Pharm Test 4 study guide

 

 

OD Reversal Drugs

 

 

  • NARCAN

 

      • Opiate antidote
      • given even if there is an OD of unknown cause

 

  • Flumazenil

 

    • Antidote for benzos

 

  • Amyl Nitrate

 

    • For Chest pain
    • cyanide antidote

 

  • Ipecac

 

    • To Puke
    • mallory weiss tear from violent puking
    • vomiting like the exorcist

 

  • Atropine

 

    • to stop cholinergic effects
    • It is an anticholinergic

 

  • Charcoal

 

      • Binds med in the gut so it cannot be absorbed then is passed in the stool.
      • Powder form mixed in water and sucked through a straw to prevent reddining of the teeth.

 

  • Vitamin K

 

      • Antidote for Warfarin

 

  • Protamine Sulfate

 

    • Antidote for heparin

 

Cancer

 

Antimetabolite

 

  • 5FU (fluorouracil)
  • Pyrimidine analog (disrupts nucleic acid fxn)

 

      • IV or topical admin (topical for skin cancer and we may not need to know this)
      • Cell cycle S-phase specific, prevents thymidine production
      • bone marrow depression
      • High alert medication

 

  • MTX methotrexate
  • Folic acid analog (prevents folic acid conversion)

 

    • Sphase specific
    • PREG category X
    • High alert med
    • dose limiting bone marrow supression
    • Kills rapidly dividing cells, and causes immunosuppression
    • SE: Pulmonary fibrosis, Hepatotoxicity, nephrotoxic, Steven-Johnson’s syndrome, and aplastic anemia
    • for the pulmonary toxicity, early signs are a dry nonproductive cough
    • for SJS, assess for rash as an early sign
    • for nephrotoxicity low back and flank pain is an early sign as well as changes in urination patterns or pain.

 

Alkylating agents

alkylates DNA and binds 2 guanines together to prevent the helix from becoming unbound, therefore inhibiting replication. The dose is limited by bone marrow suppression, but can be given in a bolus.

 

  • Mustargen (mechlorethamine)

 

      • inhibits DNA and RNA protein synthesis
      • for hodgkin’s disease and malignant lymphomas.
      • Cell cycle phase nonspecific
      • Contraindicated in pregnancy
      • SE: thrombocytopenia, Leukocytopenia, Seizures
      • monitor for bleeding and bone marrow suppression
      • notify provider for sore throat, neph-toxic s/s, bruising, bleeding, red stools
      • DO not drink alcohol, or take NSAIDs, or ASPIRIN, this will increase bleeding risk

 

  • Mustard Gas

 

      • similar to the nitrogen mustards, but for warfare.

 

  • Cytoxan (cyclophosphamide)

 

    • High alert med
    • most common alkylating agent
    • cell cycle phase nonspecific
    • SE: Pulmonary fibrosis, myocardial fibrosis, hemorrhagic cystitis(increase fluid intake to 3000ml/day), leukopenia(monitor for , thrombocytopenia(monitor for bleeding), anemia.  
    • increases effects of warfarin, phenobarb and rifampin increase toxicity of this drug. Prolongs the effects of cocaine.
    • monitor for edema, crackles, cardio/resp distress, HF s/s.
    • crosses BBB

 

Antibody Anti-tumor

 

  • Doxorubicin (Adriamycin)

 

    • antitumor antibiotic
    • binds directly to DNA and stops replication
    • High alert med
    • dose limiting heart failure, and bone
    • cell cycle S phase specific
    • SE: CARDIO TOXIC, dark urine stools, palms and nails, alopecia, leukopenia,
    • monitor uric acid levels, bleeding and CBC, I’s and O’s

 

Platinum

 

  • Cisplatin

 

    • produces crosslinks in DNA and is cell cycle nonspecific
    • dose limiting kidney failure
    • metastatic, head and neck, testicular, ovarian, bladder ,lung, and colon cancer
    • tubular necrosis in the kidney, ototoxic, bone marrow suppression,  severe nausea and vomiting in the first hour after administration.
    • MOA similar to alkylating agents
    • Kidney Failure is a dose limiting factor.

