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plz learn this Flashcards

1
Q

zofran dose

adults
kids

A

adults: 4-8 mg Iv over 2 minutes ->HA
kids: 0.05 to 0.15 mg/kg IV - careful

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2
Q

reglan dose

A

10-20 mg over 3-5 min -> abd cramping

peds T&A: 0.15 mg/kg slowly/ after

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3
Q

CV effects of reglan

A

increase HR
decrease BP

c/I with pheochromocytoma

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4
Q

omeprazole is given as a

A

pro-drug is protonated to active form

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5
Q

MOA of omeprazole

A

irreversibly inhibits H/K pump in gastric parietal cells, decreasing secretion of gastric acid and H+.
decreases gastric acid volume, increases gastric acid ph

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6
Q

bicitra is C/I in

A

pts taking aluminum salt ant acids
severe renal impairment
low sodium diet

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7
Q

antacids can result in increased rate of absorption of

A

salicylates
indomethacin.
naproxen

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8
Q

antacids with acid rebound

A

Na bicarb

calcium carbonate

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9
Q

H1 receptors are located at

A

bronchial smooth muscle (bronchoconstriction)
GI smooth muscle (Constriction)
vascular smooth muscle - (VASODILATION)
vascular endothelial cells (edema/permeability)
peripheral nerve endings - itching
Heart! AV node - SLOWS

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10
Q

H2 receptors are located at

A

proton pumps of gastric parietal cells - increase acid
heart -positive inotoropic and chronotropic effect
airway - bronchodilator

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11
Q

CV Side Effects of Benadryl

A

tachycardia

hypotension

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12
Q

Benadryl is C/I in

A

acute asthma?
CV disease r/t hypotension and tachycardia
increase IOP! (ach antagonism - mydriasis)

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13
Q

MOA H2 receptor antagonists:

A

block H2 receptor effects in gastric parietal cells, decrease cAMP, decrease H+ secretion, decrease gastric acid secretion.

does not change volume or pH of what is already in stomach.

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14
Q

least potent H2 antagonist

A

cimetidine

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15
Q

dose of cimetidine

A

300 mg IV over 15-30 minutes 1-2 hrs pre-op

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16
Q

cimetidine C/I in

A

asthma
caution in renal failure (excreted 75%)
caution in liver failure (transient increase in LFTs)

**INHIBITS CYP450
prolonged effect of WARFARIN, DIAZPEAM, LIDOCAINE, PROPANOLOL, MOPRHINE, CCB, TCAs, phenytoin

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17
Q

most potent H2 receptor antagonist

A

famotidine

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18
Q

dose of ranitidine

A

50 mg IV over 15-30 minutes, 1-2 hrs pre-op
give slowly.

50% excreted unchanged.
pulled r/t Ca risk

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19
Q

dose of famotidine

A

50 mg IV over 2 minutes, can give faster.

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20
Q

SE of H2 receptor antagonists

A

delayed awakening from anesthesia
decrease HBF, transient increase in LFTs,
HA, fatigue, dizziness, confusion
arrthymias
rapid administration - hypotension, bradycardia

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21
Q 
Dicyclomine - class 
uses:
A

dicyclomine is an anti-cholinergic,
used to decrease gastric acid secretion.

It has a poor therapeutic window, many interactions and is LESS effective than H2 antagonists and PPis

SE: Dry mouth, constipation, blurred vision, cardiac arrthymias , urinary retention

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22
Q

famotidine PK
onset:
DOA

A

famotidine
onset- 30 minutes (others are 1 hour)
DOA: 8 hours (others are 4 hours)

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23
Q

Sucralafate!

A

is a barrier drug

coats the gastric lining of the stomach to prevent further ulceration

does NOT change pH

SE
constipation, flatulence, little systemic absorption, drug interactions via binding to drugs

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24
Q

Colloidal Bismuth?

A

also a barrier drug.

stimulation of mucosal bicarbonate and PGE2, inhibits h. pylori growth, protects stomach from further ulceration.

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25
Q

Misoprostol

A

is a prostaglandin analogue.

give to pts on NSAIDs to prevent NSAID induced ulcers

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26
Q

Aprepitant (Emend?)

