Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacy Practice I > Final: HB/Dys, D/HI - Drug Info > Flashcards

Final: HB/Dys, D/HI - Drug Info Flashcards

1
Q

Insomnia: Exclusions

A
  • <12 years of age
  • ≥65 years of age
  • Pregnancy or breastfeeding
  • Frequent nocturnal awakenings or early morning awakenings
  • Chronic insomnia (>3 months)
  • Sleep disturbance secondary to psychiatric or medical disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Diphenhydramine: Onset, Half-life, Max Sed, Dosing

A 
• Rapid onset (1-4 hrs)
- T1/2: 2.4-9.3 hrs 
- (max sedation after 3-6 hrs)
• Metabolized in liver (delayed half-life in liver dysfunction)
• Transient and short-term use
• Dose: 25-50 mg HS
(Preg->PCP, Nursing->NO)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Diphenhydramine: Adverse Effects

A
  • Sedation/hangover effect
  • Anticholinergic symptoms (dry mouth, constipation, blurred vision, urinary retention, tinnitus)
  • Inability to concentrate, cognitive impairment
  • Tachycardia/QT prolongation
  • Paradoxical CNS stimulation (excitation in children and elderly)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Diphenhydramine: Contraindications

A
  • Men with BPH and difficulty urinating
  • Angle-closure glaucoma
  • Angina or arrhythmias
  • Dementia
  • Children <6 years old OR with family hx of SIDS or sleep apnea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Diphenhydramine: Interactions

A
  • ↓ clearance of metoprolol especially in women
  • May enhance CNS depression of alcohol and opioids
  • May enhance adverse effects of glucagon
  • Avoid with solid potassium supplements (may cause ulceration)
  • Avoid driving, cooking, and operating machinery until response is known
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Diphenhydramine: Patient Education

A
  • Take diphenhydramine 30-60 min before sleep
  • Do not take more than 50 mg/night
  • After 3 consecutive nights, skip for 1 night to see if relieved
  • Don’t use longer than 10 days
  • Do not take with alcohol
  • Do not take with prescription sleep aids
  • Caution with children/teens in home
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Drowsiness & Hyper-insomnia: Exclusions

A
  • <12 years of age
  • Pregnancy and breast-feeding
  • Heart disease
  • Anxiety disorders
  • Medication-induced drowsiness (refer to PCP)
  • Chronic fatigue (refer to provider to rule out hypothyroidism, sleep apnea, etc)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Caffeine: Dose, Peak, Half-life

A
  • For occasional use for mental alertness or wakefulness
  • Dose: 100-200 mg PO q3-4h PRN
  • Peak concentration within 30-75 min, half-life of 3-6 hours
  • Can accumulate causing decreased clearance
  • Rapid tolerance is common
  • HA, fatigue, decreased concentration, irritability within 12-24 hours after cessation persisting for 1-5 days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Caffeine-Containing Products

A

• Nonprescription caffeine-only

  • NoDoz Maximum Strength® (200 mg)
  • Vivarin® (200 mg)

• Nonprescription combination

  • Excedrin Migraine® caplets (65 mg)
  • Midol Complete® caplets (60 mg)

Caffeine powder NOT recommended

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Caffeine: Adverse Effects

A
  • CNS stimulation: insomnia, nervousness, restlessness, tinnitus, tremor, headache, irritability, anxiety, depression
  • GI irritation (N/V/D, stomach pain)
  • Cardiovascular (tachycardia, arrhythmias, increases in BP/HR)
  • Renal (diuresis)
  • Increased effects in caffeine-naive, elderly, females, non-smokers, anxiety/panic attack
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Caffeine: Drug Interactions

A
  • Reduce CL of theophylline (increased HR)
  • Blocks clozapine at high doses
  • HC and cipro inhibit caffeine abs.
  • If on MAO-Is or HD/cardio., avoid non-rx caffeine preparations and moderate intake of dietary caffeine
  • Cigarette smoking increases caffeine CL: if trying to quit smoking, decrease caffeine 50%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Antacids: MOA, FOR, Salts

A
  • Neutralize gastric acid; act as buffering agents in GI tract
  • FOR: Temporary and rapid relief of mild, infrequent heartburn
  • Salts: all interchangeable
    • Magnesium (hydroxide, carbonate, or trisilicate)
    • Aluminum (hydroxide or phosphate)
    • Calcium carbonate
    • Sodium bicarbonate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Avoid Antacid If…

A
  • ≥60 years old
  • History of stomach ulcers or bleeding problems
  • Using anticoagulants, systemic steroids, or NSAIDs
  • Consume ≥3 alcoholic beverages daily
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Antacids: Adverse Effects

A

• Mg2+ → diarrhea (avoid if CrCl <30 mL/min d/t toxicity)
• Al → constipation, hypophosphatemia (avoid if CrCl <30 mL/min)
• Ca2+ → belching and flatulence, constipation
• NaHCO3 → belching and flatulence
- Avoid in renal failure, HF, cirrhosis, pregnancy, and sodium-restricted diets

• If taking calcium supplement

  • Avoid Ca2+ and NaHCO3 antacids
  • Avoid Ca2+ antacid in renal failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Antacids: Counseling

A
  • Use product-specific doses, repeat in 1-2 hours PRN
  • Food slows absorption (longer relief with food)
  • Chew tablets well and drink 8 oz water
  • Do not use >2x/week or >2 weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Antacids May IN/DEC Abs. of Other Meds.

