pharm exam 3: respiratory, high risk drugs, complement therapy, drugs for anxiety, neurological

st johns wort

Antidepressant and analgesic but can accelerate metabolism of drugs and a rash can occur in sunlight

Inhalation

-lower dosages since there is no first pass effect
-less side effect
- increased therapeutic effects since it sits where it needs to effect

inhaled devies examples

metered dose inhalers (MDI), dry powder inhalers (DPI), nebulizers

metered dose inhalers

alberterol

dry powder inhaler

salmeterol diskus

nebulizer

ibratropium and albuterol

how much medication stays in the lungs with a patient who uses a spacer

21%

which group should use a spacer

parkinsons and arthritis

how long do you need in-between puffs of metered dose inhalers

at least one minute

what is the percentage of metered dose inhalers

10% will reach lungs
80% will be swallowed
10% is exhaled

what is dry powdered inhaler actives by

breath

which drug delivers more drugs MDI or dry powder

dry powder

how long does a person inhale a nebulizer for

3-5 minutes

asthma signs and symptoms

- wheezing
- difficulty breathing
- tightness in chest
- breathlessness

what does allergen bind to in asthma

mast cells

which mast cell causes bronchoconstriction and increases secretion release

histamines

which mast cell causes bronchoconstriction and is a vasodilator

leukotrienes

which mast cells is a hormone that causes inflammation

prostaglandins

which mast cell causes an inflammatory response

interleukins

What is the MOA of albuterol?

promotes bronchodilation by activating smooth muscle in the bronchioles; supresses histamine

which inhaled product last 12 hours

salmeterol

how long do the effects of albuterol last

3-5 hours

Anticholinergics

Ipratropium; prevents and relieves bronchospasm

which drugs are mixed for COPD

ipratropium and albuterol

What is DuoNeb?

It is the combination of ipratropium with albuterol in a nebulizer

what steroids effects the metabolism of cells and helps the body respond to stress - can raises blood glucose

glucocorticoids

which steroid secretes aldosterone from the adrenal cortex, and regulates blood volume by regulating sodium

mineralocorticoids

which steroid are androgens most commonly secreted and starts puberty

gonadocorticoids

what is given to people with delayed puberty and diseases that cause muscle loss; synthetic variation of the male sex hormone

anabolic steriods

what are mental effects of anabolic steroids

- paranoia and jealousy
- irritability and aggression
- delusions
- impaired judgment
- mania

what are severe and long term effect of anabolic steroids

- severe acne
- kidney disease, liver disease w tumors, hypertension and hypercholesterolemia, increased risk of blood clots

loss of appetite, fatigue, restlessness, decreased sex drive, depression w si are all symptoms of what

anabolic steroid withdrawal

what are the endings for steroids

-sone
-sonide
-cort

what is the inhaled corticosteroid that treats the inflammatory component of asthma

beclomethasone

what is a mast cell (fluid) stabilizer

Cromolyn

what is a luekotrine modifier

montelukast

what is last med used when none of the other asthma meds work

theophylline

first generation drug that makes you sleepy; also known as benadryl

diphenhydramine

There is an increased risk of bleeding when a patient has _________________, also known as a low platelet count.

thrombocytopenia

Drugs which break up blood clots are referred to as

thrombolytics

A blood clot which travels to the lungs is called a ______________________.

Pulmonary embolism

___________________ is enlargement of the organ which filters out old and damaged blood cells.

Spleenomegaly

Intravenous heparin dosaging is adjusted according to the patient's ______________.

ptt

not a type of white blood cell

hemoglobin

The PT and the ___________ are blood tests used to determine the dosaging of warfarin.

INR

Drugs which alter the ability of the body to form a blood clot are known as _________________________.

anticoagulants

A collection of blood following a soft tissue injury is called a(n) _________________.

hematoma

A _________________________________ is a clot which has formed in the peripheral circulation.

deep vein thrombosis

What is heparin used for?

