@MQW U6 > Pharm - Old/GI/Metal > Flashcards

Pharm - Old/GI/Metal Flashcards

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1
Q

Amount of drugs absorbed [increase/decrease/doesn’t change] as we get older.

What is the exception?

A

Doesn’t change

Drugs w/ extensive 1st pass effect b/c less blood flow to liver

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2
Q

As we get older [more/less] gastric acid is produced.

A

Less – natural achlorhydria

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3
Q

How does lower body water in elderly affect drug distribution?

A

Lower VD for hydrophilic drugs

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4
Q

How does lower lean body mass in elderly affect drug distribution

A

Lower VD for muscle bound drugs

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5
Q

How does higher fat stores in elderly affect drug distribution?

A

Higher VD for lipophilic drugs

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6
Q

How does lower plasma protein (albumin) in elderly affect drug distribution?

A

Higher % is unbound (active)

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7
Q

What is Phase 1 metabolism

A

Convert drugs to active metabolites (ex. hydroxylation, oxidation, dealkylation, reduction)

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8
Q

What is Phase 2 metabolism

A

Convert drug to inactive metabolites that don’t accumulate

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9
Q

What phase of metabolism is preferred in elderly?

A

Phase 2 – no active metabolites

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10
Q

What are examples of Phase 1 metabolism processes?

A

Hydroxylation
Oxidation
Dealkylation
Reduction

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11
Q

What drug class is the #1 cause of old people falling?

A

Benzodiazepines – ex. Valium (active metabolites have T1/2 of 7 days)

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12
Q

What drug has a difference in metabolism in the elderly according to gender?

A

Oxazepam (short-intermediate Benzo for anxiety, insomnia, EtOH withdrawl)

Faster in old men than in old women

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13
Q

What disease state reduces metabolism of warfarin?

A

Hepatic congestion from heart failure

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14
Q

What should we be aware of in a smoker who takes theophylline?

A

Smoking increases clearance of theophylline

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15
Q

Aging kidneys have lower tubular [reabsorption/secretion]

A

Lower renal tubular Secretion

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16
Q

Why can an older person with a low GFR have normal Cr?

A

Low lean body mass = less Cr production

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17
Q

What factors are considered in the Cockroft and Gault Equation for calculating Cr?

A

Weight, Age, Gender (Fem = 0.85 of Male)

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18
Q

How is the effect of morphine different in elderly?

A

Higher levels = longer pain relief

BUT longer sedation, possible delirium

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19
Q

Drugs involving what organ systems are most commonly involved in ADEs?

A

Cardiovascular, CNS, Msk

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20
Q

Why are are anticholinergics a problem for elderly?

A
  1. Potentiate normal cholinergic nerve decline –> cog.impairment/confusion/delirium
  2. Cause orthostasis –> fall
  3. Many drugs have anticholinergic properties, so combos can increase effect
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21
Q

What are 7 risk factors for ADEs?

A
  1. 6+ conditions
  2. 12+ doses/day
  3. 9+ meds
  4. Prior ADE
  5. Low BMI/weight
  6. 85 years +
  7. Cr clearance below 50
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22
Q

What common Rx-Rx interaction can cause HypOtension and HyperKalemia?

A

ACEI + Diuretic = used for BP management

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23
Q

How can ACE Inhibitors affect potassium (K)?

A

Cause increased K (hyperkalemia) by decreasing Aldosterone (K retention, Na wasting)

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24
Q

What are the most common ADE of Rx-Rx interaction?

