What drug is the antidote for: - Magnesium sulfate?Calcium Chloride / GluconateWhen is the following drug contraindicated: - Calcium Chloride / Gluconate?- In digitalized pts - Hypercalcemia - Ventricular fibrillationWhat class does the following drug reside in: - Atovastatin (lipitor) - Lovastatin (mevacor)?HMG-CoA reductase inhibitors (statins)What is the MOA of the following drug: - Atovastatin (lipitor) - Lovastatin (mevacor)?- Reduce LDL - Elevate HDL - May lower Triglycerides but not prescribed for thisWhat drug class has the following effect / action: - Reduce LDL - Elevate HDL - May lower Triglycerides but not prescribed for this?- Atovastatin (lipitor) - Lovastatin (mevacor)What are the side effects of the following drug: - Atovastatin (lipitor) - Lovastatin (mevacor)?- DYSPEPSIA (indigestion) + Constipation + Abd pain - Cramps - Flatulence (gas in GI tract)What drug has the following adverse effect: - DYSPEPSIA (indigestion) + Constipation + Abd pain - Cramps - Flatulence (gas in GI tract)?- Atovastatin (lipitor) - Lovastatin (mevacor)What organ would be damaged when taking: - Atovastatin (lipitor) - Lovastatin (mevacor)?- Muscles (myopathy/rhabdomyolysis) - Kidney - Liver (Hepatotoxic)What lab value should be looked at when taking: - Atovastatin (lipitor) - Lovastatin (mevacor)?- CK levels (Myopathy / rhabdomyolysis) - ALT and AST (Hepatotoxic) - BUN + Creatinine (Renal damage)What are Nursing implications when taking: - Atovastatin (lipitor) - Lovastatin (mevacor)?- Take lab - Note that these damages the Muscles, Kidney, and Liver - Avoid GRAPEFRUIT - Also kills fetus = Category XCan the following drug be administered to pregnant women safely: - Atovastatin (lipitor) - Lovastatin (mevacor)?Category X = Prohibited in pregnancyWhat is the LDL goal in a pt with: - Heart disease? - Diabetic?- Heart = 100 - Diabetes = 70What is the MOA of the following drug: - Niacin (nicotinic acid)?- Reduces LDL and TG / Triglyceride levels - Inc HDLWhat are the side effects of the following drug: - Niacin (nicotinic acid)?- INTENSE FLUSHING + ITCHING - GI upsetWhat drugs cause a drug interaction in the following drug: - Niacin (nicotinic acid)?Mitigated (made less serious) by 325 mg AspirinWhat drug has the following adverse effect: - INTENSE FLUSHING + ITCHING - GI upsetNiacin (nicotinic acid)What organ would be damaged when taking: - Niacin (nicotinic acid)?- Liver (Hepatotoxic) - Bones = GOUTY ARTHRITISWhat lab value should be looked at when taking: - Niacin (nicotinic acid)?- AST and ALT (Hepatotoxic) - Uric acid level (elevated) - Glucose (Hyperglycemia)What class does the following drug reside in: - Ezetimibe (Zetia)?Cholesterol blockerWhat is the MOA of the following drug: - Ezetimibe (Zetia)?Inhibits dietary absorption of cholesterol secreted in the bile = - Dec total cholesterol, LDL- C, triglycerides - Inc HDLsWhat organ would be damaged when taking: - Ezetimibe (Zetia)?- Muscles (rhabdomyolysis = destruction of striated muscles) - Liver (reports of Hepatitis when used with statins) - Pancreas (pancreatitis)What drug has the following adverse effect: - Rhabdomyolysis - Hepatitis - Pancreatitis?Ezetimibe (Zetia)What class does the following drug reside in: - Gemfibrozil (Lopid)?Fibric Acid Derivatives (Fibrates)What is the MOA of the following drug: - Gemfibrozil (Lopid)?- Dec VLDL's = Dec Triglyceride - Inc HDL - NO EFFECT ON LDL-CWhat drug class has the following effect / action: - Dec VLDL's = Dec Triglyceride - Inc HDL - NO EFFECT ON LDL-C?Gemfibrozil (Lopid)What organ would be damaged when taking: - Gemfibrozil (Lopid)?- Gallbladder (Gall stones) - Muscles (Myopathy when used with Statins) - Liver (Hepatotoxicity)What drug has the following adverse effect: - Gall stones - Myopathy when used with Statins - Hepatotoxicity?Gemfibrozil (Lopid)What drugs cause a drug interaction in the following drug: - Gemfibrozil (Lopid)?- Warfarin (displaces it from albumin, thus inc ANTI-coagulation) - Statins (causes Myopathy)What is the following drug used to treat / indication: - Gemfibrozil (Lopid)?Treat cholesterol and Lipoprotein (except LDL) when dietary restriction of saturated fats failsWhat class does the following drug reside in: - Hydralazine (apresoline)?VasodilatorsWhat is the MOA of the following drug: - Hydralazine (apresoline)?- Selective dilation of ARTERIOLES - NO EFFECT ON VEINS - HR increasesWhat drug class has the following effect / action: - Selective dilation of ARTERIOLES - NO EFFECT ON VEINS - HR increases?Hydralazine (apresoline)What is the following drug used to treat / indication: - Hydralazine (apresoline)?- Essential HTN - HYPERTENSIVE CRISIS (give IV) - HFWhat are the side effects of the following drug: - Hydralazine (apresoline)?- Reflex TACHYcardia (vasodilate = less bloods = Tachycardia) - Inc blood vol - LUPUS-like syndromeWhat drug has the following adverse effect: - Reflex TACHYcardia (vasodilate = less bloods = Tachycardia) - Inc blood vol - LUPUS-like syndrome?Hydralazine (apresoline)What other drug / Therapy can the following drug can be used as an adjunct: - Hydralazine (apresoline)?Beta blockers to avoid Reflex TachycardiaWhat is the route of administration for this drug: - Hydralazine (apresoline)?- Oral - IV (for emergencies like HYPERTENSIVE CRISIS)What class does the following drug reside in: - Nitroglycerine?Vasodilators (Anti-anginal)What is the MOA of the following drug: - Nitroglycerine?Relaxes smooth muscle vasculature = Dec Preload, Afterload, and myocardial O2 consumption = Dec BP and Treats CHEST PAINWhat drug class has the following effect / action: - Relaxes smooth muscle vasculature = Dec Preload, Afterload, and myocardial O2 consumption = Dec BP and Treats CHEST PAIN?NitroglycerineWhat is the following drug used to treat / indication: - Nitroglycerine?Chest painWhat is the route of administration for this drug: - Nitroglycerine?- Sublingual tablets (give 3 every 5 min) - Sublingual spray - Topical cream - Transdermal patch (apply to hairless area) - Sustained release capsule (prevents Chest pain) - IVWhat are the side effects of the following drug: - Nitroglycerine?- HEADACHE (give analgesics) - POSTURAL HYPOTENSION - Facial Flushing - Circulatory COLLAPSEWhat drug has the following adverse effect: - HEADACHE - POSTURAL HYPOTENSION - Facial Flushing - Circulatory COLLAPSE?NitroglycerineWhat drugs cause a drug interaction in the following drug: - Nitroglycerine?- Alcohol (Hypotension) - HeparinWhat are Nursing implications when taking: - Nitroglycerine?- Give analgesics for headache - Take BP before administering and one hour after for transdermal preps - Clean area after removing patch; LOCAL BURNING IS NOT SIGNIFICANT - Unrelieved pain after 15 minutes after SL is usually indicative of an MI - SWIMMING and Bathing in PATCH is FINEWhat class does the following drug reside in: - Digoxin (digitalis)?Cardiac Glycosides (also an anti-arrhythmic/dysrhythmic)What is the MOA of the following drug: - Digoxin (digitalis)?INCREASES force of myocardial CONTRACTION = Inc Contractility (positive inotropic action) + DIURESISWhat drug class has the following effect / action: - INCREASES force of myocardial CONTRACTION = Inc Contractility (positive inotropic action) + DIURESIS?Digoxin (digitalis)What is the following drug used to treat / indication: - Digoxin (digitalis)?- Atrial fibrillation - CHFWhat drug has the following adverse effect: - Bradycardia - HEART BLOCKS + Other dysrhythmias - VISUAL disturbances - N&V - Confusion + Agitation?Digoxin (digitalis)What drugs cause a drug interaction in the following drug: - Digoxin (digitalis)?Multiple; anti-acids, antibiotics, amiodarone, verapamil, quinidine, etc.What are Nursing implications when taking: - Digoxin (digitalis)?- Take apical pulse one full minute before giving, must be above ordered parameter, usually 50-60 in adults, 60-70 in children - Check med level DAILY when first started and periodically later - HYPOKALEMIA inc TOXICITYWhat is the antidote of the following drug: - Digoxin (digitalis)?Digibind (normal is 0.5-0.8 ng/ml)What class does the following drug reside in: - Adenosine?Anti-dysrhythmic drugWhat is the MOA of the following drug: - Adenosine?Dec automaticity in the SA NODE + SLOWS conduction through AV node = Inhibits cyclic AMP-induced calcium influxWhat drug class has the following effect / action: - Dec automaticity in the SA NODE + SLOWS conduction through AV node = Inhibits cyclic AMP-induced calcium influx?AdenosineWhat are the side effects of the following drug: - Digoxin (digitalis)?- Bradycardia - HEART BLOCKS + Other dysrhythmias - VISUAL disturbances - N&V - Confusion + AgitationWhat is the following drug used to treat / indication: - Adenosine?- Wolf-Parkinson White Syndrome - Supraventricular Tachycardia (SVT)What drug has the following adverse effect: - Sinus BRADYcardia - BRONCHOCONSTRICTION? <Only brief effects>AdenosineWhat is the half-life of the following drug: - Adenosine?Short half life 1.5 to 10 secondsWhat is the route of administration for this drug: - Adenosine?Give IV bolus as close to the heart as possible.What are the side effects of the following drug: - Adenosine?Only brief - Sinus BRADYcardia - BRONCHOCONSTRICTIONWhat class does the following drug reside in: - Captopril?ACE (Angiotensin Converting enzyme) Inhibitors <Ends in -pril>What is the MOA of the following drug: - Captopril?Inhibits ACE = VasoDILATION = Lowers BP; drug of choice for pt with DM <ACE is used to convert Angio I to Angio II, which is a Vasoconstrictor>What drug class has the following effect / action: - Inhibits ACE = VasoDILATION = Lowers BP? <ACE is used to convert Angio I to Angio II, which is a Vasoconstrictor>CaptoprilWhat is the following drug used to treat / indication: - Captopril?- Hypertension - HF - MIWhat are the side effects of the following drug: - Captopril?- 1st dose Hypotension (means occurs on 1st dose) - Bradycardia - ARTHRALGIA (Pain in joint) - COUGHING - Angioedema - NEUTROPENIA + AGRANULOCYTOSIS - HYPERKALEMIA - FETAL DAMAGE - HYPOGLYCEMIAWhat drug has the following adverse effect: - 1st dose Hypotension (means occurs on 1st dose) - Bradycardia - ARTHRALGIA (Pain in joint) - COUGHING - Angioedema - NEUTROPENIA + AGRANULOCYTOSIS - HYPERKALEMIA - FETAL DAMAGE - HYPOGLYCEMIA?CaptoprilWhat lab value should be looked at when taking: - Captopril?- BP (1st dose Hypotension) - Apical pulse (Bradycardia) - BG (Hypoglycemia) - WBC (Neutropenia + Agranulocytosis) - Potassium (Hyperkalemia) <Take the top 2 lab before giving med>What are Nursing implications when taking: - Captopril?- Take labs - Report FEVER - May cause HYPOGLYCEMIA so check BGWhat class does the following drug reside in: - Losartan?Angiotensin II Receptor Blockers (ARBs)What is the MOA of the following drug: - Losartan?BLOCK access of angiotensin II to its RECEPTORS in blood vessels, adrenals, and other tissues = Causes DILATION of arteries and veinsWhat drug class has the following effect / action: - BLOCK access of angiotensin II to its RECEPTORS in blood vessels, adrenals, and other tissues = Causes DILATION of arteries and veins?LosartanWhat is the following drug used to treat / indication: - Losartan?