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Pharmacology Exam 3 > Drugs > Flashcards

Drugs Flashcards

1
Q

ENDOCRINE

A

ENDOCRINE

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2
Q

What drugs are used to treat hypopituitarism?

A
  • Growth Hormone (Somatropin)

- DDAVP (desmopressin)

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3
Q

Growth Hormone (Somatropin):

  • What is the MOA of somatropin?
  • What are the AE associated with GH?
A
  • synthetic GH that has a role in bone, muscle, and organ growth
  • fluid retention/edema, muscle and joint pain
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4
Q

DDAVP (desmopressin):

  • What class of drug is DDAVP?
  • What is the MOA?
  • What are the AE?
  • What is DDAVP also used to treat?
  • What can a deficiency in AVP cause?
A
  • AVP aka ADH, synthetic version
  • acts to decrease water excretion by increasing urine concentration. Binds to V2 receptors in collecting ducts causing an increase in AQP channels
  • dry mouth, hyponatremia
  • nocturnia
  • diabetes insipidus
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5
Q

Therapeutic concerns with pituitary treatment:

A
  • Drug treatment accuracy is difficult

- Low GH levels = low bone density which leads to bone fractures

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6
Q

What are the drugs used to treat hyperaldosteronism (mineralocorticoid excess)?

A
  • Spironolactone

- Eplerenone

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7
Q

Spironolactone:

  • What is it used to treat?
  • What are the AE?
  • Is it selective or nonselective for aldosterone receptors? What does this mean?
  • What other disease state is this used for?
A
  • Hyperaldosteronism (mineralocorticoid excess)
  • Hyperkalemia, lethargy, gynecomastia, menstrual irregularities
  • Nonselective, will have more AE than eplerenone
  • HTN
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8
Q

Eplerenone:

  • What is it used to treat?
  • What are the AE?
  • Is it selective or nonselective for aldosterone receptors? What does this mean?
  • What other disease state is this used for?
A
  • Hyperaldosteronism (mineralocorticoid excess)
  • Hyperkalemia, lethargy, gynecomastia, menstrual irregularities
  • Selective, it will have less AE than spironolactone
  • HTN
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9
Q

What are the drugs used to treat glucocorticoid deficiency?

A
  • Hydrocortisole

- Fludrocortisone

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10
Q

Hydrocortisone and Fludrocortisone:

  • What is it used to treat?
  • Short term AE?
  • Long term AE?
  • In primary adrenal insufficiency, why would we replace a mineralocorticoid with flodrocortisone?
  • Do we ever increase the dosage with these meds?
A
  • Glucocorticoid deficiency
  • increased blood glucose, mood changes, fluid retention
  • osteoporosis, thin skin, muscle wasting, poor would healing, adrenal suppression, Cushing’s disease, infection
  • to decrease risk of hyperkalemia
  • yes, in times of acute stress or even before strenous exercise
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11
Q

Therapeutic concerns with adrenal steroids:

A
  • Catabolic effect on supporting tissues (don’t overload muscles/bones during strengthening)
  • May cause HTN due to Na+ retaining properties
  • Immunosuppression
  • Drug toxicity (mood changes)
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12
Q

What drug is used to treat an androgen deficiency?

A

-testosterone

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13
Q

Testosterone:

  • What is it used to treat?
  • Why do we only use it if indicated?
  • What does prolonged use lead to?
  • What do large doses cause?
A
  • androgen deficiency
  • increased risk of MI, stroke, or CV death
  • hepatotoxicity
  • infertility
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14
Q

What are the 2 main drugs used to treat mens BPH?

