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Pharm 1 > n/v, IBD > Flashcards

n/v, IBD Flashcards

1
Q

Scopolamine (Transderm Scop®)

class

A

anticholinergic

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2
Q 
"Diphenhydramine(Benadryl®)
Meclizine (Bonine®)
Doxylamine (Unisom)
dimenhydrinate(Dramamine)"
class
A

anti-histamines (1st gen)

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3
Q

class: Promethazine (Phenergan®), Prochlorperazine (Compazine®)

A

dopamine antagonists

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4
Q

class: Metoclopramide (Reglan®)

A

dopamine antagonist

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5
Q

Dronabinol (Marinol®) & Nabilone (Cesamet®)

class

A

cannabinoids

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6
Q

“Lorazepam (Ativan®) & alprazolam (Xanax®)
usually IV for hosp pt”
class

A

Benzodiazepines

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7
Q 
class: "Ondansetron (Zofran®) – 4mg IV or PO Q8 hrs PRN n/v
Granisetron (Sancuso®) – IV, patch
Dolasetron (Anzemet®) - IV
Palonosetron (Aloxi®) – IV
Long t1/2 – 40 hours"
A

Serotonin Antagonists

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8
Q

Aprepitant (Emend®), rolapitant (Varubi®)

class

A

Neurokinin-1 Receptor Antagonists

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9
Q

Olanzapine (Zyprexa®)

class

A

Antipsychotic

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10
Q

Sulfasalazine and Mesalamineare the main two, PO or rectal. OlsalazineandBalsalazine(alts very similar to mesalamine)
class

A

Aminosalicylate Derivatives (5-ASA)

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11
Q

Azathioprine(Imuran) and 6-mercaptopurine(6-MP) PO

class

A

Immunomodulators and Immunosuppressants

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12
Q

Cyclosporine(Gengraf)

class

A

Immunomodulators and Immunosuppressants

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13
Q

name the anti-TNF alpha drugs

A

etanercept (Enbrel), infliximab (Remicade) IV only, adalimumab (Humira), certolizumab pegol (Cimzia) and golimumab (Simponi)

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14
Q

SEs: Xerostomia, drowsiness, constipation, blurred vision, disorientation, dizziness

A

anticholinergics

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15
Q

Pt counseling: \Wash hands after applying or taking off patch

A

Scopolamine (Transderm Scop®)

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16
Q

how often to change patch for Scopolamine (Transderm Scop®)

A

every 3 days

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17
Q

contraindication for meclizine

A

under 12 y/o

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18
Q

contraindication for dramamine

A

under 2 y/o

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19
Q

1st line for pregnancy related N/V

A

Doxylamine+pyridoxine(VitB6) brand name: Diclegis

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20
Q

Pt counseling for antihistamines

A

Warn about ADDITIVE anticholinergic issues!

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21
Q

are 2nd gen antihistamines effective for motion sickness?

A

no

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22
Q

MOA: inhibition of central dopamine, muscarinic and H1 histamine receptors

A

Promethazine (Phenergan®), Prochlorperazine (Compazine®)

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23
Q

contraindications for Promethazine (Phenergan®), Prochlorperazine (Compazine®)

A

“Both: AVOID in elderly.
Compazine: BBW: elderly for dementia-related psychosis! Has anticholinergic effects in addition to the Dopamine antagonism. AVOID in altered consciousness,in addition to other sedative/opioids as further sedation and respiratory decline can occur additively
Phenergan: avoid IV, IM due to tissue necrosis”

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24
Q 
AE: EPS symptoms (with chronic PO use), sedation, dizziness, headache, low blood pressure (orthostatic hypotension), and blurred vision, carry anticholinergic effect too!!
Extrapyramidal symptoms (EPS) = dystonia, tardive dyskinesia (irreversible)
A

Promethazine (Phenergan®), Prochlorperazine (Compazine®)

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25
Q

Pt counseling for Promethazine (Phenergan®)

A

Following use of promethazine, hCG-based pregnancy tests may result in false-negatives or false-positives.

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26
Q

MOA: antipsychotic effects by centrally blocking postsynaptic dopamine receptors

A

Droperidol,

Haloperidol (Haldol®),”

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27
Q

indications for Droperidol,

Haloperidol (Haldol®),”

A

“n/v, Acute Psychosis, Tourette syndrome, agitation, behavioral disorders.
Droperidol: post-op n/v”

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28
Q

what class of meds has EPS as an AE?

