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Pharm Exam 3 > GI/Cancer/CNS > Flashcards

GI/Cancer/CNS Flashcards

1
Q

Cancer (Carcinoma)

A
  • disease characterized by abnormal, uncontrolled cell division
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2
Q

Metastasis

A
  • abnormal cells travel to distant sites where they populate new tumors
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3
Q

Tumor

A
  • swelling, abnormal enlargement
  • aka mass,neoplasm
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4
Q

3 goals of chemotherapy

A
  • cure
  • control
  • palliation
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5
Q

Radiation

A
  • prescribed post op to kill cancer cells that remain or for inoperable cancers to shrink size of tumors that may be pressing on organs or obstructing breathing
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6
Q

Adjuvant Chemotherapy

A
  • adminstration of antineoplastic drugs after surgery or radiation
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7
Q

Growth Fraction

A
  • ratio of replicating cells to resting cells
  • antineoplastic drugs are more effective on cells with high growth fractions
  • hair follicles, bone marrow, GI tissue have high GF–might explain adverse effects
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8
Q

Vesicants

A
  • agents that can cause serious tissue injury if they escape from an artery or vein during injection or infusion
  • use central line if possible (subclavian vein)
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9
Q

Antineoplastic Drugs

A
  • extracted from plants and bacteria, also made in lab
  • kill or stop growth of cancer cells
  • alkylating agents, antimetabolites, antitumor antibiotics, hormones, hormone antagonists, natural products, biologic response modifiers and monoclonal antibodies
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10
Q

Antitumor Antibiotics

A
  • inhibit cell growth through cytotoxicity, similar to alkylating agents
  • wear gloves when preparing
  • monitor IV site
  • adverse effects: **cardiotoxicity **
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11
Q

Hormones and Hormone Anatagonists

A
  • used to slow growth of hormone dependent tumors
  • glucocorticoids, progestins, estrogens, androgens
  • doses are magnitudes larger than what the body produces
  • less cytotoxic
  • blocks substances essential for tumor growth
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12
Q

Glucocorticoids

A
  • dexamethasone, prednisone
  • inhibit inflammation
  • sometimes given as adjunct to reduce nausea, weight loss, tissue inflammation caused by other antineoplastics
  • prolonged use can result in symptoms of Cushing’s disease
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13
Q

Hormones and Hormone Antangonists

Antiestrogens

A
  • treat tumors dependent on estrogen
  • breast cancer
  • Tamoxifen
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14
Q

methotrexate (Folex, Mexate)

A
  • antimetabolite
  • blocks synthesis of folic acid (vit B12) to inhibit replication
  • used to treat choriocarcinoma, osteogenic carcinoma, leukemias, head and neck cancers, breast carcinoma, lung carcinoma
  • improved status of pts w/ rheumatoid arthritis
  • BLACK BOX
  • fatal bone marrow toxicity in high doses
  • hemorrhage/bruising due to low platelet counts
  • n/v, anorexia, GI ulceration
  • dermatologic reactions such as Stevens Johnson syndrome
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15
Q

doxorubicin

A
  • antitumor antibiotic
  • attaches to DNA, prevents normal DNA & RNA synthesis
  • severe vesicant
  • tx for solid tumors of lung, breast, ovary, bladder, leukemias, lymphomas
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16
Q

tamoxifen (Nolvadex)

A
  • hormone/hormone antagonist
  • blocks estrogen receptors on breast cancer cells
  • adverse effects; nausea, vomiting, hot flashes, fluid retention, increased risk of endometrial cancer and thrombolytic disease
  • used as a prophylactic–Nurses study
  • hirsutism, gyneocomastia
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17
Q

Immunosuppressants

A
  • used to treat severe auto immune disease
  • inhibit patients immune system
  • prevent tissue rejection in transplants
  • toxic to bone marrow
  • increase risk of infections and lymphoma
  • glucocorticoids, antimetabolites, antibodies, cacineurin inhibitors
  • monitor for indications of infections, bone marrow suppression
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18
Q

Cyclosporine

A
  • calcineurin inhibitor
  • bind to calcineurin and inhibit helper T cells
  • used to treat psoriasis
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19
Q

ulcer

A

erosion of the mucosa layer of the GI tract usually associated with acute inflammation

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20
Q

PUD

A

cause: infection by H pylori

risk factors:

  • family hx
  • Blood type O
  • smoking
  • caffeine
  • NSAIDs, corticosteroids
  • stress
  • H. pylori
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21
Q

