Pharm exam 1 Flashcards
musculoskeletal & Immune
1
Q
Half Life
A
If this period is short then the medication will be dosed more frequently
2
Q
Liver disease findings
A
Symptoms: Jaundice/ ascites/ Edema/ Abd Pain (RUQ)/ weight gain
At risk: ETOH usage/ Hepatitis / transplant
Labs: AST/ ALT/liver fx test
3
Q
Renal findings
A
Symptoms: decrease Urine Out put/ Edema/ increased weight/ HTN
At risk: DM/ Old/ HTN
Labs: BUN/ Crat/ GFR
4
Q
Peptic Ulcer findings (stomach bleeding)
A
Symptoms: ABd pain/ epigastric / reflux/ dark tary stools/ coffee grounds
At risk: decreased immune/ smoking/ + H pylori / ETOH
Labs: Decreased RBC
5
Q
Low WBC
A
Symptoms: Fatigue/ fever/ upper resp
Risk: suppressed immune/ HIV/ CA/ auto immune
Labs: WBS
6
Q
Low Platelets
A
Symptoms: Bleeding/ Bruising / gums / rectoms
risk: anticolgulatants/
Labs: Platelets / PH, INR
7
Q
First Pass
A
Insulin can not be given orally because as it will be completely metabolized in the liver
8
Q
Steady state
A
A loading dose will be required
9
Q
Distribution
A
This process is greatly affected by whether or not the medication is protein bound or not
10
Q
Efficacy
A
Morphine 2mg will produce the same response as Diluded 0.5mg
11
Q
Synergistic
A
Two drugs work better together at lower doses
12
Q
Antagnoist
A
The effects of morphine are blocked when the medication naloxone occupies the receptor.
13
Q
Partial agonist
A
The type of drug that will act like a substance in the body but the effect is not as strong.
14
Q
MORPHINE
Opioid agonist
A
- Binds with mu and kappa receptor sites.
- Analgesia, euphoria, pupil constriction, stimulation of cardiac muscle, peripheral vasodilation
- Pre-anesthesia
- Treatment of shortness of breath associated with heart failure/pulmonary edema
- Acute chest pain with MI
Check VS before admin/ do not give if RR 12
15
Q
HIGH opioids
A
Morphine*, Hydromorphone, Fentanyl
16
Q
MODERATE opioids
A
Oxycodone*, Hydrocodone, Codeine
17
Q
PARTIAL opioids
A
Buprenorphine*, Butorphanol, Nalbuphine
18
Q
ANTAGONIST
A
Naloxone*
19
Q
Morphine S/E + RISKS
A
- IV morphine should be given by slow IV push, (4-5 minutes). Must know where the naloxone and resuscitation equipment is located.
- Head of bed down, do not get out of bed by yourself, side rails up, call light in place
- Risk of orthostatic HTN do not get out of bed for 15 min
20
Q
NALOXONE
A
Opioid antagonist - reversal agent
- Complete or partial reversal of opioid effects during emergency. (works within minutes)
- Post op opioid respiratory depression
21
Q
Buprenorphine
A
Should allow for analgesia without euphoria, decreased risk of dependence
-weaker response/ decrease ppl on opioids - prevent acute withdraws - so avoid opioid dependent ppl
22
Q
ASA
A
- COX Inhibitor (I and 2)
- Significant anti-platelet effect-IRREVERSIBLE
- Decreased inflammation/pain
- Mild to moderate decrease in fever
- Risk reduction for colorectal cancer (unknown mechanism)
- 7 days lie of platelet of schedule for SX must be off for 7 days prior sx
23
Q
ASA SE
A
- Heartburn, stomach pain, ulceration
- Bronchospasm, anaphylaxis, hemolytic anemia
- Salicylism tinnitus, impaired hearing, sweating, HA, and dizziness.
