Exam 3 Review Flashcards
(85 cards)
1
Q
What are first-line medications for acute pain?
A
NSAIDs or acetaminophen
Anticonvulsants and muscle relaxants may be used for long-term or moderate pain.
2
Q
What are non-pharmacological recommendations for pain management?
A
- Exercise programs
- Physical therapy
- Acupuncture
- Massage
- TENS
- Chiropractic treatment
- Biofeedback therapy
3
Q
What are the indications for NSAIDs?
A
- Analgesic
- Antipyretic
- Anti-inflammatory effects
4
Q
List some examples of NSAIDs. (5)
A
- Ibuprofen
- Naproxen
- Aspirin
- Toradol
- Mobic
5
Q
What are common adverse effects of NSAIDs? (4)
A
- GI: nausea, heartburn
- Mild headaches
- Dizziness
6
Q
What are contraindications for NSAIDs? (8)
A
- History of ulcers
- Crohn’s disease
- GI bleeding
- Liver or kidney disease
- Heart disease
- Bleeding or platelet disorders
- Unmanaged hypertension
- Pregnancy
7
Q
What symptoms indicate salicylate toxicity? (5)
A
- Nausea/Vomiting
- Diaphoresis
- Tinnitus
- Hyperventilation
8
Q
What is one of the earliest signs of salicylate toxicity?
A
Respiratory alkalosis
9
Q
Why do NSAIDs have a black box warning?
A
Increased risk of cardiovascular events and serious GI bleeding
10
Q
What is acetaminophen used for?
A
Treatment of mild pain and fever
Acetaminophen has no anti-inflammatory properties.
11
Q
What are contraindications for acetaminophen?
A
- Alcohol abuse
- Liver or kidney disease
- Malnutrition
12
Q
What are signs and symptoms of acetaminophen toxicity? (5)
A
- Abdominal pain
- Nausea/Vomiting
- Dark urine
- Jaundice
13
Q
What are opioids used for? (5)
A
- Serious pain
- Acute injury
- Post-surgery
- Broken bones
- Chronic cancer pain
14
Q
Define agonists in the context of opioids.
A
Interact with receptor to achieve a response
15
Q
What are full agonists? Give 3 examples of opioid full agonists.
A
Activate opioid receptor fully
Examples include Morphine, Codeine, Methadone.
16
Q
Define partial agonists in the context of opioids.
A
Activate opioid receptor to a lesser degree
17
Q
What are antagonists in the context of opioids?
A
Bind to opioid receptors without activating them
18
Q
What is the first-line agent for lowering urate levels in gout management?
A
Allopurinol
19
Q
What are adverse effects of allopurinol?
A
- Hepatotoxicity
- Gout flare at initiation of therapy
- Skin rash
20
Q
What labs should be monitored periodically when initiating allopurinol?
A
- LFT
- BUN
- Creatinine
- Uric acid level
- CBC
21
Q
What medications are used for acute gout flares?
A
- Colchicine
- NSAIDs
- Glucocorticoids
22
Q
What are the adverse effects of colchicine?
A
GI side effects
23
Q
What are the actions and effects of corticosteroids?
A
- Decreased peripheral uptake of glucose
- Glucogenesis in liver
- Lipolysis in adipose tissue
- Decreased circulating eosinophils, lymphocytes, monocytes
- Decreased leukocytes at inflammation sites
24
Q
What are the principles of corticosteroid therapy?
A
- Risk to benefit should be considered
- Short-term use for acute conditions
- Long-term use for life-threatening conditions
- Use local therapy when possible
- Do not stop abruptly
25
What are common adverse effects of corticosteroids?
* Osteoporosis
* Poor wound healing
* Peptic ulcers
* Hyperglycemia
* Increased risk of infection
* Cataracts
* Mood changes
26
What is the first-line therapy for type 2 diabetes?
Metformin (Glucophage)
27
What are the actions of Metformin?
* Improved insulin sensitivity
* Decreased hepatic gluconeogenesis
* Decreased absorption of glucose
* Inhibition of platelet aggregation
28
What is a black box warning associated with Metformin?
Risk of lactic acidosis
29
What are the two thiazolidinediones you should know?
Pioglitazone (Actos), Rosiglitazone (Avandia)
30
What is the action of thiazolidinediones?
Decreased insulin resistance via activation of PPAR-gamma
31
What are common adverse effects of thiazolidinediones?
* Weight gain
* Edema
32
What are the contraindications for thiazolidinediones?
* Pregnancy
* Lactation
33
What are sulfonylureas known for?
Most likely to cause hypoglycemia
34
What is the action of alpha-glucosidase inhibitors?
Compete with complex carbohydrates for digestion to lower postprandial blood glucose
35
What are common adverse effects of alpha-glucosidase inhibitors?
* GI symptoms
* Belching
* Bloating
* Flatulence
36
What are three selective sodium glucose co-transport 2 (SGLT-2) inhibitors?
Canagliflozin, Empagliflozin, Dapagliflozin
37
What is the action of SGLT-2 inhibitors?
Inhibit the reabsorption of glucose in the kidney proximal tubule
38
What are common adverse effects of SGLT-2 inhibitors?
* Genital infections
* UTI
* Hypovolemia/hypotension
39
What are dipeptidyl peptidase-4 inhibitors?
Sitagliptin
40
What is the action of DPP-4 inhibitors?
