Pharm Final

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Pharm Final
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2013-07-02 02:20:05
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pharmacology nursing final exam
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pharmacolgy for nursing
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  1. Relationship b/t blood volume and rate of absorption?
    increased blood volume = increased rate of absorption
  2. How does protein binding affect drug dosage?
    drugs that are highly protein bound require higher doses

    if a person is malnourished can cause overdose b/c safe dosed based on normal protein
  3. 2 ways drugs may cross the BBB?
    • 1. lipophillic
    • 2. have a transport system
  4. Hepatic dysfunction effect on drug metabolism?
    decreased albumin = more free drug to act
  5. Prodrugs?
    inactive until met. into active form
  6. Grapefruit affect on P450?
    decreases met. = increased drug effects
  7. St John's Wart effect on P450?
    increases met. = decreased drug effects
  8. 4 factors that affect distribution of a drug?
    • 1. blood flow
    • 2. protein binding
    • 3. BBB
    • 4. placental membrane
  9. Bound and unbound med? (protein binding)
    bound cannot leave BF to site of action

    unbound can have pharm response
  10. 3 disorders that can cause hypoalbuminemia?
    • 1. malnourishment
    • 2. liver dysfunction
    • 3. severe burns
  11. Increased risk for drug toxicity with what condition?

    Who is most at risk?
    obesity - old ppl
  12. Drugs are usually transformed from ____ to ____ during metabolism.

    Why?
    lipophillic to hydrophillic

    so they may be excreted
  13. 5 sites of metabolism?
    • 1. main is liver
    • 2. GI
    • 3. skin
    • 4. lungs
    • 5. kidneys
  14. Way to avoid first pass effect?
    give IV and bypass liver
  15. 4 things that induce the p450 system?
    • 1. charcoal-broiled foods
    • 2. cruciferous veggies
    • 3. cigarette smoke
    • 4. St John's Wart
  16. 3 things that inhibit the p450 system?
    • 1. grapefruit juice
    • 2. elderly
    • 3. infants
  17. 2 variables that influence dosing of a med?
    • 1. potency - strength
    • 2. efficacy - how well it produces a response
  18. Effective dose?
    amnt needed to get ther. response from 50% of population
  19. Therapeutic index?
    relationship b/t lethal dose and effective dose
  20. 4 drugs with low therapeutic index?
    • 1. lithium
    • 2. theophylline
    • 3. digoxin
    • 4. dilantin
  21. 3 S/S of anaphylactic response?
    • 1. bronchospasm
    • 2. hypotension
    • 3. angioedema
  22. Elderly have increased response to what 5 drug types?
    • 1. drugs that affect the heart in any way
    • 2. analgesics
    • 3. sedatives
    • 4. anticoagulants
  23. 3 main concerns with elderly and drugs?
    • 1. polypharmacy
    • 2. inappropriate drug
    • 3. nonadherence to therapy
  24. Beers Criteria?
    list of meds contraindicated for elderly
  25. Chinese have increased response to _____ & _____ meds and require a lower dose.
    benzos & lithium
  26. Hispanic cold/hot foods?
    • cold:  chicken, veggies,
    • hot:  beef, whole grains
  27. Drug used for anaphylaxis and why?
    EPI - vasoconstriction & bronchodilation
  28. If _____ is stopped abruptly it can cause status epilepticus
    dilantin
  29. 5 s/s of neurotoxicity?
    • 1. drowsiness
    • 2. audio/visual probs
    • 3. restless
    • 4. nystagmus
    • 5. tonic-clonic
  30. Pain med with a high first pass effect?
    talwin
  31. 4 s/s of hepatotoxicity?
    • 1. hepatitis
    • 2. jaundice
    • 3. increased liver enzymes
    • 4. fat deposits in liver
  32. 4 s/s of kidney toxicity?
    • 1. decreased UO
    • 2. increased creatinine & BUN
    • 3. altered pH
    • 4. electrolyte imbalances
  33. Tx of status epilepticus?
    first choice is benzo then give other anti-epileptics
  34. 2 s/s of heart toxicity?
    • 1. dysrrhthmias
    • 2. heart failure
  35. Ototoxicity is causes damage to the ____ nerve.
    8th
  36. What med cannot be given with continuous enteral tube feedings and requires feeding to be stopped 1 h before and 1 h after admin?
    dilantin
  37. Which anti-epileptic is used for only absence seizures
    zarontin
  38. Which anti-epileptic drug may be used in CH?
    keppra
  39. Drug that may decrease renal excretion of penicillin?
    probenicid
  40. Stim of PSNS decreases what 5 things, increases what 5 things, & constricts what 2 things?
    • 1. DECREASES:  HR, contractility, BP, liver glycogenolysis (BG),
    • 2. INCREASES:  peristalsis, secretions, bladder contraction, emptying of bladder and bowel, muscle contraction
    • 3. CONSTRICTION:  pupils/miosis, bronchial
  41. Stim. of PSNS causes miosis which allows eye to focus for _____ vision.
    near
  42. What secretions are increased by PSNS stimulation?
    • 1. bile
    • 2. gastric acid
    • 3. saliva
    • 4. resp secretions
    • 5. sweating
  43. S/S of SNS stim?
    • 1. DECREASES:  peristalsis, secretions, emptying of bowel and bladder
    • 2. INCREASES:  HR, contractility, BP, RR & depth, liver glycogenolysis (BG), EPI & NE release, BF to muscles and essential organs
    • 3. DILATES:  pupils for far vision, airways
    • 4. CONSTRICTS:  BV to kidneys & GI
  44. Receptor for PSNS?
    cholinergic receptors
  45. NT  for PSNS?
    Ach
  46. Anti-epileptic that does not decrease effects of oral contraceptives?
    depakote
  47. AchE?
    acetylcholinesterase - enzyme that B/D Ach
  48. AchE inhibitor?
    inhibits AchE & prevents it from inhibiting Ach -> cholinergic agonist effects
  49. Med that causes lithium toxicity when taken with lithium?
    ibuprofen
  50. 2 cholinergic agonist mechanisms of action?
    • 1. direct - act as agoinist at Ach receptor site
    • 2. indirect- make more Ach avail. by inhibiting AchE
  51. Nicotinic N, nicotinic M, & muscarinic are _____ receptors.
    cholinergic
  52. Functions of the 3 cholinergic receptors?
    • nicotinic N - nerves
    • nicotinic M - muscles
    • muscarnic - post-synaptic cells, muscles, glands
  53. Antiparkinsonian drug that causes livedo reticularis?
    amantidine
  54. GI AE of muscarnic stimulating drugs?
    diarrhea - bad for ulcer pt
  55. Muscarnic drug effect on sweating?
    increases sweating
  56. What anti-epileptic drug may be used to Tx eclampsia seizures?
    dilantin
  57. 3 Prototype direct-acting cholinergic agonist?
    • 1. Urecholine
    • 2. Akarpine
    • 3. nicotine
  58. Where does urecholine act?
    on sm mus. of bladder and GI tract
  59. What medication if ass. with on off syndrome?

