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Advanced Pharmacology > pharm exam 3 > Flashcards

pharm exam 3 Flashcards

1
Q

Drugs used for treatment of GERD

A

H2 blocker, PPI, antacids, prokinetics

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2
Q

Mild GERD treatment

A

antacids and lifestyle modification

H2 blocker for 4-8 weeks

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3
Q

Moderate-severe GERD treatment

A

PPI for 8 weeks
-If better, then wean off PPI
if not, then refer the patient

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4
Q

Pediatric GER

A

Very common in infants up to 18 months
-medical management is reserved for those experiencing poor weight gain, feeding difficulties, persistent irritability and pain, apnea, and cyanosis.

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5
Q

Peptic ulcer disease origin

A

from use of NSAIDs, or H. pylori

  • Gastric: erosion in the stomach
  • Duodenal: h. pylori releases toxins, phospholipase enzymes promoting inflammation and erosion
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6
Q

PUD treatment

A

Step 1: lifestyle modification and OTC antacids or H2 blocker
Step 2: H. pylori testing, treatment with PPIs
Step 3: Treatment for H. pylori
-all regimens include a PPI plus antibiotic to treat H. pylori

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7
Q

PUD triple therapy

H. pylori

A 
PPI PLUS:
Clarithromycin 500mg bid or
Metronidazole 500mg bid
Amoxicillin 1g bid
-Treat for 10-14 days
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8
Q

PUD Quadruple therapy

H. pylori

A 
PPI PLUS:
Metronidazole 250mg qid
Tetracycline 500mg qid
Bismuth subsalicylates 525mg qid
-Treat for 14 days
*Used as second line therapy in patients who fail first line therapy
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9
Q

PUD Levofloxacin-based triple therapy

H. pylori

A 
Levofloxacin 250-500mg bid
PPI bid
Amoxicillin 1g bid
-Treat for 10-14 days
*Used as second line or rescue therapy
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10
Q

After treating for H. pylori…..

A

Continue PPI for 8-12 weeks to promote healing

  • if patient is low risk, no further treatment
  • if patient is high risk, consider chronic acid suppression therapy
  • if symptoms do not resolve, then refer the patient
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11
Q

First line treatment for UTI with no complicating factors

A

Bactrim
(Trimethoprim sulfamethoxazole)
TMP/SMX

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12
Q

Alternative first line treatment of UTI

A
  • Ciprofloxacin (in adults)
  • additional alternative= cephalosporins (cephalexin, cefpodoxime, cefixime)
  • Nitrofurantoin may also be used
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13
Q

Urinary analgesic

A

Phenazopyridine

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14
Q

Length of treatment in UTI

A
  • 3 days

- longer (10 days) in children, fever, chills, pregnancy, history of DM or immunosuppression

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15
Q

UTI and infants/children

A
  • Diagnose with catheterized specimen
  • febrile UTI is treated aggressively, with IV abx (ceftriaxone) until afebrile
  • treat for 10 days
  • follow up culture to document successful treatment
  • children under 5 with UTI- consider vesicoureteral reflux
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16
Q

Adults who require workup and possible referral to urologist

A

gross hematuria, symptoms of obstruction, persistent UTI, symptomatic pregnant patient, or patient with fever or dehydration

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17
Q

Antacids

A

have a weak base, neutralize the gastric hydrochloric acid, have cytoprotective effects
-calcium carbonate, aluminum hydroxide, magnesium hydroxide, and sodium bicarbonate

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18
Q

Antacids and other drugs…

A

have many interactions, separate antacid administration with other drugs by at least 2 hours

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19
Q

Acid neutralizing capacity (ANC)

A

The ability of antacids to neutralize gastric acid; antacids with a high ANC are usually more effective
-combination products have the highest ANC

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20
Q

Indications for antacid use

A

PUD, GERD, hyperacidity

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21
Q

Calcium carbonate antacids

A
  • all calcium containing antacids require vitamin D for absorption
  • contraindicated in hypercalcemia, renal calculi
  • can cause constipation
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22
Q

Aluminum hydroxide antacids

A
  • used for hyperacidity, gastritis, or PUD
  • contraindicated in renal failure on dialysis
  • can cause constipation and hypophosphatemia
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23
Q

Magnesium hydroxide antacids

A
  • used for magnesium deficiencies
  • contraindicated in renal failure/insufficiency
  • may cause diarrhea
  • monitor mag level
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24
Q

Sodium bicarbonate antacid

A
  • precaution in HTN, CHF, or renal failure

- avoid sodium containing antacids in elderly because of fluid retention

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25
Q

Causes of diarrhea in primary care

A

infection, food or drug induced, inflammatory bowel disease

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26
Q

Opiate and opiate derivatives

antidiarrheal

A

act on the smooth muscles of the GI tract, slow motility and propulsion.

