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Pharmacology > Exam 3 from topical outline > Flashcards

Exam 3 from topical outline Flashcards

1
Q

Alpha adrenergic antagonists for BPH

A

-zosin
Recommended for use in men with smaller prostate glands, younger men, and when rapid effect is needed
MOA: functional antihypertensive, relaxes smooth muscle of prostate and bladder neck without interfering with bladder contractility
SE: headache, dizziness, asthenia, drowsiness, retrograde ejaculation, orthostatic hypotension, fluid retention
SE minimized by given at nighttime

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2
Q

Alpha adrenergic antagonists have potential effects on

A

GFR, renal perfusion, heart rate, fluid retention, may increase CO (preventing HF)

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3
Q

How long can effects take with alpha adrenergic antagonists

A

May take weeks to months or up to 2 years

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4
Q

5-alpha-reductase inhibitors for BPH

A

Finasteride + Dutasteride
Inhibits androgen transformation from steroid precurors (testosterone to DHT), decreases prostate volume, prevents progression of disease
SE: impotence, decreased libido, smaller ejaculate, orthostatic hypotension, priapism, prostate cancer risk, gynecomastia
May take 6 months for effects

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5
Q

CI for 5-alpha reductase inhibitors

A

Pregnancy (can not even touch), sensitivity to sulfa

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6
Q

First line treatment for BPH

A

Limit fluid intake after dinner
Avoid decongestants
Massage prostate after intercourse
Void frequently

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7
Q

Second line treatment for BPH

A

Alpha adrenergic antagonist first, addition of 5-alpha reductase inhibitor for more severe symptoms

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8
Q

Risk factors for UTI

A

Concentrated urine, high urine pH, glucose in urine, pregnancy, diaphragm and spermicide use, estrogen deficiency, constipation, inefficient bladder training,

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9
Q

Cultures for UTI

A

Do not need to be performed if criteria for uncomplicated UTI is met

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10
Q

Post treatment cultures for UTI

A

Only needed if symptoms recur within 2 weeks

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11
Q

Normal length of treatment for UTI

A

Uncomplicated usually 1-3 days

5-7 days if Nitrofurantoin

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12
Q

Recurrent UTI

A

3+ recurrences annually
Post-coital use of antibiotic prophylaxis
Continuous antibiotic prophylaxis in single bedtime dose (bactrim, trimethoprim, norfloxacin,, nitrofurantoin)

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13
Q

Urinary analgesics

A

Methenamine, phenazopyridine, flavoxate
Used for symptomatic relief of pain
Don’t use more than 2 days

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14
Q

First line antibiotic for UTI

A

Bactrim; avoid in patients treated within 6 months due to resistance
Nitrofurantoin–7 day course with little resistance
Fosfomycin–powder dissolved in water, one time dosing

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15
Q

second line antibiotic for UTI

A

Fluoroquinolones

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16
Q

Geriatrics and UTI

A

Usually asymptomatic–may just have change in mentation
Post-menopausal more prone due to low estrogen
E. Coli and enterobacter usual organisms
Nitrofurantoin not recommended

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17
Q

Pregnancy and UTI

A

Amoxicillin first line entire pregnancy
Nitrofurantoin can be used first and second trimester
Cephalexin can be used
Sulfonamides first and second trimester
Urine cultured 1 week after treatment and then every 4-6 weeks
Treat regardless of symptoms

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18
Q

1st line agents for children with UTI

A

Augmentin, cephalexin, cefpodoxime, bactrim

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19
Q

UTI that does not resolve or recurs within a week after treatment requires

A

C&S and treatment with fluroquinolone for 7 days

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20
Q

Acute prostatitis s/s

A

painful ejaculation, pain in rectal or perineal areas

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21
Q

Dx acute prostatitis

A

third and fourth urine secretion specimens in 4 serial urine sample
Organisms usually G-

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22
Q

Treatment of prostatitis lasts

A

4-6 weeks or up to 12 weeks due to poor penetration of antibiotics in prostate tissue

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23
Q

1st line antibiotic for prostatitis

A

Fluoroquinolones
Increase levels of theophylline and warfarin
Monitor creatinine clearance

