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Pharmacology > Pharm 2 Exam 3 > Flashcards

Pharm 2 Exam 3 Flashcards

1
Q

COX - 1 Enzymes

A
  • Protects gastric mucosa
  • Supports renal function
  • Promotes platelet aggregation (stickiness)
  • “good housekeeping” enzyme group
  • Blocking these enzymes cause “bad” things to happen (less protection for stomach, bleeding risk, renal toxicity)
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2
Q

COX - 2 Enzymes

A
  • promote inflammation, pain, fever
  • supports renal function and vasodilation
  • blocking these enzymes causes vasoconstriction and kidney toxicity
  • “good” things happen when these are blocked
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3
Q

NSAID Interactions

A
  • warfarin (increased bleeding risk)
  • glucocorticoids (risk for GI bleeding)
  • Alcohol (risk for GI bleeding)
  • ACEi or ARBs (kidney toxicity)
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4
Q

Aspirin (ASA) MOA / Uses

A
  • First generation, Nonselective (blocks COX 1 & 2), and irreversible
  • USES: reduction of fever, inflammation, pain (COX2) + protection against MI and stroke (COX1)
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5
Q

Aspirin ADEs

A
  • Gastric ulcers + Bleeding (lack of protection for gastric mucosa)
  • Renal impairment (contra for Stage 3 & 4)
  • Salicylism (acid/base imbalance)
  • Reye’s syndrome (in children)
  • Erectile Dysfunction (22% of users)
  • MAX dose = 20g / day; 12 g / day for kids
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6
Q

Aspirin Monitoring

A
  • signs of bleeding in GI (black stools, hematemesis)
  • Look for decreased urine output, weight gain
  • Monitor for increase in BUN and especially Creatinine
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7
Q

Ibuprofen (Advil), Naproxen (Aleve) MOA and Uses

A
  • First generation, nonselective, reversible
  • USES reduction in inflammation, fever, pain
  • Primarily used in RA and OA
  • Mild to Moderate pain
    NO use for MI/Stroke prevention
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8
Q

Ibuprofen & Naproxen ADEs

A
  • Gastric ulcers, GI bleeding, kidney impairment
  • Take with food or full glass of water, pt may need H2 blocker or PPI
  • MAX dose: 3200 mg / day
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9
Q

Ketorolac (Torodol)

A
  • Prescription only
  • Powerful for pain relief, not as effective for inflammation
  • Often used in Post-op
    ADEs: significant renal impairment (do NOT use for more than 5 days)
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10
Q

Celecoxib (Celebrex) MOA & Uses

A
  • Second generation, selective to COX2
  • USES: RA & OA, acute pain, dysmenorrhea
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11
Q

Celecoxib ADEs

A
  • Gastroduodenal ulcers
  • Cardiovascular effects (increased risk for MI and stroke, contra for heart disease pts)
  • Renal impairment
  • Sulfonamide allergy *
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12
Q

Acetaminophen (Tylenol) MOA & Uses

A
  • MOA: Prostaglandin blocker in CNS - blocks synthesis
  • No anti-inflammatory effects
  • USES: reduction of fever & pain
  • Interacts with warfarin and alcohol
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13
Q

Acetaminophen (Tylenol) ADEs

A
  • Hypersensitivity reactions (anaphylaxis, rashes)
  • Hepatotoxicity
  • MAX doses: 4 g / day for adults; 3 g / day for elderly; 2 g / day for alcohol abusers
  • Antidote : Acetylcysteine (Acetadote IV)
  • Monitor PT/INR if on warfarin for 1g/day for several days
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14
Q

Mu Opioid Receptor Function

A
  • Analgesia
  • Resp Depression
  • Euphoria
  • Sedation
  • Decrease in GI motility
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15
Q

Kappa Opioid Receptor Function

A
  • Analgesia (not as strong as Mu)
  • Sedation
  • GI motility
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16
Q

Pure Opioid Agonists (Morphine) MOA & Uses

A
  • Most effective pain relievers
  • MOA: Agonist of both Mu and Kappa receptors
  • USES: Moderate to severe acute pain (NOT mild pain or chronic pain)
  • Pain can get worse if used more than 6 months
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17
Q

