Term
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Definition
Degree of control determined by its cause of physical dependence
Effects: analgesia, sedation, and sense of well-being
Antitussives
Schedule II for narcotics; Schedule III if limited amount of narcotics
Assess patient for pain to determine effectiveness
IV bolus (PCA) route is most reliable
Adverse effects: respiratory depression, constipation, sedation
Can cause addiction/ tolerance |
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Term
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Definition
Treat pain and fever
Act directly on thermoregulatory cells in hypothalamus
Adverse effects: hepatotoxicity (overdose), renal dysfunction
Increase toxicity with alcohol consumption |
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Term
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Definition
Anti-inflammatory, anti-pyretic, analgesic, for treatment of arthritis
Use to reduce risk of MI (affect platelet aggregation)
Contraindication: bleeding disorders, impaired renal function
Children with chickenpox or influenza (Reye Sydrome)
One week within surgery
Adverse effect: GI bleeding |
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Term
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Definition
Indication for tonic-clonic seizure, epilepticus
Narrow therapeutic effects: measure and monitor its level carefully
Adverse effect: gingival hyperplasia, Steve-Johnson Syndrome |
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Term
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Definition
For the treatment of Parkinson’s disease
Relieve signs and symptoms of Parkinson’s disease, as disease progresses, it become less effective
Levidopa is a precursor of dopamine and can cross blood brain barrier
Levodopa combined with Carbidopa to prevent peripheral breakdown of levodopa
Lower dosage => less adverse effects
Adverse effects: cardiac irregularities |
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Term
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Definition
| Treat spasticity, upper motor neuron disease; treat multiple sclerosis. Bowel and bladder function may be improved |
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Term
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Definition
Treatment of hypothydoidism
Contraindication: acute MI, thyrotoxicosis
TSH testing: increase TSH => hypothyroidism (thydroid gland under active)
Decrease TSH => hyperthydroidism (thydroid gland over active)
Negative feedback system—when there is an adequate amount of “hormone a” present, production slows because there is a decreased demand for it. When supply is used up, demand increases, so production also increases until demand is met, and production once again decreases
For example, if the hypothalamus senses low thyroid hormone, it secretes releasing factor TRH directly into the anterior pituitary. In response to the TRH, the anterior pituitary releases thyroid stimulating hormone, which causes the thyroid to release TH.
When the hypothalamus senses rising levels of TH, it stops secreting TRH, which in turn ultimately stops/reduces TH levels. This goes back and forth constantly to maintain homeostasis. |
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Term
| Signs and symptoms of Hyperthydroidism: |
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Definition
CNS Stimulated: hyperactive reflexes, anxiety, nervousness, insomnia, tremors
CV: tachycardia, palpitations, increased pulse pressure,
Skin is flushed, warm, thin, moist, sweating
Increase metabolic rate, intolerance to heat, weight loss |
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Term
| Signs and symptoms of Hypothydroidism: |
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Definition
CNS Depressed hypoactive reflexes, lethargy, sleepiness, slow speech, emotional dullness
CV: bradycardia, hypotension
higher levels of fat and cholesterol
Metabolic rate: lower body temperature; intolerance to cold, weight gain |
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Term
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Definition
Adjunct to diet and exercise
Increase peripheral utilization of glucose
Decrease hepatic production of glucose
Decrease GI absorption of glucose
Too Much = hypoglycemie
Too Little = hyperglycemia |
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Term
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Definition
inhibits HMG-CoA reductase, which is an early step in synthesis of cholesterol. EXTENSIVE 1ST PASS METABOLISM
Causes of high cholesterol: excessive intake of fat, genetic alteration in fat metabolism
Contraindication: active or history of liver disease; pregnancy or lactation
Adverse effects: live failure, rhabdomyolysis
Drug-drug interaction: grapefruit juice, estrogen, digoxin or warfarin
Statins: take missed doses as soon as you remember. Take same time every day, use BC, Statins increase sensitivity to sun, eat low fight diet, increase exercise, don't smoke
Cholesterol level normal < 200
LDL normal < 100
HDL normal > 40
Triglyceride normal < 150 |
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Term
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Definition
Inhibits the conversion of prothrombin to thrombin
Anti-coagulant (prevent blood clot)
Antidote: protamine
Measure PTT (high = increase bleeding) |
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Term
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Definition
Anti-coagulant (prevent blood clot)
Monitor PT, get INR result
Take several days to be effective
Antidote: vitamin K
Interact with many drugs
Check signs, symptoms and lab values if other drugs are added to or removed from patient’s drug regimen |
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Term
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Definition
Low-molecular-weight heparin
Antidote: protamine
No need to monitor PTT
Indication: prevent DVT, DVT prophylaxis after hip/knee surgery
Treatment for unstable angina
Route SQ