 

Mitotic Inhibitors

 

  • Vincristine

 

    • prevents cell division (m-phase specific)
    • SE: peripheral neuropathy (Neurotoxic), barely and bone suppression!!
      • vinblastine causes bone marrow suppression and not peripheral neuropathy, so when used together there is not stacking of those side effects.

 

AntiHormones

 

  • Tamoxifen
  • antiestrogen

 

    • for treatment and PREVENTION of estrogen related cancers ie. breast
    • SE: causes CANCER, birth defects, vaginal discharge w/ bleeding.
    • DD: carbamazepine = rapid metabolism. and erythromycin = slowed metabolism.   

 

 

  • prednisone
  • use in high doses
  • glucocorticoids
  • toxic to lymphocytes and lymph tissues

 

 

 

  • progestin (megace)
    • For breast cancer and endometrial cancer
    • used in AIDS pt for anorexia, weight gain and stim of appetite

 

Anticoagulants

 

 

  • Aspirin

 

      • suppress platelet aggregation for the platelet’s life span through cyclooxygenase inhibition.
      • doubles bleeding time for up to seven days
      • can be used for prophylaxis of MI in men and questionable in women.
      • risk of GI hemorrhage
  • Heparin

 

      • Interrupt coag pathway in factor X and thrombin
      • prevents thrombosis, post op thrombus, and more clots forming
      • SE: HEMORRHAGE, HIT, Sensitivity reaction bc it is animal product, All kinds of bleeding (gums, bruises, petechiae, hematoma, red or black stool)
      • HIT heparin induced thrombocytopenia – antibodies develop against Heparin, and the person can NEVER GET THE DRUG AGAIN, there will also be long term bleeding issues associated with this
      • RAPID acting, and only given IV never PO or IM
      • Made from animals
      • normal aPTT is 40 seconds
      • therapeutic aPTT with heparin is 60-80 seconds
      • PROTAMINE SULFATE is the antidote
    • Lovenox
      • LMW Heparin – low molecular weight heparin
      • only stops factor X not thrombin
      • for prevention and treatment of DVT, prevents complications with unstable angina
      • do not need to check aPTT
      • never givin IM

 

  • Argatroban

 

      • direct thrombin inhibitor
      • Use this drug if the patient is experiencing HIT
        • also bivalirudin does this (monitor with ACT test)
      • monitor with aPTT
      • no reversal agent
      • expensive

 

  • Streptokinase

 

      • Thrombolytic: Dissolves clot after formation
      • stick all IV’s before giving drug
      • converts plasminogen to plasmin
      • for acute MI, pulmonary emboli, to break up a clot in a central line
      • can cause bleeding, Allergic RXN,

 

  • tPA alteplase

 

      • thrombolytic: Dissolves clot after formation
      • stick all IV’s before giving drug
      • major bleeding issues. but not as much of an allergy risk
      • very similar to streptokinase

 

  • Dabigatran (Pradaxa)

 

      • direct thrombin inhibitor
      • ORAL anti coag for stroke PT’s w/ non valvular Afib
      • very expensive,
      • bleeding problems as well

 

  • clopidogrel (Plavix)

 

      • ADP receptor antagonist
      • given with ASA sometimes, but do not take ASA
      • for PAD and CVA
      • these are contraindicated with HERBALS
      • proton pump inhibitors makes plavix not effective

 

  • Warfarin (coumadin)

 

    • indirectly decreases many clotting factors
    • works in the LIVER not the blood
    • normal tests while on warfarin are INR(2-3sec) and PT (12sec)
    • effects IIV, IX, X and prothrombin
    • for long term treatment of thrombosis, or pulmonary embolism, also prophylaxis of clot formation(TIA, Prosthetic valve, Afib)
    • Lasts much longer than heparin
    • SE: bleeding like the rest
    • keep Vit K levels consistent throughout treatment
    • Vit K is the antidote
    • d/d interactions increase clotting: quinidine, antibiotics, NSAIDs, cimetidine, thyroid hormones, ASA, Tylenol even

