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Fall Finals > Pharm > Flashcards

Pharm Flashcards

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1
Q

Zidovudine

A

antiviral - treat HIV, slow disease progression, prevent transfer from mother to fetus
SE: dec RBC

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2
Q

Erythropoietin Growth Factors

A

Epoietin Alfa (Epogen, Procrit): identical to epo; SE: signif HTN! (inc HCT), CV events, rare PRCA; IV, IM

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3
Q

Leukopoietic Growth Factors

A

Filgrastim (Neupogen): identical to G-CSF, inc neutrophils/maturation in marrow, IV/SubQ

Pegfilgrastim: longer acting/ T1/2

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4
Q

Thrombopoietic Growth Factor

A

Oprelvekin (Neumega): identical to IL-11

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5
Q

iron deficiency treatment

A

ferrous sulfate - PO

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6
Q

treatment for moderate to severe sickle cell crisis

A

hydroxyurea (a chemotherapy for leukemia)

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7
Q

tPA

A

plasminogen activator, help create plasmin to DISSOLVE CLOTS and produce D Dimers

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8
Q

Heparin MoA

A

activates ATIII

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9
Q

Arixta

A

subQ, inhibit F Xa

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10
Q

Pradaxa*

A

PO, direct thrombin inhibitor

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11
Q

Xarelto

A

PO, inhibit Xa

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12
Q

Warfarin*

A

inhibits Vit K dependent factors 2, 7, 9, 10, protein c/s
CANT USE IN PREGNANCY** Crosses placenta
2-5mg daily
complications: hemorrhage, purple toe syndrome**

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13
Q

Clopidegrel/Clavix

A

anti-platelet

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14
Q

When is epogen often used?

A

chronic kidney failure

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15
Q

1st gen H1 blocker

A

Benadryl (diphenhydramine)
SE: sedative, anti-cholinergic
Tx: mild allergies, motion sickness, insomnia

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16
Q

2nd gen H1 blocker

A

Zyrtec (Cetirizine), Allegra (Fexofenadin), Claritin (Loratadine)
non-sedating (don’t cross BBB), no anti-cholinergic, req less doses than 1st gen
Tx: allgeric rhinitis, chronic urticaria

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17
Q

Singulaire (Montelukast)

A

leukotriene receptor antagonist

effective for asthma!

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18
Q

Glucocorticoid

A

high dose suppresses inflammation and immune
most effective treatment for asthma
Adverse: adrenal insufficiency (so taper), infection, peptic ulcer, osteoporosis, warning in DM

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19
Q

Immunosuppressants

A

Calcineurin inhibitor: cyclosporin, tacrolimus
mTOR inhibitor: sirolimus (rapamycin), everolimus
glucocorticoids
cytotoxic drugs: azthioprine, MTX, cyclophosphamide (for refractory pts)
Antibodies
selective T cell co-stimulation blocker

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20
Q

DOC for allogenic tranplants

A

cyclosporin (calcineurin inhibitor)

