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Flashcards in Uworld Pharmacology Deck (358)
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1

alteplase

Thrombolytic agent
- are often prescribed to resolve acute thrombotic events (eg, ischemic stroke, myocardial infarction, massive pulmonary embolism).
- They are recombinant plasminogen activators that activate the blood fibrinolytic system and dissolve thrombi.

- contraindicated in clients with active bleeding, recent trauma, aneurysm, arteriovenous malformation, history of hemorrhagic stroke, and uncontrolled hypertension (blood pressure >180/110 mm Hg). Administering alteplase in the presence of these conditions can cause hemorrhage, including life-threatening intracerebral hemorrhage

2

Trimethoprim-sulfamethoxae

(Bactrim) is a sulfonamide antibiotic, commonly referred to as a sulfa drug.
- These antibiotics are prescribed to treat bacterial infections (eg, urinary tract infections).
- Contraindications include hypersensitivity to sulfa drugs, and pregnancy or breastfeeding.

3

Glyburide

used to treat diabetes mellitus, and it can cause significantly low blood sugar if ingested by a client who does not have diabetes
- is a sulfonylurea and has the potential to cause a sulfa cross-sensitivity reaction.
- The major adverse effects of sulfonylurea medications are hypoglycemia and weight gain.
- Clients should be taught to use sunscreen and protective clothing as serious sunburns can occur.
- Clients should avoid alcohol as it lowers blood glucose and can lead to severe hypoglycemia.

- carry a risk for severe and prolonged hypoglycemia in the geriatric population due to potential delayed elimination. Avoidance of these drugs is recommended. Instead, other medications that are at lower risk for hypoglycemia should be used (eg, metformin)

4

Common diuretics that can cause sulfa allergies

thiazides, furosemide are sulfa derivatives and can cause cross-sensitivity reaction.

5

Crystalluria is a potential adverse effect

of sulfa medications.
- Clients should drink at least 2-3 L of water daily to prevent crystalluria.

6

What foods decrease the effects of warfarin

Warfarin - works by inhibiting vitamin K-dependent clotting factors
- Consumption of foods rich in vitamin K will decreases the effectiveness of warfarin
- clients must be taught to eat the same amount of or avoid dark, green, leafy vegetables.

Clients are not instructed to remove those foods from their diet but are encouraged to be consistent in the intake of foods high in vitamin K, including leafy green vegetables, asparagus, broccoli, kale, Brussels sprout, and spinach.

Several beverages also affect warfarin therapy. Green tea, grapefruit juice, and cranberry juice may alter its anticoagulant effects.

7

nifedipine

- Peripherally acting calcium channel block
- used to treat hypertension and do not worsen bronchoconstriction
- cause vasodilation, and clients may develop peripheral edema
---- This is an expected, frequent side effect and is not an allergic reaction.
--- Clients are advised to elevate the legs when lying down and to use stockings.

- also used to suppress uterine contractions in preterm labor, allowing pregnancy to be prolonged for 2-7 days so that corticosteroid administration can improve fetal lung maturity.

- avoid grapefruit juice!! - cause severe hypotension

8

The following should be taught to clients taking tetracyclines (eg, tetracycline, doxycycline, minocycline):

- Take on an empty stomach – for optimum absorption, tetracyclines should be taken 1 hour before or 2 hours after meals
- Avoid antacids or dairy products – tetracyclines should not be taken with iron supplements, antacids, or dairy products as they bind with the drug and decrease its absorption
- Take with a full glass of water – tetracyclines can cause pill-induced esophagitis and gastritis; the risk can be reduced by taking with a full glass of water and remaining upright after pill ingestion
- Photosensitivity – severe sunburn can occur with tetracycline. The client should use sunblock
- Medications such as tetracycline and rifampin can decrease the effectiveness of oral contraceptives; additional contraceptive techniques will be needed

