pharm final

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pharm final
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  1. _____ are most effective analgesics available
    opioids
  2. Opioid Narcotic Drugs
    • morphine
    • demerol
    • codeine
    • fenanyl
    • oxyvodone
    • ...etc
  3. Opioids key points
    • STOP if resp.  < or  = 12
    • evaluate 1 hr after admin
    • abstinence syndrome
    • titrate carefully

    ***NARCAN ANTIDOTE***
  4. Pentazocine (Talwin)
    • Agonist-antagonist
    • less analgesia than morphine
    • Careful with opioid addcits w/drawl
    • oral, sc, or IM

    ***Narcan antidote***
  5. Codeine
    • Opioid
    • cross placenta
    • not for ppl w/ productive cough, chest tube or pneu.
  6. Morphine
    • contra fro ppl w/ biliary tract surgery
    • onset 15-30 mins
    • contra - resp conditions, incr. ICP or head injury, hepatic or renal dysfunction
    • reassess 60 mins fter admin
    • 1st choice for PCA
  7. Demerol
    • Opioid
    • should not exceed 48 hours
  8. NSAIDS
    • ibuprofen and celebrex
    • Black box warning MI/Stroke
    • RA, pain, migraine, fever
    • * GI upset, peptic ulcer, hepatocity
    • d/c pre-op 5 1/2 lives
    • old ppl renal impairment
    • avoid vacines
  9. celebrex
    • NSAID
    • SULFA ALLERGY
    • MI or Stroke rish
    • less gastci ulceration
  10. GOUT drugs
    • colchine- acute
    • allopurinol- chronic
  11. colchicine
    • Acute gout
    • 1st sign of attack
    • *vesicant
    • purine diet
    • oral or IV
    • contra: card., hep., renal
  12. allopurinpol
    • chronic- not acute gout
    • lowers uric acid
    • Increase fluids -> 2.5-3 L/day
  13. Acetaminophen
    • mild pain/fever
    • * No RA or Inflammation
    • Antidote mucamyst
    • 4,000 mg Q24/hr MAX dose
    • hepatotoxcity
  14. Salicylates
    • aspirin
    • inflam., headache, arthritis, fever, tendonities
    • 81mg for antiplatelet- irreversable
    • contra: kids w/ chickenpox for flu sypt. -> Reye
    • Salic. poisioning- no antidotes
    • give w/ milk and food- GI distress
    • monitor- GI, bleeding, anemia, tinnitis, hepatox., renal funct.
  15. RA Drugs
    • (NSAIDS and Aspirin) 
    • DMARDs
    • - methotrexate- nonbio.
    • - embrel- bio
  16. Etanercept (embrel)
    • RA
    • Biologic
    • weekly injections
  17. Methotrexate
    • RA
    • non bio DMARD
    • 1st DMARD choice
    • immunosupressive
    • contras:
    • -immunosupressed
    • - bld dyscrasia
    • -preg/lact.
    • 10-12 glasses h2o/day
    • folic acis interferes
    • 3-6 weeks
    • photosenstivity
  18. Cholest. lowering catergories
    • statins
    • fibric acid derivaties
    • cholesterol absorp. inhib.
    • nicotonic acid
    • bile acid sequestriants
  19. Statins
    • Chol. lowering
    • lower LDL, raise HDL
    • Lovastatin 
    • ( provastatin
    • lipitor
    • crestor
    • zocor)
  20. lovastatin
    • statin
    • cholest. lowering
    • high 1st pass effect
    • contra: preg X and liver disease
    • NO GRAPEFRUIT
    • liver test
    • take in PM
    • report muscle pain, tenderness or weakness
  21. Fenofibrate (tricor, lipofen)
    Gemfibrizol
    • cholest. lowering 
    • fibric acid derivatives
    • lowers tri and VLDL
    • take w/ statin
    • AE: liver and hyperglycemia
  22. Ezetimibe (zetia)
    • Chol. lowering
    • chol. absorp. inhib
    • kids >10 yo
    • oral
    • lowers LDL not HDL or tri.
    • works in instest.
  23. Nicin or Vit B3
    • lowers cholest.
    • nicotinic acid
    • lowers tri and LDL raises HDL

    take NSAIDS 30-60 mins prior
  24. Cholestryamin and colestipol
    • cholest lowering
    • bile acid sequestraints
    • last resort
    • works in lower GI
    • constipat.
