Pharm Flashcards
1
Q
Oxytocin (Pitocin, Syntocin)
A
DOC to induce labor at term if ready
Also: prevent hemorrhage, milk “let down”
2
Q
Adverse eff of Oxytocin (only at large dose)
A
Water intox
Uterine rupture
Anaphylaxis
Sinus brady of fetus
3
Q
Ergot Alkaloids (Ergonovine Malaete)
A
Activate seretonin and a-receptors, only ON switch
2nd line to decrease uterine bleeding if Oxytocin AND massage have failed
4
Q
Ergot Alkaloids
A
Rapid action, IV
AFTER COMPLETE DELIVERY of baby and placenta
5
Q
Ergot Alkaloids CONTRA
A
To induce labor
PAD (periph vasc dz)
CAD (coronary artery dz)
6
Q
Prostaglandins
“prost” in name
A
Dinoprostone
Carboprost Trom
Misoprostol
7
Q
Prostaglandins use
A
After miscarriage or birth to expel fetal contents
Also: 3rd line after massage, oxytocin, and ergots to tx postpartum bleeding
8
Q
Another use for Dinoprostine (a prostaglandin)
A
Cervical ripening prior to delivery at term
9
Q
BLACK BOX WARNING for Prostaglandins
A
Diarrhea
10
Q
Do not use Dino for Cervical ripening IF
A
Problem with mother or fetus (fetal distress, hx of C-section or difficult delivery)
11
Q
Do not use Prostaglandin for Abortion if
A
Acute Heart, Lung, Kidney, or Liver dz Asthma HTN Anemia Jaundice Epilepsy
12
Q
Tranexamic Acid
A
PRO-CLOTTING
Reduce death d/t bleeding in women WITH postpartum hemorrhage
Given in COMBO with standard uterotonic therapy
13
Q
Magnesium Sulfate (MgSO4)
A
1st line drug to prevent pre-term labor
14
Q
Other use for MgSO4
A
Treat pre-ecamplsia and ecampslia
15
Q
Nifedipine (CCB)
A
Inhibits Sm Muscle contraction
Becoming 1st ine to PREVENT PRE-TERM LABOR
16
Q
Indomethacin- COX
A
1-2nd line drug for preventing pre-term labor
Inhibits COX enzyme, therefore reducing Prostaglandin synthesis
17
Q
Indomethacin adverse effects
A
Partial closure of fetal ductus arteriosus
18
Q
Progesterone, to prevent premie delivery
A
Most effective when given PROPHYLACTICALLY to high risk mothers who have had premie hx
16th-37th week
not affective for Acute tx
19
Q
Drugs to treat Hypothyroidism (3)
A
Levothyroxine Na
Liothyronine Na
Dessicated Thyroid
20
Q
LevothyroXine Na
A
DOC for Hypo
beware that T4 levels change slowly, ~5 weeks to reach steady state
21
Q
Liothyronine Na
A
Used for initial therapy in treating Hypo, but not maintenance
Shorter duration of action
22
Q
Dessicated thyroid (Armour)
A
Mix T3 and T4 from pigs
Natural hormones
Good for pts with PERIPHREAL DEOIDONASE DEFICIENCY
23
Q
Treatment for HYPERthyroid
A
Remove gland 131-I radioactive Thioamides Iodide B- blocker symptomatic
24
Q
Propylthiouracil (PTU) and Methimazole
A
Thioamides
25
Methimazole
a Thioamide, more potent than PTU
| DOC for Graves
26
Methimazole is DOC in most cases, UNLESS
Pregnant or allergies to M, then use PTU
27
Adverse effects to Thioamides
```
Itching, skin rash
Granulocytopenia
Agranulocytosis
Goiter
Lupus like syndrome, HA, myalgia, arthralgia, lymphadenopathy, psychosis
```
28
Iodide
rapidly decreases synthesis of T3 and T4
| Short term effect
29
Iodide use
7-10 days before surgery (decrease chance of Thyroid Storm)
Also use in Radioactive emergencies
30
131-I Use
Elderly pts with Heart dz
Preferred tx for TOXIC NODULAR GOITER
Also, definitive for Graves, but Thioamides are DOC
31
131-I Use (simple)
Old ppl heart dz
Toxic Nodular Goiter (Preferred)
Definitive for Graves (but not preferred)
32
131-I CONTRA
Pregnant, nursing, or lack childcare
33
Beta-blockers
- Propranolol
- Metoprolol
Inhibit conversion of T4-->T3
Treat sx of HYPERthyroid
CONTRA: Asthma
34
If you have HYPER thyroidism and want to treat the sx but have Asthma,
Use CCB instead of beta-blocker
35
Calcitonin
Turn down Bone resorption
Antagonize PTH
Decrease bone pain, loss, and fractures
Increase bone density
36
Adequate Calcium is needed for
any other tx to work
37
Vit D is needed for
Calcium to be absorbed
38
PTH drugs
