Pharm Final

Front 1

Factors stimulating release of renin

Back 1

Decreased blood pressure or sodium level, B-adrenergic agonists, hypokalemia

Front 2

Physiological effects of renin

Back 2

Increased BP, positive chronotropic and inotropic, vasoconstriction, incr. release of NE, aldosterone, and stimulation of CNS for thirst

Front 3

Indications for ACE inhibitors

Back 3

Tx of mild to moder. htn, vasodilation to treat moderate to severe CHF

Front 4

Contraindications and s/e of ACE inhibitors

Back 4

C/I in renal pts.
S/E: hyperkalemia, hypersensitivity, first-dose effect (rapid BP fall)

Front 5

Nursing implications w/ ACE inhibitors

Back 5

Monitor BP before and after dose, K levels, incr. HR, change positions slowly, teach orthostatic hypotn, clear throat feeling r/t incr. secretions in throat, best to take on empty stomach, take at same time (AM) qd

Front 6

ACE inhibitor prototype

Back 6

captopril (Capoten)

Front 7

Why give ACE inhibitors w/ diuretics?

Back 7

Better control of htn and K levels

Front 8

Angiotensin II Receptor Antagonists

Back 8

(ARBs)anti-htn, prevents vasoconstriction and fluidretention, does NOT cause chronic cough that ACE inhibitors cause

Front 9

ARB prototype

Back 9

losartan (Cozaar)

Front 10

Extra kidney functions

Back 10

Produce erythropoietin, renin, prostaglandins, involved in synthesis of Vit. D (absorbs Ca)

Front 11

Thiazides

Back 11

incr. Na and H2O excretion at early distal tubules, give with meals to prevent GI irritation.

Front 12

Prototype for Thiazides

Back 12

hydrochlorothiazide (hydrodiuril)

Front 13

S/E of thiazides

Back 13

hyponatremia, hypovolemia, hypokalemia, HYPERglycemia (dilutional), photosensitivity

Front 14

Loop diuretics mechanism of action

Back 14

Inhibit reabsorption of Na and Cl in proximal and distal tubules but mainly in LOOP, can be given IV

Front 15

Loop diuretic prototype

Back 15

furosemide (Lasix)

Front 16

Side effects of loop diuretics

Back 16

Same as all diuretics, OTOTOXICITY

Front 17

Potassium sparing diuretics and prototype

Back 17

Can be given concurrently w/ other diuretics to counteract K loss
Prototype: triamterene (Dyrenium)

Front 18

Action of K-sparing diuretics

Back 18

Inhibit Na ion pumps in distal tubule for Na reabsorption

Front 19

S/E of K-sparing diuretics

Back 19

Hyperkalemia

Front 20

Osmotic diuretics

Back 20

low molecular weight substances that increase plasma osmolarity, glomerular filtration, and tubular fluid retention by remaining in high concentrations in renal tubules. (work in proximal tubule) Inhibits reabsorption

Front 21

Indications of osmotic diuretics

Back 21

tx glaucoma, ARF, reduction of increased introaocular pressure (before or after surgery), cerebral swelling w/ trauma

Front 22

Osmotic diuretic prototype

Back 22

mannitol (Osmitrol)

Front 23

Carbonic anhydrase inhibitors action

Back 23

inhibits carbonic anhydrase->inhibits bicarb reabsorption which alkalizes urine and acidifies blood

Front 24

Indications for carbonic anhydrase inhibitors

Back 24

adjunct tx for glaucoma, hydrocephalus, petit mal seizures, tx OD of acidic based drugs like ASA or phenobarbital

Front 25

S/E and nursing interventions for carbonic anhydrase inhibitors

Back 25

s/e: hyponatremia, hypokalemia, hypovolemia, METABOLIC ACIDOSIS
Interventions: I&O, daily weights, labs, BP, dizziness, syncope, same time qd (in am)

Front 26

Prototype for carbonic anhydrase inhibitors

Back 26

acetazolamide (Diamox)

Front 27

Causes of essential htn

Back 27

Heredity, high sodium diet, smoking, type a personality, stress, hx of atherosclerosis

Front 28

Causes of secondary htn

Back 28

Pheochromocytoma (tumor of adrenal medulla)
Coarctation of aorta

Front 29

Cold medications increase BP because...

Back 29

increasing vasoconstriction to open nasal airway

Front 30

Prototype for B-blockers

Back 30

Inderal

Front 31

Action of Inderal

Back 31

1. Decrease peripheral resistance
2. Decreases renin activity
3. Resets sensitivity of baroreceptors

Front 32

C/I for B-Blockers

Back 32

Cardiac failure, bradycardia, AV conduct. distrubance, Asthma, COPD, diabetics (exacerbates hypoglycemia)

Front 33

Centrally acting alpha adrenergic agonists mechanisms of action

Back 33

Work in CNS to lower BP (decr. SNS outflow from brain to CV system). Inhibits cardioacceleration and vasoconstriction centers

Front 34

Prototype for Centrally acting alpha adrenergic agonist

Back 34

Catapres (clonidine)

Front 35

Nursing measures for clonidine

Back 35

Bradycardia, fatigue, depression. Take at night

Front 36

Peripherally acting selective A-adrenergic blockers mechanism of action

Back 36

Selectively block a-adrenergic receptors (postsynaptic) in peripheral vasculature->vasodilation

Front 37

S/E of peripherally acting selective A-adrenergic blockers

Back 37

Reflex action causes + chronotropic and inotropic, inc. renin activity (give w/ B-blocker)

Front 38

Direct acting vasodilators mechanism of action

Back 38

Directly dilate the arterioles w/out affecting the SNS or adrenergic receptors on smooth muscle cells. Can trigger reflex tachycardia and incr. renin. May require B-blockers

Front 39

Examples of direct acting vasodilators

Back 39

hydralazine (Apresoline) and nitroprusside (Nipride)

Front 40

Nursing interventions w/ hydralazine

Back 40

Arteriole dilatore, used more for long-term htn mgt. IV or PO, watch for LUPUS and NEURITIS

Front 41

Nursing interventions w/ Nipride

Back 41

Arteriole AND veinous dilator, used in ER for sever htn (200/100). Only IV, potent dilator, short durations, thiocyanide is byproduct, given as a continuous drip (not push). Light sensitive

Front 42

Class of drugs that abolishes unidirectional blocks

Back 42

Group 1B

Front 43

Class of drugs that produces bidirectional block

Back 43

Group 1A, 2, and 4

Front 44

Class 1A Mechanism of action and example

Back 44

quinidine (Quinaglute). Given for afib and atrial flutter (superventricular arrhythmias). Slows rate of depolarization, prolongs refractory period

Front 45

Interventions w/ quinidine

Back 45

v.s., listen to heart sounds, PO w/o food, IV over 30-60 min.
S/E tinnitus, dizziness, visual disturbances, double vision, diarrhea, n/v

Front 46

Class 1B Mechanism of Action and example

Back 46

Example: lidocaine (Xylocaine)
Abolishes unidirectional block (gets impulse through the jello), used for ventricular arrhythmias,

Front 47

Nursing interventions for class 1B drugs

Back 47

Give initial IV bolus, then continuous drip on pump, monitor for extravasation, depresses CNS->drowsiness, confusion, hypotn R/T vasodilation

Front 48

Class 2 Drugs Mechanism of action and example

Back 48

propranolol (Inderal)

*B-adrenergic blockers. inhibits sympathetic stim. of heart. Tx supraventricular arrhythmias

Front 49

Class 3 Mechanism of action and example

Back 49

amiodarone (Cardarone) Blocks K channels->prolonged refractory, vert. arrythmias, use if pt. can't cardiovert, can be proarrhythmic

Front 50

Class 4 mechanism of Action and example

Back 50

verapamil (Calan)

Ca channel blocker, prolongs refractory period->depresses myocardium, vasodilation.
Tx: supraventricular arrhythmnias, htn

Front 51

Nursing interventions for Class 4 drugs

Back 51

S/E include constipation, hypotn, syncope, and ortho. hypotn.

