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Medex Winter 2016 > Pharm Final > Flashcards

Pharm Final Flashcards

1
Q

Name 2 Iron supplaments

A

Ferrous Gluconate PO & Sodium Ferric Gluconate IV

Ferrous Gluconate PO & Sodium Ferric Gluconate IV

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2
Q

Cyanocobalamin

A 
Megaloblastic anemia
B12 deficiencies (pernicious anemia lack of intrinsic factor)
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3
Q

Mechanism of EPO

A

Inducing red blood cell production by stimulating division and differentiation of erythroid precursor cells in the bone marrow.

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4
Q

EPO indications and contraindications.

A

For: CKD with anemia, chemo induced anemia

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5
Q

Name 3 anticoagulants

A

Heparin IV, Warfarin, & Dabigatran

Heparin IV, Warfarin, & Dabigatran

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6
Q

Heparin

A 
For DVT prophylaxis & MI 
Monitor H&H and platelets
Risk of HIT
Indirect thrombin inhibitor (Activates Anti-Xa molecule)
Reverse with protamine
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7
Q

Warfarin

A

For: DVT, PE, A-fib, CVA hx, mechanical heart valve and embolus.
Affects vitamin K dependent clotting factors (2,7,9,10)
Contraindicated in pregnancy
Goal is INR 2-3
Interactions: stop smoking, green tea, weed, ETOH, St. John’s wart, many antibiotics.

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8
Q

Dabigatran

A

NOAC (Novel oral anticoagulant) Direct Thrombin Inhibitor
VTE, AF
Reversal with Idarucizumab.

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9
Q

Name 2 low molecular weight Heparins

A

Enoxaprin Dalteparin

Enoxaprin Dalteparin

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10
Q

Low molecular weight heparin actions

A

For: Use with CA over other agents and all the same indications as Warfarin.
Given by injection
Prego class C
Less drug interactions-St. John’s wart-, no food interactions.

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11
Q

Enoxaprin

A

Xa-inhibitor
Need good kidney function, taken once daily. Drug interactions: verapamil, quinidine, marcrolides some HIV meds
Reverse with protamine

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12
Q

Dalteparin

A

Direct thrombin inhibitor

Protamine reversal agent, highest GI risks and taken BID due to short duration.

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13
Q

Name 2 antiplatelet drugs

A

Asprin

Clopidogrel

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14
Q

Aspirin indications contraindications

A

Primary prevention: in CV
Secondary risk: reducing risk of subsequent MI or CVA, ACS
Side effects: bleeding, GI upset and erosion, inhibits prostaglandin.

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15
Q

Aspirin action

A

Irreversibly binds to COX 1 COX 2, inhibits platelet aggregation, lasts the life of the platelet-10 days. NSAIDS complete for the same enzyme and reduce efficacy.

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16
Q

Clopidogrel action

A

P2Y12 inhibitors.

Irreversibly inhibit platelet aggregation, 2 hour onset

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17
Q

Clopidogrel indications and contraindications

A

For: ACS, recent CVA/TIA, PAD, post PCI
Don’t drink 3 glasses of grapefruit juice with it. PPI may inactivate it.
Side effects: bleeding rash, diarrhea, small risk for thrombocytopnea.

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18
Q

Alteplase

A

Fibrinolytic agent given with in 3 hours of STEMI. Improves survival. Given in acute emergent setting when timing is important

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19
Q

Name 8 NSAIDS in our obj

A

Acetaminophen, Diclofenac, Indomethacin, Sulindac, Ibuprofen, Naproxen, Meloxicam, Ketorolac.
Acetaminophen, Diclofenac, Indomethacin, Sulindac, Ibuprofen, Naproxen, Meloxicam, Ketorolac.

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20
Q

Celecoxib class and mechanism

A

COX-2 inhibitors: selectively inhibits COX-2 enzymes which only inhibits prostaglandin synthesis.
COX-2 is released on initiation of inflammation.

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21
Q

Celecoxib indications and contraindications

A

For: RA, OA, dysmenorrhea. No effects on COX-1 so no GI effects.
Cardiac/Thrombotic events.
May produce NSAID-associated nephrotoxicity

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22
Q

Methotrexate: class and mechanism

A

DMARDS: influence the disease process in RA by preventing bone loss and cartilage erosion. Anti-folate, inhibits DNA synthesis, appears to act as cell antiproliferitive agent in RA

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23
Q

Methotrexate Indications and contraindication

A

For: RA, also immunosupression, psoriasis, lupus, sarcoidosis, and for CA.
Don’t’s: teratogenic
Side effects: blurred vision, transient blindness, infertility, pulmonary fibrosis, stress fractures, skin and GI ish too.

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24
Q

Gold salts

A

Last result for RA and juvenile arthritis. Alter collagen biosynthesis, enzyme synthesis and immune response by unknown mechanism.
Contraindications: blood dyscrasias, CHF, dermatitis, colitis, and concurrent use with antimalarials.

