P3 Quiz 2 Flashcards

Question

Alendronate uses

Answer 1

1. ) Postmenopausal osteoporosis prophylaxis (M and F)- 5 mg QD, 35 mg once weekly 2. ) Postmenopausal osteoporosis (M and F) or glucocorticoid induced osteoporosis - 10mg QD, 70mg once weekly 3. ) Paget disease- 40 mg PO QD for 6 months

Answer 2

Alendronate binds to bone hydroxyapatite and, at the cellular level, inhibits osteoclast activity, thereby inhibiting bone resorption and modulating bone metabolism.

Answer 3

Esophageal abnormalities Hypersensitivity Hypocalcemia Inability to sit or stand upright for at least 30 min Increased risk for adverse esophageal effects

Answer 4

Aluminum, calcium, magnesium, or iron containing products- decreases biphosphonate abs

Answer 5

Fever, gastric ulcer, decreased serum calcium

Answer 6

Osteonecrosis of the jaw, esophageal cancer, immune hypersensitivity, arrhythmia, fractures

Answer 7

Depression- 75 mg divided into 1-3 daily doses

Answer 8

Amitriptyline is a TCA that blocks presynaptic reuptake of serotonin and NE with subsequent downregulation of adrenergic receptors

Answer 9

Suicidality, not approved for children <12 years of age

Answer 10

Hypersensitivity Concurrent MAOI or MAOI use in last 14 days Use during acute recovery period after MI Coadministration of cisapride

Answer 11

Anticholinergics- additive AE Antiarrhythmics, and drugs that increase QTc prolongation- increased risk of cardiotoxicity CYP2D6 inhibitors- decreased amitriptyline metabolism increases risk of toxicity Linezolid, MAOIs, methylene blue, SSRIs- increased risk of serotonin syndrome

Answer 12

Cardiac dysrhythmia, hepatotoxicity, seizures, suicidal thoughts

Answer 13

Aromatase inhibitor

Answer 14

1. ) Breast cancer, adjuvant, postmenopausal, hormone receptor positive- 1 mg QD for 5-10 years 2. ) Breast cancer, advanced or metastatic, postmenopausal, following tamoxifen therapy- 1 mg QD until tumor progression

Answer 15

Adrenally generated androstenedione is the primary source of estrogen in postmenopausal women and is converted to estrone by aromatase. Anastrozole is a nonsteroidal aromatase inhibitor.

Answer 16

Hypersensitivity and pregnancy

Answer 17

Tamoxifen- reduced anastrozole levels

Answer 18

Edema, HTN, vasodilation, nausea, vomiting, arthralgia, arthritis, osteoporosis, hot flashes, depression, GI tract disorder

Answer 19

MI, endometrial cancer, cerebrovascular accident

Answer 20

Monocyclic antidepressant

Answer 21

1. ) Depression- 100 mg BID x 3 days, increase to 100 mg TID 2. ) SAD- 150 mg QD 3. ) Smoking cessation assistance- 150mg BID

Answer 22

Bupropion is a monocyclic antidepressant, unique as a mild dopamine and norepinephrine uptake inhibitor with no direct effects on serotonin receptors or MAO

Answer 23

Suicidality | Neuropsychiatric reactions

Answer 24

Seizure disorder, history of anorexia/bulimia Use of MAOI within 14 days Patients undergoing abrupt d/c of ethanol, benzodiazepines, barbiturates, or antiepileptics

Answer 25

Alcohol- increased risk of seizures CYP3A4/5, 2B6 inducers- increased bupropion metabolism, reduces bupropion effectiveness CYP3A4/5,2B6 inhibitors- decreased bupropion metabolism increases risk of toxicity CYP2D6 substrates- decreased metabolism of substrates or activation of prodrugs requiring CYP2D6

Answer 26

Agitation, constipation, dizziness, HA, insomnia, nausea, tachyarrhythmia, tremor, xerostomia

Answer 27

Cardiac dysrhythmia, mania, seizure, suicidal thoughts, wide QRS complex

Answer 28

Depression- 20 mg QD

Answer 29

Citalopram is a bicyclic antidepressant that is a selective and potent inhibitor of presynaptic reuptake of serotonin. It does not affect the reuptake of NE or dopamine and has a relative lack of affinity for muscarinic, histamine, alpha1 and alpha2 adrenergic, and serotonin receptors.

