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(PA school) Pharmacology I > Exam I review > Flashcards

Exam I review Flashcards

1
Q

OTCs: for cyanocobalamin, give its:
1) Other name
2) Disease/ disorder
3) MOA or extra info

A

1) B12
2) Macrocytic anemia
3) Decreased intrinsic factor (>50+ or taking metformin)

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2
Q

OTCs: for folic acid, give its:
1) Other name
2) Disease/ disorder

A

1) B9
2) Reduction of neural tube defects

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3
Q

OTCs: for calcium and vitamin D, give its:
1) Disease/ disorder
2) Which is Rx and which is OTC?
3) Other info?

A

1) Osteoporosis
2) Ergocalciferol (D2) is Rx and cholecalciferol (D3) is OTC
3) Vit D shouldn’t still be dosed in IU but still is

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4
Q

OTCs: for iron, give its disease/ disorder

A

Microcytic anemia

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5
Q

OTCs: for vitamin E, give its disease/ disorder

A

Scar minimization (topical)

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6
Q

OTCs: for coenzyme Q10, give its:
1) MOA
2) What it can reduce

A

1) Rate-limiting cofactor in mitochondrial ATP production
2) Reduction of statin-associated adverse effects

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7
Q

OTCs: for fish oil, give its:
1) Disease/ disorder
2) What it is

A

1) Hypertriglyceridemia + inflammatory conditions
2) Omega 3 fatty acids DHA/ EPA

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8
Q

OTCs: for red yeast rice, give its:
1) Disease/ disorder
2) MOA?

A

1) Hypercholesterolemia
2) Molecular structure similar to statins

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9
Q

OTCs: for niacin give its:
1) Other name
2) Disease/ disorder
3) MOA

A

1) B3
2) Hypercholesterolemia
3) NAD and NADP precursor for mitochondrial redux rxns.

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10
Q

OTCs: List the 8 conditions gingko biloba can treat and what it does

A

1) Alzheimer’s disease (AD)
2) Vascular dementia
3) ADHD
4) Tardive dyskinesia
5) Intermittent claudication
6) Tinnitus
7) Acute mountain sickness
8) Age-related macular degeneration
-Neuroprotective properties

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11
Q

OTCs: for melatonin give its:
1) Disease/ disorder
2) MOA

A

1) Insomnia/ jetlag
2) Hormone and potent antioxidant produced by the pineal gland

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12
Q

OTCs: for St. Johns Wort, give its
1) Other name
2) Conditions it treats (3)

A

1) Hypericum perforatum flower
2) Depression, anxiety and OCD

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13
Q

OTCs: for valerian root, give its
1) Other name
2) Conditions it treats (2)

A

1) Valeriana officinalis
2) Insomnia and anxiety

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14
Q

OTCs: for kava, give its
1) Other name
2) Use
3) Risk

A

1) Piper methysticum
2) Ceremonial tranquilizer for Pacific Islanders
3) May cause severe liver damage

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15
Q

OTCs: for kratom, give its
1) Other name
2) What it does

A

1) Mitragyna speciosa
2) Psychoactive with both stimulant and opioid-like effects

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16
Q

OTCs: for CBD, give its
1) Other name
2) What its used for
3) What allows it to be used

A

1) Cannabis sativa
2) Used for everything???
3) Use proliferated after passage of the 2018 Farm Bill

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17
Q

What 4 things may prevent and treat colds (may decrease duration of infection)?

A

1) Echinacea
2) Sambucus nigra (elderberry)
3) Vitamin C (ascorbic acid)
4) Zinc

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18
Q

OTCs: for probiotics, give its
1) Use
2) Which kind is preferred by GI docs?
3) Name 2

A

1) GI flora restorations
2) Refrigerated products
3) Florajen (≈$30) and VSL (≈$60)

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19
Q

OTCs: for glucosamine and chondroitin, give their:
1) Disease/ disorder
2) MOA (4 things it does)

A

1) Osteoarthritis
2) Stimulates chondrocytes to produce cartilage and synoviocytes to produce synovial fluid and hyaluronic acid
-Inhibits matrix metalloproteinase
-Modulates activities of inflammatory cytokines
-Serves as “building blocks” for cartilage

