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156 Cards in this Set
- Front
- Back
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ACCUPRIL
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ACE inhibitor
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ALTACE
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ACE inhibitor
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AMIODARONE HCL
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Anti-arrhythmic
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ATENOLOL
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beta blocker
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AVAPRO
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Angiotensin II receptor blocker
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CAPTOPRIL
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ACE inhibitor
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CLONIDINE HCL
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adrenergic antihypertensive
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COREG
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beta blocker
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COUMADIN
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anticoagulant
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COZAAR
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angiotensin II receptor blocker
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CRESTOR
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Statin
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DIGOXIN
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Cardiac glycoside
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DILTIAZEM HCL
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antiarhythmic
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DIOVAN
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Angiotensin II receptor blocker
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DOXAZOSIN MESYLATE
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alpha blocker
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ENALAPRIL MALEATE
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ACE inhibitor
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FUROSEMIDE
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Loop diuretic
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GEMFIBROZIL
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fibric acid derivative - lowers triglycerides primarily
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HYDROCHLOROTHIAZIDE
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Thiazide diuretic
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INDAPAMIDE
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Thiazide diuretic
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INDERAL LA
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Beta blocker
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ISOSORBIDE
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Nitrate - Angina
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LABETALOL HCL
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Beta blocker
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LESCOL XL
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Statin
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LIPITOR
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Statin
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LOTREL
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ACE inhibitor
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LOVASTATIN
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Statin
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METOPROLOL TARTRATE
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Beta blocker
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NIFEDIPINE ER
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Calcium channel blocker
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NITROGLYCERIN
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Nitrate - for angina
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NORVASC
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Clacium channel blocker
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PLAVIX
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anti platelet - stroke
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PLENDIL
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Clacium channel blocker
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PRAVACHOL
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Statin
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SPIRONOLACTONE
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K sparing diuretic
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TERAZOSIN HCL
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Adrenergic antihypertensive
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TOPROL XL
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Beta blocker
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TRIAMTERENE W/HCTZ
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K sparing plus a thiazide diuretic
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TRICOR
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Fibric acid derivative
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WARFARIN SODIUM
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Anticoagulant
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ZETIA
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cholesterol lowering - new one
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ZOCOR
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statin
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ADVAIR DISKUS
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Combined inhaled corticosteroid and long acting beta 2 agonist
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ALBUTEROL
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Short acting beta 2 agonist
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Allegra
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antihistamine
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Astelin
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Antihistamine - used for
Seasonal allergic rhinitis in adults and chidren > 5 years old, and vasomotor rhinitis in adults and children > 12. |
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CLARINEX
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Antihistamine, non-sedating used for Allergic rhinitis, Chronic urticaria,
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COMBIVENT
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Combo of albuterol - a short acting beta 2 agonist and ipratropium - an anticholinergic
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FLONASE
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Nasal corticosteroid used for
Treatment of allergic rhinitis, nonallergic rhinitis, nasal polyps prophylaxis |
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FLOVENT
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inhaled glucocorticoid
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LORATADINE
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Antihistamine -
Loratadine is indicated for the relief of nasal and non-nasal symptoms of seasonal allergic rhinitis and for the treatment of chronic idiopathic urticaria in patients 2 years of age or older |
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NASONEX
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Corticosteroids nasal -
Prophylaxis & Tx seasonal allergy; and perennial allergic rhinitis |
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PROMETHAZINE W/CODEINE
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antitussive/antihistamine/narcotic -
treat allergy symptoms such as itching, runny nose, sneezing, itchy or watery eyes, hives, and itchy skin rashes; prevents motion sickness, and treats nausea and vomiting or pain after surgery. It is also used as a sedative or sleep aid; to assist in controlling postoperative pain, to control nausea and vomiting (especially after surgery); suppresses coughing, and treats diarrhea. |
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PULMICORT
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Inhaled glucocorticoid
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SINGULAIR
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leukotriene inhibitor
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THEOPHYLLINE
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methylxanthine - Primarily used in asthma for bronchodilation, but it is also used in CNS stimulation, attention deficit disorders and has other added effects of cardiac stimulation, vasodilation and diuresis.