Pure Opioid Agonists ADEs

A
  • Resp Depression
  • Constipation
  • Orthostatic hypotension
  • Urinary retention
  • Cough suppression
  • Sedation
  • N / V
  • Overdose triad: Resp depression, coma, pinpoint pupils
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18
Q

Pure Opioid Agonist Monitoring

A
  • RR (less than 10 needs to be held), contra for premies
  • Increase fluids, fiber, and activity, give surfactant lax to prevent, stimulant lax to treat
  • Watch for lightheadedness, dizziness
  • Watch I’s & O’s, assess for ab distention
  • Assess for aspiration risk
  • Avoid driving, avoid other CNS depressants
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19
Q

Pure opioid antagonists (Narcan) MOA & Uses

A
  • MOA: Blocks both Mu & Kappa receptors
  • Higher affinity for opioid receptors = kicks opioids off to counteract
  • USES: Overdoses of opioid
  • High first pass effect (not given orally), and shorter half life than many opioids
  • Onset: 1-2 min IV; 8-13 min Intranasal
20
Q

Pure opioid antagonists ADEs

A
  • Rebound pain
  • Tachycardia
  • Tachypnea
  • Can put pt’s in resp distress
21
Q

Opioid Agonist / Antagonist (Buprenorphine) MOA & Uses

A
  • MOA: Activates Mu and blocks Kappa OR Activates Kappa and blocks Mu
  • Less euphoria, used with opioid dependents and labor & delivery
22
Q

DMARDs 1 (Methotrexate) MOA & Uses

A
  • First line drug for RA, immunosuppressant, major nonbiologic
  • Slows progression of RA
  • 3-6 weeks for effects, may be months to reach therapeutic
23
Q

DMARDs 1 (Methotrexate) ADEs

A
  • Very cytotoxic (kills healthy and unhealthy cells)
  • Interacts with NSAIDs
24
Q

DMARDs 2 (Abatacept “Orenia”) MOA

A
  • Major biologic
  • MOA: targeting specific components of inflammatory process (Tumor necrosis factor, activate T-cells, destroy B-cells)
  • Can be used in combo with DMARDs 1
  • Very expensive drugs
25
Q

DMARDs 2 (Orencia) ADEs

A
  • Increased risk for infection
  • Increased risk for cancer
26
Q

DMARDs 3 (Gengraf “Cyclosporine”, Imuran)

A
  • Minor biologic, nonbiologic
  • 3rd line drug when nothing else is working
  • Significant ADEs
27
Q

Anti-inflammatory for Gout - Colchicine (Colcrys)

A
  • Treats acute gout attack
  • Meant for short term use only (max 3 days)
  • ADEs: GI toxicity (severe diarrhea), Myelosuppression & rhabdomyolysis (less common due to short term use)
  • Interacts with grapefruit juice
28
Q

Prophylactic Treatment of Gout - Allopurinol (Zyloprim)

A
  • Used to prevent frequent gouty attacks
  • Keeps uric acid levels low to prevent attack
  • ADEs: hypersensitivity reactions, nephrotoxicity, hepatitis, rhabdomyolysis
29
Q

Allopurinol (Zyloprim) Monitoring

A
  • Assess kidney function, increase fluid intake, I’s & O’s, BUN and Creatinine
  • Liver enzymes (LFTs)
  • Assess for muscle pain and tenderness, pain score
  • Interacts with warfarin = monitor PT/INR
30
Q

Calcium Supplements - Calcium citrate (Citracal)

A
  • Prevents osteoporosis & hypocalcemia
  • ADEs: hypercalcemia ( serum level over 10.5)
  • Interacts with many other meds including diuretics and digoxin
31
Q

Estrogen agonist / antagonist - Raloxifene (Evista)

A
  • MOA: agonist for estrogen on bone, lipid metabolism, and blood coagulation (risk for blood clots)
  • Antagonist on breast and endometrial tissue (decreases risk for CA)
  • Prevents and treats osteoporosis
32
Q

Bisphosphonates - Alendronate (Fosamax) MOA & Uses

A
  • MOA: decreases # and action of osteoclasts to inhibit resorption of bone, prevents bone from becoming porus
  • Prevents and treats osteoporosis
  • Poor oral absorption
33
Q

