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Pharmacology Exam 3 review > Exam 3 Review > Flashcards

Exam 3 Review Flashcards

1
Q

Wafarin (Coumadin) MOA

A

Indirectly inhibits the functional activation of “newly formed” Vit K dependent clotting factors II, VII, IX, X and protein C & C by directly inhibiting VKORC1’s ability to provide GGCX with reduced Vit K

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2
Q

Clopidogrel (Plavix) MOA

A

ADP inhibitor (antiplatelet)
Inhibit ability of ADP to increase the up regulation of gpIIb/IIIA receptors on the platelet surface that are known to mediate platelet aggregation
*Irreversible inhibition

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3
Q

ASA MOA

A

Irreversible inhibition of COX thereby decreasing the production of thromboxane A2 for the life of the platelet

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4
Q

Reversal agent - Coumadin

A

Vitamin K

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5
Q

Reversal agent - heparin

A

FFP

Protamine sulfate

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6
Q

Goal INR on Coumadin

A

2-3

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7
Q

How long does it take the “average” patient on Coumadin to get to INR goal?

A

5-7 days

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8
Q

How much should INR rise per day?

A

0.2

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9
Q

Warfarin (Coumadin) DDI

A

Inhibitors of CYP2C9: bacterium and fluconazole

others: amiodarone and metronidazole

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10
Q

Anticoagulant in pregnancy - DOC

A

Heparin (Coumadin is teratogenic)

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11
Q

Monitoring parameters - Coumadin

A

INR, maybe PT

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12
Q

Monitoring parameters - UFH

A

PTT (Goal 1.5-2 x normal)
Renal function
BUN, Creat (if >20-30 –> GI bleed?)
blood in stool/urine

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13
Q

Monitoring parameters - LMWH

A

None

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14
Q

Lovenox dosing

A

1 mg/kg BID if CrCl >30

1 mg/kg QD if CrCl <30

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15
Q

Clopidogrel DDI

A

PPI (some are OTC so patients may be taking them without your knowledge)

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16
Q

Absence seizure DOC

A

Depakote or Valproate

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17
Q

Lennox Gastaut DOC

A

Lamotrigine (Lamictal)
Levetiracetam (Keppra)
Topiramate (Topamax)

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18
Q

Drugs that worsen absence seizures

A

Phenytoin, Phenobarbital and Carbemazepine

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19
Q

Phenobarbital reference range

A

15-35 mcg/mL

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20
Q

Phenytoin reference range

A

10-20 mcg/mL

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21
Q

Carbemazepine reference range

A

4-12 mcg/mL

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22
Q

Valproate reference range

A

50-120 mcg/mL

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23
Q

Ethosuximide reference range

A

60-100 mcg/mL

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24
Q

Valproate - Lamotrigine DDI

A

Valproate inhibits lamotrigine metabolism by inhibiting glucuronidation (phase II pathway)
Start lamotrigine lower (25mg)

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25
Q

Carbidopa-Levodopa MOA

A

converted to dopamine

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26
Q

What does carbidopa inhibit?

A

conversion of L-dopa to dopamine –> decreased side effects and more to the brain

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27
Q

MAO inhibitors - SE

A

hypotension, HA, nausea

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28
Q

Dopamine agonists - SE

A

stimulation of reward center

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29
Q

Levodopa - SE

A

nightmares

psychosis

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30
Q

Carbidopa-Levodopa main therapeutic effect

A

decreases rigidity and bradykinesia (some tremor)

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31
Q

Anticholinergics main therapeutic effect

A

improves resting tremors

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32
Q

Which warfarin isomer is most potent?

A

s-isomer (CYP2C9)

[r-isomer is CYP3A4)

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33
Q

Warfarin dosing

A

65 yrs old 2.5 mg qd

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34
Q

UFH MOA

A

inhibits factors Xa:IIa by binding at 2 different places

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35
Q

Heparin induced thrombocytopenia platelet count

A

decrease >30-50%

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36
Q

What happens when antibodies that activate platelets clump so platelets decrease?

A

Heparin induced thrombocytopenia (HIT)

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37
Q

LMWH MOA

A

inhibits factor Xa

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38
Q

LMWH renal considerations

A

do not use if CrCl<30

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39
Q

Treatment of HIT

A
  1. stop UFH or LMWH
    2.start Danaparaoid or Fondaparinux or Direct Thrombin Inhibitors
    Treat until Platelets >100
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40
Q

Carbamazepine, Phenytoin, Lamotrigine - MOA

A

Inhibits Na channels

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41
Q

Phenobarbital MOA

A

increases GABA

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42
Q

Valproate MOA

A

inhibits Na channels and Increases GABA

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43
Q

Phenytoin monitoring parameters

A

albumin and BUN (both can increase free fractions)

44
Q

Valproate SEs

A

GI, weight gain, hepatotoxicity, hyperammonemia

45
Q

Carbamazepine DDI

A

Inducer CYP1A2, 2B6, 2C8/9/19 and 3A4
decreases effect of warfarin
OCP failure

46
Q

Valproic acid DDI

A 
not an inducer (unique)
inhibits UGT2B7 (phase II)
47
Q

Carbemazepine SE

A

Life threatening rash (SJS) in certain genetic profiles (Han Chinese/asian)

48
Q

Clinical Issue: OCP and inducers

A

enzyme induces decrease effectiveness of OCP (exception valproic acid and lamotrigine)
Failure rate 6%

49
Q

Selegiline and Rasagiline - class?

A

MAO inhibitor

50
Q

Pramipexole and Ropinirole - class?