  25. HTN Med cat.
    • ACE inhibitors
    • diuretics
    • beta blockers
    • CA channel blockers
  26. captopril
    • ACE inhib.
    • HTN, CHF. diabet. nephropahty, LV dystfunct. post MI
    • BLACK BOX FOR PREG.
    • loweres aldosterone
    • --> prevents Na and H2O retension- Lowers BP
    • AE:
    • -cough
    • -rash-
    • 1st does hypertenstion- monitor 2-3 hrs
    • 1hr before meals
  27. Diuretics
    • ALL SULFA BASED
    • -Lasix
    • Thiazide diu.
    • Osmotic diu.
    • Potassium sparing diu.

    Block Na and Cl reabsorption
  28. Lasix
    • Loop diuretics
    • SULFA BASED
    • most effective
    • most freq. used
    • oral or IV
    • eat K+ foods
    • ototoxic
    • hyperK
    • hyperglycemia
    • No DIG
  29. Hydrochlorothiazide (HCTZ)
    • Thiazide Diuretic
    • 1st choice for HTN
    • lower diuresis than Loop
    • prevents ostroprosis
    • Diabete Insipidus (rentention in these pts ?)
    • NO PREGGERS
    • careful w/ dig
  30. Spirondactone
    • HTN
    • Potassium sparing diuretic
    • cant use ACE or ARB
    • Can't use salt sub.
    • hyper Ca
    • contra- loop diu.
  31. Mannitol
    • Osmotic Diuretic
    • HTN
    • Head injuries
    • prophylaxis of renal fail.
    • pulls h2o into nephron
    • reduces increase ICP or Intra-ocular pressure
  32. Antidysrythmics Cat.
    • Na Channel blockers
    • Beta agonists/catecholamine
    • Ca Channel blockers
    • Cardic gyloside
  33. Lidocaine
    • antidysrythmic
    • Na channel blocker
    • slow inpulse atria/ventricals & HIS purkinje system
    • IV only
    • short term
    • small thep. range
    • NOT SAME AS LOCAL
  34. B1
    B2
    • B1- increase contraction and rate
    • B2- lungs and uterus (increase bro-dilation) slows labor
  35. Propranolol
    • Beta blocker (B1 and B2)
    • dysrhythmia
    • HTN
    • angina
    • MI
    • decrease:
    • -HR
    • -contraction
    • -velocity of conduction
  36. Beta blockers
    OLOL

    • propranolol
    • acebutolol
    • semolol
    • sotalol
    • heart to decrease CO
    • decrease outflow to periphery
    • prevents renin release
  37. metoprolol (lopressor)
    • Beta blocker B1 only
    • HTN
    • angina
    • HF
    • MI
  38. Acebutolol
    • Beta Blocker
    • B1 only
    • ok w/ asthma
  39. Veapamil
    • Ca Channel blocker
    • Dysrhythamias
    • angina
    • essential HTN
    • vasodilation- reduced arterial pressure
    • increases coronary perfusion
    • NO: DIG, Grapefruit, Beta blockers
  40. Diltiazem
    • Ca Channel blocker
    • similar to verapamil
    • bigger 1st pass effect
    • less likely to cause constipation than Verapamile
  41. Nifedipine
    • Ca Channel blocker
    • dangerous
    • angina
    • HTN
    • * reflex tachycardia
  42. A1
    A2
    Dop.
    • A1- pupil dilation- vasoconstriction
    • A2- dc pain and lowe symp. outflow
    • dop- remal vessels
  43. Epinephrine
    A1, A2, B1, B2
  44. catecholamin
    • beta-agn ^Beta
    • stimulates- epi
  45. Digoxin
    • Cardiac Gylcoside
    • ^contraction
    • slows down rate
    • hoards Ca
    • ** antidote- phentoin**
    • for:
    • HF
    • Atrial Fib and flutter
    • supraventricular tachcardia
    • small thera. range
    • TAKE PULSE: don't give if <60
  46. Heprain
    • Anticoagulant
    • rapid acting
    • prevent and treat DVT
    • only parenteral
    • ** Antidote: PROMINE SULFATE
    • Ok with preggers
    • watch platelet count <100,000 STOP
  47. Low Molecular Weight Heparin
    • Prevents DVT
    • treatment of DVT
    • 1 or 2x a day
    • **ANTIDOTE: Protamine Sulfate**
    • subQ
  48. Warfarin (coumadin)
    • Vit K antagonist
    • prevent throb.
