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254 Cards in this Set
- Front
- Back
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symptoms of allergic rhinitis
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sneezing, runny nose, itching, nasal congestion
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symptoms of allergic rhinitis are caused by
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leukotrienes, histamines, prostaglandins
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commonly associated disorders with allergic rhinitis are
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conjunctivitis, sinusitis, asthmatic reactions
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seasonal allergies tend to be _____; perennial allergies tend to be _____
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outdoor, indoor
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adverse effects of first generation antihistamines
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sedation, anticholinergic
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adverse effects of second generation antihistamines
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rare
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are antihistamines useful against colds
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no but useful against rhinorrhea of cold
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fluticasone class
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intranasal glucocorticoid
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action of fluticasone
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predominantly local anti inflammatory
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adverse effects of fluticasone
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drying, itching, burning; rare=sore throat, epistaxis, HA; rare systemic=adrenal suppression, slowed growth in children
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dose of fluticasone
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adults
2 sprays daily |
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at what stage of allergic rhinitis do we typically use fluticasone
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prophylactically, before exposure
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cromolyn class
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intranasal cromolyn
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action of cromolyn
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suppresses release of histamine
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adverse effects of cromolyn
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negligible
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cromolyn is used to treat when?
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in advance, prophylaxis
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how long does cromolyn take to see effects
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weeks
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phenylephrine class
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sympathomimetics (decongestants)
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action of phenylephrine
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reduce nasal congestion via vasoconstriction
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adverse effects of phenylephrine
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rebound congestion, CNS stimulation, cardiovascular, hemorrhagic stroke with phenylporpanoloamine, abuse (psuedoephedrine, ephedrine), can raise blood pressure
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topical phenylephrine acts how fast
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rapid and intense
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oral phenylephrine acts how fast
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prolonged, moderate, systemic effects
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phenylephrine is used to treat what besides nasal congestion
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sinusitis and colds
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what is the recommended dosing schedule for sympathomimetics (Decongestants)
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5 days on, 3 days off
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ipratropium bromide class
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anticholinergic
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action of ipratropium bromide
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blocks cholinergic receptors and inhibits secretions to relieve rhinorrhea in allergic rhinitis and asthma
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systemic effects of ipratropium bromide
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none
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side effects of ipratropium bromide
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drying, irritation; not as drying as an inhalant
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anticholinergic effects
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dry mouth, throat, nasal passages; thickened secretions, urinary hesitancy, constipation, palpations
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montelukast class
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leukotriene antagonist
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action of montelukast
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blocks binding of leukotrienes to receptors thereby relieving nasal congestion
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adverse effects of montelukast
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none significant
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how do leukotrienes cause nasal congestion
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vasodilation and increased vascular permeability
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omalizumab class
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monoclonal antibody
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action of omalizumab
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shown to decrease serum levels of IgE as much as 90%
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uses for omalizumab
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seasonal allergic rhinitis; only approved for asthma at present
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drugs for treating allergic rhinitis