A
  • mirabegron (Myrbetriq)

- oxybutynin

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15
Q

Mirabegron (Myrbetriq):

  • What class of drug is this?
  • What is the MOA?
  • What are the AE?
A
  • B3 adrenergic agonist
  • relaxes detrusor muscles to decrease voiding symptoms
  • may increase BP
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16
Q

Oxybutynin:

  • What class of drug is this?
  • What is the MOA?
  • What are the AE?
A
  • anticholinergic
  • antispasmodic effect on smooth muscle, blocks ACh on smooth muscle
  • Cant pee, cant see, cant spit, cant shit
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17
Q

Therapeutic concerns with sex hormones:

A
  • Monitor BP due to Na+ and water retention

- Androgen abuse in athletes

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18
Q

What 2 drugs are used to treat hypoparathyroidism?

A
  • Calcium

- Vitamin D

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19
Q

Calcium and vitamin D:

  • How much calcium is taken daily for osteoporosis?
  • How much vitamin D is taken daily?
  • What is the most common AE?
A
  • 1000-1200mg
  • 600-800 international units
  • constipation
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20
Q

What is the drug used to treat hypothyroidism?

A

-levothyroxine

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21
Q

Levothyroxine:

  • What is this drug used to treat?
  • What is the MOA?
  • What are the AE?
  • Does this drug require monitoring?
  • Excessive overdose can increase risk for what?
  • Long term overtreatment can lead to what?
A
  • Hypothyroidism
  • Synthetic version of T4 that is converted to T3
  • OPPOSITE of hypothyroidism symptoms; sweating, heat intolerance, tachycardia, diarrhea, increase basal metabolic rate
  • yes, it is an NTI drug (initially every 4-8 weeks, then every 6-12 months)
  • MI, HF, angina
  • decreased bone density
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22
Q

What drug is used to treat hyperthyroidism?

A

-Methimazole

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23
Q

Methimazole:

  • What is this drug used to treat?
  • This drug is preferred over what drug as a antithyroid medication?
  • What is the MOA?
  • What are the common AE?
  • What are the rare AE?
  • What is the only reason PTU would be taken over methimazole?
A
  • hyperthyroidism
  • PTU (propylthiouracil)
  • blocks formation of T4 and T3
  • rash, GI upset, arthralgia
  • agranulocytosis, hepatotoxicity
  • during 1st trimester of pregnancy, methimazole can cause birth defects
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24
Q

Therapeutic concerns about thyroid and parathyroid drugs:

A
  • excessive doses for hyper or hypo tend to produce symptoms of opposite disorder
  • avoid overexertion in patient with decreased CO and hypotension caused by hypothyroidism
  • excessive doses of calcium can produce arrhythmias
  • take advantage of weight bearing activities to stimulate bone formation AND be aware of when high impact should be avioded (osteoporosis)
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25
Q

What are the 2 main antihyperglycemic medications?

A
  • Biguanide (metformin)

- Sulfonylureas (glipizide)

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26
Q

Biguanide (metformin):

  • What is biguanide used to treat?
  • What is its MOA?
  • Is it a low or high risk hypoglycemia medication?
  • What is the most common AE?
  • What is the boxed warning?
A
  • hyperglycemia
  • inhibits glucose absorption, increases insulin sensitivity
  • low risk
  • GI issues,B12 deficiency
  • lactic acidosis
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27
Q

Sulfonylureas (glipizide):

  • What is sulfonylurea used to treat?
  • What is its MOA?
  • Is it a low or high risk hypoglycemia medication?
  • What are the AE?
A
  • hyperglycemia
  • binds to sulfonylurea receptor causing insulin release
  • high
  • hypoglycemia, weight gain
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28
Q

Therapeutic concerns for DM:

A

Diabetic associated comorbitities:

  • diabetic retinopathy
  • diabetic nephropathy
  • diabetic neuropathy
  • PVD
  • CVD

Beneficial effects of exercise:

  • increase carb metabolism = lower blood glucose
  • maintain body weight
  • increased HDL
  • decreased triglycerides
  • decreased BP
  • decreases stress and tension
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29
Q

NEUROLOGY

A

NEUROLOGY

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30
Q

What are the three main medications used to treat ADHD?

