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Advanced Pharm > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

acarbose

A

-blocks glucose absorption in intestines

s/e diarrhea, foul flatus

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2
Q

actos (pioglitazone)

A

thiazolinedione (TZD) derivative
• enhances insulin activity
-not often used anymore due to HF and bladder CA, CV effects
-may have elderly that use it

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3
Q

acetaminophen

A

fever and mild pain, safe in pregnancy

-overdose is toxic to liver, don’t use with alcohol

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4
Q

acetazolamide (Diamox)

A

diuretic and carbonic anhydrase inhibitor
-promotes excretion of bicarb
• Treats glaucoma, HTN, CHF, altitude sickness, epilepsy

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5
Q

s/e caution and interactions of acetazolamide

A
  • s/e fatigue, abdominal pain, N/V, parasthesia, Stevens-johnson
  • don’t use for patients with renal or hepatic dysfunction
  • interacts with abx, sodium bicarb, amphetamines and salicylates
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6
Q

Acetylsalicylic acid (ASA)

A

• reduced inflammation, low dose can be safe in pregnancy

  • decreases platelet aggregation
  • risk of Reyes syndrome in kids
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7
Q

Aldosterone antagonist- spironolactone

A

-blocks Na and water resorption, k sparing

• treat HTN and HF, no androgen effects

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8
Q

s/e and caution with aldosterone antagonists (ex: epelernone)

A

• s/e hyperkalemia, hypotension, dizzy, impaired renal fxn
• avoid azole antifungals and macrolide antibiotics
-monitor K, watch out for salt supplements and k sources

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9
Q

Alpha adrenergic antagonist- prazosin (minipres)

A
  • blocks vasoconstriction

* not first line drug for elderly (inc risk orthostatic hypotension)

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10
Q

amicar

A

antifibrinolytic agent

  • prevents clot breakdown
  • treats acute bleeding syndromes, leaking cerebral aneurysm
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11
Q

amiodarone

A

k channel blocker (blocks repolarization phase), iodine based
-regulate atrial and ventricular rhythms
• monitor QT interval, monitor thyroid levels
-risk of fibrosis alveolitis, need f/u cxrays
-can get yellow vision or blue skin, use sunscreen.
• can treat chronic stable angina or Prinzmetals

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12
Q

drug/drug with amiodarone

A

• don’t give with dantrolene, Cardizem, simvastain

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13
Q

Angiotensin II receptor antagonist- ex valsartan

A
  • first tx for HTN in CKD
  • decrease BP and afterload, some natriuretic and diuretic properties
  • decreases cardiac myocyte hypertrophy
  • promotes vasodilation, reduces vasopressin, reduce aldosterone
  • renal protective in DM
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14
Q

can you give ARB in pregnancy?

A

nope

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15
Q

If allergic to ___ then allergic to ___

A

ACE, ARB

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16
Q

angiotensin converting enzyme inhibitor (ex: vasotec)

A
  • first tx for HTN in CKD

* can also delay progression of diabetic nephropathy by blocking breakdown of bradykinin and substance P

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17
Q

ACEi s/e

A

• s/e is cough, angioedema

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18
Q

Aquamephyton

A

vit K replacement

• reverses coumadin, monitor INR

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19
Q

beta adrenergic antagonists (ex: propanolol, nadalol, metoprolol)

A
  • membrane stabilizing effect, decrease excitability (PVCs and atrial rhythms)
  • for exercise induced angina
  • reduces CNS activity
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20
Q

c/i for beta blockers

A

COPD/Asthma, Reynauds, bradycardia, HF, DM, pregnancy, lactation
-don’t give with Verapamil or Adenosine, decreased effect when given with NSAIDs

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21
Q

s/e with beta blockers

A

• s/e bradycardia, HF, fatigue, depression, sleep disturbance, N/V

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22
Q

propanolol

A

non-specific Beta

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23
Q

nadalol

A

a and B action

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24
Q

metoprolol

A

B1 specific blocker

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25
Q

Ca channel blocker (ex diltiazem and nifedipine)

A

prevent inward movement of calcium
• for Prinzmetals, migraine, reynauds, HTN, post infarction to preserve muscle
• dilate peripheral and coronary arteries- reduces systemic vascular resistance

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26
Q

c/i for ca channel blockers

A
  • c/i in heart block, sick sinus syndrome, renal and hepatic dysfunction
  • inhibits metabolism of many drugs like b adrenergics
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27
Q

s/e for ca channel blockers

A

• s/e dizziness, H/A, fatigue, hypotension, bradycardia, edema

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28
Q

L calcium channel

A

muscle, neurons (verapamil and nifedipine)

