Term
|
Definition
| Methylxanthine drug that increase cGMP concentration by inhibiting breakdown, which results in bronchodilation. Effects multiple body systems (CNS-excitation, insomnia; CV-positive chronotropic and iontropic effects; GI-stimulated gastric acid secretion; Renal-weak diureses; Smooth muscle-bronchodilation without tolerance; Skeletal muscle-strengthen contraction (diaphragm-reverse fatigue for COPD patients)). Narrow therapeutic index (10-20 mg/L), so monitoring is important. Many drug-drug interaction as it is metabolized by CYP 450. |
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Term
|
Definition
| Bulk forming laxative that causes colonic distention and increased peristalsis. |
|
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Term
|
Definition
| Ulcer-adherent complex at the ulcer site, protecting it against further acid attack, forms a viscous, adhesive barrier on the surface of intact mucosa of the stomach and duodenum, also inhibits pepsin activity. |
|
|
Term
| Sucralfate Kinetics & Dosing |
|
Definition
| Give on an empty stomach, as drug interferes with food. Excreted feces. Antacids should not be taken within one-half hour before or after administration. Do not take cimetidine, ciprofloxacin, digoxin, norfloxacin, ofloxacin, and ranitidine within 2 h before administration. Dosed 3-4 times a day prior to meals and bed in oral pill or suspension. |
|
|
Term
| Sucralfate Monitoring & ADR |
|
Definition
| Signs and symptoms or endoscopic improvement is indicative of efficacy, blood glucose levels in diabetic patients, renal function in elderly patients. Common side effect constipation. |
|
|
Term
|
Definition
| Type of leukotriene antagonist. Blocks leukotriene D4 receptors to inhibit leukotriene pathway. Block response to exercise and antigen challenge. Minimal side effects. |
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Term
|
Definition
| Been shown to improve asthma control and to reduce the frequency of asthma exacerbations in outpatient clinical trials. Taken orally. Approved for children as young as 6 years of age. Also used in aspirin-induced asthma. |
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Term
|
Definition
| MOA: Proton pump inhibitor, binds to H+/K+ exchanging ATPase in gastric parietal cells which blocks acid secretion. Uses: duodenal ulcer, H. Pylori, Gastric ulcer, GERD, Erosive Esophagitis, Hypersecretory condition. ADR: Due to med being metabolized in the liver, patients with impairment need dose adjustments. MANY drug intxns, cough, URI, abd pain, acid regurge, constipation, D/N/V, gas, rash, taste perversion. |
|
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Term
|
Definition
| Muscarinic anatgonist, blocks receptors in bronchi to promote bronchodilation, best results when used in combo with beta-2 adrenergic agonists. |
|
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Term
|
Definition
| approved for bronchospasm associated with COPD but often used for excercise induced or allergen induced asthma. Needs frequent q 4 hour dosing via MDI or TID with neb. |
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Term
|
Definition
| ADRs- (Combivent) contraindicated with peanut allergy (soys lethicin, family of peanut, used as carrier). Dry mouth, irritation of the pharynx. Very little to no systemic absorption through the lungs. |
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Term
|
Definition
| A mast cell stabilizer given in anticipation of an exposure to an allergen. NOT FOR ACUTE EPISODES. Works on three different pathways: Mast cells-inhibits their early response. Eosinophils-Inhibits inflammation. Airway nerves- Inhibits cough. Cromolyn and other mast cell stabilizers do not cause bronchodilation. Must be administered locally (inhalers, eye drops) as they are insoluble and have no absorption. ADR: cough, airway and nasal irritation, nausea, and unpleasant taste. Needs frequent dosing and monitoring which contributes to a poorer compliance. |
|
|
Term
|
Definition
