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Pharmacology II > Exam 2 - Questions > Flashcards

Exam 2 - Questions Flashcards

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1
Q

Treatment for acute Myasthenia Gravis exacerbations?

A

IVIG

High dose IV steroids

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2
Q

Which class of drugs can also be used to counteract the effects of nerve poisoning?

A

Acetylcholinesterase Inhibitors

Pyridostigmine, Neostigmine

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3
Q

Contraindications for acetylcholinesterase inhibitors

Pyridostigmine, Neostigmine

A

Urinary or bowel obstruction

Caution in asthma/COPD patients

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4
Q

Tensilon test for Myasthenia Gravis

A

Administer edrophonium
If weakness worsens, cholinergic crisis
If weakness improves, myasthenic crisis

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5
Q

Treatment for cholinergic crisis

A

Atropine

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6
Q

Treatment for ALS

A

Riluzole

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7
Q

Organ of caution for Riluzole

A

Liver
Elevated LFTs
Warnings in liver impairment

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8
Q

Serious ADRs for Riluzole

A

Pneumonia, decreased lung function, vertigo, paresthesia, anorexia

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9
Q

ADRs for Edaravone

A

Anaphylaxis, bruising, gait disturbance

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10
Q

Contraindications for Tetrabenazine

A

Liver disease and MAOIs

Rasagiline, Selegiline

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11
Q

ADRs for Tetrabenazine

A

Depression, suicidal ideation, akathisia, insomnia

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12
Q

Treatment for MS acute attacks

A

Glucocorticoids

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13
Q

Treatment for Secondary-Progressive or Progressive-Relapsing MS

A

Interferon beta
Natalizumab
Mitoxantrone

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14
Q

Warnings for Interferon beta

A

Depression, suicide, psychotic disorders, new autoimmune disorders, blood dyscrasias, seizures (can induce them)

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15
Q

Organs of caution for interferon beta

A

Liver (hepatotoxicity)

CHF

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16
Q

ADRs of interferon beta

A

Flu-like symptoms (for 48 hours)

Insomnia, injection-site rxn, peripheral edema, malaise, hypertension, incoordination

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17
Q

Post injection reaction in Glatiramer

A

Flushing, chest pain, palpitations, anxiety, dyspnea, urticaria, throat constriction
Usually transient
16% of patients

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18
Q

ADRs of Glatiramer

A

Lipoatrophy, transient chest pain, skin necrosis, immunosuppression, vasodilation, infection

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19
Q

Mitoxantrone MOA

A

Topoisomerase inhibitor
DNA coiling and repair
Inhibits T cells, B cells, and cytokines

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20
Q

Multiple Sclerosis medication that can also be used for cancer patients

A

Mitoxantrone

Leukemia, prostate

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21
Q

Organ of caution for Mitoxantrone

A

Heart
CHF, decreases in LVEF
Contraindicated for patients with LVEF < 50%

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22
Q

Monitoring for Mitoxantrone

A

LVEF

Monitor before every dose

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23
Q

ADRs for Mitoxantrone

A

Alopecia (hair loss), menstrual changes, amenorrhea, URI, UTI, blue-green urine

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24
Q

Pregnancy Category D Medications

A

Mitoxantrone (chemo/dna effects)