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fluticasone, cromolyn, phenylephrine, ipratropium bromide, montelukast, omalizumab
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fluticasone aka
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flonase
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cromolyn aka
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nasalcrom
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phenylephrine aka
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neo synephrine
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ipratropium bromide aka
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atrovent
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montelukast aka
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singulair
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omalizumab aka
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xolair
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what is the best opiod cough suppressant
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codeine
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what is the best non opiod cough suppressant
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dextromethorphan
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antitussives aka
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cough suppressants
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action of antitussives
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elevate cough threshold in common cold and URTI
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dextromorphan adverse effect
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can lead to mind body dissociation equal to PCP
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guaifenesin aka
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mucinex
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guaifenesin class
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expectorants
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action of guaifenesin
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increases flow of respiratory tract secretions
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what must we increase our intake of when taking expectorants
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fluids
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acetylcysteine class
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mucolytics
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acetylcysteine aka
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mucomyst
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action of acetylcysteine
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directly thins secretions
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how is acetylcysteine delivered
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inhalation
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adverse effects of acetylcysteine
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can trigger bronchospasm; obnoxious odor
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how do we treat colds
|
symptomatically
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what conditions are more susceptible to effects of drugs used to treat colds
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glaucoma, hypertension, asthma, emphysema, COPD
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what function of prostaglandins is inhibited with NSAIDS
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renal protective qualities
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calcium is critical to
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skeletal, nervous, muscular and cardiovascular systems; heart rhythm conduction, clotting
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main body store of calcium is
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bones, 90+%
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absorption of calcium is increased with
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parathyroid hormone and vitamin d
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calcium is excreted
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renally
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excretion of calcium is decreased with _____ and increased with
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parathyroid hormone and vit d; up with loop diuretics, sodium loading, calcitonin, lactation
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bone has a unique healing ability because
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it makes like new, no scar tissue
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symptoms of hypercalcemia
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usually none
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causes of hypercalcemia
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cancer, increased PTH, vit D toxicity, thiazides
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we can promote excretion of calcium with these substances
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furosemide and IV saline
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we can decrease mobilization from bone of calcium with these substances
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calcitonin, bisphosphonates, inorganic phosphates, gallium nitrate
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we can decrease intestinal absorption of calcium with these substances
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glucocorticoids
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hypocalcemia increases
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neuromuscular excitability
|
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causes of hypocalcemia
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decreased pth, decreased vit d and Ca++
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signs of hypocalcemia
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tetany, convulsions, spasm of the pharynx, carpopedal spasm
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drug therapy for hypocalcemia
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iv calcium (calcium gluconate), vitamin d
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calcium citrate aka
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citracal
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calcium citrate class
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calcium salts
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action of calcium citrate
