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Flashcards in Pharm Final Deck (38)
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1

These drugs can cause histamine release

Atracurium, dilaudid and morphine

2

Giving reglan with this medication can cause dysrhythmias

Zofran

3

For who is reglan contraindicated?

Bowel obstruction
Parkinson's
Seizure disorders

4

What can we give to reverse gastric cramping from reglan

An anticholinergic (glycopyrrolate)

5

Rapid administration of reglan can cause ____ while rapid admin of zofran can cause

Cramping
HA

6

This medication may cause out of body experiences

Droperidol

7

Thioamines take 1-2 weeks to take effect due to thyroid stores in the body. We can take these meds in the meantime to decrease symptoms

Beta blockers.

These block the hyper-adrenergic effects of hyperthyroidism.
Also, these block the peripheral conversion of T4 to T3.

8

We use this med in thyroid storm

Esmolol

9

How do corticosteroids work in treating hyperthyroidism?

1) Suppresses TSIs in Grave's disease (remember steroids are immunosuppressants!). Also decreases inflammation.
2) Blocks the peripheral conversion of T4 to T3

We use prednisone or methylprednisolone

10

Drugs that can alter thyroid status

Amiodarone (resembles thyroid hormone and contains iodine-- can cause hypo or hyperthyroidism)

Lithium (body can mistake it for iodine--> hypothyroidism)

Reglan (can increase TSH production and release)

11

Why choose methimazole over PTU?

More potent than PTU, longer half-life allows for QD dosing (PTU is TID), and has fewer SE than PTU

12

How does lugol's solution treat hyperthyroidism?

1) Blocks peripheral T4 to T3 conversion
2) Decreases the vascularity of the thyroid
3) Temporary block of T4 release (the thyroid is so busy taking up iodine that it doesn't have time to focus on releasing hormone. This effect is only temporary!!!)

This is a short-term solution to decrease thyroid activity before thyroid surgery

13

IV T3 is called ____ and can be given emergently for _____

Cytomel
Myxedema coma

14

How are sulfonylureas metabolized?

Via the liver! They are 99% protein-bound, so the liver is gonna have to deal with those before they can be excreted via the kidneys. Avoid in ESLD.

15

These sulfonylureas should be used if the pt has renal disease

Glipizide or Tolbutamine (because these will be completely metabolized to inactive or weakly active products)

16

sulfonylureas should be avoided in these patients

ESLD and those with sulfa allergies

17

How do sulfonylureas work?

1) block the ATP sensitive K+ pump
2) Increases sensitivity of the tissues to insulin

18

How to biguinides like Metformin work?

1) Shifts into anaerobic metabolism, decreasing glucose production in the liver and kidneys (less gluconeogenesis and glycogenolysis)*********

Also:
a) Enhances insulin binding (decreases insulin resistance)
b) Increases glucose utilization

19

Who are biguanides contraindicated in

ESRD, ESLD, CHF, pulm disease, shock

All related to buildup of anaerobic metabolites

20

These two oral hypoglycemic meds require insulin to work

Biguanides (like metformin)

Thiazolidinediones (TZDs like Pioglitazone)

21

These antiepileptics are CP450 inducers

Phenytoin
Barbiturates (phenobarb)
Carbamazepime (tegretol)

22

These antiepileptics are CP450 inhibitors

Valproic acid
Felbamate

23

Many anti-epileptics are associated with these life-threatening complications

Hepatotoxicity
Bone marrow suppression

We want to test for LFTs and get a CBC

24

These are the major considerations with phenytoin (Dilantin)

1) Infuse no faster than 50mg/min!! Could cause cardiac collapse
2) Enzyme inducer
3) CNS toxicity (nystagmus, double vision, vertigo, peripheral neuropathies)
4) Stevens Johnson Syndrome
5) Precipitates in solutions with a pH<7.8

25

What is fosphenytoin?

Pro-drug of phenytoin

26

Reasons nitrates are good for the heart

1) Preferentially dilate collateral vessels service ischemic areas
2) Decrease preload
3) SLIGHT decrease of afterload
4) Attenuates coronary vasospasm
5) Increases rate of relaxation during diastole**

27

Why aren't nitrates used for chronic BP control?

Because people develop tolerance to them

28

How do we prevent tolerance with nitrates?

Tell people to remove their patches at night

29

What would we use to treat the profound hypotension caused by taking nitrates with a PDE?

Phenylephrine

30

Main SE of nitrates

HA
Orthostatin hypotension/fainting

31

These medications have been shown to reduce M&M in patients with CHF

Aldosterone antagonists
ACE Inhibitors
ARBs
BBs

32

These medications have NOT been shown to reduce M&M in patients with CHF

Thiazide or loop diuretics (symptom relief only)
Digoxin (again-symptom relief only--> may worsen long-term outcomes)

33

Do we hold ACEIs and ARBs before surgery?

Yes, or else the patient will be too dry

34

A patient with CHF should be on these 3 meds

Spironolactone, BB, and ACEI

35

All ACEIs have this suffix

pril
As in "captopril"

36

ARBS have this suffix

artan
Ex- Losartan or Valsartan

37

Weuse this med for BP control in pregnancy

Methyldopa

38

How do CCBs help fight HTN?

1) Reducing heart rate and contractility
2) Reducing SVR (arteriodilation)