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Adv. Pharm > Advanced Pharm Exam 1 > Flashcards

Advanced Pharm Exam 1 Flashcards

1
Q

Aspirin- drug class?

A

NSAID: COX inhibitor (1st generation- inhibits COX-1 (stronger) & COX-2)

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2
Q

Aspirin- MOA?

A

Nonselective COX inhibitor, rapid binding/inhibition:

COX-1 inhibition leads to irreversible modification of platelets (last the life of platelet ~8days, until turnover), leading to decreased platelet aggregation and decreasing risk of stroke and MI.

COX-2 inhibition inhibits prostaglandin production, which decreases inflammation pathway including, decreasing pain and fever.
Aspirin induces ATLs, anti-inflammatory compounds.

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3
Q

Aspirin- adverse effects?

A

Gastro- GI distress, heartburn nausea, GI bleed, perforation, GI ulceration (with long-term use)
Renal- Renal impairment
Reyes Syndrome- in children: encephalopathy and fatty liver degeneration

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4
Q

Aspirin- indications

A

RA, OA (when other non-pharm routes and topical NSAIDs don’t work) - esp. when in multiple joints or hip joint

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5
Q

Aspirin- excretion?

A

Kidneys

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6
Q

What are the corticosteroid prototype drugs?

A

Prednisone, hydrocortisone, cortisone, methylprednisolone

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7
Q

Corticosteroids- indications?

A

RA, OA, asthma, Crohn’s disease, UC, IB
Used for inflammatory/immunologic disorders
Used as adjunctive for short term admin., during acute or exacerbation

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8
Q

Ibuprofen- indications?

A

RA and OA, pain relief, dysmenorrhea

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9
Q

Aspirin- max dose

A

3900mg PO

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10
Q

Ibuprofen- max dose?

A

3200mg/day PO over 3-4 doses
400mg every 4-6hours PRN

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11
Q

Ibuprofen- adverse effects?

A

Cardiovascular risk- thrombotic events, MI, stroke
GI risk- bleeding, ulceration, perforation (stomach/intestines)- GI risks higher for elderly

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12
Q

Corticosteroids- adverse effects

A

hypothalamic-pituitary-adrenal axis suppression: adrenal insufficiency

osteoporosis: from decreased osteoblasts decreasing bone formation and increased osteoclasts increasing bone resorption and decreased intestinal calcium leading to hypocalcemia leading to increased PTH leading to removal of calcium from the bone into blood

short term: hyperglycemia, BP changes, edema, GI bleed, poor wound healing, increased risk of infection, hypokalemia/hyperkalemia

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13
Q

Corticosteroids- MOA

A

Decrease prostaglandin & decrease leukotrienes -> decreased pro-inflammatory metabolites -> decreased inflammation

interrupted inflammatory process -> [decreased mediator synthesis -> decreased swelling, redness, pain, warmth AND decreased phagocytes -> decreased lysosomal enzymes -> decreased tissue injury -> decreased inflammation AND decreased lymphocyte proliferation -> decreased immune inflammatory response]

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14
Q

Ibuprofen- MOA?

A

Nonselective COX inhibition:
Cox-1 reversible inhibition (weaker than Aspirin) -> decreased platelet aggregation (not as long as Aspirin) -> decreases thrombotic events

Cox-2 inhibition -> decreases prostaglandin precursors -> decreased inflammatory response -> pain, fever, inflammation

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15
Q

Naproxen- drug class?

A

NSAID: 1st gen.- nonselective COX inhibitor

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16
Q

What are the NSAID prototype drugs?

A

Aspirin, Ibuprofen, Naproxen, Celecoxib, Indomethacin, Ketorolac

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17
Q

Indomethacin- drug class?

A

NSAID

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18
Q

Indomethacin- indications?

A

RA, OA, gout, closure of neonatal patent ductus arteriosus

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19
Q

Indomethacin- MOA?

