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Pharmacy Foundations Flashcards

1
Q

Muscarinic receptor

A

Substrate acetylcholine
Agonist: paraympathetic ANS (wet) (pilocarpine, bethanechol)
Antagonist: sympathetic (dry) (atropine, oxybutynin)

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2
Q

Nicotinic receptor

A

Substrate: acetylcholine
Agonist: increase HR and BP (nicotine)
Antagonists: neuromuscular blockade (rocuronium etc)

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3
Q

Alpha-1 receptor

A

Substrate; epinephrine, norepinephrine
Mainly peripheral
Agonist: vasoconstriciton of smooth muscles and increased BP (phenylephrine, dopamine)
Antagonist: vasodilation of smooth muscles and decreased BP (doxazosin, carvedilol, phentolamine)

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4
Q

Alpha-2 receptor

A

Substrate; epinephrine, norepinephrine
Mainly central and brain
Agonist: inhibits release of Epi and NE, decreased BP and HR (clonidine, brimonidine)
Antagonist: increased BP and HR (ergot alkaloids, yohimbine)

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5
Q

Beta-1 receptor

A

Substrate; epinephrine, norepinephrine
Mainly heart
Agonist: increased contractility, CO, HR (dobutamine, isoproterenol, dopamine)
Antagonist: decreased CO and HR (metoprolol, propranolol, carvedilol)

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6
Q

Beta-2 receptor

A

Substrate: epinephrine
Mainly in lungs
Agonist: bronchodilator (albuterol, terbutaline, isoproterenol)
Antagonist: bronchoconstriction (propranolol, carvedilol)

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7
Q

Dopamine receptor

A

Substrate: dopamine
Agonist: renal, cardiac, and CNS effects (levodopa, pramipexole)
Antagonist: renal, cardiac, and CNS effects (haloperidol, metoclopermide)

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8
Q

Serotonin receptor

A

Substrate: serotonin
Agonist: platelet, GI, psychiatric (triptans)
Antagonist: platelet, GI, psychiatric (ondansetron, quetiapine)

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9
Q

Acetylcholinesterase

A

Breaks down acetylcholine
Inhibitors: donepezil, rivastigmine, galantamine
Results in increased ACh to treat Alzheimer’s

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10
Q

Angiotensin-converting enzyme

A

Converts angiotensin I to II that controls vasoconstriction
Inhibitors: lisinopril, ramipril
Resulting in decreased vasoconstriction and aldosterone secretion to treat hypertension, HF, and kidney disease

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11
Q

Catechol-O-methyltransferase

A

Breaks down levodopa
Inhibitor: entacapone
Blocks peripheral breakdown resulting in better duraiton of levodopa to treat Parkinson’s

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12
Q

Cyclooxygenase

A

Converst arachidonic acid to prostaglandins to cause inflammation, and thromboxane A2 to cause platelet aggregation
Inhibitors: aspirin, ibuprofen
Results in decreased inflammation, and platelet aggregation

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13
Q

Monoamine oxidase

A

Breaks down catecholamines (DA, NE, 5-HT)
Inhibitors: phenelzine, tranylcypromine, isocarboxazid, selegiline, rasagiline, methylene blue, linezolid
Results in increased catecholamine levels to treat depression
Overdose: hypertensive crisis, serotonin syndrome

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14
Q

Phosphodiesterase

A

Breaks down cGMP, which is a smooth muscle relaxant
Inhibitors (5): sildenafil, tadalafil
Competitively binds to cGMP active site on the PDE-5 enzyme resulting in smooth muscle relaxation to treat erectile dysfunction

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15
Q

Vitamin K epoxide reductase

A

Converts vitK to the active form to create clotting factors
Inhibitor: warfarin
Results in less clotting factors being produced such as II, VII, IX, X for blood clot prevention

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16
Q

Xanthine oxidase

A

Breaks down hypoxanthine and xanthine to uric acid
Inhibitor: allopurinol
Results in decreased uric acid production to treat gout

