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Advanced Pharmacotherapeutics > Exam One > Flashcards

Exam One Flashcards

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1
Q

Describe Full Prescriptive Authority

A

affords the legal right to prescribe independently and without limitation.

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2
Q

Key elements required on a prescription (9)

A

NPDA, ASL, FID

  1. Medication name; 2. purpose; 3. dosing regimen ; 4. administration; 5. adverse effects; 6. any special storage needs; 7. associated lab test; 8. food/drug interactions; 9. duration of therapy
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3
Q

In Texas, APRNs can prescribe what schedule drugs?

A

Schedule 3, 4, & 5

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4
Q

Texas APRNs must have what to prescribe?

A

DEA #

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5
Q

Describe Schedule III & give drug examples

A

drugs with a moderate to low potential for dependence

Examples: Tylenol3, testosterone, ketamine, anabolic steroids)

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6
Q

Ritalin and Adderall are what schedule?

A

Schedule 2

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7
Q

Schedule IV - describe & give examples

A

drugs with low potential for abuse/dependence

Examples: xanax, valium, darvocet, ambien, talwin

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8
Q

Schedule V - describe and give examples

A

drugs with lower potential for abuse/dependence than schedule IV, but may contain small amounts of narcotics. Usually for diarrhea, antitussive, and analgesic purposes.

Examples: Robitussin AC, lomotil, lyrica

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9
Q

What lab monitoring does Lithium require?

A

CBC
Lithium level
TFTs (thyroid function test)
Renal function
Electrolytes (b/c narrow therapeutic index)
Sodium (could cause hyponatremia)

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10
Q

Lithium can cause:

A

elevated leukocytes (WBC)
renal damage
nephrogenic Diabetes Insipidus
hyponatremia

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11
Q

7 requirements on a written Rx (not related to the med)

A

Prescriber name
Prescriber DEA #
Prescriber license #
Prescriber contact info
Patient Name
Pt DOB
Pt allergies

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12
Q

7 requirements on a written Rx (med related)

A

Name of med
Indication of med
Med strength
Dose
Frequency
Number of tablets
Number of refills

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13
Q

Geriatric Medication Considerations

A

Decrease renal fx
Decrease liver fx
Cost
SE/adherence
Memory

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14
Q

pharmacokinetics - meaning and the 4 parts to it

A

Kinetics - drugs moving through the body

ADME
Absorption
Distribution
Metabolism
Excretion

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15
Q

First Pass Effect meaning

A

rapid hepatic inactivation of certain oral drugs

Drug can be completely inactivated on its 1st pass through the liver

As a result, no therapeutic effects can occur

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16
Q

Biotransformation is the

A

enzymatic alteration of drug structure

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17
Q

What pathway is most popular?

A

Cytochrome P450 Enzyme Pathway

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18
Q

3 families (highways) of drug metabolism

A

CYP1, CYP2, CYP3

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19
Q

CYP pathways - what drug goes on all of them?

A

Warfarin

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20
Q

What drug inhibits 3 of the 5 pathways?

A

Amiodarone

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21
Q

Inhibitors cause

A

“traffic jams” and can slow clearance of drug, therefore giving MORE therapeutic potential.

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22
Q

Inducers …

A

speed up clearance of drug, therefore making it LESS therapeutic

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23
Q

Popular inhibitor of CYP3A4

A

grapefruit juice

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24
Q

Some popular substrates of CYP3A4

A

CCBs, amlodipine, ED drugs, OAB meds, Statins, Warfarin

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25
pharmacodynamics is study of
biochemical & physiologic effects of drugs on the body
26
therapeutic index
1. is a measure of a drugs safety 2. Large index is desired 3. Narrow index must be monitored closely because a dosage can become lethal much more easily.
27
Define half-life.
Half-life is defined as the time required for the amount of drug in the body to decrease by 50%.
28
When a drug is administered repeatedly in the same dose, plateau will be reached in appx ______ half-lives
4
29
MAO inhibitors & food/drug interactions
Tyramine can cause MAOIs to become toxic causing hypertensive crisis
30
Examples of tyramine rich foods
aged cheeses, yeast extracts, chianti wine
31
What foods can reduce the effects of Warfarin and should be avoided by pts
Vitamin K rich foods
32
Examples of Vitamin K rich foods
broccoli, brussels sprouts, cabbage, dark greens
33
Grapefruit juice affects metabolism of .....(5)
CCBs Statins Amiodarone Carbamazepine Sildenafil
34
Grapefruit juice is a what ? And it will ______ the effects of other 3 classes of meds.
it is a CYP450 inhibitor It will INCREASE the effects Statins, SSRIs, & Viagra
35
Idiosyncratic effects
reason is not known
36
Paradoxical effects
opposite of intended drug response
37
Iatrogenic disease
medical treatment caused the disease
38
5 hepatotoxic drugs
Statins Antimicrobials (augmentin, macrobid, PCN, bactrim) Tylenol Voltaren Omeprazole
39
Drugs that lengthen QT interval (4)
Antibiotics Antidepressants Antipsychotics ADHD drugs
40
Examples of antibiotics
Drugs that lengthen QT-interval zithromax, erythomycin, levaquin, floxin
41
Examples of antidepressants
drugs that lengthen QT-interval celexa, lexapro, prozac, remeron, zoloft, effexor
42
Examples of antipsychotics
drugs that lengthen QT-interval thorazine, haldol, seroquel, risperdal, geodon
43
Examples of ADHD drugs
drugs that lengthen QT-interval adderall, strattera, dexedrine, concerta
44
What is drug tolerance
tolerance is a decreased responsiveness to a drug as a result of repeated drug administration
45
Define pharmacodynamic tolerance
the result of the adaptive processes that occur in response to chronic receptor occupation. Increased drug levels are required to produce an effective response
46
Define metabolic tolerance
tolerance resulting from accelerated drug metabolism.
47
Metabolic tolerance is brought about by the ....
ability of certain drugs to induce the synthesis of hepatic drug-metabolizing enzymes, thereby causing rates of drug metabolism to increase.
48
Tachyphylaxis is
a reduction in drug responsiveness brought on by repeated dosing over a short time
49
FDA recommends genetic testing before use of
plavix (CYP2C19 variant)
50
FDA requires genetic testing before using these 3 drugs
trastuzumab cetuximab maraviroc
51
What categories are NOT to be used in pregnant pts ?
D and X = proven risk for fetal harm
52
Category C in pregnant pts
use with caution; shows risk for fetal harm, however no studies done
53
Lipid soluble drugs cross the placenta .....
more readily. highly polar drugs do not.
54
5 drug classes to AVOID in pregnancy
Immunosuppressants/anti-cancer Antiseizure drugs Sex Hormones Anti-microbials Others (ACEi, statins, 5-alpha reductase inhibitors, hyperthyroid drugs)
55
Immunosuppressant/Anti-cancer drugs
Cyclophosphamide, methotrexate, thalidomide
56
Antiseizure drugs
carbamazepine, phenytoin, topiramate, valproic acid
57
Sex hormones drugs
androgens, diethylstilbesterol, estrogens
58
Antimicrobial drugs (in pregnancy)
Tetracyclines (teeth, bone abnormalities), bactrim (neural tube defects)
59
Other meds to avoid in pregnancy
alcohol 5-alpha reductase inhibitors (dutasteride, finasteride) ACE inhibitors (-pril) Statins Hyperthyroid drugs (methimazole, PTU) Lithium NSAIDs
60
what can happen in the Embryonic period (1st trimester)
gross malformations produced in this period when exposed to teratogens
61
