Pharm Flashcards
(202 cards)
1
Q
risk factors for drug interactions
A
multiple medications female gender extremes of age major organ dysfunction genetic polymorphisms metabolic and endocrine dysfunction
2
Q
pharmacokinetics
A
what body does to drug
3
Q
pharmacodynamics
A
what drug does to body
4
Q
additive
A
alcohol and benzo
5
Q
antagonist
A
diazepam and flumazenil
6
Q
caution with tobramycin
A
worsens respiratory depression in surgery
decrease Ach and interacts with succinylcholine
reverse with neostigmine
7
Q
antacids
A
prevent absorption
interacts with tetracycline
8
Q
cholestyramine
A
interacts with digoxin and warfarin
9
Q
mycophenolate mofetil
A
interacts with ferrous sulfate, Ca, Mg, or Al
physical complex prevents absorption
not due to pH effect
10
Q
shift in peak but not bioavailability
A
due to changes in GI motility
just changes rate of absorption
11
Q
decreased gastric motility
A
decreased rate of absorption
amitriptyline, morphine
12
Q
increases gastric motility
A
greater peak effect
metoclopramide
13
Q
raises gastric pH
A
H2 antagonists and PPI
14
Q
H2 antagonists decrease
A
ktoconazole and itraconazole
15
Q
PPI decreases
A
atazanavir, itraconazole, and ketoconazole
16
Q
p-glycoprotein
A
ATP dependent molecular transport
protects from harmful substances-out of brain, into gut, lumen, bile and urine
17
Q
inhibitors p-glycoprotein
A
ketoconazole, erythromycin, grapefruit juice, clarithromycin
some are inhibitors of CYP3A
18
Q
OCP and antibiotics
A
greater failure if taken with erythromycin
19
Q
warfarin and SMX-TMP
A
warfarin usually 99% bound
SMX-TMP increase INR>6
20
Q
cytochrome p450
A
present in ER
primarily phase I metabolism
21
Q
inhibition p450
A
ketoconazole, cimetidine, erythromycin, grapefruit juice (furanocoumarins and naringin), and clarithromycin
22
Q
induction p450
A
phenytoin, rifampin, carbamazepine, St. John Wort
23
Q
CYP1A2-theophylline
A
induced by phenobarbital
24
Q
CYP2C9-warfarin
A
induced by rifampin
25
inducer CYP3A4
phenytoin
26
inhibitor CYP3A4
erythromycin, ketoconazole
27
tamoxifen CYP2D6
less formation of active metabolite in slow metabolizers
28
CYP2C19 and clopidogrel
less effective in slow metabolizers
29
renal tubular secretion
drug compete for same transport
probenecid and penicillins
sulfa and MTX (increase MTX levels in blood)
30
altered tubular reabsorption
trimethoprim inhibits sodium channel in distal tubule results in increased K reabsorption (higher dose in pneumocystis)
lithium and diuretics leads to decreased lithium clearance
31
digoxin and quinidine
less digoxin renal excretion
| p glycoprotein inhibitor
32
alterations in urine pH
non-ionized are reabsorbed
high pH causes basic to be unionized
low pH causes acidic to be unionized
33
acetazolamide and quinidine/amphetamines
increase urine pH
| higher unionized quinidine-higher reabsorption
34
aspirin and acetazolamide
increase ASA toxicity
metabolic acidosis increase unionized ASA into brain
increase ASA filtered and reabsorbed by kidney
35
high potential macrolides
erythromycin and clarithromycin
36
high potential H2 blockers
cimetidine
37
high statins
lovastatin (prodrug) and atorvastatin
38
lethal dose
lower LD is more toxic
39
mechanism of carbon monoxide toxicity
binds ferrous iron to form carboxyHb
reduction in O2 carrying capacity
toxicity from anoxia
40
target of carbon monoxide
globus pallidus in cerebellum
41
mechanism of cyanide toxicity
mitochondrial toxin that inhibits ETC
| binds ferric iron-inhibit electron transport between a and a3
42
symptoms cyanide toxicity
rapid progression
nausea, lightheadedness, hyperventilation, feelings of suffocation, convulsions, coma
increased HR followed by decreased
death from respiratory failure, brain damage in recovered
