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PHARMACOLOGY Exam 2 (GI Drugs (Antiemetics (anticholinergic (scopolamine)…

- - - - Non-Sedating
        
        loratidine
        
        SE
        
        limited anticholinergic (drying) SE dt parasympathetic suppression
        
        MOA
        
        binds to mast cells as histamine 1 agonist to stop histamine release cascade
        
        IMP
        
        DC 4 days prior to allergy testing
        
        no children <2yo
        
        PO daily dose 2-3 days prior to exposure for quickest results
        
        lower dose for elders with renal impairment
      - Traditional
        
        diphenhydramine
        
        IMP
        
        DC 4 days prior to allergy testing
        
        no children <2yo
        
        PO daily dose 2-3 days prior to exposure for quickest results
        
        lower dose for elders with renal impairment
        
        CI rt anticholinergics
        (glaucoma, BPH, PUD)
        
        SE
        
        limited anticholinergic (drying) SE dt parasympathetic suppression
        
        drowsiness
        
        anorexia
        
        MOA
        
        binds to mast cells as histamine 1 agonist to stop histamine release cascade
        
        :!:
        tx for anaphylaxis is diphenhydramine plus epinephrine
      - :!:
        DOES NOT PREVENT INITIAL HISTAMINE RELEASE
    - - Adrenergic (sympathomimetic)
        
        PO
        
        pseudoephedrine
        
        IMP
        
        monitor HR/BP for signs of overdose (change in HR, breathing issues, seizures)
        
        no children <4yo
        
        CI rt anticholinergics
        (glaucoma, BPH, PUD)
        
        SE
        
        anxiety
        
        palpitations
        
        runny nose (dt sympathomimetic)
        
        limited anticholinergic (drying) SE dt parasympathetic suppression
        
        MOA
        
        magnifies sympathetic nervous system as agonist
        constricts small vessels that supply the URT, primarily nasal
        
        :!:
        rare to use PO dt longer weaker effect
        
        NASAL
        
        naphazoline
        
        IMP
        
        increase fluids
        
        monitor HR/BP for signs of overdose (change in HR, breathing issues, seizures)
        
        CI rt anticholinergics
        (glaucoma, BPH, PUD)
        
        SE
        
        :!:
        REBOUND CONGESTION
        with habitual (>3d) use, sudden DC will ri intense congestive reaction
        
        runny nose (dt sympathomimetic)
        
        limited anticholinergic (drying) SE dt parasympathetic suppression
        
        MOA
        
        magnifies sympathetic nervous system as agonist
        constricts small vessels that supply the URT, primarily nasal
        
        ri runny nose SE
        
        :!:
        REBOUND CONGESTION
        with habitual (>3d) use, sudden DC will ri intense congestive reaction
      - Anticholinergic
        
        NASAL
        
        ipratroprium
        
        IMP
        
        interacts synergistically with other anticholinergics
        
        CI rt anticholinergics
        (glaucoma, BPH, PUD)
        
        SE
        
        runny nose (dt anticholinergic)
        
        limited anticholinergic (drying) SE dt parasympathetic suppression
        
        MOA
        
        topical application to inside of nose removes parasympathetic stimulation, shrinking blood vessels
      - Corticosteroids
        
        NASAL
        
        fluticasone
        
        IMP
        
        contains alcohol
        
        anaphylaxis risk
        
        CI in immunosuppressed patients
        
        SE
        
        headache
        
        cough
        
        nasal irritation
        
        MOA
        
        local anti-inflammatory and immune suppressant
    - - Opioid
        
        codeine cough syrup
        
        IMP
        
        WATCH FOR OVER SEDATION AND RESPIRATORY DEPRESSION
        
        abuse potential
        
        push fluids
        
        SE
        
        sedation
        
        N/V
        
        light-headedness
        
        constipation
        
        MOA
        
        CNS depression
        "works in brain"
      - Non-Opioid
        
        dextromethorphan
        
        IMP
        
        less sedation than opioid, but still need to watch for CNS
        
        abuse potential
        
        SE
        
        drowsiness
        
        dizziness
        
        nausea
        
        MOA
        
        "works in brain"
        
        benzonatate
        
        IMP
        
        can take MUCH more often than any other antitussive due to lack of CNS effects
        
        perles must be swallowed whole
        
        SE
        
        drowsiness
        
        dizziness
        
        nausea
        
        pruritis
        
        MOA
        
        affects local stretch receptors in major airways
    - - guaifenesin
        
        IMP
        
        push fluids to aid thinning
        
        don't use for >1wk
        
        SE
        
        NV
        
        GI Irritation
        
        MOA
        
        aid in getting rid of mucus by thinning
      - :!:
        taking at the same time as an antitussive defeats the point of thinning so you can get rid of it
  - - - Beta-Adrenergic Agonists
        
