Pharmacotherapeutics Exam 2

Front 1

Glaucoma

Back 1

a group of disorders characterized by increased intraocular pressure (IOP).

Front 2

Primary Open-Angle Glaucoma (POAG)

Back 2

represents 90% of those diagnosed with glaucoma.

Front 3

Acute Angle-Closure Glaucoma

Back 3

10% of those diagnosed with glaucoma.

Front 4

Glaucoma mechanism of action

Back 4

Aqueous humor is produced by the ciliary body and secreted into the posterior chamber of the eye. It then circulates around the iris into the anterior chamber via the trabecular meshwork and the Canal of Schlemm. If outflow of aqueous humor is impeded, increased IOP occurs.

Front 5

Agents used to treat glaucoma

Back 5

Beta blockers, A2 agonists, Prostaglandin analogs, cholinergic agents, carbonic anhydrase inhibitors

Front 6

Betaxolol (Betopotic)

Back 6

Beta blocker used to treat glaucoma

Front 7

Levobunolol (Betagan)

Back 7

Beta blocker used to treat glaucoma

Front 8

Timolol (Timoptic)

Back 8

Beta blocker used to treat glaucoma

Front 9

Method of action of beta blockers used to treat glaucoma

Back 9

Decrease production of aqueous humor by the ciliary body. (Some are B1 selective (Betaxolol), some are non-selective for B1 and B2, the difference may be that B1 selective has lower risk of respiratory side effects)

Front 10

Adverse Reactions of Beta blockers for Glaucoma

Back 10

Low risk of side effects due to topical application. Possibility of respiratory side effects. May cause blurred vision, may interact with calcium channel blockers.

Front 11

Latanoprost (Xalatan)

Back 11

Prostaglandin Analog used to treat glaucoma

Front 12

Method of action of prostaglandin analog used to treat glaucoma

Back 12

Lowers IOP by facilitating the outflow of aqueous humor through relaxation of the ciliary muscle.

Front 13

ADR of prostaglandin analog used to treat glaucoma

Back 13

darkening of the iris, blurred vision, burning, stinging, conjunctival hyperemia, punctate keratopathy. May cause migranes.

Front 14

Brimonidine (Alphagan)

Back 14

Alpha2 Agonist used to treat glaucoma

Front 15

Method of action of alpha2 agonists used to treat glaucoma

Back 15

similar to beta blockers by reducing aqueous humor production. also may increase outflow.

Front 16

ADRs for Alpha2 agonists used to treat glaucoma

Back 16

dry mouth, ocular hyperemia, burning, stinging, headache, blurred vision, foreign body sensation, ocular itching. this drug crosses the blood brain barrier and may cause hypotension, fatigue, and drowsiness. Wait 15 minutes after instilling drops before putting in lenses.

Front 17

Echothiophate iodide (Phospholine)

Back 17

Cholinesterase Inhibitor used to treat glaucoma.

Front 18

ADRs of cholinesterase inhibitors used to treat glaucoma

Back 18

Temporary irritation/burning/stinging of the eye, temporary blurred vision, eyelid muscle twitching, poor vision in dim light, headache, or brow ache may occur. Unlikely but serious side effects:eye pain, flushing, diarrhea, nausea, irregular heartbeat, stomach/abdominal pain orcramps, increased saliva, increased urination, unusual sweating, vision changes. Also possibly retinal detachment.

Front 19

Dorzolamide (Trusopt)

Back 19

Carbonic anhydrase inhibitor used to treat glaucoma.

Front 20

ADRs of carbonic anhydrase inhibitors used to treat glaucoma

Back 20

stinging, bitter taste, may also cause allergic reactions and conjunctivitis

Front 21

Allergen mediated asthma

Back 21

Allergen binds to antibodies on mast cells in the airways. Release of mediators as well as immediate bronchoconstriction and or bronchospasm. Bronchial hyperactivity or sensitization (allergens/triggers will now have more pronounced effect).

Front 22

Non allergen mediated asthma

Back 22

Triggers include: cold air, stress, or exercise. Airway inflammation immune response leads to edema, mucous production, smooth muscle hypertrophy.

