Exam ID 4 Flashcards
(20 cards)
HMG-CoA Reductase Inhibitors (Medications) Medications in this class generally end in –statin; Commonly referred to as the “statins”
Fluvastatin (Lescol) Pravastatin (Pravachol) Lovastatin (Mevacor) Simvastatin (Zocor) Atorvastatin (Lipitor) Rosuvastatin (Crestor) Pitavastatin (Livalo)
HMG-CoA Reductase Inhibitors
Mechanism of Action
Blocks HMG-CoA enzyme (first step in cholesterol synthesis)
Leads to a decrease in total cholesterol and LDL
HMG-CoA Reductase Inhibitors
Indications
Hyperlipidemia
Primary and secondary prevention of CAD
HMG-CoA Reductase Inhibitors
Adverse Effects
Myalgia GI upset Diarrhea Elevated liver enzymes **Hepatotoxicity **Rhabdomyolysis
HMG-CoA Reductase Inhibitors
Contraindications to Therapy
Pregnancy/lactation
Active liver disease
Elevated transaminases
HMG-CoA Reductase Inhibitors
Pregnancy category
Category X
HMG-CoA Reductase Inhibitors
Drug interactions
Warfarin Gemfibrizol Cyclosporine Amiodarone Verapamil/Diltiazem/Amlodipine
HMG-CoA Reductase Inhibitors
Patient Counseling
For most drugs in the class, take the drug at bedtime
Avoid grapefruit juice due to enzyme inhibition
Most potent LDL lowering agent
Unexplained muscle pain call MD
HMG-CoA Reductase Inhibitors
Contraindications to Therapy
Pregnancy/lactation
Active liver disease
Elevated transaminases
Differentiate between hepatic enzyme INDUCERS and INHIBITORS and how they affect the metabolism of other drugs
Hepatic Enzyme Inducers: Will induce the effect of the drug. This will make the drug more potent and the prescriber will have to decrease the drug dose. Enzyme inducers: Rifampin Phenytoin Phenobarbital Carbamazepine Nafcillin Alcohol St. John’s wort
Hepatic Enzyme Inhibitors: Opposite of inducer. Enzyme inhibitors Erythromycin Cimetidine Ciprofloxacin Fluconazole Ketoconazole Itraconazole Clarithromycin Amiodarone Grapefruit juice
Identify the various Non-Drug (non-pharmacologic) options in the management/treatment of depression:
Non-drug management Psychotherapy (often used with drug therapy)
Electroconvulsive therapy (drug resistant cases, psychosis, pregnancy)
Sleep
Exercise
Herbal supplements
Define the specific BLACK BOX warning issued by the manufacturers of antidepressant agents and how customers/patients should be alerted of such warnings
Increased risk of suicidal thoughts and behavior
Monitor patients for worsening of disease symptoms or treatment failure
Identify the individual members of each therapeutic class of antidepressants (TCA’s, MAOI’s, SSRI’s, SNRI’s, and the miscellaneous agents)
MAOIs: Phenelzine, Isocarboxazid, Tranylcypromine, Selegiline
Avoid foods that contain tyramine (found in aged cheese, meat)
Hypertensive crisis may occur!
Drug Interactions with MAOIs:***
Conversion to an MAOI (from another agent)
2 week wait period before starting MAOI
6 week period: if starting Fluoxetine **Exam questions
SSRIs: Citalopram, Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline
Paroxetine-Pregnancy Category D
Avoid using SSRIs with other agents that effect serotonin
Adverse Effects:
Somnolence, insomnia, Sexual dysfunction
SNRIs: Duloxetine and Venlafaxine
Increase diastolic BP—VERY IMPORTANT
Describe some of the UNIQUE properties (indications and benefit of their use) of the miscellaneous group of antidepressants and their role in the management of patients
Benefit: Rapid response seen
Bupropion Less sedation, ALT if experiencing sexual side effects from other agents
Mirtazapine Less drug interactions, Less sexual side effects, Bedtime dosing due to sedative side effects
Nefazodone Live failure(not 1st line)BBW; Will increase concentrations of other drugs
Trazodone ADRs: Orthostatic hypotension, Priapism; Often used as hypnotic, Higher doses are associated with anticholinergic properties, Take with food
Distinguish the properties of the combination product Butalbital/Caffeine/Acetaminophen and its role in migraine treatment
Mechanism of action:
a. Caffeine used for its vasoconstrictive properties
b. Butalbital used to promote sedation/drowsiness
c. Acetaminophen used as an analgesic
Identify the individual members of the Triptans class of anti-migraine agents and unique properties of agents covered in class (ex. injectable formulations, orally disintegrating tablets)
Standard care of migraine HA’s
Sumatriptan - Tablets, injection and nasal spray
Rizatriptan - Orally disintegrating tablets
Zolmitriptan - Orally disintegrating tablets
Explain why close monitoring of albumin is important with the use of phenytoin
Phenytoin is highly protein bound. Will not exert its effect if its protein bound. Free levels is what exert its effect. SO low albumin will increase the phenytoin in your body and cause toxicity because of high levels of phenytoin. Usually monitor it between 10 and 20 of free phenytoin in the body.
Identify the MOST important adverse effects associated with anticonvulsant agents (phenytoin, carbamazepine, valproic acid, lamotrigine)
Phenytoin: Lethargy, blurry vision, nystagmus (toxicity); Rash, gingival hyperplasia, acne, hirsutism. Coma, death at toxic levels (supra-therapeutic)
Also know that it is an enzyme inducer and will decrease the efficacy of BC
Carbamazepine: Auto-Inducer; BBW: Steven Johns Syndrome (SJS), Toxic epidermal necrolysis (TEN), Aplastic anemia, & agranulocytosis; ADRs-Diplopia, hyponatremia, dizziness.
Also know that oxcarbazepine is not an auto-inducer.
Valproic Acid: GI, Weight gain, alopecia, blurry vision. BBW: Hepatotoxicity, pancreatitis, and teratogenicity
Lamotrigine: RASH!
State what important measures must be taken when women on oral contraceptives are also prescribed certain anticonvulsant agents
Pregnancy: 1 drug per person if pregnant to reduce the effects on the pregnancy.
Phenytoin: Decreases the efficacy of BC
Oxcarb, Topiramate and Phenobarbital: Consider using alt method of BC
Identify the MOST significant adverse effects of the atypical antidepressants
Neuroleptic malignant syndrome; Extrapyramidal reactions
Avoid alcohol and other CNS depressents; Do not double dose and never stop medication use without MD consult
BBW: Increased risk of death, Tight glycemic control for all agents
MAIN ADR: Hyperglycemia!!!
Risperidone: Prolonged QT interval.
