Exam 2 Mechanism of Action, Drug Classes & Drugs, Side Effects Flashcards
1
Q
What does histamine cause?
A
- vasodilation
- ↑ capillary permeability
- smooth muscle constriction
2
Q
Antihistamine Mechanism of Action
A
act as antagonist (block) at H1 receptors
3
Q
Antihistamine Side Effects
A
- dizziness
- tinnitus
- incoordination
- blurred vision
- nervousness
- constipation
- weight gain
- insomnia
- tremors
*** paradoxical reaction - drowsiness
4
Q
First Generation Antihistamine Drugs
A
- hydroxyzine
- meclizine
- promethazine
5
Q
What are first generation antihistamines used for?
A
nausea & vomiting
6
Q
Second Generation Antihistamine Drugs
A
- Cetirizine (zyrtec)
- Levocetirizine
- Loratadine (Claritin)
7
Q
Which antihistamines are sedating & which are non-sedating?
A
1st Generation = sedating
2nd Generation = non-sedating
8
Q
Second Generation Antihistamine Mechanism of Action / what is unique about them?
A
C- cannot cross BBB
- not as effective for N/V
9
Q
Characteristics of Parkinson’s
A
- limb rigidity
- tremor
- bradykinesia (slow moving)
- depression, psychosis, anxiety, dementia, etc.
10
Q
If Parkinson’s disease is caused by too much activity of the GABA neuron due to loss of dopamine, what are the main options for treating Parkinson’s?
A
vast majority of drugs help the brain make more dopamine or are drugs that act like dopamine. You can also use drugs that block ACh.
11
Q
What is the main underlying pathophysiological deficit in Parkinson’s Disease?
A
loss of dopamine releasing neurons in the nitro-striatal pathway
12
Q
How do drugs that stimulate Dopamine effect the CNS & PNS / what do Dopamine stimulating drugs cause in the CNS & PNS?
A
CNS: voluntary movement, cognition, motivation, reward/punishment, sleep, inhibition of prolactin
PNS: BP regulation, regulation of peristalsis (inhibition), N/V
13
Q
Drug Classes used for Parkinson’s Disease
A
- Dopamine Precursor
- Dopamine Agonists
- Anticholinergic Agents
14
Q
Drugs for Parkinson’s Disease
A
- Levodopa (DA precursor)
- Pramipexole (DA agonist)
- Ropinirole (DA agonist)
- Benztropine (Anticholinergic)
15
Q
Dopamine Precursor Drugs for Parkinson’s Disease
A
Levodopa
16
Q
Levodopa Mechanism of Action
A
neurons can turn Levodopa into dopamine
17
Q
What is Levodopa given with and why?
A
Carbidopa to prevent Levodopa from becoming dopamine outside of the brain
18
Q
Side Effects of Levodopa (Dopamine Precursor)
A
- Dyskinesia (80%)
- “Wearing Off”
- “On-Off”
- N/V
- Orthostatic Hypotension
- Psychosis
- Sedation
19
Q
What is “Wearing Off”?
A
↓ Drug Concentrations = ↑ symptoms
20
Q
What is “On-Off”?
A
can happen at any time; not related to concentration
- pt is doing well, then suddenly symptoms come back
21
Q
Dopamine Agonist Drugs
A
- Pramipexole
- Ropinerole
22
Q
Side Effects of Dopamine Agonists
A
- ↑ hallucinations
- sleepiness
- orthostatic hypotension
- **Impulse Control Disorder **
- N/V
23
Q
Dopamine Precursor Drugs for Parkinson’s, Mechanism of Action, Contraindications, & Side Effects
A
Levodopa
MOA: neurons can convert it to dopamine
SE: dyskinesia, “wearing off”, “On-Off”, N/V, orthostatic hypotension, psychosis
Contraindication: do NOT give with food, it’ll slow absorption
24
Q
Dopamine Agonist Drugs & Side Effects
A
Pramipexole & Ropinirole
SE: hallucinations, sleepiness, orthostatic hypotension, N/V, syncope, & IMPULSE CONTROL DISORDERS
25
What are Anticholinergic / Anti-muscarinic effects?
