Pharm 3 Exam: Endocrine, Respiratory, and Hematologic systems

what are the two types of antihistamines?

Histamine H1-receptor antagonists and histamine H2 antagonists (stomach)

an example of a first generation antihistamine is....

diphenhydramine (Benadryl)

what is the mechanism of action for diphenhydramines?

1. Compete with histamine for H1 receptor sites to limits vasodilation, capillary permeability, and swelling​

2. Limits acetylcholine release, which dries secretions in the bronchioles and GI system​

3. Sedative effect on the CNS

what are some adverse effects of antihistimines?

Blurred vision, dizziness, dry mouth, dry thickened secretions, nausea, GI upset, fatigue

what are some adverse effects of antihistamines specific to diphenhydramine?

Tachycardia, palpitations, confusion, sedation

what drugs/others things does diphenhydramine interact with?

CNS depressants and alcohol

True or false: you should take diphenhydramine with food if GI upset occurs?

true

what happens if you take more diphenhydramine than the provided dose?

serious side effects (hallucinations)

True or false: you can take diphenhydramine with CNS depressants?

false

what adverse effects may diphenhyradmine have when given to pediatric patients?

Paradoxical reactions may occur: Increased nervousness, confusion, or hyperexcitability

what adverse effects may diphenhyradmine have when given to elderly patients?

More likely to develop side effects such as dizziness, syncope (lightheadedness and fainting), confusion, and extrapyramidal reactions.

_______________is a condition that involves increased inflammation, swelling, and mucus production that lead to bronchiolar constriction.

asthma

_______________results because the person works to force air out through narrowed, mucous-filled passages during expiration.​

wheezing

____________________is a chronic, disabling disorder that causes destruction of alveolar walls. This destruction creates unequal areas of ventilation and perfusion in the body, and oxygen and carbon dioxide exchange is impaired. Patients experience difficulty in ________________.

COPD

expiration

inhaled __________________________ are used for long-term asthma control ​

corticosteroids

what is often used for long term asthma therapy?

inhaler

Fluticasone and beclomethasone are what type of meds?

inhaled only corticosteroids

prednisone and dexamethasoneare what type of meds?

PO and IV only corticosteroids

what is the mechanism of action for inhaled + systemic corticosteroids?

1. Block reaction to allergens and reduce airway hyperresponsiveness​

2. Inhibit cytokine production, protein activation, and inflammatory cell migration and activation​

inhaled corticosteroids have a risk for what adverse effect?

oral candidiasis

what patient education is necessary to prevent oral candidiasis?

(1) Client must rinse mouth with water or gargle after each use to prevent oral candidiasis ​

(2) Rinse equipment and dry completely​

(3) Monitor for symptoms​

(4) Report white patches, sores, pain​

(5) someone who has decreased immunity is at more risk for an infection like this

select all adverse reactions that may occur with the use of systemic corticosteroids

1. hypertension

2. hyperglycemia

3. hypotension

4. hypoglycemia

5. insomnia

6. fatigue

7. anxiety

8. appetite changes

9. vision changes

2. Hyperglycemia

8. appetite changes

5. insomnia

7. anxiety​

what are the long term risks for someone who uses systemic corticosteroids?

Adrenal gland and immune system suppression​

Bone loss, osteoporosis, growth suppression (peds)​

Cushing syndrome

after how long do you need to taper corticosteroid doses?

if the patient has been taking the for less than 10 days, then you do not need to taper. If they have been taking them for more then 10 days, you need to taper slowly.

What special considerations should be taken with diabetic patients who are on corticosteroids?

Monitor blood glucose levels closely with diabetic patients​

​because of risk for hyperglycemia

what are the types of beta-2 antagonists?

SABA - short acting = albuterol (inhaler, nebulizer)​

LABA - long-acting = formoterol, salmeterol (single and combination inhalers)​

formetorol and salmeterol are examples of which type of beta-2 antagonist?

LABA (long acting beta antagonist)

albuterol is an example of which type of beta-2 antagonist?