- HTN - Diabetic retinopathy in Type 1What drug does NOT produce the following adverse effect: - Cough - Hyperkalemia - Angioedema - Renal failure?Losartan <Look at Captopril's side effect>What class does the following drug reside in: - Verapamil (calan)?Calcium Channel BlockersWhat is the MOA of the following drug: - Verapamil (calan)?Inhibits Ca ion INFLUX through SLOW channels in MYOCARDIAL MUSCLE CELLS = - DILATES CORONARY ARTERIES - INHIBITS coronary SPASM - Inc myocardial O2 delivery - Blocks influx of calcium in BOTH HEART BLOOD VESSEL = All REDUCE hr + Dec force of CONTRACTIONWhat drug class has the following effect / action: - Inhibits Ca ion INFLUX through SLOW channels in MYOCARDIAL MUSCLE CELLS = -- DILATES CORONARY ARTERIES -- INHIBITS coronary SPASM -- Inc myocardial O2 delivery -- Blocks influx of calcium in BOTH HEART BLOOD VESSEL = All REDUCE hr + Dec force of CONTRACTION?Verapamil (calan)What is the following drug used to treat / indication: - Verapamil (calan)?- HTN - Arrhytmia (Supraventricular tachycardia / SVT) - AnginaWhat are the side effects of the following drug: - Verapamil (calan)?- Dizziness, headache, fatigue, sleep disturbances - Hypotension, bradycardia, CARDIOGENIC SHOCK, severe CHF - CONSTIPATION, nausea - EDEMA IN LEGS - ELEVATED LIVER ENZYMESWhat drug has the following adverse effect: - Constipation - Cardiogenic shock, severe CHF - Edema in legs - Elevated Liver enzymes?Verapamil (calan)What lab value should be looked at when taking: - Verapamil (calan)?- Liver enzymes: ALT + AST - BP + HR (before giving)What drugs cause a drug interaction in the following drug: - Verapamil (calan)?- GRAPEFRUIT juice - Digoxin (inc digoxin's levels) - Other antihypertensivesWhat are Nursing implications when taking: - Verapamil (calan)?- Take labs - Liver and Kidney fx test - Avoid Grapefruit juice - Report WEIGHT GAINWhat class does the following drug reside in: - Nifepidine (procardia)?Calcium Channel BlockersWhat is the MOA of the following drug: - Nifepidine (procardia)?Prevents calcium influx into the slow calcium channels. However, UNLIKE VERAPAMIL, it works only on the ARTERIES not the heart itselfWhat drug class has the following effect / action: - Prevents calcium influx into the slow calcium channels. - Works only on the ARTERIES not the heart itself?Nifepidine (procardia)What are the side effects of the following drug: - Nifepidine (procardia)?- Edema - Flushing - Headache + Dizziness - REFLEX TACHYCARDIAWhat drug has the following adverse effect: - Edema - Flushing - Headache + Dizziness - REFLEX TACHYCARDIA?Nifepidine (procardia)What class does the following drug reside in: - Atropine?Cholinergic Drugs / Muscarinic antagonistsWhat is the MOA of the following drug: - Atropine?Muscarinic antagonists selectively block the effects of ACETYLCHOLINE at the muscarinic receptors = Inc hrWhat drug class has the following effect / action: - Muscarinic antagonists selectively block the effects of ACETYLCHOLINE at the muscarinic receptors = Inc hr?AtropineWhat is the following drug used to treat / indication: - Atropine?- BRADYcardia (in ICU) - During surgery to prevent bradycardiaWhat are the side effects of the following drug: - Atropine?- TACHYCARDIA - Dry mouth, blurred vision and photophobia (insensitive to light) - Inc intraocular pressure (avoid in glaucoma), urinary retention; anhidrosis (inability to sweat)What drug has the following adverse effect: - TACHYCARDIA - Dry mouth, blurred vision and photophobia (insensitive to light) - Inc intraocular pressure (avoid in glaucoma), urinary retention; anhidrosis (inability to sweat)?AtropineWhen is the following drug contraindicated: - Atropine?- Tachycardia - Glaucoma (inc intraocular pressure) - Avoid working in hot weather b/c one side effect is Anhidrosis (lack of sweat)What drugs cause a drug interaction in the following drug: - Atropine?- Antihistamines - Phenothiazine antipsychotics - Tricyclic antidepressantsWhat is the proper dosage (or how often) for this drug: - Atropine?- 0.4 mg PO - 0.5-1 mg IV infusion (diluted) or IMWhere are the following Adrenergc (sympathetic) receptors located (and what do they do): - Alpha 1?- Arterioles and veins - ConstrictionWhere are the following Adrenergc (sympathetic) receptors located (and what do they do): - Beta 1?- Heart and Kidney - Heart = Inc rate, force contract, AV conduction - Kidney = Release ReninWhere are the following Adrenergc (sympathetic) receptors located (and what do they do): - Beta 2?- Lungs, specifically Bronchi (also in arterioles, heart, skeletal muscles) - DilationIs the following an action of an Alpha receptor or Beta receptor: - Constriction of arterioles and veins?Alpha receptor So blocker (PrazOSIN) would VasodilateIs the following an action of an Alpha receptor or Beta receptor: - Increase rate, force of contraction, AV conduction speed of the Heart?Beta receptor So blocker (PropranoLOL & MetoproLOL) reduce hr, peripheral resistance, force of contraction and AV reductionWhat class does the following drug reside in: - Prazosin (Minipress)?Alpha adrenergic antagonists (Sympatholytics) <Despite its name, it's an antagonist to sympathetic receptors>What is the MOA of the following drug: - Prazosin (Minipress)?Inhibits ALPHA 1 receptors in ARTERIOLES and VEINS = VASODILATION = DEC BP & COWhat drug class has the following effect / action: - Inhibits ALPHA 1 receptors in ARTERIOLES and VEINS = VASODILATION = DEC BP & CO?Prazosin (Minipress)What is the following drug used to treat / indication: - Prazosin (Minipress)?- Essential Hypertension - Benign prostatic hyperplasia (BPH) - Raynaud'sWhat are the side effects of the following drug: - Prazosin (Minipress)?Vasodilation can cause - Dizziness, headaches, drowsiness - Erectile dysfunction / IMPOTENCE (inhibits ejaculation) - Reflex TACHYCARDIA (trying to fix) - Nasal congestion - Edema - Postural hypotensionWhat drug has the following adverse effect: - Vasodilation that can cause: -- Dizziness, headaches, drowsiness -- Erectile dysfunction / IMPOTENCE (inhibits ejaculation) -- Reflex TACHYCARDIA (trying to fix) -- Nasal congestion -- Edema -- Postural hypotension?Prazosin (Minipress)What drugs cause a drug interaction in the following drug: - Prazosin (Minipress)?- Diuretics - Hypotensive agents <Both potentiate effects>What are Nursing implications when taking: - Prazosin (Minipress)?B/c of Postural hypotention and other side effects, have pt LIE FLAT and take it at NIGHT TIMEWhat class does the following drug reside in: - Propranolol?1st generation Beta Adrenergic Antagonists (Beta Blockers)What is the MOA of the following drug: - Propranolol?Blocks receptors in: - Cardiac (beta 1) - Lungs (beta 2) - Renal (beta 1) suppresses renin secretion = Antihypertensive, reduces HR & CO in MI, CAD, HTN, cardiac dysrhythmiasWhat drug class has the following effect / action: - Blocks receptors in: -- Cardiac (beta 1) -- Lungs (beta 2) -- Renal (beta 1) suppresses renin secretion = Antihypertensive, reduces HR & CO in MI, CAD, HTN, cardiac dysrhythmias?PropranololWhat is the following drug used to treat / indication: - Propranolol?- MI - CAD - Hypertension - Cardiac dysrhythmiasWhat are the side effects of the following drug: - Propranolol?Reducing HR & CO can lead to: - Hypotension - BRADYcardia (MASKS TACHYCARDIA IN HYPOGLYCEMIA) - BRONCHOCONSTRICTION (receptors in the lungs) - May rarely cause depressionWhat drug has the following adverse effect: - Reducing HR & CO can lead to: -- Hypotension -- BRADYcardia (MASKS TACHYCARDIA IN HYPOGLYCEMIA) -- BRONCHOCONSTRICTION (receptors in the lungs) -- May rarely cause depression?PropranololWhat are Nursing implications when taking: - Propranolol?- Don't give to pt with Bronchitis, COPD - Take Apical pulse and bp before administering (don't give if pulse is <60 or BP <90-110, call physician) - May mask TACHYCARDIC S/S in HYPOGLYCEMIAWhat lab value should be looked at when taking: - Propranolol?- Apical pulse - BPWhat drugs cause a drug interaction in the following drug: - Propranolol?Ca channel blockers (may cause cardiac suppression = VERY LOW hr + bp)What is the route of administration for this drug: - Propranolol?PO, sometimes IVWhat class does the following drug reside in: - Metoprolol (Lopressor, Toprol XL)?2nd generation Selective B1 Blocker (cardiac)What is the MOA of the following drug: - Metoprolol (Lopressor, Toprol XL)?- Blocks B1 cardiac receptors in HEART = Reduces hr, force of contraction, AV duration through the node - Also reduces secretion of reninWhat drug class has the following effect / action: - Blocks B1 cardiac receptors in HEART = Reduces hr, force of contraction, AV duration through the node - Also reduces secretion of renin?Metoprolol (Lopressor, Toprol XL)What is the following drug used to treat / indication: - Metoprolol (Lopressor, Toprol XL)?- Hypertension (#1 choice) - Angina - MI - Heart failureWhat are the side effects of the following drug: - Metoprolol (Lopressor, Toprol XL)?- BRADYcardia - Reduce CO - AV heart block - HEART FAILURE (ironic because this drug treats heart failure)What drug has the following adverse effect: - BRADYcardia - Reduce CO - AV heart block - HEART FAILURE (ironic because this drug treats heart failure)?Metoprolol (Lopressor, Toprol XL)What is the route of administration for this drug: - Metoprolol (Lopressor, Toprol XL)?- Immediate and Sustained release oral tablets - Also IVWhat class does the following drug reside in: - Clonidine (Catapres)?Central Acting Alpha 2 agonistsWhat is the MOA of the following drug: - Clonidine (Catapres)?Activates the central alpha 2 receptors in the BRAINSTEM = DEC Sympathetic outflow to blood vessels and the heartWhat drug class has the following effect / action: - Activates the central alpha 2 receptors in the BRAINSTEM = DEC Sympathetic outflow to blood vessels and the heart?Clonidine (Catapres)What is the following drug used to treat / indication: - Clonidine (Catapres)?- Hypertension - Sometimes painWhat are the side effects of the following drug: - Clonidine (Catapres)?Dec outflow of blood vessel + heart leads to: - Drowsiness + Sedation + Euphoria (thus can be abused) + Hallucinations - Xerostomia (dry mouth) + Constipation - Impotence - Rebound HypertensionWhat is the route of administration for this drug: - Clonidine (Catapres)?- Oral - Transdermal (Q7Days)What is the normal urine output?>30 mL/hrWhat class does the following drug reside in: - Furosemide (Lasix)?Loop DiureticWhat is the following drug used to treat / indication: - Furosemide (Lasix)?Very powerful diuretic given for massive movement of fluids, usually for both ACUTE (IV) & CHRONIC (oral) HEART FAILURE. So powerful that if a weaker diuretic like Thiazide can be used, do so.What is the MOA of the following drug: - Furosemide (Lasix)?