Pharm part 4

Question 1

Common indications of H2 blockers

Answer 1

Short-term tx of active duodenal ulcer, GERD, erosive esophagitis, gastritis

Question 2

MOA of H2 blockers

Answer 2

Competitively and reversibly inhibits histamine at H2 receptors on gastric cells

Question 3

Common AEs of H2 blockers

Answer 3

Abd pain
Constipation
Diarrhea
HA

Question 4

Clinically sig drug interactions of H2 blockers

Answer 4

May decrease warfarin clearance

Question 5

Major counseling points of H2 blockers

Answer 5

May be taken with food if GI upset occurs

Prolonged tx greater than or equal to 2 yrs may lead to vitamin B12 malabsorption

Question 6

Monitoring parameters of H2 blockers

Answer 6

Improvement in GI S/sx

Question 7

Common indications for alpha blockers

Answer 7

HTN

BPH

Question 8

MOA of alpha blockers

Answer 8

HTN: Competitively inhibits postsynaptic alpha-adrenergic receptors which results in vasodilation of veins and arterioles and a decrease in total peripheral resistance and blood pressure
BPH: Competitively inhibits postsynaptic alpha-adrenergic receptors in prostatic stromal and bladder neck tissues. This reduces the sympathetic tone-induced urethral stricture causing BPH sx

Question 9

Common AEs of alpha blockers

Answer 9

Dizziness
Fatigue
Orthostatic hypotension
HA

Question 10

Renal or hepatic dose adjustments for alpha blockers

Answer 10

Use with caution in mild-to-moderate hepatic dysfunction

Do not use with severe impairment

Question 11

Clinically sig drug interactions with alpha blockers

Answer 11

PDE-5 inhibitors

Question 12

Monitoring parameters of alpha blockers

Answer 12

Decrease in BP

Urinary retention

Question 13

Common indications of duloxetine

Answer 13

MDD
Neuropathic pain associated with diabetic peripheral neuropathy
GAD

Question 14

MOA of duloxetine

Answer 14

Inhibits neuronal reuptake of serotonin and norepinephrine primarily, and dopamine to a slight extent

Question 15

Common AEs of duloxetine

Answer 15

Nausea
Dry mouth
Constipation
Insomnia
Dizziness

Question 16

Renal or hepatic dose adjustments of duloxetine

Answer 16

CrCl <30: use not recommended
Mild-mod renal impairment use low dosing
Not recommended in hepatic impairment

Question 17

BBW for duloxetine

Answer 17

Antidepressants increase risk of suicidal thinking and behavior in children, adolescents, and young adults with MDD and other psychiatric d/os

Question 18

Clinically significant drug interactions of duloxetine

Answer 18

CI-ed with MAOIs, inhibitors of CYP1A2 and CYP2DC increase levels of duloxetine. Chronic use of NSAIDs increases risk of GI bleeds.

Question 19

Major counseling points of duloxetine

Answer 19

Pay close attention to mood or behavioral changes- this drug may increase suicidal thoughts or actions.
Benefits may not be seen before 2 wks of continued drug therapy;
May cause drowsiness; Avoid alcohol while taking this medication
Do not abruptly d/c
Store in a cool, dry place…
If a dose is missed, skip it and return to nl dosing schedule

Question 20

Monitoring parameters of duloxetine

Answer 20

Improvement in S/sx of anxiety/depression/pain

Abrupt changes in mood

Question 21

Common indications for risperidone

Answer 21

Bipolar mania
Bipolar I maintenance
Shizophrenia
PTSD
Tourette's syndrome
Agitation

Question 22

MOA of risperidone

Answer 22

Dopamine and serotonin antagonism

Question 23

Common AEs of risperidone

Answer 23

EPS
Tachycardia
Priapism
Rash
Somnolence
Agitation/anxiety

Question 24

Renal or hepatic dose adjustments for risperidone

Answer 24

Recommended

Question 25

BBW for risperidone

Answer 25

Increased mortality in elderly pts with dementia-related psychosis

Question 26

Clinically significant drug interactions of risperidone

Answer 26

Fluoxetine, carbamazepine, and clozapine may increase risperidone

Question 27

Major counseling points of ripseridone

Answer 27

May cause fainting during initial doses, May impair judgement Avoid EtOH Avoid excessive exposure to sunlight and heat during therapy