Block the parasympathetic NS (rest & digest)
CAUSES SLUD
- dry mouth
- dry eyes
- urinary hesitancy
- constipation
- tachycardia
26
Anticholinergic Drugs for Parkinson's Disease
Benztropine
27
Anticholinergic Mechanism of Action
block Acetylcholine at muscarinic receptors
28
Side Effects of Antichoinergic Drugs for Parkinson's Disease
- drowsiness
- inattention
- confusion
- delusions
- memory problems
29
Anticholinergic Drugs for Parkinson's Disease, MOA, & Side Effects
Benztropine
MOA: blocks ACh at muscarinic receptors
SE: drowsiness, confusion, memory problems, delusions, inattention
30
Donepezil Mechanism of Action
↑ acetylcholine in the brain
- first line of action for Alzheimer's
31
Donepezil (cholinesterase inhibitor) side effects
- N/V
- diarrhea
- headache
- bradycardia
- salivation
- sweating
- muscle weakness
AVOID STOPPING SUDDENLY
32
Alzheimer's Drugs
- Donepezil
- Memantine
33
Memantine Mechanism of Action
blocks glutamate receptor activation
- moderate to severe alzheimer's
34
Donepezil (cholinesterase inhibitor) side effects
- N/V
- diarrhea
- headache
- bradycardia
- salivation
- sweating
- muscle weakness
AVOID STOPPING SUDDENLY
35
Memantine Side Effects
- constipation
- confusion
- dizziness
36
(Organic) Nitrate Drugs
- Nitroglycerin
- Isosorbide mononitrate
37
What is the shelf-life of Nitrates?
3-5 months after you first open the bottle
38
What is asynchronous dosing?
an uneven interval of time between doses
- BID could mean one dose at breakfast, one with lunch, & nothing until breakfast the next day
39
What are Nitrates used to treat?
- angina
- hypertension
- heart failure
40
Nitrate mechanism of action
vasodilator (mainly the veins)
41
Side Effects of Nitrates
- headache
- orthostatic hypotension
- reflex tachycardia
42
Contraindications of Nitrates
Risk of Rapid Development of Resistance
- use lowest dose possible
- need 8 hrs without drugs in system per day
Cannot be used with hypotensives
43
(Organic) Nitrate Drugs, Mechanism of Action, Side Effects, & Contraindications
- Nitroglycerin
- Isosorbide mononitrate
MOA: vasodilator (donates a nitric oxide to blood vessels)
SE: headache, orthostatic hypotension, reflex tachycardia
Contraindications:
- need 8 hr / 24 hrs drug free
- do not take with hypotensive (can ↓ BP too much)
44
Hypothyroidism Drugs
Levothyroxine - synthetic T4
Thyroid - synthetic T3 & T4
45
Contraindications of Hypothyroidism Drugs
Give on EMPTY STOMACH
- Chelation (↓ absorption)
- Enzyme Inducers (↑ metab)
46
Symptoms of Hypothyroidism
- lethragy
- fatigue
- cold, dry skin
- cold intolerance
- hair loss
- ↑ cholesterol
47
Hypothyroidism Drugs & Contraindications
Levothyroxine (T4)
Thyroid (T3 & T4)
CONTRAINDICATIONS
- give on empty stomach
- chelation (↓ absorption)
- enzyme inducers (↓ metab)
48
Symptoms of Hyperthyroidism
- heat intolerance
- palpitations
- weight loss
- exophthalmos
- anxiety
- diaphoresis
49
Drugs for Hyperthyroidism
Methimazole
50
Anti-Thyroid Drugs Mechanism of Action
- inhibits synthesis of T3 & T4
51
Side Effects of Anti-Thyroid Drugs
- agranulocytosis
- hepatitis or hepatic failure
52
Anti-Thyroid (Hyperthyroidism) Drugs, MOA, & SE
Methimazole
MOA: blocks synthesis of T3 & T4
SE: agranulocytosis & liver disease
53
Types of Opioids
Opioid Agonists
Mixed Agonist-Antagonist
Opioid Antagonist
54
Opioid Agonist Drugs
- Morphine
- Oxycodone
- Hydrocodone
- Hydromorphone
55
Mixed Opioid Agonist-Antagonist Drugs
Buprenorphine
56
Opioid Antagonist Drugs
Naloxone (narcan)
57
Side Effects of Opioid Agonists
***Respiratory Depression ***
- Constipation
- Sedation
- orthostatic hypotension
- urinary retention
- ↑ intracranial pressure
58
Opioid Agonist Drugs, Mechanism of Action, & Side Effects
Morphine
Oxycodone
Hydrocodone
Hydromorphone
MOA: agonist at mu & kappa receptors
SE: ***Respiratory Depression***, constipation, sedation, euphoria, orthostatic hypotension, emesis, cough reflex, ↑ intracranial pressure
59
What is cross-tolerance?
occurs when developing a tolerance for 1 substance leads to tolerance for another substance
60
How do you prevent cross-tolerance with opioids?