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17
Q

Neutral functional groups

A

Alcohol primary group, ketone, aldehyde, amide, nitrate, nitro, aromatic benzene ring, urea, carbonate, carbamate, ether, thioether

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18
Q

Acidic functional groups

A

Carboxyl, phenol, imide, sulfonamide

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19
Q

Basic functional groups

A

Amine primary group, amine tertiary group, imine, amidine

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20
Q

Essential drug structures

A

Amoxicillin, ceftriaxone, ertapenem, aztreonam, gentamicin, sulfamethoxazole, aspirin, ibuprofen, amphetamine, levothyroxine, amiodarone, fenofibrate, amitriptyline, chlorpromazine

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21
Q

Common prodrugs

A

Capecitabine; fluorouracil
Clopidogrel; metabolites active
Codeine; morphine
Colistimethate; colistin
Famciclovir; penciclovir
Fosphenytoin; phenytoin
Isavuconazonium sulfate; isavuconazole
Levodopa; dopamine
Lisdexamfetamine; dextroamphetamine
Prednisone; prednisolone
Primidone; phenobarbital
Tramadol; metabolites active
Valacyclovir; acyclovir
Valganciclovir; ganciclovir

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22
Q

Common CYP inhibitors

A

GPACMAN
Grapefruit juice
Protease inhibitors, especially ritonavir
Azole antifungals
Cyclosporine, cobiscistat
Macrolides, except azithromycin
Amiodarone, dronedarone
Non-DHP CCB

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23
Q

Common CYP inducers

A

PS PORCS
Phenytoin
Smoking
Phenobarbital
Oxcarbazepine
Rifampin, rifabutin, rifapentine
Carbamazepine
St. John’s Wort

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24
Q

Common p-gp substrates, inhibitors, inducers

A

Substrates: anticoagulants (esp riva and api), cardiovascular (esp digoxin, verapamil, diltiazem), immunosuppressants (esp cyclosporine, tacrolimus), HCV drugs, and colchicine
Inducers: same as CYP inducers plus dexamethasone, and tipranavir
Inhibitors: Anti-infectives, cardiovascular drugs (esp amiodarone, diltiazem, verapamil), HIV drugs (esp cobiscistat, ritonavir), cyclosporine

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25
Q

Common CYP substrates

A

3A4: Analgesics, anticoagulants, immunosuppressants, statins, HIV (esp NNRTI), PDE-5 inhibitors, ethinyl estradiol
1A2: theophylline, warfarin
2C8: amiodarone, pioglitazone, repaglinide
2C9: warfarin
2C19; clopidegrel
2D6: analgesics, antipsychotics, antidepressants, tamoxifen

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26
Q

Normal BMP

A

Na: 135-145mEq/mL
K: 3.5-5mEq/mL
Cl: 95-106mEq/mL
Ca: 8.5-10.5mg/dL
Ca, ion: 4.5-5.1mg/dL
Mg: 1.3-2.1mEq/mL
PO4: 2.3-4.7mg/dL
HCO3 venous: 24-30mEq/mL
HCO3 arterial: 22-26mEq/mL
BUN: 7-20mg/dL
SCr: 0.6-1.3mg/dL
Glu: 70-110mg/dL
AG: 5-12mEq/mL

27
Q

Normal CBC

A

WBC: 4-11 thousand cells/mm3
Neut: 45-73%
Bands: 3-5%
Eos: 0-5%
Baso: 0-1%
Lymph: 20-40%
Mono: 2-8%
RBCm: 4.5-5.5 thousand cells/mcL
RBCfe: 4.1-4.9 thousand cells/mcL
HGBm: 13.5-18g/dL
HGBfe: 12-16g/dL
HCTm: 38-50%
HCTfe: 36-46%
MCV: 80-100fL
Folate: 5-25mcg/L
B12: >200pg/mL
Reticulocyte: 0.5-2.5%
G6PD: 5-14Units/g