A
  • Separate by 1 hour: isoniazid
  • Separate by 2 hours: amphetamines, azithromycin, enteric-coated products, iron, itraconazole, ketoconazole
  • Separate by 4 hours: tetracyclines and levothyroxine
  • Take 2 hours before or 6 hrs after antacid: fluoroquinolones
17
Q

H2RAs: MOA, FOR

A
  • Decrease fasting / food-stimulated gastric acid secretion and gastric volume by inhibiting histamine on the histamine type 2 receptor of the parietal cell
  • Effective in relieving fasting and nocturnal symptoms

• FOR: mild-moderate, infrequent, or episodic heartburn and for prevention of heartburn associated with acid indigestion and dyspepsia

18
Q

H2RAs: Counseling

A
  • Reduce dose if impaired RENAL function (half dose in CrCl <50 mL/min) and in elderly
  • Take at onset of sx or 30-60 min prior to anticipated heartburn, no more than 2x/day
  • Tolerance may develop if taken daily (vs PRN)
19
Q

H2RAs: Brands

A
  • Tagament HB, Cimetidine
  • Pepcid AC/Zantac 360, Famotidine
  • Pepcid MAX, Zantac MAX, Famotidine
    ^ ALL 1 tab with water, max 2 tabs
  • Pepcid Complete/Tums: Famotidine + Ca carb + mag OH (chew 1 tab, max 2)
20
Q

H2RAs: Adverse Effects

A
  • Headache, diarrhea, constipation, dizziness, drowsiness
  • Thrombocytopenia is rare (and reversible)
  • Cimetidine has weak anti-androgenic effects
21
Q

H2RAs: Interactions

A
  • Cimetidine has many! Increases concentration of nifedipine (CCB), monitor
  • May decrease absorption of pH-dependent drugs: itraconazole, ketonazole, iron sulfate, calcium carbonate
22
Q

PPIs: MOA, FOR

A
  • Inhibit H+/K+ ATPase (proton pump)
  • Irreversibly block the final step in gastric secretion, thus providing a greater prolonged and potent effect

• Indicated for frequent heartburn with symptoms ≥2 days/week or when not responding to non-rx H2RAs

23
Q

PPIs: Counseling

A
  • Onset: 2-3 hours, may take 1-4 days for complete relief
  • Do not chew or crush tablets/capsules
  • Most effective 30-60min before meal (preferably before breakfast)
  • Limit to 14 days of use, no more than every 4 months
24
Q

PPIs: Adverse Effects

A
  • Uncommon but may include diarrhea, constipation, headache
  • Rebound acid reflux upon abruptly discontinuing after long term use
  • May increase risk of traveler’s diarrhea by altering gut flora
25
Q

PPIs: Interactions

A

• Omeprazole/esomeprazole

  • May inhibit metabolism of clopidogrel
  • May inhibit metabolism -> increased concentration of cilostazol and diazepam (avoid concurrent use)

• Lansoprazole may be a safer alternative!

26
Q

Bismuth Subsalicylate (BSS): NOT REC FOR WHO, AE

A
  • Indicated for heartburn, dyspepsia, indigestion, nausea, and diarrhea
  • FDA approved for upset stomach (belching, gas) due to overindulgence in food and drink
  • Topical effect on stomach mucosa

• Adult dose: 262-525 mg every 30-60 minutes as needed

  • Not recommended for children or patients with renal failure or salicylate sensitivities
  • May turn stool and/or tongue black
27
Q

Elderly

A
  • Avoid cimetidine; avoid H2RAs in those with or at high risk for delirium
28
Q

Renally-Impaired

A
  • Avoid magnesium and aluminum antacids

- Avoid cimetidine; use low doses of other H2RAs

29
Q

Pregnant/BF

A

• Pregnancy: Infrequent, mild heartburn: diet, lifestyle interventions

  • Ca and Mg antacids ok (max 1000-1300 mg/day calcium)
  • H2RAs are ok; PPIs likely ok but limited evidence (refer for moderate heartburn)

• Breast-feeding
- Aluminum, calcium, or magnesium antacids safe
- Famotidine>cimetidine
• Avoid PPIs

Pharmacy Practice I (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions