Pharm Flashcards

Question

Lithium AE causing poluria other AE

Answer 1

Polyuria (causes nephrogenic diabetes insipidus): Inability to concentrate the urine d/t inadequate arginine vasopressin (AVP) aka ADH. AVP is released in response to rising plasma osmolality. This facilitates renal water reabsorption by increasing expression of the aquaporin 2 water channels. Lithium inhibits function of these channels --> less water reabsorption. Lithium induced hypothyroidism. - Interferes with the synthesis and release of thyroid hormone, causing a range of thyroid moralities that typically occur in the first two years of treatment. - Tx: Levothyroxine.

Answer 2

- Treatment resistant schizophrenia/schizoaffective disorder - Schizophrenia with persistent suicidality AE: - Heme: agranulocytosis/neutropenia (ANC monitoring required) - Cardiac: myocarditis, QTC prolongation - Metabolic: insulin resistance/DM - GI: constipation/adynamic ileus

Answer 3

1st line for Juvenile myoclonic epilepsy AE: - Dose-related thrombocytopenia - Hepatotoxicity - Pancreatitis - Teratogen

Answer 4

- Diplopia - Ataxia - Blood dyscrasias (agranulocytosis, aplastic anemia) - Liver toxicity - Teratogenesis (cleft lip/palate, spina bifida), - induction of cytochrome P-450 - SIADH --> hyponatremia - Stevens- Johnson syndrome

Answer 5

Cholinergic: Organophosphates D - diarrhea vs Constipation U - urination vs urinary retention M - Constricted pupils vs Dilated pupils B - bradycardia vs tachycardia, prolonged QRS, arrhythmia E - emesis L - lacrimation, sweating vs anhidrosis, flushed L - Lethargy S - Saliva vs dry mouth

Answer 6

CNS: Agitation, psychosis, insomnia, dilated pupils Cardio: tachycardia, HTN GI: dry mouth, bruxiam, anorexia Derm: diaphoresis Tx: Benzo for agitation. Antipsychotics for psychosis

Answer 7

Salicylate Sx: Tachypnea --> respiratory alkalosis N/V Cochlear toxicity --> Tinnitus Cerebral tissue injury and neuroglycopenia --> cerebral edema and AMS Inhibition of cellular metabolism --> hyperthermia and lactic acidosis Tx: Acidosis facilitates proton uptake by salicylate anion making it uncharged and free to pass through electrically neutral cell walls. - Bicarbonate acts as a base to bind free hydrogen ions in the blood --> trapping it within the bloodstream --> decrease tissue absorption - Bicarbonate also alkalinizes the urine, to reduce renal tubular absorption and increase urinary excretion. - Can also give glucose and activated charcoal (if within 2-4hrs of ingestion) ________________________________________________ Acetaminophen Path: depletion of intrahepatic glutathione --> accumulation of NAPQI Sx: Asx --> N/V/Fatigue --> elevated liver enzymes --> change in coagulation, AKI Tx: - Activated charcoal (if within 2-4hrs of ingestion) - N- acetylcysteine (most effective when given within 8 hrs)

Answer 8

Alcohol Preferred screening question: The single-item screening question “How many times in the past year have you had 5 (4 for women) or more drinks in a day? Ethylene Glycol Antifreeze, engine coolant, bake fluids Sweet tasting alcohol Sx: - AMS - Intoxication effects and GI irritation - Ethylene is metabolized into oxalic and glycolic acid --> metabolic acidosis - Oxalic acid metabolites bind to serum calcium and form calcium oxalate --> hypocalcemia --> seizures - Calcium oxylate crystals precipitate --> tubular obstruction--> AKI Tx: - Fomepizole (best) or ethanol to prevent conversion into acid. - Na Bicarb - Hemodialysis Methanol toxicity is also treated with fomepizole

Answer 9

Opioid overdose Tx: Naloxone Benzo overdose Tx: Flumazenil but can precipitate seizures

Answer 10

Alkaline solution --> injure upper GI tract and airway Emesis, dysphasia (drooling from avoiding swallowing) , stridor