| "paratide"
Teriparatide
Abaloparatide
rhPTH(1-84)
39
Teriparatide and Abaloparatide have more
OsteoBLAST activity. used for Osteoporosis, but effects diminish over time
Switch to another Osteoporosis tx in 18-24 mo
40
rh PTH 1-84 used for
Hypoparathyroid
| more osteoCLAST activity
41
Parathyroid drugs
- Teriparatide
- Abaloparatide
Effective tx for Osteoporisis in Men and Post-menopausal Women
Decrease new fractures
Stimulate formation of NEW BONE
42
Teriparatide (PTH drugs) pharm
peak in 30 min, gone in 3 hours
43
Adverse effects of PTH drugs
| "paratide"
High calcium in BLOOD and URINE
Abaloparatide can also cause HyperURICemia
44
Denosumab
Antibody to RANKL
Inhibit Bone resorption
Use: Tx Osteoporosis in Men and post-menop women
SubQ injection every 6 mo
45
Denosumab Absolute CONTRA
Hypocalcemia
| Pregnancy
46
Denosumab Relative CONTRA (just be careful)
CKD
| Pts at risk for serious infection (bc RANKL usually signals lymphocytes)
47
Biphosphonates
"dronate"
Alendronate- oral
Risedronate- oral
Ibandronate- oral, IV
Zoledronic Acid, IV
48
Biphosphonates
| "dronate"
sub for Phosphate in Calcium binding, incorporate into the bone, stay there FOREVER
49
Downfall of biphosphonates
incorporate into bone, so we are able to make more but NO BONE TURNOVER means we cant continue breaking down and making new
Bones never re-made. old and brittle. not flexible and strong
50
DOC for Osteoporosis
Biphosphonates
51
Adverse effects of Biphosphonates
Oral: abd pain, esoph irritation, ulcer, flatulence
IV: Kidney toxic
OSTEONECROSIS OF JAW***
Atypical bone fractures of femur
52
CONTRA for Biphosphonates
Oral: Cant stand upright (need to do for 30 min after taking on empty stomach with 1/2 glass water)
OR
IV: Renal dz
53
Rapid Acting Insulin
Lispro
Aspart
Glulisine
Inhaled
54
Short Acting Insulin
Regular Insulin
55
Intermdt Insulin
NPH
56
Long Acting Insulin
Glargine (Lantus)
Detemir (Levemir)
Degludee (Tresiba)
57
Preferred in Insulin pumps
Rapid Acting bc less "tail response" and less risk for Hypoglycemia
58
What mimics body's natural response the best?
Long acting + Rapid acting
59
Pump insulin
Always basal level + rapid acting b4 meal
60
GLUT 4 works in
Muscle and Adipose tissue
61
What is used 1st in Type 2 DM?
Long acting Insulin
(Glargine, Detemir, Degludee)
ONLY if A1C >10%
62
Insulin injections
Create insulin profile and eat to fill it
63
Pump insulin method
Adjust insulin bolus according to what you eat
64
Glucagon Used for:
Adults w stable DM
B-blocker overdose
GI relaxation b4 X raysG
65
Glucagon only good for well-controlled Diabetics bc it works by:
Mobilizing Hepatic glucose stores (uncontrolled diabetics will not have glucose stored in Liver)
66
Diazoxide
Non-diuretic Thiazide, vasodilator, and Hyperglycemic
67
Diazoxide
| (non-diuretic thiazide) USE
Pts with Insulinoma (pancreatic beta cell tumor that secretes too much Insulin)
68
Metformin
decrease Glucose levels in an Insulin-independent manner!
| AMPK pathway
69
Metformin
DOC for Type 2 IF A1C is below 10%
| remember if it is >10%, have to use Long acting Insulin
70
Metformin benefits
Decrese:
Macrovascular events
All cause mortality
71
DOC for Diabetes prevention
Metformin
72
Adverse Effect for Metformin
```
Diarrhea (common)
Lactic Acidosis (dangerous)
Vit B12 deficiency (reversible)
```
73
CONTRA to Metformin
Kidney dz
| failure or severe impairment, GFR <30
74
GLP-1 RA
| "glutide"
Exanatide
Liraglutide
Semaglutide
75
GLP-1 and GIP increase the release of
Insulin
76
GLP-1 Receptor Agonist (help increase the release of Insulin)
the "TIDES"
Exanatide
Liraglutide
Semaglutide
77
GLP-1 Receptor Agonists
SubQ injections, except Semaglutide is oral
78
Liraglutide
Decrease Macrovascular events
Good for Type 2DM
Decrease BP
Weight Loss
Increase: B cell # and fx
79
Out of all the GLP-RA drugs, which one is used most common/FDA approved?
