Pharmacology Unit 4 - Endocrine Pt. 4 Flashcards
(111 cards)
1
Q
there is some evidence to support efficacy of echinacea in the early treatment of _______________
A
colds
2
Q
Echinacea should be avoided in individuals with _________________
A
immune deficiencies / autoimmune disorders
3
Q
if Echinacea is used > 10-14 days it can lead to
A
immunosuppression & hepatic failure
4
Q
adverse rxn of echinacea when used IV
A
flu like sx
5
Q
adverse rxn of echinacea p.o.?
A
GI upset
rash
6
Q
What are your common botanical supplements?
A
- Echinacea
- Garlic
- Ginkgo
- Ginseng
- Milk Thistle
- St. Johns Wort
- Saw Palmetto
7
Q
if someone is taking a medication that has a disulfiram type reaction, which supplement should be avoided d/t the high alcohol content?
A
Echinacea
8
Q
Garlic can be in the ____________, _____________, or ______________ form
A
dried; powdered; aged
9
Q
uses of Garlic
A
- reduces total cholesterol and total triglycerides
- antiplt
- anti-htn
- cancer prevention
10
Q
what is the biggest concern with a pt taking garlic supplements?
A
bleeding
11
Q
Garlic should be cautioned in pts taking ____________________ meds
A
anticoagulant (warfarin, ASA, ibuprofen)
12
Q
S/e with Garlic Supplements
A
- Nausea
- hypotension
- allergic rxn
- bleeding
- bad breath/body odor
13
Q
Ginko uses
A
- improves PVD
- decreases oxidative stress in CABG pts through scavenging of free radicals
- possible antiplt effects
14
Q
Ginko has been studied for what conditions? however, insufficient evidence to support clinical use at this time
A
- allergic and asthmatic bronchoconstriction
- short term memory in health non-demented adults
- ED
- tinnitus & hearing loss
- macular degeneration
15
Q
There are over ____________ different types of Ginseng, but all are marketed as “Ginseng”
A
30
16
Q
which herbal supplement claims to be an adaptogen?
A
ginseng
17
Q
uses of Ginseng
A
- immune modulation (inc WBC)
- Increases ACh, Serotonin, NE, and Dopa
- antioxidant effects
- anti-inflammatory effects
- vasoregulatory effects
- cardioprotective activity
- improved glucose hemostasis
- anticancer properties
- antiplt meds
18
Q
Ginseng supplementation should be cautioned in what patients?
A
- those taking psych meds
- those taking anticoagulants
- those with immunosuppression/taking immunosuppressants
19
Q
Ginseng + psych meds –>
A
irritiability, sleeplessness, & manic behavior
20
Q
Ginseng has the strongest support for its uses in ?
A
- cold prevention
- lowering post-prandial glucose
- non specific cancer prevention
21
Q
what is milk thistle used for?
A
- liver disease
- chemotherapeutic effects
- lactation
22
Q
in europe, milk thistle is given IV as a treatment for ___________________
A
mushroom poisoning
23
Q
at high doses, > 1500 mg, milk thistle will have a _________________ effect
A
laxative
24
Q
St. Johns Wort is used for
A
depression
25
MOA of St. Johns Wort
inhibits the reuptake of serotonin, NE ,and Dopa --> antidepressant effect
26
s/e of St. Johns Wort
1. high level of photosensitivity
2. hypomania and mania
3. autonomic arousal
27
St. Johns Wort should bed avoided/used cautiously in pts taking _______________ or ________________
antidepressants; stimulants
28
which botanical supplement has been found to induce the CYP450 system?
St. Johns Wort
29
Which meds have been found to be at sub-therapeutic levels when used with St. Johns Wort, due to its CYP450 inducing effects?
1. Digoxin
2. Birth control meds
3. cyclosporine
4. HIV protease and nonnucleoside reverse transcriptase inhibitors
5. Warfarin
6. irinotecan
7. Theophylline
8. Anticonvulsants
30
Saw Palmetto supplements are used in the tx of
BPH
31
____________________ is a botanical supplement which produces similar effects to finasteride and tamulosin
saw palmetto
32
s/e with saw palmetto supplements
1. ABD pain
2. N/D
3. fatigue
4. HA
5. decreased libido
6. rhinitis
7. liver damage
8. pancreatitis
9. increased bleeding
33
purified nutritional supplements are from _________________ or _____________ source, but they are not from ________________
human; non-human; plants
34
what are your purified nutritional supplements?
1. Coenzyme Q10
2. Glucosamine
3. Melatonin
35
Coenzyme Q10 is found where?
in the mitochondria of organs
36
Conenzyme Q10 is used for
1. HTN
2. CHF
3. ischemia - reduces reinfarction after acute MI
4. statin induced myopathy
37
Conenzyme Q10 has little to no s/e in doses of ______________ mg/day
3000
38
s/e with coenzyme Q10
1. N/D
2. Heartburn
3. anorexia
39
Coenzyme Q10's structure is very similar to ________________; therefore, it should NOT be used in patients taking _____________________
vitamin K; warfarin
40
Glucosamine is commercially derived from ______________ & _______________
crabs; crustaceans
41
Glucosamine supplements are used for?
