Med Quiz 1
Perioperative Meds:
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Blood Thinners: increased bleeding risk; won't go to surgery
○ Coag Tests →
■ PT/INR and PTT- puts pt at risk for bleeding or may have a hard time clotting
● PT/INR- check when on coumadin/warfarin
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high- bleed out; MOST DANGEROUS of the coag tests
● PTT- heparin and lovenox (LMW heparin) (and Plt)
○ Heparin- assess pt’s PTT; may be used after surgery for clot prevention.
○ Lovenox- assess pt’s PLT
○ NSAIDS
■ Aspirin- stop taking 7-10 days before surgery
■ Ibuprofen (Advil)○ Coumadin/warfarin- assess pt’s PT/INR
■ Vitamin K is warfarin antidote
○ Vitamin G and E
○ Naproxen
Opioids
○ Ex. fentanyl, oxycodone, hydrocodone (Vicodin), codeine, morphine
○ possible respiratory depression- continuously assess during surgery
■ Would still have surgery→ they will have resp support during surgery
■ BUT keep it in mind→ will still potentially affect breathing after surgery, may prolong “getting
better”
● Post op assessment before going to unit- BP, resp rate; if not breathing, they HAVE to be
watched
● Bowel rate will be slowed down - less priority over BP and respirations
■ ANTIDOTE→ NALOXONE
Steroids
○ Can’t abruptly be stopped; interferes with renal function→ adrenal insufficiency
○ Still goes to surgery
○ Increases blood sugar  hyperglycemia
Anesthesias:
○ Succinylcholine- MUSCLE RELAXANT; do not give this drug if a pt is at risk for malignant
hyperthermia; masseter muscle spasm
■ Dantrolene- antidote IV for malignant hyperthermia
■ Give Lidocaine to relax the heart
○ Ketamine- administer this drug in a dark/quiet environment or else it will cause hallucinations (large
doses can also cause resp depression); short-acting, patient maintains airway
■ STAGE 2
○ Neuromuscular blockers- can affect the rise and fall of chest; will need mechanical ventilation
■ STAGE 4
○ ANESTHESIA
○ Stage 1 → drowsy and unconscious
■ Inhal agents and succinylcholine (DON'T GIVE WITH MALIGNANT HYPERTHERMIA RISK)
○ Stage 2→ muscles tense, swallow/vomit, breathing regular
■ Swallowing still there
■ ketamine→ muscle relaxant; make sure theres a quiet environment or it will cause hallucinations
○ Stage 3 → breathing regular again, reflexes lost
○ Stage 4 → complete respiratory depression, tubed and vented
■ Neuromuscular blockers- affect rise and fall of chest- this is why they’re intubated
○ Anesthesia- respiratory compromise!!!
Diabetes Meds:
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Oral Hypoglycemics: for type 2 ONLY
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Sulfonylureas- increases insulin production from pancreas; may decrease liver glucose
Weight gain because of excess retention of fluid. Give with food
Symptoms: n/v, upset stomach, hypoglycemia, wt gain.
■ Major side effect is hypoglycemia and wt gain
● Glucotrol (glipizide)
● Glynase (glyburide)
● Amaryl (Glimepiride)
Meglitinides- increases insulin production from pancreas
■ Rapid onset: decreases risk of hypoglycemia
■ Faster acting but shorter in duration.
■ Less chance for hypoglycemia.
● Pt education: take 30 minutes to just before each meal to mimic normal response to meal
○ DO NOT TAKE if meal is skipped
■ Examples: repaglinide (Prandin), nateglinide (starlix)
Biguanides■ helps triglycerides
■ Contraindicated for CHF, liver failure, CKD pts
■ Used in prevention of type 2 diabetes, may cause weight loss
■ Metformin (Glucophage) – most effective 1st line treatment for type 2; reduces glucose production
by liver, enhances insulin sensitivity, improves glucose transport.