28
Q

Normal anticoagulants

A

Anti-XaLMWH: 1-2IU/mL peak
Anti-XaHep: 0.3-0.7IU/mL peak
PT: 10-13sec
INR: <1.2
aPTT: 22-38sec
PLT: 150-450 thousand cells/mm3

29
Q

Normal liver and GI tests

A

Alb: 3.5-5g/dL
AST: 10-40units/L
ALT: 10-40units/L
TBili: 0.1-1.2mg/dL
Amylase: 60-180units/L
Lipase: 5-160units/L

30
Q

Normal cardiovascular

A

CK/CPKm: 55-170IU/L
CK/CPKfe: 30-135IU/L
TnT: <0.1ng/mL
TnI: <0.5ng/mL
BNP: <100pg/mL
NT-proBNPm: <61pg/mL
NT-proBNPfe: 12-151pg/mL
LDL: <100mg/dL
HDL: >60mg/dL
TG: <150mg/dL
TChol: <200mg/dL
CRP: <0.5mg/dL

31
Q

Normal diabetes

A

FPG: <100mg/dL, >126mg/dL diabetic
A1c: <7%
C-peptide fasting: 0.78-1.89ng/mL
UAE: <30mg/d

32
Q

Normal thyroid, gout, and inflammation

A

TSH: 0.3-3mIU/L
Uric acidM: 3.5-7.2mg/dL
Uric acidFe: 2-6.5mg/dL
RF: <20IU/L
ESRm: <20mm/H
ESRfe: <30mm/H

33
Q

Normal HIV

A

CD4: >200cells/mm3
HIV RNA: 0copies/mL

34
Q

Normal acid-base

A

pH: 7.35-7.45

35
Q

Normal hormones

A

PSA: <4ng/mL

36
Q

Normal other;

A

Lactic acid: 0.5-2.2mEq/L
TPMT: >15units/mL
VitD: >30ng/mL

37
Q

Common therapeutic drug levels

A

Carbamazepine: 4-12mcg/mL
Digoxin AF: 0.8-2ng/mL
Digoxin HF: 0.5-0.9ng/mL
Genta/Tobra P: 5-10mcg/mL
Genta/Tobra Tr: <2mcg/mL
Li: 0.6-1.2mEq/L
Phenytoin: 10-20mcg/mL
Free phenytoin: 1-2.5mcg/mL
Procainamide: 4-10mcg/mL
NAPA (metabolites): 15-25mcg/mL
Both: 10-30mcg/mL
Theophylline: 5-15mcg/mL
Valproic acid: 50-100mcg/mL
Vanco Bad: 15-20mcg/mL
Vanco Fine: 10-15mcg/mL
Warfarin: 2-3 INR
Warfarin mechanical: 2.5-3.5 INR

38
Q

FDA colored books

A

Orange: interchangeable Brand/generic
Pink: epidemiology and vaccine preventable diseases
Pink Sheet: news reports on regulatory, legislature, legal, and business development
Purple: Biologics and biosimilars
Red Phar: pricing
Red Peds: peds ID’s, tx, and vaccines
Yellow: international traveler’s
Green: animal drugs

39
Q

Common drugs with diluent requirements; NS or dextrose only

A

NS only, no dextrose: A DIAbetic Can’t Eat Pie
Ampicillin, daptomycin, infliximab, ampicillin/sulbactam, caspofungin, ertapenem, phenytoin
Dextrose only, no NS: Outrageous Bakers Avoid Salt
Oxaliplatin, Bactrim, Amphotericin B, Synercid

40
Q

Common drugs with leaking in PVC and filters

A

Issues with PVC: Leach Absorbs To Take In Nutrients
Lorazepam, amiodarone, tacrolimus, taxanes, insulin, nitroglycerin
Filter requirements (5 microns): GAL Is PAT who has a MaP
Golimumab, Amphotericin B lipid, Lipids (1.2 microns), Isavuconazonium, pheytoin, amiodarone, taxanes, Mannitol, parenteral nutrition (1.2 micron)

