Exam 2 Flashcards
1
Q
What is the major effect of all NSAID’s?
A
Decrease synthesis of prostaglandins by inhibiting cycle oxygenate
2
Q
What do Prostaglandins do in the body?
A
1) Enhance inflammatory process
2) Increase renal blood flow
3) protects the GI mucosa
3
Q
MOA of COX-1
A
Gastroprotective effects
4
Q
MOA of COX-2
A
Produces proinflammatory mediators
5
Q
Problems associated with acute toxicity:
A
1) GIT symptoms = MC (Dyspepsia)
2) Renal effects = 2nd MC
6
Q
Treatment for acute overdose:
A
1) Secure airway
2) Activated Charcoal
3) Transport
7
Q
MOA of Salicylate Toxicity:
A
1) Inc. metabolic rate
2) inc. O2 consumption
3) inc. CO2 formation
4) inc. heat production
5) inc. glucose use
6) depletion of hepatic glycogen
8
Q
Clinical features of salicylate toxicity
A
- nausea/vomiting
- tachypnea
- tinnitus
- metabolic acidosis
9
Q
Why is Acetomenophen toxicity worse in alcoholics?
A
Due to introduction of Hepatic Microsomal Enzyme Systems
10
Q
Vitamin A Acute Toxicity clinical features:
A
- Pseudotumor Cerebri
- Tired/Irritable
- Hair Loss
- Hepatomegaly
11
Q
Chronic Vitamin A toxicity clinical features
A
- bone pain
- visual disturbances
- fatigue, but difficulty sleeping
- dry skin/hair loss
- elevated Alk Phos
- Periosteal calcification
12
Q
Vitamin D toxicity clinical features
A
- Hypercalcemia
- Weakness
- Headache/Fatigue
- ST Calcificaton
- Polyuria/Polydipsia
- nephrocalcinosis
13
Q
Vitamin C toxicityClinical features:
A
- Urinary calculi
- elevated Estradiol (when taking birth control)
- Inc. iron absorption
- Diarrhea, Nausea, Craming
14
Q
When is increased iron absorption dangerous?
A
In patients with Hemochromatosis
15
Q
Functions of Histamine
A
1) Mediates all Allergic responses
2) Regulates Gastric acid secretion
3) CNS neurotransmitter
16
Q
Function of H1 Antihistamine
A
Stimulation…
1) constricts bronchioles
2) Dilates peripheral vasculature
3) inc. vascular permeability
17
Q
Function of H2 Antihistamine
A
1) Regulates Gastric acid secretion
18
Q
In the CNS, H1 & H2…
A
Modulate…
1) Arousal
2) Thermoregulation
3) Neuroendocrine functions
19
Q
Function of H3 Antihistamine
A
1) Presynaptic regulator of histamine synthesis and release
20
Q
What are H1 receptor blockers?
A
1) Reversible & Competitive
2) Inhibit H1 receptors
3) Competitive inhibitors of Muscanaric receptors
4) Block sodium channels disrupting cortical neurotransmission
21
Q
Antihistamine Toxicity clinical features
A
1) Sedation
2) Headache
3) Dry Mouth
4) Nausea
5) Menstrual Pain (Allegra)
22
Q
What are H2 receptor blockers used to treat?
A
Heartburn
23
Q
Clinical indications to use an H2 receptor blocker
A
1) Brady/tachycardia
2) confusion
3) agitation
4) delirium
5) Seizures
24
Q
Examples of H2 receptor blockers
A
1) Tagamet
2) Zantac
3) Pepcid
4) Axid
25
Example of H1 receptor blockers
1) Benadryl
2) Unisom
3) Chlor Trimeton
4) Atarax
5) Claritin
6) Allegra
7) Zyrtec
26
Macrolides Antibiotic toxicity effect:
Gastric Irritation
27
Chloramphenicol Antibiotic toxicity effect:
Aplastic anemia
28
Tetracyclines Antibiotic toxicity effect:
1) Photosensitivity
2) Renal Tubular Necrosis
29
Fluroquinolones Antibiotic toxicity effect:
Disrupt Cartilage synthesis
30
Low dose caffeine toxicity clinical features:
1) Nervousness
2) Insomnia
3) Abdominal pain
31
High dose caffeine toxicity clinical features:
1) Vomitting
2) Myoclonus
3) Myocardial irritability
4) Seizures
32
Clinical features of chronic caffeine toxicity
1) Irritability
2) Insomnia
3) Anxiety
4) Chronic abdominal pain
5) CVD
6) Fibrocycstic disease
33
FDA regulation of herbal medicines
Little to none…
34
In many herbal products the active ingredient __________.