A

dopamine antagonists, antipsychotic

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29
Q

BBW for Droperidol,

Haloperidol (Haldol®)

A

BBW: QT prolongation leading to torsades de pointe and sudden cardiac death

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30
Q

which is tolerated better: Droperidol,

Haloperidol (Haldol®),”

A

droperidol

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31
Q

MOA: D2 receptor antagonist. Centrally (CNS) and peripherally (GI tract). Cholinergic activity: increases lower sphincter tone and promotes gastric motility

A

Metoclopramide (Reglan®)

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32
Q

Metoclopramide (Reglan®) indications

A

chemo and post-op n/v prevention. (if benefit outweighs the risk). Promote postpartum lactation. gastroparesis, GERD

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33
Q

how to reduce risk of EPS w/ Reglan

A

Concurrent diphenhydramine use

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34
Q

AEs: Drowsiness, fatigue, QTc prolongation. EPS. Hyperprolactinemia: amenorrhea, galactorrhea, gynecomastia

A

Reglan

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35
Q

AEs: Sodium & fluid retention, hypertension, edema, hyperglycemia. Hypokalemia, dyspepsia

A

Dexamethasone (Decadron®) & methylprednisolone (Solu-Medrol®)

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36
Q

med associated with oral clefts during first trimester

A

Methylprednisolone

37
Q

indications for Dexamethasone (Decadron®) & methylprednisolone (Solu-Medrol®)

A

mod-severe chemo or radiation n/v

38
Q

BBW for Reglan

A

tardive dyskinesia

39
Q

indications: chemo n/v for those who fail to respond to conventional therapies. AIDS/chemo associated anorexia (stimulates appetite)

A

Dronabinol (Marinol®) & Nabilone (Cesamet®)

40
Q

consideration w/ dosing cannabinoids

A

avoid abrupt stop w/ high dose to prevent withdrawal

41
Q

MOA: selective 5HT3 receptor antagonist

A 
"Ondansetron (Zofran®) – 4mg IV or PO Q8 hrs PRN n/v
Granisetron (Sancuso®) – IV, patch
Dolasetron (Anzemet®) - IV
Palonosetron (Aloxi®) – IV
Long t1/2 – 40 hours"
42
Q

dosing for ondansetron

A

4mg IV or PO Q8 hrs PRN n/v

43
Q

contraindications for Serotonin Antagonists

A

“Sig hyper/hypokalemia if high dose IV. Caution: prolong QT interval
Consider underlying cardiac issues and other medications that have QT prolongation when used WITH zofran”

44
Q

are Serotonin Antagonists ok for kids?

45
Q

risk of Zofran use in pregnancy

A

can be used for severe n/v in pregnancy but concern for risk of cleft palate (24% increase)

46
Q

Pt counseling for Zofran

A

Take Zofran 20-30 min before pain killer

47
Q

MOA: NK1 receptor antagonist. Can combine with 5HT3 antagonist & corticosteroid. Increased efficacy over 2 agents alone

A

Aprepitant (Emend®), rolapitant (Varubi®)

48
Q

mod-severe chemo n/v (big guns) and prevention

A

Aprepitant (Emend®), rolapitant (Varubi®)

49
Q

AEs: Fatigue, dizziness, hiccups, diarrhea / constipation. Transient elevations in hepatic transaminases (rare)

A

Aprepitant (Emend®), rolapitant (Varubi®)

50
Q

med adjustments for Aprepitant (Emend®), rolapitant (Varubi®)

A

Moderate CYP3A4 inhibitor. Adjust chemotherapeutic agents  Vinblastine, Etoposide. Adjust warfarin

51
Q

MOA: 5-HT2A Antagonist, Moderate D2 Block

A

Olanzapine (Zyprexa®)

52
Q

last ditch for chronic n/v. Schizophrenia, Bipolar Disorder, Agitation, Depression (Adjunct)

A

Olanzapine (Zyprexa®)

53
Q

AEs: Sedation, Weight Gain, Metabolic Syndrome. Low risk of EPS and Hyperprolactinemia

A

Olanzapine (Zyprexa®)

54
Q

class: Sulfasalazine and Mesalamineare the main two, PO or rectal. OlsalazineandBalsalazine(alts very similar to mesalamine)

A

Aminosalicylate Derivatives (5-ASA)

55
Q

MOA: Anti-inflammatory+immunosuppressanteffects that act locally/topically in the GI tract

A

Sulfasalazine and Mesalamineare the main two, PO or rectal. OlsalazineandBalsalazine(alts very similar to mesalamine)

56
Q

1st line for inducing remission in UC

A

MesalaminePO or rectal

57
Q

Mesalimine red flags

A

3% will worsen with F, diarrhea, abd pain, bleeding. Consider this an allergy and never use a 5-ASA again

58
Q

AEs: HA, n, fever, rash. Rare: leukopenia, aplastic anemia, agranulocytosis, pancreatitis, hepatitis

A

suflasalazine

59
Q 
Aminosalicylate Derivatives (5-ASA)
ok in pregnancy?
A

safe in pregnancy but need to take extra folic acid.