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25
Binds leukocytes and inhibits adhesion | Prevents movement across the BBB
Natalizumab
26
Medication that can also be used for Crohn's Disease
Natalizumab
27
Warning for Natalizumab
Progressive Multifocal Leukoencephalopathy (PML) | Viral infection of the brain - limits use of the drug
28
Medication that is also used in Germany for psoriasis
Dimethyl fumarate
29
ADRs for Dimethyl fumarate
Leukopenia, flushing, redness, rash
30
Organ of caution for dimethyl fumarate
Liver Elevated liver enzymes, bilirubin Normalize after stopping the drug
31
Sphingosine 1-phosphate receptor modulator
Fingolimod
32
Warning for fingolimod
First-dose bradycardia EKG prior to dosing Monitor for 6 hours after first dose
33
ADRs for Fingolimod
Increased mortality, varicella zoster, PML, influenza, abnormal LFTs, back pain
34
Organs of caution in Teriflunomide
Liver (Hepatotoxic) | Kidneys (transient renal failure)
35
ADRs of Teriflunomide
Teratogenic, bone marrow suppression, peripheral neuropathy, hyperkalemia, flu, alopecia (hair loss)
36
First drug created for aggressive MS
Ocrelizumab
37
Contraindications for Dalfampridine
Renal impairment, seizures
38
Organ of caution in IVIG
Kidneys | Monitor renal function
39
Organ of caution in Dantrolene
Liver | Contraindicated in active liver disease
40
ADRs of dantrolene
Dizziness, drowsiness, malaise, diarrhea
41
Contraindications for Nuedexta
Long QT, AV block
42
ADRs of nuedexta
N/V/D, cough, liver
43
Combo that makes Nuedexta
Dextromethorphan/Quinidine | Quinidine increases dextromethorphan bioavailability, allows it to cross BBB, and prolongs half-life
44
Serotonin Receptor Agonists
Triptans 5-HT1 receptor Mediates vasoconstriction
45
Contraindications for Triptans
Basilar migraine, ischemic cardiac, cerebrovascular, or peripheral vascular syndromes, uncontrolled hypertension, liver disease
46
ADRs of Triptans
Coronary artery vasospasm, transient myocardial ischemia, MI, VTach, VFib, hypertension Paresthesias, flushing, chest tightness
47
Drug Interactions with Triptans
Ergot alkaloids, SNRIs/SSRIs
48
Drug Interactions with Almotriptan
Ergot alkaloids, SNRIs/SSRIs CYP3A4 inhibitors ritonavir, Clarithromycin, ketoconazole, itraconazole, cobicistat
49
Drug Interactions with Eletriptan
Ergot alkaloids, SNRIs/SSRIs Linezolid, CYP3A4 inhibitors ritonavir, Clarithromycin, ketoconazole, itraconazole, cobicistat
50
Drug interactions with Rizatriptan
Ergot alkaloids, SNRIs/SSRIs | Propranolol
51
Contraindications for Ergotamines
Renal failure, hepatic failure, vascular disease, uncontrolled hypertension, pregnancy, breastfeeding, basilar or hemiplegic migraine (stroke like HA)
52
Ergotism (St. Anthony's Fire)
HA, vomiting, diarrhea, gangrene | Presents as a life-threatening ischemia --> results from interactions with macrolides and protease inhibitors
53
Drug Interactions with Ergotamine
Serotonin drugs (triptans), P450 CYP3A4 inhibitors, vasoconstrictors
54
Ergotamine ADRs
Paresthesias, myalgia, chest tightness
55
Butorphanol ADRs
Somnolence, nasal congestion, insomnia, respiratory depression, dizziness
56
First line for Acute Migraine in the ED
IV Metoclopramide or Prochlorperazine | SubQ Sumatriptan
57
ADRs for IV Metoclopramide or Prochlorperazine
Drowsiness, Akathisia
58
Acute Migraine in Peds Medications
Ibuprofen, Acetaminophen, Sumatriptan, Rizatriptan, Zolmitriptan
59
Effective Prophylactic Therapy for Migraines
Divalproex sodium, sodium valproate, topiramate Propranolol, Metoprolol, Timolol Frovatriptan
60
Migraine Prophylaxis: How long?
Treat daily for 2-6 months Continue for 3-6 months after headaches diminish Gradually taper and discontinue
61
Contraindications for levodopa
Nonselective MAOI (discontinue 2 weeks prior) History of malignant melanoma Narrow angle glaucoma
62
Monitoring for levodopa
Liver function tests
63