    AKA?
    sinemet

    bradykinetic episodes
  60. Use for urecholine?
    1. increases voiding in NONOBSTRUCTIVE  urinary retention

    2. decreases reflux
  61. What med requires a pt to see a dermatologist & an eye doctor before admin?
    sinemet r/t increasing skin cancer & can't be taken with 1 glaucoma
  62. Why are urecholine CI in asthma?
    they cause bronchoconstriction
  63. CI  for urecholine?
    • 1. PUD
    • 2. int. or urinary obstruction
    • 3. asthma
    • 4. hyperthyroidism
  64. What will occur if urecholine is taken with hyperthyroidism
    tachycardia
  65. Uses for akarpine?
    • 1. all glaucoma
    • 2. xerostomia
  66. AE of nicotine?
    • 1. angina
    • 2. tachycardia
    • 3. BV constriction
    • 4. HA
    • 5. nervousness & insomnia

    nicotine causes BV constriction b/c stimulates vasopressin - most cholinergics cause BV dilation
  67. CI for nicotine?
    MI
  68. Antidote for cholinergic drugs?
    atropine
  69. 2 indirect-acting cholinergic agonists?
    • 1. neostigmine
    • 2. echothiopate
  70. Binding categories for indirect-acting cholinergic agonists?
    • 1. reversible
    • 2. irreversible -more AE - pesticides, echothipate
  71. Action of neostigmine?
    works on nicotinic m (muscle) receptor
  72. Use for neostigmine?
    • 1. myasthenia gravis
    • 2. reverse neuromuscular blockers used during surgeries
    • 3. antidote for cholinergic poisoning
  73. AE of neostigmine?
    resp arrest/paralysis r/t receptors becoming less sensitive b/c of too much stimulation
  74. Use for echothiopate?
    glaucoma
  75. Echothiopate antidotes?
    • 1. atropine
    • 2. protopam
    • 3. diazepam
  76. 8 anticholinergic drugs?
    • CAR BAD AS
    • Cogenin
    • Artane
    • Robinul
    • Bentyl
    • Atropine
    • Detrol
    • Atrovent
    • Scopolamine
  77. 2 anticholinergic drugs used for Parkinsons?
    cogentin & artane
  78. Use for robinul?
    PUD
  79. Use for bentyl
    IBS
  80. 2 antidotes for anticholinergics?
    neostigmine & phyostigmine
  81. Action of neuromuscular blockers?
    prevent Ach from acting at neuromuscular junctions
  82. 2 neuromuscular blocking agents?
    • 1. tubocurarine
    • 2. anectine
  83. What antiparkinsonian drug requires low protein diet and avoidance of vitamin B6?
    sinemet
  84. What anti-epileptic drug may be used to Tx trigeminal neuralgia pain?
    dilantin
  85. 2 uses for tubocruarine?
    • 1. immobility for surgery
    • 2. electroconvulsive therapy
  86. Use for anectine?
    used for short procedures - short-acting
  87. Hemorheologic med that is used to decrease pain ass. with intermittent claudication?
    trental
  88. Concerns with anectine?
    can increase K levels - check before admin