Liraglutide
- decrease macrovascular events
- Type 2 DM: reduce major CV events
- Weight loss
- Decrease BP
80
Caution GLP-RA drugs with
Pancreatitis
81
CONTRA for GLP-1 RA
Thyroid CA- BLACK BOX
82
DPP-4
Usually breaks down GLP-1 (which helps insulin release)
If we inhibit DPP-4, we allow insulin to continue being released
83
DPP-4 Inhibitors
| The "gliptins"
Sitagliptin
| Linagliptin
84
DPP-4 Inhibitors
| "gliptins"
pretty chill, neutral as far as CVD and wieght effects
CAUTION with Pancreatitis
85
DPP-4 Inhibitors: unique about Linagliptin
elim by Liver AND GI, so it's safe to Kidney
86
Drugs to use caution with for Pancreatitis
GLP-1 Agonists
| DPP-4 Inhibitors
87
SGLT-2 Inhibitors
| "Flozin"
Inhibit Na-glucose transporter in kidney
| PEE IT OUT
88
SGLT-2 Inhibitor
"Flozin"
benefits
Canag and Empag: Dec CV events
Canag: Dec CKD progression
Canag and Dapag: Dec HF hospitalizations
All: dec BP, weight loss
89
SGLT-2 Inhibitors
Canag does it all!
| Decrease CV events, decrease CKD progression, Decrease HF hospitalizations
90
Empagliflozin and Canagliflozin are approved for Type 2 DM to:
decrease risk of Major CV events
91
SGLT2 Inhibitor Adverse Effects
Urinary infections
peeing all the glucose out
Rare: kidney impairment and AKI
92
CONTRA to SGLT2 Inhibitors
Severe Kidney impairment or Dialysis
| Prone to UTI/GU infection
93
TZD
| "tazones"
Specifically target insulin resistance to increase Insulin sensitivity
94
TZD
metabolized by the Liver= KIDNEY SAFE
95
TZD
PPAR-y receptor
| Post-receptor insulin mimetic action
96
TZD benefits
Decrease Trig
Increase HDL
Improve insulin sensitivity (may help prevent Type 2, not as good as Metformin)
97
TZD Adverse Effects
Weight gain
Edema
Inc Bone fracture risk
98
CONTRA to TZD use
```
Liver dz (bc metabolized by liver)
Heart Failure (bc edema)
```
99
Alpha-glucosidase inhibitors
Acarbose
| Miglitol
100
Alpha-glucosides inhibitors
USED IN BOTH TYPE 1 and 2
101
Alpha-glucosides inhibitor mechanism
DELAY CARB DIGESTION and absorption
102
Alpha-glucosidase effects
Decrease post-meal glucose only
103
AGi Adverse effects
Flatulence
| "The nursing home Diabetes drug"
104
CONTRA to AGi
Any GI dz: obstruction, ileus, inflammatory bowel, hiatal hernia
Liver dz or Kidney impairment
105
Sulfonylureas for Diabetes
Block ATP sensitive K channel to cause membrane depol, increase Ca influx to Beta cells
Increase insulin release
106
SU effects
Long term: dec MI risk, dec microvascular risk, dec all cause mortality, dec serum glucagon
WE DONT USE THIS DRUG
107
Why don't we use SU often for Diabetes?
HUGE HYPOGLYCEMIA RISK
| Also: weight gain, GI SE
108
CONTRA to Sulfa
Severe Kidney or Liver dz
109
Sulfa 2nd gen
Glyburide (worst) 24 hr
Blipizide (least risk) 2-4 hr
Glimepride 1/day
110
Meglitinide
| Repaglinide
not a SU, can be used in SU allergy
Same mechanism, block ATP sens K channel, increase Ca flux
111
Meglitinide (Repaglinide)
Do not use with SU, caution with liver impairment
112
Colesevelam
Bile acid binding resin
| COMBO w other DM drugs
113
Colesevelam benefits
Reduce LDL
Safe
SE: constipation and bloating
114
Bromocriptine
Dopamine agonist- quick release
Decrease post meal glucose d/t SUPPRESSION OF LIVER GLUCOSE PRODUCTION
115
Bromocriptine
Give w/in 2 hrs of waking
| CYP3A4
116
Bromocriptine benefits
Dec post meal glucose levels, FFA and Trig levels, Cardiovascular problems
117
Amylin like peptide
Pramlintide (always used w Insulin)
118
Amylin is a
hormone co-secreted with Insulin
119
Pramlintide only used
IN COMBO w Insulin
Works w insulin to regulate post meal glucose
SubQ injection 3x/day
120
Pramlintide (always used w Insulin) benefits
Decrease post meal glucose
| Weight loss
121
CONTRA to Pramlintide
Gastroparesis (slow GI) bc this slows even more, delays gastric emptying
122
What is used in BOTH Type 1 and 2?
