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Pharmacology > Chemo, Derm, Pain, Headaches, Stubstance Abuse, Anemia > Flashcards

Chemo, Derm, Pain, Headaches, Stubstance Abuse, Anemia Flashcards

1
Q

when is the onset of opioid withdrawal symptoms, depending on if they take shorter and longer acting?

A

shorter: 6-24 hours later, lasts 1 weeks
longer: 2-4 hours after last dose, lasts longer

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2
Q

because it’s longer-acting opioid, which med will have a delayed (2-4 day) onset of withdrawal symptoms?

A

methadone

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3
Q

which medications are used in opioid withdrawal?

A

Buprenorphine
Naloxone/Naltrexone
Methadone

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4
Q

suboxone is a combination of which 2 drugs, used in treating opioid withdrawal

A

buprenorphine + naloxone

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5
Q

which opioids withdrawal med is short-acting and may need readministration?

A

Naloxone - can induce withdrawal symptoms

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6
Q

between naloxone and naltrexone, which is used in alcohol use disorder?

A

Naltrexone

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7
Q

T or F: naltrexone and naloxone are safe in pregnancy

A

FALSE - spontaneous abortion

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8
Q

what do you tell patients who are taking naloxone and have pain? what can they take?

A

non-opioid pain meds (ASA, NSAIDs, APAP)

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9
Q

which adverse effect must you be extra careful for in alcohol withdrawal?

A

seizure disorder - peaks at 24 hours after last drink (can be fatal)

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10
Q

what is the treatment of choice for acute alcohol withdrawal?

A

benzos (lorazepam, diazepam)

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11
Q

what are Naltrexone, Disulfiram, and Acamprosate used for?

A

long term alcohol withdrawal prevention

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12
Q

which medication causes disulfiram-ethanol reaction?

A

disulfiram (alcohol withdrawal med)

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13
Q

what does disulfiram-ethanol reaction look like?

A

decreased BP, increased HR, chest pain, palpitations, dizziness, flushing, sweating, syncope

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14
Q

what is contraindicated with disulfiram?

A

CV or cerebrovascular disease, or in combo with hypertensives

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15
Q

what is the first line choice for treating acute migraine?

A

NSAIDs (or triptans if NSAIDs unsuccessful)`

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16
Q

how do you treat an acute cluster headache?

A

Oxygen + Triptans

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17
Q

which types of headaches are triptans best for?

A

cluster and migraines (not so much tension)

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18
Q

contraindications to triptans

A 
migraine w/ neurologic focality
stroke
poorly controlled htn
unstable angina
pregnancy
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19
Q

when administering ergots by IV, what adverse effect is common? how do you handle this?

A

Nausea - give antiemetic (metoclopramide, chlorpromazine)

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20
Q

using headache medications >____ per month can cause medication overuse headache

A

> 10 days/month

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21
Q

what classes of meds are used as headache prophylaxis

A

anticonvulsants
beta blockers
antidepressants
lithium

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22
Q

when using beta blockers as headache prophylaxis, what do you need to monitor

A

heart rate, BP.

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23
Q

contraindications for Beta blockers as headache prophylaxis

A

reactive airway disease

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24
Q

which antidepressants are used for headache prophylaxis

A

Amitriptyline (TCA)

Venlafaxine (SSRI)

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25
Q

what medication class is a good alternative for headache prophylaxis if beta blockers aren’t tolerated

A

Anticonvulsants (topiramate, valproic acid, divalproex)

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26
Q

which class of headache medication is contraindicated in pregnancy?

A

Ergots - cause hypoxia to fetus and uterine contractions

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27
Q

which triptans are safe in pregnancy, while others are contraindicated

A

sumatriptan
naratriptan
rizatriptan

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28
Q

at what BMI is pharmacologic therapy for weight loss ok to begin

A

> 30

or >27 + other obesity risk factors

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29
Q

T or F: meds are the first line choice for treating obesity

A

FALSE - lifestyle changes

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30
Q 
Orlistat
Lorcaserin
Phentermine-Topiramate
Naltrexone-bupropion
Phentermine
Diethylpropion
Phendimetrazine
A

weight loss meds

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31
Q

this weight loss medication works in the GI tract inhibiting lipase and triglycerides; undigested triglycerides are not absorbed

A

Orlistat

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32
Q

you may need to bring extra clothes with you while taking this medication for weight loss - may have oily spotting, Sharts, oily evacuation, fecal incontinence

A

Orlistat

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33
Q

what is the rare AE of orlistat?