    neostigmine antidote doesn't work on it
  89. AE of anectine?
    • 1. mus contraction
    • 2. malignant hyperthermia
  90. SNS releases ___, ___, & ____.
    EPI, NE, & dopamine
  91. Why does EPI have many effects?
    nonselective SNS agonist - stimulates all SNS receptors
  92. RA medication that is CI with live virus vaccines?
    enbrel
  93. 2 main uses of SNS agonists?
    • 1. CPR resusitation
    • 2. anaphylactic shock
  94. EPI important considerations/AE?
    • 1. infiltration = tissue necrosis
    • 2. can increase BP, pulse, & RR
    • 3. need cont. EKG monitoring
    • 4. must be on pump for IV admin
  95. SQ admin of EPI 2 interventions?
    • 1. aspirate to prevent IV admin of SQ dose
    • 2. massage site for 10 seconds to prevent local vasoconstriction
  96. Antidote for EPI infiltration?
    regitine - alpha blocker that dilates BV
  97. Tx for hypertensive crisis caused by EPI admin?
    alpha-adrenergic blocking agent like prazosin
  98. Half life of EPI?
    short - usually no antidote needed
  99. Prototype alpha I adrenergic agonist?
    phenyllephrine - causes vasoconstriction
  100. 2 uses for phenyllephrine?
    • 1. vascular failure & shock
    • 2. nasal decongestant
  101. AE of phenyllephrine?
    HTN with reflex bradycardia
  102. Prototype alpha II adrenergic agonist?
    clonidine - antihypertensive
  103. Prototype beta I receptor agonist?
    dopamine
  104. Use for dopamine?
    shock
  105. Action of dopamine?
    increases CO, BV dilation, & tissue perfusion
  106. Advantage of dopamine?
    increases renal perfusion
  107. What pain med requires BP check before & 1 h after admin?
    imitrex
  108. Monitoring for dopamine?
    UO
  109. 4 adrenergic agonist drugs?
    • 1. dopamine - beta 1
    • 2. EPI - all4
    • 3. phenylephrine - alpha 1
    • 4. clonidine - alpha 2
  110. Cogentin & artane Tx ____.
    Parkinsons
  111. 3 adrenergic antagoinists?
    • 1. prazosin - alpha blocker
    • 2. propranolol - beta 1 & 2 blocker
    • 3. metoprolol - beta 1 blocker
  112. 2 uses for prazosin?
    • 1. decrease BP
    • 2. increases urine flow in benign prostatic hyperplasia
  113. 3 AE prazosin?
    • 1. ortho BP & tachycardia to compensate
    • 2. palpitations
  114. Propranolol drug type and use?
    beta 1 & 2 blocker that affects lungs & CV

    used for antianginal, cardioprotective, anti-arrhythmic, & antihypertensive
  115. AE of propranolol?
    • 1. bronchioconstriction
    • 2. can mask s/s of hypoglycemia
    • 3. CHF
    • 4. bradycardia and rebound tachycardia
    • 5. decreases production of glucose
  116. CI for propranolol?>
    • 1. DM
    • 2. CHF
    • 3. Hx of asthma
  117. Why may metoprolol be used with asthma instead of propranolol?
    metoprolol is beta 1 blocker only - does not affect lungs

    propranolol is a beta 1 & 2 blocker - affects heart and lungs
  118. Drug interaction with propranolol?
    Ca channel blockers increase bradycardia
  119. What must be done prior to the admin of imitrex?
    cardiac workup
  120. Why should pt never stop propranolol or metoprolol abruptly (beta 1 action)?
    can cause rebound tachycardia
  121. S/S that may indicate CHF dev with a beta blocker & should be reported to MD?
    weight gain of 2 lb in 24 h
  122. HR of pt taking a beta blocker that requires reporting to MD?
    50 BPM
  123. 3 ways antiepileptic drugs work?
    • 1. decrease Na into cell
    • 2. inhibit Ca into cell
    • 3. increase GABA effects
  124. What 2 NT are released when an action potential occurs to either excite or inhibit the NS?
    • glutamate - excitation
    • GABA - inhibits
  125. Action of GABA?
    lets Cl into cell -> prevents depolarization
  126. 3 things that cause a seizure?
    high level of glutamate or low level of GABA
  127. Action of dilantin?
    decreases influx of Na into the cell -> decreases firing of neurons
  128. Dilantin memory help?
    Princess Di had a seizure that stopped abruptly. (stop causes status epilepticus)  She was very dizzy when she woke up so she went to see Dr Steven Johnson even though he has hair all over him from a birth defect.  He saw that she was bleeding out all her red & white blood cells from her swollen gingiva so he gave her a slow IV admin.
  129. What type of seizures cannot be treated by dilantin?
    abscence seizures
  130. How may dilantin be used for status epilepticus Tx?

