pharm exam 2

how much is considered clinically significant body weight loss?

5% of total body weight

stimulant prototype

phentermine-topiramate (Qsymia)

qsymia epa

triggers norepi release to trigger appetite, enhance GABA activity, inhibits carbonic anhydrase; makes people feel full on less

qsymia therapeutic use

chronic weight management

qsymia admin

PO

qsymia adrs

insomnia, tachycardia, palpitation, taste perversion (dysgeusia)

qsymia contraindications

pregnancy risk, hyperthyroidism, seizures

qsymia NI

take in AM, monitor HR and BP

NDRI prototype

naltrexone-bupropion (Contrave)

contrave epa

stimulates neurons in the hypothalamus to reduce appetite; naltrexone blocks opioid mediated negative feedback on these neurons

contrave theapeuticn use

chronic weight management

contrave admin

po

contrave adrs

insomnia, anxiety, nausea/vom, hypertension, tachycardia

contrave boxed warning

increased risk of SI

contrave contraindications

uncontrolled HTN, chronic opioid use/withdrawal, seizure disorder

contrave NI

take in the AM, monitor for worsening depression, SI, unusual behavior changes, be opioid free for 7-10 days before starting; monitor HR and BP

lipase inhibitor prototype

orlistat (Xenical)

orlistat epa

blocks pancreatic lipase from breaking down dietary fat— you poop out 30% of the fat you ingest

orlistat therapeutic use

chronic weight management

orlistat admin

Po wf

orlistat adrs

oily stools (steatorrhea), fecal urgency (it’s coming out), fecal incontinence, liver injury

orlistat contraindications

chronic malabsorption syndrome, cholestasis, pregnancy

orlistat NI

strict low-fat diet, take wf or up to 1 hour pc (if meal contains fat), skip dose if meal is missed dor contains no fat; report signs of liver dysfunctions

what is a1c?

how controlled your blood glucose is over a 3-month period

incretin mimics (GLP-1s) prototype

exenatide (Byetta)

glp1 epa

activates GLP1 receptors to stimulate I nsulin release; suppresses glucagon; slows gastric emptying; signals satiety to brain

glp1 therapeutic use

chronic weight management; t2d (lowering A1C)

glp1 admin

sq or po

glp1 adrs

nausea, vom, diarrhea, constipation, acid reflux, bloating, heartburn, sulfuric burps (yikes)

glp1 contraindications

history of gallbladder illness or pancreatitis; personal or family history of medullary thyroid carcinoma; pregnancy; T1D

glp1 NI

sq inj education; eat smaller portions; stop when full; s/sx of pancreatitis, stay hydrated

serotonin agonist prototype

sumatriptan (Imitrex)

what is CGRP?

calcitonin-related gene peptide - involved in pain response from a migraine

sumatriptan epa

reverse serotonin to CGRP ratio by activating serotonin receptors to promote vasoconstriction and prevent inflammatory response

sumatriptan theapeutic use

relieve migraine symptoms

sumatriptan admin

po, sq, nasal

sumatriptan adrs

chest pressure that can progress to angina caused by coronary vasospasm

sumatriptan contraindication

liver or kidney insufficiency; CAD; PVD; MAOIs; St. John’s wort

sumatriptan NI

call 911 if you experience tightness or pain in the chest or jaw; report CNS symptoms, educate client on administration; do not exceeed 200mg in 24h

origin or primary HTN

no known cause

origin of secondary HTN

renal, CNS or other chronic illness

stage 1 HTN reading

130-139 systolic OR 80-89 diastolic

normal BP

LESS than 120 AND LESS than 80

elevated BP

120/129 AND LESS than 80

stage 2 HTN

140+ systolic OR 90+ diastolic

severe HTN (emergent)

180+ systolic and/or 120+ diastolic

symptoms of emergent HTN

chest pain, SOB, back pain, numbness, weakness, change in vision or difficulty speaking

what is the RAAS?

renin-angiotensin-aldosterone system; regulates BP

Angiotensin-converting enzyme (ACE) inhibitor prototype

captopril (Capoten)