ADVERSE: nephrotox, infection

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21
Q

H2 receptor w/histamine effects

A

gastric acid secretion by parietal cells

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22
Q

H1 receptor w/histamine effects

A

vasodilation, inc permea, bronchoconstriction, itch, pain

edema and dec BP

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23
Q

anti-cholinergic

A

dry mouth, tachycardia, difficult micturition

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24
Q

H2 antagonist

A

zantac, pepcid

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25
1st line allergic rhinitis Tx for children
cromolyn (mast cell stabilizer, very safe but mod effective)
26
decongestants
sympathomimetics Ex: Sudafed (pseudoephedrine), phenylephrine vasoconstriction of nasal vessels ADR: rhinitis medicamentosa (rebound congestion- leads to tolerance and hypersensitivity)* wane off w/nasal saline dont use >3days, not safe in children
27
most effective Tx for WATERY rhinorrhea*
Atrovent nasal spray (Ipratropium)
28
Xolair (Omalizumab)
Ab against IgE | effective to dec nasal Sx in allergic rhinitis
29
intranasal corticosteroids
flonase (fluticasone) - for mod to severe
30
What medication to avoid w/Triginous Candida and ALL CANDIDA**
Terbinafine (Lamisil) - ALL in class of Allylamine drugs like Naftifene
31
How to treat tinea versicolor
selenium shampoo
32
Tx for pitted keratolysis
20% aluminum chloride (Drysol) BACTERIAL often mistaken for tinea pedis
33
Psoriasis Tx
Topical: corticosteroids*, topical calcipotriene, Tar (anti-mitotic), anthralin Phototherapy: PUVA, UVB* Systemic: MTX, biologics (DMARDS), retinoids; HIGH TOXICITY
34
Rosacea Tx
1st line: topical metronidazole, azelaic acid | DON'T use topical steroids
35
Psoriasis Tx
Topical: corticosteroids*, topical calcipotriene, Tar (anti-mitotic), anthralin Phototherapy: PUVA (psoralen+UVA), UVB* Systemic: MTX, biologics (DMARDS), retinoids; HIGH TOXICITY
36
Varicella Tx*
supportive w/pain control as needed Acyclovir 5x a day* if high risk for complications or Shingles also famciclovir, valacyclovir: but must start w/in 72hrs of rash*
37
Keflex
Cephalexin | can treat non-MRSA staph
38
Bactrim
can treat MRSA | sulfa drug
39
DMARDS
Disease-modifying antirheumatic drugs, biologics Humira, Enbrel, Remicade treats RA, Psoriasis
40
systemic antifungals
Terbinafine (Lamisil) | Fluconazole (Diflucan)
41
Tinea Tx
topical antifungals: (imidazole)
42
Tinea Tx
topical antifungals: (imidazole); but DONT WORK ON CAPITIS
43
Tinea Corporis, Pedis Tx
topical antifungals: (imidazole); but DON'T WORK ON CAPITIS
44
Tinea versicolor Tx
selenium sulfide shampoo | topical ketoconazole
45
Tx of diaper candidiasis
nystatin cream | don't prescribe w/high potent topical steroids bc atrophy
46
Oral thrush Tx
nystatin, great for all ages
47
Tx Eczema (atopic dermatitis), other Dermatitis
``` topical steroids (except perioral dermatitis) severe cases: PO steroids + light therapy, immunosuppressants ```
48
Tx for acne
benzoyl peroxide, topical antibiotic severe: oral antibiotic: Doxycycline, Minocycline (SE: vertigo, hyperpig; contraindicated in preg/<8yo) women hormone therapy: eg ortho tri cyclen oral retinoids only for severe, refractory cases (Isotretinoin)
49
Bed bugs Tx
if symptomatic: topical steroid, antihistamine
50
Scabies Tx
5% permethrin (elimite)
51
Lice tx
1% permethrin | Malathion most effective but takes longest (8hrs)
52
Tx of impetigo
bactroban (mupirocin) 5-7 days - topical - can treat MRSA
53
Tx of cat/dog bites
Pasteurella multocida 80% Amoxicillin/Clavulanic Acid (Augmentin) x10 days (CAN'T use cephalexin/Keflex)
54
Doxycycline is contraindicated in
<8yo
55
Types of Diuretics
``` Loop: Lasix (Furosemide) Thiazides: HCTZ K sparing: spironolactone (Aldactone) Osmotic MoA: block Na, Cl reabsorption, prevent H2O reabsorp; increase urine ```
56
Loop Diuretics*
most effective; rapid and heavy diuresis; only used if milder don't work; PO, IV K WASTING*** bc not absorbing K and lose K at DCT MoA: blocks Na, Cl absorption in asc loop usage: pulm edema, refractory HTN can be used in severe renal impairment* ADR: dehydration, hypotension, electrolyte imbalance, ototox, hyperglycemia/uricemia/lipidemia DON'T USE IN PREGNANCY* ex: Lasix (furosemide)
57
Thiazides*
most used, PO MoA: block Na, Cl reabsorption in early DCT CANT use in renal impairment* Usage: HTN (DOC), mod edema, diabetes insipidus ADR: dehydration, hypotension, electrolyte imbalance, hyperglycemia/uricemia/lipidemia DON'T USE IN PREGNANCY* ex: HCTZ