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keeps levels up, prevents resorption to treat mild hypocalcemia in children, adolescents, elderly, post menopause, pregnant and lactating women
|
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adverse effects of calcium citrate
|
hypercalcemia
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|
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calcium citrate drug drug interactions
|
glucocorticoids and omeprazole
|
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calcium citrate drug food interactions
|
spinach, beets, bran, whole grain cereals
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what does calcium citrate not require that other forms of calcium do
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food for absorption
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calcium salts should be limited to _____ at one time
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600 mg
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adverse effects of iv admin for calcium salts
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give IV only, if given IM or extravasated, will cause necrosis; bradycardia with digoxin, precipitates with certain additives
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action of vitamin d
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increases serum Ca++ and phsophorus levels to prevent rickets, osteomalacia, osteoporosis
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how is vit d affected by bile
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carries vit d for excretion
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who should def supplement with vit d
|
dark skinned, photo sensitive
|
|
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adverse effects of vit d
|
hypercalcemia, toxicity
|
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calcitonin-salmon aka
|
calcimar
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|
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action of calcitonin salmon
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inhibits osteoclasts decreasing bone resorption to treat established osteoporosis; inhibits tubular resorption of Ca++ increasing its excretion to treat hypercalcemia
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what should be considered with intranasal calcitonin salmon rx
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body becomes resistant with repeated use
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alendronate class
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biphosphonates
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alendronate aka
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fosamax
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action of alendronate
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structural analogs of pyrophosphate of bone incorporated into bone and inhibit resorption by decreasing number and activity of osteoclasts
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uses of alendronate
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osteoporosis, glucocorticoid induced osteoporosis, paget's, hypercalcemia of malignancy
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do NOT give alendronate with _____
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food; decreases absorption to 7% (liquids to 60%)
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how long is alendronate effective
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remains for decades once incorporated
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adverse effects of alendronate
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esophagitis, ocular inflammation, bisphosphonate related osteonecrosis of jaw (mostly IV), low stress long bone fractures
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recommended dosing for alendronate
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take for 5 years then take a vacation due to long bone fracture risk
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raloxifene aka
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evista
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raloxifene is used to treat
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osteoporosis in women
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raloxifene class
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selective estrogen receptor modulator
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beneficial effect of raloxifene
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cardioprotective in high risk women; reduces spinal fx, can decrease plasma levels of cholesterol, reduces estrogen receptor breast cancer
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adverse effects of raloxifene
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can cause blood clots
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teriparatide promotes
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bone formation
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teriparatide aka
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forteo
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action of teriparatide
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recombinant pth that increases activity of osteoblasts-only drug to build bone
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hydrocortisone class
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topical glucocorticoids
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action of hydrocortisone
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anti inflammatory for relief of itching in bites, burns, dermatitis, psoriasis, eczema, pemphigus
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systemic effects of hydrocortisone
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osteoporosis, impaired bone formation
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adverse effects of hydrocortisone
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infection, irritiation, atrophy, acne, hair, growth and adrenals
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do not use _____ dressings with hydrocortisone
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bio occlusive
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non drug therapy for acne
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surface oil reduction, dermabrasion
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mild drug therapy for acne
|
topical antibiotics and retinoids
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moderate drug therapy for acne