  • little to no analgesic activity, may be habit forming*
  • Lamotil, motofen, and immodium.
  • ADRs: anticholinergic effects, dizziness, drowsiness, sedation, HA
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27
Q

Antisecretory agents

antidiarrheal

A

Bismuth subsalicylates

  • contraindicated in children with flu-like illness
  • ADRs: bismuth causes black tongue and gray-black stools
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28
Q

Absorbents

antidiarrheal

A
  • reduce motility, absorb fluid, and bind bacteria and toxins in the GI tract in infectious diarrhea
  • Kapectolin and bismuth subsalicylate
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29
Q

Anticholinergics

antidiarrheal

A

Slows intestinal motility

are useful only in inflammatory bowel disease

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30
Q

Acute diarrhea

A
  • treat the source of diarrhea
  • absorbents (kapectolin and bismuth subalicylate) after each loose stool
  • maintain hydration
  • opioids dosed at 3-4 times/day or after each stool
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31
Q

Traveler’s diarrhea

A
  • bismuth subalicylate with each meal and at bedtime to PREVENT traveler’s diarrhea
  • if diarrhea occurs, bismuth (max 8 doses) for up to 48 hours & loperamide 4mg then 2mg after every stool (max 8mg/day)
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32
Q

Crofelemer

A

Approved to treat diarrhea in patients with HIV/AIDS who are taking antiretrovirals
-125mg bid without regard to food

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33
Q

Cytoprotective agents

A
  • Sucralfate and misoprostol

- given for NSAID use and ulcer formation

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34
Q

Misoprostol

A
  • Cytoprotective agent
  • given if patient still requires NSAID therapy
  • dose 4x/day
  • pregnancy category X
  • ADRs: diarrhea, menstrual problems
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35
Q

Sucralfate

A
  • cytoprotective agent
  • selectively binds to ulcer tissue, acting as a barrier
  • given for duodenal ulcers for up to 8 weeks to heal ulcers
  • ADRs: constipation
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36
Q

Antiemetics

A
  • used to provide symptoms relief of n&v and prevention of fluid and electrolyte imbalances
  • drug classes: antihistamines, phenothiazines, sedative hypnotics, cannabinoids, and 5-HT3 receptor antagonists
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37
Q

Antihistamines

antiemetic

A
  • have strong anticholinergic effects as well as H2 blocking effects
  • used for motion sickness
  • ADRs: drowsiness, anticholinergic effects (dry mouth, blurred vision, urinary retention)
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38
Q

Phenothiazine

antiemetic

A
  • block dopamine receptors in the chemoreceptor trigger zone
  • can change the urine to light pink or brown
  • ADRs: drowsiness, EPS symptoms
  • Contraindicated in parkinson’s disease and children under 2 years old
  • Phenothiazine and lithium may mask lithium toxicity
  • LT monitoring: CBC for bone marrow depression and blood dyscrasia
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39
Q

Cannabinoids

antiemetic

A
  • Dronabinol
  • work in the CNS to prevent n&v associated with cancer chemotherapy
  • use with caution in seizure disorders
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40
Q

5-HT3 Receptor Blocker

antiemetic

A
  • used for n&v due to drugs or gastroenteritis
  • 5-HT3 receptor blockers may mask progressive ileus s/s
  • take 1-2 hours before departure to treat motion sickness
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41
Q

H2 Blockers

A

-Cimetidine, famotidine, nizatidine, and ranitidine
-highly selective, and reduce gastric acid secretion by 35-50%
-indicated for heartburn, acid indigestion, and “sour stomach”
-ADRs: antiandronergic reactions, CNS effects
H2 BLOCKERS NOT USED FOR TX OF PUD

42
Q

Prokinetic (Metoclopramide)

A

-metoclopramide only drug in this class
-enhance gastric motility
-BB warning: increases risk of tardive dyskinesthia
-contraindicated in obstruction, recent GI surgery, hemorrhage, or perf.
indicated for diabetic gastroparesis and GERD

43
Q

Proton pump inhibitor (PPI)

A
  • omeprazole, esomeprazole, lansoprazole, and pantoprazole.
  • used to treat gastric conditions characterized by hyperacidity.
  • risk for significant deficiencies: iron, vitamin B12 and calcium
  • LT use is associated with osteoporosis and fractures (esp hip)
44
Q

