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Final- new stuff Flashcards

1
Q

Dexlansoprazole

A

PPI

MOA- irrevirsibly inactiavtes the hydrogen potassium adenosine triphosphate (H+/ K+/ ATPase) resulting in imparied acid secretion

Pro drug is protected by enertic coating ( dissoves in intestinal lumen abd is absorbed, carried to the parietal cells of the stomach for activation)

Can be taken with food

Onset of action2-3 hours, 3-4 days for maximal effect, duration of action 24 hours

Good for renal insufficiency patients

ADR- diarrhea, headache, abdominal pain, vitamin B12 deficiency, reduced absorption of iron, calcium, magnesium osteroperosis, fractures, C, diff, community aquired pneumonia

TAPER OFF- rebound hypersecretion

DDI- ketoconazole, intraconazole, atazanavir, rilpiverine, calicum caronate, iron salts

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2
Q

Pathophysiology of acne

A

Increased sebum production (caused by increased androgen levels)

Hyperkerinization (causes clogging of the follicle)

Colonization of P. Acnes (gram posititive anaerboe colonizes ans proliferates)

Release of inflmmatory mediators (papules, pustules)

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3
Q

Clobetasol propionate

A

Topical steroid-Ultra high potency

MOA- drecrease inflammation, modulate immune response and vasocontrict blood vessels to minimize redness, warmth and swelling

Potency determined by vasocontrictor assay (higher poteny more vasocotriction)

ADR- Skin atrophy, straie, rosacea, superfical infections, hypopigmentation, contact dermatitis, tolerance, tachyphylaxsis, systemic side effects (adrenalsupression, HTN, hyperglycemia)

Considerations high potency (groups 1-3)- not to be used in the face, groin, axilla, or under occlusions, better for thichker areas (palms and bottms of feet), use for the shortest duration possible, use for psoriasis, severe poison ivy, severe atopic detmatitis

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4
Q

Avobenzone

A

UVA

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5
Q

Polycarbophil

A

Bulk forming laxative

MOA- dissolves or swells in the intestional fluid, forming wmollient gels that facilitate the passage of intestional contents and stimulate peristalsis

DOC for constipation, goos for patients on low fiber diets

1-3 days onset to soften stool

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6
Q

Tretinoin

A

Topical Retinoid

MOA- stimuate epidermal cell trunover and decrease cell cohesiveness (unplug follicles , reduces inflammtion)

ADR- skin irritation, peeling, dryness, erythema, hyperpigmentation (more tretinoin> adapalene), acne may worsen with initial use (make take 3 months for full effect),

Consideratons- wear sunscreen, avoid UV light, apply at bedtime due to photosensitivity

Available in cream or gel

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7
Q

Azathioprines

A

Thiopurines

MOA- Purine antagonist→ inhibition of DNA/ RNA synthesis→ decreased T cell function→ immunosupression

Prodrug

ADR- N/V, bone marrow supression (leukopenia), hepatoxicity

DDI- allopurinal, feboxostate

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8
Q

Magnesium Citrate

A

Saline laxative- works in small and large intestine

MOA- draws water into the intestine, increasing intraluminal pressure, whihc acts as a stimulus to increase intestinal motility

Water evacuation within 1-6 hours

Do not use in patients with electrolyte disturbances, elders, patients with renal or cardiac issues ( uncontrolled hypertensionand CHF- salt content)

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9
Q

Salicylic acid

A

MOA- Keratolytic agent

Less effective vs. retinoids and BPO

ADR- peeling, dryness, burning

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10
Q

Methylnaltrexone

A

For opioid induced constipation

MOA- peripheral acting mu opioid receptor anatagonist, DOES NOT cross BBB (does not interfer with opiod use)

ADR- abdominal pain and/ or distension, diarrhea, headache, chills

DO NOT use with patients who have history of GI obstruction

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11
Q

Azelaic acid

A

MOA- normalizes keratinization and anti- inflammatory via reduction of p. acne

Use if you cannot tolerate other therapies

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12
Q

Dimenhydrinate

A

Anti-emetic- antihistamine and antimuscarinic bloackade (vestibular system) beneficial for nausea/ vomitting, motion sickness

Blocks more H1 then M1

ADR- first gen histamien ADR (constipation, dry mouth memory impairment)

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13
Q

Cyclosporine

A

MOA- calcineurin inhibitor→ drecreases transcription of IL-2, TNF- aplha, IL-4, etc

ADR- nephrotoxicity, HTN

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14
Q

Salfasazine

A

MOA- interferes with production of inflammatory cytokines. Modulates inflammation mediators derived from COX and lipoxygenase

Topical formuation- minimal systemic effect

CONTRAINDICCATED in those with salcylate allergy

SIte of action- large intestine

ADR- rash/ hypersensitivity, photosensitivity, hemolytic anemia, folate deficicency, pancreatitis, hepatitis

Monitor- CBC, LFT

Supplement with 1 mg dailty of folic acid

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15
Q

Finger tip method

A

1 FTU- 0.5g (500 mg)

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16
Q

Crisaborole

A

MOA- not fully elucidated; non steroidal inhibitor of PDE-4

Ointment

Mild to moderate atopic dermatitis

ADR- application related pain (burning, stinging)

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17
Q

Hitting which receptors causes stimulation of vomiting center?

