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Internal Med Rotation > EOR pharm exam part 2 > Flashcards

EOR pharm exam part 2 Flashcards

1
Q

Primary action of tramadol

A

Central activity (serotonin, norepinephrine)

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2
Q

Secondary action of tramadol

A

Very weak Mu-1 receptor activity

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3
Q

Use of tramadol

A

Utilized for mild to moderate pain
Second or 3rd line option for neuropathic pain
Caution in pts at risk for seizures

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4
Q

Common SEs of tramadol

A 
SEs similar to opioids
Seizures
Serotonin syndrome
Sweating 
Dry mouth
Upset stomach
Diarrhea
C4 controlled substance
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5
Q

Considerations of tramadol

A

Do not use with MAOI

Dosing limit 400 mg/d due to seizures

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6
Q

Drug interactions of Tramadol

A

SSRIs/SNRIs (serotonin syndrome)

Tryptan migraine abortants

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7
Q

Tramadol monitoring

A

Achievement of goals
S/sx tolerance
Misuse/abuse

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8
Q

What chemical class of opioids is hydrocodone in?

A

Phenanthrenes

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9
Q

How to dose immediate-release opioids for acute pain

A

Dose q4h for pain requiring around the clock coverage
Dose q4h PRN for intermittent pain
Adjust dose daily
-Mild/moderate pain: increase 25-50%
-Severe/uncontrolled pain: increase 50-100%

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10
Q

SEs of opioids

A 
constipation
Dry mouth
CNS effects (sedation, dizziness, N/V, etc)
Respiratory depression
Pruritis
Bad dreams/hallucinations
Dysphoria/delirium
Myoclonus/seizures
Urinary retention
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11
Q

What SEs do opioid users usually develop tolerance to?

A

Sedative and euphoric effects

Respiratory depression

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12
Q

What controlled substance classification is hydrocodone

A

CII

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13
Q

Use of hydrocodone

A

Mild to moderate pain when combined with APAP

Available as a single agent for more moderate to severe pain (Hysingla; Zohydro)

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14
Q

MOA of levothyroxine

A

Synthetic hormone (T4)

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15
Q

Dosing of levothryroxine

A

PO: usually 1.6 mcg/kg/day
>50 and/or cardiovascular dz: 25-50 mcg daily
IV: 50% of oral dose

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16
Q

SEs of levothyroxine

A 
Tachycardia
Anxiety
Hyperactivity
Insomnia
Sweating
Wt loss
Diarrhea
Alopecia
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17
Q

Monitoring for levothyroxine

A

Baseline labs: TSH, T4

TSH every 4-8 wks following initiation, dose change, or change in preparation, then 6 mos, then 12 mos if therapeutic

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18
Q

Administration of levothyroxine

A

PO levothyroxine is best absorbed taken with water 30-60 minutes before a meal (usually breakfast)
Many medications can affect absorption of levothyroxine

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19
Q

MOA of amoxicillin

A

Beta lactam
Interferes with cell wall synthesis
Binds penicillin-binding proteins (PBPs)
Leads to inhibition of peptidoglycan synthesis

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20
Q

SEs of amoxicillin

A

Hypersensitivity
Rare seizures (at high doses)
Interstitial nephritis
Bone marrow suppression (rare)

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21
Q

MOA of azithromycin

A

Macrolide
Bacteriostatic agent that binds the 50s ribosome at the entrance of the protein exit tunnel, blocking polypeptide elongation

22
Q

Usual PO dose (Z-pack)

A

CAP: 500 mg x 1 dose, 250 mg x 4 days

23
Q

SEs of azithromycin

A

Torsade de pointes
QTc prolongation
Rash
N/V/D/abd pain

24
Q

When is metformin use contraindicated?

A

Pts with eGFR <30 mL/min
Initiating metformin in pts with eGFR between 30-45 mL/min is not recommended
Assess the benefits of continuing tx in pts whose eGFR falls below 45 mL/min; d/c metformin if the eGFR falls below 30 mL/min

25
Q

How does metformin work in the body?

A

Decreases hepatic glucose production
Increases insulin sensitivity
No hypoglycemia, wt neutral
Reduction in cardiovascular events and mortality

26
Q

SEs of metformin

A

Diarrhea
Abdominal cramps
Nausea

27
Q

Immediate release metformin dosing

A

Best A1c benefit= 2,000 mg/day

500 BID meals, increase by 500 mg every 1-2 wks

28
Q

Extended release metformin dosing

A

500 mg daily, increase by 500 mg every 1-2 wks

29
Q

What are examples of dihydropyridine CCBs?

A

Amlodipine

Felodipine

30
Q

What are examples of nondihydropyridine CCBs?

A

Verapamil

Diltiazem

31
Q

MOA of dihydropyridine CCBs

A

Work in the peripheral vasculature, cause vasodilation

32
Q

MOA of nondihydropyridine CCBs

A

Work centrally on the heart

Have inotropic and chronotropic effects

33
Q

Common SEs of dihydropyridine CCBs

A 
Dizziness
Flushing
HA
Gingival hyperplasia
Peripheral edema
34
Q

Common SEs of nondihyrdopyridine CCBs

A

Bradycardia
Anorexia
Nausea
Peripheral edema

35
Q

Contraindication of CCBs

A

Do not use in heart failure

36
Q

What are the cardioselective BBs (only beta1 receptors in the heart)?

A

Metoprolol
Atenolol
Bisoprolol

37
Q

What are the nonselective BBs (beta1 and beta2- lungs and pancreas)?

A

Propranolol
Nadolol
Carvedilol

38
Q

Common SEs of BBs

A

Bradycardia
AV conduction abnormalities
Alter glucose

39
Q

Special considerations of BBs

A

Do not discontinue abruptly

Signs of hypoglycemia can be masked in nonselective beta blockers

40
Q

What class of drug is Celecoxib?

A

NSAID

41
Q

MOA of NSAIDs

A

Inhibition of cyclooxygenase enzymes interrupting prostaglandin synthesis and inflammation

42
Q

COX-1 inhibitors

A

Platelet function, protective prostaglandins

43
Q

COX-2 inhibitors

A

Inflammation, pain, and fever

44
Q

Drug interactions with NSAIDs

A

Anticoagulants
Ethanol
SSRIs, SNRIs
ACE inhibitors

45
Q

MOA considerations for Celecoxib

A

Highly selective for COX-2

46
Q

Dosing for Celecoxib

A

100-200 mg BID

47
Q

Adverse effects of NSAIDs

A

Gastropathy
Renal insufficiency
Effect on platelet aggregation

48
Q

Contraindications of NSAIDs

A

Renal insufficiency
GI bleeds/gastritis
Duodenal ulcers
Cardiovascular dz (CHF, MI, stroke)

49
Q

MOA of Plavix

A

P2Y12 receptor antagonist

50
Q

Special considerations of Plavix with PPIs

A 
Omeprazole and esomeprazole inhibit 2C19
If in doubt, use:
dexlansoprazole
lansoprazole
pantoprazole
51
Q

How long should Plavix be held prior to surgery?

A

5 days

Internal Med Rotation (3 decks)

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