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Pharm > Week 1-4 > Flashcards

Week 1-4 Flashcards

(57 cards)

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1
Q

What are the steps in Rational Drug Selection

A

Define the issue
Specify theraputic goal
Collaborate w/ patient
Monitor effectiveness

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2
Q

What are some theraputic goals

A

Cure
Manage
Relieve symptoms
Replace deficiencies

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3
Q

What is the ICanPresCribE A Drug mneumonic?

A 
Indication
Contraindications
Precautions
Cost/compliance
Efficacy
Adverse effects
Dose/Duration
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4
Q

What are examples of active and passive monitoring

A

Active- lab tests

Passive- pt education about expected outcomes

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5
Q

What is bioavailibilty?

A

The percentage of drug that reaches circulation

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6
Q

How are most drugs metabolized

A

Liver pathways

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7
Q

How are most drugs excreted

A

Kidneys

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8
Q

What is the Dose concentration curve?

A

Peak concentration- when effect should be noticed

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9
Q

In pharmacodynamics, the theraputic index is important in drug selection. What is the difference between a narrow and wide index drug?

A

Narrow index- the balance between theraputic and toxic effects are limited. Drug must be closely monitors
Wide Index- The balance between theraputic and toxic effects is very large. Generally safer and requires little monitoring

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10
Q

When prescribing a medication “off-label,” what must the clinician do?

A

Inform the patient

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11
Q

Who determines what can be prescribed? Who determines who can prescribe it?

A

Federal (FDA) what can be prescribed.

State (Practice acts) who can prescribe.

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12
Q

What are Schedule II controled substances?

A

High potential for aduse & severe dependnce
Cannot issue refills
Cannot call in
Opiates (not incombination with non-narcotic & amphetamines)

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13
Q

What are Schedule III drugs?

A 
Less potential for abuse than I&II
Lower phsycial dependency but high psychological dependecny
Rx expires after 6 mo
Only 5 refills in 6 mo
OK to call in
Narcotics w/ non-narcotic meds
Anabolic steriods, testosterone
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14
Q

What is schedule IV?

A

Lower abuse potential, limited physical/psycholigcal dependency
Benzos
Tramadol
Phentermine, meprobamate, diethypropion

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15
Q

What is Schedule V drugs?

A

Lowest risk, may be dispensed w/o an Rx

Loperamide, Robutussin AC

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16
Q

What are the 4 ranges of ADR severity

A

Minor (no tx or extended hospitalization needed)
Moderate (treatment change needed)
Severe (intensive treatment needed)
Lethal

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17
Q

What are the types of ADRs?

A

Type A: Augmented (expected, known, expected)
Type B: Bizarre (hypersensitivty & allergic reactions)
Type C: Continuous (for years after exposure)
Type D: Delayed (not appearant at time taken) teratogens & carcinogens
Type E: End of use (abrupt stop of chronic therapy) W/D, addisions
Type F: Failure of efficacy

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18
Q

Are cells able to change the number of receptors?

A

Yes, down-regulate (decreased # of receptors) and occurs due to continual exposure to agonist.
Up-regulate (increased # receptors) and occurs due to exposure to antagonist

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19
Q

What is the relationship with # of receptors filled and response

A

More receptors bound equals higher response

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20
Q

An agonist drug does what?

A

Increases cellular activity

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21
Q

An antagonist drug does what?

A

Blocks cellular activity

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22
Q

What is drug distribution

A

Movement from tissues (fat/muscle) to targe cells

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23
Q

Can protein bound drugs exert action?

Study These Flashcards
A

No, only free drugs can exert action

24
Q

How do protein bound drugs exert action>

Study These Flashcards
A

Must be freed from protein, generally when proteins are saturated or other drugs cause to unbind (depending on affinity).

