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Pharmacology > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Most common cause of UTI

A

E. Coli

Staph Saprophyticus 5-20%

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2
Q

Uncomplicated UTI

A

Pre-menopausal, sexually active, non-pregnant women

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3
Q

Complicated UTI

A

Men, postmenopausal, pregnant women, urinary structural defects, neurologic lesions, catheter use, symptoms >7 days

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4
Q

How many days of UTI treatment

A

1-3 days of antibiotics usually enough

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5
Q

Urinary analgesics

A

Methenamine, phenazopyridine, flavoxate
Treats urgency, burning, frequency, discomfort; acts as local anesthetic of urinary tract; discolors urine
Should not be used for more than 2 days

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6
Q

First line antibiotics for UTI

A

Bactrim
Nitrofurantoin (7 day course for uncomplicated UTI only)
Fofomycin (one time drug)
Fluoroquinolones (given for pyelonephritis, not uncomplicated UTI)

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7
Q

Second line antibiotics for UTI

A

Fluoroquinolones and fosfomycin for recurrent cystitis

-Reserved for complicated UTI and pyelonephritis

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8
Q

Antibiotics for UTI safe for pregnancy

A

amoxicillin, cephalexin, nitrofurantoin (1st and 2nd trimesters only)

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9
Q

Geriatrics treatment for UTI

A

Nitrofurantoin CI after 65
Educate about precipitating factors
Treat for 7-10 days in women and 10-14 days in men

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10
Q

Prophylactic UTI treatment

A

For patients with 3+ UTI’s

Lifestyle changes

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11
Q

CAM for UTI

A

Cranberry acidifies the urine

Probiotics

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12
Q

Categories of prostatitis

A

1: acute bacterial prostatitis
2: chronic bacterial prostatitis
3: chronic nonbacterial prostatitis and pelvic pain syndrome
4: asymptomatic inflammatory prostatitis

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13
Q

Main organisms for acute bacterial prostatitis

A

E Coli and pseudomonas

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14
Q

S/S prostatitis

A

Pain in lower abdomen, difficulty with bladder emptying, small stream, nocturia, fever, painful ejaculation, pain in rectal or perineal area

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15
Q

Antibiotics for prostatitis

A

Coverage of G-
Usually treat for 4-6 weeks or up to 12 weeks
Fluoroquinolones have best tissue penetration
Bactrim has less penetration and high resistance
Must monitor creatinine clearance

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16
Q

2nd line therapy for prostatitis

A

Doxycycline, azithromycin, clarithromycin for 4-6 weeks

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17
Q

BPH may be due to

A

Higher amounts of estrogen within the gland which increases activity of substances that promotes cell growth
Increased smooth muscle tone in lower urinary tract due to stimulation of cell receptors–increased urethral resistance and outlet obstruction

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18
Q

Main classes of drugs for BPH

A

Alpha 1 blockers, 5 alpha reductase inhibitors, PDE type 5 inhibitor

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19
Q

alpha 1 blockers for BPH

A

-Zosin
relaxes smooth muscle of prostate and bladder neck without interfering with bladder contractility
Relaxes sympathetic tone
May take months for effects
SE: hypotension, fluid retention, fatigue
Take at night
Tamsulosin highly selective with less side effects

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20
Q

5 alpha reductase inhibitors

A

Fibasteride + Dutasteride
Decreases levels of intracellular DHT without reducing testosterone levels
Decreases size of prostate
SE: decreased libido, impotence, gynecomastia, may falsify levels of PSA
Category X (can’t even touch)

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21
Q

1st line for BPH

A

Watchful waiting if low questionnaire, limit fluids, avoid decongestants, massage prostate, void frequently

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22
Q

2nd line for BPH

A

Alpha blocker if score >7
5 alpha reductase inhibitor
If history of hypertension, use alpha blocker

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23
Q

3rd line for BPH

A

Combination of alpha blocker and 5 alpha reductase inhibitor

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24
Q

CAM for BPH

A

Saw Palmetto, pygeum, Zinc

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25
Q

Primary treatment for BPH

A

Surgery

Treatment initiated when symptoms become problematic

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26
Q

Sequence for erection to occur

A

Nerve impulses in the brain, spinal column and area around the penis + response in muscles, fibrous tissues, veins, arteries near corpora cavernosa
Release of NO following PANS essential for erection–> smooth muscle relaxation that promotes inflow of blood

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27
Q

Drugs that can affect erectile dysfunction

A

Alcohol, analgesics, anticholinergics, anticonvulsants, antidepressants, antihistamines, antihypertensives, corticosteroids, diuretics, nicotine, tranquilizers

