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Pharm Final 12-14
classes & medications
| Question | Answer |
|---|---|
| Bile Acid binding agents | Cholestryramine(Questran) Colesvelam (Welchol) Colestipol(Colestid) |
| Omega 3 Fatty acids | Omacor (fish oils) combo of two Eicosapentaenoic acid (EPA) Docosahexaenoic (DHA) |
| Common side effects of Niacin include? | Flushing, itching, headache |
| Digistalis toxicity symptoms are | amorexia, vomiting, blurred vision |
| Potassium supplements and salt substitutes should not be given with the following class of diuretic | Potassium sparing |
| HMG-CoA reductase drugs are also known as | Statins |
| H2-Receptor blockers (H2 atagonists) | *IDINE Cimetidine(tagamet) Famotidine(Pepcid) Ranitidine(Zantac) ( decrease acid secretion in stomach) |
| Proton Pump Inhibitors(PPI)aka subsituted benzimidazoles | *Prazoles Esomeprazole(Nexium) Omeprazole(Prilosec) Pantoprazole(Protonix) Rabeprazole Sodium (AcipHex) (reduce acid secretion) |
| Antacids | Calcium Carbonate(Tums) Calcium Carbonate w/ magnesium hydroxide(rolaids) Magnesium hydroxide(Milk of Mag) Sodium Bicarbonate(Alka-Seltzer) Simethicone(Gas X) |
| ATB for H Pylori | Amoxicillin(Amoxil) Clarithromycin(Biaxin) Metronidazole(Flagyl) Tetracycline |
| 5 classes of oral hypoglycemic | Alpha-glucosidase Inhibitor Miglitol(Glyset) Biguanides Meglitinides Sulfonyureas Thiazolidinediones |
| Alpha-glucosidase Inhibitor | Acarbose(Precose) (decreases hepatic glucose production, reduces absorption of glucose from small intestine, increases insulin sensitivity) |
| Miglitol(Glyset) | Enzyme inhibitor results in delayed glucose absobrtion and a lowering of post prandial hyperglycemia |
| Biguanides | Metaformin HCL (Glucophage) (decreases hepatatic glucose production, reduces absorption of glucose from small intestine, increases sensitivity to insulin. |
| Meglitinides | Nateglinide(starlix) Repalinide(Prandin) |
| Sulfonyureas first gen, less side effects | Acetohexamide(Dimelor) Tolbutamide(Orinase) |
| Sulfonyureas second gen, stronger | Glimepiride(Amaryl) Glyburide(DiaBeta) Glipizide(Glucotrol) |
| Thiazolidinediones | lower blood glucose by increasing sensitivity of muscle and fat tissue to insulin Pioglitazone(actos) Rosiglitazone(avandia) |
| Rapid Insulin | Lispro, Aspart, Humalog pk 1-2hrs |
| Short Insulin | Humulin R, Novolin R pk2-4hrs |
| Intermediate Insulin | NPH, Humulin N, Novolin N, Lente; pk 4-12hrs |
| Long acting Insulin | Humulin U, Ultralente pk 6-20hrs |
| Vitamin D supplements (active form) | Calcitriol (Rocaltrol) Paricalcitol (Zemplar) |
| Common calcium supplements | Calcium Carbonate (Bio-Cal) Calcium citrate (Citracal) Calcium gluconate (Kalcinate) |
| Hypocalcemia | • Signs and symptoms • Muscle twitching • Tremor • Cramping • Numbness and tingling of extremities • Seizures with severe hypocalcemia • Confusion • Altered mental status |
| Neuromuscular blocking agents require the availability of which drug to treat an overdose? | neostigmine methylsulfate (Prostigmin) |
| Direct-Acting Antispasmodics | Dantrolene (Dantrium) Botulinum toxin type A (Botox) |
| Centrally Acting Antispasmodics | Baclofen (Lioresal) Cyclobenzaprine (Flexeril) |
| • A client has a PRN order for loperamide (Imodium). The nurse should plan to administer this medication if the client has: | An episode of diarrhea |
| • A client has been started on psyllium (Metamucil). The nurse would teach the client to take this medication with: | A full glass of liquid, followed by a second glass |
| • A client newly diagnosed with a gastric ulcer has been prescribed sucralfate (Carafate). The nurse explains that this medication will have which of the following beneficial effects for the client? | It will help protect the eroded ulcer surface from stomach acid |
| Weight loss | Sibutramine (Meridia) Orlistat (Xenical)- Rx or Alli- OTC Meridia suppresses appetite Orlistat blocks the absorption of fat in the GI tract |
| Emetics | • Used to stimulate vomiting • Ipecac syrup is given orally • Apomorphine is given SubQ |
| Cannaboids | Dronabinol (THC)- Marinol |