Alpha-glucosidase inhibitors
Delay carb digestion and absorption
FLATULENCE: nursing home
123
FSH effects
Women: develop ovarian follicles
Men: Stimulate spermatogenesis
124
LH effects
Women: Estrogen/Progesterone synth
Men: Testosterone syntehsis
125
Long acting GnRH
Leuprolide: DOC for Endometriosis
126
GnRH antagonist
Cetrorelix
127
GnRH drugs (long acting AND antagonist) Use
Suppresses LH and FSH
IVF
Sex steroid dependent CA
Endometriosis
Precocious puberty
128
Gonadotropins
LH and FSH
129
Use of Gonadotropin therapy
Men: induce spermatogenesis
Women: In Vitro fertilization
130
Adverse effects of Gonadotropin therapy (LH and FSH)
Ovarian hyperstimulation syndrome: DANGEROUS (hypovolemia, shock, death, rapid accum of fluid in peritoneal, pericardial, and pleural cavity)
Multiple births
Gynecomastia
131
CONTRA to Gonadotropin therapy (LH and FSH)
Sex steroid dependent CA
132
Sex steroid dependent CA. What to USE and AVOID?
USE: GnRH drug
AVOID: Gonadotropins (LH and FSH)
133
Exogenous Estrogen therapy use
Birth control
Hormone replacement therapy
Stimulate puberty
134
Estrogen Adverse Effects
Migraine
| CLOT risk
135
Estrogen CONTRA
Estrogen dependent CA
Clotting disorder
Smoking AND >35YO
Pregnant
136
Anti-Estrogens
Tamoxifen
Raloxifen
Clomiphene
137
Tamoxifen (anti-estrogen)
"Breast CA drug"
| SERM: selective estrogen receptor modulator
138
Tamoxifen (anti-estrogen)
Antagonist: breast
Agonist: bone and uterus
DOC for breast CA in Pre-menop women
139
Clomiphene (anti-estrogen)
DOC for Infertility
Adverse effect: Multiple pregnancies
140
Aromatase inhibitor
| Anastrazole
DOC for Breast CA in Post-Menop women OR in advanced dz (have to make woman post-M for it to work)
141
CONTRA to Aromatase Inhibitor (Anastrozole)
Pregnancy
| Pre-menopausal
142
Progestin use
Birth control
| Prevent endometrial Hyperplasia in HRT (hormone replacement therapy)
143
Progestins
Progesterone
Levonorgestrel (plan B)
Medroxyprogesterone (Provera)
144
Antiprogestin
(Mifepristone)
Use:
Terminate pregnancy
| Prevent implantation
145
Combo pill
Ethinyl Estradiol/Drospirenone
Good bc: less water retention
146
Progestin only
Mini pill
Depo-provera
Implanon/Nexplanon
Mirena
147
When to use Mini pill (progestin only)
Breastfeeding
148
Post coital Emergency
Plan B (Prog only)
Preven (Prog and Estrog)
Mifepristone (Anti-prog)
149
Adverse effects of Combo birth control
```
Clotting (>35 and smoker huge risk)
Mild HTN
Migraine HA
MI/Stroke
Teratogenic
```
150
Benefits of Birth control
Reduced risk of Ovarian/endometrial CA, ovarian cysts, benign breast dz, Ectopic pregnancy, Iron def, RA, PMS, etc
151
Absolute CONTRA to birth conrol
```
ASCVD
Estrogen dependent CA
Pregnant
Smoker and >35YO
Uncontrolled HTN
Uncontrolled DM
```
152
Drug interactions w Birth control
P450 inducers and Abx can reduce effectiveness
153
Birth control can then inhibit the effectiveness of these drugs:
```
Anticoag
Anticonvulsant
Antidepressant
Guanethidine
Oral Hypoglycemics
```
154
Androgen use indications
```
Testicular deficiency
Female hypopituitarism
Female--> Male
Hypoprotein of Nephrosis
Negative Nitrogen balance
```
155
Androgen receptor ANTAGONIST
Flutamide
| Spironolactone
156
Androgen receptor antagonist use
Flutamide: in Prostate CA with long acting GnRH
Spironolactone: Hirsutism, PCOS, Precocious puberty
157
5-a reductase inhibitor
| Finasteride
BPH
Male pattern baldness
Stops T --> DHT conversion
158
Finasteride Adverse Effects
Gynecomastia
Erectile Dysfx
Teratogenic