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28
Q

phosphodiesterase 5 inhibitors

A

Sildenafil, tadalafil, vardenafil
30-120 minutes for response
Inhibits breakdown of one of messengers required for erection
CI: nitrates, unstable angina, systolic BP<90, uncontrolled HTN, recent stroke, arrhythmias, cardiac impairment, renal disease, alpha blockers, recent MI
SE: headache, flushing, nasal congestion, dyspesia
Avoid with high fat meals

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29
Q

1st line tx for ED

A

Lifestyle changes
PDE5 inhibitor
If no response, refer to urologist
Follow up after 6 months

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30
Q

CAM for ED

A

Yohimbine

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31
Q

Overactive bladder

A

Ach mediated activation of muscarinic receptors is predominant mediator in detrusor contraction–primarily M3 receptor

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32
Q

Behavioral therapy

A

Bladder training, pelvic floor muscle exercises, weight loss

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33
Q

Anticholinergics for OAB

A

Oxybutynin, tolterodine, trospium, solifenacin, fesoterodine
Blockade of muscarinic actions–inhibits action of ACh on bladder smooth muscle
Increases bladder capacity, decreases intensity/frequency of bladder contractions, delay initial urge to void
Can cross BBB
Time frame of response 2 weeks
CI: urinary retention, narrow angle glaucoma, severe renal impairment
SE: constipation, urinary retention, xerostomia

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34
Q

Estrogen for OAB

A

Improves tone and elasticity of female urogenital anatomy by increasing secretion of cervical mucosa, thickening of vaginal mucosa and proliferation of endometrium

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35
Q

Beta adrenoreceptor agonist for OAB

A

Mirabegron
Selective B3 agonist
Increases bladder capacity and decreases frequency of urination without impacting urine pressure or residual volume
B3->NE–>Increased cAMP–>smooth muscle relaxation–> increased storage

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36
Q

Botox for OAB

A

Reserved for patients who have failed other treatments
Injected into detrusor muscle
Inhibits Ca dependent release of ACh, ATP and substance P; desensitizes motor neurons, decreases M1, M2 and M3
UTI common SE

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37
Q

SNRI for OAB

A

Venlafaxine + Duloxetine

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38
Q

Antidiuretic drugs for OAB

A

Desmopressin
Can inhibit diuresis without impacting blood pressure
CI: hyponatremia, renal impairment
SE: Water retention

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39
Q

1st line tx for OAB

A

Anticholinergic Oxybutynin + behavioral modifications

Mirabegron can be considered

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40
Q

2nd line tx for OAB

A

Try different anticholinergic
Duloxetine
Estrogen

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41
Q

3rd line tx for OAB

A

Botox or surgery

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42
Q

CAM for OAB

A

Saw palmetto extract

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43
Q

Beta adrenoreceptor agonist for OAB

A

Mirabegron
Selective B3 agonist
Increases bladder capacity and decreases frequency of urination without impacting urine pressure or residual volume
B3->NE–>Increased cAMP–>smooth muscle relaxation–> increased storage

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44
Q

Botox for OAB

A

Reserved for patients who have failed other treatments
Injected into detrusor muscle
Inhibits Ca dependent release of ACh, ATP and substance P; desensitizes motor neurons, decreases M1, M2 and M3
UTI common SE

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45
Q

SNRI for OAB

A

Venlafaxine + Duloxetine

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46
Q

Antidiuretic drugs for OAB

A

Desmopressin
Can inhibit diuresis without impacting blood pressure
CI: hyponatremia, renal impairment
SE: Water retention

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47
Q

1st line tx for OAB

A

Anticholinergic Oxybutynin + behavioral modifications

Mirabegron can be considered

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48
Q

2nd line tx for OAB

A

Try different anticholinergic
Duloxetine
Estrogen

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49
Q

3rd line tx for OAB

A

Botox or surgery

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50
Q

CAM for OAB

A

Saw palmetto extract

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51
Q

Drugs that worsen OAB

A

Sedatives and hypnotics, phenothiazines, alpha blockers, caffeine

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52
Q

Most prevalent STI in the US

A

Chlamydia

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53
Q

S/S chlamydia

A

Vaginal discharge, mucopurulent cervicitis with edema and friability, urethritis, PID, ectopic pregnancy, infertility, endometriosis