ADRs of levodopa
Dyskinesias (choreiform movements) | Anorexia, hypotension, confusion, insomnia, nightmares, schizophrenic-like syndrome (delusions and hallucinations)
64
ADRs of Dopamine Receptor Agonists
Anorexia, hypotension, cardiac arrhythmias, hallucinations, confusion, pulmonary fibrosis
65
Which medication is associated with cardiac valvulopathy?
Cabergoline
66
Medications also used for restless leg syndrome
Pramipexole, Ropinirole
67
Major ADR of Rotigotine
Sudden somnolence Patients fall asleep during ADLs Advise not to drive
68
Medication for Parkinson's patients to help get past episodes of akinesia
Apomorphine
69
ADRs of apomorphine
Dyskinesias, drowsiness, sweating, hypotension
70
What medication should not be given with levodopa or dopamine receptor agonists?
Metoclopramide Watch out for tardive dyskinesia May make Parkinson's symptoms worse
71
ADRs of Selegiline
Blocks MOA-A at high doses, hypertensive crisis due to peripheral accumulation of NE Fatal hyperthermia - may occur when administered in conjunction with meperidine, cocaine, or fluoxetine
72
Dose adjustment for Rasagiline
Hepatic Impairment dose adjustment
73
Drug interactions for Rasagiline
Nicotine, meperidine, dextromethorphan, St. John's Wort, cyclobenzaprine, ciprofloxacin
74
ADRs of COMT Inhibitors | Tolcapone, Entacapone
Dyskinesias, confusion, orthostatic hypotension, sleep disorders, orange urine discoloration
75
Organ of caution in Tolcapone
Liver (potentially hepatotoxic)
76
Drugs to avoid with COMT meds | Tolcapone, Entacapone
MAOIs | Selegiline, Rasagiline
77
ADRs of Amantadine
Restlessness, depression, irritability, insomnia, agitation, excitement, hallucinations, confusion, seizures, edema, postural hypotension, heart failure, GI disturbances
78
Amantadine Overdose
Acute toxic psychosis (1 g can be fatal)
79
Dose adjustment in amantadine
Renal insufficiency dose adjustment
80
ADRs of anticholinergics | Trihexyphenidyl, Benztropine
Dry mouth, inability to sweat, impaired vision, urinary retention, constipation, drowsiness, confusion
81
Indicated to reduce hallucinations/delusions in patients with PD psychosis
Pimavanserin
82
ADRs of Pimavanserin
Peripheral edema, confusion, hallucination, constipation, gait changes, nausea
83
Contraindication for Safinamide
Cirrhosis
84
Drug interactions for Safinamide
Dextromethorphan, MAOI, SNRI, St. John's Wort, SSRIs, TCAs, cyclobenzaprine
85
ADRs of Safinamide
Uncontrolled involuntary movements, falls, nausea, insomnia, hypertension, serotonin syndrome, hallucinations, psychosis, narcolepsy, impulse control, retinopathy
86
First-Line treatment for Alzheimer's Disease and Dementia with Lewy Bodies
Acetylcholinesterase Inhibitors | Donepezil, Rivastigmine, Galantamine
87
ADRs for acetylcholinesterase inhibitors | Donepezil, Rivastigmine, Galantamine
N/V/D, muscle cramps, dizziness, headache, agitation, sleep disturbances Rivastigmine and Galantamine - weight loss Side effects are a much bigger deal in Alzheimer's patients!!
88
Drug interactions for Donepezil
CYP3A4 and CYP2D6 Inducers: Carbamazepine, rifampin, St. John's Wort Inhibitors: Clarithromycin, ketoconazole, etc.
89
Organ of caution for acetylcholinesterase inhibitors
Heart | Used with caution in patients with heart block or sick sinus syndrome
90
ADRs for Memantine
Agitation, diarrhea, insomnia, dizziness, headache, hallucinations
91
Treatment for mild pain in peds
Ibuprofen or acetaminophen | Acetaminophen if < 3 mo
92
Treatment for moderate pain in peds
Opioids --> morphine DOC
93
Treatment to AVOID for pain in peds
Codeine - respiratory depression
94
Organ of caution for acetaminophen
Liver
95
Acetaminophen Toxicity
Acute dose > 7.5 g Hepatotoxicity at 10-15 g Doses > 20 g can be fatal
96
Concerning conditions with acetaminophen
Alcoholism Fasting, malnutrition Viral illness (dehydration)
97
Acetaminophen Toxicokinetics