A

Substance P antagonist.

little to not affinity for serotonin, d dopamine, corticosteroid receptors.

very effective!
used in oncology and often with agents

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27
Q

Scopalamine dose

A

5 mcg/hr for 72 hr patch.

usually must be put-on 4 hours in advance for best results

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28
Q

scopolamine is C/I in

A

glaucoma, MG, tachycardia r/t CV issues
GI/GU obstruction
paralytic ileus

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29
Q

scopolamine decreases

A

effects of acetaminophen and levodopa

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30
Q

stats on statins

HDL/LDL/TG

A

statins:
decrease LDL: 20-60%
increase HDL: 10%
decrease TG: 10-20%

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31
Q

Niacin + statin =

A

increased r/f myopathy

increased r/f hepatotoxicity

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32
Q

Gemfibrozil + statin =

A

increased r/f myopathy
increased r/f hepatoxicity
also! DECREASED TG

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33
Q

increased r/f myopathy with statins:

A 
preexisting muscle condition 
>80 y/o
female 
asian 
smaller body frame 
hypothyroid 
impaired renal function
impaired hepatic function 
ETOH abuse 
High statin level
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34
Q

pravastatin differences

A

not highly PB and not highly metabolized by cYP450

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35
Q

CYP3A4 inhibits will increase concentration of…

A

prodrug statins!!
simvastatin
lovastatin

CYP3A4 inhibits:
grapefruit, verapamil, amiodarone, erythropoietin, clarithro, azole antifungals, coumadin, cyclosporine, protease inhibitors

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36
Q

Dabigatran +simva/lova =

A

high risk for bleeding.

now have reversal agent for dabigatrarin (prdxbind?)

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37
Q

cyclosporine increases

A

concentration of all statins

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38
Q

bile acid-binding, resin sequestrin stats

A

Decrease LDL
increase HDL
no effect on TG

  • get rid of more bile via GI
  • getting rid of cholesterol will also increased LDL receptors

cholestyramine, colestipol, colesevlam

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39
Q

bild acid resins can interfere with

A

PO absorption of drugs

synthroid
OC
suflas 
phenytoin 
thiazides
fat soluble vitamins
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40
Q

in small/young pts, cholecystramine can cause

A

hyperchloremic acidosis

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41
Q

resins + statins

A

further decrease in LDL

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42
Q

only pregnancy safe anti-cholesterol =

A

binding resins (cholecystryamine, colestipol, colesevalem)

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43
Q

Niacin MOA

A

acts on liver and adipose tissue to decrease TG, unsure why increase in HDL, does decrease LDL - not very effective

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44
Q

Niacin stats

A

minor decrease in LDL (10-20%)
TG - decrease
HDL increase but unsure why

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45
Q

niacin is best for pts

A

at risk of pancreatitis
increases HDL more than any other drug
does little to improve long term outcomes

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46
Q

Niacin SE

A

intense flushing - tx with ASA
GI upset
Hepatotoxicity - assess LFTs
Hyperglycemia - without DM, increases r/f DM
hyperuricemia - gout, increase fluid uptake, watch kidney function
visual changes

increased r/f myopathy and hepatotoxicity with statins

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47
Q

most effective drug to decrease TG:

A

fiber acid derivative - gemfibrozil

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48
Q

Gemfibrozil MOA

A

increase synthesis of LPL
also decreases level of apolipoprotei that decrease LPL

LPL breaks down TG

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49
Q

Gemfibrozil stats

A 
decrease TG (best)
also increase HDL!! (20%)
does very little to decrease LDL
50
Q

Gemfibrozil SE

A

Rahses/GI upset/ HA
rhabdo myopathy with statins
liver injury check LFTS - made worse with statins
GALLSTONES - dc
displaces warfarin - watch INR/ LFTs
potentiates oral anti-hyperglycemias - monitor
can increase serum level of statins

51
Q

Ezetimibe (Zetia) MOA

A

Inhibits cholesterol absorption from brush border of SI

52
Q

Ezetimibe is used to

A

decrease LDL

53
Q

Ezetimibe SE:

A 
diarrhea
also gallstones -> D/C
may increase bleeding of warfarin 
iS INCREASED BY CYCLOSPORINE 
absorption of this drug would be inhibited by resins
54
Q

PCSK9 inhibitors MOA

A

block the enzyme that breaks down LDL receptors

increase LDL receptor expression

55
Q

PCSK9-i stats

A

PCSK9 inhibitor stats

DECREASE LDL significantly.

56
Q

PCSK9-I are a good choice for

A

pts who cant tolerate high dose statins, use statin + PCSK9

57
Q

mipomersen MOA

A

mipomersen MOA:
decrease apoB protein and decrease risk of CV disease

black box warning for fatty liver
also flu like symptoms

FDA approved for familial hyperlipidemia

58
Q

Lopitamide MOA

A

triglyceride transfer protein inhibitor in ER, prevents assembly of apoB, inhibits synthesis of chylomicrons.

