Final- new stuff Flashcards

Question

Zinc Oxide

Answer 1

Lubricant MOA- Soften fecal contents by coating them, therby preventing colonic reabsorption of fecal water **Safety concern of lipid pnuemonia (risk of aspiration, SOB)** **1-3 days onset to soften stool**

Answer 2

D2 receptor antagonist Hits D2, 5-HT1c, **5-HT3 (second line chemotherapy induced nausea/ vomitting)** ADR-Dystonia, akathesia, parkinsonian, sedation, hyperprolactinemia, hypotension, dry mouth

Answer 3

Sucrose+ complexed aluminum hydroxide MOA- mixes with **HCl (DO NOT perscribe with PPIs)** to form viscous paste that binds directly to ulcers and erosions- "physical barrier to protect stomach", stimulates mucosal prostoglandin and bicarbonate secretion **Constipation (aluminum), aluminum toxicity in renal disease**

Answer 4

5-HT3 recepotr antagonist **(IV ONLY)** Used for chemotherapy induced nausea/ vomitting MOA- **central bloakade** of the chemotrigger zone and vomittng center. **Peripheral blockage (Seratonin receptors in GI tract)** of intestinal vagal and spinal afferent nerves→ **drives antiemetic benefit (80% of seratonin is found in the GI tract)** **_Does not hit H1, M1 or D2 receptors not suitable for the treatment of motion sickness_** Long half life (40 hours)- good for delayed nausea/ vomitting Metabolism- CYP 2D6 ADR- Headache, dizziness, constipation,**least likely to casue QTc prolongation (K+ channel blockade), Seratonin syndrome (Increase levels of seratonin)**

Answer 5

NK recpotor antagonist **MOA-** central blockade of NK receptors in the chemotrigger zone, blocks bnding of substance P **ONLY used for prevention of chemotherapy induced nausea/ vomitting along with 5-HT3 antagonist and corticosteriods** ARR- Fatigue/ dizziness **CYP 3A4 substrate- combination with with CYP 3A4 inhibitor (Clarithromycin, Ketoconazole, Itraconazole, HIV protase inhibitors, Grapefruit Juice, diltizem, verapamil) can cause toxicity**

Answer 6

NK recpotor antagonist **MOA-** central blockade of NK receptors in the chemotrigger zone, blocks bnding of substance P **ONLY used for prevention of chemotherapy induced nausea/ vomitting along with 5-HT3 antagonist and corticosteriods** ARR- Fatigue/ dizziness **CYP 3A4 substrate- combination with with CYP 3A4 inhibitor (Clarithromycin, Ketoconazole, Itraconazole, HIV protase inhibitors, Grapefruit Juice, diltizem, verapamil) can cause toxicity**

Answer 7

Topical steroid- medium to high potency MOA- drecrease inflammation, modulate immune response and vasocontrict blood vessels to minimize redness, warmth and swelling **Potency determined by vasocontrictor assay (higher poteny more vasocotriction)** ADR- Skin atrophy, straie, rosacea, superfical infections, hypopigmentation, contact dermatitis, tolerance, tachyphylaxsis, systemic side effects (adrenalsupression, HTN, hyperglycemia) **Considerations high potency (groups 1-3)- not to be used in the face, groin, axilla, or under occlusions, better for thichker areas (palms and bottms of feet), use for the shortest duration possible, use for psoriasis, severe poison ivy, severe atopic detmatitis**

Answer 8

MOA- PGE1 anaglog- increases mucosal and bicarbionate secretion, enhances mucosal blood flow **Used for NSAID- related ulcers or labar induction (OB/ GYN)** Comes in combinaion product with diclofenac sodium ADR- Diarrhea, enhanced uterine contractine, dont take if pregnant

Answer 9

MOA- **a****ntimicrobial (against P. acnes), anti-inflammatory, keratolytic effects** **May inactivate some formularions of tretinoin, so avoid use or sperate times of administration** **Efficacy is not concentration dependent** **ADR- contact dermatitis,** erythema, skin, dryness, peeling, **bleaching**

