Exam 2 Flashcards
(169 cards)
1
Q
For nicotine absorption, it is _____ dependent
A
pH
2
Q
The more basic a compound is then the _____ it is absorbed
A
better
3
Q
Acidic media (limited absorption)
A
cigs
4
Q
Alkaline media (significant absorption)
A
pipes
cigars
tobacco
oral nicotine products
5
Q
Nicotine is well absorbed in the where
A
small intestine (low bioavailability)
6
Q
Nicotine is rapidly absorbed across respiratory epithelium through what mechanisms
A
lung pH = 7.4
large alveolar surface area
extensive capillary system
7
Q
Approximately __ mg of nicotine is absorbed from each cig
A
1 mg
8
Q
How does excretion of nicotine occur
A
through kidneys
through breast milk
9
Q
Nicotine has predominantly ____________ effects
A
stimulatory
10
Q
CNS nicotine pharmacodynamics
A
pleasure
arousal
improved task performance
anxiety relief
11
Q
Cardiovascular system nicotine pharmacodynamics
A
Increase heart rate
Increase cardiac output
Increase blood pressure
Coronary vasoconstriction
Cutaneous vasoconstriction
12
Q
Most nicotine symptoms manifest within the first ___ to ___ days peak within the first week and subside within __ to ____ weeks
A
1-2 days
2-4 weeks
13
Q
Tobacco users maintain a minimum serum nicotine concentration in order to:
A
prevent withdraw symptoms
maintain pleasure
modulate mood
14
Q
Users self-titrate nicotine intake by
A
smoking/vaping more frequently and intensely
15
Q
Tobacco use is mainly associated by what environmental factor
A
conditioned stimuli
16
Q
Treatment for tobacco dependence should address the ___________ and __________ aspects of dependence
A
physiological and behavioral
17
Q
Pharmacotherapy is not recommended for what patients
A
pregnant smokers
smokeless tobacco users
individuals smoking fewer than 10 cigs a day
adolescents
18
Q
Nicotine replacement therapy (NRT) rational for use
A
-reduces physical withdraw from nicotine
-eliminates the immediate, reinforcing effects of nicotine that is rapidly absorbed via tobacco smoke
-allows patient to focus on behavioral and psychological aspects of tobacco cessation
19
Q
NRT products approximately _________ quit rates
A
doubles
20
Q
NRT precautions
A
patients with underlying cardio disease
-recent MI
-serious arrhythmia
-serious or worsening angina
21
Q
What is the mg strengths that nicotine gum and lozenges come in
A
2 and 4 mg
22
Q
When do you use 2 mg gum/lozenge
A
if first cig is smoked more than 30 min after waking
23
Q
When do you use 4 mg gum/lozenge
A
if the first cig is smoked within 30 min of waking
24
Q
What is the recommended baseline of gum/lozenges that someone should use a day
A
9 pieces (1 piece q 1-2 hr through wk 1-6)
25
When using gum or lozenges do not eat or drink for _____ minutes before or while using it
15
26
Chewing lozenge or using incorrect gum chewing technique can cause excessive and rapid release of nicotine resulting in what
lightheadedness/dizziness
nausea and vomiting
hiccups
irritation of throat and mouth
27
Transdermal nicotine patch
24 hour patch
avoids hepatic first-pass metabolism
nicotine levels are lower and fluctuate less than with smoking
28
Light smoker transdermal patch dosing
<10 cig a day
14 mg * 6 weeks
29
Heavy smoker transdermal patch dosing
>10 cigs a day
21 mg * 6 weeks
30
When using a transdermal patch it is best not to use the same area for about how long
1 week
31
It is important to remove nicotine patch before MRI appointments because why
all patches have metal in them
32
Transdermal nicotine patch common adverse effects
irritation at the patch site
mild itching
burning
tingling
sleep disturbances
33
What is one of the main disadvantage of transdermal nicotine patches
when used as monotherapy they can not be titrated
34
If skin stays red more than ___ days or if it swells or a rash appears, contact a health provider
4
35
What are the 5 A's of smoking cessation
Ask (about use)
Advise (to quit)
Assess (readiness to quit w/in 30 days)
Assist (quit attempt)
Arrange (follow-up care)
36
The common cold defn
a self-limiting viral infection of the upper respiratory tract
(late autumn through spring)
37
Self-inoculation of flu
the most common and effective method (contact with surface then touch eye)