Drug is expensive |
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Term
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Definition
Beta specific agonist
Indication: treatment for bronchospasm, Vasopressor during shock (ianotropic action)
Desired effects: increase HR, increase conductivity and contractility
Bronchodilation, vasodilation. ELEVATES SYSTOLIC, LOWERS DIASTOLIC |
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Term
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Definition
Non selective beta adrenergic blocker
Indication: HTN, anxiety,
Contraindication: heart block, bradycardia
COPD, acute asthma, bronchospasm
B Blockers: block epinephrine and norepinephrine on adrenergic beta receptors. Some block all B-adrenergic receptors, others are selective
B1: heart and kidneys
B2: Lungs, GI, Liver, Uterus, VASCULAR SMOOTH MUSCLE, skeletal muscle
B3: fat cells |
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Term
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Definition
Loop diuretic
Decrease K
Indication: treatment of pulmonary edema, heart failure, HTN
Adverse effects: hypokalemia, hypocalcemia hypotension, volume depletion, hyperglycemia (caution with DM patients)
Monitor kidney function
Contraindication: renal failure, electrolyte depletion
Interaction: increase effects with aminoglycosides |
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Term
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Definition
Contain sulfer; cross allergenicity sulfonamides (antibiotics)
Thiazide diuretic; Block Chloride pump. Increases Na and H2O EXCRETION
Also promotes LOSS of: Cl, K, Mg, HCO3
Interaction: increase digoxin, lithium toxicity
Decrease effectiveness of anti-diabetic agent
Do not use in neonates—causes gasping syndrome. Give in AM for adult to avoid nocturia
Adverse effects: hypokalemia
Increase uric acid can result gout (gout)
Increase glucose level (caution with diabetic patient)
Ototoxicity and even deafness have been reported with these drugs |
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Term
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Definition
K-sparing diuretic
Increase K if taking much spironolactone (hyperkalemia)
Competitively block the effects of aldosterone |
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Term
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Definition
Treatment for BPH; anti androgen
Shrink enlarged prostate |
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Term
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Definition
H2 receptor blocker
Selectively block H2 receptor => preventing release of gastrin => blocking the production of HCl
Treatment for active duodenal or benign gastric ulcers; treatment for GERD
Adverse effects: impotence (anti androgen); gynecomastia
H2 blockers: block jistamine production in gastric parietal cells, decreasing acid. Less effective than PPI |
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Term
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Definition
Prostaglandin blocker => inhibit gastric acid secretion => increase bicarbonate and mucus production
Indication: NSAIDs-induced gastric ulcers
Contraindication: pregnancy because it is abortifacient.... Its Plan B!! |
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Term
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Definition
Bulk stimulant
Increase the fluid in the intestinal contents, which enlarges bulk, stimulates local stretch receptors, and activates local activity |
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Term
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Definition
One of active ingredient in marijuana (control substance)
Treatment of nausea, vomiting associate with CA chemotherapy
Adverse effect: Anxiety for individual not exposed to it before
CNS: drowsiness, confusion, feeling “high” |
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Term
| Prochlorperazine (Compazine) |
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Definition
Centrally acting antiemetic
Adverse effects: depress CNS, drowsiness, weakness, dizziness
Contraindication: pt with coma or severe CNS depression, brain damages
Caution: during pregnancy and lactation
Can be given rectally (best for kid throwing up) |
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Term
| Pharmacokinetics vs. pharmacodynamics |
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Definition
Pharmacodynamics: is the study of the interactions between the chemical components of living systems and the foreign chemicals, including drugs, that enter those systems
The ability of a drug to attack only those systems found in foreign cells is known as selective toxicity.
Pharmacokinetics involves the study of absorption, distribution, metabolism (biotransformation), and excretion of drugs.
The amount of a drug that is needed to cause a therapeutic effect is called the critical concentration loading dose: use of a higher dose than what is usually used for treatment to allow the drug to reach the critical concentration sooner
First-pass effect: a phenomenon in which drugs given orally are carried directly to the liver after absorption, where they may be largely inactivated by liver enzymes before they can enter the general circulation; oral drugs frequently are given in higher doses than drugs given by other routes because of this early breakdown |
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Term
| Principles of antibiotic resistance |
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Definition
It is very important to use these drugs only when the identity and sensitivity of the offending bacterium have been established. Indiscriminate use of these new drugs can lead to the development of more resistant strains for which there is no effective antibiotic
Explain clearly that a particular antibiotic is effective against only certain bacteria and that a culture needs to be taken to identify the bacteria
Ensure that patients understand the importance of taking the full course of medication as prescribed.
