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Pharmacology > Geriatrics, Supplements, pain2 > Flashcards

Geriatrics, Supplements, pain2 Flashcards

1
Q

T or F: in palliative care, the goal is to minimize the number of medications in order to improve quality of life, and no longer “CURE” the disease

A

True

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2
Q

what can you do to your patient’s medications if they can no longer swallow their medications?

A

use liquids, crush tabs, injections, rectal administration

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3
Q

What classes of medications can be used to treat anxiety in palliative care?

A

Benzodiazepines
SSRI
Antipsychotics
Haloperidol

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4
Q

When is Haloperidol the best choice in treating anxiety associated with palliative care?

A

if the patient has anxiety AND delirium

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5
Q

When treating delirium in palliative care, which of the following medications should you avoid:

  • Antipsychotics
  • Haloperidol
  • Benzodiazepines
  • Chlorpromazine
A

Benzodiazepines - may worsen delirium

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6
Q

you are seeing a patient who is on palliative care, and she is suffering from dyspnea. After attempting to treat the cause without success, you prescribe _____

A

opioids

first line for dyspnea

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7
Q

T or F: use a high dose opioids for respiratory depression to alleviate dyspnea at end of life

A

FALSE - low dose is effective enough to suppress respiratory awareness

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8
Q

T or F: may need a high dose opioids for pain related to palliative care.

A

True - may need higher dose of short-acting opioid for breakthrough pain.

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9
Q

what must you be cautious of with opioids used for treating pain at end of life?

A

Respiratory depression, constipation, neurotoxicity

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10
Q

when do you start treatment of terminal secretions in the lungs?

A

At the FIRST sign of secretions - they do not help existing secretions, only prevent it

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11
Q

what is the standard of therapy for pulmonary secretions?

A

Anticholinergic Drugs (atropine, hyoscyamine, scopolamine, glycopyrrolate)

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12
Q

Atropine
Hyoscyamine
Scopolamine
Glycopyrrolate

are used for what?

A

anticholinergics, used to dry up terminal pulmonary secretions

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13
Q

How could you change medications with someone who has hypotension and is at the end stage of their life with heart failure?

A

decrease ACE Inhibitor

taper off Beta blockers

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14
Q

Your patient has end stage heart failure and is experiencing volume overload. You decide to carefully increase their diuretic, but you must be cautious of what?

A

Dehydration

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15
Q

what kind of urinary incontinence is characterized by an underactive urethra leading to a lack or resistance to outflow.

A

Stress incontinence - when intra-abdominal pressure > intra-urethral pressure

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16
Q

What are some risk factors to stress incontinence?

A

Pregnancy, vaginal delivery, menopause, obesity, increased age.

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17
Q

which type of urge incontinence is characterized by an overactive detrusor muscle?

A

urge incontinence

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18
Q

which medication will you reach for first when treating Stress incontinence?

A

Duloxetine

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19
Q

which 2 adverse effects do you need to watch for with Duloxetine used to treat stress incontinence?

A

increase in BP

increase in suicide risk

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20
Q

this class of medication is sometimes used to treat stress incontinence, but is not recommended due to adverse effects and many contraindications

A

alpha-agonists (pseudoephedrine and phenylephrine)

estrogen

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21
Q

this choice of treating stress incontinence might be a good option if patient has estrogen deficiency

A

estrogen

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22
Q 
Darifenacin
Fesoterodine
Soilfenacin
Trospium
Oxybutynin
Tolterodine
A

Anticholinergic/antimuscarinic drugs (treating urge incontinence)

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23
Q

what is the first line treatment of urge incontinence

A

anticholinergic/antimuscarinic drugs

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24
Q

you start your patient on Fesoterodine for urge incontinence, and tell her that she should wait _____ to see the full effect

A

4 weeks for full effect

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25
Q

What are the adverse effects of the anticholinergics?

A 
dry mouth
constipation
blurred vision
flushing
orthostatic hypotension
sedation
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26
Q

Bethanecol and alpha antagonists (silodosin, prazosin, terazosin) are sometimes used to treat what?

A

overflow incontinence

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27
Q

your patient has BPH, which is obstructing the urethra and causing overflow incontinence. What can you treat him with?

A

either bethenacol or alpha antagonists (silodosin, prazosin, terazosin)

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28
Q

which class of medications is the worst culprit of losing bone mass density?

A

Glucocorticoids

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29
Q

your patient asks you what they can do NONPHARMACOLOGICALLY to increase bone mass density and you tell them to eat foods that contain which nutrients?

A

foods with calcium and vitamin D

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30
Q

T or F: your patient should exercise doing NON-weight bearing activity to reduce tension on the bones

A

False - weight bearing activities are best along with muscle strengthening

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31
Q

Alendronate
Ibandronate
Risedronate
Zoledronic Acid

A

Bisphosphonates - first line therapy for osteoporosis

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32
Q

how long do you treat a person with bisphosphonates?

A

5 years

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33
Q

why shouldn’t you treat with bisphosphonates longer than 5 years?

A

risk of jaw osteonecrosis, subtrochanteric fractures

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34
Q

how long before eating breakfast should you take bisphosphonates?

A

30-60 minutes prior, and don’t lay down after

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35
Q

what is the most common adverse effects associated with bisphosphonates?

A

GI effects (n/v, diarrhea, esophagitis)

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36
Q

you are about to administer Zoledronic acid IV - how can you reduce the flu-like symptom AE that is common?

A

pre-treat with APAP

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37
Q

bisphosphonates ok for pregnancy?

A

NO

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38
Q

what should you prescribe your patient who has osteoporosis but cannot tolerate bisphosphonates

A

Denosumab

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39
Q

only use this medication for osteoporosis if the patient has VERY HIGH FRACTURE RISK

A

Teriparatide (not first line!)

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40
Q

most of the osteoporosis medications block osteoclast activity, but this one specifically enhances
osteoblastic activity

A

Teriparatide (caution if pre-existing hypercalcemia)

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41
Q

Black box warning for teriparatide

A

Osteosarcoma

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42
Q

what is the maximum recommended time frame for teriparatide

A

2 years (daily injections)

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43
Q

What is the medication under the class Selective Estrogen Receptor Modulator (SERM)

A

Raloxifine

44
Q

what is the MOA of Raloxifine

A

estrogen-like activity

45
Q

raloxifene contraindications

A

pregnancy, if could become pregnancy, nursing

46
Q

what fraction of patients do not reveal their supplement use to providers

A

2/3

47
Q

why do people take CoQ10

A

improve outcomes in heart failure and improve ejection fraction, myocardial energy

48
Q

Why do people take fish oil?

A

reduce triglycerides

49
Q

AE of fish oil

A

GI reflux, fishy taste, bleeding risk if > 5 mg

50
Q

Why do people take Ginkgo Biloba?

A

improves cognition in dementia (enhancement of cerebral blood flow)

51
Q

what is the risk with ginkgo biloba

A

increased bleeding risk due to antiplatelet and antithrombotic effects

52
Q

why do people take St. John’s Wort?

A

mild to moderate depression

53
Q

does St johns wort work with all types of depression?

A

not severe.

54
Q

Your patient notes that she wants to start an antidepressant medication to help with her depression. She mentions that she is already on St. John’s Wort. What medication should you worry about

A

NO SSRI! risk of serotonin syndrome

55
Q

this supplement is often combined with caffeine and has a high risk of hypertension, arrhythmias, MI, stroke, seizure

A

Ephedra Alkaloids

56
Q

This supplement is found in herbal supplements and teas and can cause liver toxicity, cirrhosis, fibrosis

A

Pyrrolizidine Alkaloids

57
Q

This supplement is used to self-treat opioid withdrawal, but has a risk of overdose, addiction, and salmonella contamination

A

Kratom

58
Q

this supplement is a chines herb used for weight loss, but can cause nephrotoxicity

A

Aristolochia

59
Q

which chronic conditions have the highest risk of interactions with supplements and why?

A

Seizures
Arrhythmias
CHF

these patients take more Rx medications with NARROW therapeutic indexes

60
Q

what happens when you take St. John’s Wort with Warfarin

A

increased metabolism of warfarin = decreased warfarin and lower INR

61
Q

Cardiovascular medications interact the most with what supplement?

A

St Johns Wort

62
Q

What should you educate your patient on if she takes St Johns Wort with her Oral contraceptives?

A

It interacts, and can cause contraceptive failure

63
Q

St. John’s Wort + cyclosporine can cause what?

A

transplant failure!

64
Q

T or F: most of palliative treatment is off label

A

True

65
Q

what are the FDA approved cannabinoids

A

Dronabinol

Nabilone

66
Q

of the cannabinoids used, which one is best for AIDS associated wasting?

A

Nabilone

67
Q

Which case is NOT an example of a good time to use medical marijuana
chemo-induced n/v, painful spasms not tolerated by opioids, chronic RA pain, Acute pain, AIDS wasting

A

acute pain

68
Q

THC is highly protein bound, so caution when taking with ____

A

warfarin

69
Q

THC has additive effects when combined with ___

A

sedatives, psychotropics, hypnotics, alcohol

70
Q

Contraindications THC

A 
psychotic illness
schizophrenia
bipolar
anxiety
mood disorder
substance disorder
71
Q

T or F: caution using medical marijuana with Rx opioid use

A

True

72
Q

This vaccine is found in dirt, soil and part of a combination vaccine

A

Tetanus

73
Q

Which vaccine in DTap is responsible for the vaccine against bacteria that causes membranous pharyngitis

A

Diphtheria

74
Q

How many DTaP vaaccinations necessary

A

3 (with Td booster every 10 years)

75
Q

which trimester do you give a pregnant woman DTaP

A

3rd

76
Q

how many doses of hepatitis A do we give?

A

2 doses

77
Q

How many doses of hepatitis B do we give?

A

3

78
Q

How are Hepatitis A and B different regarding transmission?

A

A - fecal/oral

B - Blood/bodily fluids

79
Q

How many doses of MMR do we give?

A

2

80
Q

which specific population should we avoid giving the MMR vaccine to, and why?

A

Immunocompromised - risk of measles (the vaccine is live-attenuated)

HIV infected is ok if not immunocompromised

81
Q

This vaccine’s common Adverse effect is a fever >1 week later (increased risk of epilepsy)

A

MMR

82
Q

this vaccine prevents a highly contagious progressive paralytic disease, that is now eradicated

A

Polio (inactivated)

83
Q

How many doses of the rotavirus vaccine do we give?

A

2-3 doses (BOTH LIVE - ATTENUATED)

84
Q

what is a major adverse effect of the rotavirus (given to kids <5 yearS)

A

Intussusception

85
Q

T or F: the rare case of seizures that happen after MMR vaccine are life-threatening

A

FALSE - they are rare, temperature related, and do NOT cause lasting damage

86
Q

What element of vaccines causes all the hype about autism?

A

Thimerosal (ethyl mercury)

87
Q

what type of vaccinations should you avoid in immunocompromised?

A

live-attenuated

88
Q

which 2 vaccinations should you give pregnant women in the second half of their pregnancy

A

Tdap
Influenza

(avoid live vaccines)

89
Q

what delayed adverse effect can happen with the varicella vaccine?

A

mild rash 20 days later

90
Q

Which medication is best for migraine pain?

A

Sumatriptan

91
Q

Which type of meds treat neuropathic pain

A

Tricyclics and Gabapentin

92
Q

Duloxetine treats what type of pain?

A

fibromyalgia

93
Q

Dexamethasone is used to treat what type of pain

A

post operative n/v

94
Q

what do you treat the pain from gout?

A

prednisone

95
Q

what medication treats pain from muscle spasm?

A

cyclobenzaprine

96
Q

which 2 opioids are less effective?

A

codeine

Tramadol - more interactions and risk of seizure

97
Q

which medication in pediatrics gives a high risk of kernicterus

A

sulfamethoxazole-trimethoprim

98
Q

Chloramphenicol in pediatric population has a risk of what?

A

Gray baby syndrome

99
Q

T or F: hepatic metabolism is slower at birth, allowing medications to build up and cause adverse effects

A

True

100
Q

benzyl alcohol and benzoic acid in babies can cause _____

A

gasping syndrome

101
Q

your patient is newly diagnosed with stress incontinence. What can you prescribe her?

A

Duloxetine

102
Q

the major risk of Ginkgo Biloba is ____

A

increased bleeding risk

103
Q

do you avoid Duloxetine in liver or kidney dysfunction?

A

Both (liver disease or CrCl < 30)

104
Q

Transdermal administration is not suggested in pediatrics, EXCEPT which?

A

methylphenidate for ADHD

105
Q

which vitamins are water soluble and excreted in urine

A

B and C

Pharmacology (12 decks)

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