Front 23

Drug classes to treat asthma and COPD

Back 23

Anti inflammatory

glucocorticoids

immune response modifiers

mast cell stabilizers, leukotriene inhibitors

bronchodilators

B2 agonists

methylxanthine

Other

anticholinergic

Front 24

method of action of glucocorticoids to treat Asthma and COPD

Back 24

suppress inflammation, suppress inflammation mediators, reduce infiltration, reduce edema, reduce mucous secretions

Front 25

Route of Glucocorticoids to treat asthma and COPD

Back 25

inhaled (first line), PO (second line), IV (hospital use)

Front 26

Cautions in use of Glucocorticoids to treat asthma and COPD

Back 26

Caution in pregnancy, children, and adolescents. Systemic use is not recommended while breast feeding.

Front 27

Use of glucocorticoids in prophylaxis of asthma and COPD

Back 27

inhaled takes several days to be effective

oral takes a few doses to be effective

IV takes several hours to be effective

Front 28

Inhaled: Beclomethasone diproprionate (QVAR)

Oral: Prednisone

IV: Solu-Medrol

Back 28

Glucocorticoid used to treat Asthma and COPD

Front 29

Inhaled: Budesonide (Pulmicort)

Oral: Prednisolone

IV: Solu-cortef

Back 29

Glucocorticoid used to treat Asthma and COPD

Front 30

Flunisolide (Aerobid) (inhaled)

Back 30

Glucocorticoid used to treat Asthma and COPD

Front 31

Fluticasone Propionate (Flovent) (inhaled)

Back 31

Glucocorticoid used to treat Asthma and COPD

Front 32

Triamcinolone acetonide (Azmacort) (inhaled)

Back 32

Glucocorticoid used to treat Asthma and COPD

Front 33

Mometasone furoate (Asmanex) (inhaled)

Back 33

Glucocorticoid used to treat Asthma and COPD

Front 34

Mometasone furoate/formoterol fumarate dihydrate (Dulera) (inhaled)

Back 34

Glucocorticoid used to treat Asthma and COPD

Front 35

ADRs of Inhaled glucocorticoids

Back 35

Adrenal supression (with lone term use), bone loss, oropharyngeal candidiasis, dysphonia (disorders of the voice)

Front 36

ADRs of po and IV glucocorticoids

Back 36

adrenal supression, bone loss, fluid/electrolyte imbalance, hyperglycemia, peptic ulcer disease, growth suppression, infection, psychological disturbances, myopathy

Front 37

Cromolyn

Back 37

prophylactic drug for asthma

Front 38

Indications for Cromolyn

Back 38

prophylaxis for chronic asthma, exercised induced bronchospasm, and allergic rhinitis (intranasal only)

Front 39

Mechanism of action of Cromolyn

Back 39

stabalizes membrane of mast cells which prevents release of histamine, eosinophils, macrophages, and other inflammatory agents

Front 40

Safest drug for asthma (has no systemic effect)

Back 40

Cromolyn

Front 41

Mechanism of action of Beta2 Agonists to treat asthma and COPD

Back 41

stimulation of B2 adrenergic receptors in the smooth muscle of lungs to cause bronchodilation, also suppress histamine release and increase ciliary motility

Front 42

Albuterol (Proventil, Ventolin)

Back 42

Short acting Beta2 agonist (SABA) (inhaled)

Front 43

Levoalbuterol (Xopenex)

Back 43

Short acting Beta2 agonist (SABA) (inhaled)

Front 44

Salmeterol (Serevent)

Formoterol (Foradil)

Back 44

Long Acting Beta2 agonist (LABA) Inhaled Agents

Front 45

Albuterol

Terbutaline

Back 45

Oral Beta2 Agonist agents

Front 46

only Short Acting Beta2 Agoinists (SABA) can treat

Back 46

acute asthmatic episodes

Front 47

ADRs of inhaled SABA

Back 47

tachycardia, angina, tremors

Front 48

ADRs of LABA

Back 48

increased risk of severe asthma

Front 49

ADRs of Oral Beta2 Agonists

Back 49

tachycardia, angina, tremors

Front 50

Methylxanthines

Back 50

bronchodilators used to treat asthma and COPD

Front 51

All generic names of Methylxanthines end in

Back 51

-phylline

Front 52

Theophylline

Back 52

a methylxanthine

Front 53

mechanism of action of methylxanthines

Back 53

relaxes smooth muscles of lungs, stimulate the CNS & respiration, dilate foronary and pulmonary vessels, cause diuresis

Front 54

theophylline has a _______ therapeutic range

Back 54

narrow

Front 55

Theophylline drug interactions

Back 55

sympathomimetic agents, caffine, enhances diuretics, enzyme inducing agent (smoking)

Front 56

steps to take when bronchodilator and inhaled glucocorticoid are the be administered at the same time

Back 56

use the bronchodilator first, wait 5 minutes, administer the glucocorticoid, rinse your mouth

Front 57

Ipratropium (Atrovent)

Tiotropium (Spiriva)

Back 57

Anticholinergics used for treating COPD

Front 58

ADRs of anticholinergics for treating COPD

Back 58

dries secretions, tachycardia, palpitations, GI upset, headache, drowsiness, confusion, urinary retention

Front 59

Combo agents for treatment of Asthma and COPD

Back 59

Dual action helpful when 1 agent is not sufficient. Combivent (Ipatropium and albuterol). Advair Diskus (Fluticasone and salmeterol)

Front 60

Leukotriene inhibitors

Back 60

immune response modifiers used to treat asthma

Front 61

zafirlukast (Accolate)

zileuton (Zyflo)

montelukast (Singulair)

Back 61

Leukotriene inhibitors

Front 62

ADRs of Leukotriene inhibitors

Back 62

Common: Headache, GI disturbances, arthralgia's, myalgia's. Uncommon: Liver InjuryDoes not apply to Montelukast

Front 63

Omalizumab (XolAir®)

Back 63

Therapeutic antibody targeted to antagonize receptors for IgE, a type of antibody. Decreases release of inflammatory mediators.

Indicated for moderate to severe asthma in adults and adolescents. Only for 12+ years of age with positive skin test or in vitro reactivity to a perennial allergen.

Last line, Very expensive

Front 64

Omalizumab (XolAir®) ADRs

Back 64

Injection site reactions, Increased susceptibility to infections, Increased risk for:CancerCardiovascular events.

Anaphylaxis- Observe patient after receiving dose

Front 65

Types of medications used to treat upper respiratory disorders (allergies, cough, cold)

Back 65

antihistamines, immune response modifiers (Cromolyn, Omalizumab, Montelukast), Inhaled glucocorticoids, sympathomimetics (often used in nasal decongestants), cough and cold remedies

Front 66

Contraindications/cautions for antihistamines

Back 66

Severe liver disease, narrow-angle glaucoma, urinary retention

Front 67

Diphenhydramine (Benadryl)

Brompheniramine (Dimetapp)

Chlorpheniramine (Teldrin)

Back 67

first generation antihistamines names

Front 68

ADRs of first generation antihistamines

Back 68

Crosses Blood Brain Barrier: Causes sedation, Acetylcholine blockages causes anticholinergic symptoms:Dry mouthConstipation & Urinary Retention

Front 69

Certirizine (Zyrtec)

Fexofenadine (Allegra)

Desloratidine (Clarinex)

Azelastine (Astepro)

Loratadine (Claritin)

Back 69

second generation antihistamines names

Front 70

ADRs improvements in second generation antihistamines

Back 70

Less anti-cholinergic effect

Very Lipo-phobic and does NOT cross Blood Brain Barrier: Causes little to no sedation

Front 71

Decongestants mechanism of action

Back 71

Stimulates the alpha-adrenergic receptors to cause vascular constriction of capillaries. Shrinks nasal mucous membranes and decreases nasal fluid secretions. Available as systemic or local/intranasal dosage forms.

Front 72

Pseudoephedrine (Sudafed)

Phenylephrine

Back 72

Systemic decongestants

Front 73

Phenylephrine (Neo-Synephrine)

Naphazoline (Privine)

Back 73

nasal decongestants

Front 74

ADRs and Drug interactions of decongestants

Back 74

Rebound congestion (nasal/topical route only)CNS excitation (oral route only)

Contraindicated or use with extreme caution in clients with hypertension, cardiac disease, hyperthyroidism and diabetes.May decrease the effect of beta blockers. Clients taking this medication should avoid large amounts of caffeine (coffee, tea) because it can increase restlessness & palpitations caused by decongestants.