- Peak 4 hours - Nontoxic routes become saturated, formation of NAPQI increases - NAPQI increased, exceeds glutathione supply - Excess NAPQI, covalent binding of cell proteins leads to cell death
98
Early signs/symptoms of acetaminophen organ toxicity
Nausea, Vomiting, AMS, metabolic acidosis | Increased PT/INR
99
Stage 1 of APAP Toxicity
No liver injury Asymptomatic or early signs/symptoms Normal LFTs Nausea, vomiting, diaphoresis, pallor, malaise
100
Stage 2 of APAP Toxicity
``` Liver injury 24 to 36 hours AST elevated (may be > 1000) RUQ pain, hepatomegaly Possible nephrotoxicity Increased PT, bilirubin, sCr, BUN Proteinuria, hematuria, casts ```
101
Stage 3 of APAP Toxicity
Maximum liver injury 72-96 hours Hepatic failure --> encephalopathy, coma, hemorrhage Nausea/vomiting may return High ammonia level AST/ALT elevated > 10,000 Abnormal PT, creatinine, glucose, pH, bilirubin, lactate Fatality - usually 3-5 days after OD Multiorgan failure: hemorrhage, ARDS, sepsis, cerebral edema
102
Stage 4 of APAP Toxicity
Recovery Hepatic regeneration Several days to weeks
103
Rumack-Matthew Nomogram
Shows if patient needs to take N-acetylcysteine antidote | Has to be within 4-24 hours post ingestion
104
Timeframe for APAP Antidote
N-acetylcysteine | Must be administered within 8 hours of overdose
105
ADRs for N-acetylcysteine
Rash, urticaria, pruritus, flushing, bronchospasm (potentially fatal)
106
Other use for N-acetylcysteine
Used to prevent contrast-induced nephropathy
107
Contraindications to NSAIDs
- 3rd trimester of pregnancy - Renal insufficiency - CHF - Cirrhosis
108
ADRs for NSAIDs
Hypertension! | SJS, nausea, dyspepsia, anorexia, abdominal pain, flatulence, diarrhea
109
NSAIDs Risks
- GI Bleeds - Ulcers - Heart Failure - Hyperkalemia - Renal papillary necrosis - Renal insufficiency
110
What happens in G6PD deficient patient that takes acetaminophen or NSAIDs?
Hemolytic Anemia
111
Medication that reduces incidence of gastric and duodenal ulcers with NSAIDs
Misoprostol
112
ADRs of Misoprostol
DIARRHEA | Nausea, abdominal pain
113
Category X Medications
Misoprostol
114
NSAID with most cardiovascular risks
Celecoxib | NSAIDs should not be used post-op for pain control for cardiac surgery
115
NSAID Drug Interactions
Aspirin (ibuprofen blocks antiplatelet effects) Anticoagulants Antihypertensive, diuretics Insulin, Sulfonylureas
116
Treatment for aspirin overdose
Sodium bicarbonate
117
First-line option for gout flares
Indomethacin | Naproxen also approved for use
118
Used to close PDA in neonates
Indomethacin Must be used within first 14 days of life IV ibuprofen is another option
119
What adjustment must be made in Meloxicam?
Renal impairment adjustment
120
What adjustment must be made in Piroxicam?
Hepatic impairment adjustment
121
Monitoring for Piroxicam:
Occult blood loss, hemoglobin, hematocrit, and periodic renal and liver function tests Periodic eye exams with chronic use
122
Indicated for symptomatic treatment of acute and chronic RA and OA
Meloxicam, Piroxicam | Celecoxib also
123
Indicated for prevention of familial adenomatous polyposis
Celecoxib
124
What adjustments must be made in Celecoxib?
Hepatic and renal impairment adjustments
125
Where is Mu receptor primarily found?
Brainstem and medial thalamus | Lots of receptors in the gut --> constipation
126
Opioid overdose antidote
Naloxone
127
Opioid ADRs
Sedation, lethargy, constipation Respiratory depression Pruritus/urticaria (direct histamine response)
128
Opioid Overdose Triad
Miosis, LOC, Respiratory Depression
129
Codeine interactions
CYP2D6 substrate | Bupropion, Cimetidine, Celecoxib, cocaine
130
Oxymorphone ADR
Thrombotic angiography
131
CYP3A4 Opioid
Fentanyl
132
Things to avoid with Meperidine
Elderly | MAOIs (respiratory depression)
133
Is Meperidine reversible with Naloxone?
Nope | Overdose: anxiety, seizures, tremors
134
Opioids with CYP3A4 Metabolism
