Pharm Concepts Flashcards
(90 cards)
1
Q
loop diuretics S/E
A
hypoK, hypoMg, hypoCa, hypoCl, hypoNa (but not as bad as thiazides)
affect ability to reabsorb Na, K, Cl and indirectly Mg & Ca)
metabolic alkalosis
2
Q
loop diuretics affect?
A
thick ascending loop of henle –> inhibit concentrating ability –> produce dilute urine
3
Q
diuretic most likely to cause hypoNa
A
thiazides (esp w/ increased free water intake)
4
Q
thiazide diuretics affect?
A
early distal convoluted tubule –> impair urinary dilution (may cause hypoNa)
5
Q
potassium sparing diuretics affect?
A
distal collecting tubules –> inhibit aldosterone (SE hyperK and metabolic acidosis)
6
Q
MC cause of acute tubular necrosis
A
aminoglycosides (amikacin, gentamicin, tobramycin)
7
Q
MC drug hypersensitivity causing acute tubulointerstitial nephritis (AIN)
A
PCN, NSAIDs, sulfa
-others: cephalosporins, cipro, rifampin, allopurinol
8
Q
phosphate binders
A
calcium acetate, calcium carbonate, sevelamer
9
Q
MC drug cause of diabetes insipidus
A
lithium
10
Q
beta blockers moa
A
reduce HR and force of pumping, reduce blood vol
-C/I ASTHMA
11
Q
ACEI moa
A
angiotensin-converting enzyme inhibitors decrease angiotensin (hormone that causes blood vessels to narrow)
12
Q
ARB moa
A
angiotensin receptor blocker ( angiotensin a hormone that causes blood vessels to narrow)
13
Q
CCB moa
A
calcium increases strength/force of contraction in heart and BV - CCB block channels and relax BV and lower HR
14
Q
HTN drugs in pregnancy
A
safe: methyldopa, labetalol, beta blockers and diuretics
C/I: ACE/ARBs
15
Q
HTN med indication in AA pop
A
thiazide diuretics or CCB
+/- ACEI or ARB
16
Q
bisphosphonates
A
decrease bone release of Ca
17
Q
which meds can lead to lactic acidosis?
A
Metformin, salicylates, and propylene glycol
18
Q
5-a-reductase inhibitors moa
A
- androgen inhibitor –> suppresses prostate growth, reduces bladder outlet obstruction in BPH
- used in androgenetic alopecia
- finasteride + dutasteride
- SE: sex dysfx, decreased libido, breast tenderness/enlargement
19
Q
a-1-blockers moa
A
- smooth muscle relaxation of prostate and bladder neck –> decreased urethral resistance –> increased outflow
- tamsulosin most uroselective (alfuzosin, doxazosin, terazosin)
- SE: non-selective - dizzy/ ORTHOSTATIC HYPOTN
20
Q
SE retrograde ejaculation
A
a-1-blockers
tamsulosin, alfuzosin, doxazosin, terazosin
21
Q
meds that increase risk for bladder cancer
A
cyclophosphamide, pioglitazone
-cyclophosphamide causes hemorrhagic cystitis
22
Q
phosphodiesterase-5 inhibitors moa
A
- for ED
- increase nitric oxide levels –> increase cyclic GMP
SE: HA, flush, hearing loss
C/I: w/nitrates or cardiovascular disease
23
Q
C/I for phosphodiesterase-5 inhibitors for ED
A
with nitrates or cardiovascular disease
-may cause severe Hypotension (synergistic w/ nitric oxide)
24
Q
meds that cause priapism
A
(prolonged erection)
PDE-5 inhibitors, antidepressants (esp trazodone), antipsychotics, anticonvulsants, alpha blockers
25
risk of desmopressin (DDAVP) in enuresis
hyponatremia
| moa - synthetic ADH
26
anticholinergics SE