Answer 30

Suicidal ideation, not approved for use in children

Answer 31

Hypersensitivity, concomitant use of pimozide, MAOIs

Answer 32

Anticoagulants, antiplatelet drugs, NSAIDs- increased risk of bleeding Dextroamphetamine, triptans, linezolid, lithium, MAOIs- serotonin syndrome CYP2C19 and CYP3A4/5 inducers- increased citalopram metabolism reduces citalopram effectiveness CYP2C19 and CYP3A4/5 inhibitors- decreased citalopram metabolism increases risk of citalopram toxicity

Answer 33

Constipation, dizziness, HA, insomnia, N, sedation, xerostomia

Answer 34

Prolonged QTc interval, serotonin syndrome, suicidal thoughts, torsades de pointes, agranulocytosis

Answer 35

SSRI antidepressant

Answer 36

1. ) Depression-10-20mg QD | 2. ) Anxiety- 10-20mg QD

Answer 37

Escitalopram is the s-enantiomer of racemic citalopram and is an antidepressant that is a selective and potent inhibitor of presynaptic reuptake of serotonin (SSRI). It does not affect reuptake of NE or dopamine and has a relative lack of affinity for muscarinic, histamine, alpha1 and 2, and serotonin receptors.

Answer 38

Suicidality

Answer 39

Hypersensitivity to citalopram or escitalopram | Concurrent MAOI use

Answer 40

Anticoagulants, antiplatelet drugs, NSAIDs, omega 3 FA- increased risk of bleeding Triptans, SNRIs, Linezolid, MAOIs- increased risk of serotonin syndrome Lithium- increased lithium concentrations CYP3A4/5, 2C19 inducers- increased escitalopram metabolism, reducing efficacy. CYP3A/4, 2C19 inhibitors- decreased escitalopram metabolism, increasing toxicity.

Answer 41

HA, nausea, sedation

Answer 42

Prolonged QTc interval, serotonin syndrome, suicidal thoughts, torsades de pointes

Answer 43

Estradiol is the most potent of the naturally occurring estrogens and the major estrogen secreted during the reproductive years. Estradiol and other estrogens produce characteristic effects on specific tissues (such as breast), cause proliferation of vaginal and uterine mucosa, increase calcium deposition in bone, and accelerate epiphyseal closure after initial growth stimulation.

Answer 44

1. ) Abnormal vasomotor function, menopause- 1-2 mg QD for 21 days, 7 off 2. ) Atrophic vulva or vagina, menopause- same as above 3. ) Breast cancer, metastatic, for palliation only- 10mg TID for 3 months 4. ) Carcinoma of prostate, advanced, androgen-dependent, palliation only- 1-2mg TID 5. ) Decreased estrogen level- 1-2mg QD 6. ) Postmenopausal osteoporosis prophylaxis- 0.5mg QD for 23 days then 5 days off

Answer 45

Endometrial and breast cancer risk, dementia risk, should not be used to reduce CV risk Secondary exposure risk (transdermal solution)

Answer 46

Hypersensitivity to estradiol H/O thromboembolic disorders, breast cancer, any estrogen-dependent neoplasm Known or suspected pregnancy

Answer 47

CYP3A4/5, 1A2, P-gp inducers- increased estradiol metabolism or transport reduces estradiol effectiveness CYP3A4/5, 1A2, P-gp inhibitors- decreased estradiol metabolism or transport increases risk of estradiol toxicity

Answer 48

Heart disease, MI, DM, venous thromboembolism, anaphylaxis, cerebrovascular accident, PE, breast, endometrial or ovarian cancer

Answer 49

5 alpha reductase inhibitor

Answer 50

Finasteride inhibits the conversion of testosterone to DHT

Answer 51

1. ) Benign prostatic hyperplasia- 5 mg QD | 2. ) Male pattern alopecia- 1 mg QD

Answer 52

hypersensitivity to finasteride, pregnancy, use in children

Answer 53

Impotence, reduced libido

Answer 54

HF, angioedema, allergic skin reactions, male breast cancer, prostate cancer

Answer 55

1. ) Depression- 20 mg QD 2. ) OCD- 20 mg QD 3. ) Panic disorder- 10 mg QD 4. ) Premenstrual dysphoric disorder- 20 mg QD 5. ) Bulimia- 20 mg QD

Answer 56

Fluoxetine is a bicyclic antidepressant that is a selective and potent inhibitor of presynaptic reuptake of serotonin