A
  • CNS (cortex, thalamus, hypothalamus, meninges)→ fear, anxiety, exciting causes stimuation of the vomitting center
  • vestibukar center (balance, spacial awareness)→ Motion sickness caused by hitting H1 and M1 receptors causes nausea and vomitting
  • Chemotigger zone- drugs hitting C2, NK and 5-HT3 receptors causes nausea and vomitting
  • GI tract/ Heart- direct GI irrtants causes seratonin to be released (5-HT3 receptors) which stimulates the vomitting center
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18
Q

Oxybenzone

A

UVA+ UVB

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19
Q

Bismuth Subsalicylate

A

MOA- reacts with HCl to form bismuth oxychloride and salicylic acid

  • Bismuth→ direct antimicrobial effect (H. pylori) used for travelers diarrhea
  • Salicylic acid→ inhibits chloride secretion in intestine to reduce lipid content of stool (AVOID in aspirin allergy)

DO not use in children under 12 years old→ Reyes syndrome

ADR- blackening of tongue and stool (black tarry stool), tinnitus, dry stool, confusion

CHILDRENS PETO- NOT used for diarrhea its used for upset stomach

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20
Q

Fosaprepitant

A

NK recpotor antagonist (IV Only)

MOA- central blockade of NK receptors in the chemotrigger zone, blocks bnding of substance P

Coverted to aprepotant 30 min after infusion

ONLY used for prevention of chemotherapy induced nausea/ vomitting along with 5-HT3 antagonist and corticosteriods

ARR- Fatigue/ dizziness

CYP 3A4 substrate- combination with with CYP 3A4 inhibitor (Clarithromycin, Ketoconazole, Itraconazole, HIV protase inhibitors, Grapefruit Juice, diltizem, verapamil) can cause toxicity

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21
Q

Magnesium hydroxide

A

Saline laxative- works in small and large intestine

MOA- draws water into the intestine, increasing intraluminal pressure, whihc acts as a stimulus to increase intestinal motility

Water evacuation within 1-6 hours

Do not use in patients with electrolyte disturbances, elders, patients with renal or cardiac issues ( uncontrolled hypertensionand CHF- salt content)

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22
Q

Hydrocortisone

A

Topical steroid- low potency

MOA- drecrease inflammation, modulate immune response and vasocontrict blood vessels to minimize redness, warmth and swelling

Potency determined by vasocontrictor assay (higher poteny more vasocotriction)

ADR- Skin atrophy, straie, rosacea, superfical infections, hypopigmentation, contact dermatitis, tolerance, tachyphylaxsis, systemic side effects (adrenalsupression, HTN, hyperglycemia)

Considerations high potency (groups 6-7)- safest for prolonged use, large surface areas, face or other areas with thin skin, children, think dermatitis, diaper rash, rash on face/ eyelids, perianal inflammation

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23
Q

Octocrylene

A

UVB

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24
Q

Triamcinolone acetonide

A

Topical steroid- medium to high potency

MOA- drecrease inflammation, modulate immune response and vasocontrict blood vessels to minimize redness, warmth and swelling

Potency determined by vasocontrictor assay (higher poteny more vasocotriction)

ADR- Skin atrophy, straie, rosacea, superfical infections, hypopigmentation, contact dermatitis, tolerance, tachyphylaxsis, systemic side effects (adrenalsupression, HTN, hyperglycemia)

Considerations high potency (groups 1-3)- not to be used in the face, groin, axilla, or under occlusions, better for thichker areas (palms and bottms of feet), use for the shortest duration possible, use for psoriasis, severe poison ivy, severe atopic detmatitis

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25
Q

Zinc Oxide

A

UVA+ UVB

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26
Q

Mineral Oil

A

Lubricant

MOA- Soften fecal contents by coating them, therby preventing colonic reabsorption of fecal water

Safety concern of lipid pnuemonia (risk of aspiration, SOB)

1-3 days onset to soften stool

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27
Q

Olanzapine

A

D2 receptor antagonist

Hits D2, 5-HT1c, 5-HT3 (second line chemotherapy induced nausea/ vomitting)

ADR-Dystonia, akathesia, parkinsonian, sedation, hyperprolactinemia, hypotension, dry mouth

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28
Q

Octisalate

A

UVB

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29
Q

Sucralfate

A

Sucrose+ complexed aluminum hydroxide

MOA- mixes with HCl (DO NOT perscribe with PPIs) to form viscous paste that binds directly to ulcers and erosions- “physical barrier to protect stomach”, stimulates mucosal prostoglandin and bicarbonate secretion