A
  • mixed amphetamine salts (Adderall)
  • methylphenidate (Concerta, Ritalin)
  • atomoxetine (Strattera)
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31
Q

Mixed amphetamine salts (Adderall):

  • What is this used to treat?
  • What is the drug class?
  • What is the MOA?
  • What are the common AE?
  • What are some rare AE?
A
  • ADHD
  • Stimulant
  • block dopamine and NE reuptake, also increases dopamine and NE release
  • decreased appetite/weight loss, stomachache, insomnia, HA, irritability
  • dysphoria, zombie like state, HTN, hallucinations
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32
Q

Methylphenidate (Concerta, Ritalin):

  • What is this used to treat?
  • What is the drug class?
  • What is the MOA?
  • What is the difference between this and Adderall AE?
  • What are the boxed warnings associated with both Adderall and Ritalin?
A
  • ADHD
  • Stimulant
  • blocks dopamine and NE reuptake
  • has one extra rare AE of skin discoloration with the patch
  • CV risk and abuse potential
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33
Q

Atomoxetine (Strattera):

  • What is it used to treat?
  • How is it different from stimulant drugs (MOA)?
  • Are the AE different than stimulant drugs?
  • What is the boxed warning for Strattera?
  • Is it more or less effective than stimulants?
A
  • ADHD
  • selective NE reuptake inhibitor
  • Generally similar but has more fatigue, sedation, and dizziness
  • increases risk of suicidal ideation in children
  • less effective but less potential for abuse
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34
Q

Therapeutic concerns with ADHD drugs:

A
  • Monitor vital signs; stimulant therapy can increase HR and BP
  • Be aware of loss of apetite and insomnia
  • Monitor behavior and attention span
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35
Q

DEGENERATIVE CONDITIONS

A

DEGENERATIVE CONDITIONS

36
Q

What are the 2 main drugs used to treat Parkinson’s Disease?

A
  • levodopa-carbidopa (Sinimet)

- ropinirole (Requip)

37
Q

Levodopa-carbidopa (Sinimet):

  • What is its drug class?
  • What is it used to treat?
  • Why is levodopa-carbidopa needed as a combo drug (MOA)?
  • What are the AE?
A
  • dopamine replacement therapy
  • PD
  • levodopa is the precursor to dopamine that CAN cross the BBB to have CNS action, carbidopa acts to stop levodopa breaking down into dopamine so we can have those CNS effects.
  • motor disturbances (end dose wearing off), “delayed on” or “no on” due to absorption issues, freezing to the floor, “on” period dyskinesia
38
Q

Ropinirole (Requip):

  • What is its drug class?
  • What is it used to treat?
  • What is its MOA?
  • What are the AE?
A
  • dopamine agonist
  • PD
  • binds to and agonizes dopamine receptors
  • nausea, drowsiness, dizziness, syncope, postural hypotension
39
Q

Therapeutic concerns for PD drugs:

A
  • Timing of PT sessions with delivery of medications
  • effects of exercise on medication absorption
  • long-term medication use and disease progression
40
Q

What are the 5 drugs used to treat Multiple Sclerosis?

A
  • Interferon B
  • Glatiramer acetate
  • Fingolimoid
  • Dimethyl fumarate
  • Monoclonal antibodies (natalizumab, ocrelizumab)
41
Q

Interferon B:

  • What is the drug class?
  • What is the MOA?
  • What is it used for?
  • What is the most common AE?
A
  • Interferon
  • Exact unknown, but has impact on immune system
  • decrease exacerbations and delay accumulation of physical disability
  • Flu-like symptoms
42
Q

Glatiramer acetate:

  • What is its class?
  • What is the MOA?
  • What are the uses?
  • What is the most common AE?
A
  • biological agent
  • reduce autoimmune response to myelin by reducing t-cell response against myelin
  • decrease exacerbations and lesions on MRI
  • injection site reaction
43
Q