A

Dopamine agonist

51
Q

Dopamine agonist - SE

A

stimulation of reward pathway

sleep attacks

52
Q

Levodopa SE

A

nightmares

psychosis

53
Q

Carbidopa-Levodopa administration

A

on an empty stomach because protein competes with absorption (consistency is the key for motor symptoms)

54
Q

MAO inhibitors and surgery

A

Stop 10-14 days before because of possibility of receiving vasoconstrictor

55
Q

Migraines DOC

A

Selective 5HT1 receptor agonist (Triptans)

abort rapidly in 70-80% of patients

56
Q

Meds for migraine prophylaxis

A 
Betablockers (propranolol - vasodilation)
CCB (verapamil)
Anticonvulsants (Topamax)
Antidepressants (TCAs)
Analgesics (NSAIDs)
Botox
57
Q

Why should propranolol not be given to asthmatics?

A

bronchospasm

58
Q

Tension HA -treatment

A

treat underlying depression or anxiety

NSAIDS, APAP, ASA

59
Q

Cluster headache - treatment

A

Sumatriptan (imitrex)

60
Q

Opioid MOA

A

binds to mu-opioid receptors to block pathway - acts as agonist

61
Q

Stadol MOA

A

agonist/antagonist (ceiling effect so can’t use long term)

62
Q

Hydrocodone, Methadone, Codeine, Demerol, Morphine, Stadol, Oxycontin - Class?

A

opioid

63
Q

Opioid reversal

A

Naloxone (OD) or Naltrexone (mild)

64
Q

Capsaicin patch MOA

A

activates vanillin receptor (causes burning)

65
Q

Capsaicin 8% patch use

A

neuropathic pain
1 time for 1 hour, up to 3 months of pain control
SE - burning (premedicate)

66
Q

APAP antidote

A

n-acetylcysteine

67
Q

Toradol info

A

Parenteral NSAID
use <5 days
caution decreased renal function and bleeding risk
May increase bleeding and platelet aggregation

68
Q

Trigeminal neuralgia DOC

A

carbemazepine

69
Q

Tramadol seizure warnings

A

may decrease seizure threshold

70
Q

Demerol metabolite

A

normeperidine (SE seizures)

71
Q

Lab findings B12 deficiency and folic acid deficiency

A

MCV/MCH increased

macrocytic RBC

72
Q

Lab findings iron deficiency anemia

A

MCV/MCH decreased

microcytic RBC

73
Q

Lab findings anemia of chronic disease

A

MCV/MCH decreased or right shift

normocytic RBC

74
Q

Lab findings hemolytic anemia or bleeding

A

normocytic RBC

Retic >3

75
Q

Fe DDI

A

antacids (decrease bioavailability)

76
Q

Normal H/H males

A

13-16 mg/dl / 40-50%

77
Q

Normal H/H females

A

12-15 mg/dl / 35-45%

78
Q

Erythopoiesis Stimulating Agents (ESA) use and SE

A

must have adequate iron stores

may increase viscosity and plasma volume so can increase BP

79
Q

Metformin MOA

A

decreases glucose production from liver

80
Q

Sulfonyureas MOA

A

increases secretion of insulin (all the time)

81
Q

DPP4 inhibitors MOA

A

stimulates pancreas in the presence of glucose

82
Q

thiazolidinediones (TDZ) MOA

A

work on receptors that make liver and muscles to make more insulin sensitive

83
Q

Metformin precautions

A

caution renal and liver disease

small risk of LA

84
Q

TDZs SE and cautions

A

edema, weight gain, bone fractures

avoid: liver disease, CHF

85
Q

SUs SE

A

hypoglycemia
weight gain
beta cell burnout

86
Q

Glusiline, Aspart, Lispro - class?

A

rapid acting insulin

87
Q

Lente, NPH - class?

A

Intermediate acting

88
Q

Glargine and Detemir - class?

A

Long acting (basal)

89
Q

Exenitide - Type I or Type II?

A

Type II

90
Q

Pramlinitie (Symlin) - Type I or Type II?

A

both

91
Q

Early am hypoglycemia (3am-5am)

Rebound normal to high blood sugars

A

Somogyi phenomenon

92
Q

absence of early am hypoglycemia

relative resistance to insulin’s effect during early AM hours

A

dawn phenomenon

93
Q

Which drugs cause hyperthyroidism?

A

iodide, lithium, amiodarone

94
Q

Which drugs cause hypothyroidism?

A

amiodaron, PTU, methimazole (MMI), lithium

95
Q

Hypothyroidism DOC

A

levothyroxine

96
Q

Thyroid storm DOC

A

PTU

97
Q

Hyperthyroidism treatment

A

surgery

Anti-thyroid meds (MMI or PTU)

98
Q

Intranasal steroids - use

A

perennial rhinitis and if moderate/severe symptoms

99
Q

when is a leukotriene modifier used in rhinitis?

A

when asthma is present

100
Q

when are allergy shots used for rhinitis?

A

resistant cases

101
Q

allergic rhinitis general approach to treatment

A

Control symptoms:
antihistamine
decongestant
+/- intranasal steroids

102
Q

Benadryl, Chlor-Trimeton, Tavist - class?

A

1st generation “sedating” antihistamines

103
Q

Zyrtec, Claritin, Allegra - class?

A

2nd generation “non-sedating” antihistamines

104
Q

Azelastine (Astelin), Olopatadine (Patanase) - class?

A

2nd generation “non-sedating” antihistamines (NS)

105
Q

1st generation antihistamine SE

A

cross BBB –> anticholinergic effects - confusion, sedation, glaucoma, urinary retention

106
Q

2nd generation antihistamine SE

A

do not cross BBB –>less anticholinergic effects

107
Q

Beclomethasone, Budesonide (Rhinocort), Fluticasone - class?

A

intranasal steroids

Pharmacology Exam 3 review (1 decks)

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