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TUSSIONEX
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narcotic antitussive & analgesic -
Cough and URI associated w/allergy or cold |
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ZYRTEC
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Antihistamine -
tx chronic rhinitis, chronic urticaria |
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DOCUSATE SODIUM
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surfactant laxative
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FAMOTIDINE - Pepcid
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H2 receptor antagonist
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HYOSCYAMINE SULFATE
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Antispasmodic and anticholinergic, Used with small or large bowel spasm in IBS. Used to dry secretion, produce constipation and reduce liquidity of stools.
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METOCLOPRAMIDE HCL
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Antiemetic -
prevention of nausea and vomiting in chemotherapy, postoperative, radiation, and gastroesophageal reflux disease. |
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Miralax
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Osmotic laxative
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NEXIUM
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Proton Pump Inhibitor
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LOPERAMIDE
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anti diarrheal
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OMEPRAZOLE
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Prilosec, PPI
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PEPTOBISMOL
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anti-diarrheal, H. pylori
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PRILOSEC
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PPI
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PREVACID
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PPI
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PROMETHAZINE HCL
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antihistamine, used for nausea and vomiting
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PROTONIX
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PPI
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beta blockers indications
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Used in hypertension, angina acute MI
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beta blockers mechanism of action
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decrease cardiac output by blocking the effect of the sympathetic nervous system on the beta cells of the heart. They decrease rate, contractility and conduction velocity.
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beta blockers side effects
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bradycardia, precipitation of heart failure, AV heart block, rebound cardiac excitation, bronchoconstriction, inhibition of glycogenolysis
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can you use beta blockers in pregnancy and lactation?
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yes and yes with caution can cause beta blockade in baby
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In what conditions should beta blockers be avoided?
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bronchospastic disease, depression, diabetes, dyslipidemia, heart block, peripheral vascular disease
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Indications for ACE Inhibitors?
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hypertension, CHF, post MI, cardiac risk reduction
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ACEI mechanism of action
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Prevent conversion of angiotensin I to angiotensin II thus suppressing the effects of angiotensin II which are vasoconstriction and stimulation of aldosterone which holds back sodium and water and causes fluid retention. The net effect is vasodilation and fluid loss.
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Side effects of ACEI
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Cough, angioedema, first dose hypotension, hyperkalemia, fetal injury
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Can you use ACEIs in pregnancy and lactation?
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NO!
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In what conditions should ACEIs be avoided?
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Pregnancy, renal vascular disease.
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Indications for Angiotensin receptor blockers?
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hypertension, diabetic nephropathy
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ARBs mechanism of action
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Blocks the angiotensin II receptors in the vasculature blocking the effect of angiotensin II, which is vasoconstriction and stimulation of aldosterone, which holds back sodium and water.
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Side effects of ARBs
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angioedema, fetal harm, renal failure with renal stenosis
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Can you use ARBs in pregnancy and lactation?
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NO!
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In what conditions should angiotensin receptor blockers be avoided?
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pregnancy, renal vasclar disease
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Indications for calcium channel blockers?
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Hypertension, angina
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Side effects of calcium channel blockers?
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Flushing, dizziness, HA, peripheral edema, gingival hyperplasia,, reflex tacchycardia
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Can calcium channel blockers be used in pregnancy and lactation?
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Yes
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In what conditions should calcium channel blockers be avoided?
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heart block, heart failure, renal insufficiancy
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Mechanism of action of calcium channel blockers?
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Block the entrance of calcium into the cell membranes of cardiac and smooth muscle. This causes decreased mycardial contractility, slowed heart rate, coronary artery dilation, peripheral arterial dilation and decreased peripheral resistance.
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Indications for diuretics
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hypertension, edema,
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Mechanism of action of diuretics
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Different classes of diuretics work at different levels of the renal filtration system, work generally by blocking resorption of sodium and chloride thereby increasing fluid excretion.
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Diuretics OK in pregnancy and lactation?
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No
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In what conditions should diuretics be avoided?
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Thiazides - gout
loop - renal insufficiency |
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Side effects of diuretics
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Thiazides:
Hyponatremia, Hypochloremia, Dehydration, hypokalemia, hyperglycemia, hyperuricemia, increase LDL, total cholesterol and triglycerides Loop diuretics: Hyponatremia, hypochloremia, dehydration, hypotension, hypokalemia, ototoxicity, hyperglycemia, Hyperuricemia, Potassium sparing diuretics: Hyperkalemia, endocrine effects similar to that of steroid hormones |
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How does digoxin work?