Reduce "equianalgesic" dose by 25-50%
61
When does physical dependence of opioids become a concern?
- with chronic use (2+ weeks)
- do NOT stop suddenly
1.) yawning, rhinorrhea, sweating
2.) anorexia, irritability, tremor
3.) violent sneezing, weakness, N/V, diarrhea, abdominal cramps, muscle spasm
62
What is Pharmacogenetics?
how genetics influence people's responses to drugs
63
What role dose CYP2D6 play in terms of Codeine?
CYP2D6 turns Codeine into Morphine in the liver
64
Dual Action Opioid Agonist Drugs
Tramadol
- weak receptor agonist
- less potent opioid-like effects
- can treat neuropathic pain
65
Mixed Agonist-Antagonist Drugs
Buprenorphine (suboxone)
66
What is Buprenorphine used to treat in some cases?
opioid dependence
67
Side Effects of Mixed Agonist-Antagonist Drugs
hallucinations
dysphoria (negative feeling)
potential
68
Mixed Agonist-Antagonist Drugs & Side Effects
Buprenorphine (suboxone)
Se: hallucinations, dysphoria (negative feelings), analgesic ceiling
69
What is Analgesic "Ceiling"?
there's a maximum pain relief effect you can expect
70
Opioid Antagonist Mechanism of Action
block or prevent the activation of opioid receptors
71
Opioid Antagonist Drugs
Naloxone (narcan)
72
How do Opioid Antagonists work centrally and peripherally?
CENTRAL: overdose, abuse deterrent (also weight loss & EtOH dependence)
PERIPHERAL: treatment of opioid-related constipation & post-operative ileus
73
Opioid Antagonist Drugs, Mechanism of Action, & How they work centrally & peripherally
Naloxone (narcan)
MOA: block / prevent activation of opioid receptors
CENTRALLY: overdose, abuse deterrent (also for weight loss & EtOH dependence)
PERIPHERALLY: treatment of opioid-related constipation
74
Nonsteroidal Antiinflammatory Drugs (NSAIDs) Mechanism of Action
Prevent the production of prostaglandins by blocking COX-1 & COX-2
75
How do NSAIDs effect temperature set point, pain, & inflammation?
↓ temperature set point
↓ pain
↓ inflammation
76
NSAID Drugs
- Ibuprofen
- Meloxicam
- Naproxen
-Diclofenac
-Celecoxib
77
Which NSAIDs are Non-specific & which are specific?
Non-specific: inhibit COX-1/2
- iburprofen
- meloxicam
- naproxen
- diclofenac
Specific: inhibit COX2
- Celecoxib
78
Side Effects NSAID Toxicicites
- hypertension
- ↓ renal function
- ↓ platelet function
- fluid retension
- GI bleeds / ulcers
- hepatotoxicity
- bronchospasm
79
NSAID Drugs, Mechanism of Action, & Side Effects from Toxicities
- Ibuprofen
- Meloxicam
- Naproxen
- Diclofenac
- Celecoxib (inhibit COX-2)
MOA: prevent the production of prostaglandins by inhibiting / blocking COX-1 & COX-2
SE: ↓ renal function, ↓ platelet function, hypertension, GI bleeds / ulcers, fluid retention, bronchospasm, hepatotoxicity
80
NSAID Related GI Bleed Management
Who is at high risk?
What are treatment options?
HIGH RISK
- on aspirin, warfarin, steroids
- prior hx of GI bleeds/ulcers
- 65+ years old
TREATMENT OPTIONS
- misoprostol (synthetic prostaglandin)
- PPI (↓ stomach acid)
- change to COX-2 agent
81
What does it mean that COX-1 is constitutively expressed?