    Consideration?
    after/concurrent with benzo

    need separate IV line
  131. 3 off-label uses for dilantin?
    • 1. anti-arrhythmic
    • 2. seizures in eclampsia
    • 3. trigeminal neuralgia pain
  132. Serum therapeutic drug level of dilantin?
    10 to 20
  133. Half-life & therapeutic index of dilantin?
    long half life and narrow therapeutic index
  134. When should dilantin drug levels be checked?
    w/in 7 days of dose change
  135. Avoid giving dilantin with ______.

    Intervention?
    continuous enteral tube feeding

    need to stop feeding for 1 h before and 1 h after dilanting admin
  136. IM dilantin admin?
    slow absorption - precipitate forms at injection site
  137. Dilantin dose change consideration?
    needs titrating r/t narrow therapeutic index
  138. 6 Black Box warnings with dilantin?
    • 1. IV admin slowly (1 h )
    • 2. direct IV max 50mg over 1 minute
    • 3. flush with NS
    • 4. DO NOT mix with other solutions except NS
    • 5. caustic to tissue
    • 6. increased risk for suicidal thoughts
  139. What may occur if dilantin in given too fast IV?
    hypotension & CV collapse
  140. 2 CI for dilantin?
    • 1. sinus bradycardia
    • 2. heart block
  141. Diuretic that crystallizes easily?
    mannitol
  142. Stopping dilantin?
    if stop abruptly can cause status epilepticus
  143. Dilantin pregnancy category and effects?

    Why is it given for eclampsia?
    • preg cat D -
    • 1. skull & face abnormalities
    • 2. underdeveloped nails
    • 3. growth deficiencies
    • 4. mild developmental delays

    may be used in 3rd trimester but not first
  144. AE of dilantin?
    • 1. dizziness & ataxia - risk for falls
    • 2. gingival hyperplasia
    • 3. hirsutism
    • 4. impaired vit D met. -> fatigue
  145. Serious AE of dilantin?
    • 1. agranulocytosis
    • 2. aplastic anemia
    • 3. Stevens Johnson Syndrome
  146. CBC monitoring with dilantin?
    monthly X 3 mo then periodically
  147. S/S of Stevens Johnson syndrome
    will get fever & sore throat then dev ulcers on MM
  148. Intervention for Stevens Johnson syndrome?
    stop all meds
  149. Drug interaction with dilantin?
    decreases effects of oral contraceptives
  150. 3 uses for carbamazepine?
    • 1. seizures
    • 2. psych disorders
    • 3. trigeminal neuralgia
  151. 2 black box warnings for carbemazepine?
    • 1. increased suicidal thoughts
    • 2. blood dyscrasias
  152. 4 uses for depakote?
    • 1. all types of seizures
    • 2. Tx mania part of bipolar
    • 3. migraine HA
    • 4. status epilepticus
  153. Black box warning with depakote?
    increased suicidal thoughts
  154. 3 life-threatening AE of depakote?
    • 1. hyperammonemia
    • 2. pancreatitis
    • 3. liver toxicity
  155. Monitoring that will be done with depakote?
    liver function tests
  156. Keppra differences from other anti-seizure meds?
    can be used in CH & does not require titration - can start on therapeutic dose
  157. Zarontin action & uses?
    decreases Ca influx into cell

    used only for absence seizures
  158. AE of zarontin?
    blood dyscrasias
  159. Anti-epileptic action of benzos?
    increase GABA effects
  160. 2 groups of ppl that may need decreased dose of benzos?
    elderly & Asians
  161. Consideration with IV diazepam?
    reacts with plastic tubing -> decreases drug to pt
  162. Benzo that may be used for acute alcohol withdrawal?
    lorazepam
  163. Parkinsons?
    CNS disorder caused by decreased dopamine & increased Ach
  164. Action of dopaminergics?
    increase dopamine levels
  165. What med crosses the BBB then turns into dopamine?