OA
42
which supplement has the potential for cross contamination with shellfish allergies
glucosamine
43
melatonin is used for
1. jet lag
2. insomina
44
melatonin is best used for jet lag when travelling > ___________ time zones
4
45
which supplement will increase heart rate and blood pressure through direct and indirect sympathomimetic effects?
ephedra
46
what are the perioperative concerns with the supplement ephedra?
1. MI
2. stroke
3. ventricular arrhythmias with halothane
4. intraoperative hemodynamic instability
5. life threatening interaction with MAOIs
47
ephedra should be d/c'd at least _______________ before surgery
24 hours
48
Garlic supplements should be D/C'd at least _________________ before surgery
7 days
49
perioperative concerns in pt taking Ginseng supplements
1. hypoglycemia
2. bleeding risk
3. decreased anticoagulation effects of warfarin
50
Ginkgo supplements should be d/c'd ________________ before surgery
36 hours
51
Ginseng should be D/c'd _____________________ before surgery
7 days
52
Kava should be d/c'd at least __________________ before surgery
24 hours
53
St. John's Wort should be d/c'd at least _____________________ before surgery
5 days
54
perioperative concerns with Kava supplementation
1. increases sedative effects of anesthetics
55
perioperative concerns of pt taking valerian supplements
1. potential to increase sedative effects of anesthetics
2. benzodiazepine like acute withdrawal
3. potential to increase anesthetic requirements with long term use
56
anything classified as a ______________________ drug is determined to be a medication about which directions for safe use by the public can be written
over the counter (OTC)
57
T/F: OTC meds are regulated by the FDA
true
58
with OTC meds, there is a approximately 1000 ingredients in a variety of forms and combinations, this increases the risk for what?
drug-drug interactions
59
there are over _______________ systemic pain relievers advertised and available to the public as OTC drugs,
100
60
of large number of OTC pain relievers, most all contain _____________, ______________, _______________ or some combination of these primary ingredients
asprin; acetaminophen; ibuprofen
61
T/F: in general the less expensive generic OTC is equally effective as the propriety product (ex: Tylenol vs walmart brand acetaminophen)
true
62
due to lack of information of generic equivalents of many brand name OTC's, the general public generally chooses which OTC meds?
the ones that are the most heavily advertised
63
what are some examples of drugs that are inappropripriate for consumer self diagnosis and treatment, thus are not available OTC ?
1. statins
2. oral acyclovir
64
what are 2 of the actions the FDA has made to OTC drugs over the past 45 years?
1. ingredients designated as ineffective or unsafe for their claimed therapeutic use are being eliminated from OTC product formulations
2. agents previously only available by prescription are now available for OTC use
65
T/F: there are OTCs available in low dose that are also available in a prescription strenght
true
66
why have classification switches from prescription only to OTC declined significantly over the past decade?
reclassification processes is costly and rigorous
67
FDA 2008 FDA advisory alert on OTC meds?
1. there is limited data on efficacy of OTC cold remedies in children under 12
2. OTC cold and cough agents should not be used in infants and children less than 2 years of age
3. pharmaceutical co. changed labels of cold and cough meds to say "do not use in children under 4"
68
OTC 2008 FDA advisory alert on cold and cough meds for pediatrics included which types of meds?
1. antitussives
2. expectorants
3. decongestants
4. antihistamines
69
T/F: insurance companies will pay for a prescription med even when a similar OTC preparation is available
false; they will not pay for the prescription med
70
Why do providers need to know/be informed of OTC meds?
1. OTC can tx common aliments, and providers can help pts in selecting appropriate med
2. there are inactive ingredients in OTCs that can worsen existing medical conditions, and/or interact with prescription drugs
3. misuse/abuse of OTCs can cause significant medical problems
4. due to pt condition or pt meds it is sometimes important that one OTC is chosen over another
71
what is the OTC med phenylpropanolamine? why was it removed from US shelves?
a sympathomimetic in cold, allergy, and weight control products ; increases the risk of hemorrhagic stroke
72
what common OTC antitussive is abused by adolescents as a hallucinogen by them taking 5-10x the recommended cough suppressing dose
dextromethorphan (found in mucinex DM and robitussin)
73
___________________ is an OTC med that is often combined with acetaminophen, antihistamines, and/or sympathomimetics, and can be fatal when taken at 5-10x the normal dose
dextromethorphan
74
____________________ is a common decongestant found in cold remedies that has been used in the illicit manufacturing of methamphetatmines
pseudoephedrine
75
meds that contain ________________, ______________, or _______________, must be purchased from behind the counter with an ID, and can only be purchased once per month
pseduoephedrine; ephedrine; phenylpropanolamine
76
what is the max dose of acetaminophen that should not be exceeded within 24 hours
4000 mg
77
cumulative dosage of tylenol exceeding 4000mg in 24 hours, plus chronic alcoholism significantly potentiates the risk of acetaminophen toxicity due to the unintentional depletion of ____________________
glutathione
78
OTC recommendation guidelines
1. single ingredient; simplest form preferred
2. select a product that contains a therapeutically effective dose
3. encourage pts to read the drug facts label
4. recommend a generic product if one is available
5. be wary of advertising claims of specific superiority over similar products
6. dose, dosage form, and palatability of med are important things to consider.