58
DOC for HTN*
Thiazides
59
K sparing Diuretics
minimal diuretic effect but SPARES K* MoA: block aldosterone in DCT, Retain K, Secrete Na usage: mostly used in conjunction w/Lasix or thiazide in HTN/edema to spare K ex: Spironolactone (Aldactone), eplerenone (Inspra), Triamterene
60
Osmotic Diuretic
MoA: freely filtered to create osmotic force, dec H2O reabsorption IV only bc can't cross GI! usage: prophylaxis of renal failure by creating renal flow ADR: edema (caution in cardiac pt) ex: mannitol
61
Ca Channel Blocker ADR
Generalized edema
62
Edema Tx
ACE-I (ALSO RENAL PROTECTIVE and treats HTN)
63
Chronic Renal Failure tx
ACE or ARB (dec BP), slow dz progression | prevent hypoglycemia from dec insulin clearance
64
Drugs that cause Fanconi Syndrome (proximal kidney tubule dysfunction)
Tetracyclines aminoglycosides anti-viral
65
Pyelonephritis Tx
Sulfa: Cipro, Bactrim Tx AFTER culture results avoid ampicillin/amox in gram neg
66
ACE-I
Inhibit ACE, prevent formation of Angiotensin II lisinopril, captopril SE: COUGH AVOID in renal artery stenosis
67
ARB
valsartan, losartan
68
Acute Angina Tx:
nitroglycerin
69
What medication to never use in renal artery stenosis?**
ACE-I/ARB | Bc of risk of azotemia from efferent arteriole dilation
70
What medication to use for isolated HTN?
Ca Channel Blockers
71
Everyone with renal dz should be on what medication?
ACE-I
72
Medication for angina
nitroglycerin ASA Beta Blocker
73
Who cannot use ACE-I
African Americans bc lower serum renin
74
Beta Blockers usage in HTN
block reflex tachycardia, eventually will reset set point to normal!
75
How to treat hypertensive emergency
Sodium Nitroprusside but CANT use >48-72hrs papilledema, end organ damage
76
First line drugs for HTN
Thiazide diuretics (Mainstay for mild to mod HTN), CCB, ACE-I, ARB
77
Classes of Calcium Channel Blockers
Dihydropyridines: more effective/selective | Non-DHP: less effective/selective
78
What drug treats hyperlipidemia
statins (HMG-CoA Reductase Inhibitors): synthesize cholesterol CATEGORY X IN PREGNANCY
79
CCB MoA
Vasodilator: decrease arterial pressure and increase coronary perfusion Block SA/AV node - slow conduction - but little net effect Ex: Verapamil, Diltiazem (Non-DHP also has effect for arrhythmias - slow ventricular rate) DHP: Nifedipine
80
1st line agents for TB*
ISONIAZID RIFAMPIN ETHAMBUTOL PYRAZINAMIDE
81
Tx of stable angina
risk modification, eg lifestyle changes nitroglycerin ASA Beta Blocker
82
amlodipine
CCB
83
DOC for HSV, VZV
Acyclovir suppress DNA synthesis (Valacyclovir = acyclovir prodrug)
84
Tx for CMV and retinitis
Ganciclovir ADR: granulocytopenia, thrombocytopenia MoA: inhibits DNA polymerase
85
Hep C Tx
peginterferon alpha PI: eg simeprevir Ritonavir DAAs: direct acting antiviral
86
Influenza Tx
Neuraminidase inhibitor: Oseltamivir, Zanamivir, Peramivir
87
What warrants high intensity statin therapy?*
LDL > 190
88
Patients with congestive heart failure and HTN should be on what?*
ACE-I and BB
89
Class I antiarrhythmics
sodium channel blockers: lidocaine and quinidine decrease conduction velocity
90
inotropic agent
increase force of contraction of heart | eg digitalis
91
SE of amiodarone
badycardia, AV block, hypotension, pulmonary fibrosis, hypo/hyperthyroidism serious SE can last even after months after d/c
92
What agent is contraindicated in systolic heart failure***
CCB (Non-DHP)
93
Supraventricular arrhythmia Tx
SVT: Vagal maneuvers --> IV adenosine, BB, CCB --> PO BB CCB --> amiodarone if refractory A flutter: Cardioversion, IV Ibutilide/amiodarone, longer term w/Na channel blocker or amiodarone
94
DOC for premature ventricular contraction (PVC)
BB
95
Amiodarone
``` Class III antiarrhythmic delay repolarization , block K channel, delay fast channel repolarization prolong AP and ERP Usage: ventricular arrythmias, afib others: Ibutilide ```
96
When is amiodarone used long term
suppression of VT or VFib (for recurrent ventricular arrhythmias) Cardioversion is Tx of choice in acute setting
97
IV Mg treats...
torsade de pointes and managing rapid atrial fibrillation
98
Prinzmetal Angina tx
treat acute episodes w/nitroglycerin, CCB
99
longterm treatment of long QT syndrome
BB
100
most common treatment for infectious endocarditis
PCN and IV Gentamycin daily, 4 weeks
101
Tx for Candida Albicans in female vagina
