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Quarter 3 Finals > Pharm > Flashcards

Pharm Flashcards

1
Q

Oxytocin (Pitocin, Syntocin)

A

DOC to induce labor at term if ready

Also: prevent hemorrhage, milk “let down”

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2
Q

Adverse eff of Oxytocin (only at large dose)

A

Water intox
Uterine rupture
Anaphylaxis
Sinus brady of fetus

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3
Q

Ergot Alkaloids (Ergonovine Malaete)

A

Activate seretonin and a-receptors, only ON switch

2nd line to decrease uterine bleeding if Oxytocin AND massage have failed

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4
Q

Ergot Alkaloids

A

Rapid action, IV

AFTER COMPLETE DELIVERY of baby and placenta

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5
Q

Ergot Alkaloids CONTRA

A

To induce labor
PAD (periph vasc dz)
CAD (coronary artery dz)

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6
Q

Prostaglandins

“prost” in name

A

Dinoprostone
Carboprost Trom
Misoprostol

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7
Q

Prostaglandins use

A

After miscarriage or birth to expel fetal contents

Also: 3rd line after massage, oxytocin, and ergots to tx postpartum bleeding

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8
Q

Another use for Dinoprostine (a prostaglandin)

A

Cervical ripening prior to delivery at term

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9
Q

BLACK BOX WARNING for Prostaglandins

A

Diarrhea

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10
Q

Do not use Dino for Cervical ripening IF

A

Problem with mother or fetus (fetal distress, hx of C-section or difficult delivery)

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11
Q

Do not use Prostaglandin for Abortion if

A 
Acute Heart, Lung, Kidney, or Liver dz
Asthma
HTN
Anemia
Jaundice
Epilepsy
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12
Q

Tranexamic Acid

A

PRO-CLOTTING

Reduce death d/t bleeding in women WITH postpartum hemorrhage
Given in COMBO with standard uterotonic therapy

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13
Q

Magnesium Sulfate (MgSO4)

A

1st line drug to prevent pre-term labor

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14
Q

Other use for MgSO4

A

Treat pre-ecamplsia and ecampslia

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15
Q

Nifedipine (CCB)

A

Inhibits Sm Muscle contraction

Becoming 1st ine to PREVENT PRE-TERM LABOR

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16
Q

Indomethacin- COX

A

1-2nd line drug for preventing pre-term labor

Inhibits COX enzyme, therefore reducing Prostaglandin synthesis

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17
Q

Indomethacin adverse effects

A

Partial closure of fetal ductus arteriosus

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18
Q

Progesterone, to prevent premie delivery

A

Most effective when given PROPHYLACTICALLY to high risk mothers who have had premie hx
16th-37th week

not affective for Acute tx

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19
Q

Drugs to treat Hypothyroidism (3)

A

Levothyroxine Na
Liothyronine Na
Dessicated Thyroid

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20
Q

LevothyroXine Na

A

DOC for Hypo

beware that T4 levels change slowly, ~5 weeks to reach steady state

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21
Q

Liothyronine Na

A

Used for initial therapy in treating Hypo, but not maintenance
Shorter duration of action

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22
Q

Dessicated thyroid (Armour)

A

Mix T3 and T4 from pigs
Natural hormones
Good for pts with PERIPHREAL DEOIDONASE DEFICIENCY

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23
Q

Treatment for HYPERthyroid

A 
Remove gland
131-I radioactive
Thioamides
Iodide
B- blocker symptomatic
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24
Q

Propylthiouracil (PTU) and Methimazole

A

Thioamides

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25
Q

Methimazole

A

a Thioamide, more potent than PTU

DOC for Graves

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26
Q

Methimazole is DOC in most cases, UNLESS

A

Pregnant or allergies to M, then use PTU

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27
Q

Adverse effects to Thioamides

A 
Itching, skin rash
Granulocytopenia
Agranulocytosis
Goiter
Lupus like syndrome, HA, myalgia, arthralgia, lymphadenopathy, psychosis
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28
Q

Iodide

A

rapidly decreases synthesis of T3 and T4

Short term effect

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29
Q

Iodide use

A

7-10 days before surgery (decrease chance of Thyroid Storm)

