Level 2 pharm part 2

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Level 2 pharm part 2
2011-03-13 13:25:30
L2 pharm KMRADN

2nd Level II pharm test drugs
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  1. albuterol
    • therapeutic: bronchodilator
    • pharm: adrenergics
  2. albuterol
    • Used as a bronchodilator to control and prevent reversible airway obstruction caused by asthma or COPD.
    • Inhaln: Used as a quick-relief agent for acute bronchospasm and for prevention of exercise-induced bronchospasm.
    • PO: Used as a long-term control agent in patients with chronic/persistent bronchospasm.
  3. albuterol
    Binds to beta2-adrenergic receptors in airway smooth muscle
  4. albuterol
    peak time?
    • PO 2-3 hours
    • Inhalant 60-90 mins
  5. albuterol
    use cautiously in?
    • Cardiac
    • disease
    • Hypertension
    • Hyperthyroidism
    • Diabetes
    • Glaucoma
    • Seizure disorders
    • Excess inhaler use may lead to
    • tolerance and paradoxical bronchospasm
  6. albuterol
    • Drug-Drug: Concurrent use with other adrenergic
    • agents will have ↑ adrenergic side effects. Use with MAO inhibitors may lead to hypertensive crisis.
    • Beta blockers may negate therapeutic effect.
    • May decrease serum digoxin levels.
    • Cardiovascular effects are potentiated in patients receiving tricyclic antidepressants. Risk of hypokalemia ↑ concurrent use of potassium-losing diuretics. Hypokalemia ↑ the risk of digoxin
    • toxicity. Drug-Natural: Use with caffeine-containing herbs (cola nut, guarana, tea, coffee) ↑ stimulant effect.
  7. Albuterol assessment
    • Assess lung sounds, pulse, and blood pressure before administration and during peak of medication. Note amount, color, and character of sputum produced.
    • Monitor pulmonary function tests before initiating therapy and periodically during therapy to determine
    • effectiveness of medication. Observe for paradoxical
    • bronchospasm (wheezing). If condition occurs, withhold medication and notify physician or other health care professional immediately. Lab Test Considerations: May cause transient ↓ in serum potassium concentrations with nebulization or
    • higher-than-recommended doses.
  8. albuterol
    • no double doses if dose missed.
    • Rinse mouth with water after inhalation
  9. Atrovent (ipratropium)
    • Therapeutic: allergy, cold, and cough remedies,
    • bronchodilators
    • Pharmacologic: anticholinergics´╗┐
  10. Atrovent (ipratropium)
    • Inhaln:
    • Maintenance therapy of reversible airway
    • obstruction due to COPD, including chronic bronchitis and emphysema. Intranasal: Rhinorrhea associated with allergic and nonallergic perennial rhinitis (0.03% solution) or the common cold (0.06% solution). Unlabelled Use: Inhaln: Adjunctive management of bronchospasm caused by asthma.
  11. Atrovent (ipratropium)

    Maintenance therapy of reversible airway
    obstruction due to COPD, including chronic bronchitis and emphysema.

    Intranasal: Rhinorrhea
    associated with allergic and nonallergic perennial rhinitis (0.03% solution) or
    the common cold (0.06% solution). Unlabelled Use: Inhaln: Adjunctive
    management of bronchospasm caused by asthma.

    • Inhaln:
    • Inhibits cholinergic receptors in bronchial smooth muscle, resulting in decreased concentrations of cyclic guanosine monophosphate (cGMP). Decreased levels of cGMP produce local bronchodilation.
    • Intranasal: Local application inhibits secretions from glands lining the nasal mucosa. Therapeutic Effects: Inhaln: Bronchodilation without systemic anticholinergic effects. Intranasal: Decreased rhinorrhea.
  12. Atrovent (ipratropium)
    Contraindicated in:
    • Hypersensitivity to ipratropium, atropine, belladonna alkaloids, or bromide Avoid use during acute
    • bronchospasm Note: Atrovent HFA has replaced
    • the discontinued Atrovent CFC (chlorofluorocarbon). Soy and CFC-allergic patients can now safely use the Atrovent HFA formulation. However, Combivent
    • (ipratropium/albuterol combination) MDI does contain soya lecithin and is contraindicated in patients with a history of hypersensitivity to soy and peanut.