        SABA
        Short Acting B2 Agonist
        
        albuterol
        
        IMP
        
        shake inhaler well,
        1-2m between puffs
        2-5m before next med
        
        if given w/steroid, this first
        
        rinse mouth with water + spit after every use to prevent thrush
        
        only clean inhaler with dry rag
        
        CI
        uncontrolled HRTN, dysrhythmias, high stroke risk
        
        limit caffeine
        
        :!:
        NEVER give someone a beta blocker w/history of obstructive lung issues
        (blocks b2 collaterally, blocks ability to bronchodilate)
        
        SE
        
        nervousness
        restlessness
        tremor
        
        chest pain
        palpitations
        tachycardia
        
        NV
        
        MOA
        
        imitates effect of norepinephrine (sympathetic nervous system)
        
        B2 receptor stimulation
        =
        bronchodilation
        
        LABA
        Long Acting B2 Agonist
        
        salmetrol
        
        SE
        
        ASTHMA
        RELATED
        DEATH
        
        nervousness
        restlessness
        tremor
        
        chest pain
        palpitations
        tachycardia
        
        IMP
        
        shake inhaler well,
        1-2m between puffs
        2-5m before next med
        if given w/steroid, this first
        
        NOT FOR ACUTE SYMPTOMS
        
        rinse mouth with water + spit after every use to prevent thrush
        
        only clean inhaler with dry rag
        
        limit caffeine
        
        :!:
        NEVER give someone a beta blocker w/history of obstructive lung issues
        (blocks b2 collaterally, blocks ability to bronchodilate)
        
        :!:
        ONLY GIVEN IN CONJUNCTION WITH CORTICOSTEROID
        
        MOA
        
        imitates effect of norepinephrine (sympathetic nervous system)
        
        B2 receptor stimulation
        =
        bronchodilation
      - Anticholinergics
        
        ipratroprium
        
        IMP
        
        NOT FOR ACUTE BRONCHOSPASM
        
        CI rt anticholinergics
        (glaucoma, BPH, PUD)
        
        if used with SABA, give after SABA but before steroid
        
        SE
        
        dry mouth
        palpitations
        urine retention
        increased intraocular pressure
        coughing
        anxiety
        
        MOA
        
        block ACH receptors on surface of bronchial tree, decreased parasympathetic stimulation
        
        decreases secretions (esp. in COPD)
      - Xanthine Derivatives
        
        theophylline
        
        SE
        
        identical to caffeine SE
        (anxiety, tachycardia, NV, seizures, arrhythmia, tremor)
        
        MOA
        
        prevents breakdown of cAMP so that it is excreted more slowly
        (cAMP relaxes smooth muscle)
        also stims CNS to stim resp drive
        
        IMP
        
        :!!:
        NARROW TI
        
        MANY d-d and some d-f interactions
        
        CAREFUL CV ASSESSMENT
        
        :!:
        xanthines break down into caffeine in the body
    - - Leukotriene Receptor Antagonists
        (LTRAs)
        
        montelukast
        
        IMP
        
        PO
        
        1wk to take effect
        MOSTLY PROPHYLACTIC
        
        EDUCATION
        even if ss clear, keep taking the medication
        will take for rest of life once on
        
        generally taken with a SABA
        
        monitor liver, especially in the elderly
        
        MOA
        
        block leukotrienes (inflammatory mediator that ri bronchoconstriction and mucus production)
        NET - bronchodilation and mucus inhibition
        
        action is limited to lungs
        
        SE
        
        headache
        nausea
        diarrhea
        suicide
      - Corticosteroids
        
        prednisone
        
        IMP
        
        used in conjunction with SABA
        (take steroid last)
        
        CI
        active untreated infection
        
        :!:
        taper off to avoid adrenal insufficiency/addisons crisis
        
        :!:
        wash mouth and spit after each use to avoid THRUSH
        
        risk of bone suppression in growing children
        
        SE
        
        oral infection
        pharyngeal irritation
        coughing
        dry mouth
        depression or euphoria
        