A

COX inhibition -> decreased prostaglandin -> vasoconstriction (for patent ductus arteriosus) AND decreased inflammation AND decreased pain

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20
Q

Indomethacin- max dose?

A

150mg / day

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21
Q

Indomethacin- adverse effects?

A

Increased risk for CNS side effects: severe frontal headache, dizziness, vertigo, light-headed, confusion

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22
Q

Celecoxib- contraindications?

A

Patients with heart disease or recent CABG surgery

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23
Q

Celecoxib- drug class?

A

NSAID- 2nd gen. selective COX-2 inhibitor

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24
Q

Celecoxib- indications?

A

RA, OA, ankylosing spondylitis, migraine, pain, dysmenorrhea

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25
Q

Celecoxib- MOA?

A

Selective COX-2 inhibition -> decreased COX-2 -> increased vasoconstriction AND decreased prostaglandin precursors -> decreased prostaglandin synthesis -> decreased pain and inflammation

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26
Q

Celecoxib- dosing?

A

200mg

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27
Q

Celecoxib- adverse effects?

A

serious cardiovascular risk: increased risk of MI and stroke

GI risk
renal impairment

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28
Q

Diclofenac- drug class?

A

NSAID- 1st gen. nonselective COX inhibitor

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29
Q

Diclofenac- indications?

A

RA, OA, pain, dysmenorrhea

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30
Q

Diclofenac- MOA?

A

first phase: COX-1 and -2 inhibition -> decreased plasma levels -> COX-2 inhibition (only) {later phase}

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31
Q

Diclofenac- dosing?

A

Max: 200mg/day

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32
Q

Diclofenac- adverse effects?

A

Cardiovascular risk, GI risk

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33
Q

Diclofenac- routes?

A

Oral, topical (patch, spray, cream)

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34
Q

Ketorolac- drug class?

A

NSAID

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35
Q

Ketorolac- indications?

A

OA, RA
short term management of acute pain (5days or less)

Strong analgesic: rapid onset, short duration
Medium anti-inflammatory drug

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36
Q

Ketorolac- MOA?

A

COX inhibition -> decreased pain, inflammation

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37
Q

Ketorolac- dosing?

A

Max: 120mg/day for max 5 days

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38
Q

Ketorolac- adverse effects?

A

GI risk, renal damage, bleeding, hypersensitivity

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39
Q

Ketorolac- routes?

A

Oral, IV, IM, intranasally

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40
Q

Naproxen- indications?

A

Gout, RA, OA, abnormal uterine bleeding, pain, fever

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41
Q

Naproxen- MOA?

A

Nonselective COX inhibitor -> decrease prostaglandin precursors -> decrease inflammatory pathway -> decreased pain, fever, inflammation

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42
Q

Naproxen- dosing?

A

Max: 1.5g / day

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43
Q

Naproxen- adverse effects?

A

GI risk, renal impairment, nausea, dizziness, tinnitus

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44
Q

Acetaminophen- drug class?

A

Non-NSAID analgesic/antipyretic
(not anti-inflammatory)

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45
Q

Acetaminophen- indication?

A

Pain, fever

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46
Q

Acetaminophen- MOA?

A

CNS COX inhibition -> decreased prostaglandin synthesis in CNS -> decreased fever and pain

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47
Q

Acetaminophen- dosing?

A

4,000mg / 24hours

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48
Q

Acetaminophen- adverse effects?

A

Toxicity, liver damage: 72-96hours post ingestion, severe hepatomegaly (AST > 10,000IU/L), plasma bilirubin > 4.0mg/dL

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49
Q

RA- tests?