    • Use Cautiously in: Patients with bladder neck
    • obstruction, prostatic hyperplasia, glaucoma, or urinary retention Geri: May be more sensitive to effects.
  13. Atrovent (ipratropium)
    Adverse Reactions/Side Effects
    • CNS: dizziness, headache, nervousness.
    • EENT: blurred vision, sore throatnasal only: epistaxis, nasal dryness/irritation. Resp: bronchospasm,
    • cough. CV: hypotension, palpitations.
    • GI: GI irritation, nausea. Derm: rash. Misc: allergic
    • reactions.
  14. Atrovent (ipratropium)
    • Assess for allergy to atropine and belladonna alkaloids; patients with these allergies may also be sensitive to ipratropium. Atrovent HFA MDI does not contain CFC or soy and may be used safely in soy or CFC-allergic patients. However, Combivent MDI should be avoided in soy or peanut-allergic patients.
    • Inhaln: Assess respiratory status (rate, breath sounds, degree of dyspnea, pulse) before administration and at peak of medication. Consult physician or other health care professional about alternative medication if severe bronchospasm is present; onset of action
    • is too slow for patients in acute distress. If paradoxical bronchospasm (wheezing) occurs, withhold medication and notify physician or other health
    • care professional immediately. Nasal Spray: Assess patient for rhinorrhea.
  15. Atrovent (ipratropium)
    • no double doses
    • rinse mouth after use
    • not to exceed 12 doses in 24 hour period
    • avoid spray in eyes
  16. captopril (Capoten)
    • Therapeutic: antihypertensives
    • Pharmacologic: ACE inhibitors
  17. captopril (Capoten)
    HTN, CHF, decreased diabetic nephropathy
  18. captopril (Capoten)
    • ACE-I blocks conversion of ANG-1 to ANG-2.
    • route: PO
  19. captopril (Capoten)
    Contraindicated in:
    • OB (death or injury ot fetus)
    • renal or liver problems
    • Geri (reduce initial dose)
    • hx of angioedema***
  20. captopril (Capoten)
    Adverse Reactions/Side Effects
    • resp: cough
    • CV: hypoTN
    • agranulocytosis
  21. captopril (Capoten)
    • Excessive hypotension may occur with concurrent use of diuretics and other antihypertensives.
    • ↑ risk of hyperkalemia with concurrent use of potassium supplements, potassium-sparing diuretics,
    • potassium-containing salt substitutes, or angiotensin II receptor antagonists. Antihypertensive response may be ↓ by NSAIDs. Absorption of fosinopril may be ↓
    • by antacids (separate administration by 1-2 hr).
    • ↑ levels and may ↑ risk of lithium toxicity.
    • Quinapril may ↓ absorption of tetracycline,
    • doxycycline, and fluoroquinolones (because of magnesium in tablets).
    • Drug-Food: Food significantly ↓ absorption of captopril and moexipril (administer drugs 1 hr before meals).
  22. captopril (Capoten)
    PO or IV
  23. captopril (Capoten)
    • take same time each day. Take missed doses as soon as possible but not if almost time for next dose. Do not double doses. Caution
    • patient to change positions slowly to minimize hypotension. Use of alcohol, standing for long periods, exercising, and hot weather may ↑ orthostatic
    • hypotension. Instruct patient to notify health care professional if rash; mouth sores; sore throat; fever; swelling of hands or feet; irregular heart beat; chest
    • pain; dry cough; hoarseness; swelling of face, eyes, lips, or tongue; difficulty swallowing or breathing occur
  24. digoxin (Lanoxin)
    • Therapeutic: antiarrhythmics, inotropics
    • Pharmacologic: digitalis glycosides
  25. digoxin (Lanoxin)
    • Treatment of CHF. Tachyarrhythmias: Atrial
    • fibrillation and atrial flutter (slows ventricular rate), Paroxysmal atrial tachycardia
  26. digoxin (Lanoxin)
    • Increases the force of myocardial contraction.
    • Prolongs refractory period of the AV node.
    • Decreases conduction through the SA and AV nodes.
