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231 Cards in this Set
- Front
- Back
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Generic of Viagra
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Sildenafil
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Brand Name of Sildenafil
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Viagra
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What is the MOA of Sildenafil
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PDE5 Inhibitor
Enhances the effect of Nitric Oxide which increases smooth muscle relaxation and blood flow |
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An increase of Nitric Oxide (NO) too high can cause what
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Reflex Tachycardia
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What is a catastrophic drop in BP when taking Sidenafil (Viagra) called
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Nitrate Interaction
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What is a consideration in frail older people when taking Viagra
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Cardiovascular status
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What other CV medications should be avoided when taking Sildenafil (Viagra)
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Alpha 1 blockers
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What is a common side effect of Sildenafil (Viagra) to consider with the eyes
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Blue green colors are altered
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What are the CYP 450 inhibitors of Viagra.
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CYP 450 3A4
Grapefruit, Cimetidine, Biaxin, Erythromycin |
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What is Sildenafil's alternate name and use
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Revatio- Tx Pulmonary HTN
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Brand name of Vardenafil
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Levitra
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Generic Name for Levitra
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Vardenafil
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What is a major precaution with Vardenafil (Levitra)
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Possible QT-interval prolongation
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Generic of Tadalafil
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Cialis
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Generic for Cialis
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Tadalafil
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Tadalafil (Cialis) is indication for ED in what men
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more than one sexual experience a week
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Generic of MUSE
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Alprostadil
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Brand name of Alprostadil
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MUSE
Medicated Urethral System for Erection |
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What type of administration is used for Alprostadil (MUSE)
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Urethral suppository : (
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What are potential complications of Alprostadil (MUSE)
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Priapism
Clots |
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What is the method of administration for the Alprostadil alternative CAVERJECT
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injection at base of the Penis
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What are the two classes of medicines used to treat BPH
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Alpha-1 blockers
5-alpha reductase inhibitors |
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Generic for Flomax
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Tamsulosin
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Brand name for Tamsulosin
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Flomax
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What is the MOA for Tamsulosin (Flomax)
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Alpha 1 blocker
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What is a potential side effect with Tamsulosin (Flomax)
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dizziness, syncope, orthostatic hypotension, vertigo, retrograde ejaculation, priapism
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What is intraoperative Floppy Iris syndrome (IFIS)
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The syndrome is characterized by a triad of a features that distinguish it:
1) a flaccid iris that billows in response to intraoperative irrigation currents, 2) progressive intraoperative miosis despite preoperative dilation with standard mydriatic drugs, and 3) potential prolapse of the iris toward the phacoemulsification incisions. |
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What is the dosing for tamsulosin (Flomax)
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.4 mg (on cap) or .8 mg (2 caps) QD at 8 PM
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Generic of Uroxatral
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Alfuzosin
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Brand Name of Alfuzosin
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Uroxatral
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What CYP 450 system inhibits Alfuzosin (Uroxatral)
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CYP-3A4
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MOA of Alfuzosin (Uroxatral)
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Alpha 1 Blocker
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Generic of Cardura XL
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Doxazosin
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Brand Name of Doxazosin
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Cardura XL
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MOA of Doxazosin (Cardura XL)
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Alpha 1 Blocker
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What do Anti Androgens block to prevent BPH
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Synthesis of androgens
5-a-reductase |
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What is a consideration to be made with administration of an antiandrogen
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PSA is reduced by 50%. This happens when prostate volume decreases.