    • anticoagulant
    • 2-3 days for peak
    • ** antidote Vit K**
    • check INR
    • watch Vit K foods
    • Preg- cat X
  49. Pradaxa
    • anticoag.
    • atrial fib- prevention of stroke pr syst. embolism
    • knee or kid replacement
  50. Xaltro
    • anticoag
    • less bleeding and less monitoring
  51. Penicillin G
    • narrow spectrum
    • IM or IV
    • least toxic of all antibiotics, not common cause of drug allergiy
    • PCN V or VK is oral
  52. cefazolin (ancef)
    • cephalosporin
    • PCN allergy
    • B.C.
    • C.dif- rare but can cause
    • no alchol
    • oral kept in fridge
    • take w/ food
  53. cefepime (maxipime)
    • cephalosporin
    • grestest spectrum
    • penetrates CSF
  54. Vancomycin
    • Last resort
    • can be toxic
    • used for c. dif and MRSA
    • nephrotoxicity
    • ototoxicity
    • peak and trough
    • admin over at least 60 Mins
  55. Gentamicin
    • bactericidal
    • Serious infection
    • ototoxic
    • nephrotoxic
    • neurtoxic
    • Benifical w/ PCN
    • NO:
    • -Loop
    • -vanc
    • -Nsaid
    • -cehalosporins
    • Infuse over 30=60 mins min.
    • peak and trough
  56. clindamycin
    NO KIDS
  57. tetracycline
    • broad spectrum
    • Rickettsia
    • pneumoniae
    • chlamydia
    • inhib. grows- not kill
    • Photo sensitivity and rash- causes
    • Preg- D
    • discolors fetal teeth
    • no mineral salts
    • empty stomach
  58. cipro
    • DNA inhib
    • UTI
  59. Rifampin and Isoniazid
    TB
  60. Acyclovir (Zovirax)
    • antiviral
    • Herpes and chickenpox
    • nephrotoxic
  61. Amantadine (symetryl)
    • antiviral
    • treats parkinsionism
  62. Oseltamivir (tamiflu)
    • take w/in 48 hours of onset
    • take with food
    • antiviral
  63. albuterol
    • Bronchodilators Prototype drug
    • Beta 2 Agonists
    • short acting
    • acute and exercise induced
  64. ipratropium bromide (Atrovent)
    • Respiratory Anticholinergic Agents
    • short acting
    • AE:  Most common- dry mouth and irritation of pharynx
    • No peanut allergy
  65. Tiotropium (Spiriva)
    • Anticholinergic inhaler
    • long acting
    • pill poping inhaler
    • prevents bronchospasm
    • Will not help with acute attack
    • Do NOT swallow capsules
    • Most common AE: dry mouth, (sugarless candy canhelp)diminishes over time
  66. Glucocorticoid inhalers
    • Oropharyngeal candidiasis*
    • *Rinse mouth/Gargle after each use, use a spacer
    • Dysphonia (hoarseness, speaking difficulty)
    • *Bone loss in premenopausal women
    • Take lowest dose possible
    • *Take calcium and vitamin D
    • *Perform weight bearing exercises
  67. Acetylcysteine (Mucomyst).
    • break down mucus
    • Administered by a nebulizer or by direct instillation into the trachea.
    • Reserved for patients who have major difficultymobilizing and coughing up secretions
  68. pseudoephedrine
    • Decongestant
    • Reduction of volume of nasal mucus,
    • temporary relief of nasal congestion
    • decrease inflamination
    • Vasoconstriction of nasal arterioles/mucus membranes
    • ^fluid intake, humidification, avoid smoke filled places,
    • *Rebound congestion, dizziness, weakness,tremor, urinary retention, caution: OTC meds:
  69. fexofenadine (Allegra).
    • Antihistamines:
    • Relieves seasonal & perennial allergy symptoms
    • Block the action of histamine (H1 receptor) released during inflammatory response to an antigen
    • Restores normal airflow through the upper respiratory system
    • No grapefruit
  70. cromolyn Na
    • Mast Cell Stabilizer drugs
    • A preventative drug that decreases episodes of asthma/bronchospasm (nasal: rhinitis)induced by different antigens (exercise, pollutants, allergans)
    • Mast Cell Stabilizer drugs
    • An anti-inflammatory agent, shields mast cells and prevents them from rupture & degradation after contactwith antigen, prevents release of histamine, possibly leukotriene's, & other chemical mediators by an unclear mechanism, possibly due to influx of calcium
    • **Does NOT cause bronchodilation**
  71. Dextromethorphan (DMX)
    • Antitussive
    • Suppress cough reflex
    • Used to treat constant nonproductive cough
    • Directly affects the cough Center in the Medulla
  72. Benzonatate
    Tessalon/ Tessalon perles
    • Non-narcotic,
    • anesthetizes stretch receptors in respiratory system to reduce cough reflex
    • Used in endoscopy
  73. Methylprednisolone
    • systemic steriod
    • immuno supress
    • taper
  74. prednisone
    systemic steriod
  75. Omeprazole (priolsec)
    • Pro. pump inhib.