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29
Q

first HTN meds for blacks

A

thiazide and ca channel blockers

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30
Q

Carbonic Anhydrase inhibiter- ex acetazolamide (Diamox)

A
  • reduces the activity of carbonic anhydrase (enzyme which catalyzes the reaction between carbon dioxide and water into carbonic acid and then bicarbonate)
  • will see increased bicarb excretion and mild increase in Na and K excretion
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31
Q

Chlorothiazide- thiazide diuretic

A

• inhibit the na/cl resorption

-good for salt sensitive HTN (elderly and black pts)

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32
Q

clonidine

A

centrally acting alpha agonist

  • dec sympathetic outflow
  • used HTN, withdrawal, ADHD
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33
Q

Clopidogrel (plavix)

A

• anti-platelet, dec risk of stroke and MI
-don’t need frequent bloodwork
-no reversal
-risk of bleeding into spinal cord when spinal taps
• don’t give with Tagamet and azole, grapefruit

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34
Q

coumadin

A
  • anti-coagulant, inhibits vitamin K clotting factors
  • need to monitor INR
  • levothyroxine increases breakdown of vit k thus enhancing coumadin, may need to reduce dose
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35
Q

Digoxin- cardiac glycoside

A

• blocks Na/K atpase- increase in intracellular Ca for stronger contraction
• vagatonic- slows SA nodal rate of fire (afib and atrial rhythms)
*monitor labs, esp K, narrow therapeutic window
-need to dig load cuz long half life

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36
Q

antidote to digoxin

A

digibind

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37
Q

Entresto

A

• Combo of neprilysin inhibitor, sacubitril and valsartan (ARB)
-will have elevated BNP to promote diuresis

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38
Q

s/e Entresto and monitor

A

• s/e hypotension, hyperkalemia, cough, dizzy, renal failure

-monitor with pro-nBNP, cxray

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39
Q

neprilysin

A

breaks down naturietic peptides and other vasoactive compounds

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40
Q

Epinephrine

A

• neurotransmitter

-B adrenergic effects, mobilizes glucose stores

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41
Q

Exenatide (Byetta)- synthetic Incretin peptide

A
  • Secreted by Gi at meals to delay emptying and reduce appetite
  • Enhanced insulin secretion, prevents glucagon release
  • Given 30 min before meals
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42
Q

s/e of exenatide (Byetta)

A

• s/e hypoglycemia, N/D, HA, dizzy

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43
Q

Furosemide (Lasix)-

A

loop diuretic, will lose K
-used in HF
• monitor BMP, K levels

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44
Q

Glipizide

A

a sulfonylurea

  • stimulates insulin release from pancreas (*risk for hypoglycemia )
  • risk of allergy to other sulfa drugs
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45
Q

Glucagon

A

rapidly elevates BG
• Naturally is a peptide hormone produced by alpha cells of the pancreas
• Causes liver to perform glycogenolysis which converts stored glycogen into glucose which is released into the bloodstream

46
Q

Glucocorticoids/Cortisol

A

• secreted from adrenal cortex

  • negative feedback response
  • secreted as it is produced–need to taper med
  • diurnal rhythm- highest in AM
47
Q

Growth Hormone

A
  • normally produced in the ant pituitary gland, can be used for doping
  • secreted as you sleep
  • important for wound healing
  • counter regulatory hormone- at risk for hyperglycemia
48
Q

H2 Receptor Antagonist examples

A

• cimetidine (Tagamet)- interferes with many drugs
• famotidine (Pepcid)- more potent, less adverse effects, less drug-drug interactions
-OTC meds

49
Q

Helicobacter pylori Treatment

A

• Supress acid (PPI, H2, bismuth subsalicylate)
• And at least 2 abx (flagyl and tetracycline) or (flagyl and amoxicillin)
**can give tagamet
-diagnose by carbonurea breath test, endoscopy

50
Q

Hydrochlorothiazide- thiazide diuretic

A
  • blocks Na/Cl transporter in distal convoluted tubule

* reduce volume and decrease peripheral vascular resistance

51
Q

s/e and caution with hydrochlorothiazide

A
  • s/e hypokalemia, inc uric acid, impaired carb intolerance, hyponatremia
  • allergy- sulfonamides, photosensitivity, hemolytic anemia
52
Q

