Pharm quiz 2 Flashcards Preview

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Flashcards in Pharm quiz 2 Deck (129):
1

thyroid replacement contraindications

after acute MI, thyrotoxicosis

2

T3 vs. T4

both are iodine-contiaining derivatives of aa tyrosine

T3-much less produced but less protein bound and much more active

T4- much more produced, becomes T3 in tissues for activity; very protein bound, must measure free T4

3

inhibiting mechanism for coagulation cascade 

antithrombin III (ATIII)

4

mimic endorphins

opiates

5

cholinergic medication considerations (3)

1. don't stop abruptly

2. spread doses evenly, short half life

3. beware of OD, can be lethal

6

pt on antipsychotics experienceing galactorrhea--must rule out

pituitary tumor; get pituitary MRI

7

DPP4 Inhibitors-action and what to watch

is like a PO GLP-1 inh (enzyme inactivates GLP-1 so this inhibits that enzyme); increases incretin hormone level

"gliptins", Januvia

 

Caution in renal impairment, watch for pancreatitis

8

what to watch with ADHD Stimulant meds

methylphenidate (Ritalin) and 

Amphetamines (Concerta, Adderall)

arrhythmias, tachycardia *get baseline EKG if any question of cardiac history

Hx sudden deaths

anxiety, weight loss, abuse, growth supression

9

Advantages (2) and Disadvantages (3) of metformin

rare hypoglycemia

wt loss, better lipid profile

 

GI side effects (often wane after a few weeks)

CI in renal insufficiency (Cr > 1.5)

can cause lactic acidosis

 

 

10

Foods to avoid with MAOIs

Tyramine-containing foods

anything fermented, aged cheeses, wine, chocolate

11

sulfonylureas-mechanism

2nd gen: glipizide, glyburide

Stimulate beta cells to release insulin

*effective monotherapy in lean pts/newer Dx bc they can still produce enough insulin

once beta cells are fatigues this isn't as effective

12

AEs of MAOIs

The three Hs:

1. hepatocellular jaundince

2. hyperthermia

3. hypertension

13

aspirin action and indications

binds COX enzyme on platelets and inhibits for life of plt, unable to produce thromboxane 2--can't clot

stroke prevention, even better if used with plavix

14

lithium AEs

GI distress: anorexia, n/v/d

ADH antagonism->polyuria/polydipsia--->can cause renal fibrosis .    *worry about kidneys with lithium

hair loss, acne, thyroid abn

CNS- reduced seizure threshold, slow cognition, intention tremor

15

baseline labs before starting lithium

BMP-creatinine, GFR

TSH

CBC  (causes nonsignificant leukocytosis)

HCG- Pregnancy Category X

16

can count on these AEs with 2nd gen antipsychotics

stronger antiserotonergic effects--

weight gain

increased blood glucose

hyperlipidemia

17

phenobarbital-mechanism and effects

enhances GABA

sedating and addictive, multiple other AEs

18

major reason for lack of adherence with SSRIs

sexual dysfunction

19

this toxin is a nicotinic antagonist

botulinum toxin

20

danger with gabapentin, what to monitor for

depression, suicidal ideation

21

hydantoins (2)

antiseizure meds

phenytoin (Dilantin)

fosphenytoin (Cerebryx)

22

last ditch antipsychotic clozapine can cause

fatal agranulocytosis--freq monitoring of CBC

many other AEs

23

tricyclic AEs

anticholinergic AEs (block M1)

oHoTN (block alpha 1)

sedation (histaminergic)

weight gain

decreased libido

cardiac arrhythmia (block Na channels) -->

cardiotoxicity

 

24

enzyme that converts fibrinogen (loose, soft clot) to fibrin

thrombin

25

GLP-1 agonist-action and advantages/dis

mimic incretin GLP-1 (stimulates insulin and suppreses glucagon when glucose is high in GI tract)

Adv:  no inc CV risk, and less risk of hoGly than SUs

Dis: injectible only; pancreatitis, endocrine tumor risk

26

propanolol mechanism and indications

nonselective (beta 1 and beta 2) blocker

HTN (poor for this)

arrhythmias, angina

migraine

stage fright/performance anxiety

 

27

increase insulin sensitivity in muscle and fat cells and liver by regulating gene expression

TZDs (Actos, Avandia)

 

many dangerous AEs: HF, liver, bladder ca

28

how to switch antidepressants

b/t SSRIs-just switch

one med class to another-taper first med over two weeks, then start low and taper next med up

some meds need washout period (MAOIs)

29

s/s serotonin syndrome

akathasia (movement disorders)

AMS 

tremors, muscle hypertonicity

hyperthermia

 

