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Su. Pharm 2 > Ex1 > Flashcards

Ex1 Flashcards

1
Q

corticosteroids MOA

A

inhibit phospholipase A2
- decr leukotrines
- decr prostaglandins

inhibit Th2 cells
- decr IL4/IL5

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2
Q

corticosteroids SE

A

oral thrush (inhaled)
adrenal supression (systemic)
incr infections
slow growth
bruising
hyperglycemia
weight gain

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3
Q

mast cell stabilizer MOA

A

inhibit prostaglandin/leukotrine release

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4
Q

mast cell stabilizer SE

A

mild anti-inflammatory

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5
Q

inhaled cortocosteroids: indication

A

chronic asthma/COPD

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6
Q

oral corticosteroids: indication

A

severe chronic asthma

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7
Q

IV corticosteroids: indication

A

acute asthma attack

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8
Q

mast cell stabilizer indication

A

mild-mod asthma

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9
Q

leukotrine R antagonist MOA

A

block leuk-R
- decr sm muscle contraction
- decr mucus
- decr inflammation

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10
Q

leuk R antagonist SE

A

headache
rash

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11
Q

leuk R antagonost indication

A

add-on therapy to corticosteroids for chronic asthma

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12
Q

leuk synthesis inhibitor MOA

A

inhibits 5-lipoxygenase

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13
Q

leuk synth inhibitor SE

A

hepatoxicity

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14
Q

leuk synth inhibitor indication

A

exercise/allergy-induced asthma

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15
Q

anti-IgE antibody MOA

A

binds IgE antibodies
- decr mast cell activation

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16
Q

anti-IgE antibody SE

A

incr infections
injection site pain
$$$$

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17
Q

anti-IgE antibody indications

A

last-line defense for allergic asthma

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18
Q

b2 agonist MOA

A

promotes B2 receptors
- incr adenyl cyclase
- incr cAMP
- incr relaxation
stabilizes mast cells

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19
Q

SABA indication

A

acute asthma
exercise bronchospasm

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20
Q

SABA SE

A

incr sympathetics

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21
Q

LABA indication

A

mx therapy as combo drug

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22
Q

LABA SE

A

significant incr sympathetics
arrythmias
HF

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23
Q

muscarinic antagnoist MOA

A

bind M3R
- decr sm muscle contraction

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24
Q

muscarinic antagonist SE

A

incr sympatheticsm

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25
Q

muscarinic antagonist CI

A

narrow angle glaucoma

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26
Q

muscarinic antagnoist indications

A

COPD additive w/LABA

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27
Q

methylxanthines MOA

A

inhibit PDE
- sm muscle relaxation
decr adenosine
- sm muscle relaxation
- vasoconstriction

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28
Q

methylxanthines SE

A

incr HR
arrythmia
insomnia
N/V
seizure
narrow therapeutic window

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29
Q

methylxanthines therapeutic window

A

narrow (5-15 mcg/mL)

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30
Q

methylxanthines CI

A

fluoxetine
ciproflaxin
(block CYP450 - inhibits metabolism)

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31
Q

intermittent asthma mgmt

A

SABA

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32
Q

mild asthma mgmt

A

low dose ICS

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33
Q

mod asthma mgmt

A

low dose ICS + LABA
OR
med dose ICS

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34
Q

severe asthma (4) mgmt

A

med dose ICS + LABA

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35
Q

severe asthma (5) mgmt

A

high dose ICS + LABA
optional omalizumab

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36
Q

severe asthma (6) mgmt

A

high dose ICS + LABA + corticosteroids
optional omalizumab

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37
Q

mild/intermittent COPD mgmt

A

SABA + SAMA

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38
Q

frequent CPOD (FEV1<60%) mgmt

A

LABA + LAMA

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39
Q

loading dose is dependent on

A

volume of distribution

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40
Q

LD equation

A

LD = tgt conc * Vd

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41
Q

when is LD required

A

if drug has long half life
(slow onset)

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42
Q

mx dose is dependent on

A

drug clearance

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43
Q

what physiology can cause abnormal drug clearance

A

major impairement to kidney, liver, heart

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44
Q

how are drugs predominantely excreted

A

via kidney/liver

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45
Q

excreted drug characteristics

A

water soluble
polarized
small size
free (not bound)

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46
Q

lipid soluble drugs require

A

hepatic metabolism to incr water solubility

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47
Q

drug filtration factos

A

renal BF
GFR
plasma protein binding

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48
Q

GA ____ renal BF by _____%

A

GA decreases renal BF by 50%

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49
Q

routine labs to assess kidney function

A

BUN
serum Cr
GFR
urine albumin

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50
Q

normal BUN

A

10-20 mg/dL

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51
Q

normal serum Cr

A

0.6-1.3 mg/dL

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52
Q

normal GFR

A

110-140 mL/min

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53
Q

normal urine albumin

A

<150 mg/day

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54
Q

specialized labs for kidney function

A

urine specific gravity
urine osmolarity
urine Na+

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55
Q

factors that influence lab interpretation

A

dehydration
protein intake
GI bleed
catabolism
adv age
sk muscle mass
timing of measurement