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20
Q

OTCs: for saw palmetto, give its
1) Disorder/ disease
2) MOA

A

1) BPH
2) Inhibits 5-alpha-reductase and cytosolic androgen receptor

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21
Q

OTCs: for black cohosh, give its
1) Other name
2) Disorder/ disease (3)

A

1) Cimicifuga racemose
2) Premenstrual syndrome, dysmenorrhea, and menopause

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22
Q

OTCs: for evening primrose oil, give its
1) Other name
2) Disorder/ disease (2)

A

1) Oenothera biennis
2) PMS and menopause

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23
Q

Differentiate between salicylic acid concentrations for acne and warts

A

1) Acne: 0.5 - 2%
2) Warts: 17 - 40%

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24
Q

A pregnant pt has a headache.

1) When can you not give them an NSAID? What are the risks?
2) Do you need to avoid anything in particular?

A

1) NSAIDs contraindicated in third trimester
-Delayed parturition, prolonged labor, and increased postpartum bleeding
-Premature closure of the ductus arteriosus
2) Avoid aspirin

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25
Q

Your pt is lactating and has a headache.

1) Do they still need to avoid aspirin?
2) What is safe? Explain

A

1) Yes
2) Ibuprofen; relevant infant dose is 0.6 – 0.9%
Acetaminophen; relevant infant dose is 3.98%

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26
Q

Your pregnant pt has a cold.
1) What is your first line of defense?
2) What about for severe congestion?

A

1) Intranasal cromolyn
2) Oxymetazoline

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27
Q

Your pregnant pt has a cold.

1) Is Phenylephrine always contraindicated for their nasal congestion?
2) What abt Pseudoephedrine?

A

1) During the first trimester has been associated with minor malformations (e.g., inguinal hernia, congenital hip dislocation)
2) Don’t use in first trimester; has been linked to abdominal wall defects (gastroschisis) in newborns

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28
Q

Your pregnant pt still has a cold.

1) What are the preferred antihistamines if she has severe symptoms and coughing? What about for mild/ mod Sx?
2) What else can be used?
3) What abt intranasal corticosteroids (INCs)?

A

1) Diphenhydramine (severe symptoms + antitussive effect) and chlorpheniramine (mild/mod)
2) Second generation antihistamines (eg, loratadine and cetirizine)
3) INCS are considered compatible with pregnancy; but systemic use of these drugs is associated with cleft lip and palate and low birth weight

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29
Q

A lactating pt got the cold from their pregnant friend.

1) Is pseudoephedrine compatible for her?
2) What abt intranasal cromolyn and intranasal corticosteroids?
3) What abt antihistamines?

A

1) Pseudoephedrine compatible (may
decrease milk production)
2) Probably compatible
3) Antihistamines contraindicated

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30
Q

1) How do you treat heartburn during pregnancy? (3 options).
2) Anything to avoid?

A

1) Lifestyle modifications
* Calcium antacids
* H2RAs
2) Avoid PPIs

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31
Q

How fast do antacids work for heartburn?

A

5 mins

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32
Q

Antacids:
1) Which can cause diarrhea? (1)
2) What abt constipation? (1)
3) With which are renal calculi possible if preexisting renal impairment? (1)
4) What about alkalosis if preexisting renal impairment? (1)

A

1) Magnesium hydroxide
2) Aluminum hydroxide
3) Calcium carbonate
4) Sodium bicarbonate

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33
Q

Antacids: What 3 antibiotics do they interact with and why?

A

Chelation via divalent cations –> able to bind easily to…
1) Doxycycline
2) Ciprofloxacin
3) Levofloxacin

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34
Q

Histamine Type 2 Receptor Antagonists:
1) How fast do they work for heartburn?
2) Which of these has antiandrogenic effects? What does this cause? (3 things)

A

1) 30-45 mins
2) Cimetidine
* Decreased libido
* Impotence
* Gynecomastia in men

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35
Q

Histamine Type 2 Receptor Antagonists (heartburn meds):
1) What 3 CYPs does cimetidine inhibit?
2) What 9 meds does it interact with?

