Drugs Affecting the Autonomic Nervous System Flashcards

Question

Tamsulosin Pharmacokinetics

Answer 1

``` Onset: Unknown Peak: 5 days Duration: Unknown Half-Life: 9-15 hours Elimination: <10% unchanged in urine ```

Answer 2

``` Onset: 15 minutes Peak: 1-2 hours Duration: 12-24 hours Half-Life: 9-12 hours Elimination: 60% in bile/feces; 40% in urine ```

Answer 3

For Hypertension: Initial Dose: 1 mg daily at bedtime Maintenance Dose: 2-16 mg daily. Depending on standing BP, increase dose in 2 mg increments until target BP is achieved. Doses >4 mg increase risk of postural hypotension. For BPH: Initial Dose: 1 mg daily at bedtime. Extended release form is 4 mg taken once daily at breakfast. Maintenance Dose: 1-8 mg daily. Depending on the urodynamics and BPH symptoms, the dose is increased to 2 mg and then to 4 mg and 8 mg/daily. The recommended maximum dose is 8 mg. The titration interval is 1-2 weeks.

Answer 4

For Hypertension: Initial Dose: 1-2 mg bid or bid; take first dose at bedtime. Maintenance Dose: 6-15 mg/daily in 2-3 divided doses. Depending on standing BP, increase dose in 1 mg increments with the larger dose being given at bedtime until target BP is achieved. Doses >20 mg/day usually do not increase efficacy.

Answer 5

For BPH: Initial Dose: 8 mg once daily with a meal Starting dose may be 4 mg with increases to 8 mg as tolerated.

Answer 6

For BPH: Initial Dose: 0.1 mg daily 30 minutes prior to the same meal May be increased after 2-4 weeks to 0.8 mg daily

Answer 7

For Hypertension: Initial Dose: 1 mg daily at bedtime Maintenance Dose: 1-5 mg daily. Depending on standing BP, increase dose in 1 mg increments until target BP is achieved. Doses >20 mg/daily do not increase efficacy. For BPH: Initial Dose: 1 mg daily at bedtime Increased in a stepwise fashion to 2, 5, and then 10 mg. Doses at 10 mg are usually required for clinical effect. Dose may be 10-20 mg daily. Four to 6 weeks are required to assess for beneficial response, so this is the interval for dosage adjustment.

Answer 8

For BPH: Initial Dose: 10 mg daily after the same meal Maintenance Dose: 10 mg daily after the same meal

Answer 9

-Ketoanazole, itraconazole, ritoniver Effect: decrease metabolism and increase effects of alfuzosin Implication: Avoid concurrent use -cimetidine, atenolol, diltiazem Effect: increase level of alfuzosin and may increase effects of atenolol and diltiazem Implication: Monitor BP and HR -Antihypertensives, calcium channel blockers, nitrates, and alcohol Effect: Increased hypotension risk Implication: Monitor BP or avoid concurrent use

Answer 10

-Beta-adrenergic blockers Effect: May enhance acute postural hypotension following first dose of alpha1 adrenergic blocker Implication: Select different alpha1 adrenergic blocker. No adverse reaction seen with doxazosin or terazosin. -Clonidine Effect: May decrease antihypertensive effect of clonidine. Implication: Avoid concurrent use -Indomethacin Effect: Antihypertensive action of prazosin may be decreased. Implication: Select different alpha1 adrenergic blocker or different NSAID. No adverse reaction with doxazosin or other NSAIDs.

Answer 11

-Calcium channel blockers and thiazides Effect: Increased incidence of dizziness and orthostatic hypotension Implication: Exercise caution and monitor for adverse effects -Azole antifungals, clarithromycin, and other strong CYP3A4 inhibitors Effect: Ketoconazole increased Cmax and AUC Implication: Concomitant use with strong CYP3A4 inhibitors contraindicated -Diltiazem, erythromycin, verapamil, and other moderate CYP3A4 inhibitors Effect: May increase plasma levels Implication: Exercise caution and monitor for adverse effects -Phosphodiesterase type 5 inhibitors (e.g., sildenafil, tadalafil Effect: Increased incidence of orthostatic hypotension Implication: Exercise caution and monitor for adverse effects

Answer 12

-Cimetidine Effect: May increase blood levels of tamsulosin, with increased risk for hypotension and toxicity Implication: Select different histamine2 blocker if one must be used

Answer 13

-NSAIDs, sympathomimetics, estrogens Effect: May decrease antihypertensive effects of terazosin Implication: Avoid concurrent use or select doxazosin or another drug class for antihypertensive therapy -Verapamil Effect: Increases serum terazosin levels and may increase sensitivity to terazosin-vnduced postural hypotension Implication: Avoid concurrent use -Finasteride Effect: Increase in peak plasma concentration and AUC of finasteride Implication: Clinical significance unknown; monitor for adverse effects of finasteride

Answer 14

-Alcohol, antihypertensives, nitrates Effect: Additive hypotension Implication: Avoid concurrent use or administer first dose in the office and monitor BP closely

Answer 15

``` Onset: 60 minutes Peak: 4-6 hours Duration: 24-30 hours Half-Life: 3-4 hours Elimination: 30 to 40% in urine, 50 to 60% in feces/bile ```

Answer 16

``` Onset: 60 minutes Peak: 2-4 hours Duration: 24 hours Half-Life: 6-9 hours Elimination: 50% unchanged in urine, rest in feces ```

Answer 17

``` Onset: 15 minutes Peak: 90 minutes Duration: 13-19 hours Half-Life: 3-7 hours Elimination: <5% unchanged in urine ```

Answer 18

``` Onset: 5 days Peak: 3-4 hours Duration: 17-24 hours Half-Life: 20-40 hours Elimination: Unchanged in urine ```

Answer 19

Onset: 15 minutes Peak: 1.5-4 hours Duration: Unknown Half-Life: 12-19 hours based on genetic differences Elimination: 38 to 67% in urine, 13 to 44% in feces

Answer 20

``` Onset: 7 days Peak: 1 hour Duration: 24 hours Half-Life: 3 to 4 hours Elimination: 60 to 65% metabolites and 35 to 40% unchanged drug in urine ```

Answer 21

``` Onset: 30 minutes Peak: 60 to 90 minutes Duration: 6-12 hours Half-Life: 3-5 hours Elimination: <1% unchanged in urine ```

Answer 22

``` Onset: Unknown Peak: 1-3 hours Duration: 12-24 hours Half-Life: 4 hours Elimination: Metabolites and unchanged drug in urine ```

Answer 23

-Aluminum salts, barbiturates, calcium salts, cholestyramine, colestipol, NSAIDs, ampicillin, rifampin, salicylates Effect: Decrease bioavailability and plasma levels of beta adrenergic antagonists, possibly resulting in decreased pharmacological effect Implication: Avoid concurrent use. Separate administration of cholestyramine or colestipol from administration of beta blocker by 4 hour. -Calcium Channel blockers Effect: Potentiate effects of beta blockers Implication: Do not administer within 24 hours of each other. If must give both, monitor for heart failure and decreased peripheral perfusion. -Ciprofloxacin and other quinolone, cimetidine Effect: Bioavailability of beta blocker metabolized by CYP450 may be increased. Implication: Select different antibiotic or different beta blocker

Drugs Affecting the Autonomic Nervous System Flashcards

(47 cards)