-blocks cholinergic receptors
| SE: dry mouth, constipation, dry eyes, blurred vision, increased HR, urinary retention, postural hypotension
27
intraoperative Floppy Iris Syndrome in cataract surgery
alpha blockers (tamsulosin/flomax)
28
meds that cause optic neuritis (CN2)
ETHAMBUTOL
| chloramphenicol
29
ototoxic topical abx
aminoglycosides (don't use if TM rupture)
30
SE gingival hyperplasia
phenytoin
cyclosporin
CCBs
phenobarbital
31
SE photo-sensitivity (exaggerated sunburn and often blisters), discoloration of teeth and inhibition of bone growth in children
doxy
32
meds that can cause gout attack
diuretics (thiazide + loop), ACEI, pyrazinamide, ethambutol, ASA, ARB (except losartan --> dec uric acid)
33
corticosteroid SE
hyperglycemia, cataracts, weight gain, fluid retention, immunosuppression, HTN, osteopenia (prevent w/ Ca + D)
34
methotrexate MOA/SE
- immunosuppressant inhibits lymphocyte proliferation (folic antagonist) - non-biologic
- SE: hepatotoxicity, stomatitis, GI sx, leukopenia bone marrow suppression, neurotoxicity, interstitial pneumonitis, renal toxicity
35
screen for before starting biologic DMARDS
PPD
| -screen HBV & HCV w/ all DMARDS
36
non-biologic DMARDs
methotrexate
leflunomide
hydroxychloroquine / plaquenil
sulfasalazine
37
biologic DMARDs
```
etanercept / enbrel
infliximab / remicade
adalimumab / humira
anakinra
rituximab
abatacept
```
38
S/E and drug interactions - PPIs
s/e: B-12 deficiency, hypoCa, hypoMg, HA, D
d/i: causes CP450 inhibition --> inc levels of Theophylline, Warfarin, phenyntoin
39
S/E and drug interactions - H2 receptor antagonists
s/e: INC LFTs
d/i:
- few w/ famotidine/pepcid
- many interactions w/ cimetidine/tagament --> CP450 --> inc levels of Theophylline, Warfarin, phenyntoin
- cimetidine --> anti-androgen effects (gynecomastia, impotence, dec libido)
ci/caution: renal or hepatic dysfx
40
drug rx = acute hepatic failure (fulminant hepatitis)
```
ACETAMINOPHEN MC CAUSE
isoniazid
pyrazinamide
rifampin
antiepileptics
abx
```
41
5-AMINOSALICYLIC ACIDS (5-ASA) or aminosalicylates
moa: anti-inflamatory agent, good for UC flares and resmission
- oral mesalamine (asacol hd) - esp active in terminal small bowel & colon; best for maintenance
- topical mesalamine: rectal suppositories and enemas; effective in distal colon
- sulfasalazine - works primarily in colon, more SE (hepatitis, pancreatitis, fever, rash) give folic acid w/ it
42
anti-diarrheals
BISMUTH SUBSALICYLATE
- pepto bismol, kaopectate
- antimicrobial, anti-secretory, anti-inflam
OPIOID AGONISTS
- diphenoxylate/atropine (lamotil)
- loperamide (immodium)
- binds to gut opioid receptors, inhibits peristalsis
ANTICHOLINERGICS
- hyoscyamine, atropine, scopolamine - inhibit GI motility, relaxes GI muscles (antispasmodic)
- phenobarbitol - slows GI motility
43
antiemetics
vomiting usually due to imbalance of serotonin, acetylcholine, dopamine + histamine
- ONDANSETRON, GRANISETRON, DOLASERTRON
- moa: block serotonin receptors, peripherally and centrally
- SE: HA, fatigue, sedation, GI: bloating, diarrhea, constipation, cardiac: prolonged QT interval, arrhythmias
