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180 Cards in this Set
- Front
- Back
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The enzyme cyclooxygenase is responsible for the synthesis of what substance?
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prostaglandins & related compounds
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Cyclooxygenase inhibitors inhibit what substance?
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prostaglandin
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3 adverse effects resulting from the inhibition of prostaglandins?
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-gastric ulceration
-bleeding -renal impairment |
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To what chemical family does aspirin belong?
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salicylates
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What is a common name for aspirin?
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acetylsalicylic acid
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Name 2 sites of absorption of aspirin.
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-small intestine
-rectum |
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How does the use of the rectal route affect the rate and extent of absorption?
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absorbed slowly and bld levels are lower.
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What is the term used for toxicity aspirin?
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salicylism
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Name 5 known and usual therapeutic uses for aspirin.
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1.suppression of infl.
2.analgesia 3.reduction of fever 4.dysmenorrhea 5.suppression of platelet aggregation |
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How does the dose of aspirin for arthritis compare to the dose used for analgesia or reduction of fever?
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-much larger than dose for analgesia or fever reduction
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For what types of pain is aspirin most effective?
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mild to moderate: joint pain,muscle pain,headache
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For what type of pain is aspirin relatively ineffectual against?
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severe pain of visceral origin
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Why is aspirin not recommended in children?
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bc of risk of Reye's syndrome:encephalopathy & fatty liver degeneration w/ 20-30% mortality rate.
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What effect will aspirin have on normal body temp?
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none
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Why is aspirin particularly effective in treating dysmenorrhea?
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bc it inhibits prostaglandin synthesis in uterine smooth muscle,which relieves cramping.
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What would be considered a "low dose" of aspirin to reduce the risk of stroke and MI?
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75-325 mg/day
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How likely is aspirin to cause adverse effects when admin short term in analgesic or antipyretic doses?
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unlikely
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When is aspirin toxicity more common?
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when txing inflammatory disorders bc require high doses administered long term
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Most common GI side effects of aspirin?
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1.gastric distress
2.heartburn 3.nausea |
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Although in most cases the amt of blood lost due to GI irritation is insignificant,what may result w/ chronic aspirin use?
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anemia
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What life threatening adverse effect may occur w/ long term,high dose therapy?
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gastric ulceration,perforation,& bleeding
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5 factors that might place a person at greater risk of ulceration when taking aspirin?
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1.advanced age
2.H/O PUD 3.previous intolerance to aspiring or other NSAIDS 4.cigarette smoking 5.H/O alcoholism |
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When should aspirin be discontinued prior to surgery and why?
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At least 1 week prior bc of risk for increased bleeding.
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When may salicylism begin to develop?
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when aspirin levels climb just slightly above therapeutic.
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Name 4 overt signs of salicylism.
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1.tinnitus
2.sweating 3.headache 4.dizziness |
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What action should be taken if salicylism develops?
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aspirin should be withheld until symptoms subside; therapy should then resume,but w/ a small reduction in dosage
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According to recommendations 4m the CDC when should aspirin and other NSAIDS be avoided in kids and teenagers?
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when suspected of having flu or chickenpox.
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Why is aspirin classified by the FDA as Pregnancy risk category D?
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bc there is evidence of human fetal risk
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In what pts are hypersensitivity rxns to aspirin more common? In what age group are they rare?
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common in adults with a H/O asthma,rhinitis and nasal polyps.
rare in children. |
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What S/S might a pt exhibit if having a hypersensitivity rxn to aspirin?
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begins w/ profuse,watery rhinorrhea,& may progress to generalized urticaria,bronchospasm,laryngeal edema and shock.
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If taken with aspirin, what drug can increase the risk of gastric bleeding?
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alcohol
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If a person is taking low dose aspirin for prevention of MI or stroke and then uses ibuprofen anytime he has pain,what could be the effect?
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could negate aspirin's benefits
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What S/S might a patient exhibit if having a hypersensitivity rxn to aspirin?
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begins w/profuse,watery rhinorrhea & may progress to generalized urticaria,bronchospasm,laryngeal edema, and shock.
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What age pt is at greatest risk for a lethal overdose of aspirin?
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children
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Why did the pharmaceutical industry first produce NSAIDS?
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to prod an aspirin-like drug w/ fewer GI,renal, & hemorrhagic effects.
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What medical conds does aspirin protect against that might actually be increased w/ some NSAIDS?
