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Pharm Exam Three
3rd pharm exam
184
Pharmacology
Undergraduate 3
11/09/2011

Additional Pharmacology Flashcards

 


 

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Term
anticoagulants
Definition
reduce the formation of fibrin
two mechanisms of action: inhibit the synthesis of clotting factors and inhibit the activity of clotting factors

category: coagulation modifiers
Term
category: coagulation modifiers
classification: anticoagulant
Definition
prototypes: heparin (unfractionated heparin), enoxaparin (low molecular weight heparin), warfarin, dabigatran
Term
heparin (unfactionated heparin) pharmacokinetics
Definition
route: IV
onset of action: immediate
peak plasma concentration: immediate
half-life: 1-2 hours
duration of action: dependent on infusion duration

route: subcut
onset of action:20-30 min
peak plasma concentration: 2-4 hours
half-life: 1-2 hours
duration of action: 8-12 hours
Term
enoxaparin (low molecular weight heparin) pharmacokinetics
Definition
**also known as Lovenox

route: subcut
onset of action: 3-5 hours
peak plasma concentration: 4-5 hours
half-life: 4-5 hours
duration of action: 12 hours
Term
unfactionated heparin (heparin) indications
Definition
DVT
MI
unstable angina
atrial fibrillation
mechanical heart valves
post-op orthopedic procedures/immobility
Term
unfactionated heparin (heparin) mechanism of action
Definition
suppreses coagulation by inhibiting activation of thrombin and factor Xa --> inhibition of fibrin formation = inhibition of clot formation
Term
unfactionated heparin (heparin) contraindications
Definition
thrombocytopenia
uncontrollable bleeding
during and immediately after surgery of the eye, brain, or spinal chord
Term
unfactionated heparin (heparin) adverse effects
Definition
hemorrhage
heparin-induced thrombocytopenia
hypersensitivity reactions

**protamine sulfate is the antidote for OD
Term
low molecular weight heparin (enoxaparin/lovenox) indications
Definition
prevention of DVT following surgery (including knee and hip replacement)
treatment of established DVT
prevention of ischemic complications (including patients with unstable angina, non-Q wave MI, and STEMI)
Term
low molecular weight heparin (enoxaparin/lovenox) mechanism of action
Definition
inactivate factor Xa --> prevention of prothrombin being converted to thrombin which ultimately prevents fibrin formation and therefore clot formation
Term
low molecular weight heparin (enoxparin/lovenox) nursing implications
Definition
administered subcut dosage based on body weight costs more than unfractionated heparin does not require monitoring/can be given at home

monitor APTT - should be 1.5 - 2 times normal 
Term
low molecular weight heparin (enoxparin/lovenox) adverse effects
Definition
bleeding (less than with unfractionated heparin)
immune-mediated thrombocytopenia
severe neurologic injury for patients undergoing spinal puncture or spinal epidural anesthesia

**protamine sulfate is the antidote OD
Term
warfarin (coumadin) pharmacokinetics
Definition
route: PO
onset of acton: 24-72 hours
peak plasma concentration: 4 hours
half-life: 0.5-3 days
duration of action: 2-5 days
Term
warfarin (coumadin) indications
Definition
not useful in emergency situations
long term prophylaxis of thrombosis:
- prevention of DVT and pulmonary embolism
- prevention of thromboembolism in patients with prosthetic heart valves
- prevention of thrombosis during atrial fibrillation
Term
warfarin (coumadin) mechanism of action
Definition
decreases production of clotting factors VII, IX, X and prothrombin inhibiting vitamin K synthesis in the intestine thereby preventing clot formation
Term
warfarin (coumadin) adverse effects
Definition
hemorrhage
fetal hemorrhage and teratogenesis from use during pregnancy