- Rapid acting - Inhibits Na and Cl reabsorption in ASCENDING Loop of Henle = Dec edema + bpWhat drug class has the following effect / action: - Inhibits Na and Cl reabsorption in ASCENDING Loop of Henle?Furosemide (Lasix)What are the side effects of the following drug: - Furosemide (Lasix)?- POSTURAL HYPOTENSION - Loss of K, Na, Mg, Cl = HypoKALEMIA, HypoATREMIA, HypoCHLOREMIA - N&V - Dehydration (it is a diuretic) - Tinnitus (ear ringing) - Aplastic anemia - Circulatory collapse (most likely from hypovolemia)What drug has the following adverse effect: - POSTURAL HYPOTENSION - Tinnitus (ear ringing); this drug is ototoxic - Aplastic anemiaFurosemide (Lasix)What lab value should be looked at when taking: - Furosemide (Lasix)?Before administering - Potassium (3.5-5.0) - BP (>110/60) - Daily weight (losing water) After administering - CBC (Aplastic anemia)What are Nursing implications when taking: - Furosemide (Lasix)?- Avoid using rapid IV, can cause CARDIAC ARREST - Monitor for hypotension (due to hypovolemia) & circulatory collapseWhat is the proper dosage (or how often) for this drug: - Furosemide (Lasix)?- Oral (Chronic HF), IV (Acute HF), IM - 20-80 mg - IV action starts in 5 min and lasts for 2 hrWhat drugs cause a drug interaction in the following drug: - Furosemide (Lasix)?- Digoxin (due to low Potassium, which enhances this drug = Toxicity = Dysrhythmias) - OTOTOXIC drugs like aminoglycosides (affects equilibrium and hearing) - LITHIUM (causes high Na levels) - Antihypertensives (hypotension)What organ would be damaged when taking: - Furosemide (Lasix)?Ear, this drug is OtotoxicWhat class does the following drug reside in: - Hydrochlorothiazide (Hydrodiuril)?ThiazidesWhat is the MOA of the following drug: - Hydrochlorothiazide (Hydrodiuril)?Blocks reabsorption of Na and Cl in early segment of the DISTAL convoluted tubuleWhat drug class has the following effect / action: - Inhibits reabsorption of Na and Cl in early segment of the DISTAL convoluted tubule?Hydrochlorothiazide (Hydrodiuril)What are Nursing implications when taking: - Hydrochlorothiazide (Hydrodiuril)?Drug not effective if there is low GFR < 15-20 ml/minWhich drug is not effective if there is low GFR < 15-20 ml/min?Hydrochlorothiazide (Hydrodiuril)What is the following drug used to treat / indication: - Hydrochlorothiazide (Hydrodiuril)?- HYPERTENSION (this is 1st choice drug especially in African Americans) - Heart failure - Edema associated with hepatic or renal diseaseWhat are the side effects of the following drug: - Hydrochlorothiazide (Hydrodiuril)?- HypoATREMIA - HypoCHLOREMIA - HypoKALEMIA - Dehydration - Inc BG - Precipitate gouty arthritisCan the following drug be administered to pregnant women safely: - Hydrochlorothiazide (Hydrodiuril)?- Can cross placental barrier causing severe harm and is contraindicated during pregnancy - Also can enter breast milkWhat drugs cause a drug interaction in the following drug: - Hydrochlorothiazide (Hydrodiuril)?- Digoxin (due to K loss) - Other anti-hypertensives = Cause hypotensionWhat class does the following drug reside in: - Mannitol (Osmitrol)?Osmotic diuretic (only one in USA)What is the MOA of the following drug: - Mannitol (Osmitrol)?- In the PROXIMAL convoluted tubule, creates osmotic action = INHIBITS passive REABSORPTION OF WATER - NO significant EFFECT on EXCRETION OF POTASSIUMWhat drug class has the following effect / action: - Inhibits passive REABSORPTION OF WATER - NO significant EFFECT on EXCRETION OF POTASSIUM?Mannitol (Osmitrol)What is the following drug used to treat / indication: - Mannitol (Osmitrol)?- Prevent/slow onset of RENAL FAILURE in SEVERE HYPOTENSION, HYPOVOLEMIC shock - Can reduce INTRACRANIAL PRESSURE caused by cerebral edema - Reduce INTRAOCULAR PRESSUREWhat are the side effects of the following drug: - Mannitol (Osmitrol)?- Headache - N&V - Electrolyte imbalance possible - Pulmonary EDEMA - Congestive heart failure EDEMA (which is ironic b/c this drug treats Cerebral edema)What drug has the following adverse effect: - Headache - N&V - Electrolyte imbalance possible - Pulmonary EDEMA - Congestive heart failure EDEMA (which is ironic b/c this drug treats Cerebral edema)?Mannitol (Osmitrol)What is the proper dosage (or how often) for this drug: - Mannitol (Osmitrol)?- Solutions are 5-25% and usually crystallized - Warm in water - Administer per IV infusion to obtain urine flow rate of 30-50mlWhat drugs are considered Potassium Sparing Diuretics?- Aldosterone antagonists = Spironolactone - Nonaldosterone antagonists = Triamterine + AmilorideWhat class does the following drug reside in: - Spironolactone (Aldactone)?Aldosterone antagonists / Potassium Sparing DiureticsWhat is the MOA of the following drug: - Spironolactone (Aldactone)?- Blocks action of ALDOSTERONE in the DISTAL nephron (works Indirectly) - Since aldosterone promotes Na uptake in exchange for K secretion = Inhibition of aldosterone causes RETENTION of K and EXCRETION of Na (low diuresis compared to Loop or Thiazide)What drug class has the following effect / action: - Blocks action of ALDOSTERONE in the DISTAL nephron (works Indirectly) = RETENTION of K and EXCRETION of Na?Spironolactone (Aldactone)What is the following drug used to treat / indication: - Spironolactone (Aldactone)? <Just like Triamterine (Dyrenium)>- Hypertension - EdemaWhat other drug / Therapy can the following drug can be used as an adjunct: - Spironolactone (Aldactone)?Loop or Thiazide diuretic because of low diuresisWhat are the side effects of the following drug: - Spironolactone (Aldactone)?- HYPERKALEMIA, >5.0; treat with INSULIN - Fatal CARDIAC DYSRHYTHMIAS like Ventricular Fib that can lead to cardiac arrest - Gynecomastia (men boobs) - Menstrual irregularitiesWhat drug has the following adverse effect: - HYPERKALEMIA, >5.0; treat with INSULIN (this is a K sparing drug) - Fatal CARDIAC DYSRHYTHMIAS like VFib - Gynecomastia (men boobs) - Menstrual irregularities?Spironolactone (Aldactone)What lab value should be looked at when taking: - Spironolactone (Aldactone)?PotassiumWhat are Nursing implications when taking: - Spironolactone (Aldactone)?Avoid potassium, salt substitutes, or another potassium sparing drugWhat class does the following drug reside in: - Triamterine (Dyrenium)?Non-Aldosterone Sparing Diuretic / Potassium Sparing DiureticsWhat is the MOA of the following drug: - Triamterine (Dyrenium)?Disrupts sodium-potassium exchange DIRECTLY in the distal nephron = Spares potassiumWhat drug class has the following effect / action: - Disrupts sodium-potassium exchange DIRECTLY in the distal nephron = Spares potassium?Triamterine (Dyrenium)What is the following drug used to treat / indication: - Triamterine (Dyrenium)? <Just like Spironolactone (Aldactone)>- Hypertension - EdemaWhat other drug / Therapy can the following drug can be used as an adjunct: - Triamterine (Dyrenium)?Loop Diuretic like Furosemide Lasix to counteract their potassium wasting effectsWhat are the side effects of the following drug: - Triamterine (Dyrenium)?HYPERkalemia = - NAUSEA & VOMITING - Leg CRAMPS - DizzinessWhat drug has the following adverse effect: - Hyperkalemia = -- NAUSEA & VOMITING -- Leg CRAMPS -- Dizziness?Triamterine (Dyrenium)What drugs cause a drug interaction in the following drug: - Triamterine (Dyrenium)?- ACE inhibitors - Angiotensin II receptor blockers (ARBS) - Direct renin inhibitorsWhat dec the levels of Potassium in the body?- Prolonged DIURESIS - Vomiting - Diarrhea - Wound drainage - DKABecause Potassium cannot be pushed in an IV line (can be mixed into a bag solution), what is the max rate?No faster than 10 meq per hour <More than 10 = Dead>What is the usual dose of a potassium IV bag?- 10 meq in 100 mL - 40 meq in 500-1000 mLWhat are Nursing implications when taking: - Potassium supplementation via IV?- No faster than 10 meq per hour - Check K level before giving each dose (X3) - Mix K well in the IV solutionWhat are Nursing implications when taking: - Potassium supplementation via oral pill?- Large pill so give with water - Pt has to SIT UPWhat are Nursing implications when taking: - Potassium supplementation via oral liquid?Dilute in orange juice according to directionsWhat are the side effects of the following drug: - Potassium supplementation (Oral in this case)?- GI irritation = Abd discomfort, N&V, diarrhea, SEVERE INTESTINAL ULCERS = Bleeding and perforation - Cardiac dysrhythmiasWhat are findings in Hyperkalemia when the level is: - Mild = 5-7? - Severe = >7?Cardiac dysrhythmias - Mild = Prolonged PR, Tented t waves - Severe = Cardiac arrest due to V-tach or V-FibFill in the blank: Steps to remove excess potassium includes: 1. Withhold potassium containing foods/meds, including potassium sparing diuretics like __(1)__ 2. Infuse __(2)__ to counteract cardiotoxicity 3. Infuse __(3)__ and __(4)__ to push potassium intracellularly 4. Infuse __(5)__ to increase ph and increase cellular intake of potassium 5. Give either oral or by enema __(6)__ (sodium polyesterene sulfonate), an exchange resin that removes K 6. Do peritoneal or hemo__(7)__ to remove potassium1) Spironolactone (Aldactone) and Triamterine (Dyrenium) 2) Calcium gluconate 3) Insulin 4) Glucose 5) Sodium bicarbonate 6) Kayexalate 7) DialysisWhat two drugs in this module causes: - Hyperkalemia?- Spironolactone (Aldactone) - Triamterine (Dyrenium)What two drugs in this module causes: - Hypokalemia - Hypoatremia - Hypochloremia?- Furosemide (Lasix) - Hydrochlorothiazide (Hydrodiuril)What body systems is calcium necessary for?- Skeletal (structural integrity of bones) - Neuro-muscular (muscular contraction + neurological excitation) - Cardiac (cardiac contraction + blood coagulation)What are dietary sources of Ca?- Milk products - Broccoli + Spinach - Fortified foods like orange juice and cerealsWhat are examples of Ca salts that can administered via IV?- Calcium gluconate - Calcium Chloride <Both are for Cardiac>What is the functions of the following drug: - Vitamin D?- Serves as a cofactor with PTH to increase GI absorption of Calcium - Inc PTH-mediated osteoCLAST maturationWhat is the following drug used to treat / indication: - Vitamin D?Treats and Prevents: - Postmenopausal osteoporosis - Renal osteodystrophyWhat are the forms of Vitamin D and which is the active and inactive form?- D2 = Inactive (converted into D3 in the Kidney) - D3 = ActiveWhat is the primary sources of Vitamin D?- Sunlight (15-20 min) - Fatty fish - Some in mushrooms (D2) - Small amounts in egg yolk, cheese, beef liver - Fortified foods are milk, infant formula (Breast milk is NOT enough), breakfast cereals, some brands orange juice, yogurtWhat is the recommended blood level of: - Vitamin D?12-20 ng/dL (>50 = Toxic)What type of people are at risk of Vit D deficiency?