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Pharm Module 7/8
NUR 334 Pharmacology Module 7 and 8 Review
| Question | Answer |
|---|---|
| What are some drugs for peptic ulcer disease (PUD) | Proton pump inhibitors H2-rececptor antagonists Antacids Antibiotics Miscellaneous drugs |
| What are some risk factors for PUD | Close family history of PUD Blood group O Smoking tobacco (Increases gastric acid secretion) Caffeine Drugs (corticosteroids, NSAIDS, platelet inhibitors) Excessive psychological stress Infection w/ Helicobacter pylori |
| PUD Medication Contradictions | -N/A |
| What is the most common ulcer? | Duodenal Ulcer |
| What are some symptoms for Duodenal Ulcer? | Gnawing or burning upper-abdominal pain Occur 1-3 hours after a meal (maybe) Pain worse when stomach is empty Pain relieved by eating Nocturnal pain, nausea, vomiting Bleeding may occur Bright red blood in vomit Black, tarry stools |
| Describe Gastric Ulcer | Not relieved by food Anorexia, weight loss, vomiting |
| What is drug is Proton Pump Inhibitor? (PPI) | Omeprazole (Prilosec) |
| What is the administration for (PPI) Omeprazole (Prilosec) | Administer before breakfast on an empty stomach It may be administered with antacids Capsules and tablets should not be chewed, divided, or crushed Pregnancy category C Should be used short-term according to book |
| What is the MOA for (PPI) Omeprazole (Prilosec) | Reduces acid secretion in stomach by binding irreversibly to enzyme H, K-ATPase |
| Which drug is classified as an H2-Receptor Antagonists? | Ranitidine (Zantac) |
| what are some adverse effects of H2-Receptor Antagonists-Ranitidine (Zantac)? | Uncommon and mild, with headache being the most common. High doses may result in impotence or loss of libido in men. |
| what is the MOA of H2-Receptor Antagonists-Ranitidine (Zantac)? | it blocks H2 receptors in the stomach, reducing acids |
| If someone did have gerd what is a non-pharm method to not have gerd anymore? | Make sure to sit up after eating. Avoid fatty & acid foods. Eliminate tobacco and alcohol. Lose weight to eliminate the symptoms. |
| what drug is an antacids | Aluminum Hydroxide pg 685 (AlternaGEL, others) |
| What is the pharm class for Aluminum Hydroxide | Antacid or anti heartburn agent |
| What is the Administrations Alerts Aluminum Hydroxide | Administer aluminum antacids at least 2 hours before or after other drugs because absorption could be affected. Pregnancy category Chew tabs do not swallow Take with water and increase fiber and fluids |
| What are some actions and uses Aluminum Hydroxide | Primary action neutralize stomach acid, raising pH of stomach contents.H2-receptor antagonists & PPIs, aluminum antacids dont reduce volume of acid secretion effectively used in combination w/ antiulcer drugs symptomatic relief /heartburn due to PUD/ GERD |
| What can Aluminum Hydroxide be mixed with | Mixed with magnesium to reduce to potential for constipation Should not be taken at the same time as other medications because they may interfere with absorption. Sodium polystyrene sulfonate may cause systemic alkalosis. |
| H. Pylori Infection, How do we take these? | Try to keep a schedule or write something down that will help with Combination Antibiotics -PPIs, antibiotics, bismuth compound |
| Drugs for H. Pylori Infection: Bismuth MOA | inhibits bacterial growth and prevents h pylori from adhering to gastric mucosa, it is like a coating |
| Drugs for H. Pylori Infection: Bismuth Education | keep a schedule if taking more than one |
| Drugs for H. Pylori Infection: Misoprostol (Cytotec) MOA is? | Inhibits acid & stimulates mucus |
| H. Pylori Infection: Misoprostol (Cytotec) is for people who take what? | nsaids or steroids |
| Adverse Effects for Misoprostol (Cytotec) includes? | diarrhea, abdominal cramping Do not give to pregnant women because it can terminate the pregnancy Pregnancy risk X, terminates pregnancy or induces abortion |
| Drugs for H. Pylori Infection: Metoclopramide (Reglan) Administered how? for? | Given iv but can be given po and im prescribed for nausea committing after surgery or chemotherapy |
| Drugs for H. Pylori Infection: Metoclopramide (Reglan) MOA | causes muscles in upper intestine to contract Helps with increased motility Faster emptying of the stomach |
| What is the black box warning for H. Pylori Infection: Metoclopramide (Reglan) | tardive dyskinesia |