50% reduction in plasma LDL levels **

59
Q

bronchodilation and cAMP

A

activation of b2 receptors will INCREASE cAMP and lead to bronchodilation

60
Q

inhaled corticosteroids

A

budesonide
beclomethasone
triamcinolone
fluticasone

61
Q

cromolyn MOA

A

Stablilizes mast cells

inhibits antigen induced release of mediators

62
Q

cromolyn must be taken

A

PROPHYLACTICALLY
must be taken 4 times daily
safest of all drugs tho

63
Q

Zileuton MOA:

A

Inhibits lipoxygenase, inhibits production of leukotrienes from arachidonic acid

64
Q

Zileuton SE:

A

hepatotoxic 2-4%

neuropsych: anxiety, depression, suicidal ideation, hallucinations

65
Q

zilueton is less effective than

A

inhaled corticosteroid and LABA

onset = 1-2 hours, not useful in acute attack

66
Q

montelukast mOA

A

cysLT1 receptor antagonist.

blocks the mechanism of bronchoconstriction and smooth muscle effects

67
Q

montelukast is used

A

to tx in asthma in pts <1 y/o
prevents exercise induced bronchospasm >15 y/o
treat allergic rhinitis

improves bronchial tone, pulmonary function, and asthma symptoms.

68
Q

montelukast max effect =

A

max effect = 24hrs after 1st dose

69
Q

omalizumab is used

A

in ALLERGY induced asthma when inhaled glucocorticoids have failed

70
Q

SE of omalizumab

A 
injection site rxn 
increased r/f viral infxn 
URI / sinusitis 
HA 
Pharyngitis 
increased CV complications, 
possible increased r/f CA

RARE adverse effect: triggering of an immune response (anaphylaxis)
monitor 2 hours after 1st 3 doses
monitor 30 minutes after all SQ doses

71
Q

SE of beta 2 agonists

A 
SE; 
minimized by inhalation delivery 
tremor 
increased HR 
vasodilation 
metabolic changes: hyperglycemia, hypokalemia, hypomagnesemia
72
Q

terbutaline administer via SC resembles

A

epi response

73
Q

terbutaline dosage

A

terbutaline dosage for child:
0.1 mg/kg

terbutaline dosage for adult:
0.25 mg q 15 minutes

each dose is 200 mcg
max dose = 16-20 puffs/day

74
Q

Long acting B2 agonists differ in that

A

they have a lipophilic side chain that allows them to bind more tightly to B2

DOA: 12-24 hours

these are not for prevention, these work prophylactically

75
Q

long acting B2 agonists

A

salmeterol and formoterol

76
Q

black box warning for LABA

A

may increase the risk of fatal or near fatal asthma attack. now they are paired with steroids. No clear reason why this is better.

77
Q

methylxanthines MOA

A

Unclear.
Also called phosphodiesterase inhibitors

maybe prevent cAMP degradation in smooth muscle as well as in inflammatory cells

dRUG EFFECT: Airway relaxation and bronchodilation

78
Q

clinical indication for methylxanthines

A

COPD

ASTHMA

79
Q

SE of methylxanthines

A

multiple SE and a narrow therapeutic index

therapuetic index: 10-20 mcg/mL

toxic at >20mg/mL

wide 1/2 life variation in different patients, especially in smokers who metabolize 50% faster

SE: 
Cardiac arrhthymias 
n/V 
Irritability 
insomnia 
seizures
brain damage
hyperglycemia 
hypokalemia 
hypotension 
dEATH FROM CV COLLAPSE
80
Q

Drug interactions with methylxanthines

A

metabolized by cYP450:

cimetidine, cipro, antifungals: cyp450 inhibitors - can INCREASE levels

phenobarbitals and phenytoin: can DECREASE levels

smoking can increase levels

caffeine can increase levels and promote CNS/CV toxicity

81
Q

Anticholinergics are used

A

to tx COPD

secondary line of tx for asthma in patients resistant to beta agonist or who have significant cardiac disease

82
Q

ipatropium bromide

A

is an anti-cholinergic agent
is a quartenary ammonium derivative of atropine - can’t cross BBB

SLOW onset 30-90 minutes
duration of action 4-6 hours
NOT significantly absorbed compared to atropine, so less SE, can have inadvertent oral absorption - GI upset, dry mouth

83
Q

Tiotropium

A

anti cholinergic
quaternary ammonium salt
not significantly absorbed
approved by FDA for COPD

84
Q

tiotropium/ipatropium is used in COPD as

A

maintenance and rescue therapy!

only used in asthma or ACUTE exacerbation

85
Q

SE of cromolyn

A

Safest of all anesthesia drugs.