41
Q

Common drugs that cannot be refrigerated

A

Dear Sweet Pharmacist Freezing Makes Me Edgy
Dexedetomidine
Sulfamethoxazole/trimethoprim
Phenytoin
Furosemide
Metronidazole
Moxifloxacin
Enoxaparin

42
Q

Common drugs that must be protected from light

A

Protect Every Necessary Med from Daylight
Phytonadione (vitK)
Epoprostenol
Nitroprusside
Micafungin
Doxycycline

43
Q

Colored IV solutions

A

Red: anthracyclines, rifampin
Blue: mitoxantrone
Yellow: methotrexate, multivitamins
Orange: tigecycline
Brown: IV iron

44
Q

Medication problems

A

Untreated medical treatment
No indications
Improper drug selection for indication
Dose is too high or low
Therapeutic duplication
Patient does not know about it
Drug allergies
Drug interactions
Improper use
Failure to receive meds
Adverse drug reactions
Nonadherence

45
Q

High alert medications

A

IV or inhaled anesthesias, IV antiarrythmias, anticoagulants, antiplatelets, chemotherapeutics, epidurals or intrathecal, hypertonic saline, immunosuppressants, inotropics, insulins, magnesium sulfate inj, neuromuscular blockers, opioids, hypoglycemic, parenteral nutrition, KCl and PO4 inj, sterile water.

46
Q

Types of drug allergies

A

Type I: IgE mediated immediate reaction; urticaria, bronchospasms, angioedema, anaphylaxis
Type II: antibody mediated delayed 5-8 days after; hemolytic anemia, thrombocytopenia
Type III: immune complex delayed 7 day reaction; serum sickness
Type IV: T cell mediated delayed 2-7 days after; Stevens-Johnson syndrome

47
Q

Meds associated with phototoxicity

A

Amiodarone, thiazide and loop diuretics, methotrexate, retinoids, quinolones, St. John’s Wort, sulfa drugs, tacrolimus, tetracyclines, voriconazole

48
Q

Meds associated with severe cutaneous side effects

A

Allopurinol, amoxicillin, ampicillin, carbamazepine, ethosuximide, lamotrigine, nevirapine, phenytoin, sulfamethoxazole, sulfasalazine, vancomycin

49
Q

Meds that follow Michaelis-Menten kinetics

A

Phenytoin, theophylline, voriconazole
Do not double dose to adjust, use smaller increments and based on levels or toxicity

50
Q

HLA pharmacogenomics

A

HLA-B5701 positive should avoid abacavir due to hypersensitivity risk.
HLA-B5801 positive should avoid allopurinol due to SJS.
HLA-B*1502 positive should avoid carbamazepine, oxcarbazepine, phenytoin, and fosphenytoin due to SJS and TEN. Testing is needed for carbamazepine in Asian patients and is recommended for all others.

51
Q

CYP pharmacogenomics

A

2C19: *1 fully functional. *2 and *3 are poor metabolizers and should not use clopidogrel due to lack of conversion to active prodrug.
2D6: ultra-rapid metabolizers should avoid codeine due to increased conversion to morphine. Nursing mothers should also avoid due to infant deaths. Poor metabolizers should also not be used.
2C9: *2 and *3 should start at a lower dose of warfarin due to increased risk for bleeding.
VKORC1 G>A variant: start at a lower dose of warfarin.

52
Q

Other pharmacokinetics

A

HER2 negative cannot use HER2 inhibitors (trastuzumab) due to lack of efficacy.
KRAS positive (aka wild type) should avoid EGFR inhibitors (cetuximab) due to lack of efficacy
Low TPMT activity should start at a low dose of azathioprine due to the risk of myelosuppression.
DPD deficiency do not use fluorouracil or capecitabine due to high risk for severity.

53
Q

Avoid drugs in these positive screenings

A

HLA and KRAS

54
Q

Avoid drugs in these negative screenings

A

HER2

55
Q

Testing recommended or strongly encouraged for these drugs

A

Abacavir and combinations, azathioprine, carbamazepine, EGFR inhibitors (cetuximab), and HER2 inhibitors (trastuzumab).
May consider also testing for allopurinol, capecitabine, fluorouracil, clopidogrel, codeine, phenytoin, fosphenytoin, and warfarin.