Answer 10

Anti-emetic- 5HT-3 antagonism and H1 antagonism ## Footnote **Used for cancer (nausea and vomitting), depressed and underweight people**

Answer 11

PPI MOA- irrevirsibly inactiavtes the hydrogen potassium adenosine triphosphate (H+/ K+/ ATPase) resulting in imparied acid secretion **Pro drug is protected by enertic coating ( dissoves in intestinal lumen abd is absorbed, carried to the parietal cells of the stomach for activation)** **Bioavailibity decreases with food (take on empty stomach 30-60 min beofre first meal)** **Onset of action2-3 hours, 3-4 days for maximal effect, duration of action 24 hours** **Good for renal insufficiency patients** **ADR- diarrhea, headache, abdominal pain, vitamin B12 deficiency, reduced absorption of iron, calcium, magnesium osteroperosis, fractures, C, diff, community aquired pneumonia** **TAPER OFF- rebound hypersecretion** **DDI- ketoconazole, intraconazole, atazanavir, rilpiverine, calicum caronate, iron salts**

Answer 12

Coricosteriods **pH controlled- entocort (pH5.5 more in the small intestine), uceris (pH\> 7 more in large colon)** **_CYP 3A4 metabolite- watch for CYP 3A4_**

Answer 13

Opioids delys gastric emptying, interrupt bowel peristalsis, reduce intestinal secretion of fluid Traditonal laxitives still first line

Answer 14

Anti-emetic- antihistamine and antimuscarinic bloackade (vestibular system) beneficial for nausea/ vomitting, motion sickness ## Footnote **Blocks more M1 then H1** **ADR- Muscarinic hot, dry fast crazy**

Answer 15

Topical steroid-high potency MOA- drecrease inflammation, modulate immune response and vasocontrict blood vessels to minimize redness, warmth and swelling **Potency determined by vasocontrictor assay (higher poteny more vasocotriction)** ADR- Skin atrophy, straie, rosacea, superfical infections, hypopigmentation, contact dermatitis, tolerance, tachyphylaxsis, systemic side effects (adrenalsupression, HTN, hyperglycemia) **Considerations high potency (groups 1-3)- not to be used in the face, groin, axilla, or under occlusions, better for thichker areas (palms and bottms of feet), use for the shortest duration possible, use for psoriasis, severe poison ivy, severe atopic detmatitis**

Answer 16

For opioid induced constipation **MOA- peripheral a**cting mu opioid receptor anatagonist, **DOES NOT cross BBB (does not interfer with opiod use)** ADR- abdominal pain and/ or distension, diarrhea, headache, chills **Short time use only- Increased risk of MI with long term use**

Answer 17

MOA- inhibits dihyrofolate reductase→ reduces purine metabolism→ inhibits DNA synthesis, repair and replication For IBS IM/ SC ADR- hepatoxcicity, myleosupression, nausea

Answer 18

Hyperosmotix laxative MOA- draws water into rectum to simulate a bowel movement **Soften stool within 1-3 days** **Okay to use in elderly, cardiac or renal deficent patients**

Answer 19

MOA- interferes with production of inflammatory cytokines. Modulates inflammation mediators derived from COX and lipoxygenase ## Footnote **Topical formuation- minimal systemic effect** **CONTRAINDICCATED in those with salcylate allergy** **SIte of action- intestine** **ADR- rash/ hypersensitivity, photosensitivity, hemolytic anemia, folate deficicency, pancreatitis, hepatitis** **Monitor- CBC, LFT** **Supplement with 1 mg dailty of folic acid**

Answer 20

hydration- more moisture, more absorption damge to stratum cornum- more damage more absorption temperature/ friction- increased temperature/ friction increased absorption drug paricle size- smaller, soluable drugs absorb better (lipid soluble)

Answer 21

Laxative use to decrease absorption of calories **weight loss is NOT do to reduce calorie absoprtion its maily due to dehydration by loss of water, electrolytes and minerals** **Can present as - tremors, weakness, blurry vision, fainting, kidney injury, metabolic alkalosis, or arrythmias** **Increased risk of infections, colon cancer- intestines over stimulated so stops working (laxy colon)**

