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Pharm Flashcards

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1
Q

What are the 2 main disease-modifying antirheumatic drugs?

A
  • Methotrexate

- Anticytokines (Enbrel)

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2
Q

What are the 4 side effects of Methotrexate?

A
  • Hepatic dysfunction
  • GI disturbances
  • Thrombocytopenia
  • Renal dysfunction
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3
Q

What can reduce adverse effects of Methotrexate?

A
  • Folic acid
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4
Q

Do anticyotkines have major side effects?

A

NO

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5
Q

Name the 6 other types of disease modifying antirheumatic drugs.

A
  • Leflunomide (Arava)
  • Infliximab (Remicade)
  • Anakinra (Kineret)
  • Sulfa drugs (Imunnosuppresants)
  • Antimalarials (Chloroquine)
  • Cyclosporine (Neoral)
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6
Q

What is the “alternative” therapy for RA?

A

Gold

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7
Q

What is the action of Leflunomide (Arava)?

A

Inhibits T and B cells

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8
Q

What drug is combined with Infliximab (Remicade)?

A

Methotrexate for cancer

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9
Q

What is the action of Anakinra (Kineret)?

A

Blocks interleukin receptors

Prevents bone erosion and cartilage destruction

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10
Q

What is the side effect of Leflunomide, Infliximab, Anakinra?

A

Increased risk of serious infection

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11
Q

What is action of sulfa drugs?

A

GI problems

Skin problems

Bone marrow depression

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12
Q

What are 2 types of sulfa drugs?

A

Penicillamine

Imuran

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13
Q

What are the side effects of antimalarials?

A

Mental status changes

Retinopathy

Muscle Weakness

Decreased DTRs

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14
Q

What is the antimalarial drug name?

A

Chloroquine

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15
Q

What is the action of cyclosporine?

A

Potent immunosuppresant

Reduces T and B cell activation

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16
Q

What are the side effects of cyclosporine?

A

HTN

Nephrotoxicity

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17
Q

What 3 classes of drug does cyclosporine interact with?

A

Calcium channel blockers

Antibiotics

Corticosteroids

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18
Q

What are the 3 adverse effects of gold therapy?

A

Blood disorders

Renal dysfunction

Skin problems/ dermatitis

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19
Q

What is the endogenous glucocorticosteroid?

A

Cortisol

Hydrocortisone

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20
Q

What are the 2 main synthetic corticosteroids?

A

Prednisone

Dexamethazone

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21
Q

What is the action of glucocorticosteroids?

A
  • Potent anti-inflammatory

via prevention of:

Capillary dysfunction
Edema formation
Migration of leukocytes and macrophages to trauma area

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22
Q

What is the most commonly used administration of glucocorticosteroids?

A

Intra-articular

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23
Q

What is the advantage and disadvantage of intra-articular injection?

A
  • Decreased risk of side effects

- Accelerated joint destruction and tendon atrophy

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24
Q

What are many side effects of corticosteroids?

