Pharm Test 2 Drugs

Antacids - function + adverse effects

Neutralize stomach acid and promote gastric defence

Constipation, diarrhea, kidney stone, alkalosis

H2 Antagonists - Suffix + Function + adverse effects

-tidine

Reduces stomach acid secretion - blocks histamine receptors preventing H ion secretion

GERD, Ulcers

mental health change, erectile dysfunction, hypotension, diarrhea, nausea, increase BUN and creatinine

Proton Pump Inhibitors - Suffix + function + adverse effect

- prazole

Bind to proton pump, stops H ion movement = prevents secretion of gastric acid

GERD that is unresponsive to other measures

osteoporosis, C.Diff, fractures, magnesium depletion, kidney injury

Sucralfate

Promotes healing of stomach ulcer

binds to ulcer surface and prevents pepsin access

give 1 hr before meals and at bedtime

Can be used during pregnancy

Misoprostol

inhibits acid and protects mucousa

Simethicone

Decrease discomfort from gas - breaks bubbles into smaller ones

Absorbent Antidiarrheal

binds causative agent to surface in order to eliminate

mild diarrhea

increased bleeding risk, dark stool, tinnitus, metallic taste, black tongue

Bismuth Subsalicylate

Absorbent Antidiarrheal

Anticholinergic Antidiarrheal

slow peristalsis + decrease gastric secretions

severe diarrhea

urine retention, blurred vision, hypotension, bradycardia, headache/dizzy

Opiate Antidiarrheal

reduce bowel motility, analgesic

severe diarrhea

CNS depression, nausea, cramps, constipation

Diphenoxylate

Opiate Antidiarrheal
little - no analgesic effect

Loperamide

opiate antidiarrheal
reduce incontinence, no dependence

Probiotic

replenish natural flora - suppress diarrhea causing bacteria

antibiotic induced diarrhea

Lactobacillus

probiotic

Bulk forming laxatives

absorb fluid, increase stool bulk to stim. BM reflex

impaction, fluid/elect imbalance, gas

Methylcellulose

bulk forming laxative

Psyllium

bulk forming laxative

Emollient laxatives

stool softener and lubricant - increase water or fat in stool

rash, reduced vitamin absorption, elect imbalance

docusate sodium

Emollient Laxative - stool softener

Mineral Oil

emollient laxative - lubricant

Hyperosmotic laxatives

increase water content in feces

ab bloating, rectal irritation, elect imbalance

Glycerin

hyperosmotic laxative
suppository

Lactulose

hyperosmotic laxative

Polyethylene Glycol 3350

hyperosmotic laxative
diarrhea with in 30-60 min

Saline Laxatives

milk of magnesia, magnesium hydroxide

Stimulant laxatives

increase peristalsis by stim nerve

risk for dependence

Bisacodyl

stimulant laxative

Senna

stimulant laxative

Anticholinergic Antiemetics

blocks ACh receptors on vestibular nuclei and reticular form - dries secretions and reduces mm spasm

dizzy/disorient, tachycardia, blurred vision - pupil dilation,

contraind = glaucoma

Scopolamine

anticholinergic antiemetic

Antihistamine (H1 blockers)

inhibit vestibular stim
anti secretory and antispasmodic effect

drowsy, dizzy, blurred vision, dilated pupils, urine retention

Dimenhydrinate/Gravol

Anticholinergic antiemetic

Diphenhydramine/Benadryl

Anticholinergic antiemetic

Antidopaminergic antiemetic

block dopamine receptor in chemoreceptor trigger zone, calms CNS

Hiccups

hypotension, tachycardia, QT widening, vent dysrhythmia, headache, invol mm contract, tremor, stiffness, repetitive mm movement (tar dive dyskinesia)

Prochlorperazine

antidopaminergic antiemetic

Promethazine

antidopaminergic antiemetic

don't exceed 25mg/mL and 25mL/min IV
Stop if pain/burning

prokinetic antiemetic

desensitize Chemoreceptor Trigger Zone to GI impulse, stim peristalsis- move content to dudenum

GERD

hypotension, tachycardia, sedation, dry mouth, nausea

Metoclopramide

prokinetic antiemetic
GERD treatment

Serotonin Blocker

block serotonin in GI, Chemoreceptor Trigger zone, and Vomit Centre

Chemo/post-op induced nausea

Headache, diarrhea/constipation, bronchospasm, prolonged QT

Ondansetron

serotonin antagonist
Preg related nausea

Tetrahydrocannabinol (THC)

inhibit effect on reticular formation, thalamus, and cerebral cortex

chemo induced nausea/anorexia

drowsy, confusion, anxiety, vision disturbance, dry mouth

Beta Blockers

-olol

decrease heart rate, renin secretion and peripheral resistance

Bradycardia, hypotension, elect imbalance
Non selective (also blocks beta 2) = bronchoconstriction, hypoglycemia

