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PHARM > Final > Flashcards

Final Flashcards

1
Q

First-line agent for atrial fibrillation

A

Warfarin

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2
Q

Nitrofurantoin renal function breakpoint

A

CrCl <30

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3
Q

Gabapentin and hydrocodone–acetaminophen interaction

A

increased risk of respiratory depression

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4
Q

Omeprazole Max Use

A

should be discontinued if the patient has been using it for longer than 8 weeks

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5
Q

Sulfamethoxazole–trimethoprim (TMP-SMX) and Amiodarone interaction

A

TMP-SMX may decrease the effects of amiodarone

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6
Q

Prazosin and furosemide interaction

A

Avoid in women because of increased risk of urinary incontinence. Prazosin (Minipress) is an alpha blocker. It lowers blood pressure by relaxing blood vessels.

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7
Q

Vaginal estrogens uses

A

May be appropriate for recurrent lower urinary tract infections

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8
Q

Use of Escitalopram in combination with Tramadol

A

Risk of hyponatremia. All SSRIs, including Escitalopram, Fluoxetine, can cause SIADH and could cause hyponatremia, should be used with caution in the depressive patients with regular monitoring of electrolytes, especially in the elderly. (Use SNRI Venlafaxine)

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9
Q

To treat Depression: If 12 years old vs 52 years old

A

If 12 years old use SSRI (Fluoxetine). If 52 years old use SNRI (Venlafaxine)

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10
Q

Ranitidine renal function breakpoint

A

CrCL less than 50 mL/min reduce by 50% (ex., was 150 mg reduce to 75 mg)

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11
Q

If Gabapentin dose is 900–3600 mg renal function recommendation

A

Creatinine clearance must be higher than 80 ml/min

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12
Q

Diphenhydramine/anticholinergic long term use effects

A

50% increased risk of dementia among people who used a strong anticholinergic drug daily for about three years; long-term use of Benadryl/Diphenhydramine, has been linked to an increased dementia risk/cognitive decline

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13
Q

Colace/Docusate

A

Stool softener/Surfactant

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14
Q

Milk of Magnesia, Miralax, poly glucol

A

Osmotic laxatives

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15
Q

Senna, Castor oil

A

Stimulant laxative

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16
Q

Sucralfate with food or without?

A

must be administered on an empty stomach

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17
Q

Ciprofloxacin and calcium interaction

A

Cipro binds to calcium and prevents absorption

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18
Q

Warfarin with low risk of bleeding (INR above therapeutic range but less than 5 but less than 10)

A

Omit 1-2 doses, resume warfarin at 10-20% lower than original dose. Check INR in 24 hours. Vitamin K is no longer recommended.

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19
Q

Warfarin with higher risk of bleeding (INR greater than 10 with no serious bleeding)

A

Hold Warfarin and give vitamin K 3 to 5 mg (5 to 10) ORALLY. Check INR in 24 hours. If still high, administer vitamin K1 1-2mg PO. Resume warfarin at 10-20% lower than original dose when the INR is within therapeutic range.

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20
Q

Serious bleeding (INR results are greater than 10)

A

Hold Warfarin, vitamin K should be given by slow IV INFUSION in a dose of 5 to 10 mg (10mg slow IV plus fresh plasma or prothrombin complex concentrate, depending on urgency). Check INR in 24 hours. Repeat Vitamin K1 every 12 hours as needed. Resume warfarin at 10-20% lower than original dose when the INR is within therapeutic range.

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21
Q

If the INR is too low (titration)

A

Total weekly dose is adjusted upward by 10% and the INR is rechecked in 2 weeks.

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22
Q

DECREASE DEMAND OF INSULIN: Medications That Increase Glucose Levels > (hyperglycemia > need more insulin dose/increases insulin requirement)

A

Steroids/Glucocorticoids (Prednisone, Hydrocortisone)
Phenytoin
Protease Inhibitors (HIV treatment)
Niacin (vitamin B)
Obesity (reduces # of receptors/insulin resistance > need more insulin)

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23
Q

INCREASE DEMAND OF INSULIN > INCREASE RISK FOR HYPOGLYCEMIA because they increase affinity (binding ability) of the insulin receptor > increases risk for hypoglycemia

A

Levothyroxine, Growth hormone (GH), ACEIs, ARBs, aspirin, beta-adrenergic blockers, bromocriptine, fibrates, fluoxetine, linezolid, MAOIs, SSRIs, Alcohol, pentoxifylline, psyllium, salicylates, selegiline, Sulfonamides, testosterone ALL increase hypoglycemic effect of insulin, including inhaled forms