| A Beta-2 specific sympatomimetic used in the treatment of asthma. Available as an inhaler and PO. MOA= relaxation of bronchial smooth muscle and inhibition of mast cell mediator release due to stimulation of B2 receptors. Typically used to provide short-term relief in asthma attacks. ADRs= tachycardia, tremors, nervousness. |
|
|
Term
|
Definition
histamine
H2-receptor antagonist that inhibits stomach acid production. |
|
|
Term
|
Definition
treatment
of peptic ulcer disease (PUD) and gastroesophageal reflux disease (GERD). |
|
|
Term
|
Definition
Alters the function of delayed chloride channels, inhibiting inflammatory cell activation. This prophylactically prevents acute
bronchospasm. |
|
|
Term
|
Definition
| Poorly absorbed, resulting in minimal ADRs. Cough, throat irritation, and mouth dryness may occur. |
|
|
Term
|
Definition
| Prophylaxis for asthma induced by both exercise and antigens (inhaled); other routes useful for ocular, nasal, and GI allergies |
|
|
Term
|
Definition
| Irreversible blocking of H+, K+-ATPase inhibitors in actve parietal cells of the stomach, leading to a decrease in gastric secretion of up to 98% |
|
|
Term
| Omeprazole Pharmacokinetics |
|
Definition
| administered as an inactive prodrug, to protect the acid labile prodrug from rapid destruction when given orally it is formulated for delayed release as an acid-resistent, enteric coated capsule or tablet; the coating is dissolved after passing through the alkaline intestine lumen and the prodrug is released. It is available as a capsule or in a powder formation |
|
|
Term
|
Definition
| GERD, Peptic Ulcer Disease, treatment of H Pylori associated ulcers, NSAID associated ulcers and prevention of stress related bleeding in critcally ill patients |
|
|
Term
| Omeprazole Adverse Effects |
|
Definition
| Very well tolerated. Diarrhea, headache, abdominal pain in 1-5% of patients. |
|
|
Term
|
Definition
| competative, nonselective antagonist at M receptors |
|
|
Term
| Ipratropium Clinical Uses |
|
Definition
| Inhilation is used for Prevention or relief of acute episodes of bronchospasm. Can be used intranasal which is a local application that inhibits secretions from glands lining the nasal mucosa which decreases rhinorrhea |
|
|
Term
|
Definition
| Xerostomia, cough, dizziniess, HA |
|
|
Term
|
Definition
| Treats constipation, a bowel prep, bowel care, is a stimulant laxative that works by stimulating sensory nerve endings to create parasympathetic reflexes producing peristaltic movement of the colon. Evacuation usually occurs 15min to 1 hr with suppository and 6-12 hour with oral dose and is effective in parapalegia and poliomyelitis patients. |
|
|
Term
|
Definition
| Bioavailable - do not take within 1 hour of milk ingestion to prevent rapid dissolution of enteric coating, is hydrolyzed to produce laxative effects, excreted in feces |
|
|
Term
| Bisacodyl Adverse Effects |
|
Definition
| Abd. cramping, colic, diarrhea with prolonged use that can produce water and potassium loss, rectal irritation, laxative abuse that can create abd. pain, weakness, fatigue, thirst, vomiting, nausea, fluid and electrolyte balance, and edema. |
|
|
Term
|
Definition
| H2 receptor antagonist. Competitive inhibition at the parietal H2 receptor and suppresses basal and-stimulated acid secretion. Reduces acid secretion by two mechanisms: 1) Histamine is blocked from binding to the parietal cell H2 receptor. 2) direct stimulation of the parietal cell by gastrin or acetylcholine has a diminished effect on acid secretion in the presence of H2 receptor blockade. |
|
|
Term
|
Definition
| GERD, Peptic Ulcer Disease, Non-Ulcer Dyspepsia, Prevention of bleeding from stress-related gastritis. H2 antagonists are heavily used by the public and continue to be prescribed, but they are becoming less favored than proton pump inhibitors. |
|
|
Term
|
Definition
| Extremely safe with ADR occurring in less than 3% of patients and consisting of diarrhea, headache, fatigue, myalgias, and constipation. Mental status changes include: confusion, hallucinations, and agitation. |
|
|
Term
