pharm chart Flashcards
(148 cards)
1
Q
what drug class is iron?
A
hematinics
2
Q
what is the MOA for iron?
A
supplement
3
Q
what are the SE of iron supplements?
A
abdominal cramps
BLACK STOOL
anaphylaxis IV formulation
4
Q
what are the contra for iron supplements? 3
A
- anaphylaxis with IV
- hemachromatosis (when body absorbs too much iron)
- hemolytic anemia
5
Q
what are the drug interactions for iron supplements? what four drugs bind Fe?
A
anatacids, phenytoin, quinolone, tetracycline
6
Q
what four things should you monitor for a patient taking iron supplements? 4
A
serum ferritin
transferrin saturation
hgb
reticulocytes
7
Q
what drug class is defoxamine?
A
iron chelator
8
Q
what is the MOA for deferoxamine?
A
chetates iron from hemosiderin, ferritin, transferrin (not hemoglobin or cytochromes)
basically binds excess iron in the body to prevent it from causing tissue damage
9
Q
what is the indication for deferoxamine?
A
excess serum iron levels
10
Q
what are the SE of deferoxamine? 4
A
leg cramps, hyptension (IV), PULMONARY SYNDROME, neurotoxicity
11
Q
what drug class is cyanacobalamin B12?
A
vitamin
12
Q
what is the MOA of cyanacobalamin B12?
A
rate limiting cofactor in the conversion folate to active form and DNA synthesis
13
Q
what is the SE of cyanacobalamin B12?
A
painful by injection
14
Q
what is the indications for cyanacobalamin B12?
A
B12 deficiency, depression, megaloblastic anemia
15
Q
what are 3 drug interactions for cyanacobalamin B12?
A
long term acid suppression therapy
metformin
phenytoin
16
Q
what is the replenishment regimen for cyanacobalamin B12?
A
IM 1,000 mcg daily for 1-2 weeks
IM 1,000 mcg weekly
IM 1,000 mcg monthly
ORRRRRRR
1,000 mcg daily
17
Q
what is the storage pool requirement for B12? what is the daily need?
A
3,000-5,000 mcg storage pool
2mcg daily need
18
Q
what is the controversy around B12 therapy? what is the controversy called?
A
variable oral absorption, dose 1,000 daily but 500 or less absorbed
IM 100-1000 every one to three months
“alternate absorption pathway”
19
Q
what is the drug class for folic acid?
A
nutritionals
20
Q
what is the MOA for folic acid?
A
cofactor in DNA synthesis
21
Q
what is the indication of folic acid? 2
A
megaloblastic anemia
prevention of neural tube defects
22
Q
what are the SE of folic acid?
A
bronchospasm
23
Q
what the the drug interactions seen with folic acid?
A
phenobarbitol phenytoin primodone trimethoprim methotrexate
24
Q
what is the dosing for folic acid?
A
variable 1-5 mg daily
25
what do you monitor when administering folic acid? 2
serum folic acid levels
| RBC folic acid levels
26
what is the liver storage amount of folic acid?
2-20 mg
27
how long is the reserve for folic acid in the body?
1-6 months
28
what are two things that can decrease the amount of folic acid in the body that you need to be concious of when treating a patient?
dialysis
| chronic alcoholism
29
what do you need to do before treating a patient with folic acid?
RULE OUT B12
for the 94094809 time!!
30
what drug class is epoetin alfa
erythrocyte stimulating agent
31
what is the MOA of epoetin alfa?
stimulates erythrocyte proliferation and differentiation
induces release of reticulocytes
32
what are 4 indications for epoetin alfa?
low RBC from HIV, RA, antineoplastic therapy, and end stage renal disease (ESRD)
33
what are SE of epoetin alfa?
```
iron deficiency
clotting
hypertension
thrombosis
seizures
```
**think about it, making more cells so these all make sense, if more cells more viscous blood**
34
what is the drug class for filgrastim?
myleoid growth factor G-CSF
35
what is the MOA of filgrastin? 3 things! woah
1. stimulates prolif and diff of myeloid cells
2. increase phagocyte/neutrophil activity and life span
3. mobalizes periphreal neutrophils
36
what is the indication for filgrastin?
neutropenia secondary to chemo
think about it!! you're increasing your immune systems response and wanting to increase defense by increasing WBC!!