    Why?
    sinemet

    b/c dopamine cannot cross BBB
  166. Action of levadopa & carbidopa in sinemet?
    carbidopa inhibits DDC & COMT - enzymes that B/D levadopa

    levadopa crosses BBB & turns into dopamine
  167. Goal of drug therapy in Parkinsons?
    balance Ach & dopamine
  168. 2 uses for sinemet/
    Parkinsons & restless leg syndrome
  169. How long does it take sinemet to take effect?
    1 to 2 months
  170. 3 CI with sinemet?
    • 1. malignant melanoma or undiagnosed skin lesions
    • 2. closed angle glaucoma
  171. AE of sinemet?
    • 1. GI effects and weight loss
    • 2. orthostatic hypotension
    • 3. abnormal movements
    • 4. neuroleptic malignant syndrome - caused by abrupt cessation
  172. S/S of NMS - neuroleptic malignant syndrome?
    • 1. rigidity & akinesia
    • 2. tremor
    • 3. fever and increased risk for seizures
  173. Akinesia paradoxica?
    pt falls suddenly r/t sinemet therapy (usually long-term)

    can last up to hours
  174. Tx for off part of bradykinetic episodes?
    apomorphine will help improve s/s when they occur
  175. AE of apomorphine & important consideration?
    causes NV

    cannot take with HT3 antagonist antiemetics:  zofran, kytril, anzemet, aloxil - will cause decreased BP & LOC
  176. 2 things that may cause NMS?
    abrupt cessation of sinemet or antipsychotic drugs
  177. 2 drug interactions with sinemet?
    • 1. high protein diet decreases absorption - need low protein diet
    • 2. avoid vitamin B6
  178. 3 cultural groups that require a larger dose of sinemet?
    • 1. chinese
    • 2. philipino
    • 3. thai
  179. 2 dopaminergic agents that are different from sinemet?
    • 1. amantidine
    • 2. eldepryl
  180. AE of amantidine?

    What is it?
    livedo reticularis: reddish-blue netlike mottling of the skin that is benign & disappears when stop med
  181. AE of eldepryl?
    insomnia
  182. Med that can decrease occurance of on-off syndrome in sinemet?
    Requip
  183. Catecholemine O-methyl transferase inhibitors?

    2 meds?
    inhibit enzyme that breaks down dopamine = more dopamine -> Tx for parkinsons

    • 1. tasmar
    • 2. comtan
  184. AE of tasmar and comtan?
    tasmar causes hepatotoxicity but comtan does not
  185. 2 anticholinergic drugs for parkinsons?
    cogentin & artane
  186. Mixed agonist-antagonist pain med?
    talwin
  187. 2 advantages for morphine use for pain?
    decreases anxiety and workload of heart
  188. Important consideration with methotrexate and other DMARDS?
    cause bone marrow suppression: blood dyscrasias
  189. When may morphine be used for dyspnea?
    with left ventricular failure & pulmonary edema
  190. Drug interaction with lithium?
    ibuprofen -> lithium toxicity
  191. CI for narcotics?
    • 1. increased ICP
    • 2. CNS/resp depression or any airway problems
  192. 2 things to assess before admin of morphine?
    RR & BP
  193. Ibuprofen and loop diuretic interaction?
    ibuprofen reduces effects of diuretic
  194. 4 s/s of opiate w/d?
    • basically the opposite of the effects of the opiate
    • 1. restless
    • 2. tachypnea
    • 3. hypertension
    • 4. tachycardia
  195. Drug interaction with ibuprofen and aminoglycoside ABX?
    can cause aminoglycoside to build up r/t decreased GFR
  196. Ibuprofen effects on beta blockers?
    decrease antihypertensive effects
  197. How long for fentanyl patch to work?
    24 h
  198. 3 drug interactions with fentanyl?
    • 1. p450 inhibitors
    • 2. ketoconazole antifungal
    • 3. clarithromycin/biaxin

    all increase levels of fentanyl and increase AE & resp depression
  199. Interaction with acet & warfarin?
    acet can increase warfarin levels
  200. Interaction with ibuprofen & SSRI?
    risk for GI bleed increases
  201. Why are codeine & hydrocodone CI for asthma, emphysema, & post surgery pt?
    no cough reflex -> accumulate fluids-> pneumonia & narrowed airways
  202. Drug interaction with codeine besides CNS depressants?
    histamine-2 receptor antagonists:  ranitidine, cimetidine, etc. increase resp depression
  203. Interaction with hydrocodone & hydantoins/dilantin?
    can increase risk for hepatotoxicity
  204. 3 narcotic agonist/antagonists?

    Consideration if given to person with opiate addiction?
    • 1. talwin
    • 2. nubain
    • 3. stadol

    can cause w/d s/s r/t antagonist action
  205. Talwin metabolism?
    high first pass effect
  206. 2 contraindications for talwin, nubain, & stadol?
    • 1. increased intracranial pressure
    • 2. MI r/t increased workload of heart
  207. AE of talwin and stadol?
    talwin - euphoria

    stadol - somnolence
  208. 2 drugs that have similar effects to morphine?
    nubain & hydromorphone
  209. Ibuprofen interaction with antifungals?
    increases NSAID adverse effects
  210. S/S of salicylate poisoning?
    • 1. resp distress
    • 2. F&E & pH imbalances
    • 3. high temp
    • 4. seizures
    • 5. shock, coma, & death
  211. Education with imitrex?
    • 1. s/s of ischemic events:  MI & stroke
    • 2. no heavy machine until know effects
  212. How long does anti-platelet action of ASA last?
    8 days- life of platelet
  213. Why may renal toxicity occur with any prostaglandin inhibitor (ASA & IBU)?
    prostaglandins normally inhibit vasoconstriction of renal arteries
  214. What arthritis med can cause multiple sclerosis & optic neuritis?
    enbrel
  215. disalcid and ASA diff?
    has antiinflammatory but no antiplatelet or antipyretic
  216. Black Box Warning with all NSAIDS?
    CV thrombotic events:  increases risk for MI & stroke
  217. Use for cytotec in pain management?
    decreases GI AE of NSAIDs
  218. 3 drug interactions with ASA?