“Is not known”
35
Definition of Infusion
Herbs steeped in water (like tea)
36
Definition of Decoction
Plant soaked then boiled in water (extracts more)
37
Definition of Tincture
Herb extract prepared by steeping in 25% mix of alcohol & water
38
Definition of Syrup
Herb extract prepared in honey or sugar
39
Definition of Compress
Cloth pad soaked in hot herbal extract and applied to painful area
40
Definition of Poultice
Similar to compress, but entire herb is applied to area
41
Definition of Emmenagogue
Herb that induces or increases menstrual flow
42
Definition of Carminative
Herb that reduces or prevents flatulence
43
MC use f herbal medicine is…
Herbal teas
44
What is “Folk” medicine?
Unrefined products derived from local plants, animals or minerals as a treatment for disease.
45
Use for Aloe:
1) Laxative
2) Cathartic effects
3) Psoriasis/Seborrhea
4) Skin Burns
46
Use for Bilberry (Huckleberry, Blueberry):
1) Atherosclerosis
2) PVD
3) lipid-lowering
4) anti-inflammatory
5) night vision/visual acuity
47
Use for Black Cohosh
1) alternative to Hormone Therapy
2) Menopausal/Dysmenorrhea/Prementrual
48
Use for Chamomile
1) Sleep
2) anti-peptic/pyretic
3) antibacterial/fungal
4) antispasmodic
49
Contraindication for using Chamomile
Allergy to Ragweed (contact dermatitis)
50
Use for Cascara Sagrada (Fletcher’s Castoria)
1) Constipation
2) Gallstones
3) Liver problems
51
Use for Cheyenne Pepper
1) Topically for anti-inflammatory for arthritis
52
Use for Chinese parsley, Coriander, Cilantro
1) cooking
2) Chelating agent
3) Inc. Hg, Pb & Al excretion from the body
53
Use for cranberry fruit
1) prevent & treat UTI/Kidney stones
2) Diuretic
3) antiseptic
54
Use for Echinacea
1) Upper respiratory viral infections
2) immune stimulant
3) promote healing
55
What can Echinacea interfere with?
Immunosuppressive therapy
56
Use of Feverfew Leaf
Prophylactic prevention of…
1) migraine/headaches
2) fever
3) arthritis
4) mentrual problems
57
Use of Ginger
1) prevent & treat motion sickness
2) appetite stimulant
3) arthritis
4) cold symtoms
58
No not use Ginger in patients with…
Cholelithiasis
59
Health benefits of Ginger Tea List: (11)
1) Motion sickness/STOMACH DISCOMFORT
2) dec. inflammation
3) asthma
4) circulation
5) mentrual discomfort/fertility
6) immunity
7) relieve stress
8) cough & cold
9) cancer
10) Alzheimer’s
11) Weight loss
60
Use for Ginkgo root:
1) Vasodilator
2) Cerebral insufficiency
3) dementia/memory enhancement
4) sexual dysfunction due to antidepressant use
61
Use of Asian Ginseng (Panay ginseng)
1) respiratory, digestive & CNS stimulant
2) Fatigue
3) Ulcers
4) Lowers cholesterol
5) immunostimulatory agent
6) cope with stress
62
Use of Goldenseal root
1) Common cold & URI
2) bacteria & inflammation
3) immune stimulant
4) infectious diarrhea
63
Use of hawthorn (Crataegus monogyna)
1) Cardiac function (HR & blood flow to heart) (dec. BP)
64
Use of Kava Root
1) anxiety
2) insomnia
3) promote relaxation
65
Why is Kava root no longer available in the U.S.?
