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Fall Finals > Pharm > Flashcards

Pharm Flashcards

1
Q

Zidovudine

A

antiviral - treat HIV, slow disease progression, prevent transfer from mother to fetus
SE: dec RBC

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2
Q

Erythropoietin Growth Factors

A

Epoietin Alfa (Epogen, Procrit): identical to epo; SE: signif HTN! (inc HCT), CV events, rare PRCA; IV, IM

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3
Q

Leukopoietic Growth Factors

A

Filgrastim (Neupogen): identical to G-CSF, inc neutrophils/maturation in marrow, IV/SubQ

Pegfilgrastim: longer acting/ T1/2

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4
Q

Thrombopoietic Growth Factor

A

Oprelvekin (Neumega): identical to IL-11

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5
Q

iron deficiency treatment

A

ferrous sulfate - PO

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6
Q

treatment for moderate to severe sickle cell crisis

A

hydroxyurea (a chemotherapy for leukemia)

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7
Q

tPA

A

plasminogen activator, help create plasmin to DISSOLVE CLOTS and produce D Dimers

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8
Q

Heparin MoA

A

activates ATIII

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9
Q

Arixta

A

subQ, inhibit F Xa

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10
Q

Pradaxa*

A

PO, direct thrombin inhibitor

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11
Q

Xarelto

A

PO, inhibit Xa

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12
Q

Warfarin*

A

inhibits Vit K dependent factors 2, 7, 9, 10, protein c/s
CANT USE IN PREGNANCY** Crosses placenta
2-5mg daily
complications: hemorrhage, purple toe syndrome**

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13
Q

Clopidegrel/Clavix

A

anti-platelet

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14
Q

When is epogen often used?

A

chronic kidney failure

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15
Q

1st gen H1 blocker

A

Benadryl (diphenhydramine)
SE: sedative, anti-cholinergic
Tx: mild allergies, motion sickness, insomnia

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16
Q

2nd gen H1 blocker

A

Zyrtec (Cetirizine), Allegra (Fexofenadin), Claritin (Loratadine)
non-sedating (don’t cross BBB), no anti-cholinergic, req less doses than 1st gen
Tx: allgeric rhinitis, chronic urticaria

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17
Q

Singulaire (Montelukast)

A

leukotriene receptor antagonist

effective for asthma!

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18
Q

Glucocorticoid

A

high dose suppresses inflammation and immune
most effective treatment for asthma
Adverse: adrenal insufficiency (so taper), infection, peptic ulcer, osteoporosis, warning in DM

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19
Q

Immunosuppressants

A

Calcineurin inhibitor: cyclosporin, tacrolimus
mTOR inhibitor: sirolimus (rapamycin), everolimus
glucocorticoids
cytotoxic drugs: azthioprine, MTX, cyclophosphamide (for refractory pts)
Antibodies
selective T cell co-stimulation blocker

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20
Q

DOC for allogenic tranplants

A

cyclosporin (calcineurin inhibitor)

ADVERSE: nephrotox, infection

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21
Q

H2 receptor w/histamine effects

A

gastric acid secretion by parietal cells

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22
Q

H1 receptor w/histamine effects

A

vasodilation, inc permea, bronchoconstriction, itch, pain

edema and dec BP

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23
Q

anti-cholinergic

A

dry mouth, tachycardia, difficult micturition

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24
Q

H2 antagonist

A

zantac, pepcid

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25
Q

1st line allergic rhinitis Tx for children

A

cromolyn (mast cell stabilizer, very safe but mod effective)

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26
Q

decongestants

A

sympathomimetics
Ex: Sudafed (pseudoephedrine), phenylephrine
vasoconstriction of nasal vessels
ADR: rhinitis medicamentosa (rebound congestion- leads to tolerance and hypersensitivity)*
wane off w/nasal saline
dont use >3days, not safe in children

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27
Q

most effective Tx for WATERY rhinorrhea*

A

Atrovent nasal spray (Ipratropium)

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28
Q

Xolair (Omalizumab)

A

Ab against IgE

effective to dec nasal Sx in allergic rhinitis

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29
Q

intranasal corticosteroids

A

flonase (fluticasone) - for mod to severe

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30
Q

What medication to avoid w/Triginous Candida and ALL CANDIDA**

A

Terbinafine (Lamisil) - ALL in class of Allylamine drugs like Naftifene

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31
Q

How to treat tinea versicolor

A

selenium shampoo

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32
Q

Tx for pitted keratolysis

A

20% aluminum chloride (Drysol)
BACTERIAL
often mistaken for tinea pedis

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33
Q

Psoriasis Tx

A

Topical: corticosteroids, topical calcipotriene, Tar (anti-mitotic), anthralin
Phototherapy: PUVA, UVB
Systemic: MTX, biologics (DMARDS), retinoids; HIGH TOXICITY

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34
Q

Rosacea Tx

A

1st line: topical metronidazole, azelaic acid

DON’T use topical steroids

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35
Q

Psoriasis Tx

A

Topical: corticosteroids, topical calcipotriene, Tar (anti-mitotic), anthralin
Phototherapy: PUVA (psoralen+UVA), UVB
Systemic: MTX, biologics (DMARDS), retinoids; HIGH TOXICITY