● WITHHOLD for 48 hours if patient is undergoing surgery or radiologic procedure
with contrast medium
○ Contraindicated for renal, liver, cardiac disease; lactic acidosis
○ Iodine based contrast medium can cause AKI
○ Excessive alcohol intake
○ ** Watch LFT and bilirubin
○ ** watch BUN/creat
● Take with food to minimize GI effects
Alpha-glucosidase inhibitors- “starch blockers (miglitol),” slow down absorption of carbohydrate in small
intestine
■ Take with first bite of each meal
● Check 2 hr postprandial glucose to determine effectiveness
■ Acarbose (Precose), Miglitol (Glyset)
■ Diarrhea and flatulence may occur
■ Can cause liver toxicity
Thiazolidinediones- “insulin sensitizer,” most effective in those with insulin resistance. Improves insulin
sensitivity, transport, and utilization at target tissues. Works in muscles and fat.
■ Rarely used because of adverse effects
■ Pioglitazone (Actos)
■ Rosiglitazone (Avandia)
■ Watch out for pts with CHF - these pts can go into fluid overload or pulmonary edema
■ Rarely used because of adverse effects
Insulin:
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Rapid
■ CLEAR: Lispro (Humalog), Aspart (Novolog), Glulisine (Apidra)
■ Onset: 15 min (10-30)
■ Peak: 60 – 90 min (30-1 hr)
■ Duration: 3-5 hr
■ Should eat food within 15 min
Short- CLEAR 1st
■ Regular (Humulin R, Novolin R, ReliOn R)
■ Onset: 0.5 – 1 hr
■ Peak: 2-5 hr
■ Duration: 5-8 hr
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20 to 30 minutes before a meal. Regular insulin is the only insulin that can be given
intravenously and is used to treat DKA
Intermediate- CLOUDY 2nd
■ NPH (Humulin N, Novolin N, ReliOn N)
■ Onset: 2-4 hr
■ Peak: 4- 12 hr
■ Duration: 12-18 hr
■ To avoid hypoglycemia, it is important that patients eat around the time of the onset and peak of
intermediate-acting insulin (2-4-10 hr).
Long
■ Glargine (Lantus), Detemir (Levemir)
■ Onset: 2 hr
■ Peak: none
■ Duration: 24+ hrs
Respiratory Meds:
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Antibiotics- best tx for PNE
Antitussive- stops cough
○ Ex. dextromethorphan (Robitussin) – reduces coughing in nonproductive cough; watch out for
drowsiness, GI upset, constipation
Mucolytic- break up mucus
○ Ex. acetylcysteine (Mucomyst) – break the links that bind mucus together so it can be coughed up;
watch out for drowsiness, dizziness, vomiting, bronchospasms, rhinorrhea, nausea
Antihistamine- stops histamine/immune response (binds w H1 receptors); acute allergy relief
○ 1st gen: causes sedative effect, loss of appetite, palpitations, urinary retention
■ CX w/ operating heavy machinery, no alcohol, fast onset
■ Diphenhydramine (Benadryl) and Chlorpheniramine
○ 2nd gen: minimal sedation, less side effects
■ More expensive, no tolerance, d't take w/ MAOIs
■ Loratadine and cetirizineon
*** can caause dry mouth, constipation
Expectorant- promotes getting rid of mucus from airways
○ Ex. guaifenesin (Mucinex) – irritates mucus membranes to release the mucus creating a productive
cough; watch out for GI upset, nausea, drowsiness
Decongestant- stim adrenergic receptors→ vasoconstriction→ reduces nasal congestion and drainage
○ SE→ SNS stimulation
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○ Topical can cause rebound if used for prolonged amount→ use less than 3 days
Anticholinergics- block hypersecretory effect and reduces runny nose
○ ANTI SLUDGE effects→ dry mouth, nose
○ Ipratropium bromide (Atrovent)- short acting; often given w albuterol
○ Tiotropium- (Spiriva)- anticholinergic to prevent bronchospasm
■ Puncture the capsule in the handihaler
■ Therapeutic effect in 30 mins
■ Peak effect in 3 hours
○ Cx with pts w glaucoma or BPH→ increases risk for CVA or CV issues
Methylxanthines○ Ex. theophylline→ ALTernate asthma therapy; less effective