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oral antibiotic and comedolytics, oral contrceptives
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severe drug therapy for acne
|
isotretinoin
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antibiotic topical agents for acne
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benzoyl peroxide, clindamycin and erythromycin, dapsone
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if you use only one acne drug _____ will result
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drug resistance
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topical retinoids for acne
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retinol
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retinoids are
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vitamin a derivatives
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action of retinol
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unplug comedones and prevent new ones, reduce inflammation
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adverse effects of retinol
|
peels, burning, crusting
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cautions with retinol
|
avoid abrasives, keratolytics, sun; apply to clean, dry skin; avoid eyes, nose, mouth, open wounds, sunburn
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action of benzoyl peroxide
|
suppresses growth of p. acnes
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oral antibiotics for acne
|
doxycycline, minocycline, tetracycline, erythromycin
|
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max benefit for acne oral antibiotics
|
3-6 months then switch to topicals
|
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isotretinoin class
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oral retinoids
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isotretinoin aka
|
accutane
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adverse effects of isotretinoin
|
nosebleed, inflamed lips/eyes, muscle and back pain, UV light sensitivity, increased triglycerides, highly teratogenic, depression (rare)
|
|
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drug drug interactions with oral retinoids
|
tetracyclines, vit a
|
|
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only full range sunscreen is
|
avobenzone
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|
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sunscreen max benefit is reached at spf
|
30
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adverse effects of sunscreens
|
contact dermatitis, photosensitivity
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drug drug interactions with sunscreen
|
benzocaines, sulfonamides, thiazides
|
|
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drugs used to treat psoriasis
|
topical glucocorticoids, vit d3, tar, uvb radiation, methotrexate
|
|
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methotrexate aka
|
trexall
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adverse effects of methotrexate
|
diarrhea, stomatitis, pancytopenia, hepatotoxic, can lead to death (gut and bone marrow cells can turn over to rapidly)
|
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three basic funtions of kidney
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cleanse ecf and maintain volume and composition; maintain acid base balance; excrete metabolic wastes and foreign substances
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the kidney considers drugs to be _____
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foreign substances
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filtration in the kidney is _____
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non selective
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resorption in the kidney is
|
highly selective
|
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purpose of diuretics
|
increase urinary output; treatment of hypertension, mobilization of edematous fluid, maintain urine flow, thereby aids prevention of renal failure
|
|
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action of diuretics
|
blockade of sodium and chloride re absorption at proximal tubule; incrase urine directly related to blockage effect
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adverse effects of diuretics
|
hypovolemia, acid base imbalance, electrolyte imbalances
|
|
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classification of diuretics
|
high ceiling loop-furosemide
thiazide-hydrochlorothiazide osmotic-manitol potassium sparing (aldosterone antagonists-spironolactone) and (nonaldosterone antagonists-triamterene) carbonic anhydrase inhibitors |
|
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furosemide aka
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lasix
|
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furosemide class
|
high ceiling loop diuretic
|
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action of furosemide
|
acts on ascending loop of henle to block re absorption
|
|
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how quickly does furosemide act
|
starts in 1 hour
|
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therepeutic uses of furosemide
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pulmonary edema of CHF, edematous states (liver, heart, kidney), hypertension resistant to other diuretics, hypercalcemia
|
|
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adverse effects of furosemide
|
hyponatremia, hypochloremia, dehydration, hypotension (decreased afterload)-loss of volume, relaxation of venous muscle
hypokalemia esp with digitalis ototoxicity hyperglycemia (uncommon) hyperuricemia use in pregnancy increased LDL, cholesterol, triglycerides, decreased HDL decreased calcium decreased magnesium |
|
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one of the first lab signs of dehydration
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BUN
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indications of K problems
|
nausea, vomiting, general weakness
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drug interactions of furosemide
|
digoxin, ototoxic drugs, potassium sparing diuretics, increased lithium levels, antihypertensive agents, NSAIDS (decreases renal blood flow)
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|
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hydrochlorothiazide aka
|
hydroDIURIL
|
|
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therapeutic use of benzothiazides and hydrochlorothiazide
|
essential hypertension, edema, diabetes insipidus
|
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benzothiazides and hydrochlorothiazides are ineffective with ___