- Children, especially when not outside - Breast fed infants (supplement with Formula) - Older people - People with DARK skin - People with fat malabsorption syndrome - Obese - Pt with gastric bypassWhich drug has the following dosage: - 400-800 mg/day?Vitamin DWhere is Calcitonin produced in the body?Thyroid glandWhat is the functions of the following drug: - Calcitonin?Reduce Ca levels when too high; DOES NOT affect Ca absorptionWhat is the recommended blood level of: - Calcium?8.5-10.5 mg/dLWhat is the MOA of the following drug: - Calcitonin-Salmon?- Dec bone RESORPTION by inhibiting activity of osteoclasts - Inc Ca excretion by inhibiting renal tubule resorptionWhat is the following drug used to treat / indication: - Calcitonin-Salmon?- Treats Postmenopausal osteoporosis (like Vit D) but DOES NOT PREVENT it (unlike Vit D) - Paget's DiseaseWhat are the side effects of the following drug: - Calcitonin-Salmon?- Nausea that DIMINISHES over time - Flushing of face + hands - Injection site reactions - Pt can develop antibodies that can last a year = Drug won't work for a yearWhat is the drug classification of the following drug: - Alendronate (Fosamax)?BisphosphonatesWhat is the MOA of the following drug: - Alendronate (Fosamax)?Suppresses bone resorption by decreasing both the NUMBER AND ACTIVITY of osteoclastsWhat is the following drug used to treat / indication: - Alendronate (Fosamax)?- Osteoporosis in men & postmenopausal women - Glucocorticoid-induced Osteoporosis - Paget's diseaseWhat are the side effects of the following drug: - Alendronate (Fosamax)?- Esophagitis - Atypical femur fracture (ironic considering what it's treating) - Ocular inflammation - Osteonecrosis of the jawWhat organ is damaged when taking: - Alendronate (Fosamax)?- Esophagus (inflam) - Bones (Fracture) - Eyes (inflam)What are Nursing implications when taking: - Alendronate (Fosamax)?Take with full glass of water in MORNING BEFORE BREAKFAST; 30-60 before consuming food/fluidWhat is the MOA of the following drug: - Raloxifene (Evista)?Structurally similar to Estrogen = Binds to estrogen receptors in some tissues (agonist), but acts as antagonist in others (Estrogen is an agonist in all tissues)Which tissues does Raloxifene (Evista) acts as an Estrogen agonist? Antagonist?- Agonist = Bone, Lipid and Blood clotting - Antagonist = Breast and EndometriumWhat is the following drug used to treat / indication: - Raloxifene (Evista)?Prevention and treatment of - Postmenopausal osteoporosis - Estrogen receptor breast cancerWhat are the side effects of the following drug: - Raloxifene (Evista)?- Thromboembolism - FETAL HARM = Category X - Hot flushesWhat are Nursing implications when taking: - Raloxifene (Evista)?- Take adequate intake of calcium and Vitamin D along with this drug - Don't give to pregnant womenWhat are the route of administration for these drugs: - Vitamin D - Calcitonin-Salmon - Alendronate (Fosamax) - Raloxifene (Evista)?- Calcitonin-Salmon = Nasal + Injection - Alendronate = OralWhich of the following drugs in this section can be taken with food & which cannot: - Vitamin D - Calcitonin-Salmon - Alendronate (Fosamax) - Raloxifene (Evista)?Alendronate must be taken in Morning 30-60 min before BreakfastWhich of the following drugs can be administered to a pregnant woman safely & which cannot: - Vitamin D - Calcitonin-Salmon - Alendronate (Fosamax) - Raloxifene (Evista)?Raloxifene causes Fetal harm = Category XWhat is the RDA of Vitamin D?600 IU/day for all age group (including pregnancy) EXCEPT FOR those >70 who need 800 IU/dayWhat age group has a RDA of Calcium of: - 700 mg/day?1-3 years oldWhat age group has a RDA of Calcium of: - 1000 mg/day?- 4-8 years old - 19-50 years old - 51-70 years old Males - 19-50 years old PregnantWhat age group has a RDA of Calcium of: - 1200 mg/day?- 51-70 years old Females - >70 years oldWhat age group has a RDA of Calcium of: - 1300 mg/day?- 9-18 years old - 14-18 years old PregnantWhat describes: - Physiologic process of stopping bleeding due to blood vessel injury; injury can be internal or external?HemostasisDoes Anticoagulants treat or prevent clots?Prevents blood clotsFill in the blank: In stage One of Hemostatsis: - Adhesion of the __(1)__ to blood vessel collagen due to __(2)__ of the intima - Platelets release __(3)__ - Endothelial wall releases __(4)__ - __(3)__ release results in massive __(5)__ and formation of a platelet plug - GP IIB/IIIa receptors on the platelets must be reconfigured in order to bind with __(6)__1) Platelets 2) Injury 3) Thromboxane A2 4) Prostacyclin 5) Platelet aggregation (& Vasoconstriction) 6) FibrinogenFill in the blank: In stage Two of Hemostatsis: The coagulation stage starts with the production of __(1)__, which is produced by two pathways (__(2)__). In this stage __(3)__is converted into __(4)__. And __(5)__ are activated.1) Fibrin 2) Intrinsic & Extrinsic 3) Prothrombin 4) Thrombin 5) Tissue Factors (VII, VIII, IX , XII etc.)What type of Prostaglandins are there?- Thromboxane A2 released by the Platelets - Prostacyclin released by the Endothelial wallWhat describes: - Type of Prostaglandin - Released by the Platelets - Causes VasoCONSTRICTION + Platelet aggregation?Thromboxane A2What describes: - Type of Prostaglandin - Released by the Endothelial wall - Causes VasoDILATION?ProstacyclinWhat are drugs that activate anti-thrombin; Anticoagulants?- Heparin (Unfractionated Heparin) - Low Molecular weight heparins (LMW) = LovenoxWhat is the drug classification of the following drug: - Heparin?AnticoagulantsWhat is the MOA of the following drug: - Heparin?Suppresses coagulation by helping anti-thrombin inactivate clotting factors, mainly Thrombin and factor XaWhat is the following drug used to treat / indication: - Heparin?- Pulmonary embolism - Evolving stroke + MI - DVT + Prevention of DVT - DIC (bleeding + clotting at the same time) - Open heart surgery + Renal dialysis + After surgery especially in of bedrest for extended timeWhat lab value should be looked at when taking: - Heparin?- aPTT before giving med - Bp (don't give for low levels) - ThrombocytopeniaWhat are Nursing implications when taking: - Heparin?- Get lab (aPTT & Bp) - Check aPTT every q6-8h if on continuous IV - Chart where injected so Injection site can be rotated - Check for the following for HEMORRHAGE: -- Broken capillaries in the eyes -- Bruising + Petechiae + Hematomas -- Blood in stools/urine + Bloody noseHow often should aPTT be checked for Heparin and What is the lab value for the pt?- Measure Q6-8H if on Continuous IV Heparin - Pt's value should be 1.5-2x Control = 60-90 secondsWhat are the side effects of the following drug: - Heparin?- Hemorrhage (check aPTT) - Spinal/Epidural hematoma (especially if using Epidural catheter, anticoagulants, or antiplatlet drugs, Hx of spinal trauma) - Heparin induced ThrombocytopeniaFill in the blank: Heparin Induced __(1)__ is an immune mediated disorder with __(1)__ and a paradoxical __(2)__ in thrombotic events. The underlying cause is development of __(3)__ which in turn __(4)__ platelets and __(5)__ the vascular endothelium; can cause death1) Thrombocytopenia 2) Increase 3) Antibodies against Heparin 4) Activates 5) DamageWhen is the following drug contraindicated: - Heparin?- Thrombocytopenia - Uncontrolled bleeding + Hemophilia - Pt w/ eye, brain or spinal cord surgeryWhat is the antidote of: - Heparin?- Protamine sulfate - Slow IV injection (20 mg/min or 50mg/ every 10 minutes) - Binds with heparin to neutralize anticoagulation action, up to TWO hoursWhat is the antidote of: - Lovenox?- Protamine sulfate - Slow IV injection (20 mg/min or 50mg/ every 10 minutes) - Binds with heparin to neutralize anticoagulation action, up to TWO hoursFill in the blank: Heparin SubQ can only be given in the __(1)__ but no closer than __(2)__ from the umbilicus. Draw up with one needle and then change to __(3)__ needle. Do not __(4)__. __(5)__ on site for up to one minute but do NOT __(6)__. Injection site must be rotated and many hospitals require a chart to designate where given.1) Abdomen 2) 2 inches 3) 25 gauge ½ inch or 5/8 inch 4) Aspirate 5) KEEP PRESSURE 6) MassageWhat is the drug classification of the following drug: - Lovenox?Low Molecular Weight HeparinFill in the blank: With Lovenox being a LMW Heparin and being compared to Heparin, Lovenox: - Has a __(1)__, no __(2)__, longer half-life (than Heparin) - Can be __(3)__1) Fixed dose 2) Blood monitoring 3) Taught to inject at home (Heparin can't be used in a home environment)What is the MOA of the following drug: - Lovenox?The molecules are short and do not have quite the same effect as unfractionated heparin. LMW Heparin does not inactivate thrombin as well as heparin canWhat are the side effects of the following drug: - Lovenox?- Heparin induced Thrombocytopenia - Bleeding - Permanent PARALYSIS when undergoing spinal puncture/anesthesiaWhich of the following drugs is more expensive: - Heparin - Lovenox?Lovenox cost $63/day compared to $8/day for unfractionated heparin but no blood monitoring for lovenox tends to level out the costs.What are the route of administration for these drugs: - Heparin - Lovenox?- Heparin = IV (continuous & push), SubQ, Hep lock/Hep flush (100 units/mL for flush) - Lovenox = SubQ in abdomen, based on body weightWhich drug has the following dosage: - 5000-10000 units q6h IV or SubQ - 25000 per 500 mL IV - 100 units/mL for Hepflush?HeparinWhat are the half-life of the following drugs: - Heparin - Lovenox?- Heparin = 1.5 hr (unless Hepatic/Renal damage) - Lovenox is longerWhat is the MOA of the following drug: - Warfarin (coumadin)?- Suppresses coagulation by dec production of factors VII, IX, X and Prothrombin, all of which need Vitamin K to be produced - Inhibits the enzyme (VKORC1) needed to convert Vitamin K to the active form - Does NOT inhibit Vitamin K action directlyWhat is the following drug used to treat / indication: - Warfarin (coumadin)?- Long term PREVENTION (Not treatment) of thrombosis; especially pts with prosthetic heart valves - Prevention of clotting in Atrial fibrillation - Dec the risk of TIA's and recurrent MI'sWhat lab value should be looked at when taking: - Warfarin (coumadin)?- Prothrombin Time (PT; very sensitive to alterations in Vitamin K levels) - INR now more commonly used (despite being less accurate); corrects for thromboplastin variabilityWhat is the desired ranges of the following labs when taking Warfarin (coumadin): - Prothrombin Time (PT) - INR?- PT = 12-14 sec; desired level is 1.5-2x control (changes quickly = More accurate; used to adjust dosage) - INR = 2-3x normal (Norm = 0.8-1.2), may be higher (Takes a week to change)What are the side effects of the following drug: - Warfarin (coumadin)?- Hemorrhage - Damages fetus = Bleeding + Death (so use Heparin for pregnant women)Why would a pt be on Heparin and Warfarin at the same time?