Pharm II: Exam #3

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Glucocorticoids Class

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165 Terms

1

Glucocorticoids Class

anti-inflammatory

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Glucocorticoid Action

  1. decrease release of inflammatory mediators

  2. block the production of cytokines

  3. decrease the recruitment of eosinophils

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3

Glucocorticoids Use

  • asthma

  • COPD

  • COVID

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4

Glucocorticoids Route

  • inhaled

  • IV

  • Intranasal

  • Eye drops

  • Ear drops

  • Topical (cream)

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5

Glucocorticoids Prototypes

  • Beclomethasone (inhaled)

  • Prednisone (PO/IV)

  • Methylprednisone (PO/IV)

  • Dexamethasone (PO/IV)

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Beclomethasone Use

  • daily preventative along with other asthma meds (long-term)

  • used to treat an acute illness or exacerbation of COPD/asthma

  • could be part of a nebulizer treatment for either of the above uses (acute/preventative)

  • part of nebulizer treatment for either of the above uses (acute/preventative)

  • NOT USED FOR ACUTE ATTACKS (no immediate relief)

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Beclomethasone Side Effects

  • less systemic effects because drug is delivered to target tissue

  • less adrenal insufficiency risk

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8

Beclomethasone Admin

  • can cause oral candidiasis so have pt rinse mouth after

  • use a spacer for better drug delivery and absorption

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9

Inhaled Steroids

  • better long-term control of disease by decreasing inflammation

  • improved lung sounds/function/breathing over time

  • not used for acute asthma attacks where the patient is having trouble breathing or SOB

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Oral/IV

  • prednisone (PO), methylprednisone (PO/IV), Dexamethasone (PO/IV),

  • same effect as inhaled but faster response due to systemic (in blood stream) administration (IV/PO)

  • each med has a different potency and rate of action

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Prednisone Side Effects

  • adrenal insufficiency

  • red/thin skin

  • mood changes/mania

  • HTN

  • delayed healing

  • impaired growth

  • hyperglycemia

  • increased risk for infection

  • dysrhythmias

  • impaired growth

  • osteoporosis

  • cataracts/glaucoma

  • cushingoid features

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Prednisone Expected Outcomes

  • inflammation relief

  • improved breathing

  • decreased SOB

  • reduced swelling of airways

  • regime to treat anaphylaxis

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Prednisone Adverse Effect

  • should not be used for long periods of time unless there is no other alternative (best for short-term effects)

    • Cushing’s Syndrome

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Hydrocortisone

  • weakest (1)

  • rapid-acting

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Prednisone

  • most common

  • less weak (4)

  • intermediate-acting

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Methylprednisone

  • moderate (5)

  • intermediate-acting

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Dexamethasone

  • strongest (25)

  • long-acting

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Montelukast Class

leukotriene modifier

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Montelukast Action

  • leukotriene receptor blocker

    • leukotrienes are released during trauma, infection, and inflammation

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Montelukast Use

  • reduces bronchoconstriction and inflammation caused by leukotrienes

  • long-term treatment of asthma in children/adults

  • decreased beta-2 agonist meds

  • improves nighttime symptoms

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Montelukast Admin

  • take in evening or at night when asthma symptoms worsen

  • NOT effective for treating acute asthma attacks but can still be taken while treating an acute issue

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Montelukast BBW

  • neuropsychiatric events

  • agitation

  • aggressive behavior

  • depression

  • disorientation

  • suicidal ideation

  • dream abnormalities

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Montelukast Expected Outcomes

  • improved asthma symptoms

  • relief of allergic rhinitis

  • absence of exercise induced symptoms

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Albuterol Class

short-acting beta-2 adrenergic agonist

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Albuterol Action

stimulates beta-2 receptors in smooth muscle of bronchi and bronchioles which produces bronchodilation

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Albuterol Use

can be used as a rescue inhaler for SOB, dyspnea, asthma, and COPD

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Albuterol Side Effects

  • jitteryness

  • tachycardia

  • tremor

  • shakiness

  • agitation/anxiety

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Albuterol Admin

  • 1-2 puffs

  • 5min between each puff

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Albuterol Contraindications

  • HTN

  • seizure disorder

  • diabetes mellitus

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Salmeterol Class

  • long-acting maintenance beta-2 adrenergic agonist

  • bronchodilator

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Salmeterol Admin

  • usually taken as part of daily regimen to control asthma symptoms

  • not effective for treating acute asthma attacks

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Salmeterol Side Effects

  • jitteryness

  • tachycardia

  • tremor

  • shakiness

  • agitation/anxiety

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Salmeterol BBW

  • use in pts with worsening or acutely deteriorating asthma may be life-threatening

