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pharm exam 3
barnes goldfarb
437
Pharmacology
Undergraduate 3
08/03/2011

Additional Pharmacology Flashcards

 


 

Cards

Term

omeprazole

actions and characteristics

Definition

 

nIrreversible inhibition of  gastric  acid secretion
nShort half-life. But effects persist long after drug has been cleared from the body.
nUsed for short-term therapy of duodenal ulcers, gastric ulcers, erosive esophagitis, & GERD – Tx should be limited to 4-8 wks;
nAnd for long term therapy of hypersecretory conditions.
Term
sulcralfate
Definition

 

nCreates a protective barrier up to 6 hours
nTherapeutic uses
nAcute ulcers and maintenance therapy
nAdverse effects
nConstipation (only in 2% of patients)
nDrug interactions
nMinimal
nAntacids may interfere with effects of sucralfate
Term
misoprostol
Definition

 nTherapeutic uses

nOnly approved GI indication is prevention of gastric ulcers caused by long-term NSAID therapy
nAdverse effects
nMost common – dose-related diarrhea (13%-40%) and abdominal pain (7%-20%)
nContraindicated during pregnancy – category X
nSignificant actions need to be taken to ensure that pregnancy does not occur after therapy starts and that patient is not pregnant at therapy initiation.
Term
misoprostol
Definition

 

nOnly approved GI indication is prevention of gastric ulcers caused by long-term therapy with NSAIDs
nAlso, used to promote cervical ripening, and
nIn combination with mifepristone (RU 486), to induce abortion
nMisoprostol prevents NSAID-induced ulcers by serving as a replacement for endogenous prostaglandins.
 

In normal individuals, prostaglandins help protect the stomach by suppressing secretion of gastric acid, promoting secretion of bicarbonate and cytoprotective mucus, and maintaining submucosal blood flow (by promoting vasodilation). As discussed in Chapter 70, aspirin and other NSAIDs cause gastric ulcers in part by inhibiting prostaglandin biosynthesis. Misoprostol prevents NSAID-induced ulcers by serving as a replacement for endogenous prostaglandins.

Term
methylcellulose
Definition
bulk forming laxative
Term
methylcellulose
Definition

nMethylcellulose, psyllium, polycarbophil

nFunction like dietary fiber – swell with water to form a gel to soften the fecal mass and increase mass
nProduce a soft, formed stool 1 to 3 days after the onset of treatment.
nPreferred treatment for temporary treatment of constipation
nUsed for diverticulosis and irritable bowel syndrome
nCan provide symptomatic relief of diarrhea and can reduce discomfort and inconvenience for patients with an ileostomy or colostomy.
nAdverse effects are minimal:  Esophageal obstruction
Term
docusate
Definition
surfactant laxative
Term
docusate
Definition

 

nProduce a soft stool several days after the onset of treatment.
nAlter stool consistency by lowering surface tension, which facilitates penetration of water into the feces.
nAlso act on the intestinal wall to:
n(1) inhibit fluid absorption
n(2) stimulate secretion of water and electrolytes into the intestinal lumen.
nSurfactants resemble the stimulant laxatives
nAdministration should be accompanied by a full glass of water. Instruct patients to take surfactant agents with a full glass of water.
Term
bisacodyl
Definition

nstimulant laxatives

Two effects on bowel

nStimulate intestinal motility
nIncrease amount of water and electrolytes in the intestinal lumen, by increasing secretion of water and ions into the intestine & by reducing water and electrolyte absorption.
nAct on the colon, producing a semifluid stool within 6 to 12 hours.
nWidely used and abused: Discourage patients from inappropriate use of these drugs.
nLegitimately used for opioid-induced constipation and constipation d/t slow intestinal transit
Term
bisacodyl
Definition

nPO tablets: act 6-12 hours; may be given at bedtime to produce a response the following morning

nPR: suppositories: act 15 to 60 minutes.
nTablets are enteric coated to prevent gastric irritation
nAdvise pts to swallow them intact, without chewing or crushing.
nMilk and antacids accelerate dissolution of the enteric coating:  Tablets should be administered no sooner than 1 hour after ingesting these substances.
nInform patients that bisacodyl suppositories may cause a burning sensation, and warn them that prolonged use can cause proctitis.
Term
ondansetron
Definition
nFirst one approved for chemotherapy-induced nausea and vomiting (CINV)
nBlocks type 3 serotonin receptors(5-HT3 receptors) on afferent vagal nerve
nEffective by itself, but more effective when used with dexamethasone
nAdministration may be oral or parenteral
ncommon side effects are headache, diarrhea, and dizziness
nAdministration is PO or IV.
Term
odansetron
Definition

serotonin receptor antagonist

antiemetics

Term
aprepitant
Definition

 nAn important new antiemetic

nBlocks neurokinin1-type receptors (for substance P) in the chemoreceptor-trigger zone (CTZ)
nPrevents postoperative nausea/vomiting and CINV
nAprepitant can enhance responses when combined with other antiemetic drugs.
nProlonged duration of action:  can  prevent delayed CINV and acute onset CINV)
nCan be used alone for managing postoperative nausea and vomiting, but only moderately effective alone..
Term
prochlorperazine
Definition
nPhenothiazines   (prochlorperazine)
nBlock dopamine2 receptors in CTZ
nReduce emesis associated with surgery, cancer, chemotherapy, and toxins
nSide effects
nExtrapyramidal reactions
nAnticholinergic effects
nHypotension and sedation
Term
sulfasalazine
Definition
Term
mercaptopurine
Definition
Term
mercaptopurine
Definition
Term
lubiprostone
Definition
Term
lubiprostone
Definition
Term
alosetron
Definition
Term
alosetron
Definition
Term
penicillin
Definition
Term

amphotericin B

therapeutic goal

Definition

progressive or fatal systemic fungal infections 

flucytosine enhances treatment

Term

itraconazole

therapeutic goals

Definition

treatment of systemic and superficial mycoses 


Term

famotidine

therapeutic uses

Definition

 

nShort-term treatment of gastric/duodenal ulcers
nProphylaxis of recurrent duodenal ulcers
nTreatment of Zollinger-Ellison syndrome and hypersecretory states
nTreatment of GERD
nOTC – to treat heartburn, acid indigestion, sour stomach
Term

H2RAs

interventions

Definition

 

nInform patients that H2RAs may be taken without regard to meals.
nWith all H2RAs, dosing may be done twice daily or once daily at bedtime. With ranitidine, dosing may also be done 4 times a day (with meals and at bedtime).
nMake sure the patient knows which dosing schedule has been prescribed.
nAdvise patients to avoid cigarettes and ulcerogenic over-the-counter drugs (aspirin and other NSAIDs).
nAdvise patients to stop drinking alcohol if drinking exacerbates ulcer symptoms.
 
Term

omeprazole adverse

effects

Definition

 

nminor (less than 1%)
nHeadache
nGastrointestinal effects (diarrhea, nausea, and vomiting)
nElevation of gastric pH increases the risk of pneumonia (about 1 extra case for every 220 people using a PPI).
nLong-term therapy may pose a risk of gastric cancer.
nMay increase the risk of osteoporosis and fractures by decreasing absorption of calcium
Term
sucralfate
Definition

 

nEffective antiulcer medication
nNotable for minimal side effects
nLack of significant drug interactions
nPromotes ulcer healing by creating a protective barrier against acid and pepsin
nNo acid-neutralizing capacity; does not enhance prostaglandin synthesis.
nDoes not decrease acid secretion (does not inhibit the enzyme that generates gastric acid).
nNo known serious adverse effects
Term
sucralfate
Definition

 

A viscid and very sticky gel that adheres to the ulcer crater, creating a barrier to back-diffusion of hydrogen ions, pepsin, and bile salts. Attachment to the ulcer appears to last up to 6 hours.

 

Sucralfate is administered orally, and systemic absorption is minimal (3% to 5%). About 90% of each dose is eliminated in the feces.

 

Sucralfate is approved for acute and maintenance therapy of duodenal ulcers. Rates of healing are comparable to those achieved with cimetidine. Controlled trials indicate that sucralfate can also promote healing of gastric ulcers.

 

Sucralfate tablets are large and difficult to swallow, especially by the elderly. The oral suspension is much easier to ingest.

Term

sucralfate

drug interactions

Definition

 nAntacids may interfere with sucralfate's effects, therefore, minimize by administering these drugs at least 30 minutes apart.

nMay impede the absorption of some drugs:
nPhenytoin, theophylline, digoxin, warfarin, and fluoroquinolone antibiotics (eg, ciprofloxacin, norfloxacin).
nMinimize by administering sucralfate at least 2 hours apart from these other drugs.
Term

misoprostol

 adverse effects

Definition

 

nMost common reactions:
nDose-related diarrhea; abdominal pain; Some women experience spotting and dysmenorrhea.
nPregnancy Risk Category X
nWomen of child-bearing age:
nMust be able to comply with birth control measures
nMust be given oral and written warnings about the dangers of misoprostol,
nMust have a negative serum pregnancy test result within 2 weeks prior to beginning therapy
nMust begin therapy only on the second or third day of the next normal menstrual cycle.
Term

 

nMethylcellulose, psyllium, polycarbophil
Definition

Bulk-forming agents have the same impact on bowel function as dietary fiber.

Following ingestion, these agents, which are nondigestible and nonabsorbable, swell in water to form a viscous solution or gel, thereby softening the fecal mass and increasing its bulk. Fecal volume may be further enlarged by growth of colonic bacteria, which can utilize these materials as nutrients. Transit through the intestine is hastened because swelling of the fecal mass stretches the intestinal wall, thereby stimulating peristalsis.

Term

Haloperidol (Haldol) and droperidol (Inapsine)

Definition

Butyrophenones

Term
nHaloperidol (Haldol) and droperidol (Inapsine)     
Definition
nSuppress emesis by blocking dopamine2 receptors in CTZ
nGood for postoperative nausea/vomiting, chemotherapy emesis, radiation therapy, and toxins
nSide effects
nSimilar to phenothiazines: extrapyramidal reactions, sedation, and hypotension
nDroperidol may cause prolonged QT and fatal dysrhythmias
nECG monitoring needed
Term
nMetoclopramide (Reglan)
Definition
nBlocks dopamine receptors in CTZ
nCan suppress postoperative nausea/vomiting;  emesis caused by anticancer drug, opioids, toxins, & radiation therapy
Term
nCannabinoids
nDronabinol (Marinol) and nabilone (Cesamet)
Definition
nRelated to marijuana; approved for medical use in US
nFor suppression of CINV; dronabinol only one is approved for stimulating appetite in AIDS pts.
nMOA with emesis unclear
Term

cannaboids

adverse effects

Definition
nTemporal disintegration, dissociation, depersonalization, and dysphoria
nCannabinoids are contraindicated for patients with psychiatric disorders
ncan cause tachycardia and hypotension – cautious use in pts with cardiovascular dz
ncan cause drowsiness – no use with alcohol, sedatives, and CNS depressants.

Some potential for abuse

Term
management of chemotherapy induced NV
Definition
nAntiemetics are more effective at preventing CINV than suppressing CINV in progress
nGive before chemotherapy drugs
nMonotherapy and combination therapy may be needed
nCurrent regimen of choice for patients taking highly emetogenic drugs consists of three agents: aprepitant plus dexamethasone plus a 5-HT3 antagonist (eg, ondansetron, palonosetron).
nLorazepam may be added to reduce anxiety and anticipatory emesis, and to provide amnesia as well.
Term
lorazepam
Definition

One of the principal effects of lorazepam is suppression of anticipatory nausea.  It is use in combination regimens to suppress chemotherapy-induced nausea and vomiting (CINV). 