60
Q

Mesalimine caution in pts w/ ____

61
Q

monitoring for Aminosalicylate Derivatives (5-ASA)

A

“mesa: BMP at 6 weeks, 6 months, then Q 12 months

sulfa: Monitor CBC and LFTs before starting therapy then routinely Q3 mo”

62
Q

pt counseling for Sulfasalazine

A

men must stop 3 mo before trying to conceive

63
Q

preferred in CD to “Induce remission”

A

budesonide

64
Q

Used in active IBD to suppress inflammation rapidly (short term use).

A

prednisone, prednisolone, methylprednisolone, hydrocortisone, budesonide

65
Q

contraindications for corticosteroids

A

use w/ caution in HF, HTN, post- acute MI, DM. caution in pts with GI dz (diverticulitis, fresh intestinal anastomoses, active or latent peptic ulcer, ulcerative colitis, abscess or other pyogenic infection) due to perforation risk

66
Q

dosing consideration for corticosteroids

A

Always taper steroids gradually if used longerthan ~3 weeks and at a high dose to prevent adrenal crisis

67
Q

MOA: inhibit purine biosynthesis in lymphocytes and reduce IBD-associated GI inflammation. Slow onset of action (3-12 mo)

A

Azathioprine(Imuran) and 6-mercaptopurine(6-MP) PO

68
Q

Top choice for maintaining remission in CD

A

Azathioprine(Imuran) and 6-mercaptopurine(6-MP) PO

69
Q

AEs: nausea. Rare AE: pancreatitis, fever, rash hepatitis, and leukopenia, bone marrow suppression. Risk for non-melanoma skin cancer. VERY small increased risk of lymphoma

A

Azathioprine(Imuran) and 6-mercaptopurine(6-MP) PO

70
Q

Azathioprine(Imuran) and 6-mercaptopurine(6-MP) PO drug interactions

A

SERIOUS drug interactions withallopurinol(Zyloprim)andfebuxostat (Uloric) (both for gout)

71
Q

pt education forAzathioprine(Imuran) and 6-mercaptopurine(6-MP)

A

use sun protection

72
Q

monitoring for Azathioprine(Imuran) and 6-mercaptopurine(6-MP)

A

“IF leukopenia (WBC ≤4000) or thrombocytopenia (platelet count <150,000) dose should be reduced by 50 percent or the drug should be discontinued
Labs every week X 4 wks, then periodically after (burden on pt)”

73
Q

Methotrexate

MOA

A

folate antagonist

74
Q

methotrexate indication

A

used primarily for maintaining remission of CD

75
Q

methotrexate contraindication

76
Q

AEs of methotrexate

A

Long-term use may result in serious adverse effects, including hepatotoxicity, pulmonary fibrosis, and bone marrow suppression

77
Q

drug interactions for methotrexate

A

do NOT use w/ Bactrim

78
Q

AEs: Significant toxicities: nephrotoxicity, risk of infection, seizures, hypertension, and liver function test abnormalities

A

Cyclosporine(Gengraf)

79
Q

indications forCyclosporine(Gengraf)

A

used to prevent organ rejection in transplant pts; fluminant or refractory active IBD

80
Q

indications: maintaining remission in CD, UC, RA, psoriasis and psoriatic arthritis, hidradenitis suppuritiva, juvenile RA, ankylosing spondylitis

A

anti-TNFalpha

81
Q

are anti-TNF ok in pregnancy?

A

ok in pregnancy but think about disease state and goals

82
Q

screening for anti-TNF prior to starting

A

Screen for TB, Hep B and C before starting

83
Q

what to do if pt on anti-TNF develops sepsis or serious infx

84
Q

can a person on anti-TNF get vax’ed?

A

yes, but not live vaxes

85
Q

AEs: Natalizumab(Tysabri) and vedolizumab (Entyvio)

A

Both are associated with risk of development of progressive multifocal leukoencephalopathy (PML) from reactivation of JCV, but natalizumab is more likely to cause

86
Q

moderate to severe CD patients who failed immunomodulators or corticosteroids

A

Ustekinumab(Stelara):

87
Q

Tofacitinib (Xeljanz):

contraindication

A

Hx of VTE/DVT/PE

88
Q

Tofacitinib (Xeljanz) must get what vax first

A

increases risk of herpes zoster (so must get vax)

Pharm 1 (17 decks)

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