Pharm Exam 2 Study Guide PDF

Respiratory: Diphenhydramine (Benadryl) - Uses: allergy and cold symptoms, Parkinson’s, motion sickness, insomnia - Administration: take at night, avoid alcohol, sugarless candies, increase fluids - Effects: drowsiness, CNS stimulation (pediatric), dry mouth, tachycardia, hypotension,...

Respiratory: Diphenhydramine (Benadryl) - Uses: allergy and cold symptoms, Parkinson’s, motion sickness, insomnia - Administration: take at night, avoid alcohol, sugarless candies, increase fluids - Effects: drowsiness, CNS stimulation (pediatric), dry mouth, tachycardia, hypotension, photosensitivity - Contraindications: BPH, glaucoma, GI obstruction Fluticasone - Uses: rhinitis, asthma, nasal stuffiness - Administration: intranasal, 2 sprays in each nostril twice a day - Onset: 12 hrs - 1 day - Effects: nasal irritation, epistaxis Phenylephrine - Uses: constricts small vessels allowing secretions to drain better. Combined with antihistamines Antitussives (Codeine and Hydrocodone) - Uses: forcibly removes excess secretions and foreign material, reduces runny nose and post nasal drip Dextromethorphan - Uses: non-opioid, antitussive for non-productive cough - Administration: PO - Effects: drowsiness, headache, GI upset - Contraindications: less than 6 year old, chronic cough Albuterol - Uses: short-acting, bronchospasm - Administration: short-term, rinse mouth after - Effects: Tachycardia, restlessness, tremors - Contraindications: cardiac - Interactions: caffeine, beta-blocker, MAOIs Ipratropium -Uses: severe asthma exacerbation -Administration: inhaled / intranasal (2-3 minutes between doses) -Effects: cough, dry nose, hoarseness, bitter taste Methylxanthines - Uses: chronic asthma (bronchodilators) - Administration: IV / PO - Effects: nausea / vomiting, CNS stimulation - Long term prophylaxis of asthma that is unresponsive to beta agonist or corticosteroids Corticosteroids - Uses: asthma - Administration: inhaled; take daily oral (10 day max) Leukotriene Modifiers - Uses: asthma, prophylaxis - Effects: headache, cough, congestion, GI upset Montelukast - Uses: asthma prophylaxis, exercise, induced bronchospasm, allergic rhinitis - Administration: PO, 2 hours before activity, only med approved for pediatrics - Effects: headache, suicidal ideations, hallucinations, aggression, depression Coagulation Modifiers: Heparin - High-risk drug (two nurse verification, correct rate and dose) - Uses: DVT and PE, prolongs coagulation time - Administration: IV, Subcutaneous - Effects: bleeding, Heparin induced Thrombocytopenia (low platelets) - Contraindications: active internal bleeding, severe hypertension, recent trauma, intracranial hemorrhage - Interactions: other anticoagulants, NSAIDs, aspirin, nicotine, digoxin, G foods (ginger, garlic, ginkgo, green tea) - Reversal Agent: Protamine Sulfate Warfarin - Oral anticoagulant - Uses: prevention of stroke, MI, DVT, PE, undergoing hip or knee surgery, long-term central line, prosthetic heart valves - 3-4 days to reach maximum warfarin effect - INR therapeutic range: 2-3 - Effects: bleeding, stop 2 weeks before surgery - Black Box: fatal bleeding - Contraindications: recent trauma, active internal bleeding, bleeding disorders, intracranial hemorrhage - Interactions: NSAIDs, antidepressants, steroids, vitamin K, G foods (ginger, garlic, ginkgo, green tea) - Reversal Agent: Vitamin K Clopidogrel - Anti-platelet - Uses: reduces rate of MI, stroke, angina, coronary bypass procedure - Administration: with aspirin - Stop 5 days before surgery - Effects: flu-like symptoms, headache, dizziness, bruising, rash, pruritus - Interactions: other anticoagulants, thrombolytics, NSAID, G foods (ginger, garlic, gingko, green tea) - Platelet transfusions may be necessary to prevent hemorrhage Fibrinolytics - tPa / alteplase - Uses: MI, DVT, CVA, PE, clearing IV catheters (PICC, IJ) - Administer 4 hours from start of stroke symptoms / clot formation Diuretics: Furosemide (Lasix) - Uses: heart failure, reabsorption of sodium and chloride in Loop of Henle - Administration: IV (5 minute effect), PO, monitor potassium prior - Effects: hypokalemia, dehydration, hypotension, syncope, ototoxicity  - Interactions: digoxin (decreases potassium), lithium toxicity, aminoglycoside antibiotics (nephrotoxicity and ototoxicity) Hydrochlorothiazide - Uses: HTN, ascites, edema, heart failure - Effects: hyponatremia and hypokalemia - Interactions: NSAIDs, digoxin, carbamazepine Spironolactone - Uses: mild hypertension, edema, slows heart failure - Administration: give with food, do not give extra potassium (potassium sparing) - Effects: hyperkalemia, gyno - Interactions: aspirin and ACE- inhibitors (increase potassium), decreases effects of digoxin Mannitol - Uses: decreases intracranial pressure due to cerebral edema, maintains urine in prolonged surgery, acute kidney injury Hypertensives: Losaratan (ARB) - Uses: hypertension - Administration: combine with hydrochlorothiazide - Effects: hypoglycemia, dizziness, angioedema, acute kidney injury - Black box: fetal injury/death - Interactions: NSAIDs, potassium supplements, Spironolactone, other antihypertensives Clonidine (Alpha 2 Adrenergic Agonist) - Uses: decreases outflow of CNS to heart and arterioles - Effects: hemolytic anemia, leukopenia, lupus, thrombocytopenia Alpha 1 Adrenergic antagonist - Uses: hypertension and benign prostate hyperplasia Carvedilol (Alpha 1 + Beta-blocker) - Uses: hypertension, decreases heart failure with digoxin, ACE, diuretics - Contraindications: cardiogenic shock, severe HF, bradycardia, asthma / COPD, cardiac conduction issues - Do not give to COPD / asthma patients ACE-inhibitors - Uses: hypertension, heart failure, slows left ventricular hypertrophy from MI, renal protection - Effects: persistent dry cough, angioedema, hyperkalemia (avoid spironolactone / limit potassium) Hydralazine (direct acting vasodilator) - Uses: hypertension, and heart failure, causes vasodilation of arterial smooth muscle - Administration: gradually increase, do not stop abruptly - Effects: headache, reflex tachycardia, flushing - Contraindications: angina, rheumatic mitral valve, lupus - Interactions: other antihypertensives, NSAIDs Antiarrhythmics: Procainamide (Sodium-Channel blocker) - Uses: atrial and ventricular dysrhythmias - Sodium-channel blocker: - Administration: IV / IM (supine) - Effects: hypotension, headache, CNS effects - Black-box: lupus-like syndrome, agranulocytosis, bone marrow suppression, neutropenia, thrombocytopenia - Contraindications: AV blocks, heart failure Propranolol (Beta-Adrenergic blocker) - Uses: hypertension, angina, prevention of heart failure, reduces portal hypertension, esophageal varices, tachycardia - Beta-Adrenergic blocker: slows the heart rate and decreases conduction velocity through the AV nodes - Administration: monitor pulse do not give if below 60 bpm  - Effects: hypotension, bradycardia, diminished libido, hypoglycemia - Black-box: gradually reduce dose - Contraindications: cardiogenic shock, bradycardia, heart block, COPD / asthma - Interactions: Calcium channel blockers, phenothiazines, MAOI Amiodarone (Potassium-Channel blocker) - Uses: V-Tach, atrial dysrhythmias - Potassium-Channel Blockers: delay repolarization by blocking potassium channels - Effects: pulmonary toxicity, increased LFTs, thyroid dysfunction - Contraindications: bradycardia, AV block, cardiogenic shock - Interactions: warfarin. beta blockers, calcium channel blockers, St. Johns, grapefruit Verapamil (Calcium-Channel blockers) - Uses: stabilizes dysrhythmias - Administration: PO / IV - Effects: headache. Flushed skin, constipation, hypotension, bradycardia - Contraindications: heart blocks, sick sinus syndrome, hypotension - Interactions: digoxin, antihypertensives, statin Adenosine - SVT - New or worse dysrhythmias, facial flushing, dyspnea Digoxin - Uses: certain types of atrial