Hydralazine and s/e

A
  • smooth muscle relaxer, arterial vasodilator, need to maintain fluid volume status
  • s/e tachycardia, edema, H/A, GI, Lupus
53
Q

can hydralazine be given in pregnancy

A

yes

54
Q

can ibuprofen be given in pregnancy

A

no, increases bleeding

55
Q

parenteral insulin

A

from animal sources, no longer used, hard to know what is consists of

56
Q

Humulin

A
  • recombinant DNA tech, less antigenic
57
Q

inhaled insulin

A
  • rapid, T1DM, lung function tests
58
Q

Invokana- Sodium glucose transport 2 inhibitor

A

• Resorption of glucose in renal proximal tubules
• Increased excretion of glucose in urine
**doesn’t interact with incretins

59
Q

caution and s/e with invokana

A
  • s/e KETOACIDOSIS, dehydration
  • *don’t give in renal insufficiency, or frequent UTI/yeast infection
  • Caution with ACE, ARBS, K sparin diuretics
60
Q

Lantus (insulin glargine)

A
  • Long acting, cannot be mixed with other insulins, once daily, initial dose 10 u per day
  • Given with lispro for basal/bolus approach
61
Q

Lispro- insulin analogue

A
  • ultra short acting, give 15 min prior to meal, peak seen in 30 min
  • Used with lantus for basal/bolus approach
62
Q

Maalox

A

contains aluminum hydroxide, mag hydroxide, and simethicone (don’t give with other meds)
• Antacid treatment, can be combined with PPI and H2 inhibitors
-s/e diarrhea

63
Q

is maalox safe in pregnancy

A

yes

64
Q

Metformin/Biguanides

A

• increase sensitivity of tissues to insulin, reduce hepatic gluconeogenesis
-T2DM and pre-diabetes, pregnancy, polycystic ovarian syndrome

65
Q

s/e and caution of metformin/biguanidea

A

-need to be paused before contrast dye
-cant give if altered renal fxn
• Monitor BUN/Creat, LFTs

66
Q

methyldopa (antihypertensive)

A

• a false neurotransmitter that replaces norepi
treats HTN in pregnancy
• alpha 2 agonist, reduction of sympathetic outflow

67
Q

is methyldopa safe in pregnancy

A

yes, first med approved for this

68
Q

Nifedipine

A

calcium channel blocker

• prinzmetals angina, severe HTN

69
Q

Nitrates (nitroglycerin-short half life or isosorbide-long half life)

A

• promotes endothelial relaxing factor (EDRF)
o Low dose large veins, high dose arteriolar dilation (dec afterload)
***prinzmetals

70
Q

hemodynamic effects of nitrates

A

o Vasodilation- reduced BP

o Have a short half life- throw away after 3 months

71
Q

s/e and caution with nitrates

A
  • s/e H/A dizziness, orthostatic hypotension, tachycardia, tachyphylaxis (need higher and higher dose to get response), ETOH potentiates effects
  • large doses associated with methemoglobinemia (pseudocyanosis and tissue hypoxia)
72
Q

NPH Insulin

A
  • intermediate acting insulin for T1DM and T2DM
    • commonly used in gestational diabetes
    • good for elderly
    -70/30 combo (7 units NPH and 3 of regular)
73
Q

Penicillin

A

beta lactam abx
• treats staphylococci and streptococci
• don’t give with cephalosporins, aminoglycosides, tetracyclines, macrolides, fluoroquinolones

74
Q

Pradaxa

A

• direct thrombin inhibitor
-has an antidote!
• for stroke reduction in afib, reduce risk or reoccurrence of DVT or PE

75
Q

black box warning pradaxa

A

: increased risk of clot when stopped, increased risk of hematoma during spinal procedures

76
Q

reverses pradaxa

A

-praxbind

77
Q

Propranolol (inderal)

A

beta 1 and 2 adrenergic antagonist, crosses BBB, s/e depression and fatigue
•don’t give with asthma

78
Q

omeprazole (Prilosec)- PPI

A

blocks movement of hydrochloric acid
o inhibits H/K atpase, use only short term
• long term use is associated with gastric cell hypertrophy and cancer
• do not crush or mix with food (granules)

79
Q

Quinidine

A

Na and K channel blocker
• used with digoxin to treat atrial arrhythmias
-seen in elderly or from other countries

