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Pharm Test - 4 > Test 4 > Flashcards

Test 4 Flashcards

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1
Q

What Types of medications may worsening HF symptoms?

A
  1. NSAIDs
  2. Chemotherapy medications
  3. TZDs
  4. CCBs
  5. Saxagliptin
  6. Alpha Blockers
  7. Itraconazole
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2
Q

How is Stage A HF treated?

A

Fix underlying issues

Ex:

HTN
Lipids
Weight
DM
Smoking
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3
Q

How is stage B HF treated (Class 1)?

A
  1. ACEi / ARB (in patients with reduced EF)
  2. Beta-Blockers
  3. Statins (h/o of MI)
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4
Q

How is stage B HF treated (Class III)?

A

Non-dihydropyridine CCBs

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5
Q

How is Stage C HF with a reduced EF treated?

A
  1. ACEi / ARB
  2. Beta-Blockers
  3. Aldosterone Agonist
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6
Q

Sacubitril/Valsartan (Entresto) is a ___________ receptor blocker/neprilysin inhibitor.

A

Angiotensin

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7
Q

Sacubitril is a __________ inhibitor

What does it promote?

A

Neprilysin

Natrieuresis
Vasodilation

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8
Q

What is a major contraindication in the use of Entresto?

A

Angioedema (related to ACEi / ARB use)

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9
Q

What are some ADRs of Entresto?

A 
Hypotension 
Hyperkalemia
Cough
Dizziness
Renal Failure
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10
Q

Ivabradine is a _____ channel inhibitor. (used in HF patients with an EF <35%)

T/F: This will lower heart rate with inotropic effects

A

HCN

False (It has NO inotropic effects)

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11
Q

What ADRs are associated with Ivabradine?

A

Bradycardia
HTN
Afib
Luminous Phenomena (Visual Brightness)

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12
Q

What class of medication is recommended in HF patients with fluid retention?

A

Diuretics

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13
Q

What should be monitored in a patient taking diuretics?

What should you do to the dosing if the patient notices increased edema or SOB?

A

Monitor the patient’s dry weigh and daily weights

If they notice increased edema or SOB, increase the dose and symptoms should improve in 3 days

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14
Q

What “type” of medication is used to treat…..

Hypokalemia

A

K+ Supplements

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15
Q

T/F: K+ supplements have NO effect on BP

A

True

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16
Q

When are contraindications to K+ supplement use?

A

Renal Impairment
Gastroparesis
GI Transit Issues

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17
Q

What are ADRs of K+ supplements?

A 
Hyperkalemia
Nausea
Vomiting
Diarrhea
Flatulence
Abdominal Pain
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18
Q

What drug is used for hyperkalemia treatment?

A

Kayexalate

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19
Q

If a patient has has a bowel ________, then use of kayexalate is contraindicated.

A

Resection

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20
Q

What are some ADRs of Kayexalate?

A 
Hypokalemia
Gastric Irritation
Nausea
Vomting
Anorexia
Constipation
Electrolyte Imbalance

BEZOARS

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21
Q

What is used to treat Stage C HF (Class 2a)

A

Digoxin

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22
Q

Digoxin inhibits the function of ___-__-_____ and regulates _____ overactivation

Do Digoxin have a positive or negative chronotropic effect?

Inotropic?

A

Na-K-ATPase

SNS

Negative

Positive

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23
Q

T/F: Digoxin is renally eliminated

A

True

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24
Q

What two classes of ABx does Digoxin interact with?