38
Methods of flu prevention
wash hands frequently (soap, alcohol)
Avoid touching nose and eyes
Avoid close contact with infected
Clean environmental surfaces in hared public spaces
39
Pathophysiology of common cold
virus attaches to mucous membrane
cell defense activated
chemical mediators of inflammation released
cholinergic stimulation
inflammation of the mucous membrane
vasodilation of nasal
40
Duration of cold
few days
typical about a week
25% of colds last >2 weeks
41
Scratchy throat sore throat symptom
most noticeable on day 1
usually present for only the first couple days
may or may not need treatment
(may use oral analgesics)
42
Sneezing symptom
Minimal; It is not the same as allergic sneezing not a concern
43
Runny Nose symptom
usually brief at start of illness
variable in clinical significance
clear and runny secretions at first
secretions then become thicker and harder to drain
may or may not need treatment
(first gen antihistamine)
44
Nasal Congestion "stuffy head" symptoms
nearly 100% of pts have nasal involvement
present for several days
often the most bothersome symptom people seek help for
decongestants
45
Cough symptoms
Infrequent
usually appears by day 4-5
often not bothersome until nasal symptoms subside
46
Systemic Complaints
usually absent of minimal severity if present
may or may not need treatment
oral antigesics
47
What to use for systemic complaints or scratchy/sore throat
acetaminophen
NSAIDs
48
Key point of runny nose
histamine is not the the cause of a runny nose
49
First generation antihistamines ______ relieve a runny nose from the common cold
MIGHT (anticholinergic activity)
50
Effectiveness of first gen antihistamines in runny nose
reduce sneezing
adults: some effectiveness
children: ineffective for the common cold
(No way to predict if patient will respond)
51
Adverse effects of first gen antihistamine in runny nose
drowsiness/sedation
drying effect (thickened nasal discharge, increase duration of nasal congestion)
52
Precautions of first gen antihistamine in runny nose
narrow angle glaucoma
urinary retention (worsen BPH)
53
Available ingredients in first gen antihistamine in runny nose
Doxylamine succinate (nyquil)
Chlorpheniramine maleate (most common)
Brompheniramine (Dimetapp)
Diphenhydramine ("nighttime" use)
-6 year age limit
54
Nasal Decongestants MOA
sympathomimetic activity
alpha-receptor stimulation constricts blood vessels in the nasal mucosa
55
FDA approved uses nasal decognestants
temporarily relief of sinus congestion and pressure
nasal congestion due to the common cold, hay fever or other upper respiratory allergies
56
Dosage Forms for nasal decongestants
Oral
Topical - nasal sprays and vapor inhalers
57
Pseudoephedrine (sudafed)
has cardiac effects due to beta-receptor stimulation (not for CV disease)
crosses BBB acts as CNS stimulant (cause insomnia)
58
Pseudoephedrine immediate release dosages
30mg tab, 15mg/5ml liquid
4-6 hours up to 4 doses/24 hours
>12 60mg (max 240mg)
6-11 30mg (max 120mg)
4-5 15mg (max 60mg)
59
Pseudoephedrine sustained release dosage
120mg SR tab q12hrs or 240mg ER tab doses q24hrs
age: >12 years
60
Issues with Pseudoephedrine (sudafed)
legal (minimize drug diversion for methamphetamine production)
CNS stimulation
wearing off of SR or ER products
61
Phenylephrine HCL (Sudafed-PE)
low oral bioavailability due to extensive 1st pass effect and erratic absorption
short half-life
(not for CV patients)
decrease CNS stimulation than Phenylephrine HCL
62
Dosage form Phenylephrine HCL immediate release
10mg tabs, 2.5mg/5ml
q4hrs up to 6 doses per day
>12 yrs 10mg (max 60mg)
6-11 yrs 5 mg (max 30mg)
4-5 2.5 mg (max 15mg)
63
Issues with phenylephrine
controversy over efficacy
CNS stimulation (less common)
64
Contraindication with Phenylephrine HCL
patients using antidepressant drugs MAO-I
(could give hypertensive crisis)
Nardil (phenelzine)**
Parnate (tranylcypromine)
Marplan (isocarboxazid)
65
Pregnancy indications in nasal decongestants
do not use except under physician advice
no self care
vasomotor rhinitis cause by increase estrogen and pregnancy causes this
66
Lactation and Breastfeeding in nasal decongestants
Phenylephrine not compatible