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Increases mycardial constractile force to increase cardiac output.
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How do statins work?
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Primarily by increasing the number of LDL receptors on liver cells.
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What are statins indicated for?
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Hypercholesterolemia, primarily to lower LDL and increase HDL, very little triglyceride lowering effect.
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What are the side effects of statins?
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myopathy and hepatotoxicity
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Can statins be used during pregnancy?
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NO! Cat X
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What are fibric acid derivatives indicated for?
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hyperlipidemia, primarily to lower triglycerides. Will also raise HDL. May lower LDL but also may raise LDL if triglycerides are high.
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What are the side effects of fibric acid derivatives?
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Generally well tolerated, can have rash and GI disturbances (nausea, abd pain, diarrhea), gallstones, myopathy, hepatotoxicity
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Can fibric acid derivatives be used in pg and lactation?
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Probably not, cat c and safety for lactation unknown.
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How do fibric acid derivatives work?
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They alter the rate of synthesis of VLDL.
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How does nicotinic acid (niacin) work, what is it used for and why isn't it commonly used?
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- Inhibits triglyceride synthesis so you cannot make VLDL’s.
- Very good at lowering triglycerides, lowers LDL, raises HDL - Has too many side effects and so that limits it's clinical usefullness. For example there is intense flushing of face and neck in just about all pts. |
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How do bile acid sequestrants work?
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Bile acid resins irreversibly bind to bile acids in the gut and prevent their reabsorption. Bile acids are made out of cholesterol and triglycerides
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What are the side effects of bile acid sequestrants?
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not absorbed so SE limited to GI – constipation, bloating, indigestion, decreased uptake of fat soluble vitamins
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How does Zetia work?
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New drug, blocks cholesterol from being absorbed from the small intestines. Can be used alone or in combo with a statin.
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What are the side effects of zetia?
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Generally well tolerated, myopathy, rhabdomyolysis, hepatitis, pancreatitis, and thrombocytopenia
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Can zetia be used in pregnancy and lactation?
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Category C, safety in lactation unknown.
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Mechanism of action of anticoagulants?
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Greatly enhance the activity of antithrombin, a protein that inactivates two major clotting factors leading to the reduction of fibrin and suppressing clotting.
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Side effects of anticoagulants?
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Hemorrhage, thrombocytopenia, hypersensitivity reactions
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Anticoagulants OK in preg/lac?
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Heparin and lovenox preferred in pregnancy.
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Mechanism of action of warfarin?
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Works by acting as an antagonist to vitamin K.
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Warfarin Ok in pregnancy and lactation?
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NO!
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Side effects of warfarin?
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hemorrhage, fetal hemorrhage, teratogenesis
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How do the various types of laxatives work?
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Bulk forming laxatives (Metamucil, citrucel) – work by swelling in the water to form viscous solution or gel thereby softening the fecal mass and increasing its bulk.
Surfactant (ducosate sodium) – alter stool consistency by lowering surface tension thereby facilitating water passage into stool. Stimulant (bisacodyl, castor oil) – stimulate intestinal motility and they increase the amount of water and electrolytes in stool. Osmotic (magnesium hydroxide, sodium phosphate) – poorly absorbed salts whose osmotic properties draw water into bowel. |
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How do serotonin antagonists work?
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Work by blocking type 3 serotonin receptors.
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An example of a serotonin antagonist?
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Ondansetron (zofran)
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Side effects of serotonin antagonists?
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HA, diarrhea, dizziness
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How do dopamine antagonists work?
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Blocking dopamine receptors in the brain.
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Example of a dopamine antagonist?
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phenergan, thorazine haldol, inapsine, reglan, and motilium
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side effects of dopamine antagonists?
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Extrapyramidal, anticholinergic effects, hypotension, sedation
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How do H2 antagonists work?
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First choice drugs for treating gastric and duodenal ulcers. They include cimetidine (tagamet), ranitidine (zantac), famotidine and nizatidine. Thye work by blocking the H2 receptors in the stomach thereby reducing both the volume of gastric acid and its hydrogen ion content.
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Side effects of H2 antagonists?