Answer 22

Thiopurines MOA- Purine antagonist→ inhibition of DNA/ RNA synthesis→ decreased T cell function→ immunosupression **ADR- N/V, bone marrow supression (leukopenia), hepatoxicity** **DDI- allopurinal, feboxostate**

Answer 23

D2 receptor antagonist Hits D2, **M1 (more)**, and alpha adrenergic ADR-Dystonia, akathesia, parkinsonian, sedation, hyperprolactinemia, **hypotension**, dry mouth

Answer 24

Pros- most widely used, easily vansih when rubbed into skin, provides lubrication Cons- more drying vs ointments, not occlusive, application mistakes **(apply toomuch or not rubbed enough)** **Subacute lesions (crusting, less oozing, pruritis)**

Answer 25

MOA- made up of fat-llike substances that soften and soothe skin, retain moisture and provide protective ## Footnote **Used in combination with topical steroids "steroid sparring"- hydrated skin increases absorption fo steriods** **Apply emollient first, wait 5-15 min, then appy steroid**

Answer 26

Synthetic vitamin D3 analog MOA- inhibitrs epidermal keratinocyte hyperproliferation Can be combined with other treatment including steroids- **"steroid sparing"** **Can help improve UVB light therapy (apply med AFTER light therapy)** * **heat from the light can increase absorption→ cause skin irratation** ADR- cutaneous irrtation, buring, stinging hypercalcemia (rare in larger areas)

Answer 27

Chronic constipation MOA- activates guanylate cyclase in response to a meal→ increase cGMP→ stimulate chloride, sodium bicarbonate, and water secretion into intestinal lumen * also activates clonic snesory and motor neurons * r**educes abdominal pain and increases smooth muscle contraction** ADR- diarrhea, dehydration, dizziness, hypokalemia **_BBB- serious dehydration- do not use under 18, cauton in elderly and advanced kidney disease_**

Answer 28

Topical steroid- low potency MOA- drecrease inflammation, modulate immune response and vasocontrict blood vessels to minimize redness, warmth and swelling **Potency determined by vasocontrictor assay (higher poteny more vasocotriction)** ADR- Skin atrophy, straie, rosacea, superfical infections, hypopigmentation, contact dermatitis, tolerance, tachyphylaxsis, systemic side effects (adrenalsupression, HTN, hyperglycemia) **Considerations high potency (groups 6-7)- safest for prolonged use, large surface areas, face or other areas with thin skin, children, think dermatitis, diaper rash, rash on face/ eyelids, perianal inflammation**

Answer 29

PPI MOA- irrevirsibly inactiavtes the hydrogen potassium adenosine triphosphate (H+/ K+/ ATPase) resulting in imparied acid secretion **Pro drug is protected by enertic coating ( dissoves in intestinal lumen abd is absorbed, carried to the parietal cells of the stomach for activation)** **Bioavailibity decreases with food (take on empty stomach 30-60 min beofre first meal)** **Onset of action2-3 hours, 3-4 days for maximal effect, duration of action 24 hours** **Good for renal insufficiency patients** **ADR- diarrhea, headache, abdominal pain, vitamin B12 deficiency, reduced absorption of iron, calcium, magnesium osteroperosis, fractures, C, diff, community aquired pneumonia** **TAPER OFF- rebound hypersecretion** **DDI- ketoconazole, intraconazole, atazanavir, rilpiverine, calicum caronate, iron salts**

Answer 30

D2 receptor antagonist D2, H1 (weak) ADR-Dystonia, akathesia, parkinsonian, sedation, hyperprolactinemia, hypotension, dry mouth

Answer 31

Anti-emetic- antihistamine and antimuscarinic bloackade (vestibular system) beneficial for nausea/ vomitting, motion sickness ## Footnote **Blocks more H1 then M1** **ADR- first gen histamien ADR (constipation, dry mouth memory impairment)**

Answer 32

H2 blockers MOA- reversibly decreases fasting and food stimulated acid secretion by inhibiting histamine on h2 recptor of the parietal cell mild-moderate heartburn, **good for noctural acid secretion** **extensive first pass effect** **onset of relief 30-60min and last 6-10 hours** **PRN only**