**vitamin K is the antidote for OD
Term
warfarin (coumadin) drug interactions
Definition
heparin, aspirin, acetaminophen
increase anticoagulant effects
promote bleeding
decrease anticoagulant effects
Term
dabigatran (pradaxa) pharmacokinetics
Definition
**class: anti-coagulant AND direct thrombin inhibitor

route: PO
onset of action: 0.5-2 hours
peak plasma concentration: 1-2 hours
half-life: 12-17 hours
duration of action: 12-24 hours
Term
dabigatran (pradaxa) indications
Definition
atrial fibrillation (DVT prevention after hip or knee surgery)
Term
dabigatran (pradaxa) mechanism of action
Definition
directly inhibits clotting factor II - thrombin
Term
dabigatran (pradaxa) adverse effects
Definition
bleeding
hemorrhage
dyspepsia
nausea
upper abdominal pain
diarrhea
Term
dabigatran (pradaxa) drug interactions
Definition
rifampin
keoconazole
verapamil
amiodaron
quinidine
clarithromycin
Term
category: antiplatelet drugs
classification: cyclooxygenase inhibitor
Definition
prototype: acetylsalylic acid (aspirin)

route: PO
onset of action: 15-30 min
peak plasma concentration: 0.25-2 hours
half-life: 2-3 hours
duration of action: 4-6 hours
Term
acetylsalylic acid (aspirin) indications
Definition
antiplatelet prophylaxis for embolic events such as MI and stroke
antiinflammatory
analgesic
antipyretic
Term
acetylsalylic acid (aspirin) mechanism of action
Definition
inhibits cyclooxygenase through acetylation in the platelet irreversibly --> loss of ability to regenerate the enzyme --> inhibition of TXA = decreased aggregation of platelets in vessels
Term
acetylsalylic acid (aspirin) adverse effects
Definition
bleeding
GI bleeding and hemorrhagic stroke
enteric-coated tablets may not reduce the risk of GI bleed
Term
acetylsalylic acid (aspirin) toxicity
Definition
in general watch for bleeding tendencies, tinnitus, stomach pain, thrombocytopenia

toxicity:
increased temp
nausea/vomiting
tinnitus
hyperventilation leading to respiratory alkalosis
severe toxicity:
metabolic acidosis
seizures
Term
category: antiplatelet drugs
classification: ADP inhibitor
Definition
prototype: clopidrogel (plavix)

route: PO
onset of action: 1-2 hours
peak plasma level: 1 hour
half-life: 8 hours
duration of action: 7-10 days
Term
clopidrogel (plavix) indications
Definition
decrease incidence of vascular clotting, MI, stroke, prevents stenosis of stents, and acute coronary syndrome
Term
clopidrogel (plavix) mechanism of action
Definition
inhibits platelet aggregation by irreversibly blocking ADP on platelet surface 
Term
clopidrogel (plavix) contraindications
Definition
thrombocytopenia
active bleeding
leukemia
traumatic injury
GI ulcer
vitamin K deficiency
recent stroke
Term
clopidrogel (plavix) what to watch for
Definition
skin disorder URI flu-like symptoms
abdominal pain
dyspepsia
diarrhea
cautious use with: HTN hepatic/renal problems history of bleeding
Term
category: antiplatelet
classification: glycoprotein IIb/IIIa antagonists
Definition
prototypes: tirofiban (aggrastat), eptifibatide (integrilin), abciximab (reopro)

route: IV
onset of action: 1 hour
peak plasma concentration: unknown
half-life: 2-2.5 hours
duration of action: 4 hours
Term
tirofiban (aggrastat) indications
Definition
prophylaxis of clot formation
short term to prevent acute coronary syndrome
Term
tirofiban (aggrastat) mechanism of action
Definition
causes reversible blockade of platelet GPIIb/IIIa receptorts --> prevention of the final step in aggregation
Term
category: thrombolytics
classification: tissue plasminogen activator
Definition
prototypes: alteplase (tPA, activase), tenectaplaxe (TNKase), streptokinase (streptase), urokinase (abbokinase)

route: IV
onset of action: 30 min
peak plasma concentration: 1 hour
half-life: 26-50 min
duration of action: dependent on infusion duration
Term
thrombolytic indications
Definition
MI
DVT
pulmonary emboli
"clot busters"
Term
thrombolytic mechanism of action
Definition
promote conversion of plasminogen to plasmin, an enzyme that degrades the fibrin matrix of thrombi --> increase profusion and decrease viscosity and aggregation of RBCs