Front 75

beclomethasone (Beconase),

fluticasone (Flonase),

triamcinolone (Nasacort)

Back 75

Intranasal Glucocorticoids names

Front 76

Intranasal Glucocorticoids Indications

Back 76

Allergic rhinitis

Front 77

ADRs Intranasa Glucocorticoids

Back 77

Drying of nasal mucosa, Itching/Burning sensation, Bleeding

Front 78

Antitussives Mechanism of Action

Back 78

Suppress ‘cough-control center’ in the medulla and suppress reflex to cough

Front 79

Codeine,

Guaifenesin & Codeine (Robitussin A-C), Hydrocodone (Hydrocodan)

Back 79

Narcotic antitussives names

Front 80

benzonatate (Tessalon),

dextromethorphan (Benylin),

promethazine w/dextromethorphan (Phenergan)

Back 80

non-narcotic antitussives names

Front 81

Guaifenesin (Robitussin, Anti-Tuss, Glycotuss, mucinex),

Hydration

Back 81

Examples of expectorants

Front 82

Mucolytics

Back 82

Mechanism of Action: Acts like detergents to liquefy & loosen thick mucous secretions so they can be expectorated.

Includes: Acetylcysteine (Mucomyst)Used frequently for Cystic Fibrosis

Front 83

central venous parenteral feeding required for

Back 83

greater than 12% dextrose

Front 84

Iodine deficiency

Back 84

nutritional deficiency that causes hypothyroidism

Front 85

Myxedema

Back 85

the name for severe hypothyroidism in adults

Front 86

Levothyroxine (Synthroid, Levoxyl)

Back 86

Synthetic thyroid for hypothyroidism

Front 87

ADRs of Levothyroxine

Back 87

symptoms of hyperthyroidism:(Tachycardia, palpitations, excess sweating, heat intolerance, nervousness, irritability, exophthalmos, weight loss)

Nervousness, insomnia, weight loss, Tremors, headache, Nausea, vomiting, diarrhea, cramps, Tachycardia, palpitations, hypertension, Dysrhythmia, angina

Front 88

Drug interactions of Levothyroxine

Back 88

Increased cardiac responsiveness with epinephrine and other vasopressors

Front 89

Antithyroid Drugs: Thionamides

Back 89

Includes:Propylthioruacil (PTU) methimazole (Tapazole).

Mechanism of Action: Prevents incorporation of iodine tyrosine. Prevents tyrosine from coupling. Prevents production of T3 and T4. *May take up to 3-12 weeks for euythyroid state.

ADR: Hypothyroidism, Rash, Nausea, Arthralgias

Front 90

Radioactive Iodine (131I)

Back 90

Mechanism of Action: Unstable isotope of iodine that destroys Thyroid tissue as it degrades.

Indication: Graves’ Disease and Thyroid Cancer.

Advantages: Low cost; Alternative to surgery; Low Mortality; Selective (only affects Thyroid).

Disadvantages: Takes months; Delayed hypothyroidism (90%)- need close monitoring of TFT’s.

Front 91

Lugol’s Solution (Strong Iodine)

Back 91

Mechanism of Action: High concentrations cause paradoxical suppression of thyroid gland. Leads to decrease in T3 and T4.

Indication: Short term use to prep for thyroidectomy or for thyrotoxic crisis. Decreased efficacy with long term use.

Side Effects: GI (abdominal pain, diarrhea, vomiting)Oral - Brassy taste, soreness in teeth/gums/throatHeadache

Front 92

When to administer thyroid replacement (levothyroxine)

Back 92

before breakfast

Front 93

If a does of thyroid replacement is missed

Back 93

take two doses the next day

Front 94

How to detect Severe Thyrotoxicosis when patient undergoes surgery OR develops a severe concurrent illness

Back 94

Go by symptoms and history alone (No lab tests)Profound hyperthermia (T > 1050F)Severe TachycardiaAgitationTremorsComa, hypotension, heart failure

Front 95

Thyrotoxicosis Treatment

Back 95

Increased doses of K iodine (Cause suppression of TH release), Propylthiouracil (Suppresses TH synthesis), Beta blocker (For heart rate control), Sedation, Cooling blankets, Steroids, IV Hydration

Front 96

What is the Hbg A1C test

Back 96

This test is based on the attachment of glucose to hemoglobin, the protein in red blood cells that carries oxygen. The test reflects the average of a person’s blood glucose levels over the past 3 months. The A1C test result is reported as a percentage. The higher the percentage, the higher a person’s blood glucose levels have been. A normal A1C level is below 5.7 percent.