- DOPAMINE BLOCKERS:
- PROCHLORPERAZINE
- PROMETHAZINE (PHENERGAN)
- METOCLOPRAMIDE (REGLAN)
- moa: blocks CNS dopamine receptors, mild antihistaminic/muscarinic
- SE: QT prolong, anticholinergic, and antihistamine SE, hypoTN, hyperprolactinemia
- EXTRAPYRAMIDAL SX: RIGIDITY, BRADYKINESIA, TRMOR, AKATHISIA, DISTONIC RX, PARKINSONISM
44
bulk forming laxatives
PYSLLIUM
METHYLCELLULOSE (CITRUCEL)
POLYCARBOPHIL (FIBERCON)
WHEAT DEXTRAN (BENEFIBER)
- moa: absorbs water and increases fecal mass
- most physiologic and effective approach to constipation
- s/e: bloating, flatulence
45
osmotic laxatives
moa: causes H2O retention in stool (osmotic effect pulls water into gut)
POLYETHYLENE GLYCOL (PEG) - Golytely, Miralax
LACUTLOSE
-synthetic sugar, pulls water into gut SE: gas/bloat
SORBITOL
-synthetic sugar SE: gas/bloat
SALINE LAXATIVES (milk of mag, mag-citrate)
-SE: hypermagnesemia
46
stimulant laxatives
moa: inc acetylcholine-regulated GI motility (peristalsis) and alters electrolyte transport in mucosa
- SE: diarrhea, abd pain
BISACODYL (DULCOLAX)
SENNA
47
drugs that can cause niacin (B3) deficiency
isoniazide, 5-fluorouracil, pyrazinamide, 6-mercaptopurine, hydantoin, ethionamide, phenobarbital, azathioprine, and chloramphenicol.
48
levothyroxine
synthetic T4
- monitor levels @ 6wk intervals when initiating/starting
- SMALL, SLOW INC IN >50YO AND PT W/ CARDIOVASCULAR DZ
- MONITOR ELDERLY, PT W/ ANGINA, MI, OR CHF FOR ADVERSE RX
- may need to lower doses of anti-coag, insulin, oral antihyperglycemics
49
BISPHOSPHONATES
moa: slows down bone loss by inhibiting osteoclast-mediated bone resorption
- take in morning (after overnight fast) w/ water and remain upright for 30 min, wait at least 30-60 min after to eat breakfast
SE: PILL ESOPHAGITIS, JAW OSTEONECROSIS, PATHOLOGICAL FEMUR FRX
PO: ALENDRONATE, RISEDRONATE, IBANDRONATE
IV: PAMIDRONATE & ZOLEDRONIC ACID
50
drugs that can cause gynecomastia
Spironolactone, Estrogens, Digitalis, Cimetidine, chronic Alcohol use, Ketoconazole: “Some Excellent Drugs Create Awesome Knockers.”
spironolactone, ketoconazole, cimetidine, 5-alpha reductase inhibitors, digoxin, GnRH agonists (leuprolide)
51
drugs that can cause hyperprolactemia
```
dopamine antagonists (dopamine inhibits prolactin)
metoclopramide
promethazine
prochlorperazine
SSRIs
TCAs
cimetidine
estrogen
```
52
drugs that can cause folate deficiency
methotrexate, bactrim, phenytoin
53
drugs that can cause autoimmune hemolytic anemia
PCN, methyldopa --> hapten formation
54
heparin overdose antidote
Protamine Sulfate
55
benzodiazepine antagonist
Flumazenil
56
anti-platelets
aspirin
| clopidogrel
57
anti-coag
warfarin
| X-aban (xarelto)
58
iron supplement dosing 1 yo
6 mg/kg/day divided into three doses.
59
DM2 meds contraindicated if hx of pancreatitis (may cause pancreatitis)
GLP-1, DPP-4
60
DM2 med highest incidence of hypoglycemia (non-insulin)
sulfonylureas
61
DM2 med "true incretin"
DPP-4 INHIBITORS “Gliptins”
62
medications causing erectile dysfunction
HCTZ, nifedipine, propanolol
63
sildenafil c/i with what med?