Gross malformations can be produced in this period
Embryonic period / 1st Trimester
62
Teratogen effects in the 2nd & 3rd trimester (fetal period)
disrupts function (rather than gross anatomy) & may cause disruption of brain development leading to learning and behavioral abnormalities
63
Function and brain development disruption happen in the
2nd & 3rd trimesters / Fetal period
64
Pediatric dosing is ALWAYS based on ....
weight (mg/kg)
65
Important to remember in pediatric dosing ....
significantly reduced renal excretion at birth and infancy
66
kernicterus & what does it cause & what is it caused by
serious condition that occurs in newborns when high levels of bilirubin, a yellowish substance in the blood, damage the brain & caused by sulfonamides for pedi pts
67
How to mitigate ADRs in older adults
"start low & go slow" & ask pt about ALL vitamins and herbal supplements they are taking
68
Difference between agonist and antagonist
Agonists directly activate receptors Antagonists prevent receptor activity
69
Different types of receptors
Cholinergic - muscarinic Adrenergic - alpha & beta
70
Sympathetic Nervous System
body's "fight or flight" response
71
Parasympathetic nervous system
controls bodily functions during rest and relaxation
72
Cholinergic receptors mediate responses ....
to acetylcholine
73
Acetylcholine matches with
cholinergic receptors
74
Adrenergic receptors mediate responses with
epinephrine and norepinephrine
75
What is a sub-type of cholinergic receptors?
nicotinicN (neuronal); nicotinicM (muscle), & muscarinic (target organs of the parasympathetic nervous system)
76
Effects of Muscarinic receptors
increased secretions contraction of smooth muscle in bronchi & GI tract slower HR miosis (contraction of pupil diameter) dilation of blood vessels (decrease BP) voiding of bladder
77
what is a muscarinic antagonist?
atropine
78
Sub-types of adrenergic receptors
Alpha1 Alpha2 Beta1 Beta2 Dopamine
79
Alpha1 Receptor Activation & responses
Eye - mydriasis arterioles/skin/mucous membranes - constriction veins - constriction bladder - constriction
80
Alpha2 Receptor Activation & responses
presynaptic nerve terminals - inhibition of transmitter release
81
Beta1 Receptor Activation & responses
heart - increase rate, force of contraction & AV conduction speed kidney - release of renin
82
Beta2 Receptor Activation & responses
Arterioles/lungs = dilation Uterus = relaxation - can slow contractions
83
Drugs that adrenergic agonists
Epi, NorEpi, Dopamine, Dobutamine Ephedrine, phenylephrine, albuterol
84
Cholinergic drugs influence what ....
the activity of cholinergic receptors (acetylcholine)
85
Common Muscarinic Agonists
Bethanechol, pilocarpine ophthalmic, pilocarpine systemic
86
Pilocarpine
Muscarinic agonist increase salivation and cause miosis (pupillary constriction)
87
Muscarinic Toxicity (dumbells)
Diaphoresis/Diarrhea Urination Miosis (pupil constriction) Bradycardia/Bronchospasm Emesis Lacrimation Salivation
88
Anticholinergic Drugs aka
muscarinic antagonists
89
Anticholinergic drugs / muscarinic antagonists' examples
they block the activity of cholinergic receptors Atropine Scopolamine Dicyclomine tropicamide
90
Therapeutic Effects of Atropine (muscarine antagonist)
increases heart rate decreases secretions from salivary, bronchial & sweat Relaxes muscles in bronchi, bladder & GI tract Dilates pupil (mydriasis)
91
Atropine is considered an antidote to the
cholinesterase inhibitors like physostigmine, pyridostigmine, or neostigmine used for myasthenia gravis
92
Antimuscarinic Toxicity signs & symptoms
Hot as a hare (hyperthermia) Dry as a bone (dry eyes, mouth, skin) Red as a beet (flushed face) Blind as a bat (mydriasis) Mad as a hatter (delirium)
93
Adrenergic Agonists
Alpha1 Alpha2 Beta1 Beta2 Dopamine
94
Adrenergic Antagonists
Alpha1 adrenergic blockade = the "osins" tamsulosin, alfuzosin, doxazosin
95
Indirect-acting Antiadrenergic Drugs are (2)
clonidine & methyldopa
96
Clonidine
alpha2 agonist with 3 approved indications - HTN, pain, & ADHD adverse effect: drowsiness & sedation (which lessens w/ time)
97
Methyldopa
labs to check: CBC, Coombs test, liver enzymes oral antihypertensive by acting at sites within CMS. 2 side effects - hemolytic anemia & hepatic necrosis

Advanced Pharmacotherapeutics (2 decks)

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