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54
Q

1st line therapy for chlamydia

A

Azithromycin 1 dose DOC
Doxycycline–less expensive
Fluoroquinolone–Ofloxacin

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55
Q

2nd line tx for OA

A

NSAIDs

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56
Q

Ointment for newborns in eyes

A

Erythromycin opthalmic ointment

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57
Q

1st line tx for syphilis

A

Penicillin G IM 1 dose
if allergic, desensitize patient
Can try doxycyline if CI penicillin

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58
Q

Most common pathogens for PID

A

N. Gonorrhoeae and C. trachomatis

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59
Q

Tx for PID

A

Same as chlamydia/gonorrhea (Azithromycin + Ceftriaxone)

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60
Q

Drug therapy for genital warts

A

Podofilox + Podophyllin Resin (self applied gel, apply weekly, wash after 1-4 hours)
Imiquimod (self applied cream, apply 3x a week, leave for 6-10 hours)
Trichloroacetic acid + Bichloroacetic acid (applied by professional, left to air dry)

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61
Q

Joints commonly affected by OA

A

Knees, hips, cervical/lumbar spine, distal interphalangeal joints and carpometacarpal joint

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62
Q

1st line tx for OA

A

Acetaminophen

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63
Q

2nd line tx for OA

A

NSAIDs

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64
Q

Diflunisal

A

Non-acetylates salicylates
Beneficial in patients sensitive to GI irritation caused by aspirin use
Can be used for OA

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65
Q

Capsalcin

A

Topical agent
Decreases substance P (usually responsible for pain transmission)
Can be used for OA

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66
Q

Steroids for OA

A

Indicated if 1-2 joint involvement and has not responded to 1st or 2nd line treatment

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67
Q

Tramadol

A

Mu opioid receptor agonist similar to other opioids such as morphine; ascending pain pathways are inhibited
Do not exceed 400mg a day
Response in 1-2 hours
CI: opioid dependency, acute intoxication of alcohol, hypnotics, psychotropics
SE: nausea, dizziness, sweating, drowsiness, constipation, respiratory depression

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68
Q

Xanthine oxidase inhibitors

A

Allopurinol + Febuxostat
Decreases uric acid levels by selectively inhibiting xanthine oxidase–primarily responsible for converting xanthine into uric acid

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69
Q

Probenecid

A

Increases excretion of serum uric acid by inhibiting reabsorption of uric acid at proximal tubule
Used if XOI is CI or not tolerated

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70
Q

Pegloticase

A

Last line therapy for gout

Very expensive IV drug

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71
Q

Acute gout treatment

A

Rest joint, ice, short course of NSAIDs, steroids or colchicine

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72
Q

Colchicine

A

Inhibits activation, degranulation and migration of neutrophils to area of gout attack
Take within 24 hours of attack

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73
Q

MOA of acetaminophen

A

Inhibits central COX, which results in decreased prostaglandin synthesis; has analgesic and antipyretic effects but not anti-inflammatory effects
Take around the clock for OA pain management; maximum of 4000mg per day
Pain relief within 1 week
SE: dizziness, rash, hepatic failure
Interactions: warfarin, isoniazid

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74
Q

NSAIDs

A

Indicated for OA, RA, mild to moderate pain
Inhibits COX
Anti-inflammatory–inhibits production of prostaglandins, prostacyclin and thromboxane in both CNS and PNS (Blocks COX enzyme)
Analgesic + antiplatelet (reduces production of TXA)
Do not take with aspirin or ACEI
SE: increased mucosal damage, less vasodilation, decreased blood flow to kidneys

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75
Q

Biologic disease modifying antirheumatic drugs

A 
Tumor necrosis factor inhibitors 
Etanercept, -mab
Bind the circulating TNF alpha and render it inactive, which decreases the chemotactic effect
All are injectables 
Rapid response
CI: infections, activation of latent TB 
Do not use with abatacept
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76
Q

Diclofenac MOA

A

Same as NSAID
Has less side effects due to being topical
Do not apply to damaged or non-intact skin
SE: rash, dry skin, itching, exfoliation

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77
Q

Sulfasalazine for RA

A

Anti-inflammatory effect
CI: sulfa allergy, pregnancy and lactation
SE: nausea, diarrhea, dizziness, intestinal and urinary obstruction, orange yellow skin, HA, depression, bone marrow suppression

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78
Q

S/S RA

A

Morning stiffness in involved joints persisting for at least 1 hour and subsides with activity; painful, swollen joints

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79
Q

NSAID for RA

A

Continued from initial diagnosis to initiation of DMARD

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80
Q

Steroids for RA

A

Higher doses are beneficial in acute flares to regain control of inflammation of pain