dysrhythmias - Effects: nausea, vomiting, headache, visual disturbances Lisinopril - ACE inhibitor - Uses: HF, HTN - Administration: assess BP, monitor renal function - Effects: dry cough, angioedema, headache, dizziness, orthostatic hypotension, hyperkalemia - Contraindications: hyperkalemia, previous angioedema - Interactions: NSAIDs, potassium-sparing diuretics, other antihypertensives, potassium supplements Metoprolol - Beta blocker - Decreases heart load, decreases heart rate, slows heart failure, angina, hypertension - Administration: monitor ECG, blood pressure, and pulse before administration  - Effects: bradycardia, hypotension - Contraindications: cardiogenic shock, heart block, hypotension, COPD, asthma - Interactions: other antihypertensives Digoxin - Cardiac glycoside - Increases contractility or strength of contraction - Administration: assess apical pulse (>60) - Effects: dysrhythmias, hypokalemia, nausea, vomiting, yellow halos - Interactions: potassium sparing diuretics, hypokalemia, ACE inhibitors, potassium supplements, beta blockers, calcium channel blockers Milrinone - Phosphodiesterase inhibitor - Uses: heart failure, increases force of contraction - Administration: IV only, monitor heart rate and blood pressure - Effects: cardiac dysrhythmias, hypotension Nitroglycerin - Vasodilator - Sublingual, PO, IV, transdermal, topical - Effects: hypotension, headache, reflex tachycardia - Contraindications: hypotension, increased intracranial pressure, head trauma - Interactions: phosphodiesterase-5 inhibit causes hypotension / cardiovascular collapse Diltiazem - Calcium channel blockers - Uses: hypertension, angina, dysrhythmias - Administration: PO, IV - Effects: headache, dizziness - Contraindications: AV heart block, sick sinus syndrome Atorvastatin - Antihyperlipidemic - Uses: hyperlipidemia, reduces risk of MI or stroke - Administration: give with food to decrease GI discomfort, give at night, 2 weeks to see effects - Effects: GI upset, hepatotoxicity, rhabdomyolysis - Contraindications: severe liver disease, hypersensitivity - Interactions: HIV protease (rhabdomyolysis), macrolide antibiotics (rhabdomyolysis) Cholestyramine - Antihyperlipidemic - Administration: power mixed with fluid once or BID, may take 30 days for max effect, give other medications 2 hours before or 4 hours after - Effects: constipation, bloating, gas, nausea - Contraindications: total biliary obstruction - A lot of interactions Ezetimibe - Uses: inhibits absorption of cholesterol in small intestine (lowers LDL levels) - Effects: nasopharyngitis, myalgia, upper respiratory infection, arthralgia, diarrhea Niacin - Uses: B-Complex vitamin to decrease VLDL - Effects: flushing, hot flashes, nausea, excess gas, diarrhea, hepatotoxicity, gout - Administration: take with full glass of water Decongestants - Causes reduction in inflammation of nasal membranes - Examples: pseudoephedrine, phenylpropanolamine - Uses: nonallergic rhinitis, nasal congestion, sinusitis, common cold / flu - Effects: hypertension, tachycardia, palpitations, insomnia, anxiety, nasal and oral dryness, headache, nausea Antihistamine - H1 receptor antagonist - 1st Gen. / short / sedating: diphenhydramine - 2nd Gen. / long / non-sedating: cetirizine, loratadine - Uses: allergic reactions, common cold, itchy eyes, hives - Effects: drowsiness, dry mouth, tachycardia, mild hypotension - Administration: take at night, increase fluid intake, sugarless candy, take prior to allergy season Expectorants - Reduces thickness of bronchial secretions and increase mucus flow that is more easily removed by coughing - Examples: Guaifenesin (mucinex), acetylcysteine (mucomyst) - Uses: cystic fibrosis, pneumonia, bronchitis, COPD, chest congestion, rhinitis, colds / cough - Effects: drowsiness, dizziness, GI upset, dyspnea, fatigue, allergic reaction, increased congestion - Administration: increase fluids, take with water, report cough longer than a week