    • don't crush or chew
    • caps can be sprinkled
    • H.pylori
    • take b4 meals
  76. H2 receptor antagonist
    • GI
    • blocks histamin
    • prevents stress ulcers
    • report black stool
    • check IV every hr
    • Cimetidine (tagament)- confusion w/ old ppl
    • others:
    • Famotidine (Pepcid)
    • Nizatidine (Axid)
    • Ranitidine (Zantac)
  77. Antacids
    • Mg not for renal pts
    • don't take Ca, milk or Vit D
    • white stool
    • local acting
    • don't take with other meds
  78. Lactulose
    • Hyperosmotic Laxative
    • draws in H2O
    • bowel distenstion and peristalysis
    • good for Liver pts- lowers amonia
  79. PEG
    • Hyperosmotic Laxative
    • draws in H2O
    • bowel distenstion and peristalysis
    • explosive dia.
    • flush NG tube
  80. Castor Oil
    Basicodyl
    Senna
    • Stimulant Lax.
    • irritates mucosa
    • good for nacotics
  81. Fibercon
    metamucil
    citrucel
    • Bulk forming lax.
    • Good for MI or ICP _don't bare down
    • ^ H20
    • long onset
  82. Docusate Sodium
    • Stool softener
    • MI/ICP/HERNIA
    • avoid strain
  83. Metoclopramide
    (Reglan)
    • Prokinietic Agents
    • ^GI motility
    • nausa in chemo
    • Tardive dyskinesia
  84. Scopolamine (Transderm Scoop)
    • Antiemetics
    • Anticholinergic: Antihistimines
    • patch
    • give b4 nausa activities
  85. Promethazine
    (Phenergan)
    • Antiemetic
    • Phenothiazies: Antidopaminergics
    • severe nausa
  86. Droperidol
    (Inapsine)
    • Antiemetic
    • extraprymidal effects
  87. Synthroid (Levothyroxine Sodium)
    • For Hypothyriod
    • b4 food or meds
    • no NSAIDS
    • Notify if pulse > 100
    • lifelong
  88. Glyburide (DiaBeta)
    • Adjunct TX to lower blood glucose levels in DM type 2.
    • stimulation of pancreatic beta cells.
    • SULFA ALLERGY
  89. Meglitinides Repaglinide (Prandin)
    • Adjunct TX to lower blood glucose levels in DM type 2.
    • preferred in patients whoare elderly or w/decreased renal function
    • Only taken if food is eaten
  90. Metformin:Pharmacodynamics
    • Decreases hepatic glucose production, decreases intestinal absorption of glucose,
    • and improves insulin sensitivity by increasing peripheral glucose uptake in skeletal muscle and adipose tissue cells
  91. Vasopressin
    • diabetes Insipidous
    • IM SubQ
    • Mont. I&O
  92. Epoetin Alfa (Epogen, Procit)
    • stim. RBC
    • amenia w/ chronic kid. disease
    • ^ iron
    • ck RBC b4 and after
    • not uncontrolled HTN
    • dont shake vial
  93. Filgrastim (neupogrn)
    • Stimulates WBC
    • prevents chemo induced neutropenia
    • dont use for bone cancer
    • can cause bone pain
    • fridge- then room temp
    • monitor for infection
    • no UV light
    • not w/ chemo- after
  94. Sagramostin (leukine)
    • WBC
    • aplastic anemia
    • inhibits grow of tumor
  95. Oprelvekin (Neumega)
    • Thrombopoietic Growth Factor
    • Platelet
    • overstim.- bld will clot too much
    • teach to be careful w/ bleeding
    • refridge and light sensitive
  96. Phenytoin (Dilantin)
    • Anticonvulsant
    • used for partial and general tonic-clonic
    • decreases BC/ not for preggers
    • gingival hyperplasia
    • feedings far away w/ NG
    • slow IV- hypotension and dysrhythmias
    • ataxia (gait)
    • liver toxix
  97. Phenobarbital (Luminal)
    • Anticonvulsant Barbituate
    • tonic clonic & acute spisodes caused by status epil.