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81
Q

DMARDs

A

Methotrexate, sulfasalazine, hydroxychloroquine, Leflunomide

Should be initiated within 3 months of symptoms

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82
Q

1st line therapy for RA

A

Methotrexate or leflunomide monotherapy
Sulfasalazine for poor prognostic factors
Hydroxychloroquine
TNF alpha inhibitors + methotrexate for high disease activity

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83
Q

Biologic disease modifying antirheumatic drugs

A

Tumor necrosis factor inhibitors
Etanercept, -mab
Bind the circulating TNF alpha and render it inactive, which decreases the chemotactic effect

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84
Q

COX2 inhibitors

A

Celebrex
Can be used if patient is a risk factor for GI complications
Less likely to cause ulcers and bleeding

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85
Q

Sulfasalazine

A

Anti-inflammatory effect
CI: sulfa allergy, pregnancy and lactation
SE: nausea, diarrhea, dizziness, intestinal and urinary obstruction, orange yellow skin, HA, depression, bone marrow suppression

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86
Q

Antimalarials for RA

A

Hydroxychloroquine
Low risk of SE, does not lower progression of RA
Inhibits antigen processing by elevating cellular pH
CI: pre-existing retinal field changes
SE: nausea, diarrhea, abdominal discomfort, photosensitivity, skin pigment changes, damage to retina
Interactions: beta blockers, cyclosporine, digoxin
Pregnancy category C

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87
Q

Lelfunomide

A

Anti inflammatory and anti proliferative, retarding erosions and joint space narrowing
Decreases B cell and T cell proliferation
Similar to methotrexate
CI: pregnancy (Wait 2 yearS), hepatotoxicity, alcoholism, liver disease
SE: elevated LFT, GI symptoms, weight loss, alopecia, bone marrow suppression
May increase warfarin

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88
Q

Abatacept

A

Decrease activation of T cells; Given IV, infusion or subcu
SE: COPD exacerbations
Interactions: live vaccines and TNF inhibitors

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89
Q

Tocilizumab

A

Blocks IL6, decreases B cell and T cell activity
Given IV
SE: increased LDL and liver enzymes
Interactions: live vaccines, leflunomide, TNF alpha inhibitors

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90
Q

1st line therapy for RA

A

Methotrexate or leflunomide monotherapy
Sulfasalazine for poor prognostic factors
Hydroxychloroquine
TNF alpha inhibitors + methotrexate for high disease activity

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91
Q

Only DMARDs ok to use during pregnancy

A

Antimalarials, sulfasalazine, azathioprine, cyclosporine

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92
Q

Indicators of reduced disease activity

A

Decreased ESR and C reactive protein, absence of joint erosions on US or MRI of the joint

93
Q

Medications for fibromyalgia

A

TCAs, SSRI, new generation anticonvulsant, cyclobenazprine, NSAID

94
Q

Lab monitoring for sulfasalazine

A

CBC, LFT, UA, renal function

95
Q

Lab monitoring for methotrexate

A

CBC, creatinine, LFT, alkaline phosphatase, chest x ray, hepatitis B + C

96
Q

Tension headache prophylaxis

A

Antidepressants (tca), fluoxetine, venalaxafine

97
Q

Elderly patient teeatment for long term management of moderate to severe OA

A

COX 2 inhibitor–celebrex

98
Q

39 year old female with primary dysmenorrhea

A

NSAID for 2-3 days

99
Q

57 year old with DM and HTN

A

Aspirin

100
Q

Dx for fibromyalgia

A

Pain on palpation in at least 11/18 tender points

101
Q

Medications for fibromyalgia

A

TCAs, SSRI, new generation anticonvulsant, cyclobenazprine, NSAID

102
Q

Tension headaches

A

Dull quality, pain radiates bilaterally from forehead to the occiput in band like fashion; radiates down neck and sometimes into trapezius muscle
Important not to overtreat

103
Q

Drugs for tension headache

A

Acetaminophen, aspirin, NSAID, antiemetics, excedrine

104
Q

Tension headache prophylaxis

A

Antidepressants (tca)

105
Q

1st line for tension headache

A

Acetaminophen, aspirin

106
Q

2nd line for tension headache

A

NSAIDs and excedrine

107
Q

Prophylaxis for migraines

A

1st line: beta blockers, calcium channel blockers, TCAs

2nd line: SSRI, anticonvulsants

108
Q

Antiemetics

A

Promethazine + Prochlorperazine

Can increase pain relieving properties of analgesics by decreasing gastric emptying and increasing analgesic absorption