25
What is the most common drug metabolism enzyme pathway?
CYP450 Inhibition of the enzyme leads to increased drug concentration Induction causeas increased metabolism (low drug levels)
26
What are some common CYP450 inhibitors?
``` Clarithromycin Cimetidine Keoconizole Valporic acid IHN Erythromycin Qunidine Grapefruit juice Omeprazole ```
27
What are some common inducers?
Barbituates Carbamazepine Rifampin Phenytoin
28
How many lives does it take to reach theraputic concentration?
4-5
29
What are the different symptoms between duodenal and gastric ulcer?
Gastric lacks a pattern, exacerbated w/ food and commonly experience N/V and anorexia Duodenal usually worsened by specific foods, noctural symtpoms, food eases symptoms.
30
When treating iron deficiency anemia, what is the follow up?
Repeat CBC in 2 weeks, then H&H and ferritin 4 weeks | Monitor 3 mo, then annually when stable.
31
A Child with thalasemia usually presents with?
Sx of IDA Enlarged spleen Bone deformities
32
Which patients is at the highest risk for folic acid deficiency?
Alcoholics, anorexics, crohns disease, and vegans
33
What is chelation?
When drugs bind to other medications & prevent absorbtion (decreases quilolones) Common with mineral salts
34
What patients should not have aluminum & magnesium salt antacids?
Renal patients
35
Which GI drug inhibits hepatic enzymes and increases drug levels?
Cimetidine
36
Which 2 acid blocking drugs are approved for use in children?
Rantidine & famotidine
37
What are some ADRs for PPIs
Hypomagnesemia Nutrient deficiencies: iron, b12 and calcium Osteoporosis risk GI infection (c-diff, salmonella, camphylobacter) Increased GI cancer risk??
38
What drugs can PPIs alter absorbtion?
``` Some Antivirals (atazanavir, indinavir) warfarin & Plavix (block box warning) ```
39
How do GI antispasmotics work?
Blocking muscarinic receptors on parietal cells | Decrease acid production
40
What drug can be given if NSAIDS cannot be avoided in someone with GERD?
Misoprostol (Cytotec)- Pregnancy class X (abortative
41
What is a risk with the prokinetic drug reglan (metoclopramide)
Tardive dsykinesia
42
Can pepto-bismol be given to a child with flu or varicella?
No, risk of Reye Syndrome
43
Which anti-diarrhea is a controlled substance?
Lomotil- diphenoxylate is a narcotic
44
Can immodium be used in a 1 year old?
No- risk of resp & cardiac depression under 2 yo
45
How do phenothiazine drugs work to treat nausea and vomiting?
Inhibit central dopamine receptors
46
Can promethazine be given to a 2 year old?
NO BBW under leads to fatal respiratory depression
47
How does reglan work?
It is a dopamine antagonist, blocks at the CTZ
48
How do 5HT-3 receptor antagonists work?
Block serotonin action in vomiting center via afferent nerves
49
Which class of anti-emetics should not be used with prolonged QT?
5HT-3 antagoinsts | Phenothiazines
50
What anti-emetic, or emesis prevention drug should not be used in someone with glaucoma?
Anticholinergics (hyoscine)
51
Which drugs increase LES tone?
Cholinergics: Bethanechol and Reglan
52
How are bethanchol and metoclopramide typically used in GERD
In combination with antacids- the prokinetic action and strengthening of LES is adjunctive and acids blockers are still needed.
53
What drugs tend to exacerbate GERD
NSAIDS, anticholinergics, alpha adernergics, prostaglandings, theophylline, sedatives, CCBs and nitrates.
54
What is the first line treatment in erosoive gastric disease?
PPIs
55
What are the steps in step up/down approach to GERD?
Lifestyle modification- antacids- h2RA blokcers x 4-8 weeks, PPI x 8 weeks (step up or step down)
56
What is the test of choice for H. Pylori
Urea breath test (97% sens/95% spec)
57
What are considered cytoprotective drugs?
Sucralfate and Mistoprostol

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