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Pharm Tox > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

What is the major effect of all NSAID’s?

A

Decrease synthesis of prostaglandins by inhibiting cycle oxygenate

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2
Q

What do Prostaglandins do in the body?

A

1) Enhance inflammatory process
2) Increase renal blood flow
3) protects the GI mucosa

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3
Q

MOA of COX-1

A

Gastroprotective effects

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4
Q

MOA of COX-2

A

Produces proinflammatory mediators

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5
Q

Problems associated with acute toxicity:

A

1) GIT symptoms = MC (Dyspepsia)
2) Renal effects = 2nd MC

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6
Q

Treatment for acute overdose:

A

1) Secure airway
2) Activated Charcoal
3) Transport

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7
Q

MOA of Salicylate Toxicity:

A

1) Inc. metabolic rate
2) inc. O2 consumption
3) inc. CO2 formation
4) inc. heat production
5) inc. glucose use
6) depletion of hepatic glycogen

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8
Q

Clinical features of salicylate toxicity

A
  • nausea/vomiting
  • tachypnea
  • tinnitus
  • metabolic acidosis
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9
Q

Why is Acetomenophen toxicity worse in alcoholics?

A

Due to introduction of Hepatic Microsomal Enzyme Systems

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10
Q

Vitamin A Acute Toxicity clinical features:

A
  • Pseudotumor Cerebri
  • Tired/Irritable
  • Hair Loss
  • Hepatomegaly
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11
Q

Chronic Vitamin A toxicity clinical features

A
  • bone pain
  • visual disturbances
  • fatigue, but difficulty sleeping
  • dry skin/hair loss
  • elevated Alk Phos
  • Periosteal calcification
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12
Q

Vitamin D toxicity clinical features

A
  • Hypercalcemia
  • Weakness
  • Headache/Fatigue
  • ST Calcificaton
  • Polyuria/Polydipsia
  • nephrocalcinosis
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13
Q

Vitamin C toxicityClinical features:

A
  • Urinary calculi
  • elevated Estradiol (when taking birth control)
  • Inc. iron absorption
  • Diarrhea, Nausea, Craming
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14
Q

When is increased iron absorption dangerous?

A

In patients with Hemochromatosis

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15
Q

Functions of Histamine

A

1) Mediates all Allergic responses
2) Regulates Gastric acid secretion
3) CNS neurotransmitter

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16
Q

Function of H1 Antihistamine

A

Stimulation…
1) constricts bronchioles
2) Dilates peripheral vasculature
3) inc. vascular permeability

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17
Q

Function of H2 Antihistamine

A

1) Regulates Gastric acid secretion

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18
Q

In the CNS, H1 & H2…

A

Modulate…
1) Arousal
2) Thermoregulation
3) Neuroendocrine functions

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19
Q

Function of H3 Antihistamine

A

1) Presynaptic regulator of histamine synthesis and release

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20
Q

What are H1 receptor blockers?

A

1) Reversible & Competitive
2) Inhibit H1 receptors
3) Competitive inhibitors of Muscanaric receptors
4) Block sodium channels disrupting cortical neurotransmission

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21
Q

Antihistamine Toxicity clinical features

A

1) Sedation
2) Headache
3) Dry Mouth
4) Nausea
5) Menstrual Pain (Allegra)

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22
Q

What are H2 receptor blockers used to treat?

A

Heartburn

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23
Q

Clinical indications to use an H2 receptor blocker

A

1) Brady/tachycardia
2) confusion
3) agitation
4) delirium
5) Seizures

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24
Q

Examples of H2 receptor blockers

A

1) Tagamet
2) Zantac
3) Pepcid
4) Axid

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25
Q

Example of H1 receptor blockers

A

1) Benadryl
2) Unisom
3) Chlor Trimeton
4) Atarax
5) Claritin
6) Allegra
7) Zyrtec

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26
Q

Macrolides Antibiotic toxicity effect:

A

Gastric Irritation

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27
Q

Chloramphenicol Antibiotic toxicity effect:

A

Aplastic anemia

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28
Q

Tetracyclines Antibiotic toxicity effect:

A

1) Photosensitivity
2) Renal Tubular Necrosis

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29
Q

Fluroquinolones Antibiotic toxicity effect:

A

Disrupt Cartilage synthesis

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30
Q

Low dose caffeine toxicity clinical features:

A

1) Nervousness
2) Insomnia
3) Abdominal pain

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31
Q

High dose caffeine toxicity clinical features:

A

1) Vomitting
2) Myoclonus
3) Myocardial irritability
4) Seizures

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32
Q

Clinical features of chronic caffeine toxicity

A

1) Irritability
2) Insomnia
3) Anxiety
4) Chronic abdominal pain
5) CVD
6) Fibrocycstic disease

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33
Q

FDA regulation of herbal medicines

A

Little to none…

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34
Q

In many herbal products the active ingredient __________.

