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Pharm Test 3 > Study Guide > Flashcards

Study Guide Flashcards

1
Q

Main SE of magnesium antacids

A

Diarrhea

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2
Q

What med class stimulates receptors on osteoblasts - can lead to bone breakdown?

A

SERMS- Tamoxifen, Raloxifene (Evista) , and Clomiphene (clomid)

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3
Q

What formulation of OCP has no androgenic activity?

Possible AE?

A

Drospirenone

- monitor for hyperkalemia

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4
Q

Retain water to increase intraluminal pressure

A

Magnesium preps, NaPhos, lactulose, glycerin, sorbitol

osmotics

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5
Q

Symptomatic treatment of hyperthyroidism
Blocks hyperadrenergic effects of thyroid excess
Blocks peripheral conversion of T4 to T3

A

β-blockers

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6
Q

Tx for IBS

MOA: stimulates intestinal fluid secretion and transit

A

Linaclotide (Linzess)

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7
Q

Main SE od calcium antacids

A

constipation

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8
Q

GLP-1 receptor antagonist

avoid use in pts with medullary thyroid cancer

A

Liraglutide

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9
Q

why can NSAIDS penetrate gastric cells

A

inhibit cox enzymes -> decrease in PGE2 -> increased gastric acid -> decreased bicarb, blood flow & mucus production

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10
Q

TX of vasomotor sxs of menopause, SIgnificant 1st pass metabolism-> increased binding of globulins, TGs, HDL, clotting factors

A

Oral Estrogen

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11
Q

Proposed uses of uterotonics

A

To empty Uterus- labor/ terminate pregnancy

Stop Bleeding- Immediately Postpartum/ late postpartum hemorrhage

Subinvolution- reduction of uterus to its normal size after childbirth

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12
Q

Important teaching info for pt on a G-CSF like Filgrastim (Neupogen)

A

will reduce risk of infection but they can have significant bone pain (bone marrow is trying to make new cells)

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13
Q

Phosphate binding to Ca
decreased GI absorption and plasma Ca level, increased PTH synthesis/ secretion is caused by what and then leads to what?

A

Hyperphosphatemia

… Hyperparathyroidism

When renal function is compromised either experimentally or by disease, there is a compensatory enlargement of the remaining nephrons and an increased rate of filtration per nephron. To remain in balance, the phosphate excretion per nephron must also increase.

As renal function progressively declines, increasingly higher levels of PTH are needed to maintain phosphate homeostasis

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14
Q

H2 Antagonists - prevents activation of proton pump by inhibiting activation of H2 receptors in gut= suppression of gastric secretions

A

Cimetidine, Nizatidine, Ranidatinie, Famotidine

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15
Q

Topical injury from NSAID use

A

Iron trapping- un-ionized goes to facilitation of transport across membrane in acid stomach lumen…
w/ in the cells ionized NSAIDs trap molecules = cellular damage (cant get out)

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16
Q

Preferred in practice for hyperthyroidism

Longer ½ life, once daily dosing

More potent than PTU - less frequent serious AEs

A

Methimazole (Tapazole)

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17
Q

Type of therapy that Targets a specific gene or protein on a cancerous cell

A

Targeted Therapy

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18
Q

Tx for IBS.

MOA: locally active Cl- channel activator that enhances Cl- rich intestinal fluid secretion

A

Lubiprostone (amitiza)

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19
Q

Why are hormone drug levels are less variable with the patch and vaginal ring?

A

more continuous absorption

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20
Q

Docusate

A

Retains water to soften stools

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21
Q

For hypothyroidism … Why not give T3 (Cytomel)?

A

Better to have a reservoir of T4 (prodrug) to normalize metabolism over a wide range of conditions.
Half-life of T3 is shorter (1 day).

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22
Q

Potential benefits of Oral contraceptives

A

Potential benefits of Oral contraceptives

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23
Q

used for colonoscopy preps

A

(osmotics) and saline laxatives

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24
Q

How do Dilantin, Griseofulvin, and Rifampin interact with OCPs?

A

induce metabolism of OCP- need backup!

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25
Q

Oral Phosphate Binder:
Binds to dietary phosphate, inhibiting its absorption
Not absorbed

A

Sevelamer (Renagel, Renvela)

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26
Q

What happens when SERMS activate receptors on osteoblasts ?

A

leads to bone anabolism

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27
Q

what’s the goal range of Hgb for a pt on erythropoietin?