A
  • Adrenal insufficiency
  • Immunosuppresion
  • Steroid buzz
  • Cataracts
  • Cushingoid state
  • Fluid retention
  • Hyperglycemia
  • Osteoporosis
  • Myopathy
  • GI disturbances
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25
Describe adrenal insufficiency.
Adrenal gland cannot replace removed corticosteroids - Malaise - Arthralgia
26
Why do cataracts develop following corticosteroid use?
- Increased intraocular pressure
27
Describe a cushingoid state.
- Fat/ moon face - Acne - Striae on extremities
28
Describe non pharmacological prevention of osteoporosis.
- Vitamin D and calcium intake - WB exercise - Smoking cessation - Decrease alcohol and caffeine intake
29
Why does caffeine affect demineralization?
Increased calcium excretion
30
What is a major risk factor for osteoporosis?
Smoking
31
Identify 4 types/ forms of pharamacological management of Osteoporosis.
Biphosphonnates Teriparatide (Forteo) Calcitonin Hormone replacement therapy
32
What is the action of biphosphonnates?
Inhibits osteoclastic bone resorption increasing bone mass density and reducing risk of fracture
33
What are 3 side/ adverse effects of biphosphonnates?
- GI problems - Myalgias - Esophageal lesions
34
What are instructions for administration of biphosphonates?
Take at least 30 mins before breakfast with full glass of tap water Remain standing or sitting for 30 minutes
35
What are 3 types of biphosphonnates?
- Aldenronate (Fosamax) - Risedronate (Actonel) - Etidronate (Didronel)
36
What is the action of Teriparatide (Forteo)?
- Parathyroid hormone (raloxifene) -- selevtive antiestrogen agent - Prevents and treats osteoporosis in postmenopausal women
37
What are 2 side effects?
- Hot flashes | - Leg cramps
38
What condition contraindicates use of Teriparatide (Forteo)?
Pts at risk for osteosarcoma/ Paget's disease
39
What is the action of Calcitonin?
Decreases osteoclastic via hormone
40
How is calcitonin administered?
- Nasal spray
41
What are 4 side effects of calcitonin?
- Pain - Myalagias - Headache - Nasal symptoms
42
May calcitonin be used with osetosarcoma/ Paget's disease?
Yes!
43
What type of drug management for osteoporosis is mainly discontinued?
Hormone replacement therapy
44
What are the risks of hormone replacement therapy?
Breast cancer Cardiovascular problems
45
What are 5 types of muscle relaxants?
- Diazepam (Valium) - Tizanidine (Zanaflex) - Chloroxaone (Parafon Foree)/ Cyclobenzprine (Flexeril)/ Methocarbamol (Robaxin)/ Orphenadrine (Norflex) - Baclofen (Lioresal) - Dantrolene (Dantrium)
46
At what level does diazepam function? What muscle dysfunction does it treat?
- Treats muscle spasm at supraspinal/ spinal interneuron level
47
What are 2 adverse/ side effects of diazepam?
- Drowsiness | - Withdrawl
48
What are 3 drug interactions of diazepam?
- Cimetidine (Tagamet, antiulcer/ anti-stomach acid) - Viracept and Norvir (antiviral agents) - AIDs medications that inhibit enzymes that metabolize diazepam
49
At what level does Tizanidine (Zanaflex) act, and what is its action?
- Spinal cord | - Adrenergic agonist to reduce spaticity
50
What is the side effect of tizanidine?
- Hypotension
51
What 5 drugs act on the level of the brain stem/ spinal cord to temporarily relieve local, acute muscle spasm?
- Chlorzoxaone (Parafon Fortee) - Cyclobenzaprine (Flexeril) - Methocarbamol (Robaxin) - Orphenadrine (Norflex)
52
What drugs is Flexeril similar to?
Sinequam and Elvail Tricyclic antidepressants
53
What are Flexeril's side effects?
- Interact with MAOIs (Nardil, Parnate) to cause HTN crisis - Tachycardia - Blurry vision - Dry mouth
54
At what level does Baclofen (Lioresal) act, and what is its action?
- Inhibits release of NT at brain and spinal cord, especially substance P to reduce inflammation and pain, and reduce spasticity.
55
What are the side effects of Baclofen?
Drowsiness Increased seizures if epileptic
56
At what level does Dantrolene act, and what is its action?
Acts on muscle fibers to block release of calcium to reduce chronic spasticity
57
What are 8 side and adverse effects of Dantrolene?
- Dizziness - Drowsiness - Diarrhea - Photosensitivity - Active toxic hepatitis - Seizures - Tachycardia - Muscle weakness
58
What Pts should Dantrolene not be used with?
Pts with cardiac and respiratory dysfunction
59
What drugs react with endogenous opioid receptors?
- Morphine - Codeine - Hydrocodone (Vicodin) - Methadone - Oxycodone (Percocet, Percodan, Oxycontin) - Meperidine (Demerol) - Hydromorphone (Dilaudid)
60
What are the therapeutic uses of opioid narcotics?
- Analgeisa - Antitussive - Antidiarrheal - Dyspnea related to MI, pulmonary edema, L ventricular failure
61
What are 8 adverse/ side effects of opioid narcotics?
- Mental status changes-drowsiness - Nausea/ vomiting - Postural hypotension from parenteral morphine - Respiratory depression - Twitches, seizures, tremor with demerol - Tolerance to drugs - Dependence/ addiction - Physiological withdrawl