Term

glucocorticoids 

and cannaboids

Definition

Glucocorticoids and cannabinoids do not cause extrapyramidal side effects. The most common side effects of serotonin-receptor antagonists are headache, diarrhea, and dizziness. They do not cause extrapyramidal effects. 

Term
scopolamine
Definition
nMuscarinic antagonist
nmost effective drug for prevention and treatment of motion sickness
nSide effects
nDry mouth
nBlurred vision
nDrowsiness
nUrinary retention, constipation, and disorientation = less common side effects
nOral, subcutaneous, and transdermal administration

[Transderm-Scop] = transdermal/behind the ear; side 

Term

antihistamines

motion sickness

Definition
nDimenhydrinate (Dramamine), meclizine (Antivert), cyclizine (Marezine)
Term
nDimenhydrinate (Dramamine), meclizine (Antivert), cyclizine (Marezine)
Definition
nConsidered anticholinergics— block both receptors for acetylcholine and histamine
nSide effects
nSedation from (H1-receptor blocking)
nDry mouth, blurred vision, urinary retention, constipation from (muscarinic receptor blocking)

Less effective than scopolamine for treating motion sickness; sedation limits utility

Term
diarrhea management
Definition
nManagement
nDiagnosis and treatment of underlying disease
nReplacement of lost water and salts
nRelief of cramping
nReducing passage of unformed stools
nTwo major groups of antidiarrheals
nSpecific antidiarrheal drugs – treat underlying cause of diarrhea
nAnti-infective drugs
nDrugs used to correct malabsorption syndromes
nNonspecific antidiarrheal drugs
nAct on or within the bowel for symptomatic relief; do not cure cause
Term

opiods 

diarrhea

Definition
nMost effective antidiarrheal agents
nActivate opioid receptors in GI tract
nDecrease intestinal motility
nSlow intestinal transit
nAllow more fluid and electrolytes to be absorbed
nDecrease secretion of fluid into small intestine and increase absorption of fluid and salt
nNet effect:  present large intestine with less water; fluidity and volume of stools are reduced, as is frequency of defecation
Term

Diphenoxylate (Lomotil) and loperamide (Imodium)

Definition
nmost frequently used
nOthers you might see:  difenoxin (Motofen), paregoric and opium tincture are also approved for diarrhea
Term
nDiphenoxylate (Lomotil)
Definition
nFormulated with atropine to discourage abuse
nOnly Opioid used only for diarrhea
nHigh doses can elicit typical morphine-like subjective responses, but unpleasant side effects from the high dose of atropine
nSide effects of the atropine include blurred vision, photophobia, dry mouth, urinary retention and tachycardia.
nObserve the patient for an increased heart rate from the atropine. 
Term
loperamide
Definition
nUsedto treat diarrhea and to reduce the volume of discharge from ileostomies
nSuppresses bowel motility and suppresses fluid secretion into the intestinal lumen.
nLoperamide has little or no potential for abuse.
Term
nDifenoxin (Motofen)
Definition

Can elicit morphine-like subjective effects at high doses
nformulated only in combination with atropine
nParegoric (camphorated tincture of opium)
nPrimary use is diarrhea
nAntidiarrheal doses cause neither euphoria nor analgesia.
nModerate potential for abuse 
Term

opium tincture 

diarrhea 

 

Definition
n10% opium by weight
nMorphine—is present at 10 mg/mL
nPrimary indication for opium tincture is diarrhea.
nHigh doses can cause typical opioid agonist effects
Term
Bismuth subsalicylate [Pepto-Bismol, others  
Definition
nEffective for prevention and treatment of mild diarrhea.
nMay blacken stools and the tongue
Term
pepto bismol
Definition

Bismuth subsalicylate [Pepto-Bismol, others] is effective for prevention and treatment of mild diarrhea. For prevention, the dosage is two 262-mg tablets 4 times a day for up to 3 weeks. For treatment, the dosage is 2 tablets every 30 minutes for up to eight doses. Users should be aware the drug may blacken stools and the tongue.

Term
methylcellulose (Citrucel), polycarbophil
Definition
bulk forming agents
Term
methylcellulose (Citrucel), polycarbophil
Definition
nother bulk-forming laxatives can help manage diarrhea.
nGives the stool a more firm, less watery consistency
nStool volume is not decreased.
Term
nAnticholinergic antispasmodics (Muscarinic antagonists (eg, atropine) 
Definition
nrelieve cramping associated with diarrhea
ndo not alter fecal consistency or volume
nanticholinergic drugs are of limited use d/t side effects (eg, blurred vision, photophobia, dry mouth, urinary retention, tachycardia)
Term

Definition
Term
Definition
nGeneral considerations
nVariety of bacteria and protozoa can be responsible.
nInfections are usually self-limited.
nMany cases require no treatment.
nAntibiotics should only be used when clearly indicated.
nManage diarrhea with non-specific anti-diarrheals
nAntibiotic treatment is indicated for severe infections d/tSalmonella, Shigella, Campylobacter, or Clostridium.
Term
amphotericin b
Definition
no contraindications
Term

amphotericin b

adverse effects

Definition

infusion reactions

fever, chills rigors nausea and headache

Term

amphotericin b

pretreatment

Definition

diphenhydramine plus acetaminophen can minimize these reactions

give meperidine or dantrolene if rigors develop 

if other measures fail, give hydrocortisone to suppress symptoms 


Term
amphotericin b
Definition

rotate the infusion site and pretreat with heparin to minimize phlebitis 

infusion reactions can be reduced by using a lipid based formulation rather than conventional amphotericin 

Term

amphotericin b

nephrotoxicity

Definition

almost all patients experience renal impairment monitor and record intake and out put 

kidney function should be tested every 3 to 4 days 

if plasma creatinine content rises about 3.5 mg/dL amphotericin dosage should be reduced 

the risk of renal damage can be decreased by infusing 1 L of saline on the day of amphotericin administration 

Term

amphotericin b

nephrotoxicity

Definition
avoiding other nephrotoxic drugs (eg. aminoglycosides, cyclosporine, NSAIDs)
Term

amphotericin b

hypokalemia

Definition

renal injury may cause hypokalemia

serum potassium should be measured frequently 

correct with potassium supplements 

Term

itraconazole

high risk patients

Definition

contraindicated: taking pimozide, quinidine, dofetilide, or cisapride

great caution: cardiac disease, significant pulmonary disease, active liver disease or a history of liver injury with other drugs 

Term

itraconazole

adverse effects

liver

 

Definition

rarely liver failure 

discontinue and obtain liver function tests 

inform patient of sign: (persistent nausea, anorexia, fatigue, vomiting, right upper abdominal pain, jaundice, dark urine, pale stools

Term

itraconazole

cardiac suppression

Definition

can suppress ventricular function posing a risk of HF 

signs of HF (fatigue, cough, dyspnea, edema, jugular distension) 

Term

itraconazole

adverse interactions

cyp3a4

Definition

pimozide, quinidine, dofetilide, and cisapride 

inhibiting CYP3A4 

itraconazole can raise levels ofthese drugs 

posing risk of fatal dysrhytmias 

Term

itraconazole 

interacitons 

cyp3a4

Definition

cyclosporine, digoxin, warfarin, sulfonylureas

can raise levels of these drugs 

monitor cyclosporine and digoxin blood levels

monitor prothrombin time in patients w warfarin 

monitor blood glucose w sulfonylurea 

Term

flucytosine 

therapeutic goal

Definition

treatment of serious infections caused by candida species and cryptococus neoformans

flucytosine is usually combined with amphotericin b

Term

flucytosine

baseline data

Definition
renal function, hematologic status, serum electrolyes
Term

flucytosine

high risk patients

Definition
extreme caution in patients with kidney disease or bone marrow suppression 
Term

flucytosine

administration

Definition

treatment may require ingestion of 10 or more capsules 4 times a day

advise to take capsules a few at a time over a 15 minute interval to minimize nausea and vomiting 

dosage must be reduced patients w renal impairment 

Term

flucytosine

monitoring

Definition

serum transaminase and alkaline phosphatase levels (liver)

leukocyte counts (hematologic)

patients also receiving amphotericin b o pre-existing renal (kidney function and flucytosine levels)

Term

sildenafil,

Tadalafil

Vardenafil

 

Definition

pde5 inhibitors

erectile dysfunction

BPH

Term

Sildenafil

Tadalafil

Vardenafil

therapeutic goal

 

Definition
PDE5 inhibitors are used to enhance both the hardness and duration of erection in men with ED
Term

Sildenafil

Tadalafil

Vardenafil

baseline data

Definition

Evaluate patients for cardiovascular disorders, including stroke, hypotension, hypertension, heart failure, unstable angina, myocardial infarction, and recent history of a severe dysrhythmia.

Term

Sildenafil

Tadalafil

Vardenafil

high risk patients

Definition
PDE5 inhibitors are contraindicated for men taking nitrates (eg, nitroglycerin), and should generally be avoided by men taking alpha blockers. Avoid vardenafil—but not sildenafil or tadalafil—in men taking class I or class III antidysrhythmic drugs.
Term

Sildenafil

Tadalafil

Vardenafil

high risk patients

Definition
Use PDE5 inhibitors with caution in men taking CYP3A4 inhibitors and in those with nonarteritic ischemic optic neuropathy (NAION), coronary heart disease, and other cardiovascular disorders.
Term

Sildenafil

Tadalafil

Vardenafil

dosing with food

Definition
Inform patients that dosing may be done with or without food, although a high-fat meal will delay absorption of sildenafil or vardenafil (but not tadalafil).
Term

Sildenafil

Tadalafil

Vardenafil

dosing

Definition

take drug about 1 hour before sex

maximum dosage is 5 mg once a day

Term

Sildenafil

Tadalafil

Vardenafil

cardiac risk

Definition

Inform men with pre-existing cardiovascular disease about the cardiac risk of sexual activity (not the PDE5 inhibitor). Advise men who experience symptoms (eg, anginal pain, dizziness) during sex to refrain from further sexual activity and discuss the event with their prescriber

.
Term

Sildenafil

Tadalafil

Vardenafil

priapism

Definition

persistent erection

permenant impotence

immediate medical attention more than 4 hours

treatment; aspiraiton of blood from corpus cavernosum...followed by irrigation with a vasoconstrictor

Term

Sildenafil

Tadalafil

Vardenafil

nonarteritic ischemic optic neuropathy

Definition

irreversible blurring of visoion or blindness

stop immediately if sudden loss of vionion i one or both eyes

Term

Sildenafil

Tadalafil

Vardenafil

sudden hearing loss

Definition

sudden loss of hearing associated with dizziness, vertigo, and tinnitus

men taking sildenafil for PAH should not interrupt treatment

Term

Sildenafil

Tadalafil

Vardenafil

nitrates interaction

Definition
Combining a PDE5 inhibitor with a nitrate (eg, nitroglycerin) can cause a severe drop in blood pressure, and hence concurrent use of these drugs is contraindicated
Term

Sildenafil

Tadalafil

Vardenafil

nitrates interaction

Definition

Instruct patients to avoid nitrates for at least 24 hours after taking sildenafil or vardenafil, and for at least 48 hours after taking tadalafil

..2.1)>

Term

Sildenafil

Tadalafil

Vardenafil

alpha adrenergic blockers

Definition
Combining a PDE5 inhibitor with an alpha blocker (eg, doxazosin) can cause a serious drop in blood pressure. To avoid harm, use caution when combining sildenafil with an alpha blocker; do not combine tadalafil with any alpha blockers except tamsulosin (0.4 mg once daily); and do not combine vardenafil with any alpha blockers at all.)>
Term

Sildenafil

Tadalafil

Vardenafil

inhibitors of CYP3A4

Definition

Agents that inhibit CYP3A4 (eg, ketoconazole, ritonavir, grapefruit juice) can raise PDE5 inhibitor levels. To avoid harm, dosage of the PDE5 inhibitor should be reduced.