109
Q

Migraine

A

Neurologic syndrome causes throbbing head pain and nausea, appetite change, phototobia, phenophobia

110
Q

1st line agent for migraines

A

NSAIDs and aspirin

111
Q

5-HT1 receptor agonists for migraines

A

-triptans

Causes cerebral vasoconstriction and can treat both pain and nausea of migraine

112
Q

Ergot derivatives for migraines

A

Constriction of peripheral and cranial vessels
Used to treat infrequent, long standing migraines in patients who have had multiple relapses with triptans
Not used usually due to unpredictable patient responses and increased SE

113
Q

Opioids for migraines

A

Used as rescue medication for severe migraines that do not respond to other medications
Do not use routinely

114
Q

Steroids for migraines

A

Can be used as rescue medication until patient free for 24 hours

115
Q

2nd line therapy

A

OTC caffeine containing compounds

Ergot derivative + antiemetic

116
Q

Floricet

A

Butalbital-Acetaminophen-Caffeine

Do not use more than 3 days; sedating; potentially habit forming

117
Q

1st line therapy for absence seizures

A

Ethosuximide, valproic acid, lamotrigine

118
Q

Steroids for headaches

A

Controls or prevents inflammation by controlling rate of protein synthesis
Used for severe or persistent headaches

119
Q

Pregnancy classes for headache medications

A

B: Cyproheptadine
C: triptans
X: ergotamines

120
Q

Prophylaxis for headaches in children

A

Amitryptilline, topiramate, divalproex, propranolol

121
Q

CAM for headaches

A

feverfew, butterbur, magnesium, CoQ10

122
Q

1st line therapy for partial seizures

A

Carbamazepine, phenytoin, fosphenytoin, valproic acid, lamotrigine, lacosamide, topiramate, oxcarbazepine

123
Q

1st line therapy for generalized tonic clonic seizures

A

Carbamazepine, lacosamide, phenytoin, valproic acid, fosphenytoin

124
Q

1st line therapy for absence seizures

A

Ethosuximide, valproic acid, lamotrigine

125
Q

Hydriantoins

A

phenytoin + fosphenytoin
Blocks post tetanic potentiation by stabilizing neuronal membranes; decreased seizure by increasing efflux and decreasing influx of Na; alters Ca uptake in presynpatic terminals
SE: gingival hyperplasia, hirsutism, rash, nystagmus, confusion, peripheral neuropathy, vitamin D deficiency, anemia, thrombocytopenia

126
Q

Carbamazepine

A

limits influx of Na ions across cell membrane

CI: allergy to TCA, bone marrow suppression, use of MAOI

127
Q

Oxycarbazepine

A

Blocks Na channels

128
Q

Valproic Acid

A

Works by affecting GABA

CI: severe hepatic disease

129
Q

Anti-epileptics and birth control pills

A

Decreases effectiveness

130
Q

Barbiturates

A

Broad spectrum antiepileptic activity
Sedating with long term cognitive, memory and behavioral effects
Binds to GABA A

131
Q

Status epilepticus tx

A

Benzodiazepines first line

IV preferred, but IM, rectal or intranasal options

132
Q

When can you think about d/c seizure medications

A

If patient has been seizure free >2 years

133
Q

Monitoring for anti-seizure medications

A

Therapeutic range annually, hepatic enzymes annually

134
Q

Prevention of febrile seizures in children

A

Phenobarbital

135
Q

Anti-epileptics for pregnancy

A

All are category X

136
Q

Anti-epileptics and birth control pulls

A

Decreases effectiveness

137
Q

Pathophysiology of ADHD

A

Decreased volume and functionality in prefrontal cortex, caudate and cerebellum
Regulated by dopamine and NE

138
Q

1st line therapy for ADHD

A

Stimulants

139
Q

2nd line therapy for ADHD

A

Non stimulants

140
Q

3rd line therapy for ADHD

A

Bupropion

141
Q

Stimulants for ADHD

A

Methylphenidate + Amphetamine
Inhibit reuptake of dopamine and NE
Amphetamines also directly stimulate release of dopamine and NE
Usually see response in 1-2 days
SE: sleep disturbance, decreased appetite, weight loss, agitation, nervousness

142
Q

Nonstimulants for ADHD

A

Atomexetin, guanfacine, clonidine, bupropion

Used only if patients have CI to stimulant

143
Q

Memantine

A

NMDA antagonist for AD
Treatment of cognitive symptoms
Focuses on glutamatergic symptoms rather than ACh
Blocks excitotoxicity effects associated with abnormal transmission of glutamate
Inhibits neuronal degeneration due to increased glutamate