Front 97

Oral type 2 diabetes management agents include

Back 97

Metformin, Sulfonylureas, Meglitinides, Thiazolidinediones, Alpha-glucosidase Inhibitors, DPP4 Inhibitors, and SGLT-2 Inhibitors

Front 98

Indications for use of insulin

Back 98

Reduce blood glucose, Management of Type 1 or Type 2 DM

Front 99

Insulin Interactions

Back 99

Increased risk of hypoglycemia with alcohol, oral hypoglycemics, and beta blockers. Decreased effectiveness with thiazides, glucocortoicoid steroids, hormonal contraceptives, thyroid drugs, and smoking

Front 100

Insulin Side Effects

Back 100

Hypoglycemia (blood glucose <60): Headache, dizziness, confusion, slurred speech, Nervousness, anxiety, agitation, irritability, Tremors, in coordination, sweating, tachycardia, seizures

Front 101

Hyperglycemia effects

Back 101

Blood glucose over 200. Extreme thirst, dry mucous membranes, Poor skin turgor, polyuria, fruity breath, Fatigue, tachycardia, Kussmaul respirations

Front 102

Rapid-acting,

Short-acting,

Intermediate-acting,

Long-acting,

Combinations

Back 102

Types of insulin

Front 103

Things to know about rapid acting Insulin

Back 103

Examples: Lispro (Humalog), Aspart (Novolog), Glulisine (Apidra).

Onset: 15 mins

Duration: <5 hr

Clarity of solution: clear

Front 104

Things to know about short acting (regular) insulin

Back 104

Examples: Regular (Humulin R, NovolinR, ReliOn R).

Onset: 30 mins

Duration: 6 to 8 hr

Clarity of solution: Clear

Front 105

Things to know about intermediate acting insulin

Back 105

Examples: NPH (HumulinN,NovolinN,ReliOn N)

Onset: 2-4 hr

Duration: 6 to 10 hr

Clarity of solution: Cloudy

Front 106

Things to know about Long acting insulin

Back 106

Examples: Glargine (Lantus)Detemir (Levemir)

Onset: 1 to 2 hr

Duration: 18 to 24 hr

Clarity of solution: Clear

Front 107

Things to know about combination (premixed) insulin

Back 107

Examples: NPH/Reg 70/30(Humulin 70/30, Novolin 70/30,ReliOn 70/30)

NPH/Reg 50/50 (Humulin 50/50)

Lispro protamine/lispro 75/25 (Humulog Mix 75/25)

Lispro protamine/lispro 50/50 (Humulog Mix50/50)Aspart protamine/aspart 70/30 (NovologMix70/30)

Clarity of solution: Cloudy

Front 108

rapid acting insulin

Back 108

Is used In association with meals to control postprandial blood sugar. Can be administered before or max 30 minutes after meals.

Front 109

Short acting insulin

Back 109

Given before meals. Is the most predictable and reversible formulation of Insulin. Only formulation given IV.

Front 110

Intermediate acting Insulin

Back 110

Mixing of insulin in same syringe is only done with NPH

Front 111

Long acting insulin

Back 111

Glargine = 18-26 hoursDetemir = 18-24 hours

Can be administered in combination with rapid acting insulin. SHOULD NOT be mixed in the same syringe.

Front 112

Combining Insulin

Back 112

Rapid/Short & NPH Insulin can be manually mixed together prior to administration. Draw non-NPH insulin 1st and NPH 2nd.“Clear then Cloudy”

Front 113

Insulin Risks

Back 113

Lipodystrophy- change in fat distribution at injection site

Somogyi effect - Rebound hyperglycemia

Dawn phenomenon –Nighttime hormone surge

Insulin shock- Hypoglycemia from overadministration or overdosing

Diabetic ketoacidosis (DKA)- lack of administration

Front 114

Injection Sites – Order of Best Absorption

Back 114

Upper arm, Abdomen (at least 1 inch from umbilicus), Thigh, Buttock.

Injections should be at least 1” apart (Avoids lipodystrophy)

Front 115

Metformin mechanism of action

Back 115

Increases binding of insulin to receptors; increased tissue responses to insulinDecrease glucose production by liver

Front 116

ADRs of Metformin

Back 116

GI symptoms (nausea/diarrhea),

Lactic Acidosis: (Caution with ETOH, renal insufficiency, and any renal toxic drugSymptoms include Myalgia, Malaise, and Hyperventilation) (Lactic acidosis is an amergency like diabetic ketoacidosis)

Front 117

Metformin

Back 117

Gold standard medication management of type 2 diabetes. Does not cause Hypoglycemia or weight gain.