A

ESR/CRP: elevated

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50
Q

RA- S/Sx

A

Morning stiffness (doesn’t resolve with movement), symmetric inflammation/pain

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51
Q

OA- S/Sx

A

Joint pain, stiffness, swelling/tenderness, grating/clicking with movement, decreased ROM

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52
Q

RA vs. OA

A

RA: morning stiffness, symmetrical swelling/pain, caused by autoimmune

OA: asymmetrical swelling/pain, grating/clicking sound w/ movement, caused by injuries/overuse

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53
Q

CD vs. UC

A

CD: inflammation throughout GI (mouth to anus), patches of damage reaching outer lining, NOT bloody diarrhea

UC: inflammation in colon & rectum, damage maintained in inner lining, bloody diarrhea

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54
Q

Glucocorticoids- MOA for osteoporosis?

A

Increased osteoclasts, decreased osteoblasts, increased calcium excretion, decreased calcium absorption

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55
Q

Glucocorticoids- bone loss time frame?

A

After initiating steroid therapy: increased bone loss within the first 3-6months

After 6 months of therapy: continued, slowed bone loss

Increased fracture risk with 3months of Prednisone, more than 5mg / day

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56
Q

Osteoclasts

A

Bone “carving”, resorption (2-3weeks)

Activated by: osteoblasts, PTH, thyroid hormone, Vitamin D3, thyroid hormone, glucocorticoids

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57
Q

Osteoblasts

A

Bone “building”, formation

Regulated by: PTH, Vitamin D, insulin growth factor
Inhibited by: glucocorticoids

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58
Q

Recommended Calcium intake for adults?

A

1000-1200mg elemental calcium
500mg/ dose, divided throughout the day

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59
Q

What is required for calcium absorption?

A

Vitamin D

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60
Q

Vitamin D deficiency can cause what in adults and what in children?

A

Adults: osteomalacia
children: Rickets

Deficiency: Serum vitamin D <30mg/mL

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61
Q

PTH Pathway- start with Caclium

A

decreased calcium -> increased PTH -> increased calcium reabsorption -> decreased calcium in bones -> increased calcium in blood

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62
Q

Calcium carbonate (CaCO3)- environmental requirements?

A

Acidic environment for absorption- must be taken with meals

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63
Q

Calcium carbonate- adverse effects?

A

Constipation, hypocalcemia, nausea

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64
Q

Calcium carbonate- indications?

A

GERD (reduces acid in stomach)
Osteoporosis (maintains calcium levels in the blood)

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65
Q

Calcium carbonate- max dose?

A

2000mg / day

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66
Q

Alendronate- drug class?

A

Bisphosphonate: Antiresorptive agent

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67
Q

Alendronate- MOA?

A

Antiresorptive- inhibits osteoclast activity -> decreases bone loss

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68
Q

Bisphosphonates- contraindications?

A

Hypocalcemia (d/t inhibited osteoclasts -> decreased calcium released into blood)

Inability to sit up right

Caution with renal impairment (DONT USE if CrCl <35mL/min)

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69
Q

Bisphosphonates- adverse effects?

A

Dyspepsia, dysphagia, heartburn, nausea, vomiting, hypocalcemia

(bisphosphonates bind to mucosal lining of esophagus -> decrease protection -> irritation of esophagus -> dysphagia, heartburn, nausea, vomiting)

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70
Q

Bisphosphonates- dosing?

A

Must be taken separate from calcium, iron, magnesium and antiacids by at least 2 hours

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71
Q

Bisphosphonates- treatment duration?

A

3-5years (pts with low fracture risk)

72
Q

Bisphosphonate- MOA?

A

Antiresorptive: osteoclast inhibition -> decreased calcium resorption -> decreased calcium leaving bone -> decreased bone loss

72
Q

Alendronate- dosing?

A

Prevention: 5mg PO / day

Treatment: 10mg PO / day

72
Q

Ibandronate- drug class?

A

Bisphosphonate- antiresorptive

72
Q

Ibandronate- MOA?

A

Osteoclast inhibition

73
Q

Ibandronate- routes?

A

PO, IV (if pt cant sit upright/esophagitis)

74
Q

Ibandronate- dosing?

A

Oral: 150mg / monthly (must stay upright at least 30min)

IV: 3mg / 3months (slow admin.)

