NUR 635 Advanced Pharmacology Midterm Review (Guaranteed Pass)

Pt on heparin in hospital setting. Why start coumadin 2 days before dc? Because coumadin needs a couple days before it starts working. Angina: bc pts dev tolerance to long-acting nitroglycerine w/i 1 day. How to pr ...

Pt on heparin in hospital setting. Why start coumadin 2 days before dc? Because coumadin needs a couple days before it starts working. Angina: bc pts dev tolerance to long-acting nitroglycerine w/i 1 day. How to prevent? Pts must have 8hrs with no nitroglycerine every days. Hint: At night, remove nitro patch bc no risk of exertional angina Underlying cause of angina coronary disease, athlerosclerosis Why do we give aspirin in pts w/atherosclerosis? Aspirin is an antiplatelet.. Prevents the existing plaques from getting bigger. Prevents plaque rupture. Cardio protective, prevents stroke, MI, CVA What is prescribed for angina pts w/DM? ACE inhibitors to protect the kidneys and nerves SE of high doses of aspirin? Tinnitus: ringing ears Pt education regarding Plavix(clopidogrel bisulfate)? Anti-platelet med. S/sx bleeding: blood in stool or vomit, excessive bruising, abd pain uterine bld, back pain, petichae. Interactions with EVERYTHING: OTC, herbals, supplements Pts on coumadin? What are we watching for? INR to check therapeutic levels. Half life is long. Check 12hrs after taking. What can be caused if pt started on heparin? day4, ordering blood work to check platelet count to observe for THROMBOCYTOPENIA coumadin and childbearing aged females Interactions with oral contraceptives- must have a back up method during time you're taking coumadin Pregnancy considerations and coumadin Need to monitor anti-Xa levels biggest food group interaction with coumadin Grapefruit, green leafy veggies. Why? high in vitamin K which counteracts warfarin Short duration: rapid acting insulin indication, MOA, usage Given w/meals Provide bs control between meals at night Can use in conjunction w/intermediate or long-acting agent lispro, aspart, gluulocene Short duration: short acting insulin indication, MOA, usage Before meals to control postprandial hyperglycemia Infused SQ via pump humulin/regular intermediate(humalin/novalin) duration insulin indication, MOA, usage BS control between meals and during the night Only one suitable for mixing w/short actings basal coverage Long duration: Insulin glargine U100 up to 24hrs, once daily subq dosing, basal coverage for DM1 or Dm2 Neostigmine is a medication uesd to tx what disease/disorder? Myastenia Gravis: AI disorder, antibodies destroy communication btw nerves and muscles. S/S weak skeletal muscles, voluntary muscles, dysphagia, ptosis Myasthenia gravis is an AI disorder that may cause what s/s? difficulty swallowing Medication must cross _____________ to affect CNS BBB Goal in Parkinson's tx is to restore ________________ in brain dopamine MCSE of dopaminergics sleep attacks, hallucinations, confusion Med appropriate to treat acute psychosis? Haloperidol ASE of first-generation antipsychotic(FGA) medications such as haloperidol, chlorpromazine: diff speaking, chewing tardive dyskinesia Med to help manage panic attacks? SSRI Cholinesterase inhibitors are used in tx of what conditon? Alzheimer's disease. MOA block normal breakdown of acetylocholine which increases their levels and duration of action in the CNS and PNS (neuromuscular junction). Also used in tx of myasthenia gravis Ex: neostigmine, donepezil, galantamine, rivastigmine What are some diseases/disorders/conditions are anticonvulsants used to treat other than seizure disorders? migraine HA prevention, bipolar DO, epilepsy Examples: carbamazepine(Tegretol), gabapentin(Neurontin), phenobarbital, topiramate(Topamax) Anti-seizure med used for prophylactic tx of migraines topiramate Anti-seizure med that is also an anti-arrhythmic phenytoin(Dilantin) Anti-seizure med w/black box warning for blood dyscrasias and serious derm rxns carbamazepine(Tegretol) First-line agent for early onset migraine NSAIDs Hallucinations may occur if __________ is stopped abruptly baclofen atomoxetine(Straterra), clonidine, and guanfacine are used in tx of which DO? ADHD initial intervention for infrequent migraine HA HA diary Meds that may cause QT prolongation methadone, tricyclic antidepressants, amiodarone CI for a triptan includes htn, CAD, MAOI