37
what are some SE of filagrastin?
BONE PAIN
**think about it, increasing cell production!!**
38
what three drugs belong to the indirect thrombin inhibitors?
unfractioned heparin
low molecular weight heparin
fondaparinux
39
what is the drug class for unfractioned heparin?
indirect thrombin inhibitors
40
what is the MOA of unfractioned heparin?
accelerates degredation of Xa and thrombin
41
what are SE of using unfractioned heparin? 4
alopecia, osteoporosis, heparin induced thrombocytopenia after 7 days, skin necrosis
42
what the the contra indications for unfractioned heparin?
prior HIT
| intracranial bleeding
43
what are the drg interactions seen with unfractioned heparin?
anticoagulants, tNSAIDS, nitroglycerin (NTG) decreases effect
44
what are four monitorings you want to do with unfractioned heparin?
aPTT, platelet count, H&H, occult blood
45
what are two interesting sources for unfractioned heparin?
pork intestinal mucosa
| bovine lung tissue
46
what can't unfractioned heparin do?
fibrinolytic activity
can't lyse a clot if its already there
47
what is the drug class for low molecular weight heparin?
indirect thrombin inhibitor
48
what is the MOA of low molecular weight heparin?
increased degredation of Xa
49
what are the 2 indications for low molecular weight heparin?
acute coronary syndrome
| DVT
50
what are two SE of low molecular weight heparin?
injection site hematoma
| increased AST/ALT (liver function tests)
51
what are 3 contraindications for low molecular weight heparin?
active bleeding
pork hypersensitivity
thrombocytopenia
52
what is low molecular weight heparin a product of?
pork
53
low molecular weight heparin doesn't need to be renally adjusted above what threshold?
>30 ml/min
54
what is the drug class for fondaparinux?
indirect thrombin inhibitor
55
what is the MOA for fondaparinux?
increases degredation of Xa
56
what are the indications for fondaparinux?
DVT prophylaxis/treament
| acute PE
57
what is a SE of fondaparinux?
rash
58
what is the origin of fondparinux?
synthetic!!! NOT OF ANIMAL ORIGIN!!
59
how is fondaparinux administered?
sub q only!!
60
what is the drug class for protamine sulfate?
antagonist of indirect thrombin inhibitors
61
what is the MOA of protamine sulfate?
binds to heparin and neutralizes its anticoag effects
**if you coag someone, there needs to be a way to reverse it!! think about it***
62
what is the drug class for dabigatran?
oral direct thrombin inhibitor
63
what is the MOA of dabigatran?
directly inhibits thrombin IIa action that convert fibinogen to fibrin, INHIBITS PLATELET AGREGATION
**prevents clotting***
64
what is the indiation for dabigatran?
prevents stroke in non-valvular a fib
65
what is are two SE of dibigatran?
bleeding 17%
| gastritis 3%
66
what CrCl should you not use dibigatran in?
CrCl
67
what drug interactions do you worry about for diabigatran? 2
P-gp antagonizers
| P-gp inhibitors
68
what is NOT avaliable for a patient taking diabigatran? so what might this patient have to do if there is a complication?
NO ANTIDOTE, would need to dialyze
69
what is interesting about diabigatrans sensitivity?
VERY MOITSURE SENSITIVE
only has a 4 MONTH SHELF LIFE!!
70
what is the drug class for warfarin?
coumarin anticoagulants
71
what is the MOA of warfarin?
blocks vit k mediated carboxylation of clotting factors 7,9,10,2, C and S
72
what is the indication for warfarin?
prevention and treatment of venous thrombosis
73
what are 3 SE of warfarin?
easy bruising, skin tissue necrosis, vasculitis
74
what are 2 contraindications for warfarin?
active bleeding
| skin necrosis
75
what is a drug interaction for warfarin?
ginkgo biloba
76
what do you use to monitor a patient taking warfarin?
