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Pharm Flashcards

1
Q

What are the 2 main disease-modifying antirheumatic drugs?

A
  • Methotrexate

- Anticytokines (Enbrel)

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2
Q

What are the 4 side effects of Methotrexate?

A
  • Hepatic dysfunction
  • GI disturbances
  • Thrombocytopenia
  • Renal dysfunction
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3
Q

What can reduce adverse effects of Methotrexate?

A
  • Folic acid
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4
Q

Do anticyotkines have major side effects?

A

NO

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5
Q

Name the 6 other types of disease modifying antirheumatic drugs.

A
  • Leflunomide (Arava)
  • Infliximab (Remicade)
  • Anakinra (Kineret)
  • Sulfa drugs (Imunnosuppresants)
  • Antimalarials (Chloroquine)
  • Cyclosporine (Neoral)
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6
Q

What is the “alternative” therapy for RA?

A

Gold

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7
Q

What is the action of Leflunomide (Arava)?

A

Inhibits T and B cells

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8
Q

What drug is combined with Infliximab (Remicade)?

A

Methotrexate for cancer

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9
Q

What is the action of Anakinra (Kineret)?

A

Blocks interleukin receptors

Prevents bone erosion and cartilage destruction

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10
Q

What is the side effect of Leflunomide, Infliximab, Anakinra?

A

Increased risk of serious infection

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11
Q

What is action of sulfa drugs?

A

GI problems

Skin problems

Bone marrow depression

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12
Q

What are 2 types of sulfa drugs?

A

Penicillamine

Imuran

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13
Q

What are the side effects of antimalarials?

A

Mental status changes

Retinopathy

Muscle Weakness

Decreased DTRs

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14
Q

What is the antimalarial drug name?

A

Chloroquine

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15
Q

What is the action of cyclosporine?

A

Potent immunosuppresant

Reduces T and B cell activation

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16
Q

What are the side effects of cyclosporine?

A

HTN

Nephrotoxicity

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17
Q

What 3 classes of drug does cyclosporine interact with?

A

Calcium channel blockers

Antibiotics

Corticosteroids

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18
Q

What are the 3 adverse effects of gold therapy?

A

Blood disorders

Renal dysfunction

Skin problems/ dermatitis

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19
Q

What is the endogenous glucocorticosteroid?

A

Cortisol

Hydrocortisone

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20
Q

What are the 2 main synthetic corticosteroids?

A

Prednisone

Dexamethazone

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21
Q

What is the action of glucocorticosteroids?

A
  • Potent anti-inflammatory

via prevention of:

Capillary dysfunction
Edema formation
Migration of leukocytes and macrophages to trauma area

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22
Q

What is the most commonly used administration of glucocorticosteroids?

A

Intra-articular

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23
Q

What is the advantage and disadvantage of intra-articular injection?

A
  • Decreased risk of side effects

- Accelerated joint destruction and tendon atrophy

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24
Q

What are many side effects of corticosteroids?

A
  • Adrenal insufficiency
  • Immunosuppresion
  • Steroid buzz
  • Cataracts
  • Cushingoid state
  • Fluid retention
  • Hyperglycemia
  • Osteoporosis
  • Myopathy
  • GI disturbances
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25
Q

Describe adrenal insufficiency.

A

Adrenal gland cannot replace removed corticosteroids

  • Malaise
  • Arthralgia
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26
Q

Why do cataracts develop following corticosteroid use?

A
  • Increased intraocular pressure
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27
Q

Describe a cushingoid state.

A
  • Fat/ moon face
  • Acne
  • Striae on extremities
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28
Q

Describe non pharmacological prevention of osteoporosis.

A
  • Vitamin D and calcium intake
  • WB exercise
  • Smoking cessation
  • Decrease alcohol and caffeine intake
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29
Q

Why does caffeine affect demineralization?

A

Increased calcium excretion

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30
Q

What is a major risk factor for osteoporosis?

A

Smoking

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31
Q

Identify 4 types/ forms of pharamacological management of Osteoporosis.

A

Biphosphonnates

Teriparatide (Forteo)

Calcitonin

Hormone replacement therapy

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32
Q

What is the action of biphosphonnates?

