Essentials One Final Pharm

Front 1

Ace Inhibitors

Back 1

"Prevents MI
Action: completely blocks the angiotensin I converting enzyme, prevents production of angiotensin II, decreases vascular tone, absence of aldosterone release leads to excretion of fluid.

SE: hypkalemia, dry cough, angioedema (stop med!), taste impairment do not use K supplements.

Drug-drug addictive effect with other anti HTN, don't take with NSAIDs."

Front 2

Albumin

Back 2

"Protein in plasma, very sticky, helps restore intravascular volume.

Used for hypovolemic shock, needs vented tubing.

Hyperosmolar moves water from interstitial space to vascular space."

Front 3

Alpha blockers

Back 3

"Blocks alpha 1 receptors, vasodilation, and lower peripheral vascular resistance.

SE: can cause orthostatic hypotension with first or increasing doses. Relaxes urinary sphincter tone, weakness, GI sx, stuffy nose, edema of lower extremities, ha, syncope, SOB

"

Front 4

Amyl nitrate

Back 4

"Decreases blood pressure, increases heart rate, relaxes involuntary muscles such as blood vessel walls and anal sphincter. Reduces after load.

Route: intranasal

Used to treat angina and is the antidote for cyanide poisoning."

Front 5

"Angiotensin receptor blockers

Prototype: Losartan (Cozaar)"

Back 5

"Action: more specific than ace inhibitors, vasodilation of smooth muscle relaxation, reduces salt and water volume.

Drug to drug: less SE than ACE, does not retain K, same DM renal protection."

Front 6

"Anti-helminth meds

1. Niclosamide (Nicolicide)
2. Mebendazole (Vermox)
3. Piperazine"

Back 6

"1. Niclosamide
Action: or flatworms, poorly absorbed from intestine so it's effects are more potent to the worm, destroys the scolex, and proximal segments of the worm which is then digested in intestine and excreted.
SE: stomach pain, anorexia, n/v, bad taste

2. Mebendazole
Action: Vermicidal and ovicidal for most helminths, oral absorption assisted by fatty foods.
SE : GI distress

3. Piperazine
Action: Causes worm paralysis, loss of attachment and expelled.
SE: GI distress, ha, dizziness, trembling, ataxia

"

Front 7

Aspirin

Back 7

"Antiplatelet aggregation.

Action: blocks enzymes necessary to create the stickiness of the vessel walls so it inhibits and permanently alters platelets.

I: prophylaxis of MI in patients with angina or a hx of MI, questionable effects for women, even used in ED when question of MI. Prophylaxis of recurrent TIA's/CVA, doesn't appear to be effective in men.

SE: GI bleeding, rash, anemia, n/v, anorexia."

Front 8

"Astelin
Azelastine"

Back 8

"Antihistamine
Intranasal
Action: Temporarily antagonizes h receptor sites.

I: seasonal allergies, rhinitis

SE: drowsy, dizzy,Nasal burning, bad taste. Myalgia

Drug to drug: CNS depressant "

Front 9

Atropine

Back 9

"Anticholinergic med and antiPNS

Action: blocks vagal stimulation, increasing HR

I: bradycardia

C: tachycardia, decreased motility of GI tract.

SE: drowsiness, blurrier vision, tachycardia, dry mouth, constipation, tachypnea

D2D: antacids decrease effectiveness, may increase GI mucosal lesion."

Front 10

Beta blockers

Back 10

"Control reflex tachycardia from NTG use. Beta 1 heart specific, beta 2 lung specific.

Beta 1 block receptors in heart by decreasing hr, conduction, force of contraction, CO, peripheral vascular resistance, inhibits renin release from renal system.

Beta 2 bronchoconstriction, can be used if asthmatics are well controlled, drug can mask signs of hypoglycemia and hyperthyroidism.

Both: negative chronotrope, inotrope, dromotrope. All results in lowering CO, which lowers BP, chronic angina, HTN, cardiac dysrythmias, vascular h/a, tremors, anxiety.

SE: Brady, fatigue, drowsiness, impotence, cold hands and feet, depression. Don't take prior to surgery can bottom out BP.

D2D: don't take with decongestants, -olol .

Education: <45 HR do not take!"

Front 11

"Discodyl
(Dulcolax)"

Back 11

"Ex lax, senokot, castor oil, stimulant laxatives.

