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Top 200 I (2020) > Exam 7 > Flashcards

Exam 7 Flashcards

1
Q

Long-Acting Antimuscarinic/Anticholinergic (LAMA)

A

Tiotropium Bromide (Spiriva Handihaler, Spiriva Respimat)

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2
Q

How do LAMAs work?

A

Blocks acetylcholine at muscarinic receptors (M3 receptors) in the lungs, lasting 24 hours.

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3
Q

Long-Acting Antimuscarinic/Anticholinergic (LAMA): FDA Approved Indications

A

Handihaler: COPD Only
Respimat: COPD (2.5 mcg), Asthma (1.25 mcg)

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4
Q

Long-Acting Antimuscarinic/Anticholinergic (LAMA): Adverse Effects

A

Dry Mouth/Cough, Constipation, Headache

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5
Q

Long-Acting Antimuscarinic/Anticholinergic (LAMA): Drug Interactions

A

Other drugs with anticholinergic effects, Acetylcholinesterase inhibitors (Donepezil, Aricept)

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6
Q

Long-Acting Antimuscarinic/Anticholinergic (LAMA): Warnings

A

No Boxed Warning, Precautions: Use in BPH and Glaucoma, Handihaler capsule contains lactose (Caution in those with milk protein hypersensitivity)

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7
Q

Long-Acting Antimuscarinic/Anticholinergic (LAMA): Patient Counseling

A
  • Complicated assembly
  • Stable for 3 months once activated (should write exp. date on vial)
  • Should be used everyday regardless of how patient feels
  • Tablets are for inhalation only (handihaler)
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8
Q

Classification of Productive Cough

A
  • Wet/Chesty Cough
  • Expels secretions from lower respiratory tract
  • Secretions may be clear, purulent, malodorous
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9
Q

Classification of NonProductive Cough

A
  • Dry/Hacky Cough

- No useful physiologic purpose

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10
Q

Cough Suppressants

A
  • Benzonatate (Tessalon Perles - RX Only)

- Dextromethorphan (Robitussin - OTC)

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11
Q

How do cough suppressants work? (Benzonatate)

A

Acts peripherally in the lungs to anesthetize receptors to the cough reflex

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12
Q

How do cough suppressants work? (Dextromethorphan)

A

Acts centrally in the brain to increase the cough threshold

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13
Q

Similarties between Benzonatate and Dextromethorphan

A

Both decrease the body’s response to the sensation to cough

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14
Q

Cough Suppressants FDA Approved Indications

A

Symptomatic relief of unproductive cough

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15
Q

Benzonatate Adverse Effects

A
  • Oral/pharyngeal numbness IF CAPSULES ARE BROKEN
  • Dizziness
  • Headache
  • GI upset
  • Sedation/bizarre behavior
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16
Q

Benzonatate Drug Interactions

A

Alcohol and CNS depressants may worsen drowsiness

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17
Q

Benzonatate Warnings

A

No Boxed Warning, Precautions: Patients with psychiatric medications, Contraindications: Kids <10 years old and patients with reactions to anesthetic agent tetracaine

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18
Q

Dextromethorphan Adverse Effects

A
  • Drowsiness
  • Nausea, vomiting, constipation, stomach discomfort
  • Overdose: restlessness, drowsiness, excitation, confusion, nervousness,
  • Respiratory depression at very high doses
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19
Q

Dextromethorphan Drug Interactions

A
  • Separate from MAOIs by 14 days
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20
Q

Dextromethorphan Warnings

A

No Boxed Warning, Should NOT be used in children <4 years old, Risk of serotonin syndrome when administered with other serotonergic medications (SSRI, SNRI), Watch for signs of abuse

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21
Q

Dextromethorphan Patient Counseling Points

A
  • Do not use if you have a productive cough outside of at bedtime for relief (Honey is more effective in children for a cough)
  • May want to limit use during the day due to risk of sedation
  • Limit administration with other sedation medications
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22
Q

Expectroants

A

Guaifenesin (Mucinex - OTC)

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23
Q

How does guaifenesin improve cough?

A

Loosens and thins lower respiratory tract secretions (enables cough to clear more mucus)

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24
Q

Guaifenesin FDA Approved Indication

A
  • Symptomatic relief of acute, ineffective productive coughs

- Not indicated for chronic cough associated with COPD, asthma, or smoker’s cough

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25
Q

Guaifenesin Adverse Effects

A
  • Well Tolerated
  • Dizziness/Drowsiness
  • Headache
26
Q

Guaifenesin Drug Interactions

A
  • None
27
Q

Guaifenesin Warnings

A
  • None
28
Q

Guaifenesin Patient Counseling

A
  • Take with full glass of water
  • Do not crush/chew ER
  • Cough lasting longer than 7 days should be followed up by a PCP
29
Q

Topical Lidocaine

A

Lidocaine 5% (Lidoderm)

30
Q

How does lidocaine work?

