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(PA school) Pharmacology I > OTCs > Flashcards

OTCs Flashcards

1
Q

For common OTC drugs, you should be able to identify what 4 things?

A

1) Pathophysiology of diseases / disorders
2) MOA of drugs
3) Adverse effects
4) Drug interactions

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2
Q

For common vitamins, minerals, enzymes & herbs, you should be able to identify what 2 things?

A

1) Diseases / disorders and acceptable products
2) MOA (if noted in slides)

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3
Q

List the 2 main categories of headaches, and what headaches are in each category

A

1) Primary
-Tension (episodic or chronic)
-Migraine (without or with aura)
-Cluster
2) Secondary
-Stroke
-Substance abuse
-Infection
-Others…

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4
Q

1) Tension headaches involve what tissues & receptors?
2) What pt of the nervous system do episodic headaches involve?
3) What about chronic headaches? How often does it happen if it’s chronic?

A

1) Myofascial tissues & pericranial nociceptors
2) PNS
3) CNS; 5 or more days per month for at least 3 months

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5
Q

1) What pathway and molecules are involved w migraines w/o aura?
2) What is stimulated? What is released and activated?

A

1) Pain pathways are stimulated and messenger molecules are involved, including nitric oxide, serotonin, and calcitonin gene–related peptide
2) Stimulation (by an axon reflex) of trigeminal sensory fibers in the large cerebral and dural vessels causes neuropeptide release with concomitant neurogenic inflammation, vasodilation, and activation of platelets and mast cells

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6
Q

1) What happens in migraines without aura?
2) What deficiency may contribute to this state?

A

1) Neuronal depolarization that spreads slowly across the cerebral cortex
2) Magnesium

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7
Q

1) What type of headaches are common in people with allergies?
2) What is a cause of headaches specific to women?

A

1) Sinus headaches
2) Estrogen withdrawal headaches

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8
Q

Why do children start taking adult doses at age 12?

A

Your liver fully matures

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9
Q

1) What is the max adult dose of APAP per day?
2) What abt ibuprofen per day?

A

1) 4000mg
2) 200-400mg every 4-6 hours as needed (1200mg)

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10
Q

1) What is the MOA of Acetaminophen (Tylenol / APAP)?
2) FDA requires manufacturers to include a boxed warning on acetaminophen products that addresses its potential to cause __________________

A

1) Central inhibition of prostaglandin synthesis
2) hepatotoxicity

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11
Q

1) Why can acetaminophen cause hepatotoxicity?
2) How may it be treated?

A

1) Metabolized by the cytochrome P450 enzyme system to a hepatotoxic intermediate metabolite that is detoxified by glutathione (Phase II conjugation)
2) May be treated with activated charcoal or acetylcysteine to supplement glutathione

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12
Q

True or false: even incidents unrelated to a drug can end up on its monograph

A

True

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13
Q

1) MOA of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
2) Give 2 examples of NSAIDs

A

1) Relieve pain through central and peripheral inhibition of cyclooxygenase (COX) with consequent inhibition of prostaglandin synthesis
2) Ibuprofen (Advil) and naproxen (Aleve)

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14
Q

Adverse effects of NSAIDs:
1) What are its side effects?
2) What is NSAID use associated with?
3) How can it cause edema?
4) What can it cause w chronic use?

A

1) GI ulceration, perforation, and bleeding
2) NSAID use is associated with increased risk for myocardial infarction (MI), heart failure, hypertension, and stroke
3) Sodium and water retention causing edema
4) Nephropathy with chronic use

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15
Q

How do NSAIDs interact with:
1) Methotrexate
2) P2Y12 inhibitors & SSRIs
3) Bisphosphonates?

A

1) Decreased methotrexate clearance
2) Increase risk of bleeding
3) Increased risk of GI bleeding / ulceration

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16
Q

How do NSAIDs interact with:
1) Digoxin
2) Phenytoin and ibuprofen
Specify what you should do for each

A

1) Decreased renal clearance; monitor
2) Displacement from protein-binding sites (albumin); monitor

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17
Q

1) Aspirin is a type of what?
2) What is its MOA
3) Is intolerance common? What are its two types?

A

1) Salicylates
2) Inhibit prostaglandin synthesis from arachidonic acid by inhibiting both COX-1 and COX-2
3) Uncommon
-cutaneous (manifesting as urticaria and angioedema) and -respiratory (manifesting as bronchospasm, laryngospasm, and rhinorrhea)

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18
Q

1) What may aspirin (salicylates) produce a positive result for?
2) What pts should it be avoided in?
3) What pts is it contraindicated for?