Action: work on intestinal muscles and excretory cells to stimulate motility and fluid movement. 6-8hrs onset, not for everyday use.

SE: fluid loss, dependency"

Front 12

Calcium carbonate

Back 12

"Tums

Interacts with tamoxifen because both act in your gut, antacids lead to loss of effectiveness of tamoxifen.

Relieves acid indigestion or heartburn.

C: hypercalcemia, renal or cardiac disease.

SE: ha, arrhythmias, constipation.

D2D: increases risk of Dig toxicity. Can decrease effectiveness of anything with an enteric coating. Avoid cereals, spinach, rhubarb."

Front 13

Calcium channel blockers

Back 13

"Antidysrhythmic BP , Ca+ antagonists, verapamil

Action: decreases automaticity and contractility, slows Ca+ influx and AV node conduction, decreases svr by coronary and peripheral vasodilation, decreases peripheral resistance,

For supra ventricular tachycardia, HTN, vasospastic angina,

SE ha, nausea, flushing, edema, tachy, get up slowly crackles."

Front 14

Captopril

Back 14

• Is the Prototype ACE Inhibitor
• Indications for use:
o Essential HTN w/normal renal function
o Often used with thiazide or loop diuretic
 Counteracts potassium retention of ACE
o CHF-used with digoxin and diuretics
o Diabetes
 For renal protection even without HTN
• Side Effects:
o Hyperkalemia
o Dry Cough
o Angioedema
• D-D interaction
o Additive effect with other antihypertensives
o NSAIDS antagonize effect
• Education
o Do not use in renal artery stenosis
o Do not use potassium supps
o Do not use if pregnant

Front 15

Cephalosporins

Back 15

cousin of PCNs, spelling is critical, very similar names, 5 generations:
1st – most active against gram +, cefazolin/ancef, like PCNs but have greater specify, so kill less normal flora, used a lot in post op pts.
2nd – against gram -, cefoxitin, cefotetan, mor effective against H. flu, used for soft tissue infections (otitis, cellulitis, pneumonia)with “caine” drugs for IM in gluteus.
4th- like 3rd but more resistant to beta-lactamase, cefapime/maxipime
5th- newest

Front 16

Ciprofloxacin

Back 16

Fluroquinolone, synthetic, bacteriocidal, broad spectrum
Act: bacteriocidal by altering bacterial DNA. Widely distributed in body.
For: anthrax, pseudomonas, UTIs (but shouldn’t be used for uti)
SE: tendon rupture, makes tendons weaker, get aches/pains when on med, tendon effects show up 3-4mo after starting med. Not for prego or kids.
Drug: don’t take with Ca, zinc, iron, aluminum, Mg b/c they CHELATE (isolates and chemically captures it and makes it inert.)

Front 17

Cromolyn sodium

Back 17

AKA Nasacor, mast cell stabilizer, best for prophylaxis.
Cromolyn/Intal: prevents degranulation and release of histamine, is a mast cell stabilizer/ mediator, NO bronchodilator action. Inhibits eos, macrophages, other inflamm cells from migrating. Prophylaxis only, take 15min prior to exercise. Given intranasal for chronic rhinitis. NO systemic effects, is a very safe drug, used a lot for exercise induced asthma.

Front 18

Digoxin

Back 18

glycoside, action: positive inotrope, negative chronotrope and neg dromotrope. Potent, small doses (.125 or .25mg/day). Med works at AV node. Given oral, IM, or IV route greatly affects absorption, t1/2= 36hrs so builds up, can get toxic quick, narrow therapeutic range (0.5-0.8mg/ml). Dig level needs to be monitored. Needs loading dose= digitalization, do asap for acute problems, slower c elders
Effects: incr cardiac contractility, decr elect conduction rate, indirectly decr HR and incr Na and H2O excretion. For: CHF, a. fib or other supravent, irregular beat issues. Dysrhythmia when vent rate is too rapid.
SE: bradycardiac, AV block, other rythym disturbances, n/v, anorexia, seeing green/yellow tint to white objects, halos around lights (halo= toxic), gynecomastia (c long term use). Must take apical pulse for 1min, if <60, must hold med! K and dig are inversely r/t, so hypokalemia is most common cause of dig OD; hypomag incr risk of toxicity.
Pulse deficit= diff b/w apical and radial pulse, don’t take radial pulse for dig!
Drug-drug: lots, doesn’t play well with others; reduce absorption/decr fx- antacids, laxitives, cholesterol-lowering meds, ACE/ARBs, increase absorption/fx- quinidine, verapamil, depress cardiac fx or raise BP, such as beta blockers, OTC decongestants.

