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Cassandra's Pharmacology > Module 1 > Flashcards

Module 1 Flashcards

1
Q

Who has full prescriptive Authority?

A

MD or DO a.k.a. physicians

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2
Q

What is prescriptive authority?

A

The legal right to prescribe drugs

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3
Q

What are the two components of prescriptive authority?

A

Right to prescribe independently and right to prescribe without limitation

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4
Q

What scheduled drug classes can PAs prescribe to?

A

Scheduled II-V

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5
Q

In Texas, APRNs can prescribe what scheduled class of meds?

A

Scheduled III—V

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6
Q

What are controlled substances?

A

Meds that require a prescription and not at risk for addiction

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7
Q

What are scheduled drugs?

A

Drugs that are at risk for addiction

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8
Q

Legend or controlled drugs are good for how much time from the date of the prescription?

How good are they after they have been turned into the pharmacy?

A

From the date the prescription is written it is good for one month.

From the date the prescription is written and has been turned into the pharmacy, it is good for one year from the date it was written

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9
Q

Controlled drugs in class three through five are good for how long?

A

It is good for six months from the date it was written

But if not turned into the pharmacy, it will expire in 1 month.

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10
Q

Class II schedule drugs Are good for how long from the date of it being issued?

A

It is good for seven days from the date it was issued

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11
Q

What are the three primary reasons for a drug monitoring?

A

To determine therapeutic dosage, Evaluating medication adequacy, and identifying adverse effects

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12
Q

What are the four Processes of pharmacokinetics?

A

Absorption, distribution, metabolism, excretion

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13
Q

What is pharmacokinetics?

A

The study of drug movement throughout the body

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14
Q

What is absorption?

A

The drugs movement from that site of administration to the blood

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15
Q

What is distribution?

A

The drugs movement from the blood to the interstitial space of tissues and into cells

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16
Q

What is another name for metabolism?

A

Bio transformation

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17
Q

PGlycoprotein or PGP Is what?

A

It is a multi drug transporter proteins that transports a wide variety of drugs out of cells

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18
Q

For a drug to directly penetrate a Membrane what kind of solubility would it need to be?

Direct penetration of the membrane is most common

A

A drug must be lipid soluble or lipophilic

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19
Q

Can polar molecules and ions Dissolve in lipids?

A

No

Only non-ionized and non-polar can dissolve in liquids

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20
Q

The ionization of the drug is?

A

PH dependent

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21
Q

What is PH portioning also called ion trapping?

A

The process where a drug accumulates on the side of a membrane were the pH most favors it’s ionization

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22
Q

Which side do acidic drugs accumulate on?

Acidic side or alkaline side

A

Alkaline side

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23
Q

Basic drugs tend to accumulate on which side?

Acidic or alkaline

A

Acidic side

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24
Q

The rate of absorption determines what?

A

How soon effects will begin

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25
Q

The amount of absorption helps determine what?

A

How intense effects will be

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26
Q

The rate of dissolution helps determines what?

A

The rate of absorption

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27
Q

In regards to absorption, when the surface area is larger, the absorption is what?

A

Faster

When the surface areas larger, the absorption is faster

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28
Q

In regards to absorption, the greater the concentration gradient has, will have what effect on absorption?

A

Absorption will be faster

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29
Q

Which drugs are absorbed faster: High lipid soluble drugs or low lipid soluble drugs?

A

High lipid soluble drugs

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30
Q

What is distribution?

A

Movement of drugs from systemic circulation or blood to the side of drug action

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31
Q

Name 3 factors determine distribution

A

Blood flow to the tissues, ability of the drug to exit the vascular system, Ability of the drug to enter cells

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32
Q

In regards to distribution, and exiting the vascular system drugs usually leave the blood how?

A

Drugs in the vascular system leave the blood at capillary beds

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33
Q

In regards to the blood brain barrier why are neonates at risk?

A

The blood brain barrier has tight junctions that prevent drug passages, this is not Fully developed At birth

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34
Q

How do you most drugs cross the placenta?

A

Most drugs possible center via simple diffusion

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35
Q

Drugs that are non-ionized and non-polar can do you what?

