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)
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
3
Q
NSAID Interactions
A
- warfarin (increased bleeding risk)
- glucocorticoids (risk for GI bleeding)
- Alcohol (risk for GI bleeding)
- ACEi or ARBs (kidney toxicity)
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)
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
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
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
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
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)
10
Q
Celecoxib (Celebrex) MOA & Uses
A
- Second generation, selective to COX2
- USES: RA & OA, acute pain, dysmenorrhea
11
Q
Celecoxib ADEs
A
- Gastroduodenal ulcers
- Cardiovascular effects (increased risk for MI and stroke, contra for heart disease pts)
- Renal impairment
- Sulfonamide allergy *
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
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
14
Q
Mu Opioid Receptor Function
A
- Analgesia
- Resp Depression
- Euphoria
- Sedation
- Decrease in GI motility
15
Q
Kappa Opioid Receptor Function
A
- Analgesia (not as strong as Mu)
- Sedation
- GI motility
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
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
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
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
DMARDs 2 (Orencia) ADEs
- Increased risk for infection
- Increased risk for cancer
26
DMARDs 3 (Gengraf "Cyclosporine", Imuran)
- Minor biologic, nonbiologic
- 3rd line drug when nothing else is working
- Significant ADEs
27
Anti-inflammatory for Gout - Colchicine (Colcrys)
- 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
Prophylactic Treatment of Gout - Allopurinol (Zyloprim)
- Used to prevent frequent gouty attacks
- Keeps uric acid levels low to prevent attack
- ADEs: hypersensitivity reactions, nephrotoxicity, hepatitis, rhabdomyolysis
29
Allopurinol (Zyloprim) Monitoring
- 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
Calcium Supplements - Calcium citrate (Citracal)
- Prevents osteoporosis & hypocalcemia
- ADEs: hypercalcemia ( serum level over 10.5)
- Interacts with many other meds including diuretics and digoxin
31
Estrogen agonist / antagonist - Raloxifene (Evista)
- 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
Bisphosphonates - Alendronate (Fosamax) MOA & Uses
- MOA: decreases # and action of osteoclasts to inhibit resorption of bone, prevents bone from becoming porus
- Prevents and treats osteoporosis
- Poor oral absorption
33
Bisphosphonates - Alendronate (Fosamax) ADEs and Monitoring
- 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
Calcitonin - Calcitonin-salmon (Fortical)
- 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
Ergot Alkaloids - Ergotamine (Ergomar)
- 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
Triptans / Serotonin receptor agonists - Sumatriptans (Imitrex)
- 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
Prevention of headaches
- 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
Alcohol Abuse - Benzodiazepines (Ativan, Valium)
- 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
Alcohol Abuse- Disulfirim (Anatabuse)
- 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
Alcohol Abuse - Naltrexone (Vivitrol)
- Pure opioid antagonist
- Blocks pleasurable effects of alcohol, decreases cravings
41
Alcohol Abuse - Acamprosate (Campral)
- Reduces some unpleasant feelings of sobriety (anxiety, tension, stress)
- Takes away need to relax by drinking
42
Nicotine Abuse - Nicotine patch (Nicoderm)
- 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
Nicotine Abuse - Short term products
- Nicotine gum (Nicorette - preferred)
- Nicotine lozenge
- Nicotine nasal spray
- Nicotine inhaler
44
Nicotine Abuse - Nicotine free Products (Chantix)
- Partial agonist of nicotinic receptors; oral prescription
- Most effective way to quit, works quickly
- ADEs: Nausea, psychosis & SI
- Contra with mental health hx
45
Nicotine Abuse - Nicotine free products (Bupropion "Zyban") aka Wellbutrin
- 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)