A

1) CYP 450, 1A2, 2C19
2) Warfarin, Amiodarone, Clopidogrel, Nifedipine, Phenytoin, Theophylline, Tricyclic Antidepressants, Opioids, Others

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36
Q

Heartburn meds: PPIs:
1) How fast do they work?
2) Adverse effects? (3)

A

1) 60 minutes - several days
2) C.diff infection
○ Spontaneous bacterial peritonitis w/ pts w/ ascites secondary to cirrhosis
○ Increased risk of osteoporosis with long term or multi daily use

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37
Q

Heartburn meds: Name a PPI, what it inhibits, and 5 meds it interacts with

A

1) Omeprazole: inhibits CYP 2C19
2) * Citalopram
* Clopidogrel
* Warfarin
* Tacrolimus
* Mycophenolate
* Others

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38
Q

Increasing the pH of the stomach will cause lots of drug interactions, name them

A

Increasing the pH of the stomach will cause lots of drug interactions
Azoles, protease inhibitors, fluoroquinolones, thyroxine, digoxin and others

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39
Q

List 4 side effects of acetaminophen/ APAP

A

○ Nausea
○ Vomiting
○ HA
○ Insomnia

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40
Q

List 3 cholinergic blockers and their side effects

A

Diphenhydramine, chlorphenamine, doxylamine
○ Dryness of the eyes and mucous membranes (mouth, nose, vagina)
○ Blurred vision
○ Urinary hesitancy and retention
○ Constipation
○ Reflex tachycardia

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41
Q

Diphenhydramine is also called what? What is its side effect?

A

Benadryl; sleepiness

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42
Q

List the 5 side effects of intranasal corticosteroids (hint: 3 eye effects + 2 others)

A

○ Changes in vision
○ Glaucoma
○ Cataract formation
○ Increased risk of fungal infections
○ Growth inhibition in children

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43
Q

Intranasal corticosteroids + PIs can cause what condition?

A

Cushing’s

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44
Q

Rebound congestion can be caused by what?

A

Afrin (oxymetazoline)

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45
Q

What are 2 side effects of codeine?

A

○ Serious, life-threatening, or fatal respiratory depression
○ Risk of opioid addiction, abuse, and misuse

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46
Q

Name 3 Dextromethorphan + CYP 2D6 inhibitors and what effects they can have

A

Bupropion, fluoxetine & paroxetine
○ Psychoactive effects

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47
Q

List 4 anticholinergic effects

A
  • dry mouth
  • blurry vision
  • constipation
  • urinary retention (rarely)
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48
Q

The FDA said what product is ineffective as of 2023? Is it a solo or combo product?

A

Phenylephrine (Sudafed PE); both solo and combo

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49
Q

1) The FDA imposed purchase limits on what drug bc of illegal meth making?
2) What pts should use of this drug be limited in? Explain

A

1) Pseudoephedrine (Sudafed D):
2) Limit use for pts with HTN (may use 30mg tablets at lowest possible frequency for 3 days if BP
is controlled)

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50
Q

Guaifenesin + pseudoephedrine (Mucinex D):
1) What does guaifenesin do?
2) What have they been associated with in large doses?

A

1) Loosens and thins lower respiratory tract secretions
2) Renal calculi development

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51
Q

Guaifenesin + dextromethorphan (Mucinex DM):
1) What does guaifenesin do?
2) What does dextromethorphan do?

A

1) Loosens and thins lower respiratory tract secretions
2) Decreases sinusoid vessel engorgement and mucosal edema

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52
Q

How do you convert lb to kg?

A

Divide lbs by 2.2

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53
Q

1) How do you calculate how much to give a pt a day based on kg?
2) How do you calculate for an oral suspension?
3) How do you find how much to give per dose?