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Antiandrogenic effect (gynecomastia, impotence) (reversible), CNS depression or excitation, pneumonia,
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Can H2 antagonists be used in pregnancy and lactation?
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yes
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Mechanism of action proton pump inhibitors?
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Most effective drug for suppressing gastric acid. Work by inhibiting the proton pump in the parietal cells of stomach and so gastric acid production is blocked.
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Are proton pump inhibitors OK for pregnancy and lactation?
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Generally B or C, prob safe
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Side effects of PPIs?
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Generally well tolerated and all fairly equivalent.
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Mechanism of action of decongestants?
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Sympathomimetics reduce nasal congestion by activating alpha1 adrenergic receptors on nasal blood vessels causing vasoconstriction
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Side effects of decongestants?
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Rebound Congestion (topical use more than a few days), CNS stimulation (oral) including restlessness, irritability, anxiety and insomnia, cardiovascular effects – can cause widespread vasoconstriction, usually no problem unless coronary artery disease or hypertension, abuse
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Mechanism of action and indications for antihistamines?
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Bind to histamine 1 receptors and block the action of histamine there. Used for allergy, motion sickness, insomnia, cold
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Side effects of antihistamines?
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Highly sedating (First generation), CNS including dizziness, incoordination, confusion, fatigue, GI including N/V/D, constipation, anorexia, Anticholinergic effects including drying of mucous membranes, urinary hesitancy, constipation and palpitations
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Mechanism of action of beta agonists?
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Sympathomimetic – produce selective activation of beta adrenergic receptors causing bronchodilation. They also suppress histamine release
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side effects of short acting beta agonists?
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Well tolerated, can have tachycardia, angina, tremor
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Side effects of long acting beta agonists?
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May increase the risk of asthma related death but only when used incorrectly as first line monotherapy. Oral agents cause more cardiac sx and can cause angina and tachydysrhythmias, tremors
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mechanism of action of leukotriene inhibitors?
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Suppress the effect of leukotreines such as bronchoconstriction, eosinophil infiltration, mucus production and airway edema
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Side effects of leukotriene inhibitors?
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Possible liver toxicity.
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Side effects of steroid nasal sprays?
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generally mild, dry mucosa, burning or itching, sore throat, epistaxis, HA, adrenal suppression and slow linear growth of children
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Side effects of inhaled glucocorticoids?
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oropharyngeal candidiasis and dysphonia, long term high dose can cause adrenal suppression, promote bone loss, slow growth in children, prolonged use can increase risk of cataracts and glaucoma
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Mechanism of action of anticholinergics?
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Improve lung function through blockade of muscarinic receptors causing bronchodilation
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Discuss the appropriate use of medications to treat upper respiratory problems including the common cold and allergies. Know when/if it is appropriate to use antibiotics to treat these conditions.
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• Colds are cause by a virus so routine antibiotics are not advised. Persistent or worsening of symptoms suggests development of a secondary bacterial infection.
• Common combination cold products frequently contain one or more of the following drugs: a nasal decongestant, an antitussive, an analgesic, an antihistamine (to suppress production of mucous due to its anticholinergic effect) and caffeine (to offset the sedating effects of antihistamines). • Cough should not be suppressed if productive or chronic. Nonproductive cough can be suppressed for sleep. |
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Definition and treatment of mild intermittent asthma.
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Defined as Daytime symptoms less than twice per week, nighttime symptoms less than twice a month. PEFR or FEV > or = 80% predicted, PEFR variability < 20%
Treatment: no daily med needed, short acting inhaled beta agonist |
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Definition and treatment of mild persistent asthma.
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Defined as daytime symptoms more than twice per week but less than daily, nighttime symptoms more than twice per month. PEFR or FEV > or = 80% predicted, PEFR variability 20-30%.
Treatment: Low-dose inhaled glucocorticoid PLUS short acting inhaled beta agonist |
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Definition and treatment of moderate persistent asthma.
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Defined as daily symptoms with daily use of short acting inhaled beta agonist, nighttime symptoms more than once per week. PEFR or FEV between 60-80 % predicted, PEFR variability > 30%.
Treatment: Low-dose inhaled glucocorticoid PLUS inhaled long acting beta agonist OR medium dose inhaled glucocorticoid EITHER of these PLUS short acting inhaled beta agonist |
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Definition and treatment of severe persistent asthma.
