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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
Q

Major systemic regulators of osteoporosis

A

PTH, calcitriol, growth hormone, glucocorticoids, thyroid hormones, sex hormones

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26
Q

T score signalling osteopenia

A

-1 to -2.5 SD below mean

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27
Q

T score signalling osteoporosis

A

more than -2.5 SD below mean

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28
Q

Ca and vitamin D supplementation recommendation

A

1000-1200mg Ca

800-1000 IU Vitamin D

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29
Q

1st line tx for osteoporosis

A

Raloxifene

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30
Q

Raloxifene

A

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

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31
Q

Biphosphanates

A

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
Q

Progestin only pill is good for

A

high blood pressure, smoking >35 years, lactation

33
Q

Progestin only pill MOA

A

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
Q

Depo-provera

A

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
Q

Effect of estrogen in hormonal replacement therapy

A

Decreases frequency of night sweats and wakefulness, reduces hot flashes, minimizes VMS and GU symptoms, assists in temperature control

36
Q

Progestin role in hormonal replacement therapy

A

Decreases risk of endometrial cancer but may increase risk of breast cancer

37
Q

Limit hormonal replacement therapy to

A

3-5 years

38
Q

Hormonal replacement therapy CI in

A

breast CA, endometrial CA, endometrial hyperplasia, hypertension, acute liver disease, active thromboembolic disease, pregnancy, smoking, intermittent porphyria

39
Q

SE hormonal replacement therapy

A

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
Q

Anticholinergic that does not cross BBB

A

Tropsium

41
Q

MOA anticholinergics for OAB

A

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
Q

SE anticholinergics

A

Xerostomia, constipation, urinary retention

43
Q

Oxybutynin

A

Antimuscarinic and antispasmodic and local anesthestic
Causes CNS adverse effects
Extensive first pass metabolism
CI: urinary retention and glaucoma

44
Q

Mirabegron

A

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
Q

Mirena

A

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
Q

Trichomonas

A

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
Q

BV due to candidiasis

A

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
Q

Partial seizures

A

Simple Focal seizures typically result in no alteration in consciousness
Complex seizures may have loss of consciousness and automatisms

49
Q

Generalized seizures

A

Include both hemispheres of brain, result in early loss of consciousness

50
Q

Status epilepticus

A

Seizure activity >30 minutes or 2 or more sequential seizures without recovery between them

51
Q

Hydantoins

A

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
Q

Carbamazepine

A

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
Q

S/S gonorrhea

A

Purulent or mucopurulent cervical discharge, dysuria, bleeding, menorrhagia, pelvic discomfort

54
Q

treatment of gonorrhea

A

single dose of IM ceftriaxone + single dose of azithromycin OR doxycycline for 7 days

55
Q

s/s chlamydia

A

vaginal discharge, mucopurulent cervicitis with edema and friability, urethral syndrome or urethritis, pID, ectopic pregnancy, infertility, endometriosis

56
Q

DOC for chlamydia

A

azithromycin/erythromycin, doxycycline and ofloxacin are DOC

57
Q

Tx of chlamydia in pregnant women

A

azithromycin single dose or amoxicillin 3x a day for 7 days

58
Q

First line therapy for OA

A

Acetaminophen

59
Q

Acetaminophen for OA

A

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
Q

second line therapy for OA

A

NSAIDs

61
Q

NSAIDs for OA

A

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
Q

Celcoxib

A

Selective NSAID for COX 2–less GI events but increased risk of CV events

63
Q

DMARDs

A

Used early to treat RA to decrease inflammation

Initiate within 3 months of symptoms

64
Q

Methotrexate

A

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
Q

Baseline labs needed for methotrexate

A

Chest X Ray, all labs, CBC (monitor every 4 weeks)

66
Q

Sulfasalazine

A

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
Q

Hydroxychloroquine

A

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
Q

Leflunomide

A

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
Q

1st line therapy for chronic gout

A

Xanthine oxidase inhibitors

70
Q

Xanthine oxidase inhibitors

A

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
Q

Probenicid

A

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
Q

NSAIDs for gout

A

good for acute attacks
Naprexen, indomethacin, sulindac
Continue for 24 hours after attack

73
Q

Corticosteroids for gout

A

Good for acute attack

Can give intra-articular dose if only 2 joints

74
Q

Colchicine

A

Inhibits activation, degranulation, and migration of neutrophils to area of gout attack; can exhibit pain relief in 18-24 hours
SE: diarrhea

75
Q

Cyclobenzaprine

A

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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