Before exam Flashcards
1
Q
Calcium Chanel blocker
ADRs/dihydropyridine?
A
Neg Inotropic effects
Dizziness
Flushing
Headache
Peripheral edema
Reflex tachycardia
2
Q
Calcium Chanel blocker
ADRs/Non-dihydropyridine?
A
Neg Inotropic effects
Anorexia, nausea
Constipation
Peripheral edema (not as much as DHP CCBs)
3
Q
Alpha Blockers
ADRs
A
1st dose effect
Dizziness
Sustained orthostatic hypotension
(elderly)
Lassitude, vivid dreams, depression
Priapism
4
Q
Central Alpha agonists
ADRs
A
Na/H2O retention
Depression
Orthostatic hypertension
Anticholinergic effects
Rebound HTN
5
Q
Clonidine
A
Central Alpha agonists
6
Q
Pregnant women are OK to prescribe which agent?
A
B-blocker/Metoprolol
CBC
7
Q
Methyldopa
A
Central Alpha agonists
8
Q
Niacin = IR drugs are what ADRs?
A
Skin problem
–Flushing
–Itching
–Rash
–Hives
9
Q
What is the statin characteristics?
A
Individuals with ASCVD
Super dec LDLS (40mg-50%)
Can cause rhabdomyolysis (damaged muscle)
10
Q
Which drug cannot be together with a statin?
A
Fibric acid
-gemfibrozil
-fenofibrate
11
Q
Which medication needs to supervision for the first dose?
Cholesterol drug
A
Evolocumba
PCSK9 inhibotors
12
Q
Which agent does the main use to reduce triglycerides?
Cholesterol drug
A
Omega-3 fatty acids
Fibric acids
13
Q
A generic drug meet pharmaceutical equivalence expect
A
Shape
It doesn’t have to be the same shape
14
Q
A generic drug meet pharmaceutical equivalence 4
A
dosage form
strength
route
active ingredient
15
Q
Noncompetitive Antagonism?
A
Binding of an antagonist to one receptor prevents an agonist from bind to another receptor
16
Q
What are involved in drug excretion?
A
LUNGS
salver GLANDS
kidney
GI TRACT
17
Q
What diuretic agent causes gynecomastia in men and breast tenderness in women?
A
aldosterone
spironolactone
18
Q
Which drug could be used with a thiazide to help balance K?
A
Triamterene
potassium-sparing diuretic
19
Q
Alpha Blockers
Name and action
A
ANTHING ENDING IN “zosin”
Selective a1 receptors antagonists in peripheral vascular
Result: vasodilation, dec BP
20
Q
Alpha Blockers
ADRs
A
1st dose effect
Dizziness
Sustained orthostatic hypotension
(elderly)
Lassitude, vivid dreams, depression
Priapism
21
Q
Central Alpha agonists
Name and action
A
Clonidine
Methyldopa
Reduces sympathetic outflow from brain 🡪 once all peripheral NE receptors are bound, drug binds to NE receptor in brain to dec NE release
Result: dec HR, CO, BP
22
Q
Central Alpha agonists
ADRs
A
Na/H2O retention
Depression
Orthostatic hypertension
Anticholinergic effects
Rebound HTN
23
Q
Beta Blockers
action/Cardio selective
A
greater effect on B1 receptors (heart and kidney) than B2 receptors (lungs, liver, pancreas)
24
Q
Beta Blockers
action/Intrinsic Sympathomimetic
A
Partial beta (B)-receptor agonist
25
Beta Blockers
ADRs
Bradycardia
CNS depression
Bronchoconstriction in COPD/asthma
Rebound HTN if abruptly discontinued
26
Black pt
Most effective treatment is c____and d_______ (since they don’t target the RAAS system)
Most black pt w/ HTN don’t have a
c) thiazides
d) calcium channel blockers
e) RAAS system
27
Pregnant women
a) HTN causes?
b) Preferred drugs?
c) Alternatives
d) Contraindicated:
a) Chronic or gestational HTN
b) labetalol, long acting nifedipine, methyldopa
c) : other beta blockers & calcium channel blockers
d) ACEi, ARBs, direct renin inhibitors
28
Elderly >65
a) causes HTN
b) which drugs should avoid?
a) Isolated systolic HTN
b) central alpha agonists, peripheral alpha blockers
29
Children & Adolescents
HTN more common in a__children
b____ HTN more common
What drug should use?
a) obese
b) Secondary
c) 1st line agents and beta blockers
30
Classify the following blood pressures:
a) 140/80
b) 110/70
c) 126/74
d) 120/80
a) Stage 2
b) Normal
c) Elevated
d) Stage 1
31
All of the following are side effects of Clonidine (Catapres) except for:
a) Rebound HTN if stopped abruptly
b) Vivid dreams
c) Anticholinergic effects
d) Sodium and water retention
b
32
What is the #1 modifiable cause of death CVD?
