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PAM Semester 4 > Pharm GI Exam 2 > Flashcards

Pharm GI Exam 2 Flashcards

1
Q

Cause of nausea (Biochemical)

A

Cause of emesis is a defense mechanism controlled by the medulla oblongata

Receptors of the fourth ventricle in the brain are chemoreceptor zone

the chemoreceptor trigger zone contains dopamine (D2) , 5HT, opioid, ACH and substance P receptors

Stimulation of different pathways lead to emesis

In the final common pathway, substance P activates Nk-1 receptor

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2
Q

Emetic MOA

A

Drugs selectively bind to receptors in vomiting brainstem

Block signaling pathway

Inhibit stimulation of the GI tract, diaphragm and abdominal muscles

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3
Q

Classes and indications of

H1 antihistamines or antimuscarinics

A

Vestibular disturbances

vertigo or motion sickness

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4
Q

Classes and indications of

Dopamine receptor antagonists

A

Most commonly used
Post op nausea
Motion Sickness

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5
Q

Classes and indications of

Glucocorticoids

A

Chemotherapy induced nausea

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6
Q

Classes and indications of

5-HT3 receptor antagonists

A

Vomiting caused by acute gastroenteritis

Post op nausea
Go-to for radiotherapy and chemotherapy induced nausea and vomiting

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7
Q 
Classes and indications of
Neurokinin 1 (NK-1) receptor antagonists
A

Relatively new class of medication
Radiotherapy and chemotherapy induced nausea and vomiting
Post op nausea

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8
Q

Drugs by type

Antihistamine, anticholinergics

A 
Hydroxyzine
Meclizine
Scopalamine
Cyclizine
Trimethobenzamide
Dimenhydrinate
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9
Q

Drugs by type

Dopamine receptor antagonists (D2)

A 
Metoclopramide
Chlorpromazine
Prochlorperazine
Promethazine
Haloperidol
Droperidol
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10
Q

Drugs by type
Serotonin 5HT3
receptor antagonists

A 
-setron
Ondansetron
Granisetron
Dolasetron
Ramosetron
Tropisetron
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11
Q

Drugs by type

Neuokinin 1 receptor antagonists

A

-pitant
Aprepitant
Faosaprepitant
Rolapitant

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12
Q

Drugs by type

Other

A

Cannabinoids
Nabilone
Dronabinol
Nabiximol

Dexamehtasone

Netupitant/palonestetron

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13
Q

Drugs used for motion sickness

A

Meclizine
(antivert, bonine)
OTC

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14
Q

Meclizine

A

Antivert (antihistamine)
For motion sickness prophylaxis or vestibular vertigo

25-50mg 1 hour prior to motion

Warnings
Asthma, glaucoma, GI/GU obstruction, Hepatic/renal impairment

Interactions
Alcohol, tranquilizers, sedative-hypnotics potentiate CNS depression

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15
Q

-Setrons
5HT3 receptor antagonists
MOA

A

Inhibit vomiting due to vagal nerve stimulation particularly due to chemotherapy, radiotherapy, anesthesia

Blocks the serotonin receptors (5HT3) in VC, CTZ, and peripheral 5HT receptors

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16
Q

Ondansetron

A

Zofran (5ht3 receptor antagonist)

Contra
Serotonin syndrome possible with SSRI’s, SNRI’s etc
May antagonize tramadol

Adverse
Diarrhea, HA, Fever, Constipation, Fatigue, transient blindness, Serotonin syndrome (discontinue)

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17
Q

Metoclopromide

A

Reglan (dopamine 2 receptor antagonist)

Contra
History of tardive dyskinesia or dystonic reaction

Warning
Tardive dyskinesia

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18
Q

Promethazine

A

Phenergan
For motion sickness or perioperative nausea/vomiting

Adverse
Drowsiness, lowered seizure threshold, Cholestatic jaundice, anticholinergic and EP effects

Phenothiazine??