A

liver injury - look for itching, yellow skin and eyes, light colored stools

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34
Q

this weight loss medication is controlled, having a potential for abuse; it is contraindicated in pregnancy.

A

Lorcaserin

phentermine-topiramate

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35
Q

your patient has been taking Lorcaserin for 12 weeks now, and has lost 2% weight. What do you tell her at her follow up?

A

D/C the med - if <5% weight loss by week 12

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36
Q

watch for serotonin syndrome in this weight loss med if combined with triptans, MAOI, SSRI, TCA, bupropion

A

Lorcaserin

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37
Q

T or F: phentermine-topiramate is ok to use long term

A

True (but D/C if <5% weight loss after 12 weeks at highest dose)

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38
Q

you must confirm negative pregnancy test before taking this weight loss med

A

phentermine topiramate

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39
Q

phentermine-topiramate interacts with MAOI, Oral contraceptives, and alcohol. What happens when taken with OCs?

A

irregular bleeding - but NOT increased risk of pregnancy

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40
Q

contraindications of naltrexone-bupriopion?

A

high BP, seizures, taking anticonvulsants or chronic opioids, MAOI within 14 days, pregnancy

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41
Q

what is phentermine’s MOA ?

A

increase NE and DA release in the CNS

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42
Q

T or F: weight loss medication containing phentermine has potential for abuse

A

True

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43
Q

Between Phentermine and phentermine topiramate, which is best if used short term?

A

Phentermine - best if short term for monotherapy

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44
Q

which 2 weight loss medications have a high potential for abuse and MANY contraindications?

A

Diethylpropion
Phendimetrazine

-only use short term!

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45
Q

this weight loss med has a risk of pulmonary hypertension if used for longer than 3 months

A

Diethylpropion

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46
Q

what kind of pain occurs when encountering something painful?

A

nociceptive

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47
Q

what kind of pain occurs when damage occurs?

A

inflammatory

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48
Q

what kind of pain occurs in the PNS

A

neuropathic

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49
Q

what pain medication is best for mild-moderate pain relief?

A

APAP (acetaminophen)

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50
Q

what pain medication is best for moderate+ pain?

A

APAP + NSAIDs

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51
Q

What pain medication is best for inflammatory pain

A

NSAIDs

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52
Q

what pain medication is best for muscle-related pain?

A

muscle relaxers

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53
Q

what are the non-opioid analgesics?

A

ASA
APAP
NSAIDs

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54
Q

how does Acetaminophen interact with warfarin?

A

can increase bleeding risk (at 2000+ mg/day)

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55
Q

T or F: acetaminophen causes renal toxicity

A

F: Hepatotoxicity - risk increases with hepatitis, chronic alcohol, binge-drinking

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56
Q

what is the maximum dose of acetaminophen?

A

4000 mg per day if NORMAL hepatic function

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57
Q

what is ASA MOA?

A

inhibits cox1 and cox2

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58
Q

what analgesic to avoid in kids?

A

Aspirin - risk of Reye syndrome

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59
Q

Adverse effects ASA

A

GI irritation/bleeding, platelet inhibition, hypersensitivity

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60
Q

Choline magnesium
sodium salicylate
salsalate
methyl salicylate

A

Nonacetylated salicylates

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61
Q

what is the preferred class of medication for pain if prostaglandins are involved?

A

NSAIDs

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62
Q

COX1 inhibition yields what effects?

A

increased GI and renal effects

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63
Q

COX2 inhibition yields what effects?

A

Cardiovascular risk and higher analgesic effect

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64
Q

T or F: NSAIDs are NOT helpful in neuropathic pain

A

True

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65
Q

your patient is being started on NSAIDs for inflammatory pain. What do you tell him regarding time until effect

A

will take 2-3 weeks for full effect

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66
Q

which NSAID do you NEVER use for more than 5 days due to high risk

A

Ketorolac

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67
Q

what is the agent of choice for moderate-severe pain associated with cancer?

A

Opioids

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68
Q

T or F: opioids are the analgesic of choice for nonmalignant chronic pain

A

FALSE - harms outweight benefits and risk for abuse/dependence

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69
Q

what is the onset of opioids?

A

30-45 min

70
Q

what are the common AEs of opioids?

A

sedation, constipation, nausea.