A

Local anesthetic that provides analgesic effect through blocking conduction of nerve impulses

31
Q

Lidocaine FDA Approved Indications

A

Postherpetic neuralgia and localized pain

32
Q

Lidocaine Adverse Effects

A
  • Localized reactions (skin irritation)
  • May contain metal (aluminum)  burns in MRI
  • Paresthesia (numbness, tingling)
33
Q

Lidocaine Drug Interactions

A

None since topical product (minimal systemic absorption)

34
Q

Lidocaine Warnings

A
  • Apply only to intact skin

- Liver dysfunction (requires use of fewer patches, shorter time periods, longer treatment-free intervals)

35
Q

Lidocaine Patient Counseling

A
  • Do not cover with tight clothes or occlusive dressing
  • Apply 1-3 patches for 12 hours
  • Only one application in 24 hours
  • Can cut into smaller pieces to fit area needed
  • Fold patches after use
36
Q

Phosphodiesterase-5 Inhibitors (PDE-I): ED

A

Sildenafil (Viagra), Tadalafil (Cialis)

37
Q

Phosphodiesterase-5 Inhibitors (PDE-I): PAH

A

Sildenafil (Revatio), Tadalafil (Adcirca)

38
Q

How do PDE-Is work?

A

Enhance smooth muscle relaxation to allow greater blood flow (Enhance nitric oxide-induced relaxation of vascular smooth muscle)

39
Q

PDE-Is FDA Approved Indications

A
  • Erectile Dysfunction (ED)
  • Pulmonary Arterial Hypertension (PAH)
  • BPH (CIALIS ONLY)
40
Q

PDE-Is Adverse Effects

A
  • Headache/ muscle ache
  • Flushing
  • Nausea
  • Chest pain
  • Low blood pressure
41
Q

PDE-Is Drug Interactions

A
  • Nitrates (Nitroglycerin)

- a-adrenergic agonists

42
Q

PDE-Is Warnings

A

No Boxed Warning, Sudden Loss of Vision/Hearing, Hypotension, Contraindicated with use of nitrates

43
Q

PDE-Is Patient Counseling

A
  • Counsel patients on signs of low blood pressure (i.e. dizziness, unsteadiness)
  • Take at least 30 minutes before anticipated sexual activity
  • Seek immediate medical attention if priapism occurs (erection lasting > 6 hours)
44
Q

PDE-Is Clinical Pearl

A

Tadalafil can be taken once daily to provide full day coverage

45
Q

What is Benign Prostatic Hyperplasia (BPH)?

A
  • Occurs in almost all men as they continue to age
  • Reduced bladder emptying
  • Increased urinary frequency and urgency
46
Q

5-a Reductase Inhibitors

A

Dutasteride (Avodart), Finasteride (Proscar (BPH), Propecia (Hair Loss)

47
Q

How do 5-a Reductase Inhibitors work?

A
  • Inhibits conversion of testosterone to dihydrotestosterone

- DHT stimulates prostate growth and contributes to male pattern baldness

48
Q

5-a Reductase Inhibitors FDA Approved Indications

A
  • Benign prostatic hyperplasia

- Male pattern baldness (finasteride only)

49
Q

5-a Reductase Inhibitors Adverse Effects

A
  • Gynecomastia
  • Reduced Libido
  • Impotence
  • Dizziness
50
Q

5-a Reductase Inhibitors drug Interactions

A
  • None
51
Q

5-a Reductase Inhibitors Warnings

A

No Boxed Warning, Hazardous Drug (special handling and disposal), Contraindicated in pregnant women or women of child bearing age

52
Q

5-a Reductase Inhibitors Patient Counseling

A
  • Patients should not give blood while taking or for up to 6 months after stopping (Concerns over transfusion to a pregnant patient)
  • It will take 3 to 6 months to see symptom improvement
53
Q

5-a Reductase Inhibitors Clinical Pearl

A
  • Women who are pregnant or may become pregnant should avoid handling and touching this medication
54
Q

a-1 Adrenergic Blocker

A

Tamsulosin (Flomax), Terazosin (Hytrin)

55
Q

How do a-1 Adrenergic blockers work?

A
  • Blockade of the alpha receptor allows for smooth muscle relaxation (Results in improved urine flow)
56
Q

Uroselective a-1 Adrenergic Blocker

A

Tamsulosin; work in bladder and urethra

57
Q

Unselective a-1 Adrenergic Blocker

A

Terazosin; works throughout body (all smooth muscle)

58
Q

a-1 Adrenergic Blocker FDA Approved Indications

A
  • Benign Prostatic Hyperplasia
  • Neurogenic bladder (tamsulosin only)
  • Ureteral stones (tamsulosin only)
  • Hypertension (terazosin only)
59
Q

a-1 Adrenergic Blocker Adverse Effects

A
  • Retrograde ejaculation
  • Rhinitis (Runny Nose)
  • Headache/Dizziness
60
Q

a-1 Adrenergic Blocker Drug Interactions

A
  • PDE-I

- Additional high blood pressure medications

61
Q

a-1 Adrenergic Blocker Warnings

A
  • No Boxed Warning

- Tamsulosin Only: Not intended for use in high blood pressure

62
Q

a-1 Adrenergic Blocker Patient Counseling

A
  • Rise slowly from sitting and lying positions (orthostatic hypotension risk)
  • Tamsulosin only: Take 30 minutes after the same meal each day

Top 200 I (2020) (5 decks)

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