A

1) Multiply kg by max dose per day/hours (mg/kg/day(or hours))
2) Then multiply by oral solution amount (mL/mg) –> gives you max daily dose or dose every __ hours
3) Divide solution of #2 by how many times daily (ex. BID, TID, QID) if needed

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54
Q

Acetaminophen:
1) MOA?
2) Adverse effects? (3)

A

1) Central inhibition of prostaglandin synthesis
2) Nausea/ vomiting
* Headache
* Insomnia
* Hepatotoxicity

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55
Q

Acetaminophen:
1) Metabolized by the cytochrome _______ enzyme system to a hepatotoxic intermediate metabolite that is detoxified by _____________ (Phase ____ conjugation)
2) May be treated with what 2 things to supplement this detoxicating substance?

A

1) P450; glutathione; II
2) Activated charcoal or acetylcysteine

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56
Q

Substances that induce or regulate hepatic cytochrome enzyme CYP ______ may alter the metabolism of acetaminophen and inc. hepatotoxic potential

A

2E1

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57
Q

Ibuprofen and Naproxin (NSAIDs):
1) MOA?
2) Adverse effects? (4)

A

1) Relieve pain through central and peripheral inhibition of cyclooxygenase (COX) w/ consequent inhibition of prostaglandin synthesis
2) GI ulceration, bleeding
* Inc risk for MI, heart failure, HTN, stroke
* Edema
* Nephropathy

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58
Q

Ibuprofen and Naproxin (NSAIDs): what are their 5 interactions?

A

1) Methotrexate
2) P2Y12 inhibitors
3) SSRIs
4) Bisphosphonates
5) Digoxin
6) Phenytoin and ibuprofen together

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59
Q

1) Aspirin is a part of what group?
2) What is its MOA?
3) What are the 2 types of uncommon intolerance to it?

A

1) Salicylates
2) Inhibit prostaglandin synthesis from arachidonic acid by inhibiting both isoforms of the COX enzyme (COX-1 and COX-2)
3) Cutaneous (manifesting as urticaria and angioedema) and respiratory (manifesting as bronchospasm, laryngospasm, and rhinorrhea)

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60
Q

What 2 things do Aspirin/ salicylates interact with?

A

1) Valproic acid
2) Sulfonylureas

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61
Q

Which 3 groups of glaucoma drugs only increase AQ humor outflow? Give an example of each group

A

1) Prostaglandin Analogs: Bimatoprost (Lumigan), Latanoprost (Xalatan), Tafluprost (Zioptan), Travoprost (Travatan Z) (end in -prost)
2) Cholinergic (miotics): Pilocarpine (Isopto Carpine)
3) Rho Kinase Inhibitor: Netarsudil (Rhopressa)

62
Q

Glaucoma meds: Carbonic Anhydrase Inhibitors
1) MOA?
2) Example?
3) Adverse effect?

A

1) Reduce aqueous humor production
2) Dorzolamide (Trusopt)
3) Sulfonamide allergy cross reactivity
* **Carb-Anhydrase Inhibitors = ends in “amid

63
Q

Glaucoma meds: Adrenergic Alpha-2 Agonist:
1) MOA?
2) Example?
3) Adverse effects) (2)

A

1) Increase outflow + reduce production
2) Brimonidine (Alphagan P)
3) CNS depression and anticholinergic effects

64
Q

1) Which glaucoma drugs may cause darkening off iris and eyelashes?
2) Which are contraindicated for heart block and bronchospastic disease?

A

1) Prostaglandins (end in prost)
2) Beta blockers (end in olol)

65
Q

Which glaucoma drugs can cause poor night vision due to pupil constriction, corneal clouding, GI distress, and need precautions if hx of corneal abrasion or retinal detachment?

A

Cholinergic (miotics) (end in -pine; pilocarpine)

66
Q

Netarsudil (Rhopressa) is a part of the _____________ group of glaucoma drugs (ends in -dil) and can cause conjunctival hemorrhage or hyperemia

A

Rho Kinase Inhibitor

67
Q

Eye drops:
1) You should wait _____ min after administration before administrating a 2nd drop or different drug w/ ophthalmic
medications
2) Drugs must be _________ or _________ prior to use
3) Don’t touch applicator tip- why?
4) Occlude the eye after administration for how long?