30

Myasthnia gravis treatment med

AChEI

pyridostigmine

31

goal of Alzheimer's treatment

to increase activity of ACh (opposite of Parkinson's)

treated with cholinesterase inhibitors (rivastigmine, donepezil-CNS specific AChEI)

32

T/F norepi is cholinergic

FALSE

norepi does not affect the PNS

33

first line partial and absence seizures, fairly sage

lamotrigine (Lamictal)

34

bisphosponates AEs

GI, eso ulcers, pathological Fx

caution with renal, liver, heart disease, GI problems

35

benzodiazepine withdrawal s/s

anxiety, insomnia

---> convulsions, death

36

atypical antidepressant-SSRI and 5HT1 agonist (mimics serotonin)

vortioxetine (Trintellix)

37

SU lite

tissue selective secreation of insulin

take with meals, good at reducting postprandial BG

meglitinides (Prandin, Starlix)

**Do not give with an SU!

 

38

inducer for intrinsic and extrinsic pathways

intrinsic induced by blood vessel injury

extrinsic induced by tissue injury

39

with antiseizure meds you need to monitor drug levels, even without dosage changes, because

many use the CYP 450 pathway and can have increased plasma levels (inducers)

40

metoprolol mechanism and indications

 selective beta 1 blocker

HTN

41

second line for anxiety

buspirone

no QTc prolongation--can use for cardiac pts when want to avoid SSRI

minimal abuse potential

1-2 weeks for effect

42

sulfonylureas-considerations (5)

1. risk of hypoglycemia, esp with EtOH/illness

2. fatigues beta cells over time

3. assoc with inc CV disease and mortality

4. Cross allergy with sulfa drugs (Bactrim, thiazides)

5. teratogenic (not glyburide)

43

first line mood stabilizer in bipolar disorder

mechanism

lithium

pre synapse-enables more serotonin to be released

post synapse- enables cells to take up serotonin

44

apixaban (Eliquis)

 direct Xa inhibitor; Better outcomes than warfarin, can renally dose, fast onset (hours); no antidote, $$, AEs unknown-new

45

two common and dangerous AEs of antiseizure meds

Cardiac effects and skin reactions

46

1st line therapy DM

mechanism

metformin (Glucophage)

inhibits glucose production by the liver, decreases absorption of glucose by GI tract, and increases insulin sensitivity

47

1st line med for partial and generalized seizures (block Na movement) but not myoclonic; 2 black box warnings, and what you must monitor (2)

carbamazepine (Tegretol)

1. Serious Derm reactions (asians at inc risk--polymorphism)

2. aplastic anemia

1. CBC

2. drug levels-CYP 450 inducer

48

preterm labor can be slowed bu use of this beta 2 agonist

terbutaline-relaxes smooth muscle in uteral, GI, bladder, and bronchioles

uterus has smooth muscle with Beta 2 receptors not no ACh receptors

 

AEs: tachycardia, anxiety

49

tolerance vs. dependence

tolerance-you need to take more of the drug to get the same effect

 

dependence--physiological state in which you need to take the drug to prevent withdrawal

50

levothyroxine directions/education

take with full glass of water at same time each day, preferably 1 hour before breakfast, 3 hrs after last meal

teach how to measure HR

don't stop taking if feel better

 

 

51

serotonin syndrome results from

toxic increase in serotonin often caused by taking two meds that increase serotonin at the same time (ex SSRIs and MAOIs)

52

dopamine is used as adrenergic agonist-mechanism and used in treatment of 

alpha and beta agonist

low BP:

hypovolemia

cardiogenic shock

53

failing to taper SSRIs when discontinuing can cause

"withdrawal" of flu-like and/or GI symptoms

 

Taper over 2 weeks

54

of the multiple AEs with hydantoins, these are the most concerning...(1)

and these should also be watched for...(3)

Cardiac (bradycardia, heart block)

 

skin rashes

gingival hyperplasia

CNS-nystagmus, cognitive slowing, lethargy

55

adjunct seizure and neuropathic pain med without risk of SI; blocks Ca++ in CNS and blocks glutamate release

pregabalin (Lyrica)

56

atypical antidepressants, no effect on serotonin 

less weight gain and  sexual AEs, no effect on serotonin

NDRIs

Wellbutrin

Zyban-smoking cessation

not good with comorbid anxiety

57

indirect cholinergic agonists

AChEIs

58

two cholinergic agonists used to treat glaucoma

pilocarpine (muscarinic agonist)

carbachol (nicotinic agonist)

59

urinary retention is treated with

cholinergics

bethanechol-relaxes urinary sphincter and causes bladder contraction

60

MAOIs

meds than inhibit MAO enzymes that break down neurotransmitters

Isoniazid

phenelzine (Nardil) 

selegiline

rasagiline 

61

irreversible ACh inhibition is caused by these toxins

Sarin

Malathion

causes muscle weakness --> respiratory depression --> death

62

how to beta one antagonists cause exercise intolerance ?