A

Pass through membranes more easily Because they are more lipid soluble friendly

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36
Q

Does IV Have any barriers to absorption?

A

No, there is no barriers to absorption

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37
Q

In regards to protein binding,

Are drugs needing to be bound or free to be pharmacologically active?

A

Drugs need to be unbound or free to be pharmacologically active

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38
Q

Most drug metabolism that takes place in the liver is performed by hepatic microsomal enzyme system known as what?

A

The P450 system also know as cytochrome P450

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39
Q

Most drug metabolism occurs where?

A

Takes place in the liver

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40
Q

P4 50 enzymes can be inhibited Or induced by drugs,Leading to what?

A

To the development of drug to drug interactions which can result in an adverse drug reactions and therapeutic failures

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41
Q

A drug that induces the P4 50 enzyme can affect another drugs rate of metabolism and its effectiveness in what way?

A

It can increase another drug’s rate of metabolism which decreases it concentration and reduces effectiveness

This requires increase dosage and can cause therapeutic failure

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42
Q

A drug that inhibits the P4 50 enzyme can affect the rate of metabolism and its effectiveness how?

A

A inhibiting drug can decrease another drugs rate of metabolism and prolong its effects.

This will require decreased Dosages and may lead to toxic drug levels

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43
Q

What is a pro drug?

A

Is a compound that is pharmacologically in active when administered but once Undergoing metabolism it becomes active

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44
Q

The liver does not develop its full capacity to metabolize drugs until how long after birth?

A

Until approximately one year after birth

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45
Q

Drugs that increase the rate of drug metabolism Are called what?

A

Inducers

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46
Q

Drugs that decrease the rate of metabolism are called what?

A

Inhibitors

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47
Q

What is the first pass effect?

A

The rapid inactivation of certain oral drugs Because they are Carrie directly to the liver before they enter systemic circulation

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48
Q

What is enterohepatic recirculation?

A

It is a repeating cycle and went to drug is transport deliver to the intestate and then back to the liver

Drugs can remain in the body much longer than they otherwise would

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49
Q

Name six methods drugs can exit their body through

A 
Urine
Bile
Sweat
Saliva
Breast milk
Expired air
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50
Q

What are the three processes for excretion or elimination?

A

Glomerular filtration, passive tubular reabsorption, active tubular secretion

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51
Q

Can drugs that are polar, ionized, or a protein bound enter the breastmilk?

A

No

Only lipid soluble drugs have ready access to breastmilk

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52
Q

What is the minimum effective concentration (MEC)?

A

It is the plasma level less than which therapeutic effects will not occur

(Aka a drug must be present in concentrations at or greater than MEC)

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53
Q

What is toxic concentration?

A

The plasma level at which toxic effects begin

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54
Q

Drugs are having a narrow therapeutic range Should:

A

Be monitored for signs and symptoms of toxicity

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55
Q

What is a Drugs half-life defined as?

A

As the time required for the amount of the drug in the body to decrease by 50%

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56
Q

When a drug is administered repealing in the same dose, plateau will be reaching approximately how many half lives?

A

4-5 half lives

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57
Q

What is pharmacodynamics?

A

It is the study of a drug’s action on the body and how the drug produces it’s therapeutic effects

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58
Q

What is maximal efficacy? In relation to pharmacodynamics and that dose- response relationship

A

It is the largest effect that a drug can produce

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59
Q

What is relative potency?

A

Potency refers to the amount of drug we must give to elicit an effect

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60
Q

What is affinity?

A

It refers to the strength of the attraction between a drug and its receptor

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61
Q

Drugs with strong and high in affinity are…

A

Attracted to their receptors

Drugs with high affinity are effective in low doses and more potent

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62
Q

What is intrinsic activity?

A

It refers to the ability of a drug to activate the receptor after binding

Low intrinsic—low maximal efficacy

High intrinsic—maximal efficacy

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63
Q

Affinity an intrinsic activity are related to what pharmacodynamic theory?

A

Modified occupancy theory

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64
Q

What is an agonist?

