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Exam 3
Diuretics, Misc antibiotics/ Drugs for HIV, HF and Angina pectoris
113
Pharmacology
Undergraduate 2
03/10/2013

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Term
Flouroquinolones *general*
Definition
Broad-spectrum
disrupts dna replication and cell division
oral/IV
Tendon rupture
end in -floxacin
Term
Flouroquinolones *main*
Definition
Tendon rupture
Broad-spectrum
Term
Ciprofoxacin (Cipro)
Definition
Oral/IV
Bactericidal (quickly)
aerobic infections (Respiraotyr, UTI, GI,Bone,joint, skin and soft tissue, ANTHRAX, cannot be used for anaerobic infections (Only systemic approved for children)
Term
Cipro *main*
Definition
ANTHRAX inhaled spores!
Term
Ciprofoxacin (Cipro) AE
Definition
Candida (pharynx and vagina)
Tendon rupture (achilles- pain, swelling or inflammation *exercise avoid*)
* Phototoxicity *severe sunburn*
* increased C. Diff
Term
Tendon rupture increased risk
Definition
>60 or <18, used with glococorticoids, heart/lung/kidney transplant (no risk to nursing infant)
Term
Ciprofoxacin (Cipro) (food/drug)
Definition
Cationic compounds can reduce absoption
*take 6 hours before or 2 hours after
raise levels (theophylline, warfarin(coumadin), tinidazole)
Term
Cationic compounds(positive charged)
Definition
1.aluminum
2. iron salts
3. zinc salts
4. Sulcrafate
5. Calcium supplements
6. milk/other dairy products
Term
Ciprovoxacin (to tx anthrax)
Definition
IV slowly over 60 minutes
Term
Metronidazole (Flagyl) *main*
Definition
protozoal/anaerobic bacterial infections
Resistance is rare
Term
Metronidazole (Flagyl) (tx what?)
Definition
CNS
Abd. organs
Bones/joints
Skin/soft tissues
GU tract
C.DIFFICILE COLITIS
Prophylaxiz for some surgeries
treat PUD (helicobacter pylori)
Term
Drug of choice for C diff.
Definition
Metronidazole (Flagyl)
Term
Prophylaxis (surgeries where it's likely to get infection with anaerobes) colorectal, abd., vaginal
Definition
Metronidazole(Flagyl)
Term
Daptomycin (Cubicin) *General*
Definition
Can use to treat MRSA
Can cause muscle injury (myopathy)
IV only
cyclic lipopeptides
Term
Can kill almost all "relevant" gram-positive bacteria including MRSA (approved for bloodstream infection with staph aureus and complicated skin and structure infections (including MRSA and VRE)
Definition
Daptomycin (Cubicin)
Term
Myopathy
Definition
monitor CPK (creatinine phosphokinase); marks muscle injury- monitor weekly, stop if goes up significantly (10 times)
Term
Daptomycin (Cubicin) *main*
Definition
Myopathy
Term
Cipro nursing implications (Cipro)
Definition
*Cationic avoid, tenton rupture, phototoxcity
Term
HIV (What is it?)
Definition
Human immunodeficiency virus
Kills CD4 T lymphocytes
Term
AIDS
Definition
syndrome in which individual is HIV positive and has CD4 T cell counts below 200 or an AIDS-defining illness
Term
AIDS-defining illness
Definition
pneumocystic pneumonia
CMV retinitis
TB
Term
Highly active antiretroviral therapy (HAART)
Definition
Decrease plasma HIV levels
*Delay or reverse loss of immune function, preserve health and prolong life
*Expensive,complex, risk of toxicity and severe drug interactions, lifelong tx.
* Cannot cure HIV infection
Term
HIV is a retrovirus
Definition
Cant self-replicate- obligate intracellular parasite
converts their RNA into DNA and instead of reverse
Term
HIV target cells
Definition
CD4 T cells (helper T lymphocytes)
Term
What is drug resistence in HIV related too?