Answer 57

Suicidality, approved in children >7 for OCD; >8 for MDD

Answer 58

Antiplatelet agents, NSAIDs, warfarin- increased risk of bleeding Agents that prolong QTc interval CYP2C9 and CYP2D6 substrates- decreased metabolism of substrates, increased substrate toxicity. CYP2C9 inducers- increased metabolism of fluoxetine and decreased fluoxetine efficacy CYP2C9 and 2D5 inhibitors- decreased metabolism of fluoxetine and increased risk of fluoxetine toxicity Triptans, dextroamphetamines, tramadol, linezolid, MAOIs, TCAs, SNRIs- increased risk of serotonin syndrome

Answer 59

Diarrhea, HA, insomnia, nausea, somnolence, tremor, xerostomia

Answer 60

Prolonged QTc interval, serotonin syndrome, suicidal thoughts, torsades de pointes, SIADH

Answer 61

1. ) Hypothyroidism | 2. ) Thyroid stimulating hormone suppression: Thyroid cancer

Answer 62

Levothyroxine sodium is a synthetic thyroid hormone. The endogenous hormones, T3 and T4, diffuse into the cell nucleus and bind to thyroid receptor proteins attached to DNA. The hormone nuclear receptor complex activates gene transcription and synthesis of messenger RNA and cytoplasmic proteins

Answer 63

Not for weight reduction

Answer 64

Hypersensitivity, nontoxic diffuse goiter or nodular thyroid disease, thyrotoxicosis, AMI Treatment of obesity or weight loss Uncorrected adrenal insufficiency; may precipitate acute adrenal crisis

Answer 65

None known

Answer 66

Aggravation of preexisting CV disease, hyperthyroidism

Answer 67

Aluminum, calcium, Mg antacids, iron, sucralfate, orlistat- decreased abs of levothyroxine Estrogens- estrogen induced increases in thyroxine binding globulin concentration Eltrombopag- inhibition of AOTP1b1-mediated elimination of levothyroxine Imatinib- decreased levothyroxine effectiveness Phenytoin, rifampin, simvastatin- increased levothyroxine clearance Warfarin- enhanced anticoagulant effect

Answer 68

Medroxyprogesterone transforms proliferative into secretory endometrium. Androgenic and anabolic effects have been noted, but the drug is apparently devoid of significant estrogenic activity

Answer 69

1. ) Abnormal uterine bleeding unrelated to menstrual cycle: 5-10 mg QD for 5-10 days 2. ) Prevention of estrogen-induced endometrial hyperplasia: 6-10 mg QD for 12-14 days 3. ) Secondary physiologic amenorrhea: 5-10 mg QD for 5-10 days

Answer 70

CV, dementia risk, loss of BMD; breast cancer

Answer 71

Hypersensitivity to medroxyprogesterone, abnormal genital bleeding, history of estrogen or progesterone dependent neoplasia, active or h/o DVT or PE, severe liver dysfunction, known or suspected pregnancy

Answer 72

CYP3A4/5 inducers- increased medroxyprogesterone metabolism reduces efficacy CYP3A4/5 inhibitors- decreased medroxyprogesterone metabolism increases toxicity CYP3A4/5 substrates- increased substrate metabolism decreases efficacy Corticosteroids- clearance of corticosteroid reduced by inhibition of corticosteroid metabolism resulting in steroid toxicity Warfarin- medroxyprogesterone may increase or decrease warfarin effectiveness

Answer 73

Weight gain, HA, amenorrhea, breast tenderness, nervousness

Answer 74

DVT, thrombophlebitis, osteoporosis, PE

Answer 75

Nortriptyline is the demethylated metabolite of amitriptyline, a heterocyclic antidepressant that blocks presynaptic reuptake of NE with subsequent downregulation of adrenergic receptors. Heterocyclic antidepressants have less effects on serotonergic activity than on other neurotransmitters

Answer 76

Depression- 25mg TID-QID

Answer 77

Suicidality

Answer 78

Hypersensitivity to nortriptyline or other TCAs MAOI concurrent use or use within 14 days Use during acute recovery period after MI Patient using linezolid or IV methylene blue

Answer 79

Amphetamines- increased risk of HTN, cardiac effects, CNS stimulation Linezolid, MAOIs, methylene blue, SSRIs- increased risk of serotonin syndrome Antiarrhythmics, agents that cause QTc prolongation- increased risk of cardiotoxicity CYP2D6 inhibitors- decreased metabolism of nortriptyline increases risk of nortriptyline toxicity CNS depressants- additive CNS depression

Answer 80

Constipation

Answer 81

Cardiac dysrhythmia, hear block, hepatotoxicity, seizures, suicidal thoughts

Answer 82

urinary antispasmodic

Answer 83

Oxybutynin is a competitive, muscarinic receptor antagonist. Muscarinic receptors play an important role in several major cholinergically mediated functions, including contractions of the urinary bladder smooth muscle and stimulation of salivary secretion.