A

1) May produce a positive result on fecal occult blood testing, so its use should be discontinued at least 3 days before testing
2) Should be avoided in patients with a history of gout or hyperuricemia because of dose-related effects on renal uric acid
3) W. hypoprothrombinemia, vitamin K deficiency, hemophilia, history of any bleeding disorder

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19
Q

The American Academy of Pediatrics, FDA, the Centers for Disease Control and Prevention, and the Surgeon General have issued warnings that aspirin and other salicylates (including bismuth subsalicylate and nonaspirin salicylates) should be avoided in children and teenagers who have ________________ or _______________ due to the risk of ___________ syndrome

A

influenza or chicken-pox; Reye’s syndrome.

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20
Q

Describe the drug interactions (2) of salicylates (aspirin)

A

Similar to NSAIDs:
1) Valproic acid = displacement of valproic acid from protein-binding sites and inhibition of valproic acid metabolism
2) Sulfonylureas = increased risk of hypoglycemia

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21
Q

Combination products available that contain caffeine, nasal decongestants or diphenhydramine
Why might caffeine be problematic for headache use?

A

Can make a HA worse

22
Q

1) What happens with concomitant EtOH and APAP or NSAIDs?
2) What should you caution the pt abt?

A

1) Hepatoxicity
2) Use of OTC analgesics for patients that use blood thinners or drink alcohol

23
Q

If a pt is pregnant, what should you tell them to take for HA? Why?

A

APAP; NSAIDs contraindicated in third trimester, avoid aspirin

24
Q

Why are NSAIDs contraindicated in third trimester?

A

1) Delayed parturition, prolonged labor, and increased postpartum bleeding
2) Premature closure of the ductus arteriosus

25
Q

1) What should you recommend for HA for a lactating pt?2) What should you avoid?

A

1) Ibuprofen; relevant infant dose is 0.6 – 0.9%
-Acetaminophen; relevant infant dose is 3.98%
2) Avoid aspirin

26
Q

What is the pediatric APAP recommendation?

A

APAP safe for all ages: 160 mg / 5 mL suspension
Rx max depends on age & weight

27
Q

What is the pediatric ibuprofen recommendation? What does the Rx max depend on?

A

1) Ibuprofen approved >= 6 months:
100 mg / 5 mL suspension
2) Rx max depends on age & weight

28
Q

For ibuprofen and acetaminophen, list their weight based dosing, schedule, and max daily dose

A

1) Ibuprofen: 5-10mg/kg, every 6-8 hours PRN, 300mg per dose up to 4 doses or 40mg/kg/day; not to exceed 1200mg max daily dose
2) Acetaminophen: 10-15mg/kg, every 4-6 hours PRN, 480mg per dose up to 5 doses or 75mg/kg/day; not to exceed 2400mg max daily dose

29
Q

Test question:
7-month-old patient weighing 18 lbs.
What is an acceptable dose (X) of ibuprofen using 5 mg / kg?

A

41mg
Work:
18/2.2 = 8.2
8.2x5 = 41

30
Q

Test question:
7-month-old patient weighing 18 lbs. Ibuprofen comes in a 100 mg / 5 mL standard concentration. How many mL will each dose be?

A

2.1mL

31
Q

Eight-year-old patient weighing 62lbs with Periorbital cellulitis. Clindamycin (Cleocin) 75 mg / 5 mL
FDA-approved dose is 8 – 20 mg / kg / day divided into 3 – 4 doses. Prescriber used 20 mg / kg / day & TID dosing for 10 days
How many mL should you prescribe?

A

375mL

32
Q

Core body temperature is controlled by the ________________ and regulated by a feedback system involving information transmitted between the thermoregulatory center in the ___________________________ and the thermosensitive neurons in the ________________________ and ____________________

A

hypothalamus; anterior hypothalamus; skin and central nervous system (CNS)

33
Q

1) Somatic pain occurs when pain impulses are transmitted from _________________ to the central nervous system
2) Inflammatory response develops through participation of multiple mediators, including what?

A

1) peripheral nociceptors
2) Histamine, bradykinin, serotonin, leukotrienes, and prostaglandin E

34
Q

List topical medications for Musculoskeletal Injuries and Disorders

A

1) Menthol 2–16%
2) Camphor 3.2%
3) Capsaicin 0.1 – 0.15%
4) Histamine dihydrochloride 0.025%
5) Trolamine salicylate 10%
6) Methyl salicylate 10 – 30%
7) Lidocaine 4%
8) Diclofenac sodium 1%

35
Q

1) What does topical menthol stimulate? What does it activate?
2) What does topical camphor stimulate? What does it produce?
3) What does capsaicin elicit? How?