use. Triptans used to ease migraine symptoms by calming overactive nerves in the brain and vasoconstriction of blood vessels in the brain What to give for hives and wheezing r/t pb? epinephrine IM Beta blockers have been used to treat _____________, _________, ____________ post MI, HTN, HF Drug route for 100% bioavailability IV Chronic renal failure will affect ___________ element of pharmacokinetics excretion Adrenergic antagonists or alpha blockers cause ____________________ vasodilation in addition to lowering BP, alpha blockers are used in tx of ________ BPH symptoms of BPH urinary frequency and urgency, nocturia, hesitancy and difficulty continuing to urinate, reduced force and size of urinary stream ("weak" stream), sensation of incomplete bladder emptying, straining to begin urination, post-void dribbling or leaking, hematuria, enlarged prostate Common side effect of ACE inhibitors dry cough Angina is a pain caused by _________________ cardiac ischemia All pts with angina should receive what drug for prophylaxis of a myocardial infarction? aspirin- antiplatelet lifestyle modifications to reduce cardiac risk include Wt loss (at least 10lbs), stop smoking, daily exercise Pt w/ heart failure, angina w/walking and slight limitation of activity is what class? Class II pt is taking hydrochlorothiazide(HCTZ) for HTN. What lab is most impt to monitor? K, for hypokalemia. Hypokalemia can result in abnormal heart rhythms, cramp and twitch muscles. HCTZ, thiazide diuretic, removes excess salt and water cardiac remodeling in HF Worsens HF. The wall of the left ventricle thickens and enlarges in an attempt to compensate for the increased workload. class of medication in pts post MI to prevent cardiac remodeling ACE inhibitors. ACE inhibitors are known to increase tissue bradykinin accumulation. Bradykinin has antigrowth effects and reduces vasomotor tone. When tx hyperlipidemia, calculation ____________ risk will help to determine tx. ASCVD risk, Atherosclerotic cardiovascular disease Class of medication contraindicated in pts w/liver failure HMG-CoA inhibitors(Statins). Because all statins are hepatically cleared and can cause elevations in liver biochemistries, there is a concern that patients with underlying liver disease may be at increased risk for hepatotoxicity. Which anticoagulant has the quickest onset of action? Heparin Pts receiving heparin are at risk for what adverse rxn? thrombocytpenia. Condition in which you have a low blood platelet count, not enough platelets, increased risk of bleeding Why would heparin and warfarin be given at the same time? warfarin has a delayed effect Risk factors that increase a pts ability to bleed herbal supplements, aspirin use, TPA Factor Xa levels may be monitored in pts on this med low molecular wt heparin, LMWH has better bioavail and longer half-life than heparin(ex: enoxaparin) Meds to be avoided in pregnancy statins, warfarin, ACE inhibitors Post hip replacement, med used to prevent DVT enoxaparin Pt started on warfarin for a fib should be taught that________ INR should be between 2-3 Epoetin alfa (erythropoietin) biologic response modifier can treat anemia to increase Hgb concentration, carries risk of tumor dev, can cause HTN, increases RBC production pernicious anemia is due to deficiency in _____________ B12 Lab monitoring for iron def anemia include reticulocyte count in 1 wk, total iron binding capacity (TIBC) in 4 wks, Hgb/Hct in 4 wks Which class of antidiabetic med used to tx CKD stage 4-5 Sulfonylureas: Sulphonylureas are insulin secretagogues, which means they work by causing the body to secrete insulin. DPP-4 inhibitors: help keep blood glucose from going too high by increasing the insulin produced by pancreas, especially right after a meal and decreasing glucagon, a hormone that releases glucose from the liver. SLGT-2 inhibitors: also known as gliflozins, prevent the reabsorption of glucose from blood that's filtered through kidneys, therefore facilitating glucose excretion in the urine. Pregnancy considerations for the pt taking diabetic meds she will be switched to insulin during pregnancy MOA of metformin (Glucophage) Increases action in peripheral tissues to increase insulin sensitivity, decreases hepatic glucose production, reduces glucose absorption in the gut When starting basal insulin, which class of med should be reduced or