A

A drug that mimics the body’s own regulatory molecule responses

Agonists=activate

Affinity allows binding and intrinsic activity allows the bound agonist to activate or turn on receptor function

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65
Q

Drugs a block the actions of an endogenous regulators are called what?

A

Antagonist

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66
Q

What are drugs that mimic the actions of endogenous regulatory molecules but they produce responses of intermediate intensity?

A

Partial Agonists

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67
Q

How do antagonist work?

A

They prevent receptor Activation by endogenous regulatory molecules and drugs

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68
Q

In regards to affinity And intrinsic activity, antagonists have what?

A

They have affinity for a receptor but No intrinsic activity

Affinity allows binding to a receptor but lack of intrinsic activity prevents receptor activation

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69
Q

In regards to affinity and intrinsic activity, Agonists have what?

A

Intrinsic activity Is high and affinity is high

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70
Q

What is the difference between non-competitive and competitive antagonist?

A

Non-competitive antagonists bind irreversibly
Competitive Antagonist bind reversibly to receptors

NI-non competitive irreversible

CR—competitive reversible

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71
Q

When continuously exposed to an agonist a cell can become…

A

Desensitized

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72
Q

Continuous exposure to antagonists causes the cell to become…

A

Hyper sensitive

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73
Q

What is ED 50?

A

It is defined as the average effective dose required to produce a therapeutic response in about half of the population

Can be considered the standard dose

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74
Q

What is LD50?

A

The average lethal dose in 50% of the population

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75
Q

Is a drug safe or unsafe if it has a large or wide therapeutic index

A

Relatively unsafe

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76
Q

Grapefruit juice raise his drug levels by inhibiting the CYP3A4 metabolism enzyme in which some meds will need to be changed how?

A

Dosage will need to be decreased

Grapefruit juice increases the drug levels

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77
Q

What are adverse drug reactions?

A

World health organization defines it as any noxious unintended and undesired effect that occurs at normal drug doses

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78
Q

What is a side effect?

A

Nearly unavoidable secondary drug affects produce a therapeutic doses

These are predictable, intensity is dose dependent

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79
Q

What is toxicity?

A

It is defined as the degree of detrimental physiological effects caused by excessive drug dosing

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80
Q

What is an allergic reaction?

A

An allergic reaction is an immune response

For an allergic reaction to occur, we exposure to a drug can trigger the response. There must be a prior sensitization of the immune system

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81
Q

What is an idiosyncratic effect?

A

An uncommon drug response resulting from a genetic predisposition

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82
Q

What is a paradoxical effect?

A

This is the opposite of the intended drug response

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83
Q

What is an Iatrogenic disease?

A

It is a disease that occurs as a result of medical care treatment with drugs

A.k.a. Drugs promote this disease

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84
Q

What is the QT interval?

A

It is the measure of time required for the ventricles to repolarize (relax) after contraction

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85
Q

When a QT interval is prolonged patients can develop what 2 heart rhythms?

A

They can develop torsades and Ventricular fibrillation

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86
Q

When is a med guide required?

A

The FDA makes it a requirement, when they determine that patient adherence to the directions for drug use is essential for efficacy and what they need to know about serious side effects

Created to minimize germ from potentially dangerous drugs

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87
Q

What is a black box warning?

A

It is the strongest safety warning still stay on the market

FDA requires this when serious or life-threatening risks related to the drug—this will alert providers for severe side effects

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88
Q

What is tolerance?

A

It is defined as a decrease responsiveness to a drug as a result of repeated drug administration

Will usually require higher doses

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89
Q

What is a reduction in a drug’s Responsiveness brought on by repeated dosing over a short time?

This can take days or longer to develop

A

Tachyphylaxis

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90
Q

What is bioavailability?

A

It refers to the amount of an active drug that reaches the systemic circulation (blood) from its site of admin

Think sustained release, enteric coating, extended or delayed release

Usually involves oral meds

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91
Q

What is precision medicine? And what is it related to?