Constipation (aluminum), aluminum toxicity in renal disease

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30
Q

Titanium dioxide

A

UVA+ UVB

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31
Q

Palonsetron

A

5-HT3 recepotr antagonist (IV ONLY)

Used for chemotherapy induced nausea/ vomitting

MOA- central bloakade of the chemotrigger zone and vomittng center. Peripheral blockage (Seratonin receptors in GI tract) of intestinal vagal and spinal afferent nerves→ drives antiemetic benefit (80% of seratonin is found in the GI tract)

Does not hit H1, M1 or D2 receptors not suitable for the treatment of motion sickness

Long half life (40 hours)- good for delayed nausea/ vomitting

Metabolism- CYP 2D6

ADR- Headache, dizziness, constipation,least likely to casue QTc prolongation (K+ channel blockade), Seratonin syndrome (Increase levels of seratonin)

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32
Q

Netupitant

A

NK recpotor antagonist

MOA- central blockade of NK receptors in the chemotrigger zone, blocks bnding of substance P

ONLY used for prevention of chemotherapy induced nausea/ vomitting along with 5-HT3 antagonist and corticosteriods

ARR- Fatigue/ dizziness

CYP 3A4 substrate- combination with with CYP 3A4 inhibitor (Clarithromycin, Ketoconazole, Itraconazole, HIV protase inhibitors, Grapefruit Juice, diltizem, verapamil) can cause toxicity

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33
Q

Rolapitant

A

NK recpotor antagonist

MOA- central blockade of NK receptors in the chemotrigger zone, blocks bnding of substance P

ONLY used for prevention of chemotherapy induced nausea/ vomitting along with 5-HT3 antagonist and corticosteriods

ARR- Fatigue/ dizziness

CYP 3A4 substrate- combination with with CYP 3A4 inhibitor (Clarithromycin, Ketoconazole, Itraconazole, HIV protase inhibitors, Grapefruit Juice, diltizem, verapamil) can cause toxicity

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34
Q

Fluticasone propionate

A

Topical steroid- medium to high potency

MOA- drecrease inflammation, modulate immune response and vasocontrict blood vessels to minimize redness, warmth and swelling

Potency determined by vasocontrictor assay (higher poteny more vasocotriction)

ADR- Skin atrophy, straie, rosacea, superfical infections, hypopigmentation, contact dermatitis, tolerance, tachyphylaxsis, systemic side effects (adrenalsupression, HTN, hyperglycemia)

Considerations high potency (groups 1-3)- not to be used in the face, groin, axilla, or under occlusions, better for thichker areas (palms and bottms of feet), use for the shortest duration possible, use for psoriasis, severe poison ivy, severe atopic detmatitis

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35
Q

Misoprostol

A

MOA- PGE1 anaglog- increases mucosal and bicarbionate secretion, enhances mucosal blood flow

Used for NSAID- related ulcers or labar induction (OB/ GYN)

Comes in combinaion product with diclofenac sodium

ADR- Diarrhea, enhanced uterine contractine, dont take if pregnant

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36
Q

Benzoyl Peroxide

A

MOA- antimicrobial (against P. acnes), anti-inflammatory, keratolytic effects

May inactivate some formularions of tretinoin, so avoid use or sperate times of administration

Efficacy is not concentration dependent

ADR- contact dermatitis, erythema, skin, dryness, peeling, bleaching

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37
Q

Mirtazapine

A

Anti-emetic- 5HT-3 antagonism and H1 antagonism

Used for cancer (nausea and vomitting), depressed and underweight people

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38
Q

Cinoxtane

A

UVB

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39
Q

lansoprazole

A

PPI

MOA- irrevirsibly inactiavtes the hydrogen potassium adenosine triphosphate (H+/ K+/ ATPase) resulting in imparied acid secretion

Pro drug is protected by enertic coating ( dissoves in intestinal lumen abd is absorbed, carried to the parietal cells of the stomach for activation)

Bioavailibity decreases with food (take on empty stomach 30-60 min beofre first meal)

Onset of action2-3 hours, 3-4 days for maximal effect, duration of action 24 hours

Good for renal insufficiency patients

ADR- diarrhea, headache, abdominal pain, vitamin B12 deficiency, reduced absorption of iron, calcium, magnesium osteroperosis, fractures, C, diff, community aquired pneumonia

TAPER OFF- rebound hypersecretion

DDI- ketoconazole, intraconazole, atazanavir, rilpiverine, calicum caronate, iron salts

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40
Q

Budesonide

A

Coricosteriods

pH controlled- entocort (pH5.5 more in the small intestine), uceris (pH> 7 more in large colon)

CYP 3A4 metabolite- watch for CYP 3A4

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41
Q

Opioid induced constipation

A

Opioids delys gastric emptying, interrupt bowel peristalsis, reduce intestinal secretion of fluid