Anti-biotics must be high enough. Low dose can cause resistance
The use of antibiotics may result in the development of superinfections or overgrowth of resistant pathogens, such as bacteria, fungi, or yeasts. |
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Term
| Aminoglycosides-major adverse effects |
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Definition
Major adverse effects: ototoxicity and nephrotoxicity
Monitor renal function and hearing
Avoid combining aminoglycosides with potent diuretics
How they work: inhibit bacterial protein synthesis—bacteriocidal. Metabolized in kidneys, treats enteroccocal infections |
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Term
| Vaccines, active vs. passive immunization, antitoxins |
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Definition
active immunity: the formation of antibodies secondary to exposure to a specific antigen; leads to the formation of plasma cells, antibodies, and memory cells to immediately produce antibodies if exposed to that antigen in the future; imparts lifelong immunity
antitoxins: immune sera that contain antibodies to specific toxins produced by invaders; may prevent the toxin from adhering to body tissues and causing disease
passive immunity: the injection of preformed antibodies into a host at high risk for exposure to a specific disease; immunity is limited by the amount of circulating antibody
vaccine: immunization containing weakened or altered protein antigens to stimulate a specific antibody formation against a specific disease; refers to a product used to stimulate active immunity |
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Term
| Treatment of adrenal insufficiency |
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Definition
Addison’s disease: lack of glucocorticoids
Treated with glucocorticoids
Glucocorticoids is made in adrenal cortex
Measure by lack of glucocorticoids |
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Term
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Definition
Diaphoresis
Tremors
Dizziness
Fatigue
Faintness
Nervousness |
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Term
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Definition
Fatigue
Lethargy
Irritation
Glycosuria
Polyphagia
Polydipsia
Itchy Skin |
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Term
| Severe complications of hyperglycemia |
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Definition
➢ Fruity breath as the ketones build up
➢ Dehydration as fluid and important electrolytes are lost through the kidneys
➢ Slow, deep respirations (Kussmaul’s respirations) as the body tries to rid itself of high acid levels
➢ Loss of orientation and coma |
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Term
| Conduction pathway of heart |
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Definition
| SA node => AV node => Bundle of His => Bundle Branch => Purkinjie Fibers |
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Term
| Stepped Care Approach to Treating Hypertension |
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Definition
Step 1: Lifestyle modifications are instituted
Step 2: If the measures in step 1 are not sufficient, drug therapy is added
Step 3: If the patient’s response is inadequate, drug dose or class may be changed or another drug added
Step 4: Includes all of the above measures with the addition of more antihypertensive agents until blood pressure is controlled
Stage 1 Hypertension: start with thiazide-type diuretics, may consider ACEI, ARB, Beta Blockers, or Calcium Channel Blocker
Stage 2 Hypertension: 2 drugs combination thiazide-type diuretics and ACEI, ARB, Beta Blockers, or Calcium Channel Blocker
Lower dose of several drugs is more effective than higher dose of one drug |
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Term
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Definition
Metabolic syndrome is a cluster of metabolic risk factors. When a patient presents with these risk factors together, the chances for future cardiovascular problems are greater than any one factor presenting alone.
Abdominal obesity (Waist circumference of 40 inches or above in men, and 35 inches or above in women)
•Triglyceride level of 150 milligrams per deciliter of blood (mg/dL) or greater
•HDL cholesterol of less than 40 mg/dL in men or less than 50 mg/dL in women
•Systolic blood pressure (top number) of 130 millimeters of mercury (mm Hg) or greater, or diastolic blood pressure (bottom number) of 85 mm Hg or greater
•Fasting glucose of 100 mg/dL or greater |
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Term
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Definition
Blocks the conversion of angiotensin I to angiotensin II; an angiotensin II receptor blocker; blocking effects of angiotensin on blood vessels
Believed to have protective effects on kidneys, thus use for DM patient with nephropathy
Cause dry cough
Orthostatic hypotension: Warn pt that it may cause dizziness getting out of bed
Can cause serious fetal abnormalities (encouraged to use barrier contraceptives) |
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Term
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Definition
| Decreases serum sodium levels and blood volume |
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Term
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Definition
Leads to a decrease in heart rate and strength of contraction as well as vasodilatation
Exacerbate asthma bronchospasm |
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Term
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Definition
Relaxes muscle contraction or other autonomic blockers
May cause peripheral edema at ankle.
