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Pharm II Exam I > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Cimetidine

1) classification
2) MOA
3) Contra
4) SE
5) Notes

A

1) H2 antagonist
2) Blocks histamine receptor –> decrease gastric acid secretion
3)
4) gynecomastia + impotence with long-time use (RARE)
5) IV Bolus –> cardiac arrythmias and hypotension
* can add to PPI to reduce nocturnal acid breakthrough, but may decrease efficacy of PPI

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2
Q

Ranitidine

1) classification
2) MOA
3) Contra
4) SE
5) Notes

A

1) H2 antagonist
2) Blocks histamine receptor –> decrease gastric acid secretion
3)
4) Agitation, anemia, confusion, depression (RARE)
5) increase risk of pneumonia
* can add to PPI to reduce nocturnal acid breakthrough, but may decrease efficacy of PPI

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3
Q

Omeprazole

1) classification
2) MOA
3) Contra
4) SE
5) Notes

A

1) PPI
2) Inhibits H/K pump in gastric parietal cells
3) Metabolized by CYP450 –> increase concentrations of diazepam, warfarin, and phenytoin; reduce absorption of ketoconazole; increase absorption of digoxin
4) Diarrhea, nausea, skin rash, dizziness
5) NOT used with H2 Antagonists; NEW - Vitamin B12 deficiency (long-term use)

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4
Q

Rabeprazole

1) classification
2) MOA
3) Contra
4) SE
5) Notes

A

1) PPI
2) Inhibits H/K pump in gastric parietal cells
3) Metabolized by CYP450 –> increase concentrations of diazepam, warfarin, and phenytoin; reduce absorption of ketoconazole; increase absorption of water
4) Headache
5) NOT used with H2 Antagonists; NEW - Vitamin B12 deficiency (long-term use)

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5
Q

Sucralfate (= aluminum sucrose sulfate)

1) classification
2) MOA
3) Contra
4) SE
5) Notes

A

1) Mucosal Protective Agent
2) Binds selectively to necrotic tissue to form a barrier against gastric acid
3) decrease absorption of cimetidine, ciprofloxacin, digoxin, ranitidine ; grapefruit promotes absorption of Al –> contra in renal failure patients
4) constipation, flatulence , dry mouth, diarrhea, nausea
5) Colloidal Bismuth (Pepto-Bismuth) works in same manner
* do NOT give with H2 antagonist (CAN give 2 hours prior)

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6
Q

Tums/Maalox/Mylanta

1) classification
2) MOA
3) Contra
4) SE
5) Notes

A

1) Antacid
2) Contains alkaline ions that neutralizes stomach acid (BRIEFLY after each use)
3) Ingestion of high amounts of calcium + adsorbable alkali –> Milk Alkali syndrome = alkalosis, hypercalcemia, renal impairment

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7
Q

Psyllium / Dietary Fiber

1) classification
2) MOA
3) Indication
4) SE
5) Contraindications
6) Notes

A
  • Solid Waste
    1) Bulking Agent
    2) Increases stool weight + fluid retention in stool
    3) Constipation
    4) Flatulence
    5) Debilitated, end-of-life patients
    6) MUST have adequate fluid intake
  • increased fiber w/o increased H2O will WORSEN constipation
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8
Q

Lactulose / Sorbitol

1) Classification
2) MOA
3) Indication
4) SE
5) Contraindications
6) Notes

A

*Water content
1) Osmotic laxative = non-absorbable sugar
2) osmotic load in colonic lumen stimulates movement
[bacteria degrade in gut , produces acids –> increases osmotic pressure + acidifies stool –> increases water stool content]
3) Constipation
4) Flatulence / bloating / cramping
5)
6) “Sickly Sweet” taste; requires prescription

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9
Q

Magnesium Hydroxide (Milk of Magnesia)

1) Classification
2) MOA
3) Indication
4) SE
5) Contraindications
6) Notes

A

*Water content
1) Osmotic Laxative = Saline + Magnesium salts
2) osmotic load in the colonic lumen stimulates movement
[osmotically active particles (Mg –> CCK) –> increase intralumen volume –> stimulates intestinal activity)
3) Constipation
4) *mild
5) Renal failure (can cause hypermagnesemia if used too regularly)
6) ions (Mg, salt, etc) can be partially absorbed

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10
Q

Magnesium Citrate

1) Classification
2) MOA
3) Indication
4) SE
5) Contraindications
6) Notes

A

Water content
1) Osmotic Laxative = Saline + Magnesium salts
2) osmotic load in the colonic lumen stimulates movement
[osmotically active particles (Mg –> CCK) –> increase intralumen volume –> stimulates intestinal activity)
HIGH DOSE –> rapid bowel evacuation
3) Bowel prep for endoscopy or surgery
4) Dehydration + electrolyte abnormalities
5) Bowel obstruction, fecal impaction, renal failure (use VERY cautiously in CHF)
6) Ischemic colitis = rare SE