A

“Is not known”

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35
Q

Definition of Infusion

A

Herbs steeped in water (like tea)

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36
Q

Definition of Decoction

A

Plant soaked then boiled in water (extracts more)

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37
Q

Definition of Tincture

A

Herb extract prepared by steeping in 25% mix of alcohol & water

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38
Q

Definition of Syrup

A

Herb extract prepared in honey or sugar

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39
Q

Definition of Compress

A

Cloth pad soaked in hot herbal extract and applied to painful area

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40
Q

Definition of Poultice

A

Similar to compress, but entire herb is applied to area

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41
Q

Definition of Emmenagogue

A

Herb that induces or increases menstrual flow

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42
Q

Definition of Carminative

A

Herb that reduces or prevents flatulence

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43
Q

MC use f herbal medicine is…

A

Herbal teas

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44
Q

What is “Folk” medicine?

A

Unrefined products derived from local plants, animals or minerals as a treatment for disease.

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45
Q

Use for Aloe:

A

1) Laxative
2) Cathartic effects
3) Psoriasis/Seborrhea
4) Skin Burns

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46
Q

Use for Bilberry (Huckleberry, Blueberry):

A

1) Atherosclerosis
2) PVD
3) lipid-lowering
4) anti-inflammatory
5) night vision/visual acuity

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47
Q

Use for Black Cohosh

A

1) alternative to Hormone Therapy
2) Menopausal/Dysmenorrhea/Prementrual

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48
Q

Use for Chamomile

A

1) Sleep
2) anti-peptic/pyretic
3) antibacterial/fungal
4) antispasmodic

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49
Q

Contraindication for using Chamomile

A

Allergy to Ragweed (contact dermatitis)

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50
Q

Use for Cascara Sagrada (Fletcher’s Castoria)

A

1) Constipation
2) Gallstones
3) Liver problems

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51
Q

Use for Cheyenne Pepper

A

1) Topically for anti-inflammatory for arthritis

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52
Q

Use for Chinese parsley, Coriander, Cilantro

A

1) cooking
2) Chelating agent
3) Inc. Hg, Pb & Al excretion from the body

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53
Q

Use for cranberry fruit

A

1) prevent & treat UTI/Kidney stones
2) Diuretic
3) antiseptic

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54
Q

Use for Echinacea

A

1) Upper respiratory viral infections
2) immune stimulant
3) promote healing

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55
Q

What can Echinacea interfere with?

A

Immunosuppressive therapy

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56
Q

Use of Feverfew Leaf

A

Prophylactic prevention of…
1) migraine/headaches
2) fever
3) arthritis
4) mentrual problems

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57
Q

Use of Ginger

A

1) prevent & treat motion sickness
2) appetite stimulant
3) arthritis
4) cold symtoms

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58
Q

No not use Ginger in patients with…

A

Cholelithiasis

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59
Q

Health benefits of Ginger Tea List: (11)

A

1) Motion sickness/STOMACH DISCOMFORT
2) dec. inflammation
3) asthma
4) circulation
5) mentrual discomfort/fertility
6) immunity
7) relieve stress
8) cough & cold
9) cancer
10) Alzheimer’s
11) Weight loss

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60
Q

Use for Ginkgo root:

A

1) Vasodilator
2) Cerebral insufficiency
3) dementia/memory enhancement
4) sexual dysfunction due to antidepressant use

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61
Q

Use of Asian Ginseng (Panay ginseng)

A

1) respiratory, digestive & CNS stimulant
2) Fatigue
3) Ulcers
4) Lowers cholesterol
5) immunostimulatory agent
6) cope with stress

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62
Q

Use of Goldenseal root

A

1) Common cold & URI
2) bacteria & inflammation
3) immune stimulant
4) infectious diarrhea

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63
Q

Use of hawthorn (Crataegus monogyna)

A

1) Cardiac function (HR & blood flow to heart) (dec. BP)

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64
Q

Use of Kava Root

A

1) anxiety
2) insomnia
3) promote relaxation

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65
Q

Why is Kava root no longer available in the U.S.?