Front 118

Sulfonylureas names and mechanism of action

Back 118

Stimulates beta cells to secrete more insulin –(not in type 1 diabetes).

1st generation: Tolbutamide, Tolazamide, Chlorpropamide (1st generation has more drug interactions)

2nd generation: Glipizide, Glyburide, Glimepiride

Front 119

Sulfonylureas interactions and ADRs

Back 119

Alcohol may cause disulfram-like reaction (cause hangover like reacton to alcohol (Increased sensitivity to alcohol). Beta-blockersCan mask Hypoglycemia symptoms.

Can cause Hypoglycemia and Weight gain.

Front 120

Thiazolidinediones

Back 120

Includes: Pioglitazone (Actos) and Rosiglitazone (Avandia)

Mechanism of Action: Affects insulin receptors by enhancing insulin sensitivity of cells; decreased insulin resistance

ADR: Renal retention of fluid with resultant edema

Caution with Heart Failure, Decrease in bone density, Increased risk for cancer, Increase lipid levels

Front 121

All generic names of thiasolidinediones end in:

Back 121

-glitazone

Front 122

Meglitinides

Back 122

Includes: Repaglinide (Prandin) & nateglinide (Starlix)

Mechanism of Action: Stimulates release of insulin from pancreatic islets

ADRHypoglycemia, Weight gain

Administration: Must administer dose with each meal

Front 123

All generic names of meglitinides end in:

Back 123

-glinide

Front 124

Alpha-Glucosidase Inhibitors

Back 124

Acarbose (Precose) & Miglitol (Glyset)

Mechanism of Action: Inhibits absorption of carbohydrates from GI tract (ONLY oral agent whose effect does not depend on presence of insulin)

No risk for hypoglycemia or weight gain

ADR: GI DisturbanceFlatulence, borborygmus, diarrhea, cramps, Liver dysfunction

Front 125

DPP4 inhibitors

Back 125

Includes: Sitagliptin, Saxagliptin, Linagliptin

Mechanism of Action: Inhibits DPP4 enzyme Leads to reduced metabolism of/increased concentration of incretin. Incretin is a hormone responsible for glucose regulation.

ADR: Upper respiratory infections, Pancreatitis

(Does not cause hypoglycemia by itself)

Front 126

All generic names of DPP4 inhibitors end in:

Back 126

-gliptin

Front 127

SGLT-2 Inhibitors

Back 127

Includes Canagliflozin, Dapagliflozin

Mechanism of Action: Inhibits transporter in kidney responsible for re-absorption of glucose from the urine back into the bloodstream

ADR: Increased frequency of urination, UTI, Orthostatic Hypotension (When used in conjunction with diuretics)

Front 128

All generic names of SGLT-2 Inhibitors end in:

Back 128

-gliflozin

Front 129

Exanatide (Byetta/Bydureon)

Back 129

Injectable Hypoglycemic Agent

Mechanism of Action: Incretin mimetic that improves beta-cell responsiveness and enhances insulin secretion. Prevents the liver from making excess glucose when not needed. Delays gastric emptying. Reduces appetite.

ADR: Pancreatitis, Renal toxicity, Anaphylaxis

Front 130

Pramlintide (Symlin)

Back 130

Injectable Hypoglycemic agent

Mechanism of Action: Amlyn mimetic that suppresses glucagon secretion and increases effects of insulin. Also delays gastric emptying & Reduces Appetite.

ADR = Nausea

Front 131

Hypoglycemia Treatment

Back 131

For Mild to Moderate Hypoglycemia (<70mg/dL)

1)Consume 15-20 grams of glucose or simple carbohydrates

2)Recheck blood glucose after 15 minutes

3)If hypoglycemia continues, repeat.

4)Once blood glucose returns to normal, eat a small snack if next planned meal or snack is more than an hour or two away.

Front 132

Glucagon

Back 132

Natural hormone secreted by alpha cells of the islets of Langerhans in the pancreas.

Mechanism of Action: Stimulates breakdown of stored glycogen to glucose in liver

Indication: Medication-induced hypoglycemia Reserved for patients that are unconscious, seizing, or unable to swallow. Given IM

Front 133

ADRs of general anesthesia

Back 133

Respiratory and cardiac depression, Nausea and Vomiting, Malignant Hyperthermia, Aspiration of Gastric contents, Hepatotoxicity

Front 134

Halogenated Hydrocarbons include

Back 134

Isoflurane, Enflurane, Desflurane

Front 135

All generic names of halogenated hydrocarbons end in:

Back 135

-flurane

Front 136

Mechanism of action of halogenated hydrocarbons

Back 136

(Inhaled anesthetic) Not well understood. Theorized to work by binding to nerves to either enhance transmission at inhibitory synapses AND/OR depress transmission at excitability synapses. In order to work:Uptake from lungsDistribution to CNS and tissues.