A

Tetracyclines

Macrolides

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25
What are some ADRs of Digoxin
``` Bradycardia Hypotension Arrhythmia N/V/D, Anorexia Blurred/Yellow vision Headache Dizziness Gynecomastia (prolonged use) ```
26
Toxic doses of Digoxin cn be found in _________ (Hint: It a plant)
Oleander
27
What are the Sx of an acute digoxin OD?
``` Sinus Bradycardia Hypotension Hyperkalemia Vomiting 3rd Degree AV block Vtach/Fib ```
28
What are the Sx of an chronic digoxin OD?
``` Sinus Bradycardia Hypotension Vision Changes Afib Hypokalemia/Magnesiumia Weakness ```
29
What two medications treat a digoxin OD?
Digibind | DigiFab
30
What is the first line treatment for hyperkalemia? Bradycardia? Vtach?
Hyperkalemia: 1. Furosemide 2. Kayexalate 3. Sodium Bicarb Bradycardia: 1. Atropine Vtach: 1. Lidocaine 2. Phenytoin
31
T/F: Statins are recommended in Stage C HF treatment
False
32
What classes of drugs should be avoided in Stage C HF treatment?
NSAIDs Many Antiarrhythmics CCBs (except amlodipine) TZDs
33
________ is a endogenous catecholamine, used to treat acute decompensated HF and shock.
Dopamine
34
What ADR is associated with Dopamine
Arrhythmias
35
Dobutamine is a ____ agonist used to treat acute decompensated HF.
B1
36
What are the ADRs associated with Dobutamine?
Tachycardia SVT Tachyarrhythmia HTN
37
_________ is a PDE3 Inhibitor (Phosphodiesterase) which promotes vasodilation and smooth muscle relaxation to be used in acute decompensated HF patients.
Milrinone
38
If milronone is given to a hypotensive patient with acute decompensated HF, would you expect the BP to improve?
Not likely
39
What ADRs are associated with Milronone?
Arrhythmia Hypotension Rare Thrombocytopenia
40
What should you check prior to giving Milronone? | Think: Thrombocytopenia
Platelets
41
Other than Dopamine, Dobutamine, or Milronone, what medications should be continued in ADHF management? What medications should be started? What medications could be added to relieve dyspnea and hypotension?
Continue..... 1. ACEi / ARB 2. Beta-blockers Start.... 1. IV Loop Diuretics 2. Low Dose IV Dopamine Relieve.... 1. IV NTG 2. Nitroprusside 3. Nesiritide
42
T/F: Nitrates are prodrugs of NO
True
43
Are nitrates vasodilators or vasoconstrictors?
Vasodilators
44
Nitrates are direct venous and arterial vasodilators. Which do they have a greater effect on?
Veins
45
T/F: Nitrates have a large first pass effect
Ture
46
Do nitrates have long or short half lives?
Short (1-2 mins)
47
What ADRs are associated with Nitrates? What is a unique ADR that effects the blood?
Headache Dizziness N/V Hypotension Methemoglobinemia
48
What drugs/medications/substances interact with nitrates?
Alcohol CCBs PDE-5s
49
You need a __ hr nitrate free interval to decrease nitrate tolerance
12
50
This form of nitrate can be taken sublingual, buccal, as a spray, or in ointment form. It typically relieves pain within 3 minutes.
Nitrogylcerin
51
What is the maximum number of NTG tablets you should take? What should you do if you reach this number and the pain is not relieved?
3 Call 911
52
___________ is a peripheral arterial vasodilator commonly used in eclampsia, in combination to treat HTN, and in combination with a nitrate to treat angina
Hydralazine
53
What ADRs are associated with hydralazine?
``` Headache Nausea Sweating Anorexia Reflex Tachycardia Lupus like reaction ```
54
___________ is a vasodilator used to treat HTN but also has the unique effect of hair growth. It works to open K+ channels.
Minoxidil
55
What ADRs are associated with Minoxidil?
``` Salt/Fluid Retention Increased HR Palpitations Angina Edema Hirsutism ```
56
_______________ is a vasodilator used in a hypertensive emergency and acts on the peripheral arterioles.
Diazoxide
57
What ADRs are associated with Diazoxide?
``` Transient hyperglycemia hypotension N/V Weakness dizziness ```
58
___________ _____________ is a vasodilator that activate guanylyl cyclase to dilate arterioles and veins. It is used for short term management of ADHF
Sodium Nitroprusside
59
In what condition is sodium nitroprusside contraindicated?
Cerebral edema
60
_____________ is a form of recombinant human BNP and used largely for ADHF.
Nesiritide
61
In what conditions is use of Nesiritide contraindicated?
Cardiogenic Shock | Hypotension
62
What ADRs are associated with Nesiritide?
``` Headache Hypotension Nausea Back Pain Worsening renal failure (Monitor sCR) ```
63
What are the Class 1a Anti-arrhythmics
Quinidine Procainamide Disopyramide
64
What medication is a Class 1b anti-arrhythmic?
Lidocaine
65
What medications are Class 1c anti-arrhythmics?
Flecainide | Propafenone
66
What medications are Class 2 anti-arrhythmics?
(Beta-blockers) ``` Propanolol Metoprolol Esmolol Timolol Atenolol Carvedilol ```
67
What medications are Class 3 anti-arrhythmics?
``` Sotalol Ibutilide Dofetilide (Tikosyn) Amiodarone Dronedarone ```
68
What medications are class 4 anti-arrhythmics?
Verapamil | Diltiazem
69
Quinidine blocks ___ and ____ channels as well as slows conduction through the heart and _______ the QRS
Na+ K+ Prolongs QRS
70
Quinidine can prolong the QT interval putting a patient at risk for what arrhythmia?
Torsades
71
Other than Torsades, what ADRs are associated qith Quinidine?
``` Syncope Asystole in patients with sick sinus syndrome Hypotension Cinchonism Hypersensitivity N/V/D ```
72
Quinidine ________ the plasma level of digoxin
Increases
73
________________ is a class 1a anti-arrhythmic which acts similarly to Quininide but is more effective.
Procainamide
74
Procainamide is more effective with _____________ (atrial/ventricular) arrhythmias
Ventricular
75
What ADRs are associated with Procainamide?
``` QT Prolongation (Torsades) Syncope Lupus Erythematous Syndrome N/V?D Hypotension (Rapid Administration) ```
76
Disopyramide is more effective with _____________ (atrial/ventricular) arrhythmias
Ventricular
77
Disopyramide is metobilzed by CYP3A4 so it should be used with caution in CYP3A4 inhibitors like ______ or ________.
Verapamil | Diltiazem
78