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24
Q

GLUT-1

A

ALL tissue: blood/brain
red blood, pancreas, brain, liver, kidney, muscle, adipose tissue, epithelial cells of small intestine, neurons

Basal uptake
blood-brain barrier
related with insulin resistance inT2DM
primary influence in exercise

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25
Q

GLUT-2

A

small intestine, kidney, liver, PANCREAS

regulates homeostasis

reduced insulin secretion seen in type 2 DM

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26
Q

GLUT-3

A

Neurons, brain, kidney, placenta

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27
Q

GLUT-4

A

muscle and adipose tissue

related to glucose uptake in exercise resistance in type 2 DM

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28
Q

GLUT-5

A

small intestine, kidney

intestinal absorption of fructose

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29
Q

overall poor BG control

A

split-mix insulin regimen

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30
Q

fasting (SLEEP) hyperglycemia

A

Bedtime IAI or LAI added

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31
Q

LAI is more effective than premixed insulin in

A

lowering fasting BG

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32
Q

Premixed insulin is more effective than LAI in

A

lowering BG levels after a meal

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33
Q

Hyperglycemia titration

A

increase insulin by 1-2 units or 10%-15% every 1-2 weeks

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34
Q

Afrezza

A

Inhaled insulin/Rapid acting

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35
Q

Sulfonylureas med names

A

Glimepiride, Glyburide, Glipizide (Hypoglycemia)

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36
Q

Sulfonylureas - Mech of Act and Side Effect

A

They work by closing the adenosine triphosphate (ATP)> sensitive Potassium channels. Can cause Diuresis/SIADH especially in heart failure or hepatic cirrhosis because drugs stimulate ADH release, the result is fluid overload and hyponatremia.

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37
Q

Meglitinides aka Glinides - Mech of Act and Side Effect

A

Ex. Noteglinide, Repaglinide; -glinide. Similar to the Sulfonylureas, they work by closing the adenosine triphosphate (ATP)–dependent potassium channels. Can cause Diuresis/SIADH especially in heart failure or hepatic cirrhosis because drugs stimulate ADH release, the result is fluid overload and hyponatremia.

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38
Q

Sulfonylureas and Meglitinides cause hypo or hyper?

A

AFFECT INSULIN NOT GLUCOSE > HYPOGLYCEMIA

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39
Q

Metformin renal function breakpoint

A

eGFR<45 ½ the dose
eGFR<30 stop metformin

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40
Q

Metformin cause hypo or hyper?

A

DOES NOT AFFECT INSULIN > NO HYPOGLYCEMIA

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41
Q

If you have CAD, which is 1st choice SGLT or GLP?

A

1st choice: SGLT 2 inhibitor (Jardiance) - (needs good renal function, this drug depends on excretion through renal tubules/urine)
2nd choice: GLP-1 (Trulicity, Victoza) - (if renal dysfunction)

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42
Q

If no CAD, which is 1st choice for oral diabetes drug?

A

Sulfonylurea (Glipizide), TZD (Actos), or DPP-4 inhibitor (Januvia) 1st choice.

43
Q

Setting a Glycemic Target HbA1c

A

< 7% Nonpregnant adults (6.5% can be suggested if can be achieved without significant hypoglycemia)

<7.5% - Children above 13 and adolescents with type 1 DM

< 8% - those with severe hypoglycemia; 65 years or older in whom hypoglycemic awareness may be suppressed, children younger than 13 years, those with extensive comorbid conditions, patients with limited life expectancies of 5 to 15 years

44
Q

Affect Glucose of Insulin?

A

Meglitinides aka Glinides: Noteglinide, Repaglinide (Hypoglycemia) – work by ATP/Calcium – SE: SIADH/Diuresis

Sulfonylureas: Glimepiride, Glyburide, Glipizide (Hypoglycemia)- work by ATP/Calcium – SE: SIADH/Diuresis

Thiazolidinediones: ~ zone, Pioglitazone (Actos) and rosiglitazone (Avandia) – (Hypoglycemia) - work by DNA – SE: CHF because of fluid retention effect

Biguanides: Metformin; (No Hypoglycemia) – SE: lactic acidosis

SGLT-2 Inhibitors ~liflozin, Canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance) – (No Hypoglycemia) - – work through renal tubule/glucosuria; needs good renal function; SE: UTI, Vaginal infection