Front 52

K removing resins mechanism of action and example

Back 52

poystyrene sulfonate (Kayexalate)

Bind w/ K (which causes arrhythmias), given orally or as enema. Used when hyperkalemia causing arrhythmias.
S/E: SEVERE DIARRHEA

Front 53

Organic nitrates mechanism of action

Back 53

Directly relax vascular smooth muscle, affect both arterial and venous tone->decr. preload->decr. BP->reflex tachycardia. Used to treat angina and CHF

Front 54

Nursing interventions for Nitro

Back 54

S/E: ha, then hypotn, bu;rning @ area of application, reflex tachycardia
SL: keep under tongue, if doesn't work in 5 min., use another, up to three. Keep in BROWN JAR, air decomposes drug. Change q6mos.
TD: put one on, take one off, non-hairy area, on in am off at hs
IV: glass bottle, use pump, monitor v.s., rate based on BP titration

Front 55

Cardiac glycosides action and example

Back 55

Digoxin
Act through the inhibition of ATPase->accumulation of Na w/in cell->release of lg. quantities of Ca->more irritable->contracts more freq. Incr. SA node sensitivity, negative chronotropic, slows impulse inside heart, sits at AV node longer (little more time for ventricles to fill)

Front 56

Indications for digoxin

Back 56

CHF, supraventricular arrhythmias

Front 57

S/S of digitoxicity

Back 57

Blurred vision, white halos, chromatopsia (white looks green or yellow), flickering lights, anorexia, n/v, diarrhea, atrial arrhythmias, SA block, bradycardia

Front 58

Antidote for digoxin

Back 58

Digoxin Immune Fab (Digibind)

Front 59

Heparin action at low and high doses

Back 59

Low: prophylaxis, inhibits Factor X, which begins common pathway
High: inactivates thrombin, prevents conversion of fibrinogen to fibrin, pt. already had TIA, CVA, prevent clot from getting worse

Front 60

Routes of Hep admin.

Back 60

IV: immediate action
SC: gradual, longer-acting
NOT IM: erratic absorption and excessive bleedig

Front 61

Clinical indicator of hep therapy

Back 61

APTT (activated partial thromboplastin time). Goal is APTT 1.5-2.0 times normal clotting time (30-40 sec)

Front 62

Oral anticoagulants mechanism of action and prototype

Back 62

warfarin (Coumadin)
Acts in the LIVER to inhibit the synthesis of active Vit. K clotting factors.

Front 63

Clinical indicators for coumadin efficacy

Back 63

PT 18-30 sec.
INR 2.0-3.0

Front 64

Nursing implications w/ Coumadin

Back 64

Take same time qd, routine bloodtests, don't change amt. of greens consumed, wait til coumadin therapeutic to take off hep, watch for bleeding, soft bristle tooth brush, electric razor

Front 65

Drugs that antagonize coumadin

Back 65

Barbituates and dilantin

Front 66

Clinical indications for thrombolytic drugs and example

Back 66

Ex: streptokinase (Streptase)
Dissolve clots, use w/ CVA if symptoms started w/in last 6hrs.

Front 67

Nursing interventions w/ streptokinase

Back 67

Given IV, use immediately after reconstituting, pump, don't stick more than once, put sandbags over puncture wound, v.s., bleeding, H and H, clotting time

Front 68

Antidote to streptokinase

Back 68

aminocarproic acid (Amicar) given IV or PO

Front 69

Platelet inhibitors mechanism of action and Ex.

Back 69

Inhibit plt. aggregation. Ex: ticlopidine (Ticlid) NO ANTIDOTE. Take w/ food

Front 70

Hemorrheologic agent mechanism of action and example

Back 70

pentoxifylline (Trental)

Improves microcirculation by incr. flexibility of RBCs

Front 71

Mechanism of action for bile acid sequestrants and example

Back 71

cholestyramine (Questran) Inhibits reabsorption of bile-> incr. excretion-> incr. use of cholesterol to make bile->decr. cholesterol. May need to take a laxative and incr. fluids, may decr. fat soluble vitamins

Front 72

S/E of nicotinic acid and example

Back 72

Niacin (Nicobid, Vit. B3)
S/E: flushing, take ASA 30 minutes before to prevent flushing

Front 73

Reductase inhibitors mechanism of action and example

Back 73

Ex: lovastatin (Mevacor, Zocor, Crestor)
Inhibit enzyme that makes cholesterol. Monitor liver, take w/ meals to decr. GI symptoms, ha

Front 74

Gompertzian Kinetics

Back 74

abnormal growth rate in which cells lack the normal regulating factors->continue to multiply pass the critical mass state

Front 75

Clinical manifestations of bone marrow depression in chemo pt. and drugs given to manage

Back 75

Neutropenia (give interferon), thrombocytopenia, and anemia (give Epogen or Procrit)

Front 76

Toxicities other than bone in chemo tx

Back 76

Stomatitis, n/v, diarrhea, alopecia, reproductive toxicity, hyperuricemia (incr. uric acid prod.)

