Pharm exam 2

suffering, help me please, I'm so tired

glomerular filtration rate (GFR)

the best marker for estimating renal function, measures the volume filtrate passing through the Bowman’s capsule per minute

urinalysis, serum creatine, BUN, imaging, biopsy

What are 5 tests that diagnosed renal failure?

hypofusion, CHF, MI, burns, fluid loss

What are 5 common causes of acute renal failure?

DM, HTN

What are 2 causes of chronic renal failure?

Lasix

What is the prototype drug for loop diuretics?

blocks reabsorption of Na and Cl in the loop of Henle

What is the mechanism of action for loop diuretics?

decrease edema from heart failure, hepatic cirrhosis, renal failure

What is the primary use of loop diuretics?

sensitivity to furosemide/ sulfamides, anuria, hepatic coma, hypotension, hypokalemia

What are 5 contraindications for loop diuretics?

digoxin

What drug causes more K loss when paired with loop diuretics?

anticoagulants, antidiabetics

What 2 drugs does loop diuretics reduce the effectiveness of?

circulatory collapse, hearing loss, renal failure, dysrhythmia

Serious adverse affects of loop diuretics?

hypotension, hypokalemia, rash, pruritus, anemia, polyuria, nocturia

What are minor effects of loop diuretics?

take in AM, increase K, change position slowly, monitor weight

What is the patient teaching for loop diuretics?

blocks Na reabsorption in distal tubule, increase K and H2O excretion

what is the mechanism of action for thiazide diuretics?

HTN, decreases edema (less effective than loop)

What is the primary use of thiazide diuretics?

anuria, pre-eclampsia, pregnancy, hypotension, hypokalemia

What are contraindications for thiazides?

lithium toxicity

Thiazides have an increased risk for?

take AM, sunscreen, increase K, monitor BG

What are the 4 pt teahings for thiazides?

spironolactone (Aldacotone)

what is the prototype drug of K-sparing diuretic?

HTN, aldosteronism

What is the primary use of K-sparing diuretics?

inhibits aldosterone

What is the mechanism of action of K sparing diuretics?

anuria, ESRD, pregnancy, hyperkalemia, hypotension, gynomastia

What are contraindications of K-sparing diuretics?

GI disturbances, gynomastia, impotence, muscle weakness

What are 4 adverse effects of K-sparing diuretics?

muscle cramps, thirst, lethargy, mensural irregularities, rash

What are 5 symptoms pt should report to the provider when on k sparing diuretics?

acetazolamide (diamox)

What is the primary drug for Carbonic anyhdrase inhibitors?

inhibits formations of carbonic acid

What is the mechanism of action of Carbonic anhydrase drugs?

decrease intraocular fluid in glaucoma

What is the primary use of carbonic anhydrase inhibitors?

sulfa allergic reaction, fluid/ electrolyte imbalance

What are the 2 adverse reactions to carbonic anhydrase inhibitors?

mannitol (osmitrol)

What is the primary drug for osmotic diurteritcs?

raises osmotic pressure, inhibits reabsorption of H2O and elctrolytes

What is the mechanism of action for osmotic diuretics?

reduce ICP, urine flow in long surgery, renal failure,

What are the 3 primary uses of osmotic diuretics?

stable angina

angina with predictable frequency, intensity, and duration, usually relieved by rest

unstable angina

angina with frequent episodes, more intense, and happens during periods of rest

vasospastic angina

anginia caused by the spasms of coronary arteries

nitroglycerin (nitrostat, nitrobid, nitrodur)

What is the prototype drug for nitrates, 1 generic 3 trade?

MI, angina

Primary use for nitrates?

decrease preload and after load, dilates coronary arteries, decreases vascular resistance

What is the mechanism of action for nitrates?

hypotension, dizzy, headache, reflux tachycardia, flushing, rash, circulatory collapse

What are the 7 adverse affects of nitrates?

hypotension, glaucoma, head trauma, pericarditis

What are 4 contraindications for nitrates?

metoprolol (lopressor, tropol, tenormin, Indernal)

What are the prototype drugs for beta blockers 1 generic + 4 trade?

HTN, angina, HF, migraines, dysrhythmia

what are the 5 primary uses of beta blockers?

bradycardia, hypotension, impotence, hypoglycemia

What are 4 adverse effects of beta-blockers?

heartblock, SSS, bradycardia, recent MI

What are 4 contraindications for beta-blockers?

no alcohol, if CP not relieved by 1st dose call 911

What are the 2 client educations for beta-blockers?

nifedipine (Procardia), diltiazem

What are the 2 prototype drugs for calcium channel blockers?

HTN, angina, HF, dysthymia

what are the primary uses for calcium channel blockers?

blocks ca channels, vasodilation, derease BP

what is the mechanism of action for calcium channel blockers?

bradycardia, hypotension, H/A, edema, photosensitivity, dyspnea, flushing

what are 7 adverse affects of calcium channel blockers?

have EKG for contraindications, don’t give IR with recent MI

what are 2 assements/things to know when administering calcium channel blockers?

