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Pharm III - Exam 4 > Cumulative Material > Flashcards

Cumulative Material Flashcards

1
Q

What are the indications for use of a loop diuretics?

A

Edema, hypercalcemia, hyperkalemia, anion overdose (fluoride, bromide, iodide).

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2
Q

MOA of loop diuretics

A

Inhibits sodium/potassium/chloride transporter at the thick ascending limb of the loop of henle.

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3
Q

Which loop diuretic should be used when concerned about sulfonamide allergy (even though there is no cross reactivity between loops and sulfa abx)?

A

Ethacrynic Acid (Edecrin)

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4
Q

Indications for the use of Spironolactone

A

Primarily hypokalemia (px and tx); hyperaldosteronism, PCOS

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5
Q

What are Eplerenone, Triamterene, and Amiloride indicated for? (All potassium sparing diuretics)

A

Hypokalemia px and tx

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6
Q

What is Conivaptan indicated for?

A

CHF, SIADH

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7
Q

Drugs that induce ED

A

Beta blockers,Clonidine, methyldopa, haloperidol, chlorpromazine, thioridazine, Fluphenazine, SSRIs, SNRIs, Finasteride, Dutasteride, Silodosin, Opioids (esp Methadone), nicotine, excess alcohol

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8
Q

Onset and Duration of Sildenafil (Viagra)

A

onset in 30 m - 1 hour; duration 4 hours

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9
Q

MOA of PDE Inhibitors

A

inhibits phosphodiesterase enzymes, slowing the breakdown of cGMP and allowing for the depression of calcium, leading to smooth muscle relaxation, allowing erection (arteriodilation + venoconstiction)

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10
Q

MOA of Alprostadil (injectable PGE-1)

A

increases cAMP leading to a drop in calcium

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11
Q

meds that induce BPH

A

testosterone, alpha agonists (pseudoephedrine, ephedrine, phenylephrine), anticholinergics (antihistamines, phenothiazine, TCAs), large doses of diuretics

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12
Q

ADE of Tamsulosin (and other alpha 1 adrenergic antagonists)

A

dizziness, hypotension, syncope with first dose, muscle weakness, H/A, floppy iris syndrome

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13
Q

indication for Finasteride (5-alpha reductase inhibitor)

A

BPH

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14
Q

MOA of 5-alpha reductase inhibitors

A

relax smooth muscle, decrease prostate size, halt disease process, and decrease PSA

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15
Q

What is the most commonly used herbal supplement in the tx of BPH?

A

Saw Palmetto

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16
Q

Drugs that cause/worsen Urinary Incontinence

A

diuretics, alpha receptor antagonists, sedation hypnotics, antidepressants, TCAs, alcohol, angiotensin converting enzyme inhibitors

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17
Q

first-line agent in the tx of stress induced urinary incontinence

A

Duloxetine (Cymbalta)

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18
Q

first-line tx for overactive bladder

A

Oxybutynin (Ditropan)

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19
Q

agents that cause vasodilation of the efferent arteriole

A

ACE-Is, ARBs, Diltiazem, Verapamil

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20
Q

drug class that affects blood/urine pH through the movement of H+ ions with K+ at the collecting duct

A

Potassium Sparing Diuretics

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21
Q

drug class that acts on the distal convoluted tubule and enhances calcium reabsorption into the blood stream

A

thiazide diuretics

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22
Q

Cholinesterase Inhibitor that is reversible and has specificity for only acetylcholine

A

Donepezil Hydrochloride (Aricept)

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23
Q

Cholinesterase Inhibitor that comes in capsule, solution, and patch forms

A

Rivastigmine

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24
Q

Rivastigmine Tartrate (Exelon) ADE

A

N/V/D, dizziness, H/A, insomnia, depression, somnolence

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25
Q

What drug is FDA approved for the tx of moderate to severe AD?

A

Memantine (Namenda)

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26
Q

What should all Alzheimer’s patients receive?

A

ASA therapy to improve vascular function

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27
Q

Which drug used to tx Alzheimer’s Disease is considered medical food?

A

Caprylidene (Axona)

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28
Q

Caprylidene (Axona) ADE

A

risk of DKA in diabetics, may increase TGs

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29
Q

drugs that cause visual abnormalities

A

Carbamazepine, Eslicarbazepine, Locasamide, Lamotrigine, Oxcarbazepine, Phenytoin, Pregabalin, Tiagabine, Vigabatrin

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30
Q

Anticonvulsants that cause weight loss

A

Ethosuximide, Felbamate*, Topiramate, Zonisamide

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31
Q

Anticonvulsants that cause weight gain

A

Gabapentin, Pregabalin, Valproic Acid, Vigabatrin

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32
Q

Why does Cimetidine cause significant DI’s?

