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Pharm Exam 3
GI drugs (F5), Fluids and Electrolytes (F6)
49
Pharmacology
Undergraduate 2
10/22/2013

Additional Pharmacology Flashcards

 


 

Cards

Term
Which antiemetics can cause extrapyramidal symptoms (EPS)?
Definition
Dopamine antagonists ex: Prochlorperazine (Compazine), haloperidol (Haldol), droperidol (Inapsine) and metoclopramide (Reglan)
Term
Dopamine antagonists
Definition
used for postoperative nausea/vomiting and emesis caused by cancer chemotherapy; Cause extrapyramidal symptoms(muscle spasms), as well as hypotension
Term
What actions are expected when lorazepam (Ativan) is given with another antiemetic such as metoclopramide (Reglan)?
Definition
Lorazepam (Ativan) is a benzodiazepine; it works in combination with other medications to prevent nausea and vomiting from chemotherapy: depresses central nervous system. Produces sedation, amnesia, and suppression of emesis helps control the EPS caused by drugs like metoclopramide (Reglan)
Term
Which antiemetics relieve nausea and vomiting, but also stimulate the appetite and can help patients gain weight?
Definition
Cannabinoids: active ingredient in marijuana are used to suppress chemotherapy-induced nausea and vomiting (CINV) also stimulate appetite which can help patients prevent or reverse weight loss.
Term
Cannabinoid side effects and name brands
Definition
Side effects include: mod changes, euphoria, drowsiness, nightmares, confusion, memory lapse, and incoordination, alcohol, sedatives and other CNS depressants can induce drowsiness, can also cause tachycardia and hypotension; contraindicated for psychiatric disorders, and used w/ caution in patients w/ cardiovascular disease ex: dronabinal (Marinol)& nabilone (Cesamet)
Term
Syrup of ipecac
Definition
emetic (induces vomiting); used when ingested substance is not caustic or a petroleum product. Pt. must be alert and the ingestion must have occurred within the last 60 minutes; given w/ water NOT milk or carbonated beverages. Emesis should occur within 15-30 minutes. If it does not activated charcoal can be given.
Term
activated charcoal (CharcoAid)
Definition
taken orally w/ a glass of water, attaches to the poison to prevent its absorption in to the body. Activated charcoal is not absorbed systemically. Used when certain toxic substances have been ingested before absorption can occur.
Term
When is vomiting NOT induced?
Definition
If caustic substances such as ammonia, chlorine bleach, lye, battery acid, or toilet cleaners are ingested. Also petroleum products such as gasoline, kerosene, paint thinner, or lighter fluid are contraindicated for emesis as they can cause aspiration with a resultant severe pneumonia.
Term
Which opioid antidiarrheal drug causes the least CNS depression?
Definition
Loperamide (Imodium) - causes less CNS depression than diphenoxylate and difenoxin because it is poorly absorbed and does not readily cross the blood brain barrier
Term
When are laxatives beneficial and indicated?
Definition
In specific situations such as in patients with hemorrhoids or anorectal lesions to ease pain of elimination, also in patients w/ cardiovascular disease, those scheduled for surgery of a diagnostic procedure of the colon need to empty the bowel completely. Also used to prevent fecal impaction in bedridden patients, remove ingested poisons and correct constipation associated w/ pregnancy or certain drugs
Term
When are laxatives contraindicated?
Definition
in patients w/ certain disorders of the bowel; if a patient has abdominal pain, nausea, cramps or other symptoms of appendicitis, or regional enteritis, diverticulitis or ulcerative colitis. Should also be avoided in patients w/ fecal impaction or bowel obstruction
Term
Which laxatives should be avoided in patients with kidney dysfunction?
Definition
magnesium salts; some osmotic laxatives include these magnesium salts: (magnesium hydroxide, magnesium citrate, and magnesium sulfate)Magnesium is mainly excreted by the kidney and patients w/ poor renal function can develop toxicity. Sodium phosphate can cause fluid retention so sodium salt drugs (sodium phosphate & polyethylene glycol or Miralax) should be avoided in patients w/ heart failure, hypertension, edema, and renal dysfunction or those that are taking drugs that affect kidney function such as diuretics
Term
What instructions should be given to a patient taking bisacodyl (Dulcolax) tablets for constipation?
Definition