A

Precision medicine refers to a more general approach to find it effective strategies for treatment of similar group of patients with specific genetic, lifestyle, and environmental factors

Pharmacogenomics

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92
Q

In the third trimester pregnancy Reno blood flow is doubled causing a large increase in the glomerular filtration rate what impact can this mean for a patient who is pregnant and taking medications?

A

Dosages of drugs may need to be increased due to the increase of drug elimination through the kidneys

This can also occur in the liver

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93
Q

For women who are pregnant tone and motility of the bowel are decreased which can have what effect on medications?

A

More time for drugs to be absorbed so a reduction in dosage might be needed

This goes for drugs that undergo enterohepatic recirculation

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94
Q

What are symptoms of a drug dependent infant?

A

Shrill cry, vomiting, and extremely irritability

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95
Q

What is Teratogenesis?

A

It is the production of congenital anomalies In the fetus

96
Q

What time period Is the pre-implantation/presomite period ?

What should you know in regards to teratogens?

A

It is from conception to week 2

Teratogens act in an all or nothing fashion—can result in death or they fully recover

97
Q

What time frame is the embryonic period?

What’s important to know in regards to teratogens?

A

Week three through week eight

Gross Malformations are produced by exposure to teratogens at this time, Pregnant patients must take special care to avoid exposure

98
Q

What time frame is the fetal period?

A

It is a week nine through term

Teratogens can disrupt function than gross anatomy

Developmental cognitive disabilities can occur if taking teratogens

99
Q

What should be done if teratogen exposure occurs during the organogenesis week 3-8?

A

Determine the expected type of malformation And at least two ultrasound scan should be done to assess the extent of the injury

If severe termination of pregnancy should be considered

100
Q

Delayed gastric emptying on pediatric patients can Have what effect on absorption?

A

It can enhance absorption

101
Q

For IM drugs, Absorption in the neonate is what?

A

Slow and erratic

102
Q

IM medication in early infancy (5-52 weeks) Has what affect on absorption?

A

It becomes more rapid in neonates than in adults

103
Q

For transdermal absorption, Which population has a faster absorption rate?

A

More rapid in kids than an older adults

This risks them for increased toxicity

104
Q

Complete maturation of the liver occurs at what age?

A

One year

105
Q

Is altered Gastro intestinal absorption a major factor in drug sensitivity in older adults?

A

No it is not

106
Q

In older adults what is the proper index of renal function?

A

Creatinine clearance

107
Q

What Female hormone is primarily dominant in the follicular phase?

A

Estrogen

108
Q

What is estrogens affect on the ovaries and endometrium?

A

They mature ovarian follicles and cars proliferation of the endometrium

109
Q

The follicle-stimulating hormone affects what female hormone?

A

Estrogen

110
Q

Mid cycle what hormone rises abruptly?

A

Luteinizing hormone

111
Q

Lutenizing hormone secretes which female hormone?

A

Progesterone

112
Q

What is the mechanism of action for estrogen and how?

A

Estrogen ask primarily through receptors in the cell nucleus Through diffusion

Emphasis that is not on the cell surface it is inside the cell in the nucleus!

113
Q

Estrogen metabolically have what effect?

A

Have important roles in glucose homeostasis

114
Q

What age does menopause typically start?

A

51 or 52 years old

115
Q

What is female sexual interest-arousal disorder?

A

Decrease in libido or decrease arousal during sexual activity

116
Q

Is estrogen FDA approved for gender affirmation therapy for transgendered women?

A

No it is not FDA approved for this purpose

It is an off label use

117
Q

What is the most common adverse effects for estrogens?

A

It’s nausea, it diminishes with continued use

118
Q

What are the Main risks for taking estrogens ?

A

Potential for Endometrial cancer, breast cancer, endometrial hyperplasia, and Cardiovascular thromboembolic events

119
Q

What is Cholasma?

A

It is a patchy brown face discoloration usually caused by estrogen. It is not dangerous

120
Q

Can you prescribe estrogen to a pregnant woman or a woman who has vaginal bleeding with no known cause?

A

No you cannot

It will be very important to find the cause of the leading prior to administration

121
Q

Estrogen is a major substrates of the CYP1A2 or CYP3A4 which means what?