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MI and stroke
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Name 2 common brand names for ibuprofen.
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advil and motrin
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Name 3 actions of Ibuprofen.
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-anti-inflammatory
-analgesic -antipyretic |
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How significant are the side effects of GI bleeding and inhibition of platelet aggregation w/ ibuprofen?
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not significant
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ID the 5 doses of standard tablets for ibuprofen.
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-100 mg
-200 mg -400 mg -600 mg -800 mg |
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Name 4 brand names for naproxen or naproxen sodium.
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-Naprosyn
-Aleve -Anaprox -Naprelan |
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What are the approximate half-lives of naproxen or naproxen sodium? How does that affect the frequency of administration?
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Naproxen:12-16
Naproxen sodium:15-17 -can be administered less frequently |
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How well tolerated are naproxen and naproxen sodium?
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well tolerated
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How frequently is it recommended that naproxen or naproxen sodium to be given?
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twice daily/every 6-8 h.
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Name 2 ways acetaminophen is like aspirin and 1 way it is not like aspirin.
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Like aspirin bc it has an analgesic and anti-pyretic props. Not like aspirin bc has no anti-inflammatory actions.
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Why is acetaminophen effective in treating fever and pain but not in reducing infl?
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bc it can decrease prostaglandin synthesis in the CNS can treat fever & pain. Cannot inhibit prostaglandin synthesis outside CNS so has no effect on infl.
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How common are adverse effects to acetaminophen at therapeutic doses.
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Extremely rare.
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What is the benefit of using acetaminophen instead of aspirin for children?
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no evidence linking it with Reye's syndrome.
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What serious adverse effect is a greater risk when large doses are combined w/ alcohol consumption?
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liver injury
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What is the max daily dose of acetaminophen recommended by some authorities if a person drinks alcohol on a regular basis?
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2 gm
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Name 2 pops of pts where acetaminophen is preferred over aspirin and NSAIDS.
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-children suspected of having chicken pox or flu.
-pts who have experienced aspirin hypersensitivity rxns. |
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Even tho acetaminophen doesn't decrease platelet aggregation, what is the suspected reason there is an increased risk of bleeding when combined w/ warfarin?
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may inhibit warfarin metabolism, which would cz warfarin levels to rise.
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How does acetaminophen rank among other causes of acute liver failure in the US?
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-leading cz for acute liver failure
-accounts for 42% of all cases |
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Name a specific antidote to acetaminophen overdose.
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Acetylcysteine.
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What is significant about the fact that many OTC products and RX drugs include acetaminophen?
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bc it creates a significant risk of overdose.
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Define peptic ulcer dz.
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a group of upper GI disorders char. by varying degrees of erosion of the gut wall.
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Name 2 complications of PUD.
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hemorrhage and perforation.
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Name 2 locations where peptic ulcers are most common.
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-lesser curvature of the stomach
-duodenum |
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When do peptic ulcers develop?
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when there is an imbalance bw mucosal defensive factors and aggressive factors.
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Name the 2 major defensive factors against ulceration.
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mucus and bicarbonate.
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Name the 4 major aggressive factors for ulceration.
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1) H.pylori
2) NSAIDS 3) gastric acid 4) pepsin |
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Name the 2 most important agents that can weaken defenses against ulceration.
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H.pylori and NSAIDS
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Explain how prostaglandins play an important role in maintaining defenses.
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stimulate secretion of mucus and bicarbonate, promote vasodilation, suppress secretion of gastric acid.
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What is Helicobacter pylori?
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gram-negative bacillus that can colonize the stomach and duodenum.
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T or F? Pts w/ gastric ulcers produce and increased amt of gastric acid.
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False.
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Name 1 lifestyle habit that delays ulcer healing and increases the risk of recurrence.
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smoking
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Name the 1st and 2nd most common causes of gastric and duodenal ulcers.
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1-> H. pylori
2-> NSAIDS |
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Name 4 goals of drug therapy for PUD.
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1)alleviate symptoms
2)promote healing 3)prevent complications(hemorrhage,perforation,obstruction) 4)prevent recurrence |
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Name the 5 classes of antiulcer drugs.
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-antibiotics
-antisecretory agents -mucosal protectants -antisecretory agents that enhance mucosal defenses -antacids |
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Name the 3 basic ways drugs used for PUD act to promote ulcer healing. ID classes of drugs that perform each action.