Front 137

ADRs of halogenated hydrocarbons

Back 137

Respiratory and cardiovascular depressionPost-operative nausea and vomiting

Front 138

Nitrous Oxide Mechanism of action

Back 138

(Inhaled anesthetic) Inhibition of NMDA receptors

Potent analgesic / Weak anesthetic

Impossible to produce surgical anesthesia

Front 139

With Nitrous Oxide there is no risk for:

Back 139

Respiratory depression, Muscle relaxation, Malignant Hyperthermia

Front 140

ADR of Nitrous oxide

Back 140

Nausea/Vomiting

Front 141

Propofol mechanism of action

Back 141

Promotes release of inhibitory neurotransmitter, GABA

No analgesiaSedative and hypnotic with rapid onset (60 seconds) and short duration

Rapidly induce anesthesia – injected slowly

Most commonly used agent for anesthesia (good for control, leaves system quickly)

Front 142

ADRs of Propofol

Back 142

Bradycardia, hypotension

Propofol infusion syndrome (rare, Seen with extended use (>48 hours) and high dosingCardiac Failure, Kidney Failure, Metabolic Acidosis, and rhabdomyolysis)

Front 143

Barbiturates for use in anesthesia

Back 143

Cause anesthesia but with high incidence of respiratory & cardiovascular depression. Rarely used for anesthesia.

Rapidly progresses (10-20 seconds) to unconsciousness.

ADRHypotension, Bradycardia, Hypoventilation

Agents Include:Pentobarbital, Methohexital sodium

Front 144

Benzodiazepine for use in anesthesia

Back 144

Agents include:Alprazolam, Diazepam, Lorazepam, Midazolam

Indications: Induce anesthesia (has multiple purposes)

Produces peri-operative amnesia

Produces sedation (Intravenous most often used)

Decreases anxiety

ADR: Hypoventilation

Front 145

All generic names for benzodiazepine end in:

Back 145

-azepan or -azolam

Front 146

Etomidate

Back 146

Hypnotic Agent for induction with no analgesic effect (Rapid, lasts about 5 minutes)

ADR: Transient apnea, pain at injection site, oliguria, electrolyte disturbances, high incidence of post-op N & V (50%)

Less Incidence of hypotension than barbiturates

Front 147

Ketamine

Back 147

Dissociative anesthetic,

Recovery: Adverse psychological reactions: Hallucinations

Front 148

Neuromuscular Blocking Agents

Back 148

Includes:Succinylcholine & Pancuronium

Indication: Adjunct to general anesthetics that allows lower dose of anesthetic by relaxing skeletal muscle

Most surgeries require skeletal muscle relaxation

ADR’s: Prevent contraction of all skeletal muscles (diaphragms, respirations)Flaccid Paralysis

Front 149

Supportive Medications to anesthesia

Back 149

Anticholinergics – Scopolamine,

Antihistimines - Diphenhydramine,

Antiemetics – Ondansetron, ProchlorperazineH2,

Receptor antagonist – Famotidine, Ranitidine,

Gastric motility stimulants – Metoclopromide,

Antacids - PRN

Front 150

Opioids

Back 150

Agents Include:Fentanyl, Morphine, Meperidine, Codeine, Oxycodone

Indications: Used to relieve pain, Also can suppress cough

ADRs: Respiratory depression / HypoventilationBowel & urinary retentionNausea / Vomiting

Front 151

Alpha2 Adrenergic Agonists

Back 151

Indications: Used in addition to other agents for anesthesia

Includes:Clonidine - Tx of HTN and pain reduction (Reduces anxiety and causes sedation)

Dexmedetomidine - Highly selective for alpha2 receptors. Short term, can be continued into the post operative period (esp in cardiac surgery)

Front 152

Anticholinergic

Back 152

Indication: Decrease risk of respiratory depression during surgery

Agents Include:Scopolamine, Atropine

Front 153

Antiemetics

Back 153

Indication: Reduction or suppression of nausea and vomiting symptoms post-surgery