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19
Q

Aprepitant

A

Emend

Substance P/NK1 receptor antagonist

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20
Q

Small intestine disorders

A

Appendicitis
Celiac’s
Intussusception
Obstruction

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21
Q

ABX for non perforated Appendix

A

Cefoxitin or Cefotetan 2g IV once
or
combo of cefazolin 2g <120kg, 3g >120kg plus
Metronidazole 500mg IV

Or if inpatient and allergic to penicillin
Clindamycin plus one of the following
ciprofloxacin, levofloxacin, gentamycin, aztreonam

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22
Q

6 elements in the management of patients with celiac disease

A 
Consult dietician
Education about disease
Lifelong adherence to a gluten free diet
ID and treat nutritional deficiencies
Access to an advocacy group
Continuous long term follow up by a multidisciplinary team
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23
Q

Celiacs

A

abnormal small intestinal mucosa that improves morphologically when treated gluten free diet and relapses when gluten is introduced

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24
Q

Celiac nutritional tests

A 
Test for deficiencies
Vitamins ADE (fat soluble) 
copper
zinc
carotene
folic acid
ferritin
iron

Thiamine, B6, mag, selenium may also be deficient

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25
Q

Common problem with celiacs

A 
Bone loss
Usually osteopenia (less likely osteoporosis)

Usually due to secondary hyperparathyroidism
due to vitamin D deficiency

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26
Q

Suggested vaccine with celiacs

A

Pneumococcal vaccine

celiacs is associated with Hyposlenism

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27
Q

intussusception treatment

A

Nonoperative reduction can be guided by fluoroscopy or ultrasound
and either pneumatic or hydrostatic enemas may be used

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28
Q

Antibiotics for small bowel obstruction surgery

A

Cefazolin plus metronidazole 500mg
2g <120kg
3g >120kg

or Cefoxitin 2g
or Cefotetan 2g

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29
Q

Antibiotics for small bowel non - obstruction surgery

A

Cefazolin
2g <120kg
3g >120kg

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30
Q

Lactose intolerance

A

Lactase deficiency is the lack of the activity of the small intestine enzyme lactase

Lactase is required for digesting disaccharide lactose to glucose and galactose

on the microvillus membrane of the intestinal absorptive cells

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31
Q

Lactose intolerance education

A

No need to completely eliminate lactose

Restriction to 2 cups of milk daily taken in divided doses with meals is sufficient

Can also use lactase supplements

May require calcium supplements

Monitor Vitamin D

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32
Q

Nut allergies

A

Avoid eating at Asian, Mexican food places

Bakeries, ice cream places use nuts regularly

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33
Q

Treatment for nut allergies

A

Epi pen for anaphylaxis

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34
Q

IgE mediated food allergies

A

Pruritis, urticaria, flushing, lip, face, throat, swelling, nausea, vomiting, cramping, diarrhea, wheezing, lightheadedness, syncope, hypotension

Usually within minutes of eating food

Severity reaction may vary over time can go from hives to anaphylaxis

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35
Q

The most common types of IgE mediated food allergy in adults

A

Oral allergy syndrome
(pruritis of the mouth and throat)
from raw fruits, veggies

Also isolated allergies to seafood or nuts

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36
Q

IgE mediated food allergy treatments

A

Decide whether to use epi or not
food avoidance
lab tests

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37
Q

Migraine trigger foods

A 
Alcohol
Chocolate
Aged cheese
MSG
Aspartame (nutrasweet)
Caffeine
Nuts
Nitrates/nitrites
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38
Q

Epinephrine

A

Epinephrine 0.3mg (1:1000) Auto injector epipen
Anaphylaxis
(Sympathomimetic)

Warnings
CVD, HTN, Hyperthyroid, DM, Parkinson’s

Adverse
Anxiety, apprehensiveness, restlessness, tremor, weakness, dizziness, sweating, palpitations

Interactions
May be potentiated by MAOI’s, TCA’s, Synthroid, antihistamines,
May be antagonized by BB, A Blockers, ergot alkaloids,
arrhythmias possible with cardiac glycosides, diuretics, anti-arrhythmic

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39
Q

C Diff test - When to do

A

In cases of recent ABX use f health care exposure

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40
Q

Most critical therapy for diarrhea

A

Volume repletion
Preferable by oral route
With solutions of salt, water and sugar

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41
Q

Antibiotics in non travel community acquired diarrhea

A

not routinely used

Drawbacks
Cost, C-diff, bacterial resistance

Can shorten duration but pros do not outweigh the cons

Usually due to viruses anyways

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42
Q

Loperamide in diarrhea?