A

Inducer’s and inhibitors can affect drug levels

122
Q

What affect can estrogens have on antidiabetic drugs and thyroid preparations?

A

They may decrease the effectiveness of those drugs

123
Q

Intravaginal estrogen rings and creams can Do what?

A

Can treat vaginal and vulval atrophy.

Helps control night sweats and hot flashes

124
Q

For an estrogen transdermal emotion how would you apply at?

A

Apply the emulsion in the morning to the top of both thighs and in the back calves

125
Q

How would you apply the transdermal gel?

A

Applied a gel once daily after showering to one arm (from shoulder to wrist)

126
Q

How would you apply the transdermal spray?

A

Instruct the patient to spray 1-3 sprays Once daily to the inner forearm and let it dry for at least two minutes before dressing and at least 30 minutes before washing

127
Q

How long can a intravaginal ring be good for?

A

Three months then replace

128
Q

What are phytoestrogens?

A

They are plant-based compounds I have weak Estrogenic activity

129
Q

What are selective estrogen receptor modulators?

A

They are drugs that activate estrogen receptors in some tissues and block them another’s

130
Q

What are three benefits of serms?

A

Protect against osteoporosis, maintenance of urogenital tract, and reduce LDL

131
Q

Tamoxifen has what affect on the breast?

A

It Can inhibit cell growth in the breast

132
Q

What drug is approved only for prevention and treatment of osteoporosis and for prevention of breast cancer in high risk women?

A

Raloxifene

133
Q

Bazedoxifene Has what action?

A

Combines an estrogen with an estrogen Agonist/antagonist (bazedoxifene)

134
Q

Where are progesterone’s receptors located?

A

In the cells nucleus and it must diffuse across the membrane

135
Q

In dysfunctional Uterine bleeding, progesterone levels are what?

A

They are insufficient or low

136
Q

Administering a progestin for 10 to 14 days Can help with what?

A

Dysfunctional uterine bleeding

When spotted med, withdrawal bleeding takes place

137
Q

Are you pre-cancerous condition can be surprise with progestin , What are the three treatment options for this?

A

Megesterol acetate oral, medroxyprogesterone acetate (depo-provera), and iud locally

138
Q

Name some adverse effects of progesterone

A

Breast tenderness, headach, depression, arthralgias.

Decrease and amount of cervical mucus, involuted endometrial layer

139
Q

Can you prescribe progestin to a female that has had a hysterectomy?

A

No you cannot, only estrogen

140
Q

Are estrogens on the beers criteria?

A

Yes because they identify as potentially inappropriate for you some geriatric patients

141
Q

High dose therapy of progestin In pregnant women during the first four months of pregnancy has been associated with what?

A

Increase incident of birth defects

Limb reductions, heat defects

142
Q

For a woman breast-feeding while on progestins they should know that it can cause what in babies?

A

Progressions may contribute to neonatal jaundice

143
Q

What is Flibanserin?

A

Also called addyi

It is the first improvement to manage FSIAD

Not indicated for treatment of women who are postmenopausal

Will take several weeks before benefits are seen

144
Q

What are the side effects of flibanserin?

A

Cns depression, hypotension with or without syncope

145
Q

What is the mechanism of action for bremelanotide?

A

It activates melanocortin receptors and the MOA for improving sexual desire is unknown

146
Q

What are specifics that you need to know bremelanotide?

A

It is administered subQ, At least 45 minutes before sexual activity.

Dosing is limited to one dose per 24 hours

A rise in bp can occur for up to 12 hours after taking med

147
Q

What is the most widely used reversible form of contraception?

A

Oral contraceptive pills

148
Q

What is the most common nonreversible birth control method?

A

Sterilization

149
Q

What are the most effective methods for birth control?

A

Nexplanon (etonogestrel implant), IUD, and sterilization

150
Q

Name the for least reliable methods in regards to birth control?

A

Barrier methods, periodic abstinence, spermicides, and withdrawal

151
Q

What is the female sterilization surgery and what is the male sterilization surgery?