144
Q

Antipsychotics for AD

A

For non-cognitive symptoms–psychosis, anxiety, depression, sleep disorders
Atypical antipsychotics preferred
Haloperidol has fewest SE

145
Q

Benzodiazepines for AD

A

Lorazepam + Alprazolam
For treatment of behavioral problems
Reserved for treatment of anxiety or episodic agitation
Long term use not recommended–may worsen AD symptoms

146
Q

Stimulant with best efficacy for ADHD

A

Methylphenidate

long acting increases compliance

147
Q

CAM for ADHD

A

Gingko biloba and glutamine–can improve concentration and alertness

148
Q

Alzheimer Disease

A

ACh levels are decreased + excessive stimulation of glutamate
Memory loss and cognitive impairment is associated with decreased levels of ACh

149
Q

Cholinesterase inhibitors for AD

A

Donepezil, Rivastigmine, Galantamine
Treatment of cognitive symptoms
No longer recommended if patient is in severe stage
SE: N/V, diarrhea, bradycardia, increased GI acid, increased secretions

150
Q

Memantine

A

NMDA antagonist for AD
Treatment of cognitive symptoms
Focuses on glutamatergic symptoms rather than ACh
Inhibits neuronal degeneration due to increased glutamate

151
Q

Antipsychotics for AD

A

For non-cognitive symptoms–psychosis, anxiety, depression, sleep disorders
Atypical antipsychotics preferred

152
Q

Benzodiazepines for AD

A

Lorazepam + Alprazolam
For treatment of behavioral problems
Reserved for treatment of anxiety or episodic agitation
Long term use not recommended–may worsen AD symptoms

153
Q

Antidepressants for AD

A

Sertraline + Citalopram first line

154
Q

1st line therapy for AD

A

Cholinesterase inhibitors–Donepezil particularly

Memantine + cholinesterase inhibitors for severe AD

155
Q

Medications that can protect against AD

A

NSAIDs, COX inhibitors, estrogen replacement

156
Q

Statins in AD

A

Linked to preserving cognitive function

157
Q

Anticholinergics for PD

A

Trihexyphenidyl + Benztropine
Useful for treatment of drooling and tremor
May cause impaired memory, hallucinations, blurry vision, dry mouth, urinary retention, constipation

158
Q

What medications can induce PD symptoms

A

Atypical antipsychotics and neuroleptic drugs

159
Q

Parkinson Disease

A

Symptoms due to decreased dopamine; leads to breakdown of communication to motor regulators in the brain

160
Q

Hallmark signs of parkinson disease

A

Bradykinesia, resting tremor, cogwheel rigidity, difficulty maintaining balance

161
Q

Mild potency drugs for PD

A

Anticholinergics, amantadine, MAO-B inhibitors

162
Q

Moderate potency drugs for PD

A

Dopamine agonists

163
Q

Pathophysiology of menstrual cycle

A

FSH stimulates conversion of androgens to estrogen–> development of dominant follicle that further produces estrogen–> stimulates development of glandular epithelium of uterus–>increases cervical mucus–> decreases viscosity of mucus–> increases vaginal pH

164
Q

Anticholinergics for PD

A

Trihexyphenidyl + Benztropine
Useful for treatment of drooling and tremor
May cause impaired memory, hallucinations, blurry vision, dry mouth, urinary retention, constipation

165
Q

Amantadine for PD

A

May inhibit NMDA receptor

Used for patients experiencing dyskinesia

166
Q

MAO-B inhibitors for PD

A

Selegiline + Rasagiline
Modest improvement in motor symptoms
Inhibits metabolism of dopamine

167
Q

Dopamine agonists for PD

A

Less effective than levodopa but causes dyskinesia and motor fluctuations less frequently
Preferred choice–Pramipexole, Ropinirole, Rotigotine
Stimulation of D2 receptors results in improved dopaminergic transmission in motor area of basal ganglia
SE: fatigue, nausea, constipation, hypotension, hallucinations

168
Q

Levodopa

A

Most effective for tx of symptomatic relief of PD
Fastest onset of action
May experience wearing off after few hours
Can cross BBB to be converted to dopamine
Administered with carbidopa to limit peripheral breakdown