nitroglycerin
64
"Typical" 1st Gen Antipsychotics (neuroleptics)
MOA: blocks CNS dopamine D2 receptors (dopa antagonists)
Ind: psychosis, SCHIZOPHRENIA (esp positive sx)
```
HALOPERIDOL / HALDOL
DROPERIDOL
FLUPHENAZINE
PERPHENAZINE
CHLORPROMAZINE
THIORIDAZINE
```
SE:
- EXTRAPYRAMIDAL SX - RIGIDITY, BRADYKINESIA, TREMOR, AKATHISIA (restlessness)
- DYSTONIC REACTIONS (DYSKINESIA ) - reversible EPS, use diphenhydramine or benztropine (anticholinergic)
- TARDIVE DISKINESIA - seen w/ long-term use
- PARKINONISM - due to dec dopamine in nigrostriatal pathways (rigid, tremor)
- NEUROLEPTIC MALIGNANT SYNDROME - life-threatening, ams, extreme muscle rigidity, tremor, autonomic instability
- QT prolongation, arrhythmias, sedation, anticholinergic effects, INC PROLACTIN, WEIGHT GAIN
65
highest incidence EPS
```
typical / 1st gen antipsycotics
HALOPERIDOL / HALDOL
DROPERIDOL
FLUPHENAZINE
PERPHENAZINE
CHLORPROMAZINE
THIORIDAZINE
```
66
"Atypical" 2nd-gen Antipsychotics
MOA: CNS dopamine D4 receptor and serotonin antagonists
Ind: 1ST LINE FOR PSYCHOTIC DISORDERS
-CLOZAPINE USEFUL FOR PT WHO DEVO RESISTANCE TO TOHER ANTIPSYCHOTICS
QUETIAPINE / SEROQUEL
OLANZIPINE / ZYPREXA
CLOZAPINE / CLOZARIL
LOXAPINE / LOXATANE
SE:
- EPS (esp less w/ clozapine and quetiapine) bc weakly bind to D2 receptors
- increased prolactin, hyperglycemia, hyperlipidemia, weight gain, neuroleptic malignant syndrome
C/I:
- CLOZAPINE CAUSES AGRANULOCYTOSIS (watch CBC) and MYOCARDITIS, seizures, QT PROLONGATION
- OLANZAPINE --> WG, DM
67
Benzisoxazoles
MOA: partial dopamine D2 receptor and serotonin receptor antagonist
Ind: schizophrenia, bipolar, psychosis
RISPERIDONE / RISPERDAL
ZIPRASIDONE / GEODON
SE: EPS, INCREASED PROLACTIN, sedation, weight gain, hypoTN, prolonged QT
68
quinolinones
MOA: dopamine D2 receptor and serotonin receptor antagonist
Ind: psychotic disorders
ARIPIPRAZOLE / ABILIFY
69
lithium
MOA: increases norepi and serotonin receptor sensitivity
Ind: bipolar disorders, acute mania
SE:
- HYPOTHYROIDISM, SODIUM DEPLETION, INCREASED URINATION AND THIRST, DIABETES INSIPIDUS, HYPERPARATHYROID (hypercalcemia)
- SEIZURES, tremor, headache
- ARRHYTHMIAS
- n/v, wg
C/I: pregnancy, severe renal disease, cardiac disease
-Narrow therapeutic index --> monitor plasma levels every 4-8 weeks
70
SSRIs
MOA: selectively inhibits CNS uptake of serotonin = inc serotonin CNS activity
Ind: 1ST LINE DEPRESSION AND ANXIETY
-PREFERRED IN CHILDREN
```
CITALOPRAM / CELEXA
ESCITALOPRAM / LEXAPRO
PAROXETINE / PAXIL
FLUOXETINE / PROZAC
SERTRALINE / ZOLOFT
FLUVOXAMINE / ZYVOX
```
SE:
-common: gi upset, SEXUAL DYSFUNCTION, headache, fatigue, anxiety, insomnia, weight change
-SEROTONIN SYNDROME (ESP IF USED W/ MAOI): ACUTE AMS, SEIZURES, coma, death, RESTLESSNESS, DIAPHORESIS, TREMOR, HYPERTHERMIA, N/V, MYDRIASIS, TACHY