What ADRs are associated with Disopyramide?
QT-Prolongation (Torsades) | CHF Sx
79
In patients with ______, disopyramide should be avoided.
CHF
80
Lidocaine is more effective with _____________ (atrial/ventricular) arrhythmias
Ventricular
81
T/F: Lidocaine blocks both inactive and active Na+ channels
True
82
Lidocaine is the first line drug of choice in treatment of ventricular arrhythmias due to _____
AMI
83
What ADRs are associated with Lidocaine?
``` Neurological Effects (parasthesias, tremor, convulsions) Hypotension (CHF) ```
84
Flecainamide is used in _____________ arrhythmias and can supress PVCs
Supraventricular | Namely Afib
85
This class 1c anti-arrhythmic is used to _________ sinus rhythm in patients with supraventricular arrhythmia
Propafenone (Rythmol)
86
What ADRs are associated with Propafenone?
Metallic Taste | Constipation
87
What are three uses of Sotalol?
1. Life-threatening ventricular arrhythmias 2. Maintain sinus rhythm in atrial fibrillation 3. Pediatric arrhythmia
88
What ADRs are associated with Sotalol
Torsades | LV Depression in CHF patients
89
Ibutilide (Corvert) is used for acute cardioversion of ______ _______ or _______ _______ to NSR.
Atrial Flutter | Atrial Fibrillation
90
Dofetilide (Tikosyn), used to treat Afib, is initiated in the ________ due to ADRs of........
Hospital Prolonged QT Bradycardia Hypokalemia
91
An IV loading dose of Amiodarone might cause what? | TWO Things
AV Block | Bradycardia
92
Amiodarone is a CYP3A4 substrate so..... Durgs like Cimetidine (a CYP3A4 inhibitor would ___________ levels of amiodarone Durgs like Rifampin (a CYP3A4 inducer would ___________ levels of amiodarone
Increase Decrease
93
What should happen to a patient's Warfarin dose is amiodarone is given?
It should be cut in half
94
What are THREE uses for amiodarone?
1. Recurrent and refractory arrhythmias 2. WPW associated arrhythmias 3. Maintain NSR in Afib patients
95
What ADRs are associated with amiodarone?
``` Bradycardia, Heart Block Pulmonary Toxicity Abnormal LFTs Gray-Blue skin Photodermitis Corneal Microdeposits ```
96
What are uses for CCBs in terms of anti-arrhytmics?
Supraventricular Arrhythmia | Reduce Ventricular rate in Afib
97
__________ is a nucleoside made naturally in the body with a half life of 10 seconds and is a supressor of calcium dependent action potentials
Adenosine
98
When treating SVT with adenosine doses should be given at __ mg followed by ___ mg if necessary
6 mg followed by 12 mg
99
Adenosine is contraindicated in patients with ______ or ________.
Asthma | Bronchospasm
100
Adenosine is contraindicated in patients with a __ _______.
AV Block
101
What ADRs are associated with Adenosine
``` Bronchospasm CP SOB Flushing AV Block Hypotension Afib Headache Nausea Palpitations ```
102
What are THREE uses for Mg2++
1. Torsades 2. Sinus Tachycardia 3. Digitalis induce arrhythmia
103
What class of anti-arrhythmics is used in patients with structurally sound hearts?
Class 1c
104
Most of the anti-arrhythmics should be avoided in patients with CHF and CAD, except which two?
Amiodarone Dofetilide (Tikosyn) (In CAD only Sotalol can also be used)
105
What anticoagulant works to inhibits vitamin K reductase and inhibits clotting factor production in the liver? What clotting factors does it inhibits?
Warfarin (Coumadin) Factors II, VII, IX, X
106
T/F: Warfarin is metabolized by CYP450 so it DOES NOT interact with everything
False | It does interact with everything
107
The anticoagulant effect of Warfarin is measured by what lab value? What is the normal lab value?
INR (2-3)
108
What are the indications for Warfarin use?
1. ACS following ASA 2. DVT (Second Line) 3. Afib (First Line) 4. Valvular Disease (First line in mechanical valves)
109
What medications should be avoided in Warfarin use?
1. NSAIDs 2. Other antiplatelets 3. Some ABx (Ceohalosporins, Bactrim, Flagyl, FQs, Amox, Doxy)
110
What are the signs and symptoms of a Warfarin toxicity? How is it treated?
Bruising Bleeding (everywhere) Tx: Transfusion Vitamin K1
111
What should be considered prior to starting anticoagulants such as Warfarin?
The patient's bleeding risk.
112
If the INR is elevated (>4) what should you do to the Warfarin dose?
Lower or skip dose If severely elevated may need to miss several doses to get the INR back in range
113
Other than bleeding and bruising, what additional ADRs are associated with Warfarin use?
``` Hypersensitivity Vasculitis Elevated LFTs N/V/D, Flatulence Rash, Dermititis Chills ```
114
______ ___ syndrome is associated with Warfrin use and is caused by small atherothrombi.
Purple Toe Syndrome
115
______ _____ occurs with Warfarin use in the setting of protein C deficiency and is most common in middle age women being treated for DVT.
Skin Necrosis (WISN)
116
What anticoagulant is derived from pig mast cells and works by accelerating the binding of antithrombin III to thrombin.
Heparin
117
What are the indications for Heparin use?
1. DVT / PE prophylaxis 2. Anticoagulant for PCI 3. STEMI / NSTEMI
118
_______ is a low molecular weight Heparin which targets Factor Xa
Enoxaparin (Lovenox)
119
T/F: Heparin does not cross the placenta
True (Preferred in pregnancy)
120
Heparin is often used as a ____ ________ to Warfarin use? What does this help prevent?
Bridging therapy prevents the pro-coagulant effect of initial Warfarin therapy
121
How is a Heparin OD treated?
Replace blood loss Observation Antidote (Protamine)
122
What is the name of the Heparin antidote and how does it work?
Protamine Binds and inactivates Heparin (onset in 30-60 minutes)
123
Is anaphaylaxis seen with Protamine? If yes, watch drugs should you have on hand?
Yes Epinephrin Diphenhydramine H2 Blocker
124
Other than bleeding, what ADRs are associated with Heparin use?
Elevated LFTs Osteoporosis Heparin Induced thrombocytopenia
125
HIT can be seen within ____ to ___ days after heparin therapy is started.
2 to 10 days
126
In type 1 HIT how fast does the platelet count fall? Type 2? Which is more serious?
Type 1: 2-3 days Type 2: 4-10 days (More serious)
127
T/F: White Clot syndrome is associated with Type 1 HIT