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25
Q

Name 2 TNF Modifiers

A

Etanercept and Infiximab

Etanercept and Infiximab

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26
Q

TNF Modifiers

A

For: moderate to severe RA, target the rheumatoid process. Can cause neutropnia, dysuria and GI ish.
Don’ts: serious infection, children, TB.

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27
Q

2 gout drugs

A

Allopurinol and Colchicine

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28
Q

Allopurinol Indication and action

A

Gout and renal calculi. Inhibits the enzyme xanthine oxidase, blocking uric acid conversion.

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29
Q

Allopurinol Side effects and contraindication

A

Adverse effects: renal failure, bone marrow depression, drowsiness.
Contraindicated in children, and breastfeeding mothers.

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30
Q

Colchicine indication and action

A

Acute gout attacks. Anti-inflammatory but does not effect uric acid in circulation. Interfere with WBC ability to perpetuate inflammatory response.

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31
Q

Colchicine side effects and contraindications

A

Side effects: alopecia, GI stuff, agranulaocytosis and anemia, renal damage.
Contraindications: cardia, renal hepatic or GI disease because toxicity may be cumulative. Fatal in OD.

32
Q

Beta blockers indication and action

A

For: Only first line for HTN if post MI, stable HF, CVD.

Slow heart rate resulting in dropping of BP. Improve CO

33
Q

Beta blocker side effects and contraindication

A

Adverse reactions: impaired glucose response, ED, depression, AV block, bronchospasm in asthma/COPD, Interacts with digoxin, ETOH, and nitrates.
Contraindication in bradycardia.

34
Q

Selective Beta blockers

A

Atenolol and Metorolol.

Beta 1 stimulation is blocked, no alpha. Heart only, no lungs/B2

35
Q

Non-selective beta blockers

A

Propranolol-migranes, anxiety, and tremors.
Use to suppress arrythymias
Beta 1 & 2 blocked, also have alpha effects. Effects heart and lungs.

36
Q

Combined Alpha and Beta Blockers

A

Carvedilol and Labetalol. Carvedilol and Labetalol-use in HTN emergency
Blocks beta 1 2 and has alpha blocking.
Cause vasodilation which lowers BP, orthostatic hypotension.

37
Q

ACE inhibitors

A

Enalapril and Lisinopril. Enalapril and Lisinopril: blocks creation of angiotension II, blocking it’s vasoconstriction.
Reduced aldosterone, decreased Na and H2O retention.

38
Q

Ace inhibitors Adverse reactions

A

Persistant dry cough, hypotension is likely in the first dose, hyperkalemia, hyponatremia, NSAIDS may decrease efficacy, contraindicated in pregnancy/poor kidney function.
Not first line for african americans

39
Q

ARBs indication Mechanism

A

Lorsartan Valsartan. Lorsartan Valsartan. First line for HTN. Works by blocking Angiotension 2 receptors. Reduces vasoconstriction and PVR. No cough like ACEI

40
Q

ARBS adverse reactions

A

Hyperkalemia, hypernatremia, increased creatinine, class D pregnancy, interacts with NSAIDS and MAOIs. Has additive effects with other HTN meds.

41
Q

Calcium channel blockers mechanism

A

Inhibit calcium ions from entering the slow channels or voltage sensitive areas of vascular smooth muscle and myocardium during depolarization.

42
Q

Calcium channel blocker cautions/contraindication.

A

Includes: dihydropyridine non-dihydropyridine

Renal impairments, hx of arrhythmias, edema, ok for prego and lactation, caution in elderly.

43
Q

Dihydropyridine

A

Nifedipine & Amlodapine. Nifedipine & Amlodapine

Short acting, act primarily to cause vasodilation

44
Q

Amlodopine

A

First line for BP, symptomatic chronic stable angina, Prinzmetal’s angina, and diastolic HF.

45
Q

Non-Dihydropyridine indications

A

Diltiazam and Verapamil. For primary HTN, stable chronic angina, spasmodic angina. Long acting, action on heart and blood vessels, reduce contractility and inotropy, depress SA and AV nodes.

46
Q

Nam 2 Alpha Antagonists

A

Prazosin and Terazosin. Prazosin and Terazosin.

47
Q

Alpha Antagonists indication and action

A

For BPH with the nice side effect of anti-hypertenstion-not first line. Blocks non-selective Alpha-1 stimulation.

48
Q

Alpha antagonists adverse reaction

A

Orthostatic hypotension, cause significant decrease in BP. Contraindicated in ED drugs-PDE5

49
Q

Clonidine mechanism

A

Direct Alpha 2-stimulates alpha 2 receptors in the brain stem. Activates inhibitory neuron, reducing sympathetic outflow. Rebound hypertension

50
Q

Clonidine indications

A

HTN, neuropathic pain, opioid detox, insomnia, ADHD, menopausal symptoms, mild sedative, and CA pain unresponsive to opioids.

