Advanced Pharm Exam 1 Flashcards
(177 cards)
1
Q
Aspirin- drug class?
A
NSAID: COX inhibitor (1st generation- inhibits COX-1 (stronger) & COX-2)
2
Q
Aspirin- MOA?
A
Nonselective COX inhibitor, rapid binding/inhibition:
COX-1 inhibition leads to irreversible modification of platelets (last the life of platelet ~8days, until turnover), leading to decreased platelet aggregation and decreasing risk of stroke and MI.
COX-2 inhibition inhibits prostaglandin production, which decreases inflammation pathway including, decreasing pain and fever.
Aspirin induces ATLs, anti-inflammatory compounds.
3
Q
Aspirin- adverse effects?
A
Gastro- GI distress, heartburn nausea, GI bleed, perforation, GI ulceration (with long-term use)
Renal- Renal impairment
Reyes Syndrome- in children: encephalopathy and fatty liver degeneration
4
Q
Aspirin- indications
A
RA, OA (when other non-pharm routes and topical NSAIDs don’t work) - esp. when in multiple joints or hip joint
5
Q
Aspirin- excretion?
A
Kidneys
6
Q
What are the corticosteroid prototype drugs?
A
Prednisone, hydrocortisone, cortisone, methylprednisolone
7
Q
Corticosteroids- indications?
A
RA, OA, asthma, Crohn’s disease, UC, IB
Used for inflammatory/immunologic disorders
Used as adjunctive for short term admin., during acute or exacerbation
8
Q
Ibuprofen- indications?
A
RA and OA, pain relief, dysmenorrhea
9
Q
Aspirin- max dose
A
3900mg PO
10
Q
Ibuprofen- max dose?
A
3200mg/day PO over 3-4 doses
400mg every 4-6hours PRN
11
Q
Ibuprofen- adverse effects?
A
Cardiovascular risk- thrombotic events, MI, stroke
GI risk- bleeding, ulceration, perforation (stomach/intestines)- GI risks higher for elderly
12
Q
Corticosteroids- adverse effects
A
hypothalamic-pituitary-adrenal axis suppression: adrenal insufficiency
osteoporosis: from decreased osteoblasts decreasing bone formation and increased osteoclasts increasing bone resorption and decreased intestinal calcium leading to hypocalcemia leading to increased PTH leading to removal of calcium from the bone into blood
short term: hyperglycemia, BP changes, edema, GI bleed, poor wound healing, increased risk of infection, hypokalemia/hyperkalemia
13
Q
Corticosteroids- MOA
A
Decrease prostaglandin & decrease leukotrienes -> decreased pro-inflammatory metabolites -> decreased inflammation
interrupted inflammatory process -> [decreased mediator synthesis -> decreased swelling, redness, pain, warmth AND decreased phagocytes -> decreased lysosomal enzymes -> decreased tissue injury -> decreased inflammation AND decreased lymphocyte proliferation -> decreased immune inflammatory response]
14
Q
Ibuprofen- MOA?
A
Nonselective COX inhibition:
Cox-1 reversible inhibition (weaker than Aspirin) -> decreased platelet aggregation (not as long as Aspirin) -> decreases thrombotic events
Cox-2 inhibition -> decreases prostaglandin precursors -> decreased inflammatory response -> pain, fever, inflammation
15
Q
Naproxen- drug class?
A
NSAID: 1st gen.- nonselective COX inhibitor
16
Q
What are the NSAID prototype drugs?
A
Aspirin, Ibuprofen, Naproxen, Celecoxib, Indomethacin, Ketorolac
17
Q
Indomethacin- drug class?
A
NSAID
18
Q
Indomethacin- indications?
A
RA, OA, gout, closure of neonatal patent ductus arteriosus
19
Q
Indomethacin- MOA?
A
COX inhibition -> decreased prostaglandin -> vasoconstriction (for patent ductus arteriosus) AND decreased inflammation AND decreased pain
20
Q
Indomethacin- max dose?
A
150mg / day
21
Q
Indomethacin- adverse effects?
A
Increased risk for CNS side effects: severe frontal headache, dizziness, vertigo, light-headed, confusion
22
Q
Celecoxib- contraindications?
A
Patients with heart disease or recent CABG surgery
23
Q
Celecoxib- drug class?