Also use in Radioactive emergencies

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30
Q

131-I Use

A

Elderly pts with Heart dz
Preferred tx for TOXIC NODULAR GOITER

Also, definitive for Graves, but Thioamides are DOC

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31
Q

131-I Use (simple)

A

Old ppl heart dz
Toxic Nodular Goiter (Preferred)
Definitive for Graves (but not preferred)

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32
Q

131-I CONTRA

A

Pregnant, nursing, or lack childcare

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33
Q

Beta-blockers

  • Propranolol
  • Metoprolol
A

Inhibit conversion of T4–>T3
Treat sx of HYPERthyroid

CONTRA: Asthma

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34
Q

If you have HYPER thyroidism and want to treat the sx but have Asthma,

A

Use CCB instead of beta-blocker

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35
Q

Calcitonin

A

Turn down Bone resorption
Antagonize PTH
Decrease bone pain, loss, and fractures

Increase bone density

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36
Q

Adequate Calcium is needed for

A

any other tx to work

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37
Q

Vit D is needed for

A

Calcium to be absorbed

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38
Q

PTH drugs

“paratide”

A

Teriparatide
Abaloparatide
rhPTH(1-84)

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39
Q

Teriparatide and Abaloparatide have more

A

OsteoBLAST activity. used for Osteoporosis, but effects diminish over time

Switch to another Osteoporosis tx in 18-24 mo

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40
Q

rh PTH 1-84 used for

A

Hypoparathyroid

more osteoCLAST activity

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41
Q

Parathyroid drugs

  • Teriparatide
  • Abaloparatide
A

Effective tx for Osteoporisis in Men and Post-menopausal Women
Decrease new fractures
Stimulate formation of NEW BONE

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42
Q

Teriparatide (PTH drugs) pharm

A

peak in 30 min, gone in 3 hours

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43
Q

Adverse effects of PTH drugs

“paratide”

A

High calcium in BLOOD and URINE

Abaloparatide can also cause HyperURICemia

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44
Q

Denosumab

A

Antibody to RANKL
Inhibit Bone resorption

Use: Tx Osteoporosis in Men and post-menop women

SubQ injection every 6 mo

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45
Q

Denosumab Absolute CONTRA

A

Hypocalcemia

Pregnancy

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46
Q

Denosumab Relative CONTRA (just be careful)

A

CKD

Pts at risk for serious infection (bc RANKL usually signals lymphocytes)

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47
Q

Biphosphonates

“dronate”

A

Alendronate- oral
Risedronate- oral
Ibandronate- oral, IV
Zoledronic Acid, IV

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48
Q

Biphosphonates

“dronate”

A

sub for Phosphate in Calcium binding, incorporate into the bone, stay there FOREVER

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49
Q

Downfall of biphosphonates

A

incorporate into bone, so we are able to make more but NO BONE TURNOVER means we cant continue breaking down and making new

Bones never re-made. old and brittle. not flexible and strong

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50
Q

DOC for Osteoporosis

A

Biphosphonates

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51
Q

Adverse effects of Biphosphonates

A

Oral: abd pain, esoph irritation, ulcer, flatulence
IV: Kidney toxic

OSTEONECROSIS OF JAW***

Atypical bone fractures of femur

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52
Q

CONTRA for Biphosphonates

A

Oral: Cant stand upright (need to do for 30 min after taking on empty stomach with 1/2 glass water)
OR
IV: Renal dz

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53
Q

Rapid Acting Insulin

A

Lispro
Aspart
Glulisine
Inhaled

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54
Q

Short Acting Insulin

A

Regular Insulin

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55
Q

Intermdt Insulin

A

NPH

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56
Q

Long Acting Insulin

A

Glargine (Lantus)
Detemir (Levemir)
Degludee (Tresiba)

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57
Q

Preferred in Insulin pumps

A

Rapid Acting bc less “tail response” and less risk for Hypoglycemia

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58
Q

What mimics body’s natural response the best?

A

Long acting + Rapid acting

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59
Q

Pump insulin

A

Always basal level + rapid acting b4 meal

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60
Q

GLUT 4 works in

A

Muscle and Adipose tissue

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61
Q

What is used 1st in Type 2 DM?