71
Q

T or F: long-acting opioids yield a higher risk for respiratory depression

A

True - caution when tolerance develops, give naloxone for reversal incase of overdose

72
Q

This opioid is NOT a first line choice due to risk of tremors, myoclonus, delirium, seizures

A

Meperidine - caution elderly, renal impairment, kids

73
Q

This opioid has a long half life of 30 hours - caution with what AE

A

respiratory depression, arrhythmia/QT prolongation

74
Q

this opioid is also used for alcohol abuse treatment

A

Methadone

75
Q

This opioid is not first line due to its increased risk of seizure, serotonin syndrome, and dependence

A

Tramadol

76
Q

What is the first line analgesic for neuropathic pain?

A

Gabapentin

77
Q 
Cyclobenzaprine
Tizanidine
Carisoprodol
Chlorzoxazone
Metaxalone
Methocarbamol
Ophenadrine
A

Muscle relaxants

78
Q

muscle relaxants decrease spasm and stiffness of muscles, but ______ are still first line

A

NSAIDs, APAP

79
Q

2 kinds of muscle relaxants: antispastic and antispasmodic. What do antispastic ones work best for?

A

CP and MS

80
Q

antispasmodic muscle relaxants work best for what type of conditions?

A

musculoskeletal conditions

81
Q

which 2 muscle relaxants are LAST CHOICE due to abuse potential

A

diazepam

carisoprodol

82
Q

most common AE of muscle relaxants

A

sedation

83
Q

T or F: topical analgesics work similarly to transdermal analgesics

A

FALSE - transdermal is systemic, topical is local pain relief.

84
Q

Menthol
Capsaicin
Camphor
Methylnicotinate

A

counterirritants (topical analgesic) - acts as distraction from pain

85
Q

which topical NSAID is best to use for pain?

A

Diclofenac

86
Q

This topical analgesic blocks superficial somatic nerve conduction, NOT DEEP areas

A

lidocaine

benzocaine

87
Q

a deficiency in what 3 things can lead to anemia?

A

iron
B12
Folic acid

88
Q

you start your patient on an iron supplement for their iron deficiency anemia. what is the dose/route

A

150-200 mg, split into 2-3 doses

89
Q

your patient has been taking her iron supplements for 2 weeks now, and complains of bloating, constipation, and dark stools. what do you tell her?

A

this is normal adverse effects - keep taking dose, try taking with food

90
Q

do we prefer IV or PO iron supplementation?

A

PO is best - IV can cause anaphylactic reactions, esp with high molecular weight Dexferrum

91
Q

How do you treat B12 deficiency anemia and when can you expect results?

A

B12 shots - will see effect in 1 week

92
Q

Folic acid anemia effects are seen in what time frame?

A

effects start by 2 weeks with folic acid supplement –> normalizes by 2-4 months

93
Q

Epoetin-alpha

Darbepoetin-alpha

A

erythropoietin stimulating agents

94
Q

use of erythropoietin stimulating agents

A

treating anemia related to cancer, chemo, CKD - results in increased RBC production

95
Q

What potency is Clobetasol Propionate for topical steroid?

A

super high

96
Q

what potency is fluocinonide ointment and mometasone furoate for topical steroids?

A

high potency

97
Q

What potency is triamcinolone acetonide for topical steroids

A

medium

98
Q

what potency is desonide cream, fluocinolone acetonide, hydrocortisone cream for topical steroids?

A

Low

99
Q

What conditions do you use topical steroids for?

A

psoriasis
atopic dermatitis
symptomatic relief for burning and pruritis

100
Q

patient presents with psoriasis of the soles of the heels. What steroid to use?

A

super high potency (Clobetasol) - nonfacial and nonintertriginous

101
Q

what potency steroid do you use for nonfacial and nonintertriginous areas and flexural surfaces

A

medium-high potency

102
Q

Your patient has lesions on his eyelids or genitals, what potency topical steroid do you use?

A

LOW potency - used on thin skin (eyes, face, genitals, intertriginous areas)

103
Q

which is strongest potency: cream, lotion, ointment

A

ointment

104
Q

what are the local cutaneous side effects of topical steroids?

A

skin atrophy, telangiectasis, striae, acne, allergic contact dermatitis, hypopigmentation

105
Q

Your patient is being started on a topical steroid, and is worried because last time she used it, it left her with white spots on her skin. What do you tell her and how do you handle It?