False (Type 2)
128
How is HIT treated?
1. Stop Heparin 2. Document Heparin allergy 3. Use alternative anticoagulant
129
__________ ___________ was the first direct oral anticoagulant which prevents the conversion of fibrinogen to fibrin.
Dafigatran etexilate (Pradaxa)
130
What are the indications for dabigatran etexilate use? When is it contraindicatied?
Indication: Reduce CVA risk in nonvalvular Afib Contraindication: Mechanical valves renal failure liver failure
131
T/F: Rifampin, Amiodarone, and Verapamil all interact with Pradaxa and should be avoid
True
132
What ADRs are associated with Dabigatran Etexilate?
``` N/V/D Fatigue Edema Dizziness Headache ```
133
How is Pradazxa toxicity treated? What is the name of the reversal agent?
Diuresis and hemodialysis FFP Idarucizumab (Praxbind)
134
When Warfarin and Pradaxa are compared in regards to Afib treat...... Praxada _____ more strokes when compared to warfarin but had a _______ risk of major GI bleeding
prevents higher
135
What are the TWO Factor Xa inhibitors?
Rivaroxaban (Xarelto) | Apixaban (Eliquis)
136
What are the indications for Rivaroxaban (Xarelto) use?
1. Reduce CVA risk in patients with Afib 2. DVT prophylaxis/Tx 3. PE Prophylaxis/Tx
137
T/F: Rivaroxaban is metabolized by P-glycoprotein, which is similar to CYP3A4
True
138
What ADRs are associated with Rivaroxaban?
1. Bleeding 2. Increased CVA risk after discontinuing in Afib patients 3. Spinal/Epidural hematoma 4. Abdominal pain 5. Dyspepsia 6. Fatigue 7. Back Pain
139
What are the indications for Apixaban (eliquis) use?
Reduce CVA risk in nonvalvular Afib
140
T/F: Apixaban (Eliquis) is NOT a substrate of CYP3A4
False | It is
141
Is there a specific antidote for Apixaban (Eliquis)
No
142
Which anticoagulant should be used in patients with renal failure? prosthetic heart valves? decreased ischemic stroke risk?
Warfarin Warfarin Dabigatran
143
T/F: Anticoagulants can often be continued through minor dental procedures, skin surgeries, or cataract surgery
True
144
Should anticoagulants be continued through invasive surgery? When should they be restarted?
No Restart 12-24 hours post-op
145
______ is an antiplatelet drug that inhibits COX1 and TXA2
Aspirin (ASA)
146
What are indications for ASA use?
1. Pain Relief 2. Fever Reducer 3. Inflammatory treatment 4. Secondary TIA prevention 5. Post-MI or CAD patients 6. Primary Prevention of ischemic cardiac events 7. Kawasaki's disease
147
What ADRs are associated with ASA use?
GI Bleed Abdominal pain, N/V Decreased Renal Function
148
_____ _______ commonly occurs when ASA is given to children with influenza or chicken pox. Sx include.... ``` Vomiting Somnolence Diarrhea Tachypnea Irritabilty ```
Reye's Syndrome
149
What composes the "ASA Triad"?
Asthma Nasal Polyps ASA Sensitivity This can result in a life-threatening asthma attack
150
What dose of ASA is given in "MONA Therapy" in AMI?
325 mg
151
___________ works to inhibit DP receptor binding and ADP activation in the G protein complex to block platelet activation and aggregation irreversibly.
Clopidogrel (Plavix)
152
What are the indications for Clopidogrel (Plavix) use?
1. Unstable angina / NSTEMI (Reduce CVA/MI risk deaths) 2. STEMI (reduce re-infarct) 3. Recent MI / CVA 4. PAD
153
T/F: Clopidogrel has a increased effectiveness in poor etabolizers
False | It has a diminished effect
154
Other than bleeding, what ADR is associated with Clopidogrel?
TTP
155
This anti-platelet drug is a prodrug which inhibits ADP-dependent platelet aggregation and activation
Prasugrel (Effient)
156
T/F: Prasugrel (Effient) is converted to an active metabolite by CYP3A4
True
157
Other than active bleeding, what is a contraindication of Prasugrel (Effient) use?
Previous TIA / CVA
158
This anti-platelet drug is a direct acting, REVERSIBLE P2Y12 inhibitor which has a greater effect on platelet inhibition.
Ticagrelor (Brilinta)
159
T/F: Ticagrelor is metabolized by CYP 3A4
True
160
This anti-platelet drug also acts as a vasodilator and is also indicated for caudication treatment
Cilostazol (Pletal)
161
In what cardiac disease if Cilostazol use contraindicated?
Heart Failure
162
Why should Cilostazol be avoided in the elderly?
Increased syncope risk
163
What ADRs are associated with Cilostazol?
Headache Diarrhea Abnormal Stools Rhinitis
164
What are the recommendations for anti-platelet therapy following PCI treatment for STEMI?
1. ASA (81 mg following PCI) 2. Plavix 3. Effient 4. Brilinta
165
What is the antifibrinolytic drug we learned about? What are the agents?
Tissue Plasminogen Activators (t-PA) Alteplase Reteplase Tenecteplase
166
Where does t-PA bind to fibrin
binds to fibrin via lysine binding sites
167
What are the indications of tPA use?
1. STEMI (within 12 hrs of onset, w/o PCI access) 2. Acute CVA (Within first 4.5 hours) 3. PE
168
What are contraindications of tPA use?
1. Intracranial hemorrhage/malignancy/Surgery 2. Aortic Dissection 3. Active bleeding 4. Uncontrolled HTN
169
Other than bleeding, what ADRs are associated with tPA?
Hypersensitivity Hypotension Cerebral Edema
170
What is the name of the fibrinolytic antidotes? `
Aminocaproic acid Tranexamic Acid Lysine anolog
171
What is improtant to remember in assessing a patient's stool patterns for constipation or diarrhea?
Everyone has their own "normal"
172
What classes of medications commonly have constipation as an ADR?
``` Opiods Anticholinergics Antidepressants Antacids Iron Verapamil ```
173
What is first line for constipation treatment? What can this be combined with to improve bowel movements?
Soluble fiber (20-25g daily - slow increase) Increased fluids Increased exercise
174
What are the bulk-forming laxatives
``` Psyllium (Metamucil) ethylcellulose (Citrucel) Calcium polycarbophil (Fibercon) Fiber inulin (Metamucil clear) Wheat Dextrin (Benefiber) Malt Soup Extract (Maltsupex Liquid) ```
175
How do the bulk forming laxative work?
Dissolve or sell in intestinal fluid to distend colon and promote peristalsis
176
Are bulking agents a good option for the elderly or post-partum women?