Answer 33

5-HT3 recepotr antagonist Used for chemotherapy induced nausea/ vomitting MOA- **central bloakade** of the chemotrigger zone and vomittng center. **Peripheral blockage (Seratonin receptors in GI tract)** of intestinal vagal and spinal afferent nerves→ **drives antiemetic benefit (80% of seratonin is found in the GI tract). Only one in the class that hits 5-HT1** **_Does not hit H1, M1 or D2 receptors not suitable for the treatment of motion sickness_** **_Desenegrated oral tablet→ less likely to vomit the medication_** Half life of about 4-6 hours Metabolism- CYP 3A4 ADR- Headache, dizziness, constipation,**small but significantly significant QTc prolongation (K+ channel blockade), Seratonin syndrome (Increase levels of seratonin)**

Answer 34

D2 receptor antagonist Hits **D2 (more),** M1, and alpha adrenergic ADR- **Dystonia, akathesia, parkinsonian, sedation, hyperprolactinemia,** hypotension, dry mouth

Answer 35

**Pros-** most occlusive, most useful for chronic lesions, relieves dryness, bitteness, and provide protection **cons-**greasy, may be cosmeticlalt unacceptable, not applied to acutely inflamed lesiolns, do **not apply intertriginous, burns, or hariy areas** **Good for chronic dry lesions like psoriasis**, chronic inflammation **(dryness, erythema, pruritus, scaling, thick)**

Answer 36

H2 blockers MOA- reversibly decreases fasting and food stimulated acid secretion by inhibiting histamine on h2 recptor of the parietal cell mild-moderate heartburn, **good for noctural acid secretion** **extensive first pass effect** **onset of relief 30-60min and last 6-10 hours** **PRN only**

Answer 37

5-HT3 recepotr antagonist Used for chemotherapy induced nausea/ vomitting **MOA- central bloakade** of the chemotrigger zone and vomittng center. **Peripheral blockage (Seratonin receptors in GI tract)** of intestinal vagal and spinal afferent nerves→ **drives antiemetic benefit (80% of seratonin is found in the GI tract)** **Does not hit H1, M1 or D2 receptors not suitable for the treatment of motion sickness** Half life of about 4-6 hours Metabolism- CYP 2D6 ADR- Headache, dizziness, constipation,**small but significantly significant QTc prolongation (K+ channel blockade), Seratonin syndrome (Increase levels of seratonin)**

Answer 38

Anti-emetic- antihistamine and antimuscarinic bloackade (vestibular system) beneficial for nausea/ vomitting, motion sickness ## Footnote **Blocks more H1 then M1** **ADR- first gen histamien ADR (constipation, dry mouth memory impairment)**

Answer 39

Active ingredient THC reduces nausea/ vomitting by binding to the CB1 receptor in the CNS ## Footnote **Controlled substance- need to monitor for physiological and psycological dependence** **Increase euphoria/ increase appetite** **Used for HIV and cachexia**

Answer 40

Pros- cooling, may privide lubrication, may be good for oozing lesions, **good for hairy areas and scalp** Cons- drying, not occlusive, must be shaken well prior to use **Good for wet lesions (posion ivy) , acute lesions (oozing, weeping, edema, pruritis, redness)**

Answer 41

D2 receptor antagonist D1, 5-HT3 (weak) Used for gastroparesis (stomach cannot empty)→ stimulation of peristalsis ADR-Dystonia, akathesia, parkinsonian, sedation, hyperprolactinemia, hypotension, dry mouth

Answer 42

PPI MOA- irrevirsibly inactiavtes the hydrogen potassium adenosine triphosphate (H+/ K+/ ATPase) resulting in imparied acid secretion **Pro drug is protected by enertic coating ( dissoves in intestinal lumen abd is absorbed, carried to the parietal cells of the stomach for activation)** **Bioavailibity decreases with food (take on empty stomach 30-60 min beofre first meal)** **Onset of action2-3 hours, 3-4 days for maximal effect, duration of action 24 hours** **Good for renal insufficiency patients** **ADR- diarrhea, headache, abdominal pain, vitamin B12 deficiency, reduced absorption of iron, calcium, magnesium osteroperosis, fractures, C, diff, community aquired pneumonia** **TAPER OFF- rebound hypersecretion** **DDI- ketoconazole, intraconazole, atazanavir, rilpiverine, calicum caronate, iron salts**