- Toxicity: sweating, high fever, coma, respiratory depression
- Reye’s Syndrome (children with viral infection ASA is contraindicated. Can cause vomiting and mental status change. Elevated LFTs, elevated ammonia, possible serious brain injury
- children under 12 can not take
- contraindication c ppl peptic ulcers/ asthma
24
Q
COX2
A
inflammatory postaglandins
- undesire effects*
- inflammation
- pain
- fever
- decrease platelets
25
COX1
Cytoprotective postaglandins
* desire effects*
- GI protection
- increased platelets
- renal protection
- vasodilation
- Bronchodilation
26
IBU
COX Inhibitor (1 and 2) with reversibility
Mild to moderate pain, inflammation and fever reduction
Anti-platelet effect is less significant
27
IBU SE
- Headache, drowsiness, dizziness, anorexia, dyspepsia, nausea, possible occult blood loss
- Peptic ulcer, GI bleed, aplastic anemia, agranulocytosis, laryngospasm/edema, anaphylaxis, renal failure, vomiting, constipation, diarrhea
- Serious increased risk of thrombotic events, MI and CVA
* HX of MI/ Stroke should not take
28
Celebrex
Selective inhibition of COX 2
Decreased pain and inflammation
Abdominal pain, dizziness, headache, sinusitis, hypersensitivity
Some taken off of the market d/t increased risk of cardiac events (Vioxx, Bextra)
29
Prednisone
*Blocks COX 1&2*
Decrease synthesis of prostaglandins
Suppress histamine, phagocytes and lymphocytes
Larger side effect profile especially with prolonged use-adrenal insufficiency, hyperglycemia, mood changes, cataracts, PUD, electrolyte imbalance and osteoporosis. May suppress active infection.
30
Prednisone safety
```
If on steroids long term should carry medic alert bracelet or information in wallet.
Periodic lab monitoring.
Monitor BP, HR, and weight
Report changes in mood.
Report changes in vision
Do not stop abruptly
Weight bearing and calcium intake.
Review signs of GI bleeding. Take with food.
```
31
Acetaminophen
-Centrally acting COX inhibitor (direct action to hypothalamus) and dilation of peripheral vessels.
minimal anti-inflammatory activity and no effect on platelets
-Adjunct to opioid use (synergistic drug + drug effect)
Main action is reduction of fever (allow for sweating and dissipation of heat)
32
Acetaminophen SE
Anaphylaxis with angioedema
Hepatic toxicity/ Liver tox
Antidote is acetylcysteine (Smells like rotting eggs)
Labs: ALT increase/ AST increase/ Bili increase
33
Tramadol
Weak opioid
Main action is to inhibit re-uptake of norepinephrine and serotonin in the spinal neurons.
Hypotension, dry mouth, constipation, drowsiness, sedation, dizziness.
- Helps with decreasing addiction
34
Ergotamine (anti- migraines)
- Interact with adrenergic, dopamine, and serotonin receptors. Pregnancy category X.
- If used often can lead to withdrawal symptoms
- Weakness, nausea, vomiting, pruritus, delirium, seizures, claudication
35
Ergotamine 2(anti- migraines)
- Contraindicated with hx of MI/CAD, HTN, kidney or liver function
- Could lead to vasospasm if taken with triptans and thus should be separated by 24 hours.
- Grapefruit juice increases effect.
36
Sumatriptan (anti- migraines)
-Cranial artery vasoconstriction, can give via multiple routes. Can repeat dose, max 2 doses per day.
Serotonin receptor agonists
- Contraindicated in patients with CAD, HTN, liver disease
- Pregnancy category C
- Do not give with ergot alkaloids
37
Risk factor for Osteoporosis
```
enopause
>60 years
Family history
High alcohol consumption
Anorexia
Smoking
Low testosterone
Low vitamin D or calcium in diet
Medications
```
38
Calcium Carbonate
-Risk of hypercalcemia
-Nausea, vomiting, constipation (groans)
Increased UO
- Depression (moans)
- Kidney stones (stones)
-Work better with the addition of vitamin D.
Oral, chew and then swallow
Take with full glass of water
**May need to be separated from other medications as it may alter absorption 1 hr before or 2 hrs after**
39
Raloxifene
- Activates estrogen in bones and uterus/ Blocks estrogen in the breast
- Should take with Calcium/Vitamin D and encourage weight bearing exercise
- Oral, daily, with or without food
- acts like estrogen in uterus
* * RISK of endometrial CA - med will stimulate regrowth of layers
- post metapausal med
40
Raloxifene SE
- worse Hot flashes
- risk of clots (DVT/ PE) - so have pt walk/ no smoke/ move/ weight bearing exercise
- preg cat X
41
Alendronate ( FOSAMAX)
- Oral medication, daily
- Taken prior to breakfast with full glass of water.
