Pharmacology Flashcards
1
Q
Pharmacology is the
A
study of the interactions between the body and drugs
2
Q
Pharmacokinetics is the
A
movement of drugs through the body (absorption, bioavailability, distribution, metabolism and excretion)
3
Q
Pharmacodynamics is the
A
study of the physiologic and biochemical effects of drugs
4
Q
Pharmacogenomics is the
A
study of how a person’s genes affect responses to medications
5
Q
What drug classes are affected by kidney disease?/
A
- NSAIDs: Reduction in blood flow will damage kidneys
- ACEIs: Higher risk of hyperkalemia
- Warfarin: Higher incidence of overcoagulation
- Lithium: Increases risk of kidney injury
- Contrast dyes: can injure kidneys
- K+ sparring diuretics: Increased risk of hyperkalemia
- Bowel prep (oral sodium phosphate) may result in sudden loss of kidney function
6
Q
What drug classes are potent inhibitors of the CYP450 system
A
- Macrolides (erythromycin, clarithromycin)
- Antifungals (ketoconazole, fluconazole, phenytoin)
- Cimetidine (Tagamet)
- Citalopram (Celexa)
- Protease inhibitors (saquinavir, indinavir, nelfinavir)
- Grapefruit juice
7
Q
What drugs are affected by grapefruit juice
A
- statins
- erythromycin
- CCB
- Antivirals
- Amiodarone
- Benzodiaepines
- Cisapride
- Carbamazepine
- buspirone
8
Q
What drugs have a narrow therapeutic index and require monitoring of levels
A
- warfarin: monitor INR
- digoxin: monitor dig levels, EKG, lytes
- Theophylline: Monitor blood levels
- Carbamazepine (tegretol) and phenytoin (dilantin): Monitor blood levels
- Levothyroxine: Monitor TSH
- Lithium: Monitor blood levels and TSH
9
Q
What is a safety consideration with H2 antagonists
A
-mental status changes with kidney disease avoid if creatinine clearance is <50mL/min
10
Q
What is a safety issue with proton pump inhibitors
A
increased risk of
- fractures
- pneumonia
- c diff
- hypomagnesium
- B12
- iron malabsorption
- atrophic gastritis
- kidney disease
11
Q
What herbs does warfarin interact with
A
G herbs
- garlic
- ginger
- gingko
- ginseng
also feverfew, green tea, fish oil
12
Q
What is the black box warning for Pioglitazone (Actos)
A
Can exacerbate CHF so do not use if NYHA Class III or IV
13
Q
Aside from HF what other contraindications do you need to consider with Pioglitazone
A
- hx of MI
- hx of stroke
- hx of bladder CA
- T1DM
- Eye or liver problems
14
Q
What are examples of atypical antipsychotics
A
- Risperidone (Risperdal)
- Olanzapine (Zyprexa)
- Quetiapine (Seroquel)
15
Q
What are AE and drug safety considerations for atypical antipsychotics
A
- weight gain
- metabolic syndrome
- T2DM
- monitor weight q3 months
- higher mortality on elderly patients
16
Q
What labs should you consider in patients taking atypical antipsychotics
A
- TSH
- lipids
- blood glucose
- A1C
- Weight
- BMI
17
Q
What is a consideration with bisphosphonates
A
- erosive esophagitis (chest pain with eating, odonophagia, dysphagia; take with 8oz glass of water before breakfast and do not lie down for 30 minutes afterwards
- CI: Active GI disease, esophageal strictures/varices
18
Q
What are safety concerns of stains
A
-don’t mix with grapefruit juice will result in drug induced hepatitis, or rhabdomyolysis
19
Q
What statin has the highest risk for rhabdo
A
-high dose zocor
20
Q
What medication increases risk for c diff diarrhea
A
clindamycin
21
Q
What is an AE with inhaled corticosteroids
A
-adrenal insufficiency (check if sx like hypoglycemia, hypotension, altered mental status, weakness)
22
Q
What is an AE of systemic glucocorticoids
A
- cataracts
- osteoporosis
- skin changes
- emotional lability
- weight gain
- high BP
23
Q
What medications should be avoid in older adults according to the beers criteria
A
Anti-psychotics Rivaroxaban and dabigatra Tramadol Antihistamines Anticholinergics
24
Q
What are life threatening effects of digoxin
A
- severe bradycardia
- heart block
- ventricular tachycardia
- ventricular fibrillation
25
What is a normal potassium level
3.5-5
26
In valvular disease or prosthetic heart valves the only anticoagulant you can use is
aWarfarin
27
In warfarin use the INR will increase __ to ___ days after first dose but full anticoagulation effect takes __ to ___ days
2-3
| 5-7
28
If a patient has a stable INR and has a single out of range INR 0.5 or less below or above therapeutic, advise
to continue current dose and recheck in 1-2 weeks
29
If INR is <5 with no signifcant bleeding you should
-omit 1 dose and or reduce the maintenance dose slightly
30
Beta blockers are contraindicated in
chronic lung disease (COPD, asthma)
| -Do not discontinue because of severe rebound
31
_____ is the SSRI most likely to prolong QT interval
Celexa
32
What are adverse effects of thiazide diuretics
- Hyperglycemia
- Hyperuricemia
- Hyperlipidemia
- Hypokalemia
33
AE of spironolactone include
- gynecomastia
| - hyperkalemia
34
People with both hypertension and osteoporosis receive extra benefit from this class of medication
Thiazides
35
Patients with sulfa allergies should avoid what diuretics
thiazide and loop
36
Adverse effects of ACEi and ARBS
- Hypotension
- Hyperkalemia
- Angioedema
- AKI
in ACEi only ACEi cough
37
What are adverse effects of CCBs
- hypotension
- bradycardia
- heartblock
- headache
- Reflex tachycardia
38
What medication is 1st line for raynauds
CCBs
39
What are adverse effects of beta blockers
- bronchospams
- bradycardia
- depression
- fatigue
- erectile dysfunction
- blunts the hypoglycemic response
40
What are adverse effects of alpha blockers
- Orthostatic hypotension
- dizziness, syncope
- priapism
41
Tetracycline antibiotics are affective again gram ____ as well as
positive and negative and atypical bacteria/pathogens
42
What are examples of Tetracyclines
- Doxycycline
- Minocycline
- Tetracycline
43
What are the adverse effects of tetracyclines
- CI: in pregnancy or lactation, risk of neural tube defects, cleft palate, skeletal defects
- teeth discoloration (can use after 8 years old)
44
Doxycycline is indicated in the treatement of
- STIs
- Resp tract infect
- anthrax
- RMSF
- ophthalmic infections
- skin
- malaria prophylaxis
- specific bacterial infection
45
Minocycline is indicated in
- Acne
- STIs
- infective endocarditis
46
What are the adverse effects of tetracyclines
- photosensitivity reactions
- esophageal irritation
- Pseudotumor cerebri
47
Macrolides cover what pathogens
gram positive
| atypical bacteria
48
What are examples of macrolides and are the CYP34A inhibitors?