A

Used cautiously in patients whom fever is absent or low grade and no blood is present in stool

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43
Q

Causative agents of diarrhea
Stool type
Viral

A

Rotavirus

Watery stools

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44
Q

Causative agents of diarrhea
Stool type
Bacterial

A

E.coli, shigella, salmonella

Blood in stool

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45
Q

Causative agents of diarrhea
Stool type
Parasitic

A

Giardia
Entamoeba
Histolytica

Green stools with mucus

46
Q

Tinidazole

A

Tindamax (500mg) (Nitroimidazole)
for giardia

Warning
risk of carcinogenicity

Interactions
Avoid alcohol during and for 3 days after use

47
Q

Shigella treatment

A

Levo 500mg PO QD x 3 days

Cipro 500mg PO BID x 3 days
or
Cipro 750mg PO QD x 3 days

48
Q

How to prevent stress ulcers in stomach

A

Gastric acid suppression with IV PPI

49
Q

Agents poorly absorbed by activated charcoal

A 
Cyanide
Ethanol
Ethylene glycol
Iron
Isopropanol
Lithium
Methanol
Strong mineral acids and alkali
50
Q

Activated charcoal MOA

A

A highly adsorbent powder made of high surface area porous organic material
(Surface area of 2000 m2/g)

Covered with a carbon based network which adorbs chemicals within minutes of contact

Preventing GI absorption and systemic toxicity

51
Q

Contraindications of Activated charcoal

A

Not for convulsing patients unless given through NG tube and patient is intubated

Not for patients with ileus or intestinal obstruction

Not for patients who have a planned endoscopy

52
Q

G6PD Deficiency

A

Most common inherited RBC enzymatic defect (400 million world wide)
X linked disorder
Males more likely
Heterozygous females are unaffected carriers

Kurds, Jewish, Black, sub saharan, brazil, african american, Thailand, sardinia, greece, south china, india

53
Q

G6PD Clinical

A

Acute hemoytic anemia
(induced by medications, chemicals, foods, illness)
Oxidant injury
Fava beans, infection, henna, naphthaline

Most are intermittent hemolysis
some get life threatening jaundice or hemolytic anemia

Can cause neonate jaundice

54
Q

G6PD treatment

A

Depends on severity and clinical setting

Preganancy is safe
Can be blood donor as long as they are not anemic

55
Q

Medications that are completely unsafe for G6PD

A 
Chlorpropamide
Dabrafenib
Dapsone
Methylene blue
Nitrofurantoin (other nitro's)
Phenazopyridine
Primaquine (other quines)
Rasburicase and pegloticase
56
Q

Paget’s disease

A

Osteoarthritis in nearby joints and neurologic disease are common complications

The vascularity of the pagetic bone may result in excessive bleeding during surgery on affected areas

57
Q

Paget’s Disease treatment

A

Goal of treatment is to ease pain and normalize rate of bone remodeling

Success of treatment is assessed by periodic alkaline phosphatase

Secondary consequences of Paget disease need to be treated with other things

This includes hearing aids, analgesics for arthritis pain, physical therapy, walking aids and psychosocial issues

58
Q

Side effects of bisphosphanates

A

acute phase response lasting several days (more common with IV meds first time use)

Can be treated with acetaminophen or NSAIDS

Rare patients are intolerant of bisphosphonates and can be treated with cacitonin

59
Q

Zoledronic acid

A

Reclast (bisphosphanate)

Contra
Children
Hypocalcemia, CrCl <35, acute renal impairment

Adverse
Pyrexia, MSK pain, HA, Arthralgia,
Rare: osteonecrosis of jaw

60
Q

Bisphosphonate MOA

A

Pyrophosphate analogues
2 phosphorus groups linked to C atom

Prevent loss of bone density and decrease fractures

Decreases osteoclasts mediated bone resorption

Stimulates osteoclast apoptosis
Inhibits cholesterol pathways
Decrease osteoclast number, function and bone resorption

61
Q

Calcitonin

A

Miacalcin (hormone)

For paget disease of bone, Hyper calcemia

Interactions
May antagonize lithium (dose adjustment)

Adverse
Nausea, vomiting, local inflammation, flushing, rash

62
Q

Calcitonin MOA

A

Lower serum calcium and phosphate by actions on bone and kidney

Calcitonin inhibits osteoclastic bone resorption

Decreases calcium and phosphate reabsorption in proximal tubules of kidney

Secretion is always determined by calcium concentration

63
Q

Phenylketonuria

A

PKU
A deficiency of phenylalanine hydroxylase (PAH)
and if untreated
results in irreversible disability among other things

64
Q

PKU

A

Normal
Protein gets broken down into amino acids
Phenylalanine is hydrolyzed into tyrosine

PKU
Protein gets broken down into amino acids
Phenylalanine cannot be broken down and builds up
This results in health problems

65
Q

Sapropterin dihydrochloride (Kuvan) MOA

A

Newer FDA approved drug for PKU

A form of BH4 which is used to break down Phenylalanine

Even if it helps, it will not decrease phenylalanine to the desired amount
Must be used with PKU Diet

66
Q

sapropterin

A

Kuvan (phenylalanine hydroxylase activator)

For PKU with a PKU diet
Reduces Phe blood levels in HPA due to BH4 in patients with PKU

Interactions
Monitor neurologic status with concomitant levodopa
Caution in drugs that inhibit folate metabolism (i.e., methotrexate)
Monitor BP with vaso-relaxors (i.e., PDE-5 inhibit)

67
Q

Rickets

A

Inadequate intake of Vitamin D or calcium

Can result in phosphate deprivation
May occur in infants whose breast milk is the sole source of nutrition

68
Q

Rickets therapy

A

Daily doses of D2 or D3

69
Q

Vitamin A

A

Retinoic acid, Retinol

Night blindness
xeropthalmia
keratomalacia
Bitot spot
Follicular hyperkeratosis
70
Q

Vitamin D

A

Cholecalciferol

Rickets
osteomalacia
craniotabes
rachitic rosary

71
Q

Vitamin E

A

tocopherosis

Sensory and motor neuropathy
Ataxia
retinal degeneration
hemolytic anemia

72
Q

Vitamin K

A

Phylloquinone

Hemorrhagic disease

73
Q

Wernicke Korsakoff syndrome

A 
COAT RACK
C Confusion
O Ophthalmoplegia
A Ataxia
T Thiamine Deficiency

R Retrograde amnesia
A Anterograde amnesia
C Confabulation
K Korsakoff syndrome

74
Q

Wernicke Korsakoff syndrome causes

A

Thiamine B1 deficiency = Wernicke’s encephalopathy
Can turn into korsakoff if untreated

Chronic alcoholism
Malabsorption from stomach cancer or IBD

75
Q

Which vaccination is suggested for those with celiac disease?

Flu vaccine
Pneumococcal vaccine
Herpes-Zoster vaccine
Hepatitis B vaccine

A

Pneumococcal vaccine

76
Q

Which of the following is not a precaution for EPIPEN?

Hypothyroidism
DM
HTN
Cardiovascular disease

A

Hypothyroidism

77
Q

What is the boxed warning for the giardia drug tinidazole?

Pregnancy
Carcinogenicity
Atrial fibrillation
Suicidal thoughts in younger patients

A

Carcinogenicity

78
Q

Which of the following is not usually associated with bloody stools?

Giardia
Salmonella
E.coli
Shigella

A

Giardia

79
Q

Which of the following vitamins is not a fat-soluble vitamin?

Vitamin C
Vitamin D
Vitamin A
Vitamin E

A

Vitamin C

80
Q

There have been many controversies involving the administration of vaccines allegedly causing various diseases/disorders. Which of the below controversies is the most well-known in the medical community?

MMR vaccine and dementia
MMR vaccine and Parkinson's Disease
MMR vaccine and ADHD
MMR vaccine and autism spectrum disorder
None of the above
A

MMR vaccine and autism spectrum disorder

81
Q

How many days should a patient wait before receiving another live, attenuated vaccine, if him or her received the same type of vaccine within the past 4 weeks?