| Benzodiazepines | Lorazepam (Ativan) Midazolam (Versed) Diazepam (Valium) |
| Corticosteroids | Dexamethasone (Decadron) Methylprednisolone |
| Neurokinin-1 receptor antagonists | Aprepitant (Emend) |
| Serotonin Antagonists | Ondansetron (Zofran) |
| Antihistamines (Anticholinergic agents) | Diphenhydramine (Benadryl) Promethazine (Phenergan) |
| Phenothiazines (Dopamine Antagonists) | These medications inhibit dopamine receptors that are part of the pathway to the vomiting center. Prochlorperazine (Compazine) Metoclopramide (Reglan) |
| Bismuth subsalicylate (Pepto Bismol) | • Acts by binding and absorbing toxins • Psyllium and pectin preparations slow diarrhea by absorbing large amounts of fluid to form bulkier stools |
| Opioids for diarrhea: | Diphenoxylate (Lomitil)- Rx Loperamide (Immodium)- OTC |
| Stool Softeners/surfactant | Docusate (Colace)• Causes more water and fat to be absorbed into the stools • May be prescribed postoperatively to relieve straining |
| Saline/osmotic laxatives | Magnesium Citrate Magnesium Hydroxide (Milk of Magnesia, MOM) Sodium biphosphate (Fleet Phospho-Soda)- enema |
| Bulk forming laxatives | Calcium polycarbophil (Fibercon) Methylcellulose (Citrucel) Psyllium muciloid (Metamucil) |
| Antispasmodic agents: | Inhibition of cholinergic cell conduction results in decreased GI motility and reduced secretions. Belladonna Dicyclomine (Bentyl) |
| Prokinetic Agents | Metoclopramide (Reglan) • Gastric stimulant • Used to relieve symptoms of gastric reflux esophagitis and diabetic gastroparesis, to stimulate gastric emptying • Also used as an antiemetic with cancer chemotherapy |
| Coating agents | Sucralfate (Carafate) • It is a combo of sugar and aluminum hydroxide (antacid) • Creates a thick gel-like substance to coat the ulcer to promote healing • Must be taken 4 times per day |
| GI prostaglandins | Misoprostol (Cytotec) • Inhibits gastric acid secretion and increases mucous production • Used to prevent peptic ulcers in pts taking high doses of NSAIDs or glucocorticoids • Classified as a pregnancy category X |
| Statins aka HMG-CoA reducase inhibitors | Atorvastatin (Lipitor) Simvastatin (Zocor) Rosuvastatin (Crestor) First drug of choice to reduce blood lipid levels. Statin is a class of antihyperlipidemics. Can produce a 20-40% reduction in LDL cholesterol. Can also lower triglyceride and VLDL level |
| Carbonic anhydrase inhibitors | *AMIDE Acetazolamide (Diamox) Diclorphenamide (Daramide) Methazolamide (Neptazane) Carbonic anhydrase is an enzyme that affects acid-base balance by its ability to form carbonic acid from water and carbon dioxide. |
| Methylxanthines | Used for the cardiorenal disease. Also used as bronchodilators. Aminophylline Theophylline (TheoDur) |
| Potassium sparing diuretics | Amiloride HCL (Midamor) Spironolactone (Aldactone) Triamterene (Dyrenium) can cause HYPERKALEMIA |
| Thiazide Diuretics | Most commonly prescribed class of diuretics. Act on the distal tubule to block sodium reabsorption and increase water excretion. Less effective than loop diuretics and are INEFFECTIVE in pts with severe renal disease. Hydrochlorothiazide (HCTZ)-short act |
| Loop diureticsAKA high ceiling diuretics | *IDE, Furosemide (Lasix) Torsemide (Demadex) Bumetanide (Bumex) |
| Phosphodiesterase inhibitors | Side effects- biggest one is ventricular dysrhythmia Pt needs to be on telemetry during infusion Inamrinone (Inocor) Milrinone (Primacor) |
| Nitrates | IV nitroglycerin Nitroprusside |
| Natriuretic Peptides | Nesiritide (Natrecor) |
| Digitalis Glycosides | Need to check apical HR Verify the dose carefully Digoxin (Lanoxin) |
| Preload- | How much fibers stretch for contractions. |
| Afterload | pressure in aorta that must be oover come so that blood can be pumped from the heart to the body |
| Hemostatics AKA antifibrinolytics | Aminocaproic Acid (Amicar) Action is opposite of anticoagulants…they shorten bleeding time. |
| Thrombolytics | Clot busters- dissolve existing clots. ***Need to monitor your pt and stop the med ASAP if there are signs of bleeding • Reteplase recombinant (Retavase) • Streptokinase (Streptase)- this was the first thrombolytic |