 

Term

Sildenafil

Tadalafil

Vardenafil

antidysrhythmics

Definition
Avoid vardenafil in men taking class I or class III antidysrhythmic drugs. Vardenafil prolongs the QT interval, and can thereby cause a severe dysrhythmia when combined with these agents.
Term

Cimetidine

_ Famotidine

_ Nizatidine

_ Ranitidine

Definition
H2RAs are used primarily to treat PUD. The objective is to relieve pain, promote healing, prevent ulcer recurrence, and prevent complications.
Term

Cimetidine

_ Famotidine

_ Nizatidine

_ Ranitidine

Definition
Definitive diagnosis of PUD requires radiographic or endoscopic visualization of the ulcer and testing for H. pylori infection, either by a noninvasive method (urea breath test, stool antigen test, or serologic antibody test) or by an invasive method involving evaluation of a biopsy sample by either (1) staining and viewing under a microscope to see if H. pylori is present, (2) assaying for the presence of urease, or (3) culturing and then assaying for the presence of H. pylori.
Term

Cimetidine

_ Famotidine

_ Nizatidine

_ Ranitidine

high risk patients

Definition
caution with renal or hepatic dysfunction
Term

Cimetidine

_ Famotidine

_ Nizatidine

_ Ranitidine

routes

Definition

cimetidine: PO, IM, IV

famotidine: PO, IV

nizatidine: PO

Term

Cimetidine

_ Famotidine

_ Nizatidine

_ Ranitidine

dosing

Definition

With all H2RAs, dosing may be done twice daily or once daily at bedtime. With ranitidine, dosing may also be done 4 times a day (with meals and at bedtime).

without regard to meals

Term

Cimetidine

_ Famotidine

_ Nizatidine

_ Ranitidine

measures to enhance therapeutic effects

Definition
Advise patients to avoid cigarettes and ulcerogenic over-the-counter drugs (aspirin and other NSAIDs). Advise patients to stop drinking alcohol if drinking exacerbates ulcer symptoms. Inform patients that five or six small meals per day may be preferable to three larger ones.
Term

Cimetidine

_ Famotidine

_ Nizatidine

_ Ranitidine

evaluating therapeutic effects

Definition
Monitor for relief of pain. Radiologic or endoscopic examination of the ulcer site may also be employed. Monitor gastric pH; treatment should increase pH to 5 or above.
Term

Cimetidine

_ Famotidine

_ Nizatidine

_ Ranitidine

evaluating therapeutic effects

Definition

Educate patients about signs of GI bleeding (eg, black, tarry stools; “coffee-grounds” vomitus), and instruct them to notify the prescriber if these occur.

 

Term

Cimetidine

_ Famotidine

_ Nizatidine

_ Ranitidine

minimizing adverse effects

antiandrogenic

Definition

Cimetidine

can cause gynecomastia, reduced libido, and impotence. These effects reverse after drug withdrawal.

Term

Cimetidine

_ Famotidine

_ Nizatidine

_ Ranitidine

minimizing adverse effects

CNS effects

Definition

Cimetidine

can cause confusion, hallucinations, lethargy, somnolence, restlessness, and seizures. These responses are most likely in elderly patients who have renal or hepatic impairment.CNS effects are less likely with ranitidine, famotidine, and nizatidine.

Term

Cimetidine

_ Famotidine

_ Nizatidine

_ Ranitidine

minimizing adverse effects

pneumonia

Definition
Elevation of gastric pH increases the risk of pneumonia.
Term

Cimetidine

_ Famotidine

_ Nizatidine

_ Ranitidine

minimizing adverse interactions

metabolism

Definition

Cimetidine

inhibits hepatic drug-metabolizing enzymes and can thereby increase levels of other drugs. Drugs of particular concern are warfarin, phenytoin, theophylline, and lidocaine. Dosages of these drugs may need to be reduced.

Term

Cimetidine

_ Famotidine

_ Nizatidine

_ Ranitidine

minimizing adverse interactions

metabolism

Definition

Ranitidine

inhibits drug metabolism, but to a lesser degree than cimetidine. Famotidine and nizatidine do not inhibit drug metabolism.

Term

Cimetidine

_ Famotidine

_ Nizatidine

_ Ranitidine

minimizing adverse interactions

antacids

Definition

Antacids can decrease absorption of cimetidine and ranitidine. At least 1 hour should separate administration of antacids and these drugs.

 

Term

Esomeprazole

Lansoprazole

Omeprazole

Pantoprazole

Rabeprazole

PPI's

therapeutic goals

Definition
PPIs are used primarily to treat PUD. The objective is to relieve pain, promote healing, prevent ulcer recurrence, and prevent complications.
Term

Esomeprazole

Lansoprazole

Omeprazole

Pantoprazole

Rabeprazole

PPI's

high risk patients

Definition
PPIs are remarkably safe. Their only contraindication is hypersensitivity to the drug itself or to a component of the formulation.
Term

Esomeprazole

Lansoprazole

Omeprazole

Pantoprazole

Rabeprazole

PPI's

routes

Definition

esomeprazole, omeprazole, rabeprazole: PO only

pantoprazole, lansoprazole: PO, IV

Term

Esomeprazole

Lansoprazole

Omeprazole

Pantoprazole

Rabeprazole

PPI's

administration

Definition

nform patients that capsules and tablets should be swallowed intact—not opened, split, crushed, or chewed.

Instruct patients to take esomeprazole at least 1 hour before a meal, and to take omeprazole or lansoprazole just before eating. Inform patients that pantoprazole and rabeprazole may be taken without regard to food.

Term

Esomeprazole

Lansoprazole

Omeprazole

Pantoprazole

Rabeprazole

PPI's

Definition

adverse effects are uncommon and inconsequential

elevation of gastric pH increases the risk of pneumonia

Term

Esomeprazole

Lansoprazole

Omeprazole

Pantoprazole

Rabeprazole

PPI's

osteoporosis and fractures

Definition

Long-term, high-dose therapy may pose a risk of osteoporosis and hip fracture. To minimize fracture risk, use the lowest dose needed for the shortest time possible.

encourage patients to take calcium and vitamin D

Term

Esomeprazole

Lansoprazole

Omeprazole

Pantoprazole

Rabeprazole

PPI's

adverse interactions

Definition

Atazanavir, Ketoconazole, and Itraconazole.

 

Term

laxatives

high risk patients

Definition
Laxatives are contraindicated for individuals with abdominal pain, nausea, cramps, and other symptoms of appendicitis, regional enteritis, diverticulitis, and ulcerative colitis. Laxatives are also contraindicated for patients with acute surgical abdomen, fecal impaction, and obstruction of the bowel.
Term

Bulk-Forming Laxatives: Psyllium, Methylcellulose, and Polycarbophil

Definition

Instruct patients to take bulk-forming agents with a full glass of water or juice to prevent esophageal obstruction.

Bulk-forming laxatives are contraindicated for individuals with narrowing of the intestinal lumen, a condition that increases the risk of intestinal obstruction and impaction.

Term

Surfactants: Docusate Salts

Definition
take w full glass of water
Term

Stimulant Laxatives

Definition
Stimulant agents are the laxatives most commonly abused by the general public. Discourage patients from inappropriate use of these drugs. These drugs are commonly—and appropriately—used to manage opioid-induced constipation.
Term
bisacodyl
Definition
Administer PO and by rectal suppository.Instruct patients to take oral bisacodyl no sooner than 1 hour after ingesting milk or antacids. Instruct patients to swallow the tablets intact, without crushing or chewing.Inform patients that bisacodyl suppositories may cause a burning sensation, and warn them that prolonged use can cause proctitis.
Term
senna
Definition
nform patients that senna can impart a harmless yellowish-brown or pink color to urine.
Term
castor oil
Definition
Castor oil acts rapidly (in 2 to 6 hours); do not administer at bedtime. Advise patients not to take castor oil late at night. Warn patients that castor oil is a powerful laxative and should not be used to treat routine constipation. Administer in chilled fruit juice to improve palatability.
Term

Osmotic Laxatives: Magnesium Salts and Sodium Salt

 

Definition

Effects are dose dependent. Low doses produce a soft or semifluid stool in 6 to 12 hours. Higher doses cause watery evacuation of the bowel in 2 to 6 hours.

To prevent dehydration, increase fluid intake during treatment.

Magnesium salts are contraindicated for patients with renal dysfunction.

Term
Osmotic Laxatives: Magnesium Salts and Sodium Salt
Definition

Sodium phosphate

is contraindicated for patients with heart failure, hypertension, or edema, and should be used with caution, if at all, by patients with kidney disease and by those taking drugs that alter renal function (eg, diuretics, ACE inhibitors, ARBs).

Term

insulin

high risk patients

Definition

Special care is needed in patients taking drugs that can raise or lower blood glucose levels, including sympathomimetics, beta blockers, glucocorticoids, sulfonylureas, metformin, glinides (eg, repaglinide), thiazolidinediones (eg, troglitazone), and pramlintide.

(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 685).

<vbk:978-1-4160-6249-3#outline(57.8.2.1.1.3)>

Term

insulin

injection

Definition

Usual sites of injection are the abdomen, upper arm, and thigh. To minimize variability in responses, make all injections in just one of these areas. Injections in the abdomen provide the most consistent insulin levels and effects.

_

Rotate the injection site within the general area employed (eg, the abdomen).

 

Allow about 1 inch between sites. If possible, use each site just once a month.

(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 685).

<vbk:978-1-4160-6249-3#outline(57.8.2.1.2.3)>

Term

insulin

enhancing therapeutic

Definition

SMBG should be employed to evaluate day-to-day treatment. Teach patients how to use the blood glucose monitor, and encourage them to measure blood glucose before meals and at bedtime. Hemoglobin A1c should be measured 2 to 4 times a year to assess long-term glycemic control. Measuring urinary glucose is not helpful

(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 686).

<vbk:978-1-4160-6249-3#outline(57.8.2.1.3.1)>

Term

insulin

adverse effects

Definition

Hypoglycemia occurs whenever insulin levels exceed insulin needs.

Inform the patient about potential causes of hypoglycemia (eg, insulin overdose, reduced food intake, vomiting, diarrhea, excessive alcohol intake, unaccustomed exercise, termination of pregnancy), and teach the patient and family members to recognize the early signs and symptoms of hypoglycemia (tachycardia, palpitations, sweating, nervousness, headache, confusion, drowsiness, fatigue)

Term

insulin

hypoglycemia

Definition

Rapid treatment is mandatory. If the patient is conscious, oral carbohydrates are indicated (eg, glucose tablets, orange juice, sugar cubes, honey, corn syrup, nondiet soda). However, if the swallowing or gag reflex is suppressed, nothing should be administered PO. For unconscious patients, IV glucose is the treatment of choice. Parenteral glucagon is an alternative.

(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 686).

<vbk:978-1-4160-6249-3#outline(57.8.2.1.3.2.1)>

Term

insulin

hypoglycemia

Definition

Hypoglycemic coma must be differentiated from coma of diabetic ketoacidosis (DKA). The differential diagnosis is made by measuring plasma or urinary glucose: Hypoglycemic coma is associated with very low levels of glucose, whereas high levels signify DKA.

(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 686).

<vbk:978-1-4160-6249-3#outline(57.8.2.1.3.2.1)>

Term

insulin

adverse

Lipohypertrophy (Lipodystrophy)

 

Definition

Accumulation of subcutaneous fat can occur at sites of frequent insulin injection.

can be alleviated by systemic rotation of injection site

Term

insulin

adverse

allergies

Definition

Systemic reactions (widespread urticaria, impairment of breathing) are rare. If systemic allergy develops, it can be reduced through desensitization (ie, giving small initial doses of human insulin followed by a series of progressively larger doses).