    • Therapeutic Effects: Increased cardiac output (positive inotropic effect) and slowing of the heart rate (negative
    • chronotropic effect).
  27. digoxin (Lanoxin)
    PO (slowest), IM, IV (fastest)
  28. digoxin (Lanoxin)
    Contraindicated in:
    • Hypersensitivity
    • Uncontrolled ventricular arrhythmias
    • AV block
    • Idiopathic hypertrophic subaortic stenosis
    • Constrictive pericarditis
    • Known alcohol intolerance (elixir only).
  29. digoxin (Lanoxin)
    caution with:
    • Hypokalemia
    • (greatly increases risk of digoxin toxicity)
    • Hypercalcemia (increases risk of
    • toxicity, especially with mild hypokalemia)
    • Hypomagnesemia (may potentiate digoxin
    • toxicity)
    • Diuretic use (may cause electrolyte abnormalities including hypokalemia and hypomagnesemia)
    • Hypothyroidism
    • Geri: Geriatric patients (very sensitive to toxic effects, dose adjustments required for age-related decrease in renal function and body weight)
    • MI
    • Renal impairment (dose reduction required)
    • Obesity (dose should be based on ideal body weight)
    • OB: Pregnancy (although safety has not been established, has been used during pregnancy
    • without adverse effects on the fetus);Lactation: Similar
    • concentrations in serum and breast milk result in subtherapeutic levels in infant, use with caution).
  30. digoxin (Lanoxin)
    Adverse Reactions/Side Effects
    • interacts with St. John's wort (decreases dig levels)
  31. digoxin (Lanoxin)
    • Monitor ECG throughout IV administration and 6 hours after each dose.
    • Notify health care professional if bradycardia or new arrhythmias occur.
    • High Alert: Digoxin has a narrow therapeutic range. Medication errors associated with digoxin include miscalculation of pediatric doses and insufficient monitoring of digoxin levels. Have second practitioner independently check original order and dose calculations. Monitor therapeutic drug levels.
    • High Alert: Emphasize the importance of routine follow-up exams to determine effectiveness and to monitor for toxicity. .
  32. furosemide (Lasix)
    • Therapeutic: diuretics
    • Pharmacologic: loop diuretics
  33. furosemide (Lasix)
    Edema due to heart failure, hepatic impairment or renal disease. Hypertension.
  34. furosemide (Lasix)
    Inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule. Increases renal excretion of water, sodium, chloride, magnesium, potassium, and calcium. Effectiveness persists in impaired renal function. Therapeutic Effects: Diuresis and subsequent mobilization of excess fluid (edema, pleural effusions). Decreased blood pressure.
  35. furosemide (Lasix)
    Contraindicated in:
    • Cross-sensitivity with thiazides and sulfonamides may occur
    • Hepatic coma or anuria
  36. furosemide (Lasix)
    Adverse Reactions/Side Effects
    • Hemat:
  37. furosemide (Lasix)
    Drug-Drug: ↑ hypotension with antihypertensives, nitrates, or acute ingestion of alcohol. ↑ risk of hypokalemia with other diuretics, amphotericin B, stimulant laxatives, and corticosteroids. Hypokalemia may ↑ risk of digoxin toxicity and ↑ risk of arrhythmia in patients taking drugs that prolong the QT interval. ↓ lithium excretion, may cause lithiumtoxicity. ↑ risk of ototoxicity with aminoglycosides. NSAIDS↓ effects of furosemide.
  38. furosemide (Lasix)
    PO, IM, IV
  39. furosemide (Lasix)
    • Assess fluid status. Monitor daily weight, intake and output ratios, amount and location of edema, lung sounds, skin turgor, and mucous membranes. Notify
    • physician or other health care professional if thirst, dry mouth, lethargy, weakness, hypotension, or oliguria occurs.
  40. atorvastatin (Lipitor)
    • Therapeutic: lipid-lowering agents
    • Pharmacologic: HMG-CoA reductase inhibitors
  41. atorvastatin (Lipitor)
    • Atorvastatin: Primary prevention of cardiovascular disease (↓ risk of MI or stroke) in patients with multiple risk factors for coronary heart disease CHD or type 2 diabetes mellitus (also ↓ risk of angina or
    • revascsularization procedures in patients with multiple risk factors for CHD).