SABA (short acting beta antagonist)

what are bronchodilators such as beta-2 antagonists used for?

Relief of symptoms of bronchospasm in acute or chronic asthma, bronchitis, and COPD

what is the mechanism of action for beta-2 antagonists?

(1)Selectively stimulates beta-2 adrenergic receptors, relaxes smooth muscle, results in bronchodilation​

(2) Inhibit histamine release​

(3) Vasoconstriction of blood vessels in body (decreases mucosal and submucosal edema)​

(4)Increase the rate and force of heart contraction​

what are adverse effects of beta-2 antagonists?

patients may report feeling "shaky" & "nervous", common side effect that usually subsides in 15 - 60 minutes​

Nausea, diarrhea, dizziness, insomnia, cough​

what are serious adverse effects of beta-2 antagonists?

Serious: Hypertension, angina, arrythmia, bronchospasm​

true or false: it is okay to skip beta-2 antagonist doses if you have mild side effects?

no, just let them have a little break, then resume therapy

True or false: people with asthma should carry their SABA with them because it serves as a rescue if they have an asthma attack?

true

should people with asthma have an "action plan"

yes

____________________- Decreases the thickness of respiratory secretions, which facilitates expectoration

(also known as "liquefying agent"​)

Mucolytics/Expectorants ​

what are Mucolytics/Expectorants ​used for and what do they treat?

Treat productive cough, assist with thick mucus​

when a person is on a mucolytic, should they drink more water?

yes, it loosens/liquefies the secretions

what is an example of a med that is a mucolytic?

Guaifenesin (Mucinex)​

what is the mechanism of action for expectorants?

drugs that liquefy the lower respiratory tract secretions. ​

Stimulate production of secretions to improve a cough's productivity​

what is the mechanism of action for mucolytics?

Work to break down mucus to aid high-risk respiratory patients in coughing up thick, tenacious secretions.​

what med should a person on mucolytics or an expectorant avoid and why?

antihistamines bc they are a "drying" agent

normal cholesterol range is below ___________

200

a ________________ is the combination of triglyceride or cholesterol with apolipoprotein.

lipoprotein

is LDL or HDL known as the good cholesterol

HDL

what are antilipemic drugs used for?

Drugs used to lower lipid levels​

Used as an adjunct to diet therapy​

All reasonable nondrug means of controlling blood cholesterol levels (e.g., diet, exercise) should be tried for at least how long and found to fail before drug therapy is considered?

6 months

name 2 antilipemic drugs

1. HMG-CoA Reductase Inhibitors (statins)

2. Cholesterol absorption inhibitor

what are two examples of HMG-CoA Reductase Inhibitors?

atorvastatin and simvastatin

what is an examples of a cholesterol absorption inhibitor?

Ezetimibe (zetia)

statins are used in patients with what disease and with what level of LDL cholesterol?

Patients with clinical atherosclerotic cardiovascular disease (CVD)​

Patients with LDL cholesterol levels >190 mg/dL​

Diabetics with high LDL

what is the mechanism of action for statins?

Inhibit HMG-CoA reductase, which is used by the liver to produce cholesterol​

Lower the rate of cholesterol production​

statins are the first-line drug therapy for...

hypercholesterolemia​

do statins increase or decrease triglycerides and HDL

increase

what are the adverse effects of statins?

Mild, transient gastrointestinal (GI) disturbances​

Rash​

Headache​

Myopathy (muscle pain, muscle weakness), possibly leading to the serious condition rhabdomyolysis

Elevations in liver enzymes (AST/ALT) or liver disease​

what lab values can help determine someone has rhabdomyolysis?

elevated CK, Creatine Kinase

what problems can rhabdomyolsis lead to

acute renal failure and even death​

True or false: when recognized reasonably early, rhabdomyolysis is usually reversible with discontinuation of the statin drug.​

true

true or false: instruct patients to immediately report any signs of toxicity, including muscle soreness or changes in urine color (dark, or dark red color), as this may indicate rhabdomyolysis

true

what drugs interact with statins?