(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 686).

<vbk:978-1-4160-6249-3#outline(57.8.2.1.3.2.3)>

Term

insulin

interactions

hypoglycemics

Definition

Several drugs, including sulfonylureas, glinides, alcohol (used acutely), and beta blockers, can intensify hypoglycemia induced by insulin. When any of these drugs is combined with insulin, special care must be taken to ensure that blood glucose content does not fall too low.

(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 686).

<vbk:978-1-4160-6249-3#outline(57.8.2.1.3.3.1)>

Term

insulin

interaction

hyperglycemics

Definition

Several drugs, including thiazide diuretics, glucocorticoids, and sympathomimetics, can raise blood glucose concentration and can thereby counteract the beneficial effects of insulin. When these agents are combined with insulin, increased insulin dosage may be needed.

(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 686).

<vbk:978-1-4160-6249-3#outline(57.8.2.1.3.3.2)>

Term

insulin

interaction

beta blockers

 

Definition

Beta blockade can mask sympathetic responses (eg, tachycardia, palpitations, tremors) to a steep drop in glucose levels, and can thereby delay awareness of insulin-induced hypoglycemia. Also, because beta blockade impairs hepatic conversion of glycogen to glucose (glycogenolysis), beta blockers can make insulin-induced hypoglycemia even worse, and can delay recovery from a hypoglycemic event.

(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. pp. 686 - 687).

<vbk:978-1-4160-6249-3#outline(57.8.2.1.3.3.3)>

Term

metformin

therapeutic goal

Definition

Metformin, taken alone or combined with any other antidiabetic drug, is used as an adjunct to calorie restriction and exercise to help maintain glycemic control in patients with type 2 diabetes. The drug is also used to prevent type 2 diabetes and to treat women with polycystic ovary syndrome. Metformin is not used for, nor is it effective in, type 1 diabetes.

(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 687).

<vbk:978-1-4160-6249-3#outline(57.8.2.2.1.1)>

Term

metformin

high risk patients

Definition

Metformin is contraindicated or should be used with great caution in patients with or at imminent risk of developing renal insufficiency, liver disease, severe infection, heart failure, a history of lactic acidosis, or shock or other conditions that can cause hypoxemia. It should not be administered to patients who consume excessive amounts of alcohol acutely or long term, until and unless alcohol consumption can be cut back markedly. Likewise, patients for whom the drug is prescribed should be cautioned and encouraged to drink alcohol in moderation.

(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 687).

<vbk:978-1-4160-6249-3#outline(57.8.2.2.1.2)>

Term

metformin

adverse effects

lactic acidosis

Definition

Rarely, metformin causes lactic acidosis, a medical emergency with a 50% mortality rate. Avoid metformin in patients with renal insufficiency and other conditions that increase acidosis risk (eg, liver disease, severe infection, shock), and use with caution in patients with heart failure. Inform patients about early signs of lactic acidosis—hyperventilation, myalgia, malaise, and unusual somnolence—and instruct them to seek immediate medical attention if these develop. Withhold metformin until lactic acidosis has been ruled out. If lactic acidosis is diagnosed, hemodialysis may correct the condition and remove accumulated metformin.

(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 687).

<vbk:978-1-4160-6249-3#outline(57.8.2.2.3.1.1)>

Term

metformin

adverse

GI

Definition

Metformin can cause nausea, diarrhea, and appetite reduction, which usually subside over time. If these reactions are intolerable and the drug must be stopped, suitable alternative drugs should be started.

(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 687).

<vbk:978-1-4160-6249-3#outline(57.8.2.2.3.1.2)>

Term

metformin

vitamin deficiency

Definition

Metformin can reduce absorption of vitamin B12 and folic acid. Supplements may be needed.

(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 687).

<vbk:978-1-4160-6249-3#outline(57.8.2.2.3.1.3)>

Term

metformin

alcohol

 

Definition
alcohol increases risk of lactic acidosis
Term

SULFONYLUREAS

First-Generation Agents

Acetohexamide

Chlorpropamide

Tolazamide

Tolbutamide

Second-Generation Agents (Preferred)

Glimepiride

Glipizide

Glyburide (glibenclamide)

therapeutic goal

Definition

Sulfonylureas—taken alone or with other hypoglycemic agents—are used as an adjunct to calorie restriction and exercise to maintain glycemic control in patients with type 2 diabetes. These drugs do not work in patients with type 1 diabetes

(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 687).

<vbk:978-1-4160-6249-3#outline(57.8.2.3.3.1)>

Term

SULFONYLUREAS

First-Generation Agents

Acetohexamide

Chlorpropamide

Tolazamide

Tolbutamide

Second-Generation Agents (Preferred)

Glimepiride

Glipizide

Glyburide (glibenclamide)

high risk patients

Definition

Sulfonylureas are contraindicated 

 pregnancy and breast-feeding.

not be used w alcohol.

caution kidney or liver dysfunction.

 

Term

SULFONYLUREAS

First-Generation Agents

Acetohexamide

Chlorpropamide

Tolazamide

Tolbutamide

Second-Generation Agents (Preferred)

Glimepiride

Glipizide

Glyburide (glibenclamide)

administration

Definition

Advise patients to administer with food if GI upset occurs.

Note that dosages for the second-generation agents, which are preferred, are much lower than dosages for first-generation agents (see Table 56-12).

Sulfonylureas are intended only as supplemental therapy of type 2 diabetes. Encourage patients to maintain their established program of exercise and caloric restriction.

(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 687).

<vbk:978-1-4160-6249-3#outline(57.8.2.3.4.2)>

Term

SULFONYLUREAS

First-Generation Agents

Acetohexamide

Chlorpropamide

Tolazamide

Tolbutamide

Second-Generation Agents (Preferred)

Glimepiride

Glipizide

Glyburide (glibenclamide)

hypoglycemia

Definition

Inform patients about signs of hypoglycemia (palpitations, tachycardia, sweating, fatigue, excessive hunger), and instruct them to notify the prescriber if these occur.

Treat severe hypoglycemia with IV glucose.

(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 687).

<vbk:978-1-4160-6249-3#outline(57.8.2.3.5.1.1)>

Term

SULFONYLUREAS

First-Generation Agents

Acetohexamide

Chlorpropamide

Tolazamide

Tolbutamide

Second-Generation Agents (Preferred)

Glimepiride

Glipizide

Glyburide (glibenclamide)

pregenancy and lactation

Definition

 

Pregnancy.

Discontinue sulfonylureas during pregnancy. If a hypoglycemic agent is needed, insulin is the drug of choice.

Lactation

Sulfonylureas are excreted into breast milk, posing a risk of hypoglycemia to the nursing infant. Women who choose to breast-feed should substitute insulin for the sulfonylurea

(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. pp. 687 - 688).

<vbk:978-1-4160-6249-3#outline(57.8.2.3.5.3.1)>

Term

GLINIDES (MEGLITINIDES)

Repaglinide

Nateglinide

therapeutic goal

Definition

glinides—taken alone or combined with metformin or a glitazone—are used as adjuncts to calorie restriction and exercise to maintain glycemic control in patients with type 2 diabetes. Glinides are not used for type 1 diabetes.

(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 688).

<vbk:978-1-4160-6249-3#outline(57.8.2.4.1.1)>

Term

GLINIDES (MEGLITINIDES)

Repaglinide

Nateglinide

administration

Definition

Inform patients that dosing must be associated with a meal, and instruct them to take the drug 30 minutes or less before eating.

(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 688).

<vbk:978-1-4160-6249-3#outline(57.8.2.4.2.2)>

Term

 

GLINIDES (MEGLITINIDES)

Repaglinide

Nateglinide

adverse

hypoglycemia

Definition

Inform patients about signs of hypoglycemia (palpitations, tachycardia, sweating, fatigue, excessive hunger), and instruct them to notify the prescriber if these occur.

Treat severe hypoglycemia with IV glucose.

(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 688).

<vbk:978-1-4160-6249-3#outline(57.8.2.4.3.1.1)>

Term

 

GLINIDES (MEGLITINIDES)

Repaglinide

Nateglinide

adverse

interactions

Definition

Gemfibrozil slows metabolism of glinides, and thereby increases their levels and the risk of hypoglycemia. Avoid gemfibrozil if possible.

(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 688).

<vbk:978-1-4160-6249-3#outline(57.8.2.4.3.2.1)>

Term

 

THIAZOLIDINEDIONES (GLITAZONES)

 

Pioglitazone

Rosiglitazone

therapeutic goals

 

Definition

Glitazones—taken alone or combined with metformin, a sulfonylurea, or insulin—are used as adjuncts to calorie restriction and exercise to maintain glycemic control in patients with type 2 diabetes. Glitazones are not used for type 1 diabetes.

(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 688).

<vbk:978-1-4160-6249-3#outline(57.8.2.5.1.1)>

Term

THIAZOLIDINEDIONES (GLITAZONES)


Pioglitazone

Rosiglitazone

high risk patients

Definition

Glitazones are contraindicated for patients with severe heart failure, and should be used with caution in those with mild heart failure or even heart failure risk factors. Caution is also needed in patients taking insulin or gemfibrozil.

(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 688).

<vbk:978-1-4160-6249-3#outline(57.8.2.5.1.2)>

Term

THIAZOLIDINEDIONES (GLITAZONES)


Pioglitazone

Rosiglitazone

baseline data

Definition

Obtain a baseline value for serum alanine aminotransferase (ALT

(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 688).

<vbk:978-1-4160-6249-3#outline(57.8.2.5.1.3)>

Term

THIAZOLIDINEDIONES (GLITAZONES)


Pioglitazone

Rosiglitazone

administration

 

Definition

 

Rosiglitazone

Advise patients to take the drug twice daily, with or without food.

Pioglitazone

Advise patients to take the drug once daily, with or without food.

 

(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 688).

<vbk:978-1-4160-6249-3#outline(57.8.2.5.2.2.1)>

Term

THIAZOLIDINEDIONES (GLITAZONES)


Pioglitazone

Rosiglitazone

adverse effects

fluid retention

Definition

Glitazones promote fluid retention, and can thereby cause edema and weight gain. Because fluid retention can exacerbate heart failure, glitazones must be used with caution in patients with mild heart failure or heart failure risk factors, and must be avoided in those with severefailure.

Inform patients about signs of heart failure (dyspnea, edema, weight gain, fatigue), and instruct them to consult the prescriber if these develop.

Term

THIAZOLIDINEDIONES (GLITAZONES)


Pioglitazone

Rosiglitazone

adverse effects

liver injury

Definition

Rosiglitazone and pioglitazone may pose a risk of liver injury. Accordingly, ALT should be determined at baseline and periodically thereafter (eg, every 3 to 6 months). If ALT levels rise to more than 3 times the upper limit of normal, or if jaundice develops, glitazones should be withdrawn.

Inform patients about symptoms of liver injury (nausea, vomiting, abdominal pain, fatigue, anorexia, dark urine, jaundice), and instruct them to notify the prescriber if these develop.

(

Term

THIAZOLIDINEDIONES (GLITAZONES)


Pioglitazone

Rosiglitazone

adverse effects

hypoglycemia

Definition

Glitazones pose a risk of hypoglycemia when combined with insulin or gemfibrozil, but not when used alone. Use the combinations with caution

(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 688).

<vbk:978-1-4160-6249-3#outline(57.8.2.5.3.1.3)>

Term

THIAZOLIDINEDIONES (GLITAZONES)


Pioglitazone

Rosiglitazone

adverse interactions

insulin

Definition
Like the glitazones, insulin increases the risk of (1) hypoglycemia and (2) fluid retention and the associated risk of heart failure. Use the combination with caution.
Term

THIAZOLIDINEDIONES (GLITAZONES)


Pioglitazone

Rosiglitazone

adverse interactions

gemfibrozil

Definition

Gemfibrozil can raise plasma levels of glitazones, and may thereby increase the risk of hypoglycemia. Use the combination with caution.