  42. atorvastatin (Lipitor)
    Inhibit an enzyme, 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, which is responsible for catalyzing an early step in the synthesis of cholesterol.
  43. atorvastatin (Lipitor)
    Contraindicated in:
    • OB: lactation, women of child-bearing age
    • Children less than 8
  44. atorvastatin (Lipitor)
    adverse rxn, side effects
    RHABDOMYOLYSIS (breakdown of muscle fibers into blood)
  45. atorvastatin (Lipitor)
  46. atorvastatin (Lipitor)
    • Obtain a dietary history, especially with regard to fat consumption. Lab Test Considerations: Evaluate
    • serum cholesterol and triglyceride levels before initiating, after 4-6 wk of therapy, and periodically thereafter.
    • *** If patient develops muscle tenderness during therapy, monitor CK levels. If CK levels are >10 times the upper limit of normal or myopathy occurs,
    • therapy should be discontinued. .
  47. atorvastatin (Lipitor)
    Instruct patient to notify health care professional if unexplained muscle pain, tenderness, or weakness occurs, especially if accompanied by fever or malaise.
  48. enoxaparin (Lovenox) (low molecular weight heparin)
    • Therapeutic: anticoagulants
    • Pharmacologic: antithrombotics
  49. enoxaparin (Lovenox)
    prevention of DVT, treatment of DVT
  50. enoxaparin (Lovenox)
    Contraindicated in:
    • Hypersensitivity to specific agents or pork products; cross-sensitivity may occur. Some products contain sulfites or benzyl alcohol and should be avoided in patients with known hypersensitivity or intolerance.
    • Active major bleeding
    • History of heparin-induced thrombocytopenia
  51. enoxaparin (Lovenox)
    adverse/side effects:
    • Careful with geri pts.
    • Interxn with cloves, garlic, ginger, ginkgo (bleeding risk)
  52. enoxaparin (Lovenox)
    • Assess for signs of bleeding and hemorrhage (bleeding gums; nosebleed; unusual bruising; black, tarry stools; hematuria; fall in hematocrit or blood pressure; guaiac-positive stools); bleeding from surgical site. Notify
    • physician or other health care professional if these occur.
  53. enoxaparin (Lovenox)
    High Alert: Unintended concomitant use of two heparin products (unfractionated heparin and LMW heparins) has resulted in serious harm and death. Review patients' recent and current medication administration records before administering any heparin or low-molecular-weight heparin product.
  54. promethazine (Phenergen)
    Therapeutic: antiemetics, antihistamines, sedative/hypnotics
  55. promethazine (Phenergen)
    Treatment of various allergic conditions and motion sickness. Preoperative sedation. Treatment and prevention of nausea and vomiting. Adjunct to anesthesia and analgesia.
  56. promethazine (Phenergen)
    • Blocks the effects of histamine.
    • Has inhibitory effect on the chemoreceptor trigger zone in the medulla, resulting in antiemetic properties.
    • Alters the effects of dopamine in the CNS.
    • Possesses significant anticholinergic activity.
    • Produces CNS depression by indirectly decreased stimulation of the CNS reticular system.
    • Therapeutic Effects: Relief of symptoms of histamine excess usually seen in allergic conditions. Diminished
    • nausea or vomiting. Sedation.
  57. promethazine (Phenergen)
    adverse/side effects
  58. promethazine (Phenergen)
    Monitor blood pressure, pulse, and respiratory rate frequently in patients receiving IV doses.
  59. clopidogrel (Plavix)
    • Therapeutic: antiplatelet agents
    • Pharmacologic: platelet aggregation inhibitors
  60. clopidogrel (Plavix)
    Reduction of atherosclerotic events (MI, stroke, vascular death) in patients at risk for such events including recent MI, acute coronary syndrome (unstable angina/non-Q-wave MI), stroke, or peripheral vascular disease.
  61. clopidogrel (Plavix)
    • Inhibits platelet aggregation by irreversibly inhibiting the binding of ATP to platelet receptors.
    • Therapeutic Effects: Decreased occurrence of atherosclerotic events in patients at risk.