| ***Need to monitor your pt and stop the med ASAP if there are signs of bleeding • Reteplase recombinant (Retavase) • Streptokinase (Streptase)- this was the first thrombolytic | Aspirin (ASA) Ticlopidine (Ticlid) Clopidogrel (Plavix) Glycoprotein IIb/IIIa receptor blockers |
| Anticoagulants | Prevent formation of clots |
| Antiplatelets - | Diminish clotting action of platelets |
| Thrombolytics | Dissolve life threatening clots |
| Hemostatics - | Inhibit the normal removal of fibrin |
| Fatty Oxidase Enzyme Inhibitor | Exact mechanism is unknown but it decreases the demand for oxygen which reduces myocardial ischemia and symptoms of angina. Ranolazine (Ranexa) |
| Amyl nitrate (Vaporole) | inhalation nitrate |
| Nitrate SE | Hypotension/orthostatic hypotension, Reflex tachycardia, Headache, Flushing of skin • Frequently pts are instructed to remove patch for 8-12 hours/day usually at night to delay the onset of tolerance |
| There are 7 classes of drugs used to treat angina | – Nitrates – Beta Blockers – Calcium Channel Blockers – ACE Inhibitors – Statins – Platelet-active agents – Fatty oxidase enzyme inhibitor |
| CABG | coronary artery bypass graft |
| LIMA | left interior mammary artery |
| PTCA | Percutaneous transluminal coronary angioplasty |
| The generic names of all drugs in the classification end in “sartan | Angiotensin II receptor antagonists |
| The generic names of all but one drug in the classification end in “pril” | Angiotensin-converting enzyme inhibitors |
| Direct vasodilators Causes relaxation of arteriolar smooth muscle which reduces peripheral vascular resistance This leads to increased HR, CO and renin release with sodium and water retention These meds work best when the pt is taking a beta blocker an | Hydralazine (Apresoline) Minoxidil (Loniten) |
| Minoxidil-SE | Hair growth, Increased pulse rate, Lightheadedness, Dizziness, Orthostatic hypotension, Salt and water retention |
| Peripheral-acting adrenergic agents Causes relaxation of vascular smooth muscle which decreases total peripheral resistance and venous return, Hypotensive effect is greater when standing than supine, Fluid retention is common. | Guanadrel (Hylorel) Guanethidine sulfate (Ismelin) Reserpine (Serpasil) SE-Orthostatic hypotension, Sedation, Lightheadedness, Edema, Nasal stuffiness |
| Benzothiazepine CCBs -Have both cardiac depressant and vasodilator actions. | Diltiazem (Cardizem) SE-Headache, Facial flushing, Hypotension and syncope, Edema |
| Phenylalkylamine CCBs Phenylalkylamine CCBs are selective to the myocardium, reduce the demand for oxygen in the myocardium, and reverse coronary vasospasm. They cause minimal vasodilatation | • Verapamil (Isoptin) |
| Calcium Channel Blockers (CCB) | *IPINE Amlodipine (Norvasc) • Felodipine (Plendil) • Nifedipine (Procardia) |
| Beta-adrenergic blockers Reduce HR, CO, and BP JNC 7 recommends beta blockers as initial therapy for stages 1 and 2. Should be avoided in pts with asthma, type 1 DM, heart failure caused by systolic dysfunction and PVD. | *LOLAtenolol (Tenormin) Carvedilol (Coreg) alpha and beta combo blocker Metoprolol (Lopressor, Toprol) Propranolol (Inderal) alpha and beta combo blocker |
| alpha2 agonists | Clonidine (Catapres) Also Catapres TTS (transdermal patch) Methyldopa (Aldomet) SE- Sedation, Dizziness, Dry mouth, Fatigue, Sexual dysfunction |
| Alpha blockers | *SIN Prazosin (Minipress) Terazosin (Hytrin) Doxazosin (Cardura) • Are selective alpha1 blockers -also used for BPH (BPH-Benign prostatic hyperplasia) |
| Aldosterone Receptor Antagonist Blocks the stimulation of the mineralcorticoid receptors by aldosterone which prevents sodium reabsorption (which leads to lower BP) | Eplerenone (Inspra) Nausea, Fatigue, HA, Diarrhea, Orthostatic hypotension, Slight increases in serum potassium levels, Increased lipids, Nephrotoxicity, Hepatotoxicity |
| ARBs Angiotensin Receptor Blockers Used to prevent angiotensin II from acting on angiotensin receptors Aldosterone receptor antagonists... | Irbesartan (Avapro) Candesartan (Atacand) Losartan (Cozaar) Orthostatic hypotension, HA, Dizziness, Lightheadedness, Hyperkalemia |