56
Q

Commonly used supplements in disease states: Anxiety, ADHD, cold sores, cold and flu, dementia, depression, diabetes, dyslipidemia, dyspepsia, energy/weight loss, heart health, erectile dysfunction, hypertension, GI health, inflammation, insomnia, liver disease, menopause, migraine, motion sickness, osteoarthritis, osteoporosis, prostate health, skin conditions, UTI, and weight loss.

A

Anxiety: valerian, passionflower, kava, St. Johns Wort, chamomile, 5-HTP (hydroxytryptophan).
ADHD: omega-3 fatty acids.
Cold sores: L-lysine.
Cold/flu: echinacea, zinc, vitamin C, eucalyptus oil, probiotics.
Dementia: ginkgo, vitamin E, vitamin D, acetyl-L-carnitine, vinpocetine.
Depression: St. John’s Wort, SAMe, valerian, 5-HTP.
Diabetes: Alpha lipoic acid, chromium, cassia cinnamon, magnesium, American ginseng, Panax ginseng.
Dyslipidemia: Red yeast rice, omega-3 fatty acids, garlic, plant sterol, fibers, artichoke extract.
Dyspepsia: calcium, magnesium, peppermint, chamomile.
Energy: bitter orange, caffeine, guarana.
Erectile dysfunction: ginseng, L-arginine, yohimbine.
Heart health: Coenzyme Q10, hawthorn, omega-3 fatty acids.
Hypertension: omega-3 fatty acids, L-arginine, coenzyme Q10, garlic, fiber, potassium.
GI health: fibers, chamomile, probiotics, peppermint, horehound, wheatgrass.
Inflammation: omega-3 fatty acids, flax seeds, turmeric.
Insomnia: melatonin, valerian, chamomile, lemon balm, passionflower, coenzyme Q10, 5-HTP, L-tryptophan.
Liver disease: milk thistle.
Menopause: black cohosh, dong quai, evening primrose oil, red clover, soy, Panas ginseng.
Migraine: feverfew, butterbur, magnesium, vitamin B2 (riboflavin), coenzyme Q10, guarana, caffeine.
Motion sickness: ginger, peppermint.
Osteoarthritis: glucosamine, chondroitin, SAMe, turmeric.
Osteoporosis: calcium, vitamin D, soy, ipriflavone.
Prostate: saw palmetto, lycopene, pygeum, pumpkin seed.
Skin: tea tree oil, aloe vera, vitamin D, biotin.
UTI: cranberry, yogurt, probiotics.
Weight loss: garvinia cambogia.

57
Q

Safety issues with common supplements

A

St. John’s Wort: induces CYP 3A4, 2C19, 2C9, 1A2, is serotonergic, photosensitivity, and lowers the seizure threshold.
Increased bleeding risk: 5 G’s; garlic, ginger, ginkgo, ginseng, glucosamine, fish oils, vitamin E, dong quai, willow bark, feverfew,
Liver toxicity; black cohosh, kava, chaparral, comfrey, green tea extracts.
Cardiac toxicity; bitter orange, DMAAlicorice, yohimbe.
Serotonergic; 5-HTP, SAMe.
Allergic reactions: artichoke extract, chamomile, echinacea.
Other heart: Qt prolongation with passionflower, positive inotrope with hawthorn (interacts with digoxin).