| Laxatives :Psyllium (Metamucil) Administration | mix with 8 oz of water, juice, or milk, takes 1-3 days to have a therapeutic effect may reduce serum glucose for patients with diabetes pregnancy category C |
| Psyllium (Metamucil) Mechanism of action | wells and increases size of fecal mass which promotes passage of food helps with constipation |
| Antidiarrheals Probiotics Lactobacillus help with? | Restores the normal flora in the stomach They are live microorganisms |
| Antidiarrheals Diphenoxylate with Atropine (Lomotil) pharm class is? | Opioid |
| Antidiarrheals Diphenoxylate with Atropine (Lomotil) adverse include what? | dizziness & drowsiness, |
| How do you give Diphenoxylate with Atropine (Lomotil)? | Slowly |
| What is the MOA of Diphenoxylate with Atropine (Lomotil)? | slow peristalsis, allows time for absorption from the stomach |
| What is the chance for dependency on Lomotil | Low potential for abuse, no pain-relieving properties |
| Can you drive on Lomotil | No |
| What is an OTC antidiarrheal | Loperamide (Imodium) |
| Drugs for IBS Definition? | ulcerative colitis: erosions in large intestine and inflammatory disease, Crohn’s disease: ulcers in small intestine |
| What are some symptoms for IBS? | abdominal cramping and diarrhea |
| What drug helps ibs but also tx constipation? | Anticholinergics |
| Definition of IBD is? | ulcerative colitis: erosions in large intestine and inflammatory disease, Crohn’s disease: ulcers in small intestine |
| name some symptoms for IBD | abdominal cramping and diarrhea |
| Prototype for IBD is | Sulfasalazine (Azulfidine) |
| What is the MAO for Sulfasalazine (Azulfidine) ? | inhibits inflammatory mediators such as prostaglandins and leukotrienes |
| What is the Pharm class for Sulfasalazine (Azulfidine)? | 5-aminosalicylate, sulfonamide |
| What is Sulfasalazine (Azulfidine)? considered? | DMARD |
| What is the administer alert for Sulfasalazine (Azulfidine)? | Do not crush, monitor hepatic function, do not take if you have allergies to aspirin or sulfa |
| What are some contraindications Sulfasalazine (Azulfidine)? | patients hypersensitive to sulfa or aspirin, anemia, hepatic impairment, urinary obstruction, dehydration, diabetes, hypoglycemia, do not give to people with HIV or children under age 2 |
| What is the zone that helps with vomiting? | Medulla of the brain, the inner ear, chemoreceptor trigger zone, cerebral cortex |
| What can you give to someone that is not meds? | Mint or ginger |
| Antiemetics prototype is? | Prochlorperazine (Compazine) - antipsychotic |
| Prochlorperazine (Compazine) - antipsychotic MOA is? | blocks dopamine receptors in the brain |
| What are some adverse effects for Prochlorperazine (Compazine) ? | dry mouth & mucous membranes, constipation, sedation, orthostatic hypotension, tachycardia, EPS |
| what are some herbal options for Antiemetics | Mint or Ginger |
| Med: ondansetron (Zofran) admin alert includes? | administer according to schedule not prn. Q4-8hrs |
| Pancrelipase is.... | a Pancreatic Enzyme Replacement |
| Pancreatic Enzyme Replacement actions include? | converts lipase into glycerol and fatty acids, converts starches into dextran and starches, converts protein into peptides |
| Pancreatic Enzyme Replacement adverse effects | nausea, vomiting, diarrhea, Steatorrhea (fatty stools), Hyperuricosuria |
| What people do you give Pancreatic Enzyme Replacement to? | cystic fibrosis |
| Why do we check if the eat pork with pancreatic enzyme replacements? | Make sure they can eat pork because it is made from it |
| When do you give Pancreatic Enzyme Replacement | 1-2 hours before or with meals, also given as a powder on food |
| Drugs for Nutritional Disorders - Vitamins What is the role for vitamins? | Vitamins are organic compounds required by the body in small amounts for growth and for the maintenance of normal metabolic processes. Cannot make ourselves except for vit D Essential substances needed to maintain optimal wellness. |
| Nutritional disorders - Liable soluble include which vitamins? | A, D, E, K |
| What is the vitam A pharm class? and adverse effects? | CNS toxicity, Headache, irritability, possible coma |
| which vitamin helps with clotting? | K |
| for the table for lipid soluble check table 43.2 | N/A |