| ACE Inhibitors | *PRIL Ramipril (Altace) Lisinopril (Zestril, Prinivil) Captopril (Capoten) Quinipril (Accupril) Enalapril (Vasotec) Enlaprilat (Vasotec IV) exception to PRIL |
| Renin-Angiotensin-Aldosterone System (RAAS | is a hormone system that helps regulate long-term blood pressure control and extracellular volume in the body. Renin is released from the kidneys. Renin converts angiotensinogen into angiotensin I. Angiotensin I is converted to angiotensin II by angiotens |
| Metabolic syndrome | Insulin resistance leads to type 2 diabetes and induces atherosclerosis, which leads to coronary artery disease. Key characteristics include: – Type 2 diabetes mellitus – Abdominal obesity – Hypertriglyceridemia – Low levels of high density lipopro |
| Which of the following classes of medication is more beneficial if given before exposure to allergens? | Antihistamines |
| Blurred vision, constipation, urinary retention and dryness of the oral mucosa are anticholinergic effects produced by: | Antihistamines SE |
| Patients using intranasal corticosteroids should be counseled about which of the following? | Therapeutic effects are not immediate |
| Following the inhalation of steroid medications, the patient should do which of the following | Rinse the mouth and spit out water |
| Guaifenesin (Robitussin) is classified as a(n): | Expectorant |
| An antitussive agent acts to: | Suppress cough reflex response in the brain |
| Miscellaneous antiinflammatory agents | • Cromolyn (Intal) and is given as an MDI • Is also available as intranasal spray (Nasalcrom) for seasonal allergies • Nedocromil (Tildade) is given as an MDI |
| Nedocromil | can cause an unpleasant taste |
| Immunomodulator agent Works by decreasing the amount of IgE antibodies in the blood which decreases the release of inflammatory chemicals that can lead to the symptoms of asthma. | Omalizumab (Xolair) |
| Antileukotriene agents(Anti-Inflammatory) | All are oral. Used for prophylaxis of chronic asthma. Ineffective in relieving bronchospasm. They decrease inflammation and ease bronchoconstriction |
| Oral corticoisteroids | prednisone SE-Inhaled: HA, cough, epistaxis, dry mouth, hoarseness, May cause thrush, Oral: Usually only taken for 5-7 days for asthma. If taken longer adrenal gland suppression, peptic ulcers, hyperglycemia and weight gain are possible |
| Inhalant corticosteroids | Budesonide phosphate (Pulmicort Turbuhaler) Fluticasone (Flovent) Triamcinolone acetonide (Azmacort) |
| Xanthine deritives AKA methylanthines | • Aminophylline (Truphylline) • Theophylline (Theo-dur) SE-Nausea, Vomiting, CNS stimulation, Tachycardia and or palpitations, Cardiac arrhythmias can occur with high doses. |
| Anticholinergic agents (another bronchodilator) Block the parasympathetic nervous system Few systemic side effects because they are inhaled. Work best in combination with other bronchodilators. | • Ipratropium (Atrovent) • Tiotropium (Spiriva) • Combivent (Albuterol and Atrovent) |
| Bronchodilators | • Albuterol (Proventil)- short acting • Salmeterol (Serevent)- long acting • Pirbuterol (Maxair)- short acting • Epinephrine (Primatene, Bronkaid)- short acting |
| Bronchodilators SE- | SE- Tachycardia, palpitations, tremors, nervousness, anxiety, restlessness, HA, nausea and vomiting, dizziness |
| Mucolytics: Acetylcysteine (Mucomyst) | Used for cystic fibrosis, chronic emphysema, pneumonia and asthmatic bronchitis SE-Nausea, Vomiting, Bronchospam (occasionally) |
| Benzonatate (Tessalon) | doesn’t act on the cough center. It has an anesthetic-like effect on the stretch receptors in the lung. This interrupts the cough message ***Can’t be chewed or the throat and tongue will be numb |
| Diphenhydramine (Benadryl) | Is an anticholinergic agent with antihistamine and antitussive properties It causes significant drowsiness in many people. Should be avoided in pts with glaucoma or prostatic hyperplasia. |
| Expectorants Drugs that stimulate the flow of bronchial secretionsThis thins or liquefies the mucous and allows it to be coughed up easier | - guaifenesin (Robitussin, Mucinex) Side effects are rare: Nausea, Vomiting, GI upset • Potassium Iodide (SSKI) Works as an expectorant by stimulating increased secretions from the bronchial glands which makes it easier to cough up mucous plugs. |
