Leik - Pharm

Question 1

Define pharmacokinetics

Answer 1

What the body does to a drug

Movement of drugs through the body - absorption, bioavailability, distribution, metabolism, excretion

Question 2

Define pharmadynamics

Answer 2

What a drug does to the body

Physiologic and biochemical effects of drugs.

Question 3

Define pharmacogenomics

Answer 3

How a person’s genes affect response to medications

Question 4

What is a drug that represents extensive first pass metabolism

Answer 4

FPM = all drugs go through this that are ingested, except sublingual drugs.
Insulin - GI tract would not leave enough of the active drug to have any affect on the person.

Question 5

What are age-related changes that impact pharmacokinetics?

Answer 5

what the body does to a drug:
increased fat to water ratio (less water/dehydrated)
decrease in albumin and plasma proteins
decrease in liver blood flow and size
decrease in some CYP450 pathways (less drug clearance)
Decrease in GFR

Question 6

What drugs are affected by kidney disease? (7)

Answer 6

NSAIDs 
ACEIs 
Warfarin/Coumadin 
Lithium 
Contrast dyes 
Potassium sparing diuretics 
Oral sodium phosphate - bowel prep = sudden loss of kidney function FDA warning.

Question 7

What drugs are responsible for a large number of drug-drug interactions? (5 drugs and 1 item/3 are classes of drugs)

Answer 7

potent CYP450 inhibitors.
Macrolides (-mycin), Antifungals (-azoles), Cimetidine (Tagamet), Citalopram (Celexa), Protease inhibitors (-navir), grapefruit juice

Question 8

What should be monitored for Warfarin (Coumadin)?

Answer 8

INR

Question 9

What should be monitored for Digoxin (Lanoxin)

Answer 9

digoxin level, EKG, electrolytes (K, Mg, Ca)

Question 10

Omeprazole places postmenopausal women at an increased for what?

Answer 10

fractures

Question 11

What is the black box warning of Pioglitazone (Actos)? (-glitazone)

Answer 11

TZDs of oral hypoglycemics 
may cause or exacerbate CHF - NO class III or IV HR patients. 
No hisotry of MI, stroke, BLADDER CANCER, type 1 diabetes, eye or liver problems. Stop drug if dyspnea, weight gain, cough

Question 12

What should be monitored every 3 months if a patient is on an atypical antipsychoitc?

Answer 12

Risperidone, Olanzapine, Quetiapine

Weight q3 months - high risk of weight gain, metabolic syndrome, T2DM. HIGHER mortality in elderly.

Question 13

What is an adverse effect of bisphosphonates that should be monitored?

Answer 13

Alendronate, Risedronate (nates)
Erosive esophagitis or jaw pain/Osteonecrosis
Patient teaching is necessary: take alone with water only, sit upright for 30 minutes. NO GI diesease

Question 14

What statin medication has the highest risk of rhabdomyolysis?

Answer 14

high dose Simvastatin (Zocor) - 80 mg, Chinese decent 40 mg with niacin = rhabdo

Question 15

BEERS criteria: What drug has a risk of hyponatremia from SIADH secretion?

Answer 15

Tramadol

Question 16

What are indications to place a patient on Warfarin (Coumadin) therapy? (7 conditions)

Answer 16

Atrial fibrillation 
Prosthetic heart valve 
PE 
DVT 
Stroke/CVA 
HF 
Antiphospholipid syndrome

Question 17

For patients with mechanical mitral valves, what is the target INR when on Warfarin (Coumadin) therapy?

Answer 17

2.5 - 3.5

Question 18

If a patient has a stable INR and one out of range INR <0.5 below or above therapeutic requirements, what should be done?

Answer 18

Continue current dose - retest INR within 1 - 2 weeks

Question 19

What should be done for a patient with INR <5, but it is greater than target therapy?

Answer 19

Omit one dose and/or reduce maintenance dose slightly, recheck INR

Question 20

What should you tell a patient that has missed one dose of Warfarin (Coumadin)?

Answer 20

take dose ASAP on the same day. DO NOT double dose the next day.

Question 21

What is the maximum dose of Citalopram (Celexa) for patients over the age of 60 years?

Answer 21

20 mg/day - may prolong QT interval

Question 22

What 3 household products have high levels of vitamin K?

Answer 22

Mayonnaise, canola oil, and soybean oil

Question 23

A patient with serious sulfa allergies should avoid what 2 drugs? What is alternative therapy for these patients that need management?

Answer 23

Avoid thiazide and loop diuretics

Alternatives are potassium-sparing Triamterene, Amiloride

Question 24

What is a benefit of thiazide diuretics?

Answer 24

patients with HTN and osteoporosis (reduces fracture risk)

Question 25

What are 4 major adverse effects of thiazide diuretics?

Answer 25

Hyperglycemia (monitor diabetics), elevates cholesterol and LDL, Elevates uric acid (GOUT), Hypokalemia

Question 26

What hypertension medications are safe during pregnancy? (3)

Answer 26

Methylodopa, Hydralazine, Labetalol

Question 27

What two drug classes are preferred for hypertension in diabetic patients with mild to moderate chronic kidney disease? When the eGFR is

Answer 27

ACEIs and ARBs

eGFR <60 = AVOID due to risk of hyperkalemia

Question 28

What adverse effect of calcium channel blockers are most bothersome to the patient?

Answer 28

ankle and pedal edema - consider dose decrease or inform patient to take dose later in day since this is positional/can be improved with laying down

common with dihydropyridines - Amlodipine, Nifedipine