H2-receptor blockers

A
  • slow acid secretion by stomach by blocking H2-receptors
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22
Q

antacids

A
  • neutralize stomach acid
  • inexpensive, OTC
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23
Q

ranitidine (Zantac)

A
  • H2-receptor blocker
  • decreases acid production to treat PUD
  • AE: possible reduction in red and while blood cells and platelets, loss of libido in men
24
Q

omeprazole (Prilosec)

A
  • proton pump inhibitor
  • reduces acid secretion in stomach by binding to H1 K1-ATPase
  • short term use
  • AE: headache, nausea, diarrhea, rash, abdominal pain
25
Q

aluminum hydroxide (Amophejel)

A
  • antacid
  • neutralizes stomach acid by raising pH of stomach contents
  • for relief of heartburn due to PUD or GERD
  • AE: minor; constipation
26
Q
A
27
Q

Sympathetic Nervous System

(Adrenergic System)

A
  • “fight or flight”
  • neurotransmitter: norepinephrine
  • receptors: alpha 1, alpha 2, beta 1, beta 2
28
Q

Parasympathetic Nervous System

(Cholinergic System)

A
  • “rest and digest”
  • neurotransmitter: acetycholine
  • receptors: nicotinic (neuromuscular), muscarinic (smooth muscle/heart)
29
Q

Alpha 1

A
  • increases force of cardiac contraction
  • vasocontriction
  • increases BP
  • dilates pupils
  • decreases salivary gland secretion
  • increases contraction in prostate capsule
30
Q

Alpha 2

A
  • dilates blood vessels–hypotension
  • decreases GI motility and tone
  • inhibits release or norepinephrine
31
Q

Beta 1

A
  • (mainly cardiac) increase HR & force of contraction
  • increase release of renin
32
Q

Beta 2

A
  • (mainly pulmonary) bronchioles dilate
  • blood flow increases to skeletal muscles, GI, uterus
  • bladder relaxation
  • increases glucose production
33
Q

Epinephrine

A
  • acts on more than one receptor (nonselective)
  • Alpha1: increases BP
  • Beta1: increases HR (tachycardia)
  • Beta2: promotes bronchodilation
  • used to treat allergic reaction, bronchospasm, cardiac arrest
  • adverse effects: tachycardia, V-fib, nervousness, headache, pulmonary edema, palpitations
34
Q

metroclopramide (Reglan)

A
  • direct-acting cholinergic
  • used to increase GI motility/GERD
  • also used for post op nausea and vomiting
35
Q

atropine

A
  • anticholinergic
  • acetylcholine inhibitor, increases HR, decreases secretions
  • blurred vision, urinary hesitancy, dry mouth, flush, constipation
36
Q

Immunostimulants

A
  • biologic response modifiers
  • boost patient’s immune system
  • tx of viral infections, immunodeficiencies, cancers
  • interferons, interleukins
37
Q

Immunosuppressants

A
  • inhibit patient’s immune system
  • tx of severe autoimmune disease and to prevent transplant rejection
38
Q

Drugs with Immunosuppresant activity

A
  • glucocorticoids
  • antimetabolites
  • antibodies
  • calcineurin inhibitors
39
Q

metformin

(Fortamet, Glucophage, Glumetza)

A
  • Biguanide
  • decreases hepatic production of glucose (gluconeogenesis)
  • do not promote insulin resistance
  • lowers LDL & triglyceride levels
  • adverse effects: anorexia, flatulence, n/v/d,
  • monitor liver function–contraindicated in patients with renal disease or excessive ETOH
  • discontinue before using contract dye
40
Q

Sulfonylureas

(glipizide, glimeripride, glyburide)

A
  • oral hypoglycemic
  • stimulates production of insulin from pancreatic islet cells
  • increases sensitivity of insulin receptors on target cells
  • adverse effects: hypoglycemia, GI distress, hepatotoxicity
  • flushing, palpitations, nausea with ETOH
41
Q

Insulin regular

(Humulin)

A
  • short acting
  • onset: 30-60min
  • peak: 1-5h
  • duration: 6-10h
  • only insulin that can be given IV
  • used for emergency cases of DKA
  • Promotes cellular uptake of glucose, amino acids, potassium
  • Promotes protein synthesis
    Glycogen formation and storage
  • Fatty acid storage as triglycerides
  • Conserves energy stores by promoting utilization of glucose for energy needs
  • Inhibits gluconeogenesis
42
Q

isophane susp

(NPH)