71
SSNRIs
MOA: inhibits neuronal serotonin, norepi and dopamine reuptake
Ind: good for pt w/ significant fatigue or pain syndromes in association w/ depression; 2nd line if no response to SSRI
VENLAFAXINE / EFFEXOR
DESVENLAFAXINE / PRISTIQ
DULOXETINE / CYMBALTA
SE: similar to SSRIs, plus HTN, dizziness
C/I: MAOI use, renal/hepatic impairment, seizures, AVOID ABRUPT DISCONTINUATION
*INC RISK SEROTONIN SYNDROME IF SNRIs USED W/ ST. JOHN'S WORT
72
TCAs
MOA: inhibit the reuptake of serotonin and norepi
Ind: depression, insomnia, dm neuropathic pain, post-herpetic neuralgia, migraine, urge incontinence
```
AMITRIPTYLINE / ELAVIL
CLOMIPRAMINE / ANAFRANIL
DESIPRAMINE / NORPRAMIN
DOXEPIN / SINEQUAN
IMIPRAMINE / TOFRANIL
NORTRIPTYLINE / PAMELOR
```
SE: ANTICHOLINERGIC EFFECTS, QT PROLONG, sedation, weight gain
-SEVERE TOXICITY W/ OD: Na channel blocker --> sinus or wide TACHY, neurologic sx, ARDS, SIADH
C/I: MAOi, recent MI, seizure hx
73
bupropion hydrochliride
MOA: inhibits neuronal update of dopamine and norepi
Ind: wellbutrin for depression; zyban for smoking
BUPROPION / WELLBUTRIN OR ZYBAN
SE: seizures, agitation, anxiety, weight loss, htn, ha, LESS GI DISTRESS OR SEXUAL DYSFUNCTION COMPARED TO SSRIS, dry mouth
C/I: SEIZURE DISORDER, EATING DISORDERS, pt undergoing drug/etoh detox, avoid abrupt withdrawal
74
MAO inhibitors
MOA: blocks breakdown of nt (dopamine, serotonin, epi, norepi) by inhibiting monoamine oxidase
Ind: refractory depression, many anxiety and affective d/o
Nonselective:
PHENELZINE / NARDIL
TRANYLCYPROMIN / PARNATE
ISOCARBOXAZID / MARPLAN
Selective:
SELEGINE / ELDEPRYL - less chance of htn crisis w/ tyramines
SE: insomina, anxiety, ortho-hypo, wg, sexual dysfunction
-HYPERTENSIVE CRISIS (MUST AVOID TYRAMINE FOODS)
C/I:
- MAOI + SSRI = MAYBE SEROTONIN SYNDROME
- MAOI + TCA = MAYBE DELIRIUM AND HTN
75
trazodone
MOA: serotonin antagonist and reuptake inhibitor
ANTIDEPRESSANT, ANTI-ANXIETY AND HYPNOTIC EFFECT
SE: sedation, arrhythmias
-PRIAPISM rare side effect
76
SYMPATHOMIMETIC MEDS (STIMULANTS)
MOA: blocks norepinephrine and dopamine reuptake, increases release of norepinephrine and dopamine in extraneuronal space
Ind: ADD, ADHD, narcolepsy, excessive daytime sleepiness
- methylphenidate (ritalin)
- amphetamine / dextroamphetamine (adderall)
- dexmethylphenidate (focalin)
SE: anxiety, htn, tachycardia, weight loss, growth delays, addiction
77
thiazide diuretics
MOA: affect bp by reducing blood volume, PREVENT KIDNEY NA/WATER REABSORPTION AT DISTAL TUBULES
Ind: TX OF CHOICE AS INITIAL FOR UNCOMPLICATED HTN; CARDIOPROTECTIVE
HYDROCHLOROTHIAZIDES
CHLORTHALIDONE
SE: hypoNa, hypoK, hyperCa, hyperuricemia, hyperglycemia
78
loop diuretics
MOA: INHIBITS WATER TRANSPORT ACROSS LOOP OF HENLE