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56
Q

G1

A

normal/high

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57
Q

G2

A

mild decrease

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58
Q

G3a

A

mild-mod decrease

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59
Q

G3b

A

mod-severe decrease

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60
Q

G4

A

severe decrease

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61
Q

G5

A

kidney failure

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62
Q

what GFR categories indicate CKD

A

G3a-G5

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63
Q

A1

A

normal/mild albuminuria

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64
Q

A2

A

moderate albuminuria

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65
Q

A3

A

severe albuminuria

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66
Q

which albuminuria category indicates nephrotic syndrome

A

A3

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67
Q

what labs can be used to estimate renal function

A

serum Cr
Cr clearance

cystatin C
125I-iothalamate
inulin

68
Q

types of renal function calculations

A

CG
MDRD
CKD-EPI

69
Q

which calculation is the primary use for drug development by FDA

A

CG

70
Q

which calculation could replace CG in drug development

A

MDRD

71
Q

which calculation is the most accurate est of gFR

A

CKD-EPI

72
Q

when is CG most inaccurate

A

with fluctuating serum Cr

73
Q

how should you properly dose drugs in pts with renal dysfunction

A

measure renal function w/any equation
adjust according to package insert

74
Q

what drugs have incr accumulation in renal pts (9)

A

sugammadex
neostigmine
atropine
glyco
digoxin
hydralazine
milrinone
antimicrobials
midazolam

75
Q

which drug has active metabolites build up in kidney

A

midazolam

76
Q

what drugs req decr dose in renal pts (5)

A

codeine
fentanyl
ketorolac
meperidine
morphine

77
Q

what drugs req incr dosing interval in renal pts

A

acetominophen
acetylsalycilic acid

78
Q

what drugs are safest for rental pts

A

remifentanil
sufenta
alfenta

79
Q

AKI Serum Cr

A

increased

80
Q

AKI urine volume

A

decreased

81
Q

AKI urine Na+

A

low

82
Q

AKI Cr/plasma ration

A

high

83
Q

prerenal

A

blood cannot get to kidney

84
Q

intrinsic

A

issue with kidneys

85
Q

postrenal

A

block between kidney and urinary tract

86
Q

_____- % of periop AKIs are ______

A

70% of periop AKIs are prerenal

87
Q

how can you prevent periop AKI

A

adequate hydration and BP

88
Q

prehepatic

A

incr bilirubin

89
Q

causes of pre-hepatic dysfunction

A

hemolysis
hematoma
blood transfusion

90
Q

intrahepatic

A

incr bilirubin
incr AST/ALT

91
Q

cause of intrahepatic dysfunction

A

virus
drugs
alcohol
sepsis
hypoxemia
cirrhosis

92
Q

posthepatic

A

incr bilirubin
incr AST/ALT
incr Alk phos

93
Q

causes of posthepatic dysfunction

A

billiary stones/tumors
sepsis

94
Q

factors in liver drug elimination

A

BF through liver
free drug level
intrinsic ability of hepatic enzymes to metabolize drug

95
Q

child pugh score

A

grades liver disease

96
Q

child pugh is based on

A

bilirubin
albumin
PT/INR
ascites
encephalopathy

97
Q

child pugh safe to proceed with surgery

A

A/B

98
Q

child pugh defer elective surgery

A

C

99
Q

safest NMB in liver pts

A

atracurium
cisatracurium

100
Q

which NMB req decr dose in liver pts

A

Roc
Vec

101
Q

safest opioids in liver pts

A

remi
sufenta
fenta

102
Q

opioids that req decr dose in liver pts

A

morphine
hydromorphone

103
Q

opioids to avoid in liver pts

A

meperidine

104
Q

can you give benzos to liver pts

A

yes but decrease dose

105
Q

hepatic dysfunction impact on drug disposition is related to

A

type/severity of disease
characteristics of the drug

106
Q

are high or low protein bound drugs going to be impacted more in liver pts

A

high bound drugs

107
Q

low extraction ration

A

clearance dependent on intrinsic activity of metabolizing enzymes

difficult metabolism

108
Q

high extraction ration

A

hepatic clearance dependent on hepatic blood flow

easiest metabolism

109
Q

low extraction ratio drugs
(NTW VIP)

A

indomethacin
naproxen
theophylline
warfarin
valrpoic acid
procainamide

110
Q

intermediate extraction ratio drugs
(PNACQ)