43
treatment cyanide toxicity
nitrite to converte hemoglobin to HbFe3
| administer thiosulfate
44
mechanism of toxicity organophosphates
inhibit AchE
| increase Ach levels and exaggerate effects of cholinergic
45
treatment for organophosphates
atropine and 2PAM
46
carbamates mechanism of toxicity
inhibits AchE but reactivates faster (half life 1 hr)
47
treatment for carbamate
atropine only
| do not use 2PAM
48
symptoms paraquat
inhaled-acute irritation, pulmonary fibrosis
oral-irritation and ulceration of mucous membranes
dermal-erythema, ulceration, cataract formation
49
treatment paraquat
gastric lavage
kaolin-limited use
hemodialysis or hemoperfusion
50
qualitative test
paraquat
| sodium dithionite in 2N sodium hydroxide forms blue color
51
acute toxicity benzene
CNS depression and/or pulmonary irritation/edema
52
chronic toxicity benzene
anemia, leukemia, lymphomas
53
acute toluene and xylene toxicity
CNS depression
54
standardized supplements
certain concentration is consistent between batches
55
NF
meets standard for purity, strength of marker compound and labeling
56
effects of garlic
lowers cholesterol
| inhibits platelet aggregation
57
ingredients of garlic responsible for platelet aggregation
ajoene (allicin) and diallyl trisulfide
58
non-refrigerator chopped garlic
risk of c. diff if stored at room temperature
59
activity in horse chesnut
escin (good) and asesculin (adverse)
60
effect of escin in horse chesnut
reduces leg pain and swelling
| decreases vascular permeability of venous capillaries
61
effect of aesculin
similar to warfarin
| bleeding gums, nose
62
contraindications horse chesnut
anticoagulants, NSAIDs-enhance bleeding
pregnancy
breast feeding
63
standardized ginko
for quercetin, kaempferol, and isorhamnetine
64
effects kaempferol from ginko
anti-oxidant
| improves ATP and glucose utilization
65
effects of kaempferol and apigenin
inhibitors of MAO-A and MAO-B
66
adverse effects of ginko
major bleeding
drug interactions-aspirin, NSAIDs, warfarin, heparin, clopidogrel
seizures and ingestion from lethal ingestion
67
interferes with amino acid metabolism
antivitamin B6
68
standardized St. John Wort
hypericin and hyperforin
69
serotonin re-uptake inhibitor
dependent on hyperforin content
70
MAO inhibition
hypericin and hyperforin
| SSRI>MAOI
71
side effects St. John Wort
HA, loss of appetite
should not be taken with MAOI or SSRI
induces P450 cyp3A4
72
increase dose when on St. John Wort
OCP, theophylline, warfarin
73
active ingredient Valerian
valerenic acid, valtrate
| glutamine
74
neural effects of valerian
bind GABA A open Cl
| hyperpolarization
75
use echinacea
lessens symptoms of colds, flu, infections
76
e purpura
only aerial
77
e pallida
aerial and root active
78
e angustifolia
root
79
arabinogalactan
releases IL-1 TNFa
80
heteroxylan
stimulates PMN phagocytosis
81
side effects for echinacea
avoid if allergic to plants in daisy or ragweed
| avoid with immunosuppressants
82
actions saw palmetto
inhibitor of 5alpha reductase
| may block translocation of cytosol androgen receptor to nucleus
83
marketed uses ginseng
antioxidant
anti-aging
anticancer
adaptogen
84
active ingredient ginseng
gensenosides
85
effect ginseng
```
lipid lowering and increase HDL
panax inhibits platelet aggregation
stimulate NO
adaptogen-reduces cortisol and NT during stress
improves chemotaxis of PMN
improves glycemic control in diabetics
```
86
anti-cancer ginseng
lowers stomach and colon cancer
87
adverse effects ginseng
nervousness, insomnia-avoid use with caffeine
88
uses KAVA
sedation and relaxation
| interaction with GABA
89
side effects KAVA
hepatic toxicity
sedation do not mix with alcohol
yellow pigment to skin and nails
90
ingredients feverfew
sesquiterpene, lactones, parthenolide