58
Q

Iron recommendations and levels

A

0-4 months: not required
4-6 months: 1mg/kg/d
6-12 months: 11mg/d
12-36 months: 7mg/d

59
Q

Meds that cause nutrient depletions

A

Acetazolamide: Ca, K
Antiepileptics: Ca
Amphotericin B: Mg, K
Isoniazid: B6
Loops: K
Metformin: B12
Methotrexate: B9
Orlistat: B-carotene, fat soluble vitamins
PPI: Mg, B12
Sulfamethoxazole: B9

60
Q

Vitamin names

A

A; retinol
B1; thiamine
B2; riboflavin
B3; niacin
B6; pyridoxine
B9; folic acid
B12; cobalamin
C; ascorbic acid
D2; ergocalciferol
D3; cholecalciferol
E; alpha-tocopherol

61
Q

Diseases with recommended supplements

A

Alcohol use disorder; B1, B9
Goiter; iodine
Microcytic anemia; ferrous sulfate
Macrocytic anemia; B12, B9
Pregnancy; B6, B9, Ca, D
Osteopenia; Ca, D
CKD; D
Scurvy; C
Crohn’s; iron, zinc, B, D, Ca
Bariatric surgery; patient-specific

62
Q

Drug overdose symptoms and management

A

Acetaminophen: N/V, hepatotoxicity 24-48h, hepatic failure 48-96h. NAC using Rumack-Matthew monogram.
Anticholinergics (atropine, Benadryl, dimenhydrinate, belladonna, jimson weed): Dry as a bone, red as a beet, blind as a bat etc. Physostigmine rarely.
Anticoagulants: bleeding. Andexanet alfa for apixaban/rivaroxaban, idarucizumab for dabigatran, phytonadione or Kcentra for warfarin, protamine for LMWH or heparin, Kcentra for Xa inhibitors.
Antipsychotics; benztropine or bicarbonate.
Benzos; flumazenil. BB; glucagon, insulin, lipi emulsion.
CCB: glucagon, insulin, lipid emulsion, Ca.
Cyanide (nitroprusside); hydroxocobalamin (Cyanokit, Na thiosulfate with Na nitrite (Nithiodote).
Digoxin, oleander, foxglove; digoxin immune Fab. 40mg vials bind 0.5mg digoxin.
Heavy metals: dimercaprol for arsenic, gold, Hg, penicillamine for copper, ferric hexacyanoferrate (Prussian blue) for thallium, and for lead either dimercaprol with Ca Na2 EDTA edetate, or succimer with DMSA dimercaptosuccinic acid.
Hydrocarbons; do not induce vomiting.
Insulin; dextrose, glucagon, and octreotide for sulfonylureas.
isoniazid; vitamin B6, benzos, barbiturates.
Iron, Al: deferoxamine. Iron overload: deferiprone, deferasirox.
Local anesthetics: IV lipid emulsion 20%
Methotrexate; leucovorin (folinic acid), levoleucovorin (Fusilev), glucarpidase (Voraxaze)
Methemoglobinemia (benzocaine, dapsone, nitrates, sulfonamide); methylene blue except in G6PD, SSRI, and SNRI.
Amatoxin mushrooms; atropine.
Naphthalene mothballs; methylene blue.
Neostigmine, pyridostigmine; pralidoxime, atropine, glycopyrrolate.
Nicotine; early sx abdominal pain and nausea, late sx bradycardia. Atropine and benzos.
Paralytics; neostigmine methylsulfate for Roc, Vec, and Pan, or sugammadex for Roc or Vec.
Salicylates; bicarb.
Stimulants; benzos.
Alcohols; fomepizole or ethanol.
TCA: bicarb, benzos, vasopressors.
Valproate (hyperammonia); levocarnitine.

63
Q

Organophosphate overdose and treatment

A

SLUDD: salivation, lacrimation, urination, diarrhea, defecation.
Atropine blocks ACh. Pralidoxime reactivates cholinesterase.
Combo is called DuoDote.
Usually caused by pesticides.

64
Q

Antidotes to bites and stings

A

Animal bites generally: Rabies vaccine (RabAvert, Imovax) or human immune globulin (HyperRAB S/D, Imogam Rabies HT).
Black widow spider: Antivenin for Latrodectus mactans.
Scorpion stings: Antivenin immune FAB Centruroides (Anascorp).
Snake bites: Crotalidae polyvalent immune FAB (CroFab) for copperheads and rattlesnakes, and Crotalidae immune Fab2 (Anavip) for rattlesnakes.

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