A

Female sterilization surgery is a tubal ligation. A male sterilization surgery is a vasectomy

152
Q

Name three factors to consider when a method of birth control is being chosen

A

Effectiveness, safety and personal preference

153
Q

What does coitus mean?

A

Sex

154
Q

Can spermicide and barrier methods offer protection against STDs?

A

Yes it can also provide contraception

This method would be used If sexual activity is limited

155
Q

What are three possible alternatives For women with Cardiovascular disorders that are over the age of 35 and smoke?

A

Diaphragm, progesterone only pill, and an IUD

156
Q

What hormone do mini pills have?

A

Progesterone only

157
Q

What is the mechanism of action for estrogen?

A

It suppresses the release of the follicle-stimulating hormone, it inhibits follicular maturation

158
Q

What is progesterone’s mechanism of action in combination oral contraceptives?

A

It suppresses the mid cycles lutenizing hormone surge Which prevents ovulation

Normally LH surge triggers ovulation

159
Q

Is a pelvic exam needed to prescribe oral contraceptives?

A

No

160
Q

When prescribing oral birth control what should be done from the provider’s standpoint before prescribing?

A

Take thorough medical history and blood pressure should be taken

161
Q

These two progesterones:

Drospirenone and desogestrel appear to have what?

A

The greatest risk for thrombotic events

These should be avoided

162
Q

When should oral contraceptives be discontinued before surgery to prevent post operative thrombosis?

A

At least four weeks before surgery

163
Q

Women with a history of thrombosis should avoid combination oral contraceptives but can still do what?

A

They can take progestin only method mini pill, depo provers, IUD, and nexplanon

164
Q

What is the black box warning for oral contraceptives?

A

Cigarette smoking increases the risk of cardiovascular side effects

165
Q

Oral contraceptives protect against which two forms of cancer?

A

Ovarian and endometrial cancer

166
Q

In relation to breast cancer estrogens would have what effect?

A

It would promote the growth of existing breast carcinoma

167
Q

Oral contraceptives raise blood pressure by increasing what 2 compounds in the blood?

A

It increases angiotensin and aldosterone

168
Q

What is the effect do oral contraceptives have on the breast during early stages of lactation?

A

It can enter breastmilk, and reduce milk production in the early stages of lactation

Once milk supply is more established with solids it to the infants diet use of oral contraceptives may resume

169
Q

What is an alternative to combination oral contraceptives in the early stages of lactation?

A

Progestin only contraception

170
Q

How can a patient manage nausea related to estrogen in an oral contraceptive?

A

It can be managed by dosing at bedtime or switching to an oral contraceptive with less estrogen

Using less estrogen can reduce breast discomfort

171
Q

When is changing birth control a good time?

A

Changing birth-control is best made at the beginning of a new cycle

172
Q

Name some side effects of excess estrogen

A

Nausea, breast tenderness, edema, bloating, hypertension, migraine

173
Q

Early or mid cycle breakthrough bleeding or increase spotting is a deficiency in what hormone?

A

Estrogen

174
Q

Name some side effects of excess progestin

A

Increase appetite, weight gain, depression, fatigue, breast regression, acne, oily scalp, hair loss, hirsutism

175
Q

Late breakthrough bleeding, amenorrhea and hypermenorrhea Is a deficiency in what hormone?

A

Progestin

176
Q

Which hormone an oral contraceptives can elevate glucose levels?

A

Progestin

177
Q

Products that induce Hepatic cytochrome P3A4 can accelerate OC metabolism which can

A

Reduce the oral contraceptives affect making the need for increased dosage necessary

178
Q

What effect does oral contraceptives have on warfarin and hypoglycemic agents?

A

It can decrease the effectiveness of those meds which may require increased dosage for those meds

179
Q

Theophylline, tricyclics antidepressants, diazepam, and chlordiazepoxide Are affected by oral contraceptives how?

A

Oral contraceptives can impair hepatic metabolism and which accumulation of these drugs may result in toxic levels

Dosages may need to be reduced

180
Q

In women who normally experience heavier prolong menstrual bleeding What medication would be good for them?

A

Natazia

181
Q

If one or more pills are missed and the first week of a 28 day cycle pack what should you do?