A
NSAID- 2nd gen. selective COX-2 inhibitor
24
Q
Celecoxib- indications?
A
RA, OA, ankylosing spondylitis, migraine, pain, dysmenorrhea
25
Celecoxib- MOA?
Selective COX-2 inhibition -> decreased COX-2 -> increased vasoconstriction AND decreased prostaglandin precursors -> decreased prostaglandin synthesis -> decreased pain and inflammation
26
Celecoxib- dosing?
200mg
27
Celecoxib- adverse effects?
serious cardiovascular risk: increased risk of MI and stroke
GI risk
renal impairment
28
Diclofenac- drug class?
NSAID- 1st gen. nonselective COX inhibitor
29
Diclofenac- indications?
RA, OA, pain, dysmenorrhea
30
Diclofenac- MOA?
first phase: COX-1 and -2 inhibition -> decreased plasma levels -> COX-2 inhibition (only) {later phase}
31
Diclofenac- dosing?
Max: 200mg/day
32
Diclofenac- adverse effects?
Cardiovascular risk, GI risk
33
Diclofenac- routes?
Oral, topical (patch, spray, cream)
34
Ketorolac- drug class?
NSAID
35
Ketorolac- indications?
OA, RA
short term management of acute pain (5days or less)
Strong analgesic: rapid onset, short duration
Medium anti-inflammatory drug
36
Ketorolac- MOA?
COX inhibition -> decreased pain, inflammation
37
Ketorolac- dosing?
Max: 120mg/day for max 5 days
38
Ketorolac- adverse effects?
GI risk, renal damage, bleeding, hypersensitivity
39
Ketorolac- routes?
Oral, IV, IM, intranasally
40
Naproxen- indications?
Gout, RA, OA, abnormal uterine bleeding, pain, fever
41
Naproxen- MOA?
Nonselective COX inhibitor -> decrease prostaglandin precursors -> decrease inflammatory pathway -> decreased pain, fever, inflammation
42
Naproxen- dosing?
Max: 1.5g / day
43
Naproxen- adverse effects?
GI risk, renal impairment, nausea, dizziness, tinnitus
44
Acetaminophen- drug class?
Non-NSAID analgesic/antipyretic
(not anti-inflammatory)
45
Acetaminophen- indication?
Pain, fever
46
Acetaminophen- MOA?
CNS COX inhibition -> decreased prostaglandin synthesis in CNS -> decreased fever and pain
47
Acetaminophen- dosing?
4,000mg / 24hours
48
Acetaminophen- adverse effects?
Toxicity, liver damage: 72-96hours post ingestion, severe hepatomegaly (AST > 10,000IU/L), plasma bilirubin > 4.0mg/dL
49
RA- tests?
ESR/CRP: elevated
50
RA- S/Sx
Morning stiffness (doesn't resolve with movement), symmetric inflammation/pain
51
OA- S/Sx
Joint pain, stiffness, swelling/tenderness, grating/clicking with movement, decreased ROM
52
RA vs. OA
RA: morning stiffness, symmetrical swelling/pain, caused by autoimmune
OA: asymmetrical swelling/pain, grating/clicking sound w/ movement, caused by injuries/overuse
53
CD vs. UC
CD: inflammation throughout GI (mouth to anus), patches of damage reaching outer lining, NOT bloody diarrhea
UC: inflammation in colon & rectum, damage maintained in inner lining, bloody diarrhea
54
Glucocorticoids- MOA for osteoporosis?
Increased osteoclasts, decreased osteoblasts, increased calcium excretion, decreased calcium absorption
55
Glucocorticoids- bone loss time frame?
After initiating steroid therapy: increased bone loss within the first 3-6months
After 6 months of therapy: continued, slowed bone loss
Increased fracture risk with 3months of Prednisone, more than 5mg / day
56
Osteoclasts
Bone "carving", resorption (2-3weeks)
Activated by: osteoblasts, PTH, thyroid hormone, Vitamin D3, thyroid hormone, glucocorticoids
57
Osteoblasts
Bone "building", formation
Regulated by: PTH, Vitamin D, insulin growth factor
Inhibited by: glucocorticoids
58
Recommended Calcium intake for adults?
1000-1200mg elemental calcium
500mg/ dose, divided throughout the day
59
What is required for calcium absorption?