 

Musculoskeletal

 

 

  • Diazepam (Valium)

 

      • Centrally acting MM relaxants
      • flumazenil is the antidote for this
      • used to treat spasticity
      • CNS depression, sedation
      • benzo

 

  • Selegiline (Eldepryl)

 

    • for parkinson’s and for pt’s taking levodopa

 

 

  • Baclofen

 

      • for spasticity
      • analog for GABA
      • SE: sedation and HA, dizziness, diplopia and weakness
      • do not stop the administration of this drug suddenly
      • taper over 2 weeks or: hallucinations, fever rigidity, paranoia, seizures
      • DO NOT mix with ALCOHOL
      • given 2-3 times/day
      • herbal interactions: kava-kava, valerian root, or chamomile these can cause CNS depression
      • no antidote
    • Carbamazepine (tegretol)
      • SZ med
      • nerve pain and bipolar disorder

 

  • cyclobenzaprine (Flexeril)

 

      • Centrally acting MM relaxants
      • do not use in:hyperthyroidism, heart conduction difficulties, heart failure, recent MI.
      • urine color change
      • do not use with other SSRI’s

 

  • Metaxalone (Skelaxin)

 

      • Centrally acting MM relaxants
      • ACH effects, caution in sedation w/ elderly

 

  • methocarbamol (Robaxin)

 

      • Central acting MM relaxant
      • unknown MOA
      • for acute injuries
      • give ¾ x/day, urine color change, dizzy, drowsy, metallic taste.
      • intensifies with ETOH
      • chemically similar to tricyclic antidepressants

 

  • Tizanidine (Zanaflex)

 

      • Centrally acting MM relaxants
      • ACH effects, caution in sedation w/ elderly

 

  • NM Blocker in general
  • Bisphosphonates (alendronate)

 

      • decrease bone resorption
      • SE: esophageal irritation, Heartburn, osteonecrosis of the jaw, atypical femur fracture
      • SEVERE esophagitis, stand for 30 MINUTES after swallowing with water only
      • do not take with other drugs

 

  • Teriparatide

 

      • STIMULATES bone formation
      • SQ injection
      • can be taken for up to 2 years

 

  • NSAIDs (COX 1 and 2)

 

      • used in RA until the DMARDS kick in, (this is changing from NSAIDS to glucocorticoids though)
      • 1st line treatment for gout

 

  • DMARDs (MTX, Arava, Plaquenil)
  • Disease-modifying anti-rheumatic drugs

 

      • given first for RA
      • take glucocorticoids until DMARD’s take effect
      • suppress autoimmune inflammatory process
        • TNF is a part of the inflammatory process…

 

  • Synvisc

 

      • injectable directly into the joint
      • cartilage and synovial fluid synthesis

 

  • Indomethacin

 

    • NSAID for gout
    • inhibits prostaglandins
    • only give for 3-6  days

 

  • colchicine

 

    • older gout drug
    • stops inflammation cycle, by decreasing mobility of granulocytes
    • treats acute gout attack

 

  • Allopurinol

 

    • febuxostat (Uloric)
    • Xanthine oxidase inhibitor, stops production of uric acid
    • for chronic gout
    • Drink 3 liters of water per day

 

Diabetes Mellitus

 

Proinsulin is the prohormone to insulin, and is bound to a C-peptide. The peptide will be found in T2DM, but not T1DM.

type 1 can have Ketoacidosis (DKA), and type 2 can have Hyperosmolar hyperglycemic non ketotic state (HHNK)

 

incretins stimulate insulin release, suppresses glucagon, slows GI emptying, as well as suppress appetite.