Front 19

Ketoconazole

Back 19

Anti-fungal, not as bad a drug as other antifungals
Act: fungistatic or fungicidal depending on dose, affect fungal biosynthesis. Well distributed in fluids and tissues, doesn’t cross BBB. PO or IV.
For: candidiasis, tineas, nail fungus in adults. DM who have painful nails that are falling off.
SE: GI sx, rash, flushing, h/a, photophobia, gynecomastia, impotency, mentral irregularities. If used with erythromycin can cause V. TACH or death!
Drug: many which can cause cardiac dysrhythmias and death, like erythromycin and cousin antibiotics

Front 20

Kwell (lindane)

Back 20

• Classified as a Pediculocide or Scabicide
• Used to treat lice, crabs, scabies, and mites

Front 21

Lactulose

Back 21

Rx osmotic laxative. Act: consists of sugars which are metabolized to acids to produce an osmotic effect with increased fluid accumulation, distension, peristalsis. Also decreases serum ammonia levels ( BM will have ammonia smell) in people with chronic liver disease, good thing. Should have BM within 24-72 hrs. Not very addictive.
For: chronic constipation that doesn’t respond to OTC bulk lax.
SE: dose-related flatus and intestinal cramps, gas, belching, excessive dose may cause n/v.

Front 22

Leukotriene meds

Back 22

Bronchoconstriction, inhibit leukotriene
Reduces eosinophil infiltration?
Montelukast/singular
Act: antagonizes effects of leukotrienes, which results in a decreased inflammatory process, which is part of asthma and allergic rhinitis. Rapidly absorbed, most metabolized in liver by cyp450
Used for allergy, cold and cough remedies, and bronchodilation. Prophylaxis treatment for chronic asthma and management of seasonal allergies. Prevents exercise induced asthma bronchoconstriction in pts >15yo. Antagonized=irritated effects of leukotrienes, resulting in decreased inflammatory process. Drug-drug: drugs that induce CYP450 enzyme system (phenobarbital and rifampin) may decrease the effects of this med.

Front 23

Maalox

Back 23

• Action:
o Buffer/neutralize hydrochloric acid and increase gastric pH
• Indications:
o Hyperactivity r/t gastritis, peptic ulcers, GERD, hiatal hernia
o Goal is to neutralize pH to 3.5
• ADME:
o Rapid onset, lasts 20-40 mins if fasting but can be extended up to 3 hr if taken after meals
• D-D interactions:
o Reduces absorption of other drugs
 Timing give other drugs 2 hours after or 1 hour before other meds or they will be absorbed by the med.
• SE:
o Constipation, bone demineralization
o Calcium-gastric acid hypersecretion, constipation, kidney failure, increased Ca levels
o Magnesium-diarrhea, increased K, decreased Mg
o Sodium-overload (CV workload), gastric acid hypersecretion

Front 24

Metered dose inhalers

Back 24

• Used for Asthma
• Requires respiration/hand coordination
• Propelled by hydroflouroalkane
• 1-2 puffs inhaled of aerosol solution

Front 25

Metoclopramide (Reglan)

Back 25

Act: increases acetylcholine levels and stimulates the PNS.
For: GERD, postop risk for ileus, to eliminate barium from system.
SE: do not give if pt has intestinal blockage

Front 26

Mucinex (guaifenesin)

Back 26

OTC, used to decrease mucous viscosity and decrease surface tension, so changes cough from non-productive to productive. Used for colds, sinusitis, bronchitis, questionable for asthma.

Front 27

Mylanta

Back 27

• Indication for use:
o Acid indigestion, PUD, GERD, heartburn, upset stomach.