  • not for acute symptoms

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Ipratropium Class

bronchodilator, anticholinergic

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Ipratropium Action

blocks muscarinic acetylcholine receptors in smooth muscles of bronchi, inhibiting bronchoconstriction and mucous secretion

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Ipratropium Use

  • asthma

  • chronic bronchitis

  • emphysema

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Ipratropium Admin

  • improves pulmonary function within a few minutes

  • NOT effective for treating acute asthma attacks however it can be used with other adrenergic bronchodilators

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Ipratropium Expected Outcomes

  • reduced rate and improved quality of respirations and pulmonary function

  • improved breathing

  • reduced anxiety

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39

Isoniazid Class

antitubercular

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Isoniazid Action

inhibits cell wall synthesis

  • most common anti-TB drug

  • bactericidal

  • used alone for latent TB but used with others for active TB

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Isoniazid Adverse Effects

  • hepatotoxicty

  • peripheral neuropathy (give with vitamin B6 to prevent)

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Isoniazid Contraindictaions

  • liver disease

  • chronic alcoholism

  • elderly

  • no ETOH

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Isoniazid Nursing Considerations

  • observe for signs of active TB

  • report increased liver enzymes

  • bilirubin

  • numbness/tingling

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44

Rifampin Class

antitubercular

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Rifampin Action

inhibits RNA synthesis

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Rifampin Uses

  • used alone for latent TB infections

  • used for INH resistant TB

  • can also be used as prophylaxis for exposure to meningococcal meningitis

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Rifampin Adverse Effects

  • GI upset

  • hepatotoxicty

  • acute renal failure

  • skin rashes

  • prolonged use can lead to C.diff

  • many drug interactions

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Rifampin Contraindications

  • use cautiously in those with liver disease or those with a history of alcoholism

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Rifampin Nursing Considerations

  • observe for signs of active TB

  • report increased liver enzymes

  • bilirubin

  • numbness/tingling

  • monitor liver function

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50

Pyrazinamide Class

anti-tubercular

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51

Pyrazinamide Action

  • bactericidal

  • exact mechanism unknown

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52

Pyrazinamide Uses

part of a multi-drug anti-TB regimen used with INH, RIF, and ethambutol during first two months of active TB care

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Pyrazinamide Side Effects

  • GI upset, can inhibit uric acid excretion → gout

  • hepatotoxicity

    • pts with pre-existing liver impairment should not take drug unless its essential

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54

Diphenhydramine Class

histamine antagonist

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55

Diphenhydramine Action

blocks effects of histamine (H1 receptors) in the brain

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Diphenhydramine Uses

  • allergy treatment (runny nose, itchy eyes, congestion)

  • used for sleep (side effects of drowsiness)

  • pre medication for blood transfusion that can cause reactions

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Diphenhydramine Adverse Effects

  • drowsiness

  • dry mucous membranes

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58

Diphenhydramine Contraindications

HTN

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Diphenhydramine Pt Education

  • do not drive or operate heavy equipment

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60

Loratadine Class

antihistamine

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Loratadine Action

  • second generation antihistamine (non-drowsy)

    • sold OTC

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Loratadine Uses

  • seasonal allergies

  • chronic itching (urticaria)

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Loratadine Side Effects

  • dry mucous membranes

  • drowsiness in some

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64

Loratadine Contraindications

  • asthmatics (careful use b/c dries membranes)

  • hepatic/renal impairment

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65

Pseudoephedrine Class

decongestant

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Pseudoephedrine Action

  • sympathomimetic

  • reduces nasal congestion by constricting vessels

  • buy OTC as phenylephrine but can get from pharmacist

  • can be used to make meth

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Pseudoephedrine Uses

  • congestion during URI

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Pseudoephedrine Side Effects

  • tachycardia/palpitations

  • HTN (fight or flight)

  • CNS stimulation

    • inability to sleep

    • feeling “wired”

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69

Pseudoephedrine Contraindications

  • cardiac arrhythmias

  • HTN

  • diabetes (masks symptoms of hypoglycemia)

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70

Dextromethorphan Class

cough suppressant, antitussive

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71

Dextromethorphan Action

NMDA agonist, but not well understood, works in brain to suppress cough

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Dextromethorphan Uses

cough due to common cold (not nearly as effective as codeine)