Yes In general this is a good choice in patients who need to avoid straining
177
What ADRs are associated with bulk-forming laxative?
Bloating Flatulence Cramping
178
Should bulk-forming laxatives be avoided in with DM? Megacolon? Fecal Impaction?
Yes
179
What are the emollient laxatives ("stool softners")?
``` Docusate Sodium (Colace) Docusate Calcium (Kaopectate) ```
180
How do emollient laxatives work?
Increase wetting of intestinal fluid to create a soft mass
181
Are emollient laxatives a good choice for colostomy patients?
Yes
182
What are common ADRs of emollient laxative use?
Diarrhea | Abdominal Cramping
183
T/F: Mineral Oil is a Emolient laxative
True
184
Why should you not take Mineral Oil at bed time? What is this
To avoid lipid pneumonia PNA caused by ingestion or inhalation of mineral oil Sx include.... Hemoptysis Cough Dyspnea
185
What are the saline laxatives?
``` Magnesium Citrate (Citroma) Magnesium Hydroxide (Phillip's Milk) Magnesium Sulfate (Epsom Salt) Magnesium Oxide (Mag-Ox) Sodium Phosphate (Fleet Phospho-Soda) ```
186
How do Saline Laxatives work?
Increases SI intestinal pressure and stimulates intestinal motility
187
Are Saline laxatives a good choice for patients who need complete bowel evacuation?
Yes
188
Are saline laxatives contraindicated in patients with and ileostomy, colostomy, or renal impairment?
Yes
189
What ADRs are associated with saline laxatives?
N/V/D Cramping Dehydration
190
Saline laxatives should be taken on an ________ stomach.
Empty
191
What are the TWO hyperosmotic laxitives?
1. Glycerin (Fleet Suppository | 2. Polyethylene glycol (Miralax / Dulcolax)
192
How do hyperosmotic laxatives works?
Create an osmotic effect in combination with an irritating effect to cause a BM
193
Are hyperosmotic laxatives more useful for chronic or occasional laxatives?
Occasional
194
What are the most common ADRs associated with hyperosmotic laxatives
``` Rectal irritation Bloating Cramping Flatulence Diarrhea ```
195
This non-digestible sugar is a prescription only "anti-constipaiton" medication
Lactulose
196
Lactulose is useful in treating constipation in the elderly as well as in _______-induced constipation
opioid-induced
197
What ADRs are associated with Lactulose?
``` Diarrhea Flatulence Nausea Abdominal Discomfort Bloating ```
198
Lactulose can also be given to treat _________ ___________
Hepatic Encephalopathy
199
What are the sugar alcohols that are used to treat constipation
Sorbitol Mannitol Xylitol
200
Sugar alcohols may effect ______ levels in diabetes
glucose
201
What are the stimulant laxatives used to treat constipation?
``` Sennosides (Senoket) Bisacodyl (Dulcolax) Castor Oil Aloe Cascara Sagrada ```
202
How do stimulant laxatives work?
Increase peristalic activity of intestines via irritation. Irritation also stimulates water accumulation and intestinal motility.
203
When should stimulant laxatives be used?
1. Colostomies 2. Opioid use 3. Bowel evacuation prior to GI procedures
204
Castor oil should be avoided in ________.
Pregnancy
205
___________ + _______ is the best combination to treat opioid induced constipation
stimulant + Emollient | Senokot-S or Perdiem Granules
206
_______ are great to use in children
Probiotics
207
What are TWO non-pharmacological ways to manage constipation in children?
1. Establish a regular toileting routine | 2. Consider a change in diet
208
What medications are recommended in children to treat constipation? What should be AVOIDED?
1. Docusate or MOM 2. Glycerin suppositories (2-6 y.o.) Avoid... Mineral Oil Castor Oil Magnesium Sulfate
209
What is the most common age group effected by constipation?
Elderly
210
______-________ laxatives are the first line choice in elderly with constipation? What should be avoided?
Bulk-forming laxatives Avoid.... Saline Laxatives Mineral Oil
211
What anti-constipation medications should be avoided in pregnancy?
Mineral oil Caster Oil Saline Laxatives
212
This intestinal secretagogue is a prostaglandin E derivative that actives CIC-2 to increase fluid secretion to aid in the passage of stools.
Lubiprostone (Amitiza)
213
What are the indications for Lubiprostone?
1. Chronic Idiopathic Constipation | 2. Constipation in IBS
214
What ADRs are associated with Lubiprostone?
Nausea (take with food to reduce) Diarrhea Dyspnea
215
This intestinal secretagogue is a guanylate cyclase agonist that increases Cl- channel activity which increases fluid secretion and intestinal motility.
Linaclotide (Linzess)
216
What are the indications for Linaclotide use?
1. Idiopathic chronic constipation | 2. Constipation in IBS
217
What are the contraindications for Linaclotide use?
1. Pediatrics | 2. Mechanical Bowel Obstruction
218
What ADRs are associated with Linaclotide use?
``` Diarrhea Abdominal Pain Headache Flatulence Gastroenteritis Bloating GERD Vomiting Fatigue ```
219
__________ is the newest medication for idiopathic chronic constipation, which is a guanylate cyclase-C agonist structurally identical to uroguanylin that increases fluid movement into the intestinal lumen
Plecanatide (Trulance)
220
T/F: Plecanatide is contraindicated in kids under 12 y.o
False | Contraindicated in kids under 6 yo.
221
What is the most common ADR associated with Plecanatide? Most severe?
Diarrhea Dehydration
222
In what age group is diarrhea more common?
Children less than 5 y.o.
223
What types of medications are associated with diarrhea? | THERES A LOT
1. Antibiotics 2. Metformin 3. SSRIs 4. Mg2+ containing antacids 5. Colchicine 6. Corticosteroids 7. Digoxin 8. Diuretics 9. Laxatives 10. Chemotherapy 11. Propanolol 12. Quinidine
224
What is a common, more serious, result of diarrhea, especially in children? How can this be treated non-pharmocologically? If you have diarrhea should you continue eating?
Fluid lose and electrolyte imbalance FLUID REPLACEMENT: Pedialyte in children Soup in adults YES! (Small meals, avoid fats/spices, limit dairy)
225
What are the anti-motility agents used in diarrhea treatment?
1. Loperamide (Imodium) 2. Diphenoxylate/Atropine (Lomotil) 3. Morphine 4. Difenoxin/Atropine (Motofen)