  62. clopidogrel (Plavix)
    peak times:
    • PO: onset (within 24 hours)
    • peak (3-7 days)
    • duration (5 days)
  63. clopidogrel (Plavix)
    side effects
  64. clopidogrel (Plavix)
    • Drug-Natural: ↑ bleeding risk with anise, arnica,
    • chamomile, clove, fenugreek, feverfew, garlic,
    • ginger, ginkgo, Panax ginseng, and others.
  65. clopidogrel (Plavix)
    • Assess patient for symptoms of stroke, peripheral vascular disease, or MI periodically during therapy.
    • Monitor patient for signs of thrombotic thrombocytic purpura (thrombocytopenia, microangiopathic hemolytic anemia, neurologic findings, renal dysfunction, fever). May rarely occur, even after short exposure (<2 wk). Requires prompt treatment.
    • Lab Test Considerations: Monitor bleeding time during therapy. Prolonged bleeding time, which is time- and dose-dependent, is expected. Monitor
    • CBC with differential and platelet count periodically during therapy.
    • Neutropenia and thrombocytopenia may rarely occur.
    • May cause ↑ serum bilirubin, hepatic enzymes, total cholesterol, nonprotein nitrogen (NPN), and uric acid
    • concentrations.
  66. clopidogrel (Plavix)
    Advise patient to notify health care professional promptly if fever, chills, sore throat, or unusual bleeding or bruising occurs.
  67. pantoprazole (Protonix)
    • Therapeutic: antiulcer agents
    • Pharmacologic: proton-pump inhibitors
  68. pantoprazole (Protonix)
    • Erosive esophagitis associated with GERD.
    • Decrease relapse rates of daytime and nighttime heartburn symptoms on patients with GERD.
    • Pathologic gastric hypersecretory conditions. Unlabelled Use: Adjunctive treatment of duodenal ulcers associated with Helicobacter pylori.
  69. pantoprazole (Protonix)
    • Binds to an enzyme in the presence of acidic gastric pH, preventing the final transport of hydrogen ions into the gastric lumen.
    • Therapeutic Effects: Diminished accumulation of acid in the gastric lumen, with lessened acid reflux. Healing
    • of duodenal ulcers and esophagitis. Decreased acid secretion in hypersecretory conditions.
  70. pantoprazole (Protonix)
    side effects:
    • CNS: headache.
    • GI: abdominal pain, diarrhea, eructation, flatulence.
    • Endo: hyperglycemia.
  71. pantoprazole (Protonix)
    • Assess patient routinely for epigastric or abdominal pain and for frank or occult blood in stool, emesis, or gastric aspirate.
    • Lab Test Considerations: May cause abnormal liver function tests, including ↑ AST, ALT, alkaline
    • phosphatase, and bilirubin.
  72. pantoprazole (Protonix)
    • Instruct patient to take medication as directed for the full course of therapy, even if feeling better.
    • Advise patient to avoid alcohol, products containing aspirin or NSAIDs, and foods that may cause an increase in GI irritation.
    • Advise patient to report onset of black, tarry stools; diarrhea; or abdominal pain to health care professional
    • promptly.
  73. rifampin (Rifadin)
    • Therapeutic: antituberculars
    • Pharmacologic: rifamycins
  74. rifampin (Rifadin)
    • Active tuberculosis (with other agents).
    • Elimination of meningococcal carriers. Unlabelled Use: Prevention of disease caused by Haemophilus
    • influenzae type B in close contacts.
  75. rifampin (Rifadin)
    • Inhibits RNA synthesis by blocking RNA transcription in susceptible organisms. Therapeutic Effects: Bactericidal action against susceptible organisms. Spectrum: Broad spectrum notable for activity against: Mycobacterium spp, Staphylococcus aureus, H.
    • influenzae, Legionella pneumophila, Neisseria meningitidis.
  76. rifampin (Rifadin)
    • may cause red urine or body fluids.
    • Perform mycobacterial studies and susceptibility tests prior to and periodically during therapy to detect possible resistance.
  77. rifampin (Rifadin)
    • Advise patient to take medication once daily (unless biweekly regimens are used), as directed, and not to skip doses or double up on missed doses. Emphasize the importance of continuing therapy even after symptoms have subsided. Length of therapy for tuberculosis depends on regimen being used and underlying disease states. Patients on short-term prophylactic therapy should also be advised of
    • the importance of compliance with therapy.
