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156 Cards in this Set

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ACCUPRIL
ACE inhibitor
ALTACE
ACE inhibitor
AMIODARONE HCL
Anti-arrhythmic
ATENOLOL
beta blocker
AVAPRO
Angiotensin II receptor blocker
CAPTOPRIL
ACE inhibitor
CLONIDINE HCL
adrenergic antihypertensive
COREG
beta blocker
COUMADIN
anticoagulant
COZAAR
angiotensin II receptor blocker
CRESTOR
Statin
DIGOXIN
Cardiac glycoside
DILTIAZEM HCL
antiarhythmic
DIOVAN
Angiotensin II receptor blocker
DOXAZOSIN MESYLATE
alpha blocker
ENALAPRIL MALEATE
ACE inhibitor
FUROSEMIDE
Loop diuretic
GEMFIBROZIL
fibric acid derivative - lowers triglycerides primarily
HYDROCHLOROTHIAZIDE
Thiazide diuretic
INDAPAMIDE
Thiazide diuretic
INDERAL LA
Beta blocker
ISOSORBIDE
Nitrate - Angina
LABETALOL HCL
Beta blocker
LESCOL XL
Statin
LIPITOR
Statin
LOTREL
ACE inhibitor
LOVASTATIN
Statin
METOPROLOL TARTRATE
Beta blocker
NIFEDIPINE ER
Calcium channel blocker
NITROGLYCERIN
Nitrate - for angina
NORVASC
Clacium channel blocker
PLAVIX
anti platelet - stroke
PLENDIL
Clacium channel blocker
PRAVACHOL
Statin
SPIRONOLACTONE
K sparing diuretic
TERAZOSIN HCL
Adrenergic antihypertensive
TOPROL XL
Beta blocker
TRIAMTERENE W/HCTZ
K sparing plus a thiazide diuretic
TRICOR
Fibric acid derivative
WARFARIN SODIUM
Anticoagulant
ZETIA
cholesterol lowering - new one
ZOCOR
statin
ADVAIR DISKUS
Combined inhaled corticosteroid and long acting beta 2 agonist
ALBUTEROL
Short acting beta 2 agonist
Allegra
antihistamine
Astelin
Antihistamine - used for
Seasonal allergic rhinitis in adults and chidren > 5 years old, and vasomotor rhinitis in adults and children > 12.
CLARINEX
Antihistamine, non-sedating used for Allergic rhinitis, Chronic urticaria,
COMBIVENT
Combo of albuterol - a short acting beta 2 agonist and ipratropium - an anticholinergic
FLONASE
Nasal corticosteroid used for
Treatment of allergic rhinitis, nonallergic rhinitis, nasal polyps prophylaxis
FLOVENT
inhaled glucocorticoid
LORATADINE
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
NASONEX
Corticosteroids nasal -
Prophylaxis & Tx seasonal allergy; and perennial allergic rhinitis
PROMETHAZINE W/CODEINE
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.
PULMICORT
Inhaled glucocorticoid
SINGULAIR
leukotriene inhibitor
THEOPHYLLINE
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.
TUSSIONEX
narcotic antitussive & analgesic -
Cough and URI associated w/allergy or cold
ZYRTEC
Antihistamine -
tx chronic rhinitis, chronic urticaria
DOCUSATE SODIUM
surfactant laxative
FAMOTIDINE - Pepcid
H2 receptor antagonist
HYOSCYAMINE SULFATE
Antispasmodic and anticholinergic, Used with small or large bowel spasm in IBS. Used to dry secretion, produce constipation and reduce liquidity of stools.
METOCLOPRAMIDE HCL
Antiemetic -
prevention of nausea and vomiting in chemotherapy, postoperative, radiation, and gastroesophageal reflux disease.
Miralax
Osmotic laxative
NEXIUM
Proton Pump Inhibitor
LOPERAMIDE
anti diarrheal
OMEPRAZOLE
Prilosec, PPI
PEPTOBISMOL
anti-diarrheal, H. pylori
PRILOSEC
PPI
PREVACID
PPI
PROMETHAZINE HCL
antihistamine, used for nausea and vomiting
PROTONIX
PPI
beta blockers indications
Used in hypertension, angina acute MI
beta blockers mechanism of action
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.
beta blockers side effects
bradycardia, precipitation of heart failure, AV heart block, rebound cardiac excitation, bronchoconstriction, inhibition of glycogenolysis
can you use beta blockers in pregnancy and lactation?
yes and yes with caution can cause beta blockade in baby
In what conditions should beta blockers be avoided?
bronchospastic disease, depression, diabetes, dyslipidemia, heart block, peripheral vascular disease
Indications for ACE Inhibitors?
hypertension, CHF, post MI, cardiac risk reduction
ACEI mechanism of action
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.
Side effects of ACEI
Cough, angioedema, first dose hypotension, hyperkalemia, fetal injury
Can you use ACEIs in pregnancy and lactation?
NO!
In what conditions should ACEIs be avoided?
Pregnancy, renal vascular disease.
Indications for Angiotensin receptor blockers?
hypertension, diabetic nephropathy
ARBs mechanism of action
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.
Side effects of ARBs
angioedema, fetal harm, renal failure with renal stenosis
Can you use ARBs in pregnancy and lactation?
NO!
In what conditions should angiotensin receptor blockers be avoided?
pregnancy, renal vasclar disease
Indications for calcium channel blockers?
Hypertension, angina
Side effects of calcium channel blockers?
Flushing, dizziness, HA, peripheral edema, gingival hyperplasia,, reflex tacchycardia
Can calcium channel blockers be used in pregnancy and lactation?