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24
Q

2nd line antibiotic for prostatitis

A

Bactrim

Drug-drug interactions with phenytoin, oral hypoglycemics, warfarin

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25
Major systemic regulators of osteoporosis
PTH, calcitriol, growth hormone, glucocorticoids, thyroid hormones, sex hormones
26
T score signalling osteopenia
-1 to -2.5 SD below mean
27
T score signalling osteoporosis
more than -2.5 SD below mean
28
Ca and vitamin D supplementation recommendation
1000-1200mg Ca | 800-1000 IU Vitamin D
29
1st line tx for osteoporosis
Raloxifene
30
Raloxifene
Selective estrogen receptor modulator Mimics effects of estrogen on bones without replicating stimulating effects of estrogen on breasts and uterus; decreases bone resorption and bone turnover; decreased cholesterol and LDL CI: pregnancy, lactation, history of thrombo embolic events D/C 72 hours before prolonged immobilization SE: hot flashes, GI distress, flu like symptoms, leg cramps, DVT, arthralgias
31
Biphosphanates
Prevention and tx of osteoporosis -dronate Deposits in bone at sites of mineralization and in resorption lacunae; increases bone density Bone turnover rates increase to previous levels after 6-9 months CI: history of esophagus problems, gastritis, PUD SE: GI disturbance, esophagitis, diarrhea, abdominal pain
32
Progestin only pill is good for
high blood pressure, smoking >35 years, lactation
33
Progestin only pill MOA
Does not consistently suppress LH and FSH; primary effect is through changing endometrial and cervical mucus environments No placebo week 0.35mg norethindrone and 0.075mg norgestrel
34
Depo-provera
Suppresses ovulation and affects cervical mucus Dosed every 13 weeks Give within 5 days of menses Can be used in lactation Safe for hx of CV disease, stroke, thromboembolism, PVD SE: unpredictable bleeding >7 days, decreased serum estradiol (can cause bone loss)
35
Effect of estrogen in hormonal replacement therapy
Decreases frequency of night sweats and wakefulness, reduces hot flashes, minimizes VMS and GU symptoms, assists in temperature control
36
Progestin role in hormonal replacement therapy
Decreases risk of endometrial cancer but may increase risk of breast cancer
37
Limit hormonal replacement therapy to
3-5 years
38
Hormonal replacement therapy CI in
breast CA, endometrial CA, endometrial hyperplasia, hypertension, acute liver disease, active thromboembolic disease, pregnancy, smoking, intermittent porphyria
39
SE hormonal replacement therapy
Intolerance to contact lenses, headache, gallbladder disease, increase in triglycerides, N/V, abdominal cramps, increased BP. thromboembolic disease, edema, breast CA, breast tenderness, breakthrough bleeding
40
Anticholinergic that does not cross BBB
Tropsium
41
MOA anticholinergics for OAB
Antagonizes parasympathetic muscarinic receptors in the bladder; reduces frequency and contraction intensity, increases bladder contractions, delays initial urge to void Usually see a response after 2 weeks
42
SE anticholinergics
Xerostomia, constipation, urinary retention
43
Oxybutynin
Antimuscarinic and antispasmodic and local anesthestic Causes CNS adverse effects Extensive first pass metabolism CI: urinary retention and glaucoma
44
Mirabegron
Beta adrenoreceptor agonist Increases bladder capacity and decreases frequency of urination without affecting urination pressure or residual volume Causes smooth muscle relaxation Does not have anticholinergic effects Therapeutic response within 8 weeks Can cause QT prolongation in large doses and high blood pressure
45
Mirena
Releases 20ug/d of lNG Approved for 5 years of use No estrogen Can be helpful for dysmenorrhea, menorrhagia, anemia Check string after every menstrual period
46
Trichomonas
Profuse, frothy, yellow vaginal discharge, vaginal and vulvar irritation, dysuria, dyspareunia or post-coital bleeding Can be dx by pap smear or wet mount
47
BV due to candidiasis
Fishy odor, yellow or gray discharge, vaginal irritation DX requires: vaginal pH greater than 4.5, positive amine or whiff test, more than 20% positive clue cells, gray discharge
48
Partial seizures
Simple Focal seizures typically result in no alteration in consciousness Complex seizures may have loss of consciousness and automatisms
49
Generalized seizures
Include both hemispheres of brain, result in early loss of consciousness
50
Status epilepticus