91
mechanism of action feverfew
inhibits PLA2
| inhibits platelet serotonin release
92
adverse effects feverfew
joint pain, muscle aches, insomnia
causes uterine contraction
menstrual irregularities and heavier blood flow
93
herbs to avoid prior to surgery
```
garlic
horse chesnut
ginko biloba
St. John wort
feverfew
```
94
herbs to avoid when taking MAOI and SSRI
St. John Wort
| valerian
95
herbs to avoid with alcohol
valerian
| kava
96
risks from metasl
accumulate because not metabolized
| bind to proteins, enzymes via S, O, N
97
properties of ideal chelating agent
less toxic than metal
enhance excretion
chelate at physiological pH
not metabolized readily
hydrophilic-distribution similar to metals
greater affinity for metals than calcium or iron in body
98
calcium disodium EDTA
administer IM or IV for lead and cadmium
| metal displaces Ca in center of molecule
99
contraindications calcium disodium EDTA
renal disease
100
disodium EDTA
used for hypercalcemia
101
succimer
sulfhydryl groups bind metal
administer orally for lead toxicity
low compliance due to taste
102
dimercaprol
SH bind to metal
| used for lead, arsenic, inorganic mercury
103
contraindication dimercaprol
peanut allergy
104
contraindication BAL dimercaprol
liver disease
105
drug of choice Wilson disease
Penicillamine
106
adverse effect penicillamine
agranulocytosis
107
contraindication penicillamine
renal disease
108
distribution of lead in body
liver, kidney, RBC
RBC>95% of lead bound to Hb
redistributes to bone replacing Ca-form tertiary lead phosphate
109
signs of lead poisoning
```
microcytic anemia, basophilic stipling and hemolysis
lead colic (chronic)
lead palsy (chronic)
```
110
signs of lead encephalopathy
convulsions, cerebral edema and death
111
lead interaction with neurological tissue
peripheral, axon degeneration
| in brain interferes with Ca dependent reactions
112
lead interactions with blood
inhibits heme synthesis
basophilic stipling due to RNA
decrease life span and heme synthesis
113
lead inhibition of heme enzymes
alpha aminolevulinate dehydratase (cytosolic) and ferrochelatase (mitochondrial)
114
blood and urine indicators lead
increase levels of alpha aminoleuvulinic acid and coporphyrin III
whole blood sensitive indicator
115
chelation for low levels of lead
succimer and penicillamine
116
chelation for high levels of lead
calcium disodium EDTA and dimercaprol
117
mercury through inhalation
elemental
118
mercury through inhalation or oral
inorganic
119
most toxic mercury
organomercurial
120
mechanism of mercury toxicity
bind to sulfhydryl groups and inactivate proteins and enzymes
121
damage from elemental mercury
converted from valence to +2 by catalase in RBC
122
uncharged mercury causing damage
charged BBB
123
signs of mercury toxicity
tremor, irritability, erethism
124
inorganic mercury causing gray color
bind to SH protein in mouth and esophagus
125
chronic inorganic mercury
photophobia and acrodynia (reddening of face and chest)
126
most toxic form of mercury
organomercurials-targets nervous system
127
minamata disease
methylmercury causing weakness, visual field constriction, ataxia, and numbness
inorganic mercury released into environment taken up by algae-methylmercury into fish that ate algae
128
treatment low mercury
penicillamine
129
treatment severe mercury
dimercaprol
130
contraindications dimercaprol
high brain mercury levels
| increases brain levels
131
mechanism arsenic toxicity
As3 binds sulfhydryl
As5 replaces P in ATP uncoupling oxphos
AsH3 hemolysis
132
signs of arsenic toxicity
vasodilator, permeability of capillary, arrhythmia, rice water diarrhea, loss of albumin, cancer and hyperkeratosis, hemolysis (from gas)
garlic odor to breath and sweat
133
