - 5000 to 7500 units every 8 -12 hours (weight-based) -IV therapy - acute thrombosis (MI/PE). Initial bolus of 80 units per kg, then 18 units per kg per hour by infusion based on aPTT. An aPTT of 1.5 to 2.0 times the control is desirable (60-80 seconds). -in treatment give it IV -look at activated partial time -60-80 seconds to make sure its effective Side Effects: -Itching, burnng, and ecchymosis on the injection site Adverse Effects: -Heparin -Induced Thrombocytopenia (HIT), bleeding. -Highest in patients with any of the following: age >65, recent surgery, or conditions such as peptic ulcer disease, liver disease, neoplasia, and bleeding diathesis Interactions: -Increased effect with aspirin, NSAIDs, thrombolytics, and probenecid Antidote: -Protamine Sulfate. 1-1.5 mg per 100 USP units of heparin; not to exceed 50 mg. Monitor aPTT 5-15 min after dose then in 2-8 hours.Low Molecular Weight Heparin uses? Mechanism of Action:? antidote? notes?-anticoagulant -Fractionated - made of fragments/derivatives of unfractionated heparin Mechanism of Action: -Binds with antithrombin and accelerates the rate at which antithrombin inhibits Factor Xa and thrombin -Uses: similar to heparin -Examples: Enoxaparin (Lovenox) -Antidote: Protamine Sulfate -Notes: Less risk bleeding, more stable response, does not require frequent aPTT monitoring, ½ life 2-4X Heparin, thrombocytopenia less likelyPentoxifylline (Trental)Hemorrheologic Agent Improves microcirculation and tissue perfusion Decreases blood viscosity Improves flexibility of erythrocytes Inhibits aggregation of platelets and red blood cells Decreases blood viscosityAlteplasethrombolytics Short ½ life: 30-45 min Excretion: Urine Side Effects: Bleeding Adverse Reactions: -Intracerebral hemorrhage -Stroke -dysrhythmiaPradaxa (Dabigatran Etexilate)-Category: Direct Thrombin inhibitor -Use: non-valvular atrial fibrillation and stroke treatment and prophylaxis, HIT, DVT, and PE -Metabolized in the liver -½ life 12 - 17 hours (longer in the elderly) and renal impairment -Excreted in the urine. Severe Renal failure = risk for bleeding -Dosage: 150 mg twice daily P.O.Amitriptyline (Elavil)Tricyclic Antidepressants Blocks uptake/reuptake (removal of) norepinephrine & serotonin Effective & < expensive than SSRIs & other drugs Elevate mood, ↑interest in ADL, & ↓insomnia Usually given at night to ↓problems re: sedative action Interactions -Also blocks histamine and anticholinergic receptors -Increased CNS effects with alcohol and other CNS depressants -Increased sedation and anticholinergic effects with phenothiazines, haloperidol Side effects/adverse reactions -Sedation, dizziness, blurred vision, dry mouth and eyes, urinary retention, constipation, weight gain, GI distress, sexual dysfunction -Orthostatic hypotension, dysrhythmia, EPS, blood dyscrasiasAmitriptyline (Elavil)