Smoking
(#2 is HTN)
33
What % of CV events are due to HTN?
25%
34
HTN is most highly associated with?
Hypercholesterolemia
35
ACEi are primarily used for?
HF
Chronic kidney disease
36
Thiazides, ARBs and B blocker used for?
HTN
37
A receptor blocker used for?
Resistance HTN
38
A pt on ramipril shows Scr has risen 40%, nurse should do what?
Stop or Dec.
Scr is more than 35%
39
Angioedema is more common in what population?
Obese
Smoker
40
Which group of B blocker are not as good?
Intrinsic sympathomimetic
41
Which of the following statements by the patient requires further teaching? SATA
a) I can take doxazosin in the morning before I start my day
b) If I am on prazosin, I need to be careful when changing positions quickly
c) I had a vivid dream last night, but that is normal when I’m taking terazosin
d) Taking doxazosin may stop me from being able to have an erection
A and D
Taking alpha blockers can cause first dose effect and must be taken before bedtime since it causes a dramatic dec in BP, the pt must also remain adherent since coming off and restarting the doses can cause the same effect
Alpha blockers also cause priapism which causes long erections not the inability to have an erection
42
Which of the following is false about central alpha agonists?
a) Contain the drugs clonidine & methyldopa
b) Causes cholinergic effects
c) Abrupt cessation can cause rebound HTN
d) Causes sodium/water retention
B
Central alpha agonists cause anticholinergic effects – dry mouth, sedation, urinary retention – think of the effects of anticholinergic this way: can’t see, can’t spit, can’t pee, can’t sh**t
43
What is the role of HDLs?
Rescue LDLs
Good cholesterol, prevent atherosclerosis
44
Which drugs is used to with statin to increase LDL lowering?
Ezetimibe
directly lowering cholesterol
45
Which drug is cause rhabdomyolysis?
Fluvastatin
Myopathy can progress to rhabdomyolysis
muscle tissue breakdown
46
The medication causes dry mouth, sedation and urinary retention is?
Methyldopa
Center a blocker
47
Which of the following medications should the nurse monitor for signs of myopathy? (SATA)
a) Rosuvastatin
b) Niacin
c) Aliocumab
d) Gemfibrozil
a and d
48
Which of the following is an ADR of spironolactone?
a) Hypokalemia
b) Nausea
c) Edema
d) Gynecomastia
d
49
. Which of the following drugs causes you to hang on to potassium (hyperkalemia)? (SATA)
a. Triamterene
b. Furosemide
c. Metolazone
d. Amiloride
e. Spironolactone
a,d,e
50
Potassium-sparing drugs (hyperkalemia) are typically used with thiazide (hypokalemia) diuretics due to the canceling out the effect it has on the patient’s potassium levels, what is this called?
a. Antagonistic Pharmacodynamic Drug-Drug Interaction
b. Synergistic Pharmacodynamic Drug-Drug Interaction: synergistic therapeutic, synergistic adverse
effect
c. Antagonistic Pharmacokinetic Drug-Drug Interaction
d. Synergistic Pharmacokinetic Drug-Drug Interaction
a
51
You clock into your shift at the hospital and you notice your patient’s creatinine clearance is 13 mL/min, grade their renal function?
a. Normal :
b. Mild impairment :
c. Moderate impairment :
d. Severe impairment :
c
Normal: 80<
Mild: 50-80
Moderate: 10-50
Severe: 10>
52
Which component of the urinary system is responsible for controlling voiding and storing waste?
a) Kidneys
b) Ureters
c) Bladder
d) Urethra
c
53
What percentage of CO flows to the kidneys?
a) 5%
b) 20%
c) 25%
d) 50%
c
54
BP must stay above this range in order for kidney filtration to continue.