infrequent SEs are 
cough / bronchospasm 
laryngeal edema 
angio edema 
urticaria 
anaphylaxis
86
Q

protamine sulfate dosing

A

1 mg protamine sulfate per 100 units heparin

give slowly, can cause drop in BP

87
Q

dabigatran is given as a

A

pro-drug

that is rapidly converted by plasma esterases into active form

88
Q

fondaparinux MOA

A

Is a LMW heparin, has a 5 sugar base, binds to anti-thrombin 3 and then binds to only Xa. No thrombin effect.

good in HIT,
can cause thrombocytopenia

more effective than other LMW heparin, so greater bleeding risk but less than heparin

89
Q

dabigatran MOA

A

DIRECT thrombin inhibitor.
pro drugs.
binds to free and bound thrombin.

90
Q

dabigatran pk

A 
dabigatran 
onset; RAPID
e1/2life ; 13 hours 
pb: low 
primarily cleared by kidneys, encourage PO uptake
91
Q

drug interactions with dabigatran

A

Dabiagatran DDI:

  1. p-glycopreotein inhibitors will iNCREASE drug levels (amino, verapamil, ketoconazole, quinine),
  2. with simvastatin/lovastatin - major bleed, need reversal
92
Q

Surgical considerations for dabigatran

A

stop 48 hours before surgery with normal renal function.

stop 72-96 hours before surgery with impaired renal function.

stop 5 days before surgery if high risk for bleed during surgery

93
Q

reversal agent for rivaroxaban

A

andexxa

94
Q

surgical considerations for rivaroxaban

A

hold 48 hours pre-op

hold 5 days if high risk for bleeds

95
Q

dypridamole is used often

A

following heart valve replacement

96
Q

dypridamole + ASA =

A

stroke prevention

“aggrenox”

97
Q

dypridamole requires

A

BID dosing

98
Q

Dypridamole SE

A 
HA, hypotension - vasodilation 
bronchospasm, dyspnea 
MI
arrthymias
nausea, dizziness 
rash/flushing
99
Q

abciximab used for

A

unstable angina, acute MI

PCI

100
Q

tpa + ACE-i

A

increased risk for angio edema

101
Q

anti-plt drugs are not recommended for patients with

A

severe hepatic disease or patients with GI ulcers

102
Q

ADP receptor antagonists act for

A

the LIFE of the plt. 7-10 days

exception: Ticagrelor

103
Q

bare metal stents and drug eluding stents require

A

6 weeks and 6 months for seeding, post pone elective surgery until after this period

104
Q

if no stent and pt on plavix and HIGH risk

A

dc 5 days before. placid washout,
resume 24 hrs post - op
use ASA in between

105
Q

no stent, on plavix, LOW risk

A

dc 7-10 days prior

resume 24 hrs post -op

106
Q

TXA dose

A

1 gm in 100 mL Ns given over 10 minutes [loading]

followed by 1 gm in 100 ml NS over 8 hours

107
Q

pk of TXA

A

95% excreted, decease dose in renal failure

108
Q

SE of TXA

A

seizures
vision changes
ureteral obstruction and bleeding
renal toxicity

109
Q

opioid that is always combined with something else

A

HYDROcodone

ASA, ibuprofen, anti-histamine, acetaminophen

110
Q

diphenyl derivative =

A

methadone

111
Q

MOA of acetaminophen

A

unclear
NMDA receptor antagonist in CNS
substance P ANTAGONIST in spinal cord

112
Q

NSAIDs displace

A

highly PB drugs

warfarin
phenytoin
sulfonylureas
sulfonamides
digoxin
113
Q

NSAIDs decrease effectiveness of

A

diuretics
beta blockers
ace I

INCREASElithium levels

114
Q

Celecoxbin dosing

A

<200 mg/day

115
Q

ketorolac dosing

A

30 mg IV or Im x 1 q 6 hours
max - 120 mg

cut doses by 50% in elderly

do not exceed 5 days of use

116
Q

hydrochlorothiazide clearance

A

100% in urine

117
Q

dose of hydrochlorothiazide

A

25 mg - 100 mg / day
max: 200 mg day
low ceiling effect

118
Q

hydrochlorothiazide is synergistic with

A

ACE-I or BB

NSAIDs DECREASE efficacy

119
Q

Hydrochlorothiazide is C/I in

A

renal failure , Anura
decrease dose in elderly,
anti-arrthymic agents that prolong QTI

120
Q

dose of mannitol

A

0.25 to 1 g/kg IV

over 30-60 minutes

Spring Pharm (11 decks)

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