Monistat (Miconazole)
102
Tx for Bacterial Vaginosis
Metronidazole
103
Tx for Trichomonas
Metronidazole
104
Tx for Candida glabrata
Nystatin cream
105
Oral Anti-fungals ADR
Hepatotoxic
106
Tx of gonorrhea and Chlamydia
azithromycin, ceftriaxone | treat both bc don't know which one
107
What diuretic causes gynectomastia
Spironolactone (K sparing)
108
Pseudomonas Tx
4th gen cephalosporin
109
Clindamycin ADR
Pseudomembranous colitis
110
Isoniazid ADR
Peripheral neuropathy
111
Community acquired MRSA Tx
Doxycycline
112
Clindamycin worst ADR
Pseudomembranous colitis
113
Recurrent MRSA Tx
Mupirocin
114
Community acquired MRSA Tx
Clindamycin
115
Acyclovir ADR
Nephrotoxicity
116
Lyme Tx
Doxycycline
117
Chloramphenicol ADR and Tx
ADR: grey baby syndrome Tx: typhoid fever, meningitis
118
Tx of chlamydia in nursing homes
Doxycycline
119
What organ must be checked with amphotericin B?
Kidney function
120
What organ must be checked with Azole anti-fungals?
Liver function
121
Influenza Tx
Oseltavir
122
What organism causes rheumatic fever, tonsil abscess?
S. pyogenes
123
What disease should NOT take ASA? and why?
Varicella Dengue Fever can cause Reye's disease
124
What disease should NOT take ASA? and why?
Varicella Dengue Fever can cause Reye's disease
125
ADR of interferon alpha (Tx Hep C)
severe depression | flu like symptoms
126
What do you use to treat Thrush (oral Candida)
nystatin clotrimazole miconazole
127
What are the adverse effects of Amphotericin B?
Highly toxic! Renal damage in >80% patients Hypersensitivity
128
Most Common TB treatment
isoniazid (INH) rifampin (RIF) ethambutol (EMB) pyrazinamide (PZA)
129
What drugs not to use with Multi-Drug Resistant TB
don't use isoniazid (INH) and Rifampin
130
Leprosy Tx
Dapsone, rifampin, clofazimine
131
What is an appropriate antibiotic choice for empiric treatment in an assumed Mycoplasma pneumonia?
Azithromycin 500 mg on day 1, 250mg once daily on days 2-5
132
What is the drug of choice for Chlamydia pneumonia?
Doxycycline
133
Dysfunctional Uterine Bleeding Tx
NSAIDs, High dose estrogen, OCP depends on underlying cause in adolescents: just watch if no anemia
134
Psoriasis of vulva Tx
Steroids
135
erosive lichen planus and Tx
glassy, bright red erosions on vulva, vagina can bleed, yellow discharge (inflammatory, autoimmune) Tx: testosterone/corticosteroid cream, tacrolimus
136
Tx for Candidas albicans, tropicalis, glabrata***
a: PO diflucan (hyphae and buds)* t: Terazol (hyphae) g: nystatin, azole resistant (buds)
137
recurrent candida Tx
nystatin
138
BV Tx
metronidazole | clindamycin
139
Trich Tx
Metronidazole
140
Gonorrhea Tx
2 Abiotics: treat both gonorrhea and chlamydia | ceftriaxone, azithromycin
141
monophasic v multiphasic combo OCP
mono: constant doses multi: varying doses fertility returns quickly after discontinuation
142
How do combined OCPs work?*
mimicking early pregnancy (estrogen, progesterone)
143
Depo-Provera
3 months effective injectable very good and no estrogen cant be on >2yrs
144
Cons of Depo-Provera***
return to fertility in 12-18 months
145
Pyelonephritis
fluoroquinolone (Cipro) | amoxicillin
146
Tx for urolithiasis
Penicillins - can have resistance quickly (E. coli) Sulfonamides - G6PD deficiency (hemolysis) macrobid (nitroflurantoin) cipro - least resistance for e. coli
147
Tx for interstitial cystitis
elmiron (PO) | DMSO - through catheter into bladder to coat lining
148
Moderate to Severe kidney infection tx
IV ceftrioxone or gentamycin
149
Tx of BPH
mild: watch mild-moderate: alpha blocker (hytrin) severe: alpha blocker, 5 alpha reductase inhibitor (effetcive on 30% patients) severe: surgery (TURP)
150
Tx for epididymitis*
<35yo: doxycycline 14 days | >50yo: cipro (WITH CAUTION)
151
bacterial orchitis Tx*
<35yo: Ceftriaxone AND either doxycycline or azithromycin | >50yo: Fluoroquinolone
152
Seizure Tx*
try lorazepam, diazepam, or paraldehyde first (1-2 repeats) | PERSISTS then use longer-acting anticonvulsant: phenytoin, phenobarbital
153
Tx seizures in pts already on phenytoin or phenobarbital
booster doses of 5 mg/kg, subsequent based on severity
154
Neonatal seizure treatment
phenobarbital = first line
155
Agents to control intracranial pressure if seizures >60min
Mannitol | Dexamethasone
156
generalized seizure medications
barbiturates phenytoin valproic acid ethosuximide
157
why is phenytoin a helpful maintenance AED
lack of CNS depressing action, except at high levels
158