75
Q

Alendronate- indication?

A

Osteoporosis

76
Q

Ibandronate- indication?

A

Osteoporosis (for post-menopausal women)

77
Q

Raloxifene- drug class?

A

Selective estrogen receptor modulator (SERM)

78
Q

Raloxifene- MOA?

A

SERM: Estrogen agonist/antagonist -> decreased bone resorption

79
Q

Raloxifene- dosing?

A

60mg / day (prevention & treatment)

Separate from levothyroxine
Discontinue 72hours before prolonged immobilization (surgery)

80
Q

Raloxifene- contraindications?

A

History of VTE, pregnancy

Increases risk of venous thromboembolism (VTE)

81
Q

Raloxifene- adverse effects?

A

Hot flashes, peripheral edema, arthralgia, leg cramps/muscle spasms/flu symptoms

Menopausal symptoms

82
Q

What form can Vitamin D supplementation be in to help with bone building?

A

Vitamin D3 and Vitamin D2

83
Q

Raloxifene- indication?

A

Osteoporosis- treatment and prevention (postmenopausal women)

84
Q

What drugs can treat osteoperosis?

A

Raloxifene, Ibandronate, Alendronate, Calcium Carbonate

85
Q

What are the two parts in asthma treatment?

A

Bronchodilation (symptom relief)

Inhaled corticosteroid (control of inflammation)

86
Q

What is the primary treatment of COPD?

A

Bronchodilators

87
Q

GOLD COPD Guidlines

A

Group A (low exacerbations/assessment score): only bronchodilator

Group : (low exacerbations and assessment score): bronchodilator and LAMA/LABA
Groups E (high exacerbations): bronchodilator and LABA/LAMA

88
Q

Which of these gets shaken before use?: MDI or DPI

A

MDI (metered dose inhaler)- use a propellant spray

89
Q

Which of these does NOT get shaken before use?: MDI or DPI

A

DPI (dry powder inhaler)

90
Q

What drug is a short acting beta2 agonist? (SABA)

91
Q

What is a short acting beta2 agonist (SABA)?

A

Short term relief- rescue inhaler

92
Q

What is a long acting beta2 agonist (LABA)?

A

Long term maintenance, not used alone for asthma

Salmeterol

93
Q

Albuterol- dose?

A

MDI/DPI 1-2 inhalations / 4-6hours

Nebulizer

94
Q

Albuterol- cautions?

A

CVD, glaucoma, hyperthyroidism, seizures, diabetes

95
Q

Albuterol- adverse effects?

A

Nervousness, tremor, tachycardia, palpitations, cough, hyperglycemia, decreased potassium

96
Q

Albuterol- drug class?

A

Short acting beta2 agonist (SABA)

97
Q

Salmeterol- drug class?

A

Long acting beta2 agonist (LABA)

98
Q

Salmeterol- dosing?

A

DPI 1 inhalation BID (2x / day)

Maintenance inhaler only

99
Q

Salmeterol- adverse effects?

A

Nervousness, tremor, tachycardia, palpitations, cough, hyperglycemia, decreased potassium

100
Q

Salmeterol- cautions?

A

Only use in pts receiving inhaled corticosteroids

Maintenance inhaler only

101
Q

Can oral corticosteroids be used long-term?

A

NO, significant adverse effects:
mood swings, hypertension, etc

102
Q

What drugs are inhaled corticosteroids?

A

Fluticasone and budesonide

103
Q

Inhaled corticosteroids (ICS)- adverse effects?

A

Fluticasone and budesonide-

Prolonged high doses -> adrenal suppression

Dysphonia, oral candidiasis (thrush)

104
Q

What drug do you need to rinse and spit after use?

A

ICS- fluticasone and budesonide

105
Q

ICS (fluticasone and budesonide)- MOA?

A

Activates anti-inflammatory gene expression -> suppresses airway inflammation -> controls underlying inflammation in asthma

106
Q

ICS (fluticasone and budesonide)- indication?