Fingolimod:

  • What is the drug class?
  • What is the MOA?
  • What is the use?
  • What are the most common AE?
A
  • S1P receptor modulator
  • blocks release of lymphocytes into CNS thus decreasing inflammation
  • decrease exacerbations and overall disease severity
  • HA in >15%, increase LFTs
44
Q

Dimethyl fumarate:

  • What is the drug class?
  • What is the MOA?
  • What is the use?
  • What are the most common AE?
A
  • fumeric acid derivative
  • unknown, may have anti-inflammatory properties
  • decrease exacerbations and overall disease severity
  • GI and flushing (rare hepatotoxicity)
45
Q

Monoclonal antibodies (natalizumab, ocrelizumab):

  • What is the MOA?
  • What is the use?
  • What are the most common AE?
A
  • natalizumab and ocrelizumab both decrease inflammation
  • decrease exacerbations, decrease lesions on MRI and/or slow progression
  • infusion reactions, HA, fatigue, arthralgia
46
Q

What are the drugs that CAN cause Progressive Multifocal Leukoencephalopathy (PML)?

A
  • Monoclonal antibodies (-lizumab)
  • Dimethyl fumarate
  • S1P receptor modulators (fingolimod)
47
Q

Therapeutic concerns for MS treatment:

A
  • FATIGUE
  • Corticosteroid drug treatment
  • Disease modifying drugs can have substantial AE including flu-like symptoms to immunosuppression
48
Q

What are the drugs used to treat Alzheimer’s Disease?

A
  • donepezil (Aricept)

- memantine (Namenda)

49
Q

Donepezil (Aricept):

  • What is the drug class?
  • What is it used to treat?
  • What is the MOA?
  • What is the duration of benefit?
  • What are the AE?
A
  • cholinesterase inhibitor
  • AD
  • inhibits acetylcholinesterase which typically breaks down ACh
  • 3-24 months
  • N/V most common, SLUDGE and DUMBBELLS also AE
50
Q

Memantine (Namenda):

  • What is the drug class?
  • What is it used to treat?
  • What is the MOA?
  • What are the AE?
A
  • NMDA Antagonist
  • AD
  • antagonizes NMDA to decrease excitation and neuronal death
  • usually well tolerated, but monitor for falls
51
Q

What should AD patients not be taking?

A

Anticholinergic drugs

52
Q

Therapeutic concerns for AD treatment:

A
  • Be aware of potential AEs
    • Cholinergic meds- GI issues most common
    • Memantine- may cause dizziness, watch for falls
  • Communicate behavioral issues to healthcare providers
  • Timing of PT
53
Q

SPASTICITY AND MUSCLE SPASMS

A

SPASTICITY AND MUSCLE SPASMS

54
Q

What are the 3 drugs used to treat muscle spasticity?

A
  • Tizanidine
  • Cyclobenzaprine (Flexeril)
  • Baclofen
55
Q

Tizanidine:

  • What is it used to treat?
  • What is the drug class?
  • What is the MOA?
  • What are the AE?
A
  • Spasticity
  • A2 agonist
  • selectively bind A2 to decrease release of excitatory neurotransmitters
  • drowsiness, dizziness, asthenia
56
Q

Cyclobenzaprine (Flexeril):

  • What is the drug used to treat?
  • What is the drug class?
  • What is the MOA?
  • What are the most common AE?
A
  • spasticity
  • Centrally acting antispasmodic
  • unknown
  • sedation, dizziness
57
Q

Baclofen:

  • What is the drug used to treat?
  • What is the drug class?
  • What is the MOA?
  • What are the AE?
  • What is the boxed warning for baclofen?
  • How else can baclofen be given?
A
  • spasticity
  • Direct acting agent
  • Inhibitory effect on alpha motor neuron through inhibition of excitatory neurons
  • CNS depressant (sedation, ataxia, cardiac/resp depression) muscle weakness, impaired memory and cognition
  • Abruptly stopping medication can cause; high fever, AMS, exagerated rebound spasticity and muscle rigidity, rare rhabdomyolysis
  • intrathecal
58
Q

Therapeutic concerns with antispasticity treatment:

A
  • sedation and weakness most notable impact on PT participation
  • awareness of pump malfunction
59
Q

What are the 6 drug classes to treat depression?