226
What anti-motility drug is the treatment of choice in most cases of diarrhea treatment?
Loperamide (Imodium)
227
How does Loperamide work?
Opioid agonist Slows intestinal motility Allows for absorption
228
When should Loperamide be avoided?
Avoid in bloody diarrhea or inflammatory processes
229
T/F: The FDA warns that Loperamide has an abuse potiential (especially in opioid withdrawal treatment) and has been linked to cardiac events like torsades, ventricular arrhythmias, or SCD
True
230
What common ADRs are associated with Loperamide?
``` Dizziness Constipation Abdominal Pain Dry Mouth Sedation ```
231
Should loperamide be avoided in children under 6 y.o.? In C. Diff patients?
YES
232
Diphenoxylate works to ________ GI transit time and is used in combination with atropine which is a ___________ that inhibits smooth muscle tone in the GI tract decreasing ________
Lengthens Anti-cholinergic Peristalsis
233
Should Diphenoxylate/Atropine (Lomotil) be used in children under 2 y.o.?
No
234
What ADRs are associated with Diphenoxylate/Atropine?
1. Sedation 2. Dizziness/Headache 3. Abdominal Pain 4. N/V 5. Anaphylaxis 6. Toxic Megacolon in UC patients
235
T/F: Alcohol will interact with Diphenoxylate/Atropine
True
236
Difenoxin is an _________ metabolite of Diphenoxylate with a similar MOA and ADRs
Active
237
What are the anti-secretory agents used to treat diarrhea
Bismuth Subsalicylates (Pepto Bismol) Lactase Enzymes Probiotics Octreotide
238
How does Bismuth Subsalicylate (Pepto) work?
Reacts with hydrochloric acid in the stomach to form bismuth oxychloride and salicylic acid Increases stool consistency Decrease N/V/D
239
Why should Bismuth Subsalicylates be avoid in children under 12 y.o? What could an overdose cause?
Reye's Syndrome risk in children OD can result in neurotoxicity
240
Should Bismuth Subsalicylates be used in pregnancy?
No
241
T/F: Bismuth Subsalicylates does NOT interact with Warfarin, tetracyclines, or ciprofloxacin
False | It does
242
_______ is a anti-secretory agent that is used in patients with diarrhea due to lactose intolerance
Lactase (Lactaid)
243
________ is an opioid receptor agonist used to treat IBS related diarrhea in adults.
Eluxadoline (Viberzi)
244
In what conditions is Eluxadoline contradindicated
Hepatitis Pancreatitis Alcohol Abuse
245
This anti-secretory agent is a somastatin analog used to treat diarrhea associated with a VIP tumor or acromegaly
Octreotide
246
_________ __ is commonly used to treat rectal hemorrhoids
Preparation H ointment
247
What are the anticholinergic medications (antispasmodics) which work to increae motility to decrease abdominal pain Are these typically used short-term, PRN, or long-term?
Dicyclomine (Bentyl) Hyoscyamine (Levsin) Methscopolamine Short-term or PRN
248
__________ is a antimuscarnic (anticholinergic) that relaxes smooth muscle spasm in the GI tract
Dicyclomine (Bentyl)
249
Is dicyclomine (Bentyl) contraindicated in GI obstruction, Reflux, and Glaucoma?
Yes
250
What ADRs are associated with Dicyclomine (Bentyl)?
1. Dry mouth, N/V, constipation 2. CNS effects 3. Blurred vision, diplopia 4. Urinary Hesitancy/retention 5. Tachycardia 6. Dyspnea, apnea 7. Lactation Suppression
251
What class of anti-arrhythmics does Dicyclomine (Bentyl) interact with?
Class 1
252
_________ is a 5-HT3 receptor agonist that prevents serotonin binding that blocks abdominal pain signals and reduces GI secretion
Alostetron (Lotronex)
253
What are the indications for Alostetron (Lotronex) use?
1. Severe IBS associated diarrhea that has not responded to typically treatment
254
What are contraindications of Alostetron (Lotronex) use?
1. Constipation | 2. Severe hepatic/bowel disorders
255
T/F: Alosetron is metabolized by CYP3A4
True
256
What ADR is associated with Alostetron (Lotronex) use? What should you do? What can it progress to?
1. Constipation | d/c immediately b/c it can progress to Toxic Megacolon or obstruction
257
_________ is similar to Dicyclomine, but is not FDA approved
Hyoscyamine (Levsin)
258
________ ___ is a supplement that works similar to antispasmodics to slow peristalsis and relax GI smooth muscle
Peppermint Oil
259
What ADRs are associated with Peppermint Oil?
1. Dyspepsis 2. N/V 3. Hypersensitivity
260
T/F: Peppermint Oil is a mild P450 inducer
False | Inhibitor
261
______ are typically used to treat IBS. What are examples of these?
Salicylates Mesalamine sulfasalazine olsalazine balsalazide
262
_______ is a salicylate and is the drug of choice for UC treatment
Sulfasalzine (Azulfidine)
263
What ADRs are associated with Sulfasalzine (Azulfidine) use?
1. Nausea, Diarrhea, Abdominal Pain 2. Photosensitiity 3. Reversible oligospermia 4. Hepatotoxicity 5. Rare renal toxicity 6. Rare serious rash (Stevens-Johnson) 7. Rare blood dyscrasias 8. Rare goiter, hypoglycemia, diuresis
264
_____________ is a salicylate that is believed to have anti-inflammator effects and is indicated for the treatment of UC
Mesalamine
265
What is the most concerning ADR associated with Mesalamine?
Mesalamine-induced acute intolerance syndrome (Cramping, bloody diarrhea, fever, headache, rash) Discontinue the drug if you see this
266
___________________ is a corticosteroid used in the management of moderate to severe IBD and mild to moderate Crohn's Disease
Budesonide (Entocort)
267
________ is the most effective corticosteroid in the use of moderate to severe Crohn's Disease or IBD not responding to mesalamine
Prednisone
268
What should be monitored when giving corticosteroids?
1. Adrenal Insufficiency 2. BMD 3. Eye Exam 4. Hyperglycemia 5. Infection
269
What are the two purine antimetabolites which act as immunosuppressants? What are their indications?
Azathioprine (AZA) which is used in transplant rejection and RA 6-mercaptopurine (6-MP) which is used in Leukemia
270
Are purine anti-metabolites indicated in pregnancy?
No
271
What ADRs are associated with purine antimetabolites?
1. Increased risk of lymphoma/malignancies 2. Bone marrow suppression (Monitor CBC) 3. N/V 4. Hepatotoxicity 5. Rash, Fever, Arthralgia
272