9

Drug of choice to treat SVT

Adenosine is the drug of choice to treat SVT and has a 5- to 6-second half-life (the time it takes for the drug to be reduced to half of its original concentration).
- Placing the IV line as close as possible, not distal, to the heart is essential for the drug to have full effect.
- Adenosine is given rapidly over 1-2 seconds and then followed by a rapid 20-mL normal saline flush.
- Transient asystole is common, and clients often experience flushing and dizziness.
- Repeat boluses of 12 mg may be given twice if the rapid rhythm persists

10

benztropine

(Cogentin) - Anticholinergic
- used in the treatment of extrapyramidal side effects associated with antipsychotic medications or metoclopramide.
- given for tremors for parkinsons
- Give IV for a dystonic reaction --Severe neck spasms in an individual taking haloperidol (and other psychotropic medications)
- a common side effect is xerostomia (dry mouth) due to the blockade of muscarinic receptors of the salivary glands, which inhibits salivation. Sugar-free candies or gum may be used to alleviate dry mouth and throat
- in clients with benign prostatic hyperplasia or glaucoma, caution must be taken as anticholinergic drugs can precipitate urinary retention and an acute glaucoma episode

11

radioactive iodine (RAI)

- the primary treatment for nonpregnant adults with hyperthyroid disorders such as Graves' disease (a type of autoimmune hyperthyroid disease).

- RAI damages or destroys the thyroid tissue, thereby limiting thyroid secretion, and can result in hypothyroidism. Clients need to take thyroid supplementation (levothyroxine) for life.

- The use of RAI is contraindicated in pregnancy and could cause harm to a fetus. Pregnancy results should therefore be confirmed using a valid pregnancy test in all clients who still have menstrual cycles rather than using a subjective form of assessment such as asking when the last menstrual period occurred

- Radiation thyroiditis and parotitis, which cause dryness and irritation to the mouth, may occur after RAI treatment.
--The nurse can teach the client to take sips of water frequently or to use a salt and soda gargle solution 3-4 times daily to relieve these symptoms.

12

levothyroxine

- thyroid replacement supplement for hypothyroidism
- used to replace thyroid hormone in clients with hypothyroidism (inadequate thyroid hormone) and for those who have had their thyroid removed.
- These clients must understand that this medication must be taken for the rest of their lives
- A client's dose is adjusted based on serum TSH levels to prevent too much or too little hormone. Clients must be taught to report signs of excess thyroid hormone such as heart palpitations/tachycardia, weight loss, and insomnia
- safe to take during pregnancy
- best to take this medication first thing in the morning as it is best absorbed on an empty stomach (1 hour before or 2 hours after a meal)

Several medications impair the absorption of levothyroxine (Synthroid). Common offenders are antacids, calcium, and iron preparations. Some of these could be present in several over-the-counter multivitamin and mineral tablets. Therefore, clients with hypothyroidism should be instructed to take levothyroxine on an empty stomach, preferably in the morning, separately from other medications.

The client's therapeutic response to levothyroxine (Synthroid) is evaluated by resolution of hypothyroidism symptoms. The expected response includes improved well-being with elevated mood, higher energy levels, and a heart rate that is within normal limits. The nurse should consult the health care provider if the heart rate is >100/min, or if the client reports chest pain, nervousness, or tremors; this may indicate that the dose is higher than necessary. Pharmacological therapy manages the symptoms of hypothyroidism, but it takes up to 8 weeks after initiation to see the full therapeutic effect

13

alprazolam =

Xanax - Benzodiazepine
- commonly used antianxiety drugs.
- work by potentiating endogenous GABA, a neurotransmitter that decreases excitability of nerve cells, particularly in the limbic system of the brain, which controls emotions.
- may cause sedation, which can interfere with daytime activities. Giving the dose at bedtime will help the client sleep.
- never be stopped abruptly. Instead, it should be tapered gradually to prevent rebound anxiety and a withdrawal reaction characterized by increased anxiety, confusion, and more.