ACE inhibitor epa

block the enzyme that converts angiotensin 1 to angiotensin 2, reducing vasoconstriction and aldosterone (reducing retention of sodium and water); result is vasodilation and potassium retention

lisinopril therapeutic use

HTN and heart failure

lisinopril admin

po

lisinopril adrs

orthostatic HTN, dry nonproductive cough, angioedema (swelling in lips and tongue), taste distortion, rash

lisinopril contraindications

teratorgenic, breastfeeding, liver disease w/ elevated enzymes, NSAIDs (risk of renal complications)

lisinopril NI

avoid salt substitutes, monitor BP, educate pts about the cough, monitor for s/sx of hyperkalemia; monitor BP

normal K level

3.5-5 mEq/L

s/sx of hyperkalemia

slow, irregular HR, palpitations, muscle twitching, weakness, diarrhea, paresthesia

angitensin 2 receptor blockers (ARBs) prototype

losartan (Cozaar)

losartan epa

blocks vasoconstriction further in the system; blocks aldosterone secretion from angiotensin 2; increases renal blood flow; vasodilation and retention of K

losartan theapeutic use

treatment of HTN; stroke prevention (losartan); diabetic nephropathy (losartan/irbesartan), heart failure (valsartan)

losartan admin

po

losartan adrs

angiedema, headache, insomnia, dizziness, hypotension

losartan contraindications

teratogen, NSAIDs, lithium

losartan NI

monitor K levels, monitor for side effects

aldosterone antagonist protoype

eplerenone (Inspra)

other aldosterone antagonist

spironalactone

spironalactone epa

blocks aldosterone receptors, encouraging excretion of sodium, water and retention of potassium

spironalactone therapeutic use

HTN and post MI heart failure symptoms

spironalactone admin

PO, up to 4 weeks

spironalactone adrs

hyperkalemia

spironalactone contraindications

meds that increase K, do not take if K levels are below 5, NSAIDs, lithium

direct renin inhibitor prototype

aliskiren (Tekturna)

aliskiren epa

binds with renin, inhibiting activation of angiotensin 1, leading to vasodilation and excretion of sodium and water

aliskiren therapeutic use

HTN

aliskiren admin

po 1h ac; do not take with fatty food

aliskiren contraindications

teratorgen, hyperkalemia, pediatrics, ACE inhibitors, ARBs

aliskiren NI

monitor BP, monitor for s/sx of kyperkalemia; periodic blood levels of K, BUN; avoid salt substitutes

what is BUN?

blood urea nitrogen levels

calcium channel blocker prototype

amlodipine (Norvasc)

other calcium channel blocker

nifedipine (Adalat)

amlodipine epa

block calcium channels in vascular smooth muscle of peripheral arteries

amlodipine therapeutic use

HTN, stable angina

amlodipine admin

PO (IR or ER)

amlodipine adrs

reflect tachycardia, angina, vasodilatory headache, facial flushing, peripheral edema. arrhythmias, gingival hyperplasia

amlodipine contraindications

pediatrics, heart block, bradycardia, grapefruit

amlodipine NI

dental checkups, monitor BP and HR

alpha 1 blockers protrotype

doxazosin (Cardura)

other alpha 1 blocker

prazosin (Minipress)

doxazosin epa

block alpha 1 receptors for venous and arterial dilation

doxazosin therapeutic use

HTN, BPH

doxazosin admin

po hs

doxazosin adrs

orthostatic hypertension, reflex tachycardia, headache, dizziness

doxazosin contraindications

sildenafil

doxazosin NI

monitor BP when changing positions, fall risk, move from sitting to standing slowly

beta blockers prototype

atenolol (Tenformin)

other beta blockers

carvedilol, metoprolol

atenolol epa

block beta 1 receptors - decrease in HR and contractility, decrease cardiac output and suppress reflex tachycardia, block renin release

atenolol therapeutic use

HTN, angina, dysrhythmias, MI, heart failure

atenolol admin

PO, IV

atenolol adrs

bradycardia, heart failure, rebound excitation with sudden withdrawal