These drugs should not be used during pregnancy unless the benefit to the mother clearly outweighs any potential risk to the fetus because of the potential for adverse effects on the fetus or neonate (page 716). |
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Term
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Definition
contraindicated during pregnancy, serious fetal abnormalities and even death when given in the second or third trimester
Table 2. Suggested dosages of commonly used antihypertensive medications in pregnancy
Severe hypertension Hydralazine, Labetalol, nifedipine
Mild to moderate hypertension Methyldopa, Labetalol, nifedipine |
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Term
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Definition
| Insufficient folic acid or vitamin B12 to create the stromal structure needed in a healthy RBC |
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Term
| Iron Deficiency Anemia (microcytic) |
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Definition
A negative iron balance occurs
Treatment:
Oral Iron preparations (Ferrous Sulfate): treat iron deficiency anemia; can cause black stool
Folic acids: treatment for megaloblastic Anemia
Vitamin B12: given by IM only
Erythropoietins: commonly used for renal failure who are not making enough.
Also make sure, renal patient have enough irons also. |
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Term
| MAJOR CLASSES OF DIURETICS |
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Definition
| Thiazide, loop, K-Sparing. There also also combination |
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Term
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Definition
block chloride pump, keeps chloride and the sodium in the tubule to be excreted in the urine
Adverse effects: hypokalemia , hypercalcemia (decreased calcium excretion) |
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Term
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Definition
Block the chloride pump in the ascending loop of Henle
Adverse effects: hypokalemia, Alkalosis, Hypocalcemia |
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Term
| Carbonic Anhydrase Inhibitors |
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Definition
Block the effects of carbonic anhydrase, ; slow down the movement of hydrogen ions
Indication: Glaucoma
Adverse effects: Metabolic acidosis, Hypokalemia |
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Term
| Potassium sparing diuretics |
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Definition
blocking actions of aldosterone; cause a loss of sodium while promoting the retention of potassium
Adverse effects: hyperkalemia (avoid food with high K, avocado, banana ) |
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Term
| Osmotic diuretic (mannitol) |
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Definition
sugar that is not well reabsorbed by the tubules; acts to pull large amounts of fluid into the urine due to the (osmotic pull)
Indication: Increased cranial pressure or acute renal failure due to shock, drug overdose, or trauma
Adverse effects: sudden drop in fluid levels |
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Term
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Definition
act at cholinergic receptors in the peripheral nervous system to mimic the effects of ACh and parasympathetic stimulation
Effects of parasympathetic stimulation (rest and digest): slowed heart rate and decreased myocardial contractility, vasodilation, bronchoconstriction and increased bronchial mucus secretion, increased GI activity and secretions, increased bladder tone, relaxation of GI and bladder sphincters, and pupil constriction.
Indication: Treat urinary retention; induce miosis or pupil constriction |
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Term
| Anticholinergic drug (parasympatholytic) |
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Definition
competitively block the acetylcholine receptors at the muscarinic cholinergic receptor sites that are responsible for mediating the effects of the parasympathetic postganglionic impulses.
Effects: Decrease GI activity and secretions (treat ulcers); Increase HR
Decrease in GI activity; pupil dilation, dilates the bronchi
Cycloplegia (paralysis of the ciliary muscle in the eye, causing pupil dilatation and loss of accomodation)
Block only the muscarinic effectors in the PNS and cholinergic receptors in the SNS
Do not block the nicotinic receptors; Have little or no effect at the neuromuscular junction |
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Term
| Muscarinic acetylcholine receptors |
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Definition
| are acetylcholine receptors acetylcholine of postganglionic fibers in the parasympathetic nervous system. Examples: Atropine, Tolterodine, Oxybutynin |
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Term
| Nicotinic acetylcholine receptors |
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Definition
| are neuron receptor proteins that signal for muscular contraction upon a chemical stimulus. Examples: nicotine, memantine |
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Term
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Definition
Alzheimer’s disease is a progressive disorder involving neural degeneration in the cortex (Ach-producing neurons) that leads to a marked loss of memory and of the ability to carry on activities of daily living.