A

1) 5-10 min
2) shaken or inverted
3) Cause bacterial keratitis
4) One minute

68
Q

True or false: Contact removal/reinsertion depends on formulation. Explain

A

Contact removal/reinsertion depends on formulation:
○ Drugs w/ benzalkonium chloride (BAK) require a 15 min wait prior to reinsertion
○ Ointments are generally not used while wearing contacts

69
Q

You should roll ear drops in hand prior to use, why?

A

If drops are cold, they may cause vertigo

70
Q

1) Define steady state
2) Define clearance

A

1) The rate of drug intake equals the rate of drug elimination
2) Rate of drug removal in plasma over time

71
Q

CYP 450 includes what 5 CYPs?

A

3A4/5/7 - most predominant one for adults
2D6
2C9
2C19
1A1/2

72
Q

List the purpose for each of the 3 clinical trial phases

A

1) Safety, PD, PK
2) Safety and efficacy (dose response)
Usually those who are healthy but with the disease
3) Safety and efficacy at specified dose
and determining labeling

73
Q

List the subjects for each of the 3 clinical trial phases

A

1) Healthy volunteers
2) Intended population
3) Wide range of intended population

74
Q

List the scope for each of the 3 clinical trial phases

A

1) 20-80 subjects
2) 100-300 subjects
3) 100s to 1000s of subjects

75
Q

List the length of time for each of the 3 clinical trial phases

A

1) 6-12 months
2) 1-2 years
3) 2-3 years

76
Q

1) Protein binding has to do with ______________ of the drug throughout the body.
2) What protein?

A

1) distribution
2) Albumin

77
Q

1) What is bioavailability?
2) How is it calculated?

A

1) % of drug that reaches systemic circulation from site of administration
2) As area under the plasma concentration time curve (AUC)

78
Q

List and describe 2 important ISMP practices

A

1) Leading zeros
○ “naked decimal point”
○ .5 mg instead of 0.5 mg
○ Can be mistaken as 5 mg if decimal not seen
○ USE THE ZERO before a decimal point when less than whole unit
2) Trailing zeros
○ 1.0 mg instead of 1 mg
○ Can be mistaken at 10 mg if decimal not seen
○ DON’T USE trailing zero for doses in whole numbers

79
Q

For bacteria what should you know?

A

Morphology
Enzymatic activity
Which antibiotic do you want to use for that bacteria??
(know bacteria based off of lab information)
Several ??s

80
Q

1) Reconstituted medications will expire in how long?
2) Some reconstituted medications will require what?
3) What reconstitution needs to be flavored?

A

1) 10 - 14 days
2) Refrigeration
3) Clindamycin

81
Q

1) ____________ reconstitution will turn stool red even though liquid is not red (reaction with dietary iron)
2) True or false: Round the dose - do not make parent measure 3.89 mL dose

A

1) Cefdinir
2) True

82
Q

What is the pediatric Tx for AOM?

A

Amoxicillin 90 mg/kg/day orally in 2 divided doses for 10 days

83
Q

What do the names of penicillins end in?

A

-illin

84
Q

What do the names of cephalosporins start with?

A

Cef/ ceph

85
Q

What do carbapenems end in?

A

-penem

86
Q

What do aminoglycosides end in?

A

-cin

87
Q

List the 4 misc. antibiotics

A

○ Telavancin
○ Daptomycin
○ Tigecycline
○ Quinupristin/ dalfopristin

88
Q

Clarithromycin belongs to what group?

A

Macrolides

89
Q

PO penicillins:
1) Does penicillin require renal dosing?
2) What abt dicloxacillin?
3) What abt amoxicillin?

A

1) NONE
2) NONE
3) CrCl 10-30 mL/min

90
Q

Which two PO cepholosporins require renal dosing? When?

A

1) Cephalexin - CrCl 10-50 mL/min
2) Cefdinir - CrCl <30 mL/min

91
Q

Which PO macrolide should you reduce at CrCl < 30 ml/min?

A

Clarithromycin

92
Q

Does tetracycline (PO only) need to be renal dosed? Explain

A

Yes; CrCl 51-90 mL/min

93
Q

Which penicillin that can be IV or PO requires renal dosing at CrCl 10-50 mL/min?