Ind: HTN, CHF, hyperCa, edema, mild renal dz
FUROSEMIDE
BUMETANIDE
SE: volume depletion, hypoK, hypoNa, hypoCa, hyperglycemia, metabolic alkalosis, OTOTOXIC
C/I: SULFA ALLERGY
79
potassium-sparing diuretics
MOH: INHIBITS ALDOSTERONE MEDIATED NA/WATER ABSORPTION (spares K)
SPIRONOLACTONE
AMILORIDE
EPLERENONE
SE: hyperK,
GYNECOMASTIA W/ SPIRONOLACTONE
C/I: renal failure, hypoNa
80
CCBs
dihydropyridines
NIFEDIPINE / PROCARDIA
AMLODIPINE / NORVASC
non-dihydropyridines
VERAPAMIL
DILTIAZEM / CARDIZEM
81
BBs
CATECHOLAMINE INHIBITOR - BLOCKS "ADRENERGIC" RENIN RELEASE
cardioselective (B1)
ATENOLOL
METOPROLOL
ESMOLOL
nonselective (B1, B2)
PROPANOLOL
both alpha and B1, B2:
LABETALOL
CARVEDILOL
82
alpha-1 blockers
antihypertensive, also inc HDL, dec LDL, improves insulin sensitivity
GOOD FOR HTN W/ BPH
PRAZOSIN
TERAZOSIN
DOXAZOSIN / CARDURA
SE: 1ST DOSE SYNCOPE, DIZZY, HA
83
cholesterol meds
- Best for LDL --> STATIN, bile acid sequestrants
- Best for TRIGS --> FIBRATES, niacin
- Best for HDL --> NIACIN, fibrates
- TYPE II DM --> fibrates, statins (niacin may cause hyperglycemia)
84
statins
MOA: inhibits rate-limiting step in hepatic cholesterol synthesis (HMGcoA reductase inhibitor), inc LDL receptors (removes LDL from blood)
SE: MYOSITIS, rhabdo, HEPATITIS
-best given at bedtime
85
bile acid sequestrants
MOA: binds bile acids in intestine blocking enterohepatic reabsorption; liver inc LDL receptors and removes LDL from blood
-used for itching related to biliary obstruction
CHOLESTRYAMINE
CHOLESTIPOL
COLESEVELAM
SE: GI, inc LFTs, INC TRIGS
- may impair absorption of warfarin, digoxin, fat-soluble vitamins (so take these 1 hr before or 4 hr after)
- ONLY MEDS SAFE IN PREGNANCY (not systemically absorbed)
86
anti-dote to heparin
PROTAMINE SULFATE
87
pneumonia meds
B-lactams: CEFTRIAXONE, cefotaxime, amp/sulb (Unasyn) or Ertapenem
Anti-Pseudomonal B-lactams: PIP/TAZO, CEFEPIME, Imipenem, Meropenem, Ceftazidime
Macrolides: Clarithromycin, Azithromycin
Respiratory FQ: LEVO, MOXI, Gemi (cipro not respiratory fq, may be used for pseudomonas or legionella)
Aminoglycosides: Amikacin, Gentamicin, Tobramycin
88
ACETYLCHOLINESTERASE INHIBITORS
PYRIDOSTIGMINE OR NEOSTIGMINE
Ind: 1st line MYASTHENIA GRAVIS
MOA: increases ACH (by decreasing acetylcholine breakdown)
SE: CHOLINERGIC CRISIS (excess ACh --> weakness, n/v, pallor, sweating, salivation, diarrhea, miosis, bradycardia, respiratory failure)
- IF FLACCID PARALYSIS IMPROVES W/ TENSILON --> MYASTHENIC CRISIS
- IF FLACCID PARALYSIS WORSENS W/ TENSILON --> CHOLINERGIC CRISIS
89
tx schizophrenia
ANTIPSYCHOTICS: DOPAMINE RECEPTOR ANTAGONISTS (first line = 2ND GEN: Risperidone, Olanzapine, Quetiapine)
90
leuprolide
GnRH inhibition --> dec estrogen = dec endometrial growth shrinks uterus 50% but will return
Ind: leiomyomas/fibroids