A

it is a CYP inhibitor

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33
Q

tx algorithm for early-established seizures

A

0-10 minutes: IV lorazepam (or diazepam)
10-30 minutes: IV phenytoin or fosphenytoin
30-60 minutes: additional dose of hydantoin 5 mg/kg, IV phenobarbital 20 mg/kg at a rate of 100 mg/min

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34
Q

treatment algorithm for refractory seizures > 60 minutes wit 10-15% GCSE

A

additional dose of phenobarbital 10 mg/kg every hour until sz stop
or
IV valproate 15-25 mg/kg followed by 1-4 mg/kg/hr
or
medically induced coma

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35
Q

only class that should be used in the elderly to tx sx of anxiety, restlessness, and insomnia in AD

A

Benzodiazepines (Lorazepam, Diazepam, Temazepam)

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36
Q

use of anticonvulsants (Carbamazepine, VA) in non-elderly AD pts

A

agitation or aggression

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37
Q

use of anitpsychotics (Aripiprazole, Olanzapine, Quetiapine, Risperidone) in non-elderly pts with AD

A

disruptive behavior, agitation, aggression

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38
Q

medications associated with memory loss

A

anticholinergics, benzos, other sedative hypnotics, opioid analgesics, antipsychotics, anticonvulsants, NSAIDs, H2 receptor antagonists, digoxin, amiodarone, corticosteroids, antihypertensives (dizziness)

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39
Q

Indications for Rasgiline (Azilect - MAOB Inhibitor)

A

mono tx in early PD or adjunct to LD in advanced PD (typically first-line in early disease)

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40
Q

medication used for Parkinson’s that is an antiviral

A

Amantidine (Symmetrel)

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41
Q

drug used to tx PD for which tachyphylaxis may be expected in 4-8 weeks

A

Amantidine (Symmetrel)

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42
Q

drug of choice in PD if resting tremor is the initial presenting sx

A

Benztropine Mesylate (Cobentin) or Trihexylphenidyl* (Artane)

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43
Q

Pt population in which Benztropine and Trihexyphenidyl (Anticholinergics) should be avoided.

A

pts with cognitive deficits

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44
Q

MOA of Ergot Derivative Dopamine Agonists (Bromocriptine, Pergolide)

A

Moderate affinity for D2 and D3 receptors.

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45
Q

What needs to be done for patients who have renal issues and are taking Pramipexole (Mirapex)?

A

dose adjust

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46
Q

Drug class of Ropinerol (Requip)

A

Non-Ergot Derivative Dopamine Agonists

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47
Q

Indication for Rotigotine (Neupro - Non-Ergot Derivative Dopamine Agonist)

A

early stage idiopathic PD and advanced stages

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48
Q

Which Non-Ergot Derivative Dopamine Agonist comes in patch form?

A

Rotigotine (Neupro)

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49
Q

indication for Apomorphine (Apokyn)

A

rescue med for “delayed on”/”no on” or “freezing episodes” (PRN)

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50
Q

What prophylaxis is required when using Apomorphine (Apokyn)?

A

Trimethobenzamide 3 days prior

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51
Q

Indication for CD/LD

A

cornerstone of tx of PD, required by nearly all PD pts at some point in dz but use as first-line is controvertial d/t ADE

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52
Q

MOA of CD/LD

A

CD inhibits decarboxylase, delaying the conversion of LD to dopamine prior to crossing the BBB, increasing its bioavailability once on the other side of the BBB

53
Q

ADE of CD/LD

A

N/V, orthostasis, confusion, postural hypotension, vivid dreams, wearing-off fluctuations, dyskinesias (5-10%), random motor oscillations possible with chronic use; issues with dose gap (add DA’s)

54
Q

Special Recommendations for pts taking CD/LD

A

avoid high protein meals, take 30 m before or 60 m after meals d/t competition with other aa’s for GI absorption

55
Q

major ADE of COMT Inhibitors (Entacapone, Tolcapone)

A

brownish-orange urinary discoloration, potential for serious liver dysfunction (monitor LFTs!)

56
Q

Stalevo

A

CD/LD + Entacapone

57
Q

What is the purpose of COMT Inhibitors in PD therapy?

A

increases the “time on” by 1-3 hours when used as an adjunct to CD/LD (Entacapone*)

58
Q

drugs that extend the effects of CD/LD

A

DA’s and COMT-I’s

59
Q

appropriate tx in a Parkinson’s pt experiencing freezing or start hesitation who is on CD/LD

A

increase CD/LD dose, add DAs or MAO-B-Is, PT, sensory cues, walking devices

60
Q

For a pt presenting with tremor who is already being tx’d for PD, how does age change the tx’s available?