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Dextromethorphan Side Effects

  • few

  • hallucinogen at high doses

  • nausea

  • vomiting

  • constipation

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74

Acetylcysteine Class

mucolytic (mucous buster)

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Acetylcysteine Action

  • splits disulfide bonds in mucoproteins

  • lowers mucus viscosity resulting in larger volume of sputum

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Acetylcysteine Uses

  • emphysema

  • bronchitis

  • cystic fibrosis

  • asthma

  • acetaminophen overdose

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Acetylcysteine Side Effects

  • nausea

  • vomiting

  • chest pain

  • trouble breathing

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78

Fluticasone Therapeutic Class

drug for allergic rhinitis, asthma, and skin inflammation

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79

Fluticasone Pharmacologic Class

  • corticosteroid

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80

Fluticasone Actions/Use

  • used to decrease local inflammation in nasal passages, thereby reducing stuffiness.

  • Some new formulations that combine antihistamine with corticosteroid in a nasal spray (Dymista)

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Fluticasone Adverse Effects

adverse effects are rare. Nasal irritation and epistaxis (nose bleeds)

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Fluticasone Forms

  • Cream

  • Nasal Spray

  • Inhaler

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Fluticasone Contraindications

known hypersensitivity pts w/ known viral, fungal, bacterial, or parasitic infections should not receive drug

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84

Metoprolol Class

beta blocker

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85

Metoprolol Action

bind to B1 and B2 adrenoceptors (predominantly B1) in cardiac tissue; bind norepinephrine released from sympathetic adrenergic nerves

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Metoprolol Use

treatment of HTN, MI, angina, a-Fib

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Metoprolol Side Effects

  • bradycardia

  • postural hypotension

  • bronchospasm

  • heart block

  • cold extremities

  • dizziness

  • CHF

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Metoprolol Nursing Care

  • Contraindicated with HR < 60 bpm or SBP <100 in heart blocks, ventricular failure, pulmonary edema, acute asthma

  • monitor for hypotension, bradycardia, signs of heart failure hypoglycemia in diabetics and bronchospasm

  • teach patients to take pulse for one minute, do not chew extended release

  • taper over 2 weeks

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89

Diltiazem Class

calcium channel blocker

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Diltiazem Action

  • relaxes the muscle of heart and blood vessels

  • inhibit the influx of calcium ions during membrane depolarization of cardiac and vascular smooth muscle

  • decreases myocardial demand and dilates coronary arteries

  • Suppression of dysrhythmias by blockage of calcium channels – slows conduction velocity and stabilizes dysrhythmia

      1. slowing of SA node automaticity

      1. delay of AV nodal conductivity

      1. reduction of myocardial contractility

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Diltiazem Use

  • HTN

  • angina

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Diltiazem Side Effects

  • edema

  • nausea

  • constipation

  • headache

  • drowsiness

  • fatigue

  • URI

  • dizziness

  • hypotension

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Diltiazem Nursing Care

  • monitor BP, pulse, cardiac rhythm

  • do not crush ER or SR preparations

  • teach to take radial pulse

  • limit alchohol anf caffeine

  • may elevate ALT, AST, LDH, CPK, and Alk Phos

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94

Verapamil Class

calcium channel blocker

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95

Verapamil Action

  • relaxes the muscle of heart and blood vessels

  • inhibit the influx of calcium ions during membrane depolarization of cardiac and vascular smooth muscle

  • decreases myocardial demand and dilates coronary arteries

  • Suppression of dysrhythmias by blockage of calcium channels – slows conduction velocity and stabilizes dysrhythmia

      1. slowing of SA node automaticity

      1. delay of AV nodal conductivity

      1. reduction of myocardial contractility

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96

Verapamil Use

  • HTN

  • angina

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Verapamil Side Effects

  • edema

  • nausea

  • constipation

  • headache

  • drowsiness

  • fatigue

  • URI

  • dizziness

  • hypotension

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Verapamil Nursing Care

  • monitor BP, pulse, cardiac rhythm

  • do not crush ER or SR preparations

  • teach to take radial pulse

  • limit alchohol anf caffeine

  • may elevate ALT, AST, LDH, CPK, and Alk Phos

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99

Lisinopril Class

ACE Inhibitor

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Lisinopril Action

  • inhibits angiotensin converting enzyme (ACE); prevents conversion of angiotensin I to angiotensin II.

  • Increases plasma renin activity

  • Reduces aldosterone secretion to lower BP

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