 

Term

levothyroxine

therapeutic

Definition
Resolution of signs and symptoms of hypothyroidism and restoration of normal laboratory values for serum TSH and free T4.
Term

levothyroxine

administration

oral

Definition

Instruct the patient to take levothyroxine on an empty stomach in the morning, at least 30 minutes before breakfast.

Make certain the patient understands that replacement therapy must continue for life. Caution patients against discontinuing treatment without consulting the prescriber.

Instruct the patient to take levothyroxine on an empty stomach in the morning, at least 30 minutes before breakfast.

Make certain the patient understands that replacement therapy must continue for life. Caution patients against discontinuing treatment without consulting the prescriber.

4.2.1.2.2.1)>

Term

levothyroxine

administration

intravenous

Definition

ntravenous administration is reserved for treating myxedema coma and for patients who cannot take levothyroxine orally.

(2.2)>

Term

levothyroxine

evaluation therapy

adults

Definition

Clinical evaluation should reveal reversal of signs of thyroid deficiency and an absence of signs of thyroid excess (eg, tachycardia). Laboratory tests should indicate normal plasma levels of TSH and T4.

 

Term

levothyroxin

evaluation therapy

infants

Definition

clinical evaluation should reveal normalization of intellectual function, growth, and development. Monthly measurements of height provide a good index of thyroid sufficiency. Laboratory tests should show normal plasma levels of TSH and T4. (Note: TSH levels may remain high in some children, despite adequate dosing.)

 

Term

levothyroxine

adverse effects

thyrotoxicosis

Definition

Overdose may cause thyrotoxicosis.

Inform patients about symptoms of thyrotoxicosis (tachycardia, angina, tremor, nervousness, insomnia, hyperthermia, heat intolerance, sweating), and instruct them to notify the prescriber if these develop.

(2.1)>

Term

levothyroxine

adverse effects

interactions

reduce absorption

Definition

Absorption of levothyroxine can be reduced by cholestyramine, colestipol, sucralfate, aluminum-containing antacids, ferrous sulfate, and calcium supplements.

Instruct patients to separate administration of levothyroxine and these drugs by 4 hours.

)>

Term

levothyroxine

adverse effects

interactions

increase metabolism

Definition

Several drugs, including carbamazepine, rifampin, phenytoin, phenobarbital, and sertraline, can accelerate metabolism of levothyroxine, and can thereby reduce its effects. An increase in levothyroxine

(

Term

levothyroxine

interactions

warfarin

Definition

Levothyroxine can intensify the effects of warfarin. Warfarin dosage may need to be reduced.

 

Term

levothyroxine

interactions

catecholamines

Definition

Thyroid hormones sensitize the heart to catecholamines (epinephrine, dopamine, dobutamine) and may thereby promote dysrhythmias. Exercise caution when catecholamines and levothyroxine are used together.

(

Term

liothyronine T3

therapy evaluation

Definition

Success is indicated by resolution of the signs and symptoms of hypothyroidism and by normalization of plasma T3 and TSH levels. T4 levels cannot be used to evaluate therapy.

otherwise:-->: same as levothyroxine T4

Term

propylthiouracil

therapeutic goals

Definition
propylthiouracil has four indications: (1) reduction of thyroid hormone production in Graves' disease, (2) control of hyperthyroidism until the effects of radiation on the thyroid become manifest, (3) suppression of thyroid hormone production prior to subtotal thyroidectomy, and (4) treatment of thyrotoxic crisis.
Term

propylthiouracil

baseline data

Definition
Obtain serum levels of free T3 and free T4.
Term

propylthiouracil

high risk patients

antithyroid

Definition
caution pregnancy and lactation
Term

propylthiouracil

administration

Definition
instruct the patient to take PTU at regular intervals around-the-clock (usually every 8 hours).
Term

propylthiouracil

summary of monitoring

Definition

Evaluate treatment by monitoring for weight gain, decreased heart rate, and other indications that levels of thyroid hormone have declined. Laboratory tests should indicate a decrease in serum free T3 and free T4.

(

Term

propylthiouracil

adverse

agranulocytosis

antithyroid

Definition

inform patients about early signs of agranulocytosis (fever, sore throat), and instruct them to notify the physician if these develop.

If follow-up blood tests reveal leukopenia, PTU should be withdrawn. Giving granulocyte colony-stimulating factor may accelerate recovery.

Term

propylthiouracil

adverse

hypothyroidism

Definition

Propylthiouracil may cause excessive reductions in thyroid hormone synthesis. If signs of hypothyroidism develop or if plasma levels of T3 and T4 become subnormal, PTU dosage should be reduced. Supplemental thyroid hormone may be needed.

(

Term

propylthiouracil

pregnancy

lactation

Definition
Propylthiouracil can enter breast milk and can cross the placenta—albeit much less readily than methimazole. Hence, if an antithyroid drug must be used by a woman who is pregnant or breast-feeding, PTU is preferred to methimazole.
Term

radioactive iodine

therapy

Definition

suppression

of thyroid hormone production

Term

radioactive iodine

high risk patients

Definition
Iodine-131 is contraindicated during pregnancy and lactation.
Term

radioactive iodine

dosing administration

Definition
Iodine-131 is administered in capsules or an oral liquid. The dosing objective is to reduce thyroid hormone production without causing complete thyroid destruction. The dosage for Graves' disease is 4 to 10 mCi.
Term

radioactive iodine

promoting therapy

Definition
Responses take 2 to 3 months to develop fully. Propylthiouracil or methimazole may be required during this interval.
Term

radioactive iodine

adverse

Definition
Excessive thyroid destruction can cause hypothyroidism. Patients who develop thyroid insufficiency need thyroid hormone supplements.
Term

radioactive iodine

use in thyroid cancer

Definition
High doses (50 to 150 mCi) are required. These doses can cause radiation sickness, leukemia, and bone marrow depression. Monitor for these effects. Body wastes will be contaminated with radioactivity and must be disposed of appropriately.
Term

radioactive iodine

diagnostic use

Definition
odine-131 is used to diagnose hyperthyroidism, hypothyroidism, and goiter. Diagnostic doses are so small (less than 10 microcuries) as to be virtually harmless
Term

strong iodine solution

lugol's solution

therapy goal

Definition
Suppression of thyroid hormone production in preparation for subtotal thyroidectomy. Also used to suppress thyroid hormone release in patients experiencing thyroid storm.
Term

strong iodine solution

lugol's solution

baseline

Definition
Obtain tests of thyroid function.
Term

strong iodine solution

lugol's solution

administration

Definition
Advise patients to dilute strong iodine solution with fruit juice or some other beverage to increase palatability.
Term

strong iodine solution

lugol's solution

adverse

mild toxicity

Definition

Inform patients about symptoms of iodism (brassy taste, burning sensations in the mouth, soreness of gums and teeth), and instruct them to discontinue treatment and notify the prescriber if these occur.

Symptoms fade upon drug withdrawal.

Term

strong iodine solution

lugol's solution

adverse

severe toxicity

Definition

odine solution can cause corrosive injury to the GI tract. Instruct patients to discontinue the drug and notify the prescriber immediately if severe abdominal distress develops. Treatment includes gastric lavage and giving

sodium thiosulfate.

Term

 

SOMATROPIN (HUMAN GROWTH HORMONE)

 

therapy goal

Definition
Normalization of growth and development in children with (1) proven GH deficiency and (2) very short stature despite normal GH levels.
Term

 

SOMATROPIN (HUMAN GROWTH HORMONE)

baseline

Definition
Assess developmental status (height, weight, etc.), and obtain laboratory data on thyroid function and GH levels.
Term

 

SOMATROPIN (HUMAN GROWTH HORMONE)

high risk patients  

Definition

GH is contraindicated during and after epiphyseal closure, and in children with PWS who are severely obese or have severe respiratory impairment.

Use with caution in children with diabetes mellitus and hypothyroidism.

Term

SOMATROPIN (HUMAN GROWTH HORMONE)

route 

Definition

subcut (preffered)

available IM

Term

SOMATROPIN (HUMAN GROWTH HORMONE)

administraiton

Definition
For powdered preparations, reconstitute with the appropriate volume of diluent. Mix gently; do not shake. Do not inject if the preparation is cloudy or contains particulate matter.
Term

SOMATROPIN (HUMAN GROWTH HORMONE)

treatment evaluation

Definition

Monitor height and weight monthly. Continue therapy until a satisfactory adult height has been achieved, until epiphyseal closure occurs, or until a response can no longer be elicited (usually by age 20 to 24).

If no stimulation of growth occurs, discontinue treatment and re-evaluate the diagnosis of GH deficiency.

Term

SOMATROPIN (HUMAN GROWTH HORMONE)

adverse

hyperglycemia

Definition
GH can elevate plasma glucose levels in diabetics. Increase insulin dosage as needed.
Term

SOMATROPIN (HUMAN GROWTH HORMONE)

adverse

hypothyroidism

Definition
GH may suppress thyroid function. Assess thyroid function before treatment and periodically thereafter. If levels of thyroid hormone fall, institute replacement therapy.
Term

SOMATROPIN (HUMAN GROWTH HORMONE)

adverse

carpal tunnel

Definition
Serostim (a form of somatropin) can cause carpal tunnel syndrome. If symptoms do not resolve after reducing the dosing frequency, Serostim should be discontinued.
Term

SOMATROPIN (HUMAN GROWTH HORMONE)

adverse

fatality in PWS patients

Definition
Owing to a risk of death, do not give GH to pediatric patients with PWS who are severely obese or have severe respiratory impairment.
Term

SOMATROPIN (HUMAN GROWTH HORMONE)

adverse

glucocorticoids interaction

Definition
Glucocorticoids can oppose the growth-stimulating effects of GH. Carefully adjust glucocorticoid replacement dosage to avoid growth inhibition.
Term

SOMATROPIN (HUMAN GROWTH HORMONE)

adverse

neutralizing  antibodies

Definition
Development of neutralizing antibodies can inactivate exogenous GH. If these antibodies develop, mecasermin (recombinant IGF-1) may be an effective alternative to GH.
Term

antidiuretic hormone

 desmopressin

vasopressin

hypothalamic diabetes insipidus

therapy

Definition
Normalization of urinary water excretion in patients with hypothalamic diabetes insipidus.
Term

antidiuretic hormone

 desmopressin

vasopressin

hypothalamic diabetes insipidus

baseline

Definition

Determine creatinine clearance and fluid and electrolyte status.

 

Term

antidiuretic hormone

 desmopressin

vasopressin

hypothalamic diabetes insipidus

high risk patients

Definition
Use vasopressin with caution in patients with coronary artery disease and other vascular diseases.
Term

antidiuretic hormone

 desmopressin

vasopressin

hypothalamic diabetes insipidus

routes

Definition

desmopressin: intranasal, PO, subQ, IV

vasopressin: IM, subQ

 

Term

antidiuretic hormone

 desmopressin

vasopressin

hypothalamic diabetes insipidus

evaluation therapy

Definition

Teach the patient to monitor and record daily intake and output of fluid.

If ADH dosage is correct, urine volume should rapidly drop to normal.