Oral tabs are enteric coated to prevent gastric irritation so they should not be crushed or chewed. Milk and antacids dissolve the enteric coating so tabs should be administered at least on hour after ingestion of these substances.
Term
Which patient should not take castor oil for constipation?
Definition
Pregnant women should not take castor oil because it can stimulate uterine contractions and spontaneous abortion my result
Term
What instructions should be given to a patient who is taking polycarbophil (Fibercon) everyday?
Definition
Take with a full glass of water or juice and maintain good fluid intake daily
Term
Which laxatives are commonly used to prevent straining after surgery or after a myocardial infarction?
Definition
Surfactant laxatives - docusate calcium (Surfak) & docusate sodium (Colace); act by lowering surface tension and promoting water accumulation in the intestine and penetration of water into the stool
Term
What causes gastric ulcers?
Definition
The breakdown of the gastric mucosal barrier because of inadequate mucous to form a barrier, inadequate bicarbonate to neutralize the acid and pepsin, or insufficient blood flow to the mucosa.
Term
What is the most common cause of peptic ulcers?
Definition
Heliobacter pylori (H. pylori) infection is the most common cause and is present in 60-75% of patients with peptic ulcer disease
Term
What drug regimen is used to treat an H. pylori infection?
Definition
Antiulcer drug therapy includes 2-3 antibacterial agents, plus histamine 2 receptor antagonists, OR proton pump inhibitors
Term
What adverse effects can be caused by all H2 blockers (-tidiness)?
Definition
cimetidine (Tagmamet), ranitidine (Zantac), famotidine (Pepcid) & nizatidine (Axid); Cimetidine has more side effects than the other H2 blockers, it binds to androgen receptors causing blockade of these receptors. This causes gynecomastia, reduced libido, and impotence; all of which are reversed when the drug is discontinued. The other three H2 blockers do not bind to androgen receptors; therefore they do not cause the side effects seen w/ cimetidine. All H2 blockers increase the risk of pneumonia because when gastric acidity is reduced more bacteria will grow including bacterial in the respiratory tract.
Term
Drug interactions of Cimetidine (Tagament)
Definition
Cimetidine interacts with various drugs due to its ability to inhibit liver enzyme function which causes the blood level of these other drugs to rise: Warfarin (anticoagulant), phenytoin (antiepileptic), theophylline (bronchodilator0, or lidocaine (antidysrhythimic agent)
Term
Which adverse effects can be caused by proton pump inhibitors (-prazoles)?
Definition
ex: omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid), raberprazole (Aciphex) & pantoprazole (Protonix); these are the five available proton pump inhibitors. They like H2 blockers also increase gastric pH increasing the risk for pneumonia. Long term therapy in high doses may increase risk of osteoporosis and fractures. Drug interactions may occur due to elevation of gastric pH Atazanavir (HIV drug) and two antifungal agents (ketoconazole and itraconazole) are poorly absorbed if given with a proton pump inhibitor. Other drug levels may increase due to interference with liver metabolism, including digoxin, warfarin, and phenytoin
Term
Which antacid can change the pH causing alkalosis?
Definition
Sodium bicarbonate; it is systemically absorbed, and can alter systemic pH causing alkalosis (excessive bicarbonate)
Term
Why are aluminum antacids commonly combined with magnesium antacids?
Definition
Aluminum antacids commonly cause constipation where magnesium causes diarrhea; together they reduce the chances of changing bowel habits
Term
Why is aluminum given to patients with renal failure?
Definition
it binds to substances including tetracyclines (antibacterial agents), warfarin and digoxin; reducing their effects. It will also bind phosphate which can result in low blood phosphate levels (hypophosphatemia); however it can be used to treat hyperphosphatemia which commonly occurs in patients with renal failure
Term
What are common anticholinergic effects caused by glycopyrrolate (Robinul)?
Definition
most common is dry mouth. Other anticholinergics may cause constipation, visual disturbances, or urinary retention
Term
Anticholinergics
Definition
glycopyrrolate (Robinul), propatheline bromine (Pro-Banthine) and pirenzepine (Gastrozepine)
Term
What teaching should be given to a patient with sulcralfate (Carafate) for an ulcer?
Definition