14

clonazepam

Benzodiazepines - commonly used antianxiety drugs.
- work by potentiating endogenous GABA, a neurotransmitter that decreases excitability of nerve cells, particularly in the limbic system of the brain, which controls emotions.
- may cause sedation, which can interfere with daytime activities. Giving the dose at bedtime will help the client sleep.
- never be stopped abruptly. Instead, it should be tapered gradually to prevent rebound anxiety and a withdrawal reaction characterized by increased anxiety, confusion, and more.

15

lorazepam =

Ativan - Benzodiazepine
- commonly used antianxiety drugs.
- considered standard treatment to control agitation in the client in alcohol withdrawal
- work by potentiating endogenous GABA, a neurotransmitter that decreases excitability of nerve cells, particularly in the limbic system of the brain, which controls emotions.
- may cause sedation, which can interfere with daytime activities. Giving the dose at bedtime will help the client sleep.
- never be stopped abruptly. Instead, it should be tapered gradually to prevent rebound anxiety and a withdrawal reaction characterized by increased anxiety, confusion, and more.
- has a long half-life (10-17 hours). Side effects include drowsiness, dizziness, ataxia, and confusion

- IV used acutely to control seizures. However, rectal diazepam is often prescribed when the IV form is unavailable or problematic

16

Eliminating aged cheeses and processed meats is necessary with?

monoamine oxidase inhibitors (eg, tranylcypromine, phenelzine), which are used for depressive disorders.

aged cheeses and processed meats contain tyramine

17

tranylcypromine

monoamine oxidase inhibitor - used for depressive disorders.

18

phenelzine

(Nardil) monoamine oxidase inhibitor - used for depressive disorders.

Clients taking MAOIs must avoid high-tyraminefoods to prevent life-threatening hypertensive crisis. Foods and beverages to avoid include aged cheeses (eg, most cheeses except for cream and cottage cheese); protein-rich foods; and foods that have been processed (eg, hot dogs), pickled, fermented (eg, sauerkraut, pepperoni), or smoked (eg, smoked salmon). Most fruits and vegetables (eg, salad, broccoli) contain little to no tyramine

19

tenecteplase

Thrombolytic agent
- are often prescribed to resolve acute thrombotic events (eg, ischemic stroke, myocardial infarction, massive pulmonary embolism).
- They are recombinant plasminogen activators that activate the blood fibrinolytic system and dissolve thrombi.

- contraindicated in clients with active bleeding, recent trauma, aneurysm, arteriovenous malformation, history of hemorrhagic stroke, and uncontrolled hypertension (blood pressure >180/110 mm Hg). Administering alteplase in the presence of these conditions can cause hemorrhage, including life-threatening intracerebral hemorrhage

20

reteplase

Thrombolytic agent
- are often prescribed to resolve acute thrombotic events (eg, ischemic stroke, myocardial infarction, massive pulmonary embolism).
- They are recombinant plasminogen activators that activate the blood fibrinolytic system and dissolve thrombi.

- contraindicated in clients with active bleeding, recent trauma, aneurysm, arteriovenous malformation, history of hemorrhagic stroke, and uncontrolled hypertension (blood pressure >180/110 mm Hg). Administering alteplase in the presence of these conditions can cause hemorrhage, including life-threatening intracerebral hemorrhage

21

amlodipine

(Norvasc) - Peripherally acting calcium channel blockers
- used to treat hypertension and do not worsen bronchoconstriction
- cause vasodilation, and clients may develop peripheral edema
---- This is an expected, frequent side effect and is not an allergic reaction.
--- Clients are advised to elevate the legs when lying down and to use stockings.

22

felodipine

- Peripherally acting calcium channel blockers

- cause vasodilation, and clients may develop peripheral edema
---- This is an expected, frequent side effect and is not an allergic reaction.
--- Clients are advised to elevate the legs when lying down and to use stockings.