-must double the PSA level to get accurate reading |
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Generic of Proscar
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Finasteride
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Brand Name of Finasteride
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Proscar
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MOA of Finasteride (Proscar)
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Inhibits 5 a reductase
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What is the alternate name and use of Finasteride
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Propecia
Tx Male pattern Baldness |
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What is a precaution with women handling Finasteride (Proscar)
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Pregnant women: advise not to handle the active ingredient (broken tablets)
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What OTC must you counsel with in conjunction with Finasteride (Proscar)
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Antihistamines
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What is an off label use of Finasteride
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Has been used off-label for trans-gender male patients prior to surgery
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Generic of Avodart
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Dutasteride
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Brand Name of Dutasteride
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Avodart
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MOA of Dutasteride (Avodart)
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5-a reductase inhibitor
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What drug class should you stay away from with pts that have prostatitis
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Anticholinergics
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What drug class is usually used for urinary incontinence
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Anticholinergics: Treatment for overactive bladder (Relax detrusor, squeeze sphincter
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Brand name of Oxybutynin
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Ditropan
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Generic of Ditropan
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Oxybutynin
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What is the MOA of Oxybutynin (Ditropan)
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Antimuscarinic (atropine-like) actions on smooth muscle of bladder
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What is the usual dose of Oxybutinin (Ditropan)
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5 mg TID
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What is oxytrol
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Transdermal system (Patch): One patch (3.9 mg oxybutynin) applied to abdomen, hip, or buttocks twice a week.
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What is the dosing regimen of Oxybutynin (Ditropan)
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Tabs or Syrup: BID - QID
Extended release: QD Transdermal: twice a week |
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What is a precaution when using oxybutynin (Ditropan)
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Narrow angle glaucoma, CHF, elderly, arrhythmia pts
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Generic of Detrol
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Tolterodine
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Brand Name of Tolterodine
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Detrol
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What is the advantage of tolterodine (Detrol) over Ditropan
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More selective for the bladder
Less dry mouth |
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Brand Name of Trospium
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Sanctura
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Generic of Sanctura
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Trospium
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What is Trospium (Sanctura) indicated for
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Overactive Bladder
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what is the dosing regimen of Trospium (Sanctura)
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Tabs: 20 mg, BID 1 hr before meals
CAPSULE- SANCTURA XR 60 mg: 1 in AM with water 1 hr BEFORE BKFST |
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Generic of Enablex
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Darifenacin
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Brand Name of Darifenacin
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Enablex
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What is Darifenacin indicated for
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Overactive bladder
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Generic of Vesicare
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Solifenacin
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Brand Name of Solifenacin
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Vesicare
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What is Solifenacin (Vesicare) indicated for
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Overactive bladder
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Generic of Levsin
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L-Hyoscyamine
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Brand Name of L-Hyoscyamine
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Levsin
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MOA of Levsin (L-Hyoscyamine)
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anticholinergic
Anti spasmodic |
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What is Levsin used for in terminally pts
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sputum and saliva drying agent
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What are Methanamine products used for
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Urinary Antimicrobials
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Brand Name of Methenamine Hippurate
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Hiprex
Urex |
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Generic of Hiprex or Urex
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Methenamine Hippurate
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Brand Name of Methenamine Mandelate
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Mandelamine
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Generic of Mandelamine
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Methenamine Mandelate
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MOA of Methenamines
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converted to formaldehyde and decreases pH
nearly all bacteria are sensitive to formaldehyde if a critical concentration is reached |
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What else can pt do to treat urinary bacteria
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Acidify urine: Cranberry juice or Vitamin C (500 mg once or twice a day, up to 1 g or more)
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What drug class should you avoid when your urine is more acidic from using methenamines
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Sulfa interaction: acidic urine increases
possibility of precipitating sulfonamides Avoid sulfonamides with methenamine |
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Brand Name of Nitrofurantoin
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Macrodantin; Macrobid
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Generic of Macrodantin ; Macrobid
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Nitrofurantoin
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MOA of Nitrofurantoin
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Forms a reactive metabolite: inactivates bacterial ribosomal proteins & damages bacterial DNA
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What type of Nitrofurantoin is best for the stomach
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Large flakes (macro-particles): Less GI upset
***Take with food or milk*** |
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What are some side effects of Nitrofurantoin
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Caution: Pulmonary adverse effects
(Severe cough & interstitial pneumonitis) CHRONIC USE: Permanent damage (Pulmonary fibrosis or respiratory failure, even if drug is withdrawn. Monitor pulmonary function) Contraindicated if Clcr is less than 60 mL/min |
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Brand Name of Norfloxacin
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Noroxin
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Generic of Noroxin
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Norfloxacin
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What is the MOA of Norfloxacin (Noroxin)
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Inhibits DNA gyrase (Quinolone)
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What is Norfloxacin (Noroxin) used for
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UTI, Intestinal infections, Traveler’s diarrhea
(not for general systemic bacterial infections) |
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What OTC should you stay away from when on Norfloxin (Noroxin)
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No antacids (polyvalent cations): Chelation
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Generic of Pyridium
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Phenazopyridine
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Brand Name of Phenazopyridine
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Pyridium
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MOA of Phenazopyridine (Pyridium)
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Topical (local) analgesic effect on urinary tract mucosa (not antibacterial)
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What is a Side effect of Phenazopyridine (Pyridium)
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Urine color change (reddish orange)
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What is a precaution with urine color change in Phenazopyridine (Pyridium)
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The painful symptoms are treated, but not the source or cause of the pain. This may MASK the painful symptoms of UTI.