A

Long acting Insulin
(Glargine, Detemir, Degludee)
ONLY if A1C >10%

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62
Q

Insulin injections

A

Create insulin profile and eat to fill it

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63
Q

Pump insulin method

A

Adjust insulin bolus according to what you eat

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64
Q

Glucagon Used for:

A

Adults w stable DM
B-blocker overdose
GI relaxation b4 X raysG

65
Q

Glucagon only good for well-controlled Diabetics bc it works by:

A

Mobilizing Hepatic glucose stores (uncontrolled diabetics will not have glucose stored in Liver)

66
Q

Diazoxide

A

Non-diuretic Thiazide, vasodilator, and Hyperglycemic

67
Q

Diazoxide

(non-diuretic thiazide) USE

A

Pts with Insulinoma (pancreatic beta cell tumor that secretes too much Insulin)

68
Q

Metformin

A

decrease Glucose levels in an Insulin-independent manner!

AMPK pathway

69
Q

Metformin

A

DOC for Type 2 IF A1C is below 10%

remember if it is >10%, have to use Long acting Insulin

70
Q

Metformin benefits

A

Decrese:
Macrovascular events
All cause mortality

71
Q

DOC for Diabetes prevention

A

Metformin

72
Q

Adverse Effect for Metformin

A 
Diarrhea (common)
Lactic Acidosis (dangerous)
Vit B12 deficiency (reversible)
73
Q

CONTRA to Metformin

A

Kidney dz

failure or severe impairment, GFR <30

74
Q

GLP-1 RA

“glutide”

A

Exanatide
Liraglutide
Semaglutide

75
Q

GLP-1 and GIP increase the release of

A

Insulin

76
Q

GLP-1 Receptor Agonist (help increase the release of Insulin)

A

the “TIDES”
Exanatide
Liraglutide
Semaglutide

77
Q

GLP-1 Receptor Agonists

A

SubQ injections, except Semaglutide is oral

78
Q

Liraglutide

A

Decrease Macrovascular events
Good for Type 2DM
Decrease BP
Weight Loss

Increase: B cell # and fx

79
Q

Out of all the GLP-RA drugs, which one is used most common/FDA approved?

A

Liraglutide

  • decrease macrovascular events
  • Type 2 DM: reduce major CV events
  • Weight loss
  • Decrease BP
80
Q

Caution GLP-RA drugs with

A

Pancreatitis

81
Q

CONTRA for GLP-1 RA

A

Thyroid CA- BLACK BOX

82
Q

DPP-4

A

Usually breaks down GLP-1 (which helps insulin release)

If we inhibit DPP-4, we allow insulin to continue being released

83
Q

DPP-4 Inhibitors

The “gliptins”

A

Sitagliptin

Linagliptin

84
Q

DPP-4 Inhibitors

“gliptins”

A

pretty chill, neutral as far as CVD and wieght effects

CAUTION with Pancreatitis

85
Q

DPP-4 Inhibitors: unique about Linagliptin

A

elim by Liver AND GI, so it’s safe to Kidney

86
Q

Drugs to use caution with for Pancreatitis

A

GLP-1 Agonists

DPP-4 Inhibitors

87
Q

SGLT-2 Inhibitors

“Flozin”

A

Inhibit Na-glucose transporter in kidney

PEE IT OUT

88
Q

SGLT-2 Inhibitor
“Flozin”
benefits

A

Canag and Empag: Dec CV events
Canag: Dec CKD progression
Canag and Dapag: Dec HF hospitalizations

All: dec BP, weight loss

89
Q

SGLT-2 Inhibitors

A

Canag does it all!