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1.eradicate H.pylori(antibiotics)
2.reduce gastric acidity(antisecretory,misoprostol,antacids) 3.enhance mucosal defenses(sucralfate,misoprostol) |
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What class of drugs are used to cure PUD czed by documented H.pylori inf?
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antibiotics
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Name the 2 preferred drug options for prevention of NSAID-induced ulcers.
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misoprostol & proton pump inhibitors
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Name the 2 preferred drug options for tx of NSAID-induced ulcers.
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Histamine2-receptor blockers & proton pump inhibitors
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What common diet restrictions have not been shown to accelerate healing of PUD?
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restriction of caffeine-containing beverages.
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What is 1 dietary change that may accelerate healing of PUD?
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consumption of 5 or 6 small meals, rather than 3 large ones.
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What life-style habit should be avoided by pts w/ PUD?
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smoking
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What group of pts w/ PUD may continue to take aspirin and why?
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Those using it to prevent cardiovascular dz,bc it's a low dose and it's only a small factor.
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What restriction should be placed on alcohol consumption by pts w/ PUD?
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if it exacerbates their symptoms, alcohol consumption should be stopped.
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What invasive procedure is necessary to obtain a biopsy to conduct tests for H.pylori?
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endoscopy
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Name 3 types of noninvasive tests used in the USto test for H.pylori.
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-breath
-serologic -stool tests |
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Name the 5 antibiotics used to treat PUD czed by H.pylori.Which ones can be used alone?
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-amoxicillin
-clarithromycin -bismuth -tetracycline -metronidazole ~none can be used alone |
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List the antibiotics used in order of least resistance to most resistance.
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Tetracycline(1%)
Amoxicillin(3%) Clarithromycin(10%) Metronidazole(40%) |
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Name 1 common side effect that amoxicillin and clarithromycin have in common.
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diarrhea
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Name 2 other side effects of clarithromycin besides diarrhea.
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-nausea
-distortion of taste |
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What is 1 common brand name of bismuth subsalicylate.
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Pepto-Bismol
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What effect can bismuth have on the tongue and stool and what serious symptom may be difficult to assess bc of this side effect?
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black coloration;gastric bleeding
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Why should Tetracycline not be used by pregnant women or young children?
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bc it can stain developing teeth.
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Which of the 5 antibiotics used to treat PUD can cz a disulfram-like rxn if is used w/ alcohol?
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Metronidazole
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To min. emergence of resistance, how many diff. antibiotics should be used to treat PUD czed by H.pylori?
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at least 2, preferably 3.
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What other type of med should be included along w/ the antibiotics?
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an antisecretory agent
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For how many days should the antibiotic regimen last?
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14 days
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List some reasons why compliance w/ antibiotic therapy can be difficult.
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-complex regimen
-side effects are common -course of tx is somewhat expensive |
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How do histamine2-receptor antagonists(H2RAs) promote ulcer healing?
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by suppressing secretion of gastric acid.
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Name the 4 H2RAs that are effective.Which ones are most effective?
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-cimetidine
-ranitidine -famotidine -nizatidine ~all equally effective |
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What is the brand name of cimetidine?
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Tagamet
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What is the mechanism of action of cimetidine and the other H2RAs?
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blocks H2 receptors to reduce vol of gastric juice and it's hydrogen ion conc.
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What will be the effect if cimetidine is taken orally w/ meals?
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Food decreases the rate of absorption but not the extent.
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How long must cimetidine be taken to heal duodenal and gastric ulcers?
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Duodenal:4-6 wks
Gastric:8-12 wks |
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Name 4 other conds besides PUD for which cimetidine might be used.
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-GERD
-Zollinger-Ellison syndrome -Aspiration pneumonitis -heartburn,acid indigestion,sour stomach |
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Describe antiandrogenic effects.
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Gynecomastia,reduced libido,impotence.
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What pts are most at risk for CNS effects during the use of cimetidine?
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Elderly pts who have renal or hepatic impairment.
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What type of effects may occur in elderly pts w/ renal or hepatic impairment taking cimetidine?
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confusion,hallucinations,CNS depression(lethargy,somnolence,restlessness),CNS excitation(seizures)
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If a pt is taking both cimetidine and antacids, how should the drugs be scheduled?
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At least 1 hr apart.
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What is the brand name of ranitidine?
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Zantac
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How does food effect the absorption of ranitidine?
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has no effect
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How common are antiandrogenic effects with ranitidine?
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never
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How do antacids effect ranitidine?
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have a small effect on absorption.
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What is the brand name of famotidine?
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Pepcid AC
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What are proton pump inhibitors(PPIs) most effective at doing?
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suppressing secretion of gastric acid.
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What is the brand name of omeprazole?
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Prilosec
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Explain the mechanism of action of omeprazole.
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blocks the final common pathway of gastric acid prod.
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Name 2 ways omeprazole is formulated to protect it from being destroyed by stomach acid.
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-capsule that contains enteric-coated granules.
-powdered mix of omeprazole w/ sodium bicarbonate. |
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When should omeprazole be taken in relation to meals?
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before a meal
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What is the brand name of esomeprazole?
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Nexium
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What is the brand name of lansoprazole?
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Prevacid
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What is the brand name of pantoprazole?
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Protonix
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What is the brand name of sucralfate?
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Carafate
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Hoe does sucralfate work to promote ulcer healing?
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creates a protective barrier against acid and pepsin.
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What is the most significant side effect of sucralfate?
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constipation
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Since sucralfate may impede the absorption of some drugs, what would be an appropriate nursing action to minimize this effect?
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administer at least 2 hrs apart
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How should sucralfate be administered in relation to meals?
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on an empty stomach
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What form of the drug may be used if a pt finds the large tablets difficult to swallow?
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oral suspension
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What is the brand name of misoprostol?
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Cytotec
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What is misoprostol?
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an analog of prostaglandin E1.
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In the US what is the only approved GI use for misoprostol?
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prevention of gastric ulcers czed by long-term therapy w/ NSAIDS.
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What use,unrelated to GI problems,is misoprostol used for?
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to promote cervical ripening and in combo w/ mifepristone, to induce abortion.
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In normal individuals,how do prostaglandins help protect the stomach?
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1)suppressing secretion of gastric acid.
2)promoting secretion of bicarbonate and cytoprotective mucus. 3)maintaining submucosal blood flow(by promoting vasodilation) |
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How do aspirin and other NSAIDS cz gastric ulcers?
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by inhibiting prostaglandin biosynthesis.
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How does misoprostol prevent NSAID-induced ulcers?
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by serving as a replacement for endogenous prostaglandins
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Why is misoprostol contraindicted during pregnancy?
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bc it has czed expulsion of developing fetus.
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What is the FDA Pregnancy Risk Category for misoprostol?
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pregnancy category X
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When is misoprostol administered in relation to meals?
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with meals
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T or F? Antacids neutralize acid and decrease destruction of the gut wall.
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True
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T or F? Antacids may also enhance mucosal protection y stimulating prod of prostaglandins
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True
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T or F? Antacids coat the ulcer crater to protect it from acid and pepsin.
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False
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Bc the objective of peptic ulcer therapy is to promote healing, and not simply to relieve pain how often should antacids be administered?
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7 times a day.
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What are the 2 most common adverse effects of antacids?
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constipation and diarrhea
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Since antacids can influence the dissolution and absorption of many other drugs how should antacids be scheduled in relation to other drugs?
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1 hr. bw antacids and other drugs.
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Which of the 2 most common antacids causes constipation?
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aluminum hydroxide
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Which of the 2 most common antacids causes diarrhea?
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magnesium hydroxide
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Name the 3 major groups of sedative-hypnotics and how long each has been in use.
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1. Barbiturates-eary 1900s
2. Benzodiazepines-1950s 3. Benzodiazepine like drugs-1990s |
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Name the benzodiazepine that is prob most familiar to people. Generic and Brand.
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diazepam; Valium
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What are the 2 most frequently RXed benzodiazepines? Generic and Brand
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-lorazepam(Ativan)
-alprazolam(Xanax,Niravam) |
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Name the 3 therapeutic effects of benzodiazepines due to action on the CNS.
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-reduce anxiety
-promote sleep -induce muscle relaxation |
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How significant is the risk of respiratory depression w/ benzodiazepines?
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weak respiratory depressants
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With oral therapy, when might clinically significant depression occur?
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only when benzodiazepines combined w/ other CNS depressants.(opiods,barbiturates,alcohol)
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Name 3 principle indications for benzodiazepines.