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Should Phenazopyridine (Pyridium) be used long term
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Not for long term use to tx undiagnosed urinary tract pain
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What are Methenamine (low-mg), phenyl salicylate, hyoscyamine, benzoic acid, methylene blue used for
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Urinary Antiseptics
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What are the MOAs of Urinary Antiseptics
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Anticholinergic – antibacterial – analgesic (anticholinergic is main therapeutic agent)
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What urine change may you see with Urinary antiseptics
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May discolor urine. (Blue color)
This is a color issue only |
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what does the beers list contain?
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Drugs which are considered to be not appropriate for the elderly.
By Dr. Mark Beers |
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what is gout?
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The term Gout describes a disease spectrum including:
-hyperuricemia -recurrent attacks of acute arthritis associated with urate crystals in leukocytes, synovial fluid and tissues -interstitial renal disease -uric acid nephrolithiasis |
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what is an important relationship between hyperuricemia and gout?
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Hyperuricemia does not always lead to gout, but gout is always preceded by hyperuricemia.
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In humans, what is the end product of purine metabolism?
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sodium urate is the end product of purine metabolism.
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Acute gouty attacks can result from...
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-excessive alcohol consumption
-a diet rich in purines -kidney disease |
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why is aspirin contraindicated in acute gouty attacks?
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because it competes with
uric acid for the organic acid secretion mechanism in the proximal tubule of the kidney |
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what is a common treatment for acute gouty attacks?
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Indomethacin
It decreases pain and inflammation. |
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Chronic gout can be caused by:
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1) a genetic defect, such as one resulting in an increase in the rate of purine synthesis
2) renal deficiency 3) excessive synthesis of uric acid associated with cancer chemotherapy. |
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allopurinol is aka
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zyloprim
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what enzyme does zyloprim (allopurinol) inhibit?
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xanthine oxidase
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zyloprim is aka
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allopurinol
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what should happen with the dose if Imuran or Purinethol (6-MP). (Immunosuppressive drugs) are used in conjunction with allopurinol?
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immunosuppresive drugs must be decreased to 1/3 or 1/4 of the original dose when allopurinol is used
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Probenecid is aka
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Benemid
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Benemid is aka
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Probenecid
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Col-Probenecid is aka
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Col-Benemid
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Col-Benemid is aka
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Col-Probenecid
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What is the best indication for Col-Benemid
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Maintenance (sometimes for rest of patient's life)
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what are good counseling and dietary tips for patients on allopurinol?
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No alcohol, no aspirin (unless 81 mg)
A good dietary tip: No lobsters, clams, shellfish, wine, liquor, beer or liver. This can and commonly does provokes an attack of gout. Organ meats are also a problem |
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why do we start low in dose for uricosuric drugs?
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If you don’t start low, the uric acid in blood is pushed out in pee too quickly and crystals will form destroying the kidneys.
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what is the acceptable milligram dosage of aspirin when on uricosuric drugs?
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81 mg daily (no more than this)
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what are 4 non-drug strategies for osteoporosis?
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√ Dietary Calcium & Vit-D
√ Weight-bearing exercise (Brisk walking) √ Smoking cessation √ Avoiding glucocorticoid drugs (They increase bone loss) |
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What are the first-line agents for the management of osteoporosis in postmenopausal women as well as in men on long-term glucocorticoid therapy?
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Bisphosphonates
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how do bisphosphonates work?