Front 28

N-acetylcystine (mucomyst)

Back 28

• Reversal agent for Tylenol

Front 29

Macrolides (z-packs)

Back 29

• Prototype: erythromycin, azithromycin (Zithromax), clarithromycin (Biaxin)
• Inhibits protein synthesis (bacteriostatic)
• Indications
o Oral and topical preparations
o Respiratory infections
o Least toxic with fewest allergies
o Chlamydia and legionella
• SE
o GI symptoms can affect compliance
o Some forms can cause metallic taste
• D-D interactions
o Digoxin, warfarin

Front 30

Nitroglycerin

Back 30

(NTG), used as long and short term Tx, is cheap and effective. Action: vasodilates vessels in periphery, by relaxing smooth muscle lining of vessels, so decreases workload of heart and preload. Dilates coronary arteries, which improves blood flow. Does NOT dilate plaque damaged vessels. Decr afterload and preload by incr pooling. Comes in tabs, sprays, oinments. Oral: time-released form- for chronic care, have heavy 1st pass effect, so not for emergencies, but works well sublingual for emergencies. Reflex tachycardia and rebound HTN are possible. Subling: for emergencies, take with chest pain, wait 5min, if still have pain repeat, if still have pain call 911 then take 3rd dose. Allow to dissolve slowly, don’t eat, drink, or smoke. SE: should feel tingling/burning sensation under tongue, and h/a if not then drug lost potency, h/a-lessens after 1st 2 wks. Monitor BP q15-60min. Hypotension- dose dependent, if BP drops too much or too fast get poor perfusion and reflex tachy. Long term use: nitrobid caps, ointment, transdermal patch – best if put over heart, 12hr on/12hr off. Drug-drug: all antihypertensives and sympathomimetics, nicotine (causes vasoconstriction and cardiac stim.), ED meds. Remember bottles ‘expire’ 6 months after opening, expect orthostatic hypotension, drugs are temp sensitive, spray cost more, but lasts longer and goes under tongue. IV med is NOT in polyvinyl chloride bag (PVC)

Front 31

NSAIDs (non steroidal anti-inflammatory drugs)

Back 31

• Treat inflammation, pain, and fever
• Can cause GI bleeding

Front 32

Omeprazole (Prilosec) PPI

Back 32

• Is the prototype of Proton Pump Inhibitors
• Action: stops pumps from pumping allowing ulcers to heal
o Blocks acid secretion by inhibiting ATPase enzyme at the gastric parietal cells
o Used in repair of ulcer or “itis”
• Indications:
o Severe erosive esophagitis from GERD, duodental ulcer, long-term treatment of hypersecretion (rare)
• ADME:
o Rapid onset, peak 2 hr, duration 2-4 hours
• SE:
o Heartburn, weakness, dizziness
o Increase risk of C. diff, pneumonia and development of food allergies
o Ostenopenia

Front 33

Penicillin

Back 33

most effective against gram +, bactericidal, contain beta-lactam ring. G, V, methicillin, ampicillin. G or V used for dental prophylaxis, syphilis, lymes, meningitis. Meth and Diclo treat staph, has beta-lactam ring.

Front 34

Polyethylene glycol (GoLYTEly)

Back 34

Rx laxative.
Act: mixture of PEG, Na salts, and K+ Chloride (powder), is isotonic to body fluids so doesn’t absorb or secrete electrolytes but acts as osmotic.
For: before colonoscopy or barium enema, has less electrolyte loss than other meds. Can be safely used possibly in pts who are dehydrated or have renal or cardiac disease.

Front 35

Probenecid

Back 35

• Used to make certain antibiotics more effective by preventing the body from passing them
o Blocks excretion
 Get higher levels for longer periods of time
 HELPFUL drug interaction

Front 36

Prochlorperazine (Compazine)

Back 36

• Is an Antiemetic
o Is a Phenothiazine
• Atropine like effects, extrapyramidal (muscle movements) effectscan get tardive dyskinesia (involuntary, repetitive body movements of any portion)

Front 37

Proton Pump Inhibitors

Back 37

Omeprazole/Prilosec, mexium, prevacid, protonix, aciphex
Act: blocks acid secretion by inhibiting the ATPase enzyme at the gastric parietal cells. Rapid onset, peak 2hrs, duration 3-4 days
For: severe erosive esophagitis from GERD, duodenal ulcer, long term tx of hypersecretion.
SE: heartburn, weakness, dizziness, esp if use long term. Increased risk of C. Diff, pneumonia, and development of food allergies ( same as H2 blockers but less so), osteopenia.
Educate: therapy for healing of ulcers is 4-6 weeks, and long term use can change gastric secretions

Front 38

Protamine sulfate-

Back 38

Heparin antidote

Front 39

Pseudoephedrine

Back 39

Sudafed/ Robitussin PE: high abuse potential. Used for non-allergic rhinitis. SE: excitatory effects, CNS effects similar to amphetamines. Adverse: rebound congestion when used topically, oral- widespread vasoconstriction, use caution c HTN/CVD b/c alpha-1 and beta 1 agonist effects, glaucoma and thyroid meds.