Oral anticoagulants

why is atorvastatin given at night with meals or at bedtime?

to correlate with diurnal rhythm

(bc liver usually makes cholesterol at night and the cholesterol needs to be blocked).​

true or false: simvastatin has many drug interactions which may require dosing adjustments​

true

what is the function of Ezetimibe (Zetia)​?

Inhibits absorption of cholesterol and related sterols

true or false: Ezetimibe (Zetia)​ is often combined with a statin?

true

what is the mechanism of action for the drug niacin?

Thought to increase activity of lipase, which breaks down lipids​

what are the adverse effects of niacin?

Flushing (caused by histamine release)​

Small dose aspirin or NSAIDS 30 minutes before Niacin may help cutaneous flushing​

Pruritus​

GI distress​

true or false: anticoagulants dissolve clots

false, they prevent them

are anticoagulants a high alert drug?

yes

where is heparin usually given?

Abdomen above iliac crest/2 inch from umbilicus​

what type of needles are used for heparin injections? (size and gauge)

Small and short needles (25-26 gauge, <3/8 in)

what is heparin used for?

prompt anticoagulant activity for stroke, Pulmonary embolism, massive DVT

low dose for post-op thrombosis prophylaxis, other uses​

what are the adverse effects of heparin?

Bleeding

Heparin-induced thrombocytopenia (HIT)

when should you stop administering heparin to someone with heparin induced thrombocytopenia?

stop if platelets < 100,000 & notify provider​

what labs should be monitored with heparin use?

Labs value to monitor include:

aPTT (60-80 sec)

platelets (150,00-400,000)

CBC (5,000-10,000)​

what is the antidote for heparin?

protamine sulfate

where should enoxaparin be given?

Abdomen/above iliac crest/2 inches from umbilicus ​

what is enoxaparin commonly used for?

commonly used to prevent DVT following orthopedic surgery; treat DVT & PE; used to prevent post-MI​

what are the adverse effects of enoxaparin?

BLEEDING, HIT, toxicity​

what lab is not required to be monitored when someone is on enoxaparin?

APTT

when should you hold enoxaparin?

if platelets <100,000

what is the antidote for enoxaparin?

protamine sulfate

what is the mechanism of action for warfarin?

Blocks Vitamin K synthesis in the liver, interfering with clotting cascade which prevents coagulation​

how long does it take warfarin to reach a "steady state"? How long until it is gone from someone's system?

Takes 3-4 days to reach steady state

4-5 days to clear​

what are the side effects of warfarin?

bleeding, hepatitis, toxicity

what type of meds should you NOT take with warfarin?

NSAIDS, they increase the risk of bleeding

Therapeutic INR is condition dependent but is generally ____ to _____

2 to 3

when should you hold warfarin?

if INR > 3

true or false: a patient on warfarin should maintain a conistent intake of foods with vitamin K so they do not bleed out or form clots too quickly

true

what is the antidote for warfarin?

vitamin k

what foods are high in vitamin K?

green leafy vegetables

DOACs = direct oral anticoagulants are a subtype of what?

Selective factor Xa inhibitors​

what med is an example of a Selective factor Xa inhibitor?

apixaban

what are the benefits of DOACs over warfarin

1. does not require frequent lab testing​

2. cheaper than warfarin

what are contraindications for apixaban?

hypersensitivity to the drug, active bleeding, severe liver or kidney impairment​

what is the antidote to apixaban?

Andexanet alfa (Andexxa)​

true or false: apixaban is only available in oral form

true

true or false: you can't crush apixaban and add it to food or water

false, it may be crushed and added to water or applesauce

When apixaban is co-administered with other anticoagulants and antiplatelet agents like heparin, aspirin, and chronic NSAIDs, it may increase the risk of____________

bleeding

true or false: unlike warfarin, apixaban does not need monitoring of the patient's international normalized ratio (INR), offering an advantage.​

true

true or false: apixaban needs to be stored in the fridge

false, it needs to be kept at room temperature