Indirect-acting cholinergic agonists available to slow the progression of this disease
• Tacrine, galantamine, rivastigmine, donepezil |
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Term
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Definition
Carbonic anhydrase inhibitors are used to treat glaucoma because the inhibition of carbonic anhydrase results in decreased secretion of aqueous humor of the eye
• Drpos: trusopt, Azopt
• Pills: Acetazolamide, Methazolamide |
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Term
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Definition
Alpha-adrenergic blockers block postsynaptic alpha1-adrenergic receptors, which results in a dilation of arterioles and veins and a relaxation of sympathetic effects on the bladder and urinary tract
Anti-androgen drugs that block testosterone production—dutasteride and finasteride |
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Term
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Definition
Pathophysiology: symptoms of asthma result from a combination of inflammation and bronchoconstriction, so treatment must address both components
Drugs:
Anti-inflammatory drug: ie. suppress effects of leukotrienes
Combination of Glucocorticoid and long acting Beta Adrenergic drugs
Management:
Agents for long-term control (eg, inhaled glucocorticoids)
Agents for quick relief of ongoing daily attack (eg, inhaled short acting beta adrenergic)
Such as exercise induced, cold induced
Emergency:
Acute severe asthmatic exacerbations or status asthmaticus:
Giving oxygen to relieve hypoxemia
Giving a IV systemic glucocorticoid to reduce airway inflammation
Giving a nebulized high-dose SABA to relieve airflow obstruction
Giving nebulized ipratropium to further reduce airflow obstruction (anticholinergic drug).
Stepwise therapy
Step chosen for initial therapy is based on pretreatment classification of asthma severity
Moving up or down a step is based on ongoing assessment of asthma control
Step 1 : no daily meds needed; only prn meds
Step 2: low dose inhaled glucocorticoid
Step 3: low dose igc+ long acting beta or medium dose igc
Step 4: Medium dose igc AND LABA
Step 5: High dose igc and LABA
Step 6: High dose igc and LABA and oral glucocorticoid |
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Term
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Definition
Drug: Cromolyn
Action: Works at the cellular level to inhibit the release of histamine and inhibits the release of SRSA. |
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Term
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Definition
Xanthines: Direct effect on the smooth muscles of the respiratory tract, both in the bronchi and in the blood vessels; reversal of cause bronchodilation
Sympathomemetics: Beta2 selective adrenergic agonists; cause bronchodilation
Anticholinergic:
Anticholinergic that blocks vagally mediated reflexes by antagonizing the action of acetylcholine;
cause bronchodilation
Inhaled steroids: Decrease the inflammatory response in the airway
Leukotriene Receptor Antagonists: Selectively and competitively block or antagonize receptors for the production of leukotrienes; anti inflammatory |
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Term
| Drugs for allergic rhinitis |
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Definition
Topical Nasal Decongestants: Sympathomimetic
Affects sympathetic nervous system to cause vasodilatation
Adverse effects: Local stinging and burning, Rebound congestion, Sympathetic effects
Oral Decongestants: Shrink the nasal mucous membrane by stimulating the alpha-adrenergic receptors in the nasal mucous membranes
Adverse effects: Rebound congestion, Sympathetic effects
Topical Nasal Steroid Decongestants: Exact mechanism of action is not known
Adverse effects: Local burning, irritation, suppress healing
Antihistamines: Selectively block the effects of histamine at the histamine-1 receptor sites, decreasing the allergic response; Anticholinergic and antipruritic effects
Adverse effects: Drowsiness and sedation, Anticholinergic effects |
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Term
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Definition
Cimetidine
Actions
Selectively block histamine-2 receptor sites
This blocking leads to a reduction in gastric acid secretion and reduction in overall pepsin production
Indications
H. Polyri gastritis; reflux esophagitis
Short-term treatment of active duodenal ulcer or benign gastric ulcer
Treatment of pathological hypersecretory conditions such as Zollinger–Ellison syndrome
Prophylaxis of stress-induced ulcers and acute upper GI bleeding in critical patients
Treatment of erosive gastroesophageal reflux
Relief of symptoms of heartburn, acid indigestion, and sour stomach (OTC preparations) |
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Term
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Definition
Treatment: 1 PPI + 2 Antibiotics
Clarithromycin–based
PPI in standard dose + Clarithro+Amoxicillin
If tested Positive for H. Pylori again, another round of treatment with different combination is used |
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Term
| Treatment of opioid related constipation |
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Definition
| Methylnaltrexone (Relistor): Only used to treat opioid-related constipation for patients with chronic pain and receiving palliative care; Selective opioid antagonist that does NOT cross the blood-brain barrier; Needs to be given via subcut. Injection daily. |
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Term
| Antiemetics and antidiarrheals safe for pedi |
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Definition
If ingest poison, do not induce vomiting (contact local poison control center)
Antiemetics should be used with caution in children who are at higher risk for adverse effects, including depressing central nervous system (CNS) effects, as well as fluid and electrolyte disturbances.
Prochlorphenazine is often a drug of choice with children. |
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