Definition
total Viral load
Term
HIV- Initial phase
Definition
massive HIV replication occurs (flu-like acute retroviral syndrome
Term
HIV- Middle phase
Definition
prolonged clinical latency butstill replicating
Term
HIV- Late phase
Definition
CD4 T cells drop critically low- opportunistic infectionsand neoplasms
AIDS 20-40% neurologic complications
Term
HIV- combination drug therpy
Definition
Two NRTIS combined with either a PI or NNRTI
*Attacks HIV in different ways
*Reduces risk of resistance
* Reduces plasma HIV levels, cause CD4 T-cell counts to return to normal, restoring some immune function
Great potential AE and drug interactions
Term
Threshold for initating drug therapy
Definition
< 500 cells/mm3
Term
Viral load: Therapy goal
Definition
decrease to undectable level
Term
Basic goals of tx (6)
Definition
Maximal and durable supression of viral load
*Restoration or preservation of immune function
*Improved quality of life
*Reduction of HIV-related morbidity and mortality
*Reduction of sexual HIV transmission
* Prevention of vertical HIV transmission (mother to baby)
Term
opportunistic infections (long list)
Definition
Pneumocystis carinii pneumonia (PCP)
cytomegalovirus retinitis(CMV)
Myobacterium TB and Mycobacterium avium complex
Toxoplasma encephalitis
Cryptococcal meningitis
Varicella-Zoster
Herpers Simplex
candidiasis
Term
Antiretroviral therapy (ART)
HAART and 3-4 drugs *benefits*
Definition
decreased incidence of new OIs has declined dramatically; ART can cause CD4 counts to rise, restoring come immunocompetence
Term
Nursing implications- goals
Definition
decrease viral loag, improve quality and quantity of life
Term
HIV- patients teaching
Definition
correct drug administration
adverse effects are serious and debilitating
Patients need to be followed closely
Term
Diuretics (uses)
Definition
Hypertension- move edmatous fluid (HF, cirrhosis, kidney disease) - prevent renal fauilure( maintaining urine flow)
Term
Nephron
Definition
basic functional unit of kidney- 4 regions
Term
Glomerulus
Definition
contained in the renal corpuscle
Term
Proximal convoluted tubule
Definition
one of 4 functionally distinct regions
Term
upper portion of Henle's loop
Definition
located in the renal cortex and the lower end of the loop descends toward the renal medulla.
Term
The final segment of the distal convoluted tubule plus the collecting duct into which it empties can be considered a single functional unit
Definition
the distal nephron
Term
Kidneys 3 functions
Definition
1.Cleanse extracellular fluid and maintain ECF volume and composition
2. Maintain acid-base balance
3. Excrete metabolic wastes and foreign substances.
Term
Filtration- location
Definition
Occurs at glomerulus and is nonselective
Term
Reabsorption
Definition
Most water, electrolytes and nutrients get absorbed
Solutes are reabsorbed by active transport
Diuretics act by disrupting solute reabsoption
Term
Active tubular secretion
Definition
In proximal convoluted tubule
Term
Effects of the kidney on ECF are the net result of three basic processes
Definition
filtration, reabsoption, and active secretion
Term
Reabsoption- what?
Definition
99% of water, electrolytes, and nutrients that are filtered
Term
Filtration is nonselective
Definition
Reabsoption and secretion are selective and determine composition of urine.
Term
all ECF processed in
Definition
100 minutes- 14x aday
Term
filtrate consists of
Definition
sodium and chloride ions, also bicarbonate and potassium ions in smaller amounts.
Term
what remains behind in blood
Definition
lipds and proteins
Term
small molecules present in plasma undergo filtration
Definition
electrolytes, aminoacids, glucose, drugs, metabolic wastes
Term
how do diuretics work
Definition
interfer with reabsoption
Term
active transport- what solutes
Definition
electrolytes, amino acids, glucose
Term
water reaborbed how?