Mee's lines
horizontal lines on fingernails
134
treatment arsenic poisoning
penicillamine
dimercaprol
treat symptoms of arsine gas
135
target cadmium
kidney-damage to proximal tubules
| lungs-emphysema
136
metallothionein
inducible protein
induced by cadmium, mercury, arsenic exposure
high cysteine content, metal-SH binding
137
accumulation Cd
in liver and kidney bound to metallothionein
| Cd cleaved giving high tissue levels
138
treatment cadmium toxicity
disodium EDTA
| BAL contraindicated-increases renal toxicity
139
monitor for cadmium
beta2 microglobulin
| protein excretion increased following renal damage
140
itai itai disease
accidental ingestion of cadmium in water and food
| causes renal damage, osteoporosis, bone pain (from replacement of Ca by Cd)
141
deaths from acute poisoning
cardiovascular complications
| depressed respiration
142
most common items for accidental ingestion in children
vitamins containing iron, OTC medications, cleaning supplies, pesticides
143
most common poisons in adults
analgesic, drugs of abuse, antidepressants, sedatives, anti-anxiety agents, alcohol
144
syrup of ipecac
stimulates CTZ in brain
direct effect on stomach
used for acetaminophen, atnihistamines, vitamins, cold remedies, benzos, pesticides
145
contraindications emesis
```
corrosive agents-drain cleaner, ammonia, electric dishwasher cleaner
loss of gag reflex
comatose
sharp objects (glass)
agents associated with steroids
hydrocarbons-aspiration
```
146
agents causing seizures
strychnine
tricyclic antidepressants
gamma hydroxybutyrate
147
MOA activated charcoal
absorbs drugs then removed by lavage or through feces
148
uses activated charcoal
acetaminophen, aspirin, amphetamines, benzos (oxazepam), digoxin, opiates, malathion, nicotine, syrup of ipecac
149
contraindications activated charcoal
corrosive or caustic agents
| ineffective for acids, alkali, most metals or petroleum distillates
150
naloxone
opiate overdose
| competitive reversible antagonist of opiate receptor
151
flumazenil
benzodiazepine overdose
| competitive reversible antagonist
152
method to enhance excretion
sodium bicarbonate alkalinize urine to enhance excretion of acidic drugs (barbituates and aspirin)
153
petroleum distillates
major target is aspiration into lungs
| household solvents most common cause
154
risk of aspiration
dependent on viscosity, volatility and surface tension
155
best determinant of aspiration potential
viscosity (low viscosity SUS=high aspiration risk)
156
surface tension
low surface tension allows rapid spreading
157
volatility
movement from liquid to gas, displace oxygen from alveoli causing hypoxia
158
death from huffing
hypoxia
| may also cause permanent brain damage
159
benzene causes
leukemia
160
toluene causes
blindness and hearing loss
161
huffing while pregnant
decreased birth weight, increased fetal death, nerve damage
162
calculating iron toxicity
off elemental Fe content (ferrous sulfate higher than ferrous gluconate)
163
first stage iron toxicity
vomiting, stomach pain, diarrhea
164
second phase iron toxicity
apparent recovery-lethargy with no vomiting
| 6-24 hr
165
third phase iron toxicity
organ failure of heart, liver, kidney, nervous system
| 12-24 hr
166
fourth phase iron toxicity
scarring causes pyloric obstruction
| 4-6 wks
167
treatment iron toxicity
emesis
lavage-bicarbonate to decrease absorption
chelation-deferoxamine
168
target organ acetaminophen
liver and kidney
| causes liver centrilobular necrosis and kidney tubular necrosis
169
liver damage from acetaminophen
metabolized to NAPQI by p450
| detoxed by glutathione-with glutathione depletion NAPQI binds proteins
170
timeline acetaminophen toxicity
first 24 hr minor GI and nausea
24-48 hr hepatic damage appears