Anticoagulant; used for prompt attention like dvt, pe, surgical procedures and chemo dialysis

what does lmw heparin (enoxaprin) do

treats dvt and pe
prevents dvt
prevents complication after MI

Heparin is a ___________ acting, _________ charges.

rapid; negatively - stays in blood instead of tissue

what does heparin suppress in veins

fibrin formation

therapeutic uses of heparin

-Preferred anticoagulant during pregnancy and when rapid anticoagulation is required
-Pulmonary embolism (PE)
-Stroke from thrombosis
-Massive deep venous thrombosis (DVT)
-Open heart surgery
-Renal dialysis

Heparin antidote

Protamine @ 20mg/min

signs and symptoms of blood loss heparin

-black tarry stools
-hematomas
-change in consciousness

what do you do if there is heparin induced thrombocytopenia

- monitor platelet count
- use another anticoagulant

what disorder can cause heparin to destroy platelets

immune

how many mg of protamine inactive 100u of heparin

1

PTT therapeutic range

60-80

what do you do if ptt is too high

turn off heparin or administer protamine

what do you do if ptt is too low

bolus of heparin and recheck ptt

where should heparin be given

lower abdomen deep subcutaneous

where should lmw hep be given

at least two inches from belly button

adverse effect of lmw hep

bleeding

What is the lab for warfarin?

inr

INR range

2-3 for low risk
2.5-3.5 for high risk

Which anticoagulant should be given if pt is pregnant

heparin

adverse effect of warfarin

hemorrhage

what are you at risk for when taking warfarin

hepatitis

how do you treat warfarin toxicity

vitamin k

Why is warfarin contraindicated in pregnancy?

-passes the placental barrier, may cause bleeding in fetus
- category x

Warfarin contraindications

- low platelet
- bleeding issues
- surgical
- liver disease (clots made)

what drugs increase the effects of warfarin

- aspirin
- acetominphen
- glucocorticoids
- sulfonamides
- parenteral cephalosporins

what drugs decrease the effects of warfarin

seizure meds and oral contraceptives

what do direct acting oral anticoagulants do

block a single clotting factor

which works faster DOACS or warfarin

DOACS

what is an alternative to warfarin (coumadin)

dabigatrin - doacs

who shouldn't take dabigatrin

- pregnancy category c
- active bleeding
- liver impairments

dabigatran adverse effects

bleeding, GI disturbances

Drug-Food Interactions of dobigatran

- rifampin: reduces effectivenesss
- other anticoags ^ effect

Fondaparinux works by

inhibiting clotting factors

what are you at risk for when taking fondaparinux

- bleeding
- ^ liver enzymes
- allergy

What does ASA do?

prevents platelet adhesion and suppresses vasoconstriction

When is ASA appropriate?

- preventing MI
- preventing stroke

what are you at risk for when taking ASA

- tinnitus
- hearing loss
- raises risk of GI bleed and stroke

when should a larger dose of ASA be given

during an acute event

when should a smaller dose of ASA be given

to prevent MI and CVA

clopidogrel

Antiplatelet; used if can't use ASA

Where is iron absorbed in the body?

small intestine (duodenum)

what should be watched when given iron supplements

- GI upset
- staining of teeth and skin
- anaphylaxis if given parenterally

ferrous

oral iron salts

primary cause of birth defects in babies

folic acid deficiency

what is used for hematopoietic growth factors

epoetin alfa

adverse reactions of epoetin alfa

-hypertension
-develop antibodies that worsen anemia
- ^ risk of thromboembolism and DVT
- headaches
- bone aches

Neutropenia treatment

filgrastim or sargramostin

filgastrim

- increase production in bone marrow
- make neutrophils work harder

Filgastrim adverse effects

- Bone pain
- Leukocytosis (high wbc)
- splenomegaly (enlarged spleen) and risk of spleen rupture

what assessment should be reported when taking filgastrim

left upper quadrant and shoulder pain

what medicine should be taken for thrombocytopenia

oprelvekin and platelet infusion

Thrombocytopenia

a condition in which there is an abnormally small number of platelets circulating in the blood w an increased risk of bleeding