**give 2-6 hours after MI and 4.5 hours after a stroke 
Term
thrombolytic what to look for
Definition
allergic reactions
spontaneous bleeding
oozing from any fresh wound site
Term
heparin nursing implications
Definition
doses usually double checked with another RN
do not give subcut doses within two inches of umbilicus, abdominal incisions, or unhealed wounds
do not aspirate subcut injections
do not massage subcut injection sites
anticoagulant effects seen immediately
labs are done daily to monitor coagulation effects (APTT)
protamine sulfate can be given as an antidote in case of excessive anticoagulation
Term
warfarin nursing implications
Definition
may be started while the patient is still on heparin until PT times indicate adequate coagulation full therapeutic effect takes several days monitor PT and PT-INR regularly antidote is vitamin K many herbal products such as capsicum pepper, garlic, ginger, ginko, ginseng, and feverfew may have potential interactions (increased bleeding)
avoid eating foods high in vitamin K (green leafy veggies, avocado, kiwi, grapes, tomatoes, bananas, fish)

INR should be 2-3  
Term
antiplatelet drugs nursing implications
Definition
nicotine causes vasoconstrictions, which alters the effectiveness of antiplatetlet agents
drug-drug interactions
adverse reactions to report
monitor for abnormal bleeding
Term
thrombolytic agent nursing implications
Definition
follow strict manufacturer guidelines for preparation and administration
monitor IV sites for bleeding, redness, and pain
monitor for bleeding from gums, mucous membranes, and nose
observe for signs of internal bleeding (decreased BP, restlessness, increased pain)
Term
patient education for anticoagulants
Definition
should include:
importance of regular lab testing
signs of abnormal bleeding
measures to prevent bruising, bleeding, or tissue injury
wearing a medical alert bracelet
avoiding foods high in vitamin K (tomatoes, dark leafy greens, bananas, fish)
consulting physician before taking other meds or OTC products/herblas
Term
category: hematopoetic growth factors
classification: antianemic
Definition
prototype: epoetin alfa (procrit, epogen)
Term

epoetin alfa (procrit, epogen) indications
HIV-infect patients taking zidovudine

chemo-inuced anemia
patients facing surgery
**basically just anemia 

Definition
anemia secondary to chronic renal failure
Term
epoetin alfa (procrit, epogen) mechanism of action
Definition
stimulates the production of RBCs in the bone marrow of severely anemic patients
Term
category: hematopoetic growth factors
classification: granulocyte stimulating colony factor
Definition
prototypes: filgrastim (neupogen) and pepfilgrastim (neulasta)
Term
prefilgrastim (neupagen) indications
Definition
neutropenia
reduces the incidence of infection
need for hospitalization
need for intravenous antibiotics
Term
prefilgrastim (neupagen) mechanism of action
Definition
stimulates myeloid cells to increase production of neutrophils
produces dose-dependent increase in circulating neutrophils
Term
filgrastim (neupogen) indications
Definition
reduces the incidence of severe neutropenia
produces dose-dependent increases in circulating neutrophils
reduces the incidence of infection, need for hospitalization, and need for intravenous antibiotics
Term
filgrastim (neupogen) mechanism of action
Definition
colony-stimulating factor leukopoietic growth factor --> used for recombinant DNA technology
Term
filgrastim (neupogen) adverse effects
Definition
bone pain leukocytosis
edema --> contraindicated in patients with heart failure
cough
dyspnea
sore throat
anorexia
N/V
diarrhea
alopecia
rash at injection site
fever
headache 
Term
category: hematopoietic growth factor
classification: granulocyte-macrophage colony stimulating factor
Definition
prototype: sargramostim (leukine)
Term
sargramostin (leukine) indications
Definition
adjunct to autologous bone marrow transplantation
treatment of failed bone marrow transplants
patients with a cute myelogenous leukemia (AML)
Term
sargramostin (leukine) mechanism of action
Definition
acts on bone marrow to increase production of neutrophils, monocytes, and eosinophils
acts on mature cells to enhance their actions
Term
sargramostin (leukine) adverse effects
Definition
diarrhea
weakness
malaise
bone pain
leukocytosis
thrombocytosis
Term
category: hematopoietic growth factor
classification: thrombopoietic growth factor
Definition
prototype: oprelvekin (interleukin-11)
Term
oprelvekin (interleukin-11) indications
Definition
myelosuprresive chemotherapy
prevent platelet transfusions
Term
oprelvekin (interleukin-11) mechanism of action
Definition
stimulates platelet proginator cells to increase platelet production
Term
oprelvekin (interleukin-11) adverse effects
Definition
fluid retention (contraindicated in patients with heart failure)
cardiac dysrhytmias conjuctival infections visual blurring papilledema
Term
hematopoietic growth factor CAUTION
Definition
epoetin alfa, filgrastim, sargramostim, and oprelvekin stimulate proliferation of bone marrow cells

****use with great caution, if at all, for patients with cancer of bone marrow origin
Term
category: analgesic
classification: opioid
Definition
prototypes: codeine sulfate, fentanyl citrate, morphine sulfate, morphine sulfate continuous release (MS contin), oxycodone, oxycodone CR (oxycontin), meperidine HCl (demerol), methadone HCl (dolophine)
Term
opioid analgesia indications
Definition
to alleviate moderate to severe pain
Term
opioid analgesia mechanism of action
Definition
mimicks actions of endogenous opioid peptides
primarily at the Mu1 opiod sites
Term
opioid analgesia contraindications
Definition
known drug allergy
severe asthma or other respirator insufficiency
increased intracranial pressure
pregnancy
Term
opioid analgesia adverse effects
Definition
euphoria
CNS depression
pupil constriction (miosis)
diaphoresis
flushing
bradycarida
hypotension
respiratory distress
nausea
vomiting
constipation
urinary retention
itching
wheal formation
Term
category: opiate antagonists classification: opiates
Definition
prototypes: naloxone (narcan) and naltrexone (revia) --> narcan is the drug of choice
Term
opiate indications
Definition
used for complete or partial reversal of opiod-induced respiratory depression
Term
opiate mechanism of action
Definition
bind to opiate receptors and prevent a response
Term
opiate adverse effects
Definition
tolerance
physical dependence
psychological dependence
Term
opiate physical dependence
Definition
seen when the opioid is abruptly discontinued or when an opiod antagonist is administered

narcotic withdrawal/opioid abstinence syndrome
Term
narcotic withdrawal/opioid abstinence syndrome
Definition
manifested as:
anxiety
irritability
chills/hot flashes
joint pain
lacrimation
rhinorrhea
diaphoresis
nausea
vomiting
abdominal cramps
diarrhea
Term
category: analgesias
classification: non-opiod
Definition
prototype: acetaminophen (tylenol)
Term
non-opioid analgesia indications
Definition
mild to moderate pain
fever
alternative for those who cannot take aspirin products
Term
non-opioid analgesia
Definition
blocks pain impulses peripherally by inhibiting prostaglandin synthesis
Term
acetaminophen toxicity
Definition
available OTC, but lethal when overdosed
overdose, whether intentional or due to chronic unintentional misuse, causes hepatic necrosis
long-term ingestion of large doses also causes nephtropathy

**acetylcysteine is the recommended antidote
Term
acetaminophen interactions
Definition
dangerous interactions may occur if taken with alcohol
should not be taken in the presence of:
liver dysfunction
possible liver failure
when taking other hepatotoxic drugs
Term
analgesic nursing implications
Definition
perform a thorough pain assessment, including pain intensity and character, onset, location, description, precipitating and alleviating factors, type, remedies, and other pain treatments
be sure to medicate patients before the pain becomes severe as to provide adequate analgesia and pain control
pain management includes pharmacologic and non-pharmacologic approaches
instruct patients to notify physician for signs of allergic reaction or adverse effects
Term
opiod analgesic nursing implications
Definition
withhold dose and contact physician if there is a decline in the patients condition of if VS are abnormal, especially if RR is < 12 breaths/min
check dosages carefully --> follow proper administration guidelines for IM injections and follow guidelines for IV administration, including dilution, rate of administration, etc.
constipation is a common side effect and may be prevented with adequate fluid and fiber intake
instruct patients to follow directions for administration carefully, and to keep a record of their pain experience and response to treatments
patients should be instructed to change positions slowly to prevent possible orthostatic hypotension
Term
monitoring for analgesic adverse effects
Definition
should VS change, patient's condition decline, or pain continue contact physician immediately
respiratory depression may be manifested by RR of < 12 breaths/min, dyspnea, diminished breath sounds, or shallow breathing
Term
monitoring for analgesic therapeutic effects
Definition
decreased complaints of pain
decreased severity of pain
increased periods of comfort
improved ADLs, appetite, and sense of well-being
decreased fever (acetaminophen)
Term
category: cyclooxygenase inhibitors
classification: non-aspirin non-steroidal anti-inflammatory (NSAIDS)

FIRST GENERATION
Definition
propionic acid derivatives:
ibuprofen (advil, motrin), naproxen (naprosyn), naproxen plus lansoprazole, indomethacin (indocin), ketorolac (tordol), ketoprofen (oruvail)

others on ppt...a lot of fucking NSAIDS!
Term
category: cyclooxygenase inhibitors
classification: non-aspirin non-steroidal anti-inflammatory (NSAIDS)

SECOND GENERATION
Definition
prototype: celecoxib (celebrex)
Term
celecoxib (celebrex) indications
Definition
osteoarthritis
rheumatoid arthritis
acute pain
dysmenorrhea
familial adenomatous polyposis
Term
celecoxib (celebrex) mechanism of action
Definition
reversible inhibition of the leukotriene or prostaglandin pathway or both
more specifically blocks the action of cyclooxygenase II
Term
celecoxib (celebrex) adverse effects
Definition
moderate to severe noncardiogenic pulmonary edema
FDA warning: may increase risk of thromboembolic event including MI and stroke (increased for patients who already have CVD and other risk factors)
gastric ulceration
bleeding
renal impairment
Term
celecoxib (celebrex) drug interactions
Definition
warfarin
may decrease diuretic effect of furosemide
may decrease anti-hypertensive effect of ACE inhibitors
may increase levels of lithium
levels of celecoxib may be increased by fluconazole
Term
category: insulin
classification: rapid action
Definition
prototypes: insulin lispro (humalog), insulin aspart (novolog), insuline glulisine (apidra)
Term
category: insulin
classification: short acting
Definition
prototypes: regular insulin (humalin R, novolin R)
Term
category: insulin
classification: intermediate
Definition
prototypes: neutral protamines hagedorn aka NPH (humalin N, novolin N)
Term
category: insulin
classification: long acting
Definition
prototypes: insulin detemir (levemir) and insulin glargine (lantus)
Term
insulin indications
Definition
principal: diabetes mellitus
required by all type I and some type II patients
IV insulin for DKA
hyperkalemia: can promote uptake of potassium
aids in the diagnosis of GH deficiency
Term
insulin mechanism of action
Definition
restores body's ability to metabolize carbohydrates, fats, and proteints --> to store glucose in the liver and to convert glycogen to fat stores
Term
insulin administration
Definition
subcut injections:
syringe and needle
pen injectors
jet injectors

inhalation:
exubera --> withdrawn in 2007

subcut infusion:
portable insulin pumps
implanted insulin pumps

IV infusion
Term
insulin storage
Definition
unopened vials should be stored in refrigeration until needed
should not be frozen
can be used until expiration date if kept in refrigerator
after opening, can be kept up to one month without significant loss of activity
keep out of direct sunlight and extreme heat
mixtures of insulin in vials are stable for one month at room temperature and three months in refrigeration
mixtures in prefilled syringes should be stored in refrigeration for up to one week and should be stored vertically with needle pointing up
Term
complications of insulin therapy
Definition
hypoglycemia
lipodystophies
allergic reactions
hypokalemia
drug interaction:
hypoglycemic agents
hyperglycemic agents
beta andrenergic blocking agents
Term
category: oral antidiabetic agents
classification: sulfonylureas
Definition
prototypes: chlorpropamide (diabinese), tolazamaide (tolinase), tolbutamide (orinase), glimepiride (amaryl), glipizide (glucotrol), glyburide (diabeta)
Term
sulfonylureas indications
Definition
type II diabetes - non insulin dependent
Term
sulfonylureas mechanism of action
Definition
stimulate insulin secretion from the beta cells of the pancreas, thus increasing insulin levels
Term
sulfonylureas what to watch for
Definition
epigastric fullness, diarrhea, hypoglycemia, heartburn, pruritus

**do not use when pregnant
Term
category: oral antidiabetic drugs
classification: biguanides
Definition
prototype: metformin (glucophage)
Term
bigunaides indications
Definition
type II diabetes - non insulin dependent
Term
biguanides mechanism of action
Definition
decrease production of glucose
increase uptake of glucose by tissues
do not increase insulin secretion from the pancreas
Term
category: oral antidiabetic agents
classification: meglitinides
Definition
prototype: repaglinide (prandin)
Term
meglitinides indications
Definition
type II diabetes
Term
meglitinides mechanism of action
Definition
similar to sulfonylureas --> stimulate insulin secretion from pancrease
good choice for patients with erratic eating habits
Term
category: oral antidiabetic drugs
classification: alpha-glucosidase inhibitors
Definition
prototypes: acarbose (precose) and miglitol (glyset)
Term
alpha-glucosidase inhibitors indications
Definition
type II diabetes
Term
alpha-glucosidase inhibitors mechanism of action
Definition
reversibly inhibit the enzyme alpha-glucosidase in the small intestinge --> delayed absorption of glucose
must be taken with meals to prevent excessive postprandial blood glucose elevations
Term
category: oral antidiabetic drugs
classification: thiazolidinediones
Definition
prototypes: pioglitazone (actos) and rosiglitazone (avandia)

**sept. 23, 2010 - avandia restricted by FDA due to heart risk
Term
thiazolidinediones indications
Definition
type II diabetes
Term
thiazolidinediones mechanism of action
Definition
decrease insulin resistance (insulin sensitizing agents)
increase glucose uptake and use in skeletal muscles
inhibit glucose and triglyceride production in the liver
Term
sulfonylureas adverse effects
Definition
hypoglycemia
hematologic effects
nausea
epigastric fullness
Term
biguanides adverse effects
Definition
abdominal bloating
nausea
cramping
diarrhea
metallic taste
reduced vitamin B12 levels
Term
alpha-glucosidase inhibitors adverse effects
Definition
flatulence
diarrhea
abdominal pain
Term
thiazolidinediones adverse effects
Definition
moderate weight gain
edema
mild anemia
hepatic toxicity
Term
category: oral antidiabetic drugs
classification: incretin memetics
Definition
prototype: sitagliptin (januvia)
Term
incretin memetics indications
Definition
type II DM
Term
incretin memetics mechanism of action
Definition
enhances the actions of incretin hormones
stimulates glucose dependent release of insulin
suppresses postprandial release of glucagon
Term
incretin memetics adverse effects
Definition
headache, URI inflammation (throat and nasal passages)
Term
insulin overdose
Definition
preferred treatment is IV glucose --> immediately raises blood glucose level
glucagon can be used if IV glucose isn't available --> delayed elevation of blood glucose; will not work in starvation (promotes glycogen breakdown and the malnourished have little glycogen left)
Term
insulin nursing implications
Definition
when insulin is ordered ensure correct route, correct type of insulin, timing of dose, correct dosage
insulin order and prepared dosages are second-checked with another RN
check blood glucose before administration
ensure correct timing of insulin dose with meals
when drawing up two types of insulin in one syringe, always withdraw the regular insulin first
provide thorough patient education regarding self-administration of insulin injections, including timing of doses, monitoring blood glucoses, and injection site rotations
Term
oral antidiabetic drugs nursing implications
Definition
always check blood glucose levels before giving
usually given 30 min before meals
alpha-glucosidase inhibitors are given with the first bite of each main meal
biguanides are taken with meals to reduce GI effects
monitor for therapeutic response
assess for signs of hypoglycemia

if hypoglycemia occurs:
give glucagon
have the patient eat glucose tablets or gel, corn syrup, honey, fruit juice, or nondiet soft drink
have the patient eat a small snack such as crackers or half a sandwhich
monitor blood glucose levels
Term
category: thyroid replacement
classification: thyroid hormone
Definition
prototypes: levothyroxine (syntrhoid, levoxyl), liothyronine (cytomel), liotrix (thyrolar), thyroid
Term
thyroid hormone indications
Definition
hypothyroidism
dx hyperthyroidism prevention of goiters
Term
thyroid hormone mechanism of action
Definition
thyroid preparations are given to replace what the thyroid gland cannot produce to achieve normal thyroid levels (euthyroid)

**thyroid drugs work the same as thyroid hormones
Term
thyroid hormone contraindications
Definition
known drug allergy
recent MI
adrenal insufficiency
hyperthyroidism
Term
thyroid hormone adverse effects
Definition
insomnia, headache, anxiety, tremors, cardiac dysrhythmias, angina, hypertension, palpitations, nausea, diarrhea, weight loss, menstrual irregularities, heat intolerance
Term
thyroid hormone interactions
Definition
oral anticoagulants
digitalis glycosides
cholestyramine
patients with diabetes may need to increase their doses of hypoglycemic agents
Term
category: antithyroid
classification: thionamides
Definition
prototypes: methimazole (tapazole) and propylthiouracil (PTU)
Term
category: antithyroid
classifications: radioactive iodine
Definition
prototype: iodine-131 (iodotope)
Term
antithyroid indications
Definition
hyperthyroidism
graves disease
Term
iodine-131 mechanism of action
Definition
emits beta particles which destroy the thyroid tissue
Term
PTU mechanism of action
Definition
blocks action of thyroid synthesis by preventing oxidation of iodine, thereby inhibiting incorporation of iodine into tyrosine and by preventing the coupling of tyrosines and suppresses the conversion of T4 to T3, the active form of thyroid hormone
Term
methimazole mechanism of action
Definition
similar to that of PTU
Term
thyroid agent nursing implications --> patient teaching
Definition
take thyroid agents once daily in the morning to decrease the likelihood of insomnia
take the medication at the same time every day
don't switch brands without MD approval
report any unusual symptoms, chest pain or heart palpitations,
therapeutic effects may take several months to occur
too high of a dose of a thyroid agent will result in nervousness, irritability, and insomnia
Term
antithyroid nursing implications
Definition
better tolerate when given with food
give at the same time each day to maintain consistent blood levels
never stop these medications abruptly
avoid eating foods high in iodine (seafood, soy sauce, tofu, and iodized salt)
Term
thyroid agent nursing implications
Definition
monitor for therapeutic response
monitor for adverse effects
s/s of thyroid hormone OD include cold intolerance, depression, and edema
Term
antiepileptic agents goals
Definition
to control or prevent seizures while maintaining a reasonable quality of life
to minimize side effects and drug induced toxicity

**therapy is usually lifelong
Term
antiepileptic agents indications
Definition
prevention or control of seizure activity
long-term maintenance therapy for chronic, recurring seizures
acute treatment of convulsions and status epilepticus
Term
classification of antiepileptic agents
Definition
traditional AEDs:
phenytoin, carbamazepine, valproic acid, primidone, and ethosuximide

newer AEDs:
oxcarbazepine, gabapentin, zonisamide, lamotriginr, levetiracetam, pregablin, tigabine, topiramate
Term
antiepileptic agent safety
Definition
very narrow therapeutic index
toxic levels can be reached quickly
monitor therapeutic drug levels with phenobarbital, phyenytoin, carbamazepine, valproic acid
Term
category: antiepileptic agents
classification: anticonvulsant barbituates
Definition
prototypes: phenobarbital (solfoton, luminal) and primidone (mysoline)
Term
anticonvulsant barbituates indications
Definition
prevention of seizures
control of seizures
seizure types used for:
partial seizures
secondary general
generalized tonic clonic
Term
anticonvulsant barbituates mechanism of action
Definition
potentiates the activities of GABA --> increased response to GABA
Term
anticonvulsant barbituates adverse effects
Definition
drowsiness, dizziness, lethargy, paradoxical restlessness, excitement, nausea, vomiting, rash, stevens-johnson syndrome, urticaria
Term
category: antiepileptic agents
classification: valproate
Definition
prototypes: divalproex sodium (depakote), valproate sodium (depacon), vaproic acid (depakene)
Term
valproate indications
Definition
partial and secondary generalized seizures
bipolar disorder
migraines
Term
valproate mechanism of action
Definition
suppression of high frequency neuronal firing through blockade of sodium channels --> cell membrane stabilization
suppreses Ca+ influx into neural cell --> cell membrane stabilization
augments inhibitory action of GABA
Term
valproate adverse effects
Definition
pancreatitis, irregular menses, secondary amenorrhea, weight gain, galactorrhea