dose-related side effects of phenobarbital and phenytoin
sedation and ataxia
159
complications of longterm use of phenytoin***
gingival hyperplasia hirsutism lymphadenopathy
160
idiosyncratic risk of phenobarbital and phenytoin
hepatotoxicity rash lupus-like syndrome (phenytoin)
161
dose related side effects of valproic acid
sedation, GI upset, THROMBOCYTOPENIA, hyperammonemia
162
Valproic acid treats
generalized, partial seizure, myoclonic | useful in mixed seizure disorders
163
Worst idiosyncratic complication of valproic acid
fulminant hepatotoxicity | greatest risk: children <2yo, children on mult AED
164
what is Ethosuximide (Zarontin) used to treat?***
absence (petit mal) epilepsy
165
Carbamazepine effective against*
partial seizures* | secondary generalized seizures
166
first line treatments for partial seizures
phenytoin (also generalized) valproic acid (also generalized) carbamazepine
167
Infantile Spasms tx
ACTH
168
Most common drug causing medication overuse headache*
Acetaminophen*
169
Tx for migraines*
everyone needs acute tx!!!* 1st: tylenol, motrin, excedrin then try: Triptans, Ergots
170
Mechanism of action of triptans and ergots
vasoconstriction
171
Tx for tension headaches
simple analgesics (NSAID, ASA, Acetaminophen), more effective w/caffeine
172
What medication should you AVOID in tension headaches?***
TRIPTANS or muscle relaxants
173
Tx of cluster HA***
O2, subQ sumatriptan | prevention with: verapamil (CCB)***
174
Contraindications of tPA
recent surgery, GI bleed, MI, prior ICH, high refractory BP, low platelet, low or high glu
175
When can you treat ischemic strokes with IV tPA?*
<4.5hr of onset*
176
Medications for secondary prevention of stroke w/TIA**
Anti-thrombotic ARB/ACE-I Statin ALL PTS (REGARDLESS OF LEVELS)
177
mainstay of PD Tx
Carbidopa/Levodopa (Sinemet) - replace DA Levodopa = DA precursor, crosses BBB to CNS Carbidopa prevents conversion to DA in Periphery to prevent side effects
178
COMT Inhibitors
increases half-life of L-DOPA
179
MAO B inhibitor
reduces breakdown of DA
180
What drug should you use in extreme caution in Dementia w/Lewy Bodies**
anti-psychotics* serious side-effects n 50% antidepressants* can cause sudden changes in consciousness
181
Tx for bacterial meningitis for 1mon-50yo***
vancomycin and 3rd gen cephalosporin
182
Tx for bacterial meningitis for >50yo
ampicillin (covers Listeria), vaco, 3rd gen cephalosporin
183
Tx of transverse myelitis (inflammatory demyelination of both sides of a section of spinal cord)
Short course of high dose corticosteroids: | Methylprednisolone 1,000 mg 3-5 days
184
commonly used Rx for delirium (w/agitation)
Haldol (haloperidol) 0.5 to 1 mg PO or IM q12 hours prn agitation Ativan (lorazepam) 0.5 to 1 mg PO or IM q6 hours prn agitation
185
Tx BPPV* (Benign Paroxysmal Positional Vertigo)
Epley maneuver: remove Ca deposits | do Dix-Hallpike maneuver first to confirm: pt sit, rapidly lie back, repeat
186
what drug is ototoxic?
aminoglycosides (gentamicin), destroys vestibular system
187
Ménière's Disease Tx
aggressive low-salt diet and diuretics | avoid caffeine, chocolate, red wine
188
BRACHIAL PLEXITIS tx (trauma, malig, idiopath)
steroids, pain management
189
GBS Tx
``` Need to act QUICKLY! IV IG Plasmapheresis: Removing autoantibodies Respiratory support may be necessary DVT prophylaxis (can cause: cardiac arrhythmias and breathing problems) ```
190
Relapsing remitting MS Tx
Plasmapheresis | High dose steroid: short term, doesn't help relapse
191
MS Injectable Tx*
``` Glatiramer acetate (Copaxone, Glatopa) - reduce relapse Interferon beta-1a/1b*** Peginterferon beta-1a (Plegridy)*** (all try to reduce immune cells in CNS) ```
192
Examples of long acting basal insulin
Levemir, Lantus, Tresiba, Toujeo, Basaglar (all insulin glargine) once a day subQ, no peak
193
NPH medication
12-20hrs, 2 shots a day, has peak
194
Examples of short acting insulin
Aspart, glulisine, lispro (4-6 hours) - subQ, works in 15min | Regular (6-8 hours) - subQ, peaks 30min-1hr
195
example of biguanide - oral
metformin (oral anti-diabetic agent)
196
action of biguanides - oral***
insulin sensitizer - make pt's own insulin work better reduce hepatic glucose output** and stimulate incretin system AVOID IN RENAL DYSFUNCTION*********
197
sulfonylurea action - oral
ex: glyburide, glipizide, glimepiride increase insulin secretion from beta cells (INDEPENDENT of glu level) can have sensitivity to sulfa drugs AVOID IN RENAL DYSFUNCTION***
198