Live issues
66
Use of Milk Thistle (Silybum Marianum)
1) prevent/cure liver disease
2) protects cell membrane
3) Scavenges harmful Oxygen radicals in the liver
67
Use of Saw Palmetto (Serenoa Repens)
1) Benign Prostatic Hyperplasia
2) Enlarged prostate
68
Use of Red Yeast Rice Extract
1) Lowers total cholesterols, LDL’s & triglycerides
[Marketed as Cholestin]
69
Do not take Red yeast Rice Extract with…
1) Alcohol
2) Zantac
3) selected antibiotics
[blocks metabolism] -> [produces GABA analog]
70
Use of St. John’s Wort (Hypericum Perforatum)
1) Depression/Anxiety
2) CT swelling
3) Menopausal neurosis
4) wound healing
71
Use of Tea Tree
Antiseptic &Antimicrobial applied to the Skin
72
Use of Valerian Root:
1) Anxiety
2) Insomnia (sedative)
73
What is L-Tryptophan?
- Essential amino acid
- Precursor for Serotonin
74
What can L-Tryptophan Treat?
1) Insomnia
2) depression
3) PMS
75
Caution when taking Pennyroyal:
Liver Damage & may cause abortion
76
Caution when taking Senna
Electrolyte Loss
77
Caution when taking White Willow Bark
Reye’s Syndrome
78
Caution when taking Wormwood:
Neurological Symtoms
79
Mandrake is used to treat…
1) Ovarian cancer
2) Sedative
3) Hallucinogen
4) Purgative, Emetic & Analgesic
80
Do not give Mandrake to…
Pregnant women
81
Thorn Apple tea is used to treat…
1) Asthma
2) boils
3) piles
4) cancer
82
Burdock root tea is used to treat…
1) Psoriasis & Eczema
2) Gout
3) Sores
4) Cancer
5) Skin Diseases
6) Arthritis
83
Burdock Root Tea is a ___________ and a _____________.
Diuretic; Diaphoretic
84
Mormon Tea is used to treat…
1) Asthma
2) Diarrhea
3) Stimulant to control Hay fever
4) Adrenal Stimulant
85
Drug interactions with Ginkgo Biloba:
1) Aspirin
2) NSAID’s
3) Warfarin
4) Heparin
86
Drug interactions with Ephedra
Caffeine or other stimulants
87
Drug interactions with Feverfew:
1) Anticoagulants
2) Pregnancy
88
Drug interactions with Garlic:
1) Warfarrin
2) Aspirin
3) May inhibit clotting
89
Drug interactions with Kava Kava
Benzodiazepines
90
Drug interactions with St. John’s Wort:
Antidepressants
91
Drug interactions with Licorice:
BP Medications
92
Drug interactions with Ginseng:
1) Digitalis
2) MAO Inhibitors
3) Avoid w/ Antidepressants
93
MOA of Carboxylic Acids (Acetylsalicylic Acid, Aspirin, White Willow Bark):
Inhibits PROSTAGLANDIN SYNTHETASE found in the Cyclooxygenase pathway
94
Toxicity of Aspirin Clinical Features
1) Tinnitus
2) Metabolic acidosis
3) ulcers
4) Leads to Reye’s Syndrome
95
Examples of Carboxylic Acids:
1) Acetylsalicylic Acid
2) Aspirin
3) White Willow Bark
96
Examples of non-opiate/non-anti-inflammatory analgesics:
Acetomenophin (Tylenol, Tempra)
97
Examples of Propionic Acids:
1) Ibuprofen (Motrin, Advil)
2) Ketoprofen (Orudis)
3) Fenoprofen (Nalfon)
4) Naproxen (Aleve)
98
MOA of Propionic Acids:
- Block PROSTAGLANDIN SYNTHETASE
- Accumulate in synovial fluids
- Long lasting effects
99
MOA of Acetic Acids:
100
Toxicity of Acetic Acids
101
What effect do Glucocorticoids have on the HPA Axis?