Pseudoephedrine is okay?? (known to decrease milk production) -> talk to physician
67
Topical Nasal Decongestants MOS
sympathomimetic vasoconstrictor; act locally on the nasal mucosa; acts very rapidly
68
Liquid nasal sprays
age limitation depends on drug
usually >6 or >12 yo
Parents should be discouraged from using these products in children
69
Oxymetazoline
administered q10-12 hours (max 2 doses in 24 hrs)
>12 yo
Afrin
70
Phenylephrine
q4hrs
pts >6 or >12 yo
Neosynephrine
71
Warnings for nasal decongestants
heart disease
high BP
difficulty urinating due to enlarge prostate
rebound congestion (rhinitis medicamentosa, when drug wears off)
do not use longer than 3 days
72
When might the nasal sprays be appropriate to consider recommending
when someone can not take sudafed
take at bedtime (no insomnia)
73
Vapor Inhaler (medicated) age
>6 yo
(can use in cardiac disease)
74
Ingredients in vapor inhalers
levmetamfetamine
-max use 7 days
propylheadrine
-max 3 days
75
Purpose of coughing
defensive mechanism; clears airways of inhaled or foreign material, excess mucus, abnormal secretion such as fluid, blood, pus
76
Non-productive cough/dry cough/hacking cough
-stimulated by a mechanical irritant, other type of irritant or inflammation
-excessive coughing can cause damage to respiratory structures
(can suppress cough with drugs)
77
Productive cough/wet cough
-associated with an underlying inflammatory process
-secretions may be clear, purulent, discolored, blood-tinged or foul-smelling
-self-care may not be appropriate based on other symptoms
78
Appropriate use of expectorants/protussive ingredients
to make an ineffective produce cough become productive
(increase effectiveness of cough by making mucus thinner)
79
guaifenesin (mucinex) dosing and adverse effects
should be taken with water to make more effective
> 12 yrs higher dose
>4 yo peds dosing
80
guaifenesin (mucinex) adverse effects
nausea
GI upset
81
cough suppressant/antitussive ingredient appropriate use
for some nonproductive coughs (dry cough)
82
dextromethorphan (delsym)
non-narcotic; no addictive properties at normal antitussive doses
no sedative, analgesic, or respiratory depressive properties at normal doses
83
dextromethorphan (delsym) MOA
acts centrally in the medulla
depresses the cough center which increases the cough threshold
84
dextromethorphan (delsym) dosing
>12 max, 10-20 mg q4hr, 120mg/24 hrs
>4 peds
(OHIO legal issue 18yo to purchase w/ prescription)
85
dextromethorphan (delsym) contraindications
in people taking or w/in 14 days of using MAOI antidepressant
DM
serotonin syndrome
86
What patient types are at high risks for flu
65 yo and older
people with chronic medical conditions
pregnant women
younger children
87
For 1st gen antihistamines label warning now include do NOT use "..."
to make child sleepy
88
Modification of OTC cough and cold products to state do not use in children under ___ yo
4
89
Patient assessment indications
allergy
common cold
flu
90
Patient assessment symptoms
how bothersome
options for treatment
side effects
91
Patient assessment patient factors
age
allergies
medical conditions
medications
pregnancy
breastfeeding
92
RDA (recommended dietary allowance)
nutrient intake that meets the needs of ~98% of healthy Americans
developed by the National Academy of Sciences
subdivided by sex and age
93
RDI (reference daily intake)
established by FDA
based on RDA values
94
% Daily Value (DV) calculation
(# nutrient per serving/RDI) *100
95
AI (adequate intake)
when insufficient evidence exists to set an RDA
96
UL (tolerable upper intake level)
highest level of daily nutrient intake that is likely to pose no adverse health risk for almost all individuals in the general population
97
What are the fat-soluble vitamins
A: retionol bio active, beta carotene (from animals)
D: D2 and D3 in foods, supplements
E: (alpha-tocopherol)
K: synthesized by intestinal bacteria
98
What are the water-soluble vitamins
C: ascorbic acid (antioxidant, immune function, blood vessels, collagen)
99
What are the actual names of vitamin B1, B2, B3, B5, B6, B7, B9 and B12
B1: thiamine
B2: riboflavin
B3: niacin
B5: pantothenic acid
B6: pyridoxine
