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Exam 3 Review Flashcards

1
Q

What are first-line medications for acute pain?

A

NSAIDs or acetaminophen

Anticonvulsants and muscle relaxants may be used for long-term or moderate pain.

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2
Q

What are non-pharmacological recommendations for pain management?

A
  • Exercise programs
  • Physical therapy
  • Acupuncture
  • Massage
  • TENS
  • Chiropractic treatment
  • Biofeedback therapy
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3
Q

What are the indications for NSAIDs?

A
  • Analgesic
  • Antipyretic
  • Anti-inflammatory effects
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4
Q

List some examples of NSAIDs. (5)

A
  • Ibuprofen
  • Naproxen
  • Aspirin
  • Toradol
  • Mobic
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5
Q

What are common adverse effects of NSAIDs? (4)

A
  • GI: nausea, heartburn
  • Mild headaches
  • Dizziness
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6
Q

What are contraindications for NSAIDs? (8)

A
  • History of ulcers
  • Crohn’s disease
  • GI bleeding
  • Liver or kidney disease
  • Heart disease
  • Bleeding or platelet disorders
  • Unmanaged hypertension
  • Pregnancy
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7
Q

What symptoms indicate salicylate toxicity? (5)

A
  • Nausea/Vomiting
  • Diaphoresis
  • Tinnitus
  • Hyperventilation
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8
Q

What is one of the earliest signs of salicylate toxicity?

A

Respiratory alkalosis

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9
Q

Why do NSAIDs have a black box warning?

A

Increased risk of cardiovascular events and serious GI bleeding

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10
Q

What is acetaminophen used for?

A

Treatment of mild pain and fever

Acetaminophen has no anti-inflammatory properties.

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11
Q

What are contraindications for acetaminophen?

A
  • Alcohol abuse
  • Liver or kidney disease
  • Malnutrition
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12
Q

What are signs and symptoms of acetaminophen toxicity? (5)

A
  • Abdominal pain
  • Nausea/Vomiting
  • Dark urine
  • Jaundice
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13
Q

What are opioids used for? (5)

A
  • Serious pain
  • Acute injury
  • Post-surgery
  • Broken bones
  • Chronic cancer pain
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14
Q

Define agonists in the context of opioids.

A

Interact with receptor to achieve a response

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15
Q

What are full agonists? Give 3 examples of opioid full agonists.

A

Activate opioid receptor fully

Examples include Morphine, Codeine, Methadone.

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16
Q

Define partial agonists in the context of opioids.

A

Activate opioid receptor to a lesser degree

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17
Q

What are antagonists in the context of opioids?

A

Bind to opioid receptors without activating them

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18
Q

What is the first-line agent for lowering urate levels in gout management?

A

Allopurinol

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19
Q

What are adverse effects of allopurinol?

A
  • Hepatotoxicity
  • Gout flare at initiation of therapy
  • Skin rash
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20
Q

What labs should be monitored periodically when initiating allopurinol?

A
  • LFT
  • BUN
  • Creatinine
  • Uric acid level
  • CBC
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21
Q

What medications are used for acute gout flares?

A
  • Colchicine
  • NSAIDs
  • Glucocorticoids
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22
Q

What are the adverse effects of colchicine?

A

GI side effects

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23
Q

What are the actions and effects of corticosteroids?

A
  • Decreased peripheral uptake of glucose
  • Glucogenesis in liver
  • Lipolysis in adipose tissue
  • Decreased circulating eosinophils, lymphocytes, monocytes
  • Decreased leukocytes at inflammation sites
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24
Q

What are the principles of corticosteroid therapy?

A
  • Risk to benefit should be considered
  • Short-term use for acute conditions
  • Long-term use for life-threatening conditions
  • Use local therapy when possible
  • Do not stop abruptly
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25
Q

What are common adverse effects of corticosteroids?

A
  • Osteoporosis
  • Poor wound healing
  • Peptic ulcers
  • Hyperglycemia
  • Increased risk of infection
  • Cataracts
  • Mood changes
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26
Q

What is the first-line therapy for type 2 diabetes?