Traditonal laxitives still first line

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42
Q

Scopolamine (Patch)

A

Anti-emetic- antihistamine and antimuscarinic bloackade (vestibular system) beneficial for nausea/ vomitting, motion sickness

Blocks more M1 then H1

ADR- Muscarinic hot, dry fast crazy

43
Q

Betamethasone dipropionate

A

Topical steroid-high potency

MOA- drecrease inflammation, modulate immune response and vasocontrict blood vessels to minimize redness, warmth and swelling

Potency determined by vasocontrictor assay (higher poteny more vasocotriction)

ADR- Skin atrophy, straie, rosacea, superfical infections, hypopigmentation, contact dermatitis, tolerance, tachyphylaxsis, systemic side effects (adrenalsupression, HTN, hyperglycemia)

Considerations high potency (groups 1-3)- not to be used in the face, groin, axilla, or under occlusions, better for thichker areas (palms and bottms of feet), use for the shortest duration possible, use for psoriasis, severe poison ivy, severe atopic detmatitis

44
Q

Alvimopen

A

For opioid induced constipation

MOA- peripheral acting mu opioid receptor anatagonist, DOES NOT cross BBB (does not interfer with opiod use)

ADR- abdominal pain and/ or distension, diarrhea, headache, chills

Short time use only- Increased risk of MI with long term use

45
Q

Methotrexate

A

MOA- inhibits dihyrofolate reductase→ reduces purine metabolism→ inhibits DNA synthesis, repair and replication

For IBS IM/ SC

ADR- hepatoxcicity, myleosupression, nausea

46
Q

Polyethylene glycol 3350

A

Hyperosmotix laxative

MOA- draws water into rectum to simulate a bowel movement

Soften stool within 1-3 days

Okay to use in elderly, cardiac or renal deficent patients

47
Q

Dioxybenzone

A

UVA+ UVB

48
Q

Balasalazide

A

MOA- interferes with production of inflammatory cytokines. Modulates inflammation mediators derived from COX and lipoxygenase

Topical formuation- minimal systemic effect

CONTRAINDICCATED in those with salcylate allergy

SIte of action- intestine

ADR- rash/ hypersensitivity, photosensitivity, hemolytic anemia, folate deficicency, pancreatitis, hepatitis

Monitor- CBC, LFT

Supplement with 1 mg dailty of folic acid

49
Q

How does hydration, damge to stratum cornum , temperature/ friction and drug paricle size affect absorption?

A

hydration- more moisture, more absorption

damge to stratum cornum- more damage more absorption

temperature/ friction- increased temperature/ friction increased absorption

drug paricle size- smaller, soluable drugs absorb better (lipid soluble)

50
Q

Laxative Abuse

A

Laxative use to decrease absorption of calories

weight loss is NOT do to reduce calorie absoprtion its maily due to dehydration by loss of water, electrolytes and minerals

Can present as - tremors, weakness, blurry vision, fainting, kidney injury, metabolic alkalosis, or arrythmias

Increased risk of infections, colon cancer- intestines over stimulated so stops working (laxy colon)

51
Q

6-meracaptropurine

A

Thiopurines

MOA- Purine antagonist→ inhibition of DNA/ RNA synthesis→ decreased T cell function→ immunosupression

ADR- N/V, bone marrow supression (leukopenia), hepatoxicity

DDI- allopurinal, feboxostate

52
Q

Promethazine

A

D2 receptor antagonist

Hits D2, M1 (more), and alpha adrenergic

ADR-Dystonia, akathesia, parkinsonian, sedation, hyperprolactinemia, hypotension, dry mouth

53
Q

Creams

A

Pros- most widely used, easily vansih when rubbed into skin, provides lubrication

Cons- more drying vs ointments, not occlusive, application mistakes (apply toomuch or not rubbed enough)

Subacute lesions (crusting, less oozing, pruritis)

54
Q

Emollients- Lanolin, mineral oil, shea butter, cocoa butter

A

MOA- made up of fat-llike substances that soften and soothe skin, retain moisture and provide protective

Used in combination with topical steroids “steroid sparring”- hydrated skin increases absorption fo steriods

Apply emollient first, wait 5-15 min, then appy steroid

55
Q

Calcipotriene

A

Synthetic vitamin D3 analog

MOA- inhibitrs epidermal keratinocyte hyperproliferation

Can be combined with other treatment including steroids- “steroid sparing”

Can help improve UVB light therapy (apply med AFTER light therapy)

  • heat from the light can increase absorption→ cause skin irratation

ADR- cutaneous irrtation, buring, stinging hypercalcemia (rare in larger areas)

56
Q

Linaclotide

A

Chronic constipation

MOA- activates guanylate cyclase in response to a meal→ increase cGMP→ stimulate chloride, sodium bicarbonate, and water secretion into intestinal lumen

  • also activates clonic snesory and motor neurons
    • reduces abdominal pain and increases smooth muscle contraction