B7: biotin
B9: folate
B12: cobalamin
100
Populations of concern for vitamin B9 (folic acid)
women of childbearing age
pregnant women (w/o can lead to neural tube birth defects)
alcoholism/malabsorption disorders
101
The labeling of folic acid supplements has changed to account for what
the bioavailability of synthetic folic acid is greater than the folate in foods
102
RDA of adult females and pregnant females for folic acid
adult: 400 mcg DFE
pregnant: 600 mcg
103
UL of folic acid
1000 mcg
104
Vitamin B12 (cobalamin) RDA
2.4 mcg/day
105
populations of concern for cobalamin
vegans
adults >50 yo (from decrease in stomach acid secretion)
people who use PPIs
patients on longterm metformin
106
Irons
mineral required for adequate hemoglobin and functioning of RBCs
107
UL of iron
45 mg (can be hard to tolerate)
108
what does tannins in coffee and tea do to iron
decrease absorption
109
what does vitamin C do to iron
increase absorption
110
Magnesium
electrolyte cofactor involved in a wide variety of functions and processes in the body
111
RDA and UL of magnesium
males 400mg
females 300mg
UL: 400 mg
112
Common uses for magnesium
constipation
muscles
insomnia
113
Who should not take magnesium
people with severe kidney disease
114
Who might benefit from taking a multivitamin
-eat poorly due to disease, socioeconomic, EtOH abuse, older age
-eliminate a variety of food sources from their diet
-malabsorption problems
(fills gap in diet)
115
Safety issues for multivitamins
children
elderly (tough to swallow pills)
116
What is heartburn
a symptom of burning sensation in the chest that can spread to neck and back (usually w/in 1 hr of eating)
117
What is episodic heartburn
infrequent/occasional
may be associated with diet/lifestyle
118
What is frequent heartburn classified as
>2 days per week
119
What is dyspepsia
Symptoms of epigastric discomfort; pain, burning, fullness, early satiation, bloating, belching, nausea
120
What is GERD (gastroesophageal reflux disease)
Disease with esophageal symptoms or tissue injury from gastric acid flowing back into the esophagus or beyond
121
Typical Symptoms of GERD
frequent heartburn
regurgitation
water brash
122
Atypical Symptoms of GERD
noncardiac chest pain
asthma
laryngitis, hoarseness, chronic cough, pnemonitis
dental erosion
globus sensation
123
What is PUD (peptic ulcer disease)
disease with sores/ulcers in stomach lining or duodenum
124
Pathophysiology of heartburn: Anti-Reflux Barriers
lower esophageal sphincter
diaphragmatic crura
phernoesophageal ligaments
acute angle of His
125
Pathophysiology of heartburn: esophageal acid clearance
peristalsis
saliva secretions
gravity
126
Pathophysiology of heartburn: tissue resistance
blood supply replenishes tissues w/ nutrients and removes hydrogen and CO2
127
Risk factors of heartburn
diet
lifestyle
diseases (motility disorders, PUD, scleroderma)
medications
genetics
pregnancy
128
Exclusions for self-care of heartburn
>3 months
symptoms while taking H2RA or PPI
severe heartburn
nocturnal
difficulty swallowing foods
vomiting blood
chronic coughing
chest pain
129
Goals of treatment for heartburn
provide symptom relief
reduce recurrence of symptoms
prevent and manage unwanted side effects of meds
130
Non-pharm therapy of heartburn
avoid certain foods, large meals, lying down after eating
weight loss
elevate head of bed (6-8 inches)
smoking cessation
limit alcohol and caffeine
131
Pharm therapy of heartburn
antacids
132
Antacids approved OTC use (>2 yo)
mild, infrequent, acid indigestion
(combo w/ ASA or APSP may be used for over eating, drinking, or hangover)
133
Characteristics of antacids
Rapid relief (<5 min)
Brief Duration (only as long as present in stomach)
134
MOA of antiacids
neutralizes gastric acid
increase LES pressure
act as a buffer
135
Potency of antiacids
based on mEQ of ANC (acid neutralizing capacity)
-amount of acid buffered per dose over specified time
-must have at least >5 mEQ per dose
calcium carb > sodium bicarb > magnesium salts > aluminum salts
136
Drug interactions of antiacids: antacid binding
attaches to different drug affected absorption
separate doses by 2-4 hrs
(tetracyclines, fluoroquinolones, azithromycin)