Osmotics

Laxative

A

mag hydroxide, mag citrate, sodium phosphate, polyethylene glycol electrolyte solution and polyethylene glycol PEG
-draw water into the intestinal lumen

45
Q

starting dose levothyroxine

A

no more than 50mcg

46
Q

when to check labs after starting thyroid medications

A

6-8 weeks

47
Q

osteopenia

A

T score -1 to -2.5

mild bone loss

48
Q

alendronate (Fosamax)

A

bisphosphonate for osteoporosis and Paget’s

10 year half life

49
Q

dynamics of bisphosphonates

A

rapid increase in BDM for 1st year, plateau after 2-3 years

50
Q

ADRs of bisphosphonates

A

esophagitis
gastric irritation
musculoskeletal pain (rare osteonecrosis of jaw)
H2 blockers double alendronate activity

51
Q

who are the only people that can take a PPI long term>

A

Barretts esophagus

52
Q

how often to check A1C?

A

every 90 days

53
Q

target treatments for DM

A

preprandial BG 70-130
2 hr postprandial BG less than 180
A1C target <7%

54
Q

Colchicine

A

antigout

  • decreases inflammatory response from acute gout, does not prevent gout from progressing
  • causes significant diarrhea and vit B12 malabsorption
55
Q

Probenecid

A

uricosuric drug

  • increases renal excretion of uric acid
  • started after an acute attack has resolved
  • begin to taper dose after 6mo of therapy with no attacks
  • reacts with pcn and cephalosporins
56
Q

long acting insulin

A 
Lantus, Levimir, Tresiba
onset- 2-4 hours
peak- none
duration 24 hours
DO NOT MIX WITH OTHER INSULIN!
57
Q

Corticosteroid ADRs

A

atrophy of skin, purple striae, hirsutism, poor healing, truncal obesity, buffalo hump, moon face, osteoporosis (LT use), cataracts (LT use), mood swings, agitation, severe depression, hyperglycemia

58
Q

where is insulin excreted

A

urine

59
Q

at what point in treatment would a pt. need insulin?

A

after 3 months of failure of an oral agent

60
Q

First line oral agent for adults and kids >10?

A

Biguanides: Metformin (Glucophage)

61
Q

Metformin

A
  • does not cause hypoglycemia or wt. gain
  • inhibits platelet aggregation
  • favorable impact on triglycerides
  • may be used in prediabetes, insulin resistance, and PCOS
62
Q

GFR contraindications with Metformin

A

cut dose in half if GFR 45, STOP when GFR reaches 30

63
Q

2 major contraindications of Metformin

A

Renal disease and lactic acidosis

64
Q

Metformin ADRs

A
  • GI disturbances (diarrhea mainly)
  • withhold 48 hours prior to iodine-based contrast
  • decreases B12 (watch in anemia patients)
65
Q

Selective sodium Glucose Co-transporter 2 (SGLT-2) inhibitors

A

Invokana, Farxiga, Jardiance
monotherapy or in combination
NOT for type 1 or DKA, or hx bladder cancer
works by dumping glucose in urine- increased risk for UTI

66
Q

SGLT-2 inhibitor ADRs

A

severe renal impair (<30), ESRD, dialysis
pregnancy C
may increase LDL
works by dumping glucose in urine- increased risk for UTI and genital fungal infections

67
Q

Urine volume output on SGLT-2 inhibitor

A

urine volume increases abuot 300cc on day 1, and stabilizes to about 135cc by day 5.

68
Q

sulfonylureas: glipizide, glyburide, glimeperide

A

stimulates insulin release from beta cells (hypoglycemia risk)
do not use in DM 1 or DKA, uncontrolled infection, burns, trauma
cross sensitivity to TZDs and sulfonamides

69
Q

older adult on sulfonylurea?

A

no glyburide per ADA- falls risk

give short acting glipizide

70
Q

sulfonyurea ADRs

A 
hypoglycemia
weight gain
sore throat
rash
unusual bleeding/bruising
SIADH
71
Q

Dipeptidyl Peptidase-4 inhibitors (DPP-4 inhibitors)

A

“gliptins” sitagliptin, saxaglipin, linagliptin, alogliptin
well tolerated by elderly
best used as add on therapy in combo with Metformin and 2nd line therapy

72
Q

DPP-4 inhibitor precautions

A

RENAL dysfunction- decrease with declining GFR
pregnancy B
not for kids
potential medullary cancer concerns

73
Q

Meglitinides

A

Starlix and Prandin
shouldnt be used in place of metformin monotherapy or if other insulin-stimulating drugs have been unsuccessful
Pregnancy C; not for kids

74
Q

repaglinide (prandin) for?