80
Q

s/e quinidine

A

s/e chiconism (vertigo/dizziness), diarrhea, vagolytic

-need to monitor QT interval, highly protein bound

81
Q

Regular Insulin

A

Humulin R, Novolin R

• short acting that moves glucose from the blood into the body’s cells

82
Q

Rosiglitazone (TZD)

A

(another example is actos)
-monitor LFTs
• banned in US due to reports of cardiac problems

83
Q

Saxagliptin (Onglyza)

A

DPP4 inhibitor- block breakdown of incretins
• less hypoglycemia
• s/e runny hose, HA, N/V, bloating, hives, rash, swelling, hoarseness

84
Q

Sitagliptin (januvia)

A

DPP4 inhibitor

• reduce inactivation of incretin, inc insulin levels and dec glucagon, promotes satiety, less chance of hypoglycemia

85
Q

s/e januvia (sitagliptin)

A

• s/e HA, upper resp infection, angioedema, pancreatitis, anaphylaxis, Stephen-johnson

86
Q

Spironolactone

A

aldosterone antagonist, K sparing

• prevents remodeling in HF, edema

87
Q

s/e spironolactone

A

• s/e hyperkalemia, nausea, lethargy, androgen effects- resembles sex steroids (irregular periods, gynecomastia)

88
Q

Sulfonylureas

A

increase insulin release from pancreas
• pts need to have functioning pancreatic B cells
• Ex: glipizide, glimepride, glyburide

89
Q

caution with sulfonylureas

A
  • *cross reactivity with sulfa drugs
  • *disulfiram rxn and hypotension with EtOH
  • High risk for hypoglycemia, pancreas can be overworked
90
Q

Tagamet (cimetidine)

A

• h2 receptor antagonist, OTC for heartburn

-many drug interactions

91
Q

s/e tagamet

A

• s/e diarrhea, HA, fatigue, seizure, depression, anti-androgen (reversible gynecomastia), dec libido
**many drug/drug interactions

92
Q

Tetracycline

A

protein synthesis inhibitor abx, broad spectrum
• don’t give in pregnancy or children due to bone/teeth effects
-h pylori

93
Q

Thiazide diuretic

A

first line for HTN in non-hispanic blacks

• mild to moderate HTN

94
Q

TZD (thiazolidinedione)

A

for DM
• not first line treatment, inc risk of CV disease
• ex: actos

95
Q

Vasotec (enalapril)- ACEi

A

• works by reducing cardiac myocyte hypertrophy and L vent hypertrophy

96
Q

s/e and c/i with vasotec

A
  • c/I with history of angioedema, pregnancy, renal artery stenosis
  • check kidney function, K, etc at 2 wks, 6 wks, 6 mos
  • s/e postural hypotension, hyperkalemia, cough
97
Q

Verapamil

A

calcium channel blocker
-dec SA nodal rate of fire
• for atrial rhythms
• slight peripheral vasodilation, suppresses early and delayed after depolarization

98
Q

don’t give verapamil with___

A

beta blockers

99
Q

vit K

A

give for high INR, reverses coumadin

100
Q

adenosine

A
  • for rapid atrial arrhythmias
  • can have long pause before pt converts to NSR
  • short half life
101
Q

amlodipine (Norvasc)

A

ca channel blocker

  • HTN
  • s/e pedal edema
  • good for elderly, and 2nd line for blacks
102
Q

4 classes of drugs for HTN

A

ACE, ARB, thiazide diuretics, ca channel blocks

103
Q

HTN treat for blacks

A

thiazide and ca channel blockers

104
Q

many blacks are low in

A

aldosterone, renin

-ACE isn’t going to make a big difference

105
Q

why use ACE or ARB?

A

decreases myocyte hypertrophy

-less likely to develop LVH, less HF risk

106
Q

incretins

A
  • intestinal hormones secreted from small intestines as you eat
  • stimulate insulin release, promotes sense of fullness, decrease glucagon
107
Q

ibuprofen

A

antiplatelet, antifever

-given often in kids cuz no risk Reyes syndrome

108
Q

sulfonamide

A
  • sulfa abx

- cross reactivity to sulfa allergy

109
Q

heparin

A

monitor aptt

-antidote is protamine

110
Q

verapamil can treat which rhythm

A

SVT

111
Q

Cardizem

A

slows sa nodal rate of fire, also HTN

112
Q

drug trial phases

A

1- safety
2-small group effective
3- adverse effects
4- nurse eval in practice

Advanced Pharm (2 decks)

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