Hypothalamus: release CRH
Ant. Pituitary: release ACTH
Adrenal Cortex: release Glucocorticoids
102
MOA of Gluccorticoids:
Block formation of Arachidonic Acid
(Prevent PHOSPHOLIPASE A2 to form Arachidonic acid to stop inflammation)
103
Glucocorticoids promote…
Gluconeogenesis from non-CHO sources
104
Glucocorticoids effects on the liver:
1) inc. amino uptake
2) inc. glycogen deposition
3) inc. blood glucose to stimulate insulin release
4) Cause glycosuria > 200mg
105
Cushing Syndrome can be caused by:
Taking glucocorticoid drugs or a functional adenoma
(ACTH would be lower in Cushing’s)
106
Glucocorticoids effects on muscle/catabolism:
1) inc. amino acids release from muscle
2) Inhibit protein synthesis
3) Catabolic effect on: lymph, CT, muscle, skin, bone
107
Glucocorticoid Effects on Bone:
1) Catabolic- > Osteoporosis
2) Decreased Osteoblastic activity
108
Glucocorticoid Effect on RBC components & WBC’s:
Neutrophils: increase
Lymphocytes: decrease
Monocytes: Inhibit ability to turn into macrophages
Eosinophils: decrease
Platelets: Increase
Chemotaxis of all WBC’s: decrease
109
Glucocorticoids effects on:
1) Macrophages
2) Lysosomal Membranes
3) Fibroblasts
4) Collagenase
5) Phagocytes
M -> Dec. ability to phagocytize bacteria
L -> Stabilize
F -> Inhibit growth
C -> Potentiate
P -> long-term leads to suppression
110
Effects of Glucocorticoids on:
1) Capillaries
2) Vessels
3) Histamine
4) ACTH
5) Gastric Acid & Pepsin
C -> Dec. permeability
V -> vasoconstriction
H -> Dec. release
ACTH -> Dec. release
G & P -> inc. release in stomach
111
Effects of Glucocorticoids on TSH release:
Decreases, so patients present similar to hypothyroidism: Depression, mood swings, weight gain, cold intolerance
112
Effect of Glucocorticoids on Sodium & Potassium:
Na: Retention
K: Depletion
113
Conditions treated with Glucocorticoids: (12)
1) RA
2) Lupus
3) Inflammatory Bowel Disease
4) Allergic Conditions
5) Asthma
6) Skin Disorders
7) Neoplasm (lymphocytic leukemia, lymphoma Roma, hodgkin’s)
8) Surgical Graft’s
9) Preterm Labor
10) Shock
11) Cerebral Edema
12) Bell’s Palsy
114
Glucocorticoids combined with NSAID’s can cause…
Severe GIT disturbances and risk of ulceration
115
Components that aid in the production of Peptic Ulcer Disease
Duodenal > Peptic
H. PYLORI (infection) & NSAIDS (COX-1)
116
Examples of H2 Receptor Antagonists:
1) Tagamet (prototype)
2) Pepcid
3) Axid
117
MOA of H2 Receptor Antagonists:
Decrease HCl in the stomach
Metabolized in liver
Excreted in the Urine. (Tagamet excreted in bile)
118
Clinical Indications for H2 Receptor Antagonists:
1) Dyspepsia
2) Heartburn
119
What do Proton Pump Inhibitors do?
Inhibit the pumping Hydrogen ions into stomach to combine with Cl to make HCl Acid.