A

aspirine
quinidine
codeine
nifedipine
phenytoin

111
Q

high extraction ratio drugs

A

cocaine
lidocaine
meperidine
morphine
nicotine
NTG
propranolol
verapamil

112
Q

MAC req in pregnancy

A

decreased by 30-40%

113
Q

pregnant pts have ______ absorption

A

increased absorption

114
Q

pregnant pts have _______ distribution

A

increased distribution

115
Q

pregnant pts have _____ free drugs

A

increased free drug

116
Q

pregnant pts have ______ change to CYP enzyme activiity

A

can increase or decrease CYP metabolism

117
Q

pregnant pts have ____ GFR and drug elimination

A

increased GFR and drug elimination

118
Q

drugs impacted by incr GFR

A

decr concentration of:
enoxaparin
levetiracetam

119
Q

what MW drug easily crosses placenta

A

low (<500) cross easily

120
Q

do heparin and insulin cross the placenta

A

no
(too heavy)

121
Q

what level of protein binding drugs cross placenta

A

free drugs cross easily

122
Q

what level of ionized drugs cross placenta

A

only unionized

123
Q

what level of lipophilic drugs cross placenta

A

high lipophilic cross easily

124
Q

what level of maternal blood flow aids placental crossing

A

high maternal blood flow

125
Q

do efflux proteins help placental crossing

A

no - they pump meds back into maternal system

126
Q

teratrogen

A

agent that has the potential to cause abnormal fetal growth and development

127
Q

teratrogenicity risk

A

3-6%

128
Q

causes of tetragonicity

A

unknown cause: 75%
genetic: 15%
environmental: 10%
medication: <1%

129
Q

teratrogenicity timing of exposure

A

blastogenesis: week 1-2
- embryo destruction
organogenesis
- structural anomalies
growth/maturation
- slow growth
- CNS anomalies

130
Q

tetragon drugs

A

nitrous oxide (avoid 1-2 trimester)
midazolam (avoid high dose)

131
Q

properties that influence placental transfer

A

molecular weight
protein binding
solubility
ionization

132
Q

anesthetic drugs safe in non-ob surgery for pregnant pts

A

regional is best
propofol
ketamine
sux
IV opioids
acetaminophen

133
Q

which induction drug should you use in hypovolemic preg pts

A

ketamine

134
Q

can you give preg pts NSAIDs

A

avoid
especially after 32 weeks

135
Q

CCB MOA

A

decr Ca2+ into cells
- decr sm muscle contraction

first line to delay labor

136
Q

CCB SE

A

maternal hypotension

137
Q

b2 agonist MOA

A

incr cAMP
decr sm muscle contraction

138
Q

b2 agonist indication

A

uterine hypertonus (treat excess oxytocin administration)

139
Q

b2 agonist CI

A

maternal heart problems
hypotension
hyperglycemia
hypoklameia

140
Q

prstaglandin inhibitors MOA

A

reversible inhibir Cox 1/2
decr sm muscle contraction

141
Q

prostaglandin inhibitor SE

A

nausea
GERD
bleeding

142
Q

prostaglandin inhibitor fetal SE

A

premature closure of ductus arteriosis

143
Q

first line drug to delay labor

A

nifedipine

144
Q

2nd line to delay labor

A

indomethacin
ketorolac

significant risk to fetus

145
Q

NTG MOA

A

incr NO
incr relaxation

146
Q

NTG uses

A

short duration procedures
placenta removal
uterine inversion
fetal head entrapment

147
Q

NTG SE

A

hypotension
headache

148
Q

what drug do you give to promote fetal lung maturation

A

antenatal corticosteroids
- dexamethasone
- betamethasone

149
Q

what drug should you give to protect fetal neuro function

A

mag sulfate

150
Q

oxytocin SE

A

hypotension
tachycardia
fluid retention

151
Q

oxytocin fetal SE

A

hypoxia
fetal bradycardia

152
Q

methergine MOA

A

alpha adrenergic receptors

153
Q

methergine uses

A

uterine atony
postpartum hemorrhage

154
Q

methergine SE

A

incr BP
N/V

155
Q

methergine CI

A

avoid in HTN
Preeclampsia

156
Q

prostaglandins use

A

atony
labor induction
cervical ripening

157
Q

carboprost CI

A

asthma
renal/hepatic

158
Q

carboprost SE

A

N/V
HTN
pyrexia

159
Q

misoprostol/dinoprostone SE

A

tachysystole
fetal HR decel
shivering
pyrexia

160
Q

MgSo4 purpose in pre-ecclampsia/eclampsia

A

prevent maternal seizures by lowering maternal BP

161
Q

MgSo4 MOA

A

inhibits Ca in SR binding sites

162
Q

MgSo4 SE

A

palpitations
nausea
sedation
decr fetal HR
muscle weakness

163
Q

MgSO4 consideration

A

decr SVR
neuraxial safe
GA safe

164
Q

treat MgSo4 toxicity

A

CaCl
Ca Gluc

165
Q

hypertension mgmt in preg pt

A

hydralazine
labetalol
nifedipine
sodium nitrotprusside
fenoldopam
NTG

166
Q

pulm aspiration prevention in preg

A

rantidine
metoclopramide

Su. Pharm 2 (6 decks)

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