| What are the water soluble vitamins? | Vitamin C, B complex 6 b vitamins Folic acid (B 9) |
| What does Folic acid promote? | Promotes normal fetal growth, neural tube defects during pregnancy Helping with chronic alcohol abuse |
| What is an adversed effect for folic acid | flushed after iv |
| What if we do not have enough vitamin C? | Scurvy |
| What are some minerals nutritional disorders? | Calcium, sulfate |
| what can happen when you take enough Calcium? | it can cause muscle twitching, cardiac abnormalities |
| Admin alerts/ labs checked when?avoid which type of foods for Calcium | IF given iv look for pushing, pain at injection, check for infiltration and redness Recheck labs 4-6 hours after infusion Avoid zinc-rich foods |
| How can you admin calcium? | Can give by mouth, but also IV By mouth is given twice daily |
| …sulfate helps with what and how is admin? | Helps with restless leg syndrome, muscles, heart Can give IV, slow infusion, give over 4 hours |
| Nutritional Supplement included? | TPN (hyperalimentation) |
| TPN (hyperalimentation) Administration and Monitor for… | let it set at least 30 min before giving it |
| TPN (hyperalimentation)Nursing interventions include... | monitor CMP, AST/ALT, monitor for fluid overload (crackles, JVD, tachycardia, high bp), weigh daily |
| TPN (hyperalimentation) Parenteral is through... | IV |
| For the peripheral vein and the central vein is long term and which is short term? | Peripheral vein: (short term), Central: long term |
| What is a Drug for obesity? | Orlistat (Alli) |
| Orlistat (Alli) pharm class is? | a lipase inhibitor |
| what is the MOA for Orlistat (Alli) | inhibits absorption of lipids |
| What is the primary use for Orlistat (Alli) ? | administer if higher than 30 (obesity) or 27 if no other morbidity |
| What is the administration for Orlistat (Alli) | take 1 hr before meals containing fat, skip dose if it does not contain fat |
| Orlistat (Alli) adverse effects are? | oily stool, fecal urgency, abdominal pain, flatus with discharge |
| What is the an Anorexiant: | appetite suppressors |
| Anorexiant example is? | Phentermine |
| What is the Intrinsic Factor? | Helps intestines absorb B12 |
| Drugs for disorders and conditions of the Male Reproductive Pharmacotherapy with androgens : Definition | male sex hormone |
| Testosterone pg. 809 Black Box Warning | virilization in women and children may occur if exposed |
| Testosterones is drug for male infertility's Pharm class? | androgen; anabolic steroid; antineoplastic |
| What does testosterone promote? | virilization and treats hypogonadism |
| Which gland secretes testosterone? | The testes |
| Contraindications with disorders and foods for testosterone includes.. | Breast cancer or prostate cancer, liver disease, kidney disease, BPH, women becoming pregnant |
| what are some actions and uses for testosterone? | promotes virilization (secondary sex characteristics, enlargement of sex organs) and treats hypogonadism, increases libido, extra hair, corrects erectile dysfunction |
| testosterone Administration: | wash hands and use gloves if women are administering it, especially pregnant women because it can also harm baby, apply on hairless area on back, abdomen, back of arm, rotate sites every 7 days, if given IM give it in the gluteal muscle |
| What pregnancy category is testosterone? | X |
| what are some adverse effects with medication with testosterone? | virilization, edema, if taken too much it can retain salt, damage to liver, acne, skin irritation, increased or decreased libido |
| what are some Drug to Drug interactions with testosterone? | anticoagulants because it increases bleeding, corticosteroids can cause edema, hepatotoxic drugs |
| what is Hypogonadism? | low testosterone |
| what can low testosterone lead to? | Can lead to erectile dysfunction |
| what is the prototype for drugs for erectile dysfunction? | Sildenafil (Viagra) |
| what are some contraindications with Sildenafil (Viagra) | cardiac problems, nitrates (nitroglycerin), MI, stroke, HF, arrythmias, deformities of the penis |
| for Sildenafil (Viagra) what are some herbal/food interactions? | avoid grapefruit juice bc it increases plasma concentrations, avoid high-fat meals bc it decreases absorption |
| what is the MOA for Sildenafil (Viagra) | relaxes smooth muscle in cavernosa allowing increased blood flow to penis |