120
Examples of Proton Pump Inhibitors:
1) Prilosec (prototype)
2) Nexium (2nd generation Prilosec)
3) Prevacid (biggest competitor)
121
MOA of Sucralfate (Carafate)
Works in an acid environment; lays down a protective coating
122
Side Effects of Mylanta/Maalox:
- Constipation
- loose stools
123
Examples of Antacids:
1) Milk of Magnesia
2) Amphogel
3) Tums, Roland’s
4) Mylanta, Maalox
124
MOA of Antacids:
Immediately neutralize the acids that are already there
125
MOA of Fecal Softeners (Mineral Oil):
Blocks absorption of water which allows water to be retained in the bowel
126
Examples of Irritant Laxatives:
1)Castor Oil
2) Cascara Sagrada (Flether’s Castoria)
3) Senna
127
MOA of Irritant Laxatives:
Stimulant to the bowel
128
MOA of Bulk Laxatives (Citrucel):
Non-digestible fiber that has been ground into powder form
129
MOA for Saline Laxatives (epsom salts, Mg Citrate, Fleet Enema):
Have a lot of electrolytes, so act as a diuretic to draw fluid into bowel
130
Examples of Antidiarrheal OTC medications:
1) Pepto Bismol
2) Kaopectate
3) Imodium-AD
4) Donnagel
131
MOA of Pepto Bismol
Binds to toxins in the bowel, producing a dark stool
132
MOA for Kaopectate:
Binding agent that thickens the stool (flour to gravy)
133
MOA for Imodium:
1) Slows down longitudinal peristalsis
2) Inc. Intersegmental peristalsis to absorb more water
3) Inc. transit time
134
Prescription Meds for Diarrhea containing Opiates:
1) Lomotil
2) Paregoric
135
Examples of bronchodilators:
1) Albuterol
2) Metaproterenol
3) Terbutaline
4) Ephedrine
136
MOA of Bronchodilators
Beta 2 Agonists that affect smooth muscle to relax the respiratory tree
137
Clinical Indication for using Bronchodilators (Beta 2 agonists)
Asthma attacks
138
Side effects of Bronchodilators (Beta 2 agonists)
Can stimulate B1 receptors in the heart -> inc. HR
139
Examples of Methylxanthines:
1) Theophylline (Theodur, Slo-Phyllin)
2) Aminophylline
140
MOA of Methylxantines:
Affect PHOSPHODIESTERASE causing inc. cyclic AMP which relaxes smooth muscle
141
Clinical indications fro Methylxantines:
Take routinely to prevent asthma attacks and when you have an asthma attack it is much milder
142
MOA of Cromones:
Stabilize mast cell membranes to block the release of HISTAMINE
143
MOA of Inhaled Steroids
Catabolic steroids that minimize inflammation around your respiratory tree
144
MOA of Mucolytics (n-acetyl-cysteine)
Minimize accumulation of mucus from mucous membranes & breaks down mucus being secreted
145
Clinical Use for Mucolytics (n-acetyl-cysteine)
Used as the only treatment for Tylenol overdose
146
Examples of antihistamine H1 receptor blockers:
1) Benadryl (prototype)
2) Claritin
3) Allegra
4) Zyrtec
147
MOA of Antihistamine H1 receptor blockers:
Basophils release histamine & act against rhino RRROA
148
Side effects of antihistamine H1 receptor blockers
1) Drowsiness/sedation
2)) drying agents
149
Examples of nasal decongestants:
1) Sudafed (prototype)
2) Afrin
3) Dristan
4) Ephedrine
150
MOA of Nasal Decongestants:
Alpha 1 stimulators causing Vasoconstriction
151
Do not give Nasal Decongestants to:
1) Hypertensive Patients
2) Prostate issue patients
3)can become addictive/dependant
152
Examples of Expectorants:
1) Guaifenesin (Robitussin)
2) Iodine (PotassiumIodine)
153
MOA of Expectorants:
Thin out mucus secretions by adding ions so it expels
154
Side effects of Expectorants:
None
155
Examples of Antitussives:
1) Dextromethorphan (non-narcotic)
2) Codeine (narcotic) -> natural extract
3) Hydrocodone (Narcotic) -> controlled substance
156
MOA of Antitussives:
Used to suppress a cough, (suppress centrally in the Medulla)
157
Side-Effects of Antitussives:
1) Non-Addicting
2) Sedating effects
3) Constipation
158
OIC stands for:
Opiate Induced Constipation
159
Doxylamine =
Antihistamine
160
Pseudoephedrine =
Decongestant
161
Guaifenesin =
Expectorant
162
Dextromethorphan =
Cough Suppressant
163
Acetaminophen =
Pain Reliever