COX-1 is always around, all day every day
82
What does it mean that COX-2 is inducible?
COX-2 is only present during injury or inflammation
83
What is the difference in terms of when COX-1 & COX-2 are present?
COX-1 is ALWAYS around (constitutively expressed) & COX-2 is only present during injury or inflammation (inducible)
84
Guidelines & Contraindications of Ketorolac (Toradol)
- Super NSAID
- maximum of 5 days use
- dose adjustment for 65+ or less than 50 kg
CONTRAINDICATIONS
- prior / active ulcer
- advanced renal dx or ↑ risk
- ↑ risk of bleeding
- on aspirin, NSAID, or probenecid (for gout)
85
Acetaminophen Mechanism of Action
blocks prostaglandin production, but only works in the brain (centrally)
- reduces pain & lowers temperature (does not help with swelling)
86
Toxicity associated with Acetaminophen
liver damage / toxicity is a concern but is much LESS common than GI bleeds with NSAIDs
87
Acetaminophen Risk Factors & FDA Actions
***leading cause of acute liver failure***
*Hi*
Risk Factors: ↑ doses, EtOH use, chronic liver disease
FDA ACTIONS: restrict dose in combo products to 325 mg & consider limiting maximum doses
88
Acetaminophen MOA, toxicity, risk factors, & FDA Actions
MOA: inhibits production of prostaglandins in the brain (centrally)
Toxicity: concerned with liver toxicity, but is less common than GI Bleeds with NSAIDs (leading cause of acute liver failure)
Risk Factors: ↑ doses, EtOH use, chronic liver disease
FDA Actions: restrict dose in combo products to 325 mg & consider limiting maximum doses
89
Steroids Mechanism of Action
Change gene transcription
- increase / decrease translation of certain genes
90
What do steroids play an important role in?
maintaining blood glucose levels & blood pressure
91
What is HPA Axis Suppression & what are the clinical consequences?
HPA AXIS SUPRESSION: if a patient takes steroids at a high dose for a long time, the body recognizes the steroids as cortisol which tells the HPA Axis to stop producing cortisol & shut off.
CONSEQUENCES:
1.) ADRENAL ATROPHY (shrink/shrivel) - TAPER OFF
- NOT stop steroid suddenly (taper dose allows HPA axis / adrenal glands to 'wake up')
2.) STRESS DOSING - short term ↑ in steroid dose to account for physical stress (prior to surgery, after a trauma / MVA, etc.)
92
Side Effects of Steroids
- ↑ risk of infection
- leukocytosis (↑ WBC count not from infection)
- growth retardation
- cataracts
- oral candidiasis
93
Steroid Related Immunosupression
Doses greater than 20 mg / day for 2+ weeks
94
What is Mineralcorticoid Potency in terms of Steroid Comparison?
ability of the kidneys to hold onto sodium & water
95
Compare the mineralocorticoid potency of prednisone, methylprednisolone, & hydrocortisone from highest to lowest potency.
Hydrocortisone (2)
- ↑ability to retain H2O & NA+
Prednisone (1)
Methylprenisolone (0)
- no ability to retain Na+ & H2O; can lead to ↓ BP
96
Corticosteroid Drugs
- fluticasone
- budesonide
- triamcinolone
- beclomethasone
97
Corticosteroid Drugs, MOA, & SE
Fluticasone
Budesonide
Triamcinolone
Beclomethasone
MOA: change gene translation
SE: HPA-Axis Suppression; leukocytosis (↑ WBC count); ↑ risk of infection; growth retardation; cataracts
98
What are the 2 ways to treat Gout?