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36
Q

Varicella Tx*

A

supportive w/pain control as needed
Acyclovir 5x a day* if high risk for complications or Shingles
also famciclovir, valacyclovir: but must start w/in 72hrs of rash*

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37
Q

Keflex

A

Cephalexin

can treat non-MRSA staph

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38
Q

Bactrim

A

can treat MRSA

sulfa drug

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39
Q

DMARDS

A

Disease-modifying antirheumatic drugs, biologics
Humira, Enbrel, Remicade
treats RA, Psoriasis

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40
Q

systemic antifungals

A

Terbinafine (Lamisil)

Fluconazole (Diflucan)

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41
Q

Tinea Tx

A

topical antifungals: (imidazole)

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42
Q

Tinea Tx

A

topical antifungals: (imidazole); but DONT WORK ON CAPITIS

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43
Q

Tinea Corporis, Pedis Tx

A

topical antifungals: (imidazole); but DON’T WORK ON CAPITIS

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44
Q

Tinea versicolor Tx

A

selenium sulfide shampoo

topical ketoconazole

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45
Q

Tx of diaper candidiasis

A

nystatin cream

don’t prescribe w/high potent topical steroids bc atrophy

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46
Q

Oral thrush Tx

A

nystatin, great for all ages

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47
Q

Tx Eczema (atopic dermatitis), other Dermatitis

A 
topical steroids (except perioral dermatitis)
severe cases: PO steroids + light therapy, immunosuppressants
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48
Q

Tx for acne

A

benzoyl peroxide, topical antibiotic
severe: oral antibiotic: Doxycycline, Minocycline (SE: vertigo, hyperpig; contraindicated in preg/<8yo)
women hormone therapy: eg ortho tri cyclen
oral retinoids only for severe, refractory cases (Isotretinoin)

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49
Q

Bed bugs Tx

A

if symptomatic: topical steroid, antihistamine

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50
Q

Scabies Tx

A

5% permethrin (elimite)

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51
Q

Lice tx

A

1% permethrin

Malathion most effective but takes longest (8hrs)

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52
Q

Tx of impetigo

A

bactroban (mupirocin) 5-7 days - topical - can treat MRSA

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53
Q

Tx of cat/dog bites

A

Pasteurella multocida 80%
Amoxicillin/Clavulanic Acid (Augmentin) x10 days
(CAN’T use cephalexin/Keflex)

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54
Q

Doxycycline is contraindicated in

A

<8yo

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55
Q

Types of Diuretics

A 
Loop: Lasix (Furosemide)
Thiazides: HCTZ
K sparing: spironolactone (Aldactone)
Osmotic
MoA: block Na, Cl reabsorption, prevent H2O reabsorp; increase urine
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56
Q

Loop Diuretics*

A

most effective; rapid and heavy diuresis; only used if milder don’t work; PO, IV
K WASTING** bc not absorbing K and lose K at DCT
MoA: blocks Na, Cl absorption in asc loop
usage: pulm edema, refractory HTN
can be used in severe renal impairment
ADR: dehydration, hypotension, electrolyte imbalance, ototox, hyperglycemia/uricemia/lipidemia
DON’T USE IN PREGNANCY*
ex: Lasix (furosemide)

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57
Q

Thiazides*

A

most used, PO
MoA: block Na, Cl reabsorption in early DCT
CANT use in renal impairment*
Usage: HTN (DOC), mod edema, diabetes insipidus
ADR: dehydration, hypotension, electrolyte imbalance, hyperglycemia/uricemia/lipidemia
DON’T USE IN PREGNANCY*
ex: HCTZ

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58
Q

DOC for HTN*

A

Thiazides

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59
Q

K sparing Diuretics

A

minimal diuretic effect but SPARES K*
MoA: block aldosterone in DCT, Retain K, Secrete Na
usage: mostly used in conjunction w/Lasix or thiazide in HTN/edema to spare K
ex: Spironolactone (Aldactone), eplerenone (Inspra), Triamterene

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60
Q

Osmotic Diuretic

A

MoA: freely filtered to create osmotic force, dec H2O reabsorption
IV only bc can’t cross GI!
usage: prophylaxis of renal failure by creating renal flow
ADR: edema (caution in cardiac pt)
ex: mannitol

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61
Q

Ca Channel Blocker ADR

A

Generalized edema

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62
Q

Edema Tx

A

ACE-I (ALSO RENAL PROTECTIVE and treats HTN)

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63
Q

Chronic Renal Failure tx

A

ACE or ARB (dec BP), slow dz progression

prevent hypoglycemia from dec insulin clearance

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64
Q

Drugs that cause Fanconi Syndrome (proximal kidney tubule dysfunction)

A

Tetracyclines
aminoglycosides
anti-viral

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65
Q

Pyelonephritis Tx

A

Sulfa: Cipro, Bactrim
Tx AFTER culture results
avoid ampicillin/amox in gram neg

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66
Q

ACE-I

A

Inhibit ACE, prevent formation of Angiotensin II
lisinopril, captopril
SE: COUGH
AVOID in renal artery stenosis

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67
Q

ARB

A

valsartan, losartan

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68
Q

Acute Angina Tx:

A

nitroglycerin

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69
Q

What medication to never use in renal artery stenosis?**

A

ACE-I/ARB

Bc of risk of azotemia from efferent arteriole dilation

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70
Q

What medication to use for isolated HTN?