A

Live issues

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66
Q

Use of Milk Thistle (Silybum Marianum)

A

1) prevent/cure liver disease
2) protects cell membrane
3) Scavenges harmful Oxygen radicals in the liver

67
Q

Use of Saw Palmetto (Serenoa Repens)

A

1) Benign Prostatic Hyperplasia
2) Enlarged prostate

68
Q

Use of Red Yeast Rice Extract

A

1) Lowers total cholesterols, LDL’s & triglycerides
[Marketed as Cholestin]

69
Q

Do not take Red yeast Rice Extract with…

A

1) Alcohol
2) Zantac
3) selected antibiotics
[blocks metabolism] -> [produces GABA analog]

70
Q

Use of St. John’s Wort (Hypericum Perforatum)

A

1) Depression/Anxiety
2) CT swelling
3) Menopausal neurosis
4) wound healing

71
Q

Use of Tea Tree

A

Antiseptic &Antimicrobial applied to the Skin

72
Q

Use of Valerian Root:

A

1) Anxiety
2) Insomnia (sedative)

73
Q

What is L-Tryptophan?

A
  • Essential amino acid
  • Precursor for Serotonin
74
Q

What can L-Tryptophan Treat?

A

1) Insomnia
2) depression
3) PMS

75
Q

Caution when taking Pennyroyal:

A

Liver Damage & may cause abortion

76
Q

Caution when taking Senna

A

Electrolyte Loss

77
Q

Caution when taking White Willow Bark

A

Reye’s Syndrome

78
Q

Caution when taking Wormwood:

A

Neurological Symtoms

79
Q

Mandrake is used to treat…

A

1) Ovarian cancer
2) Sedative
3) Hallucinogen
4) Purgative, Emetic & Analgesic

80
Q

Do not give Mandrake to…

A

Pregnant women

81
Q

Thorn Apple tea is used to treat…

A

1) Asthma
2) boils
3) piles
4) cancer

82
Q

Burdock root tea is used to treat…

A

1) Psoriasis & Eczema
2) Gout
3) Sores
4) Cancer
5) Skin Diseases
6) Arthritis

83
Q

Burdock Root Tea is a ___________ and a _____________.

A

Diuretic; Diaphoretic

84
Q

Mormon Tea is used to treat…

A

1) Asthma
2) Diarrhea
3) Stimulant to control Hay fever
4) Adrenal Stimulant

85
Q

Drug interactions with Ginkgo Biloba:

A

1) Aspirin
2) NSAID’s
3) Warfarin
4) Heparin

86
Q

Drug interactions with Ephedra

A

Caffeine or other stimulants

87
Q

Drug interactions with Feverfew:

A

1) Anticoagulants
2) Pregnancy

88
Q

Drug interactions with Garlic:

A

1) Warfarrin
2) Aspirin
3) May inhibit clotting

89
Q

Drug interactions with Kava Kava

A

Benzodiazepines

90
Q

Drug interactions with St. John’s Wort:

A

Antidepressants

91
Q

Drug interactions with Licorice:

A

BP Medications

92
Q

Drug interactions with Ginseng:

A

1) Digitalis
2) MAO Inhibitors
3) Avoid w/ Antidepressants

93
Q

MOA of Carboxylic Acids (Acetylsalicylic Acid, Aspirin, White Willow Bark):

A

Inhibits PROSTAGLANDIN SYNTHETASE found in the Cyclooxygenase pathway

94
Q

Toxicity of Aspirin Clinical Features

A

1) Tinnitus
2) Metabolic acidosis
3) ulcers
4) Leads to Reye’s Syndrome

95
Q

Examples of Carboxylic Acids:

A

1) Acetylsalicylic Acid
2) Aspirin
3) White Willow Bark

96
Q

Examples of non-opiate/non-anti-inflammatory analgesics:

A

Acetomenophin (Tylenol, Tempra)

97
Q

Examples of Propionic Acids:

A

1) Ibuprofen (Motrin, Advil)
2) Ketoprofen (Orudis)
3) Fenoprofen (Nalfon)
4) Naproxen (Aleve)

98
Q

MOA of Propionic Acids:

A
  • Block PROSTAGLANDIN SYNTHETASE
  • Accumulate in synovial fluids
  • Long lasting effects
99
Q

MOA of Acetic Acids:

A
100
Q

Toxicity of Acetic Acids

A
101
Q

What effect do Glucocorticoids have on the HPA Axis?