62
What opioid narcotic is indicated for stable, chronic pain?
- Fentanyl (Duragesic, Actiq)
63
How long does Fentanyl work?
15 - 45 minutes to reduce acute pain
64
How is Fentanyl applied?
As patch (Durgesic) Lozenge (Actiq Buccal)
65
What is the nonopioid narcotic?
Acetaminophen (Tylenol)
66
What is the action of Acetaminophen?
Weak inhibitor of prostaglandins for mild-moderate pain relief and fever reduction
67
What are the adverse effects of Acetaminophen?
Severe liver damage in large doses | 4 grams/ day maximum
68
What are 4 classes of anti-hypertensives?
- Diuretics - Beta-adrenergic blockers - Calcium channel blockers - Alpha-adrenergic blockers
69
What are the 3 types of diuretics?
- Thiazide - Loop - Potassium-sparing
70
What is a specific thiazide diuretic?
Hydrochlorothiazide (HCTZ, HydroDiuril)
71
What is the action of hydrochlorothiazide?
- Inhibit tubular reabsorption of sodium and chloride in kidney, which inhibits water resorption and increases urine volume for decreased vascular resistance
72
What populations should avoid Thiazide diuretics?
Elderly or anyone with renal dysfunction
73
What are 5 side effects of Thiazides?
- Hyperglycemia - esp for diabetes - Hypokalemia - Hyperuricemia (too much uric acid -- gout) - Hypercalcemia - Increased LDL
74
What are 2 drug interactions of Thiazide diuretics?
- Increased lithium reabsorption | - Digoxin toxicity
75
What are 3 specific Loop diuretics?
- Furosemide (Lasix) - Bumex - Edecrin
76
What is the action of Loop diuretics?
- Sodium and chloride reabsorption inhibited at loop of henle
77
What is more effective -- Loop Diuretics or Thiazide diuretics?
Loop
78
May loop diuretics be used with the elderly?
Yes
79
What are 4 side effects of loop diuretics?
- Hypokalemia - Hypocalcemia (opposite of thiazides) - Hyperglycemia - Hyperurecemia
80
What are 3 specific potassium-sparing diuretics?
- Aldactone - Dyrenium - Midamor
81
What is the action of a potassium sparing diuretic?
Weak Prevent hypokalemia
82
What is the side effect of potassium sparing diuretics?
- Hyperkalemia, especially when combined with ACE inhibitors or potassium supplements
83
Where are beta-1 and beta-2 receptors located?
Beta-1 in heart | Beta-2 in lungs and arterioles
84
What are 3 non-selective beta blockers?
- Propanolol (Inderal) - Nadolol (Corgard) - Penbutolol (Levatol)
85
What are 2 selective beta-blockers for beta-1 receptors?
- Lopressor | - Atenolol
86
What is the mechanism of action of beta-blockers?
- Block renin release from kidneys | - Decrease CO by slowing HR
87
What conditions should not be managed with beta-blockers?
- Certain types of angina - All forms of COPD - Diabetes mellitus
88
Why should beta-blockers never be stopped suddenly?
Anginal attack
89
What are 3 side effects of beta-blockers
- Sleep disturbances - Mental status changes including depression and disorientation - Cold extremities since alpha-adrenergic vasoconstriction is unopposed
90
What are 4 calcium channel blockers?
- Procardia XL - Norvasc - Cardizem - Verapamil
91
What are 2 side effects of calcium channel blockers?
- Significant bradycardia | - Peripheral vasodilation causing headache, ankle swelling, reflex tachycardia
92
What are 2 drug interactions of calcium channel blockers?
- Digoxin toxicity | - Verapamil can cause cardiac depression or AV block
93
What is the alpha-1 selective blocker?
- Prazosin (Minipress)
94
What is the action of Prazosin?
Blocks peripheral vasodilation
95
What are 3 side effects of Prazosin?
- Syncope - Headache - Palpitations
96
What are 2 alpha-2 agonists?
- Clonidine (Catapres) | - Methyldopa (Aldomet)
97
What is the action of the alpha-2 agonists?
Stimulate alpha-2 receptors in brainstem | - Decrease NS signals to decrease HR, peripheral resistance, BP
98
What are 5 side/ adverse effects of Clonidine or Methyldopa?
- Dry mouth - Sedation - Depression - Risk of rebound hypertension with Clonidine - Decreased mental acuity and hemolytic anemia with Methyldopa
99
What is the anginal medicine of choice?
Nitrates
100
What is the action of nitrates?
- Peripheral vasodilation - Reduced work of heart - Decreased O2 demand - Vasodilation of collateral vessels to heart - Relieve coronary artery spasm
101
How may nitro be used prophylactically?
Prior to exercise
102
What are side effects of nitro?
- Dizziness - Flushing and headache - Reflex tachycardia
103
When must EMS be called if nitro is ineffective?
After 3 tabs with no effect. Sit the patient, call EMS
104
What are nitropatches and ointments used for?
Chronic angina
105
What type of nitro is useful for Pts with RA of the hands, unable to handle pills?
Nitrospray
106
What class of medicine is useful for the stress related to aging?
Non-tricyclic antidepressants