A

Ca Channel Blockers

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71
Q

Everyone with renal dz should be on what medication?

A

ACE-I

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72
Q

Medication for angina

A

nitroglycerin
ASA
Beta Blocker

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73
Q

Who cannot use ACE-I

A

African Americans bc lower serum renin

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74
Q

Beta Blockers usage in HTN

A

block reflex tachycardia, eventually will reset set point to normal!

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75
Q

How to treat hypertensive emergency

A

Sodium Nitroprusside
but CANT use >48-72hrs
papilledema, end organ damage

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76
Q

First line drugs for HTN

A

Thiazide diuretics (Mainstay for mild to mod HTN), CCB, ACE-I, ARB

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77
Q

Classes of Calcium Channel Blockers

A

Dihydropyridines: more effective/selective

Non-DHP: less effective/selective

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78
Q

What drug treats hyperlipidemia

A

statins (HMG-CoA Reductase Inhibitors): synthesize cholesterol
CATEGORY X IN PREGNANCY

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79
Q

CCB MoA

A

Vasodilator: decrease arterial pressure and increase coronary perfusion
Block SA/AV node - slow conduction - but little net effect
Ex: Verapamil, Diltiazem (Non-DHP also has effect for arrhythmias - slow ventricular rate)
DHP: Nifedipine

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80
Q

1st line agents for TB*

A

ISONIAZID
RIFAMPIN
ETHAMBUTOL
PYRAZINAMIDE

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81
Q

Tx of stable angina

A

risk modification, eg lifestyle changes
nitroglycerin
ASA
Beta Blocker

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82
Q

amlodipine

A

CCB

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83
Q

DOC for HSV, VZV

A

Acyclovir
suppress DNA synthesis
(Valacyclovir = acyclovir prodrug)

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84
Q

Tx for CMV and retinitis

A

Ganciclovir
ADR: granulocytopenia, thrombocytopenia
MoA: inhibits DNA polymerase

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85
Q

Hep C Tx

A

peginterferon alpha
PI: eg simeprevir
Ritonavir
DAAs: direct acting antiviral

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86
Q

Influenza Tx

A

Neuraminidase inhibitor: Oseltamivir, Zanamivir, Peramivir

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87
Q

What warrants high intensity statin therapy?*

A

LDL > 190

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88
Q

Patients with congestive heart failure and HTN should be on what?*

A

ACE-I and BB

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89
Q

Class I antiarrhythmics

A

sodium channel blockers:
lidocaine and quinidine
decrease conduction velocity

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90
Q

inotropic agent

A

increase force of contraction of heart

eg digitalis

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91
Q

SE of amiodarone

A

badycardia, AV block, hypotension, pulmonary fibrosis, hypo/hyperthyroidism
serious SE can last even after months after d/c

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92
Q

What agent is contraindicated in systolic heart failure***

A

CCB (Non-DHP)

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93
Q

Supraventricular arrhythmia Tx

A

SVT: Vagal maneuvers –> IV adenosine, BB, CCB –> PO BB CCB –> amiodarone if refractory

A flutter: Cardioversion, IV Ibutilide/amiodarone, longer term w/Na channel blocker or amiodarone

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94
Q

DOC for premature ventricular contraction (PVC)

A

BB

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95
Q

Amiodarone

A 
Class III antiarrhythmic
delay repolarization , block K channel, delay fast channel repolarization
prolong AP and ERP
Usage: ventricular arrythmias, afib
others: Ibutilide
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96
Q

When is amiodarone used long term

A

suppression of VT or VFib (for recurrent ventricular arrhythmias)
Cardioversion is Tx of choice in acute setting

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97
Q

IV Mg treats…

A

torsade de pointes and managing rapid atrial fibrillation

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98
Q

Prinzmetal Angina tx

A

treat acute episodes w/nitroglycerin, CCB

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99
Q

longterm treatment of long QT syndrome

A

BB

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100
Q

most common treatment for infectious endocarditis

A

PCN and IV Gentamycin daily, 4 weeks

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101
Q

Tx for Candida Albicans in female vagina

A

Monistat (Miconazole)

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102
Q

Tx for Bacterial Vaginosis

A

Metronidazole

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103
Q

Tx for Trichomonas

A

Metronidazole

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104
Q

Tx for Candida glabrata

A

Nystatin cream

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105
Q

Oral Anti-fungals ADR

A

Hepatotoxic

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106
Q

Tx of gonorrhea and Chlamydia

A

azithromycin, ceftriaxone

treat both bc don’t know which one

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107
Q

What diuretic causes gynectomastia

A

Spironolactone (K sparing)

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108
Q

Pseudomonas Tx

A

4th gen cephalosporin

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5
Perfectly
109
Q

Clindamycin ADR

A

Pseudomembranous colitis

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110
Q

Isoniazid ADR

A

Peripheral neuropathy

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111
Q

Community acquired MRSA Tx

A

Doxycycline

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112
Q

Clindamycin worst ADR

A

Pseudomembranous colitis

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113
Q

Recurrent MRSA Tx

A

Mupirocin

114
Q

Community acquired MRSA Tx

A

Clindamycin

115
Q

Acyclovir ADR

A

Nephrotoxicity

116
Q

Lyme Tx

A

Doxycycline

117
Q

Chloramphenicol ADR and Tx

A

ADR: grey baby syndrome
Tx: typhoid fever, meningitis

118
Q

Tx of chlamydia in nursing homes

A

Doxycycline

119
Q

What organ must be checked with amphotericin B?

A

Kidney function

120
Q

What organ must be checked with Azole anti-fungals?

A

Liver function

121
Q

Influenza Tx

A

Oseltavir

122
Q

What organism causes rheumatic fever, tonsil abscess?

A

S. pyogenes

123
Q

What disease should NOT take ASA? and why?

A

Varicella
Dengue Fever
can cause Reye’s disease

124
Q

What disease should NOT take ASA? and why?

A

Varicella
Dengue Fever
can cause Reye’s disease

125
Q

ADR of interferon alpha (Tx Hep C)

A

severe depression

flu like symptoms

126
Q

What do you use to treat Thrush (oral Candida)

A

nystatin
clotrimazole
miconazole

127
Q

What are the adverse effects of Amphotericin B?

A

Highly toxic!
Renal damage in >80% patients
Hypersensitivity

128
Q

Most Common TB treatment

A

isoniazid (INH)
rifampin (RIF)
ethambutol (EMB)
pyrazinamide (PZA)

129
Q

What drugs not to use with Multi-Drug Resistant TB

A

don’t use isoniazid (INH) and Rifampin

130
Q

Leprosy Tx

A

Dapsone, rifampin, clofazimine

131
Q

What is an appropriate antibiotic choice for empiric treatment in an assumed Mycoplasma pneumonia?

A

Azithromycin 500 mg on day 1, 250mg once daily on days 2-5

132
Q

What is the drug of choice for Chlamydia pneumonia?

A

Doxycycline

133
Q

Dysfunctional Uterine Bleeding Tx

A

NSAIDs, High dose estrogen, OCP
depends on underlying cause
in adolescents: just watch if no anemia

134
Q

Psoriasis of vulva Tx

A

Steroids

135
Q

erosive lichen planus and Tx

A

glassy, bright red erosions on vulva, vagina
can bleed, yellow discharge (inflammatory, autoimmune)
Tx: testosterone/corticosteroid cream, tacrolimus

136
Q

Tx for Candidas albicans, tropicalis, glabrata***

A

a: PO diflucan (hyphae and buds)*
t: Terazol (hyphae)
g: nystatin, azole resistant (buds)

137
Q

recurrent candida Tx

A

nystatin

138
Q

BV Tx

A

metronidazole

clindamycin

139
Q

Trich Tx

A

Metronidazole

140
Q

Gonorrhea Tx

A

2 Abiotics: treat both gonorrhea and chlamydia

ceftriaxone, azithromycin

141
Q

monophasic v multiphasic combo OCP

A

mono: constant doses
multi: varying doses
fertility returns quickly after discontinuation

142
Q

How do combined OCPs work?*

A

mimicking early pregnancy (estrogen, progesterone)

143
Q

Depo-Provera

A

3 months effective
injectable
very good and no estrogen
cant be on >2yrs

144
Q

Cons of Depo-Provera***

A

return to fertility in 12-18 months

145
Q

Pyelonephritis

A

fluoroquinolone (Cipro)

amoxicillin

146
Q

Tx for urolithiasis

A

Penicillins - can have resistance quickly (E. coli)
Sulfonamides - G6PD deficiency (hemolysis)
macrobid (nitroflurantoin)
cipro - least resistance for e. coli

147
Q

Tx for interstitial cystitis

A

elmiron (PO)

DMSO - through catheter into bladder to coat lining

148
Q

Moderate to Severe kidney infection tx

A

IV ceftrioxone or gentamycin

149
Q

Tx of BPH

A

mild: watch
mild-moderate: alpha blocker (hytrin)
severe: alpha blocker, 5 alpha reductase inhibitor (effetcive on 30% patients)
severe: surgery (TURP)

150
Q

Tx for epididymitis*

A

<35yo: doxycycline 14 days

>50yo: cipro (WITH CAUTION)

151
Q

bacterial orchitis Tx*

A

<35yo: Ceftriaxone AND either doxycycline or azithromycin

>50yo: Fluoroquinolone

152
Q

Seizure Tx*

A

try lorazepam, diazepam, or paraldehyde first (1-2 repeats)

PERSISTS then use longer-acting anticonvulsant: phenytoin, phenobarbital

153
Q

Tx seizures in pts already on phenytoin or phenobarbital

A

booster doses of 5 mg/kg, subsequent based on severity

154
Q

Neonatal seizure treatment

A

phenobarbital = first line

155
Q

Agents to control intracranial pressure if seizures >60min

A

Mannitol

Dexamethasone

156
Q

generalized seizure medications

A

barbiturates
phenytoin
valproic acid
ethosuximide

157
Q

why is phenytoin a helpful maintenance AED

A

lack of CNS depressing action, except at high levels

158
Q

dose-related side effects of phenobarbital and phenytoin

A

sedation and ataxia

159
Q

complications of longterm use of phenytoin***

A

gingival hyperplasia
hirsutism
lymphadenopathy

160
Q

idiosyncratic risk of phenobarbital and phenytoin

A

hepatotoxicity
rash
lupus-like syndrome (phenytoin)

161
Q

dose related side effects of valproic acid

A

sedation, GI upset, THROMBOCYTOPENIA, hyperammonemia

162
Q

Valproic acid treats

A

generalized, partial seizure, myoclonic

useful in mixed seizure disorders

163
Q

Worst idiosyncratic complication of valproic acid

A

fulminant hepatotoxicity

greatest risk: children <2yo, children on mult AED

164
Q

what is Ethosuximide (Zarontin) used to treat?***

A

absence (petit mal) epilepsy

165
Q

Carbamazepine effective against*

A

partial seizures*

secondary generalized seizures

166
Q

first line treatments for partial seizures

A

phenytoin (also generalized)
valproic acid (also generalized)
carbamazepine

167
Q

Infantile Spasms tx

A

ACTH

168
Q

Most common drug causing medication overuse headache*

A

Acetaminophen*

169
Q

Tx for migraines*

A

everyone needs acute tx!!!*
1st: tylenol, motrin, excedrin
then try: Triptans, Ergots

170
Q

Mechanism of action of triptans and ergots

A

vasoconstriction

171
Q

Tx for tension headaches

A

simple analgesics (NSAID, ASA, Acetaminophen), more effective w/caffeine

172
Q

What medication should you AVOID in tension headaches?***

A

TRIPTANS or muscle relaxants

173
Q

Tx of cluster HA***

A

O2, subQ sumatriptan

prevention with: verapamil (CCB)***

174
Q

Contraindications of tPA

A

recent surgery, GI bleed, MI, prior ICH, high refractory BP, low platelet, low or high glu

175
Q

When can you treat ischemic strokes with IV tPA?*

A

<4.5hr of onset*

176
Q

Medications for secondary prevention of stroke w/TIA**

A

Anti-thrombotic
ARB/ACE-I
Statin
ALL PTS (REGARDLESS OF LEVELS)

177
Q

mainstay of PD Tx

A

Carbidopa/Levodopa (Sinemet) - replace DA
Levodopa = DA precursor, crosses BBB to CNS
Carbidopa prevents conversion to DA in Periphery to prevent side effects

178
Q

COMT Inhibitors

A

increases half-life of L-DOPA

179
Q

MAO B inhibitor

A

reduces breakdown of DA

180
Q

What drug should you use in extreme caution in Dementia w/Lewy Bodies**

A

anti-psychotics*
serious side-effects n 50%
antidepressants* can cause sudden changes in consciousness

181
Q

Tx for bacterial meningitis for 1mon-50yo***

A

vancomycin and 3rd gen cephalosporin

182
Q

Tx for bacterial meningitis for >50yo

A

ampicillin (covers Listeria), vaco, 3rd gen cephalosporin

183
Q

Tx of transverse myelitis (inflammatory demyelination of both sides of a section of spinal cord)

A

Short course of high dose corticosteroids:

Methylprednisolone 1,000 mg 3-5 days

184
Q

commonly used Rx for delirium (w/agitation)

A

Haldol (haloperidol) 0.5 to 1 mg PO or IM q12 hours prn agitation

Ativan (lorazepam) 0.5 to 1 mg PO or IM q6 hours prn agitation

185
Q

Tx BPPV* (Benign Paroxysmal Positional Vertigo)

A

Epley maneuver: remove Ca deposits

do Dix-Hallpike maneuver first to confirm: pt sit, rapidly lie back, repeat

186
Q

what drug is ototoxic?

A

aminoglycosides (gentamicin), destroys vestibular system

187
Q

Ménière’s Disease Tx

A

aggressive low-salt diet and diuretics

avoid caffeine, chocolate, red wine

188
Q

BRACHIAL PLEXITIS tx (trauma, malig, idiopath)

A

steroids, pain management

189
Q

GBS Tx

A 
Need to act QUICKLY!
IV IG 
Plasmapheresis: Removing autoantibodies
Respiratory support may be necessary
DVT prophylaxis
(can cause: cardiac arrhythmias and breathing problems)
190
Q

Relapsing remitting MS Tx

A

Plasmapheresis

High dose steroid: short term, doesn’t help relapse

191
Q

MS Injectable Tx*

A 
Glatiramer acetate (Copaxone, Glatopa) - reduce relapse
Interferon beta-1a/1b***
Peginterferon beta-1a (Plegridy)***
(all try to reduce immune cells in CNS)
192
Q

Examples of long acting basal insulin

A

Levemir, Lantus, Tresiba, Toujeo, Basaglar (all insulin glargine)
once a day subQ, no peak

193
Q

NPH medication

A

12-20hrs, 2 shots a day, has peak

194
Q

Examples of short acting insulin

A

Aspart, glulisine, lispro (4-6 hours) - subQ, works in 15min

Regular (6-8 hours) - subQ, peaks 30min-1hr

195
Q

example of biguanide - oral

A

metformin (oral anti-diabetic agent)

196
Q

action of biguanides - oral***

A

insulin sensitizer - make pt’s own insulin work better
reduce hepatic glucose output** and stimulate incretin system
AVOID IN RENAL DYSFUNCTION*******

197
Q

sulfonylurea action - oral

A

ex: glyburide, glipizide, glimepiride
increase insulin secretion from beta cells (INDEPENDENT of glu level)
can have sensitivity to sulfa drugs
AVOID IN RENAL DYSFUNCTION***

198
Q

meglitinides action - oral

A 
ex: repaglinide, nateglinide
not used much
increase insulin secretion from beta cells (INDEPENDENT of glu level)
quick onset, short duration of action*
no sensitivity to sulfa drugs
safe w/ mild renal insufficiency
199
Q

TZD action - oral

A

Ex: Pioglitazone
insulin sensitizer (like metformin)
increases HDL! dec visceral fat
avoid in heart failure (edema)***

200
Q

incretin (GLP-1) effect

A

secreted by small intestines upon ingestion of food to improve/stimulate insulin secretion from beta cells (glu dependent)
also decreases glucagon production in liver
turns off appetite
decreases beta cell workload
prolong beta cell activity and lifespan
effect signif REDUCED in type II diabetes

201
Q

GLP-1 Agonist examples

A 
Byetta – subQ twice a day
Victoza – subQ once a day
Bydureon – subQ weekly
Tanzeum – subQ weekly
Trulicity – subQ weekly
Ozempic – subQ weekly
202
Q

DPP4 inhibitors

A

oral agent that prevents inactivation of GLP-1 and GIP (incretin)
NOT used in Type I DM***
ex: januvia, onglyza, tradjenta, alogliptin

203
Q

SGLT2 Inhibitors**

A

block renal reabsorption of glucose –> pee out glu
large A1c reduction
weight loss
lower SBP (also lose water and Na)
BENEFIT CARDIOVASCULAR HEALTH! (reduce heart failure risks)*
RENAL PROTECTIVE (greater than ACE/ARB)*
SE: inc risk of yeast infection, UTI, rare euglycemic DKA
ex: invokana, farxiga, jardiance, steglatro
CONSTRICT AFFERENT ARTERIOLE**

204
Q

therapy algorithm for DM II

A

if A1c<7.5%: monotherapy: metformin, GLP-1, SGLT2, DPP4, TZD, SFU
>7.5%: dual therapy (metformin + GLP1, SGLT2, DPP3, basal insulin, SFU)
>9% no acute hyperglycemic symptoms: dual
>9% w/acute hyperglycemic symptoms: insulin and oral

205
Q

how should thyroid medication be taken?

A

without food and 30min before eating

206
Q

Anti-thyroid drugs***

A

EX: Tapazole, PTU (reduce oxidation and organification of iodide)
SE: rash, urticaria, fever, agranulocytosis (low WBC)
use tapazole first bc no liver tox (PTU)
dose for 1-1.5yr and see if recurrence
improves immune and condition might not recur
PTU in first trimester or thyroid storm

207
Q

Hyperthyroidism Tx

A

Anti-thyroid drugs
Beta blockers: controls adrenergic Sx*
Radioactive Iodine: destroys thyroid (result hypothyroid)
subtotal thyroidectomy: result hypothyroid

208
Q

Hypothyroidism Tx

A

L-thyroxine (T4) daily on empty stomach, T1/2 a week
monitor TSH in 2mon (takes time to reach steady state)
avoid using T3 - short half life

209
Q

how does amiodarone cause hypothyroidism*

A

high iodine content or direct tox on thyroid (half life 3 mon)
prevent conversion of T4 to T3, blocks T3 recep bind
usu. underlying hashimotos
Tx: w/T4 but keep amiodarone

210
Q

What drugs can cause hypothyroidism?

A

amiodarone

lithium

211
Q

cinacalcet (sensipar)

A

calcimemetic, lower PTH

used for hyperparathyroidism

212
Q

Tx for hypercalcemia***

A

IV hydration – NSS
Bisphosphonates: inhibit bone resorption, effects last a wk
Salmon Calcitonin: dec bone resorption, inc kidney excre
START ALL AT ONCE
(steroids can get rid of excess Vit D)

213
Q

Cushing’s Treatment

A

hydrocortisone and several months of slow taper until AM cortisol >12*

214
Q

Addison’s Dz Tx

A

Daily maintenance hydrocortisone 20 mg in AM, 10 mg in late afternoon (not night bc insomnia)
Mineralocorticoid replacement: Fludrocortisone (Florinef) 0.1 mg/d with salt (to exchange w/K)
during minor stress/illness: 3X3 rule, triple dose 3 days
hyperglycemia management: consider NPH or mix

215
Q

how does glucocorticoids affect glucose?

A

increase hepatic glu production
increase postprandial glu rapidly
dec

216
Q

adrenal crisis Tx

A

Fluids – Dextrose with saline
Steroids
No previous dx – dexamethasone 4mg IV
Known dx – dexamethasone 4mg IV or hydrocortisone 100mg IV

217
Q

Pheochromocytoma Management - pre op***

A

ALPHA BLOCK FIRST - control BP*
THEN BB - control BP
Enzyme blocker to block catecholamine production

218
Q

Prolactinoma Tx

A

dopamine agonists first line 2 wks (ex: bromocriptine, cabergoline), Bigger the tumor better the response
ONLY PITUITARY TUMOR W/O SURGERY AS 1ST LINE*

219
Q

acromegaly tx

A

transsphenoidal surgery

somatostatin analogs after surgery if didn’t get all (ex: octreotide, ianreotide) - growth hormone inhibiting hormone

220
Q

Tx diabetes insipidus*

A

dDAVP (desmopressin), works like ADH

221
Q

SIADH Tx

A

Restrict fluid

Demeclocycline - block ADH at kidney, increase water excretion

222
Q

at what level of hypercalcemia require treatment?*

A

<12mg/dL: doesnt require immediate Tx

>14mg/dL: URGENT regardless of Sx**

223
Q

bisphosphonates

A

treat hypercalcemia by inhibiting osteoclasts

ex: pamidronate, zoledronic acid

224
Q

PCOS Tx

A

BCP (OCP): inc SHBG, reduce amt of free testosterone, endometrial protective bc get menses, has progestin, ex: YAZ
anti-androgens: spironolactone, blocks testosterone recep but no fertility
insulin resistance: metformin! and TZD
weight loss
clomiphene for fertility - ovulation

225
Q

SSRI

A

fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa), paroxetine (Paxil), escitalopram (Lexapro)

226
Q

SNRI

A

venlafaxine, duloxetine, desvenlafaxine

227
Q

Benzodiazepines

A

clonazepam, lorazepam, alprazolam, diazepam

228
Q

TCA

A

imipramine, clomipramine

229
Q

what is TCA at risk for?

A

long qt syndrome, not recommended in heart disease

lethal in overdose

230
Q

gold standard treatment for bipolar disorder*

A

lithium
Contraindicated in severe renal disease, acute MI, myasthenia gravis, 1st trimester pregnancy and breast-feeding. NSAIDS should be avoided***

231
Q

Tx of schizophrenia*

A

Antipsychotic drugs are first-line treatment for schizophrenia –> Low, slow, titrate up for “remission”
Draw labs and start treatment before results except for clozapine (need result first) *** (agranulocytosis risk) –> need weekly CBC

232
Q

Drugs that can prolong qt interval

A

clozapine,thioridazine,iloperidone,ziprasidone.

233
Q

treat severe agitation in schizophrenia

A

A combination ofhaloperidol5 mg,lorazepam2 mg, andbenztropine1 mg given intramuscularly
(none in first trimester pregnancy, some ok with breastfeeding)

234
Q

1st generation antipsychotics

A

D2 dopamine antagonists, cholinergic tracts, alpha1-adrenergic and histamine receptors

  • low potency agents esp affect cholinergic tracts, alpha1-adrenergic and histamine receptors
  • High potency agents esp affect dopamine receptors
235
Q

2nd generation antipsychotics

A

D1, D2, D4, D5 dopamine (selective for the limbic receptors), serotonin, adrenergic, muscarinic, histamine, and nicotinic receptors
Side effects: less EPS, more DM and obesity
-Clozapine (Clozaril): schizoaffective disorders (reduces suicide risk), category B breastfeeding
-risperdone (Risperdal): bipolar, mania, psychosis
-olanzapine (Zyprexa): bipolar, mania, psychomotor agitation, schizophrenia agitation
-quetiapine (Seroquel): bipolar, schizophrenia
-ziprasidone (Geodon): bipolar, psychomotor agitation
-cariprazine (Vraylar): bipolar, manic, depression, major depressive disorder

236
Q

haloperidol (Haldol)

A

1st gen antipsychotics: High potency agents esp affect dopamine receptors
treats acute psychosis, conduct disorders, Tourette’s
Side effects: EPS and diarrhea

237
Q

chlorpromazine (Thorazine)

A

1st gen antipsychotics: low potency agents
treats mania, bipolar, conduct disorders in children, N/V, hiccups
treats GAD (generalized anxiety disorder), N/V, migraines
Side effects: dry mouth, constipation, orthostatic hypotension, sedation

238
Q

prochlorperazine (Compazine)

A 
1st gen antipsychotics: low potency agents
treats GAD (generalized anxiety disorder), N/V, migraines
Side effects: dry mouth, constipation, orthostatic hypotension, sedation
239
Q

Benzodiazepines

A

Triazolam, estazolam, lorazepam, temazepam, flurazepam, and quazepam
Reduce the time to the onset of sleep, prolong stage 2 sleep, prolong total sleep time, and may slightly reduce the relative amount of rapid eye movement (REM)
Decrease anxiety, impair memory, and have anticonvulsive properties

240
Q

Nonbenzodiazepine hypnotics

A

Zaleplon, zolpidem (Ambien), eszopiclone, and zolpidem extended release
target GABA type A receptor

241
Q

Melatonin Agonists

A

Ramelteon: Binds to melatonin receptors expressed in the suprachiasmatic nucleus with much higher affinity than melatonin itself and has a half-life of 1.5 to 5 hours

Tasimelteon: Approved in the United States for treatment of non-24-hour sleep-wake disorder (N24SWD), a circadian sleep-wake rhythm disorder that occurs primarily in blind individuals

Side effects: Somnolence, dizziness, nausea, fatigue, and headache; Elevated prolactin levels and decreased testosterone levels

242
Q

Orexin receptor agonists

A

Suvorexant
Orexin A and orexin B are hypothalamic neuropeptides that play a key role in promoting wakefulness and regulating the sleep-wake cycle

243
Q

DOC (1st line) for ADHD in children >/=6yo

A

Methylphenidate: Ritalin, Metadate CD, Methylin ER, Ritalin SR, Cotempla XR-ODT, Jornay PM, Daytrana (the patch)
Others: amphetamine, Dextroamphetamine/amphetamine:, Dexmethylphenidate, Lisdexamfetamine

244
Q

2nd line Tx for ADHD

A

Non-stimulant: Atomoxetine (Straterra)
less effective, NE reuptake inhibitor
black box warning for suicidal ideation in children with ADHD

245
Q

1st line medication for PTSD

A

SSRI: Paxil, Zoloft

but try Exposure therapy or CBT first

246
Q

pediatric opioid of choice

A

hydrocodone elixir
or morphine
NEVER codeine

247
Q

Gold standard for alcohol acute withdrawal

A

Benzodiazepine taper: long acting like Valium (Diazepam) or librium
bad liver: use Lorazepam
ALSO GIVE: thiamine, folate, magnesium***

248
Q

opioid antagonist meds

A

Naloxone (Narcan)

Naltrexone (Vivitrol) - maintain sobriety but pt need to be off opioid atleast 1 week

249
Q

medication for opioid detox

A

buprenorphine (Suboxone) - want pt in mild to mod**withdrawal –> reduce withdrawal Sx and reduce cravings
methadone

250
Q

Opioid Overdose Tx*

A

Naloxone (Narcan), MORE effective than Naltrexone

251
Q

Tx tobacco addiction

A

Pills:
Bupropion (Zyban®/Wellbutrin®)
Varenicline (Chantix®): caution if have history of mental illness

Nicotine Replacement Therapy (NRT):
Commit® lozenge
Habitrol® patch
Nicoderm® CQ: patch
Nicorette®: gum, use as needed max 24 per day
Nicotrol Nasal Spray®
Nicotrol Inhaler®
252
Q

Tx for drug overdoses other than opioids*

A

Benzodiazepines

253
Q

What drug classes contribute to Erectile Dysfunction?***

A 
Anti-HTN: beta blockers, diuretics
Anti-cholinergic
Anti-depressant
Anti-psychotics
Sedatives/drug abuse
254
Q

What does viagra (Sildanefil) do?

A

prolong vasodilation (PDE5 inhibitor)

255
Q

COPD treatment

A

prevent progression, exacerbation, infections
maintain at least 88% oxygenation
short acting, long acting bronchodilators
STEP UP and CUMULATIVE Tx

256
Q

When are inhaled glucocorticoids used in COPD?

A

Severe cases
helps airway inflammation
s/e: oral thrush, increase risk infection in immunocomp
eg fluticasone

257
Q

What is the mainstay treatment at EVERY stage of COPD?

A

Inhaled bronchodilators (BA or anti-cholingeric)

258
Q

Examples of short acting bronchodilators

A

Beta agonist: albuterol –> b2 receptor agonist*
Anti-cholinergic: ipratropium
used for sx relief

259
Q

Examples of long acting bronchodilators

A

LABA: salmeterol
LAMA: Tiotropium (anti-cholinergic)
used for prevention

260
Q

Tx for COPD Exacerbation

A

sputum culture but start empirical abiotic first
Antibiotics (50% from bacterial infection) - azithro
bronchodilator, systemic corticosteroids (prednisone), O2

261
Q

When is systemic corticosteroids used in asthma?

A

> or equal 3 wheezing/yr

or 2 eps/6mon

262
Q

What should every with asthma get?

A

SABA - rescue inhaler - for acute bronchospasm

263
Q

What is the preferred long term control for all age groups for asthma?

A

Inhaled corticosteroids - prevent exacerbations, most effective
for persistent asthma

264
Q

Tx for severe asthma exacerbation

A

oral corticosteroids

265
Q

How is LABA used?**

A

ONLY in combo w/ICS, NOT monotherapy
only for Step 3 and above and greater than 5 yo
(can increase asthma related death in young children)

266
Q

preferred anticoagulant for PE

A

DAOAC (Direct acting oral anticoag): eliquis, xarelto

-only HD stable pts

267
Q

ADR of ganciclovir and valcyclovir

A

agranulocytosis

268
Q

Tx for Cushings and MoA

A

Ketoconazole, suppresses testosterone and cortisol

269
Q

ACE-I ADR

A

Cough, Angioedema

270
Q

Alpha blocker Tx

A

BPH

ex: prazosin (Minipress)

271
Q

Why is glucocorticoid used in anaphylactic shock

A

prevent biphasic rxn

272
Q

Why would someone w/BPH taking Benadryl experience worsened Sx?

A

due to difficulty micturition (anti-cholinergic effect)

273
Q

Alpha1 Agonist

A

Methylphenidate (Ritalin)

274
Q

Alpha 1 Agonist

A

Methylphenidate (Ritalin)

275
Q

Alpha 2 Agonist

A

Methyldopa - for HTN emmergency

276
Q

Alpha 2 Agonist

A

Methyldopa - for HTN emergency

277
Q

Beta 1 Agonist MoA

A

ex: dobutamine - induce stress testings

sympathetic functions

278
Q

Beta 2 Agonist MoA

A

Bronchodilator - lungs

279
Q

What drugs cant you use in CHF

A

NSAID
CCB - N-DHP
TZD

280
Q

Prinzmetal Angina Tx

A

CCB

NSAID

281
Q

Tx for Torsades

A

Mg

282
Q

Atropine

A

Muscarinic antagonist

Anti-cholinergics

Fall Finals (2 decks)

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