137
Drug interactions of antiacids: pH changes
disintegration, dissolution, ionization of drug changes affecting absorption
separate doses by 2 hrs
(ketoconazole, itraconazole, iron)
138
Alginic acid
inactive ingredient in gaviscon
best taken after eating
more effective if standing
139
Alginic acid MOA
combines w/ sodium bicarb in saliva to form sodium alginate
viscous layer floats on surface of stomach contents acting a protectant/barrier to esophagus
140
H2RAs approved use >12 yo
treats mild-moderate episodic heartburn
prevents heartburn and acid indigestion when anticipated due to triggers
141
H2RAs MOA
reversibility inhibit histamine on H2 receptor of the parietal cell decreasing acid production
good for fasting or nocturnal symptoms
142
Potency of H2RAs
can sub for one another (low -> low dose or high -> high)
143
Drug interactions with H2RAs: pH changes
disintegration, dissolution, ionization of drug changes affecting absorption
avoid longer durations
(ketoconazole, itraconazole, iron)
144
Drug interactions with H2RAs: cimetidine
inhibit various CYP enzymes
avoid interactions with warfarin, theophylline, phenytonin
145
PPIs approved use >18 yo
Treats frequent heartburn (no more than 4 months)
Take 30-60 min before breakfast
146
PPIs characteristics
slower onset
longer duration
147
PPIs MOA
irreversibly inhibit hydrogen potassium ATPase (proton pump) of parietal cell blocking secretion with longer effects than H2RAs
148
PPIs potency
clinically equally effective and interchangeable
some individuals respond better to different drugs
149
PPIs drug interactions: pH changes
disintegration, dissolution, ionization of drug changes affecting absorption
avoid longer durations
(ketoconazole, itraconazole, iron)
150
PPIs drug interactions: Inhibits CYP2C19
increases drug concentration or reduce conversion to active forms
151
Bismuth Subsalicylate
treat heartburn, upset stomach indigestion, nausea every 30-60 min as needed
avoid in children (Reyes syndrome)
advise that stool and tongue turn black
152
Bismuth Subsalicylate MOA
uncertain, but believed to be topical effect
153
What heartburn drugs are not used in pregnancy
H2RAs
PPIs
(antacids are recommended)
154
What are the antiacid drugs
calcium carbonate
magnesium hydroxide (milk of magnesium)
aluminum hydroxide
sodium bicarbonate
155
What are the H2RA drugs
Famotidine (pepcid)
Cimetidine (tagamet)
156
What are the PPI drugs
Omeprazole (Prilosec)
Lansoprazole (Prevacid)
Esomeprazole (Nexium)
Omeprazole (Zegrid)
157
What are the overweight, obesity, and extreme obesity classifications for BMI
overweight: 25-29.9
obese: 30-39.9
extreme: >40
158
Waist circumference assesses what
distribution of adipose tissue
159
What is the worst kind of obesity
Central (fat around the waist)
component of metabolic syndrome
160
What is a higher risk waist circumference
male: >40 inches
female: >35 inches
161
What is a low calorie diet for females and males
females: 1200-1500
males: 1500-1800
162
According to the obesity guidelines physical activity to lose weight is what
not an effective way to lose weight
163
What are the changes in behavior for lifestyle modifications in obesity
social support
self-monitoring calories
stimulate control, problem solving, and cognitive strategies
164
What are the 4 strategies for weight loss
>1 yr maintenance prograns
weighting at least once a wk
continue reduced calorie diet
high levels of physical activity (~300 min/wk)
165
What is the recommended weight loss goals
decrease weight by 5-10% w/in 6 months
166
Non-prescription pharmacotherapy orlistat MOA
intestinal lipase inhibitor
(you will increase your weight loss more than 50% then if you would just go on a weight loss diet)
167
What is the required lifestyle modification of taking orlistat
low-fat diet (less than 15g of fat)
(can cause flatulence with discharge)
take a multivitamin at bedtime
168
What is the selected dietary supplements promoted for weight loss
chromium
picolinate
helps with carb metabolism
169
What are the three supplements that claim to increase energy expenditure
caffeine
green tea extracts (hepatotoxicity problems)
bitter orange (causes CNS stimulation and cardio effects)