A
  • SSRI (selective seretonin reuptake inhibitor)
  • SNRI (serotonin/NE reuptake inhibitor)
  • Atypical Agents
  • Tricyclic Antidepressants
  • MOAI
  • Other
60
Q

What are the 2 main SSRI drugs?

A
  • citalopram (Celexa)

- escitalopram (Lexapro)

61
Q

citalopram (Celexa) and escitalopram (Lexapro):

  • What are they used to treat?
  • What is the drug class?
  • What is the MOA?
  • What are the common AE?
  • What are the less common AE?
A
  • depression
  • SSRI
  • inhibit reuptake of 5-HT in CNS
  • HA, N/V/D, insomnia, sexual side effects
  • hyponatremia, bleeding
62
Q

What are the 2 main SNRI drugs?

A
  • venlafaxine (Effexor)

- duloxetine (Cymbalta)

63
Q

venlafaxine (Effexor) and duloxetine (Cymbalta):

  • What are they used to treat?
  • What is the drug class?
  • What is the MOA?
  • What are the common AE?
A
  • depression
  • SNRI
  • inhibits reuptake of 5-HT and NE in CNS
  • HA, nausea, dry mouth, sweating, sexual dysfunction
64
Q

What is duloxetine (Cymbalta) specifically used for?

A

fibromyalgia, neuropathic pain

65
Q

What is the main atypical agent drug?

A

-bupropion

66
Q

bupropion:

  • What is it used to treat?
  • What is the drug class?
  • What is the MOA?
  • What are the common AE?
  • It also has a risk for what?
A
  • depression
  • atypical agent (DA/NE reuptake inhibitor)
  • inhibits NE and DA reuptake
  • HA, nausea, significant insomnia, tremor, dry mouth
  • risk of seizures
67
Q

Tricyclic antidepressants (no specific drugs):

  • What is it used to treat?
  • Are they more or less commonly used?
  • What is the MOA?
  • What are the common AE?
  • Is overdose a risk?
  • Why do they have more side effects?
A
  • depression (also neuropathic pain, migraine, insomnia)
  • less commonly due to safer options
  • inhibit reuptake of 5-HT and NE in CNS
  • weight gain, sexual dysfunction, sedation, anticholinergic effects, hypotension/dizziness
  • yes, due to blocking cardiac Na+ channels
  • blocks multiple channels/sites
68
Q

MAO Inhibitors (no specific drugs):

  • What is it used to treat?
  • When is this typically used?
  • What is the MOA?
  • What are the common AE?
  • What is a unique risk to these drugs?
  • What will cause a hypertensive crisis with these drugs?
A
  • depression (also Parkinson’s adjunct)
  • last line treatment
  • increase 5-HT, NE, and dopamine by inhibiting MAO
  • orthostatic hypotension, weight gain, sexual dysfunction
  • serotonin syndrome
  • using sympathomimetic agent, tyramine containing foods
69
Q
  • What are the overall AE of antidepressants?

- Remember that TCAs are what?

A
  • HA, GI, sexual dysfunction, insomnia, BP issues

- anticholinergic

70
Q

What classes of drugs may cause tremors?

A

TCAs and SSRIs

71
Q

What are the classes used to treat anxiety?

A
  • SSRI and SNRI
  • Benzodiazepines
  • buspirone (drug)
72
Q
  • What is the common first line treatment for anxiety?

- Why are they more common?

A
  • SSRI and SNRI

- can be used long-term, no abuse risk and better tolerability

73
Q

What is the main benzodiazepine drug used for anxiety?