A

Take one pill as soon as possible and continue with the pack. Also use an additional form of birth control for seven days

182
Q

If one or two pills are missed and the second or third week of a 28 day cycle pack what should you do?

A

Take one pill as soon as possible and then continue with active pills in the pack. Go ahead and skip the placebo pills and Go straight into a new pack once all the active pills have been taken

183
Q

If three or more pills are missed during the second or third week of a 28 day cycle pack, what should you do?

A

Take one pill as soon as possible and continue taking the active pills in the pack and skip the in active pills and go straight into a new pack. Also use an additional form of contraception

184
Q

If you miss taking a progesterone only contraceptive even if for just three hours late what do you need to do?

A

Use back up protection or emergency contraception if unproductive sex occurs

185
Q

For progesterone only contraceptives, if one or more doses is missed or taken after 3 hours, What should you do?

A

Take the pill ASAP and use back up contraception for two days

186
Q

For a progesterone only contraceptives, if two pills are missed in the regimen what should you do?

A

The regimen should be restarted,

And back up contraception should be used for at least two days

187
Q

And progesterone only contraception, if two pills or more amidst and there is no menstrual bleeding what should you do?

A

Take a pregnancy test

188
Q

For women switching from oral contraceptives to the transdermal patch when should the first patch be applied?

A

The first day of withdrawal bleeding

189
Q

If the patch is off more than 24 hours what should you do?

A

A new cycle has started so apply a new patch and backup contraception for the first 7 days

190
Q

Which causes more Venousthromboembolism in women: The patch or oral contraceptives?

A

The patch because they are more exposed to estrogen

191
Q

What are the patient instructions for the vaginal contraceptive ring?

A

One ring is inserted each month, Left in place for three weeks and then removed. A new ring is inserted after seven days

192
Q

Where is the Nexplanon inserted?

A

It is inserted sub-dermal in the groove between the bicep and triceps in the non-dominant arm

193
Q

How long is the Nexplanon good for?

A

FDA approves it good for three years but studies show they can be effective for five years

194
Q

When the Nexplanon is removed, how long does it take for the medicine to be undetectable in the body?

A

5 to 7 days

195
Q

For Depo-Provera, when injections or just continued return of fertility is delayed by how many months?

A

Nine months

196
Q

The Depo-Provera shot protects against pregnancy for how many months?

A

For three months

It is given by injection or subQ

197
Q

What is the black box warning for Depo-Provera?

A

This drug should not be used for more than two years

198
Q

What does Depo-Provera pose a risk for?

A

Reversible bone loss

Usually returns after discontinuation within 30 months

199
Q

What is the most reliable reversible form of birth control?

A

Intrauterine devices

200
Q

When should emergency contraception be taken?

A

Within 72 hours of unprotected intercourse

I can still be effective up to five days after intercourse

201
Q

How should you take next choice emergency contraception?

A

First how that should be taken within 72 hours of unprotected sex and in the next 12 hours the second tab it should be taken

If vomiting occurs within two hours after dosing a repeat dose may be required

202
Q

What are some patient education info for phosphodiesterase five inhibitors?

A

Can be taken with or without food although a high fat meal will delay absorption except in tadalafil

All meds should be taking one hour before sex except for Avanafil it should be taken 15-30 minutes

If lightheadedness or chest pain occurs refrain from sexual activity and notify provider

Seek medical attention if erections us more than four hours

203
Q

You should avoid grapefruit juice in phosphodiesterase five inhibitors because it will what?

A

Can raise PDE-5 inhibitors levels

204
Q

How many hours should you avoid nitrates when taking of Avanafil?

Think ASVT in time order

A

12 hours

205
Q

How many hours should you avoid nitrates when Taking sildenafil (viagra) or vardenafil?

A

24 hours

206
Q

How many hours should you avoid nitrates after tadalafil?

A

48 hours

207
Q

What is revatio’s generic name and what is it used for?

A

It is sildenafil (viagra)

It is used to treat pulmonary hypertension

208
Q

Which PDE-5 inhibitor causes prolonged QT interval?