Decrease CV events, decrease CKD progression, Decrease HF hospitalizations

90
Q

Empagliflozin and Canagliflozin are approved for Type 2 DM to:

A

decrease risk of Major CV events

91
Q

SGLT2 Inhibitor Adverse Effects

A

Urinary infections
peeing all the glucose out
Rare: kidney impairment and AKI

92
Q

CONTRA to SGLT2 Inhibitors

A

Severe Kidney impairment or Dialysis

Prone to UTI/GU infection

93
Q

TZD

“tazones”

A

Specifically target insulin resistance to increase Insulin sensitivity

94
Q

TZD

A

metabolized by the Liver= KIDNEY SAFE

95
Q

TZD

A

PPAR-y receptor

Post-receptor insulin mimetic action

96
Q

TZD benefits

A

Decrease Trig
Increase HDL
Improve insulin sensitivity (may help prevent Type 2, not as good as Metformin)

97
Q

TZD Adverse Effects

A

Weight gain
Edema
Inc Bone fracture risk

98
Q

CONTRA to TZD use

A 
Liver dz (bc metabolized by liver)
Heart Failure (bc edema)
99
Q

Alpha-glucosidase inhibitors

A

Acarbose

Miglitol

100
Q

Alpha-glucosides inhibitors

A

USED IN BOTH TYPE 1 and 2

101
Q

Alpha-glucosides inhibitor mechanism

A

DELAY CARB DIGESTION and absorption

102
Q

Alpha-glucosidase effects

A

Decrease post-meal glucose only

103
Q

AGi Adverse effects

A

Flatulence

“The nursing home Diabetes drug”

104
Q

CONTRA to AGi

A

Any GI dz: obstruction, ileus, inflammatory bowel, hiatal hernia
Liver dz or Kidney impairment

105
Q

Sulfonylureas for Diabetes

A

Block ATP sensitive K channel to cause membrane depol, increase Ca influx to Beta cells

Increase insulin release

106
Q

SU effects

A

Long term: dec MI risk, dec microvascular risk, dec all cause mortality, dec serum glucagon

WE DONT USE THIS DRUG

107
Q

Why don’t we use SU often for Diabetes?

A

HUGE HYPOGLYCEMIA RISK

Also: weight gain, GI SE

108
Q

CONTRA to Sulfa

A

Severe Kidney or Liver dz

109
Q

Sulfa 2nd gen

A

Glyburide (worst) 24 hr
Blipizide (least risk) 2-4 hr
Glimepride 1/day

110
Q

Meglitinide

Repaglinide

A

not a SU, can be used in SU allergy

Same mechanism, block ATP sens K channel, increase Ca flux

111
Q

Meglitinide (Repaglinide)

A

Do not use with SU, caution with liver impairment

112
Q

Colesevelam

A

Bile acid binding resin

COMBO w other DM drugs

113
Q

Colesevelam benefits

A

Reduce LDL
Safe
SE: constipation and bloating

114
Q

Bromocriptine

A

Dopamine agonist- quick release

Decrease post meal glucose d/t SUPPRESSION OF LIVER GLUCOSE PRODUCTION

115
Q

Bromocriptine

A

Give w/in 2 hrs of waking

CYP3A4

116
Q

Bromocriptine benefits

A

Dec post meal glucose levels, FFA and Trig levels, Cardiovascular problems

117
Q

Amylin like peptide

A

Pramlintide (always used w Insulin)

118
Q

Amylin is a

A

hormone co-secreted with Insulin

119
Q

Pramlintide only used

A

IN COMBO w Insulin
Works w insulin to regulate post meal glucose

SubQ injection 3x/day

120
Q

Pramlintide (always used w Insulin) benefits

A

Decrease post meal glucose

Weight loss

121
Q

CONTRA to Pramlintide

A

Gastroparesis (slow GI) bc this slows even more, delays gastric emptying

122
Q

What is used in BOTH Type 1 and 2?

A

Alpha-glucosidase inhibitors
Delay carb digestion and absorption
FLATULENCE: nursing home

123
Q

FSH effects

A

Women: develop ovarian follicles
Men: Stimulate spermatogenesis

124
Q

LH effects

A

Women: Estrogen/Progesterone synth
Men: Testosterone syntehsis

125
Q

Long acting GnRH

A

Leuprolide: DOC for Endometriosis

126
Q

GnRH antagonist

A

Cetrorelix

127
Q

GnRH drugs (long acting AND antagonist) Use

A

Suppresses LH and FSH

IVF
Sex steroid dependent CA
Endometriosis
Precocious puberty

128
Q

Gonadotropins

A

LH and FSH

129
Q

Use of Gonadotropin therapy

A

Men: induce spermatogenesis
Women: In Vitro fertilization

130
Q

Adverse effects of Gonadotropin therapy (LH and FSH)

A

Ovarian hyperstimulation syndrome: DANGEROUS (hypovolemia, shock, death, rapid accum of fluid in peritoneal, pericardial, and pleural cavity)
Multiple births
Gynecomastia

131
Q

CONTRA to Gonadotropin therapy (LH and FSH)

A

Sex steroid dependent CA

132
Q

Sex steroid dependent CA. What to USE and AVOID?