        MOA
        
        anti-immune effects lower inflammation
- - - - MOA
        
        block enzymes that help synthesize prostoglandin
      - IMP
        
        CI
        bleeding risk
        preg c for 1+2, d for 3
        
        less opiate needed when
        used in conjunction
      - SE
        
        GI Bleeds
        renal failure (w/dehydration)
        toxicity = metabolic acidosis
    - - ibuprofen
        
        anti inflammatory results in 7 days
    - - celecoxib
        
        developed because fewer GI issues, but has more CV issues
    - - indomethacin
        
        specific use in arthritis
        
        can close patent ductus arteriosus in neonates
      - ketorolac
        
        primarily analgesic, comparable to morphine
        
        USE FOR >5 DAYS
        =
        RENAL FAILURE
    - - acetylsalycilic acid
        
        TOXICITY
        hearing loss/tinnitus is first sign
        metabolic acidosis
        hyperventilation
        sweating
        glucose changes
        
        prophylactic for thrombotic events
        
        NO USE UNDER 2yo
        (or children with flulike symptoms)
        dt REYES
  - - - MOA
        
        Interferes with WBCs in initiating the inflammatory response to uric acid crystals
      - IMP
        
        :red_flag:
        HIGH ALERT MEDICATION
        OD - weakness, pale gray lips tongue and hands, bleeding/bruising
        
        if tolerated take on empty stomach
        
        push fluids
      - SE
        
        GI/GU bleeds
        diarrhea, NV
        agranulocytosis
    - - MOA
        
        xanthine oxidase inhibitor
        prevents uric acid production
      - IMP
        
        push fluids
        
        DC at first sign of rash
        risk for fatal skin conditions
        
        closely monitor I&O to assess for renal function
      - SE
        
        agranulocytosis
        
        aplastic anemia
        
        drowsiness
        
        FATAL skin conditions
- - - - magnesium
        
        ED
        
        don't use >2wks without HCP consult
        
        hard on kidneys
        
        IMP
        
        D-D
        lower acid means altered absorption of drugs that dissolve in the stomach
        
        hard on kidneys
        
        also used
        as a laxative
        
        BEWARE
        sodium restrictions
        
        SE
        
        diarrhea
        flushing
        sweating
      - calcium
        
        ED
        
        don't use >2wks without HCP consult
        
        D-D
        lower acid means altered absorption of drugs that dissolve in the stomach
        
        fluids dt constipation
        
        IMP
        
        BEWARE
        sodium restrictions
        renal calculi
        
        SE
        
        constipation
        
        arrhythmias
        
        calculi
      - sodium bicarbonate
        
        ED
        
        don't use >2wks without HCP consult
        
        D-D
        lower acid means altered absorption of drugs that dissolve in the stomach
        
        fluids dt constipation
        
        IMP
        
        BEWARE
        sodium restrictions
        renal calculi
        
        2h spacing with other medications
        
        SE
        
        metabolic alkalosis
        flatulence
        hypernatremia
      - :!:
        do NOT stop acid production, rather neutralize acid that is already present
      - aluminum
        
        SE
        
        constipation
        
        hypophosphatemia
        
        IMP
        
        BEWARE
        sodium restrictions
        
        constipating agent
        push fluids
        
        ED
        
        D-D
        lower acid means altered absorption of drugs that dissolve in the stomach
        
        don't use >2wks without HCP consult
    - - omeprazole
        
        ED
        
        take on an empty stomach
        
        D-D
        lower acid means altered absorption of drugs that dissolve in the stomach
        
        fluids dt constipation
        
        IMP
        
        ACHLORYDIA = C.diff
        
        2h spacing with other medications
        
        higher chance of osteoporosis in pops already at risk
        
        INTERACTIONS
        
        lower eff diazepam and phenytoin
        
        higher bleed warfarin
        
        SE
        
        C.diff diarrhea rt achlorhydia
        hypomagnesemia w/LT use
      - pantoprazole
        (same as omeprazole)
    - - famotidine
        
        ED
        
        smoking reduces peristalsis
        ri lowered effectiveness
        
        SE
        
        confusion
        impotence
        gynecomastia
        thrombocytopenia
        
        IMP
        
        ASSESS FOR CONFUSION IN THE ELDERLY
        
        ASSESS FOR BLEEDING/BRUISING
        
        slow IV push
        (fast can ri hypotension)
      - cimetidine
        
        SE
        
        confusion
        impotence
        gynecomastia
        thrombocytopenia
        
        IMP
        
        ASSESS FOR CONFUSION IN THE ELDERLY
        
        ASSESS FOR BLEEDING/BRUISING
        
        slow IV push
        (fast can ri hypotension)
        
        must be given with food
        
        ED
        
        smoking reduces peristalsis
        ri lowered effectiveness
        
        must be given with food
  - - - Bulk Forming
        
        psyllium
        
        MOA
        
        absorbs water into intestine, raises bulk, distending wall and triggering evacuation reflex
      - Stimulant
        
        bisacodyl
        
        MOA
        
        stimulates nerves in the intestine to increase peristalsis and increase fluid in stool
      - Emmolient
        
