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Pharm Exam 4 - Class Review > ch 66 > Flashcards

ch 66 Flashcards

1
Q

zofran common side effects

A

headache
diarrhea
dizziness
prolongs QT

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2
Q

zofran is more effective when combined with

A

dexamethasone

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3
Q

Aprepitant (emend) is approved for

A

preventing post-op n/v (PONV) and CINV (chemo induced n/v)

has to be given with another antiemetic (glucocorticoid such as dexamethasone) or serotonin antagonist (zofran)

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4
Q

suffix for Substance P/Neurokinin-1 Antagonist

A

-pitant

aprepitant
rolapitant
netupitant
fosaprepitant

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5
Q

adverse effects of Aprepitant (emend)

A

combining with zofran and dex - more fatigue and asthenia (muscle weakness), dizziness, diarrhea
and transient elevation of circulation aminotransferases ->could indicate liver injury

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6
Q

Drug interactions for Aprepitant (emend)

A

inducer of CYP

inhibitors (itraconazole, ritonavir) can raise levels of aprepitant

can also raise levels of chemo cancer drugs

can raise levels of glucocorticoids to prevent CINV

can induce CYP2d6
decrease levels of warfarin, ethinyl estradiol (birth control)

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7
Q

what benzodiazepine is used for antiemetic in CIMV

A

lorazepam (ativan)

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8
Q

Promethazine (phenergan) side effecct

A

resp depression

local tissue injury

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9
Q

what 2 Butyrophenones are used as antiemetics

used for

side effects

A

Haloperidol (haldol)
droperidol

used for postop n/v and emesis caused by cancer therapy

extrapyramidal reactions
sedation
hypotension

droperidol - QT prolongation

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10
Q

what prokinetic agent used for an antiemetic

used in

A

Metoclopramide (Reglan)

suppress postop nausea/vomiting as well as emesis caused by anticancer drugs, opioids, toxins and radiation

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11
Q

chemotherapy is associated with 3 types of emesis

A

anticipatory

acute

delayed

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12
Q

emesis that begins within minutes to a few hours after receiving chemotherapy and often resolves within 24 hours

A

acute emesis

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13
Q

emesis that develops a day or more after drug administration

A

delayed emesis

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14
Q

when are antiemetics more effective in CINV

A

more effective prevention than at suppressing

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15
Q

the current regimen of choice for a pt taking highly emetogenic drugs consists of 3 agents

A

aprepitant
dexamethasone
5HT3 antagonist (ie) ondansetron and palonosetron)

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16
Q

a severe form of n/v of pregnancy (NVP) , characterized by dehydration, ketonuria, hypokalemia, loss of 5% or more of body weight

A

hyperemesis gravidarum

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17
Q

nondrug measures for managing NVP

A

eating small portions of food throughout the day

avoid odors, foods and supplements that can trigger NVP (fatty foods, spicy foods, iron tablets)

use of alternative treatments such as acupuncture and ginger

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18
Q

first line therapy for NVP consists of what

A

2 drug combo

doxylamine plus vit B6 (pyridoxine) - the combo is sold as Diclegis

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19
Q

other drugs for NVP is

A

prochlorperazine
metoclopramide
zofran

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20
Q

age for Promethazine

A

2 and older

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21
Q

dronabinol in kids?

A

yes for n/v

22
Q

chenodiol in pregnancy

A

no, contraindicated

23
Q

what for gi safe in breastfeeding

A

prochlorperazine and promethazine safe for short term - observe infant for sedation

24
Q

what to avoid in breastfeeding

A

metoclopramide
dronabinol
droperidol

25
Q

gi meds to avoid in older adults

A

benzodiazepines
scopolamine
metoclopramide

26
Q

drug for motion sickness

A

Scopalamine

27
Q

antihistamines for motion sickness

A

dimenhydrinate (dramamine)
meclizine (antivert)
cyclizine (cyclivert)

28
Q

what drug class is the most effective antidiarrheal agents

why

A

opioids - decrease intestinal motility which allows more time for absorption of fluids and electrolytes

29
Q

In pt with IBD, opioids may cause

A

toxic megacolon

30
Q

what opioid preps are approved for diarrhea

A

diphenoxylate (lomotil)
imodium (loperamide)

difenoxin
paregoric
opium tincture

31
Q

when taken orally in antidiarrheal doses, diphenoxylate affects the CNS in what way

A

no cns effects

32
Q

Lomotil is Diphenoxylate in combo with what drug

A

atropine

33
Q

Lomotil is a schedule

A

V

34
Q

Loperamide (imodium) is schedule

A

not regulated

35
Q

what infectious diarrhea needs abx

A

Salmonella
shigella
Campylobacter
Clostridium species

36
Q

causative organism for travelers diarrhea

A

E coli

37
Q

for travelers diarrhea do you need an antibiotic

A

self limited, run its course in a few days

however if symptoms are esp severe, treat with

fluoroquinolone - ciprofloxacin adults

azithromycin is drug of choice for children and pregnant women

rifaximin may also be used as long as pt is not pregnant or febrile with non-bloody stools

38
Q

abx for travelers diarrhea in adults

A

fluoroquinolone such as ciprofloxacin

39
Q

abx for travelers diarrhea for children and pregnant women

A

azyithromycin

40
Q

antidiarrheal for mild symptoms of travelers diarrhea

A

loperamide but if you slow peristalsis, you will delay export of the offending organism thereby prolonging the infection

41
Q

how do you avoid getting travelers diarrhea

A

avoid local drinking water and carefully washing foods

fluoroquinolones for prophylaxis but non generally recommended

can be vaccinated against some pathogens to protect against diarrhea caused by E coli and vibrio cholerae

42
Q

c. diff is a gram

A

gram positive anaerobic bacillus

43
Q

symptoms of c diff

A

abd discomfort
nausea
fever
diarrhea

toxic megacolon
pseudomembranous colitis
colon perforation
sepsis
death
44
Q

IBS is defined by

A

Rome IV criteria
for at least 12 weeks in the previous year
abd pain and discomfort that cannot be explained by structural or chemical abnormalities and at least 2 of listed features p. 611

45
Q

ibs symptom triggers

A 
stress
depression
dietary factors including 
caffeine
alcohol
fried foods
high fat foods
gas generating veggies such as beans, brocolli, cabbage - 
too much sorbitol (found in chewing gum and some diet products)
46
Q

Ibs helpful tips

A

smaller more frequent meals
increase fluid
increase fiber

47
Q

what drug classes for IBS

A

antispasmodics (hyoscyamine and dicyclomine)
bulk forming agents (psyllium and polycarbophil)
antidiarrheals (loperamide)
tricyclic antidepressants (TCAS)

48
Q

Bismuth subsalicylate has the side effect of

A

black tongue and stools

harmless

49
Q

Sulfasalazine does what for UC

A

reduces inflammation

50
Q

Alosetron can cause

A

ischemic colitis (intestinal damage secondary to reduced blood flow)

and complication of constipation have led to hospitalization, blood tx, surgury, death

51
Q

alosetron is contraindicated in

A 
chronic constipation
intestinal obstruction 
toxic megacolon
gi perf
adhesions
chrohn 
Uc
diverticulitis

Pharm Exam 4 - Class Review (14 decks)

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