| Intranasal corticosteroids Exact mechanism isn’t known. Highly effective in reducing inflammation when used intranasally. Newer steroids have few side effects. May take 2 weeks for the full effect of the medication to become evident | • Budesonide (Rhinocort Aqua) • Fluticasone (Flonase) • Mometasone (Nasonex) • Triamcinolone (Nasacort AQ) • Cromolyn sodium (Nasalcrom) |
| **Oral decongestants should be used with caution in pts with: | • HTN • Hyperthyroidism • DM • Cardiac disease • Increased intraocular pressure • Prostatic hyperplasia |
| **Oral decongestants should be used with caution in pts with: | • HTN • Hyperthyroidism • DM • Cardiac disease • Increased intraocular pressure • Prostatic hyperplasia |
| Antihistamines (H1 receptor antagonist) Taken orally and reduce the symptoms of sneezing, rhinorrhea and watery eyes Antihistamines work by competing for the H1 receptor sites in the mucous membranes Antihistamines do not prevent the release of histam | • Cetirizine (Zyrtec) • Chlorpheniramine (Chlor-Trimeton) • Diphenhydramine HCL (Benadryl) • Loratadine (Claritin) Drowsiness, impaired memory or coordination, Constipation, Dry mouth |
| A client entering the medicine clinic has been diagnosed with an overactive bladder. Which medication would the nurse expect to be ordered? | Tolterodine tartrate (Detrol) |
| Urinary Antimuscarinics | : tolterodine tartrate (Detrol) Action: control an overactive bladder • Side effects-Similar to anticholinergics – dry mouth, constipation, blurred vision • Caution-Avoid if client has narrow-angle glaucoma |
| Anticholinergics | Atropine; Ipratropium (Atrovent; Scopolamine (Hyoscine) |
| Atropine | • To dry secretions prior to anesthesia • To increase HR • To dilate pupils |
| Ipratropium (Atrovent) | • To treat asthma |
| Scopolamine (Hyoscine) | • To treat IBS • Motion sickness |
| Parasympathomimetics | Bethanechol (Urecholine);Neostigmine (Prostigmin); Pilocarpine (Isopto Carpine; Pyridostigmine (Mestinon) |
| Bethanechol (Urecholine) | • To contract bladder muscles • Stimulates return of normal GI and urinary tract function following general anesthesia |
| Neostigmine (Prostigmin) | • To contract ureters • Also used to treat myasthenia gravis |
| Pilocarpine (Isopto Carpine) | • To decrease intraocular pressure |
| Pyridostigmine (Mestinon) | • To treat myasthenia gravis |
| Adrenergic Agents | • Phenlyephrine (Neo-Synephrine) • Dobutamine (Dobutrex) • Dopamine (Inotropin) • Albuterol (Proventil) • Epinephrine (Adrenalin) • Pseudoephedrine (Sudafed) • Isoproterenol (Isuprel) • Norepinephrine (Levophed) • Salmeterol (Serevent) |
| Acetylcholine ***Remember ACP Acetylcholine, Cholinergic, Parasympathetic | Receptors are called nicotinic receptors in the ganglia and skeletal muscle • Receptors are called muscarinic receptors at the end of postsynaptic neurons in the parasympathetic nervous system Adrenergic Agents- Mimic actions of the sympathetic nervous |
| Norepinephrine *** Remember NAS Norepinephrine, Adrenergic, Sympathetic | Receptor subtypes alpha (α) and beta (β) • Drugs may be selective and affect one type of receptor or non-selective and affect all Alpha 1 vasoconstrict; Alpha2 stops release of norepinephrine; Beta1 stimulate receptors of heart; Beta2 relax smooth musc |
| • Norepinephrine (NE)- | released by sympathetic nerves, also called adrenergic nerves |
| • Acetylcholine (Ach)- | Primarily released by parasympathetic nerves, also called cholinergic nerves |
| Parasympathetic division Rest and digest | • Constricts pupils • Stimulates salivation • Slows heart • Constricts breathing • Stimulates digestion • Stimulates gallbladder • Contracts bladder • Stimulates sex organs |
| Sympathetic Division Fight or flight | • Inhibits salivation • Accelerates heart • Facilitates breathing • Inhibits digestion • Stimulates release of glucose • Secretes epinephrine and norepinephrine • Relaxes bladder • Inhibits sex organs |
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