    What will occur?
    • ASA will increase effects of:
    • 1. anticoagulants
    • 2. oral hypoglycemics
    • 3. insulin
  219. 7 drug interactions with ibuprofen?
    • 1. salicylates & heparin
    • 2. aminoglycoside ABX
    • 3. antifungals
    • 4. beta blockers
    • 5. loop diuretics
    • 6. SSRIs
    • 7. lithium
  220. Pt at increased risk for GI bleeds with ibu admin?
    pt over 60
  221. Serotonin-selective drugs are AKA ____ & are used to TX ______.
    triptans

    migraines
  222. 3 migraine drugs?
    • 1. imitrex
    • 2. maxalt
    • 3. zomig
  223. Action of triptans?
    vasoonstriction of BV in brain to decrease inflammation
  224. CI for triptans/imitrex?
    • 1. any problem with heart, BV, or brain/stroke
    • 2. seizures
  225. Common AE of imitrex/triptans?
    dizziness & vertigo & warm/tingling sensation
  226. 3 DMARDs drugs?

    Their use?
    • 1. methotrexate
    • 2. humira
    • 3. hydroxychlorquine

    arrest progression  of RA
  227. Memory help for methotrexate?
    Metho made some meth out of a FA supplement and sunblock. (photosensitivity)  It made him feel like he was in a fog and he couldn't breathe. (pulmonary probs)  He fell down and was bleeding so badly that he got blood dyscrasias.  He got an infection in his wound and it would not heal. (immunosuppression) He tried eating good and not drinking caffeine, but the meth had already damaged his liver & he died.
  228. Action of methotrexate?
    interferes with FA met -> inhibits DNA synth and cell reproduction
  229. CI for methotrexate?
    • 1. blood dyscrasias & immunosuppression
    • 2. alcoholism & liver disease
  230. Diuretic that may cause ototoxicity?
    lasix
  231. AE of methotrexate?
    • 1. methotrexate fog
    • 2. photosensitivity
    • 3. blood dyscrasias & immunosuppression
  232. 2 life-threatening AE of methotrexate?
    • 1. severe myelosuppression
    • 2. pulmonary fibrosis or interstitial pneumonitis
  233. Important methotrexate monitoring/assessments?

    Requires follow-up q 4 to 6 weeks for what 4 tests?
    • 1. CBC
    • 2. liver and renal function
    • 3. chest x-ray for pulmonary probs


    • 1. CBC
    • 2. liver profile
    • 3. albumin
    • 4. creatinine
  234. Why does albumin need to be monitored for methotrexate?
    malnourishment can increase blood dyscrasias and immunosuppression AE
  235. Pt education for methotrexate?
    • 1. decrease caffeine
    • 2. good nutrition
    • 3. take vitaminB/FA supplement to decrease AE
    • 4. wear sunblock
  236. Why methotrexate pt not need to have caffeine?
    can interfere with the med
  237. Tumor Necrosis Factor Inhibitor drug?

    Action?
    enbrel

    binds to TNF & inactivates it -> decreases inflammation mediated by TNF
  238. Admin of enbrel?
    weekly injection
  239. Use for enbrel?
    delay damage ass. with RA
  240. CI with enbrel?
    current active infection
  241. AE of enbrel?
    • 1. can induce multiple sclerosis & optic neuritis
    • 2. upper resp infections
  242. 3 serious AE of enbrel?
    • 1. severe infections
    • 2. blood dyscrasias
    • 3. induction of multiple sclerosis & optic neuritis
  243. Pt teaching with enbrel?
    no live virus vaccines
  244. Addison's disease?
    adrenal insufficiency
  245. Cushing's syndrome?
    too much adrenocortical secretion
  246. CI for prednisone?
    fungal infections r/t increased BG with prednisone admin
  247. 3 most important considerations with prednisone?"
    • 1. supresses immune system
    • 2. raises BG
    • 3. can decrease serum K
  248. Best time to take glucocorticoids?
    am
  249. Main drug class used for CHF?
    ACE inhibitors
  250. 3 types of drugs given for CHF?
    • ACE inhibitors
    • diuretics
    • cardiac glycosides
  251. BP/cardiac med that should be used cautiously in CHF pt?
    beta blockers
  252. Ionotropic drugs?
    Tx contractility of the heart
  253. Dromotropic drugs?
    affect conduction of current in the heart
  254. Chronotropic drugs?
    change HR
  255. AE of digoxin?
    dose related and due to toxicity
  256. Most frequent cause of digoxin toxicity?
    hypokalemia
  257. 3 s/s of digoxin toxicity?
    • 1. GI disturbances: anorexia, NV
    • 2. cardiotoxicity:  irregular pulse, peripheral edema/weight gain
    • 3. CNS toxicity:  blurred/yellow vision, fatigue
  258. IV push digoxin?
    pushing too fast can cause dropped HR & death
  259. Which diuretic requires filtered tubing?
    mannitol
  260. EPI & beta blockers?
    EPI will not resusitate a person on beta blockers because it blocks epi
  261. Relationship of K & digoxin?
    use the same receptors

    K down = digoxin effects up
  262. Antihypertensive drug that prevents reflex tachycardia?
    labetalol
  263. Therapeutic range of digoxin?
    0.5-2.0
  264. Pt education with digoxin?
    • 1. never stop abruptly
    • 2. weigh daily & report 5lb gain in 24 h
    • 3. seek help immediately for SOB
  265. Coreg/carvedilol serious AE
    drops BP drastically
  266. Actions of beta blocker/coreg?
    • 1. decreases contractility, CO, & peripheral resisitance
    • 2. vasodilation
  267. CHF pt taking coreg/beta blocker?
    can exacerbate CHF s/s at first - monitor lung sounds

    may need to give diuretic with it
  268. 2 drugs that are short term Tx for CHF in pt not responding to other therapy?

    Their actions?
    inocor & primocor

    increase contractility & vasocilate
  269. Cardiac drug that is metabolized into cyanide?
    nipride
  270. When will BP meds be held?
    systolic < 90
  271. Antihypertensive drug that is broken down if exposed to light?
    nipride
  272. Stim of alpha I receptor causes _____.
    vasoconstriction
  273. Drug for hypertensive crisis?

    Admin?
    nipride

    always via pump
  274. First line drugs for HTN?
    • 1. diuretics
    • 2. beta blockers
    • 3. Ca channel blockers
  275. ACE inhibitor prototype?
    captopril
  276. ACE inhibitor AE?
    • 1. first dose hypotension
    • 2. angioedema
    • 3. hyperkalemia
  277. Beta II receptor stimulation effects?
    bronchial & peripheral dilation & decreased BP
  278. What type of drug is cozaar?
    ARB
  279. Action of ARB?
    blocks effects of angiotensin II:  excretion of Na & water & vasodilation
  280. AE of ARB/cozaar?
    upper resp infection
  281. What type of drug is inspra?
    selective aldosterone blocker:  antihypertensive
  282. 2 electrolyte imbalances that may be caused by inspra?
    hyperkalemia & hyponatremia
  283. Labetalol drug type?
    alpha/beta blocking agent
  284. Actions of labetalol?
    alpha blocking:  peripheral vasodilation that reduces BP

    beta blocking:  prevents reflex tachycardia
  285. What type of drug is clonidine?
    alpha-2 agonist:  potent antihypertensive
  286. What diuretic can cause nocturia?
    HCTZ
  287. Actions of clonidine?
    decreased HR, BP, renal vascular resistance, and vasoconstriction
  288. Admin of lasix?
    • 1. check K level - K wasting
    • 2. do not ever push - must give slowly by pump
  289. Use for clonidine other than antihypertensive?
    helps w/d symptoms
  290. AE of clonidine?
    drowsiness
  291. Action of hydralazine?
    vasodilator -> decreases BP
  292. Uses for hydralazine?
    • 1. decrease BP
    • 2. prevent reflex tachycardia with other antihypertensives
  293. Imp considerations with nipride?
    • 1. BP
    • 2. cyanide
    • 3. protect from light
  294. What type of drugs are used for shock?
    vasopressors - dopamine
  295. Effect of dopamine?
    increases contractility
  296. Imperitive in dopamine therapy?
    cont. monitoring of CV status
  297. Normal MAP?
    60
  298. AE of dopamine or levafed?
    extreme vasoconstriction can lead to ischemia & amputation
  299. Diuretic that can exacerbate gout?
    HCTZ - increases uric acid levels
  300. CI for HCTZ?
    pre-existing renal disease b/c reduces GFR
  301. Rate of admin of IV K?
    IV by PUMP no more than 10meq/h
  302. Toxicity that may occur with lasix?
    ototoxicity
  303. What diuretic is contraindicated in CHF?
    mannitol b/c draws water into vascular space = increased work on heart
  304. AE of mannitol?
    • 1. fluid overload & electrolyte imbalances
    • 2. crystallizes easily - need filter in IV
  305. Action of diamox/carbonic anhydrase inhibitor diuretics?
    inhibits hydrogen ion secretion & increases loss of Na, K, bicarb, and water
  306. Use for diamox?
    open angle glaucoma & CHF
  307. OTC drug that can increase HDL?
    nicotinic acid
  308. Chol. drugs that may cause elevated liver enzymes?
    statins - lovastatin
  309. Use for zetia?
    decrease cholesterol
  310. 3 imp considerations with NTG admin?
    • 1. check BP & pulse before admin
    • 2. monitor for hypotension & ortho hypotension & reflex tachycardia
  311. Drug of choice for prinzmetal's angina?
    Ca channel blocker - work for spasms of the artery
  312. CI for statins?
    liver damage and alcohol use
  313. Risk with quinidine?  Why?
    arrhythmias:

    • 1. increases QT time
    • 2. affected by K levels
  314. Drug/food interactions with statin?
    grapefruit juice / anything that affects p450 system
  315. Serious AE of statins?
    • myalgia & rhabdomyolysis that can lead to renal damage
    • liver damage
  316. Use for quinidine?
    antiarrhythmic
  317. 2 ways to help cholesterol with Rx?
    nicotinic acid & exercise
  318. Action of bile acid sequestrants?
    bind with bile and have it excreted -> must use cholesterol to make new bile
  319. Admin of bile acid sequestrants?
    admin before a meal
  320. Admin of IV NTG?
    must run out some med r/t binding to plastic
  321. 2 bile acid sequestrants?
    • 1. questran
    • 2. colestid
  322. Action of zetia?
    inhibits absorption of chol. from food in intestine
  323. 3 types of antianginal drugs?
    • 1. nitrates - emergency
    • 2. Ca channel blockers
    • 3. beta blockers
  324. Primary use for Ca channel blockers in angina?
    BV spasms like Raynauds
  325. AE of Ca channel blockers?
    constipation
  326. Why must a pt taking amiodarone see an eye doctor?
    can cause optic neuropathy
  327. Why should NTG patch be removed at night?
    tolerance can develop to it
  328. CI for NTG?
    increased ICP/head injuries
  329. Quinidine is used to Tx _____ arrhythmias.
    atrial
  330. K & quinidine relationship?
    increased K = enhanced effects of quinidine
  331. Lidocaine use?
    code or lethal arrhythmia
  332. Lidocaine is given for ______ arrhythmias.
    ventricular
  333. AE of lidocaine?
    • 1. arrhythmias
    • 2. hypotenstion
    • 3. drowsiness
    • 4. lidocaine crazies:  confusion & seizures
  334. Use for tambocor?
    life-threatening ventricular arrhythmias
  335. Monitor ____ & _____ with tambocor?
    EKG & BP
  336. What med is CI with allergy shot?

    Why?
    beta blockers b/c if have reaction to the shot EPI won't help
  337. Use for amiodarone?
    atrial and ventricular arrhythmias
  338. 3 major AE of amiodarone?
    • 1. prolongs QT time
    • 2. CHF s/s & pulmonary toxicity
    • 3. arrhythmias
  339. Use for kayexalate?
    removes K - not given for fatal levels b/c won't work fast enough
  340. sorbitol?
    laxative that may be admin with kayexalate to help excrete K
  341. 2 drugs that may be given to lower lethal levels of K?
    insulin or bicarb

    insulin must be given with D5W
  342. Antidote for warfarin?
    vitamin K/aquamephyton
  343. Lab monitoring with heparin?
    APTT & thrombocytopenia
  344. Heparin antidote?
    protamine sulfate
  345. Thrombocytopenia with heparin?
    if platelets drop - pt can never take heparin again
  346. Any antihypertensive drug that decreases BP/CO can cause ______ s/s.
    CHF
  347. If a pt is taking heparin and has CNS s/s what is the concern?
    • head bleed
    • risk for bleeding if injured
  348. IV admin of heparin?
    always on pump
  349. 4 heparin drugs?
    • 1. lovenox
    • 2. fragmin
    • 3. innohep
    • 4. atrixtra
  350. Drug used in heparin induced thrombocytopenia?
    refludan
  351. Warfarin lab?
    PT & INR
  352. Most important AE with bile acid sequestrants?
    constipation/diarrhea & risk for impaction
  353. Antiplatelet drugs?
    plavix and ASA
  354. Use for trental?
    decrease pain ass. with intermittent claudication ass. with PVD
  355. Action of trental?
    inceases flexibility of RBC to get through narrow BV
  356. IMP AE of trental?
    tachycardia
  357. Alteplace?
    given in medical emergency for MI or ischemic stroke
  358. 4 CI for antithrombolytics/alteplase?
    • 1. active bleed
    • 2. injury/surgery
    • 3. severe HTN
    • 4. seizures
  359. Why does pt on thrombolytics need frequent LOC assessment?
    assess for intracranial bleed
  360. Hemostatic prototype?
    aminocaproic acid
  361. 4 AE of aminocaproic acid?
    • 1. renal failure
    • 2. rhabdomylysis
    • 3. thromboembolism
    • 4. arrhythmias

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