|
low glomerular filtration rate
|
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adverse effects of benzothiazides and hydrochlorothiazides
|
same as high ceiling loops except can use with ototoxics
|
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ototoxic drugs include
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aspirin, NSAIDS
|
|
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preload
|
how far the ventricles have to stretch and pump against
|
|
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afterload
|
resistance to pumping out blood
|
|
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hydrostatic pressure
|
pressure exerted by water (blood) on the system
|
|
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cardiac strength
|
inotropic, how strong is the heart muscle
|
|
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arterial pressure is regulated by
|
autonomic nervous system (ANS), RAAS (renin angiotension aldosterone system), kidneys, natriuretic peptides
|
|
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actions of angiotensin II
|
vasoconstriction, release of aldosterone, alter structure of heart and vessels
|
|
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actions of aldosterone
|
fibrosis of vessels; regulation of sodium and water
|
|
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captopril, ramipril class
|
ace (angiotensin converting enzyme) inhibitors
|
|
|
captopril aka
|
capoten
|
|
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ramipril aka
|
altace
|
|
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action of captopril, ramipril
|
reduce angiotensin II and increase bradykinin to dilate vessels, excrete na and h2o, conserve k and help prevent vessel and heart tissue changes
|
|
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uses of captopril, ramipril
|
htn, heart failure, diabetic neuropathy, prevention of mi, stroke and death
|
|
|
special benefits of ace inhibitors
|
do NOT interfere with heart reflexes-ok with exercise; safe in asthma; do not cause hypokalemia, hyperuricemia or hyperglycemia; do NOT induce lethargy, weakness or sexual dysfunction; reduce risk of cardiovascular mortality from htn, mi and stroke; reduce mortality following MI; reduce chance of developing heart failure; slow progression of renal disease
|
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what drug should NOT be used with ace inhibitors
|
potassium sparing diuretics
|
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adverse effects of ace inhibitors
|
1st dose hypotension, cough, hyperkalemia, rf in renal artery stenosis, angiodema, neutropenia (rare), dysgeusia and rash
|
|
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ace inhibitors are excreted
|
renally
|
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drug drug interactions with ace inhibitors
|
diuretics, antihypertensive agents, drugs that raise potassium levels, lithium, NSAIDS
|
|
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drug food interactions with ace inhibitors
|
salt sub
|
|
|
losartan, valsartan class
|
angiotensin II receptor blockers (ARBS)
|
|
|
losartan aka
|
cozaar
|
|
|
valsartan aka
|
diovan
|
|
|
action of arbs
|
blocks action of angiotensin II, protects from cardiovascular structural changes and valsartan reduces cv mortality; decreases aldosterone; slow progression of established renal disease (irbesartan and losartan); increases renal excretion of na and h20; does not inhibit kinase II or increase bradykinin in the lungs
|
|
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what are arbs also used for that is not cardiac related
|
migraine
|
|
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main difference between aces and arbs
|
no cough or significant hyperkalemia with arbs
|
|
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drug drug adverse reactions for arbs
|
antihypertensives
|
|
|
adverse effects of arbs
|
same as aces; less angioedema
|
|
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eplerenone class
|
aldosterone antagonist
|
|
|
eplerenone aka
|
inspra
|
|
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action of eplerenone
|
selective blockade of aldosterone receptors for tx of htn and heart failure
|
|
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how long does eplerenone need to be effective
|
4 weeks
|
|
|
adverse effects of eplerenone
|
hyperkalemia
|
|
|
drug drug interactions of aldosteron antagonists
|
inhibitors of cyp3a4; drugs that raise potassium levels; caution when combined with lithium
|
|
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spironolactone class
|
aldosterone antagonists
|
|
|
spironolactone aka
|
aldactone
|
|
|
action of spironolactone
|
blocks aldosterone receptors; binds with receptors for other steroid hormones
|
|
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uses for spironolactone
|
hypertension and heart failure
|
|
|
adverse effects of aldosterone antagonists
|
hyperkalemia, gynecomastia, menstrual irregularities, impotence, hirsutism, deepening of the voice
|
|
|
effects of calcium channel blockers
|
decreased inotropic effect; slows conduction through sa and av nodes; same effect as beta blockers
|
|
|
nifedipine class
|
calcium channel blocker
|
|
|
nifedipine aka
|
procardia
|
|
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action of nifedipine
|
peripheral artery dilation=decreased bp; increased coronary perfusion; blocks conduction, decreases hr, decreases force of contraction
|
|
|
nifedipine indicated for
|
angina pectoris, essential hypertension, cardiac dysthythmias, a flutter/fib/svt, prevent migraine
|
|
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adverse effects of nifedipine
|
constipation, dizziness, facial flushing, headache, edema of ankles and feet, gingival hyperplasia, bradycardia, heart block and reduced stroke volume
|
|
|
hold nifedipine when?
|
hr below 60
|
|
|
drug drug interactions of nifedipine
|
digoxin and beta adrenergic blocking agents
|
|
|
toxicity symptoms of ccbs
|
severe hypotension, bradycardia and av block, ventricular tachy dysrhythmias
|
|
|
treatment for ccb toxicity
|
calcium gluconate, nor epi, atropine, pacer, cathartics, cardioversion
|
|
|
action of vasodilators
|
selectively dilates arteries, veins or both
|
|
|
principal indications of vasodilators
|
essential hypertension, hypertensive crisis, angina pectoris, mi, heart failure, pheochromocytoma, peripheral vascular disease, pulmonary arterial htn, controlled hypotension during surgery
|
|
|
hydralazine class
|
vasodilator
|
|
|
hydralazine aka
|
apresoline
|
|
|
action of hydralazine
|