A

If under 65 consider an anticholinergic or Amantadine, if over 65 anticholinergics should not be used

61
Q

monitoring for Phenytoin (Dilantin)

A

CBC, LFTs, albumin, and serum concentration

62
Q

What disturbing oral ADE is Phenytoin (Dilantin) associated with?

A

Gingival Hyperplasia

63
Q

What would be seen if Carbamazepine were to be given concomitantly with CYP inhibitors (ex: Cimetidine)?

A

increase in serum concentration

64
Q

Pan-Inducers used to tx seizure disorders

A

Carbamazepine and Phenobarbital

65
Q

Topiramate (Topimax) ADE

A

weight loss, cognitive functioning impairment, kidney stones, ataxia, somnolence

66
Q

Lamotrigine (Lamictal) ADE

A

rash (SJS, TENS), coordination abnormalities, anxiety, mania, diplopia, insomnia, drowsiness, fatigue

67
Q

Indication for Valproic Acid/Divalproex Sodium/Valproate Sodium in sz disorders

A

primary generalized sz (myoclonic, atonic, absence); partial sz, mixed disorders

68
Q

What is unique about the metabolism of Valproic Acid/Divalproex Sodium/Valproate Sodium?

A

undergoes gluconuridation and inhibits glucuronidation in other agents

69
Q

Valproic Acid/Divalproex Sodium/Valproate Sodium ADE

A

dose related: N/V, abdominal pain, heartburn, sedation, fine hand tremor, weight gain and increased appetite, hair loss, hepatotoxicity, thrombocytopenia

70
Q

Gabapentin ADE

A

somnolence, ataxia, tremor, dizziness, H/A

71
Q

Pregabalin ADE

A

dizziness, ataxia, somnolence, peripheral edema, weight gain, H/A (NO DIPLOPIA!!)

72
Q

Zonisamide ADE

A

fatigue, dizziness, ataxia, somnolence, anorexia, weight loss, psychomotor slowing

73
Q

Indication for Ethosuximide (Zarontin)

A

absence sz

74
Q

Risk Factors for Iron Deficiency Anemia

A

premature infants, children in rapid growth periods, pregnant and lactating women, pts undergoing chronic hemodialysis, pts after gastrectomy, pts with small bowel disease, menstruation, occult GI bleeding

75
Q

Which form of parenteral iron requires a 25 mg test dose for anaphylaxis?

A

Iron Dextran

76
Q

How long is the tx of B12 Deficiency Anemia with cyanocobalamin?

A

typically for life

77
Q

Indications of Nasocobal (nasal spray) Use

A

maintenance therapy in Vit B12 Deficiency Anemia tx

78
Q

What is the difference in half life of ESAs (Darbepoetin and Epoetin Alfa)?

A

Darbe has a much longer half life allowing for less frequent dosing

79
Q

What are the supportive tx’s used in Sickle Cell Anemia?

A

NS for hydration
Acetaminophen and NSAIDs for mild-moderate pain
Opioids for moderate to severe pain

80
Q

What causes reduced efficacy of cancer drugs on cancer cells?

A

cancer cells can alter their characteristics to reduce their susceptibility

81
Q

Where in the cell cycle do Alkylating Agents (Carmustine, Lomustine, Mechlorethiamine, Melphan, Thiotepa, Procarbizine, Chlorambucil, Cyclophosphamide, Bendamustine, Temozolamide, Dacarbazine) act?

A

cell cycle non-specific

82
Q

Ankylating Agent (Cyclophosphamide) ADE

A

bone marrow toxicity, mucositis, sterility, N/V, tissue damage following extravasation, risk of secondary malignancies

83
Q

Where in the cell cycle do Platinum Analogs (Carboplatinum) act?

A

cell cycle non-specific

84
Q

ADE of Carboplatinum

A

myelosuppression

85
Q

Where in the cell cycle do Antimetabolites (Methotrexate, 5-FU, Cytarabine) act?

A

S phase (DNA synthesis)

86
Q

Cytarabine (Ara-C) ADE

A

cerebellar toxicity

87
Q

Indication of Leocorvin (Special Antimetabolite)

A

reduction of MTX toxicity and increased colon cancer tx

88
Q

Cell cycle phase where Leocorvin is active

A

S phase/DNA phase

89
Q

Leucorvin MOA

A

no anticancer action! rescues normal cells by bypassing the inhibition of DHFR by MTX. increases 5-FU activity against colon cancer by enhancing binding.