| what is the Administration for Sildenafil (Viagra)? | avoid taking with high fat meals, avoid grapefruit juice, take it after dinner, or in the mood |
| Sildenafil (Viagra) pharm class is... | phosphodiesterase (PDE)-5 inhibitor |
| what is an Adverse effect for Sildenafil (Viagra) | hypotension, because it dilates vessels, flushing, HA, dizziness, rash, nasal congestion, diarrhea, UTI, chest pain, indigestion, blurred vision, priapism |
| what are the drugs for benign prostatic hyperplasia for? | Blocks urethra |
| what are some common symptoms for drugs for benign prostatic hyperplasia? | dribbling, nocturia, increased frequency, urgency, incomplete emptying of bladder, decreased forced |
| Alpha-adrenergic blockers --Tamsulosin (Flomax) is for? | Relaxes smooth muscles cells in prostate, urethra, bladder neck |
| 5 Alpha reductase for benign prostatic hyperplasia prototype is.. | Finasteride (Proscar) |
| The Assesment for Finasteride (Proscar) includes... | |
| what is the MAO for Finasteride (Proscar) | inhibits 5 alpha reductase, shrinks the enlarged prostate |
| what is the admin for Finasteride (Proscar) | pregnant nurses & pharmacists should avoid handling crushed tablets bc it can harm fetus, patients taking it cannot donate blood |
| what is the contraindication for Finasteride (Proscar) | pregnancy/lactation, children |
| what is an adverse effect of Finasteride (Proscar)? | sexual dysfunction |
| Drugs for disorders and conditions of the Female Reproductive inlcude... | Estrogen and progesterone |
| What do you assess first? female reproductive | if they’re pregnant, if they have a hx of clots, stroke, CAD |
| Hormonal contraceptives contain... | contain estrogen and progesterone |
| Combination contraceptives is... | ethinyl estradiol and norethindrone (Ortho-Novum) |
| Pt education for Hormonal contraceptives? | record duration and frequency of breakthrough bleeding, evaluate for possible pregnancy if 2 or more periods are missed, if taking orally, take it daily at same time, if missed, f/u with provider and use back up contraceptive method |
| what happens if you miss a day of hormonal contraceptives? | if you don’t take them then, take as soon as remembered or 2 the next day, if you miss 3 days then ASSESS first if they had sex (might need plan b) then restart a new pack |
| Why 28 days? | So you don’t miss one |
| Inert pills tx is? | acne, endometriosis |
| what are some adverse effects of hormonal contraceptives? | Nausea, pain, breast tenderness, weight gain, breakthrough bleeding, edema, changes in vision, HA, HTN |
| Plan B One-Step is... | (levonorgestrel): (1 dose), take within 120 hours after unprotected sex |
| Plan B is.. | (levonorgestrel) take within 72 hrs, 12 hours apart (2 doses) |
| what is the Mechanism of action for plan B | prevents ovulation or implantation of fertilized egg; does not induce abortion |
| Estradiol and Norethindrone Black Box Warning is.. | don’t take if smoking, it can increase risk for cardiovascular effects |
| Estradiol and Norethindrone Contraindications include.. | smoking, breast cancer, thromboembolic events (stroke, MI, blood clots, CAD), pregnancy risk X, abnormal vaginal bleeding, jaundice |
| a drug to drug interaction with Estradiol and Norethindrone include.. | carbamazepine, phenobarbital, warfarin, heparin, oral hypoglycemics, theophylline, imipramine |
| what is the brand name for Medroxyprogesterone | Depo Provera |
| What is the MOA for depo provera? | inhibits effect of estrogen on uterus and restores hormonal balance Used for Endometriosis, uterine bleeding, amenorrhea, and contraceptive |
| what is the pharm class for depo provera | Progestin |
| what are some Adverse effects for depo provera | weight gain, depression, nausea, vomiting, breakthrough bleeding, breast tenderness, amenorrhea, dysmenorrhea, thromboembolic events are contraindicated |
| what is the Administration for depo provera? | Given IM q3mo, watch for site redness or swelling, pain at injection site. |
| what is the prototype for hormonal replacement | Conjugated estrogen (Cenestin, Enjuvia) |
| Who can get Conjugated estrogen (Cenestin, Enjuvia) | For women that had hysterectomy (removal of ovaries) and for postmenopausal |
| How can it be Administered? | IV, pill |