A

Don’t try and get them in a normal range
- try for 10-12 -
if you push to high there is a greater risk of CV events

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28
Q

why can there be compliance issues with Sucracate

A

Large tablets and frequent administration

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29
Q

Oral Phosphate Binder: Binds to dietary phosphate, inhibiting its absorption
Dose with meals

A

Calcium carbonate/calcium Acetate

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30
Q

Contraindicated in Pregnancy - for prevention of NSAID induced ulcers

A

Misoprostol

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31
Q

This drug class can help to prevent and/or treat neutropenia associated with chemotherapy

A

Granulocyte-colony stimulating factors (G-CSF) ex. Filgrastim (Neupogen)

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32
Q

How do OCPs interact with corticosteroids?

A

OCPs potentiate corticosteroids - may need lower dose

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33
Q

Counseling pts for pts with GERD

A 
avoid caffeine (increases acid secretion)
avoid alcohol (can have direct toxic effect on the mucosa) 
stop smoking (decreased production of duodenal bicarb and decreased blood flow decrease ulcer healing)
avoid NSAIDs
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34
Q

What to counsel pts taking topical testosterone gel/ patch?

A

caution w/ transfer to children or pets - kids can develop premature pubic hair, increased libido, aggressive behavior

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35
Q

Opium derivatives

ex. Paregoric/ tincture of opium

A

Inhibits peristalsis and diarrhea

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36
Q

Loperamide (imodium) AE/ CI

A

AE: abdominal pain, n/v, bloating, QT prolongation

CI: less than 2 years old-> fetal paralytic ileus, fever, ecoli, salmonella, campylobacter infections

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37
Q

Drugs That Alter Thyroid Status

A

Amiodarone
Lithium
Metoclopramide (Reglan)

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38
Q

AEs of Cimetidine (Tagamet) - H2 antagonists

A

potential for diarrhea, headache, muscle pain, constipation, fatigue, confusion

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39
Q

2nd most effective. inhibit CYP enzymes a

decrease elimination of some drugs

A

H2 Antagonists

Cimetidine, Nizatidine, Ranidatinie, Famotidine

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40
Q

SERM, Inhibits growth of estrogen dependent (ER+) breast tumors, agonist activity in bones can delay or prevent osteoporosis, does not stimulate endometrium

A

Raloxifene (Evista)

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41
Q

Not caused by H. Pylori, esophageal mucosa damaged by reflux of low PH material into lower esophagus

A

GERD

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42
Q

Uterotonic - Induces labor by promoting contractions, administered IV*, use w/ caution in cardiac/ renal disease, PIH

A

Oxytocin (pitocin)

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43
Q

why give colloidal bismuth to pt with H.Pylori and PUD?

A

coating agent used in PUD - inhibits growth of H. Pylori

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44
Q

increases release of norepi and dopamine from nerve terminals in addition to inhibiting their reuptake
avoid using with MAOIs

avoid abrupt withdrawal

A

Phentermine

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45
Q

Continue this drug for 1-2 weeks for GI to determine effectiveness

A

Esomeprazole (Nexium)

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46
Q

Lightheadedness, dizziness, sedation, nausea/ vomiting, euphoria, constipation,pruritus
drug dependence if used consistently

A

Side effects of tincture of opium

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47
Q

*Potential drug interactions via binding to drugs

AE: constipation

A

Sucralfate

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48
Q

How does Plan B work? AEs?

A

interferes with ovulation, fertilization, egg transport, and/ or implantation
ineffective after implantation

Nausea and vomiting

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49
Q

what is usually the culprit to acne?

A

Progestin

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50
Q

Androgen Receptor Antagonist (2)

A

Flutamide, Bicalutamide

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51
Q

non-competitive irreversible antagonist. shuts down acid activity by working on potassium hydrogen ATPase pump

A

Omeprazole (prilosec)

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52
Q

TX of vasomotor sxs of menopause, caution w/ transfer to children/ pets

A

Topical Estrogen

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53
Q

Goal of chemo treatment

A

want to give the highest dose of chemo you can with least amount of side effects

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54
Q

Impedes growth of H. pylori,

AE: constipation

A

Colloidal Bismuth

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55
Q

Treatment goals of PUD

A

decrease gastric acidity,
enhance mucosal defenses, eliminate H. Pylori,
Advise pt to quit smoking*

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56
Q

Who could benefit from progestin only contraceptives?