ADR- diarrhea, dehydration, dizziness, hypokalemia

BBB- serious dehydration- do not use under 18, cauton in elderly and advanced kidney disease

57
Q

Desonide

A

Topical steroid- low potency

MOA- drecrease inflammation, modulate immune response and vasocontrict blood vessels to minimize redness, warmth and swelling

Potency determined by vasocontrictor assay (higher poteny more vasocotriction)

ADR- Skin atrophy, straie, rosacea, superfical infections, hypopigmentation, contact dermatitis, tolerance, tachyphylaxsis, systemic side effects (adrenalsupression, HTN, hyperglycemia)

Considerations high potency (groups 6-7)- safest for prolonged use, large surface areas, face or other areas with thin skin, children, think dermatitis, diaper rash, rash on face/ eyelids, perianal inflammation

58
Q

Rabeprazole

A

PPI

MOA- irrevirsibly inactiavtes the hydrogen potassium adenosine triphosphate (H+/ K+/ ATPase) resulting in imparied acid secretion

Pro drug is protected by enertic coating ( dissoves in intestinal lumen abd is absorbed, carried to the parietal cells of the stomach for activation)

Bioavailibity decreases with food (take on empty stomach 30-60 min beofre first meal)

Onset of action2-3 hours, 3-4 days for maximal effect, duration of action 24 hours

Good for renal insufficiency patients

ADR- diarrhea, headache, abdominal pain, vitamin B12 deficiency, reduced absorption of iron, calcium, magnesium osteroperosis, fractures, C, diff, community aquired pneumonia

TAPER OFF- rebound hypersecretion

DDI- ketoconazole, intraconazole, atazanavir, rilpiverine, calicum caronate, iron salts

59
Q

Trimethobenzamine

A

D2 receptor antagonist

D2, H1 (weak)

ADR-Dystonia, akathesia, parkinsonian, sedation, hyperprolactinemia, hypotension, dry mouth

60
Q

Meradimate

A

UVA

61
Q

Diphenhydramine

A

Anti-emetic- antihistamine and antimuscarinic bloackade (vestibular system) beneficial for nausea/ vomitting, motion sickness

Blocks more H1 then M1

ADR- first gen histamien ADR (constipation, dry mouth memory impairment)

62
Q

Nizatidine

A

H2 blockers

MOA- reversibly decreases fasting and food stimulated acid secretion by inhibiting histamine on h2 recptor of the parietal cell

mild-moderate heartburn, good for noctural acid secretion

extensive first pass effect

onset of relief 30-60min and last 6-10 hours

PRN only

63
Q

Ondansetron

A

5-HT3 recepotr antagonist

Used for chemotherapy induced nausea/ vomitting

MOA- central bloakade of the chemotrigger zone and vomittng center. Peripheral blockage (Seratonin receptors in GI tract) of intestinal vagal and spinal afferent nerves→ drives antiemetic benefit (80% of seratonin is found in the GI tract). Only one in the class that hits 5-HT1

Does not hit H1, M1 or D2 receptors not suitable for the treatment of motion sickness

Desenegrated oral tablet→ less likely to vomit the medication

Half life of about 4-6 hours

Metabolism- CYP 3A4

ADR- Headache, dizziness, constipation,small but significantly significant QTc prolongation (K+ channel blockade), Seratonin syndrome (Increase levels of seratonin)

64
Q

Procholorperazine

A

D2 receptor antagonist

Hits D2 (more), M1, and alpha adrenergic

ADR- Dystonia, akathesia, parkinsonian, sedation, hyperprolactinemia, hypotension, dry mouth

65
Q

Ointments

A

Pros- most occlusive, most useful for chronic lesions, relieves dryness, bitteness, and provide protection

cons-greasy, may be cosmeticlalt unacceptable, not applied to acutely inflamed lesiolns, do not apply intertriginous, burns, or hariy areas

Good for chronic dry lesions like psoriasis, chronic inflammation (dryness, erythema, pruritus, scaling, thick)

66
Q

Cimetidine

A

H2 blockers

MOA- reversibly decreases fasting and food stimulated acid secretion by inhibiting histamine on h2 recptor of the parietal cell

mild-moderate heartburn, good for noctural acid secretion

extensive first pass effect

onset of relief 30-60min and last 6-10 hours

PRN only

67
Q

Dolasetron

A

5-HT3 recepotr antagonist

Used for chemotherapy induced nausea/ vomitting

MOA- central bloakade of the chemotrigger zone and vomittng center. Peripheral blockage (Seratonin receptors in GI tract) of intestinal vagal and spinal afferent nerves→ drives antiemetic benefit (80% of seratonin is found in the GI tract)

Does not hit H1, M1 or D2 receptors not suitable for the treatment of motion sickness

Half life of about 4-6 hours

Metabolism- CYP 2D6

ADR- Headache, dizziness, constipation,small but significantly significant QTc prolongation (K+ channel blockade), Seratonin syndrome (Increase levels of seratonin)