A

Confusion
Cog. impairment
Arterial Hypotension
Acute Renal Failure

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25
Where are G-cells primarily located and what do they do?
Antrum of stomach, secrete Gastrin --> stimulate acid production
26
What 2nd messengers are involved in stimulating Parietal cell secretion of acid?
cAMP for Histamine and PGE2 | Ca for ACh and Gastrin
27
What kind of drugs decrease acid production?
1. Anticholinergics 2. Antihistamines 3. Proton Pump Inhibitors
28
What kind of drugs increase stomach mucosal resistance?
1. Prostaglandins | 2. Sucralfate, Bismuth
29
What active ingredient is not used much anymore in antacid preparations b/c of side effects?
Sodium bicarbonate -- systemic alkalosis, serum Na changes, electrolyte abnormalities
30
What are the different active ingredients in solid vs liquid antacids
``` Solids = Calcium carbonate Liquids = Magnesium Hydroxide, Magnesium carbonate ```
31
What antacid active ingredient shouldn't be used in people with renal failure? Why?
Magnesium hydroxide/carbonate -- can't excrete It can cause bradycardia
32
What antacid active ingredient should be used in the setting of renal failure?
Aluminum hydroxide
33
What is simethicone?
Defoaming agent -- decrease amount of gas, antiflatulent
34
How do H2 blockers work?
Competitive H2 receptor blocker preventing Gs stimulation of cAMP production
35
How do PPIs work?
Noncompetitive blocker of lumenal Na/K ATPase Requires stimulation of acid production in order to block it
36
When is the best time to take a PPI?
1/2 Hour before Breakfast
37
What is the only PPI that can be given IV?
Pantoprazole
38
In what 2 ways are PPIs mroe effective than H2 blockers?
1. Better pain relief | 2. Faster healing rates
39
What cells in the stomach produce bicarbonate?
Surface epithelial cells
40
How do bismuth salts and sucralfate work to treat ulcers?
Increase mucosal resistance by mechanical protection (coat ulcer crater)
41
When is Misoprostol therapy used?
PGE2 analog = Patients on long term NSAID (Rheumatoid Arthritis) to prevent NSAID induced gastric ulcers
42
What is included in Triple Therapy?
H. pylori treatment: 1. PPI or Ranitidine bismuth citrate 2 and 3. 2 of: amoxicillin, clarithromycin, or metronidazole. all BID
43
Melena can be caused by bleeding in what 2 places?
Esophagus or Stomach
44
What patient population has increased gastric reflux?
Pregnant women -- gravid uterus pushes up stomach
45
What 3 drug groups are used in persistent GERD?
Alginic acid antacids Promotility drugs H2 blockers
46
What are the promotility drugs?
Metochlopramide = peripheral DA antagonist | Cisapride
47
Where and on what receptors do Antiemetics work?
Chemo-receptor Trigger Zone (CRTZ) | 5HT-3, D2, M1, CB1 receptors
48
What are the 4 groups of antiemetics?
1. Phenothiazines 2. Benzamide derivatives 3. Tetrahydro-cannabinol 4. 5HT3 receptor blockers
49
Toroticollis is an adverse effet or what antiemetic?
Prochlroperazine -- Phenothiazine class
50
What is current 1st line antiemetic class?
5HT3 blockers
51
What antiemetic drugs are commonly used post-anesthesia?
Granesitron | Dolasetron
52
What is used to treat gastroparesis?
Metochlopramide, Cisapride, Domperidone
53
What 3 classes of drugs are used to treat diarrhea (disregarding treating infection causes)?
1. Anticholinergics 2. Opoid Agonists 3. Colloids and Pectins
54
Which Opoid agonist can be used in kids, and which can't?
In kids as young as 3: Loperamide | No kids: Diphenoxylate
55
What are and how do Colloids and Pectins work?
``` Colloid = Metamucil Pectin = Kaopectate ``` Absorb water to reduce loss
56
Which groups of constipation drugs are commonly used for acute constipation? Chronic?
Acute: Irritant or stimulant, Osmotic cathartics Chronic: Bulk-forming (hydrophilic colloids), lubricant and fecal softeners
57
What are the 3 receptor-mediated anti-constipation drugs?
1. Lubiprostone 2. Linaclotide 3. Naloxegol
58
What are the acute anti-inflammatories used for IBD?
1. Mesalamine 2. Sulfasalazine 3. Olsalazine