A

hypopigmentation is a common adverse effect of steroids - we will reduce this risk by using the LEAST POTENT STEROID FOR THE SHORTEST TIME

106
Q 
Which systemic (rare) side effect is NOT a possibility in using topical steroids?
Glaucoma, Hypothalamic pituitary axis suppression, Cushing's syndrome, SJS, Hypertension, Hyperglycemia
A

SJS

107
Q

T or F: to avoid the serious systemic side effects of topical steroids, you should use plastic wrap and bandages to keep them localized

A

FALSE - widespread use and occlusive methods cause this

108
Q

how does the treatment duration differ from super high potency, high/medium potency, and low potency topical steroids?

A

super high: <4 weeks tx
high/medium: <6-8 weeks tx
Low: side effects rare, but treat for 1-2 week intervals to avoid side effects

109
Q

what can patients with chronic atopic dermatitis use to reduce the risk of relapse?

A

twice weekly application of topical steroids

110
Q

how many BSA does 1 of the patient’s palm cover?

A

1%

111
Q

1 finger tip units (FTU) covers how much BSA?

A

2% (2 palms)

1 FTU = 0.5 gm

112
Q

how many grams to cover average adult body for one application?

A

30 g

113
Q

what type of topical steroid to use on infants/kids?

A

low potency - they have a higher BSA area-to-volume ratio

114
Q

This medication is used for treating P.acnes (acne vulgaris), and is a vitamin A derivative

A

Topical retinoids

115
Q

This acne medication works using free radicals to oxidize proteins in P.acnes cell wall

A

Benzoyl peroxide

116
Q

Topical Abx are also used in treating acne. what are the 2 kinds?

A

erythromycin

Clindamycin

117
Q

Topical antibiotics are commonly combined with ______ as opposed to monotherapy in treating acne. Why?

A

Benzoyl peroxide

-prevent development of antibiotic resistance

118
Q

T or F: acne treatment targets NEW lesions, not old lesions, not present ones

A

True

119
Q

how long do topical acne treatments take to see effects?

A

2-3 months (patient adherence is biggest cause of failure)

120
Q

you are seeing your patient for follow up of acne treatment. It has been 6 weeks and he hasn’t seen any major improvement. What do you do?

A

reassurance - wait 8 weeks to see changes before making changes to medications

121
Q

initial treatment for MILD acne

A 
Topical BP or 
topical Retinoid (1 agent)
122
Q

initial treatment for moderate acne

A

Combo BP + retinoid

(+/- topical antibiotic)

123
Q

initial treatment severe acne

A

Combination oral antibiotic + topical retinoid + topical BP (+/- topical antibiotic)

124
Q

how do you manage patient complaining of dry skin, irritation as an effect of acne treatment

A

add a ceramide-containing lotion to maintain skin barrier

125
Q

which skin conditions are NOT treatable with topical antifungals?

A

hair and nail infections - need po

126
Q

what type of topical antifungals are fungistatic?

A

Imidazoles (ketoconazole, econazole, clotrimazole)

127
Q

what does fungistatic antifungals treat?

A

dermatophytes and candida

128
Q

which topical antifungals are FUNGICIDAL

A

Naftifine
Terbinafine
Butenafine
treats dermatophytes BUT NOT CANDIDA

129
Q

which fungistatic topical treats candida but NOT DERMATOPHYTES

A

nystatin

130
Q

what class of antifungals are first line for tinea corporis (ring worm)

A

miconazole (imidazoles) - apply bid until resolution then continue 2 weeks (4-6 weeks total)

131
Q

what potency topical steroid is best for treating psoriasis?

A

high potency (maybe with topical vit D analog)

132
Q

which class of chemo medications causes cardiac toxicity?

A

anthracyclines (doxorubicin)

133
Q

which chemo medication class causes neurotoxicity

A

microtubule-targeting agents (vincristine)

134
Q

which chemo medication class causes secondary malignancies?

A

alkylating agents (melphalan)

135
Q

What are dose-dense therapies

A

chemo that only allows a short time between cycles

136
Q

what do you give with dose-dense chemo therapy

A

colony stimulating factors

137
Q

while getting infused with chemo, your patient experiences severe tissue damage. what is this disorder and what do you do?

A

extravasation - stop injection, aspirate fluid out of injection site

138
Q

how do you treat a hypersensitivity reaction to chemo?

A

give H1 blocker (steroids may help too)

139
Q

T or F: chemo treatment has a low therapeutic index

A

TRUE

140
Q

what is the optimal regimen for treating nausea during chemo

A

prophylaxis + breakthrough antiemetic prn

141
Q

what are the classes of antiemetic that are most commonly used in treating n/v during chemo

A

Corticosteroids
Serotonin receptor antagonists
NK1 receptor antagonists
Olanzapine

142
Q

your patient has been receiving chemo for a couple of rounds, and she follows up complaining of decomposition of gums, and bleeding. what is this?