What are the TWO Tnf-alpha inhibitors
Infliximab (Remicade) | Golimumab (Simponi)
273
What are the indications for Tnf-alpha inhibitor use
1. Crohn's 2. UC 3. RA
274
How do Tnf-alpha inhibitors work?
Block tumor necrosis factor alpha
275
In what condition are Tnf-alpha inhibitors contraindicated
CHF
276
What types of medications relax the LES?
NItrates CCBs Beta-blockers Anticholinergics
277
What foods/drinks worsen GERD Sx?
``` Alcohol Carbonated Drinks Chocolate Coffee Fatty Foods Peppermint Spicy Food Tomato Products ```
278
What are FOUR examples of antacids?
Aluminumon Hydroxide Magnesium Hydroxide Calcium Carbonate Sodium Bicarbonate
279
How do antacids work?
They neutralize stomach acids as weak bases
280
What ADRs are associated with Sodium Bicarbonate? Calcium Carbonate? Magnesium hydroxide? Aluminum Hydroxide?
1. Gastric Distension 2. Eructation 3. Fluid retention 4. Metabolic Alkalosis in higher doses 1. Eructation 2. Metabolic Alkalosis 1. Diarrhea 1. Constipation
281
What are the FOUR H2 receptor blockers? | Histamine receptor antagonists
1. Ranitidine (Zantac) 2. Famotidine (Pepcid) 3. Nizatadine (Axid) 4. Cimetidine (Tagamet)
282
How do H2 receptor blockers work?
Competitively inhibit parietal H2 receptors for great potency and longer duration of action than antacids
283
What are the indications for H2RAs use?
1. Gastric and duodenal ulcers 2. Short-term treatment of uncomplicated GERD 3. Stress ulcer prophylaxis 4. Hypersecretory conditions
284
What ADRs are associated with Famotidine (Pepcid) and Nizatadine (Axid)?
Headache Dizziness Diarrhea Constipation
285
T/F: Ranitidine will interact with Warfarin, Ketoconazole, Glipizide (Increase levels), Procainamide (increases levels)
True
286
T/F: Cimetidine is a P45o inducer
False | It is an inhibitor
287
What ADRs are associated with Cimetidine?
``` Diarrhea Dizziness Headache Gynecomastia (Long term) Bradycardia Tachycardia Agranulocytosis ```
288
How do Proton Pump Inhibitors work?
Ireversibly block proton pumps on parietal cells which is the terminal step in HCL production.
289
T/F: Proton Pump Inhibitors are prodrugs
True
290
What are the indications for proton pump inhibitor use?
GERD Gastric and duodenal Ulcers Hypersecretory conditions
291
What ADRs are associated with PPIs?
1. Nausea, Diarrhea, Flatulence 2. Myopathy, Arthralgia 3. Decreased B12 absorption 4. Increased C. diff (Elderly, ABx use) 5. Increased Fx risk (max use 14 days up to 3x yearly) 6. Increased PNA (S. Pneumo)
292
What are the FIVE PPIs?
1. Omeprazole (Prilosec) 2. Esomeprazole (Nexium) 3. Lansoprazole (Prevaicd) 4. Pantoprazole (Protonix) 5. Rabeprazole (AcipHex)
293
T/F: Omeprazole and Esomeprazole interact with Clopidogrel and warfarin
True
294
PPIs should be a course of __ weeks, starting ____ daily and moving to __ if partial response. _______ can be added as maintenance or in combination with PPIs at bedtime.
8 weeks once daily BID H2RAs
295
At what age can antacids be used without physician recommendation? H2RAs? PPIs?
> 2y.o. > 12 y.o. > 18 y.o.
296
What is the first line for treatment for ulcers?
PPI, Amoxicillin, Clarithromycin | Metronidazole can be used as an alternative to clarithromycin
297
What are the THREE cytoprotective Agents?
Bismuth Subsalicylate (Pepto Bismol) Sucralfate (Carafate) Misoprostol (Cytotec)
298
If Bismuth Subsalicylates are used for H. ptlori treatment what should it be used in combination with?
Tetracycline | Metronidazole
299
T/F: Black tongue is a common side effect of Bismuth Subsalicylate
True
300
How does Sucralfate (Carafate) work?
Creates a "gooey" gel that adheres to the ulcer and inhibits pepsin activity
301
What are the indications for Sulcralfate (Carafate) use?
Short-term treatment of duodenal ulcers
302
What is a contraindication for Sucralfate use?
Renal Disease
303
What ADRs are associated with Sucralfate (Carafate)?
1. Constipation 2. Diarrhea 3. Dry mouth 4. N/V 5. Flatuence
304
____________________ is a prostoglandin E1 analog that binds to EP3 receptors on parietal cells to suppress acid production and stimulates the production of mucus and bicarb.
Misoprostol (Cytotec)
305
How is Misoprostol (Cytotec) used?
To prevent NSAID induced ulcers | commonly packaged with diclofenac
306
Misoprostol (Cytotec) is pregnancy category __.
X It increases uterine contractility and can lead to miscarraige
307
What non-pharmacologic treatments would you recommend for gastroporesis?
1. Diet: Small Frequent Meals 2. Discontinue meds causing slower gastric transit 3. Antiemetics 4. Prokinetic Agents
308
Patients with gastroporesis should be on a ____ ________ diet and avoid ____ ____ or _____ foods.
Low residue High fiber Raw
309
What are the THREE prokinetic agents?
Metoclopramide (Reglan) Erythromycin Domperidone
310
What are the indications for Metoclopramide (Reglan) use?
1. DM Gastroporesis | 2. Symptomatic GERD
311
How does Metoclopramide (Reglan) work?
Central and Peripheral D2 receptor antagonist Acitivates serotonin receptors to release acetylcholine Accelerates gastric emptying
312
In what conditions is Mectoclopramide (Reglan) contraindicated?
1. Intestinal Obstruction/Hemorrhage/Perforation 2. Epilepsy 3. Phenochromocytoma
313
What are the ADRs associated with Metoclopramide (Reglan)?
``` Headache N/V Fatigue Somnolence Sleep Disturbances Agitation Akathisia ```
314
Is Metoclopramide (Reglan) associated with hyperprolactinemia
Yes
315
What is the most severe side effect of Metoclopramide (Reglan)?
Tardive Dyskinesia Uncontrolled movements Irreversible Common when used for > 3 months, women, elderly Also can see..... ``` Dystonia Depression Suicide Parkinsonian Tremors Neuroleptic Malignant Syndrome HTN Edema ```
316
_________ is a D2 receptor antagonist with similar effects as Metocloparmide but DOES NOT cross the BBB
Domperidone
317
T/F: Domperidone is associated with a prolonged QT, cardiac arrest, and SCD and is no longer approved by the FDA in the US
True
318
How does erythromycin work as a prokinetic drug?
It works on motilin receptors in the stomach and duodenum.
319