 

prediabetes

Impaired fasting glucose (IFG) 100-125

impaired glucose tolerance (IGT) 140 – 199 two hours after the oral glucose tolerance test

6.5% > HgA1c > 5.7%

 

Diabetes Diagnosis

HgA1c > 6.5%

FBG > 126

glucose tolerance > 200

 

Insulin

(also promotes K uptake by the cells, so can also be given for hyperK)

 

  • Lantus

 

      • no peak, duration of 24 hours

 

  • Detemir

 

      • no peak, duration of 24 hours

 

  • NPH

 

      • O: 60-120 P: 6-14 D: 16-24
      • cloudy solution

 

  • 70/30

 

      • 70% NPH, 30% Regular
      • roll gently to mix

 

  • Regular

 

      • O: 30-60 min P: 1-5hr D: 6-10hr

 

  • Lispro

 

    • O: 5-10 min P: 30min-2.5hr D: 3-6.5hr

 

Orals

 

  • Biguanide (Metformin)

 

      • stops liver glucose production in liver, increases glucose uptake in the periphery skeletal muscles.
      • Will NOT cause insulin production. this means that this drug does NOT put a person at risk for hypoglycemia.
      • Can be used with regular insulin and sulfonylureas
      • SE: Renal issues from LACTIC ACIDOSIS. If a person has renal insufficiency they are put at a much higher mortality rate.
      • MONITOR renal fxn.

 

  • Sulfonylureas (glipizide, Amaryl)

 

      • First line, promotes insulin secretion,
      • SE: HYPOGLYCEMIA
      • similar structure to a sulfonamide antibiotic
      • these are 2nd gen. and have longer durations than the 1st gen and fewer d/d interactions.
      • D/D: all cause HypoGLY: ETOH, sulfonamides, Cimetidine, NSAIDs, beta blockers

 

  • Glitazones (pioglitazone)

 

      • decrease insulin resistance, and decreases liver glucose production
      • SE: HYPOGLYCEMIA
      • Not a first line med
      • D/D interactions: CIMETIDINE, ketoconazole, rifampin, Atorvastatin

 

  • Glinides

 

      • stimulates pancreatic secretion of insulin
      • SE: HYPOGLYCEMIA
      • Can be used with metformin
      • DD: Gemfibrozil

 

  • A-Glucosidase inhibitors (acarbose, miglitol)

 

      • Delays carb absorption
      • 2% of drug is absorbed orally
      • SE: abb cramps, borborygmus bowel sounds, flatulence

 

  • DPP-4 inhibitors (Sitagliptin)

 

    • Stops DPP-4 from breaking down incretin
    • the hormone Incretin increases insulin release, decreases hepatic glu production and release.
    • Few SE and DD

 

Injectable noninsulin

 

 

  • INcretin mimetics (exenatide – Byetta)

 

      • increase release of insulin, decrease glucagon secretion, makes you feel full, and slows GI emptying
      • SQ INJECTION at breakfast and supper
      • from Gila monster spit
      • Nausea and vomiting
      • Hypoglycemia possible WITH sulfonylureas
      • a new formulation is once a week SQ injection!
      • SE: weight loss

 

  • Amylin mimetics (pramlintide – Symlin)

 

    • Slows GI emptying, decrease glucagon release, pt will feel more full, decrease postprandial glucose levels
    • SE: HYPOGLYCEMIA

 

Antianemics (heme)

 

 

  • Iron sulfate

 

      • use a straw
      • toxic in kids
      • Makes RA worse
      • for iron deficiency anemia

 

  • B12

 

      • treats b12 or pernicious anemia
      • b12 is needed to synthesize folic acid for cell growth and development
      • Cyanocobalamin

 

  • Folic Acid (folate)

 

      • for folic acid anemia
      • essential for cell replication
      • anemia can be from alcoholism, liver damage.

 

  • Deferoxamine

 

      • high affinity for ferric iron
      • do not take with oj

 

  • Erythropoietin

 

    • stimulates RBC production
    • mimics a natural hormone produced in the kidney
    • needs the supplies to make RBC’s: iron, folate, and B12
    • indications: chronic renal failure, anemia from chemo, or a chronic anemic patient having surgery.
    • can cause HTN
    • if HGB increases above 11 MI, CVA, and HF chances are increased dt increased clotting
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