EOR pharm exam part 2 Flashcards
Primary action of tramadol
Central activity (serotonin, norepinephrine)
Secondary action of tramadol
Very weak Mu-1 receptor activity
Use of tramadol
Utilized for mild to moderate pain
Second or 3rd line option for neuropathic pain
Caution in pts at risk for seizures
Common SEs of tramadol
SEs similar to opioids Seizures Serotonin syndrome Sweating Dry mouth Upset stomach Diarrhea C4 controlled substance
Considerations of tramadol
Do not use with MAOI
Dosing limit 400 mg/d due to seizures
Drug interactions of Tramadol
SSRIs/SNRIs (serotonin syndrome)
Tryptan migraine abortants
Tramadol monitoring
Achievement of goals
S/sx tolerance
Misuse/abuse
What chemical class of opioids is hydrocodone in?
Phenanthrenes
How to dose immediate-release opioids for acute pain
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%
SEs of opioids
constipation Dry mouth CNS effects (sedation, dizziness, N/V, etc) Respiratory depression Pruritis Bad dreams/hallucinations Dysphoria/delirium Myoclonus/seizures Urinary retention
What SEs do opioid users usually develop tolerance to?
Sedative and euphoric effects
Respiratory depression
What controlled substance classification is hydrocodone
CII
Use of hydrocodone
Mild to moderate pain when combined with APAP
Available as a single agent for more moderate to severe pain (Hysingla; Zohydro)
MOA of levothyroxine
Synthetic hormone (T4)
Dosing of levothryroxine
PO: usually 1.6 mcg/kg/day
>50 and/or cardiovascular dz: 25-50 mcg daily
IV: 50% of oral dose
SEs of levothyroxine
Tachycardia Anxiety Hyperactivity Insomnia Sweating Wt loss Diarrhea Alopecia
Monitoring for levothyroxine
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
Administration of levothyroxine
PO levothyroxine is best absorbed taken with water 30-60 minutes before a meal (usually breakfast)
Many medications can affect absorption of levothyroxine
MOA of amoxicillin
Beta lactam
Interferes with cell wall synthesis
Binds penicillin-binding proteins (PBPs)
Leads to inhibition of peptidoglycan synthesis
SEs of amoxicillin
Hypersensitivity
Rare seizures (at high doses)
Interstitial nephritis
Bone marrow suppression (rare)
MOA of azithromycin
Macrolide
Bacteriostatic agent that binds the 50s ribosome at the entrance of the protein exit tunnel, blocking polypeptide elongation
Usual PO dose (Z-pack)
CAP: 500 mg x 1 dose, 250 mg x 4 days
SEs of azithromycin
Torsade de pointes
QTc prolongation
Rash
N/V/D/abd pain
When is metformin use contraindicated?
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
How does metformin work in the body?
Decreases hepatic glucose production
Increases insulin sensitivity
No hypoglycemia, wt neutral
Reduction in cardiovascular events and mortality
SEs of metformin
Diarrhea
Abdominal cramps
Nausea
Immediate release metformin dosing
Best A1c benefit= 2,000 mg/day
500 BID meals, increase by 500 mg every 1-2 wks
Extended release metformin dosing
500 mg daily, increase by 500 mg every 1-2 wks
What are examples of dihydropyridine CCBs?
Amlodipine
Felodipine
What are examples of nondihydropyridine CCBs?
Verapamil
Diltiazem
MOA of dihydropyridine CCBs
Work in the peripheral vasculature, cause vasodilation
MOA of nondihydropyridine CCBs
Work centrally on the heart
Have inotropic and chronotropic effects
Common SEs of dihydropyridine CCBs
Dizziness Flushing HA Gingival hyperplasia Peripheral edema
Common SEs of nondihyrdopyridine CCBs
Bradycardia
Anorexia
Nausea
Peripheral edema
Contraindication of CCBs
Do not use in heart failure
What are the cardioselective BBs (only beta1 receptors in the heart)?
Metoprolol
Atenolol
Bisoprolol
What are the nonselective BBs (beta1 and beta2- lungs and pancreas)?
Propranolol
Nadolol
Carvedilol
Common SEs of BBs
Bradycardia
AV conduction abnormalities
Alter glucose
Special considerations of BBs
Do not discontinue abruptly
Signs of hypoglycemia can be masked in nonselective beta blockers
What class of drug is Celecoxib?
NSAID
MOA of NSAIDs
Inhibition of cyclooxygenase enzymes interrupting prostaglandin synthesis and inflammation
COX-1 inhibitors
Platelet function, protective prostaglandins
COX-2 inhibitors
Inflammation, pain, and fever
Drug interactions with NSAIDs
Anticoagulants
Ethanol
SSRIs, SNRIs
ACE inhibitors
MOA considerations for Celecoxib
Highly selective for COX-2
Dosing for Celecoxib
100-200 mg BID
Adverse effects of NSAIDs
Gastropathy
Renal insufficiency
Effect on platelet aggregation
Contraindications of NSAIDs
Renal insufficiency
GI bleeds/gastritis
Duodenal ulcers
Cardiovascular dz (CHF, MI, stroke)
MOA of Plavix
P2Y12 receptor antagonist
Special considerations of Plavix with PPIs
Omeprazole and esomeprazole inhibit 2C19 If in doubt, use: dexlansoprazole lansoprazole pantoprazole
How long should Plavix be held prior to surgery?
5 days