Answer 84

Overactive or neurogenic bladder- 5 mg BID-TID

Answer 85

Hypersensitivity to oxybutynin, gastric retention, glaucoma, urinary retention

Answer 86

CYP3A4/5 inhibitors- decreased oxybutynin metabolism increasing toxicity CYP3A4/5 inducer- increased oxybutynin metabolism, decreasing efficacy Anticholinergic agents- additive anticholinergic AE

Answer 87

Constipation, xerostomia, blurred vision

Answer 88

Prolonged QTc interval, seizures, tachycardia

Answer 89

Progesterone transforms proliferative endometrium into secretory endometrium. Parenterally administered progesterone inhibits gonadotropin production, which in turn prevents follicular maturation and ovulation.

Answer 90

1. ) Prevention of estrogen-induced endometrial hyperplasia- 200mg QHS got 12 days of a cycle 2. ) Secondary physiologic amenorrhea- 400 mg QHS for 10 days 3. ) Assisted reproduction for infertile women

Answer 91

CV disorders, breast cancer, dementia risk, risk versus benefit

Answer 92

Abnormal vaginal bleeding, history of estrogen or progesterone dependent neoplasia Active or h/o DVT or PE Known or suspected pregnancy

Answer 93

CYP2C19, 3A4/5 inducers- increased progesterone metabolism reducing efficacy CYP2C19, 3A4/5 inhibitors- increased toxicity Warfarin- may increase or decrease warfarin efficacy

Answer 94

Weight change, HA, amenorrhea, breast tenderness, abdominal pain

Answer 95

Thromboembolism (DVT, PE), thrombophlebitis, osteoporosis

Answer 96

Selective estrogen receptor modulator

Answer 97

Raloxifene is a selective estrogen receptor modulator (SERM) and binds to estrogen receptors, resulting in activation of estrogenic pathways in some tissues (Agonism) and blockade in others (antagonism). Raloxifene appears to act as an estrogen agonist in bone, decreasing bone resorption and bone turnover and increasing BMD

Answer 98

Venous thromboembolism, stroke

Answer 99

Hypersensitivity to raloxifene | Pregnancy or lactation, current or history of thromboembolic disorders

Answer 100

Bile acid sequestrants- reduced abs of raloxifene

Answer 101

Hot flashes, arthralgia, flu-like symptoms

Answer 102

Edema, hypertriglyceridemia, VTE, cerebrovascular accident, PE

Answer 103

Sertraline is an SSRI that indirectly results in a downregulation of beta-adrenergic receptors. It has no clinically important eff3ect on noradrenergic or histamine receptors and no effect on MAO. It lacks stimulant, CV, anticholinergic, and convulsant effects.

Answer 104

CYP2D6 inhibitors- decreased sertraline metabolism increasing toxicity CYP2B6, 2C19, 2D6, substrates- decreased substrate metabolism increasing toxicity Antiplatelet drugs, NSAIDs- increased risk of bleeding Triptans, SSRIs, dextroamphetamine, tramadol, MAOIs, linezolid, opioids- increased risk of serotonin syndrome

Answer 105

Diarrhea, fatigue, HA, insomnia, nausea

Answer 106

Serotonin syndrome, suicidal thoughts

Answer 107

Inhibition of PDE5 by sildenafil increases the amount of cyclic guanosine monophosphate (GMP) enhancing erectile function and pulmonary vasculature relaxation. Penile erection during sexual stimulation is mediated by the release of NO from nerve terminals and endothelial cells, which stimulates the synthesis of cyclic GMP in smooth muscle cells. Cyclic GMP causes smooth muscle relaxation and increased blood flow into the corpus cavernosum and vasodilation in the pulmonary bed

Answer 108

1. ) Erectile dysfunction- 25-100mg PO prn 1 hr prior to sexual activity 2. ) Pulmonary HTN: 5-20 mg PO TID

Answer 109

hypersensitivity to PDE inhibitors, concurrent nitrates, concurrent HIV protease inhibitors when used for treating pulmonary HTN, concurrent guanylate cyclase stimulators

Answer 110

CYP3A4/5 inducers- increased sildenafil metabolism reduces efficacy CYP3A4/5 inhibitors- decreased sildenafil metabolism increases toxicity alpha adrenergic agents- additive hypotension Nitrates- additive hypotension Protease inhibitors- increased concentration of sildenafil and increased toxicity