Bisphosphonates - Alendronate (Fosamax) ADEs and Monitoring

A
  • ADEs: Esophagitis, esophageal ulcers
  • Take with at least 8oz of water
  • Stay upright after taking for at least 30 min
  • Interacts with calcium sources (supplements, antacids, OJ) as well as caffeine = can decrease absorption
34
Q

Calcitonin - Calcitonin-salmon (Fortical)

A
  • Comes in SQ, IM, and nasal spray but not oral
  • MOA: decreases bone resorption by inhibiting osteoclasts
  • ADEs: Can increase calcium excretion in kidneys (contra for hypocalcemia)
  • Encourage pt to eat foods high in Ca and Vitamin D
  • ONLY treats osteoporosis
  • Works well for post-menopausal osteoporosis
35
Q

Ergot Alkaloids - Ergotamine (Ergomar)

A
  • Used to abort headaches
  • MOA: vasoconstriction decreases blood flow to brain
  • ADEs: GI discomfort (n/v), ergotism (muscle pain, paresthesia, cold extremities), physical dependence, fetal abortion
  • Contra for cardiac disease, hx of HTN (due to vasoconstriction)
  • Interacts with Triptans
36
Q

Triptans / Serotonin receptor agonists - Sumatriptans (Imitrex)

A
  • Used to abort headaches, 70-80% of pts experience complete relief
  • Activates serotonin and induces vasoconstriction
  • ADEs: vasoconstriction leading to chest pain, dizziness, and liver failure (monitor)
  • Contra with cardiac disease & HTN
  • Interacts with Ergotamine, MAOIs, and SSRIs (can cause serotonin syndrome)
37
Q

Prevention of headaches

A
  • Propranolol (beta blocker - monitor for bradycardia and hypotension)
  • Verapmil (CCB - monitor for bradycardia and hypotension; causes constipation)
  • Topamax and Depakote (Anticonvulsants - causes neural tube defects, liver toxicity, pancreatitis)
  • Elavil (Tricyclic antidepressants - anticholinergic, drowsiness)
  • Estraderm (Estrogen - migraines related to hormonal changes)
38
Q

Alcohol Abuse - Benzodiazepines (Ativan, Valium)

A
  • Cross tolerance to alcohol allows us to use it to wean pts off alcohol
  • IV use
  • Withdrawal assessment scale used to find out how much to use
  • Stabilizes vital sign changes associated with alcohol withdrawal
39
Q

Alcohol Abuse- Disulfirim (Anatabuse)

A
  • Very unpleasant reaction when used with alcohol (nausea and profuse vomiting)
  • All forms of alcohol need to be avoided (cough syrups, aftershave, mouthwash, cologne)
40
Q

Alcohol Abuse - Naltrexone (Vivitrol)

A
  • Pure opioid antagonist
  • Blocks pleasurable effects of alcohol, decreases cravings
41
Q

Alcohol Abuse - Acamprosate (Campral)

A
  • Reduces some unpleasant feelings of sobriety (anxiety, tension, stress)
  • Takes away need to relax by drinking
42
Q

Nicotine Abuse - Nicotine patch (Nicoderm)

A
  • First line treatment
  • Only long acting nicotine product
  • Works in 24 hour dose
  • Pack/day smokers might still have cravings even while taking this
43
Q

Nicotine Abuse - Short term products

A
  • Nicotine gum (Nicorette - preferred)
  • Nicotine lozenge
  • Nicotine nasal spray
  • Nicotine inhaler
44
Q

Nicotine Abuse - Nicotine free Products (Chantix)

A
  • Partial agonist of nicotinic receptors; oral prescription
  • Most effective way to quit, works quickly
  • ADEs: Nausea, psychosis & SI
  • Contra with mental health hx
45
Q

Nicotine Abuse - Nicotine free products (Bupropion “Zyban”) aka Wellbutrin

A
  • Works well with pts with mental health hx and smoking
  • ADE: appetite suppression
  • Start 1-2 weeks before quitting, takes up to 4 weeks to become therapeutic
  • Stop taking when cravings stop (might be 6mo-1yr)

Pharmacology (6 decks)

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