90
Q

Vincristine (Vinca Alkaloid) MOA

A

inhibit tubulin polymerization required for microtubule assembly; prevents microtubule formation, blocking cell division during metaphase, resulting in cell death

91
Q

Cell cycle where Vinca Alkaloids are active

A

M phase

92
Q

Vincristine ADE

A

potent vesicant action upon extravasation

93
Q

Cell cycle where Taxanes (Pacitaxel) act

A

M phase

94
Q

cell cycle where Antitumor Abx/Anthracyclines act

A

cell cycle non specific

95
Q

Doxorubicin (Anthracycline) ADE

A

vesicant if extravasated

96
Q

What is an important aspect of tx with Doxorubicin?

A

limit lifetime dose of anthracyclines in general and use in combo with dextrazoxane

97
Q

cell cycle where Bleomycin (antitumor antibiotics) is active

A

cell cycle-non specific

98
Q

What are the toxicity risks of Bleomycin?

A

persons > 70, cumulative dose > 400 units, underlying pulmonary disease, prior mediastinal radiation, supplemental disease

99
Q

Indication for use of Imatinib (TKI)

A

Ph+ CML and ALL

100
Q

MOA of TKIs

A

(Imatinib) binds to and blocks specific sites on various TKI’s that are needed to activate them, promotes cancer cell death via apoptosis (phosphorylate mostly cell surface receptors)

101
Q

Tx for multiple myeloma

A

Thalidomide (Immunomodulators)

102
Q

Tx for Breast Cancer that is HER-2/neu overexpressing

A

Monoclonal Antibodies

103
Q

MOA of Monoclonal Antibodies

A

targets specific proteins in CA cells and blocks their standard function

104
Q

Monoclonal Antibody ADE

A

Trastuzumab: infusion related rx (px with acetaminophen, diphenhydramine +/- dexamethasone), HF

105
Q

Major warning associated with ESA use

A

increased mortality, increased CV and TEEs, increased tumor growth or loss of remission

106
Q

translocation that occurs in CML

A

t9:22 = Philadelphia Chromosome

107
Q

What is breast cancer tx based on?

A

pre or post menopausal status

108
Q

What are the hormonal therapies for Breast Cancer?

A

Tamoxifen, Raloxifene, Anastrozole, Letrozole, Leuprolide

109
Q

What is the goal of chemo tx in malignant melanoma?

A

prolong survival

110
Q

How do secondary malignancies and de novo cancer differ?

A

secondary malignancies are more difficult to tx than de novo cancer

111
Q

What kind of tx is chemo considered?

A

systemic

112
Q

What is the principle of cancer cell growth that describes how the growth fraction of a tumor changes over time?

A

growth fraction decreases as tumor size increases, therefore fewer cells are susceptible to chemo (Gompertzian Model of tumor cell growth)

113
Q

Define adjuvant therapy

A

used after local therapy to improve long term effect by eliminating any remaining undetected CA cells

114
Q

define remission

A

complete response (CR), when the presence of cancer is undetectable

115
Q

define palliation

A

used to reduce sx of disease, improve QOL, and prolong survival; cure unlikely

116
Q

Cyclophosphamide (Ankylating Agent) MOA

A

targets DNA/RNA to transfer ankylating groups to other molecules in the strands, preventing their use in replication and cell division; = apoptosis

117
Q

Methotrexate (Antimetabolite) MOA

A

inhibits dihydrofolate reductase which converts one form of folic acid to another (blocks purine synthesis), also inhibits thymidine synthase

118
Q

Vincristine (Vinca Alkaloids) MOA

A

inhibits tubulin polymerization requried for M.T. formation, blocking cell division during metaphase

119
Q

What is the mechanism by which resistance to TKIs may occur?

A

mutations in the AA sequence of TK may cause the site bound to be inadequate

120
Q

What are two mechanisms of drug interactions with TKIs?

A

changes in metabolism secondary to other drugs affecting CYP450 3A4 and reduced absorption secondary to acid reducing drugs (ex: PPIs)

121
Q

families of drugs with vesicant activity if extravasated

A

antitumor antibiotics, vinca alkaloids, alkylating agents

122
Q

Carboplatin ADE

A

myelosuppression

123
Q

Doxorubicin ADE

A

cardiotoxicity

124
Q

Cytarabine ADE

A

cerebellar toxicity

125
Q

What are two methods to reduce the risk of cardiotoxicity associated with Doxorubicin?

A

limit lifetime dose, use in combo with dextrazone

126
Q

What occurs in phase III of drug trials?

A

assess efficacy of compound compound compared to standard tx

127
Q

hormone sensitive cancers

A

breast and prostate

128
Q

MOA of Carbonic Acid Anhydrase Inhibitors

A

Inhibits enzyme responsible for dehydration of H2CO3 (H2CO3 ->HCO3)

Pharm III - Exam 4 (5 decks)

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