Amylin analogs ~ tide GLP-1 injectable Trulicity, Victoza, DPP-4 oral ~liptin, Januvia, Tradjenta) (No Hypoglycemia)- work by activate GLP-1 and decrease gastric emptying; SE: PANCREATITIS, weight loss, NAUSEA; RESP INFECTION; UTI

Alpha Glucosidase Inhibitor: Acarbose, Miglitol, (No Hypoglycemia) – work by decreasing intestinal absorption of glucose; SE: Flatulence and Diarrhea; NO Lactic acidosis

45
Q

weight loss/weight gain diabetic oral meds

A

Meglitinides/glipizide, Su, TZD, Insulin > weight gain (hypoglycemia)

DPP/GLP, SGLT, Metformin > weight loss

Alpha - No effect on weight

46
Q

Factor inhibitors

A

Fondaparinux - 10
Warfarin - 10
LMWH - 10 and 2

Heparin >antithrombin III

Dabigatran (Pradaxa) - direct 2; ; Idarucizumab (monoclonal antibody fragment) is antidote for Dabigatran

RivaroXaban (Xarelto), ApiXaban (Eliquis) – direct 10; NO ANTIDOTE

(10 is fibrin inhibitor and 2 is thrombin inhibitor)

47
Q

UFH Heparin

A

monitor PTT; risk of HIT; antidote Protamine sulfate

48
Q

Warfarin

A

monitor INR; Antidote Vitamin K

49
Q

COX

A

Aspirin, NSAIDs; Aspirin and ibuprofen have antiplatelet, analgesic, antipyretic, and anti-inflammatory actions related to their cyclooxygenase (COX) activity

50
Q

P2Y12

A

(inhibit ADP pathway)
Clopidogrel, Prasugrel, Ticlopidine, Ticagrelor - they have no effect on prostaglandin metabolism

51
Q

GP2b/3a

A

Abciximab, Tirofiban, Eptifibatide

52
Q

PDE3

A

(phosphodiesterase – inactivates converting cAMP to AMP > increase calcium)

Dipyridamole, Cilostazol

(Cilostazol side effect headache due to vasodialation of blood vessel

53
Q

Increase Warfarin Response - increased risk for bleed

A

NSAIDS, ASA, Acetaminophen

Antibiotics/Antifungals (cephalosporins); Quinolones/Fluoroquinolones (e.g., Cipro), sulfonamides, metronidazole

Amiodarone

Fibrates

54
Q

Decrease Warfarin Response

A

Seizure meds (Phenobarbital, Carbamazepine, Phenytoin)

Vitamin K rich foods/Green leafy vegetables

Coenzyme Q10, St. John’s wort, echinacea, goldenseal

Ginseng, Grapefruit, ginkgo, garlic, ginger, anise, arnica, chamomile, clove, feverfew

55
Q

DVT Initial and Long-term treatment

A

Initial: Heparins
First: Warfarin
Second: Dabigatran (Pradaxa), Rivaroxaban (Xarelto), Apixaban (Eliquis), or Edoxaban

56
Q

Surgery/Hip replacement

A

First: Non UFH Heparins
Second: UFH Heparin
Third: ASA/Dextran

57
Q

TIA

A

First: ASA, or combination of ASA and Dipyridamole, or Clopidogrel

58
Q

AFib

A

First: Warfarin
Second: ASA
Third: combination of ASA and Clopidogrel

59
Q

Recurrent Embolism or Prosthetic Heart Valves

A

Warfarin

60
Q

AMI with ST-segment elevation (STEMI)

A

Initial: Fibrinolytics; Tranexamic acid and ε-Amino-n-Caproic Acid are antidotes for fibrinolytic agents
Long term with stent: Warfarin, ASA and Clopidogrel for a month after stent placement, then warfarin and one antiplatelet drug for months 2 and 3 after stent placement. After 3 months, warfarin can be discontinued and replaced with dual antiplatelet therapy (ticagrelor and ASA or Clopidogrel and ASA) for up to 12 months.

Who do not get a stent are treated with Warfarin and ASA.

61
Q

Rheumatic mitral valve disease but no AF

A

ACCP recommends no antithrombotic therapy

62
Q

Prevention of DVT after abdominal surgery

A

Dalteparin (Fragmin)

63
Q

lower initiation Warfarin/ antithrombotic therapy doses for

A

Older than 75 years
Multiple comorbid conditions
Poor nutrition (low albumin)
Elevated INR when off warfarin
Elevated liver function tests
Changing thyroid status

64
Q

Air travel time longer than 8 hours

A
  • wear loose clothing
  • avoid tight clothing around the waistline or lower extremities
  • achieve good hydration
  • perform frequent calf muscle exercises
  • wear compression stockings providing 15 to 30 mm Hg of pressure during air
65
Q

superficial vein thrombosis of the lower limb of at least 5 cm in length

A

45 days of Fondaparinux or LMWH. Fondaparinux preferred over LMWH.