Front 77

Subcategories of antimetabolites

Back 77

*Folic Acid antagonists
*Purine antagonists
*Pyrimidine antagonists

Front 78

Pyrimidine antagonists mechanism of action and S/E

Back 78

Fluorouracil (5-FU), inhibits pyrimidine synthesis.
S/E: neurotoxicity (monitor for q in LOC), hyperpigmentation, no significant drug interactions

Front 79

Subcategories of mitotic inhibitors

Back 79

Vinca alkaloids
Podophyllotoxins
Taxenes

Front 80

Vinca alkaloids prototype and mechanism of action

Back 80

Vincristine (Oncovin)
Interferes w/ microtubule assembly.

Front 81

Vinca alkaloids s/e and interactions

Back 81

S/e: neurotoxicity, vesicant
Interactions: Phanytoin, digoxin, Ca channel blockers

Front 82

Podophyllotoxins prototype and mechanism of action

Back 82

Etoposide (Vepesid)
Inhibits DNA synthesis so cell doesn't enter mitosis,

Front 83

S/E and interactions w/ podophyllotoxins

Back 83

S/E: bone marrow suppression, alopecia, mild peripheral neuropathy, and sever hypersensitivity, teratogenic and mutagenic risks. GIVE B6.

No significant interactions

Front 84

Prototype and mechanism of action for Taxanes

Back 84

Paclitaxel (Taxol)

Promotes abnormal formation of spindle fibers during interphase

Front 85

S/E and interactions w/ taxanes

Back 85

S/E: bone marrow depression, peripheral neuropathy, cardiotoxicity, severe hypersensitivity, vesicant

Interacts w/ Verapamil, Quinidine, and Ketoconazole

Front 86

Subcategories of alkylating agents

Back 86

Nitrogen mustards
Nitrosureas
Alkylator-like agents

Front 87

Nitrogen mustard prototype and mechanism of action

Back 87

Cyclophophamide (Cytoxan)
Screws up protein matching in double helix (cross-linking) blocks replication

Front 88

S/E of nitrogen mustards

Back 88

Bone marrow depression, hemorrhagic cystitis (blood in urine), alopecia, hepatotoxicity, teratogenic and mutagenic risks. Keep pt. HYDRATED

Front 89

Prototype and mechanism of action for nitrosureas

Back 89

carmustine (BCNU)
Causes cross-linking, realily crosses BBB

Front 90

S/E and interactions w/ Nitrosureas

Back 90

bone marrow depression, frequent n/v, pulmonary toxicity, hypersensitivity, hyperpigmentation, teratogenic

Interactions: cimetidine, digoxin, and phenytoin

Front 91

Antitumor antibiotics mechanism for action and prototype and S/E

Back 91

Doxorubicin (Adriamycin)
Inhibits DNA and RNA synthesis
S/E: irreversible cardiomyopathy, truns urine pink/red, bone marrow depression, alopecia, hyperuricemia, GI disturbances

Front 92

Use of corticosteroids in CA pts.

Back 92

Used in conjunction w/ xrt, decreases sxs, gradually taper doses, s/e include F/E imbalances,exacerbation of DM, osteoporosis, peptic ulcers, increased infections

Front 93

Antiestrogen prototype and mechanism of action

Back 93

Tamoxifen (Nolvadex)
Blocks estradiol uptake and is effective w/ tumors that contain high conc. of estrogen receptors. Breast CA prevention

Front 94

Interferons prototype and S/E

Back 94

Interferon alfa-2a
Assist lymphocytes but don't know how.
S/E: flu-like sx, anorexia, diarrhea, dizziness, bone marrow depression, alopecia, cardiotoxicity, neurotoxicity, hyperuricemia

Front 95

Antigout drugs

Back 95

Allopurinol, Colchicine, and Probenecid

Front 96

Gout

Back 96

Results from inappropriate uric acid metabolism from overproduction or underexcretion of uric acid.