EOR pharm exam part 2 Flashcards
(51 cards)
Primary action of tramadol
Central activity (serotonin, norepinephrine)
Secondary action of tramadol
Very weak Mu-1 receptor activity
Use of tramadol
Utilized for mild to moderate pain
Second or 3rd line option for neuropathic pain
Caution in pts at risk for seizures
Common SEs of tramadol
SEs similar to opioids Seizures Serotonin syndrome Sweating Dry mouth Upset stomach Diarrhea C4 controlled substance
Considerations of tramadol
Do not use with MAOI
Dosing limit 400 mg/d due to seizures
Drug interactions of Tramadol
SSRIs/SNRIs (serotonin syndrome)
Tryptan migraine abortants
Tramadol monitoring
Achievement of goals
S/sx tolerance
Misuse/abuse
What chemical class of opioids is hydrocodone in?
Phenanthrenes
How to dose immediate-release opioids for acute pain
Dose q4h for pain requiring around the clock coverage
Dose q4h PRN for intermittent pain
Adjust dose daily
-Mild/moderate pain: increase 25-50%
-Severe/uncontrolled pain: increase 50-100%
SEs of opioids
constipation Dry mouth CNS effects (sedation, dizziness, N/V, etc) Respiratory depression Pruritis Bad dreams/hallucinations Dysphoria/delirium Myoclonus/seizures Urinary retention
What SEs do opioid users usually develop tolerance to?
Sedative and euphoric effects
Respiratory depression
What controlled substance classification is hydrocodone
CII
Use of hydrocodone
Mild to moderate pain when combined with APAP
Available as a single agent for more moderate to severe pain (Hysingla; Zohydro)
MOA of levothyroxine
Synthetic hormone (T4)
Dosing of levothryroxine
PO: usually 1.6 mcg/kg/day
>50 and/or cardiovascular dz: 25-50 mcg daily
IV: 50% of oral dose
SEs of levothyroxine
Tachycardia Anxiety Hyperactivity Insomnia Sweating Wt loss Diarrhea Alopecia
Monitoring for levothyroxine
Baseline labs: TSH, T4
TSH every 4-8 wks following initiation, dose change, or change in preparation, then 6 mos, then 12 mos if therapeutic
Administration of levothyroxine
PO levothyroxine is best absorbed taken with water 30-60 minutes before a meal (usually breakfast)
Many medications can affect absorption of levothyroxine
MOA of amoxicillin
Beta lactam
Interferes with cell wall synthesis
Binds penicillin-binding proteins (PBPs)
Leads to inhibition of peptidoglycan synthesis
SEs of amoxicillin
Hypersensitivity
Rare seizures (at high doses)
Interstitial nephritis
Bone marrow suppression (rare)
MOA of azithromycin
Macrolide
Bacteriostatic agent that binds the 50s ribosome at the entrance of the protein exit tunnel, blocking polypeptide elongation
Usual PO dose (Z-pack)
CAP: 500 mg x 1 dose, 250 mg x 4 days
SEs of azithromycin
Torsade de pointes
QTc prolongation
Rash
N/V/D/abd pain
When is metformin use contraindicated?
Pts with eGFR <30 mL/min
Initiating metformin in pts with eGFR between 30-45 mL/min is not recommended
Assess the benefits of continuing tx in pts whose eGFR falls below 45 mL/min; d/c metformin if the eGFR falls below 30 mL/min