23

diazepam

Benzodiazepine - commonly used antianxiety drugs.
- work by potentiating endogenous GABA, a neurotransmitter that decreases excitability of nerve cells, particularly in the limbic system of the brain, which controls emotions.
- may cause sedation, which can interfere with daytime activities. Giving the dose at bedtime will help the client sleep.
- never be stopped abruptly. Instead, it should be tapered gradually to prevent rebound anxiety and a withdrawal reaction characterized by increased anxiety, confusion, and more.
- considered standard treatment to control agitation in the client in alcohol withdrawal
- IV diazepam used acutely to control seizures. However, rectal diazepam is often prescribed when the IV form is unavailable or problematic

24

Vancomycin

(Vancocin) is a potent antibiotic used to treat gram-positive bacterial infections (eg, Staphylococcus aureus, Clostridium difficile).

- strong antibiotics that can cause nephrotoxicity and ototoxicity
- To lower the risk of dose-related nephrotoxicity, especially in clients with renal impairment and those who are >60 years of age, serum vancomycin trough levels should be monitored to assess for therapeutic range (10-20 mg/L).
- normal levels of creatinine (0.6-1.3 mg/dL) and BUN (6-20 mg/dL) are necessary in clients receiving vancomycin.

25

omeprazole

proton pump inhibitor that suppresses the production of gastric acid by inhibiting the proton pump in the parietal cells of the stomach. In most hospitalized clients without a history of GERD or ulcers, PPIs are prescribed to prevent stress ulcers from developing during surgery or a major illness.
- Although evidence has shown that two-thirds of clients who receive PPIs do not need them, these medications are still widely prescribed in hospitalized clients. PPIs can be identified by their "-prazole" ending (eg, pantoprazole, lansoprazole, esomeprazole).
- used for GERD, also used for ulcer tx, and prevention
- PPIs impair intestinal calcium absorption and therefore are associated with decreased bone density, which increases the possibility of fractures of the spine, hip, and wrist.
- PPIs cause acid suppression that otherwise would have prevented pathogens from more easily colonizing the upper gastrointestinal tract. This leads to increased risk of pneumonias.
- can possibly cause C.diff
- associated with increased risk of pneumonia, Clostridium difficile diarrhea, and calcium malabsorption (osteoporosis

26

proton pump inhibitors =

prazoles
- used for GERD
- PPIs impair intestinal calcium absorption and therefore are associated with decreased bone density, which increases the possibility of fractures of the spine, hip, and wrist.
- PPIs cause acid suppression that otherwise would have prevented pathogens from more easily colonizing the upper gastrointestinal tract. This leads to increased risk of pneumonias.
- can possibly cause C.diff

27

lansoprazole

proton pump inhibitor
- used for GERD
- PPIs impair intestinal calcium absorption and therefore are associated with decreased bone density, which increases the possibility of fractures of the spine, hip, and wrist.
- PPIs cause acid suppression that otherwise would have prevented pathogens from more easily colonizing the upper gastrointestinal tract. This leads to increased risk of pneumonias.
- can possibly cause C.diff

28

pantoprazole

proton pump inhibitor
- used for GERD, also used for ulcer tx and prevention
- PPIs impair intestinal calcium absorption and therefore are associated with decreased bone density, which increases the possibility of fractures of the spine, hip, and wrist.
- PPIs cause acid suppression that otherwise would have prevented pathogens from more easily colonizing the upper gastrointestinal tract. This leads to increased risk of pneumonias.
- can possibly cause C.diff

29

rebeprazole

proton pump inhibitor
- used for GERD
- PPIs impair intestinal calcium absorption and therefore are associated with decreased bone density, which increases the possibility of fractures of the spine, hip, and wrist.
- PPIs cause acid suppression that otherwise would have prevented pathogens from more easily colonizing the upper gastrointestinal tract. This leads to increased risk of pneumonias.
- can possibly cause C.diff

30

Metronidazole

(Flagyl)
first-line anti-infective drug used to treat infectious diarrhea caused by Clostridium difficile
is the initial drug of choice for STIs.
- Clients should avoid alcohol while taking metronidazole and for 24 hours after completion of the therapy due to a reaction that includes flushing, nausea/vomiting, and abdominal pain.
- The medication can cause a metallic taste and turn the urine a deep red-brown color.
- med of choice for c.diff
- used for bacterial vaginosis, an overgrowth of vaginal bacterial flora