79
alcohol (% ethanol) is hidden in what type of OTC drugs
1. cough syrups
2. cold preparations
3. mouthwashes
80
antihistamines are hidden in what type of OTC drugs
1. analgesics
2. menstrual products
3. sleep aids
81
aspirin/salicyclates are often hidden in what OTC drugs
1. anti-diarrheals
2. antacids
3. menstrual products
4. cold/allergy preparations
82
caffeine is often hidden in what OTC drugs
1. analgesics
2. menstrual products
3. stimulants
83
local anesthetics, usually benzocaine; are hidden in what OTC drugs
1. antitussives/lozenges
2. dermatologic preparations
3. hemrrhoidal products
4. toothache/teething products
5. cold sore products
84
sodium is hidden in what OTC drugs
1. analgesics
2. antacids
3. cough/cold preparations
4. laxatives
85
sympathomimetics are hidden in what OTC drugs
1. analgesics
2. asthma products
3. cold/cough remedies
4. allergy preparations
5. hemorrhoidal products
86
sympathomimetic containing agents should be avoided or used cautiously in pts with which conditions?
1. T1DM
2. HTN
3. angina
4. hyperthyroidism
87
________________________ should not be used in children or adolescents for the tx of viral illnesses due to the risk of reyes syndrome
asprin
88
asprin should be avoided in whom?
1. peds
2. PUD
3. Plt disorders
4. pts on anti-coagulants
89
why should NSAIDs be avoided in pts with PUD
it decreases COX1 in the GI tract --> decreased prostaglandins --> decreased protective mucosal layer
90
why should NSAIDs be avoided in pts with plt disorders and those on anti-coagulants
blocks cyclooxygenase (COX) --> block in the formation of Thromboxane A2 --> impaired plt aggregation and increased bleeding time
91
_____________________ is often hidden in OTC drugs, and they may cause sedation/drowsiness especially when taking with other sedating agents, CNS depressants, or alcohol
antihistamines
92
long term use of OTC antacids can cause _____________ and ______________ in the elderly, and possibly __________________
constipation; impaction; hypophosphatemia
93
OTC laxative use/abuse can cause _________________ and ______________
abdominal cramping; fluid and electrolyte imblances
94
caffeine containing analgesics, like excedrin, can result in ____________________ when stopped
rebound HA
95
long term use of analgesics (OTC) can cause ________________________
interstitial nephritis
96
ASA and NSAID containing OTC analgesics can cause __________________ and _______________ in those consuming more than 3 etoh beverages per day
hepatotoxicity; GI hemorrhage
97
in a preop hx, when asking about medications, one should specifically ask about _____________________ because not all patients consider them to be "medications"
non-prescription drugs (OTC)
98
insulin is released at a rate of ______________ microunits/L; but peaks with meals at a rate of _______________ microunits/L
5-15; 60-90
99
MOA of insulin
1. binds to insulin receptor on most tissues
2. increases glucose uptake
3. increases glycogen synthase activity
4. increases glycogen formation
5. enhances DNA synthesis
6. effects on protein synthesis, lipolysis, and lipogenesis
100
which glucocorticoids have NO Nacl retaining activity
long acting glucocorticoids: betamethasone and dexmethasone
101
place the glucocorticoids in order starting with the one that has the greatest anti-inflammatory effects, down to the least anti-inflammatory effects
dexmethasone > betamethasone > fludrocortisone > methylprednisolone > prednisone > hydrocortisone
102
place the glucocorticoids in order starting with the one that has the greatest NaCl retaining activity to the least
fludrocortisone > hydrocortisone > prednisone > methylprednisolone > betamethasone and dexmethasone
103
drug facts label must contain what items (in order)
1. active ingredients (including amount in dosage units)
2. purpose of product (pharmacologic action)
3. uses for the product - indications for use
4. specific warnings to include pregnancy information
5. notice of when the patient should seek medical attn
6. side effect/contraindications
7. dosage instructions
8. inactive ingredients
104
if someone consumes 3+ etoh beverages per day, ASA and NSAID containing analgesics can cause ________________ and/or _______________
GI hemorrhage; hepatotoxicity
105
what is the most comprehensive source for information about OTC drugs
handbook of nonprescription drugs
106
toxicity of ginko will cause
seizures
107
s/e of ginko
1. nausea
2. GI upset
3. HA
4. bleeding
5. allergy
6. anxiety
7. insomnia
8. toxicity = seizure
108
s/e of ginseng with high doses
1. vaginal bleeding/mastalgia
2. insomnia
3. nervousness
4. HTN
109
which herbals cause bleeding
1. garlic
2. ginko
3. ginseng
4. glucosamine
110
which herbal should a patient taking warfarin be educated to avoid due to it being similar in structure to vitamin K thus will cause sub-therapeutic levels?
coenzyme Q10
111
perioperatively blood pressure is low 2ndary to pt taking ephedra, how should you treat it?
with direct vasoconstrictor like phenylephrine