51
Q

Name 6 diuretics:

A

HCTZ, chlorthaidone, furosemide, spironolactone, mannitol, acetazolamide.
HCTZ, chlorthaidone, furosemide, spironolactone, mannitol, acetazolamide.

52
Q

Thiazide diuretics indication:

A

HCTZ & Chlothaidone, HCTZ & Chlothaidone

For: 1st for BP, HF, renal calcui, diabetes insipidus, chronic renal failure, osteoperosis, cirrosis.

53
Q

Thiazide mechanism:

A

Inhibit Na reabsorption at distal convoluted tubial

54
Q

Thiazide cautions:

A

Monitor electrolytes, BUN, uric acid, glucose, torsades.

Adverse reactions: hypokalemia, hyponatremia. NSAIDS may reduce efficicacy. Caution with gout.

55
Q

Furosimide

A

Loop diuretic, inhibits sodium, potasium and chloride in the ascending loop of Henle. For: HTN, nephrotic syndrome, hyper alemia, ascites, hypercalcemia, fluid overload.

56
Q

Adverse effects of furosimide

A

Hypokalemia, tinnitus, electrolyte imbalances. Contraindicated in renal failure, anuria, sulfa allergies, and hepatic coma.

57
Q

Spironolactone

A

Spironolactone - Potassium sparing diuretic, inhibits sodium reabsorption in the kidney while saving potasium and hydrogen by antagonizing aldosterone receptors.

58
Q

Spironolactone indications

A

Used in conjunction with thiazides or loop diuretics for essential HTN. Also for hyperaldosteronism.

59
Q

Spironolactone contraindications

A

May cause gynecomastia. Contraindicated in cardiopulmonary or kidney impairment. Interacts with NSAIDs -reduced efficacy- and ACEI- potentiated hyperkalemia.

60
Q

Mannitol

A

Osmotic diuretic: induced diuresis by adding solutes to the renal tubular fluid which pulls more water from circulation into the kidneys. Pulls fluids from tissues to the circulatory system.

61
Q

Mannitol does and don’ts

A

For acute renal failure, glaucoma and cerebral edema. Contraindicated in heart, lung, and kidney impairment.

62
Q

Acetazolamide mechanism

A

Carbonic anhydrase inhibitor, works on the proximal tubule. Weakest diuretic. Reduce IOP by partially suppressing secretion of aqueous humor.

63
Q

Acetazolamide indications

A

Epilepsy, motion/mountian sickness, chronic open angle glaucoma.

64
Q

Sulfonylyreas

A

Glipizide & Glyburide, Glipizide & Glyburide, for type 2 DM. Lower BG by increasing insulin secretion from beta cells

65
Q

Sufonylureas side effects

A

Glipizide & Glyburide, Glipizide & Glyburide. Adverse effects: hypoglycemia, weight gain. Contraindications: sulfa allergies, severe renal, hepatic, thyroid or endocrine disorders.

66
Q

Biguanides

A

Metformin. Metformin. Decreases hepatic production and intestinal absorption of glucose. Prevents glucose from being made from lactate. Enhances insulin sensitivity. Positive effects of weight loss.

67
Q

Metformin side effects

A

Diarrhea, lactic acidosis. Contraindicated in hepatic dysfunction, HF, acidosis, dehydration, & alcohol abuse.

68
Q

Meglitinide

A

Repaglinide, Repaglinide, Repaglinide. Most useful with posprandial hyperglycemia. Stimulates pancreatic insulin secretion.

69
Q

TZA

A

Rosiglitazone, Rosiglitazone, Rosigliazone. Increases peripheral insulin sensitivity.

70
Q

TZA = Rosiglitazone side effects

A

Fluid retention, increased risk of MI and CVA, increased cholesterol and anemia. Contraindicated in hepatic impairment and CHF.

71
Q

GLP-1 agonist

A

Exenatide. Exenatide. Exenatide. Sub Q Given before meals to increase insulin production and inhibit glucagon. Highly effective 1.5% A1c reduction. Slows gastric emptying leading to GI side effects.

72
Q

DPP-4 antagonist

A

Sitagliptin. Sitagliptin. Sitagliptin. Given before meals to increase insulin production & inhibit glucagon. Well tolerated but not very effective on A1c. Adverse effects=URI.

73
Q

Glucagon

A

gylconeolysis resulting in breakdown of liver glycogen to glucose. Contraindicated in pheochromocytoma. Can cause hypotension, urticaria, RD & NV.

74
Q

Rapid acting insulin

A

Aspart & Lispro. Aspart & Lispro. Aspart & Lispro. Covers insulin needs when meals are eaten (prandial) at the same time as the injection. This type is used with longer-acting insulin.

75
Q

Intermediate acting insulin

A

NPH, NPH, NPH. Covers insulin needs for about half the day or overnight. Often combines with rapid acting or short acting

76
Q

Long acting insulins

A

Glargine & Detemir, Glargine & Detemir. Covers insulin need for about 1 full day. This type is often combined

Medex Winter 2016 (1 decks)

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