Term

antidiuretic hormone

 desmopressin

vasopressin

hypothalamic diabetes insipidus

adverse effects

water intoxication

Definition
Excessive retention of water can produce water intoxication—most often at the beginning of therapy. Instruct patients to decrease their accustomed fluid intake at the start of treatment. Inform patients about early signs of water intoxication (drowsiness, listlessness, headache), and instruct them to notify the prescriber if these occur. Treatment includes fluid restriction and diuretic therapy. Avoid ADH in patients with creatinine clearance below 50 mL/min.
Term

antidiuretic hormone

 desmopressin

vasopressin

hypothalamic diabetes insipidus

adverse cardiovascular

Definition

Vasopressin

, but not desmopressin, is a powerful vasoconstrictor. Excessive vasoconstriction can produce angina pectoris, myocardial infarction, and gangrene (from extravasation of IV vasopressin). Use vasopressin with caution, especially in patients with coronary insufficiency

Term

PENICILLINS

Amoxicillin...Ampicillin...Dicloxacillin....Nafcillin

Oxacillin...Penicillin G...Penicillin V....Piperacillin

Ticarcillin

baseline data

Definition

The prescriber may order tests to identify the infecting organism and its drug sensitivity. Take samples for microbiologic culture prior to starting treatment.

In patients with a history of penicillin allergy, a skin test may be performed to determine current allergic status.

Term

 

PENICILLINS

Amoxicillin...Ampicillin...Dicloxacillin....Nafcillin

Oxacillin...Penicillin G...Penicillin V....Piperacillin

Ticarcillin

high risk patients

Definition
Penicillins should be used with extreme caution, if at all, in patients with a history of severe allergic reactions to penicillins, cephalosporins, or carbapenems.
Term

 

PENICILLINS

Amoxicillin...Ampicillin...Dicloxacillin....Nafcillin

Oxacillin...Penicillin G...Penicillin V....Piperacillin

Ticarcillin

administration instrucitons

Definition

During IM injection, aspirate to avoid injection into an artery. Take care to avoid injection into a nerve.

Instruct the patient to take oral penicillins with a full glass of water 1 hour before meals or 2 hours after. Penicillin V, amoxicillin, and amoxicillin/clavulanic acid may be taken with meals.

Instruct the patient to complete the prescribed course of treatment, even though symptoms may abate before the full course is over.

Term

 

PENICILLINS

Amoxicillin...Ampicillin...Dicloxacillin....Nafcillin

Oxacillin...Penicillin G...Penicillin V....Piperacillin

Ticarcillin

therapy evaluation

Definition
Monitor the patient for indications of antimicrobial effects (eg, reduction in fever, pain, or inflammation; improved appetite or sense of well-being).
Term

 

PENICILLINS

Amoxicillin...Ampicillin...Dicloxacillin....Nafcillin

Oxacillin...Penicillin G...Penicillin V....Piperacillin

Ticarcillin

monitor kidney function

Definition
Renal impairment can cause penicillins to accumulate to toxic levels, and hence monitoring kidney function can help avoid injury. Measuring intake and output is especially helpful in patients with kidney disease, acutely ill patients, and the very old and very young. Notify the prescriber if a significant change in intake/output ratio develops.
Term

PENICILLINS

Amoxicillin...Ampicillin...Dicloxacillin....Nafcillin

Oxacillin...Penicillin G...Penicillin V....Piperacillin

Ticarcillin

adverse allergic reaction

Definition

Penicillin allergy is common. Very rarely, life-threatening anaphylaxis occurs. Interview the patient for a history of penicillin allergy.

For patients with prior allergic responses, a skin test may be ordered to assess current allergy status. Exercise caution: The skin test itself can cause a severe reaction. When skin tests are performed, epinephrine and facilities for respiratory support should be immediately available.

Advise patients with penicillin allergy to wear some form of identification (eg, Medic Alert bracelet) to alert emergency healthcare personnel.

Instruct outpatients to report any signs of an allergic response (eg, skin rash, itching, hives).

(

Term

PENICILLINS

Amoxicillin...Ampicillin...Dicloxacillin....Nafcillin

Oxacillin...Penicillin G...Penicillin V....Piperacillin

Ticarcillin

adverse reaction

Definition

Whenever a parenteral penicillin is used, keep the patient under observation for at least 30 minutes. If anaphylaxis occurs, treatment consists of epinephrine (subQ, IM, or IV) plus respiratory support.

As a rule, patients with a history of penicillin allergy should not receive penicillins again. If previous reactions have been mild, a cephalosporin (preferably oral) may be an appropriate alternative. However, if severe immediate reactions have occurred, cephalosporins should be avoided too.

Rarely, a patient with a history of anaphylaxis nonetheless requires penicillin. To minimize the risk of a severe reaction, administer penicillin according to a desensitization schedule. Be aware, however, that the procedure does not guarantee that anaphylaxis will not occur. Accordingly, have epinephrine and facilities for respiratory support immediately available

Term

PENICILLINS

 

Ticarcillin

adverse sodium loading

Definition
High IV doses of ticarcillin can produce sodium overload. Exercise caution in patients under sodium restriction (eg, cardiac patients, those with hypertension). Monitor electrolytes and cardiac status.
Term

IV potassium Penicillin G

hyperkalemia adverse

Definition
High doses of IV potassium penicillin G may cause hyperkalemia, possibly resulting in dysrhythmias or cardiac arrest. Monitor electrolyte and cardiac status.
Term

PENICILLINS

Amoxicillin...Ampicillin...Dicloxacillin....Nafcillin

Oxacillin...Penicillin G...Penicillin V....Piperacillin

Ticarcillin

incorrect injection

Definition

Take care to avoid intra-arterial injection or injection into peripheral nerves, because serious injury can result.

(

Term

UTI

bacteria

Definition

e coli at least 50% of infections

most common of uncomplicated, community acquired UTIs

hospital acquired: klebsiella, proteus, enterobacter, pseudomonas

Term

acute cycstitis

cohort

symptoms

Definition

women of child bearing age

manifestations: dysuria, urinary urgency, urinary frequency, suprapubic discomfort, pyuria, and bacteriuria

Term
acute uncomplicated pyelonephritis
Definition

young children, elderly, women of child bearing age

manifestations: fever, chills, sever flank pain, dysuria, u frequency, u urgency, pyuria, and usually bacteriuria

Term
treatment
Definition

except for pyelonephritis most UTIs can be treated with oraltherapy at home

severe pyelonephritis requires hospitalization and IV

Term

UTI

TMP/SMZ

Definition
trimethoprim/sulfamethoxazole is commonly the treatment of choice for oral therapy of UTI's
Term

nitrofurantoin

methenamine

nalidixic acid

cinoxacin

UTI antiseptics

Definition

second choice drugs for UTIs

these drugs are used only for UTI's

become concentrated in urine

Term

tuberculosis

diagnosis

Definition

microscopic examination

culturing of sputum

Term

TB

four drug regimen

Definition

isoniazid and rifampin

almost always included

Term

TB

principal first line drugs

Definition

isoniazid

rifampin

rifapentine

rifabutin

pyrazinamide

ethambutol

Term
isoniazid
Definition

primary agent for treatment and prophylaxis of TB

superior with regard to efficacy, toxicity, ease of use, patient accpetance, and affordability

Term

isoniazid

neuropathy

Definition

can cause peripheral neuropathy by depleting pyridoxine (vit B6)

neuropathy can be reversed or prevented with supplements

can cause unjury to liver...greatest risk factor is advancing age

can interfere with metabolism of phenytoin

toxic levels

Term

rifampin

drug metabolism

Definition

can increase metabolism of oral contraceptives, warfarin, and drugs for HIV

protease inhibitors, nonnucleoside revers trasncriptase inhibitors

Term

isoniazid

rifampin

pyrazinamide

Definition
hepatotoxic
Term
rifampin
Definition

frequently red-orange color

urine

sweat

saliva

tears

Term
rifampin
Definition

P450

hasten metabolism...reducing effects

oralcontraceptives, warfarin, HIV (protease inhibitors and NNRTI's

Term

pyrazinamide

TB

Definition

bactericidal

currently

combo of pyrazinamide, rifampin, isoniazid and ethambutol

preferred regimen initial ther

Term

pyrazinamide

adverse

liver

Definition

high dose therapy has caused

hepatitis

fatal hepatic necrosis

Term

ethambutol

adverse

eyes

Definition
optic neuritis
Term

ethambutol

S&S

eyes

Definition

blurred vision

constriction of visual field

disturbance of color discrimination

Term

R207910

new class diarylquinolines

TB

Definition

faster and better

than all TB drugs

proven safer

does not accelerate metabolism of other drugs

used safely in HIV patients

Term
Leprosy
Definition

most regimen include rifampin

most effective drug

three drug regimen

rifampin

dapsone

clofazimine

Term
fluoroquinolones
Definition

broad spectrum antibiotic

disrupts DNA replication

cell division

Term
ciprofloxacin
Definition
alternative to parental antibiotics
Term

ciprofloxacin

approved for

Definition

respiratory

urinary

GI

bone

joint

skin

soft tissue infections

preferred drug for preventing

anthrax

Term

ciprofloxacin

adverse

GI

CNS

candida

Definition

GI

n-v, diarrhea, abdominal pain

CNS

diziness, headache, restlessness, confusion

Candida infections

of

pharynx and vagina

 

Term

fluoroquinolones

tendon

Definition

cause tendon rupture

discontinue

at first sign of tendon pain or inflammation

do not

exercise until tendinitis has been ruled out

Term

fluoroquinolones

absoprtion

reduced

Definition

reduced by

cationic substances

milk products (calcium)

aluminum & magnesium containing antacids

iron & zinc salts

sucralfate

Term

metronidazole

fluoroquinolones

uses

Definition

against protozoa

also against obligate anaerobic bacteria

bacteroides fragilis

clostridium difficile

Term

daptomycin

(cubicin)

cyclic lipopeptides

Definition

first of new class o antibiotics

can rapidly kill virtually all

gram positive bacteria included

MRSA

Term

daptomycin

cyclic lipopeptide

Definition

devoid of interactions

only notable side effect

muscle injury

once a day

IV

no need to monitor

plasma

Term

opportunistic mycoses

examples

Definition

candidiasis

aspergillosis

cryptococcosis

mucormycosis

Term

amphotericin B

family

Definition
polyene antibiotics
Term

amphotericin B

use

Definition

drug of choice most

systemic mycoses

Term

amphotericin B

action

Definition

binds to ergosterol in fungal cell membrane

becomes more permeable

leakage of intracellular cations reduces viability

Term

amphotericin B

toxicity

Definition

results from binding to cholesterol

in host cell membrane

Term

amphotericin B

absorption

Definition

oral absorption is poor

IV is

required

Term

onychomycosis

azoles

Definition

fungal infection of finger/toenails difficult to treat

preffered treatment

terbinafine

and

itraconazole

Term

nyastin

family

treats

Definition

polyene antibiotic only for candidiasis

drug of choice for intestinal candidiasis

also for

candidal infections of

skin

mouth

esophagus

vagina

oral/topical

Term

vulvovaginal candidiasis

treatments

Definition

single PO fluconazole

or

short term topical therapy

Term

acyclovir

treats

Definition

drug of choice for

herpes simplex

&

varicella zoster

Term

acyclovir

action

Definition

once active form

suppresses viral reproduction by

inhibiting viral DNA polymerase &

by

premature termination of viral DNA strand growth

Term

acyclovir

active form process

Definition

thymidine kinase

enzyme converts acyclovir

Term

acyclovir

kidney

Definition

eliminated unchanged in kidneys

accordinly

dosage reduced in renal impaired

Term

IV acyclovir

kidney

Definition

injures kidneys

infuse slowly

ensure adequate hydration

during

&

after infusion

Term

acyclovir

resistance

 

Definition

decreaded production - thymidine kinase

alteration of thymidine kinase

alteration of viral DNA

polymerase

less sensitive to inhibition

Term

BPH

benign prostatic hyperplasia

 

Definition

prostate: major function: produce fluids that contribte to ejaculate volume

non malignant

excessive growth glandular cells & smooth muscle

epithelial--mechanical obstruction

smooth muscle--dynamic obstruciton

of

urethra

Term

BPH

treatment

two classes

Definition

5 alpha reductase inhibitors

alpha 1 adrenergic antagonists

both

relieve symptoms

delay progression

Term

finasteride (proscar)

