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Pharmacology Exam 3 review > Exam 3 Review > Flashcards

Exam 3 Review Flashcards

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1
Q

Wafarin (Coumadin) MOA

A

Indirectly inhibits the functional activation of “newly formed” Vit K dependent clotting factors II, VII, IX, X and protein C & C by directly inhibiting VKORC1’s ability to provide GGCX with reduced Vit K

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2
Q

Clopidogrel (Plavix) MOA

A

ADP inhibitor (antiplatelet)
Inhibit ability of ADP to increase the up regulation of gpIIb/IIIA receptors on the platelet surface that are known to mediate platelet aggregation
*Irreversible inhibition

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3
Q

ASA MOA

A

Irreversible inhibition of COX thereby decreasing the production of thromboxane A2 for the life of the platelet

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4
Q

Reversal agent - Coumadin

A

Vitamin K

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5
Q

Reversal agent - heparin

A

FFP

Protamine sulfate

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6
Q

Goal INR on Coumadin

A

2-3

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7
Q

How long does it take the “average” patient on Coumadin to get to INR goal?

A

5-7 days

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8
Q

How much should INR rise per day?

A

0.2

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9
Q

Warfarin (Coumadin) DDI

A

Inhibitors of CYP2C9: bacterium and fluconazole

others: amiodarone and metronidazole

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10
Q

Anticoagulant in pregnancy - DOC

A

Heparin (Coumadin is teratogenic)

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11
Q

Monitoring parameters - Coumadin

A

INR, maybe PT

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12
Q

Monitoring parameters - UFH

A

PTT (Goal 1.5-2 x normal)
Renal function
BUN, Creat (if >20-30 –> GI bleed?)
blood in stool/urine

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13
Q

Monitoring parameters - LMWH

A

None

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14
Q

Lovenox dosing

A

1 mg/kg BID if CrCl >30

1 mg/kg QD if CrCl <30

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15
Q

Clopidogrel DDI

A

PPI (some are OTC so patients may be taking them without your knowledge)

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16
Q

Absence seizure DOC

A

Depakote or Valproate

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17
Q

Lennox Gastaut DOC

A

Lamotrigine (Lamictal)
Levetiracetam (Keppra)
Topiramate (Topamax)

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18
Q

Drugs that worsen absence seizures

A

Phenytoin, Phenobarbital and Carbemazepine

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19
Q

Phenobarbital reference range

A

15-35 mcg/mL

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20
Q

Phenytoin reference range

A

10-20 mcg/mL

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21
Q

Carbemazepine reference range

A

4-12 mcg/mL

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22
Q

Valproate reference range

A

50-120 mcg/mL

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23
Q

Ethosuximide reference range

A

60-100 mcg/mL

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24
Q

Valproate - Lamotrigine DDI

A

Valproate inhibits lamotrigine metabolism by inhibiting glucuronidation (phase II pathway)
Start lamotrigine lower (25mg)

