Leik - Pharm Flashcards
Define pharmacokinetics
What the body does to a drug
Movement of drugs through the body - absorption, bioavailability, distribution, metabolism, excretion
Define pharmadynamics
What a drug does to the body
Physiologic and biochemical effects of drugs.
Define pharmacogenomics
How a person’s genes affect response to medications
What is a drug that represents extensive first pass metabolism
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.
What are age-related changes that impact pharmacokinetics?
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
What drugs are affected by kidney disease? (7)
NSAIDs ACEIs Warfarin/Coumadin Lithium Contrast dyes Potassium sparing diuretics Oral sodium phosphate - bowel prep = sudden loss of kidney function FDA warning.
What drugs are responsible for a large number of drug-drug interactions? (5 drugs and 1 item/3 are classes of drugs)
potent CYP450 inhibitors.
Macrolides (-mycin), Antifungals (-azoles), Cimetidine (Tagamet), Citalopram (Celexa), Protease inhibitors (-navir), grapefruit juice
What should be monitored for Warfarin (Coumadin)?
INR
What should be monitored for Digoxin (Lanoxin)
digoxin level, EKG, electrolytes (K, Mg, Ca)
Omeprazole places postmenopausal women at an increased for what?
fractures
What is the black box warning of Pioglitazone (Actos)? (-glitazone)
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
What should be monitored every 3 months if a patient is on an atypical antipsychoitc?
Risperidone, Olanzapine, Quetiapine
Weight q3 months - high risk of weight gain, metabolic syndrome, T2DM. HIGHER mortality in elderly.
What is an adverse effect of bisphosphonates that should be monitored?
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
What statin medication has the highest risk of rhabdomyolysis?
high dose Simvastatin (Zocor) - 80 mg, Chinese decent 40 mg with niacin = rhabdo
BEERS criteria: What drug has a risk of hyponatremia from SIADH secretion?
Tramadol
What are indications to place a patient on Warfarin (Coumadin) therapy? (7 conditions)
Atrial fibrillation Prosthetic heart valve PE DVT Stroke/CVA HF Antiphospholipid syndrome
For patients with mechanical mitral valves, what is the target INR when on Warfarin (Coumadin) therapy?
2.5 - 3.5
If a patient has a stable INR and one out of range INR <0.5 below or above therapeutic requirements, what should be done?
Continue current dose - retest INR within 1 - 2 weeks
What should be done for a patient with INR <5, but it is greater than target therapy?
Omit one dose and/or reduce maintenance dose slightly, recheck INR
What should you tell a patient that has missed one dose of Warfarin (Coumadin)?
take dose ASAP on the same day. DO NOT double dose the next day.
What is the maximum dose of Citalopram (Celexa) for patients over the age of 60 years?
20 mg/day - may prolong QT interval
What 3 household products have high levels of vitamin K?
Mayonnaise, canola oil, and soybean oil
A patient with serious sulfa allergies should avoid what 2 drugs? What is alternative therapy for these patients that need management?
Avoid thiazide and loop diuretics
Alternatives are potassium-sparing Triamterene, Amiloride
What is a benefit of thiazide diuretics?
patients with HTN and osteoporosis (reduces fracture risk)