A

anyone who would benefit from avoiding estrogen- lupus sickle cell, cardiovascular disease, migraines, breastfeeding, VTE

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57
Q

considered the drug of choice for hypothyroidism because its converted to T3 over time

A

Levothyroxine

58
Q

Work later on in the cycle- most effective- can take days or longer to take effect, non-competitive irreversible antagonist of potassium hydrogen ATPase pump to help decrease acid production

A

PPIs

Lansoprazole (Prevacid), Pantoprazole, Esomeprazole (Nexium), Omeprazole (prilosec)

59
Q

Non-specific forms of cytotoxic chemo

A

Radiation & Nitrosoureas

60
Q

Potential Harm of Oral Contraceptives

A

Increase risk of MI/stroke/ VTE

Relative CI if woman > 35 yrs and smokes due to increased risk of VTE and cardiovascular events*

61
Q

Bulk Forming:

stimulate stretch receptors

A

FiberCon, Metamucil, Citrucel, Metrolan

62
Q

TX of vasomotor sxs of menopause, Tx vaginal atrophy, GU sxs of menopause

A

Vaginal Estrogen

63
Q

Type of therapy that activates immune system to treat cancer
Immune-mediated toxicities (ex. vaccines, cytokines, immunomodulators…)

A

Immunotherapy

64
Q

What do you need to monitor for pt on G-CSF?

A

Absolute neutrophil count

65
Q

Type of therapy that Targets rapidly dividing cells - hair loss, bone marrow loss (affects RBCs, WBCs, platelets)

A

Cytotoxic

66
Q

Targeted therapy drug class: intracellular target to shut down some cellular pathway

A

Tyrosine Kinase Inhibitors (TKIs)

67
Q

Decrease T4 to T3 conversion

A

PTU, β-blockers, amiodarone, glucocorticoids

68
Q

AE/ CI of Pepto-Bismol

A

AE: Black coating on tongue

CI: avoid in pts with renal failure

69
Q

If pts don’t loose a 5% of total body weight in 12 weeks consider removing them from this drug

A

Lorcaserin

70
Q

What is tumor lysis syndrome? signs and symptoms?

A

caused by therapy working too fast that cell contents spill into the bloodstream

N/V/D
weakness, tingling, fatigue

71
Q

Who derives the biggest benefit of hormone replacement therapy? *

A

Pts with most severe symptoms

72
Q

Tx of CKD- secondary hyperparathyroidism

A

Phosphate binders

calcimimetics

73
Q

What to give pt if you want to stimulate their RBC count? Helps minimize length of time of anemia

A

Erythropoietin (Procrit)

Darbepoetin (Aranesp)

74
Q

Med used to treat BPH and alopecia*

A

Finasteride

75
Q

Rank effectiveness of med classes that reduce gastric acid secretion

A
  1. Proton Pump Inhibitors
  2. H2 Antagonists
  3. Anticholinergic Agents
76
Q 
Drug class that stimulates neutrophils and macrophages 
- example?
A

GM- CSF - Granulocyte Macrophage Colony stimulating factor

Sargramostim (Leukine)

77
Q

GI drug that does not alter the pH, but does provide symptomatic relief

A

Sucralfate

78
Q

why is estrogen always administered with progesterone?

A

unopposed estrogen promotes endometrial growth = increased risk of endometrial cancer

79
Q

anticholinergic- works on muscarinic acetylcholine receptors- decreases gastric acid secretion

A

Dicyclomine (bentyl)

80
Q

MOA of OCPs (oral contraceptive pills)

A

Suppression of mid-cycle gonadotropin (FSH, LH) secretion = inhibiting ovulation*

81
Q 
Drug class of choice for GERD
what warning?
A

PPIs

Warning for increased risk of C Diff.

82
Q

TX of vasomotor sxs of menopause, as effective as oral estrogen for menopause and bone density but less AEs

A

Transdermal Estrogen

83
Q

coats the lining of GI tract and soothes irritation, preventing stimulation of local refluxes that cause exc essive GI activity/ diarrhea

A

(Pepto-Bismol)

Bismuth- subsalicylate

84
Q

Uterotonic- Cervical ripening agent, naturally occurring PGE2, vaginal administration*

A

Dinoprostone (Cervidil)

85
Q

what labs would you want to check for a pt with thyroid problems on Methimazole or PTU

A

Thyroid function panel - TSH and T4
LFTs
WBC and CBC (due to risk of agranulocytosis)

86
Q

Most effective treatment of pts with Hypercalcemia and tumor lysis syndrome?