meglitinides action - oral
``` ex: repaglinide, nateglinide not used much increase insulin secretion from beta cells (INDEPENDENT of glu level) quick onset, short duration of action* no sensitivity to sulfa drugs safe w/ mild renal insufficiency ```
199
TZD action - oral
Ex: Pioglitazone insulin sensitizer (like metformin) increases HDL! dec visceral fat avoid in heart failure (edema)***
200
incretin (GLP-1) effect
secreted by small intestines upon ingestion of food to improve/stimulate insulin secretion from beta cells (glu dependent) also decreases glucagon production in liver turns off appetite decreases beta cell workload prolong beta cell activity and lifespan effect signif REDUCED in type II diabetes
201
GLP-1 Agonist examples
``` Byetta – subQ twice a day Victoza – subQ once a day Bydureon – subQ weekly Tanzeum – subQ weekly Trulicity – subQ weekly Ozempic – subQ weekly ```
202
DPP4 inhibitors
oral agent that prevents inactivation of GLP-1 and GIP (incretin) NOT used in Type I DM*** ex: januvia, onglyza, tradjenta, alogliptin
203
SGLT2 Inhibitors**
block renal reabsorption of glucose --> pee out glu large A1c reduction weight loss lower SBP (also lose water and Na) BENEFIT CARDIOVASCULAR HEALTH! (reduce heart failure risks)*** RENAL PROTECTIVE (greater than ACE/ARB)*** SE: inc risk of yeast infection, UTI, rare euglycemic DKA ex: invokana, farxiga, jardiance, steglatro CONSTRICT AFFERENT ARTERIOLE**
204
therapy algorithm for DM II
if A1c<7.5%: monotherapy: metformin, GLP-1, SGLT2, DPP4, TZD, SFU >7.5%: dual therapy (metformin + GLP1, SGLT2, DPP3, basal insulin, SFU) >9% no acute hyperglycemic symptoms: dual >9% w/acute hyperglycemic symptoms: insulin and oral
205
how should thyroid medication be taken?
without food and 30min before eating
206
Anti-thyroid drugs***
EX: Tapazole, PTU (reduce oxidation and organification of iodide) SE: rash, urticaria, fever, agranulocytosis (low WBC) use tapazole first bc no liver tox (PTU) dose for 1-1.5yr and see if recurrence improves immune and condition might not recur PTU in first trimester or thyroid storm
207
Hyperthyroidism Tx
Anti-thyroid drugs Beta blockers: controls adrenergic Sx* Radioactive Iodine: destroys thyroid (result hypothyroid) subtotal thyroidectomy: result hypothyroid
208
Hypothyroidism Tx
L-thyroxine (T4) daily on empty stomach, T1/2 a week monitor TSH in 2mon (takes time to reach steady state) avoid using T3 - short half life
209
how does amiodarone cause hypothyroidism*
high iodine content or direct tox on thyroid (half life 3 mon) prevent conversion of T4 to T3, blocks T3 recep bind usu. underlying hashimotos Tx: w/T4 but keep amiodarone
210
What drugs can cause hypothyroidism?
amiodarone | lithium
211
cinacalcet (sensipar)
calcimemetic, lower PTH | used for hyperparathyroidism
212
Tx for hypercalcemia***
IV hydration – NSS Bisphosphonates: inhibit bone resorption, effects last a wk Salmon Calcitonin: dec bone resorption, inc kidney excre START ALL AT ONCE (steroids can get rid of excess Vit D)
213
Cushing's Treatment
hydrocortisone and several months of slow taper until AM cortisol >12*
214
Addison's Dz Tx
Daily maintenance hydrocortisone 20 mg in AM, 10 mg in late afternoon (not night bc insomnia) Mineralocorticoid replacement: Fludrocortisone (Florinef) 0.1 mg/d with salt (to exchange w/K) during minor stress/illness: 3X3 rule, triple dose 3 days hyperglycemia management: consider NPH or mix
215
how does glucocorticoids affect glucose?
increase hepatic glu production increase postprandial glu rapidly dec
216
adrenal crisis Tx
Fluids – Dextrose with saline Steroids No previous dx – dexamethasone 4mg IV Known dx – dexamethasone 4mg IV or hydrocortisone 100mg IV
217
Pheochromocytoma Management - pre op***
ALPHA BLOCK FIRST - control BP* THEN BB - control BP Enzyme blocker to block catecholamine production
218
Prolactinoma Tx
dopamine agonists first line 2 wks (ex: bromocriptine, cabergoline), Bigger the tumor better the response ONLY PITUITARY TUMOR W/O SURGERY AS 1ST LINE*
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acromegaly tx
transsphenoidal surgery | somatostatin analogs after surgery if didn't get all (ex: octreotide, ianreotide) - growth hormone inhibiting hormone
220
Tx diabetes insipidus*
dDAVP (desmopressin), works like ADH
221
SIADH Tx
Restrict fluid | Demeclocycline - block ADH at kidney, increase water excretion
222
at what level of hypercalcemia require treatment?*
<12mg/dL: doesnt require immediate Tx | >14mg/dL: URGENT regardless of Sx**
223
bisphosphonates
treat hypercalcemia by inhibiting osteoclasts | ex: pamidronate, zoledronic acid
224
PCOS Tx
BCP (OCP): inc SHBG, reduce amt of free testosterone, endometrial protective bc get menses, has progestin, ex: YAZ anti-androgens: spironolactone, blocks testosterone recep but no fertility insulin resistance: metformin! and TZD weight loss clomiphene for fertility - ovulation
225
SSRI
fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa), paroxetine (Paxil), escitalopram (Lexapro)
226
SNRI
venlafaxine, duloxetine, desvenlafaxine
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Benzodiazepines
clonazepam, lorazepam, alprazolam, diazepam
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TCA
imipramine, clomipramine
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what is TCA at risk for?
long qt syndrome, not recommended in heart disease | lethal in overdose
230
gold standard treatment for bipolar disorder*
lithium Contraindicated in severe renal disease, acute MI, myasthenia gravis, 1st trimester pregnancy and breast-feeding. NSAIDS should be avoided***
231
Tx of schizophrenia*
Antipsychotic drugs are first-line treatment for schizophrenia --> Low, slow, titrate up for “remission” Draw labs and start treatment before results except for clozapine (need result first) *** (agranulocytosis risk) --> need weekly CBC
232
Drugs that can prolong qt interval
clozapine, thioridazine, iloperidone, ziprasidone.
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treat severe agitation in schizophrenia
A combination of haloperidol 5 mg, lorazepam 2 mg, and benztropine 1 mg given intramuscularly (none in first trimester pregnancy, some ok with breastfeeding)
234
1st generation antipsychotics
D2 dopamine antagonists, cholinergic tracts, alpha1-adrenergic and histamine receptors - low potency agents esp affect cholinergic tracts, alpha1-adrenergic and histamine receptors - High potency agents esp affect dopamine receptors
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2nd generation antipsychotics
D1, D2, D4, D5 dopamine (selective for the limbic receptors), serotonin, adrenergic, muscarinic, histamine, and nicotinic receptors Side effects: less EPS, more DM and obesity -Clozapine (Clozaril): schizoaffective disorders (reduces suicide risk), category B breastfeeding -risperdone (Risperdal): bipolar, mania, psychosis -olanzapine (Zyprexa): bipolar, mania, psychomotor agitation, schizophrenia agitation -quetiapine (Seroquel): bipolar, schizophrenia -ziprasidone (Geodon): bipolar, psychomotor agitation -cariprazine (Vraylar): bipolar, manic, depression, major depressive disorder
236
haloperidol (Haldol)
1st gen antipsychotics: High potency agents esp affect dopamine receptors treats acute psychosis, conduct disorders, Tourette’s Side effects: EPS and diarrhea
237
chlorpromazine (Thorazine)
1st gen antipsychotics: low potency agents treats mania, bipolar, conduct disorders in children, N/V, hiccups treats GAD (generalized anxiety disorder), N/V, migraines Side effects: dry mouth, constipation, orthostatic hypotension, sedation
238
prochlorperazine (Compazine)
``` 1st gen antipsychotics: low potency agents treats GAD (generalized anxiety disorder), N/V, migraines Side effects: dry mouth, constipation, orthostatic hypotension, sedation ```
239
Benzodiazepines
Triazolam, estazolam, lorazepam, temazepam, flurazepam, and quazepam Reduce the time to the onset of sleep, prolong stage 2 sleep, prolong total sleep time, and may slightly reduce the relative amount of rapid eye movement (REM) Decrease anxiety, impair memory, and have anticonvulsive properties
240
Nonbenzodiazepine hypnotics
Zaleplon, zolpidem (Ambien), eszopiclone, and zolpidem extended release target GABA type A receptor
241
Melatonin Agonists
Ramelteon: Binds to melatonin receptors expressed in the suprachiasmatic nucleus with much higher affinity than melatonin itself and has a half-life of 1.5 to 5 hours Tasimelteon: Approved in the United States for treatment of non-24-hour sleep-wake disorder (N24SWD), a circadian sleep-wake rhythm disorder that occurs primarily in blind individuals Side effects: Somnolence, dizziness, nausea, fatigue, and headache; Elevated prolactin levels and decreased testosterone levels
242
Orexin receptor agonists
Suvorexant Orexin A and orexin B are hypothalamic neuropeptides that play a key role in promoting wakefulness and regulating the sleep-wake cycle