68
Q

Meclizine

A

Anti-emetic- antihistamine and antimuscarinic bloackade (vestibular system) beneficial for nausea/ vomitting, motion sickness

Blocks more H1 then M1

ADR- first gen histamien ADR (constipation, dry mouth memory impairment)

69
Q

Dronabinol

A

Active ingredient THC reduces nausea/ vomitting by binding to the CB1 receptor in the CNS

Controlled substance- need to monitor for physiological and psycological dependence

Increase euphoria/ increase appetite

Used for HIV and cachexia

70
Q

Sulisobenzone

A

UVA +UVB

71
Q

Ensuli

A

UVB

72
Q

Lotions/ gels

A

Pros- cooling, may privide lubrication, may be good for oozing lesions, good for hairy areas and scalp

Cons- drying, not occlusive, must be shaken well prior to use

Good for wet lesions (posion ivy) , acute lesions (oozing, weeping, edema, pruritis, redness)

73
Q

Metoclopramide

A

D2 receptor antagonist

D1, 5-HT3 (weak)

Used for gastroparesis (stomach cannot empty)→ stimulation of peristalsis

ADR-Dystonia, akathesia, parkinsonian, sedation, hyperprolactinemia, hypotension, dry mouth

74
Q

esomeprazole

A

PPI

MOA- irrevirsibly inactiavtes the hydrogen potassium adenosine triphosphate (H+/ K+/ ATPase) resulting in imparied acid secretion

Pro drug is protected by enertic coating ( dissoves in intestinal lumen abd is absorbed, carried to the parietal cells of the stomach for activation)

Bioavailibity decreases with food (take on empty stomach 30-60 min beofre first meal)

Onset of action2-3 hours, 3-4 days for maximal effect, duration of action 24 hours

Good for renal insufficiency patients

ADR- diarrhea, headache, abdominal pain, vitamin B12 deficiency, reduced absorption of iron, calcium, magnesium osteroperosis, fractures, C, diff, community aquired pneumonia

TAPER OFF- rebound hypersecretion

DDI- ketoconazole, intraconazole, atazanavir, rilpiverine, calicum caronate, iron salts

75
Q

Sodium bicarbinate

A

Antacid

MOA- neutralize gastric pH

Symptom relief for GERD, sour stomach, acid indigestion

Work with 5 min but only last 20-30 min

Can decrease the effecicay of other drugs that require acidic environment- tetracyclines, iron, itraconazole

ADR- flatulence

Watch for renal insufficiceny

76
Q

Granisetron

A

5-HT3 recepotr antagonist

Used for chemotherapy induced nausea/ vomitting

MOA- central bloakade of the chemotrigger zone and vomittng center. Peripheral blockage (Seratonin receptors in GI tract) of intestinal vagal and spinal afferent nerves→ drives antiemetic benefit (80% of seratonin is found in the GI tract)

Does not hit H1, M1 or D2 receptors not suitable for the treatment of motion sickness

Half life of about 4-6 hours

Metabolism- CYP 3A4

ADR- Headache, dizziness, constipation,small but significantly significant QTc prolongation (K+ channel blockade), Seratonin syndrome (Increase levels of seratonin)

77
Q

Psylium

A

Bulk forming laxative

MOA- dissolves or swells in the intestional fluid, forming wmollient gels that facilitate the passage of intestional contents and stimulate peristalsis

DOC for constipation, goos for patients on low fiber diets

1-3 days onset to soften stool

78
Q

Adapalene

A

Topical Retinoid- Greater anti-inflammatory

MOA- stimuate epidermal cell trunover and decrease cell cohesiveness (unplug follicles , reduces inflammtion)

ADR- skin irritation, peeling, dryness, erythema, hyperpigmentation (more tretinoin> adapalene), acne may worsen with initial use (make take 3 months for full effect),

Consideratons- wear sunscreen, avoid UV light, apply at bedtime due to photosensitivity

Available in cream or gel

79
Q

Diphenoxylate/ atropine

A

MOA- peripheral mu opioid agonist, at hihg doses can get into CNS

Atropine co-forumation to reduce absue potential,

anticolinergic properties can contribute to antidiarrheal effect

Controlled substance- monitor for physiological and physcological dependence

ADR- dry mouth, constipation,eurphoria, respiratory depression (high doeses)

80
Q

Bisacodyl

A

Stimulant laxative

MOA- increases the propulsive peristatic activity of the intestine by local irratation of the mucosa. Stimulates the secretion of water and electrolytes in the large intestine

Can cause electrolyte and fluid deficines along with malabsportion

takes 6-12 hours for semi-fluid stool

81
Q

Tazarotene

A

Topical Retinoid- effective but poorly tolerated

MOA- stimuate epidermal cell trunover and decrease cell cohesiveness (unplug follicles , reduces inflammtion)