59
What are the chronic immunosuppressive agents used for IBD?
1. Azathioprine 2. Corticosteroids 3. Methotrexate 4. Biologics: anti TNFa or antiIntegrin 5. Cyclosporine
60
What is the molecular mechanism of metal toxicity?
Bind to sulfhydryl groups in proteins --> inhibit enzyme function
61
Rice-water diarrhea + long QT interval points toward poisoning by what heavy metal?
Arsenic
62
What chelation therapy is usually used for Mercury poisoning?
Succimer
63
Intention tremor + labile mood points toward poisoning by what heavy metal?
Mercury
64
All acute heavy metal toxicities have symptoms of what organ system?
GI: nausea, vomiting, diarrhea
65
Wrist drop + foot drop points toward poisoning by what heavy metal?
Lead
66
Painful peripheral neuropathy + alopecia points toward poisoning by what heavy metal?
Thallium
67
Lab: microcytic anemia w/ basophilic stippling points toward poisoning by what heavy metal?
Lead
68
What heavy metal toxicity can cause cardiomyopathy?
Cobalt
69
What are the 3 main Chelators?
1. Dimercaprol (British Anti-Lewisite (BAL)) 2. Succimer/DMSA (2,3-Dimercaptosuccinic Acid 3. Edetate Calcium Disodium (CaNa2EDTA)
70
What is an important consideration when giving Dimercaprol/BAL?
Peanut allergy -- it's mixed w/ peanut oil
71
BAL/Dimercaprol is the chelator of choice for what?
Lead encephalopathy
72
What is the main adverse event to be worried about when using BAL/Dimercaprol?
Dissociation of metal chelate in acidic urine -- always add urine alkalinizer
73
What are the routes of administrations for BAL, Succimer, and Edetate?
``` BAL/Dimercaprol = IM injection DMSA/Succimer = Oral Edetate = IV injection ```
74
Thallium/Cesium poisoning can be treated with what chelator?
Insoluble Prussian Blue -- oral dosing, not absorbed well, binds thallium in GI tract
75
How are FEP (Free eythrocyte protoporphyrin) levels in acute vs chronic lead poisoning?
``` Acute = unchanged (normal under 70) Chronic = elevated ```
76
Multiple episode of vomiting + ill-appearing + tachycardic + hypotensive. Think what poisoning?
Iron
77
What acid/base change does iron poisoning cause?
Anionic Gap Metabolic Acidosis -- iron uncouples ox phos --> anaerobic --> lactic acidosis
78
What is the chelator for iron and what are important points about it?
Deferoxamine - -chelates Ferric (Fe3+) iron - -urine turns reddish/brown - -can chelate free iron only - -given in first 24h of poisoning - -acute lung injury (when used after 24h)
79
Why would a child given Edetate Calcium Disodium develop hypocalcemia (severe)?
Stupid homeopaths gave NaEDTA instead of CaNaEDTA
80
What is the antidote for Iron poisoning?
Deferoxamine -- look for "de-fe" in drug name
81
What is the antidote to APAP (acetaminophen) overdose?
N-acetylcysteine (NAC)
82
What are the opioid antidotes?
Naloxone (mainly), Nalmefene, Naltrexone
83
What is the benzodiazepine antidote?
FLUMAZENIL!
84
What antidote do you give someone who took a lot of antidepressants now with 6mm pupils, dry mucous membranes, dry flushed skin, and no bowel sounds?
Sodium Bicarbonate -- This is TCA antidepressant toxidrome
85
What do you give someone for pure anticholinergic toxidrome?
Physostigmine -- AChE Inhibitor
86
What do you give someone who is mad as a hatter (screaming, crazy) and probably, but not definitely, took some anticholinergics?
Sedative-hypnotics (ex. Diazepam) -- AChE inhibitor only indicated when there is good Hx that it is pure anticholinergic
87
What can you give a gardener who has writhing, vomiting, diarrhea, disorientation, and profuse sweating?
Atropine, pralidoxime -- Cholinergic toxidrome SLUDGE
88
Mnemonic for anion gap metabolic acidosis causes?
Methanol Uremia Diabetic ketoacidosis (or alcoholic or starvation) ``` Paraldehyde, phenformin, metformin Iron, INH Lactate (CO, CN, methemoglobinemia) Ethylene Glycol Salicylate ```
89
What can succimer be used for that Dimercaprol/BAL can't be used for?
Cadmium poisoning Both = arsenic, lead, mercury
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