1.) ↓ uric acid concentrations in the blood & body
2.) ↓ immune response to uric acid crystals
99
Drugs for treating Gout
Allopurinol (chronic)
Colchicine (acute)
100
Xanthine Oxidase Inhibitor Drug, purpose, SE, & contraindications
Allopurinol
- for chronic gout
SE: liver damage (abnormal LFTs); SCAR (severe skin rxn); genetic predisposition
Contraindications: anti-cancer drugs
101
Colchicine Purpose, MOA, & SE
for acute gout episodes
MOA: impairs WBCs (leukocytes) so they cannot get to the tissue & cause inflammation (prevents inflammation)
SE: N/V, Diarrhea, abdominal pain, rhabdomyolysis, seizures, bone marrow suppression, renal failure, hepatotoxicity
102
Colchicine MOA
impairs WBCs so they cannot migrate to tissue & cause inflammation
103
Colchicine Side Effects
- N/V
- Diarrhea
- Abdominal Pain
- Bone marrow suppression
- Renal failure
- Hepatotoxicity
- Seizures
- Rhabdomyolysis
104
Drug classes used for migraine treatment
- aspirine, NSAID, opioids
- antiemetics
- ergot alkaloids
- serotonin receptor agonists
- prophylactic agents
105
Ergot Alkaloid (DHE) Mechanism of Action
Serotonin agonist at the 5-HT1 receptors - stimulates serotonin production
- also stimulates alpha, beta, & dopamine receptors
106
Side Effects of Ergot Alkaloids
chest tightness
cold, numb, painful extremities
paresthesias
↓ peripheral puulses
107
Contraindications of Ergot Alkaloids
avoid with uncontrolled HTN, CAD/CVD, PVD, & pregnancy
108
Ergot Alkaloids should not be taken within 24 hours of taking what other drug class?
Serotonin Receptor Agonists (Triptans)
109
Ergot Alkaloids (DHE) MOA, SE, & Contraindications
MOA: serotonin agonist at 5-HT1 receptor (stimulates serotonin; also works to stimulate alpha, beta, & dopamine receptors)
SE: chest tightness; cold, numb, painful extremities; paresthesias; ↓ perisperhal pulses
CONTRAINDICATIONS: avoid with uncontrolled HTN, CAD/CVD, PVD, pregnancy
110
Serotonin Receptor Agonists Mechanism of Action
stimulate specific serotonin receptors (5-HT 1B/1D)
- normalize dilated intracranial arteries
111
Serotonin Receptor Agonists Side Effects
- paresthesias
- fatigue
- dizziness
- flushing
- "chest symptoms" (15-50%
112
Serotonin Receptor Agonists Contraindications
- don't take within 24 hours of an ergot alkaloid
- be careful with SSRIs
113
Serotonin Receptor Agonist Drugs
Rizatriptan (maxalt)
Sumatriptan (imitrex)
114
Serotonin Receptor Agonist Drugs, MOA, SE, & Contraindications
Rizatriptan (maxalt)
Sumatriptan (imitrex)
MOA: stimulates specific serotonin receptors (5-HT 1B/1D)
SE: paresthesias, fatigue, dizziness, flushing, "chest symptoms" (15-50%
Contraindications: avoid within 24 hrs of ergot alkaloid & be careful with SSRIs
115
Antiemetic Drugs
** Ondansetron (Zofran)
ANTIHISTAMINES: hydroxyzine & meclizine
ANTIPSYCHOTIC: promethazine (phenergan)
116
Antiemetic Mechanism of Action
5-HT3 Antagonist - blocks serotonin receptor
117
Side Effects of Antiemetics
- prolonged QT-interval
- constipation
- headache
118
Beta-2 Adrenergic Agonists Mechanism of Action
Binds to & activates the Beta-2 receptor
- smooth muscle relaxation (in bronchioles)
- mast cell stabilization (makes it harder for mast cells to release histamine)
119
What are Beta-2 Adrenergic Agonists used to treat?
Asthma & COPD
120
Side Effects of Beta-2 Adrenergic Agonists
- tremor
- tachycardia
- nervousness
- hypokalemia
121
FDA Warnings of Long-Acting Beta-Agonists (LABAs)
1.) must be used with another controller agent
2.) only used if asthma isn't controlled by the other gucocorticoid (controller agent)
3.) used for as short a duration as possible
4.) when possible use combo products
122
What can overuse of a long-acting beta agonist cause?
↓ beta receptor sensitivity
123
Beta-2 Adrenergic Agonist Drugs
SHORT ACTING: albuterol
LONG ACTING
- Salmeterol
- Formoterol
- Vilanterol
124
Short Acting Beta-Adrenergic Agonist Drugs
Albuterol
125
Long Acting Beta-Adrenergic Agonist Drugs
Salmeterol
Formoterol
Vilanterol
126
What are the advantages & disadvantages of using inhalers?