Answer 43

Antacid MOA- neutralize gastric pH Symptom relief for GERD, sour stomach, acid indigestion **Work with 5 min but only last 20-30 min** **Can decrease the effecicay of other drugs that require acidic environment-** tetracyclines, iron, itraconazole **ADR- flatulence** **Watch for renal insufficiceny**

Answer 44

5-HT3 recepotr antagonist Used for chemotherapy induced nausea/ vomitting **MOA- central bloakade** of the chemotrigger zone and vomittng center. **Peripheral blockage (Seratonin receptors in GI tract)** of intestinal vagal and spinal afferent nerves→ **drives antiemetic benefit (80% of seratonin is found in the GI tract)** **Does not hit H1, M1 or D2 receptors not suitable for the treatment of motion sickness** Half life of about 4-6 hours Metabolism- CYP 3A4 ADR- Headache, dizziness, constipation,**small but significantly significant QTc prolongation (K+ channel blockade), Seratonin syndrome (Increase levels of seratonin)**

Answer 45

Bulk forming laxative **MOA-** dissolves or swells in the intestional fluid, forming wmollient gels that facilitate the passage of intestional contents and stimulate peristalsis **DOC for constipation, goos for patients on low fiber diets** **1-3 days onset to soften stool**

Answer 46

Topical Retinoid- **Greater anti-inflammatory** MOA- stimuate epidermal cell trunover and decrease cell cohesiveness **(unplug follicles , reduces inflammtion)** ADR- skin irritation, peeling, dryness, erythema, hyperpigmentation (more tretinoin\> adapalene), acne may worsen with initial use (make take 3 months for full effect), Consideratons- wear sunscreen, avoid UV light, apply at bedtime due to photosensitivity **Available in cream or gel**

Answer 47

MOA- peripheral mu opioid agonist, at hihg doses can get into CNS **Atropine co-forumation to reduce absue potential,** anticolinergic properties can contribute to antidiarrheal effect **Controlled substance- monitor for physiological and physcological dependence** ADR- dry mouth, constipation,**eurphoria, respiratory depression (high doeses)**

Answer 48

Stimulant laxative MOA- increases the propulsive peristatic activity of the intestine by local irratation of the mucosa. Stimulates the secretion of water and electrolytes in the large intestine **Can cause electrolyte and fluid deficines along with malabsportion** **takes 6-12 hours for semi-fluid stool**

Answer 49

Topical Retinoid- **effective but poorly tolerated** MOA- stimuate epidermal cell trunover and decrease cell cohesiveness **(unplug follicles , reduces inflammtion)** ADR- skin irritation, peeling, dryness, erythema, hyperpigmentation (more tretinoin\> adapalene), acne may worsen with initial use (make take 3 months for full effect), Consideratons- wear sunscreen, avoid UV light, apply at bedtime due to photosensitivity **Available in cream or gel**

Answer 50

Hyperosmotix laxative MOA- draws water into rectum to simulate a bowel movement **Soften stool within 1-3 days** **Okay to use in elderly, cardiac or renal deficent patients**

Answer 51

H2 blockers MOA- reversibly decreases fasting and food stimulated acid secretion by inhibiting histamine on h2 recptor of the parietal cell mild-moderate heartburn, **good for noctural acid secretion** **extensive first pass effect** **onset of relief 30-60min and last 6-10 hours** **PRN only**

Answer 52

MOA- interferes with production of inflammatory cytokines. Modulates inflammation mediators derived from COX and lipoxygenase Topical formuation- minimal systemic effect **CONTRAINDICCATED in those with salcylate allergy** **SIte of action-** * **small and large intestine- Pentasa,** * **illeum of small intestine and large intestine- Asacol, Lialda** * **enema- Rowasa** * **supository- Canasa** **Well tolerated- HA, abdominal pain, nausea**