 

what other complication can they cause?

can't inc HR and CO to meet demands

 

can also mask s/s of hypoglycemia--pt won't know

63

third line anxiety med

benzodiazepines-mimic GABA

okay short term, avoid long term

can cause daytime sedation

high abuse potential

choose based on onset and duration of action

64

why use an SNRI instead of an SSRI

 to treat more cognitive slowing and dec concentration

actually have a few more AEs than SSRIs

65

alpha-glucosidase inhibitors-action and considerations

inhibits enzyme that breaks down starches; minimizes postprandial BG

take with meal; do not use dissacharides for hypoglycemia, monitor liver function

66

three types of mood stabilizers

1. lithium

2. anticonvulsants

3. antipsychotics

67

AE cholinergics and anticholinergics have in common

erectile disfunction

PNS causes erection (pleasure)

SNS causes ejaculation (survival)

68

if hyperlipidemia exists with hypothyroidism

treat thyroid first; dec thyroid activity will cause inc lipids

69

First line in all seizure types, thought to increase GABA effects

valproic acid

70

with an alpha 1 blocker like doxazosin, what education does the patient need?

rise from supine position slowly (compensatory mechanisms used in position change are inhibited)

71

first line for anxiety

antidepressants

(takes weeks for effect, can use benzo short term)

72

First line in partial and generalized seizures, blocks Na movement

hydantoins

73

first line for absence seizures, a little safer than valproic acid but still many AEs, ex. SLE

ethosuximide (Zarontin)

74

cholinergic crisis antidote

atropine 

muscarinic antagonist

also used for bradycardia

75

how long to use antidpressents before you see effects

4-6 weeks

76

dobutamine-mechanism and indication

beta one agonist

cardiac stimulation in cardiogenic shock

77

advantages of LMW heparins (Fragmin, Lovenox) over unfractionated

more predictibe pharmokinetics, less monitoring needed, lower incidence of HIT

Monitor with renal/hepatic disease

78

doxazosin and silodosin- mechanism and indication

alpha one blockers-vasodilators

last ditch treatment for HTN

BPH-relaxes smooth muscles to decrease size of prostate

79

SGLT-2 Inhibitors-action

Pros and Cons

sodium glucose transport inhibitors (Invokana)

increase excretion of glucose in urine by inhibiting resorption

Better reduction in HgA1C than others

lower CV mortality, BP, low risk of HoGly

Cons: UTIs/pyelo, candida, need good renal function

80

antipsychotic AEs Summary (6)

1. EPS, tardive dyskinesia can be permanent

2. hyperprolactinemia (dec inh of prolactin) gynecomastia, galactorrhea, *osteoporosis

3. Sexual dysfunction, priapism

4. Cardiac arrhythmia, prol QTc-->torsades; sudden cardia death risk inc 2x

5. Seizures-all lower threshold

6. Metabolic syndrome-weight gain, bad glycemic control, hyperlipidemia

81

aspirin AEs

GI bleed/ulcer

bronchospasm

renal damage

reye's syndrome

dangerous OD

82

2nd line seizures and commonly used for status epilepticus, febrile seizures

phenobarbital

83

donepezil and rivastigmine are used in AD treatment because

they are cholinergic (AChEIs)

increase ACh in brain which supports memory

affects are temporary and take six weeks for effect

84

albuterol mecahnism and indications

beta 2 agonist-cause bronchodilation in asthma, allergy

AE: tachycardia

85

MAOS Alzheimer's adjunct

selegiline

also used for smoking cessation, ADHD

86

muscarinic antagonists have a similar effect as

beta agonists

87

anti-thyroid meds

block incorporation of iodine into hormone

methimazole, PTU

*do not miss dose, don't make up if you do; teach hypothyroid symptoms, reduce dietary iodine

 

88

adrenergic agonists that are not broken down by MAOx, can be taken PO and are nonpolar-cross BBB

non-catecholamines

89

rivoraxaban (Xarelto)

action and considerations

direct factor Xa inhibitor-prevents conversion of prothrombin to thrombin

similar to warfarin in effects, less ICH

fast onset (2-4h) and can renally dose

no antidote, $$, unknown AEs-new

90

intrinsic and extrinsic pathways both lead to 

activated factor X= Xa

converts prothrombin to thrombin

(the common pathway from then on)

91

use this in valvular AFib

warfarin

Do not use dabigatran (Pradaxa)

92

black box warning on many antidepressants

4% inc risk of SI <25 years old

93

Pt education-bisphosphonates

take with full glass of water in am

remain upright for 30 minutes after dose

good dietary Ca and Vit D

avoid use with antacids, EtOH

94

1st gen antipsychotics vs 2nd

mechanism of both and AEs

1st gen treats positive but not negative symptoms, 2nd treats both; less AEs with 2nd, varies