Vitamin D
60
Vitamin D deficiency can cause what in adults and what in children?
Adults: osteomalacia
children: Rickets
Deficiency: Serum vitamin D <30mg/mL
61
PTH Pathway- start with Caclium
decreased calcium -> increased PTH -> increased calcium reabsorption -> decreased calcium in bones -> increased calcium in blood
62
Calcium carbonate (CaCO3)- environmental requirements?
Acidic environment for absorption- must be taken with meals
63
Calcium carbonate- adverse effects?
Constipation, hypocalcemia, nausea
64
Calcium carbonate- indications?
GERD (reduces acid in stomach)
Osteoporosis (maintains calcium levels in the blood)
65
Calcium carbonate- max dose?
2000mg / day
66
Alendronate- drug class?
Bisphosphonate: Antiresorptive agent
67
Alendronate- MOA?
Antiresorptive- inhibits osteoclast activity -> decreases bone loss
68
Bisphosphonates- contraindications?
Hypocalcemia (d/t inhibited osteoclasts -> decreased calcium released into blood)
Inability to sit up right
Caution with renal impairment (DONT USE if CrCl <35mL/min)
69
Bisphosphonates- adverse effects?
Dyspepsia, dysphagia, heartburn, nausea, vomiting, hypocalcemia
(bisphosphonates bind to mucosal lining of esophagus -> decrease protection -> irritation of esophagus -> dysphagia, heartburn, nausea, vomiting)
70
Bisphosphonates- dosing?
Must be taken separate from calcium, iron, magnesium and antiacids by at least 2 hours
71
Bisphosphonates- treatment duration?
3-5years (pts with low fracture risk)
72
Bisphosphonate- MOA?
Antiresorptive: osteoclast inhibition -> decreased calcium resorption -> decreased calcium leaving bone -> decreased bone loss
72
Alendronate- dosing?
Prevention: 5mg PO / day
Treatment: 10mg PO / day
72
Ibandronate- drug class?
Bisphosphonate- antiresorptive
72
Ibandronate- MOA?
Osteoclast inhibition
73
Ibandronate- routes?
PO, IV (if pt cant sit upright/esophagitis)
74
Ibandronate- dosing?
Oral: 150mg / monthly (must stay upright at least 30min)
IV: 3mg / 3months (slow admin.)
75
Alendronate- indication?
Osteoporosis
76
Ibandronate- indication?
Osteoporosis (for post-menopausal women)
77
Raloxifene- drug class?
Selective estrogen receptor modulator (SERM)
78
Raloxifene- MOA?
SERM: Estrogen agonist/antagonist -> decreased bone resorption
79
Raloxifene- dosing?
60mg / day (prevention & treatment)
Separate from levothyroxine
Discontinue 72hours before prolonged immobilization (surgery)
80
Raloxifene- contraindications?
History of VTE, pregnancy
Increases risk of venous thromboembolism (VTE)
81
Raloxifene- adverse effects?
Hot flashes, peripheral edema, arthralgia, leg cramps/muscle spasms/flu symptoms
Menopausal symptoms
82
What form can Vitamin D supplementation be in to help with bone building?
Vitamin D3 and Vitamin D2
83
Raloxifene- indication?
Osteoporosis- treatment and prevention (postmenopausal women)
84
What drugs can treat osteoperosis?
Raloxifene, Ibandronate, Alendronate, Calcium Carbonate
85
What are the two parts in asthma treatment?
Bronchodilation (symptom relief)
Inhaled corticosteroid (control of inflammation)
86
What is the primary treatment of COPD?
Bronchodilators
87
GOLD COPD Guidlines
Group A (low exacerbations/assessment score): only bronchodilator
Group : (low exacerbations and assessment score): bronchodilator and LAMA/LABA
Groups E (high exacerbations): bronchodilator and LABA/LAMA
88
Which of these gets shaken before use?: MDI or DPI
MDI (metered dose inhaler)- use a propellant spray
89
Which of these does NOT get shaken before use?: MDI or DPI
DPI (dry powder inhaler)
90
What drug is a short acting beta2 agonist? (SABA)
Albuterol
91
What is a short acting beta2 agonist (SABA)?
Short term relief- rescue inhaler
92
What is a long acting beta2 agonist (LABA)?
Long term maintenance, not used alone for asthma
Salmeterol
93
Albuterol- dose?