A
  • intermediate
  • onset: 1-2h
  • peak: 6-14h
  • duration: 16-24h
  • cloudy–mix last
43
Q

insulin glargine

(Lantus)

A
  • long acting
  • onset: 1.1h
  • no peak
  • duration: up to 24h
  • do not mix
44
Q

insulin lispro

(Humalog)

A
  • rapid acting
  • onset: 5-15min
  • peak: 1-1.5h
  • duration: 3-4h
45
Q

Actos

(pioglitazone)

A
  • thiazolidinediones (glitazones)
  • reduce blood glucose by decreasing insulin resistence and inhibiting hepatic gluconeogenesis
  • adverse effects: fluid retention, edema, weight gain, liver damage, headache
  • monitor LFTs
46
Q

Acarbose

(precose)

A
  • alpha-glucosidase inhibitor
  • inhibits enzyme neccessary for breaking down complex carbohydrates–delaying digestion of glucose
  • well tolerated, only minor GI side effects
  • take with first bite of meal–helps with post-prandial hyperglycemia
  • hypoglycemia must be treated with glucose not sucrose
47
Q

Valproic Acid

(Depakote)

A
  • phenytoin-like drugs, antiseizure
  • desensitizes sodium channels
  • tx for absence seizures
  • adverse effects: GI irritation, sedation, prolonged bleeding time
48
Q

Dilantin

(phenytoin)

A
  • antiseizure, hydantoin derivative
  • desensitizes sodium channels
  • used for tx of all types of epilepsy except absence seizures
  • not compatible with many other drugs–only use with NS when giving IV, run 50mg/min . flush or prime line before giving, monitor site (can cause tissue damage)
  • first line drug for status epilepticus
  • adverse effects: cardiac dysrhythmias, rash, gingival hyperplasia, drowsiness, CNS depression, hypotension
49
Q

Levodopa

(laradopa)

A
  • tx for Parkinsons
  • inscreases biosynthesis of dopamine within nerve terminals
  • can cross blood-brain barrier (dopamine cannot)
  • effectiveness “boosted” with cardidopa, combo drug=Sinemet
  • Sinemet makes more Levodopa available to CNS
  • adverse effects: dizziness, sleep dysfunction, fatigue, n/v, constipation, orthostatic hypotension, dystonia, dyskinesia
50
Q

Remicade

(Infliximab)

A
  • immunosuppressant, antibody
  • suppresses inflammation in autoimmune disorders, blocks TNF
  • tx for Crohn’s, rheumatoid arthritis, ulcerative colitis
  • one infusion can cause remission in 65% of Crohn’s pts
  • monitor WBC, RBCs, platelets, infection
51
Q

Lomotil

(diphenoxylate w/ atropine)

A
  • antidiarrheal, opioid
  • slows peristalsis
  • adverse effects: drowsiness, dizziness, avoid ETOH
  • contraindicated in patients with liver disease, glaucoma
52
Q

Vistaril, Atarax

(hydroxyzine)

A
  • antiemetic, antihistamine
  • tx of post op n/v
  • PO or IM–never IV
  • given pre op with narcotics to decrease nausea
  • adverse effects: dry mouth, drowsiness
53
Q

Compazine

(prochloroperizine)

A
  • antiemetic, dopamine antagonist
  • blocks dopamine receptors, inhibits vomiting center
  • tx for severe n/v, most frequently prescribed
  • adverse effects: dry mouth, sedation, constipation, tachycardia, orthostatic hypotension
  • adminster 2 hr before or after antacids
  • prolonged periods of high doses can cause Parkinsonian like symptoms
54
Q

Psyllium mucilloid

A
  • bulk-type laxative
  • increases absorption of water to increase size of fecal mass
  • treatment/prevention of chronic constipation
  • regular use as fiber supplement
  • slow onset
  • mix w/ 8oz of juice, milk, water
  • decreases absorption of some drugs–dig, warfarin
55
Q

Insulin

A
  • Protein that is destroyed by the GI tract
  • Promotes entry of glucose into cells
  • Provides storage of glucose as glycogen
  • Inhibits breakdown of fat and glycogen
  • Inhibits glycogenesis
  • SQ or IV (only regular insulin can be given IV) give at room temp
  • Use 100u/ml syringe at 90–rotate sites
  • roll first, Clear air bubbles
  • Regular and long acting may be mixed together in the same syringe
  • Lantus cannot be mixed with any other insulin
  • Administration must be carefully planned in conjunction w/ diet and lifestyle habits
56
Q
A

Pharm Exam 3 (1 decks)

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