169
Q

Catechol-o-methyltransferase Inhibitors

A

Entacapone + Tolcapone
Used in combination with levodopa to decrease wearing off but they can increase risk of dyskinesia
Inhibits breakdown of levodopa in periphery
Used in adjunct with carbidopa + levodopa

170
Q

Combined OC decreases risks of

A

Endometriosis, ovulatory pain, ovarian cysts, benign breast disease, PMS, premenstrual dysphoric disorder, ovarian, endometrial cancer
Estrogen–suppression of FSH
Progestin–Suppression of LH

171
Q

Lifespan of egg

A

1-3 days

172
Q

Nuvaring

A

15mcg ethinyl estradiol + 120mcg etonogestrel

Removed for 4th week

173
Q

Periodic abstinence for birth control

A

4th day of sticky, wet mucus

174
Q

Combined birth control pill

A

Estrogen (ethinyl estradiol) + Progestin (desogestrel, ethynodiol diacetate, levonorgestrel, norethindrone, norgestimate, norgestrel)
Works by preventing ovulation by suppressing FSH + LH

175
Q

IUD

A

Causes sterile inflammatory reaction within uterus that interferes with sperm transport,
Thickens cervical mucus, suppresses ovarian function, thins uterine lining
Can decrease bleeding

176
Q

Combined OC decreases risks of

A

Endometriosis, ovulatory pain, ovarian cysts, benign breast disease, PMS, premenstrual dysphoric disorder, ovarian, endometrial cancer

177
Q

Emergency contraception

A

High dose progestin
Used for prevention of pregnancy up to 5 days after intercourse
MOA: delays ovulation, alteration of endometrium, interference of fertilized egg, interference with tubal transport of sperm/egg
SE: N/V, fatigue, breast tenderness, HA, abdominal pain, dizziness

178
Q

Nuvaring

A

15mcg ethinyl estradiol + 120mcg etonogestrel

Removed for 4th week

179
Q

Progestin only hormonal contraceptives

A

Does not suppress LH + FSH; primary effect is through changing endometrial and cervical mucus environments
Oral, IM, Subdermal

180
Q

IM Depo

A

Decreases ovulation and effects cervical mucus
Given every 13 weeks
Safe for women with CV disease
More prolonged bleeding possible

181
Q

IUD

A

Causes sterile inflammatory reaction within uterus that interferes with sperm transport
Can decrease bleeding

182
Q

Implant

A

Nexplanon–contains etonogestril

Blocks LH surge and prevents ovulation and thickens cervical mucus and thins endometrial lining

183
Q

Progestin only OC good for

A

Women unable to tolerate estrogen, smokers, women over 35, lactating women

184
Q

If taken pill more than 3 hours late

A

Use back up for 7 days

185
Q

Depo prevera may cause

A

Osteoporosis
Recommend regular exercise, calcium, vitamin D
Can be given for breastfeeding women

186
Q

IUD good for women with history of

A

Dysmenorrhea, menorrhagia, anemia

187
Q

CI for OC

A

Hypersensitivity, thrombophlebitis, thromboembolic conditions, DVT, CVA, MI, CAD, breast CA, endometrial CA, hepatic CA, liver disease, abnormal genital bleeding, pregnancy, jaundice of pregnancy

188
Q

Warnings for OC

A

Smoking, thromboembolism signs, CVD, ocular lesions

189
Q

Why does menopause occur

A

Due to failure of ovary to produce estrogen

190
Q

Risk factors for early menopause

A

History of irregular menses, African American, smoking, weight loss diets

191
Q

Ospemifene

A

Estrogen agonist/antagonist
Indicated mostly for treatment of genitourinary symptoms
Acts as agonist at receptors in vaginal tissue and antagonist in breast tissue and endometrial tissue

192
Q

Tissue selective estrogen complex

A

CEE + bazedoxifene

Indicated for moderate to severe VMS

193
Q

Hormone therapy for menopause

A

Estrogen + Progestin

Decreases night sweats, insomnia, hot flashes

194
Q

Estrogen therapy can cause

A

Increased endometrial hyperplasia and increased risk of endometrial CA

195
Q

Progestin therapy may cause

A

Breast CA

196
Q

SE progestin

A

Bloating, irritability, weight gain, HA, acne

197
Q

Paroxetine

A

Treatment of VMS

Preoptic area of anterior hypothalamus, responsible for temperature regulation, is under influence of 5HT and NE

198
Q

SE of estrogen therapy

A

HA, depression, gallbladder disease, N/V, breast tenderness, breast CA, breakthrough bleeding, CVA
May increase levels of corticosteroids

