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Pharmacology > Pharm Concepts > Flashcards

Pharm Concepts Flashcards

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

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2
Q

loop diuretics affect?

A

thick ascending loop of henle –> inhibit concentrating ability –> produce dilute urine

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3
Q

diuretic most likely to cause hypoNa

A

thiazides (esp w/ increased free water intake)

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4
Q

thiazide diuretics affect?

A

early distal convoluted tubule –> impair urinary dilution (may cause hypoNa)

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5
Q

potassium sparing diuretics affect?

A

distal collecting tubules –> inhibit aldosterone (SE hyperK and metabolic acidosis)

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6
Q

MC cause of acute tubular necrosis

A

aminoglycosides (amikacin, gentamicin, tobramycin)

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7
Q

MC drug hypersensitivity causing acute tubulointerstitial nephritis (AIN)

A

PCN, NSAIDs, sulfa

-others: cephalosporins, cipro, rifampin, allopurinol

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8
Q

phosphate binders

A

calcium acetate, calcium carbonate, sevelamer

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9
Q

MC drug cause of diabetes insipidus

A

lithium

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10
Q

beta blockers moa

A

reduce HR and force of pumping, reduce blood vol

-C/I ASTHMA

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11
Q

ACEI moa

A

angiotensin-converting enzyme inhibitors decrease angiotensin (hormone that causes blood vessels to narrow)

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12
Q

ARB moa

A

angiotensin receptor blocker ( angiotensin a hormone that causes blood vessels to narrow)

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13
Q

CCB moa

A

calcium increases strength/force of contraction in heart and BV - CCB block channels and relax BV and lower HR

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14
Q

HTN drugs in pregnancy

A

safe: methyldopa, labetalol, beta blockers and diuretics

C/I: ACE/ARBs

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15
Q

HTN med indication in AA pop

A

thiazide diuretics or CCB

+/- ACEI or ARB

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16
Q

bisphosphonates

A

decrease bone release of Ca

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17
Q

which meds can lead to lactic acidosis?

A

Metformin, salicylates, and propylene glycol

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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
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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
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20
Q

SE retrograde ejaculation

A

a-1-blockers

tamsulosin, alfuzosin, doxazosin, terazosin

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21
Q

meds that increase risk for bladder cancer

A

cyclophosphamide, pioglitazone

-cyclophosphamide causes hemorrhagic cystitis

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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

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23
Q

C/I for phosphodiesterase-5 inhibitors for ED

A

with nitrates or cardiovascular disease

-may cause severe Hypotension (synergistic w/ nitric oxide)

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24
Q

meds that cause priapism

A

(prolonged erection)

PDE-5 inhibitors, antidepressants (esp trazodone), antipsychotics, anticonvulsants, alpha blockers

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25
Q

risk of desmopressin (DDAVP) in enuresis

A

hyponatremia

moa - synthetic ADH

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26
Q

anticholinergics SE

A

-blocks cholinergic receptors

SE: dry mouth, constipation, dry eyes, blurred vision, increased HR, urinary retention, postural hypotension

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27
Q

intraoperative Floppy Iris Syndrome in cataract surgery

A

alpha blockers (tamsulosin/flomax)

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28
Q

meds that cause optic neuritis (CN2)

A

ETHAMBUTOL

chloramphenicol

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29
Q

ototoxic topical abx

A

aminoglycosides (don’t use if TM rupture)

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30
Q

SE gingival hyperplasia

A

phenytoin
cyclosporin
CCBs
phenobarbital

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31
Q

SE photo-sensitivity (exaggerated sunburn and often blisters), discoloration of teeth and inhibition of bone growth in children

A

doxy

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32
Q

meds that can cause gout attack

A

diuretics (thiazide + loop), ACEI, pyrazinamide, ethambutol, ASA, ARB (except losartan –> dec uric acid)

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33
Q

corticosteroid SE

A

hyperglycemia, cataracts, weight gain, fluid retention, immunosuppression, HTN, osteopenia (prevent w/ Ca + D)

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34
Q

methotrexate MOA/SE

A
  • immunosuppressant inhibits lymphocyte proliferation (folic antagonist) - non-biologic
  • SE: hepatotoxicity, stomatitis, GI sx, leukopenia bone marrow suppression, neurotoxicity, interstitial pneumonitis, renal toxicity
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35
Q

screen for before starting biologic DMARDS

A

PPD

-screen HBV & HCV w/ all DMARDS

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36
Q

non-biologic DMARDs

A

methotrexate
leflunomide
hydroxychloroquine / plaquenil
sulfasalazine

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37
Q

biologic DMARDs

A 
etanercept / enbrel
infliximab / remicade
adalimumab / humira
anakinra
rituximab
abatacept
38
Q

S/E and drug interactions - PPIs

A

s/e: B-12 deficiency, hypoCa, hypoMg, HA, D

d/i: causes CP450 inhibition –> inc levels of Theophylline, Warfarin, phenyntoin

39
Q

S/E and drug interactions - H2 receptor antagonists

A

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
Q

drug rx = acute hepatic failure (fulminant hepatitis)

A 
ACETAMINOPHEN MC CAUSE
isoniazid
pyrazinamide
rifampin
antiepileptics
abx
41
Q