■ Has many drug interactions and side effects
■ toxicity→ n/v and seizures
■ AVOID CAFFEINE
■ Check blood levels for therapeutic dosing (and avoid toxicity) due to narrow margin of safety
Bronchodilator○ Beta2 adrenergic agonist: Albuterol (Proventil), Salmeterol (Serevent), Terbutaline (Brethine)
■ Watch for toxicity
■ SE: tachycardia, headache, irritability, anginal pain, tremors
■ SABA- Albuterol (Proventil)-→ (SHORT ACTING// RESCUE) Shake inhaler well→ blow out as
much as you can→ breathe in while pushing in med→ hold breath for as long as u can up to 10
sec→ repeat in 2-3 min
● Side effects→ inc HR, thrush, anxiety, SNS STIM.; palpitations
○ Tell pt to wash mouth after inhaling
● Caution in pt w CVD; overuse can cause rebound
● ASSESS HR BEFORE→ but give if in an ATTACK ALWAYS
● 4-8 hr duration
■ LABA- salmeterol (Serevent)/formoterol→ long acting; added to inhaled steroid for maintenance
● Not for acute or monotherapy(unless COPD)
● Once Q12
■ Combo therapy LABA & ICS- fluticasone/salmeterol (Advair) & budesonide/formoterol
(Symbicort) - more convenient, improve compliance, ensure both are used
Corticosteroid- decreases inflammation; can cause hyperglycemia and thrush (oral fungal infection; white patches,
pain), rinse after use; does not work automatically
○ Budesonide/Formoterol (Symbicort) – not for immediate rescue; for maintenance; decreases inflammation;
tells the immune system to stop acting
○ Budesonide (Pulmicort)- For maintenance long term of asthma; 2 puff in AM then PM; won't work
immediately; decreases inflammation; RINSE AFTER
■ Anti inflammatory and anti allergy
■ CI: hypersensitivity to steroids, systemic fungal infections, oral candida albicans
■ Caution with adrenal insufficiency, cirrhosis, glaucoma, osteoporosis
■ DILATE then DECREASE; DILATOR then STEROID
○ Advair Diskus****-inhaled powder; both bronchodilator and steroid
■ LONG TERM, NOT RESCUE
■ Decreases inflammation
■ Can also cause thrush
■ Make sure you rinse after use
○ Singular***-pill or asthma (and allergies);
Leukotriene Modifying Antagonist/Inhibitors
○ Examples: zafirlukast, montelukast, zileuton
○ Oral
○ Inhibits airway edema and constriction, decreases inflammatory response
○ NOT FOR ACUTE ATTACKS
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○ Usually for those w exercised induced (take 2 hours before to prevent)
○ For prophylaxis and maintenance
○ SE→ HA, dizzy, rash, altered LFT, abd pain, interact with zileuton, warfarin, theophylline
○ Watch LFTs (stop if too high)
○ Take on empty stomach
Anti Tuberculosis Meds
○ DRUG THERAPY:
■ Initial 8wk to 3 mo- all 4 meds
■ Continuation 18 wk- isoniazid and rifampin
● NEED TO TAKE ALL MEDS TO BE EFFECTIVE (ADHERE)
■ Watch LFT, BUN and creatinine
■ LIVER TOXICITY MAIN ADVERSE EFFECT OF ALL THESE DRUGS (hepatitis)
○ Isoniazid- used for active TB and prophylaxis
■ avoid tyramine – soy sauce, sauerkraut, tuna, aged cheese, cured meats, beer, red wine
■ CAN CAUSE NEUROPATHY→ take vit B!
■ SE→ flushed, light headed, low BP; sweat/ palpitations
○ Rifampin- will cause orange body fluids, which can stain contacts; disrupts effectiveness of oral
contraceptives, so pt needs to use other alternatives to prevent pregnancy
○ Pyrazinamide○ Ethambutol- can cause ocular toxicity (red v. green)
** IT IS IMPORTANT TO MONITOR LFTS, BUN AND CREATININE
Allergic rhinitis meds: steroids, antihistamines, decongestants, LTRAs
Dantrolene
Spiriva
Liver toxicity
Sulfonylureas – weight gain
Rifampin – orange fluids
Know the difference:
Advair –
Spiriva – s
Bronchodilators – know the risks and benefits of these
Steroids – causes hyperglycemia; so don’t give it to diabetics
Pulmicort – causes thrush; give candy
Know clear and cloudy
Ketamine – hallucinations