66
Q

Prophylaxis of DVT in adult hospitalized/ limited mobility in the hospital

A

Betrixaban (Bevyxxa)

67
Q

ACEIs and Amiloride/Triamterine interaction

A

Risk of Hyperkalemia

68
Q

Warfarin and Amiodarone interaction

A

Risk for bleeding

69
Q

Serotonin Antagonist for Nausea

A

Ondansetron - setron

70
Q

Histamine blockers

A

Famotidine

71
Q

Dopamine antagonist for nausea

A

Droperidol, Metoclopramide /risk for extrapyramidal effects)

72
Q

Prostaglandin E1/inhibit cAMP

A

Misoprostol (can cause spontaneous abortion)

73
Q

Weakly Acidic

A

Decreased absorption and increased excretion - Salicylates

74
Q

Weakly basic

A

Increased absorption and decreased excretion - Levodopa

75
Q

Antiadiarrheals

A

Bismuth causes black tongue and gray-black stool contractions in children

76
Q

Mucosal protectant

A

Sucralfate binds to ulcer tissue & stimulates prostaglandin

77
Q

Antiemetic classes

A

Antihistamines
Phenothiazines
Sedative hypnotics
Cannabinoids
5-HT3 receptor antagonists

78
Q

Classes of GI Meds

A

Stimulant laxative: Bisacodyl, Senna

Surfactants/Stool softener: Docusate

Antacids

Proton Pump Inhibitors (PPIs)

H2 Blockers (Famotidine)

Metoclopramide (Dopamine antagonist)

Misoprostol (Prostaglandin E analog)

Orlistat (blocks fat)

Octreotide (blocks Growth Hormone)

Osmotic: milk of magnesia, miralax, polyethylene glycol

Hyperosmolar laxatives: glycerin, lactulose

Bulk Forming Laxatives (Psyllium, Methylcellulose)

Antidiarrheals (Loperamide, Diphenoxylate-Atropine)

79
Q

Hyper-Osmolar laxative

A

Lactulose, Glycerine

80
Q

PY12 ADP
PD cAmp

A
81
Q

Hypoglycemia S/S

A

hunger, tachycardia, decreased levels of consciousness, irritability, diaphoresis, weakness, dizziness

82
Q

Hyperglycemia S/S

A

(PPP) precedes DKA and give warning of its impending occurrence

weight loss, polyuria, polydipsia, polyphagia, fatigue, vomiting, dehydration, ketone odor to the breath, abdominal pain

83
Q

DKA S/S

A

drowsiness, dim vision, Kussmaul respiration

84
Q

Insulin effects on Liver

A

storage of glucose as glycogen

resets liver

decreases urea

decreases protein

decrease cAMP

promotes triglyceride synthesis

increases potassium and phosphate uptake

85
Q

Insulin effect on Muscle Cells

A

promotes protein synthesis by increasing amino acid transport by stimulating ribosomal activity

promotes glycogen synthesis to replace glycogen stores

86
Q

Insulin effect on Adipose Tissue

A

decreases free fatty acids

promotes storage of triglycerides

87
Q

Insulin lowers blood glucose levels by following mechanisms

A

Stimulates glucose entry into cells

Storage of glucose as glycogen/Inhibits glucose production (glycogenesis and glycolysis)

Promotes protein synthesis

Increases/Decreases fat storage (lipogenesis and lipolysis)

~genesis > increase
~lysis > decrease

88
Q

Diabetic Meds Mech of Action

A

Sulfonylureas: Glimepiride, Glyburide, Glipizide (Hypoglycemia)- work by ATP/Calcium – SE: SIADH/Diuresis

Meglitinides aka Glinides: Noteglinide, Repaglinide (Hypoglycemia) – work by ATP/Calcium – SE: SIADH/Diuresis

Biguanides: Metformin; (No Hypoglycemia) – SE: lactic acidosis

Thiazolidinediones: ~ zone, Pioglitazone (Actos) and rosiglitazone (Avandia) – (Hypoglycemia) - work by DNA – SE: CHF because of fluid retention effect