Block dopamine receptors-->cause extrapyrimidal side effects

parkisonian syndrome, tardive dyskinesia, neuroleptic malignant syndrome (can start any time during treatment)

 

 

95

mimic GABA

benzodiazepines

96

antiplatelet agents, can use with ASA in ACS and post MI but not preventative for stroke

clopidrogel (Plavix)

ticlodipine (Ticlid)

block platelet activation

97

warfarin-action and indications

antagonizes vitamin K

PO

prophylaxis/Tx of DVT, PE, Afib clot, post MI, hypercoagubility disorders

98

long term use of levothyroxine associated with 

dec bone density in hip/spine in post-menopausal women--monitor

99

common AEs SSRIs

sexual dysfunction (dec libido)

weight gain

insomnia/sedation

GI effects

prolonged QTc

100

bladder spasms are due to overactive PNS activity so treat with

anticholinergics

101

adjunct antiseizure med often also commonly used for neuropathic pain; mimics GABA

gabapentin (Neurontin)--

works like a benzo without the addiction risk

102

AChEIs used to treat MG

edrophonium- short acting, used for Dx

neostigmine and physostigmine (also used for AD and delayed gastric emptying)

103

succinylcholine mechanism for skeletal muscle paralysis

anticholinergic

nicotinic antagonist

104

warfarin-considerations

highly protein bound

metabolized in liver using CYP450 pathway

many drug interactions (any broad spectrum abx can dec absorption)

AEs: bleeding; teratogenic; warfarin-induced skin necrosis

Food interations: inh by Vit K and EtOH

and herbal interactions

 

105

mechanism of action of ipratropium (Atrovent) and tiotropium (Spiriva)

anticholinergic muscarinic antagonists that block PNS bronchoconstriction

 

1st line for COPD

106

if you need cardiac stimulation with vasoconstriction, use ...

if you don't need vasoconstriction, use ...

dopamine

 

dobutamine

107

considerations-metformin (3)

1. decrease/hold in dehydration

2. hold 48 hrs before and after radiocontrast

3. discourage EtOH

108

...is the precursor of norepi

norepi is the precursor of ...

dopamine

epinephrine

109

dangers

opiates vs. benzos

opiate withdrawal is not fatal, benzo withdrawal can be 

easier to OK with opiates, need 2nd depressant to OK with benzos.

110

adrenergic agonists that are destroyed by MAO; can't take PO, don't cross BBB

catecholamines (epi and norepi)

111

anticholinergic used for bowel spasm treatment to relax smooth muscle and dec GI motility

dicyclomine

112

better than warfarin in prevention of CVAs with reduced risk of bleeding; pros and cons

direct thrombin inhibitors (pradaxa)

Pros: no lab monitoring, no drug/food interactions

Cons: no antidote, $$

113

atypical antidepressants given for sleep

mirtazapine (Remeron)

trazadone (Desryel)

114

prazosin, mechanism and indications

alpha one antagonist/blocker

antihypertensive

115

goal of Parkinson's disease treatment

increase effect of dopamine

dopamine agonists (Ex Requip) + Levodopa/Carbidopa

116

cholinergic medications that inhibit ACh breakdown

Acetylcholinesterase inhibitors (AChEIs)

117

baseline labs before starting metformin and to monitor during use

CMP (renal and hepatic function)

HgA1C

118

INR management

therapeutic 2-3

<8 no significant bleeding: hold dose(s) until <5 then resume doses

>8 no bleeding; hold until <5, maybe hospitalize

Any inc INR with serious bleeding-->hospitalize

119

MAOI used for Parkinson's treatment

rasagiline (Azilect)

120

121

this med (type/name) is used to constrict the pupil in glaucoma treatment

cholinergic

carbachol

122

do not use propanolol in patients with 

asthma, COPD

nonselective--will block beta 2

123

phenylephrine-mechanism and indications

alpha one agonist--vasoconstrictor

decongestant and hypotension 

124

heparin action

increase the action of antithrombin III up to 1000x

inc inh of Xa on factor II-dec formation of fibrin

125

benzodiazepine reversal agent

flumazenil

126

heparin indications and AEs

immediate anticoagulation in which quick reversal may be needed-DVT, PE, ACS, can be used in pregnancy

 

AEs: bleeding, HIT, osteoporosis long term high dose use

 

*requires regular monitoring of aPTT

127

why are beta blockers useful in patients post MI?

decrease myocardial oxygen consumption and cardiac workload

128

muscarinic antagonist used to treat parkinson's dyskinesia

benztropine

129

what type of med is contraindicated in a patient with bowel obstruction

an anticholinergic medication like hyoscimine