ADR- skin irritation, peeling, dryness, erythema, hyperpigmentation (more tretinoin> adapalene), acne may worsen with initial use (make take 3 months for full effect),

Consideratons- wear sunscreen, avoid UV light, apply at bedtime due to photosensitivity

Available in cream or gel

82
Q

Glycerin

A

Hyperosmotix laxative

MOA- draws water into rectum to simulate a bowel movement

Soften stool within 1-3 days

Okay to use in elderly, cardiac or renal deficent patients

83
Q

Famotidine

A

H2 blockers

MOA- reversibly decreases fasting and food stimulated acid secretion by inhibiting histamine on h2 recptor of the parietal cell

mild-moderate heartburn, good for noctural acid secretion

extensive first pass effect

onset of relief 30-60min and last 6-10 hours

PRN only

84
Q

Mesalamine (5- ASA)

A

MOA- interferes with production of inflammatory cytokines. Modulates inflammation mediators derived from COX and lipoxygenase

Topical formuation- minimal systemic effect

CONTRAINDICCATED in those with salcylate allergy

SIte of action-

  • small and large intestine- Pentasa,
  • illeum of small intestine and large intestine- Asacol, Lialda
  • enema- Rowasa
  • supository- Canasa

Well tolerated- HA, abdominal pain, nausea

85
Q

Lubiprostone

A

Chronic consitpation, opioid induced constipation

MOA- Activate chlroide channel-2 (CIC-2) in GI epithelial cells→ efflux of Cl- into lumen of GI tract → followed by efflux of Na+→ follwoed by water (increase fluid secretion, increase intestinal transport)

ADR- nausea, diarrhea, abdominal pain and distention, headache

86
Q

Pantoprazole

A

PPI

MOA- irrevirsibly inactiavtes the hydrogen potassium adenosine triphosphate (H+/ K+/ ATPase) resulting in imparied acid secretion

Pro drug is protected by enertic coating ( dissoves in intestinal lumen abd is absorbed, carried to the parietal cells of the stomach for activation)

Bioavailibity decreases with food (take on empty stomach 30-60 min beofre first meal)

Onset of action2-3 hours, 3-4 days for maximal effect, duration of action 24 hours

Good for renal insufficiency patients

ADR- diarrhea, headache, abdominal pain, vitamin B12 deficiency, reduced absorption of iron, calcium, magnesium osteroperosis, fractures, C, diff, community aquired pneumonia

TAPER OFF- rebound hypersecretion

DDI- ketoconazole, intraconazole, atazanavir, rilpiverine, calicum caronate, iron salts

87
Q

Fluocinonide

A

Topical steroid- high potency

MOA- drecrease inflammation, modulate immune response and vasocontrict blood vessels to minimize redness, warmth and swelling

Potency determined by vasocontrictor assay (higher poteny more vasocotriction)

ADR- Skin atrophy, straie, rosacea, superfical infections, hypopigmentation, contact dermatitis, tolerance, tachyphylaxsis, systemic side effects (adrenalsupression, HTN, hyperglycemia)

Considerations high potency (groups 1-3)- not to be used in the face, groin, axilla, or under occlusions, better for thichker areas (palms and bottms of feet), use for the shortest duration possible, use for psoriasis, severe poison ivy, severe atopic detmatitis

88
Q

Olsalazine

A

MOA- interferes with production of inflammatory cytokines. Modulates inflammation mediators derived from COX and lipoxygenase

Topical formuation- minimal systemic effect

CONTRAINDICCATED in those with salcylate allergy

SIte of action- large intestine

ADR- secretory diarrhea

89
Q

Loperamide

A

MOA- synthetic, peripheral mu opiod agonist that stimuate recptors located in the intestinal circular muscle (slows intestinal contraction, inhibits sevretion of electrolytes and water)

at high doses hits central mu opoid receptors for analgesic effect (abuse potential)

ADR- dizziness, mild constipation, abdominal pain/ distention

ADR- caridac arrhythmias (K+ channel blockade), syncope, cardiac arrest

90
Q

Homosalate

A

UVB

91
Q

Halobetasol propionate

A

Topical steroid-Ultra high potency

MOA- drecrease inflammation, modulate immune response and vasocontrict blood vessels to minimize redness, warmth and swelling

Potency determined by vasocontrictor assay (higher poteny more vasocotriction)

ADR- Skin atrophy, straie, rosacea, superfical infections, hypopigmentation, contact dermatitis, tolerance, tachyphylaxsis, systemic side effects (adrenalsupression, HTN, hyperglycemia)

Considerations high potency (groups 1-3)- not to be used in the face, groin, axilla, or under occlusions, better for thichker areas (palms and bottms of feet), use for the shortest duration possible, use for psoriasis, severe poison ivy, severe atopic detmatitis

92
Q

Senna

A

Stimulant laxative

MOA- increases the propulsive peristatic activity of the intestine by local irratation of the mucosa. Stimulates the secretion of water and electrolytes in the large intestine