| what are some Contraindications for Conjugated estrogen (Cenestin, Enjuvia) | pregnant women, thromboembolic events, liver disease, breast cancer, abnormal uterine bleeding |
| Drugs for dysfunctional uterine bleeding.. | Uterine stimulants and relaxants |
| Prototype for dysfunctional uterine bleeding.. | Oxytocin |
| What is the pharm class for Oxytocin | oxytocic hormone |
| what are some actions and uses for Oxytocin? | induces labor, reduces hemorrhage after baby is delivered so it brings uterus back to normal |
| what is the MOA for Oxytocin... | increases contractions |
| Which gland does it come from? | Posterior pituitary gland |
| What are some drugs for emergency contraception and pharmacologic abortion | Levonorgestrel |
| Alternative birth control: length of use Depot injections | provides 3 months of protection |
| Alternative birth control: length of use Subdermal implants | Provides contraception protection up to 3 years, goes into fatty tissue |
| Alternative birth control: length of use Transdermal implants | 7 days then reapply patch for the first 3 weeks followed by patch-free week 4 |
| Alternative birth control: length of use Vaginal route | NuvaRing- Covered for 3 weeks |
| Alternative birth control: length of use Intrauterine Route (IUD) | Marena- 5 years 3-6 yrs depending on brand |
| Drugs for bone and joint disorders -Calcitriol (Calcijex, Rocaltrol) - Administration? | give with meals (2x a day) |
| Pharm class for -Calcitriol (Calcijex, Rocaltrol) | bone resorption inhibitor |
| MOA for bone resorption inhibitor Calcitriol (Calcijex, Rocaltrol) | elevates serum levels of calcium, reduces bone resorption, promotes intestinal absorption of calcium |
| What would you monitor for Calcitriol (Calcijex, Rocaltrol) | electrolyte levels |
| Drugs for bone and joint disorders Raloxifene (Evista) MOA... | decreases bone reabsorption and increases bone mass and density |
| Pharm class for -Raloxifene (Evista) | selective estrogen receptor modulator |
| Primary use for-Raloxifene (Evista) is ... | prevents osteoporosis in postmenopausal women, also reduces risk of breast cancer in women |
| Administration for -Raloxifene (Evista) is.. | with or without food, pregnant category X, increase intake of calcium & vit D |
| What are some common effects with -Raloxifene (Evista) | hot flashes, weight gain, leg cramps, migraine HA, |
| What is the Black Box Warning for Raloxifene (Evista) | increases risk of venous thromboembolism and death from strokes in women with CAD or hx of thromboembolism |
| Pharmacotherapy for Joint Disorders Therapy of RA… | First give NSAIDs, then steroids, then DMARD therapy. |
| Pharmacotherapy for Joint Disorders Methotrexate (Otrexup) :adverse effects? | HA, sore throat, black tarry stools, bone marrow depression, gingivitis, mild leukopenia, nausea, ulcerative stomatitis, aplastic anemia, liver cirrhosis, nephrotoxicity, sudden death, pulmonary fibrosis, teratogenicity Folic acid reduces toxic effects |
| Pharmacotherapy for Joint Disorders Hydroxychloroquine (Plaquenil) adverse effects? | s: anorexia, GI disturbances, loss of hair, HA, mood and mental changes, affects vision, photophobia, blacked out areas in visual fields. |
| Pharmacotherapy for Joint Disorders Hydroxychloroquine (Plaquenil) Mechanism of action: ? | relieves inflammation of lupus, RA, and malaria |
| Pharmacotherapy for Joint Disorders Hydroxychloroquine (Plaquenil) check pts ..... | Check pts eyes during treatment |
| Gout is... | buildup of uric acid in the big toe |
| Gout is triggered by | Triggered by alcohol, red meat |
| What do you give for GOUT | Give endomethacin, naproxen, steroids |
| Prototype for Gout | Allopurinol (Lopurin) |
| When do you take Allopurinol (Lopurin) | Daily |
| Allopurinol (Lopurin) MOA is... | inhibits synthesis of uric acid and decreases chances of acute gout attacks |
| Allopurinol (Lopurin) pharm class... | Xanthine oxidase inhibitor |
| Allopurinol (Lopurin) primary use includes? | decreases inflammation of gout |
| Cannot take if | alcoholism, renal disease/impaired liver function, hx of peptic ulcers, lower GI disease, pregnancy, bone marrow depression |
| IMPORTANT | Make sure to know what bph meds do |
| IMPORTANT | Tamsulosin vs finasteride and the type of drugs |
| If someone comes in with gu, peptic ulcer disease. What meds do you question? | NSAIDS on a daily basis. |
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