107
What are 4 types of ACE inhibitors?
- Quinipril (Accupril) - Captopril (Capoten) - Fosinopril (Monopril) - Benazepril (Lotensin)
108
What is the action of ACE inhibitors?
Inhibits conversion of angiotensin I to II -- inhibits vasocontrition Inhibits secretion of aldosterone from adrenal cortex -- decreased sodium and water retention Inactivation of bradykinin -- Decrease vasodilation
109
What are the overall effects of the actions of ACE inhibitors?
- Ateriolar vasodilation - Decreased peripheral resistance - Increased flow
110
What are ACE inhibitors typically used to treat?
Heart failure
111
What are 5 side/ adverse effects of ACE inhibitors?
- Nonproductive dry cough - Decreased taste perception - Excessive hypotension - Hyperkalemia - Angioedema
112
What are 3 drug interactions of ACE inhibitors?
- Diuretics (hypotension) - Potassium-sparing diuretics (hyperkalemia) - Lithium toxicity
113
What is step 1 medical management of CHF?
ACE inhibitors
114
What is step 2 medical management of CHF?
Diuretics Especially loop diuretics (Lasix)
115
What is step 3 medical management of CHF?
Nonselective beta-blocker and selective Alpha-1-adrenergic blocker (carvedilol-coreg) Administered carefully to prevent worsening CHF
116
What is step 4 medical management of CHF?
Digoxin (Lanoxin)
117
What is the action of digoxin?
Increases force of contraction of cardiac muscle without increasing O2 demand Increased EF
118
When is digoxin utilized during treatment of CHF?
Systolic dysfunction Arhhythmias present
119
What is the major adverse effect of digoxin?
Digoxin toxicity, which is fatal
120
What are 5 signs of digoxin toxicity?
- Cardiac arrhythmia - Anorexia - Nausea - Vomiting - Mental status changes (hallucinations, blurred vision)
121
Where can you check for arrhythmias related to digoxin toxicity?
Palpate apical pulse
122
What aspect of pt ed needs to be addressed in Pt taking digoxin?
Adherence to dosage Missed appointments a red flag
123
What drug may be used in combination with ACE inhibitors to increase survival, or beta-blockers to reduce hypertension?
Hydralazine (Apresoline) and mixoxidil Vasodilators
124
What are 6 side/ adverse effects of vasodilators?
- GI disturbances - Headache - Flushing - Nasal congestion - Lupus-like symptoms (myalgias, arthralgias, skin rash) - Reflex tachycardia (anginal attack)
125
What are 3 common anti-coagulants?
- Warfarin (coumadin) - Heparin - Fondaparinux (Atrixtra)
126
Which anti-coagulant is endogenous?
Heparin
127
What is the action of warfarin?
Antagonist of vitamin K, which functions in the clotting cascade
128
What is warfarin used to treat?
- Emboli - MI - Venous thrombosis
129
How long is required for maximum antithrombotic effects of warfarin?
3 - 6 days
130
What are 3 adverse effects of warfarin?
- Massive or minor hemorrhage - Purple toe hemorrhage from microemboli - Birth defects/ spontaneous abortion
131
How is warfarin related hemorrhage treated?
Vitamin K (may take 24h to work
132
What drugs decrease the anticoagulant effect of warfarin?
- Phenytoin - Barbiturates - Carbamazepine - Alcohol intake
133
What drugs increase the anticoagulant effect of warfarin?
- Cimetidine - Ciprofloxacin - Antibiotics - Aspirin - Hepatic dysfunction - Malnutrition - CHF
134
What is the medication form of heparin?
Heparin sodium
135
What are the 3 low molecular weight types of heparin?
- Fragmin - Lovenox - Innohep
136
What are the benefits of low molecular weight types of heparin?
High bioavailability Greater inhibition of factor Xa and clotting cascade Less frequent dosing -- No need to monitor prothrombin times
137
What anticoagulant is contraindicated with renal dysfunction?
Fondaparinux (Atrixtra)
138
What is the action of fondaparinux (atrixtra)?
- Inhibition of factor Xa by binding to antithrombin III, and disrupting clotting cascade
139
After what procedure is fondaparinux administered? When?
After THA (at least 6-8 hours post or earlier)
140
What are the 3 medications used for antiplatelet therapy?
Aspirin Clopidogrel (Plavix) Ticlopidine (Ticlid)
141
What is the action of aspirin, clopidogrel (plavix), and Ticlopidine (Ticlid) in platelet therapy?
Irreversibly inhibits platelet aggregation at injury/ damaged sites of vessels
142
What conditions is aspirin used to treat for antiplatelet therapy?
Angina CAD MI
143
When is aspirin not used since it prolongs clotting?
Acute athletic injury
144
What condition is clopidogrel (plavix) used in?
PVD
145
What is condition is ticlopidine (ticlid) used in?
Prevent TIAs and stroke
146
What are the side/ adverse effects of ticlopidine (ticlid)?
GI symptoms Dizziness Neutropenia - agranulocytosis
147
What are the drug interactions of ticlopidine?
Inhibits enzymes that breakdown dilantin and theophylline (a bronchodilator)?

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