ADVANTAGES
1.) more direct access & a faster onset
2.) less systemic side effects (works directly on the lungs)
DISADVANTAGES
1.) technique (adequate spacing from mouth & timing of breath)
2.) Very severe asthma - patient must be able to move air in order for these to work
127
Beta-2 Adrenergic Agonist Drugs, Mechanism of Action & Side Effects
Albuterol (short acting)
Salmeterol (long acting)
Formoterol (long acting)
Vilanterol (long acting)
MOA: smooth muscle relaxation (of bronchioles) & mast cell stabilization (harder for mast cells to release histamine)
SE: tremor, tachycardia, nervousness, hypokalemia
128
Leukotriene Modifying Agents Mechanism of Action
reduce inflammation & bronchoconstriction
129
Leukotriene Modifiers (LTD4 Antagonists) Drugs
Montelukast
130
Leukotriene Modifiers - LTD4 Antagonist Side Effects
- headache
- GI upset
- ↑↑ LFTs
- suicide risk
- vivid nightmares
- agression & depression
131
Leukotriene Modifiers Drugs, MOA, & SE
Montelukast
MOA: reduces inflammation & bronchoconstriction
SE: headache, GI upset, ↑ LFTs, suicide risk, anxiety & depression, vivid nightmares, aggression
132
Inhaled Anticholinergic Agent Drugs
Ipratropium
Tiotropium
Umeclidinium
133
Inhaled Anticholinergic Agents Mechanism of Action
dilate airways by blocking acetylcholine
134
Side Effects of Inhaled Anticholinergic Agents
ANTICHOLINERGICS CAUSE SLUD
- dry mouth
- dry eyes
- urinary hesitancy
- constipation
- Tachycardia
135
Which of these is LEAST likely to cause sedation?
a.) meclisine
b.) cetirizine
c.) loratadine
d.) hydroxyzine
loratadine (c)
136
Which of these drugs is used to treat nausea & vomiting via its antihistamine, anticholinergic, & anti-dopamine effects?
a.) promethazine
b.) carbidopa
c.) loradatine
d.) benztropine
promethazine (a)
137
Impulse control disorders have been most often associated with what drugs?
a.) Gen. 1 antihisatmines
b.) levodopa /carbidopa
c.) central anticholinergics
d.) dopamine receptor agonists
dopamine receptor agonists (c)
138
Which of these describes the phenomenon where a patient's Parkinson's symptoms abruptly return, despite adequately high serum levodopa concentrations?
a.) wearing off
b.) dyskinesia
c.) food-drug interaction
d.) on / off
on / off (d)
139
Disorientation, confusion, dementia, & memory problems are all side effects most likely to be seen with what drug?
a.) levodopa / carbidopa
b.) pramipexole
c.) ropinerole
d.) benztropine
benztropine (d.)
140
How is food likely to impact levodopa therapy?
a.) it may substantially enhance its actions by enhancing its appearance in the brain
b.) it may delay its absorption & onset of actions
c.) it is unlikely to have any significant impact
d.) patients need to eat a low protein diet to ensure levodopa still works
it may delay its absorption & onset of actions (b.)
141
which of these drugs is a dopamine receptor agonist?
a.) benztropine
b.) pramipexole
c.) promethazine
d.) levodopa
pramipexole (b.)
142
"Antimuscarinic effects" would be expected to include which of the following?
a.) bradycardia
b.) diarrhea
c.) excessive salivation
d.) dry eyes
dry eyes (d.)
143
Math the given drugs to their actions or class:
isosorbide mononitrate (Ismo)
memantine (namenda)
donepezil (aricept)
hydromorphone (dilaudid)
methimazole (tapazole)
1.) opioid receptor agonist
2.) NMDA glutamate receptor
3.) anti-thyroid agent
4.) organic nitrate
5.) cholinesterase inhibitor
1.) opioid receptor agonist: HYDROMORPHONE (Dilaudid)
2.) NMDA glutamate receptor: MEMANTINE (Namenda)
3.) anti-thyroid agent: METHIMAZOLE (Tapazole)
4.) organic nitrate: ISOSORBID MONONITRATE (Ismo)
5.) cholinesterase inhibitor: DONEPEZIL (Aricept)
144
Which of these drugs must be taken on an empty stomach, either 30-60 minutes before a meal or 3-4 hours after eating?
a.) hydrocodone (Vicodin)
b.) levothyroxine (Synthroid)
c.) donepezil (Aricept)
d.) nitroglycerin (Nitrostat)
levothyroxine (b.)