SGLT-2 Inhibitors ~liflozin, Canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance) – (No Hypoglycemia) - – work through renal tubule/glucosuria; needs good renal function; SE: UTI, Vaginal infection

Amylin analogs ~ tide GLP-1 injectable Trulicity, Victoza, DPP-4 oral ~liptin, Januvia, Tradjenta) (No Hypoglycemia)- work by activate GLP-1 and decrease gastric emptying; SE: PANCREATITIS, weight loss, NAUSEA; RESP INFECTION; UTI

Alpha Glucosidase Inhibitor: Acarbose, Miglitol, (No Hypoglycemia) – work by decreasing intestinal absorption of glucose; SE: Flatulence and Diarrhea; NO Lactic acidosis

89
Q

Metformin Mech of Act

A

Decreases hepatic gluconeogenesis (inhibits creation of glycogen)

Decreases absorption of glucose in liver

Decreases intestinal absorption of glucose

Increase glycolysis (increases ATP)

Increases peripheral glucose uptake

90
Q

Rapid insulins

A

LAG-Lispro, Aspart, Glulisine

Humalog, Novolog

Administer 15 before meals (not 30 as with Regular insulins)

Afrezza inhaled insulin

91
Q

Regular/Short insulin

A

Humulin R

Novolin R

Administer 30 min before meals

92
Q

NPH

A

Isophane

Combined with protamine

93
Q

Long Insulin

A

Detemir, Levemir, Lantus, Glargine

No peak

Detemir/Levemir avoid combining with other insulins

94
Q

Ultra Long insulins

A

Tresiba, Toujeo, Degludec

Degludec can be used in 1 yo

No peak

24hr-120hr lasts

95
Q

Switch from twice daily IAI or LAI titration

A

Reduce LAI by 20%

96
Q

Switch from once daily IAI to LAI titration

A

Do not change initial dose

97
Q

LAI vs PREMIXED INSULINS

A

Premixed higher risk for hypoglycemia

Premixed less weight gain

98
Q

Insulin titration

A

1-2 units or 10-15% once or twice weekly

99
Q

lactic acidosis s/s

A

chills, cool hands or feet, dizziness, low blood pressure, muscle pain, sleepiness, trouble breathing, slow or irregular heart rate, stomach pains or nausea/vomiting, and weakness; to report them immediately

take off Metformin 48hrs prior and after surgery d/t risk of lactic acidosis due to hypoperfusion during surgery

100
Q

Metformin precautions

A

Cautious use is in older than age 80 due to the probability of decreased renal function and they may have CHF, Metformin contraindicated in CHF and Renal dysfunction
eGFR<45 ½ the dose
eGFR<30 stop metformin

Metformin crosses placenta and insulin does not

There are many drug interactions with metformin; risk for lactic acidosis increases in the presence of renal and hepatic dysfunction; drugs that are eliminated by renal secretion (e.g., amiloride, digoxin, morphine, procainamide, quinidine, ranitidine, triamterene, trimethoprim, and vancomycin) may compete with metformin for its elimination pathway. Dosage adjustments may be needed in metformin or the interacting drugs

Furosemide increases metformin levels > dosage adjustment for metformin may be necessary

Alcohol should be avoided when metformin is used.

Potential for vitamin B12 deficiency

GI upset – major side effect

101
Q

Fondaparinux

A

No antidote

102
Q

No antidote

A

Fondaparinux

Direct 10 Eliquis

103
Q

Drugs that increase the risk of bleeding when used with any anticoagulant

A

Aspirin
NSAIDs
Dipyridamole
Quinidine
Valproic acid

104
Q

CHADS2 scores: Antiplatelet/Anticoagulant treatment for AFib or with a CHADS2 (congestive heart failure; HTN; age 75 years or older; diabetes mellitus; prior stroke, TIA, or thromboembolism)

A

Patients with AF, a CHADS2 score of 0: patients with low risk of stroke, the ACCP guidelines recommend no therapy. If a patient chooses therapy, then aspirin dosed at 75 mg to 325 mg daily is prescribed.

Patients with AF, a CHADS2 score of 1: patients with intermediate risk of stroke, should be treated with oral anticoagulation therapy. If intermediate-risk patients refuse to take anticoagulants, a combination of aspirin (75 to 325 mg once daily) and Clopidogrel.

Patients with AF, a CHADS2 score of 2 or greater: patients with high risk of stroke, require Warfarin therapy as a first line therapy. Or 150 mg of Dabigatran twice daily.

PHARM (2 decks)

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