pharm final 2

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pharm final 2
2013-12-09 14:55:05

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  1. Amiodarone / Cadarone
    • Class III K+ blocker
    • DOC for ANY dysrhythmias
  2. Nitrates

    Beta Blocks

    Ca++ blocks
    Tx Angina

    N= dialte veins and decrease preload

    B=decrease rate and force of contrction

    C= Dilate arteriole, decrease afterload
  3. Nitroglycerine
    • 1st drug given for Angina
    • Acts directly on vascular smooth mucsle
    • Dilates veins and pulls fluid from heart, DECREASING Preload
    • -Give Tylenol to prevent Nitro headache

    • SE= Dec. BP
    • = drug interaction with Viagra
  4. Nitroglycerine routes and info
    Highly lipid soluble

    Sublingual - 3 doses, 5 min apart

    • Oral - sustained release (Prophylaxis ONLY)
    •   - Isosorbide/Imdur

    Transdermal - off at night

    • IV fusion - short term only
    •  - 5-50 ug/min
  5. IV Nitro needs special tubing b/c it sticks to plastic
    IV Nitro needs special tubing b/c it sticks to plastic
  6. Diuretics
    increase urine output

    • -Tx of HTN
    • -Mobilization of edematous fluid
    • -Prevent renal failure
    •   =when fluids are low on this pt. we give fluids and diuretics to flush kindeys out
  7. Adverse effects of diuretics
    • Hypovolemia
    • -dehydration, orthostatic hypoTN, thirst
    • Acid/Base imbalance
    • Disturbances of electrolyte levels
  8. Furosemide / Lasix
    • Loop (high ceiling) Diuretic
    • Works in the Ascending loop of Henle
    • -depends on prostaglandin availability (which dec. with ibuprofen use)
    • Blocks Na+ and Cl- reabsoprtion
    • DOC for fluid overload

    SE= Hypokalemia
  9. Thaizide diuretic
    • Blocks Na and CL reabsorption
    •  ->much LESS h2o and electrolyte loss than loops
    • Doesn't work well with low GFR rate, so not given for Renal Failure
    • Used for HTN and Edema
    • BAD for Gout (uric acid build up)

    Paradoxical (reverse) effects on Diabetes Insipidus (decreases urine in a disease that increases urine
  10. K+ sparing diuretic
    -used with other diurs.

    • Aldosterone Antagonist
    • Inc. Na+ excretion so Kidney saves K+

    Limited urine production but dec. K+ loss
  11. Manntiol / Osmotorol
    • Creates an osmotic effect in the nephron
    • -inhibits passive reabsorption of h2o
    • NO Metab effect, just a big molecule that attracts h2o
    • Moves fuild from tissue into vascular space
    • MUST be given IV and use a filter needle
    • Given mainly to Dec. ICP, also used for edema
  12. drugs for emergencies:
    a= Epi

    HTN= Nitroprusside / Nipride

    SVT= Adenosine  (Cardizem ?)
  13. Heparin
    • anti-coag
    • Inactivates Thrombin and Factor 10a
    • -fibrin production is reduced, clotting suppressed
    • -short 1/2
    • First pass effect

    Used for PE, Embolic stroke, MI, DIC

    Monitor aPTT (22-34 sec.)

    Risk for Bleeding
  14. Protamine Sulfate
    Antidote for heparin induced bleeding
  15. Warfarin / Coumadin
    • oral anti-coag
    • Vit K antagonist

    Monnitor PT and INR

    • risk for bleeding
    • many drug reactions
  16. ASA / Aspirin
    • Anti-platelet
    • prevent platelet aggregation
    • prevent thromboses in arteries

    • Interrupts clotting by interfering with Thromboxane
    • SE= GI bleed
  17. *Glycoprotein receptor antagonist

    -reversible blocking of receptor to prevent agg

    Given IV short term for ACS
  18. Cilostazol / PLetal

    Platelet inhibitor and vasodilator

    DOC for intermittent Claudication
  19. HMG-CoA Reductase and their Inhibitors
    HMG reductase provides for cholest product