    • strong sedative effect
    • inactivated BC and Warfarin
  98. Diazepam (Valium)
    Lorazepan (Ativan)
    (seizures)
    • benzo
    • ** antidote Flumazenil (romazicon)
  99. Carbidopa-Levodopa
    • Parkinson’s Disease
    • Dopaminergics
    • taper slowly
  100. Selegiline
    • Parkinson’s Disease
    • Dopaminergics
    • extends levodopa
  101. Entacapone (Comatan)
    • Parkinson’s Disease
    • COMT Inhibitors
    • liver failure
    • for wearing off effect
  102. Bethanechol
    (Urecholine)
    • Cholinergics
    • Muscarinic Agonists
    • WET
    • rest and digest
    • makes you pee (fast- bedpan)
    • can decrease HR and cause Hypotenstion
    • **ANTIDOTE: ATOPINE***
    • I&O
  103. Pilocarpine
    • Cholinergics
    • Muscarinic Agonists
    • WET
    • rest and digest
    • Eye drops- reduces eye pressure in glaucoma
  104. Acetylcholine
    • Cholinergics
    • Muscarinic Agonists
    • WET
    • rest and digest
  105. Oxybutin (Ditropan)
    • Anticholinergics   
    • Overactive Bladder for Women
    • DRY
    • FIGHT OR FLIGHT
  106. Atropine
    • Anticholinergics
    • pre-op
    • DRY
  107. Anti psychotics w/ elderly
    double rate of mortality
  108. SSRI
    • Most common for depression
    • NO Preg- HTN in infants
    • NO MAOIs or alcohol
    • serotonin sydrome
    • used for:
    • depression
    • OCD
    • Panic
    • Social Phob
    • GAD
    • PMDD
    • PTSD
  109. SSRI drugs
    • Citalopram (Celexa)
    • Escitalopram (Lexapro)
    • Fluxetine (Prozac)
    • Fluvoxamine (Luvox)
    • Paroxetine (Paxil)
    • Sertraline (Zoloft)
  110. SNRIs used for
    • Used for depression,
    • peripheral neuropathic pain in diabetics,
    • general anxiety disorder.
    • Off-label use- Fibromyalgia, neuropathicpain/chronic pain, stress urinary incontinence.
  111. SNRIs drugs
    • Venlafaxine (EffexorXR)
    • Desvenlafaxine (Pristiq)
    • Duloxetine (Cymbalta)
  112. SNRIs
    General
    • often better tolerated
    • Warnings
    • – Uncontrolled angle-closure glaucoma,
    • -ESRD,
    • -chronic hepatitis.
    • Drug Interactions- Absolute contraindicated with MAOIs.
  113. Tricyclic Antidepressants
    • Blocks re-uptake of norepinephrine and serotonin into nerve endings.
    • Orthostatic Hypotension – Most serious and commonadverse effect.
    • NO MAOI
    • Toxicity- don't give more than a week supply at a time- SI risk
  114. Tricyclic Antidepressants
    Therapeutic Uses:
    • – Depression
    • – Bipolar Disorder
    • – Fibromyalgia
    • – Neuropathic pain
    • – Chronic Insomnia
    • – Attention-Deficit/Hyperactivity Disorder
    • – Pain Disorder
    • – Obsessive-compulsive Disorder
  115. Monoamine Oxidase Inhibitors(MAOIs)
    • Inhibits the enzyme MAO that breaks down norepinephrine and serotonin.
    • More dangerous than other antidepressants.
    • Orthostatic Hypotension
    • – Hypertensive Crisis with dietary Tyramine
  116. Oral MAOIs–
    • Isocarboxazid (Marplan)–
    • Phenelzine (Nardil)–
    • Tranylcypromine (Parnate)
  117. Transdermal MAOI–
    Selegiline (Emsam)
  118. Buproprion (Wellbutrin, Wellbutrin SR)
    • smoking cess.
    • Can actually INCREASE libido, may promote compliance
    • Can also cause psychosis (normally stopped at agitation)
  119. Mirtazapine (Remeron)
    • Atypical Antidepressants
    •  More wt gain and sedation/somnolence
  120. Trazodone (Desyrel, Trialodine)
    • Atypical Antidepressants
    • Does not work well alone, often given to treat insomnia causedby other antidepressants.

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