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they inhibit osteoclasts (breakdown of bone) which allows osteoblasts (builders of bone) to continue bone growth
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after oral administration, what percentage of bisphosphonates are absorbed by the body?
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1%
They should be taken 30 to 60 minutes before food with ONLY water. NO FOOD! It is easily bound to food products. |
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why should patients stay upright for 30-60 minutes after bisphosphonate dosing?
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to reduce esophageal irritation
Bisphosphonates are caustic!!! Just like eating hot peppers, a burning effect on the esophagus. |
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what drug class will complicate bone density in men and women?
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glucocorticoids (prednisone)
bisphosphonates are given to counteract bone loss |
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How does Paget's disease manifest symptoms?
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Bone pain is the most common symptom
a chronic disorder that typically results in enlarged and deformed bones excessive breakdown and formation of bone tissue that occurs with Paget's disease can cause bone to weaken, resulting in bone pain, deformities, and fractures. |
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How do we diagnose paget's disease?
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bone scan
x-ray |
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How is paget's disease treated
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Bisphosphonates
Calcitonin |
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Alendronate is aka?
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Fosamax
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Fosamax is aka?
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Alendronate
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What is the most common milligram dosage of Fosamax?
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70 mg
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Which has better absorption for calcium intake, calcium citrate or calcium carbonate?
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Calcium citrate
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Risendronate is aka
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Actonel
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Actonel is aka?
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Risedronate
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Which bisphosphonates can be administered one time a month?
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Risedronate (ACTONEL)
Ibandronate (BONIVA) |
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Which bisphosphonate(s) can be given one time a year?
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RECLAST (IV infusion over 15 minutes)
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Which bisphosphonates can be given IV?
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Zoledronic Acid (ZOMETA, RECLAST)
Pamidronate (AREDIA) Ibandronate (BONIVA) |
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What is a major side effect common with bisphosphonate administration IV?
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Bisphosphonate-related osteonecrosis of the jaw
More common with IV than PO |
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Raloxifene is aka?
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EVISTA
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EVISTA is aka?
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Raloxifene
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How does Raloxifene work?
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A selective estrogen receptor modulator (SERM) (it’s a modulator instead of an agonist or antagonist)
Binds to estrogen receptors, activating some, and blocking others. (↓ risk of breast cancer) Acts as estrogen receptor agonist in bone. Decreases resorption of bone & bone turnover, increases bone mineral density (BMD) & decreases fracture incidence |
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What are adverse effects of EVISTA?
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-Deep venous thrombosis (VTE) (1%)
-pulmonary embolism (PE) -Hot flashes (25%) -Leg cramps -In certain individuals there is some edema (toes) |
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where does calcitonin come from?
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Hormone secreted by parafollicular cells of thyroid gland
Reduces number of osteoclasts |
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when would nasal spray bisphosphonates be indicated?
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patients with ulcers
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FORTEO is aka
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Teriparatide
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Teriparatide is aka
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FORTEO
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What is the only drug in the US that stimulates osteoblasts directly?
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Teriparatide (FORTEO)
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what is the major risk of FORTEO?
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osteosarcoma
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what is the route for FORTEO
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sub-q injections one time a day
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How does teriparatide work?
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Teriparatide affects calcium and phosphorus metabolism in a pattern consistent with the known actions of endogenous PTH (i.e., increases serum calcium and decreases serum phosphorous.) Teriparatide binds to the same receptors as PTH and is known to exert effects identical to that of PTH on the bone and the kidney.
PTH and teriparatide stimulate bone formation and resorption and can increase or decrease bone mass, depending on the level of exposure. |
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what is dyspareunia?
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painful intercourse
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where does premarin come from?
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Derived from urine of pregnant mares
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when is premarin cream indicated?
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Cream indicated BIW for dyspareunia
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what form of premarin is on the negative formulary in florida?
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Negative formulary in Florida for tablet form
Delayed action Counsel: No smoking |
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what drug would you not want to take if you were taking premarin
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Tamoxifen
There is some, possibly significant systemic absorption with the vaginal cream (problem with TAMOXIFEN due to estrogen receptor blocking applications) |
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what is the gold standard test for thyroid?