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1.anxiety
2.insomnia 3.seizure disorders |
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What are 4 CNS effects when benzodiazepines are taken in sleep-inducing doses?
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-drowsiness
-lightheadness -incorrdination -difficulty concentrating |
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Anterograde amnesia?
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impaired recall of events that take place after dosing.
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What pt complaint may indicate the possibility of drug induced amnesia?
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forgetfulness
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Name 4 possible symptoms of withdrawal after short term use w/ benzodiazepines.
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-anxiety
-insomnia -sweating -tremors -dizziness |
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After long term use w/ benzodiazepines, what more serious reactions to withdrawal may occur?
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-panic
-paranoia -delirium -hypertension -muscle twitches -convulsions |
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How can the intensity of withdrawal symptoms be minimized?
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by discontinuing tx gradually.
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While similar in mechanism of action to benzodiazepines, what is the only indication for benzodiazepine-like drugs?
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treating insomnia
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In contrast to benzodiaepines, what 3 other therapeutic actions does zolpidem not share?
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lacks anxiolytic, muscle relaxant, and anticonvulsant actions.
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What are the 2 most common side effects of zolpidem? How frequent is their occurence?
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-daytime drowsiness and dizziness
-occur in only 1-2% of pts. |
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What is the recommended dose adjustment when zolpidem is given to elderly and debilitated pts?
|
reduced to 5 mg.
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What is melatonin?
|
a hormone prod by the pineal gland. Secretion is suppressed by environmental light, and stimulated by darkness.
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What can be said about the melatonin levels in insomniacs?
|
low
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Which of the 2 most common antacids causes diarrhea?
|
magnesium hydroxide
|
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Name the 3 major groups of sedative-hypnotics and how long each has been in use.
|
1. Barbiturates-eary 1900s
2. Benzodiazepines-1950s 3. Benzodiazepine like drugs-1990s |
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Name the benzodiazepine that is prob most familiar to people. Generic and Brand.
|
diazepam; Valium
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What are the 2 most frequently RXed benzodiazepines? Generic and Brand
|
-lorazepam(Ativan)
-alprazolam(Xanax,Niravam) |
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Name the 3 therapeutic effects of benzodiazepines due to action on the CNS.
|
-reduce anxiety
-promote sleep -induce muscle relaxation |
|
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What is the mechanism of action of ramelteon?
|
activation of receptors for melatonin
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In what way does ramelteon promote sleep?
|
primarily 4m activating MT1 receptors.
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Name 3 advantages for the use of ramelteon.
|
-no residual effects the day after dosing
-no rebound insomnia -no limit on how long it may be used |
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4 side effects of ramelteon r/t sexuality and reproduction which may result 4m incr levels of prolactin and decr levels of testosterone?
|
-amenorrhea
-galactorrhea -reduced libido -fertility problems |
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List 4 undesirable prop of barbiturates that have led to the decr use of these agents.
|
-cz tolerance and dependence
-have a high abuse potential -subject to multiple drug interactions -powerful respiratory depressants |
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Name the short to intermediate acting barbiturate used to tx insomnia
|
Secobarbital
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ID at least 3 disadvantages to the use of chloral hydrate for insomnia
|
-tolerance develops quickly
-w/drawal is assoc w/ sleep disruption and nightmares -abrupt w/drawal can cz delirium and seizures |
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Defien insomnia and ID 4 diff. char of poor sleep.
|
An inability to sleep well.
-difficulty falling asleep -difficulty maintaining sleep -troubled by early morning awakening -sleep that is not refreshing |
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List 3 non-drug ways to tx insomnia.
|
-avoidance of naps
-adherence to a regular sleep schedule -decr consumption of caffeine-containing beverages |
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To minimize drug-dependency insomnia, how should hypnotics be used?
|
judiciously
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What is the brand name for flurazepam?
|
Dalmane
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Bc flurazepam has a delayed onset and more prolonged duration, for what type of insomnia would it be a good choice?
|
difficulty falling asleep and difficulty maintaining sleep.
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Bc flurazepam has a relatively long half-life what is it likely to cz?
|
daytime drowsiness
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What are the brand names for zolpidem and eszopiclone?
|
zolpidem: Ambien
eszopiclone:Lunesta |
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What is the active ingredient in the OTC meds Nytol and Sominex? and drug class?
|
-diphenhydramine
-antihistamine |
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common brand name for diphenhydramine?
|
Benadryl
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