A

Vardenafil (Levitra)

209
Q

When taking CYP3A4 inhibitor, what should be done for patients taking PDE-5 inhibitors?

A

Reduce dosage of PDE-5 inhibitors

210
Q

What is Viagra’s (sildenafil) mechanism of action?

A

It increases and preserves cGMP levels making the erection last longer and harder

211
Q

Are PDE-5 inhibitors approved for women?

A

No

212
Q

Severe hypotension Can occur as an adverse effect when taking PDE-5 inhibitors and what 2 other Drugs?

A

Nitrates or alpha adrenergic blockers

213
Q

If sudden hearing loss occurs Do men stop taking sildenafil for ED and pulmonary artery hypertension?

A

They should stop taking it for ED. They should continue taking it for pulmonary artery hypertension

214
Q

Non-arteric ischemic optic neuropathy (NAION) Is what?

A

It is an adverse effect from taking Viagra (sildenafil). It causes blockage of blood flow to the optic nerve

215
Q

Which PDE5 inhibitor can last for 36 hours?

A

Tadalafil

216
Q

Which PDE5 inhibitor has the fastest onset of action?

A

Avanafil

217
Q

What drug class does Tamsulosin belong to?

A

Alpha adrenergic antagonist or blocker

When used with Viagra this can cause symptomatic postural hypotension

218
Q

What is the generic name for Levitra and Staxyn?

A

Vardenafil

219
Q

What is the generic name for Cialis?

A

Tadalafil

220
Q

Tadalafil is used to treat what three medical problems

A

Erectile dysfunction, benign prostate hyperplasia, and pulmonary artery hypertension

221
Q

Can tadalafil (cialis) be take daily ?

A

Yes but only in men who anticipate sexual activity at least twice a week

This medication can persist for about 36 hours

222
Q

What is the generic name for Stendra?

A

Avanafil

223
Q

Are there any FDA approved meds for premature ejaculation?

A

No there are drugs prescribed off label

224
Q

What two drug classes treat benign prosthetic hyperplasia?

A

Five alpha reductase inhibitors and alpha one adrenergic antagonist/blockers

225
Q

Five alpha reductase inhibitors treat men with what kind of prostate and what kind of obstruction?

A

They are most appropriate for men with large prostate that have mechanical obstruction

Think LME

226
Q

Alpha one adrenergic antagonist/blockers are most appropriate for men with what kind of protests and what kind of obstruction?

A

They are treated for men with relatively small prostates that have dynamic obstruction

Think ASMD

227
Q

Finasteride and dutasteride Belong to what class of medications?

A

Five alpha reductase inhibitors

228
Q

Five alpha reductase inhibitors do want to the prostate?

A

They reduce the prostate size over several months

About 6 to 12 months

229
Q

Proscar is the brand name for what med?

A

Finasteride

230
Q

Women should not handle the tablets that have been broken or crushed in what med?

A

Finasteride (proscar)

The med is teratogenic to the male fetus

231
Q

Should men donate blood on finasteride (proscar)?

A

Men should not donate blood while taking this med. They should wait at least one month after stopping the drug to avoid the risk of having a pregnant woman as a blood recipient.

232
Q

If prostate specific antigen does not decrease in men while taking this med what should happen?

A

They should be evaluated for cancer

233
Q

What is important to know about dutasteride (avodart)?

A

This man has an extremely long half life about five weeks. It can take months to clear the drug after stopping. It is teratogenic, should not donate blood for 6 months after stopping. This man can increased likelihood of high-grade prostate tumors but reduce low grade prostate tumors

234
Q

When used in combination alpha one blocker and five alpha reductase inhibitor what are there actions?

A

Five alpha reductase inhibitors shrink the prostate.

Alpha one blockers provide relief by relaxing prostate smooth muscle

235
Q

Do you alpha one adrenergic antagonist reduce prostate size?

A

No they do not

They improve urinary flow

236
Q 
Alfuzosin, terazosin, fox’s Zoe in, sildosin, and tamsulosin 
Belong to what class medications?
A

Alpha one adrenergic antagonist/blockers

Cassandra's Pharmacology (14 decks)

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