BPH

Definition

5 alpha reductase inhibitor

regression of epitheial

decreases

mechanical obstruction

most effective in men

whose

prostate

highly enlarged

Term

finasteride (proscar)

adverse

BPH

Definition

does decrease ejacultae volume

and libido

also

gynecomastia

Term

tamsulosin (flomax)

BPH

& other alpha blocers

Definition

relax smooth muscle in prostate

capsule

prostatic urethra

and bladder neck (trigone and sphincter)

decreases

dynamic obstruction of urethra

Term

NSAID's

PUD

Definition

2nd most common

decrease submucosal blood flow

supress secretion of mucus and bicarbonate

promote secretion of gastric acid

also

can irritate mucosa directly

Term

gastric acid

PUD

Definition

gastric acid

absolute requirement for PUD generation

Term

PUD

complications

Definition

hemmorrhage

perforation

obstruction

Term

PUD

treatment

Definition

antibiotics

antisecretories (H2RA's)

PPI's

mucosal protectants (antisecretory agents)

Term

if H pylori

treatment

Definition

antibiotics

in combination with

antisecretory agent

Term

prophylaxis

of PUD

Definition

misoprostol

&

PPI's

Term

PUD

most often prescribed

Definition

amoxicillin

clarithromycin

bismuth

tetracycline

metronidazole

Term

H2RA's

duodenal & gastric

ulcers

Definition
first choice drugs
Term

cimetidine

ulcers

H2RA

action

Definition

reduces both the volume of gastric juice

and its hydrogen ion concentration

Term

cimetidine

androgen receptors

adverse

PUD

H2RA

Definition

cimetidine binds to androgen receptors

producing blockage

causes

gynecomastia

reduced libido

impotence

all reverse if dosing stopped

Term

cimetidine

CNS effects

Definition

most likely CNS effects

occur

in elderly

who have

renal or hepatic

impairment

reactions include

confusion & hallucinations

Term

PPI's

PUD

action

Definition

most effective inhibitors

of

acid secretion available

Term

omeprazole

PUD

PPI's

treatment (special)

Definition

approved for

short term therapy of duodenal

& gastric ulcers

erosive esophagitis

&GERD

long term theraphy of hypersecretory conditions

(zollinger ellison syndrome

Term

H2RA's

and omeprazole

adverse

Definition

headache

diarrhea

nausea

vomiting

Term

acute maintenance therapy

of duodenal ulcers

MED

Definition
sucralfate
Term

antacids

principal indications

(2)

Definition

PUD

GERD

Term

group III laxatives

 

Definition

surfactants

docusate sodium

Term

serotonin antagonists

odansetron

Definition

most effective antiemetics

 

Term

serotonin antagonists

odansetron

adverse

Definition

most common side effects

headache

diarrhea

dizziness

Term

two glucocorticoids

CINV

Definition

methylprednisolone

dexamethasone

commonly used to suppress CINV

effective alone and in combination

Term
aprepitant
Definition

unlike most antiemetics

prevent

both

delayed and acute CINV

Term

aprepitant

toleration of patients

Definition

aprepitant plus

odansetron and dexamethasone

experience more

fatigue

&

asthenia

Term

preferred antiemetic

regimen

(3)

Definition

aprepitant

glucocorticoid (dexamethasone)

serotonin antagonist (ondansetron)

Term

diphenoxylate

diarrhea

action

Definition

opioid used only for diarrhea

formulated in combo with

atropine

combination best known as

LOMOTIL

Term

loperamide (imodium)

diarrhea

ileostomies

Definition

structural analong of

meperidine

traveler's dirrhea can be treated w this

or a

fluoroquinolone (ciprofloxacin)

or a

azithromycin (child/pregnant)

Term

IBS

most common

only (2) MEDS

 

Definition

alosetron

&

lubiprostone

Term

alosetron

1 of 2 only IBS drug

adverse

Definition

ischemic colitis

severe constipation

Term

long term complications

diabetes 1/2

Definition

macrovascular

heart diseaes

hypertension

stroke

microvascular

retinopathy

renal failure

neuropathy

lower limb amptuations

erectile dysfunciton

gastroparesis

Term

diabetes

&

pregnancy

Definition

placenta produces hormones that antagonize insulins actions

2nd

production of cortisol increases 3fold promotes hyperglycemia

both 1st & 2nd

increase need for insulin

Term

diabetes

&

pregnancy

Definition

3rd factor

glucose passes freely from maternal circulation to fetal

hyperglycemia in mother stimulates secretion of fetal insulin

Term

diabetes

diagnosis

tests (3)

Definition

fasting plasma glucose

casual plasma glucose test

oral glucose tolerance test

 

Term

diabetes

diagnosis

test results

Definition

FPG is 126 mg/d or higher

casual BG 200 mg/dL or higher

&

patient has classic S&S

(polyuria, polydipsia, sudden weight loss)

Term

prediabetes

diagnosis

Definition

defined as

impaired FPG 100-125 mg/dL

or

impaired GT

(2 hour OGTT o 140-199 mg/dL)

 

 

Term

in addition to insulin

treatment

includes

Definition

BP

and blood lipids in

range

Term

type 1

diabetes

Definition

insulin replacement

oral hypoglycemic agents

ineffective

normally unusually

thin

dietary goal

maintain weight

Term

type 2

diabetes

treatment

Definition

oral hypoglycemics

insulin

always w diet and gym

& only if

glycemic control cannot be

maintained by

diet & gym

Term

diabetes

monitoring

reasons

Definition

(1) glucose levels safe range- long/short term

(2) guide changes in regimen

Term

diabetes

long term control

monitor

Definition
glycolated hemoglobin
Term

SMBG

self monitoring

diabetes

Definition

premeal target is

90-130 mg/dL

peak postmeal target

180mg/dL or lower

Term

glycolated hemoglobin

target level

Definition

7% of total or

lower

Term

insulin

physiology

effects

Definition

(1) stimulates uptake of glucose, amino acids, and K

(2) promotes synthesis of complex organics ->

glycogen

proteins

triglycerides

Term

insulin

short acting

rapid onsets (3)

Definition

lispro

aspart

glulisine

Term

lispro (humalog)

actions

time

Definition

analog of regular insulin

onset 15-30 min

persist 3-6 hours

Term
aspart (novolog)
Definition

analog of human insulin

onset 10-20 min

duration 3-5 hours

Term

intermediate

insulins

Definition

NPH insulin

and

insulin detemir

Term

prolonged

insulin

Definition

insulin glargine

no definite

peak

Term
NPH
Definition

only suspension insulin

 

Term

insulin

storage

disposal

Definition

under refrigeration/not frozen

can be kept after opened

at room temp

for

1 month

Term

intensive

insulin

therapy

consists of

Definition

(1) evening inj o insulin glargine supplemented w mealtime inj

regular

lispro

aspart

or glulisine inuslin

or

continuouus subQ infusion of

regular

lispro

aspart

or glulisine insulin

sopplemented w mealtime bolus doses

Term

intensive

insulin

therapy

drawbacks

Definition

hypoglycemia

glucose levels kept pretty low

prob o hypo increased

Term

intensive

insulin

therapy

SMBG

Definition

frequent monitoring only way to achieve safely

measure 3-5 x day

Term

hypoglycemia

define

Definition
below 50 mg/dL
Term
oral hypoglycemics
Definition

sulfonylureas

glinides

metformin

thiazolidinediones

alpha glucosidase inhibitors

gliptins

only for type 2 diabetes

Term

oral hypolgycemics

actions

Definition

two actions

(1)

sulfonylureas

glitazones

glinides

actively drive blood glucose down

(2)

metformin (biguanid)

alpha-glucosidase inhibitors

simply modulate the rise in glucose after a meal

Term

metformin

oral hypo

Definition

decreases glucose production by the liver

increase glucose uptake by

muscle

can also help by reducing

appetite

Term

sulfonylureas

action

Definition

stimulte release of insulin from pancreas

also

increase cellular sensitivity to insulin

Term

rosiglitazone

oral hypo

action

Definition

increases insulin sensitivity of target cells

therefore

increases glucose uptaek by muscle

and

decreases glucose production by the liver

Term

rosiglitazone

glitazone

oral hypo

adverse

Definition

promotes water retention

causes weight gain and edema

and heart failure

and

exacerbate symptoms in pre-existings

 

Term

oral hypo

common adverse

Definition

like sulfonyluresa

unlike metformin

rosiglitazone

poses a risk of hypoglycemia

Term

pramlintide

amylin mimetic

diabetes

indication

Definition

injected sub Q b4 meal

enhances

effects of mealtime insulin

type 1 and 2

Term

pramlintide

amylin mimetic

diabetes

action

Definition

delays gastric emptying

and

suppresses glucagon release and thus helps reduce

postprandial hyperglycemia

Term

pramlintide

amylin mimetic

diabetes

adverse

Definition

combo of pramlintide + insulin

risk of severe

hypoglycemia

nausea is common

Term

exenatide

incretin mimetic

diabetes

indication

Definition

type 2

sub Q b4 meal

supplement actions of

metformin

and/or

sulfonylurea

Term

exenatide

incretin mimetic

diabetes

action

Definition

delays gastric emptying

suppresses

glucagon release

and stimuates glucose-dependent

release of insulin

Term

exenatide

incretin mimetic

diabetes

adverse

Definition

in combo with sulfonylurea

risk of hypoglycemia

but not with metformin

common

is

nausea

Term

DKA

physiology

Definition

most common diabetes deaths

kids

deranged glucose metabolism

hyperglycemia

water loss

hemoconcentration

treatment goals:

restoring acceptable plasma G

correcting acidosis

replacing lost H2O & Na

normalizing K levels

Term

tyroid deficiency

moderate

severe

def

Definition

mild deficiency-hypothyroidism

severe: mysexema

infants-hypo-cretinism

Term

iodine sufficent areas

major cause

hypothyroidism

Definition

chronic autoimmune thyroiditis

also called

hashimoto's thyroiditis

Term

dx

hypothyroidism

Definition

most sensitive way to test

test serum for

elevated levels of TSH

Term

somatropin

GH

if antibody produced which

neutralizes GH

alternative

Definition
mecasermin (recombinant IGF-1)
Term

selective toxicity

achieved by

Definition

disruption of the bacterial cell wall

inhibition of an enzyme unique

to bacteria

disruption of protein synthesis

Term
classification by mechanism
Definition

(1)inhibit bacterial cell wall synthesis

(2)durgs that increase cell membrane permeability

(3)lethal or nonlethal inhibition of bacterial protein synthesis

(4) inhibit bacterial synthesis of DNA and RNA

(5) antimeetabolites

(6) viral replication

Term

bacteria

show resistance

Definition

 

Enterococcusfaecalis
Enterococcusfaecium
Staphylococcus aureus
Staphylococcus epidermidis
Streptococcus pneumoniae
Klebsiellapeneumonia
Term

mechanism

of

resistance

Definition

 

Reduction of drug concentration at its site of action
Drug inactivation
Alteration of drug target molecules
Production of antagonist to the drug
Term

how to delay

resistance

Definition

(1)diagnosing and treating infection effectively

(2) diagnosing and treating infection effectively

(3) using antimicrobial drugs wisely

(4) preventing patient-to-patient transmission

Term

effective

therapy

Definition

identify bug

and

its drug sensitivity

Term

MIC

minimum inhibitory concentration

Definition

lowest concentration of antibiotic that produces complete inhibiton of bacterial growth

not kill

Term

MBC

minimum bactericidal concentration

Definition

lowest concentration of drug that produces 99.9% decline in # of colonies

does kill

Term

unique to selection

of

antibiotic

Definition

host defenses

and

site of infection

Term

drug levels

MIC

Definition

4 to 8 times MIC

often

desirable

Term

essential to success of

antimicrobials

Definition

host defenses

immune

&

phagocytics

Term

antibiotic combos generally avoided

although

appropriate when

Definition

(1) initial treatment of severe infections

(2) infection with more than one organism

(3) prevention of resistance

(4) decreased toxicity

(5) infection which combo greatly enhance antibacterial effects

Term

multiple antibiotics

drawbacks

Definition

(1) increased risk of toxic and allergic reactions

(2) possible antagonism of antimicrobial effects

(3) increased risk of suprainfection

(4) selection of drug resistant bacteria

(5) increased cost

Term

prophylactic

antimicrobial

circumstances

Definition

certain surgeries

at risk for bacterial endocarditis

(prosthetic heart valves or

congenital heart disease)

neutropenia

Term

antimicrob

misuse

Definition

(1) treatment of untreatable infections

(2) treatment of fever of unknown origin (except immunocompromised)

(3) improper dosages

(4) treatment in absence of adequeate bacteriologic info

(5) treatment in absence of appropriate surgical drainage

Term

indicators of

antimicrobial

success

Definition

reduction of fever

resolution of S&S

breath sounds -> pneumonia..etc.