``` Meperidine Propoxyphene Methadone Buprenorphine Tramadol ```
135
Opioids recommended to avoid in elderly
meperidine | Propoxyphene
136
Is Propoxyphene reversible with Naloxone?
Yup | Overdose: seizures and cardiotoxicity
137
Opioid that is also a NMDA antagonist and a SNRI
Methadone
138
ADR associated with Methadone
Cardiotoxicity | Torsades de pointes
139
Opioid used for heroin/opioid addiction
Buprenorphine
140
Naloxone ADRs
Headache, myalgia, increased BP, opioid withdrawal
141
Opioid used for opioid and alcohol addiction
Naltrexone
142
Indications for naltrexone
Patients using opioids
143
Risks with use of Tramadol
Seizure Risk Suicide Risk Serotonin Syndrome Risk
144
ADRs of Tramadol
Vertigo, dizziness, constipation, HA, somnolence, pruritus
145
1st opioid specifically approved for diabetic neuropathy
Tapentadol
146
Rules while on Tapentadol
NO ALCOHOL --> potentially fatal
147
Opioid withdrawal symptoms
Irritability, anxiety, restlessness, chills, sweating, abdominal pain, nausea, diarrhea, sneezing, rhinorrhea, dilated pupils, muscle weakness, pains, insomnia
148
Slow opioid detoxification
Tapering of opioids through prescription of methadone
149
Rapid opioid detoxification
Naltrexone, buprenorphine or clonidine
150
Milnacipran Warnings
Suicidal Ideation Serotonin Syndrome (interaction with MAOIs, triptans) Elevated BP, tachycardia
151
Milnacipran ADRs
Palpitations, tachycardia, HA, constipation, hyperhidrosis, dizziness
152
CYP3A4 Muscle Relaxants
Cyclobenzaprine
153
Cyclobenzaprine ADRs
Anticholinergic | Dry mouth, sedation, headache
154
Drug Interactions for Cyclobenzaprine
MAOI (potentially fatal) EtOH and other depressants Increased seizure risk with tramadol
155
Contraindications for cyclobenzaprine
Urinary retention | Acute angle closure glaucoma
156
ADRs for Carisoprodol
Drowsiness, dizziness, vertigo, ataxia, tremor, depression, agitation, irritability, syncope, insomnia, tachycardia, hypotension
157
Major ADR for Carisoprodol
Transient quadriplegia | Fairly rare
158
ADRs for Metaxalone
Drowsiness, dizziness, nervousness | Leukopenia, hemolytic anemia, jaundice
159
Indicated for muscle spasms due to multiple sclerosis, spinal cord injury trigeminal neuralgia
Baclofen
160
Can help chronic hiccups
Baclofen
161
Orphenadrine ADRs
Anticholinergic | Dry mouth, tachycardia, urinary retention, blurry vision, mydriasis, increased ocular pressure, constipation, dizziness
162
Inhibits multisynaptic reflex arcs that produce and maintain skeletal muscle pain
Chlorzoxazone
163
Associated with idiosyncratic hepatotoxicity
Chlorzoxazone | Need to get baseline LFTs before prescribing this
164
Stimulates metabolism of chondrocytes in articular cartilage and synovial cells in synovial tissues
Glucosamine Sulfate
165
Binds N-type calcium channels in primary nociceptive afferent nerves in dorsal horn
Ziconotide
166
ADRs for Ziconotide
Neuropsychiatric ADRs, cognitive impairment, hallucinations, mood change or change in consciousness Dizziness, ataxia, somnolence, asthenia, abnormal gait
167
Contraindications for Ziconotide
History of psychosis
168
ADRs for Intrathecal Baclofen
Hypotonia, somnolence, dizziness
169
Warnings for topical analgesics
Watch use with anticoagulants Watch for aspirin allergy Short term use (no more than 1 week)
170
Menthol ADRs
Skin irritation, contact dermatitis | Orally: heartburn, N/V
171
ADRs for Camphor when taken orally
Burning of mouth and throat initially Camphor breath Can lead to seizure, respiratory failure
172
TRPV 1 channel agonist
Capsaicin
173
Indicated for post-herpetic neuralgia
Capsaicin
174
ADRs for capsaicin
burning, stinging, erythema | Worsening ACEI cough
175
Iontophoresis
Ion current to deliver charged drugs through the skin | Dexamethasone, NSAIDs, anesthetics, salicylates

Pharmacology II (6 decks)

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