A

Metformin (Glucophage)

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27
Q

What are the actions of Metformin?

A
  • Improved insulin sensitivity
  • Decreased hepatic gluconeogenesis
  • Decreased absorption of glucose
  • Inhibition of platelet aggregation
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28
Q

What is a black box warning associated with Metformin?

A

Risk of lactic acidosis

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29
Q

What are the two thiazolidinediones you should know?

A

Pioglitazone (Actos), Rosiglitazone (Avandia)

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30
Q

What is the action of thiazolidinediones?

A

Decreased insulin resistance via activation of PPAR-gamma

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31
Q

What are common adverse effects of thiazolidinediones?

A
  • Weight gain
  • Edema
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32
Q

What are the contraindications for thiazolidinediones?

A
  • Pregnancy
  • Lactation
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33
Q

What are sulfonylureas known for?

A

Most likely to cause hypoglycemia

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34
Q

What is the action of alpha-glucosidase inhibitors?

A

Compete with complex carbohydrates for digestion to lower postprandial blood glucose

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35
Q

What are common adverse effects of alpha-glucosidase inhibitors?

A
  • GI symptoms
  • Belching
  • Bloating
  • Flatulence
36
Q

What are three selective sodium glucose co-transport 2 (SGLT-2) inhibitors?

A

Canagliflozin, Empagliflozin, Dapagliflozin

37
Q

What is the action of SGLT-2 inhibitors?

A

Inhibit the reabsorption of glucose in the kidney proximal tubule

38
Q

What are common adverse effects of SGLT-2 inhibitors?

A
  • Genital infections
  • UTI
  • Hypovolemia/hypotension
39
Q

What are dipeptidyl peptidase-4 inhibitors?

A

Sitagliptin

40
Q

What is the action of DPP-4 inhibitors?

A

Slows the breakdown of GLP-1 by DPP-4

41
Q

What are the adverse effects of DPP-4 inhibitors?

A
  • Hypoglycemia
  • Skin rash
  • Arthralgia
  • Pancreatitis
42
Q

What is the first-line treatment for hypothyroidism?

A

Levothyroxine

43
Q

What are the adverse effects of levothyroxine?

A
  • Diarrhea
  • Weight loss
  • Cardiac arrhythmias
  • Menstrual irregularity
  • Heat intolerance
44
Q

What are thioamides used for?

A

Treatment of hyperthyroidism

45
Q

What are the adverse effects of thioamides?

A
  • Agranulocytosis
  • Aplastic anemia
  • Hepatitis (black box warning for liver failure)
  • Hair loss
46
Q

What is agranulocytosis?

A

Severe reduction in granulocytes critical for fighting bacterial infections

47
Q

What are the actions of ACE inhibitors?

A
  • Blocks conversion of AT I to AT II
  • Vasodilation
  • Decreased intravascular volume
48
Q

What should be done if a cough occurs during ACE inhibitor therapy?

A

Switch to an ARB

49
Q

What are the adverse effects common to both ACE inhibitors and ARBs?

A
  • Hypotension
  • Tachyphylaxis
50
Q

What is the action of calcium channel blockers?

A

Prevent calcium from entering cells resulting in vasodilation

51
Q

What are the two major categories of calcium channel blockers?

A
  • Dihydropyridine
  • Non-dihydropyridine
52
Q

Why are dihydropyridines preferred over non-dihydropyridines for hypertension?

A

Non-dihydropyridines can decrease HR and cause severe bradycardia with beta-blockers

53
Q

What are common adverse effects of dihydropyridine calcium channel blockers?

A
  • Hypotension
  • Dizziness
  • Edema
  • Headache
54
Q

What are the indications for non-dihydropyridine calcium channel blockers?

A

Used for angina and rate control in atrial fibrillation

55
Q

What can occur when calcium channel blockers (CCBs) are combined with beta-blockers?