A

Ampicillin

94
Q

Which cephalosporin that can be IV or PO requires renal dosing at CrCl 10-< 30 mL/min

A

Cefuroxime

95
Q

What two tetracyclines can be IV and PO?

A

Doxycycline and Minocycline

96
Q

Name 2 misc antibiotics that can be both IV and PO that don’t require renal dosing

A
  • Linezolid
  • Clindamycin
97
Q

Sulfonamides: Trimethoprim/sulfamethoxazole:
1) IV, PO, or both?
2) Renal dosing or no?

A

1) Both
2) CrCl 15-30 mL/min REDUCE

98
Q

1) What is the only cephalosporin that can be both IV and PO?
2) What is the only penicillin that can be both IV and PO?

A

1) Cefuroxime
2) Ampicillin

99
Q

What are the 4 PO only penicillins?

A

○ Penicillin V
○ Dicloxacillin
○ Amoxicillin
○ Amoxicillin/Clavulanate

100
Q

What are the PO only cephalosporins?

A

○ Cephalexin
○ Cefprozil
○ Cefaclor
○ Cefdinir
○ Cefixime
○ Cefpodoxime

101
Q

Which 3 groups of antibiotics have the following adverse effects?:
○ GI upset
○ Diarrhea
○ Rash / allergic reactions
○ Seizures with accumulation

A

Penicillins, Cephalosporins, Carbapenems

102
Q

What are the 2 adverse effects of monobactams?

A

○ Rash
○ GI intolerance

103
Q

What are the 3 adverse effects of aminoglycosides?

A

○ Nephrotoxicity
○ Hearing loss
○ Vestibular toxicity

104
Q

3 adverse effects of macrolides?

A

○ GI upset
○ QT prolongation
○ Hepatotoxicity

105
Q

What are the 4 adverse effects of fluroquinolones?

A

○ Mental side effects
○ Low blood sugar
○ Neuropathy
○ Tendinitis - tendon rupture

106
Q

What are the 2 black box warnings for fluroquinolones?

A

○ QT prolongation
○ Avoid in peds and pregnancy

107
Q

What group of antibiotics should you limit use in children <8 to 12 years old due to teeth discoloration?

A

Tetracyclines

108
Q

What group of antibiotics has only one adverse effect (rash)?

A

Sulfonamides

109
Q

List the not-highlighted antibiotic adverse effects

A

○ Vancomycin - nephro/ototoxicity
○ Telavancin - QT prolongation
○ Daptomycin - increased CPK
○ Linezolid - thrombocytopenia
○ Metronidazole - disulfiram reaction
with alcohol + metallic taste in mouth

110
Q

Telavancin has a BB warning when?

A

Pregnancy

111
Q

What are the antibiotics to use for MRSA?

A

“Vampires Let Cats Drink Tea, Quietly.”
○ Vancomycin
○ Linezolid**
○ Ceftaroline
○ Daptomycin
○ Tigecycline
○ Quinupristin/dalfopristin

112
Q

What two antibiotics can you use for VRSA?

A

Linezolid or daptomycin

113
Q

What are the antibiotics for community acquired (CA) MRSA?

A

○ Doxycycline, Minocycline, Tetracycline
○ Trimethoprim/sulfamethoxazole
○ Clindamycin

114
Q

What antibiotics can treat P. aeruginosa?

A

1) Aztreonam IV
2) Carbapenems (ertapenem, imipenem)
3) Cephalosporins (3rd and 4th gen): Ceftriaxone / cefdinir + Cefepime
4) Fluoroquinolones (ciprofloxacin, levofloxacin)

115
Q

CYP 2D6 inhibitors bupropion, fluoxetine & paroxetine all __________ the effect of codeine because codeine is a __________

A

reduce; prodrug

116
Q

List the max adult and child prescription doses for acetaminophen (APAP) and ibuprofen

A

1) APAP:
-Adult: 4000mg per day max dose
-Children: 160mg/5mL suspension (rx max depends on weight & age); safe for all ages
2) Ibuprofen:
-Adult: 1200 mg per day max dose
-Children: 100 mg/ 5ml suspension (rx max depends on weight & age); safe for >= 6 months

117
Q

Azithromycin, clarithromycin, and erythromycin
1) Treat what?
2) What limits utility?

