Pharm Exam 2

Flashcards

Upper Respiratory Drug Classes

Antitussives

MOA:

• Suppress a dry, nonproductive cough by blocking the cough reflex.

Uses:

• Dry, nonproductive cough

Key Drugs:

• Codeine, Hydrocodone, Dextromethorphan, Benzonatate

Adverse Effects:

• CNS effects/drowsiness

• Dry mucous membranes

• Opioid-related effects with codeine/hydrocodone

Contraindications/Cautions:

• Patients who need to cough to maintain/clear their airway

• Hx of narcotic addiction with codeine/hydrocodone

Decongestants

MOA:

• Vasoconstrict swollen nasal tissue; opens a stuffy nose

Uses:

• Nasal congestion

• Common cold

• Sinusitis

• Allergic rhinitis

Key Drugs:

• Pseudoephedrine

• Phenlyephrine

• Oxymetazoline

• Fluticasone/Beclomethasone (steroid nasal)

Adverse Effects:

• Anxiety, restlessness, HTN, arrhythmias

• Rebound congestion

• Burning, stinging, mucosal dryness for steroid nasals

Contraindications/Cautions:

• Steroid nasal products with acute infection

• Risk of overdose w/ multiple OTC products

Antihistamines

MOA:

• Block histamine; decrease allergy symptoms + secretions

Uses:

• Allergic rhinitis

Key Drugs:

• Diphenyhydramine

• Cetirizine (Zyrtect)

• Loratadine (Claritin)

• Azelastine

Adverse Effects:

• Drowsiness/sedation

• Dry mouth

• Urinary retention

Contraindications/Cautions:

• First-Generation Agents: caution w/ arrhythmias or prolonged QT

• Decongestants: uncontrolled HTN

• Antihistamines: narrow-angle glaucoma

Expectorants

MOA:

• Thin respiratory secretions so the patient can cough mucus up easier

Uses:

• Coughs with thick secretions

• Makes cough more productive

Key Drugs:

• Guaifenesin

Adverse Effects:

• Nausea/vomiting

• Headache

• Dizziness

• Rash

Mucolytics

MOA:

• Break apart thick, tenacious mucus

Uses:

• Thick respiratory secretions

• Cystic fibrosis (dornase alfa)

• Acetaminophen toxicity (acetylcysteine)

Key Drugs:

• Acetylcysteine

• Dornase alfa

Adverse Effects:

• GI upset

• Stomatitis

• Rhinorrhea

• 🚨 Bronchospasm

Education:

• Acetylcysteine: also treats acetaminophen toxicity

• Dornase alfa: cystic fibrosis

Lower Respiratory Drug Classes

Xanthines

MOA:

• Relax bronchial smooth muscle; bronchodilation

Uses:

• Asthma

• COPD-associated bronchospasm

Key Drugs:

• Theophylline

• Aminophylline

• Caffeine

Adverse Effects:

• Nausea

• Irritability

• Tremors

• Insomnia

• 🚨 Seizures

• 🚨 Life-threatening arrhythmias

• Hypotension/coma

Contraindications/Cautions:

• GI disease

• Coronary disease

• Renal/hepatic disease

• Alcoholism

• Hyperthyroidism

Sympathomimetics/Beta 2 Agonists

MOA:

• Stimulate beta 2 receptors; open the bronchi

Uses:

• Acute bronchospasm

• Asthma

• COPD

• Exercise-induced bronchospasm

Key Drugs:

• Albuterol

• Levalbuterol

• Salmeterol

• Terbutaline

• Epinephrine

Adverse Effects:

• Tachycardia/palpitations

• Anxiety

• Headache

• Increased BP

• 🚨 Pardoxical bronchospasm

Education:

• Short-acting = rescue/acute bronchospasm

• Long-acting = scheduled maintenance

Anticholinergic Bronchodilators

MOA:

• Block acetylcholine, relax airway smooth muscle; bronchodilation

Uses:

• COPD maintenance

• Bronchospasm

• Allergic rhinitis (ipratropium nasal spray)

Key Drugs:

• Ipratropium

Adverse Effects:

• Dry mouth

• Constipation

• Nervousness

• Cough

• Urinary retention

Inhaled Corticosteroids

MOA:

• Decrease airway inflammation, swelling, and mucus.

Uses:

• Asthma prevention

• Long-term asthma maintenance

Key Drugs:

• Budesonide

• Beclomethasone

• Fluticasone

Adverse Effects:

• Sore throat

• Hoarseness

• Oral/pharyngeal fungal infection

• Long-term = decreased bone mineral density/cataracts

Leukotriene Receptor Antagonists

MOA:

• Block leukotrienes, reduce airway inflammation and edema.