A

Inhibits osteoclastic bone resorption increasing bone mass density and reducing risk of fracture

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33
Q

What are 3 side/ adverse effects of biphosphonnates?

A
  • GI problems
  • Myalgias
  • Esophageal lesions
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34
Q

What are instructions for administration of biphosphonates?

A

Take at least 30 mins before breakfast with full glass of tap water

Remain standing or sitting for 30 minutes

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35
Q

What are 3 types of biphosphonnates?

A
  • Aldenronate (Fosamax)
  • Risedronate (Actonel)
  • Etidronate (Didronel)
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36
Q

What is the action of Teriparatide (Forteo)?

A
  • Parathyroid hormone (raloxifene) – selevtive antiestrogen agent
  • Prevents and treats osteoporosis in postmenopausal women
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37
Q

What are 2 side effects?

A
  • Hot flashes

- Leg cramps

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38
Q

What condition contraindicates use of Teriparatide (Forteo)?

A

Pts at risk for osteosarcoma/ Paget’s disease

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39
Q

What is the action of Calcitonin?

A

Decreases osteoclastic via hormone

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40
Q

How is calcitonin administered?

A
  • Nasal spray
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41
Q

What are 4 side effects of calcitonin?

A
  • Pain
  • Myalagias
  • Headache
  • Nasal symptoms
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42
Q

May calcitonin be used with osetosarcoma/ Paget’s disease?

A

Yes!

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43
Q

What type of drug management for osteoporosis is mainly discontinued?

A

Hormone replacement therapy

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44
Q

What are the risks of hormone replacement therapy?

A

Breast cancer

Cardiovascular problems

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45
Q

What are 5 types of muscle relaxants?

A
  • Diazepam (Valium)
  • Tizanidine (Zanaflex)
  • Chloroxaone (Parafon Foree)/ Cyclobenzprine (Flexeril)/ Methocarbamol (Robaxin)/ Orphenadrine (Norflex)
  • Baclofen (Lioresal)
  • Dantrolene (Dantrium)
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46
Q

At what level does diazepam function? What muscle dysfunction does it treat?

A
  • Treats muscle spasm at supraspinal/ spinal interneuron level
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47
Q

What are 2 adverse/ side effects of diazepam?

A
  • Drowsiness

- Withdrawl

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48
Q

What are 3 drug interactions of diazepam?

A
  • Cimetidine (Tagamet, antiulcer/ anti-stomach acid)
  • Viracept and Norvir (antiviral agents)
  • AIDs medications that inhibit enzymes that metabolize diazepam
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49
Q

At what level does Tizanidine (Zanaflex) act, and what is its action?

A
  • Spinal cord

- Adrenergic agonist to reduce spaticity

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50
Q

What is the side effect of tizanidine?

A
  • Hypotension
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51
Q

What 5 drugs act on the level of the brain stem/ spinal cord to temporarily relieve local, acute muscle spasm?

A
  • Chlorzoxaone (Parafon Fortee)
  • Cyclobenzaprine (Flexeril)
  • Methocarbamol (Robaxin)
  • Orphenadrine (Norflex)
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52
Q

What drugs is Flexeril similar to?

A

Sinequam and Elvail

Tricyclic antidepressants

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53
Q

What are Flexeril’s side effects?

A
  • Interact with MAOIs (Nardil, Parnate) to cause HTN crisis
  • Tachycardia
  • Blurry vision
  • Dry mouth
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54
Q

At what level does Baclofen (Lioresal) act, and what is its action?

A
  • Inhibits release of NT at brain and spinal cord, especially substance P to reduce inflammation and pain, and reduce spasticity.
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55
Q

What are the side effects of Baclofen?

A

Drowsiness

Increased seizures if epileptic

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56
Q

At what level does Dantrolene act, and what is its action?

A

Acts on muscle fibers to block release of calcium to reduce chronic spasticity

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57
Q

What are 8 side and adverse effects of Dantrolene?

A
  • Dizziness
  • Drowsiness
  • Diarrhea
  • Photosensitivity
  • Active toxic hepatitis
  • Seizures
  • Tachycardia
  • Muscle weakness
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58
Q

What Pts should Dantrolene not be used with?

A

Pts with cardiac and respiratory dysfunction

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59
Q

What drugs react with endogenous opioid receptors?

A
  • Morphine
  • Codeine
  • Hydrocodone (Vicodin)
  • Methadone
  • Oxycodone (Percocet, Percodan, Oxycontin)
  • Meperidine (Demerol)
  • Hydromorphone (Dilaudid)
60
Q

What are the therapeutic uses of opioid narcotics?

A
  • Analgeisa
  • Antitussive
  • Antidiarrheal
  • Dyspnea related to MI, pulmonary edema, L ventricular failure
61
Q

What are 8 adverse/ side effects of opioid narcotics?

A
  • Mental status changes-drowsiness
  • Nausea/ vomiting
  • Postural hypotension from parenteral morphine
  • Respiratory depression
  • Twitches, seizures, tremor with demerol
  • Tolerance to drugs
  • Dependence/ addiction
  • Physiological withdrawl
62
Q

What opioid narcotic is indicated for stable, chronic pain?

A
  • Fentanyl (Duragesic, Actiq)
63
Q

How long does Fentanyl work?

A

15 - 45 minutes to reduce acute pain

64
Q

How is Fentanyl applied?

A

As patch (Durgesic)

Lozenge (Actiq Buccal)

65
Q

What is the nonopioid narcotic?

A

Acetaminophen (Tylenol)

66
Q

What is the action of Acetaminophen?

A

Weak inhibitor of prostaglandins for mild-moderate pain relief and fever reduction

67
Q

What are the adverse effects of Acetaminophen?

A

Severe liver damage in large doses

4 grams/ day maximum

68
Q

What are 4 classes of anti-hypertensives?

A
  • Diuretics
  • Beta-adrenergic blockers
  • Calcium channel blockers
  • Alpha-adrenergic blockers
69
Q

What are the 3 types of diuretics?

A
  • Thiazide
  • Loop
  • Potassium-sparing
70
Q

What is a specific thiazide diuretic?

A

Hydrochlorothiazide (HCTZ, HydroDiuril)

71
Q

What is the action of hydrochlorothiazide?

A
  • Inhibit tubular reabsorption of sodium and chloride in kidney, which inhibits water resorption and increases urine volume for decreased vascular resistance
72
Q

What populations should avoid Thiazide diuretics?

A

Elderly or anyone with renal dysfunction

73
Q

What are 5 side effects of Thiazides?

A
  • Hyperglycemia - esp for diabetes
  • Hypokalemia
  • Hyperuricemia (too much uric acid – gout)
  • Hypercalcemia
  • Increased LDL
74
Q

What are 2 drug interactions of Thiazide diuretics?

A
  • Increased lithium reabsorption

- Digoxin toxicity

75
Q

What are 3 specific Loop diuretics?

A
  • Furosemide (Lasix)
  • Bumex
  • Edecrin
76
Q

What is the action of Loop diuretics?

A
  • Sodium and chloride reabsorption inhibited at loop of henle
77
Q

What is more effective – Loop Diuretics or Thiazide diuretics?

A

Loop

78
Q

May loop diuretics be used with the elderly?

A

Yes

79
Q

What are 4 side effects of loop diuretics?

A
  • Hypokalemia
  • Hypocalcemia (opposite of thiazides)
  • Hyperglycemia
  • Hyperurecemia
80
Q

What are 3 specific potassium-sparing diuretics?

A
  • Aldactone
  • Dyrenium
  • Midamor
81
Q

What is the action of a potassium sparing diuretic?

A

Weak

Prevent hypokalemia

82
Q

What is the side effect of potassium sparing diuretics?

A
  • Hyperkalemia, especially when combined with ACE inhibitors or potassium supplements
83
Q

Where are beta-1 and beta-2 receptors located?

A

Beta-1 in heart

Beta-2 in lungs and arterioles

84
Q

What are 3 non-selective beta blockers?

A
  • Propanolol (Inderal)
  • Nadolol (Corgard)
  • Penbutolol (Levatol)
85
Q

What are 2 selective beta-blockers for beta-1 receptors?

A
  • Lopressor

- Atenolol

86
Q

What is the mechanism of action of beta-blockers?

A
  • Block renin release from kidneys

- Decrease CO by slowing HR

87
Q

What conditions should not be managed with beta-blockers?

A
  • Certain types of angina
  • All forms of COPD
  • Diabetes mellitus
88
Q

Why should beta-blockers never be stopped suddenly?

A

Anginal attack

89
Q

What are 3 side effects of beta-blockers

A
  • Sleep disturbances
  • Mental status changes including depression and disorientation
  • Cold extremities since alpha-adrenergic vasoconstriction is unopposed
90
Q

What are 4 calcium channel blockers?

A
  • Procardia XL
  • Norvasc
  • Cardizem
  • Verapamil
91
Q

What are 2 side effects of calcium channel blockers?

A
  • Significant bradycardia

- Peripheral vasodilation causing headache, ankle swelling, reflex tachycardia

92
Q

What are 2 drug interactions of calcium channel blockers?

A
  • Digoxin toxicity

- Verapamil can cause cardiac depression or AV block

93
Q

What is the alpha-1 selective blocker?

A
  • Prazosin (Minipress)
94
Q

What is the action of Prazosin?

A

Blocks peripheral vasodilation

95
Q

What are 3 side effects of Prazosin?

A
  • Syncope
  • Headache
  • Palpitations
96
Q

What are 2 alpha-2 agonists?

A
  • Clonidine (Catapres)

- Methyldopa (Aldomet)

97
Q

What is the action of the alpha-2 agonists?

A

Stimulate alpha-2 receptors in brainstem

- Decrease NS signals to decrease HR, peripheral resistance, BP

98
Q

What are 5 side/ adverse effects of Clonidine or Methyldopa?

A
  • Dry mouth
  • Sedation
  • Depression
  • Risk of rebound hypertension with Clonidine
  • Decreased mental acuity and hemolytic anemia with Methyldopa
99
Q

What is the anginal medicine of choice?

A

Nitrates

100
Q

What is the action of nitrates?

A
  • Peripheral vasodilation
  • Reduced work of heart
  • Decreased O2 demand
  • Vasodilation of collateral vessels to heart
  • Relieve coronary artery spasm
101
Q

How may nitro be used prophylactically?

A

Prior to exercise

102
Q

What are side effects of nitro?

A
  • Dizziness
  • Flushing and headache
  • Reflex tachycardia
103
Q

When must EMS be called if nitro is ineffective?

A

After 3 tabs with no effect.

Sit the patient, call EMS

104
Q

What are nitropatches and ointments used for?

A

Chronic angina

105
Q

What type of nitro is useful for Pts with RA of the hands, unable to handle pills?

A

Nitrospray

106
Q

What class of medicine is useful for the stress related to aging?

A

Non-tricyclic antidepressants

107
Q

What are 4 types of ACE inhibitors?

A
  • Quinipril (Accupril)
  • Captopril (Capoten)
  • Fosinopril (Monopril)
  • Benazepril (Lotensin)
108
Q

What is the action of ACE inhibitors?

A

Inhibits conversion of angiotensin I to II – inhibits vasocontrition

Inhibits secretion of aldosterone from adrenal cortex – decreased sodium and water retention

Inactivation of bradykinin – Decrease vasodilation

109
Q

What are the overall effects of the actions of ACE inhibitors?

A
  • Ateriolar vasodilation
  • Decreased peripheral resistance
  • Increased flow
110
Q

What are ACE inhibitors typically used to treat?

A

Heart failure

111
Q

What are 5 side/ adverse effects of ACE inhibitors?

A
  • Nonproductive dry cough
  • Decreased taste perception
  • Excessive hypotension
  • Hyperkalemia
  • Angioedema
112
Q

What are 3 drug interactions of ACE inhibitors?

A
  • Diuretics (hypotension)
  • Potassium-sparing diuretics (hyperkalemia)
  • Lithium toxicity
113
Q

What is step 1 medical management of CHF?

A

ACE inhibitors

114
Q

What is step 2 medical management of CHF?

A

Diuretics

Especially loop diuretics (Lasix)

115
Q

What is step 3 medical management of CHF?

A

Nonselective beta-blocker and selective Alpha-1-adrenergic blocker (carvedilol-coreg)

Administered carefully to prevent worsening CHF

116
Q

What is step 4 medical management of CHF?

A

Digoxin (Lanoxin)

117
Q

What is the action of digoxin?