- B/c heparin starts quick, Coumadin takes a week to reach it's therapeutic dosage level. Eventually stop heparin and keep the oral Coumadin. - If have HEART SURGERY w/ ARTIFICIAL VALVE, use bothWhy does Warfarin have so many drug interactions?B/c it's an albumin-bound drug; doesn't mean to stop one drug, can adjust to lower dosage and give both drugs at the same timeWhat drug dec the effects of Warfarin?Cephalosporins (antibiotic)What are Nursing implications when taking: - Warfarin (coumadin)?- Have pt wear medical alert bracelet - Monitor blood levels - Do not give to preg nor those who wish to be preg - HOLD BEFORE SURGERY (1-2 WEEKS); discuss w. surgeon - Keep Vit K consumption at at CONSTANT LEVEL, do not changeWhat contains Vitamin K?- Green leafy vegetables - Mayo - Canola + Soybean oilWhat is the antidote for Warfarin (coumadin)?Vitamin KWhat is the drug classification of the following drug: - Dabigastran etexilate (Pradaxa)?Reversible, Direct Thrombin InhibitorWhat advantages does the following drugs have over Warfarin: - Dabigastran etexilate (Pradaxa) - Rivaroxaban (Xarelto)?Both have: - Rapid onset - No need to monitor anticoagulation effect; No need to monitor INR - Few drug-food interactions - Lower risk of major bleeding - Fixed dosageWhat is the following drug used to treat / indication: - Dabigastran etexilate (Pradaxa)?- Atrial fibrillation - Prevention of stroke, systemic embolism with nonvalvular atrial fibrillationWhat are the side effects of the following drug: - Dabigastran etexilate (Pradaxa)?- Bleeding (so stop before surgery; no Antidote) - DyspepsiaWhat drugs cause a drug interaction in the following drug: - Dabigastran etexilate (Pradaxa)?All cause bleeding due to inc blood levels - Ketoconazole - Amiodarone - Verapmil - QuinidineWhat are Nursing implications when taking: - Dabigastran etexilate (Pradaxa)?- Can be taken with or without food (fine with Grapefruit juice) - Do NOT crush or chew - Prevent exposure to moisture, heat - Caps won't last more than 30-60 days depending on the research studyWhat is the MOA of the following drug: - Rivaroxaban (Xarelto)?Directly Inhibits Factor Xa (activated Factor X) = Inhibits production of thrombinWhat is the following drug used to treat / indication: - Rivaroxaban (Xarelto)?- Prevention of DVT and PE following total hip or knee replacement surgery - Prevention of stroke in patients with A FibWhat are the side effects of the following drug: - Rivaroxaban (Xarelto)?- Bleeding in those with Hepatic & Renal impairment - Spinal/Epidural hematomas - Permanent paralysisWhat are the route of administration for these drugs: - Warfarin (coumadin) - Dabigastran etexilate (Pradaxa) - Rivaroxaban (Xarelto)?- Warfarin = Oral - Dabi = Oral - Riva = OralWhich of the following drugs can be administered to a pregnant woman safely & which cannot: - Warfarin (coumadin) - Dabigastran etexilate (Pradaxa) - Rivaroxaban (Xarelto)?- Warfarin = Fetal bleeding, death, and teratogenesis - Riva = Do not use in pregnancyWhich drug has the following dosage: - 2.0-10 mg/day?Warfarin (coumadin)Which drug has the following dosage: - 75 or 150 mg BID?Dabigastran etexilate (Pradaxa)Which of the following drugs binds with Albumin: - Warfarin (coumadin) - Dabigastran etexilate (Pradaxa) - Rivaroxaban (Xarelto)?- Warfarin (coumadin) - Rivaroxaban (Xarelto)Which of the following drugs in this section can be taken with food & which cannot: - Warfarin (coumadin) - Dabigastran etexilate (Pradaxa) - Rivaroxaban (Xarelto)?- Dabi = Absorption delayed by food, but does not prevent - Riva = Uses cytochrome P450What is the drug classification of the following drug: - Aspirin?Anti-platelet AggregatorsWhat is the MOA of the following drug: - Aspirin - Clopidogrel (Plavix); similar to aspirin?- Prevents platelet aggregation (clot formation) by suppressing production of an enzyme necessary for platelets to produce Thromboxane A2 (a prostaglandin) - Inhibits synthesis of Prostacyclin from the endothelium of the arterial cell wall but as long as dosage is kept low this is NOT a problemWhat is the following drug used to treat / indication: - Aspirin?- PRIMARY Prevention of MI (reason most men >40 & women >70 are on this) - Prevention of recurrence of MI - Reduces risk of death from strokes & TIA's - Reduces risk of sudden death in USA - Prevents reocclusion during coronary stenting (PCI)What are the side effects of the following drug: - Aspirin?- GI bleeding - Hemorrhagic stroke <Thus usage of enteric coated ASA is advocated but does not always work>What other drug / Therapy can the following drug can be used as an adjunct: - Aspirin?- Proton pump inhibitor to reduce gastric acidity - Clopidogrel (Plavix) after PCI (coronary stenting) to prevent thrombotic events - Abciximab (Reopro) to promote revascularization in pt undergoing thrombolytic therapy, acute MI and/or PCIWhat is the drug classification of the following drug: - Clopidogrel (Plavix)?P2Y12 Adenosine Diphosphate Receptor Blockers (ADP)What other drug / Therapy can the following drug can be used as an adjunct: - Clopidogrel (Plavix)?Aspirin after PCI (coronary stenting) to prevent thrombotic eventsWhat is the following drug used to treat / indication: - Clopidogrel (Plavix)?- Given for six months to 2 years after the acute coronary event or procedure - Prevents occlusion of coronary stents (give along with aspirin)What are the side effects of the following drug: - Clopidogrel (Plavix)?- Bleeding + Bruising + Anemia - Thrombocytopenia - Renal dysfunction - Fever <Usually occurring within the FIRST TWO WEEKS OF THERAPY>What organ would be damaged when taking: - Clopidogrel (Plavix)?Kidney (cause renal dysfunction)What is the drug classification of the following drug: - Ticagrelor (Brilinta)?P2Y12 Adenosine Diphosphate Receptor Blockers (ADP)What is the MOA of the following drug: - Ticagrelor (Brilinta)?- Inhibits the receptor site on the surface of the platelet, thus preventing aggregation of platelets - Unlike Clopidogrel (Plavix), this drug cause a REVERSIBLE blockade of receptors & wears off fasterWhat is the following drug used to treat / indication: - Ticagrelor (Brilinta)?Prevents occlusion of coronary stents, used for about 18-24 months post procedure <Bit longer than Clopidogrel>What are the side effects of the following drug: - Ticagrelor (Brilinta)?- Hemorrhage + Dizziness - Dyspnea + Coughing - Noncardiac chest pain + Bradycardia + Ventricular pauses - DiarrheaWhat are Nursing implications when taking: - Ticagrelor (Brilinta)?- Drug must be discontinued 5 days before surgery - Though can be given with Aspirin at low dosage, do not go >100 mg otherwise reduce benefit of TicagrelorWhat lab value should be looked at when taking: - Ticagrelor (Brilinta)?- Respiratory rate - Heart rateWhat is the drug classification of the following drug: - Abciximab (Reopro)?GP IIb/IIIa Antagonists <It's a purified Fab fragment of a monoclonal antibody>What is the MOA of the following drug: - Abciximab (Reopro)?Binds to platelets near the GP IIb/IIIa receptors and then prevents the receptors from binding fibrinogenWhat is the following drug used to treat / indication: - Abciximab (Reopro)?Given in conjunction with HEPARIN (IV infusion) + ASPIRIN to promote revascularization in patients undergoing thrombolytic therapy, acute MI and/or PCIWhat other drug / Therapy can the following drug can be used as an adjunct: - Abciximab (Reopro)?Given in conjunction with HEPARIN (IV infusion) + ASPIRIN to promote revascularization in pt undergoing thrombolytic therapy, acute MI and/or PCIWhat are the side effects of the following drug: - Abciximab (Reopro)?MAJOR MAJOR bleeding, especially at site of PCI access (femoral artery); STOP if major bleed occurs (b/c effects last 24-48 hr + Very expensive)What is the drug classification of the following drug: - Alteplase (tPA) Tissue Plasminogen activator?Thrombolytic DrugWhat is the suffix for Thrombolytic Drugs?-teplaseWhat is the following drug used to treat / indication: - Alteplase (tPA) Tissue Plasminogen activator?- Acute MI (give within 2 hr; give 2 doses) - Ischemic stroke (NOT hemorrhagic stroke) - Acute massive pulmonary embolismWhat are the side effects of the following drug: - Alteplase (tPA) Tissue Plasminogen activator?Acute hemorrhage + Death due to massive dissolving of all clots in the bodyWhen is the following drug contraindicated: - Alteplase (tPA) Tissue Plasminogen activator?- Hemorrhagic stroke - Postpartum hemorrhage - Surgery within 2 weeks - No IMs or SubQ, also keep pressure on IV puncture sitesWhat are Nursing implications when taking: - Alteplase (tPA) Tissue Plasminogen activator?- Give within 2 hours of acute MI (Give 2 doses) - Hold if pt HAD surgery within the last 2 weeks - No IMs or SubQ, also KEEP pressure on IV puncture sitesWhich drug has the following dosage: - 81 or 325 mg/day?AspirinWhat classes of antibiotics are there?*- Bacteriocidal - BacteriostaticWhat describes: - A class of antibiotics - Drugs are directly lethal to bacteria at clinically achievable concentrations?*BacteriocidalWhat describes: - A class of antibiotics - Drugs can SLOW bacterial growth but DO NOT cause cell death?*BacteriostaticHow does antibiotic use promotes resistance?Drugs make conditions favorable for overgrowth of microbes that have acquired mechanisms for resistance. The more that antibiotics are used, the faster drug-resistant organisms emerge.What type of antibiotics (not class) promotes bact resistance?Broad-spectrum agents do the most to facilitate the emergence of resistance.What describes: - A new infection that appears during the course of treatment for a primary infection - Caused by drug-resistant microbes = Often are difficult to treat?SuperinfectionWhat are ways to delay emergence of drug resistant bact?- Promote adherence to appropriate prescribing guidelines - Reduce demand for antibiotics among healthy adults and parents of young children - Emphasize adherence to prescribed antibiotic regimensWhat describes: - Antibiotic therapy for patients BEFORE causative organism is positively identified?*Empiric TherapyTrue/False: Antibiotics must not be discontinued prematurely.*True, tell pt to never suddenly stop taking antibiotics; even if they feel better, they have to finish their presciptionWhat are times Antimicrobials are used for Prophylactic use = To PREVENT infection rather than treat infection?*- Surgery - Bacterial endocarditis - NeutropeniaWhat are clinical indicators of success for Antimicrobial Therapy?- Reduction of fever - Resolution of s/s related to the affected organFill in the blank: Misuses of Antimicrobial Drugs include: - Attempted treatment of __(1)__ infections - Treatment of fever of __(2)__ - Improper __(3)__ - Treatment in the absence of adequate __(4)__ - Omission of __(5)__1) Viral 2) Unknown origin 3) Dosage 4) Bact Information 5) Surgical drainageWhat are the chances of toxicity when taking: - Penicillins?LowWhat are the side effects of the following drug: - Penicillins?