    Inhibitors sterols  --> are called Statins -> DOC for dec. LDL and inc. HDL
  20. Statins
    • Dec. LDL
    • INc. HDL
    • Promote plaque stability
    • Also, an Inc in Hepatic LDL receptors

    take drug at night b/c most chol production is done at night

    create risk for liver failure and muscle breakdown
  21. SE of Statins
    Headache, rash, GI

    Hepatotoxicity major SE, monitor every 6 months

    Muscle inflamm and breakdown

    Grapefruit juice
  22. two catagpries of Asthma
    inflammtion and bronchospasms
  23. inflammation med choice
  24. Glucocorticoids
    • ***Most effective anti-asthma (anti-inflamm) drugs available
    • Prophylaxis of chronic asthma
    • Beneficial effects develope OVER TIME (will not help in middle of attack)
    • Used on a regular schedule

    must be weened off to avoid adrenal suppression
  25. asthma management - IV therapy
    • for acute-short term use only
    • toxicity risk increases with long term
  26. Oral vs. inhalation use of Glucocorticoids
    • O= Adrenal suppression, bone loss
    •  = nl cortisol production stops by body
    •  = pts must be weaned off so adrenal glands pick up production

    • I= oropharyngeal candidiasis and dysphonia
    •  = little inhaled meds reaches systemic circulation
    •  = changing from oral to inhale must include weaning, even if using both
  27. bronchospasm med of choice
    inhaled Beta 2 agonist
  28. Asthma - Beta 2 agonists
    • bronchodilators
    • inhibit bronchospasm by relaxing smooth ms
    • suppress histamine release in the lungs
  29. Fluticasone / Salmeterol - Advair

    Budesonide / Formotorol - Symbacort
    • combo inhalers
    • long term Beta agonists and inflamm agents
    • Have good asthma control
  30. Diet therapy for ulcers
    • traditional ulcer bland diet not effective
    • avoiding caffeine not effective

    • eat 5-6 small meals daily
    • Avoid NSAIDS and ASA
  31. Histamine2 receptor blockers (type of med?)

    H2 receptors
    • anti-acid secretion drug
    • = reduce volume and acidity of secretions

    recept= parietal cells of stomach
  32. What can result from long term H2 receptor blockers?
    Pneumonia b/c Dec. acid means Inc. bacteria growth
  33. Proton pump inhibitors
    • most effective acid suppresion b/c it shuts everything down
    • prevents basal and stimulated acid production

    • Cancer risk with long term use
    • along with pneumonia, fractures, rebound hypersecretions, and for C-Diff
  34. Sucralfate / Carafate
    other anti-ulcer drug

    • Inert-provides viscous protective barrier b/w acid and epithelium
    • May impede absorption of some drugs
  35. Antacids
    • Alkaline cmps that neutralize
    • Stimulate production of prostaglandins
    • Do not provide physical barrier
    • poorly absorbed

    Provide symptomatic relief for GERD
  36. Laxatives

    • to ease of stimulate defecation
    • -soften
    • -increase stool volume
    • -hasten fecal passage
    • -facilitate evacuation
  37. laxative effects
    L= mild leisurely results

    C= Fast, intense effects
  38. **group 1 laxative**
    • watery stool in 2-6 hours
    • Osmotics, Castor oil, Electrolyte solutions

    used to clean bowels before surgery
  39. **group 2 laxatives**
    • Semi-fluid stools in 6-12 hours
    • Osmotics, stimulants

    used for general constipation
  40. **group 3 laxatives**
    • Soft stool in 1-3 DAYS
    • Bulk, surfactant, lactulose

  41. Bulk forming
    • group 3
    • Like dietary fiber
    • Stretch of intestinal wall stimulates peristalsis
    • Absorbs water to soften stool
  42. Surfactant
    • group 3
    • Lower surface tension - greater water absorption
  43. Stimulant
    • Stimulate instestinal motility
    • Inc. water and electorlyte in intestinal lumen
  44. Osmotics
    • Laxative Salts
    • Draw water into the gut
    • Poorly absorbed systemically, but high doses can cause problems for cardiac pt.s
  45. Lactulose
    • made of fructose and galactose
    • Enhances intestinal excretion of ammonia

    used for liver failure pt.s to help rid ammonia in stool