dc? sulfonylurea bc these cause the body to secrete insulin Alcohol can mask the s/s of hypoglycemia. Symptoms of hypoglycemia: sweating, fatigue, tired, dizzy, hungry, shaky or trembling, tachycardia, irritable, anxious, moody, tingly lips diabetics that develop HTN should be started on what class of med? ACE inhibitor when to take levothyroxine (synthroid) First thing in the morning, 30 mins prior to eating Lab level that indicates effectiveness of levothyroxine decrease in TSH Form of estrogen w/ least SE transdermal Post menopausal screening questions before HRT Smoker? Hysterctomy? Hx DVT/PE? Concern for male pt with 7lb wt gain requesting an early refill on testosterone. Testosterone abuse Epotetin Alfa/ EPOGEN/PROCRIT o Erythopoesis stimulating agent o Used in anemia especially in presence of CKD or chemo-related o May be used preoperatively for transfusion reduction- start 10 days before sx and cont for 4 days post o Check Hgb weekly w/tx start until stable o Black Box: § Increased CV events with adm to Hgb>11 § Increased mortality CAN CAUSE TUMORS and tumor progression in CA pts, dc once chemo completed § Increased thromboembolic events in sx pts- use DVT prophylaxis Vitamin B12 Deficiency o Causes § Impaired absorption § Lack of intrinsic factor (PERNICIOUS ANEMIA) o Consequences: megaloblastic anemia, neurological damage, death o DX: megaloblastic anemia, low plasma B12 o TX: parental cyanocobalamin Ferrous Sulfate o TX of choice for IDA (iron def. anemia) o Preferred drug for preventing def when iron needs unmet by diet o ASE: GI disturbance- nausea, heartburn, constipation, diarrhea. May cause dark green/black stools. o Avoid in pts w/peptic ulcers or ulcerative colitis o Toxicity: LEADING CAUSE OF POISONING FATALITIES IN CHILDREN, death rare in adults o Antacids reduce absorption o ASCORBIC ACID INCREASES ABSORPTION o RETICULOCYTES WILL INCREASE IN 4-7 DAYS, Hgb/Hct w/in 1 wk, Hgb should rise 2g/dl after 1 mos Aspirin/ASA o Cyclooxygenase inhibitor (inhibits Cox-1 and Cox-2) o Chemical family: salicylates- acetic salicylic acid o Inhibition of COX-2: § reduction of pain, inflammation, fever § harmful SE: renal impairment, prevention of MI, stroke (suppresses vasodilation) o Inhibition of COX-1: § Protection against MI/stroke secondary to reduced platelet aggregation § Harmful SE: gastric erosion/ulcers, bleeding tendencies, renal impairment o Decreases risk of colorectal CA (r/t effects of COS-2 inhibition which slows tumor growth) o Saliclyism: supratherapeutic levels- tinnitus, sweating, HA, dizziness o Reye syndrome: avoid use under 18yrs often prescribed w/levodopa-carbidopa in tx of Parkinson's Disease Bromocriptine taking too much of these can make you "blind as a bat" or "mad as a hatter" anticholinergics & antimuscarinics absorption, distribution, metabolism, excretion pharmacokinetic processes drug used to relieve myasthenic crisis Neostigmine/pyridostigmine (cholinergic or ace inhibitor) drug w/very narrow therapeutic index and high risk for toxicity, therefore levels should be monitored frequently Lithium drug class that carries an increased risk of suicidality in children, adolescents and young adults SSRI/SNRIs antidote for organophosphate poisoning Atropine do not stop this class of drug abruptly due to an increased risk of cardiovascular events Beta Blockers agents that indirectly block the breakdown of acetylcholine and are often used in tx of Alzheimer's disease Cholinesterase inhibitors drug has led to the death of children in ultrarapid metabolizers as 10% is converted into morphine Codeine leading cause of liver failure in U.S. Hepatotoxic drugs autoimmune disease that attacks the nicotinic receptors in skeletal muscle Myasthenia Gravis opioid agonist that works quickly to reverse CNS and respiratory depression Naloxone/Narcan how drug affects the body Pharmacodynamics term for amt of drug that reaches systemic circulation. Often affected by route of admin. Bioavailability symptoms for this syndrome include confusion, irritability, tachcardia, htn, diaphoresis, and is caused by having too much of this "happy" substance Serotonin dopamine agonist often used in tx of Parkinson's disease that is least likely to cause sleep attacks Pramipexole clonidine is often prescribed to children to tx this disorder ADHD Drug most effective in ETOH withdrawal lorazepam/ ATIVAN