Question 28

Monitoring parameters of risperidone

Answer 28

Decrease of S/sx of bipolar, schizophrenia, PTSD and Tourette's syndrome

Question 29

Common indications for bupropion

Answer 29

Depression Anxiety Aid in smoking cessation

Question 30

MOA of bupropion

Answer 30

Weak inhibitor of neuronal uptake or norepinephrine, serotonin, and dopamine

Question 31

Common AEs of bupropion

Answer 31

Tremor Wt loss Insomnia

Question 32

Renal or hepatic dose adjustments of bupropion

Answer 32

Hepatic/renal: consider reducing dose and frequency

Question 33

BBW for bupropion

Answer 33

Suicidality

Question 34

Clinically sig drug interactions of bupropion

Answer 34

EtOH may lower seizure threshold Toxicity is increased by monoamine oxidase inhibitors Chronic use with NSAIDs increases risk of GI bleeds

Question 35

Major counseling points of bupropion`

Answer 35

Swallow XL and SR tabs whole Avoid EtOH Wt loss or gain may be temporary May need up to 2 wks to show noticeable improvement Pay attention to sudden mood/thought change Do not abruptly d/c

Question 36

Monitoring parameters for bupropion

Answer 36

Improvement in mood/smoking frequency | Unusual changes in behavior/suicidality

Question 37

Common indications for diazepam

Answer 37

``` Acute EtOH withdrawal Anticonvulsant Anxiety Muscle spasm Sedation Status epilepticus ```

Question 38

MOA of diazepam

Answer 38

Enhances the inhibitory effect of GABA

Question 39

Common AEs of diazepam

Answer 39

``` Drowsiness Ataxia Fatigue Sedation Cognitive impairment ```

Question 40

Renal or hepatic dose adjustments for diazepam

Answer 40

Daily 50% reduction of dose for cirrhosis pts

Question 41

Clinically sig drug interactions with diazepam

Answer 41

Additive effect with other CNS depressants Cimetidine delays clearance Grapefruit juice may increase plasma level

Question 42

Major counseling points of diazepam

Answer 42

May cause drowsiness May be habit forming Avoid EtOH while taking this medication Do not abruptly d/c

Question 43

Monitoring parameters for diazepam

Answer 43

Improvement in S/sx of anxiety Muscle spasticity Seizure control Abuse, misuse

Question 44

Common indications for methylprednisolone

Answer 44

Allergic or inflammatory dz | MS

Question 45

MOA of methylprednisolone

Answer 45

Regulate gene expression subsequent to binding specific intracellular receptors and translocation into the nucleus Modulate carbs, protein, and lipid metabolism and maintenance of fluid and electrolyte homeostasis CV, immunologic, musculoskeletal, endocrine, and neurologic physiology are influenced Decreases inflammation by suppression of PMN leukocytes and reversal of increased capillary permeability

Question 46

Common AEs of methylprednisolone

Answer 46

``` Blurred vision Upset stomach Nausea Vomiting Fluid and electrolyte disturbances Agitation Insomnia Long-term Cushings Osteoporosis ```

Question 47

BBWs for methylprednisolone

Answer 47

Epidural corticosteroid injection may cause neurologic complications

Question 48

Clinically significant drug interactions with methylprednisolone

Answer 48

Anticholinesterase Barbiturates Estrogens Ketoconazole

Question 49

Major counseling points of methylprednisolone

Answer 49

Take with or without food Do not d/c on your own DM pts could see an increase in BG readings

Question 50

Monitoring parameters of methylprednisolone

Answer 50

S/sx of inflammation | BG