A

1) Strep pneumoniae, Hemophilus, Neisseria, Moraxella (+ atypicals)
2) Increasing resistance

118
Q

True or false: codeine and acetaminophen both have black box warnings

A

True:
- Codeine: respiratory depression/addictive
- Acetaminophen: hepatotoxicity

119
Q

4 mechanisms of how bacteria become resistant: list and give examples

A

1) Antibiotic inactivation/modification
Ex: beta-lactamase = immune to beta lactams
2) Alteration of target/binding site
Ex: Methicillin-resistant Staph. aureus(MRSA) = immune to all penicillins
3) Bypassing metabolic inhibitions
Ex: some bacteria can scavenge folic acid from elsewhere making them resistant to sulfonamides because the way sulfonamides kill bacteria is by disrupting folic acid production
4) Preventing antibiotic accumulation
Ex: Efflux pumps; decrease permeability of membrane

120
Q

Explain what happens when the following groups take codeine:
1) Extensive metabolizers
2) Poor metabolizers
3) Ultra-rapid metabolizers

A

1) (i.e., have a normal-functioning CYP2D6 gene) Codeine is converted to morphine effectively, and they experience typical therapeutic effects.
2) (due to genetic variations) Will not metabolize codeine efficiently and may receive little to no benefit from the drug.
3) (multiple copies of the CYP2D6 gene) may convert codeine to morphine too quickly, increasing the risk of morphine toxicity, including severe respiratory depression or even death.

121
Q

Dextromethorphan:
1) Explain its metabolism
2) What does it metabolize to?
3) What is the result of this?

A

1) Primarily metabolized by CYP2D6 as well, but its metabolism doesn’t involve conversion to another active compound (like codeine to morphine).
2) CYP2D6 metabolizes it into dextrorphan, a less potent but still active form.
3) Inhibition or variation in CYP2D6 activity can affect the levels of dextromethorphan and potentially influence its effects, but the risk for toxicity with dextromethorphan isn’t as high as with codeine when it comes to CYP2D6 interactions

122
Q

If dextromethorphan or another medication inhibits CYP2D6, it could do what to the conversion of codeine to morphine?

A

Make codeine less effective for pain relief.

123
Q

Inducers of CYP2D6 could potentially lead to ____________ conversion of codeine into morphine, raising the risk of _______________

A

faster; opioid toxicity.

124
Q

The combination of codeine (prodrug) and dextromethorphan (active drug) raises the concern of what?

A

CYP 2D6 enzyme interaction.

125
Q

Using both codeine and dextromethorphan is not advised because it could lead to two things; what are they? What is the determining factor?

A

If both drugs are metabolized simultaneously, they may alter each other’s pharmacokinetics, which could lead to:
1) An increased risk of morphine toxicity (from codeine)
2) Altered efficacy of codeine.
- The CYP2D6 enzyme’s role is central here; depending on whether a person is a poor, extensive, or ultra-rapid metabolizer of CYP2D6, the interaction could result in either inadequate pain relief (if codeine is not converted properly) or overdose (if codeine is converted to morphine too rapidly).

126
Q

Vulvovaginal Candidiasis 2 Tx options and MOAs of each?

A

1) Azoles (clotrimazole, miconazole, tioconazole)
-Inhibit CYP 450 enzymes in the cell membrane of the infecting pathogen.
2) Topical (monistat) 1-7 days of therapy. 7 days if pregnant
- Decreases synthesis of the fungal sterol ergosterol

127
Q

1) List the 2 ways to treat vaginal itching and irritation
2) How might you treat overactive bladder? What’s the MOA?

A

1) Hydrocortisone 1% or benzocaine 5 to 10%
2) Oxybutynin patches; anti muscarinic

128
Q

What two topicals provide a cooling sensation? Which provides a warming sensation?