Yes
In what conditions should calcium channel blockers be avoided?
heart block, heart failure, renal insufficiancy
Mechanism of action of calcium channel blockers?
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.
Indications for diuretics
hypertension, edema,
Mechanism of action of diuretics
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.
Diuretics OK in pregnancy and lactation?
No
In what conditions should diuretics be avoided?
Thiazides - gout
loop - renal insufficiency
Side effects of diuretics
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
How does digoxin work?
Increases mycardial constractile force to increase cardiac output.
How do statins work?
Primarily by increasing the number of LDL receptors on liver cells.
What are statins indicated for?
Hypercholesterolemia, primarily to lower LDL and increase HDL, very little triglyceride lowering effect.
What are the side effects of statins?
myopathy and hepatotoxicity
Can statins be used during pregnancy?
NO! Cat X
What are fibric acid derivatives indicated for?
hyperlipidemia, primarily to lower triglycerides. Will also raise HDL. May lower LDL but also may raise LDL if triglycerides are high.
What are the side effects of fibric acid derivatives?
Generally well tolerated, can have rash and GI disturbances (nausea, abd pain, diarrhea), gallstones, myopathy, hepatotoxicity
Can fibric acid derivatives be used in pg and lactation?
Probably not, cat c and safety for lactation unknown.
How do fibric acid derivatives work?
They alter the rate of synthesis of VLDL.
How does nicotinic acid (niacin) work, what is it used for and why isn't it commonly used?
- 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.
How do bile acid sequestrants work?
Bile acid resins irreversibly bind to bile acids in the gut and prevent their reabsorption. Bile acids are made out of cholesterol and triglycerides
What are the side effects of bile acid sequestrants?
not absorbed so SE limited to GI – constipation, bloating, indigestion, decreased uptake of fat soluble vitamins
How does Zetia work?
New drug, blocks cholesterol from being absorbed from the small intestines. Can be used alone or in combo with a statin.
What are the side effects of zetia?
Generally well tolerated, myopathy, rhabdomyolysis, hepatitis, pancreatitis, and thrombocytopenia
Can zetia be used in pregnancy and lactation?
Category C, safety in lactation unknown.
Mechanism of action of anticoagulants?
Greatly enhance the activity of antithrombin, a protein that inactivates two major clotting factors leading to the reduction of fibrin and suppressing clotting.
Side effects of anticoagulants?
Hemorrhage, thrombocytopenia, hypersensitivity reactions
Anticoagulants OK in preg/lac?
Heparin and lovenox preferred in pregnancy.
Mechanism of action of warfarin?
Works by acting as an antagonist to vitamin K.
Warfarin Ok in pregnancy and lactation?
NO!
Side effects of warfarin?
hemorrhage, fetal hemorrhage, teratogenesis
How do the various types of laxatives work?
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.
How do serotonin antagonists work?
Work by blocking type 3 serotonin receptors.
An example of a serotonin antagonist?
Ondansetron (zofran)
Side effects of serotonin antagonists?
HA, diarrhea, dizziness
How do dopamine antagonists work?
Blocking dopamine receptors in the brain.
Example of a dopamine antagonist?
phenergan, thorazine haldol, inapsine, reglan, and motilium
side effects of dopamine antagonists?
Extrapyramidal, anticholinergic effects, hypotension, sedation
How do H2 antagonists work?
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.
Side effects of H2 antagonists?
Antiandrogenic effect (gynecomastia, impotence) (reversible), CNS depression or excitation, pneumonia,
Can H2 antagonists be used in pregnancy and lactation?
yes
Mechanism of action proton pump inhibitors?
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.
Are proton pump inhibitors OK for pregnancy and lactation?
Generally B or C, prob safe
Side effects of PPIs?
Generally well tolerated and all fairly equivalent.
Mechanism of action of decongestants?
Sympathomimetics reduce nasal congestion by activating alpha1 adrenergic receptors on nasal blood vessels causing vasoconstriction
Side effects of decongestants?
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
Mechanism of action and indications for antihistamines?
Bind to histamine 1 receptors and block the action of histamine there. Used for allergy, motion sickness, insomnia, cold
Side effects of antihistamines?
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
Mechanism of action of beta agonists?
Sympathomimetic – produce selective activation of beta adrenergic receptors causing bronchodilation. They also suppress histamine release
side effects of short acting beta agonists?
Well tolerated, can have tachycardia, angina, tremor
Side effects of long acting beta agonists?
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
mechanism of action of leukotriene inhibitors?
Suppress the effect of leukotreines such as bronchoconstriction, eosinophil infiltration, mucus production and airway edema
Side effects of leukotriene inhibitors?
Possible liver toxicity.
Side effects of steroid nasal sprays?
generally mild, dry mucosa, burning or itching, sore throat, epistaxis, HA, adrenal suppression and slow linear growth of children
Side effects of inhaled glucocorticoids?
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
Mechanism of action of anticholinergics?
Improve lung function through blockade of muscarinic receptors causing bronchodilation
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.
• 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.
Definition and treatment of mild intermittent asthma.
 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
Definition and treatment of mild persistent asthma.
 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
Definition and treatment of moderate persistent asthma.
 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
Definition and treatment of severe persistent asthma.
 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
Definition and treatment of stage I mild COPD.
 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.
Definition and treatment of stage II moderate COPD.
 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
Definition and treatment of stage III severe COPD.
 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.
Definition and treatment of stage IV very severe COPD.
 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.
What are the classifications of hypertension?
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
Treatment recommendations for hypertension?
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
What are compelling reasons for antihypertensive treatment?
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.
Differentiate between different treatments for hyperlipidemia and hypertriglyceridemia
• 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.
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.
• Pts being anticoagulated – 2-3
• Artificial valve or post MI – 2.5-3.5