A

Asthma (long-term)

107
Q

What drugs are muscarinic antagonists?

A

Ipratropium and tiotropium

108
Q

Which drug is a short acting muscarinic antagonist (SAMA)?

A

Ipratropium

109
Q

Which drug is a long acting muscarinic antagonist (LAMA)?

A

Tiotropium

110
Q

Ipratropium- drug class?

A

Anticholinergic bronchodilator- short acting muscarinic antagonist (SAMA)

111
Q

Tiotropium- drug class?

A

Anticholinergic bronchodilator- long acting muscarinic antagonist (LAMA)

112
Q

Anticholinergic bronchodilators: muscarinic antagonists- MOA?

A

inhibition of airway vagal tone -> blocks bronchoconstriction effects -> bronchodilation -> relieves COPD symptoms of obstruction

113
Q

Ipratropium- indication?

A

COPD, asthma

114
Q

Tiotropium- indication?

115
Q

Ipratropium- dosing?

A

MDI 2inhalations / 4 times daily

116
Q

Ipratropium- adverse effects?

A

dry mouth, URTI, cough, bitter taste

117
Q

Tiotropium- dosing?

A

MDI 2 inhalations / day

118
Q

Tiotropium- indications?

A

COPD maintenance treatment

119
Q

Tiotropium- adverse effects?

A

dry mouth, urinary retention, cough, hoarseness

120
Q

What drugs are oral corticosteroids?

A

Prednisone, methylprednisolone

121
Q

What is a prednisone steroid burst?

A

40-60mg prednisone daily for 3-10 days (or more if no change), taper down (gradual reduction to determine lowest dose to keep pt symptom free)

122
Q

Long term effects of oral corticosteroids (prednisone and methylprednisolone?

A

adrenal suppression, osteoporosis, hyperglycemia, immunosuppression

123
Q

Short term effects of oral corticosteroids (prednisone and methylprednisolone)?

A

Hyperglycemia, insomnia, irritation, upset stomach

124
Q

What is a methylprednisolone steroid burst?

A

Asthma exacerbation (no response from SABA): 40-60mg / day for 5-7 days, or resolution of symptoms

COPD exacerbation: 40-60mg/ day for 5-14 days (use IV if pt cant PO)

125
Q

Prednisone- indications?

A

COPD, asthma, IBD, OA, RA

126
Q

Methylprednisolone- indications?

A

COPD, asthma, UC, CD, OA, RA

127
Q

Montelukast- drug class?

A

Leukotriene receptor antagonist (reduces airway inflammation and constriction)

128
Q

Montelukast- indication?

129
Q

Montelukast- dosing?

A

10mg / day in the evening

130
Q

Montelukast- warnings?

A

Neuropsychiatric events (mood changes, suicidal thoughts/actions)- to be monitored

131
Q

Montelukast- adverse effects?

A

headache, abdominal pain, increased liver function tests

132
Q

What drugs are antihistamines?

A

Azelastine, Cetirizine, Fexofenadine, Levocetirizine, Loratadine

133
Q

Which antihistamines is most sedating but faster onset?

A

Cetirizine and levocetirizine

134
Q

Which antihistamines are less sedating?

A

Fexofenadine and loratadine

135
Q

What drugs are used for GERD?

A

Calcium carbonate, famotidine, pantoprazole

136
Q

What drugs are used for PUD?

A

Bismuth subsalicylate, metronidazole, tetracyclines

137
Q

What drugs are used for Ulcerative Colitis (UC) / Crohn’s Disease (CD)?

A

Azathioprine, ustekinumab, vedolizumab

138
Q

What drugs are used for IBS- constipation?

A

Polyethylene glycol, methylcellulose, linaclotide, lubiprostone

139
Q

What drugs are used for IBS- diahrrea?

A

Loperamide, dicyclomine

140
Q

Calcium carbonate- adverse effects?