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11
Q

Sodium Phosphate

1) Classification
2) MOA
3) Indication
4) SE
5) Contraindications
6) Notes

A

Water content
1) Osmotic Laxative = Saline + Magnesium salts
2) osmotic load in the colonic lumen stimulates movement
[osmotically active particles (Mg –> CCK) –> increase intralumen volume –> stimulates intestinal activity)
HIGH DOSE –> rapid bowel evacuation
3) Bowel prep for endoscopy or surgery
4) Dehydration + electrolyte abnormalities
5) Bowel obstruction, fecal impaction, renal failure (use VERY cautiously in CHF)
6) Acute phosphate nephropathy = intratubular deposition of calcium phosphate
* can be given rectally as ENEMA

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12
Q

Miralax / Glycolax

1) Classification
2) MOA
3) Indication
4) SE
5) Contraindications
6) Notes

A

*Water content
1) Osmotic laxative = low-dose polyethylene glycol
2) osmotic load in the colonic lumen stimulates movement
[ increases bowel movements + softens stools]
3) Constipation
4)
5)
6) “tasteless” + NO absorption of ions

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13
Q

Colyte / Golytely

1) Classification
2) MOA
3) Indication
4) SE
5) Contraindications
6) Notes

A

*Water content
1) Osmotic Laxative = high-dose polyethylene glycol
2) osmotic load in the colonic lumen stimulates movement
3) Bowel prep for colonoscopy + surgery
4)
5)
6) 1-4 L of volume of prep!
* NO ion absorption; requires a prescription

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14
Q

Senna / Bisacodyl

1) Classification
2) MOA
3) Indication
4) SE
5) Contraindications
6) Notes

A
  • Motility
    1) Stimulant Laxative
    2) Stimulates intestinal motility via myenteric plexus
    3) Constipation; prevention of constipation with opiate therapy
    4) Cramping
    5)
    6) Melanosis coli (long-term use)
  • Bisacodyl can be given rectally in suppository form
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15
Q

Docusate (colase)

1) Classification
2) MOA
3) Indication
4) SE
5) Contraindications
6) Notes

A
  • Lubrication
    1) Detergent Laxative (stool softener)
    2) Surfactant –> increases penetration of fluid in stools
    3) Prevention of hard stool
    4)
    5)
    6) Recent studies have brought its utility into question
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16
Q

Glycerin

1) Classification
2) MOA
3) Indication
4) SE
5) Contraindications
6) Notes

A
  • Lubrication
    1) Lubricant
    2) Administered rectally; osmotic + irritant –> stimulates rectal contractions
    3) Fecal impaction
    4)
    5)
    6)
17
Q

Mineral Oil

1) Classification
2) MOA
3) Indication
4) SE
5) Contraindications
6) Notes

A
  • Lubrication
    1) Lubricant
    2) Administered rectally; coats feces –> softens and lubricates feces
    3) Fecal impaction
    4)
    5)
    6) NEVER use oral mineral oil in patients at risk of aspiration (e.g. debilitated patients) –> Lipid pneumonitis
18
Q

Enemas: tap water, sodium phosphate

1) Classification
2) MOA
3) Indication
4) SE
5) Contraindications
6) Notes

A

1) Large volume enema
2) Increases water content of stool ; distends distal colon; induces peristalsis
3) Fecal impaction
4)
5)
6)

19
Q

Prochlorperazine

1) Classification
2) MOA
3) Indication
4) SE
5) Contraindications
6) Notes

A

1) Dopamine receptor antagonist
2) Central: blocks D2 in CTZ
Peripheral: blocks GI vagus nerve projecting to the vomiting center
3) Opioid-induced nausea + vomiting
Primary GI disorders = gastroenteritis (inflammation + infection)
4) Extrapyramidal effects (“Parkinsonism”)
Acute dystonic reactions
5)
6)

20
Q

Metoclopramide

1) Classification
2) MOA
3) Indication
4) SE
5) Contraindications
6) Notes

A

1) Dopamine receptor antagonist
2) Central: blocks D2 in CTZ
Peripheral: blocks D2 in upper GI tract (prokinetic)
3) Moderately emetogenic chemotherapy-induced N/V Postsurgical N/V
Dysmotility of upper GI tract = gastroparesis, gastric stasis
4) Tardive dyskinesia; extrapyramidal effects; acute dystonic reactions
5) Caution w/ Parkinson Disease
6) Black Box Warning: avoid use > 12 weeks –> Tardative Dyskinesia

21
Q

Ondansetron

1) Classification
2) MOA
3) Indication
4) SE
5) Contraindications
6) Notes

A

1) 5HT-3 Receptor Antagonist
2) Central: blocks D2 in CTZ
Peripheral: blocks 5HT-3 (GI tract) induced transmission of vagal stimulation of vomiting center
3) Highly emetogenic chemotherapy-induced N/V
Radiation-induced N/V
Postoperative N/V
4) QT prolongation , headache
5) Prolonged QT –> Torsades des Pointes
6) Potent anti-emetic