Answer 11

Smoking cessation can lower risk of all-cause mortality and cardiovascular events within 5yrs - Smoking cessation can reverse or reduce loss of bone density and decrease the risk of fractures within 10yrs - Weight changes are not significant Varenicline - MOA: partial nicotine receptor agonist - Most effective than either bupropion or combined nicotine replacement therapy - AE: disordered sleep, abnormal dreams, nausea Bupropion - Decrease postcessation weight gain - Good choice of patients with unipolar depression - AE: can worsen HTN - CI in patients with seizure or eating disorder Nicotine patches and nasal spray: - decrese craving and daytime withdrawal sx - No real AE

Answer 12

NMDA receptor agonist Sx - Agitation, hallucinations - Combative - Bizarre behavior lasting 8 hrs - Traumatic injuries - HTN, Tachycardia, Ataxia, Prominent Nystagmus Tx: 1st line Benzo , Adjunctive Haloperidol

Answer 13

Inhibit protein synthesis by bind to the 23S rRNA of the 50S ribosomal subunit Bacteriostatic.

Answer 14

MOA: Blocks Na+ channels AE: PHENYTOIN: P450 induction Hirsutism Enlarged gums Nystagmus - Tx: reduce dosage Yellow-brown skin Teratogenicity (fetal hydantoin syndrome) Osteopenia Inhibited folate absorption Neuropathy Rare adverse reactions including Stevens-Johnson syndrome, DRESS syndrome, SLE-like syndrome. Toxicity leads to diplopia, ataxia, sedation.

Answer 15

MOA: beta 1 receptor agonist --> increased production of cAMP --> positive inotropic effect (increase contractibility) and positive chronotropic effects (increased HR) Decrease SVR

Answer 16

Basil insulin is typically added first to control nocturnal and fasting hyperglycemia through its continuous suppression of baseline hepatic gluconeogenesis. Options include intermediate-acting NPH (neutral protamine hagedorn) which is given twice a day, or long-acting insulin given once a day. Although both are equally effective in controlling fasting hyperglycemia, NPH carries a higher risk of hypoglycemia. In contrast, insulin glargine has no significant effect making the risk of hypoglycemia lower. SLT-2: decreases reabsorption of Na + glucose --> more Na in the renal tubules --> decrease RAAS --> reduced constriction of efferent arterioles --> decrease GFR

Answer 17

MOA: Inhibits transpeptidase from cross linking a growth peptidoglycan chain by binding to the D-ala-D-ala terminus. Resistance occurs when D-ala-D-ala terminus is replaced with D-ala-D-lactase --> decrease vancomycin binding Drug-induced direct mast cell activation through a non-IgE mediated pathway. Vancomycin binds to Mas-related G protein receptor X2 found on mast cells, triggering the release of preformed vasoactive mediators (histamine).

Answer 18

Can be used for tremors (essential tremor, tremors secondary to hyperthyroidism) Toxicity Excessive blockage --> decrease intracellular cAMP Sx of Beta 1blockade: - Cardiac suppression with bradycardia & hypotension - Confusion due to cerebral hypoperfusion Sx of Beta 2 blockade: - Broncospam - Hypoglycemia (impaired gluconeogenesis/glycogenolysis) - Confusion & seizures due to hypoglycemia DX: - ECG: sinus node dysfunction and AV block - Clinical presentation TX: - IV fluids for hypotension - Atropine for bradycardia - Glucagon to direct counteract toxicity (increasing cAMP) - Calcium gluconate sometimes given to increase blood pressure

Answer 19

Alendronate, ibandronate, risedronate, zoledronate MOA: Pyrophosphate analogs; bind hydroxyapatite in bone, inhibiting osteoclast activity. AE: - Esophagitis (if taken orally, patients are advised to take with water and remain upright for 30 minutes) - Osteonecrosis of jaw - Atypical femoral stress fractures - Hypocalcemia (decrease bone resorption) so must confirm Ca and Vit D levels before starting