Seizure activity >30 minutes or 2 or more sequential seizures without recovery between them
51
Hydantoins
Phenytoin + Fosphenytoin First line agents for seizures Increases efflux and decreases influx of sodium ions across all cell membranes Inhibits calcium uptake in presynaptic terminals May cause CV events (hypotension and arrhythmia) with rapid IV admin SE: gingival hyperplasia, hirsutism, coarsening of facial features, rash, ataxia, altered coordination, nystagmus, confusion, peripheral neuropathy Potent CYP450 inducer
52
Carbamazepine
Similar MOA as hydantoins Depresses activity in thalamus and decreases summation of temporal stimulation CI: allergy to TCA, bone marrow suppression, recent use of MAOI, concurrent use of NNRTI SE: pruritus, rash, constipation, N/V, ataxia, dizziness, somnolence, blurred vision, urinary retention, xerostomia, hyponatremia
53
S/S gonorrhea
Purulent or mucopurulent cervical discharge, dysuria, bleeding, menorrhagia, pelvic discomfort
54
treatment of gonorrhea
single dose of IM ceftriaxone + single dose of azithromycin OR doxycycline for 7 days
55
s/s chlamydia
vaginal discharge, mucopurulent cervicitis with edema and friability, urethral syndrome or urethritis, pID, ectopic pregnancy, infertility, endometriosis
56
DOC for chlamydia
azithromycin/erythromycin, doxycycline and ofloxacin are DOC
57
Tx of chlamydia in pregnant women
azithromycin single dose or amoxicillin 3x a day for 7 days
58
First line therapy for OA
Acetaminophen
59
Acetaminophen for OA
Decreases prostaglandin synthesis; has analgesic and antipyretic effects but no anti-inflammatory Must be taken regularly to be effective Can experience pain relief in 1 week Can increase INR in patient taking warfarin
60
second line therapy for OA
NSAIDs
61
NSAIDs for OA
Inhibits conversion of arachidonic acid to prostaglandin, prostacyclin, and thromboxanes; inhibits both COX 1 and COX 2 CI: allergy to aspirin, alcohol dependence, pregnancy, sulfa allergy SE: visual changes, weight gain, headache, dizziness, nervousness, photosensitivity, weakness, tinnitus, easy bruising/bleeding, fluid retention, GI ulcers, GI bleeding
62
Celcoxib
Selective NSAID for COX 2--less GI events but increased risk of CV events
63
DMARDs
Used early to treat RA to decrease inflammation | Initiate within 3 months of symptoms
64
Methotrexate
DMARD for RA Best for patients with morning stiffness and synovitis Folic acid antagonist; affects leukocyte suppression; decreases inflammation May take 3-8 weeks before improvement occurs When tx stops, exacerbation occurs in 2 weeks CI: pregnancy and breastfeeding, leukopenia, AIDS, renal impairment, liver disease
65
Baseline labs needed for methotrexate
Chest X Ray, all labs, CBC (monitor every 4 weeks)
66
Sulfasalazine
DMARD for RA Best for patients with significant synovitis but no poor prognostic factors May see effects in 1-4 months CI: Sulfa allergy, pregnancy, GU, GI obstruction
67
Hydroxychloroquine
Antimalarial DMARD for RA Has a tolerable adverse effect profile Can not limit progression of RA--Use with methotrexate Elevates cellualr pH which changes antigen degeneration Effects within 2-6 months of therapy CI: pre-existing retinal field changes
68
Leflunomide
DAMRD for RA Retards erosions and joint space narrowing Competitive inhibitor of dihydrofolate reductase Similar to methotrexate Benefits seen within 4 weeks to 3 months CI: pregnancy (within 2 years)
69
1st line therapy for chronic gout
Xanthine oxidase inhibitors
70
Xanthine oxidase inhibitors
Allopurinol + Febuxostat Decreases uric acid levels within 2 weeks Draw serum uric acid levels every 2-5 weeks during titration SE: rash, arthralgias, GI complications ACEI, diuretics may increase levels of allopurinol
71
Probenicid
Use if XAOI not tolerated Increases excretion of uric acid in proximal convoluted tubule May take 6 months for effect Do not give in acute attack
72
NSAIDs for gout
good for acute attacks Naprexen, indomethacin, sulindac Continue for 24 hours after attack
73
Corticosteroids for gout
Good for acute attack | Can give intra-articular dose if only 2 joints
74
Colchicine
Inhibits activation, degranulation, and migration of neutrophils to area of gout attack; can exhibit pain relief in 18-24 hours SE: diarrhea
75
Cyclobenzaprine
muscle relaxant used for acute low back pain SE: drowsiness and dizziness Benefit seen in first few days Risk for abuse

Pharmacology (56 decks)

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