Slows the breakdown of GLP-1 by DPP-4
41
What are the adverse effects of DPP-4 inhibitors?
* Hypoglycemia
* Skin rash
* Arthralgia
* Pancreatitis
42
What is the first-line treatment for hypothyroidism?
Levothyroxine
43
What are the adverse effects of levothyroxine?
* Diarrhea
* Weight loss
* Cardiac arrhythmias
* Menstrual irregularity
* Heat intolerance
44
What are thioamides used for?
Treatment of hyperthyroidism
45
What are the adverse effects of thioamides?
* Agranulocytosis
* Aplastic anemia
* Hepatitis (black box warning for liver failure)
* Hair loss
46
What is agranulocytosis?
Severe reduction in granulocytes critical for fighting bacterial infections
47
What are the actions of ACE inhibitors?
* Blocks conversion of AT I to AT II
* Vasodilation
* Decreased intravascular volume
48
What should be done if a cough occurs during ACE inhibitor therapy?
Switch to an ARB
49
What are the adverse effects common to both ACE inhibitors and ARBs?
* Hypotension
* Tachyphylaxis
50
What is the action of calcium channel blockers?
Prevent calcium from entering cells resulting in vasodilation
51
What are the two major categories of calcium channel blockers?
* Dihydropyridine
* Non-dihydropyridine
52
Why are dihydropyridines preferred over non-dihydropyridines for hypertension?
Non-dihydropyridines can decrease HR and cause severe bradycardia with beta-blockers
53
What are common adverse effects of dihydropyridine calcium channel blockers?
* Hypotension
* Dizziness
* Edema
* Headache
54
What are the indications for non-dihydropyridine calcium channel blockers?
Used for angina and rate control in atrial fibrillation
55
What can occur when calcium channel blockers (CCBs) are combined with beta-blockers?
Severe bradycardia or high degrees of heart block
## Footnote
Dihydropyridine CCBs are preferred due to fewer negative side effects.
56
What forms of CCBs are preferred in the treatment of angina?
Long-acting forms
## Footnote
Short-acting forms can cause breakthrough angina.
57
List some adverse effects of dihydropyridine calcium channel blockers.
* Hypotension
* Dizziness
* Lower extremity edema
* Headache
* Reflex tachycardia
58
What are the two main non-dihydropyridine CCBs?
Verapamil and Diltiazem
59
What is negative inotropy?
Decreased force of contraction
60
What is negative chronotropy?
Decreased heart rate
61
Why do non-dihydropyridines cause negative inotropic and chronotropic effects?
They block L-type channels in myocardium, SA node, and AV node, reducing calcium influx.
62
What should be avoided in the treatment of HFrEF?
Non-dihydropyridine CCBs
63
List some side effects of non-dihydropyridine CCBs.
* Fatigue
* Dizziness
* Constipation
64
What is the primary focus when studying antilipidemics?
HMG-CoA reductase inhibitors (statins)
65
Name two statins.
* Rosuvastatin (Crestor)
* Atorvastatin (Lipitor)
66
What do statins block?
HMG-CoA reductase
67
What are the pleiotropic effects of statins?
* Decreased production of pro-inflammatory cytokines
* Increased activity of endothelial nitric oxide
* Reduced platelet activity and synthesis of thromboxane A2
68
List common adverse effects of statins.
* Headache
* Nausea
* Constipation
* Indigestion
* Flatulence
69
What is the best action if a patient reports myalgias while on statins?
Draw creatinine kinase level to check for elevations
70
What is the action of Ezetimibe (Zetia)?
Inhibits the absorption of cholesterol at the brush border of the small intestine
71
What are the uses of Gemfibrozil and Fenofibrate?
Reduce hypertriglyceridemia
72
What is the mechanism of action of anticoagulants?
Inhibit coagulation cascade and fibrin formation
73
What is the action of Dabigatran (Pradaxa)?
Reversible competitive thrombin inhibitor
74
List some adverse effects of Dabigatran.
* Heartburn
* Nausea
* Belching
* Diarrhea
* Bleeding
75
What is Idarucizumab (Praxbind)?
Reversal agent for Dabigatran
76
What is the action of Clopidogrel (Plavix)?
Inhibits the binding of ADP to its platelet receptor
77
What is the black box warning associated with Clopidogrel?
Antiplatelet activity is dependent on conversion to an active metabolite by the CYP2C19 enzyme
78
What are the four pillars of therapy for HFrEF?
* ARNI
* Beta-blockers
* Mineralocorticoid receptor antagonists
* SGLT-2 inhibitors
79
What does ARNI stand for?
Angiotensin receptor-neprilysin inhibitor
80
What is the mechanism of action of sacubitril?
Prevents the breakdown of natriuretic peptides by inhibiting neprilysin
81
What is the effect of beta-blockers in HFrEF?
Decreased myocardial oxygen demand and improved diastolic filling times
82
What is the mechanism of action of loop diuretics?
Decrease preload by increasing excretion of sodium and water
83
What is the primary use of Ivabradine?
Slows conduction through the sinoatrial node
84
What is the main action of Amiodarone?
Prolongs cardiac myocyte repolarization through blockade of potassium channels
85
Name some adverse effects of Amiodarone.
* Nausea
* Vomiting
* Fatigue
* Lung damage
* Thyroid dysfunction