A

alprazolam (Xanax)

74
Q

alprazolam (Xanax):

  • What is it used to treat?
  • What is the drug class?
  • What is the MOA?
  • When is this used?
  • What are the common AE?
  • What are the less common AE?
  • Who is at high risk with these drugs?
A
  • anxiety
  • benzodiazepines
  • binds BZD receptors on GABA channels to enhance GABA inhibitory effect
  • used for acute anxiety because of high risk for dependence, must be tapered off
  • sedation, ataxia, memory problems
  • paradoxical excitement, anxiety
  • elderly
75
Q

buspirone (Buspar):

  • What is it used to treat?
  • What is the MOA?
  • What are the advantages?
  • What is the most common AE?
  • How long does it take to see impact on anxiety?
A
  • anxiety
  • unclear in anxiety
  • no risk of abuse or dependence, limited motor and memory problems
  • dizziness (3-12%)
  • 3 weeks
76
Q

What are the therapeutic concerns for anxiolytic drugs?

A
  • older adults higher risk of falls with benzodiazepine
  • benzos also disturb sleep cycle
  • overall sedative effect which hinders PT participation
77
Q

What are the drug classes used to treat schizophrenia?

-Which is more the more likely 1st line and why?

A
  • FGA (first generation)
  • SGA (second generation)

-SGA because of less EPS (extrapyramidal symptoms) and TD (tardive dyskinesia)

78
Q

What is the main SGA drug used to treat schizophrenia?

A

-quetiapine (Seroquel)

79
Q

quetiapine (Seroquel):

  • What is it used to treat?
  • What is the drug class?
  • What is the MOA?
  • Are EPS possible?
  • What receptors do SGA drugs act on? What AE are associated with each receptor?
A
  • schizophrenia
  • SGA
  • blocks D2 receptors but less than FGA;
  • EPS still possible, less likely

D2 Receptor Blocker

  • motor: dystonia, akathisia, tremor, rigidity, etc.
  • endocrine: gynecomastia, sexual dysfunction
  • neuroleptic management syndrome

H1 Receptor Blocker
-sedation, weight gain

Muscarinic Receptor Blockade
-anticholinergic

A1 Receptor Blockade
-hypotnesion, dizziness, syncope, reflex tachycardia

80
Q

Therapeutic concerns for FGA agents?

A
  • Cardiac abnormalities: tachycardia, altered ECG, arrhythmia
  • UV exposure
  • Caution of overexertion
  • EPS
81
Q

Therapeutic concerns for SGA agents?

A
  • weight gain, hyperglycemia, lipid abnormalities
  • cardiac abnormalities
  • heat intolerance
82
Q

What is the main treatment used for bipolar disorder?

A

lithium

83
Q

Lithium:

  • What is it used to treat?
  • What is the MOA?
  • What are the 2 roles of lithium?
  • What are the common AE?
  • Is it effective?
  • Does it require monitoring?
  • What is the boxed warning?
  • What do we want to educate the patient on?
A
  • bipolar disorder
  • unknown
  • management of acute manic or hypomanic episode, prevention of further manic and depressive episodes
  • GI, weight gain, polydipsia and polyuria, CNS
  • Yes (can decrease suicide) but many AE
  • Yes
  • toxicity, refer if diarrhea, vomiting, tremor, ataxia, drowsiness, muscle weakness
  • maintain adequate hydration and Na+ intake
84
Q

Way to remember lithium side effects?

A 
L-evels (2-4 times a year)
I-ncreased Urination
T-hirsty and Tremors
H-air thinning and Hypothyroidism
I-nteractions (DDI)
U-pset stomach
M-uscle weakness
S-kin effects
85
Q

What are the therapeutic concerns for drugs used for bipolar disorder?

A
  • significant AE
  • toxicity potential
  • be aware of changes in symptoms and condition

Pharmacology Exam 3 (10 decks)

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