PTINR
| H&H
77
what counteracts the effects of warfarin? and how long does this stay in your system after stopping it?
Vit K
2-5 days because of half lives
78
what drug class does vitamin K belong to?
antagonist of coumarin anticoagulants
79
what is the MOA of vitamin K?
promotes liver synthesis of 2, 7, 9, 10
80
what is the indication of vitamin k?
counteracts excess warfarin anticoagulation or vit k deficiency
81
what is the difference between the vitamin k onset times when given IV and given PO?
oral 6-10H onset, peak 24-48 hours
IV 1-2H onset, 12-14H peak
82
where does vitamin k come from?
green leafy vegetables, salads
83
what happens if you give a pt a high dose TX of vitamin K over >10mg? what do you need to do to account for this?
may cause warfarin resistance for up to 7 days so use LMWH temporarily
84
what drug class does rivaroxaban belong to?
direct factor Xa inhibitor
85
what is the MOA of rivaroxaban?
directly and selectively inhibits factor Xa
86
what are the indications for rivaroxaban? 4 things
1. reduce clots associated with knee/hip replacement, non-valvular a fib, DVT/PE
87
what are the contraindications for rivaroxaban? 2 things
```
active bleeding
mod-severe liver disease child-pugh class B/C
```
88
what are the drug interactions seen with rivaroxaban?
CYP34A drugs P-gp inhibitors/inducers
| clarithromycin, fluconazole, carbamazepine, phenytoin, johns wart
89
should you use rivaroxaban in pregnancy/lactation?
NO!
90
how should you take rivaroxaban? is there an antidote?
with food at dinner, increases the bioavaliability NO ANTIDOTE
91
what is the half life for rivaroxaban? how long does it take to work?
7-11 hours halflife
| works in 2-4H
92
what should you caution when taking rivaroxaban?
grapefruit juice!
93
explain what happens in the elderly when taking rivaroxaban?
clear it more slowly so at higher risk for negative symptoms
94
what drug class does streptokinase belong to?
fibrinolytic
95
what is the MOA of steprokinase?
activates the conversion of plasminogen to plasmin which degrades fibrin
96
what are the SE of using streptokinase?
SEVERE DVT, PE, AMI, OCCULDED AV CANNULAS
97
what drug class does animocaproic acid belong to?
fibrinolysis inhibitors
98
what is the MOA of aminocaproic acid?
binds to plasminogen and plasmin and blocks plasmin lysis of fibrin
99
what is the indication for aminocaproic acid?
state of excess fibrinolysis
***to much cloth breaking down**
100
what is a rare side effect of aminocaproic acid?
muscle necrosis
101
what drug class does alteplase belong to?
plasminogen activator tPAs
102
what is the MOA of alteplase?
preferentially binds to plasminogen bound to fibrin (theory: confines thrombolysis to formed thrombus only)
103
what is one strange SE associated with alteplase?
reprofusion arrythmias
104
what is the drug class for aspirin?
anti-platelet drugs
105
what is the MOA for aspirin? does two things!
irreversible inactivation (via acetylation) of cyclo-oxygenase
inhibits synthesis of thromboxane A2 which prevents platelet aggregation and vasconstriction by thromboxane A2
106
what is the indication for apsirin?
secondary prophylaxis of MI or CVA
107
what are two side effects of taking aspirin?
30% gastritis, tinnitus
108
what percent of patient taking aspirin get gastritis?
30%
109
what is a strange conta indication for using aspirin in a patient?
nasal polyposis (polyps...thats weird!)
110
what are drug interactions for asprin?
anticoagulants and NSAIDS
111
what is the pregnancy rating for aspirin?
D!!!
112
explain what the aspirin indication is for a patient over 50?