What is the difference between selective and non - selective beta 1 blockers

Selective = just heart effects
non-selective = heart and lung effects

Metoprolol

selective beta 1 blocker

Nebivolol

Selective Beta 1 blocker

Propranolol

non-selective beta blocker

Carvedilol

non-selective beta blocker

Atenolol

selective beta 1 blocker

ACE inhibitors

-pril

prevents angiotensin 2 and aldosterone production - vasodilation, reduced rents toon = reduced plasma vol - protects kidneys

unsafe for pregnancy, must be metabolized in liver

Angioedema, Cough, Elevates K, hypotension

Treatment for ACE inhibitor Toxicity

IV fluid - expand blood vol
Hemodialysis if severe

Captopril

ACE inhibitor
TID/QID
Doesn't need to be metab in liver first

Enalapril

ACE inhibitor

ARBs

-sartan

block Angiotensin 2 receptors = vasodilation + no aldosterone secretion

When pt can't tolerate ACE

Upper resp infect, hyperkalemia, dizzy, insomnia, heartburn

Losartan

ARB

Treatment for ARB toxicity

IV fluid to increase blood vol - symptom management

Calcium Channel Blockers: Dihydropyridines

-dipine

Prevent Ca from entering sm. mm. cells - vasodilation

hypotension, edema

Don't take with grapefruit- will cause toxicity

Calcium Channel Blockers: Nondihydropyridines

-amil

Prevent Ca entering Smooth and myocardial cells - vasodilation, reduced contraction, HR, and conduction

hypotension, edema

caution with grapefruit - toxicity risk

Felodipine

DHP Calcium Channel Blocker

Verapamil

Non-DHP Calcium Channel Blocker

Diltiazem

Non-DHP Calcium Channel Blocker

Nifedipine

DHP Calcium Channel Blocker

Thiazide diuretics

-Thiazide
Potassium wasting diuretic

inhibits Na, K and Cl reabsorption

Can't be used if creatinine clearance

Thiazide Toxicity treatment

K+ supplement - ie IV KCl
Fluid replacement

Hydrochlorothiazide

thiazide diuretic
no risk to fetus

Metolazone

thiazide-like diuretic
can be used with creatine clearance =>10mL/min
danger to fetus

Loop Diuretics

-nide and -mide

Potassium Wasting

inhibit na and cl reabsoption, used with creatinine clearance

Furosemide

loop diuretic

Bumetanide

most potent loop diuretic

Potassium sparing diuretics

blocks basal and aldosterone induced Na reabsorption, cardio protective,

Hyperkalemia, diarrhea, erectile dysfunction, drowsiness

Spironolactone

potassium sparing diuretic
Blocks aldosterone receptors

Osmotic Diuretics

increase osmotic pressure of filtrate, pull fluid to filtrate, not as much elect loss

convulsion, thrombophlebitis, tachycardia, blurred vision, chills/fever

*check solution before admin -> crystallizes in low temp.

Mannitol

osmotic diuretic

Nitrates

Anginal Pain

vasodilator - mainly in coronary artery
*rapid tolerance - 8hr off nitrate

Don't use with erect dysfunction drug

Isosorbide

Nitrate

Nitroglycerin

Nitrate
Large first pass effect when oral

Anti anginal drugs (3)

Beta blockers
CCB
Nitrates

Antihypertension drugs in order (5)

Thiazide
ACE inhibitors
ARBs
CCB
beta blocker

Heart Failure Drugs (6)

Ace inhibitors
Aldosterone antagonists (diuretics)
ARBs
beta blockers (selective)
phosphodiesterase inhibitors
cardiac glycosides

Phosphodiesterase Inhibitors

positive inotropic and vasodilation
Short term

Phosphodiesterase Inhibitors toxicity

Hold dose, cardiac support

Milrinone

Phosphodiesterase Inhibitor

Cardiac Glycosides

reduced ejection fraction, normal rhythm, moderate-severe sympt

positive inotropic, negative chronotropic, negative dromotropic

Dromotropic

rate of electrical conduction

Chronotropic

heart rate

Inotropic

strength of contraction

Digoxin

cardiac glycoside

Signs of digoxin toxicity

headache, confusion
clouded vision
halo vision/photophobia
anorexia, nausea, vomiting

Therapeutic Digoxin Level

0.5 - 2 ng/mL

Management of Digoxin Toxicity

hold digoxin
admin digoxin immune fab

How does digoxin interact with K

Competes for K receptor on Na/K pump

low potassium = reduced competition = toxicity

high potassium = too much competition = reduced digoxin effect

Heparin

Anticoagulant
Turns off factors III, X, IX

Heparin Induced Thrombocytopenia- reduced platelet count

safe during pregnancy

Monitor PTT - therapy = 60-80sec

Low Molecular Weight Heparin (LMWH)

-parin

specifically inhibits Xa - more predictable

bridge therapy to get off warfarin
more bioavailability + longer half life

Warfarin

inhibits vitamin K = inhibits vit K dependant factors (II, VII, IX, X)

purple toe syndrome - necrosis

Monitor INR - therapy =2-3

what is the effect of vitamin K on Warfarin

Higher Vit K = less warfarin effect - warfarin can't adequately block new levels

Factor Xa inhibitors

(drugs with Xa in name and fondaparinux)
inhibits Xa only
monitor platelet and creatine
creatine can't be

Antithrombins

inhibits the activity of thrombin and factors IXa, Xa, XIa, and XIIa.

-artran and -atroban

Heparin toxicity treatment

hold heparin
protamine sulfate
1mg protamine =100unit heparin

LMWH toxicity treatment

hold LMWH
protamine sulphate
1mh protamine = 1mg LMWH

Warfarin toxicity treatment

stop/hold dose
Vitamin K
10mg reverse effects in 6hr
Low on time = plasma/clotting factor concentrate transfer

Antithombotics/Xa inhibitors toxicity treatment

transfusion/hemodialysis