|
Definition
| Natural plant product that acts as a bulk-forming laxative. It is an indigestible, hydrophilic colloid that absorbs water and forms a bulky, emollient gel that distends the colon and promotes peristalsis |
|
|
Term
|
Definition
| Increased bloating and flatus |
|
|
Term
|
Definition
| Sucralfate has a negative charge and it binds to the positively charged proteins at the base of GI ulcers. This forms a barrier, protecting the ulcer and also stimulates mucosal prostaglandin and bicarbonate secretion. |
|
|
Term
|
Definition
| Prevention of GI bleeding in critically ill patients. It is slightly less effective than H2 antagonists and proton pump inhibitors, but does not increase the risk of nosocomial pneumonia. |
|
|
Term
| Sucralfate Adverse Effects |
|
Definition
| Constipation in 2% of patients because of aluminum salt. No systemic effects because it is not absorbed. |
|
|
Term
| Sucralfate Drug Interactions |
|
Definition
| It can bind to other medications, which impairs their absorption. |
|
|
Term
|
Definition
| Only small amounts of aluminium salt is absorbed. For this reason prolonged use should be avoided in patients with renal impairment. Most of the medication is not absorbed in the GI tract. |
|
|
Term
|
Definition
| Methylxanthine; Uncertain of exact MOA. Phosphodiesterase inhibition. Adenosine receptor antagoinst |
|
|
Term
|
Definition
| Bronchodilation; cardiac stimulation; increased skeletal muscle strength (diaphragm) |
|
|
Term
| Theophylline Clinical Applications |
|
Definition
|
|
Term
|
Definition
| Narrow therapeutic window; its therapeutic and toxic effects are related to its blood level; Anorexia; N/V; abd. discomfort; HA; anxiety; seizures; arrhythmias;watch in pts with liver disease since it is metabolized by the liver |
|
|
Term
| Montelukast (Singulair) MOA |
|
Definition
| Blocks the leukotriene LTD4 receptors |
|
|
Term
|
Definition
| Shown to improve asthma control and to reduce the frequency of asthma exacerbations. Approved for use in children as young as 6 years old. Used for aspirin-induced asthma. |
|
|
Term
|
Definition
| Blocks airway response to exercise and antigen challenge |
|
|
Term
| Montelucast adverse effects |
|
Definition
| minimal. Little toxicity. Nausea, diarrhea, abdominal pain, HA, dizziness, neuropsychiatric events. Pregnancy Category Class B |
|
|
Term
|
Definition
| sympathomimetic-beta specific |
|
|
Term
|
Definition
| beta 2 receptor agonist that causes relaxation of bronchial smooth muscle resulting in bronchodilation |
|
|
Term
|
Definition
| Treatment for bronchoconstriction of Asthma, used for acute episodes of bronchospasms, not for prophylaxis |
|
|
Term
| Albuterol Adverse Effects |
|
Definition
| skeletal muscle tremors, nervousness, occassional weakness, tachycardia, arrhythmias, and LOC |
|
|
Term
|
Definition
Anti-inflammatory
-Inhibits chloride channels in cell membrane
-prevents mast cell degradation in the lung... which prevents bronchoconstriction
-prevents release of histamine (aka antihistamine) |
|
|
Term
|
Definition
Prophylactic treatment of ASTHMA-
-drug is Inhaled
(does NOT work during asthma attack)
Allergic Rhinoconjuctivitis= perennial allergies
-drug is given nasally or via eye drops
(prevents runny nose, itchy, watering eyes) |
|
|
Term
|
Definition
Very little toxicity since drug is very poorly absorbed
(which is why it isn't given orally):
Minor S/E:
-throat irritation
-cough
-dry mouth
-chest tightness/wheezing (rare)
SAFE for use in CHILDREN |
|
|
Term
|
Definition
Selective and active leukotriene receptor antagonist, binds to cysteinyl leukotrienes (CysLT) type-1 receptors
found in human airway (smooth muscle cells and macrophages),preventing airway edema, smooth muscle contraction and other respiratory
inflammation. |
|
|
Term
| Montelukast (Clinical Uses) |
|
Definition
| asthma and exercise induced asthma, seasonal and perennial allergy rhinitis; approved for use in children as young as 6 years old (per Micromedex, other sources stated use in children as young as a year.). |
|
|
Term
|
Definition
| Headache, Allergic granulomatosis angiitis, Stevens-Johnson syndrome, Toxic epidermal necrolysis, Aggressive behavior, Altered behavior, Suicidal thoughts |
|
|
Term
|
Definition
Antagonist that competitively blocks the H2 receptor of the parietal cell in the stomach, leading to a decrease in acid production. Used in the treatment of:
-Gastroesophageal Reflux Disease (GERD)
-Peptic Ulcer Disease
-Dyspepsia (non-ulcer)
-Prevention of stress related gastritis |
|
|
Term
|
Definition
| few ADR, but can include diarrhea, headach, fatigue, myalgias, and constipation. With IV preps can cause mental status changes esp. those that are elderly, or renal or hepatic impairment |
|
|
Term
|
Definition
Bulk forming laxatives made from indigestible parts of fruits, vegetables, and seed
Used to absorb water causing a bulky emollient gel that distends the colon, induces peristalsis, and stimulates evacuation |
|
|
Term
| psyllium (ADR and nursing considerations) |
|
Definition
| Increased bloating and flatus. Need adequate amount of water to prevent obstruction. |
|
|
Term
| Sucralfate (Clinical Uses |
|
Definition
| Short term treatment of duodenal ulcers |
|
|
Term
|
Definition
| Negatively charged sucralfate ions bond to high numbers of positively charged protiens of duodenal ulcer craters. |
|
|
Term
|
Definition
| Bisacodyl is hydrolyzed to bis(p-hydroxyphenyl)pyridyl-2-methane, which is responsible for its laxative effects. |
|
|
Term
|
Definition
| Treatment of acute and chronic constipation. BM within 6-12 hours when given po and 15-60 minutes when given rectally. Available in tablet and suppository. |
|
|
Term
|
Definition
| Abdominal discomfort, abdominal cramps or colic, diarrhea, proctitis, atony of colon |
|
|
Term
|
Definition
| Proton Pump Inhibior that irreversibly blockades the H+, K+ ATPase pump in active parietal cells of the stomach |
|
|
Term
|
Definition
| Peptic ulcer, GERD, erosive gastritis |
|
|
Term
|
Definition
-One daily dose can stope about 98% of daily gastric acid secretion BUT cause GI intolerance due to loss of bacteria barrier
-Reduction of acid can reduce absorption of some drugs and increases others
-Pregnancy category C |
|
|
Term
|
Definition
| Several proposed but none are firmly established. Possibly PDE inhibitor, possibly inhibits adenosine receptors on the cells surface, and possibly from the enhancement of histone deacetylation. The most directly involved is as a PDE4 inhibitor: In inflammatory cells it reduces the release of cytokines and chemokines which in turn results in a decreased immune cell activation and migration |
|
|
Term
|
Definition
| Major therapeutic use is the effect on smooth muscle, which causes bronchodilation especially helpful in patients with asthma. CNS: In low and moderate doses causes increased alertness and deferral of fatigue. In higher doses may cause nervousness, insomnia, and bronchodilation in sensitive individuals. CV: Positive chronotropic and inotropic effects (increased rate and force of contraction of hte heart). In low to moderate doses may cause increased cardiac output, tachycardia, increased PVR, slight increase in BP. |
|
|
Term
| Theophylline clinical uses |
|
Definition
| Effective bronchodilator; relieves airflow obstruction in acute asthma exacerbations and reduces severity of symptoms in chronic asthma. |
|
|
Term
|
Definition
| Methylxanthine: Others in this class include theobromine and caffeine |
|
|
Term
|
Definition
| Narrow therapeutic window; plasma concentration goal of 5-20 mg/L associated with an increase in pulmonary function. Routine monitoring of plasma levels ESSENTIAL |
|
|
Term
|
Definition
| May occur in plasma concntration of 15 mg/L in some patients: Anorexia, nausea, vomiting, abdominal discomfort, headache, anxiety, then seizures or arrhythmias are associated with plasma levels >40 mg/L |
|
|
Term
|
Definition
| Associated with plasma levels >40 mg/L: Tachycardia, tremors, vomiting, hypotension, hypokalemia, hyperglycemia. In severe poisoning (plasma level >100 mg/L seizures often occur and are resistant to anticonvulsants. Hemodialysis indicated in levels >100 mg/L and in patients with lower levels experiencing intractable seizures. |
|
|
Term
|
Definition
| Selective antimuscarinic bronchodilator; derivative of atropine; clinical uses include COPD, nasal discharge, and adjunct therapy to asthma exacerbation; aerosol administration limits systemic anticholinergic activity |
|
|
Term
| Ipratropium bromide drug class |
|
Definition
| antimuscarinic (a derivative of atropine) |
|
|
Term
| Which route is ipratropium bromide administered? |
|
Definition
| Inhalation (can be given in large doses as is poorly absorbed and does not readily enter the CNS) |
|
|
Term
| Ipratropium bromide drug class |
|
Definition
| albuterol (enhances the bronchodilation produced by nebulized albuterol) |
|
|
Term
|
Definition
| Competitive antagonist of smooth muscle muscarinic receptors of the PSNS |
|
|
Term
| Clinical effects of Ipratropium bromide (antimuscarinics) |
|
Definition
| Prevents cholinergic medicated bronchoconstriction, prevents vagally mediated mucous production |
|
|
Term
| Uses of Ipatropium bromide |
|
Definition
| COPD, beta blocker induced bronchospasm |
|
|
Term
| ADR of Ipatropium bromide |
|
Definition
| Very few ADR d/t no absorption from the lung and poor CNS entry which minimizes systemic effects |
|
|
Term
|
Definition
| sympathomimetic bronchodilator; beta-specific agonist; short acting |
|
|
Term
|
Definition
| respiratory status; BP; CV status; use (more than one Rx fill per month means not controlled) |
|
|
Term
|
Definition
| most widely used sympathomimetics for treatment of bronchoconstriction of asthma |
|
|
Term
|
Definition
| stimulate beta-2 receptors to relax airway smooth muscles; inhibit mediator release; and cause skeletal muscle tremor & tachycardia as s/e |
|
|
Term
|
Definition
| best delivered by inhalation (MDI, neb) to gain the greatest local effect on airway smooth muscle with the least systemic toxicity; also available PO & parenteral |
|
|
Term
|
Definition
| sketetal muscle tremor; tachycardia; nervousness; arrhythmias |
|
|
Term
|
Definition
| asthma; COPD; drug of choice in acute asthmatic bronchospasm |
|
|
Term
|
Definition
| short onset, max levels 15-30"; duration 3-4 hrs |
|
|
Term
|
Definition
| use for acute episodes of bronchospasm not for prophylaxis (except exercise-induced asthma, may be useful before exercise to prevent bronchospasm) |
|
|
Term
|
Definition
| purified preparation of R-isomer of albuterol, since only the R-isomer activates the beta agonist receptor |
|
|
Term
| albuterol (bronchodilator) emergency asthma action plan |
|
Definition
| Instruct all patients with asthma: for a severe attack, take up to four puffs every 20 minutes over 1 hour. If no clear improvement after the first four puffs, take the additional treatments while on the way to an ER. |
|
|
Term
| Psyllium pharmacologic Category |
|
Definition
|
|
Term
| How should psyllium be administered? |
|
Definition
| Drink at least 8 ounces of liquid with each dose. Mix powder in water or juice. |
|
|
Term
| Psyllium Adverse Reactions |
|
Definition
| GI-abdominal cramps, constipation, diarrhea, esophageal or bowel obstruction |
|
|
Term
|
Definition
| Soluble fiber. Absorbs water in the intestine to form a viscous liquid which promote peristalsis and reduces transit time |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Protects gastroduodenal mucosa - a salt of sucrose complexed to sulfated aluminum hydroxide, which in water or acidic solutions forms a viscous, tenatious paste that binds selectively to ulcers or erosions to act as a barrier. The (-) charged sucrose sulfate is believed to bind with (+) charged proteins in the base of ulcers or erosion creating a viscous protective barrier, protecting from caustic damage and stimulating mucosal prostaglandin and bicarbonate secretion. |
|
|
Term
|
Definition
| Not signifcantly absorbed, thus no systemic adverse effects. Small amount Aluminum absorbed: Not to be used long-term in those with renal insufficiency. Constipation rare: 2% |