A

Severe bradycardia or high degrees of heart block

Dihydropyridine CCBs are preferred due to fewer negative side effects.

56
Q

What forms of CCBs are preferred in the treatment of angina?

A

Long-acting forms

Short-acting forms can cause breakthrough angina.

57
Q

List some adverse effects of dihydropyridine calcium channel blockers.

A
  • Hypotension
  • Dizziness
  • Lower extremity edema
  • Headache
  • Reflex tachycardia
58
Q

What are the two main non-dihydropyridine CCBs?

A

Verapamil and Diltiazem

59
Q

What is negative inotropy?

A

Decreased force of contraction

60
Q

What is negative chronotropy?

A

Decreased heart rate

61
Q

Why do non-dihydropyridines cause negative inotropic and chronotropic effects?

A

They block L-type channels in myocardium, SA node, and AV node, reducing calcium influx.

62
Q

What should be avoided in the treatment of HFrEF?

A

Non-dihydropyridine CCBs

63
Q

List some side effects of non-dihydropyridine CCBs.

A
  • Fatigue
  • Dizziness
  • Constipation
64
Q

What is the primary focus when studying antilipidemics?

A

HMG-CoA reductase inhibitors (statins)

65
Q

Name two statins.

A
  • Rosuvastatin (Crestor)
  • Atorvastatin (Lipitor)
66
Q

What do statins block?

A

HMG-CoA reductase

67
Q

What are the pleiotropic effects of statins?

A
  • Decreased production of pro-inflammatory cytokines
  • Increased activity of endothelial nitric oxide
  • Reduced platelet activity and synthesis of thromboxane A2
68
Q

List common adverse effects of statins.

A
  • Headache
  • Nausea
  • Constipation
  • Indigestion
  • Flatulence
69
Q

What is the best action if a patient reports myalgias while on statins?

A

Draw creatinine kinase level to check for elevations

70
Q

What is the action of Ezetimibe (Zetia)?

A

Inhibits the absorption of cholesterol at the brush border of the small intestine

71
Q

What are the uses of Gemfibrozil and Fenofibrate?

A

Reduce hypertriglyceridemia

72
Q

What is the mechanism of action of anticoagulants?

A

Inhibit coagulation cascade and fibrin formation

73
Q

What is the action of Dabigatran (Pradaxa)?

A

Reversible competitive thrombin inhibitor

74
Q

List some adverse effects of Dabigatran.

A
  • Heartburn
  • Nausea
  • Belching
  • Diarrhea
  • Bleeding
75
Q

What is Idarucizumab (Praxbind)?

A

Reversal agent for Dabigatran

76
Q

What is the action of Clopidogrel (Plavix)?

A

Inhibits the binding of ADP to its platelet receptor

77
Q

What is the black box warning associated with Clopidogrel?

A

Antiplatelet activity is dependent on conversion to an active metabolite by the CYP2C19 enzyme

78
Q

What are the four pillars of therapy for HFrEF?

A
  • ARNI
  • Beta-blockers
  • Mineralocorticoid receptor antagonists
  • SGLT-2 inhibitors
79
Q

What does ARNI stand for?

A

Angiotensin receptor-neprilysin inhibitor

80
Q

What is the mechanism of action of sacubitril?

A

Prevents the breakdown of natriuretic peptides by inhibiting neprilysin

81
Q

What is the effect of beta-blockers in HFrEF?

A

Decreased myocardial oxygen demand and improved diastolic filling times

82
Q

What is the mechanism of action of loop diuretics?

A

Decrease preload by increasing excretion of sodium and water

83
Q

What is the primary use of Ivabradine?

A

Slows conduction through the sinoatrial node

84
Q

What is the main action of Amiodarone?

A

Prolongs cardiac myocyte repolarization through blockade of potassium channels

85
Q

Name some adverse effects of Amiodarone.

A
  • Nausea
  • Vomiting
  • Fatigue
  • Lung damage
  • Thyroid dysfunction

PHARM (12 decks)

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