    • Advise patient to notify health care professional promptly if signs and symptoms of hepatitis (yellow eyes and skin, nausea, vomiting, anorexia, unusual tiredness, weakness) or of thrombocytopenia (unusual bleeding or bruising) occur.
    • Caution patient to avoid the use of alcohol during this therapy, because this may increase the risk of
    • hepatotoxicity. Instruct patient to report the
    • occurrence of flu-like symptoms (fever, chills, myalgia, headache) promptly. Rifampin may occasionally cause
    • drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known. Inform patient that saliva,
    • sputum, sweat, tears, urine, and feces may become red-orange to red-brown and that soft contact lenses may become permanently discolored. Advise patient that this medication has teratogenic properties and may decrease the effectiveness of oral contraceptives. Counsel patient to use a nonhormonal form of contraception throughout therapy. Emphasize the importance of regular follow-up exams to monitor progress and to check for side effects.
  78. terbutaline (Brethaire)
    • Therapeutic: bronchodilators
    • Pharmacologic: adrenergics
  79. terbutaline (Brethaire)
    Management of reversible airway disease due to asthma or COPD; inhalation and subcut used for short-term control and oral agent as long-term control. Unlabelled Use: Management of preterm labor (tocolytic).
  80. terbutaline (Brethaire)
    Therapeutic Effects: Bronchodilation.
  81. terbutaline (Brethaire)
    PO, inhalnt, sub-q
  82. terbutaline (Brethaire)
    side effects
  83. terbutaline (Brethaire)
    • Observe for paradoxical bronchospasm (wheezing). If condition occurs, withhold medication and notify health care professional immediately.
    • Bronchodilator: Assess lung sounds, respiratory pattern, pulse, and blood pressure before administration and during peak of medication. Note amount, color, and character of sputum produced, and notify health care professional of abnormal findings.
  84. terbutaline (Brethaire)
    • Instruct patient to contact health care professional immediately if shortness of breath is not relieved by medication or is accompanied by diaphoresis, dizziness, palpitations, or chest pain.
    • Advise patient to consult health care professional before taking any OTC medications or alcoholic beverages concurrently with this therapy. Caution patient also to avoid smoking and other respiratory irritants. .
  85. levalbuterol (Xopenex)
    • Therapeutic: bronchodilators
    • Pharmacologic: adrenergics
  86. levalbuterol (Xopenex)
    Bronchospasm due to reversible airway disease (short-term control agent).
  87. levalbuterol (Xopenex)
    R-enantiomer of racemic albuterolBinds to beta-2 adrenergic receptors in airway smooth muscle
  88. levalbuterol (Xopenex)
    • Contraindicated in: Hypersensitivity to levalbuterol or
    • albuterol. Use Cautiously in: Cardiovascular disorders (including coronary insufficiency, hypertension, and arrhythmias)
    • History of seizures
    • Hypokalemia
    • Hyperthyroidism
    • Diabetes mellitus
    • Unusual sensitivity to adrenergic amines
    • Pregnancy, lactation, or children <2 yr (safety not established).
    • Exercise Extreme Caution in: Concurrent use or use within 2 weeks of tricyclic antidepressants or MAO inhibitors (may increase the risk of adverse
    • cardiovascular reactions).
  89. levalbuterol (Xopenex)
    • ***Concurrent use or use within 2 weeks of tricyclicantidepressants or MAO inhibitors may ↑ risk of adverse cardiovascular reactions (use with extreme
    • caution).
  90. levalbuterol (Xopenex)
    Assess lung sounds, pulse, and blood pressure before administration and during peak of medication. Note amount, color, and character of sputum produced. Closely monitor patients on higher dose for adverse effects. Monitor pulmonary function tests before initiating therapy and periodically during course to determine effectiveness of medication. Observe for paradoxical bronchospasm (wheezing). If condition occurs, withhold medication and notify physician or other health care provider immediately.
  91. levalbuterol (Xopenex)
    Advise patients to use levalbuterol first if using other inhalation medications, and allow 5 min to elapse before administering other inhalant medications unless otherwise directed.