A

1) Stimulates cutaneous receptor response (i.e., acts as a counterirritant)
-Activates the transient receptor potential (TRPM8) menthol receptor, triggering the sensation of cold
2) Stimulates nerves; produces cooling sensation
3) A transient feeling of warmth through stimulation of the TRPV1 receptor and ↑ depletion of substance P

36
Q

1) Which topical for MSK disorders/ injuries is a vasodilator?
2) Which two inhibit prostaglandin synthesis?

A

1) Histamine dihydrochloride 0.025%
2) Trolamine salicylate 10%; & Methyl salicylate 10 – 30% (Rubefacient (increase blood flow))

37
Q

1) What does topical lidocaine 4% do?
2) What type of medication is Diclofenac sodium 1% topical?

A

1) Inhibits the conduction of nerve impulses
2) NSAID

38
Q

slide 25
BV:
1) What are the classic signs and symptoms?
2)

A

1) Thick white discharge w/o odor, dysuria, etc
2)

39
Q

What is Vulvovaginal Candidiasis (VVC) treated with? How is it administered? When is 7 day therapy preferred?
4) Give examples

A

Azoles; Topical – 1 to 7 days of therapy
7-day therapy preferred if pregnant
4) Clotrimazole
Miconazole
Tioconazole

40
Q

slide 28 & highlight

A

These drugs inhibit cytochrome P450 (CYP) enzymes in the cell membrane of the infecting pathogen, thereby decreasing synthesis of the fungal sterol ergosterol. The reduced membrane content of ergosterol is accompanied by an increase in lanosterol-like methylated sterols. These sterols cause structural damage to fungal membranes, resulting in the loss of normal membrane function.

41
Q

slide 29

A

Hydrocortisone 1%
Benzocaine 5 – 10% / resorcinol 2 – 3%
Rare risk of methemoglobinemia associated with benzocaine-containing products
Others

42
Q

slide 30

A

Vaginal dryness, burning, itching, and dyspareunia (if vaginal dryness is the cause of painful sexual intercourse)
Lubricants
Glycerin
Propylene glycol
Mineral oil
Others

43
Q

slide 31
How do you treat overactive bladder?

A

Oxybutynin patches (Oxytrol)
MOA: antimuscarinic

44
Q

slide 33 and highlighyt
1) Give examples of colds
2) What receptors does a virus bind to? On what cells where?

A

1) Rhinoviruses, coronaviruses, parainfluenza, respiratory syncytial virus, adenoviruses, and human metapneumovirus
2) intercellular adhesion molecule-1 receptors on respiratory epithelial cells in the nose and nasopharynx

45
Q

slide 33 and highlight

A

Infected cells release chemokine “distress signals,” and cytokines then activate inflammatory mediators and neurogenic reflexes
Inflammatory mediators and parasympathetic nervous system reflex mechanisms cause hypersecretion of watery nasal fluid

46
Q

Types of allergic rhinitis

A

Sensitization phase
Allergen stimulates beta-lymphocyte–mediated IgE production
Early phase
Rapid release of preformed mast cell mediators (e.g., histamine, proteases), as well as the production of additional mediators (e.g., prostaglandins, kinins, leukotrienes, neuropeptides)
Cellular recruitment
Leukocytes, especially eosinophils, are attracted to the nasal mucosa and release more inflammatory mediators
Late phase
Mucus hypersecretion secondary to submucosal gland hypertrophy and congestion

47
Q

slide 34

A
48
Q

slide 34

A
49
Q

slide 36
1) What initiates a cough?
2) What are the two main types?
3) What are the further classifications (next slide)

A

1) Initiated by stimulation of chemically and mechanically sensitive, vagally mediated bronchopulmonary and extrapulmonary sensory nerves in the pharynx, larynx, esophagus, and tracheobronchial airway epithelium

50
Q

Types of productive cough

A

Clear  usually acute bronchitis
Purulent  usually bacteria
Putrid malodor  usually anerobic bacteria
Smoker’s cough  purulent  usually chronic bronchitis from smoking

51
Q

nonproductive cough

A

May be associated with viral and atypical bacterial infections, gastroesophageal reflux disease (GERD), cardiac disease (e.g., congestive heart failure), and some medications

(PA school) Pharmacology I (4 decks)

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