Front 40

Ranitidine (Zantac)

Back 40

Antiulcer agent, H2 antagonist, Action: inhibits histamine at H2 receptor site located mostly in gastric parietal cells, resulting in inhibition of gastric acid secretion. For: tx and maintenance therapy for erosive esophagitis, prevention and tx of stress-induced upper GI bleeding in critically ill pts. SE: confusion, arrhythmias, aplastic anemia, agranulocytosis, neutropenia, anemia, thrombocytopenia, renal impairment.

Front 41

Small pox vaccine

Back 41

(variola virus)
Route: skin pricks (live virus)
Schedule: up to 5 days post exposure, recommended for high risk groups.
Forms lesion that can transfer to others, does not transmit small pox, just transfers vaccine rash.
Doubt immunity if over 40yo. Scar left at immunization site, nurses cannot have direct pt contact until skin is healed.

Front 42

Sodium bicarbonate

Back 42

• Is an antacid

Front 43

Spironolactone

Back 43

Aldactone): K sparing diuretic, blocks action of Aldosterone in distal tubule, promotes Na and h2o excretion. Low potency, similar to thiazides, allows K to remain in system. For: prevention and tx of hypokalemia, HTN and edema esp in liver failure and adrenal disease, can use in combo with HCTZ to counteract K loss. SE: like other diuretics, but K goes up.

Front 44

Steroids

Back 44

PRETTY GENERAL!

Front 45

Sucralfate (Carafate)

Back 45

Cytoprotective agent
Act: chemically combines with substances from damaged cells in the ulcer crater, forms a protective acid-resistant barrier in the crater and prevents further erosion.Works on mucous layer in stomach. Minimal absorption. For: peptic ulcer tx, prevent NSAID ulcers, need to take med 30min or more after other meds.
Subtype misoprostol can be used to open cervix for delivery/abortion.
Drug: binds to some meds like Dilantin. Caution when using antacids, separate doses by 30min or more.

Front 46

Sulfonamides

Back 46

TMP-SMX/Bactrim, “azole”,
Act: interfere with bacterial enzymes/bacteriostatic, interferes with folic acid metabolism, good absorption on empty stomach
For: UTIs, MRSA. Hard on kidneys, should drink 3qt/day.
SE: kidney stones, GI sx, crystalluria, bone marrow tox, allergic rxn with diuretics. Hematologic effects if long term therapy, stevens Johnson syndrome, hyposugar risk if DM

Front 47

Tetracyclines

Back 47

Act: inhibits protein synthesis (bacteriostatic)
For: chlamydia, lymes disease, rickettsial infections- rocky mt spotted fever or typhus, and other rare things: rabbit fever/tularemia and plague -(weaponized for biological warfare), cholera, atypical bacteria like mycoplasma pneumonia.
PO only, absorbed good on EMPTY stomach. Do not mix with milk, antacids, iron sup. Not for prego, kids under 8 yo (permanent teeth staining).
SE: GI irritation, oral candidiasis, photosensitivity (should avoid UV).

Front 48

Warfarin

Back 48

Action: does not work in the blood but in the liver to inhibit synthesis of clotting factors ( 8, 9 10, and prothrombin). Rapidly absorbed, highly protein bound, t1/2 36hrs. For: long term prophylaxis and tx of venous and arterial thrombosis or pulmonary embolism, adjunctive tx with acute MI. dose individualized, 2-10mg daily. Must monitor INR/prothrombin time q2-4wks. SE: bleeding increased K intensifies effect, K and warafin inversely related. Drug-drug: increase drug effects with quinidine, antibiotics. NSAIDs, cimetidine, thyroid hormones, ASA, Tylenol. Tox: increased bleeding, usually fixed with omitting 1-2 doses, don’t stop abruptly, antidote= vit K. traditional doses given at 1700 or later, nurses can use sliding scale to alter dose, pt will need new INR weekly. Diff from heparin b/c: onset 24-48hrs, route is oral, duration 2-5 days, labs PT/INR, antidote vit K.