MDI/DPI 1-2 inhalations / 4-6hours
Nebulizer
94
Albuterol- cautions?
CVD, glaucoma, hyperthyroidism, seizures, diabetes
95
Albuterol- adverse effects?
Nervousness, tremor, tachycardia, palpitations, cough, hyperglycemia, decreased potassium
96
Albuterol- drug class?
Short acting beta2 agonist (SABA)
97
Salmeterol- drug class?
Long acting beta2 agonist (LABA)
98
Salmeterol- dosing?
DPI 1 inhalation BID (2x / day)
Maintenance inhaler only
99
Salmeterol- adverse effects?
Nervousness, tremor, tachycardia, palpitations, cough, hyperglycemia, decreased potassium
100
Salmeterol- cautions?
Only use in pts receiving inhaled corticosteroids
Maintenance inhaler only
101
Can oral corticosteroids be used long-term?
NO, significant adverse effects:
mood swings, hypertension, etc
102
What drugs are inhaled corticosteroids?
Fluticasone and budesonide
103
Inhaled corticosteroids (ICS)- adverse effects?
Fluticasone and budesonide-
Prolonged high doses -> adrenal suppression
Dysphonia, oral candidiasis (thrush)
104
What drug do you need to rinse and spit after use?
ICS- fluticasone and budesonide
105
ICS (fluticasone and budesonide)- MOA?
Activates anti-inflammatory gene expression -> suppresses airway inflammation -> controls underlying inflammation in asthma
106
ICS (fluticasone and budesonide)- indication?
Asthma (long-term)
107
What drugs are muscarinic antagonists?
Ipratropium and tiotropium
108
Which drug is a short acting muscarinic antagonist (SAMA)?
Ipratropium
109
Which drug is a long acting muscarinic antagonist (LAMA)?
Tiotropium
110
Ipratropium- drug class?
Anticholinergic bronchodilator- short acting muscarinic antagonist (SAMA)
111
Tiotropium- drug class?
Anticholinergic bronchodilator- long acting muscarinic antagonist (LAMA)
112
Anticholinergic bronchodilators: muscarinic antagonists- MOA?
inhibition of airway vagal tone -> blocks bronchoconstriction effects -> bronchodilation -> relieves COPD symptoms of obstruction
113
Ipratropium- indication?
COPD, asthma
114
Tiotropium- indication?
COPD
115
Ipratropium- dosing?
MDI 2inhalations / 4 times daily
116
Ipratropium- adverse effects?
dry mouth, URTI, cough, bitter taste
117
Tiotropium- dosing?
MDI 2 inhalations / day
118
Tiotropium- indications?
COPD maintenance treatment
119
Tiotropium- adverse effects?
dry mouth, urinary retention, cough, hoarseness
120
What drugs are oral corticosteroids?
Prednisone, methylprednisolone
121
What is a prednisone steroid burst?
40-60mg prednisone daily for 3-10 days (or more if no change), taper down (gradual reduction to determine lowest dose to keep pt symptom free)
122
Long term effects of oral corticosteroids (prednisone and methylprednisolone?
adrenal suppression, osteoporosis, hyperglycemia, immunosuppression
123
Short term effects of oral corticosteroids (prednisone and methylprednisolone)?
Hyperglycemia, insomnia, irritation, upset stomach
124
What is a methylprednisolone steroid burst?
Asthma exacerbation (no response from SABA): 40-60mg / day for 5-7 days, or resolution of symptoms
COPD exacerbation: 40-60mg/ day for 5-14 days (use IV if pt cant PO)
125
Prednisone- indications?
COPD, asthma, IBD, OA, RA
126
Methylprednisolone- indications?
COPD, asthma, UC, CD, OA, RA
127
Montelukast- drug class?
Leukotriene receptor antagonist (reduces airway inflammation and constriction)
128
Montelukast- indication?
Asthma
129
Montelukast- dosing?
10mg / day in the evening
130
Montelukast- warnings?
Neuropsychiatric events (mood changes, suicidal thoughts/actions)- to be monitored
131
Montelukast- adverse effects?
headache, abdominal pain, increased liver function tests
132
What drugs are antihistamines?
Azelastine, Cetirizine, Fexofenadine, Levocetirizine, Loratadine
133
Which antihistamines is most sedating but faster onset?
Cetirizine and levocetirizine
134
Which antihistamines are less sedating?
Fexofenadine and loratadine
135
What drugs are used for GERD?
Calcium carbonate, famotidine, pantoprazole
136
What drugs are used for PUD?
Bismuth subsalicylate, metronidazole, tetracyclines
137
What drugs are used for Ulcerative Colitis (UC) / Crohn's Disease (CD)?
Azathioprine, ustekinumab, vedolizumab
138
What drugs are used for IBS- constipation?
Polyethylene glycol, methylcellulose, linaclotide, lubiprostone
139
What drugs are used for IBS- diahrrea?
Loperamide, dicyclomine
140
Calcium carbonate- adverse effects?
constipation, bloating, belching
141
Famotidine- drug class?
Histamine-2 receptor antagonist
142
Famotidine- indication?
GERD
143
Famotidine- MOA?
Binds to H-2 receptor -> antagonizes effects of histamine on partial cells -> decreased acid secretion
144
Famotidine- onset?
within 60minutes
145
Famotidine- duration?
4-10hours
146
Famotidine- adverse effects?
Tolerance if taken on a schedule (take PRN)
147
Famotidine- warnings?
Delirium, vitamin B12 deficiency w/ prolonged use >2years
QT prolongation w/ renal dysfunction
148
Pantoprazole- drug class?
Proton Pump Inhibitor (PPI)
149
Pantoprazole- indication?
GERD, PUD, H. pylori infections
150
Pantoprazole- MOA?
Binds (irreversibly) to gastric H+, K+-ATPase in parietal cells -> inhibit acid secretion
151
Pantoprazole- onset?
1-3hours
152
Pantoprazole- duration?
>24hours
153
Pantoprazole- therapeutic/symptom relief?
1-4days (not for immediate relief, can be paired with calcium carbonate)
154
Pantoprazole- warnings?
C. diff, osteoporosis (long-term use, >1year), Vitamin B12 deficiency(prolonged use >2years)
Rebound acid secretion- if stopped abruptly, must taper down over 4-6weeks
155
Pantoprazole- adverse effects?
headache, ab pain, nausea, diarrhea
156
Pantoprazole- dosing?
Take 30-60minutes before meals to maximize effects
157
Tetracycline- indication?
PUD, triple therapy
158
Tetracycline- adverse effects?
Photosensitivity, tooth discoloration (children)
159
Bismuth- indication?
PUD, combination therapy, GERD
160
Bismuth- adverse effects?
dark stools, dark "hairy" tongue
161
Metronidazole- indication?
PUD, combination therapy
162
Metronidazole- adverse effects?
N/V/D, ab pain, metallic taste
Avoid alcohol
163
What is Inflammatory Bowel Disease (IBD)?
Ulcerative colitis, Crohn's disease
164
Vedolizumab- indication?
CD, UC
165
Vedolizumab- MOA?
Binds to alpha4beta7 integrin -> blocks interaction with mucosal addressin cell adhesion molecule 1 -> inhibits migration of memory T-lymphocytes across endothelium into inflamed GI parenchymal tissue
166
Vedolizumab- dosing?
300mg at 0week, 2weeks, then every 8weeks
d/c if no results after 14weeks
167
Ustekinumab- indications?
CD, UC
168
Ustekinumab- MOA?
Interferes w/ cytokines, IL12, IL13 -> inhibits T-cell activation -> inhibits inflammatory response
169
Ustekinumab- dosing?
First: 260-520mg IV single dose
Maintenance: 90mg SW Q8weeks, 8weeks after first dose
170
Duloxetine- Drug class? indications? MOA?
Selective serotonin reuptake inhibitor (SNRI- used for depression)
Osteoarthritis
Increases serotonin and norepinephrine in brain -> decreased pain signals
171
Methotrexate- indications? MOA?
OA, RA
Promotes release of adenosine -> anti-inflammatory
172
Adalimumab- drug class? Indication? MOA?
Biologics
Autoimmune disease (RA), CD, UC
Blocks tumor necrosis factor (TNF-a) from binding to receptor -> prevents activation of inflammatory pathways / producing cytokines
173
Infliximab- drug class? Indications? MOA?
Biologics
CD, UC, RA
Binds to TNF-a -> inflammatory response is blocked -> reduces inflammation
174