- erythromycin
- Clarithromycin
- Azithromycin
*Only erythromycin and Clarithromycin are CYP34A inhibitors
49
What are adverse effects of macrolides
- GI distress
- Hepatotoxicity
- QT prolongation
- May exacerbate myasthemia Gravis
50
Rocephin (Ceftriaxone) 250mg IM is 1st line for
gonorrheal infections
51
First generation cephalosporins work agains
-gram +
52
What are adverse effects of cephalosporins
- hypersensitivity reactions
- C Diff
- Leukopenia
- Thrombocytopenia
53
3rd generation cephalosporins are indicated in
- meningitis
- genitourinary tract infections
- CAP
- Bone and joint infections
- skin and soft tissue infections
54
Example of a 1st generation cephalosporin
Keflex or Cephalexin
55
What are adverse effects of penicillins
- diarrhea
- C diff
- vaginitis
- Steven Johnson syndrome
56
You should avoid ____ in patients with concurrent mono because
amoxicillin; produces a morbilliform rash
| macular or maculopapular lesion
57
Gram-Positive Bugs
- Staph
- Strep
- Enterococcus
Plus listeria, diptheria, clostridium, bacillus anthracis. p. acne,
Everything else is gram negative
58
What medications are beta-lactams
- penicillins
| - cephalosporins
59
Never give a cephalosporin if the pt had the following reactions to penicillins
- PCN reaction was anaphylaxis
| - if PCN reaction was Hives
60
You can give a cephalosporin if the patient had penicillin and had a
morbiliform rash
61
Morbiliform rashes occur with
- Sulfa drugs and HIV
| - Pencillins and Mono
62
Penicillins are used to treat
- Gram + (not staph)
- Strep A, B, C, G
- Enterococcus
- Strep pneuo
- SRSP
- Botulism (wound)
63
Amoxicllin/Clavulanic acid is used to treat
- gram positive
- Gram negatives
- Beta lactamase (not MRSA)
- strep
- enterococcus
- strep pneumo
- DRSP
- H influenza
- M catarrhalis
- E coli
- Neisseria
- Diptheria
64
You assume a bug produces beta-lactamase if the patient has had
antibiotics in last 3 months
65
Sulfonamides are used for
Gram negatives and MRSA
| *now have high resistance for E. Coli
66
Tetracyclines are used for
Gram negatives, atypicals, MRSA
- Minocycline is a good choice for MSSA and CA-MRSA
- Doxycycline good for atypical pathogens and lower resp tract pathogens
67
1st generation cephalosporins are used to treat
Staph: MSSA
| Strep
68
2nd generation cephalosporins are used to treat
- gram + (staph, strep)
- gram negatives
H.Flu
E.coli
Proteus mirabillis
*Not beta lactamase
69
3rd generation cephalosporin are used to treat
Strep groups, gram negatives, Beta-lactamase, H. flu, M. cat, E. coli, Klebsiella, shigella
70
Extended spectrum 3rd generation are used to treat
-gram +, gram -, beta lactamase
71
What do macrolide treat
-atypical pathogens
72
Ciprofloxacin is used to kill
Gram negatives and atypical pathogen (3rd choice)
73
Respiratory quinolones is used to treat
-gram positive, negative (above the belt), atypical pathogens, DRSP, aerobes, anaerobes
74
Nitrofurantoin treats
urinary pathogens
75
Flagyl is used to treat
- anaerobes
| - clostridium
76
Clindamycin is used to treat
-gram +, aerobes, anaerobes
77
Vancomycin is used to treat
-gram +, anaerobes
78
Fluoroquinolones are effective agains
Gram negative and atypical bacteria
4th gen (levo, moxi) have great gram + coverage
79
What is the black box warning for quinolones
Achilles tendon ruputre
80
What are CI of quinolones
- Children (<18)
- Myasthenia gravis
- Pregnancy
- Breastfeeding
- Hx of CVD, aneurysms and hypertension
81
What are adverse effects of quinolones
- hypoglycemia
- CNS effects
- QT prolongation
- Peripheral neuropathy
- Phototoxicity
- Double vision
- Tendinopathy
- Hepatotoxicity