Morphine, Oxygen, nitrates, aspirin, reperfusion, clopidogrel, heparin, betablocker, anticoagualant, statin, inhibit angiotension II, correct risk factors

What are the pharmocological goals with a MI (MONARCH BASIC)

retaverse (retephase)

What is the prototype drug for thrombolytics?

converts plasminogen to plasmin which degrades thrombi

What is the mechanism of action for thrombolytics?

treat MI, DVT, cerebrovascular, pulmonary embolism, clear IV

What are 5 primary uses of thrombolytics?

bleeding, recent surgery, h/o stroke

What are 3 contraindications for thrombolytics?

abnormal bleeding, dysthymia

What are 2 adverse affects for thrombolytics?

PT, aPTI, INR

What are 3 labs that measure coagulation?

suppresses synthesis of vitamin K dependent coagulation factors

What is the mechanism of action for Warfarin (Coumadin)?

prevent clot formation, post MI, atrial fib

what are the 3 primary uses of Warfarin (Coumadin)?

bleeding, elevated INR, elevated PT, hypertension

what are the 4 contraindications of Warfarin (Coumadin)?

pregnancy X, hematuria, hemorrhage

adverse effects of Warfarin (Coumadin)?

vitamin K, FFP

What 2 things reverse the effects of Warfarin (Coumadin)?

prevents conversion of prothrombin to thrombin, and fibrogen to fibrin

What is the mechanism of action of heparin?

prevent clot formation

What is the primary use of heparin?

hemorrage, anemia, HIT, hematuria

What are the 4 adverse affects of heparin?

monitor K, garlic intake, okay for pregnancy

What are 3 pt teachings about heparin?

PT, protamine sulfate

What is the lab used and reversal agent for heparin?

alter plasma membrane of platelets so they can’t aggregate

What is the mechanism of action for antiplatelets?

prevent thrombi formation after stroke or MI

what is the primary use of antiplatelet?

clopidogrel (plavix)

what is the prototype drug for antiplatelets?

stimulates RBC production

What is the mechanism of action of Epoetin alfa (procrit, epogen)?

with chemo, cancer, chronic kidney disease

What are 3 primary uses of Epoetin alfa (procrit, epogen)?

hypertension, headache, fever, N/D, edema

what are 5 adverse effects of Epoetin alfa (procrit, epogen)

risk of cardiovascular and thromboembolic events, give with anticoagulant

what is the black box warning for Epoetin alfa (procrit, epogen)?

uncontrolled hypertension, bone cancer

what are 2 contraindications for Epoetin alfa (procrit, epogen)?

enhances and increases neutrophils

What is the mechanism of action of colony stimulating factors, filgrastim (nuepogen)?

chemo, organ transplant, AIDs

What are 3 primary uses of colony stimulating factors, filgrastim (nuepogen)?

Do not give at the same time as chemo

What is something to consider for administration of colony stimulating factors, filgrastim (nuepogen)?

obtain CBC, sepsis, respiratory disease

What are 3 precautions of colony stimulating factors, filgrastim (nuepogen)?

skeletal pain, hypertension, thrombocytopenia, dysthymia, respiratory distress

What are 5 adverse affects of colony stimulating factors, filgrastim (nuepogen)?

<100, >60, <150

What is the desired range for LCL, HDL, and VLDL (triglyerides) respectfully?

atorvastatin, lipator, lescol, mevacor, crestor, zocor

What are the 6 statin prototype names?

inhibts HMG-CoA reductase that’s needed for lipid production

What is the mechanism of action of statins?

hepatotoxic, joint pain, rhabdomyolysis, heart burn

what are 4 adverse affects of statins?

blurred vision, muscle pain, GI distress

When should a pt report to provider when on a statin?

monitor liver function, no pregnancy, no grapefruit, give at night

what are 4 pt teachings related to statins?

cholestyramine (Questran)

What is the prototype drug for bile acid sequestrants?

binds with bile acids, increase cholesterol excretion in stool

What is the mechanism of action of bile acid sequestrants?

GI tract issues, drug-drug interactions

what are 2 adverse effects of bile acid sequestrants?

give separately from other meds, 4 hours before, 2 hours after

What is an administration consideration of bile acid sequestrants?

niacin (nicotinic acid)

a b-complex vitamin that decreases VLDL levels but has a lot of adverse affects such as flushing, hepatotoxicity and gout, can take an ASA to reduce flusing

gemfibrozil (Lopid)

What is the prototype drug for fibric-acids?

decreases hepatic triglycerides production, increases removal of cholestrol

What is the mechanism of action of fibric acid agents?

treat severe hypertriglycerdemia

what is the primary use of fibric acid agents?

rhabdomyolysis, GI distress, myopathy with statins

What are 3 adverse effects of fibric acid agents?

warfarin increase anticoagulation effects so monitor PT, INR

What is something to look out for when using fibric acid agents?

ezetimibe (Zetia)

What is the prototype cholesterol absorption inhibitor?

inhibits absorption of cholesterol in small intestine, decrease LDL

What is the mechanism of action of cholesterol absorption inhibitors?

120, 140, 160

what is the starting SBP for prehypertension, stage 1, and stage 2 hypertension respectively?

lisinopril (Prinivil, Zestril)

what are 3 prototype ACE inhibitors?

inhibits ACE enzyme (vasodilation), decrease aldosterone

What is the mechanism of action of ACE inhibitors?