Uses:

• Prevention and long-term treatment of asthma

• Maintenance asthma therapy

Key Drugs:

• Montelukast

• Zafirlukast

Adverse Effects:

• Headache

• Dizziness

• Nausea

• 🚨 Hepatotoxicity

• 🚨 Neuropsychiatric events

Immune Modulators

MOA:

• Target specific parts of the immune system; allergic/inflammation airway response

Uses:

• Moderate-severe persistent asthma maintenance

Key Drugs:

• Omalizumab

Adverse Effects:

• Injection-site reactions

• Fatigue

• Headache

• Rash

• 🚨 Anaphylaxis

Mast Cell Stabilizers

MOA:

• Prevent inflammatory mediator release from mast cells

Uses:

• Prevention/maintenance of allergic/asthmatic responses

Key Drugs:

• Cromolyn

No longer standard therapy

Lung Surfactants

MOA:

• Reduce surface tension in alveoli, help newborn lungs expand and stay open

Uses:

• Prevention/treatment of neonatal RDS

Key Drugs:

• Beractant

• Calfactant

• Poractant

Adverse Effects:

• Bradycardia

• Hypotension

• Pneumothorax

• Sepsis

• Intraventricular hemorrhage

GI Secretion Drug Classes

H2 Receptor Antagonists

MOA:

• Block H2 receptors; decrease stomach acid and pepsin

Uses:

• Acid-related GI conditions

• Peptic ulcers

• GERD/hyperactivity

Key Drugs:

• Cimetidine (many drug interactions, slows metabolism of many drugs)

• Famotidine

• Nizatidine

Adverse Effects:

• GI effects

• CNS effects

• Hypotension

• Arrhythmias

Education:

• Give before meals or at bedtime

Antacids

MOA:

• Neutralize acid already present in the stomach

Uses:

• Hyperacidity/heartburn

• Gastritis

• Peptic ulcer symptom relief

Key Drugs:

• Sodium Bicarbonate

Adverse Effects:

• Acid rebound

• Electrolyte/acid-base imbalance

• Magnesium = diarrhea

• Aluminum = constipation

• Hypokalemia

• Systemic alkalosis

Education:

• Give 1-3 hours after meals + at bedtime

• Space 2 hours from other meals or medications

Proton Pump Inhibitors

MOA:

• Block the gastric proton pump, strongly decrease acid production

Uses:

• GERD

• Gastric + Duodenal Ulcers

• H.pylori treatment w/ antibiotics

Key Drugs:

• Omeprazole

Adverse Effects:

• GI/CNS effects

• Upper respiratory symptoms

• Long-term = Osteoporosis

Education:

• Give 30-60 min before breakfast

GI Protectants

MOA:

• Coat and protect an ulcer from acid, bile, and pepsin

Uses:

• Duodenal ulcers

• Oral + Esophageal Ulcers

Key Drugs:

• Sucralfate

Adverse Effects:

• Constipation

• Nausea/diarrhea

• Dizziness

Major Interaction:

• Decreases absorption of other medications (Warfarin)

• Separate from other drugs (phenytoin, digoxin)

Prostaglandins

MOA:

• Decrease gastric acid and increase protective mucus/bicarbonate

Uses:

• Prevention of NSAID induced ulcers

Key Drugs:

• Misoprostol

Adverse Effects:

• Diarrhea

• Abd pain

• Nausea

• Uterine bleeding

• Miscarriage

Contraindication:

• 🚨 Pregnancy

Digestive Enzymes

MOA:

• Replace missing enzymes, help the patient to digest food properly

Uses:

• Pancreatic enzyme deficiency

Key Drugs:

• Pancrelipase

Adverse Effects:

• Nausea

• Abd cramps

• Diarrhea

• Hyperuricosuria

GI Motility Drug Classes

Stimulant Laxatives

MOA:

• Directly stimulate intestinal nerves, increase bowel movement

Uses:

• Short-term constipation

• Bowel evacuation

• Senna: also encopresis

Key Drugs:

• Senna

• Bisacodyl

• Castor oil (avoid in pregnancy)

Adverse Effects:

• Diarrhea

• Abd cramps

• Perianal irritation

• Cathartic dependence

Bulk-Forming Laxatives

MOA:

• Increase stool bulk and pull water in, stimulate a natural bowel movement

Uses:

• Occasional constipation

• Short-term constipation relief

Key Drugs:

• Psyllium

Adverse Effects:

• Bloating

• Abd cramps

• Diarrhea

Education:

• Drink with PLENTY of water

Osmotic Laxatives

MOA:

• Pull water into bowel, increase stool volume and motility

Uses:

• Constipation

• Prevent straining

• Bowel preparation before diagnostic procedures

Key Drugs:

• Magnesium citrate

• Lactulose

• Polyethylene glycol

Adverse Effects:

• Diarrhea

• Abd cramps

• Bloating

• Fluid/electrolyte imbalance

Lubcricant/Stool-Softening Laxatives

MOA:

• Coat and soften stool, easier to pass without straining

Uses:

• Short-term constipation

• Prevent straining after surgery, MI, or obstetrical delivery

Key Drugs:

• Docusate

Adverse Effects:

• Diarrhea

• Abd cramps

• Bloating

• Stool leakage

GI Stimulants

MOA:

• Increase upper Gi movement, help the stomach empty faster

Uses:

• Diabetic gastroparesis

• Gastroparesis

• GERD

• Promote small-bowl intubation

Key Drugs:

• Metoclopramide (Reglan)

Adverse Effects:

• Tardive dyskinesia

• EPS symptoms

• Parkinson-like reactions

• Seizures

Antidiarrheals

MOA:

• Slow intestinal motility, decrease diarrhea

Uses:

• Acute nonspecific diarrhea

• Chronic diarrhea associated with IBSI

Key Drugs:

• Bismuth subsalicylate

• Loperamide

Adverse Effects:

• Constipation

• Abd discomfort

• Dry mouth

• Nausea

• Dizziness/drowsiness

Avoid In:

• Gi obstruction

• Hepatic impairment

• Certain poisonings

Peripheral Opioid Receptor Antagonists

MOA:

• Block opioids only in the gut, relieve opioid constipation

Uses:

• Opioid-induced constipation

Key Drugs:

• Methylnaltrexone

IBS Drugs

MOA:

• Target abnormal bowel motility/secretion depending on whether the patient has IBS-D or IBS-C

Key Drugs + Main Uses:

• Alostetron = severe IBS-D

🚨 Ischemic colitis

• Eluxadoline = IBS-D

🚨 Pancreatitis

• Liinacltoide/Plecanatide = IBS-C + chronic constipation

• Tegaserod = IBS-C in females <65

🚨 Potential new-onset depression/self harm

Antiemetics

Phenothiazines

MOA:

• Block dopamine in the CTZ, suppress nausea/vomiting

Uses:

• Severe nausea/vomiting

Key Drugs:

• Promethazine

• Prochlorperazine

Adverse Effects:

• Drowsiness/dizziness

• 🚨 EPS

• Hypotension

• Arrhythmias

• Photosensitivity

Avoid In:

• Coma

• Severe CNS depression

• Severe liver dysfunction

• Sever BP abnormalities

May turn urine pink/red-brown

Nonphenothiazines

MOA:

• Blocks dopamine + stimulate upper Gi movement, decreases N/V and speeds gastric emptying

Uses:

• Diabetic gastroparesis

• GERD

• Post-op N/V

• Chemotherapy associated N/V

Key Drugs:

• Metoclopramide

Adverse Effects:

• 🚨 Parkinson-like effects

• 🚨 Seizures

• 🚨 EPS

• Fatigue/restlessness

• 🚨 Tardive dyskinesia

5-HT3 Receptor Blockers

MOA:

• Block serotonin receptors involved in the vomiting reflex

Uses:

• Chemotherapy induced N/V

• Radiation induced N/V

Key Drugs:

• Ondansetron

Adverse Effects:

• Constipation

• Urinary retention

• Myalgia

• Headache

Avoid In:

• Long QT psyndrome

• Electrolyte abnormalities

NK1 Receptor Antagonists

MOA:

Uses:

• Prevention of acute AND delayed chemotherapy induced nausea

Key Drugs:

• Aprepitant

• Fosaprepitant

• Rolapitant

Adverse Effects:

• Elevated liver enzymes

• Dehydration

• Constipation/diarrhea

• Neutropenia/anemia

Major Drug Interactions:

• Warfarin

• Hormonal contraceptives

• Pimozide

Antihistamine Antiemetics

MOA:

Uses:

• Motion sickness

• Vestibular/inner-ear N/V

Key Drugs:

• Meclizine

• Dimenhydrinate

Adverse Effects:

• Anticholinergic Effects

Anticholinergic Antiemetics

MOA:

Uses:

• Motion-sickness prevention

Key Drugs:

• Scopolamine

Adverse Effects:

• Dry mouth

• Blurred vision

• Urinary retention

MOA:

Uses:

Key Drugs:

Adverse Effects: