NR 508 Pharmacology Final All Answers Rated A+

NR 508 Pharmacology Final All Answers Rated A+ 1st line treatment for HTN (non-black, no CKD) 1st line treatment for HTN for black pts (no ckd) 1st line option for HTN for anyone with CKD ACEI (arb), thiazide, ccb thiazide, ccb ACEI (arb) Types of diuretics thiazides, loop diuretics, k-sparing preferred diuretic with renal impairment diuretics - S/E & D/I loop-diuretics S/E All - hypokalemia, arrhythmia, metbolic alkalosis, fatigue, postrual hypotension, hyperlipidemia S/E for k-sparing - hyperkalemia, gynecomastia, peptic ulcer) S/E for thiazides - hyperglycemia & hypercalcemia S/E for loop hypocalcemia D/I All- digoxin (hypokalemia/toxicity risk), NSAIDs (reduce diuresis), lithium (toxicity risk), corticosteroids (enhance hypokalemia), anti-diabetic drugs (decrease anti-diabetic levels) D/I for thiazides - BB's - increase hyperglycemia/ hyperlipidemia D/I for loops - aminoglycosides = ototoxicity & nephrotoxicity which diuretic causes post diuretic sodium retention loop diuretics post-diuretic effect, a compensatory sodium-retention process that begins as the diuretic action wanes. Diuretics that do not contain a sulfonamide derivative ****ethacrynic acid*** also: amiloride, hydrochloride, eplerenone, spironolactone, and triamterene (safe for pt with allergy to sulfa) CHF drugs including diuretic choices potassium sparing) -ACEI's & ARB's decrease mortality First line: ACEI's or ARB, Beta-blocker, diuretics (loop & -if ACEI contraindicated: use ARB or Hydralizine & Isosorbide (decrease mortality/less effective than ACEI) -Beta-blockers: decrease mortality, NEVER when active failure, ONLY after diuresed & other medications -Digoxin: add if needed for systolic HF **if 1st line tx not enough.........******* Spironolactone & Eplerenone Nitrates and hydralazine (lower mortality in class 3&4 for African American) Calcium channel blockers (Can worsen hf use caution **BUT NEVER IN SYSTOLIC DYSFUNCTION - thats for digoxin) (DA BD is aa sad) Diuretics ACE inhibitors Beta-Blockers (after acute) Digoxin (Syst. HF/A-fib/diuretic failure) Know migraine management and prophylactics *NSAIDS or APAP *Triptans (sumatriptan/imitrex, zolmatriptan/zomig, rizatriptan/maxalt) -nasal, oral, subq -use no more than 2d/wk -C/I-recent use of MAOIs, ergots, or SSRIs, CVD, CAD, TIA, HTN, pregnancy *Ergots (ergotamine tartrate/cafergot) not used often, expensive -nasal, oral, rectal, IM, IV, siblingual -CI-recent use of triptans, CVD, CAD, TIA, HTN, pregnancy *Caffeine (Excedrin) *antiemetics Migraine prevention *beta blockers (metoprolol, propranolol, timolol) - 2-3 months for effect- decrease frequency & severity by 50% -A/E- drowsiness, exercise intolerance, depression -CI-CHF, asthma *anticonvulsants (valproate, topiramate) effective but major A/E -valproate AE- dizziness, platelet dysfunction, hair loss, hepatotoxic, teratogenic -topiramate AE- cognitive dysfunction, weight loss, renal stones Herbal migraine management Butter bur root. It should be PA free or could result in liver damage Feverfew (Tanacetum parthenium) - Action: Antiinflammatory effects Uses: migraine prevention Interactions: Anticoagulants, antiplatelet drugs, aspirin (Pg. 99) Alternative therapies that have been described in the evidence-based literature include feverfew, riboflavin, and magnesium (pg. 481) What medications migraine medications to avoid in patients with asthma. Propranolol Beta Blockers such as cyproheptadine (Periactin) - The drug may produce an atropine-like action, so it must be used with caution in patients treated for bronchial asthma (pg. 487) Know the common side effects of methylphenidate Ritalin Nervousness, insomnia. Maybe controlled with dose reduction or omitting afternoon or evening dose. Other SE- decreased appetite, ABD pain, headache, depression, weight loss, rebound symptoms. Page 453 Also: Temporary slowing of growth rate/Height and weight should be monitored with long term use ADHD management - stimulants including side effects alternatives, age they may be used, strattera, which is the longest acting stimulant? UNDER AGE 6 IS OFF LABEL HA, tics, appetite suppression, elevated BP Stimulants: increase "background" dopamine levels in synapse. However, trials of stimulants fail to distinguish between those without ADHD. Amphetamine Like Drugs (Methylphenidate, ritalin, metadate, concerta) 1st LINE OF Rx TREATMENT *S/E: common - Nervousness, insomnia less common- decreased appetite, abdominal pain, headache, depression, irritability, weight loss, and rebound symptoms, decreased growth velocity Amphetamines - (Adderall, Vyvanse) S/E:anorexia, weight loss, nausea, xerostomia, abdominal pain, diarrhea, and constipation.