Answer 53

Chronic consitpation, **opioid induced constipation** **MOA-** Activate chlroide channel-2 (CIC-2) in GI epithelial cells→ efflux of Cl- into lumen of GI tract → followed by efflux of Na+→ follwoed by water (increase fluid secretion, increase intestinal transport) ADR- **nausea,** diarrhea, abdominal pain and distention, headache

Answer 54

PPI MOA- irrevirsibly inactiavtes the hydrogen potassium adenosine triphosphate (H+/ K+/ ATPase) resulting in imparied acid secretion **Pro drug is protected by enertic coating ( dissoves in intestinal lumen abd is absorbed, carried to the parietal cells of the stomach for activation)** **Bioavailibity decreases with food (take on empty stomach 30-60 min beofre first meal)** **Onset of action2-3 hours, 3-4 days for maximal effect, duration of action 24 hours** **Good for renal insufficiency patients** **ADR- diarrhea, headache, abdominal pain, vitamin B12 deficiency, reduced absorption of iron, calcium, magnesium osteroperosis, fractures, C, diff, community aquired pneumonia** **TAPER OFF- rebound hypersecretion** **DDI- ketoconazole, intraconazole, atazanavir, rilpiverine, calicum caronate, iron salts**

Answer 55

Topical steroid- high potency MOA- drecrease inflammation, modulate immune response and vasocontrict blood vessels to minimize redness, warmth and swelling **Potency determined by vasocontrictor assay (higher poteny more vasocotriction)** ADR- Skin atrophy, straie, rosacea, superfical infections, hypopigmentation, contact dermatitis, tolerance, tachyphylaxsis, systemic side effects (adrenalsupression, HTN, hyperglycemia) **Considerations high potency (groups 1-3)- not to be used in the face, groin, axilla, or under occlusions, better for thichker areas (palms and bottms of feet), use for the shortest duration possible, use for psoriasis, severe poison ivy, severe atopic detmatitis**

Answer 56

MOA- interferes with production of inflammatory cytokines. Modulates inflammation mediators derived from COX and lipoxygenase ## Footnote **Topical formuation- minimal systemic effect** **CONTRAINDICCATED in those with salcylate allergy** **SIte of action- large intestine** **ADR- secretory diarrhea**

Answer 57

MOA- synthetic, **peripheral mu opiod agonist** that stimuate recptors located in the intestinal circular muscle (slows intestinal contraction, inhibits sevretion of electrolytes and water) **at high doses hits central mu opoid receptors for analgesic effect (abuse potential)** ADR- dizziness, mild constipation, abdominal pain/ distention ADR- caridac arrhythmias (K+ channel blockade), syncope, cardiac arrest

Answer 58

Topical steroid-Ultra high potency MOA- drecrease inflammation, modulate immune response and vasocontrict blood vessels to minimize redness, warmth and swelling **Potency determined by vasocontrictor assay (higher poteny more vasocotriction)** ADR- Skin atrophy, straie, rosacea, superfical infections, hypopigmentation, contact dermatitis, tolerance, tachyphylaxsis, systemic side effects (adrenalsupression, HTN, hyperglycemia) **Considerations high potency (groups 1-3)- not to be used in the face, groin, axilla, or under occlusions, better for thichker areas (palms and bottms of feet), use for the shortest duration possible, use for psoriasis, severe poison ivy, severe atopic detmatitis**

Answer 59

Stimulant laxative MOA- increases the propulsive peristatic activity of the intestine by local irratation of the mucosa. Stimulates the secretion of water and electrolytes in the large intestine **Can cause electrolyte and fluid deficines along with malabsportion** **takes 6-12 hours for semi-fluid stool**

Answer 60

Antacid MOA- neutralize gastric pH **Symptom relief for GERD, sour stomach, acid indigestion** Work with 5 min but only last 20-30 min **Can decrease the effecicay of other drugs that require acidic environment-** tetracyclines, iron, itraconazole **ADR- magnessium (diarrhea), aluminium (constipation),** **Watch for renal insufficiceny**