14 days
28 days
42 days
64 days
100 days
A

28 days

82
Q

Which of the below diagnoses is associated with all 50 U.S. States in allowing students to possess self-administered emergency medication?

cardiovascular disease
diabetes mellitus
hypertension
asthma
ADHD
A

asthma

83
Q

Which of the following complementary and alternative therapies (CAM) is not in the top 5 of all CAM involved with the pediatric population?

Tai chi
homeopathy
guided imagery
vitamins
None of the above
A

guided imagery

84
Q

Which of the following factors is not considered a factor that affects the pharmacokinetics and pharmacodynamics of a pediatric patient?

gastric pH
intestinal transmit time
activity of bile fluid
activity of CSF
none of the above
A

activity of CSF

85
Q

How many drugs were available for PEDS before the FDA’s pediatric program?

A

20%

86
Q

Factors that affect children and medications

oral bioavailability

A 
Gastric pH
Emptying time
intestinal transit time
immaturity of secretion
activity of bile and pancreatic fluid
87
Q

Medications that specifically act differently in peds

Stimulants and non stimulants

A

Stimulantsare the best-known and most widely used ADHD medications.
Between 70-80% of children with ADHD have fewer ADHD symptoms when taking these fast-acting medications

Nonstimulantswere approved for the treatment of ADHD in 2003.
They do not work as quickly as stimulants, but their effect can last up to 24 hours.

Medications can affect children differently and can have side effects such as decreased appetite or sleep problems.
One child may respond well to one medication, but not to another.

88
Q

Medications that specifically act differently in pregnant women
ACE Inhibitors

A

ACE inhibitors-May cause kidney damage in the fetus when used in II and III trimester, decrease in the amount of amniotic fluid and deformities of face, limbs and lungs

89
Q

Medications that specifically act differently in pregnant women
Cough syrup

A

If you have a cough, Mucinex, Robitussin, and other medications containing guaifenesin can increase the risks of neural tube defects in infants if taken during the first trimester of pregnancy.

90
Q

Medications that specifically act differently in pregnant women
Misc

A

NSAIDs & Aspirin and other Salicylates-Delay in start of labor, premature closing of ductus arteriosus, jaundice, brain damage in the fetus and bleeding problems in the woman during and after delivery and in the newborn.

Antibiotics- Tetracycline- Slowed bone growth, permanent yellowing of the teeth and increased susceptibility to cavities in the body.

Ciprofloxacin-Possibility of joint abnormalities (seen in animals)

91
Q

Alcohol and miscarriage

A

Alcohol in any amount can cause miscarriage

92
Q

Where to find medication info

A

Always use Epocrates, Uptodate, or other evidence-based medical databases to look up the latest information.

93
Q

Breastfeeding women and meds

A

Breastfeeding women should avoid aspirin and products containing aspirin (this includes Pepto Bismal taken for an upset stomach), as well as products containing naproxen (Aleve).

In contrast, acetominophen (Tylenol) and ibuprofin (Motrin, Advil) are not known to have any negative effects on nursing babies.

94
Q

Accidental poisoning and drug toxicity in infants and children
Most common things

A

medicines sold over the counter, such as Tylenol, cough and cold remedies, iron tablets, antihistamines and anti-inflammatory drugs;

prescription medicines, such as antidepressants, narcotics and analgesics;
recreational drugs, such as cannabis and cocaine;

household products – such as bleach, disinfectants, detergents, cleaning agents,

cosmetics and vinegar;

pesticides – including insecticides, rodenticides and herbicides;

poisonous plants; animal or insect bites.

95
Q

Over-the-counter and alternative therapies in children

A 
Natural products
Chiropractic or osteopathic manipulation
Yoga, Tai chi, Qui gong
Deep breathing
Homeopathy
96
Q

Social issues that may prohibit or hinder treatment plans.

A

One study found higher adherence rates in clinics located in suburban areas compared to inner city clinics among adolescents who were taking oral contraceptives.

This could be due to lack of transportation, access to pharmacies, or funds to purchase medications.