Can cause electrolyte and fluid deficines along with malabsportion

takes 6-12 hours for semi-fluid stool

93
Q

Magneisum and aluminum hydroxide

A

Antacid

MOA- neutralize gastric pH

Symptom relief for GERD, sour stomach, acid indigestion

Work with 5 min but only last 20-30 min

Can decrease the effecicay of other drugs that require acidic environment- tetracyclines, iron, itraconazole

ADR- magnessium (diarrhea), aluminium (constipation),

Watch for renal insufficiceny

94
Q

omeprazole

A

PPI

MOA- irrevirsibly inactiavtes the hydrogen potassium adenosine triphosphate (H+/ K+/ ATPase) resulting in imparied acid secretion

Pro drug is protected by enertic coating ( dissoves in intestinal lumen abd is absorbed, carried to the parietal cells of the stomach for activation)

Bioavailibity decreases with food (take on empty stomach 30-60 min beofre first meal)

Onset of action2-3 hours, 3-4 days for maximal effect, duration of action 24 hours

Omeprazole (CYP 2C19 inhibitor) and clopidogrel (CYP 2C19 prodrug)= theraputic failure of clopedigrel

Good for renal insufficiency patients

ADR- diarrhea, headache, abdominal pain, vitamin B12 deficiency, reduced absorption of iron, calcium, magnesium osteroperosis, fractures, C, diff, community aquired pneumonia

TAPER OFF- rebound hypersecretion

DDI- ketoconazole, intraconazole, atazanavir, rilpiverine, calicum caronate, iron salts

95
Q

Aprepitant

A

NK recpotor antagonist

MOA- central blockade of NK receptors in the chemotrigger zone, blocks bnding of substance P

ONLY used for prevention of chemotherapy induced nausea/ vomitting along with 5-HT3 antagonist and corticosteriods

ARR- Fatigue/ dizziness

Aprepitant and warfarin can cause decrease INR (increase clotting, increase risk of stroke or DVT)

CYP 3A4 substrate- combination with with CYP 3A4 inhibitor (Clarithromycin, Ketoconazole, Itraconazole, HIV protase inhibitors, Grapefruit Juice, diltizem, verapamil) can cause toxicity

96
Q

Rantidine

A

H2 blockers

MOA- reversibly decreases fasting and food stimulated acid secretion by inhibiting histamine on h2 recptor of the parietal cell

mild-moderate heartburn, good for noctural acid secretion

extensive first pass effect

onset of relief 30-60min and last 6-10 hours

PRN only

97
Q

Docusate sodium

A

Emollient laxative

MOA- increase the wetting efficacy of intertinal fluid and facilittes a mixture of aq and fatty substances to soften feces (doesn’t bulk stool)

Good for patients with dry stoool, straining when defecating

1-3 days onset to soften stool

98
Q

Ecamsule

A

UVA

99
Q

Padimate O

A

UVB

100
Q

Mometasone furoate

A

Topical steroid- medium potency

MOA- drecrease inflammation, modulate immune response and vasocontrict blood vessels to minimize redness, warmth and swelling

Potency determined by vasocontrictor assay (higher poteny more vasocotriction)

ADR- Skin atrophy, straie, rosacea, superfical infections, hypopigmentation, contact dermatitis, tolerance, tachyphylaxsis, systemic side effects (adrenalsupression, HTN, hyperglycemia)

Considerations medium (groups 4-5)- consider starting here and switiching to higher (or lower) potency as needed, think atopic dermatitis, hemorrhoids (severe), dermatitis (severe)

101
Q

Calcium carbonate

A

Antacid

MOA- neutralize gastric pH

Symptom relief for GERD, sour stomach, acid indigestion

Work with 5 min but only last 20-30 min

Can decrease the effecicay of other drugs that require acidic environment- tetracyclines, iron, itraconazole

ADR- constipation

Watch for renal insufficiceny

102
Q

Sodium phosphate/ diphosphate

A

Saline laxative- works in small and large intestine

MOA- draws water into the intestine, increasing intraluminal pressure, whihc acts as a stimulus to increase intestinal motility

takes 6-12 hours for semi-fluid stool

Do not use in patients with electrolyte disturbances, elders, patients with renal or cardiac issues ( uncontrolled hypertensionand CHF- salt content)

103
Q

Nabilone

A

Active ingredient THC reduces nausea/ vomitting by binding to the CB1 receptor in the CNS

Controlled substance- need to monitor for physiological and psycological dependence

Increase euphoria/ increase appetite

104
Q

Methylcellulose

A

Bulk forming laxative

MOA- dissolves or swells in the intestional fluid, forming wmollient gels that facilitate the passage of intestional contents and stimulate peristalsis

DOC for constipation, goos for patients on low fiber diets

1-3 days onset to soften stool

Pharm (9 decks)

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