A

postprandial hyperglycemia

75
Q

administration of Meglitinides

A

no more than 30 min before a meal
hold if not eating
extra meals? take extra dose!

76
Q

Target TSH

A

0.3-3

Measure 6-8 weeks after starting therapy

77
Q

treatment for hyperthyroid induced tachycardia and palpitations?

A

Beta blocker!

78
Q

Bulk producing laxatives

A
  • psyllium, methylcellulose, and polycarbiphil
  • natural and alternatives polysaccharides and cellulose that mixes with water in the intestine
  • have slower response and are indicated for LT use
  • safest to use in pregnancy
79
Q

Lubricants

laxative

A
  • mineral oil

- softens stool and lubricates intestine

80
Q

Surfactants

laxative

A
  • docusate compounds
  • reduces surface tension of the oil-water interface on the stool and facilitate admixture of fat and water into the stool
81
Q

Hyperosmolar laxatives

A
  • glycerin, lactulose

- draws water into the intestine

82
Q

Stimulants

laxative

A
  • cascara, senna, bisacodyl, and castor oil
  • drug of choice for constipation*
  • direct action on intestinal mucosa by stimulating the myenteric plexus
83
Q

Laxative ADRs

A

excessive bowel activity, cramping, flatulence, and bloating

84
Q

Phases of gout

A

asymptomatic hyperuricemia, acute gouty arthritis, intercritical gout, and chronic tophaceous gout

85
Q

Acute gout s/s

A

acute onset of pain, erythema, decreased ROM, and swelling of involved joints.

86
Q

Allopurinol

A

antigout

  • reduces production of uric acid (levels fall in 2-3 days)
  • works best in patients with renal dysfunction
  • ADRs: rash, drowsiness, dizziness
87
Q

Febuxostat

A

antigout

  • may take 2 weeks to see effect
  • used in chronic gout (maintenance drug)
  • may cause acute gouty flare- NSAIDs or colchicine are given for first 6 mo. of therapy
88
Q

Probenecid

A

uricosuric drug

  • increases renal excretion of uric acid
  • started after an acute attack has resolved
  • begin to taper dose after 6mo of therapy with no attacks
89
Q

Sulfinpyrazone

A

uricosuric drug

  • inhibits renal reabsorption of uric acid (increases secretion through urine)
  • may cause platelet dysfunction
90
Q

Clinical usage of corticosteroids

A

adrenal insufficiency, inflammation, immune suppression, and rheumatoid arthritis

91
Q

Education regarding corticosteroids

A

take exactly as prescribed, do not abruptly stop treatment, wear medic alert bracelet, need diet high in potassium and calcium and low in sodium and carbohydrates

92
Q

NSAID mechanism of action

A

inhibit cox-1 and cox-2 activity, thus inhibiting prostaglandin synthesis
-primarily used for their anti-inflammatory activity

93
Q

NSAID ADRs

A

GI disturbances- most common

BB warning: increased risk of MI or CVA

94
Q

NSAID monitoring

A

renal function with LT therapy, CBC prior to therapy and annually thereafter

95
Q

Acetaminophen indications

A
  • mild to moderate pain in pregnancy, history of GI bleed, blood coagulation disorders, upper GI disease
  • fever in children younger than 6mo old, especially children with fever during flu-like illness
96
Q

Acetaminophen toxicity

A
  • acute hepatic necrosis occurs with doses of 10-15mg (doses above 25 usually fatal)
  • refer to poison center, get acetaminophen level, oral N-acetylcysteine is specific antidote
97
Q

Aspirin clinical usages

A 
Fever (not in kids or pregnancy)
Mild to moderate pain
RA
Osteoarthritis
acute rheumatic fever
MI &amp; CVA prophylaxis
98
Q

Aspirin ADRs

A

GI irritation, ulcers, bleeding, iron deficiency anemia, ototoxic at high levels, aspirin in kids associates with reye’s syndrome, avoid after surgery due to bleeding risk, pregnancy category D

99
Q

Aspirin poisoning

A

lethal doses in adults is 10-30g

  • respiratory alkalosis
  • tx includes emesis, gastric lavage (within 2 hours of ingestion), hemodialysis
100
Q

Aspirin monitoring

A
  • random salicylate level should be drawn 7-10 days after initiation of therapy
  • renal function
  • CBC at baseline and annually
  • fecal blood testing
101
Q

Aspirin education

A
  • take with plenty of water and remain upright for 15-30 minutes
  • do not crush or chew enteric-coated tablets
  • tablets with a vinegar-like odor should be discarded

Advanced Pharmacology (3 decks)

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