*- Lip swelling - Rash Big s/s for ANAPHYLACTIC REACTION = - Laryngeal edema - Bronchoconstriction - HypotensionBecause of Penicllin's structure, what other drug can you NOT give to a pt who has Penicillin allergy?*Cephalosporins, same family as penicllinWhich drug group is the most common cause of drug allergy?*PenicillinsWhat is used to TREAT Penicillin allergy?* What is used to PREVENT it?- Treat = EPINEPHRINE + Respiratory support - Prevent = Skin testingWhen looking through a microscope, what should be seen in the Penicillin's structure?A Beta-Lactam ring; Cephalosporins belong to the same familyWhat is the MOA of the following drug: - Penicillins?- Weaken the cell wall = Bact take up excessive water = Rupture - Active ONLY against bacteria undergoing GROWTH & DIVISION - BactericidalHow/Why would bacteria become resistant to Penicillin?- Inability of penicillins to reach their target - Inactivation of penicillins by bacterial enzymes - Production of penicillin-binding proteins (PBPs) that have a low affinity for penicillinsWhat describes: - A Beta-lactamases - Enzymes that render penicillin INACTIVE - Produced by Bact specifically for penicillin?PenicillinasesWhat types of Penicllin: - Bactericidal - Targets numerous gram-positive and some gram-negative organisms - AE = Least toxic of all antibiotics though commonly causes drug allergy?Penicillin G (Benzylpenicillin)Fill in the blank: When assessing for penicillin allergy in each patient who will be receiving penicillin" - If history of mild reaction, consider __(1)__ - If history of anaphylaxis, __(2)__*1) Cephalosporin 2) Avoid Penicillin or CephalosporinsWhat is the type of Penicllin allergy if it occurs within: - 2 to 30 min?ImmediateWhat is the type of Penicllin allergy if it occurs within: - 1 to 72 hr?AcceleratedWhat is the type of Penicllin allergy if it occurs within: - Reaction takes days or weeks to develop?DelayedWhat drugs cause a drug interaction in the following drug: - Penicillin?*- Aminoglycosides - Bacteriostatic antibiotics - ProbenecidWhat are examples of: - Penicillinase-Resistant Penicillins?*- Nafcillin - Oxacillin - DicloxacillinWhat are examples of: - Broad-spectrum penicillins (aminopenicillins)?* <Note that these types are the ones that most facilitate the emergence of resistance>- Ampicillin - AmoxicillinWhat is the route of the following drug: - Ampicillin - Amoxicillin?*Oral liquid suspensionWhat are the side effects of the following drug: - Ampicillin - Amoxicillin?Broad-spectrum penicillins (aminopenicillins) can cause: - GI PROBLEMS = N&V + DIARRHEA - Rash - Facilitate the emergence of resistanceWhat are examples of: - Broad-spectrum penicillins that are Penicillinase sensitive? <Might not sound as good as aminopenicillins but they also target other organisms>- Ticarcillin - PiperacillinWhat are examples of: - Beta-lactamase inhibitors? <These extends antimicrobial spectrum when combined with penicillinase-sensitive antibiotics like Aminopenicillins>- Clavulanic acid - Tazobactam - SulbactamWhat Penicllin combination treats Pseudomonas?*Piperacillin/Tazobactam [Zosyn]What drugs are treatment of choice for Oral therapy of UTIs?- Trimethoprim/sulfamethoxazole (last set of cards) - NitrofurantoinWhat is the s/s of Acute Cystitis?- Dysuria - Urinary urgency + frequency - Suprapubic discomfort - Pyuria - Bacteriuria (subclinical pyelonephritis)What is the following drug used to treat / indication: - Nitrofurantoin [Furadantin, Macrodantin, Macrobid]?*Lower UTIs, prophylaxis, recurrent lower UTIsWhat are the side effects of the following drug: - Nitrofurantoin [Furadantin, Macrodantin, Macrobid]?*- GI EFFECTS - Pulmonary reactions: Acute and subacute - HEMATOLOGIC EFFECTS (bleeding, bruising, ecchymosis) - PERIPHERAL NEUROPATHY = Pain, burning, tingling - HEPATOTOXICITY - Birth defectsWhat organ would be damaged when taking: - Nitrofurantoin [Furadantin, Macrodantin, Macrobid]?- Lungs = Pulmonary reactions - Nerves = Peripheral neuropathy from Demyelinization and nerve degeneration - Liver = HepatotoxicityWhat is the MOA of the following drug: - <Drug class> Fluoroquinolones?Disrupt DNA replication and cell divisionWhat are the side effects of the following drug: - <Drug class> Fluoroquinolones?*Tendon rupture (usually Achilles tendon) = Dec ROM of footWhat are Nursing implications when taking: - <Drug class> Fluoroquinolones?*- Avoid in pt younger than 18 years - Tendon rupture risk especially for: -- >60 -- Taking Glucocorticoids -- Those who have undergone kidney, heart, or lung transplantation;What is the drug classification of the following drug: - Ciprofloxacin?*FluoroquinolonesWhat is the MOA of the following drug: - Ciprofloxacin?Inhibits bacterial DNA gyrase and topoisomerase IIWhat kind of bacteria does the following drug target: - Ciprofloxacin?Gram negative and some Gram positive organismsWhat is the following drug used to treat / indication: - Ciprofloxacin?- ANTHRAX - Infections in multiple systems: -- Respiratory -- Urinary tract (UTI) -- GI -- Bones + Joints -- Skin and soft tissueWhat bacteria are resistant to the following drug: - Ciprofloxacin?- Staphylococcus aureus - Serratia marcescens - Campylobacter jejuni - Pseudomonas aeruginosa - Neisseria gonorrhoeaeWhat are the side effects of the following drug: - Ciprofloxacin?*1) Mild s/s - GI = Nausea/vomiting, diarrhea, abdominal pain - CENTRAL NERVOUS SYSTEM (CNS) = Dizziness, headache, restlessness, confusion, rarely seizures - Tendon rupture (remember the class) - PHOTOTOXICITY - CANDIDA INFECTION in Pharynx and Vagina (Yeast infection) - C Diff Infection 2) In OLDER pt - Confusion, somnolence, psychosis, visual disturbances - Myasthenia gravis = Muscle weaknessWhat organ would be damaged when taking: - Ciprofloxacin?*- Tendons for ruptures - Skin for phototoxicity - Pharynx and Vagina for Candida infection - Muscles (in older pt) from Myasthenia gravis = Muscle weaknessWhich drug in this section has their absorption dec if taken the following: - Aluminum + Magnesium antacids - Iron + Zinc salts - Sucralfate - Milk and dairy products?*CiprofloxacinWhat drugs cause a drug interaction in the following drug: - Ciprofloxacin?All inc the drug levels: - Theophylline (used for asthma) - Warfarin (an anticoagulant) - Tinidazole (an antifungal drug)What is the following drug used to treat / indication: - Metronidazole [Flagyl]?*- C DIFF - Protozoal infections - Infections caused by Obligate anaerobes - Helicobacter pyloriWhat are the side effects of the following drug: - Metronidazole [Flagyl]?- Neurotoxicity - Allergy - SuperinfectionsWhat are the Nursing implications for: - Metronidazole [Flagyl]?*- Do NOT take with Alcohol, otherwise may vomit and possibly die - Take WITH food to reduce metallic, bitter tasteWhat organ would be damaged when taking: - Metronidazole [Flagyl]?Nerves from NeurotoxicityWhich of the following drugs is Bacteristatic and/or Bactericidal: - Nitrofurantoin [Furadantin, Macrodantin, Macrobid] - Ciprofloxacin - Metronidazole [Flagyl]?- Nitrofurantoin = Static when low dose, Cidal when high dose - Metronidazole = CidalWhich of the following drugs can be administered to a pregnant woman safely & which cannot: - Nitrofurantoin [Furadantin, Macrodantin, Macrobid] - Ciprofloxacin - Metronidazole [Flagyl]?Nitrofurantoin causes birth defectsWhich of the following drugs is Broad spectrum & Narrow spectrum: - Nitrofurantoin [Furadantin, Macrodantin, Macrobid] - Ciprofloxacin - Metronidazole [Flagyl]?Ciprofloxacin = Broad specWhat are the route of administration for these drugs: - Nitrofurantoin [Furadantin, Macrodantin, Macrobid] - Ciprofloxacin - Metronidazole [Flagyl]?- Nitrofurantoin = Oral - Ciprofloxacin = Oral, IVWhich of the following drug is <Hepatotoxic>: - Nitrofurantoin [Furadantin, Macrodantin, Macrobid] - Ciprofloxacin - Metronidazole [Flagyl]?NitrofurantoinWhat are the 3 main functions of Anti-Inflammatory Drugs?- Suppress Inflammation - Relieve Pain - Reduce FeverWhat is the MOA of the following drug: - Anti-Inflammatory Drugs?Inhibition of Cyclooxygenase (COX) enzymes: - Inhibit COX-1 = BAD = Was used to prevent Gastric ulceration, Bleeding, and Renal Impairment; The only GOOD thing is that inhibition would prevent MI & STROKE by dec platelet aggregation - Inhibit COX-2 = GOOD = Dec INFLAM, PAIN, FEVER, & protection against COLORECTAL CANCER So the best Anti-Inflam drugs are the ones that just inhibit COX-2What is the difference between NSAIDS (Aspirin, ibuprofen) and Acetaminophen?Despite both being Cyclooxygenase Inhibitors, NSIADS has antiinflammatory properties while Acetaminophen does not.What is the MOA of the following drug: - First-Generation NSAIDs?- Inhibit COX-1 and COX-2 (Look back at what happens when inhibit COX-1) - Treats inflam disorders (RA, OA, Bursitis) - Relieves mild-moderate pain - Suppress Fever - Relieve DysmenorrheaWhat is the drug classification of the following drug: - Aspirin?- First Generation NSAIDS - By extension Cyclooxygenase InhibitorWhat is the MOA of the following drug: - Aspirin?- Irreversible inhibitor of COX1 (Not a good thing) - Relief mild-moderate Pain - Suppression of platelet aggregation (irreversible) + Protects in thrombotic disorders - Anti-pyreticWhat are Nursing implications when taking: - Aspirin?- B/c it's irreversible, it stops platelet aggregation for the drug's lifetime; thus hold Aspirin 8 days before surgery, b/c inc risk for bleeding - Take 2 hours before another NSAID like IbuprofenWhat is the following drug used to treat / indication: - Aspirin?- Drug of Choice for RA (along with Methotrexate) - Mild-Moderate Pain - Fever for febrile adults (not for children)What are the side effects of the following drug: - Aspirin?- GI effects + Bleed (ALL 1st Gen NSAIDS has risk of GI bleeding) - RENAL impairment - Toxicity = Tinnitus (ear ringing), sweating, headache, dizziness - REYE'S syndrome = Encephalopathy + Liver dysfunction, seen if child takes aspirinWhen is the following drug contraindicated: - Aspirin?Do not give to Children, chance for Reye's syndrome (Encephalopathy + Liver dysfunction)What is the Toxic effects of: - Aspirin?- Tinnitus (ear ringing) - Sweating + Fever (Hyperthermia) - Dehydration - Hyperventilation leading to Resp Alkalosis (Metabolic Acidosis when Severely toxic)What organ would be damaged when taking: - Aspirin?- GI organs - Kidney - Toxicity = Ears from Tinnitus (ringing) - Brain + Liver from EncephalopathyWhat drugs cause a drug interaction in the following drug: - Aspirin?- Anticoagulants = Warfarin and heparin = Bleeding - Glucocorticoids - Alcohol = Inc risk of bleed - Ibuprofen (Another NSAID, take Aspirin 2 hours before this) - ACE inhibitor (-pril) + Angiotensin II receptor blockers (ARBs)What lab value should be looked at when taking: - Aspirin?- Monitor PT & INR for bleeding - Creatinine + BUN for Renal impairmentWhat's the difference between Aspirin and other First-Generation NSAIDS?