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TSH test (thyrotropin)
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Where does TSH come from and what two hormones are secreted from the thryoid gland as a result of TSH?
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Thyroid-stimulating hormone (also known as TSH or thyrotropin) is a hormone synthesized and secreted by cells in the anterior pituitary gland which regulates the endocrine function of the thyroid gland.
TSH stimulates the thyroid gland to secrete the hormones thyroxine (T4) and triiodothyronine (T3). |
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which thyroid hormone is the active form and actually enters the nucleus?
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T3 enters the nucleus and attaches to specific receptors.
The activation of these receptors promotes the formation of RNA and subsequent protein synthesis, which is responsible for the effects of the thyroid hormone. The active form is T3 |
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How would you describe the role of TSH to T3 and T4
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This effect creates a regulatory negative feedback loop.
When the levels of T3 and T4 are low, the production of TSH is increased, and conversely, when levels of T3 and T4 are high, then TSH production is decreased. |
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what is the dosage equivalence of thryoid hormone and synthroid?
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Dosage equivalence: 0.05 to 0.06 mg (or up to 0.1 mg) equals the potency of about 60 mg (or 1 grain) of thyroid hormone. (Crude hormone has T3 & T4, in varying potencies)
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is synthroid used to treat obesity?
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NO
There is a boxed warning - not to be used to treat obesity. |
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how do we begin dosing schedule of thyroid for patients?
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DOSES START LOW
(as low as 25 mcg, - 0.025 mg, or 50 mcg with increments of 25 mcg every 2 to 3 weeks. Should be reduced if angina occurs). Maintenance dose- 0.075 and 0.088 mg & 0.1 mg are common, with most patients requiring no more than 0.2 mg /day, or as much as 0.3 mg / day |
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what is T4 called?
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Levothyroxine
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what is T3 called?
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liothyronine
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what is dessicated thyroid?
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also known as crude thyroid hormone and Thyroid USP, is a naturally occurring thyroid hormone derived from animal (beef &/or pork) thyroid glands.
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what is the usual starting dose of synthroid?
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Usual starting dose:
1.6 mcg/kg/day of body weight or less per kg in elderly patients |
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what is the comparison between T3, T4, and crude hormone?
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25 mcg Cytomel= therapeutic effect of 1 grain crude hormone= 50-100 mcg levothyroxine
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what is the difference between Cytomel (T3) and levothyroxine (T4) ?
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-T3 is shorter-acting than levothyroxine, however it is the active thyroid hormone
-T4 is more for maintenance |
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what products do synthroid interact with?
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Interactions- binding with Al (Mylanta), and iron in vitamins and minerals, (Feosol, Theragran M and Centrum) : all polyvalent cations (iron, zinc, copper)(don’t take any minerals)
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What is Grave's disease?
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an autoimmune disease. It affects the thyroid gland, causing it to grow to twice its size or more (goiter), be overactive, with related hyperthyroid symptoms such as weight loss, diarrhea, insomnia, and irritability. It can also affect the eyes, causing bulging eyes (exophthalmos). It affects other systems of the body, including the skin. Diagnosis is usually made on the basis of symptoms, although thyroid hormone tests are used, particularly to monitor treatment. The TSH is very low to almost non-detectable.
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what is the treatment for Grave's disease?
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-Antithyroid drugs
-Radioactive iodine -Surgery to remove the thyroid gland |
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Methimazole is aka?
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Tapazole
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Tapazole is aka?
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Methimazole
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what type of drug is tapazole and PTU
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anti-thyroid drugs
They both inhibit the synthesis of thyroid hormones and are effective in the treatment of hyperthyroidism (thyrotoxicosis or thyroid storm or Grave's disease) In addition, PTU inhibits the peripheral conversion of T4 to T3 |
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what is the most serious side effect of methimazole?
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Agranulocytosis is potentially the most serious side effect of therapy.
Instruct patients to report any symptoms such as hay fever, sore throat, skin eruptions, fever, headache, or general malaise. Agranulocytosis is a low count of neutrophils, basophils, eosinophils. |
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what pregnancy category is methimazole?