A

Oral and IV Hydration*

87
Q

What is first line choice for pt with H. Pylori and PUD? When there is not a concern w/ resistance

A

triple therapy
amoxicillin,
clarithromycin, PPI

88
Q

Drug that slows peristalsis and allows increase time for absorption of fluid/ electrolytes

A

Loperamide (imodium)

89
Q

SERM, pro-estrogenic effect on endometrium, antagonistic estrogenic effects on breast tissue

A

Tamoxifen

90
Q

Uterotonic, Synthetic form of PGE1, Pregnancy category X, Cervical ripening agent, vaginal administration*

A

Misoprostol (cytotec)

91
Q

how to help a pt with anticipatory nausea/ vomiting from past chemo?

A

Benzodiazepine

92
Q

What kind of hormonal contraceptives would be useful for breastfeeding mother? Route of admin, AE, CI

A

Progestin Only- Oral/ IM/ Intrauterine

must take at same time everyday, more breakthrough bleeding, less effective than combo pills

93
Q

stimulates myenteric plexus, alters water/ electrolyte secretion

A

Senna, Bisacodyl,

Oils

94
Q

What to give pts who are allergic to PCN and have H. Pylori and PUD?

A

Quadruple Therapy

tetracycline, Metronidazole, PPI
Bismuth

95
Q

Counseling for pts with PUD

A

stop NSAIDS and smoking

96
Q

most useful for myxedema coma (an acute hypothyroid state)- because it is not a prodrug

A

Cytomel

97
Q

Potential drug interactions via CYP inhibition

AE: headache, GI disturbances

A

H2 Antagonists and PPIs

98
Q

mimics iodide and can cause hypothyroidism

A

Lithium

99
Q

Can increase plasma iodide levels causing hyperthyroidism and increase thyroid hormone synthesis causing hypothyroidism

A

Amiodarone

100
Q

Decreased phosphate excretion

no activation of vit D

A

CKD

101
Q

what meds could be prescribed for symptomatic tx for pt with goiter

A

Beta Blocker, Iodide, Corticosteroids

102
Q

How should you treat rashes caused by immunotherapy agents?

A

High dose steroid pack for at least 2 weeks

103
Q

What are PDE-5 inhibitors contraindicated to take with?

A

Nitrates (will have too much smooth muscle relaxation)

104
Q

Why can’t you use benadryl to treat GERD?

A

Benadryl is a H1 antihistamine, Tagamet is a H2 antagonist- so they work on different receptors in different areas of the body

105
Q

Converted to active thyroid hormone T3 in the body

A

T4

106
Q

gold standard anticoagulant for cancer pts?

A

Low molecular weight heparin

107
Q

GI problem caused by H.Plylori

A

PUD

108
Q

Estrogen receptor antagonist, inhibits growth of estrogen dependent (ER+) breast tumors

A

Fulvestrant

109
Q

Phenobarbital, phenytoin, rifampin, and carbamazepine can reduce levels of what thyroxine ? How?

A

levothyroxine - by inducing its metabolism

110
Q

Targeted therapy: target protein on outside of the cell

A

Monoclonal Antibodies

111
Q

Finasteride

Dutasteride

A

5A Reductase Inhibitors
(Competitive Synthesis Inhibitors)

prevent conversion of testosterone toi DHT

FIn used for alopecia and BPH

112
Q

Pentanoic Acid ester that inhibits gastric and pancreatic lipases
take with a multivitamin

A

Orlistat

113
Q

What drug do you also need to stop when you get Hgb in range of 10-12?

A

Darbepoetin (Aranesp)

114
Q

SERM and ER antagonist in hypothalamus gland anterior pituitary gland = increased GnRH , Induces ovulation via partial agonism in ovaries

A

Clomiphene (clomid)

115
Q

Selectively activates 5HT 2c
avoid in pts with heart failure
avoid with SSRIs, SNRIs, MAOIs

A

Lorcaserin

116
Q

Classic symptom of GERD?