97
Q

Use of and legal requirements for the use of medications in the school system

A

As of October 2014, all 50 states and the District of Columbia have laws or statutes allowing students with a diagnosis of

asthma or life-threatening allergic reactions

to possess and self-administer emergency medication.

98
Q

Antitoxin Definition

A

Antitoxin.
A solution of antibodies against a toxin. Antitoxin can be derived from either human (e.g., tetanus immune globulin) or animal (usually equine) sources (e.g., diphtheria and botulism antitoxin). Antitoxins are used to confer passive immunity and for treatment.

99
Q

Immune globin Definition

A

Immune globulin.

A sterile solution containing antibodies, which are usually obtained from human blood.

100
Q

Antigen vs antibody

A

Antigen
A substance that can induce the immune system to produce antibodies against it
Has combinations of polysaccharides
Can be cells
Act as the key
2 main types (self antigens and non self antigens)

Antibody
Antibody is a protective protein produced by the B cells of the immune system in order to attack antigens
Purely made of proteins
Not cells
Act as the lock
Five main categories (IgA, IgD, IgE, IgG, IgM)

101
Q

Antigen

A

Antigen
A substance that can induce the immune system to produce antibodies against it
Has combinations of polysaccharides
Can be cells
Act as the key
2 main types (self antigens and non self antigens)

102
Q

Antibody

A

Antibody
Antibody is a protective protein produced by the B cells of the immune system in order to attack antigens
Purely made of proteins
Not cells
Act as the lock
Five main categories (IgA, IgD, IgE, IgG, IgM)

103
Q

Vaccines

A

Vaccines train our immune system to defend against disease

Live attenuated vaccines
use a living virus that has been weakened to the point that iti is incapable of causing disease.

Inactivated vaccines
contain a virus that has been killed and is completely incapable of causing disease

Subunit vaccine
contain purified pieces of virus to create the vaccine

Conjugate vaccines
Connect outer sugar like coatings found on bacteria to proteins to induce an immune response

Toxoid vaccines
contain inactivated toxins no longer capable of causing harm or disease

104
Q

Live attenuated vaccines

A

Live attenuated vaccines

use a living virus that has been weakened to the point that iti is incapable of causing disease.

105
Q

Inactivated vaccines

A

Inactivated vaccines

contain a virus that has been killed and is completely incapable of causing disease

106
Q

Subunit vaccine

A

Subunit vaccine

contain purified pieces of virus to create the vaccine

107
Q

Conjugate vaccines

A

Conjugate vaccines

Connect outer sugar like coatings found on bacteria to proteins to induce an immune response

108
Q

Toxoid vaccines

A

Toxoid vaccines

contain inactivated toxins no longer capable of causing harm or disease

109
Q

Resources for immunizations

A

Primarily Centers for Disease Control and Prevention (CDC) websites!

110
Q

When is a live vaccine contraindicated

A

From CDC:
A person who received either live, attenuated influenza vaccine or an injectable live-virus vaccine (e.g., MMR-II, Varivax) in the past 4 weeks should wait 28 days before receiving another live vaccine.

Inactivated vaccines may be administered at the same time or at any time before or after a live vaccine.

Severely immunocompromised persons and pregnant females should not receive live vaccines!

111
Q

Vaccine safety surveillance systems

A

The Vaccine Adverse Event Reporting System (VAERS) is a national vaccine safety surveillance program run by CDC and the Food and Drug Administration (FDA).

VAERS serves as an early warning system to detect possible safety issues with U.S. vaccines by collecting information about adverse events (possible side effects or health problems) that occur after vaccination.

VAERS was created in 1990 in response to theNational Childhood Vaccine Injury Act.

112
Q

Vaccine controversies

A

Distrust of the scientific ‘establishment’ who generally promotes vaccination, albeit based on careful risk-benefit analyses,

suspicion that those conducting vaccine safety studies are in the pay of the pharmaceutical industry

sincerely held personal belief that their child was damaged by a vaccine

pseudoscientific beliefs such that vaccination is unnatural and it is better for a child to experience the real disease or that giving several vaccines to a young child can ‘overload the immune system

Best well-known controversy was the unfounded MMR vs autism report.

PAM Semester 4 (7 decks)

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