22
Q

Promethazine

1) Classification
2) MOA
3) Indication
4) SE
5) Contraindications
6) Notes

A

1) Histamine 1 Receptor Antagonist
2) Blocks H1 in vestibular apparatus
3) Motion sickness
4) Sedation
5)
6)

23
Q

Scopolamine

1) Classification
2) MOA
3) Indication
4) SE
5) Contraindications
6) Notes

A

1) Anticholinergic
2) Blocks cholinergic receptor in vestibular apparatus
3) Motion sickness
4) Delirium, dry mouth, urinary retention
5) Glaucoma
6) Use at end-of-life to dry up oral secretions (“the death rattle”

24
Q

Dexamethasone

1) Classification
2) MOA
3) Indication
4) SE
5) Contraindications
6) Notes

A

1) Steroids
2) Blocks CNS projections to vomiting center
3) Increasing intracranial pressure
4)
5)
6)

25
Q

Lorazepam

1) Classification
2) MOA
3) Indication
4) SE
5) Contraindications
6) Notes

A

1) Benzodiazepine
2) Blocks CNS projections to vomiting center
3) Anxiety-induced N/V

26
Q

Chloroquine

1) MOA
2) Stage of life cycle inhibited
3) Use
4) AE
5) children or pregnant?
6) Notes

A

1) Inhibits heme polymerase –> increases free heme
2) RBC schizont
3) Treatment + chemo-prophylaxis
4) Pruritis (Africans)
5) safe
6) major limitation = resistance

27
Q

Quinine, Quinidine

1) MOA
2) Stage of life cycle inhibited
3) Use
4) AE
5) children or pregnant?
6) Notes

A

1) Inhibits heme polymerase –> increases free heme
2) RBC schizont
3) Treatment of P. Falciparum
4) Cinchonism ( = tinnitus, headache, neausea, dizziness, flushing, visual disturbances) , hypoglycemia, Blackwater fever
5) Ok (children), Ok if needed (Quinine, pregnant women), Ok but contractions in 3rd semester (Quinidine)
6) ONLY IV Quinidine available in US; DOC for SEVERE malaria; cardiac monitoring recommended; used with a 2nd agent

28
Q

Mefloquin

1) MOA
2) Stage of life cycle inhibited
3) Use
4) AE
5) children or pregnant?
6) Notes

A

1) Inhibits heme polymerase –> increases free heme
2) RBC schizont
3) Treatment and prophylaxis
4) Neuropsychiatric toxicities (*less common w/ prophylaxis)
5) Safe (children), Ok for prophylaxis but NO for treatment (pregnant women)
6) DOC for chemoprophylaxis in most regions; NOT recommended for treatment of severe malaria

29
Q

Primaquin

1) MOA
2) Stage of life cycle inhibited
3) Use
4) AE
5) children or pregnant?
6) Notes

A

1) Inhibits heme polymerase –> increases free heme
2) Hypnozoites (dormant in liver), gametocytes
3) Radical cure for P. vivax + ovale
4) Hemolysis in G6PD-Deficiency
5) Ok (children), UNSAFE (pregnant women)
6) Testing for G6P deficiency is recommended

30
Q

Proguanil

1) MOA
2) Stage of life cycle inhibited
3) Use
4) AE
5) children or pregnant?
6) Notes

A

1) Inhibits plasmodial DHFR
2) RBC schizont, hypnozoite of P.falcip
3) WITH chloroquin or atovaquone for prophylaxis
4)
5) Ok (children), (never given alone)
6)

31
Q

Atovaquone

1) MOA
2) Stage of life cycle inhibited
3) Use
4) AE
5) children or pregnant?
6) Notes

A

1) Inhibits parasite mitochondrial ETC
2) RBC schizont, hypnozoite of P.falcip
3) WITH proguanil (= Malarone) for prophylaxis
4) GI side effects; contra in severe renal impairment
5) NO (children

32
Q

Doxycycline

1) MOA
2) Stage of life cycle inhibited
3) Use
4) AE
5) children or pregnant?
6) Notes

A

1) Inhibits protein synthesis in parasite organelles
2) RBC schizont
3) Adjucant treatment of P. falciparum and prophylaxis
4) Photosensitivity, esophagitis
5) NO, NO
6) Used for prophylaxis in areas with high mefloquine resistance (i.e. Southwest Asia)

33
Q

Artemisinin

1) MOA
2) Stage of life cycle inhibited
3) Use
4) AE
5) children or pregnant?
6) Notes

A

1) Binds iron in malaria pigment, producing free radicals
2) RBC schizont, gametocyte
3) Treatment
4) Potential neurotoxicity (ototoxicity)
5) Probably OK (not approved in US)
6) Used for treatment (Asia/Africa) in combo with other antimalarial agents

Pharm II Exam I (1 decks)

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