A

Hypothalamus: release CRH
Ant. Pituitary: release ACTH
Adrenal Cortex: release Glucocorticoids

102
Q

MOA of Gluccorticoids:

A

Block formation of Arachidonic Acid
(Prevent PHOSPHOLIPASE A2 to form Arachidonic acid to stop inflammation)

103
Q

Glucocorticoids promote…

A

Gluconeogenesis from non-CHO sources

104
Q

Glucocorticoids effects on the liver:

A

1) inc. amino uptake
2) inc. glycogen deposition
3) inc. blood glucose to stimulate insulin release
4) Cause glycosuria > 200mg

105
Q

Cushing Syndrome can be caused by:

A

Taking glucocorticoid drugs or a functional adenoma
(ACTH would be lower in Cushing’s)

106
Q

Glucocorticoids effects on muscle/catabolism:

A

1) inc. amino acids release from muscle
2) Inhibit protein synthesis
3) Catabolic effect on: lymph, CT, muscle, skin, bone

107
Q

Glucocorticoid Effects on Bone:

A

1) Catabolic- > Osteoporosis
2) Decreased Osteoblastic activity

108
Q

Glucocorticoid Effect on RBC components & WBC’s:

A

Neutrophils: increase
Lymphocytes: decrease
Monocytes: Inhibit ability to turn into macrophages
Eosinophils: decrease
Platelets: Increase

Chemotaxis of all WBC’s: decrease

109
Q

Glucocorticoids effects on:
1) Macrophages
2) Lysosomal Membranes
3) Fibroblasts
4) Collagenase
5) Phagocytes

A

M -> Dec. ability to phagocytize bacteria
L -> Stabilize
F -> Inhibit growth
C -> Potentiate
P -> long-term leads to suppression

110
Q

Effects of Glucocorticoids on:
1) Capillaries
2) Vessels
3) Histamine
4) ACTH
5) Gastric Acid & Pepsin

A

C -> Dec. permeability
V -> vasoconstriction
H -> Dec. release
ACTH -> Dec. release
G & P -> inc. release in stomach

111
Q

Effects of Glucocorticoids on TSH release:

A

Decreases, so patients present similar to hypothyroidism: Depression, mood swings, weight gain, cold intolerance

112
Q

Effect of Glucocorticoids on Sodium & Potassium:

A

Na: Retention
K: Depletion

113
Q

Conditions treated with Glucocorticoids: (12)

A

1) RA
2) Lupus
3) Inflammatory Bowel Disease
4) Allergic Conditions
5) Asthma
6) Skin Disorders
7) Neoplasm (lymphocytic leukemia, lymphoma Roma, hodgkin’s)
8) Surgical Graft’s
9) Preterm Labor
10) Shock
11) Cerebral Edema
12) Bell’s Palsy

114
Q

Glucocorticoids combined with NSAID’s can cause…

A

Severe GIT disturbances and risk of ulceration

115
Q

Components that aid in the production of Peptic Ulcer Disease

A

Duodenal > Peptic
H. PYLORI (infection) & NSAIDS (COX-1)

116
Q

Examples of H2 Receptor Antagonists:

A

1) Tagamet (prototype)
2) Pepcid
3) Axid

117
Q

MOA of H2 Receptor Antagonists:

A

Decrease HCl in the stomach
Metabolized in liver
Excreted in the Urine. (Tagamet excreted in bile)

118
Q

Clinical Indications for H2 Receptor Antagonists:

A

1) Dyspepsia
2) Heartburn

119
Q

What do Proton Pump Inhibitors do?

A

Inhibit the pumping Hydrogen ions into stomach to combine with Cl to make HCl Acid.

120
Q

Examples of Proton Pump Inhibitors:

A

1) Prilosec (prototype)
2) Nexium (2nd generation Prilosec)
3) Prevacid (biggest competitor)

121
Q

MOA of Sucralfate (Carafate)

A

Works in an acid environment; lays down a protective coating

122
Q

Side Effects of Mylanta/Maalox:

A
  • Constipation
  • loose stools
123
Q

Examples of Antacids:

A

1) Milk of Magnesia
2) Amphogel
3) Tums, Roland’s
4) Mylanta, Maalox

124
Q

MOA of Antacids:

A

Immediately neutralize the acids that are already there

125
Q

MOA of Fecal Softeners (Mineral Oil):

A

Blocks absorption of water which allows water to be retained in the bowel

126
Q

Examples of Irritant Laxatives:

A

1)Castor Oil
2) Cascara Sagrada (Flether’s Castoria)
3) Senna

127
Q

MOA of Irritant Laxatives:

A

Stimulant to the bowel

128
Q

MOA of Bulk Laxatives (Citrucel):

A

Non-digestible fiber that has been ground into powder form

129
Q

MOA for Saline Laxatives (epsom salts, Mg Citrate, Fleet Enema):

A

Have a lot of electrolytes, so act as a diuretic to draw fluid into bowel

130
Q

Examples of Antidiarrheal OTC medications:

A

1) Pepto Bismol
2) Kaopectate
3) Imodium-AD
4) Donnagel

131
Q

MOA of Pepto Bismol

A

Binds to toxins in the bowel, producing a dark stool

132
Q

MOA for Kaopectate:

A

Binding agent that thickens the stool (flour to gravy)

133
Q

MOA for Imodium:

A

1) Slows down longitudinal peristalsis
2) Inc. Intersegmental peristalsis to absorb more water
3) Inc. transit time

134
Q

Prescription Meds for Diarrhea containing Opiates:

A

1) Lomotil
2) Paregoric

135
Q

Examples of bronchodilators:

A

1) Albuterol
2) Metaproterenol
3) Terbutaline
4) Ephedrine

136
Q

MOA of Bronchodilators

A

Beta 2 Agonists that affect smooth muscle to relax the respiratory tree

137
Q

Clinical Indication for using Bronchodilators (Beta 2 agonists)

A

Asthma attacks

138
Q

Side effects of Bronchodilators (Beta 2 agonists)

A

Can stimulate B1 receptors in the heart -> inc. HR

139
Q

Examples of Methylxanthines:

A

1) Theophylline (Theodur, Slo-Phyllin)
2) Aminophylline

140
Q

MOA of Methylxantines:

A

Affect PHOSPHODIESTERASE causing inc. cyclic AMP which relaxes smooth muscle

141
Q

Clinical indications fro Methylxantines:

A

Take routinely to prevent asthma attacks and when you have an asthma attack it is much milder

142
Q

MOA of Cromones:

A

Stabilize mast cell membranes to block the release of HISTAMINE

143
Q

MOA of Inhaled Steroids

A

Catabolic steroids that minimize inflammation around your respiratory tree

144
Q

MOA of Mucolytics (n-acetyl-cysteine)

A

Minimize accumulation of mucus from mucous membranes & breaks down mucus being secreted

145
Q

Clinical Use for Mucolytics (n-acetyl-cysteine)

A

Used as the only treatment for Tylenol overdose

146
Q

Examples of antihistamine H1 receptor blockers:

A

1) Benadryl (prototype)
2) Claritin
3) Allegra
4) Zyrtec

147
Q

MOA of Antihistamine H1 receptor blockers:

A

Basophils release histamine & act against rhino RRROA

148
Q

Side effects of antihistamine H1 receptor blockers

A

1) Drowsiness/sedation
2)) drying agents

149
Q

Examples of nasal decongestants:

A

1) Sudafed (prototype)
2) Afrin
3) Dristan
4) Ephedrine

150
Q

MOA of Nasal Decongestants:

A

Alpha 1 stimulators causing Vasoconstriction

151
Q

Do not give Nasal Decongestants to:

A

1) Hypertensive Patients
2) Prostate issue patients
3)can become addictive/dependant

152
Q

Examples of Expectorants:

A

1) Guaifenesin (Robitussin)
2) Iodine (PotassiumIodine)

153
Q

MOA of Expectorants:

A

Thin out mucus secretions by adding ions so it expels

154
Q

Side effects of Expectorants:

A

None

155
Q

Examples of Antitussives:

A

1) Dextromethorphan (non-narcotic)
2) Codeine (narcotic) -> natural extract
3) Hydrocodone (Narcotic) -> controlled substance

156
Q

MOA of Antitussives:

A

Used to suppress a cough, (suppress centrally in the Medulla)

157
Q

Side-Effects of Antitussives:

A

1) Non-Addicting
2) Sedating effects
3) Constipation

158
Q

OIC stands for:

A

Opiate Induced Constipation

159
Q

Doxylamine =

A

Antihistamine

160
Q

Pseudoephedrine =

A

Decongestant

161
Q

Guaifenesin =

A

Expectorant

162
Q

Dextromethorphan =

A

Cough Suppressant

163
Q

Acetaminophen =

A

Pain Reliever

Pharm Tox (3 decks)

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