- Aspirin = Irreversible inhibition of COX-1; Treats RA - Other 1st-Gen NSAIDS = REVERSIBLE inhibition of both COX; Treats RA and OA; DOES NOT PROTECT AGAINST MI & STROKEWhat is the drug classification of the following drug: - Ibuprofen?- First Generation NSAIDS - By extension Cyclooxygenase InhibitorWhat is the MOA of the following drug: - Ibuprofen?Inhibits COX-1 & COX-2 (REVERSIBLE)What is the following drug used to treat / indication: - Ibuprofen?- Anti-inflam (Arthritis) - Analgesic for Mild-Mod Pain - AntipyreticWhat is the max dose of Ibuprofen?3.2 g/dayWhat is the drug classification of the following drug: - Indomethacin?- First Generation NSAIDS - By extension Cyclooxygenase InhibitorWhat is the following drug used to treat / indication: - Indomethacin?- Arthritis - BursitisWhat are the side effects of the following drug: - Indomethacin?- Severe frontal Headache - Seizures - Psychiatric changesWhen is the following drug contraindicated: - Indomethacin?Do not give to Infants and ChildrenWhat is the drug classification of the following drug: - Ketorolac (Toradol)?- First Generation NSAIDS - By extension Cyclooxygenase InhibitorWhat is the following drug used to treat / indication: - Ketorolac (Toradol)?Powerful analgesic = Acute Pain reliefWhat are Nursing implications when taking: - Ketorolac (Toradol)?Combined oral and parental treatment should not exceed 5 daysWhat are examples of Opportunistic fungal infections from Immunocompromised host?*- Candidiasis - Aspergillosis - Cryptococcosis - Mucormycosis <Fungal infection = Mostly ends in -osis>Which of the following is true/false: Pertaining with Systemic Mycoses: - "Treatment can be difficult" - "Infections often resist treatment" - "Treatment may require prolonged therapy with drugs that frequently prove toxic"?All trueWhat is the drug of choice for most systemic mycoses?*Amphotericin B (Ketoconazole are alternatives)What is the MOA of the following drug: - Amphotericin B?- Binds to ergosterol (much more than cholesterol) in fungal cell membrane (Bacterial cell membranes lack sterols = Won't work on them & the fungi cells will be more damaged than the human cells) - This will inc permeability = Cell leaks intracellular cations (especially potassium) - Fungistatic or fungicidalWhat are the side effects of the following drug: - Amphotericin B?*HIGHLY TOXIC - NEPHROTOXICITY - Hypokalemia - Bone marrow suppression - Phlebitis (Vein wall inflam, so change venous sites often & use Heparin) - IV INFUSION REACTION (1-3 hr after start of infusion and last an hr) = Fever, Chills, Rigors, Nausea, and Headache (more details in other card)What lab value should be looked at when taking: - Amphotericin B?- Potassium for Hypokalemia (result from kidney damage) - CBC for Bone marrow suppression - Hematocrit for Bone marrow suppression (look for anemia) - Creatinine for Nephrotoxicity every 3-4 days (reduce dosage if 3.5 mg/dL)What organ would be damaged when taking: - Amphotericin B?Kidney (especially if total dose exceeds 4 g, residual impairment is likely); minimized by infusing 1 L of SALINE on treatment day; also avoid other nephrotoxic drugs like NSAIDS, AMINOGLYCOSIDES, CYCLOSPORINESWhat are the s/s of Amphotericin B IV infusion reaction?*- Nausea - Headache - Fever - Chills - Rigors (feeling of cold w/ shivering then a rise in temperature w/ sweating)What causes the IV Infusion reaction in Amphotericin B?Caused by release of proinflammatory cytokines; s/s will last 1 to 3 hr after start of infusion and last for 1 hrWhat can be given for the IV Infusion reaction in Amphotericin B?*- Mild reactions Pretreatment = Diphenhydramine + Acetaminophen (Aspirin can help but damages kidneys) - IV Meperidine or Dantrolene for RigorsWhat is the drug classification of the following drug: - Fluconazole [Diflucan]?*AzolesWhat are the side effects of the following drug: - Fluconazole [Diflucan]?- Nausea - Headache - Vomiting - Abdominal pain - DiarrheaWhat is the drug classification of the following drug: - Ketoconazole?*AzolesWhat is the MOA of the following drug: - Ketoconazole?Inhibits ergosterolWhat is the following drug used to treat / indication: - Ketoconazole?- Alternative to amphotericin B for systemic mycoses like Fluconazole; though less toxic + somewhat less effective + slower effects - More useful in SUPPRESSING chronic infections THAN in TREATING severe, acute infectionsWhat are the side effects of the following drug: - Ketoconazole?*- GI side effects, lessens if given with food - HEPATOTOXICITY - DEC EFFECTS IF TAKEN W/ ANTACIDS - Effect on sex hormones = Can inhibit steroid synthesis in humans - Rash, itching, dizziness, Fever, Chills, constipation, Diarrhea, photophobia, and HeadacheWhat organ would be damaged when taking: - Ketoconazole?*- LIVER = Hepatotoxic - GI disturbance but can be lessen with food - Eyes = Photophobia (sensitivity, not damage)Which of the following drugs is Broad spectrum & Narrow spectrum: - Amphotericin B - Fluconazole [Diflucan] - Ketoconazole?- Ampho = Broad - Fluco = BroadWhich of the following drugs in this section can be taken with food & which cannot: - Amphotericin B - Fluconazole [Diflucan] - Ketoconazole?Ketoconazole = Take with food to reduce GI effectsWhich of the following drugs uses the P450 enzyme: - Amphotericin B - Fluconazole [Diflucan] - Ketoconazole?- Fluconazole [Diflucan] - KetoconazoleWhat are the route of administration for these drugs: - Amphotericin B - Fluconazole [Diflucan] - Ketoconazole?*- AMPHO = IV - Fluco = Oral + IV (dosage is the same)Which of the following drugs is Bacteristatic and/or Bactericidal: - Amphotericin B - Fluconazole [Diflucan] - Ketoconazole?- Ampho = Static & Cidal - Fluco = StaticWhich of the following drug is <Hepatotoxic>: - Amphotericin B - Fluconazole [Diflucan] - Ketoconazole?KetoconazoleWhich of the following drug is <Nephrotoxic>: - Amphotericin B - Fluconazole [Diflucan] - Ketoconazole?Amphotericin BWhat 2 groups of organisms cause Superficial Mycoses?- Candida - Dermatophytic (ringworm)What describes: - A group of organism that cause Superficial Mycoses - Usually in mucous membranes and moist skin (like in the mouth or vagina) - Chronic infections may involve scalp, skin, and nails?*CandidaWhat is the risk factors for Vulvovaginal candidiasis?- Pregnancy - Diabetes - Debilitation (weak/feeble) - HIV - Oral contraceptives - Systemic glucocorticoids + Anticancer agents + Systemic antibioticsWhat is used to treat: - Vulvovaginal candidiasis?*- 1-3 days topical therapy - Single dose of fluconazoleWhat is used to treat: - Oral candidiasis?*- Topical = Bystatin, Clotrimazole, Miconazole, and Amphotericin B - If Immunocompromised = Oral therapy of Fluconazole or KetoconazoleWhat is the drug classification of the following drug: - Fluconazole - Ketoconazole?*AzolesWhat is the following drug used to treat / indication: - Ketoconazole?*Oral & Topical therapy of Superficial mycosesWhat is the following drug used to treat / indication: - Fluconazole?*Oral therapy of VULVOVAGINAL CANDIDIASIS (Single dose) + ORAL CANDIDIASIS (used for Immnocompromised pt)What kind of bacteria does the following drug target: - Nystatin [Mycostatin]?*Only for Candidiasis infections in skin, mouth, esophagus, and vaginaWhat is the following drug used to treat / indication: - Nystatin [Mycostatin]?- Drug of choice for Intestinal candidiasis - Also for candidal infections in skin, mouth, esophagus, and vaginaWhat are the route of administration for these drugs: - Fluconazole - Ketoconazole - Nystatin [Mycostatin]?- Fluco = Oral - Keto = Oral & Topical - Nyst = TopicalWhat describes: - A group of organism that cause Superficial Mycoses - Usually confined to skin, hair, and nails - Many types of ringworms, depending on location (later cards)?DermatophyticWhat describes: - Type of Dermatophytic infection - In the foot = Athlete's foot?Tinea pedisWhat describes: - Type of Dermatophytic infection - Ringworm of the body?Tinea corporisWhat describes: - Type of Dermatophytic infection - In the groin = Jock itch?Tinea crurisWhat describes: - Type of Dermatophytic infection - In the scalp?Tinea capitisWhat is the Uric Acid level in Gout in Men? Women?- Men = >7 mg/dL - Women = >6 mg/dLWhat are the indications of Gout?- Recurrent inflammatory disorder (seen more in Men) - Hypreuricemia (other card for Uric acid levels) - Episodes of severe joint pain (typically in Large toe)What causes Gout?- Excessive production of uric acid - Impaired renal excretion of uric acidWhat meds are the first choice for acute gouty arthritis?NSAIDS; mainly b/c it's better tolerated and predictable than Colchicine + Relief in 24 hr. - Indomethacin (Indocin) - Naproxen [Naprosyn] - Diclofenac [Voltaren]What is the drug classification of the following drug: - Indomethacin (Indocin) - Naproxen [Naprosyn] - Diclofenac [Voltaren]?NSAIDWhat is the following drug used to treat / indication: - Indomethacin (Indocin) - Naproxen [Naprosyn] - Diclofenac [Voltaren]?Acute Gout pain reliefWhat are the side effects of the following drug: - Indomethacin (Indocin) - Naproxen [Naprosyn] - Diclofenac [Voltaren]?- Highest risk of thrombosis out of all the NSAIDs > risk 70% - Smoking inc risk of CV eventWhat is the following drug used to treat / indication: - Colchicine?- Treats, Dec, and Aborts impending Gout attacks - NOT the first-line drug for Gout due to toxicity - Reserved for pt who are unresponsive to or intolerant of safer agents like Indomethacin (Indocin)What are the side effects of the following drug: - Colchicine?- Gastrointestinal - Myelosuppression (Bone marrow suppression so check for s/s of infection) + Bone Pain - Myopathy (Muscle tissues)What organ would be damaged when taking: - Colchicine?- Bone (Bone pain + Marrow Suppression) - MusclesWhat lab value should be looked at when taking: - Colchicine?- Thrombocytopenia - LeukopeniaWhat drugs cause a drug interaction in the following drug: - Colchicine?- Statins (cause Rhabdomyolysis / Muscle loss) - P-glycoprotein (PGP) inhibitors - Inhibitors of CYP3A4What drugs are used for Hyperuricemia but NOT acute Gouty attack?- Allopurinol (inhibits uric acid formation) - Probenecid (promotes excretion)What is the MOA of the following drug: - Allopurinol (Zyloprim)?- Reduces blood levels of uric acid by Inhibiting xanthine oxidase (XO), an enzyme required for uric acid formation - Prevents new tophus formation and causes regression of tophi that have already formed - Improves Joint functionWhat is the following drug used to treat / indication: - Allopurinol (Zyloprim)?- Drug of choice for Chronic tophaceous gout - Hyperuricemia due to chemotherapyWhat are the side effects of the following drug: - Allopurinol (Zyloprim)?- Hypersensitivity syndrome = Fever, rash, kidney dysfunction - GI effects - Neurological effects - Cataracts if used longer than 3 yearsWhat organ would be damaged when taking: - Allopurinol (Zyloprim)?