blood levels correlate to toxicity and time expired
171
treatment acetaminophen toxicity
emesis, lavage with activated charcoal
N-acetylcystine to provide cys for glutathione-replenish it
glutathione ineffective on its own
172
combination of acetaminophen and alcohol
alcohol lowers glutathione and induces p450
diminishes NADPH so NAPQI damage occurs
excess NADH/NAD, less APAP glucuronidation
173
first order kinetics aspirin
head ache dose-constant fraction
174
zero order kinetics aspirin
arthritis-constant amount
| increases half life
175
mechanism for salicylate toxicity
hyperventilation-stimulates respiratory centers in medulla
| uncouples oxidative phosphorylation-stimulates CO2 production
176
symptoms salicylate toxicity
HA, tinnitus, sweating, hyperventilation, fever, drowsiness
fever in children
acid-base and electrolyte imbalance
respiratory alkalosis from stimulation of resp centers, respiratory acidosis over time, metabolic acidosis due to uncoupling oxphos (increase ketones)
177
electrolyte and fluid imbalance with salicylates
increased bicarbonate excretion
dehydration-hyperventilation and sweating
low potassium levels
178
treatment salicylate toxicity
emesis, lavage +/- charcoal
alkalinize urine-effective for aspirin and methyl salicylate
correct fluid and electrolytes
179
isopropyl alcohol
greater toxicity than ethanol
converted to acetone in body, less affinity for enzymes than ethanol
gastric pain, ketones, ketoacidosis
180
methanol toxicity
eye, photophobia, blindness
| due to formic acid
181
ethylene glycol
induces inebriation, nausea, renal failure
| oxalate crystals deposit in lumen of kidney
182
treatment for alcohols
emesis or lavage <3hr
treat with IV ethanol (compete for alcohol dehydrogenase)
fomepizol (inhibitor alcohol dehydrogenase)
183
neonate
0-4 weeks
184
perinatal
26th week gestation to 1 month postpartum
185
infant
5-2 weeks after birth
186
drug absorption in neonates
low muscle mass
gastric pH decreases after first 24 hr of life, delayed gastric emptying
pulmonary routes under development
187
renal function in children
GFR neonate lower than adults
| normalizes in 6-12 months
188
drug metabolism in children
decrease p450 activity
| conjugation reactions diminished
189
plasma protein binding in children
decreased plasma protein binding causes diff affinity for acidic anionic drugs until 10-12 months
displacement of bilirubin-phenytoin and indomethacin
190
furosemide in children
delayed response
191
cause of problems in drugs in elderly
changes in pharmacokinetics and pharmacodynamics
192
changes in cardiac and renal elderly
CO declines
| GFR declines
193
changes in absorption in elderly
decreased gastric acid-less absorption ferrous sulfate and ketoconazole
antacids lower absorption of cimetidine, digitalis, tetracycline, phenytoin
194
Vd lipid soluble
increased due to increased adipose
| increase half life-diazepam, amiodarone
195
Vd water soluble
decreased causing increased serum levels
| ethanol, procianamide, atendol
196
Vd muscle soluble
decreased due to decreased lean body mass
| digoxin
197
plasma binding elderly
lower albumin increases free fraction of acidic drugs-warfarin and phenytoin
protein binding decreased by renal disease or uremia
198
hepatic clearance in elderly
lower phase I metabolism
| no change in phase II metabolism
199
pharmacodynamic changes
changes in binding of drug to receptor, receptor number or altered translation of receptor responses
decreased effect of beta-adrenergic agonists and antagonists
increased response to opiates and benzos
200
digoxin in elderly
lower renal elimination
201
black box warning in elderly
atypical and typical dopamine antagonists
202
long term use of analgesics
induce papillary necrosis