199
Q

MOA of progestin therapy

A

Decreases risk of estrogen induced irregular bleeding, endometrial hyperplasia, carcinoma

200
Q

SE progestin

A

Bloating, irritability, weight gain, HA, acne

201
Q

SE testosterone

A

Hepatocellular neoplasma, edema, possible elevation of cholesterol

202
Q

Absolute CI for menopausal hormonal therapy

A

Breast CA, endometrial CA, genital bleeding, liver disease, thromboembolic diseases, pregnancy

203
Q

CAM for menopause

A

Black Cohosh, St Johns Wort, Soy, Remifemen

204
Q

Follow up with menopause treatment

A

2 months after starting therapy and then 6 months and then annually

205
Q

Monitoring for menopause therapy

A

BP, mammogram, vaginal bleeding, height for osteoporosis, weight for obesity, pap test

206
Q

Menopause cause of osteoporosis

A

Decreased estrogen levels cause up regulation of RANKL–increases osteoclast activity

207
Q

Prevention of osteoporosis

A

Ca supplements (1200-1500mg/day), Vitamin D (800-1000IU/day)

208
Q

Biphosphanates

A

-dronate
Inhibits bone resorption and increases bone density
Bone turnover increases to previous levels after 6-9 months
Take on empty stomach with 8oz water, stay in upright position 30 mins after administration
SE: esophageal ulcers, acid reflux, nausea; injectable can cause flu like symptoms
May increase risk of jaw bone destruction and atypical femur fractures
CI: esophageal problems, gastritis, PUD

209
Q

Calcitonin

A

Inhibits action of osteoclasts
Available as injection and nasal spray
Decreased risk of vertebral compression fractures
SE: rhinitis (inspect nasal mucosa every 6 months), GI upset, flushing, rash, back pain

210
Q

Raloxifene

A

Selective estrogen receptor modulators
Decreases bone resorption
Decreased risk of vertebral fractures but not hip fractures
Mimics effects of estrogen on bones but not breasts/uterus
Also decreases TC and LDL levels
CI: pregnancy, lactation, history of clots
D/C 72 hours prior to prolonged immobilization
SE: hot flashes, GI distress, flu like symptoms, leg cramps, DVT, arthralgias

211
Q

Follow up for osteoporosis

A

DEXA every 2 years; follow up at 1-2 months when initiating treatment then every 3-6 months

212
Q

Denosumab

A

RANK ligand inhibitor

Decreases osteoclast activity

213
Q

1st line therapy for osteoporosis

A

Raloxifene or biphosphanates for prevention
Biphosphanates for treatment
Ca and Vit D supplement

214
Q

2nd line therapy for osteoporosis

A

Calcitonin, teriparatide, denosumab

215
Q

Most common cause of vaginitis

A

vulvovaginal candidiasis, bacterial vaginosis, trichomonas vaginalis

216
Q

S/S vaginitis

A

vaginal/perineal itching, burning, vulvar irritation, abnormal discharge

217
Q

Bacterial vaginosis

A

Due to hydrogen peroxide producing lactobacillus normally present in the vagina being diminished; allows other bacteria to proliferate

218
Q

Bacteria responsible for BV

A

Gardnerella vaginalis, preotella, mobiluncus, mycoplasma hominis

219
Q

Medication for vaginitis

A

Topical azoles
Oral azoles
Antibiotics–Metronidazole, topical clindamycin

220
Q

Topical azoles for vaginitis

A

Time frame for response: 3 days
SE: local irritation, abdominal cramps, headache
Interactions: may weaken latex condoms and diaphragms

221
Q

Oral azoles for vaginitis

A

Fluconazole
CI: hypersensitivity
Time frame for response: 2-3 days
SE: headache, nausea, abdominal pain

222
Q

SE + interactions metronidazole

A

metallic taste, headache, GI distress
Do not consume alcohol during treatment and up to 24 hours after treatment stops
Interactions: anticoagulants

223
Q

Medication for yeast infections

A

OTC: clotrimazole + miconazlee creams

Oral fluconazole rx

224
Q

S/S BV

A

grayish, sometimes frothy, fishy discharge

225
Q

Tx for trichomonas

A

Metronidazole, avoid sex, treat sex partners

2nd line: tindazoel

226
Q

S/S trichomonas

A

pruritus, malodorous frothy/yellow-green discharge, diffuse vaginal erythema, red macular lesions on cervix

227
Q

Metronidazole and pregnancy

A

CI

228
Q

CAM for vaginitis

A

probiotics

Pharmacology (56 decks)

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