320 mg daily
113
what does a higher dose than 320 mg of aspirin do?
decrease PGI2 (prostacylcin) that inhibits platelet aggregation in vivo
114
what does class does clopidogrel belong to?
platelet ADP inhibitors
115
what is the MOA of clopidogrel?
irreversibly blocks ADP receptor on platelets preventing platelet/fibrinogen binding and platelet aggregation
116
what are three indications for clopidogrel
secondary prevention of acute myocardial infarction, CVA aka stroke, PAD periphreal artery disease
117
what percent of people experience gastritis when using clopidogrel? what is rare when using this drug?
27%
leukopenia is rare
118
what are 3 drug interactions to watch for when taking clopidogrel?
1. antiplatelet/anticoagulant
2. atorvastatin
3. MACROLIDE ANTIBOITICS
119
clopidogrel is a________. what is the dosing?
PRODRUG!!! doesn't effect PG metabolism
300 mg loading dose and 75 mg every day!!
120
what is used as a aspirin allergy alternate?
clopidogrel!!!!
121
what drug class does abciximab belong to?
glyoprotein IIB/IIIA inhibitors
122
what is the MOA for abciximab?
blocks platelet GBIIb/IIIa receptors for thromboxane, A2, thrombin, collagen and prevents platelet aggregation
123
what is the indication for abciximab? (two of them and theyre good)
coronary artery stent, acute coronary syndrome
124
what is the half life for abciximab when given IV?
30 minutes!! woah thats short
125
if there is severe bleeding on abciximab...what might be indicated?
platelet infusion
126
what is the drug class for dipyridamole
phosphodiesterase inhibitor
127
what is the MOA of dipyridamole?
increases platelet concentration of AMP, DECREASING PLATELET AGGREGATION
128
what is the indication for dipyridamole? 3 things!!!
- post op
- primary prophylaxis for prosthetic heart valves
- prophylaxis after CVA (stroke)
129
what are four SE of dipyridamole?
38% headache
blurred vision
dizziness
130
what is a major side effect of taking dipyridamole and what percent of people experience this?
38% headache
131
when is dipyridamole contraindicated for a patient?
sever hepatic/renal impairment
132
what drug should you not take when taking dipyridamole?
aspirin
...its already in this drug so you would be taking it double!
133
what do you need to monitor when taking dipyridamole?
CrCl and H&H
134
what compound do you want to add to dipyridamole to make it more effective?
aspirin
dipyridamole alone has questionable efficacy orally, but when taken with aspirin it works better ***SO DON"T USE IF SOMEONE HAS ASPIRIN SENSITIVITY***
135
what drug should someone with a aspirin sensitivity avoid?
dipyridamole
136
what is the PG rating for dipyridamole?
D, so also avoid lactation!
137
what drug class does cilostazol belong to?
phosphodiesterase inhibitor
138
what two drugs are phosphodiesterase inhibitors?
dipyridamole and cliostazol
139
what is the MOA of cilostazol?
inhibits platelet phosphodiesterase and therefor limits platelet aggregation
140
what is the indication for cilostazol?
periphreal arterial disease (intermitten claudication)
141
what are SE (3) that are associated with cilstazol and what are the percents?
rhinnititis- 27-34%
headache 12-15%
abnormal stools
142
drugs that interact with cilostazol are
```
CYP34A inhibitors
macrolides (increase)
NSAIDs
omeprazol
anticoagulants
```
143
what are two things you should monitor for someone taking cilostazol?
walking distance
| CrCl
144
what two things do you need to avoid eating when taking cilostazol? 2 things!
Grapefruit juice since CYP34A
| High fat meals
145
how long does cilostazol take to act and how long does the patient get benefits?
2-4 weeks to act
| benefits last 12 weeks
146
which patients do you not want to use cilstazole in?
CHF patients!!
147
which two drugs are effected by the CYP34A system?
rivaroxaban
| cilostazol
148
what is interesting about the storage options/shelf life for dabigatran?
has a self life of 4 months
HOWEVER, comes in two forms, a 60 day loose caps in a bottle or a blister pack (individually packaged where you punch the pill out), however, the price is the same and literature doesn't distinguish a discard threshold between the two
**you think the blister pack would last longer**