A

Increases force of contraction of cardiac muscle without increasing O2 demand

Increased EF

118
Q

When is digoxin utilized during treatment of CHF?

A

Systolic dysfunction

Arhhythmias present

119
Q

What is the major adverse effect of digoxin?

A

Digoxin toxicity, which is fatal

120
Q

What are 5 signs of digoxin toxicity?

A
  • Cardiac arrhythmia
  • Anorexia
  • Nausea
  • Vomiting
  • Mental status changes (hallucinations, blurred vision)
121
Q

Where can you check for arrhythmias related to digoxin toxicity?

A

Palpate apical pulse

122
Q

What aspect of pt ed needs to be addressed in Pt taking digoxin?

A

Adherence to dosage

Missed appointments a red flag

123
Q

What drug may be used in combination with ACE inhibitors to increase survival, or beta-blockers to reduce hypertension?

A

Hydralazine (Apresoline) and mixoxidil

Vasodilators

124
Q

What are 6 side/ adverse effects of vasodilators?

A
  • GI disturbances
  • Headache
  • Flushing
  • Nasal congestion
  • Lupus-like symptoms (myalgias, arthralgias, skin rash)
  • Reflex tachycardia (anginal attack)
125
Q

What are 3 common anti-coagulants?

A
  • Warfarin (coumadin)
  • Heparin
  • Fondaparinux (Atrixtra)
126
Q

Which anti-coagulant is endogenous?

A

Heparin

127
Q

What is the action of warfarin?

A

Antagonist of vitamin K, which functions in the clotting cascade

128
Q

What is warfarin used to treat?

A
  • Emboli
  • MI
  • Venous thrombosis
129
Q

How long is required for maximum antithrombotic effects of warfarin?

A

3 - 6 days

130
Q

What are 3 adverse effects of warfarin?

A
  • Massive or minor hemorrhage
  • Purple toe hemorrhage from microemboli
  • Birth defects/ spontaneous abortion
131
Q

How is warfarin related hemorrhage treated?

A

Vitamin K (may take 24h to work

132
Q

What drugs decrease the anticoagulant effect of warfarin?

A
  • Phenytoin
  • Barbiturates
  • Carbamazepine
  • Alcohol intake
133
Q

What drugs increase the anticoagulant effect of warfarin?

A
  • Cimetidine
  • Ciprofloxacin
  • Antibiotics
  • Aspirin
  • Hepatic dysfunction
  • Malnutrition
  • CHF
134
Q

What is the medication form of heparin?

A

Heparin sodium

135
Q

What are the 3 low molecular weight types of heparin?

A
  • Fragmin
  • Lovenox
  • Innohep
136
Q

What are the benefits of low molecular weight types of heparin?

A

High bioavailability

Greater inhibition of factor Xa and clotting cascade

Less frequent dosing – No need to monitor prothrombin times

137
Q

What anticoagulant is contraindicated with renal dysfunction?

A

Fondaparinux (Atrixtra)

138
Q

What is the action of fondaparinux (atrixtra)?

A
  • Inhibition of factor Xa by binding to antithrombin III, and disrupting clotting cascade
139
Q

After what procedure is fondaparinux administered? When?

A

After THA (at least 6-8 hours post or earlier)

140
Q

What are the 3 medications used for antiplatelet therapy?

A

Aspirin

Clopidogrel (Plavix)

Ticlopidine (Ticlid)

141
Q

What is the action of aspirin, clopidogrel (plavix), and Ticlopidine (Ticlid) in platelet therapy?

A

Irreversibly inhibits platelet aggregation at injury/ damaged sites of vessels

142
Q

What conditions is aspirin used to treat for antiplatelet therapy?

A

Angina

CAD

MI

143
Q

When is aspirin not used since it prolongs clotting?

A

Acute athletic injury

144
Q

What condition is clopidogrel (plavix) used in?

A

PVD

145
Q

What is condition is ticlopidine (ticlid) used in?

A

Prevent TIAs and stroke

146
Q

What are the side/ adverse effects of ticlopidine (ticlid)?

A

GI symptoms

Dizziness

Neutropenia - agranulocytosis

147
Q

What are the drug interactions of ticlopidine?

A

Inhibits enzymes that breakdown dilantin and theophylline (a bronchodilator)?

NPTE (7 decks)

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