Definition
osmosis
Term
Proximal convuluted tubule
Definition
high reabsoptive capcity (65% Na and Cl reaborded,also HCO3 and K+) as these are actively reabsorbed, water follows passively
Term
Loop of Henle
Definition
descending limb: freely premable to water so it is drawn into the interstitial space,urine becomes concentrated.ascending limb: 20% of Na and Cl is reabsorded, Not permeable to water so concentration of urine returns to original state
Term
Distal convoluted tubule
Definition
10% of Na and Cl reabsorbed in early segment followed by water
Term
Distal nephron
Definition
site of two important processes: exchange of Na for K+ which is under the influence of aldosterone and final concentration of urine determined (regulated by ADH)
Term
Diuretics *main function*
Definition
Block sodium and chloride reabsoption
* causes water and solute retention in the kidney and eventual excretion
* amount of diuresis directly related to amount of sodium and chloride reabsoption blocked.
Term
greater the diuretic effect
Definition
the earier inthe kidney/nephron that the drug action occurs- amount gets smaller as you go alone
Term
Potential AE on ECF
Definition
Hypovolemia, Disturbance of electrolyte levels, Acid-base disturbance
Term
Minimize AE of diuertics
Definition
Use short-acting diuretics
allow periods of kidney being "drug free"
Term
High-ceiling (loop) diuretics *drug*
Definition
furosemide (Lasix)
Term
Thiazide diuretics
Definition
hydrochlorothiazide (HCTZ)
Term
Potassium-sparing diuretics
Definition
aldosterone antagonists (spironolactone)
nonaldosterone antagonists triamterene
Term
osmotic diuretics
Definition
mannitol
Term
Mannitol *part of nephron*
Definition
Proximal Convuluted Tubule
65%
Term
furosemide
Definition
Thick Segment- ascending limb of henle's loop 20%
Term
thiazide
Definition
Early Distal Convoluted tubule 10%
Term
spironolactone, triamterene
Definition
late distal convoluted tubule and collecting duct (distal nephron)
Term
Lasix
Definition
most effective diuretic, rapid onset
for pulmonary edema associated with CHF
Edema of hepatic, cardiac,or renal origin unresponsive to other diuretics.
Hypertension uncontrolled by other diuretcs
Term
Lasix
Definition
*** Can use when renal flow blood flow and glomerular filtration are low
Term
AE- lasix
Definition
Hyponatremia
Hypochloremia
Dehydration
Hypotension
Hypokalemia
Avoid use during pregnancy
Ototoxicity
***Hyperglycemia, hyperuricemia, lower HDL, raise LDL and triglycerides, hypomagnesemia, hypocalcemia
Term
lasix- drug interations
Definition
digoxin- low potassium
ototoxic drugs- aminoglycosides
Potassium-sparing diuretics
Lithium
Antihypertensive- hypotension
NSAIDS-blunt (prostaglandin)
Term
Thiazides- Hydrochlorothiazide (HCTZ)
Definition
CANNOT be used when renal blood flow is low!!