The most common side effect is constipation. Drug interactions can occur including decreased absoption of some drugs: phenytoin, theophylline, digoxin, warfarin, and flourquinolones (antibacterial agents). These interactions can be minimized by administering sucralfate 2 hours apart from these other drugs. Antacids interfere with sucralfate's effects and should be given at least 30 minutes apart. this drug works by covering ulcer and protecting it from acid
Term
What drug is used to prevent gastric ulcers caused by NSAIDs?
Definition
Misoprostol (Cytotec) serves as a replacement for prostaglandins, since prostaglandin synthesis is inhibited by the NSAIDs. Most common side effects are diarrhea and abdominal pain; contraindicated during pregnancy [pregnancy Risk Category X], prostaglandins cause uterine contractions and spontaneous abortion may occur.
Term
What is the approved used of alosteron (Lotronex)?
Definition
Alosetron (Lotronex) is for women w/ Irritable bowel syndrome w/ diarrhea who have had symptoms for at least 6 months that have not responded to conventional drugs. It is a serotonin receptor antagonist blocking type 3 serotonin receptors in the colon; relieving abdominal pain, slowing colon transit time, reducing intestinal secretions and increasing sodium and water absorption.
Term
How does budesonide (Entocort) work to improve symptoms of inflammatory bowel disease?
Definition
It is a glucocorticoid used to relive symptoms of ulcerative colitis and Crohn's disease through its anti-inflammatory effects. Approved for crohn's disease because the drug is released when it reaches the ileum and ascending colon.
Term
What should the patient taking infliximab (Remicade) be told to report?
Definition
Immunomodulators increase the risk of serious infections including tuberculosis, patients should report signs of infection such as fever or pain
Term
Immunomodulators
Definition
infliximab (Remicade), certolizumab (Cimzia) & adalimumab (Humira)
Term
What are the daily water needs?
Definition
30ml/kg or 15ml/lb
Term
A fever adds what percent of water requirement?
Definition
15%
Term
hyperosmolality
Definition
greater than 295 mOsm/kg
Term
What causes hyperosmolality?
Definition
severe diarrhea, increased salt intake, inadequate water intake, diabetes or sweating
Term
Crystalloids
Definition
IV solutions that contain electrolytes and other substances that closely resemble the body's extracellular fluid
Term
Examples of crystalloids
Definition
Isotonic: D5W, 0.9% NaCl, D5/0.2% NaCl, LR ; Hyptotonic: D5W (rapid or continuous) 0.45% NaCl ; Hypertonic: D10W, D5/ 0.9% NaCl,D5LR
Term
Where does the fluid go with each type?
Definition
Hypotonic - water moves from the plasma to the interstitial space and the cells; Isotonic - no net fluid shift; Hypertonic - plasma gains more solute than the interstitial fluid and water moves from the interstitial space to the intravascular space
Term
What situation is a hypotonic solution used for?
Definition
Used to treat cellular dehydration
Term
What situation would you use an Isotonic solution?
Definition
Used to treat fluid loss due to vomiting, diarrhea, or surgical procedures, especially when BP is low
Term
What situation would you use a Hypertonic solution?
Definition
Used to treat cellular edema such as cerebral edema or increased intraocular pressure
Term
What adverse effects can occur with a Hypotonic solution?
Definition
Can result in hypotension because of movement of water out of the intravascular space
Term
What adverse effects can occur with an Isotonic solution?
Definition
Care must be taken to avoid fluid overload because they can expand the blood volume rapidly
Term
What adverse effects can occur with a Hypertonic solution?
Definition
Water also leaves the cells and moves into the plasma compartment which can result in dehydration
Term
Colloids
Definition
solutions that expand the blood volume and replace plasma proteins
Term
What adverse effects can occur with hetastarch?
Definition
Has an extended duration action, lasting more than 24 hours, can persist in the body for weeks causing decreased platelet and hematocrit counts; contraindicated in patients with bleeding disorders, heart failure, and renal dysfunction
Term
Which blood product will most benefit a patient with low oxygen levels, low plasma protein levels, and low clotting factors?
Definition
Whole blood because it contains oxygen carrying rbc's, plasma with all its proteins and clotting factors
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