A

Menthol 2-16% and Camphor 3.2%: provides cooling sensation
Capsaicin 0.1-0.15%: provides warm sensation

129
Q

2 ways to Tx lice and MOAs of each

A

1) Permethrin 1% (nix): Disrupts the sodium channel
2) Ivermectin 0.5% (Sklice): Opens chloride channel

130
Q

List all the G- bacilli bacteria

A

1) SPACE-M
Serratia
Proteus, Pseudomonas
Acinetobacter
Citrobacter
Enterobacter
Morganella
2) Non-fermenters
Acinetobacter baumanii
Stenotrophomonas maltophilia

131
Q

List all the G- diplococci

A

Neisseria species (2)

132
Q

List 2 G- coccobacilli

A

H. influenzae & L. pneumophila

133
Q

What are the 2 main groups of G- bacilli?

A

Lactose + and -

134
Q

What group of bacteria is lactose+?

A

Enterobacteriaceae (Ex: E. coli, Proteus, Klebsiella)

135
Q

What bacteria is lactose- and glucose +?

A

P. aeruginosa

136
Q

Name a strict anaerobe that’s lactose-

A

B. fragilis

137
Q

What are the 3 groups of lactose- bacteria? List members of each group

A

1) Oxidase+ (cholera, P. aerginosa)
2) Oxidase - (urease+ H. pylori, P. mirabilis)
3) Strict anaerobe (B. f)

138
Q

If I said I had a G+ bacteria in grape like clusters what is that?

A

S. aureus

139
Q

Dextromethorphan (Robitussin or Delsym) drug interactions

A

1) CYP2D6 inhibitors bupropion, fluoxetine & paroxetine
2) SSRIs/ MAOIs
-All increase psychoactive effects

140
Q

Codeine and dextromethorphan are both what?

A

Anti-tussives

141
Q
A
142
Q

List the max adult daily doses for:
1) Ibuprofen/ Advil
2) Naproxen/ Aleve
2) Aspirin

A

1) 1200mg
2) 660mg
3) 4000mg

143
Q

For kids Advil/ ibuprofen dosing, list:
1) The weight-based dosing
2) Dosing schedule
3) Max daily dose

A

1) 5-10mg/kg
2) Every 6-8hrs PRN
3) 300mg/dose up to 4 doses; no more than 1200mg/day

144
Q

For kids Tylenol/ acetaminophen, list:
1) The weight-based dosing
2) Dosing schedule
3) Max daily dose

A

1) 10-15mg/kg
2) Every 4-6hrs PRN
3) 480mg/dose up to 5 doses; no more than 2400mg/day

145
Q

1) List a spirochete bacteria
2) List a spirilla bacteria
3) What shape is streptococcus pneumoniae?
4) List a spore-forming bacilli (rod)

A

1) Treponema pallidum
2) Heliobacter pylori
3) Cocci/ sphere
4) Clostridium botulinum

146
Q

1) If you hear something is G+ & in a cluster, what should you think of?
2) What abt G+ in pairs or chains?
3) What abt G+ and in chains?

A

1) Staphylococci (S.a and S.e)
2) Streptococci
3) Enterococci

147
Q

First gen antihistamines end in what?

A

“-mine”

148
Q

What antibiotic cannot be given alone?

A

Imipenem (needs cilastin)

149
Q

List 3 antibiotics with great G+ coverage

A

1) Vancomycin
2) Daptomycin
3) Linezolid/ tedizolid

150
Q

What are the 2 counseling points for linezolid (IV and PO)?

A

1) Bone marrow suppression (Thrombocytopenia)
2) Nonselective MAOI (concern for serotonin syndrome)

151
Q

List the general spectrum of activity trends for:
1) Carbapenems
2) Monobactams (Aztreonam)

A

1) Great G+, G-, & anaerobic coverage
-NO MRSA or atypicals
2) Great G- coverage, NO G+ coverage
-Incl. pseudomonas

152
Q

List the general spectrum of activity trends for:
1) Aminoglycosides
2) Macrolides
3) Fluroquinolones

A

1) Mainly G-s, synergy dosing for G+s
-Incl. pseudomonas
2) Great atypical coverage
-Also Streptococcus pneumoniae, Haemophilus, Neisseria, and Moraxella
3) Variety of G+, G-, & atypical coverage

(PA school) Pharmacology I (13 decks)

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