- Neurologic effects - Cataracts = GET EYE EXAM every 6 monthsWhat is the MOA of the following drug: - Probenecid?Acts on renal tubules to inhibit reabsorption of uric acidWhat are the side effects of the following drug: - Probenecid?- Use may exacerbate acute episodes of gout; Add indomethacin (NSAID) for relief - Mild GI effect so take w/ food - Risk of Kidney damage, so drink 2.5-3 L of fluids daily during first few days of treatmentWhat are Nursing implications when taking: - Probenecid?- Take with food to avoid mild GI effects - Drink 2.5-3 L of fluids daily during first few days of treatment to reduce Kidney damageWhat drugs cause a drug interaction in the following drug: - Probenecid?Aspirin + other salicylatesWhat is the MOA of the following drug: - Vancomycin?Inhibits cell wall synthesisWhat is the following drug used to treat / indication: - Vancomycin?- Severe infections only - MRSA, Staphylococcus epidermidis, Clostridium difficileWhat are the side effects of the following drug: - Vancomycin?*- OTOTOXICITY (reversible or permanent) - "RED MAN" syndrome = From RAPID infusion of med, s/s = Flush + Itching face + Tachycardia + HYPOtension - Thrombophlebitis (common) - Thrombocytopenia (rare) - AllergyWhat organ would be damaged when taking: - Vancomycin?*Ear (Ototoxic) = Conduct Whisper testWhat lab value should be looked at when taking: - Vancomycin?Platelets for ThrombocytopeniaWhat is the suffix for drugs from the following family: - Tetracycline family?-cyclineWhat is the MOA of the following drug: - Tetracyclines?Broad-spectrum antibiotics that inhibit protein synthesisWhat is the following drug used to treat / indication: - Tetracyclines?- Treatment of infectious disease: -- Helicobacter pylori -- Mycoplasma pneumoniae - Treatment of: -- Acne -- Anthrax -- Lyme disease -- Peptic ulcer disease -- Periodontal disease -- Rheumatoid arthritisWhat are the side effects of the following drug: - Tetracyclines?*- GI Irritation - EFFECTS BONES AND TEETH (Discoloration; Don't give to preg women, babies, children) - Diarrhea from Superinfection (new infection that appears during the course of treatment for a primary infection) - Hepatotoxicity (from High-dose IV therapy) - Renal toxicity - PhotosensitivityWhat organ would be damaged when taking: - Tetracyclines?*- GI organs for irritation - BONES AND TEETH Discoloration - Liver = Hepatotoxic - Kidney = Renal toxic; also eliminated primarily in urine so accumulate for pt with kidney disease - Skin = PhotosensitivityWhat is the drug classification of the following drug: - Erythromycin?*MacrolidesWhat drug would be given if the pt can't take Penicillin?- Erythromycin - ClindamycinWhat is the suffix for drugs from the following family: - Macrolides family?*-thromycinWhat is the MOA of the following drug: - Erythromycin?Broad-spectrum antibiotics that inhibit protein synthesisWhat is the following drug used to treat / indication: - Erythromycin?- Used if pt is allergic to penicillin - Treats Whooping cough - Treats Acute diphtheria caused by Corynebacterium diphtheriae - Targets: -- Corynebacterium diphtheriae -- Chlamydial infections -- M. pneumoniae -- Group A Streptococcus pyogenesWhat kind of bacteria does the following drug target: - Erythromycin?Active against most gram-positive and some gram-negative bacteria; usually bacteriostatic but can be bactericidalWhat are the side effects of the following drug: - Erythromycin?*- GI IRRITATION (most common side effect for antibiotics in general) - QT prolongation and Sudden cardiac death - Superinfections - Thrombophlebitis - Transient hearing lossWhat organ would be damaged when taking: - Erythromycin?*- GI organs - Heart = QT prolongation and Sudden cardiac death (monitor cardiac status) - Ear = Hearing lossWhat is the MOA of the following drug: - Clindamycin [Cleocin]?Inhibits protein synthesisWhat is the following drug used to treat / indication: - Clindamycin [Cleocin]?- Only for certain anaerobic infections outside the central nervous system (CNS) - An alternative to penicillinWhat are the side effects of the following drug: - Clindamycin [Cleocin]?*- C Diff ASSOCIATED DIARRHEA (CDAD) = Fatal - Hepatic toxicity - Blood dyscrasias (imbalance of blood, bile, lymph, and phlegm) - Hypersensitivity reactionsWhat organ would be damaged when taking: - Clindamycin [Cleocin]?*- NOT GI organs like the other 2 protein syn inhibitors - Liver = Hepatic toxicityWhat kind of bacteria does the following drug target: - Clindamycin [Cleocin]?*Active against most anaerobic bacteria (gram positive and gram negative)Which drug in this section has their absorption dec if taken the following: - Milk products - Ca supplements - Iron supplements - Mg-containing laxatives - Most antacids?TetracyclinesWhat slows the absorption of Tetracyclines?*- Milk products - Ca supplements - Iron supplements - Mg-containing laxatives - Most antacids (avoid most drugs with antacids)What are the route of administration for these drugs: - Vancomycin - Tetracyclines - Erythromycin - Clindamycin [Cleocin]?Vancomycin = IVWhich of the following drugs inhibit Protein synthesis as their MOA: - Vancomycin - Tetracyclines - Erythromycin - Clindamycin [Cleocin]?- Tetracyclines - Erythromycin - Clindamycin [Cleocin]What pt can you NOT give the following drug to: - Tetracyclines?*- Preg women - Babies - Children Due to the effects on bones and teethWhich of the following drug is <Ototoxic>: - Vancomycin - Tetracyclines - Erythromycin - Clindamycin [Cleocin]?*VancomycinWhich of the following drug is <Hepatotoxic>: - Vancomycin - Tetracyclines - Erythromycin - Clindamycin [Cleocin]?TetracyclinesTrue/False: You can give Cephalosporin if the pt has an allergy for Penicillin.False, both belong to the same family and have similar structures; DON'T give to pt who has a Penicillin allergyWhat are the chances of toxicity when taking: - Cephalosporins?LowWhen looking through a microscope, what should be seen in the Cephalosporins' structure?A Beta-Lactam ring like PenicillinWhat route are Cephalosporins usually given?ParenterallyWhat is the MOA of the following drug: - Cephalosporins?*- Bind to penicillin-binding proteins (PBPs), disrupt cell wall synthesis, and cause cell lysis - Most effective against cells undergoing active growth and divisionWhat describes: - A Beta-lactamases - Enzymes that render the drug INACTIVE - Destroys the First generation Cephalosporins; Second generation are less sensitive to this while the later (Third, Fourth, Fifth) are more resistant?CephalosporinasesWhat is the term to describe: - First generation Cephalosporins?CephalexinWhat is the following drug used to treat / indication: - Cephalexin?Widely used for prophylaxis against infection in surgical patients; rarely used for active infectionsWhat is the term to describe: - Second generation Cephalosporins?CefoxitinWhat is the following drug used to treat / indication: - Cefoxitin?Rarely used for active infectionWhat is the term to describe: - Third generation Cephalosporins?- Cefotaxime - Ceftriaxone - CeftazidimeWhat is the following drug used to treat / indication: - Cefotaxime?- Preferred therapy for several infections - Highly active against gram-NEGATIVE organisms - Able to penetrate to cerebrospinal fluid (CSF)What kind of bacteria does Cefotaxime target?Gram-NegativeWhat is the following drug used to treat / indication: - Ceftriaxone (Rocephin)?*- Gonorrhea - ChlamydiaWhat must be assessed when using: - Ceftazidime (Fortaz)?*Pt's stool = Expect diarrhea, to the point of life threateningWhat is the term to describe: - Fourth generation Cephalosporins?CefepimeWhat is the following drug used to treat / indication: - Cefepime?Commonly used to treat health care‒ and hospital-associated PNEUMONIAS, including those caused by the resistant organism PSEUDOMONASWhat is the term to describe: - Fifth generation Cephalosporins?CeftarolineWhat is the following drug used to treat / indication: - Ceftaroline?Infections associated with methicillin-resistant Staphylococcus aureus (MRSA)What drugs cause a drug interaction in the following drug: - Cephalosporins?- Probenecid - Alcohol - Drugs that promote bleeding - CALCIUM and ceftriaxoneWhat are the side effects of the following drug: - Cephalosporins?*- PSEUDOMEMBRANOUS COLITIS = Uncontrollable bloddy diarrhea + fever + ABD pain (Came from C Diff) - Allergy - Bleeding - ThrombophlebitisWhat lab value should be looked at when taking: - Cephalosporins?CBC for bleedingWhat's the difference between 1st and 2nd Gen NSAIDS?2nd Gen: - Inhibits just COX-2 - Has lower risk of GI side effects - Impairs RENAL and cause HTN and Edema - Inc risk of Severe MI and StrokeWhat are the side effects of the following drug: - 2nd Gen NSAIDS?- Lower risk of GI side effects compared to 1st Gen - Impairs RENAL function = HTN and Edema - Inc risk of Severe MI and StrokeWhat organ would be damaged when taking: - 2nd Gen NSAIDS?- Kidneys = Leads to HTN and Edema - Heart = Risk of MI and StrokeWhat is the drug classification of the following drug: - Celecoxib [Celebrex]?Second-generation COX-2 inhibitorWhat is the following drug used to treat / indication: - Celecoxib [Celebrex]?- Osteoarthritis (OA) - Rheumatoid arthritis (RA) - Acute pain; BUT b/c of Cardio risks, this is the LAST-choice drug for long-term management of pain - DysmenorrheaWhat are the side effects of the following drug: - Celecoxib [Celebrex]?- Dyspepsia - ABD pain - Renal impairment - Sulfonamide allergy - Stroke, MIWhat drugs cause a drug interaction in the following drug: - Celecoxib [Celebrex]?- Warfarin = Bleeding = Monitor PT & INR - May decrease diuretic effect of Furosemide - May decrease antihypertensive effect of ACE inhibitors - May increase levels of Lithium - Celecoxib levels may be increased by FluconazoleWhat lab value should be looked at when taking: - Celecoxib [Celebrex]?- Monitor PT & INR for bleeding - Creatinine + BUN for Renal impairmentWhen is the following drug contraindicated: - Celecoxib [Celebrex]?If pt has Sulfonamide allergyWhat is the following drug used to treat / indication: - Acetaminophen [Tylenol]?- Analgesic - Antipyretic - NO ANTI-INFLAM effects (Also not associated with Reye's syndrome)What is the MOA of the following drug: - Acetaminophen [Tylenol]?Inhibits prostaglandin synthesis in CNSWhat are the side effects of the following drug: - Acetaminophen [Tylenol]?- Stevens-Johnson syndrome (SJS) - HepatotoxicityWhat organ would be damaged when taking: - Acetaminophen [Tylenol]?- Skin/Mucous membrane from Stevens-Johnson syndrome - Liver from HepatotoxicityWhat lab value should be looked at when taking: - Acetaminophen [Tylenol]?ASt & ALT from HepatotoxicityWhat drugs cause a drug interaction in the following drug: - Acetaminophen [Tylenol]?- Alcohol - Warfarin - VaccinesRBC4.5-5.0 millionwbc5,000-10,000Platelets200,00-400,000HemoglobinMale : 14-16.5 Female: 12-15HematocritMale: 40-50% Female : 37-47%

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