Answer 111

flushing, N, HA, visual disturbance, lack of blue/green color discrimination

Answer 112

AMI, seizures, strokes, sudden hearing loss, priapism

Answer 113

Same as sildenafil

Answer 114

1. ) Erectile dysfunction- daily use or 30 min prior to activity 2. ) BPH- 5 mg QD 3. ) Pulmonary HTN- 40 mg QD

Answer 115

Hypersensitivity to PDE inhibitors, concurrent nitrates, concurrent guanylate cyclase stimulators

Answer 116

CYP3A4/5 inducers- increased tadalafil metabolism reducing efficacy CYP3A4/5 inhibitors- decreased tadalafil metabolism increases toxicity Alpha adrenergic agents and nitrates- hypotension

Answer 117

Flushing, nausea, myalgia, HA

Answer 118

SJS, AMI, seizures, strokes, sudden hearing loss

Answer 119

Alpha 1 adrenergic blocker

Answer 120

Tamsulosin is closely related to quinazoline derivatives that selectively block postsynaptic alpha1 adrenergic receptors. Total peripheral resistance is reduced through arterial and venous dilations. Reflex tachycardia that occurs with other vasodilators is infrequent because there is no presynaptic alpha 2 receptor blockade. The drugs also decrease total cholesterol, increase HDL cholesterol, and may improve glucose tolerance and reduce left ventricular mass during long term therapy. They increase urine flow in BPW by relaxing smooth muscle tone in the bladder neck and prostate

Answer 121

BPH- 0.4mg QD

Answer 122

Hypersensitivity to tamsulosin

Answer 123

Alpha1 blockers- hypotension CYP3A4/5 inducers- increased Tamsulosin metabolism reduces efficacy CYP3A4/5, 2D6 inhibitors- decreased tamsulosin metabolism, increasing toxicity Beta blockers, CCBs, MAOIs- increased risk of hypotension, especially with 1st dose

Answer 124

Dizziness, HA, abnormal ejaculation, rhinitis

Answer 125

Retinal detachment, priapism

Answer 126

Androgens are responsible for normal growth and development of male sex organs. Testosterone is involved in the growth and maturation of the prostate, seminal vesicles, penis, and scrotum; development of mail hair distribution; laryngeal enlargement; vocal cord thickening; alterations in body musculature and fat distribution

Answer 127

Hypogonadism

Answer 128

Secondary exposure

Answer 129

Hypersensitivity to testosterone; men with breast or prostate cancer; women who are pregnant, who may become pregnant, or who are breast-feeding

Answer 130

Warfarin- testosterone suppresses clotting factors II, V, VII, and X, and competes with warfarin for plasma protein binding, increasing risk of bleeding

Answer 131

BPH, testicular atrophy, PSA increase

Answer 132

Cardiac arrest, cerebrovascular accident, hepatotoxicity, hallucinations, hostility and aggression

Answer 133

Antimuscarinic

Answer 134

Tolterodine, a competitive muscarinic receptor antagonist, has a high binding affinity for the cholinergic muscarinic receptors that mediate contraction of the urinary bladder and salivation. The drug exerts its significant effects on the lower urinary tract by increasing the residual urine and decreasing detrusor pressure

Answer 135

Bladder muscle dysfunction, overactive- 1-2 mg BID IR or 2-4mg QD ER

Answer 136

Hypersensitivity to tolterodine, fesoterodine Gastric retention Uncontrolled narrow angle glaucoma Urinary retention

Answer 137

Mechanism of antidepressant action is not fully understood but suspected to be related to its potentiation of serotonergic activity in the CNS by inhibiting reuptake of serotonin. Trazodone also significantly blocks H1 and alpha 1 adrenergic receptors

Answer 138

Suicidal ideation, not for use in children

Answer 139

Hypersensitivity, use of MAOI

Answer 140

Amiodarone, agents that prolong QTc interval CYP3A4/5 inhibitors- decreased trazodone metabolism, increasing toxicity CYP3A4/5 inducers- increased trazodone metabolism decreasing efficacy Digoxin, phenytoin- increased digoxin or phenytoin concentrations and risk of toxicity Fluoxetine, linezolid, paroxetine, venlafaxine- increase AE or serotonin syndrome Warfarin- increase or decreased prothrombin times

Answer 141

Dizziness, sedation, HA, N, somnolence, xerostomia

Answer 142

Bleeding risk, cardiac dysrhythmia, fractures, priapism, prolonged QTc, serotonin syndrome, suicidal thoughts, torsades de pointes