145
You look on your hospital's opioid conversion chart & see 30 mg of oral morphine is equivalent to 20 mg of oral oxycodone. You want to switch your patient from 30 mg of oral morphine per day to oral oxycodone before sending them home. What is the most appropriate daily dose of oral oxycodone to start with?
a.) 20 mg, since that is the equivalent dose
b.) 15 mg, to allow for incomplete cross-tolerance
c.) 30 mg, due to accumulated tolerance on morphine
d.) 5 mg, since oxycodone is more potent
15 mg, to allow for incomplete cross tolerance (b.)
146
Your patient is using sublingual nitroglycerin, & they open a new bottle of 25 tablets today. When do they need to replace their bottle of tablets with a refill?
a.) one year from today
b.) whenever they're down to 2-3 remaining tablets in the bottle
c.) on the expiration date listed on the bottle
d.) approximately 3-5 months from today
approximately 3-5 months from today (d.)
147
You must ensure patients taking which class of drugs has a minimum period of 8 hours each day where their body is free of drug in order to prevent rapid development of resistance?
a.) organic nitrates
b.) anti-thyroid agents
c.) cholinesterase inhibitors
d.) opioid receptor agonists
organic nitrates (a.)
148
Which of these represents an approach for treating Alzheimer's Disease?
a.) ↑ CNS acetylcholine
b.) ↑ CNS dopamine activity
c.) ↑ CNS histamine
d.) ↑ CNS glutamate
↑ CNS acetylcholine (a.)
149
Which of these steroids is MOST likely to cause salt-retention and, as a result, fluid retention, edema, & hypertension?
a.) hydrocortisone
b.) prednisone
c.) they are all equally likely
d.) methylprednisolone
hydrocortisone (A.)
150
Nightmares, aggressive behavior, depression, & anxiety are all side effects associated with what drug?
a.) salmeterol (Serevent)
b.) iprattropium (Atrovent)
c.) montelukast (Singular)
d.) albuterol (Proventil)
montelukast (C.)
151
Which of these is true regarding Long-Acting Beta 2 Agonists (LABAs)?
a.) must be used with a steroid or leukotriene antagonist to prevent negative morbidity & mortality effects
b.) associated with substantially positive effects on morbidity & mortality but only useful when used without other medications
c.) not any more effective than placebo
d.) should only be used on an 'as needed' basis to treat acute exacerbations to prevent negative effects
must be used with a steroid or leukotriene antagonist to prevent negative morbidity & mortality effects (A.)
152
Which of these is a disadvantage of inhaled anti-asthma medicines vs. oral administration?
a.) there is no difference in safety or effectiveness when given by inhalation
b.) optimal effectiveness relies on proper technique
c.) inhaled administration results in substantially more side effects overall
d.) inhaled administration is not effective because the drug can only work on the airway surface & not deeper into the lung tissue
optimal effectiveness relies on proper technique (B.)
153
Which of these drugs is associated with severe cutaneous adverse reactions, for which there is a genetic predisposition such that patients may benefit from having a genetic test prior to its use?
a.) colchicine (Colcrys)
b.) ondansetron (Zofran)
c.) rizatriptan (Maxalt)
d.) allopurinol (Zyloprim)
allopurinol (D.)
154
Which of these drug classes is most likely to cause paresthesias, chest tightness, cold & numb extremities, & abdominal pain?
a.) Xanthine oxidase inhibitors
b.) Leukotriene D4 antagonist
c.) 5-HT3 antagonists
d.) Ergot alkaloids
ergot alkaloids (D.)
155
For a patient who is altering use of a "triptan" & use of an ergot alkaloid, how long must they wait after to use an ergot alkaloid after using sumatriptan (Imitrex)?
a.) at least 24 hours
b.) at least 12 hours
c.) at least 2 weeks
d.) at least 1 week
at least 24 hours (A.)
156
Which of these is an inhaled anticholinergic?
a.) colchicine
b.) triamcinolone
c.) tiotropium
d.) formoterol
tiotropium (C.)