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Pregnancy category D (There is evidence of human fetal risk, but the potential benefits from the use of the drug in pregnant women may be acceptable despite its potential risks).
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when anti-thyroid medications are needed for pregnant women, which drug do we choose?
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They both can cause fetal harm, but if an antithyroid agent is needed, PTU is preferred because it is less likely than methimazole to cross the placenta and induce fetal/neonatal complications. Literature leans toward PTU for pregnant women, Europe still uses the other med due to easy dosing. Tapazole has only 6 documented cases of fetal abnormalities. PTU is less likely to cause abnormalities.
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what is the role of TSH in hypothyroidism?
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TSH is HIGH
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what is the role of TSH in hyperthyroidism?
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TSH is low
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why should oral anticoagulants be used carefully with PTU?
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PTU may cause hypoprothrombinemia and bleeding, therefore the activity of oral anticoagulants may be potentiated by the anti-vitamin K activity attributed to PTU.
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what is the mechanism of cilostazol (pletal)
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Platelet aggregation inhibitor (phosphodiesterase type III (PDE III) is inhibited)
Mechanism: Inhibits PDE III. This suppresses cAMP degradation with a resultant increase in cAMP in platelets and blood vessels, leading to vasodilation and inhibition of platelet aggregation |
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cilostazol is aka
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pletal
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pletal is aka
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cilostazol
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what is the warning for pletal?
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Boxed warning: Contraindicated in patients with any class congestive heart failure (associated with Milranone which was taken off the market after cardiac death)
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when is pletal indicated?
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Indication: Intermittent claudication (claudication: From Latin: claudicatio, a limping)—cramp-like pains in the calves caused by poor circulation of the blood to the leg muscles
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what is important to know about pletal with other drugs?
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Interaction with CYP-450 inhibitors (3A4 and 2C19)- consider smaller doses of Pletal or avoid the interaction (Grapefruit juice, ‘conazoles, erythromycin, etc)
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how long does the therapeutic effect take for pletal?
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Advise the patient that it may take 2, 4, or even up to 12 weeks before a beneficial effect is experienced
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Trental is aka
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pentoxyfylline
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pentoxyfylline is aka
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trental
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which drug has a better effect on claudication, trental or pletal?
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pletal
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what is the action of pletal?
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Same indication plus many other circulation uses.
It decreases blood viscosity and improves RBC flexibility. |
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clopidogrel is aka
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plavix
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plavix is aka
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clopidogrel
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what is the action of plavix?
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Selectively inhibits the binding of ADP to its platelet receptor and activation of the glycoprotein GPIIb/IIIa complex, thereby inhibiting platelet aggregation.
Acts by irreversibly modifying the platelet ADP receptor resulting in platelets that are affected for the remainder of their lifespan. |
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what happens to the platelet ADP receptor when using plavix?
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Because the active metabolite of clopidogrel irreversibly modifies the platelet ADP receptor; platelets exposed to the drug are affected for the remainder of their lifespan.
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when is plavix indicated?
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Indications: recent MI or stroke, established peripheral arterial disease, acute coronary syndrome
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what is a precaution when using plavix?
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Precautions: Bleeding risk. D/C 5 days prior to any surgery
Warnings: thrombotic thrombocytopenic purpura (TTP): hemolytic anemia, etc. Occurs in 4 patients per million |
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what patient information needs to be given when prescribing plavix?
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Patient information: It may take longer to stop bleeding when they take this and should report any unusual bleeding to the prescriber. All of their physicians, health care practitioners, and dentists should be informed that this drug is being taken.
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Ticlid is aka
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Ticlopidine
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Ticlopidine is aka
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ticlid.
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Docusate is aka
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(COLACE, SURFAK)
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(COLACE, SURFAK) is aka
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docusate
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what is the mechanism of docusate?
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Mechanism: facilitates admixture of fat and water to soften stool (Surfactant action)
It lowers the surface tension at the oil-water interface of the feces, allowing water and lipids to penetrate the stool. This helps to hydrate and soften the fecal material, facilitating natural defecation. |
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how long does docusate take before theapeutic effect is seen?
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It has a delayed onset of action, with softening of the stool occurring after 12 to 72 hours.