|
|
Term
| Sucralfate - To give or not to give with food |
|
Definition
| Give on an empty stomach (1g four times daily). |
|
|
Term
|
Definition
| Limited to use in ICU settings for critically ill patients as a slurry through NG tube for stress related bleeding. |
|
|
Term
|
Definition
| Once a very popular medication used for asthma, it is no longer available in the US |
|
|
Term
| Cromolyn Route of Administration |
|
Definition
| Microfine powder or microfine suspension |
|
|
Term
|
Definition
| Alters the function of chloride channels and inhibits inflammatory cell activation therefore blocking bronchoconstriction before exposure to allergen that causes asthma symptoms |
|
|
Term
|
Definition
| In addition to being used for asthma, this medication has also been used for allergic rhinoconjunctivis as a nasal spray/eye drops |
|
|
Term
|
Definition
| Minimal ADRs, only localized effects such as dryness or irritation with nasal spray or eye drops |
|
|
Term
|
Definition
| Methylxanthine drug with MOA: phosphodiesterase inhibition, adenosine receptor agonist. Of note: several mechanisms have been proposed for the actions of methylxanthines, but none have been firmly established. |
|
|
Term
|
Definition
| Bronchodilation, cardiac stimulation, increased skeletal muscle strength (diaphram) |
|
|
Term
| Theophylline applications |
|
Definition
|
|
Term
|
Definition
| Insomnia, anorexia, nausea, vomiting, abdominal discomfort, headache & anxiety |
|
|
Term
|
Definition
| Improves long-term control of asthma, is inexpensive (important advantage for economically disadvantaged patients in societies in which heatlh care resources are limited), and it can be taken orally. |
|
|
Term
|
Definition
|
|
Term
|
Definition
| GERD, PUD, prevention of bleeding from stress related gastritis |
|
|
Term
| Ranitidine adverse effects |
|
Definition
| very minimal, possibly diarrhea, headache, fatigue |
|
|
Term
| Ranitidine's effects on acid secretion |
|
Definition
| Marked reduction in nocturnal acid secretion, modest reduction in meal time acid secretion |
|
|
Term
|
Definition
| A selective and irreversible proton pump inhibitor. Suppresses gastric acid secretion by antagonism of the H+/K+-ATPase enzyme system on the secretory surface of parietal cells. |
|
|
Term
|
Definition
| Hepatic metabolism with extensive first-pass effect. Dose adjustment is recommended for patients with hepatic impairment. |
|
|
Term
| Omeprazole- common adverse effects |
|
Definition
| Abdominal pain, nausea, flatulence, vomitting, diarrhea, and headache |
|
|
Term
| Omeprazole- serious side effects |
|
Definition
| Stevens-Johnson syndrome, Toxic epidermal necrolysis, C. Diff diarrhea, fracture of bone (hip fracture), rhabdomyolysis, liver failure. |
|
|
Term
| Omeprazole has antimicrobial activity against which organism? |
|
Definition
| Helicobacter pylori; via selective inhibition of H. pylori urease, which is necessary for gastric colonization. |
|
|
Term
| Montelukast Classification |
|
Definition
| Bronchodilator, Leukotriene Receptor Antagonist |
|
|
Term
|
Definition
| Inhibits leukotriene formation; leukotrienes exert their effects by increasing neutrophil, eosinophil migration. These actions further lead to bronchoconstriction, inflammation, and edema. This medication blocks the effects of leukotriene's |
|
|
Term
|
Definition
| Chronic Asthma, seasonal allergic rhinitis, bronchospasm prophylaxis |
|
|
Term
| Montelukast Contraindications |
|
Definition
| Class B Pregnancy, alcohol consumption, severe hepatic disease, corticosteroid withdrawal |
|
|
Term
|
Definition
| Dizziness, fatigue headache, seizures, suicidal ideation, pancreatitis, abdominal pain, influenza, cough, pancreatitis |
|
|
Term
| Montelukast Pharmacokinetics |
|
Definition
| Rapidly absorbed; peak 3-4 hours; half life of 2.7-5.5 hours; 99% protein binding; metabolized in the liver and excreted via bile. |
|
|
Term
|
Definition
| Commonly used medications: Barbiturates, Carbamazepine, Phenytoin. May increase AST and ALT labratories |
|
|