a) 50 mmHg
b) 80 mmHg
c) 20 mmHg
d) 5 mmHg
a
55
The urinary system secretes 100% of which blood components? (SATA)
a) Glucose
b) Sodium
c) Water
d) Creatine
e) Urea
f) Proteins
d
56
The urinary system reabsorbs 100% of which blood components? (SATA)
a) Glucose
b) Sodium
c) Water
d) Creatine
e) Urea
f) Proteins
a
57
The following conditions cause fluid overload except:
a) Heart failure
b) Liver disease
c) Kidney disease
d) Hypoaldosteronism
e) Corticosteroid therapy
d
HYPERaldosteronism causes fluid overload – remember that aldosterone functions to reabsorb sodium/water, so too much of it causes too much fluid to be reabsorbed
58
Torsemide would most likely be used for a patient suffering from: (SATA)
a) Heart failure
b) High BP d/t smoking
c) Severe edema
d) Liver disease
e) Renal disease
a,c,d,e
59
A patient experiencing hypokalemia may be prescribed: (SATA)
a)Amiloride
b)Triamterene
c) Spironolactone
d) Eplerenone
e) Moduretic
f) Dyazide
g) Aldactazide
all of them
60
Drug name
a) Triamterene + hydrochlorothiazide
b) Amiloride + hydrochlorothiazide
c) Spironolactone + hydrochlorothiazide
a) dyazide
b) Moduretic
c) aldactazide
61
Potassium sparing diuretics are typically combined with Thiazides. Together the two drugs have what type of relationship? (SATA)
a) Pharmacokinetic antagonistic relationship
b) Pharmacodynamic antagonistic relationship
c) Synergistic adverse side effects
d) Synergistic therapeutic effects
B D
pharmacoDYNAMIC antagonistic (because thiazides cause hypokalemia & potassium sparing cause hyperkalemia) and synergistic therapeutic (because they both cause diuresis so their individual effects add up to inc diuresis more than either drug can do alone)
62
Which of the following are the risk groups for potassium sparing diuretics? (SATA)
a) Renal impaired
b) Diabetics
c) Elderly
d) Pt undergoing a blood transfusion
d) Pt taking salt substitutes
all of them
ALL – D & E are examples of sources of hidden potassium – pts on potassium sparing diuretics are already at risk for hyperkalemia, so adding more potassium to their lives makes their risk even higher
63
A patient with heart failure is discussing drug options. Which of the following diuretic drugs would the doctor think would be best? (SATA)
a) Hydrochlorothiazide
b) Mannitol
c) Spironolactone
d) Furosemide
c D
Thiazides: HTN
Loops: any condition causing edema (HF, liver disease, renal disease, high BP d/t fluid overload)
Potassium sparing: used w/ other diuretics to maintain K levels and enhance diuresis, Aldosterone antagonists: pts w/ high levels of aldosterone (HF, liver failure)
Osmotic drugs: cerebral edema and glaucoma
Carbonic anhydrase: glaucoma, some drug overdoses
64
T/F: Eplerenone, an aldosterone antagonistic drug, can cause hyperkalemia and hormonal effects?
F: eplerenone causes hyperkalemia, but spironolactone is the only aldosterone antagonist that causes hormonal effects
65
Osmotic diuretics function to: (SATA)
a) Trap water in the renal tubule to cause diuresis
b) Draw blood from tissues
c) Cross the blood brain barrier to inc the amount of blood going to the brain
d) Dec cerebral edema
a, b, d
66
Which of the following is an example of a carbonic anhydrase inhibitor? (SATA)
a) Acetazolamide
b) Moduretic
c) Chlorothiazide
d) Triamterene
a
67
The object drug is the a______ of the drug-drug interation while the precipitant drug is the b_______ of the drug-drug interaction
a) victim
b) perpetrator
68
1. The most clinically relevant drug would be one that: (the most relevant = the most concerning)
a. has a low therapeutic index (narrow therapeutic range) and interaction with a precipitant drug produces a large effect
b. has a low therapeutic index and interaction with a precipitant drug produces a small effect
c. has a high therapeutic index and interaction with a precipitant drug produces a small effect - the
one we want :)
d. has a high therapeutic index and interaction with a precipitant drug produces a large effect
a
69
A patient is taking Drug A and Drug B. Drug A is an enzyme inducer that creates more enzymes that metabolize Drug B.
If Drug B is a prodrug, are we worried about toxic or sub-therapeutic drug levels?
pro: inactive drug
Subtherapeutic: not working well
Enzyme inhibition = toxic
70
A patient is taking Drug C to lower their blood pressure. The patient is then started on Drug D, which has the action of increasing blood pressure. The type of drug interaction that occurred is:
a. pharmaceutic
b. pharmacokinetic
c. pharmacodynamic antagonistic-
c
work against eachother
Other two: synergistic therapeutic effects, synergistic adverse effects
71
enzyme induction
a) onset
b)Max effect
c) offset
a) 5 days
b) 2 weeks
c) 3 or more
72
enzyme inhibition
a) onset
b)Max effect
c) offset
a,b,c within 24 hours
Enzyme inhibition is the most common reported mechanism. It is also the most dangerous = very toxic,
very quick
73
Antagonist binding to a secondary domain on the receptor and preventing the binding of an agonist to the primary domain.
a. Competitive antagonism
b. Partial Agonism
c. Agonism
d. Noncompetitive Antagonism
d
74
Which of the following are involved in drug excretion?
a. Cytochrome P-450
b. Lungs
c. Salivary glands
d. Kidneys
e. GI tract
b,c,d,e
75
A patient is taking a diuretic to get rid of excess fluid volume and then starts taking another one to get rid of even more fluid. What is this an example of?
A. Antagonistic drug interaction
B. Synergistic additive therapeutic effects
C. Synergistic adverse effects
D. Pharmaceutical drug interaction
b
76
3. Which of the following characteristics puts a patient at risk for a serious drug interaction? Select all that
apply.
A. Narrow therapeutic range
B. Slight dose response
C. Steep dose response
D. Wide therapeutic range
a c
76
A generic drug meets pharmaceutical equivalence if it has the same
__________________________________ it may differ in shape, scoring and excipients
dosage form
strength
route
active ingredient
77
What makes an object drug important in drug interactions? SATA
a. steep dose response curve
b. has a narrow therapeutic range
c. typically used chronically
d. are metabolized by hepatic enzymes
all of them
78
2. A patient is prescribed a drug for a fungal infection and has a level of 10. A week later, labs are drawn and the patient now has a level of 20. What drug interaction is that?
a. pharmacokinetic
b. pharmacodynamic
c. pharmaceutical
a
79
. When one drug in the gut binds to another drug in the gut and results in them no longer being absorbed, it is an example of what?
a. changes in GI motility
b. complexation
c. changes in pH
b
80
What are factors affecting drug metabolism? SATA
a. very old
b. disease state
c. pregnancy
d. gender
e. very young
a,b,c,e
81
Precipitant drug that increases metabolic enzymes within the liber is classified as what?
a. enzyme inhibition
b. agonism
c. enzyme induction
d. synergistic therapeutic effects
c
81
a. Pure Food and Drug Act - (1906)
b.Food drug and cosmetic act 1938Food drug and cosmetic act (1938)
c. Kefauver-Harris Amendment (1962)
d. Durham-Humphrey Amendment (1962)
Drug Price Competition and Patent Term Restoration Act(1984)
a) protect from adulterated or mislabel drug and food
list if 1 of 11 dangerous
b) Test for harmful effectsTest for harmful effects
c) Required proof of both safety and efficacy prior to approve Permitted generic versions
d) Specified how prescription drugs can be ordered
Established the approval pathway for generic drug products
82
Where drugs do come from?
Plants
Animals
Microbes
Synthetic
Semi-Synthetic
Biosynthetic
83
a) C max
b) T max
c) AUC
a) The amount of drugs that get into the bloodstream
b) How long it take for drug to take effect
c) Result of time and concentration, used to determine equivalence
84
What is an ANDA?
A
After 5 years generic companies can submit an ANDA to get their generic drug approved
Drug must be able to display pharmaceutical equivalence and bioequivalence
85
What is an NDA?
A
New Drug Application (NDA)
Must go through the FDA drug approval process (3 phases) then submit an NDA drug application to the FDA
86
Oral Dosage Forms 8
A
Dissolved Liquid (elixir, syrup)
Suspensions
Powders
Capsules
Tablets
Coated Tablets
Enteric-Coating
Sustained-Release
87
Pharmacokinetic Phase
Rate of absorption can determine?
Onset of action
Duration of action
Intensity of response
88
The drug agonist binds to receptor A in the brain to raise blood pressure & the drug antagonist binds to receptor A in the brain to decrease blood pressure
Pharmacological antagonism
One receptor/ same receptor
cancel out
89
The drug agonist binds to receptor A in the brain to raise blood pressure & the drug antagonist bind to receptor B in the blood vessels to decrease blood pressure
Effect antagonism
Opposite effect
Two different receptor
90
What dose Disintegration means?
Increase the surface area of the drug and starts to break apart
91
What dose Dissolution means?
A
In order for drug to cross the biological membrane it needs to undergo dissolution.
92
93
The form of drug elimination in which an active drug is metabolized into an inactive form is called the?
Biotransformation
94
An interaction between drugs that have opposite effect, they can block or reduce the effect is called?
Antagonistic drug interaction
95
The combined effects of drugs when take together is greater than when take alone is called?
Synergistic drug interaction
a: Decrease BP + b Decrease BP= double effect
96
Name 3 ways that drug interactions can occur as a result of altered absorption.
Complexation
pH change
GI motility change
97
Source of drug
Animal
a) cows and pigs
b) horses
c) cow stomach
d) anchovies, sardines
e) diphtheria, tetanusInsulin
Conjugated estrogens
Pepsin
Fish oil
Antitoxin sera
Insulin
Conjugated estrogens
Pepsin
Fish oil
Antitoxin sera