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which is easier to ingest between surfak and colace?
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Sodium salt: COLACE- 50 mg, 100 mg, capsules, (Generic names: DOS, DOSS)
Syrup: 60 mg/15mL Liquid: 150 mg/15mL –Give in milk, fruit juice or infant formula to mask taste. Calcium Salt: SURFAK (KAOPECTATE STOOL SOFTENER): 240 mg capsules. Larger than Colace, harder to swallow |
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what is the most widely used product for constipation in the elderly?
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Docusate
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what are contraindications when using docusate?
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DO NOT take with mineral oil
Loss of laxative effect, potential for absorption of mineral oil, foreign body reaction |
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Scopolamine is usually administered via...
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transdermal patch
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what is the action of Scopolamine?
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Scopolamine is a belladonna alkaloid. It inhibits ACh in the vestibular apparatus and input to the CNS.
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what is the mechanism of scopolamine?
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As an antiemetic, scopolamine blocks neural pathways from the vestibular nuclei in the inner ear to the brain stem and the vomiting center.
Because acetylcholine mediates impulses from the inner ear, it is an effective antiemetic in motion sickness when used as a transdermal patch applied behind the ear. |
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when should the scopolamine patch be applied to behind the ear?
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One patch is applied behind the ear about 4 hours before the effect is required.
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what should happen after appllication of the patch?
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After applying the disc on dry skin behind the ear, the hands should be washed thoroughly with soap and water, then dried. After it is used, the patch should be discarded and the hands washed
Traces of the drug should be prevented from coming into direct contact with the eyes |
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what are the precautions for scopolamine?
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Precautions: To be used with caution in patients with pyloric obstruction, urinary bladder neck obstruction, glaucoma, and intestinal obstruction.
Also should be used with caution in the elderly, and patients with impaired kidney & liver function. |
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what are common side effects and adverse reactions of scopolamine?
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It may produce drowsiness, disorientation, and confusion.
Most common adverse reaction: Dry mouth (67%) and drowsiness (<17%) |
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meclizine is aka
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antivert
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antivert is aka
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meclizine
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what is over-the-counter dramamine?
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LESS DROWSY FORMULA, BONINE (50 mg)
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what is the action of meclizine?
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Works by anticholinergic effect in brain, being an antihistamine (at H-1 receptors)
It also causes some drowsiness (not as much as Benadryl). Meclizine is an Antihistamine with some anticholinergic action |
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what is a precation when using antivert?
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Major caution: The “Anticholinergic Burden”
Watch the patient who has BPH (benign prostatic hyperplasia). Anticholinergic effect may produce urinary obstruction since the alpha-1 receptors (sympathetic) have more influence on the lower part of the bladder, prostate & sphincter when the muscarinic (or cholinergic) receptors are blocked by an ANTI-cholinergic drug. If Rx for Antivert for a patient on Catapres, Elavil, Benadryl, Scopolamine patches, or any anticholinergic (Rx or OTC) the additive effect will cause problems. anticholinergics are sphincter squeezers |
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what does anti-slud stand for?
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Anti-SLUD:
Anti-Salivation Anti-Lacrimation Anti-Urination Anti-Defecation) Although it is less anticholinergic than the other antihistamines, the potential for all the anti-slud problems exist. |
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Lactulose is aka
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enulose
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enulose is aka
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lactulose
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when is lactulose indicated?
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Indicated to treat constipation and prevention & treatment of portal-systemic encephalopathy.
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what is the mechanism of lactulose?
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Degraded in colon to mild acids.
Ammonia (NH3) converted to ammonium cation (NH4+ ): flushed from body. Increased osmolarity causes osmotic evacuation. |
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how is lactulose administered to treat portal systemic encephalopathy
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rectal enema
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what other drugs should not be used in conjuction with lactulose?
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Not to be used while taking other laxatives
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PEG 3350 is aka
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Miralax
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Miralax is aka
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PEG 3350, Polyethylene Glycol
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what is the primary action of miralax?
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An osmotic laxative used to treat occasional constipation.
Binds water and causes water to be retained within the stool |
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when is miralax contraindicated?
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Contraindicated in patients with GI obstruction, perforation, pain
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