        Softener
        
        docusate
        
        MOA
        
        moves water and fat into stool
        
        Lubricant
        
        mineral oil
        
        MOA
        
        prevents intestinal water absorption and lubricates colonic walls
        
        Hyperosmotic
        
        polyethylene glycol
        
        MOA
        
        draws water into the intestinal lumen
      - Saline
        
        phosphate/biphosphate
        
        MOA
        
        inhibits water absorption and increases salt movement into stool to create watery stool
    - - Probiotics
        
        I . antibiotic induced diarrhea
        MOA . Replace normal flora in the GI tract
        EX . lactinex
      - Adsorbents
        
        I . mild diarrhea
        MOA . binds to causative pathogen and eliminates in stool
        EX . pepto-bismol
      - Anticholinergics
        
        I . moderate to severe diarrhea
        MOA . reduce peristalsis + gastric secretions
        EX . atropine
      - Opiates
        
        I . moderate to severe diarrhea
        MOA . reduce bowel motility
        EX . loperamide
      - :!:
        DO NOT USE FOR ACUTE GI DISEASE
  - - - scopolamine
        
        ED
        
        given transdermal
        CNS depressant
        drying effect dt antichol
        
        SE
        
        drowsiness
        blurred vision
        tachycardia
        dry mouth
    - - dronabinol
        
        ED
        
        change positions slowly dt orthostatic hypotension
        
        give 1-3h pre chemo
        
        grapefruit raises toxicity
        
        SE
        
        WEED S/S
        seizures
    - - metoclopramide
        
        IND
        
        :red_flag:hypomobility
        
        SE
        
        drowsiness/restlessness
        EPS
        tardive dyskinesia
        
        ED
        
        30m before meals or HS
        promotes peristalsis (obs + seiz not ok)
    - - aprepitant
        
        ED
        
        dose is higher at first then goes down
        NO WARFARIN
        
        SE
        
        dizziness
        fatigue
        weakness
    - - promethazine
        
        ED
        
        1-2h pre for prophylaxis
        be aware of drowsiness
        take with food/milk to reduce GI irritation
        
        SE
        
        confusion
        disorientation
        sedation
    - - ondansetron
        
        ED
        
        SEROTONIN SYNDROME
        NO ASA
        
        SE
        
        headache
        serotonin syndrome
        constipation/diarrhea
    - - meclizine
        
        ED
        
        1h pre for prophylaxis
        dry mouth
        motion sickness
        
        SE
        
        drowsiness
        child = paradoxical
        elder = confusion/psychosis
- - - - RISK
        
        potentiates hypoglycemic effects and anticoagulation
        D-D
      - REASON
        
        favorable effects on blood pressure and plasma lipids
    - - RISK
        
        increases CNS depression when used with other sedative
      - REASON
        
        helps with sleep
    - - RISK
        
        liver damage
      - REASON
        
        improve sleep
        relieve anxiety
  - - - MOA
        
        needed for proper use Ca + Phos
        BONE CALCIFICATION
        requires functional liver and kidney to use
      - DEF
        
        ricketts
        tetany
        osteomalacia
    - - MOA
        
        mainly in bones and teeth
        plays role in clotting reactions
        maintains nervous, muscular, skeletal system
      - DEF
        
        infantile rickets
        osteomalacia/osteoarthritis
        muscle cramps
        renal dysfunction
    - - DEF
        
        night blindness
        xeropthalmia
        keratomalacia
        hyperkeratosis of skin/sclera
        retard infant growth
        weakness
      - MOA
        
        skin/eyes
        normal cell growth + differentiation
        G+D of bones, teeth, reproduction, integrity mucosal and epithelial surfaces
        cholesterol and steroid synthesis
    - - MOA
        
        Kreb's Cycle
        (lactic acid fermentation)
        carb metabolism
      - DEF
        
        seen in alcoholics
        beriberi
        wernicke's encephalopathy
    - - DEF
        
        growth retardation
        loss of appetite
        impaired immune function
      - MOA
        
        used for tissue growth and repair
        esp. wound healing
    - - MOA
        
        CREATES COAG FACTORS
        no vK, no coagulation
        ANTIDOTE TO WARFARIN
      - DEF
        
        hypoprothrombinemia