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Defined as continual symptoms with limited physical activity and frequent exacerbations plus frequent nighttime symptoms. PEFR or FEV < or = 60%, PEFR variability > 30%
Treatment: high-dose inhaled glucocorticoid PLUS long acting beta agonist PLUS oral glucocorticoids if needed PLUS short acting inhaled beta agonist |
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Definition and treatment of stage I mild COPD.
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Diagnosis: Mild airflow limitation (FVE > or = 80% predicted), and sometimes, but not always chronic cough and sputum production.
Treatment: Active reduction of risk factors, PLUS short acting bronchodilator if needed. |
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Definition and treatment of stage II moderate COPD.
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Diagnosis: Worsening airflow limitation (FEV < 80% predicted) with DOE
Treatment: Active reduction of risk factors, PLUS short acting bronchodilator, ADD regular treatment with one or more long acting bronchodilator PLUS rehabilitation |
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Definition and treatment of stage III severe COPD.
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Diagnosis: Further worsening airflow limitation (FEV < 50% predicted) with greater shortness of breath, reduced exercise capacity, and repeated exacerbations which impact QOL.
Treatment: Active reduction of risk factors, PLUS short acting bronchodilator, PLUS regular treatment with one or more long acting bronchodilator PLUS rehabilitation, ADD inhaled glucocorticoids if repeated exacerbations. |
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Definition and treatment of stage IV very severe COPD.
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Diagnosis: Severe airflow limitation (FEV < 30% or < 50% with chronic respiratory failure) plus very severe COPD
Treatment: Active reduction of risk factors, PLUS short acting bronchodilator, PLUS regular treatment with one or more long acting bronchodilator PLUS rehabilitation, PLUS inhaled glucocorticoids if repeated exacerbations, ADD long term oxygen if chronic respiratory failure, CONSIDER surgical treatment. |
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What are the classifications of hypertension?
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o Normal: <120 and < 80
o Prehypertensive: 120 – 139 or 80-89 o Stage 1 htn: 140-159 or 90-99 o Stage 2 HTN: >or= 160 or >or= 100 |
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Treatment recommendations for hypertension?
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o Normal: encourage lifestyle modification
o Prehypertension: encourage lifestyle modification PLUS drug(s) with compelling reason* o Stage 1: encourage lifestyle modification PLUS thiazide type diuretic for most. May consider ACEI, ARB, CCB, BB or combo. Consider drugs for compelling reasons o Stage 2: encourage lifestyle modification PLUS two drug combo for most, thiazied diuretic plus ACEI, ARB, BB or CCB. Consider drugs for compelling reasons |
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What are compelling reasons for antihypertensive treatment?
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o Ischemic heart disease: First choice usually a beta blocker, alternatively long acting CCBs can be used.
o Heart failure: Without symptomatic ventricular dysfunction – ACEis or BBs; with symptomatic ventricular dysfunction – ACEIs, BBs, ARBs, and aldosterone blockers along with loop diuretics o Diabetic Htn: Combo of two or more drugs usually needed. Thiazide diuretics plus BBs, ACEIs, ARBs, CCBs have been shown to reduce CVD and stroke; ACEIs and ARBs favorably affect the progression of diabetic neuropathy and reduce albuminemia. o Chronic kidney disease: Need aggressive tx often with three or more drugs. ACEIs and ARBs have shown favorable effects on the progression of renal disease o Cerebrovascular disease: recurrent stroke rates are lowered with a combo of ACEIs and thiazide diuretics. |
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Differentiate between different treatments for hyperlipidemia and hypertriglyceridemia
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• Hyperlipidemia – Drugs that lower LDL include statins, bile-acid sequestrants, nicotinic acid and ezetimibe. Statins are generally most effective, well tolerated and cause fewer adverse effects.
• Hypertriglyceridemia – The most effective drug available for lowering triglycerides are the fibrates. |
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Know recommendations for INR readings for patients receiving anticoagulant therapy for atrial fibrillation, artificial heart valves, and past history of embolic disease. Suggest possible adjustment in warfarin therapy based on INR reading.
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• Pts being anticoagulated – 2-3
• Artificial valve or post MI – 2.5-3.5 |