A

Heartburn- pain in center of chest

117
Q

Also inhibits conversion of T4 to T3 in the periphery
Short half-life requires TID dosing
Can deplete levels of prothrombin leading to increased bleeding tendency
Preferred agent in pregnancy and thyroid storm

A

PTU

118
Q

AE of Dicyclomine (Bentyl)

A

dry mouth, constipation, blurred vision, heart arrhythmias, urinary retention

119
Q

Noncompetitive synthesis Inhibitors

A

Exemestane

Formestane

120
Q

Precursor to androgen and estrogen synthesis

A

Progestin

121
Q

What group of drugs inhibits absorption of drugs that need acid in the stomach?

A

PPIs

Lansoprazole (Prevacid)

122
Q

Infusion reactions are biggest concern
Titrate slowly
More human=less reaction

Premedicated with
Acetaminophen (+/-)
Diphenhydramine (+/-)
Glucocorticoid (+/-)

A

Monoclonal Antibody Toxicity

123
Q

How to treat SE from immunotherapy?

A

TREATED WITH HIGH DOSE STEROIDS*

SE (LEGS)
L: liver (increased LFTs)
E: endocrine (hypothyroidism)
G: gastrointestinal (diarrhea and colitis)
S: skin (rash)

More serious SE include cytokine release syndrome and infusion reactions

124
Q

What to give pts with minimal or low emetic risk?

A

minimal= No prophylaxis

Low= Dexamethasone 8 mg -or- first-generation 5HT3 antagonist (Zofran)

125
Q

What to give pts with moderate emetic risk?

A

5HT3 antagonist and dexamethasone

Add NK1 antagonist if severe/refractory emesis develops

If risk of delayed emesis:
Continue dexamethasone for a few days
-or-
Use palonosetron as 5HT3 antagonist

126
Q

What to give pts with severe emetic risk?

A

NK1 antagonist + 5HT3 antagonist + dexamethasone

127
Q

how to tx breakthrough chemo nausea?

A

Use a drug with a different MOA

EX: Olanzapine, prochlorperazine, promethazine, metoclopramide, dronabinol

128
Q

PPI that can prevent the conversion of Clopidogrel (plavix) to its active form

A

Omeprazole

129
Q

H2 antagonist that inhibits CYP3A4, 2D6, 1A2

Benzos and warfarin

A

Cimetidine

130
Q

Drugs that work to neutralize gastric acid? used for pain relief, fast onset- short acting

A 
Aluminum hydroxide
Mag. Hydroxide
Sodium bicarb.
Calcium Carbonate
 (antacids)
131
Q

Antibiotic that interferes with OCP?

A

Rifampin (for TB tx)

132
Q

What to do if no response to thioamines in 6-12 months?

A

Radioactive iodine-thyroid gland ablation

Surgical removal of thyroid, then, thyroid hormone replacement therapy

133
Q

Not a thyroid drug that Increases TSH production and release?

A

Reglan

134
Q

Actively concentrated in thyroid gland
Body recognizes it as iodine
Can inhibit synthesis of thyroid hormone causing hypothyroidism

A

Lithium

135
Q

Acts like thyroid hormone, structural resemblance
Contains large amounts of iodine
Can cause hypo- or hyperthyroidism

A

Amiodarone

136
Q

lowers serum bicarb, may cause metabolic acidosis

Useful in pts with hypercalcemia

A

Renagel (phosphate binder)

137
Q

buffered form of Sevelamer, avoids acidosis

Useful in pts with hypercalcemia

A

Renvela (phosphate binder)

138
Q

Used with calcium for osteoporosis treatment and prevention to increase calcium levels
Cholecalciferol= ______
Ergocalciferol= ________
Doxercalcifero= _______

A

Cholecalciferol (vitamin D3)
Ergocalciferol (vitamin D2)
Doxercalciferol (vitamin D2)

139
Q

activated vitamin D?
Where?
Better for CKD, bypasses synthesis by kidneys

A

Calcitonin

Liver

140
Q

Paricalcitol (Zemplar)

A

Synthetic analogue of vitamin D

141
Q

Binds to calcium sensing receptors, increasing sensitivity to calcium

Suppresses PTH

Treatment of secondary hyperparathyroidism

Treatment of hypercalcemia associated with parathyroid carcinoma

A

Cinacalcet (Sensipar) [Calcimimetic]

142
Q

For Severe HYPOcalcemia (IV)

HYPOparathyroidism and osteoporosis (PO)

A

Calcium
(Calcium gluconate, calcium chloride)[IV]

(Calcium citrate, calcium carbonate, calcium phosphate, calcium lactate)[PO]

Pharm Test 3 (7 decks)

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