indications- hypertension and edema
Term
Thiazides and related diuretics AE
Definition
Hyponatremia,hypochloremia, and dehydration
Hypokalemia
Hyperglycemia, hyperuricemia, increased lipds hypomagnesemia
Avoid in pregnancy and breastfeeding
Term
Thiazides *other drugs*
Definition
chlorothiaside (Diuril)
metolazone (Zaroxolyn)
Term
Thiazides (drug interactions)
Definition
same as loop except not ototoxic
Term
Potassium-sparing diuretics *general*
Definition
Modest urine output
Less potassium excretion
minimize K+ loss
delayed action
Hypertension/edema/HF
protective effects of aldosterone blockade in heart
(ACE's, ARB's, DRI's elevate K+)
distal nephron
Term
Non-aldosterone antagonists *drugs*
Definition
trimterene (Dyreium) and amiloride (Midamor)
Term
Non-aldosterone antagonists *general*
Definition
distal nephron
alone or combined with other diuretic
Uses- Hypertension and edema
AE- Hyperkalemia, N V leg cramps and dizziness possible
works more quickly
Term
Ostmotic Diuretics
Definition
No significant impact on electrolyte balance
given IV
Term
mammitol- uses
Definition
Prevent renal failure
Reduce intracranial pressure
Reduce intraocular pressure
Term
mannitol *side effects*
Definition
edema, HA, N V
Term
foods that contain potassium
Definition
nuts, dried fruits, spinach, citrus fruits, potatoes, bananas
Term
BID
Definition
8 and noon
Term
HF *progressive disorder characterized by*
Definition
Ventricular dysfunction
Reduced cardiac output
Inefficient tissue perfusion
Signs of fluid retention- volume overload
Term
Inefficient tissue perfusion
Definition
fatigue, SOB, exercise intolerence
Term
body compensates decreased CO
Definition
cardiac dilation
Increased sympathetic tone
water retention and increased blood volume
Natriuretic peptides seceted
Term
ACE inhibitors
Definition
blocks angiotensin II production and decreases aldosterone release
* Can cause hypotension, hyperkalemia, cough, angioedema and fetal injury
Term
Angiotension II receptor blockers (ARB)
Definition
can't use ACE
Aldosterone antagonist
* Either block aldosterone receptors or decrease aldosterone production
* Can cause hyperkalemia
Term
ACE inhibitors *drugs/facts*
Definition
lisionpril, enalapril
arteriolar and venous dilation; suppress release of aldosterone (that can cause sodium andwater retention)
Term
DRI- only Tekturna and not approved for HF
Definition
shut down the renin system because it prevents angiotension from being produced
Term
Digoxin *uses*
Definition
HF and dysrhythmiz control
Positive inotropic action
Term
Digoxin *range*
Definition
0.5-0.8 ng/ml
Cardiac glycoside
Term
Management of dysrhythmias with dig
Definition
* stop digoxin and K+ wasting diuretics
* Monitor serum K+
* possible antidysrhythmic drugs
* Digibind IV, cholestyramine or activated charcoal po
Term
Antidysrhythmic drugs
Definition
phenytoin, lidocaine, atropine and pacemaker
Term
Dig noncardiac AE
Definition
GI: anorexia, N, V
Fatigue
Visual disturbance (blurred, yellowed or halos)
Term
Sympathomimetics with dig
Definition
dopamine and dobutamine can add positive inotropic effects of dig but can increase risk of fast dysrhythmias.
Term
CCB (Verapmil) with dig
Definition
can increase dig levels dramatically- supress myocardial contractility and counter act
Term
Dig administration
Definition
po or iv
reduce for kidney dysfunction
monitor levels
avoid bran decrease adsoption
IM- tissue damage and pain
Term
Patient education digoxin
Definition
take digoxin exactly as prescribed
limit salt intake 2gm/day and avoid excess fluids
Avoid excess alcohol intake
weight control
exercise
recognize dysrhythmias
ss hypokalemia and toxcity
Term
3 forms of angina
Definition
chronic stable angina (exertional)
Variant angina (prinzmetal's or vasospastic)
Unstable angina
Term
underlying cause is CAD
Definition
reduced blood flow- angina
Complete blockage- myocardial infartion
Term
triggers angina
Definition
cold, large meal, emotional excitement
Term
decrease oxygen demand
Definition
organic nitrates, beta blockers, CCB, ranalozine- symptomatic releif don't change pathology
Term
Varient angina (drugs)
Definition
CCB and Organic nitrates
beta blockers- aren't effective
Term
nitroglycerin half life
Definition
5 to 7 minutes
Term
Nitroglycerin AE
Definition
HA, orthostatic, Reflex tachycardia
Term
Nitroglycerin drug interactions
Definition
Hypotensives- + BB, CCB, diuretics and other
PDE5- viagra, cialis and levitra
BB, Verapamil, Diltiazem- suppress tachycardia
Term
sublingual *onset"
Definition
1-3 minutes up to 60 minutes
take every 5 minutes (call 911 if one doesn't releive)
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