Drug used for anaphylactic rxn or cardiac arrest epinephrine 1st line drug for migraine prevention beta blockers (propanolol) parasympatholytic used for unstable bradycardia atropine drug class used to tx ADHD stimulants drugs that have no medical use and high potential for abuse schedule I controlled substances/ illicit this drug is an antispasmodic muscle relaxant that must be tapered off due to risk of seizure or hallucinations if stopped abruptly baclofen this muscle relaxant is also a schedule IV controlled substance carisoprodol/SOMA 1st line abortive drug for mild to moderate HA NSAIDs 1st line abortive drug for mod to severe migraine HA sumatriptain/IMITREX used in tx of non hypovolemic hypotension norepinephrine or phenylephrine drug used for acute mgmt. of seizure lorazepam used in tx of beta blocker overdose glucagon (increases heart rate and myocardial contractility) often used for tx of opiod use disorder. May cause QT prolongation methadone this opioid analgesic is used for tx of postop shivering or rigors meperidine/ DEMEROL antiseizure medication that carries black box warning for severe skin rxns such as Steven-Johnson syndrome carbamazepine. Stevens-Johnson syndrome (SJS) is a rare, serious disorder of the skin and mucous membranes. It's usually a reaction to medication that starts with flu-like symptoms, followed by a painful rash that spreads and blisters. Then the top layer of affected skin dies, sheds and begins to heal after several days. drug class used to tx extrapyramidal symptoms anticholinergics cause of menstrual associated migraine drop in estrogen level chronic use may cause amotivational syndrome of hyperemesis syndrome marijuana or THC a deadly bacterial toxin used in prevention of chronic migraine HA botox/botulinum toxin Pt taking epoetin alpha. What do I need to monitor? BP, epoetin alpha can cause HTN because it can produce too many RBCs What three meds to we prescribe to pts w/angina? statin, ASA, nitro If I want to self-donate blood, what would I take. 2 drugs: Epogen and iron If I prescribe iron, what lab to I order 1 week out? Reticulocyte count. Rationale: reticulocytes are the immature (teen) red blood cells. A high count confirms production is being increased. TIBC- 4 wk Ferratin-4 wk Hgb/hct-4wk pt education for iron replacement Empty stomach with glass of OJ when taking B12, what do we need to monitor for in first couple of days? Hypokalemia can happen first two days as a result of increased rbc requirements during hematopoiesis how long for NPH onset? 60-90 mins biggest SE for tx of DM? hypoglycemia: cold and clammy needs some candy alcohol plus beta blockers risk? ETOH masks s/s hypoglycemia in DM pts switching pt from NPH(intermediate) to glargine(long-acting), what do I have to do dosing glargine? Decrease glargine by 20% to avoid hypoglycemia Considerations for prescribing metformin Contrast studies= hydration status, A1C (is it working?), renal function baseline, Gliptins (DPP-4 Inhibitors) indirectly increase insulin production through incretin system GLP-1 agonists MOA -directly bind to pancreatic cells to stim insulin production -reduce glucose output, lowering blood sugar -slows glucose absorption into bloodstream by reducing speed of stomach emptying, increasing satiety Angina w/o s/s, staging? Stage I Stage II- angina w/min exertion Stage III- angina even without much exertion/ activity Stage V- even at 4, ready for a CABG Two reasons we see pts go into HF cardiac remodeling r/t myocardial ischemia or MI CI with flagyll ETOH, cannot drink on flagyll With any prescribed hepatotoxic meds, what are needed baseline labs? AST,ALT Most dangerous time for pregnant person to consume a teratogen 1st trimester, neural tube defects BFing pt. When should she take a med with questionable safety? Right after feeding baby. What does baclofen treat? spasticity, muscle spasms, MS, spinal cord injuries, cerebral palsy Rivastigmine (Exelon) alzheimer's tx daily transdermal patch Oxycodone tolerance If pt dev. tolerance, w go to something stronger, long-acting. methadone monitoring parameters EKG once a year bc QT prolongation risk If pt is on MAOI and I want them started on an SNRI, what must we do Need to stop for 2 weeks before starting the other pre surgical considerations for pt's taking oral contraceptives Progesterone only reduces chances of clots