selectively dilates vsm of arterioles lowering bp and reduces afterload
|
|
|
hydralazine for treatment of
|
essential hypertension, hypertensive crisis (iv form), angina pectoris, mi, heart failure
|
|
|
adverse effects of hydralazine
|
postural hypotension, reflex tachycardia, increased blood volume, reversible SLE-like syndrome
|
|
|
drug drug interactions with hydralazine
|
other antihypertensive agents
|
|
|
combine hydralazine with beta block to prevent _____
|
reflex tachy
|
|
|
other vasodilators besides hydralazine include
|
aces, arbs, ccbs, organic nitrates (ntg), sodium nitroprussid (nipride), sympatholytics, nesiritide (natrecor)
|
|
|
types of hypertension
|
primary (essential) and secondary
|
|
|
normal hypertension levels
|
systolic <120 and diastolic <80
|
|
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prehypertension levels
|
systolic 120-139 OR diastolic 80-89
|
|
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stage 1 hypertension levels
|
systolic 140-159 OR diastolic 90-99
|
|
|
stage 2 hypertension levels
|
systolic >= 160 OR diastolic >= 100
|
|
|
consequences of hypertension
|
heart disease (myocardial infarction, heart failure, angina pectoris), kidney disease, stroke
|
|
|
meds for hypertension are targeted to affect
|
heart rate, myocardial contractility, blood volume, venous return/resistance
|
|
|
list special considerations related to african americans and hypertension
|
320% have hypertension related ESRD; diuretics/ccbs med of choice, aces, arbs if indicated with comorbidities
|
|
|
drugs for hypertensive emergencies
|
sodium nitroprusside (nipride); fenoldopam, labetalol, diazoxide
|
|
|
response to alpha 1 receptor activation
|
increased pupil size, arteriole constriction, vein constriction, male ejaculation, contraction of prostate capsule, contraction of trigone and sphincter in bladder
|
|
|
response to alpha 2 receptor activation
|
inhibition of transmitter release at presynaptic nerve terminals
|
|
|
response to beta 1 receptor activation
|
increased heart rate, increased force of contraction, increased av conduction velocity; renin release from kidneys
|
|
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response to beta 2 receptor activation
|
dilation of arterioles, dilation of bronchi, relaxation of uterus, glycogenolysis in liver, enhanced contraction and glycogenolysis in skeletal muscle
|
|
|
response to dopamine receptor activation
|
dilation of kidney vasculature
|
|
|
therapeutic effects of alpha receptor blockade
|
essential hypertension (vasodilation), reverses toxicity from a1 agonists; benign prostatic hyperplasia (decreases smooth muscle contraction in bladder neck), pheochromocytoma (catecholamine secreting tumor), raynauds disease (vasodilation)
|
|
|
prazosin class
|
selective alpha 1 blocker
|
|
|
prazosin aka
|
minipress
|
|
|
action of prazosin
|
dilates arterioles and veins, relaxes smooth muscle in bladder neck and prostate capsule
|
|
|
adverse effects of prazosin
|
orthostatic hypotension, reflex tachycardia, inhibition of ejaculation, nasal congestion
|
|
|
therapeutic effects of beta blockade
|
decreased heart rate and decreased force of contraction; decreased velocity of impulses through av node
|
|
|
beta blockers for management of
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angina pectoris, myocardial infarction, hypertension, cardiac dysrhythmias, heart failure, hyperthyroidism, migraine, stage fright, pheochromocytoma, glaucoma
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propranolol class
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non selective beta blocker
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propranolol aka
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inderal
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adverse effects of propranolol
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bradycardia, av heart block, precipitation of heart failure, reduced cardiac output, rebound cardiac excitation w abrupt cessation, bronchoconstriction, blockade of glycogenolysis
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contraindications with beta blockers
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severe allergic conditions, diabetes
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drug interactions with beta blockers
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ccbs esp verapamil
insulin |
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things to watch with beta blockers
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heart rates (brady or rebound tachy), masking of hypoglycemia reactions, taper off gradually
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metoprolol class
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cardioselective beta1 blocker
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metoprolol aka
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lopressor, toprol
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action of metoprolol
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beta1 at therapeutic doses, global at higher doses; don't cause bronchoconstriction (otherwise same as propranolol)
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adverse effects of metoprolol
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same as propranolol except bronchoconstriction and glycogenolysis; safer in asthmatics and diabetics
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clonidine class
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centrally acting alpha 2 agonists
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clonidine aka
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catapres
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action of clonidine
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decreases release of norepi, limiting vasoconstriction, therefore lowering blood pressure and heart rate
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clonidine is used for what besides hypertension
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severe cancer pain
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how soon does clonidine begin working
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within 30 mins; can last for 24 hours
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adverse effects of clonidine
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rebound htn from sudden withdrawal; drowsiness, xerostomia, embryotoxic, constipation, impotence, gynecomastia
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clonidine is administered in what forms
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po and patches
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