A

constipation, bloating, belching

141
Q

Famotidine- drug class?

A

Histamine-2 receptor antagonist

142
Q

Famotidine- indication?

143
Q

Famotidine- MOA?

A

Binds to H-2 receptor -> antagonizes effects of histamine on partial cells -> decreased acid secretion

144
Q

Famotidine- onset?

A

within 60minutes

145
Q

Famotidine- duration?

146
Q

Famotidine- adverse effects?

A

Tolerance if taken on a schedule (take PRN)

147
Q

Famotidine- warnings?

A

Delirium, vitamin B12 deficiency w/ prolonged use >2years
QT prolongation w/ renal dysfunction

148
Q

Pantoprazole- drug class?

A

Proton Pump Inhibitor (PPI)

149
Q

Pantoprazole- indication?

A

GERD, PUD, H. pylori infections

150
Q

Pantoprazole- MOA?

A

Binds (irreversibly) to gastric H+, K+-ATPase in parietal cells -> inhibit acid secretion

151
Q

Pantoprazole- onset?

152
Q

Pantoprazole- duration?

153
Q

Pantoprazole- therapeutic/symptom relief?

A

1-4days (not for immediate relief, can be paired with calcium carbonate)

154
Q

Pantoprazole- warnings?

A

C. diff, osteoporosis (long-term use, >1year), Vitamin B12 deficiency(prolonged use >2years)

Rebound acid secretion- if stopped abruptly, must taper down over 4-6weeks

155
Q

Pantoprazole- adverse effects?

A

headache, ab pain, nausea, diarrhea

156
Q

Pantoprazole- dosing?

A

Take 30-60minutes before meals to maximize effects

157
Q

Tetracycline- indication?

A

PUD, triple therapy

158
Q

Tetracycline- adverse effects?

A

Photosensitivity, tooth discoloration (children)

159
Q

Bismuth- indication?

A

PUD, combination therapy, GERD

160
Q

Bismuth- adverse effects?

A

dark stools, dark “hairy” tongue

161
Q

Metronidazole- indication?

A

PUD, combination therapy

162
Q

Metronidazole- adverse effects?

A

N/V/D, ab pain, metallic taste

Avoid alcohol

163
Q

What is Inflammatory Bowel Disease (IBD)?

A

Ulcerative colitis, Crohn’s disease

164
Q

Vedolizumab- indication?

165
Q

Vedolizumab- MOA?

A

Binds to alpha4beta7 integrin -> blocks interaction with mucosal addressin cell adhesion molecule 1 -> inhibits migration of memory T-lymphocytes across endothelium into inflamed GI parenchymal tissue

166
Q

Vedolizumab- dosing?

A

300mg at 0week, 2weeks, then every 8weeks
d/c if no results after 14weeks

167
Q

Ustekinumab- indications?

168
Q

Ustekinumab- MOA?

A

Interferes w/ cytokines, IL12, IL13 -> inhibits T-cell activation -> inhibits inflammatory response

169
Q

Ustekinumab- dosing?

A

First: 260-520mg IV single dose
Maintenance: 90mg SW Q8weeks, 8weeks after first dose

170
Q

Duloxetine- Drug class? indications? MOA?

A

Selective serotonin reuptake inhibitor (SNRI- used for depression)

Osteoarthritis

Increases serotonin and norepinephrine in brain -> decreased pain signals

171
Q

Methotrexate- indications? MOA?

A

OA, RA

Promotes release of adenosine -> anti-inflammatory

172
Q

Adalimumab- drug class? Indication? MOA?

A

Biologics

Autoimmune disease (RA), CD, UC

Blocks tumor necrosis factor (TNF-a) from binding to receptor -> prevents activation of inflammatory pathways / producing cytokines

173
Q

Infliximab- drug class? Indications? MOA?

A

Biologics

CD, UC, RA

Binds to TNF-a -> inflammatory response is blocked -> reduces inflammation

Adv. Pharm (9 decks)

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