A

USE: GnRH drug
AVOID: Gonadotropins (LH and FSH)

133
Q

Exogenous Estrogen therapy use

A

Birth control
Hormone replacement therapy
Stimulate puberty

134
Q

Estrogen Adverse Effects

A

Migraine

CLOT risk

135
Q

Estrogen CONTRA

A

Estrogen dependent CA
Clotting disorder
Smoking AND >35YO
Pregnant

136
Q

Anti-Estrogens

A

Tamoxifen
Raloxifen
Clomiphene

137
Q

Tamoxifen (anti-estrogen)

A

“Breast CA drug”

SERM: selective estrogen receptor modulator

138
Q

Tamoxifen (anti-estrogen)

A

Antagonist: breast
Agonist: bone and uterus

DOC for breast CA in Pre-menop women

139
Q

Clomiphene (anti-estrogen)

A

DOC for Infertility

Adverse effect: Multiple pregnancies

140
Q

Aromatase inhibitor

Anastrazole

A

DOC for Breast CA in Post-Menop women OR in advanced dz (have to make woman post-M for it to work)

141
Q

CONTRA to Aromatase Inhibitor (Anastrozole)

A

Pregnancy

Pre-menopausal

142
Q

Progestin use

A

Birth control

Prevent endometrial Hyperplasia in HRT (hormone replacement therapy)

143
Q

Progestins

A

Progesterone
Levonorgestrel (plan B)
Medroxyprogesterone (Provera)

144
Q

Antiprogestin
(Mifepristone)
Use:

A

Terminate pregnancy

Prevent implantation

145
Q

Combo pill

A

Ethinyl Estradiol/Drospirenone

Good bc: less water retention

146
Q

Progestin only

A

Mini pill
Depo-provera
Implanon/Nexplanon
Mirena

147
Q

When to use Mini pill (progestin only)

A

Breastfeeding

148
Q

Post coital Emergency

A

Plan B (Prog only)
Preven (Prog and Estrog)
Mifepristone (Anti-prog)

149
Q

Adverse effects of Combo birth control

A 
Clotting (>35 and smoker huge risk)
Mild HTN
Migraine HA
MI/Stroke
Teratogenic
150
Q

Benefits of Birth control

A

Reduced risk of Ovarian/endometrial CA, ovarian cysts, benign breast dz, Ectopic pregnancy, Iron def, RA, PMS, etc

151
Q

Absolute CONTRA to birth conrol

A 
ASCVD
Estrogen dependent CA
Pregnant
Smoker and >35YO
Uncontrolled HTN
Uncontrolled DM
152
Q

Drug interactions w Birth control

A

P450 inducers and Abx can reduce effectiveness

153
Q

Birth control can then inhibit the effectiveness of these drugs:

A 
Anticoag
Anticonvulsant
Antidepressant
Guanethidine
Oral Hypoglycemics
154
Q

Androgen use indications

A 
Testicular deficiency
Female hypopituitarism
Female--> Male 
Hypoprotein of Nephrosis
Negative Nitrogen balance
155
Q

Androgen receptor ANTAGONIST

A

Flutamide

Spironolactone

156
Q

Androgen receptor antagonist use

A

Flutamide: in Prostate CA with long acting GnRH

Spironolactone: Hirsutism, PCOS, Precocious puberty

157
Q

5-a reductase inhibitor

Finasteride

A

BPH
Male pattern baldness

Stops T –> DHT conversion

158
Q

Finasteride Adverse Effects

A

Gynecomastia
Erectile Dysfx
Teratogenic

Quarter 3 Finals (10 decks)

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