**rarely breast enlargement...not exactly "adverse" to get tig ole' bitties
Term
category: antiepileptic agents
classification: hydantoins
Definition
prototypes: phenytoin (dilantin) and fosphenytoin (cerebyx)
Term
hydantoins indications
Definition
partial seizures
tonic clonic seizures
Term
hydantoins mechanism of action
Definition
selective inhibition of Na+ channels --> suppression of action potentials and decreased irritability of neuron --> decreased firing
Term
hydantoins adverse effects
Definition
dysrhytmias, hypotension, exfoliative dermatitis, lupus, stevens-johnson syndrome, bone marrow suppression, neuropathies, gingival hyperplasia
Term
category: antiepileptic agents
classification: newer AEDs
Definition
prototypes: gabapentin (neurontin) and pregabalin (lyrica)
Term
newer AEDs indications
Definition
partial seizures
neuropathic pain
Term
newer AEDs mechanism of action
Definition
chemical analog of GABA inhibits neuronal action
Term
newer AEDs adverse effects
Definition
dizziness, somnolence, visual changes, fatigue, nausea, vomiting
Term
category: antiepileptic
classification: imostilbenes
Definition
prototypes: carbamezapine (tegretol) and oxcarbazepine (tripeptal)
Term
imostilbenes indications
Definition
partial seizures
generalized tonic clonic seizures
Term
imostilbenes mechanism of action
Definition
blocks voltage sensitive Na+ channels --> stabilization of hyperactive neuronal cell membranes
Term
imostilbenes adverse effects
Definition
visual disturbances, nystagmus, blurred vision, ataxia, vertigo, headache, leukopenia, anemia, thrombocytopenia, rash, stevens-johnson syndrome, toxic epidermal necrolysis, audoinducer of hepatic enzymes
Term
category: antiepileptic agents
classification: succinimide
Definition
prototype: ethosuximide (zarontin)
Term
succinimide indications
Definition
absence seizures
Term
succinimide mechanism of action
Definition
suppression of thalamus hyperexcited neurons by suppression of Ca+ channels --> stabilization of neuronal cell membrane
Term
succinimide adverse effects
Definition
drowsiness, dizziness, lethargy, nausea, vomitting
Term
succinimide adverse effects
Definition
drowsiness, dizziness, lethargy, nausea, vomiting
Term
succinimide adverse effects
Definition
drowsiness, dizziness, lethargy, nausea, vomiting
Term
AED nursing implications - assessment
Definition
health history, including current medications
drug allergies
liver function studies, CBC
baseline vital assessments
Term
AED nursing implications - oral agents
Definition
take regularly, same time each day
take with meals to reduce GI upset
do not crush, chew, open extended-release forms
Term
AED nursing implications - IV forms
Definition
follow manufacturer's recommendations for IV delivery - usually given slowly
monitor VS during administration
avoid extravasation of fluids
use only normal saline with IV phenytoin (know this!!)
Term
AED nursing implications
Definition
should not be discontinued abruptly
driving may be impaired until drug levels stabilize
patients need to know that therapy is long term, and possibly lifelong - not a cure
Term
AED nursing implications - monitoring for therapeutic response
Definition
seizure activity is decreased or absent
Term
AED nursing implications - monitoring for adverse effects
Definition
change in mental status, mood, LOC, or sensorium
eye problems, visual disorders
sore throat
fever
blood dyscrasias may occur with hydantoins
Term
AED nursing implications - pregnancy
Definition
teratogenesis:
hydantoins
carbamazepines

birth defects:
valproates
phenobarbital
oxcarbamazepine
gabapentin/pregabalin
Term
hydantoins drug interactions
Definition
hepatic enzyme inducer --> decrease in therapeutic effect of other drugs
increase/decrease levels of phenytoin
CNS depression
Term
carbamazepine drug interactions
Definition
hepatic enzyme inducer
grapefruit juice
Term
valproate drug interactions
Definition
phenobarbital
phenytoin
topiramate
Term
phenobarbital drug interactions
Definition
hepatic enzyme inducer
CNS depression
valproates
Term
newer AED drug interactions
Definition
oxcarbazepine (trileptal) --> oral contraceptives
gabapentin (neurontin)
pregablin (lyrica)
Term
dabigatrin (pradaxa) nursing implications
Definition

makes the stomach acidic

monitor people with GERD

can't be taken with a meal

very expensive...but don't have to monitor as much

expires 30 days after opening

not for patients over 75

Term
epoetin alfa adverse effects
Definition
headache, insomnia, edema, MI, stroke, heart failure, joint/muscle aches, pains, soreness, nausea, vomiting, diarrhea, stomach pain constipation indigestion, blindness
Term
epoetin alfa contraindications
Definition
any history of heart problems
cautious use in patients with bone marrow cancer
monitor Hgb twice a week --> should not exceed 12 
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