243
DOC (1st line) for ADHD in children >/=6yo
Methylphenidate: Ritalin, Metadate CD, Methylin ER, Ritalin SR, Cotempla XR-ODT, Jornay PM, Daytrana (the patch) Others: amphetamine, Dextroamphetamine/amphetamine:, Dexmethylphenidate, Lisdexamfetamine
244
2nd line Tx for ADHD
Non-stimulant: Atomoxetine (Straterra) less effective, NE reuptake inhibitor black box warning for suicidal ideation in children with ADHD
245
1st line medication for PTSD
SSRI: Paxil, Zoloft | but try Exposure therapy or CBT first
246
pediatric opioid of choice
hydrocodone elixir or morphine NEVER codeine
247
Gold standard for alcohol acute withdrawal
Benzodiazepine taper: long acting like Valium (Diazepam) or librium bad liver: use Lorazepam ALSO GIVE: thiamine, folate, magnesium***
248
opioid antagonist meds
Naloxone (Narcan) | Naltrexone (Vivitrol) - maintain sobriety but pt need to be off opioid atleast 1 week
249
medication for opioid detox
buprenorphine (Suboxone) - want pt in mild to mod**withdrawal --> reduce withdrawal Sx and reduce cravings methadone
250
Opioid Overdose Tx*
Naloxone (Narcan), MORE effective than Naltrexone
251
Tx tobacco addiction
Pills: Bupropion (Zyban®/Wellbutrin®) Varenicline (Chantix®): caution if have history of mental illness ``` Nicotine Replacement Therapy (NRT): Commit® lozenge Habitrol® patch Nicoderm® CQ: patch Nicorette®: gum, use as needed max 24 per day Nicotrol Nasal Spray® Nicotrol Inhaler® ```
252
Tx for drug overdoses other than opioids*
Benzodiazepines
253
What drug classes contribute to Erectile Dysfunction?***
``` Anti-HTN: beta blockers, diuretics Anti-cholinergic Anti-depressant Anti-psychotics Sedatives/drug abuse ```
254
What does viagra (Sildanefil) do?
prolong vasodilation (PDE5 inhibitor)
255
COPD treatment
prevent progression, exacerbation, infections maintain at least 88% oxygenation short acting, long acting bronchodilators STEP UP and CUMULATIVE Tx
256
When are inhaled glucocorticoids used in COPD?
Severe cases helps airway inflammation s/e: oral thrush, increase risk infection in immunocomp eg fluticasone
257
What is the mainstay treatment at EVERY stage of COPD?
Inhaled bronchodilators (BA or anti-cholingeric)
258
Examples of short acting bronchodilators
Beta agonist: albuterol --> b2 receptor agonist* Anti-cholinergic: ipratropium used for sx relief
259
Examples of long acting bronchodilators
LABA: salmeterol LAMA: Tiotropium (anti-cholinergic) used for prevention
260
Tx for COPD Exacerbation
sputum culture but start empirical abiotic first Antibiotics (50% from bacterial infection) - azithro bronchodilator, systemic corticosteroids (prednisone), O2
261
When is systemic corticosteroids used in asthma?
> or equal 3 wheezing/yr | or 2 eps/6mon
262
What should every with asthma get?
SABA - rescue inhaler - for acute bronchospasm
263
What is the preferred long term control for all age groups for asthma?
Inhaled corticosteroids - prevent exacerbations, most effective for persistent asthma
264
Tx for severe asthma exacerbation
oral corticosteroids
265
How is LABA used?**
ONLY in combo w/ICS, NOT monotherapy only for Step 3 and above and greater than 5 yo (can increase asthma related death in young children)
266
preferred anticoagulant for PE
DAOAC (Direct acting oral anticoag): eliquis, xarelto | -only HD stable pts
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ADR of ganciclovir and valcyclovir
agranulocytosis
268
Tx for Cushings and MoA
Ketoconazole, suppresses testosterone and cortisol
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ACE-I ADR
Cough, Angioedema
270
Alpha blocker Tx
BPH | ex: prazosin (Minipress)
271
Why is glucocorticoid used in anaphylactic shock
prevent biphasic rxn
272
Why would someone w/BPH taking Benadryl experience worsened Sx?
due to difficulty micturition (anti-cholinergic effect)
273
Alpha1 Agonist
Methylphenidate (Ritalin)
274
Alpha 1 Agonist
Methylphenidate (Ritalin)
275
Alpha 2 Agonist
Methyldopa - for HTN emmergency
276
Alpha 2 Agonist
Methyldopa - for HTN emergency
277
Beta 1 Agonist MoA
ex: dobutamine - induce stress testings | sympathetic functions
278
Beta 2 Agonist MoA
Bronchodilator - lungs
279
What drugs cant you use in CHF
NSAID CCB - N-DHP TZD
280
Prinzmetal Angina Tx
CCB | NSAID
281
Tx for Torsades
Mg
282
Atropine
Muscarinic antagonist | Anti-cholinergics

Fall Finals (2 decks)

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