Term

pencillin

action

Definition

weaken bacterial cell

wall

causing lysis and death

Term

bacteria

resistance

penicillin

enzyme

Definition

beta lactamases

penicillinases

Term

penicillin G

class

use

Definition

 

 
Narrow-spectrum penicillins:  penicillinase sensitivity
Streptococcus species, Neisseria species, anaerobes, spirochetes (syphillis)
Term

penicillin G

adverse

Definition

 

Least toxic of all antibiotics
Safest
 
rarely:
 
Pain at injection site
Temporary Sensory and motor dysfunction if accidently injected into a nerve
Neurotoxicity (blood levels too high)
Gangrene, necrosis if accidently injected arterially
Term

penicillinase resistant penicillins

nafcillin

oxacillin

dicloxacillin

Definition

used primarily against strains

of

staphylococcus aureus

Term

ampicillin

amoxicillin

useful ->

Definition

in contrast to penicillin G

broad spectrum penicil

useful against

gram - bacilli

H flu

e coli

proteus mirabilis

neisseria gonorrhea

Term

ticarcillin

use

Definition

extended spectrum penicillin

useful against

pseudomonas aeruginosa

Term
MRSA
Definition

resistant to all penicillins

IV vancomycin

Term

community acquired

MRS

Definition

 

20-30% colonize this bacteria in nose or on skin
Usually less dangerous
Boils
Skin to skin contact
Treat carrier state with intranasal application of topical antibiotic (mupirocin)
Term

if penicillin allergy

safe

alternatives

Definition

vancomycin

erythromycin

clindamycin

Term

clavulanic acid

w

penicillin

Definition

beta lactamase inhibitor

combined w certain

penicillins

 

Term

ampicillin

amoxicillin

Definition

only two broad spectrums available

same spectrum as pen G plus

increased activity

against

gram -

bacilli

Term

ticarcillin (ticar)

penicillin

special b/c

Definition

broadest spectra of all penicillins

susceptible to destrucion by

penicillinase

Term

fluoroquinolones

UTI

Definition

used for parenteral therapy

of
UTI's

Term

fluoroquinolones

action

define

Definition

broad spectrum antibiotic

benefits from

disrupting DNA replication and cell division

Term

fluoroquinolones

administer

Definition

PO

alternatives to IV

outpatient potential

vs. parenteral-hospitalization

Term
ciprofloxacin
Definition
fluoroquinolone
Term

fluoroquinolones

faq

Definition

 

Resistance is emerging, especially N. gonorrhoeae
Ciprofloxin, ofloxin, levofloxinmoxifloxin
Term

fluoroquinolones

faq

ciprofloxin

Definition

 

Limitations
Most staphylococcal infections are resistant
Limited pediatric use due to concerns for tendon rupture
UTI:  E. coli
Post exposure to inhaled anthrax
Only fluoroquinolone approved for pediatric use
Term

ciprofloxin

risk group

and

toxicity

Definition

 

60 and older
Glucocorticoid use
 
Warfarin, theophylline, azoleantifungals
Toxicity may occur
Term

tetracyclines

indicaitons

Definition

 

Tickborne disease
Chlamydia
Cholera
Mycoplasma pneumonia
Lyme disease
Anthrax
Gastric infection with H. pylori
Acne
Periodontal disease
Term

tetracyclines

pharmacokinetics

Definition

 

Absorption (food affects GI absorption)
Short acting (tertracycline) reduced
Long acting (doxycycline/minocycline) not reduced
Becomes insoluble when combined with calcium, magnesium, aluminum, zinc
Dairy
Milk
Iron supplements
Magnesium-containing laxatives
antacids
Term

tetracyclines

adverse

Definition

 

GI irritation
Effects on bones and teeth
Suprainfection
Candia infection
C difficile colitis
Hepatic and renal toxicity especially with high dose IV
Term

macrolides

define

meds

Definition

 

Broad spectrum antibiotics that inhibit bacterial protein synthesis
Why called macrolide?  Very big molecules
erythromycin---oldest
others --derivatives
 
Clarithromycin
Dirithromycin
Azithromycin
Term

erythromycin

microlide

action

resistance

Definition

 

Mechanism of action
Inhibits protein synthesis
Acquired Resistance
Nationally high level of resistance for sinusitis with azithromycin (zpack)
Term

erythromycin

microlide

spectrum

indications

Definition

 

Antimicrobial spectrum:  similar to penicillin
Most gram-positive bacteria
Some gram-negative bacteria
Therapeutic uses
Alternative to penicillin in allergic patients
Preferred treatment
Legionnaires disease
Pertussis
Diptheria
Chlamydia
Term

erythromycin

microlide

absorption

CSF

elimination

 

Definition

food reduces absorption

penetration into CSF

poor

crosses placenta

but no adverse

hepatic metabolism

CP450

Term

erythromycin

macrolide

adverse

Definition

 

GI intolerance
Epigastric pain
Nausea and vomiting
Diarrhea
QT prolongation and sudden cardiac death
Occur with toxicity
Potentially occur when combined with another CYP3A4 inhibitor
Term

erythromycin

macrolide

interactions

Definition

 

CYP3A4 inhibiting drugs
Azoleantifungals
Verapamil, diltiazem
HIV protease inhibitors
Warfarin
Theophlline
Carbamazepine
Term

aminoglycosides

gentamicin

tobramycin

amikacin

action

Definition

 

Highly polar (carry several positive charges)
Cannot readily cross membranes
Give IV
Bactericidal
Term

aminoglycosides

gentamicin

tobramycin

amikacin

spectrum

Definition

 

Antimicrobial Spectrum
Limited almost exclusively  to Aerobic gram-negative bacilli
E coli
Klebsiella
Serratia
Proteus mirabilis
Pseudomonas
Term

aminoglycosides

gentamicin

tobramycin

amikacin

uses

Definition

 

Parenteral therapy
IV or IM
Serious infections only
Gentamicin is often combined with vancomycin to treat serious infections
Term

aminoglycosides

gentamicin

tobramycin

amikacin

adverse

Definition

 

Serious toxicity
Ototoxicity
Hearing and balance are impaired
Occurs with excessive trough levels (persistently elevated)
Renal impairment
Term

aminoglycosides

gentamicin

tobramycin

amikacin

Definition

 

Gentamycin and tobramycin
Effective opthalmic solutions and ointments
Used as a treatment of cystic fibrosis
Nebulized
28 days on and 28 days off
Neomycin
Very nephrotoxic
Only topical for eye, ear, skin
Term

 

Stevens-Johnson syndrome
Definition

 

Rare reaction
25% mortality
Wide spread lesions of skin and mucous membranes
Toxemia
Secondary infections
Term

antifungals

treat

this

Definition

 

Opportunistic
Candidiasis, aspergillosis, cryptococcosis
Primarily seen in debilitated or immunocompromised hosts
Non-opportunistic
Uncommon
Term

amphotercin B

 

Definition

 

Important but dangerous drug
Highly renal toxic drug
Before this drug, systemic fungal infections were fatal
IV administration due to poor absorption for GI
Term

 

azole anti fungals
Fluconazole
Itraconazole
Ketoconazole
Others…
Definition

 

Therapeutic uses
Systemic disease
Superficial mycosis
Vaginal candida
Tineacorporus
onychomycosis
Term

azole antifungals

adverse

Definition

 

Well tolerated in usual doses
GI reactions are most common
Rash
Liver injury
Cardiac suppression (avoid with heart failure and dysrhythmias)
Term

azole antifungals

interactions

Definition

 

CYP3A4 inhibitors
Drugs that raise gastric ph
Lessen absorption of azoleantifungals
Dose at least 1 hour before or 2 hours after
Term

antiviral

meds

adverse

Definition

 

IV
Phlebitis
Reversible nephrotoxicity
Other drugs
Valacyclovir (valtrex)  and Famciclovir (Famvir)
Term

interferon alpha preparations

drugs

for

hepatitis

Definition

 

Subcutaneous injections/not orally
1-3 times a week
Adverse effects
Flu-like syndrome
Neuropsychiatric effects
Depression
GI intolerance
Term

 

Ribavirin (oral)
antiviral
Definition

 

Use in combination with peginterferon alpha
Treatments of choice for hepatitis C
Also used as inhaled therapy for pediatric patients with RSV
Term

 

Oseltamivir (Tamiflu)
Zanamivir (Relenza)
antiviral
flu
Definition

 

Active against Influenza A and B
Seasonal flu
H1N1 swine
H5N1 avian
 
Adverse effects
GI intolerance questionable neuropsych disturbances
 

Tamiflu….only effective 48 hours after flu

Prophylaxis….7 days before

Term

whooping cough

bordetella pertussis

treatment

Definition

erythromycin

macrolide

Term

acarbose

alpha-glucosidase inhibitor for type 2 diabetes,

action

Definition
inhibits digestion and absorption of carbohydrates, and thereby reduces the postprandial rise in blood glucose. To be effective, acarbose must be taken with every meal.
Term

acarbose

alpha-glucosidase inhibitor for type 2 diabetes,

adverse

Definition
are GI disturbances: flatulence, cramps, and abdominal distention
Term

tetracyclines

first choice drugs for

Definition

Chlamydia trachomatis

, rickettsia (eg, Rocky Mountain spotted fever),

Helicobacter pylori (ie, peptic ulcer disease),

Bacillus anthracis (anthrax),

Borrelia burgdorferi (Lyme disease),

and Mycoplasma pneumonia.

Term

tetracyclines

bacteriostatic

common adverse

Definition

photosensitivity

and

severe sunburn

Term

clarithromycin

macrolide

metabolism

Definition

inhibit hepatic metabolism

of

warfarin

and

theophylline

INR check

Term

clindamycin

 

Definition

·        is used primarily as an alternative to penicillin for serious gram-positive anaerobic infections.

·        Clindamycin causes a high incidence of AAPMC.

·        Diarrhea is also relatively common.

Term

linezolid

new class

VRE

gram +

Definition

·        is the first member of a new class of antibiotics, the oxazolidinones

·        Linezolid is important because it can suppress multidrug-resistant gram-positive pathogens, including vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA).

Term

linezolid

adverse

myelo--

new class

gram +

Definition

·        is generally well tolerated. The most common side effects are diarrhea (5.3%), nausea (3.5%), and headache (2.7%).

·        Linezolid can cause reversible myelosuppression, manifesting as anemia, leukopenia, thrombocytopenia, or even pancytopenia.

Term

aminoglycosides

flaccid paralysis

treat

Definition

calcium gluconate

kalcinate

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