What are the indications for erythromycin use as a prokinetic?
1. Diabetic Gastroporesis 2. Idiopathic Gastroporesis 3. Post-surgical gastroporesis
320
What are common ADRs associated with Erthromycin?
1. N/V/D 2. Abdominal Pain 3. Anorexia 4. Prolonged QT 5. Liver abnormalities 6. C. diff
321
What are the phenothiazines antiemetics?
Promethazine (Phenergan) Prochlorperazine (Compazine) Trimethobenzamide (tigan)
322
Promethazine (Phenergan) is a ______________ which blocks ___ receptors.
Antihistamine H1
323
What are the indications for Promethazine (Phenergan)?
1. Nausea and vomiting 2. Allergic and vasomotor rhinitis 3. Urticaria 4. Anaphylaxis 5. Motion Sickness
324
Should you use Phenergan in children under 2 y.o.?
No (Fatal respiratory Depression)
325
What warnings are associated with Promethazine (Phenergan) use?
Neuroleptic malignant syndrome CNS depression Bone marrow depression
326
What is neuroleptic malignant syndrome?
Potentially fatal adverse reaction to medications ``` Sx..... Fever Sweating Unstable BP Stupor Muscular Rigidity Tachycardia ``` Presents withing the 1st week of use
327
What is a treatment option for refractory gastroporesis?
Botox injections (paralyzes pyloric valve)
328
_______ is a pancreatic enzyme that is used to treat cystic fibrosis, chronic pancreatitis, and following a pancreatectomy
Pancrelipase (Creon)
329
What ADRs are associated with Pancrelipase (Creon)?
Colonopathy Hyperuricemia Allergy
330
What types of foods should patients avoid in celiac disease?
``` Wheat Barley Rye Spelt Triticale Kamut Einkorn Some oats ```
331
This weight loss medication is a reversible gastric and pancreatic lipase inhibitor that mimics systemic absorption. Diet must be < 30% fat
Orlistat (Alli)
332
Orlistat may be taken ___ times a day with meals
3x
333
T/F: Orlistat is NOT a good choice for patients who do not feel hungry or have an increased risk for cardiovascular disease
False | It is
334
What are the indications for Orlistat use?
Obesity Management Weight Loss Weight Maintenance
335
What are the contraindications to Orlistat use?
``` Pregnancy Chronic Malabsorption syndrome Cholestasis Hx of CaO kidney stones Hx of anorexia/Bulimia ```
336
What ADRs are associated with Orlistat?
1. Diarrhea 2. Steatorrhea 3. Oily Spotting, Stools 4. Flatulence 5. Fecal Urgency
337
What are the SERIOUS ADRs associated with Orlistat?
1. Hypersensitivity 2. Angioedema 3. Vitamin Deficiencies 4. Hepatotoxicity 5. Lower GI Bleed
338
Orlistat will _____ ____ when it interacts with arfarin and ______ vitamin K absorption
Increase INR Decrease
339
This is a weight loss medication is a serotonin receptor agonist which is thought to decrease food intake.
Lorcaserin (Belviq)
340
What things should be monitored when a patient is using Lorcaserin (Belviq)
Monitor for depression or SI Monitor blood glucose
341
T/F: Priapism is not associated with Lorcaserin (Belviq)
False | It is
342
T/F: Lorcaserin with interact with serotonin drugs
True
343
What ADRs are associated with Lorcaserin (Belviq)?
``` Headache Dizziness Fatigue Nausea Dry mouth Constipation Cough Bradycardia hyperprolactinemia ```
344
______/______ is an opioid antagonist in combination with an antidepressant that is used for weight loss in obesity and in the overweight with comorbidities
Naltrexone/Bupropion (Contrave)
345
What are the contraindications to Naltrexone/Bupropion (Contrave) use?
Uncontrolled HTN Sz Chronic Opioid use
346
What are the warning associated with Naltrexone/Bupropion (Contrave)?
``` SI SZ HTN Tachycardia Liver dysfunction ```
347
What ADRs are associated with Naltrexone/Bupropion (Contrave) use?
``` N/V/D Constipation HA Dizziness Insomina Dry Mouth ```
348
What THREE drugs are approved for short term use in weight loss?
Phentermine Diethylpropion Phendimetrazine
349
___________ is a sympathomimetic similar to amphetamines that stimulates CNS activity promoting catecholamine release thus decreasing hunger
Phentermine
350
Patients with a history of what should not take Phentermine?
Heart Disease
351
What SERIOUS ADRs are associated with Phentermine?
``` Dependency Psychosis Tachycardia HTN Pulmonary HTN Valvular Heart Disease ```
352
_______ is a antiseizure medication that is used off-label as monotherapy for weight loss
Qsymia
353
In what THREE conditions is Qsymia contraindicated
1. Pregnancy 2. Glaucoma 3. Hyperthyroidism
354
T/F: Qsymia interacts with OCP and EtOH
True
355
_______ is a short-term option (<12 weeks of use) for weight lose that is a sympathomimetics that stimulates catecholamine release decreasing hunger
Diethylpropion (Tenuate)
356
What are the contraindications of Diethylpropion (Tenuate) use?
``` Pulmonary HTN Severe HTN Agitiation Heart Murmurs Valvular disease CAD Arteriosclerosis ```
357
What are the common ADRs of Diethylpropion (Tenuate) use?
``` Dry Mouth Diarrhea/Constipation Restlessness/Anxiety Headache HTN Palpitation/Arrhythmias ```
358
_____ is another short term weight lose drug similar to Diethylpropion/
Phendimetrazine (Bontril)
359
What ADRs are associated with Phendimetrazine (Bontril) use?
``` Palpitations Tachycardia Restlessness Hypertension Insomnia Agitation Dizziness Headache Flushing Sweating Tolerance Diarrhea/constipation ```
360
What shou;ld be evaluated prior to starting Phendimetrazine?
Cardiology baseline functions EKG BP CV Exam Echocardiogram should be considered
361
What THREE drugs are used off-label for weight loss?
Desvenlafaxine (Pristiq) Spironolactone Pindolol
362
________ is a recently approved drug for binge-eating disorder and is a prodrug of dextroamphetamine.
Lisdexamfetamine (Vyvanse)
363
What are the serious warnings associated with Lisdexamfetamine (Vyvanse)?
1. Serious CV events 2. HTN 3. Tachycardia 4. Peripheral Vasculopathy 5. Psychotic/Mania
364
What are the common ADRs of Lisdexamfetamine (Vyvanse) use?
1. Dry Mouth 2. Insomnia 3. Decreased appetite 4. Increased HR 5. Constipation 6. Feeling jittery 7. Anxiety
365
How much did this suck?
A good amount

Pharm Test - 4 (1 decks)

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