Answer 61

PPI **MOA**- irrevirsibly inactiavtes the hydrogen potassium adenosine triphosphate (H+/ K+/ ATPase) resulting in imparied acid secretion **Pro drug is protected by enertic coating ( dissoves in intestinal lumen abd is absorbed, carried to the parietal cells of the stomach for activation)** **Bioavailibity decreases with food (take on empty stomach 30-60 min beofre first meal)** **Onset of action2-3 hours, 3-4 days for maximal effect, duration of action 24 hours** **Omeprazole (CYP 2C19 inhibitor) and clopidogrel (CYP 2C19 prodrug)= theraputic failure of clopedigrel** **Good for renal insufficiency patients** **ADR- diarrhea, headache, abdominal pain, vitamin B12 deficiency, reduced absorption of iron, calcium, magnesium osteroperosis, fractures, C, diff, community aquired pneumonia** **TAPER OFF- rebound hypersecretion** **DDI- ketoconazole, intraconazole, atazanavir, rilpiverine, calicum caronate, iron salts**

Answer 62

NK recpotor antagonist MOA- central blockade of NK receptors in the chemotrigger zone, blocks bnding of substance P **_ONLY used for prevention of chemotherapy induced nausea/ vomitting along with 5-HT3 antagonist and corticosteriods_** ARR- Fatigue/ dizziness **Aprepitant and warfarin can cause decrease INR (increase clotting, increase risk of stroke or DVT)** **CYP 3A4 substrate- combination with with CYP 3A4 inhibitor (Clarithromycin, Ketoconazole, Itraconazole, HIV protase inhibitors, Grapefruit Juice, diltizem, verapamil) can cause toxicity**

Answer 63

H2 blockers MOA- reversibly decreases fasting and food stimulated acid secretion by inhibiting histamine on h2 recptor of the parietal cell mild-moderate heartburn, **good for noctural acid secretion** **extensive first pass effect** **onset of relief 30-60min and last 6-10 hours** **PRN only**

Answer 64

Emollient laxative **MOA-** increase the wetting efficacy of intertinal fluid and facilittes a mixture of aq and fatty substances to soften feces (doesn't bulk stool) **Good for patients with dry stoool, straining when defecating** **1-3 days onset to soften stool**

Answer 65

Topical steroid- medium potency MOA- drecrease inflammation, modulate immune response and vasocontrict blood vessels to minimize redness, warmth and swelling **Potency determined by vasocontrictor assay (higher poteny more vasocotriction)** ADR- Skin atrophy, straie, rosacea, superfical infections, hypopigmentation, contact dermatitis, tolerance, tachyphylaxsis, systemic side effects (adrenalsupression, HTN, hyperglycemia) **Considerations medium (groups 4-5)- consider starting here and switiching to higher (or lower) potency as needed, think atopic dermatitis, hemorrhoids (severe), dermatitis (severe)**

Answer 66

Antacid MOA- neutralize gastric pH Symptom relief for GERD, sour stomach, acid indigestion **Work with 5 min but only last 20-30 min** **Can decrease the effecicay of other drugs that require acidic environment-** tetracyclines, iron, itraconazole **ADR- constipation** **Watch for renal insufficiceny**

Answer 67

Saline laxative- works in small and large intestine MOA- draws water into the intestine, increasing intraluminal pressure, whihc acts as a stimulus to increase intestinal motility **takes 6-12 hours for semi-fluid stool** **Do not use in patients with electrolyte disturbances, elders, patients with renal or cardiac issues ( uncontrolled hypertensionand CHF- salt content)**

Answer 68

Active ingredient THC reduces nausea/ vomitting by binding to the CB1 receptor in the CNS **Controlled substance- need to monitor for physiological and psycological dependence** **Increase euphoria/ increase appetite**

Answer 69

Bulk forming laxative **MOA**- dissolves or swells in the intestional fluid, forming wmollient gels that facilitate the passage of intestional contents and stimulate peristalsis **DOC for constipation, goos for patients on low fiber diets** 1-3 days onset to soften stool