A

Mucositis

143
Q

what is the best way to prevent mucositis?

A

oral hygiene! keep mouth clean

144
Q

what is febrile neutropenia

A

gram positive infections through bloodstream due to aggressive chemo. Flora on skin is introduced to blood stream

145
Q

what is the best way to prevent febrile neutropenia?

A

HAND hygiene
avoid infections
prophylactic abx
colony-stimulating factors

146
Q

your chemo patient is complalining of blood in your urine. you think that it might be ____

A

hemorrhagic cystitis - bleeding from lining of bladdder

147
Q

which 2 medications are at high risk of causing hemorrhagic cystitis

A

cyclophosphamide

ifosfamide

148
Q

how is hemorrhagic cystitis prevented?

A

Mesna

149
Q

an adverse effect of chemo is described as the tumor being destroyed and its contents get into circulation, leading to crystallization in the renal tubules of the kidney. What is this called

A

tumor lysis syndrome

150
Q

what medication can be used as prophylaxis to tumor lysis syndrome

A

Allopurinol - PROPHYLAXIS ONLY

151
Q

your patient has uric acid crystalizing the renal tubule of the kidney. You think it may be a result of tumor lysis syndrome. You immediately treat him with Allopurinol, as it decreases the amount of uric acid

A

FALSE - does not decrease uric acid, only prevents it. PROPHYLAXIS ONLY

152
Q

what medication do you use for chemo-induced diarrhea, if NOT c.diff

A

Loperamide

153
Q

what medication do you use for chemo-induced diarrhea diarrhea if c.diff present

A

Metronidazole

154
Q

Filgrastim
Pegfilgrastim
Sargromostim

A

colony stimulating factors

155
Q

what is the purpose of using colony stimulating factors?

A

shortens hospitalization

shortens duration of neutropenia

156
Q

when administering methotrexate as chemo, what other med can you administer to prevent myelosuppression and mucositis

A

Leucovorin

157
Q

which medication is added to Methotrexate, and what does it prevent?

A

Leucovorin - prevents myelosuppression and mucositis

158
Q

what adverse effect happens with Capecitabine, and what class is it in?

A

Antimetabolite; hand-foot syndrome

159
Q

what are the 3 main toxicities that happen with combined chemo?

A

cardiotoxicity
neurotoxicity
secondary malignancies

160
Q

the Vinca alkaloids are commonly used in treating hematologic malignancies. What adverse effect to be aware of?

A

neurotoxicity

161
Q

what can happen 48-72 hours after administration of the Nitrogen Mustards?

A

encephalopathy (reversible)

162
Q

What is contraindicated (medication) while using Aldesleukin as chemo?

A

Aldesleukin is an immunotherapy

CORTICOSTEROIDS contraindicated

163
Q

the “umabs” are more humanized than the “imab, omab”. Less humanized = more likely to react. What type of “reaction” are they more likely to?

A

fever, chilss, to life-threatening allergic reactions

164
Q

What class of chemo are Imatinib and Sorafenib involved with? And what CYP do they interact with?

A

Tyrosine kinase inhibitors; CYP 3A4

165
Q

When choosing a prophylactic treatment for Migraines, your patient can’t tolerate beta blockers. what is your next best choice?

A

Anticonvulsants (topiramate, Valproic acid, Divalproex, Carbamazepine)

166
Q

which anticonvulsant do you choose as migraine prophylaxis if you want to treat both migraine + trigeminal neuralgia?

A

Carbamazepine

167
Q

You’re choosing a migraine prophylaxis medication for your patient, and she mentions she can’t gain any more weight, and is trying to lose weight. Which anticonvulsant has the least likelihood of causing weight gain?

A

Topiramate

168
Q

which is the heart rate controlling medication of choice specifically for prophylaxis against cluster headaches?

A

Verapamil (CCB)

can also choose Lithium for prophylaxis

169
Q

your diabetic patient is wanting to start Lorcaserin for extra weight loss help. What adverse effect do you need to monitor for that is especially dangerous considering his diabetes

A

hypoglycemia

170
Q

which topical analgesic induces depletion of substance P

A

capsaicin - takes 1-2 weeks to work

Pharmacology (12 decks)

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