5-AMINOSALICYLIC ACIDS (5-ASA) or aminosalicylates

A

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
Q

anti-diarrheals

A

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
Q

antiemetics

A

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
Q

bulk forming laxatives

A

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
Q

osmotic laxatives

A

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
Q

stimulant laxatives

A

moa: inc acetylcholine-regulated GI motility (peristalsis) and alters electrolyte transport in mucosa
- SE: diarrhea, abd pain

BISACODYL (DULCOLAX)
SENNA

47
Q

drugs that can cause niacin (B3) deficiency

A

isoniazide, 5-fluorouracil, pyrazinamide, 6-mercaptopurine, hydantoin, ethionamide, phenobarbital, azathioprine, and chloramphenicol.

48
Q

levothyroxine

A

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
Q

BISPHOSPHONATES

A

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
Q

drugs that can cause gynecomastia

A

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
Q

drugs that can cause hyperprolactemia

A 
dopamine antagonists (dopamine inhibits prolactin)
metoclopramide
promethazine
prochlorperazine
SSRIs
TCAs
cimetidine
estrogen
52
Q

drugs that can cause folate deficiency

A

methotrexate, bactrim, phenytoin

53
Q

drugs that can cause autoimmune hemolytic anemia

A

PCN, methyldopa –> hapten formation

54
Q

heparin overdose antidote

A

Protamine Sulfate

55
Q

benzodiazepine antagonist

A

Flumazenil

56
Q

anti-platelets

A

aspirin

clopidogrel

57
Q

anti-coag

A

warfarin

X-aban (xarelto)

58
Q

iron supplement dosing 1 yo

A

6 mg/kg/day divided into three doses.

59
Q

DM2 meds contraindicated if hx of pancreatitis (may cause pancreatitis)

A

GLP-1, DPP-4

60
Q

DM2 med highest incidence of hypoglycemia (non-insulin)

A

sulfonylureas

61
Q

DM2 med “true incretin”

A

DPP-4 INHIBITORS “Gliptins”

62
Q

medications causing erectile dysfunction

A

HCTZ, nifedipine, propanolol

63
Q

sildenafil c/i with what med?

A

nitroglycerin

64
Q

“Typical” 1st Gen Antipsychotics (neuroleptics)

A

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
Q

highest incidence EPS

A 
typical / 1st gen antipsycotics
HALOPERIDOL / HALDOL
DROPERIDOL
FLUPHENAZINE
PERPHENAZINE
CHLORPROMAZINE
THIORIDAZINE
66
Q

“Atypical” 2nd-gen Antipsychotics

A

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
Q

Benzisoxazoles

A

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
Q

quinolinones

A

MOA: dopamine D2 receptor and serotonin receptor antagonist

Ind: psychotic disorders

ARIPIPRAZOLE / ABILIFY

69
Q

lithium

A

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
Q

SSRIs

A

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
Q

SSNRIs

A

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
Q

TCAs

A

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
Q

bupropion hydrochliride

A

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
Q

MAO inhibitors

A

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
Q

trazodone

A

MOA: serotonin antagonist and reuptake inhibitor
ANTIDEPRESSANT, ANTI-ANXIETY AND HYPNOTIC EFFECT

SE: sedation, arrhythmias
-PRIAPISM rare side effect

76
Q

SYMPATHOMIMETIC MEDS (STIMULANTS)

A

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
Q

thiazide diuretics

A

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
Q

loop diuretics

A

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
Q

potassium-sparing diuretics

A

MOH: INHIBITS ALDOSTERONE MEDIATED NA/WATER ABSORPTION (spares K)

SPIRONOLACTONE
AMILORIDE
EPLERENONE

SE: hyperK,
GYNECOMASTIA W/ SPIRONOLACTONE

C/I: renal failure, hypoNa

80
Q

CCBs

A

dihydropyridines
NIFEDIPINE / PROCARDIA
AMLODIPINE / NORVASC

non-dihydropyridines
VERAPAMIL
DILTIAZEM / CARDIZEM

81
Q

BBs

A

CATECHOLAMINE INHIBITOR - BLOCKS “ADRENERGIC” RENIN RELEASE

cardioselective (B1)
ATENOLOL
METOPROLOL
ESMOLOL

nonselective (B1, B2)
PROPANOLOL

both alpha and B1, B2:
LABETALOL
CARVEDILOL

82
Q

alpha-1 blockers

A

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
Q

cholesterol meds

A
  • 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
Q

statins

A

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
Q

bile acid sequestrants

A

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
Q

anti-dote to heparin

A

PROTAMINE SULFATE

87
Q

pneumonia meds

A

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
Q

ACETYLCHOLINESTERASE INHIBITORS

A

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
Q

tx schizophrenia

A

ANTIPSYCHOTICS: DOPAMINE RECEPTOR ANTAGONISTS (first line = 2ND GEN: Risperidone, Olanzapine, Quetiapine)

90
Q

leuprolide

A

GnRH inhibition –> dec estrogen = dec endometrial growth shrinks uterus 50% but will return

Ind: leiomyomas/fibroids

Pharmacology (4 decks)

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