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25
Carbidopa-Levodopa MOA
converted to dopamine
26
What does carbidopa inhibit?
conversion of L-dopa to dopamine --> decreased side effects and more to the brain
27
MAO inhibitors - SE
hypotension, HA, nausea
28
Dopamine agonists - SE
stimulation of reward center
29
Levodopa - SE
nightmares | psychosis
30
Carbidopa-Levodopa main therapeutic effect
decreases rigidity and bradykinesia (some tremor)
31
Anticholinergics main therapeutic effect
improves resting tremors
32
Which warfarin isomer is most potent?
s-isomer (CYP2C9) | [r-isomer is CYP3A4)
33
Warfarin dosing
65 yrs old 2.5 mg qd
34
UFH MOA
inhibits factors Xa:IIa by binding at 2 different places
35
Heparin induced thrombocytopenia platelet count
decrease >30-50%
36
What happens when antibodies that activate platelets clump so platelets decrease?
Heparin induced thrombocytopenia (HIT)
37
LMWH MOA
inhibits factor Xa
38
LMWH renal considerations
do not use if CrCl<30
39
Treatment of HIT
1. stop UFH or LMWH 2.start Danaparaoid or Fondaparinux or Direct Thrombin Inhibitors Treat until Platelets >100
40
Carbamazepine, Phenytoin, Lamotrigine - MOA
Inhibits Na channels
41
Phenobarbital MOA
increases GABA
42
Valproate MOA
inhibits Na channels and Increases GABA
43
Phenytoin monitoring parameters
albumin and BUN (both can increase free fractions)
44
Valproate SEs
GI, weight gain, hepatotoxicity, hyperammonemia
45
Carbamazepine DDI
Inducer CYP1A2, 2B6, 2C8/9/19 and 3A4 decreases effect of warfarin OCP failure
46
Valproic acid DDI
``` not an inducer (unique) inhibits UGT2B7 (phase II) ```
47
Carbemazepine SE
Life threatening rash (SJS) in certain genetic profiles (Han Chinese/asian)
48
Clinical Issue: OCP and inducers
enzyme induces decrease effectiveness of OCP (exception valproic acid and lamotrigine) Failure rate 6%
49
Selegiline and Rasagiline - class?
MAO inhibitor
50
Pramipexole and Ropinirole - class?
Dopamine agonist
51
Dopamine agonist - SE
stimulation of reward pathway | sleep attacks
52
Levodopa SE
nightmares | psychosis
53
Carbidopa-Levodopa administration
on an empty stomach because protein competes with absorption (consistency is the key for motor symptoms)
54
MAO inhibitors and surgery
Stop 10-14 days before because of possibility of receiving vasoconstrictor
55
Migraines DOC
Selective 5HT1 receptor agonist (Triptans) | abort rapidly in 70-80% of patients
56
Meds for migraine prophylaxis
``` Betablockers (propranolol - vasodilation) CCB (verapamil) Anticonvulsants (Topamax) Antidepressants (TCAs) Analgesics (NSAIDs) Botox ```
57
Why should propranolol not be given to asthmatics?
bronchospasm
58
Tension HA -treatment
treat underlying depression or anxiety | NSAIDS, APAP, ASA
59
Cluster headache - treatment
Sumatriptan (imitrex)
60
Opioid MOA
binds to mu-opioid receptors to block pathway - acts as agonist
61
Stadol MOA
agonist/antagonist (ceiling effect so can't use long term)
62
Hydrocodone, Methadone, Codeine, Demerol, Morphine, Stadol, Oxycontin - Class?
opioid
63
Opioid reversal
Naloxone (OD) or Naltrexone (mild)
64
Capsaicin patch MOA
activates vanillin receptor (causes burning)
65
Capsaicin 8% patch use
neuropathic pain 1 time for 1 hour, up to 3 months of pain control SE - burning (premedicate)
66
APAP antidote
n-acetylcysteine
67
Toradol info
Parenteral NSAID use <5 days caution decreased renal function and bleeding risk May increase bleeding and platelet aggregation
68
Trigeminal neuralgia DOC
carbemazepine
69
Tramadol seizure warnings
may decrease seizure threshold
70
Demerol metabolite
normeperidine (SE seizures)
71
Lab findings B12 deficiency and folic acid deficiency
MCV/MCH increased | macrocytic RBC
72
Lab findings iron deficiency anemia
MCV/MCH decreased | microcytic RBC
73
Lab findings anemia of chronic disease
MCV/MCH decreased or right shift | normocytic RBC
74
Lab findings hemolytic anemia or bleeding
normocytic RBC | Retic >3
75
Fe DDI
antacids (decrease bioavailability)
76
Normal H/H males
13-16 mg/dl / 40-50%
77
Normal H/H females
12-15 mg/dl / 35-45%
78
Erythopoiesis Stimulating Agents (ESA) use and SE
must have adequate iron stores | may increase viscosity and plasma volume so can increase BP
79
Metformin MOA
decreases glucose production from liver
80
Sulfonyureas MOA
increases secretion of insulin (all the time)
81
DPP4 inhibitors MOA
stimulates pancreas in the presence of glucose
82
thiazolidinediones (TDZ) MOA
work on receptors that make liver and muscles to make more insulin sensitive
83
Metformin precautions
caution renal and liver disease | small risk of LA
84
TDZs SE and cautions
edema, weight gain, bone fractures | avoid: liver disease, CHF
85
SUs SE
hypoglycemia weight gain beta cell burnout
86
Glusiline, Aspart, Lispro - class?
rapid acting insulin
87
Lente, NPH - class?
Intermediate acting
88
Glargine and Detemir - class?
Long acting (basal)
89
Exenitide - Type I or Type II?
Type II
90
Pramlinitie (Symlin) - Type I or Type II?
both
91
Early am hypoglycemia (3am-5am) | Rebound normal to high blood sugars
Somogyi phenomenon
92
absence of early am hypoglycemia | relative resistance to insulin's effect during early AM hours
dawn phenomenon
93
Which drugs cause hyperthyroidism?
iodide, lithium, amiodarone
94
Which drugs cause hypothyroidism?
amiodaron, PTU, methimazole (MMI), lithium
95
Hypothyroidism DOC
levothyroxine
96
Thyroid storm DOC
PTU
97
Hyperthyroidism treatment
surgery | Anti-thyroid meds (MMI or PTU)
98
Intranasal steroids - use
perennial rhinitis and if moderate/severe symptoms
99
when is a leukotriene modifier used in rhinitis?
when asthma is present
100
when are allergy shots used for rhinitis?
resistant cases
101
allergic rhinitis general approach to treatment
Control symptoms: antihistamine decongestant +/- intranasal steroids
102
Benadryl, Chlor-Trimeton, Tavist - class?
1st generation "sedating" antihistamines
103
Zyrtec, Claritin, Allegra - class?
2nd generation "non-sedating" antihistamines
104
Azelastine (Astelin), Olopatadine (Patanase) - class?
2nd generation "non-sedating" antihistamines (NS)
105
1st generation antihistamine SE
cross BBB --> anticholinergic effects - confusion, sedation, glaucoma, urinary retention
106
2nd generation antihistamine SE
do not cross BBB -->less anticholinergic effects
107
Beclomethasone, Budesonide (Rhinocort), Fluticasone - class?
intranasal steroids

Pharmacology Exam 3 review (1 decks)

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