Agents Include: Ondansetron –(Zofran), Prochlorperazine

Front 154

H2 Receptor antagonists & Antacids

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Indication: Decrease risk of stress ulcer post surgery

Agents Include:FamotidineRanitidine

Note: Antacids are used PRN

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Gastric Motility Stimulants

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Indication: relieve constipation post surgery

Includes: Metoclopramide

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Local anesthetics

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Includes: procaine, lidocaine

Metabolized by blood

Lidocaine is given with epinephrine

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Lidocaine is given with _________

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epinephrine

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routes of administration of local anesthetics

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Epidural, Intrathecal, Nerve block, Local infiltration, Topical, Inhaled

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ADRs of Local anesthetics

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Hypotension, Hypothermia, Headache, Drowsiness, or change in mental status (too high dose or improper placement of IV), Transient neurological issues: Radicular symptoms, including pain, a burning sensation on the buttocks, dysesthesia, and paresthesia, Urinary retention, Hematoma

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Opiates ADRs

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Respiratory depression, Orthostatic hypotension, Urinary and Bowel retention, Elevation of ICP, Euphoria/dysphoria, Sedation or Coma, Miosis (Pinpoint pupils). Prolonged use can cause hormonal disequilibrium (Prolactin levels, LH, FSH, testosterone, estrogen)

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Opioid Drug interactions

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CNS depressants: Intensify sedation & respiratory depression,

Anticholinergic,

Hypotensive drugs: Exacerbate constipation & urinary retention

Agonist-Antagonist Opioids(like buprenorphine (Suboxone)): Can precipitate a withdrawal syndromeCan also suppress overdose symptoms

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Oxycodone

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Opiate analgesic

Analgesic actions equivalent to codeine.

Brand NamesOxy + ASA = Percodan, Oxy + acetaminophen = Percocet, Oxy + Ibuprofen = Combunox

Caution with combination formulations!

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Hydrocodone

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Opiate analgesic

Most widely prescribed drug in the US. Pain and cough suppression.

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Codine

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Opiate analgesic

Used for mild to moderate pain

great cough suppressant activity

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Hydromorphone (Diludid)

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strong opioid agonists similar to morphine

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Methadone (Dolophine, Methadose)

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similar to morphine

long duration of action

check concentration

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Fentanyl

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100X more potent than morphine

Available dosage forms: parental, transdermal, transmucosal, buccal

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Meperidine (Demerol)

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Toxic metabolite

caution in renal insufficiency

ADR=Seizures

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Naloxone (Narcan)

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reversal agent

competitive antagonist at opioid receptors

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NSAIDs include

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NSAIDs:

ASA (Aspirin)

Ibuprofen

Ketoprofen

Naproxen

Ketorolac

Cycloooxygenase (COX)-2 Inhibitors:

Celecoxib (celebrex)

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NSAIDs mechanism of action

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Non-selective inhibitor of cycloxygenase (COX)Results in:Reduction of inflammation, pain and feverProtection from MI/Stroke (due to platelet aggregation)

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NSAIDs ADRs

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GI effects, bleeding, renal impairment, salicylism, Reyes’ syndrome (characterized by acute noninflammatory encephalopathy and fatty degenerative liver failure)

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COX Inhibitors-cyclooxygenase

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COX1First generation, causing reversible inhibition. Has risk for gastric ulceration

COX2Second generation, little or no risk of gastric ulceration

Includes:Celecoxib (Celebrex)

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Acetaminophen (Tylenol)

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Differs from NSAIDs

Does not inhibit COX

Lacks anti-inflammatory effects

Does not inhibit platelet aggregation

Does not promote gastric ulceration, renal failure or thrombotic events

InteractionsETOH

OVERDOSE IS LETHAL!

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Acetaminophen overdose is treated with

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Acetylcysteine (mucomyst)

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Symptoms of Acetaminophen overdose

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abdominal pain, nausea, signs of liver failure (low blood sugar, low blood pH, easy bleeding, and hepatic encephalopathy), liver failure

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Tramadol

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Mechanism of Action: Analog of codeine Moderately strong analgesic with minimal potential for dependence, abuse or respiratory depression

ADR: Sedation, dizziness, headache, and constipation

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Clonidine

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Mechanism of Action: Alpha2 adrenergic agonist

Relief of severe pain via epidural infusion

ADR: Hypotension, Bradycardia