- Cannot eat or drink anything after taking for the next 30 minutes
- Must be upright (sitting or standing) after taking
- No calcium supplements or dairy within 30 min pre and post taking this medication, will decrease absorption
* * can get esophagitis unceration*
42
Alendronate ( FOSAMAX) Side Effects
Nausea, vomiting, abd pain, muscle and joint pain
Esophagitis, eye pain, vision change
*if GERD occurs pt must stop med*
43
Calcitonin-Salmon
- Will treat post menopausal osteoporosis
- Also can treat increased calcium levels related to hyperparathyroidism
- allow CA to leave kidney and inhibits osteoclast
* pt should have fish allergy testing*
- Can decrease calcium
- Can lead to nasal irritation, dryness and ulceration
- After a year can stop working
44
Hydroxychloroquine
- Take the same time everyday, with milk to decrease GI upset.
- Pregnancy category C
- Anorexia, GI disturbance, loss of hair, HA, mood/mental changes.
- Ocular side effects: blurred vision, diminished ability to read, blacked out areas, possible irreversible retinal changes.
45
Methotrexate
| DMARD
-Given as a once weekly dose (IM, SQ, PO) Cannot touch the medication
-Is an anti-metabolite, it interferes with the production of immune cells. The end result is immunosuppression
-Must drink 8-12, 8oz glasses of water per day.
No alcohol
Cannot take with NSAIDS or ASA as will increase toxicity of both.
46
Methotrexate Side effects
```
Pregnancy Category X
Can also pass through breast milk
Hepatotoxic
Bone marrow suppression
GI ulceration (anywhere down the GI tract, including mouth)
Pulmonary Fibrosis
```
47
Allopurinol
```
GI distress: nausea, vomiting, diarrhea
Drowsiness, vertigo
Headache
Metallic Taste
- Blocks uric acid production
*Drink 3 L of water daily
*Adverse effects: Cats/ Bone marrow supression/ Hypersensitivity
```
48
Active Immunity
The body creates antibodies
- you get sick
- vaccine to create antigen
49
Passive Immunity
The body is given antibodies
- get antibiodies
ex: breast milk/ immunoglobins
50
Immunostimulant
- Vaccines: MMR, Hepatitis B, Gardasil
- Immunoglobulin: HepB1IgG
- Interferon: interferon alpha 2a
51
Vaccines: MMR, Hepatitis B, Gardasil
aficially Acquired Adaptive Immunity
- MMR is a live attenuated vaccine. As the vaccine is live can cause a subclinical expression of the disease. Does need a booster.
- Hepatitis B is a recombinant vaccine. Requires 3 doses. Cannot take if allergic to yeast.
- Gardasil is a recombinant vaccine. Requires 2 doses.
52
Immunoglobulin - Passive Immunity
HBIG-given within 24 hours of exposure but no later than 7 days. Repeat in 28-30 days.
Side effects: local reaction, flu-like symptoms, headache, transient hypotension.
Adverse effects: anaphylaxis, thrombosis, renal toxicity
53
Interferon
Works by attaching to cytokines (immune system messengers)
Warning to other cells
Protects cells from being infected.
Can be used for treatment of viral infections and some cancers.
54
Interferon Side effects
Side effects: GI (diarrhea, nausea, vomiting), flu-like symptoms (decrease over time) hair loss.
Adverse effects: profound headache/seizures, severe depression with suicide ideation, bone marrow suppression.
55
Cyclosporine - Immunosuppressant
Anti-rejection
Inhibits helper T cells
-75% have decreased urine output
50% will have HTN/tremor
- Side effects: HA, gingival hyperplasia
- Adverse effects: elevated liver enzymes, leukopenia, thrombocytopenia, long term risk of cancer (lymphomas)
- Grapefruit juice can increase risk of toxicity
56
Methotrexate-Immunosuppressant
- Blocks the synthesis of folic acid thereby inhibiting replication of rapidly dividing cells.
- Combined with NSAIDS can lead to fatal myelosuppression, hepatoxic, ulcerative stomatitis, diarrhea, opportunistic infections, fatal dermatologic interactions (SJS and TEN)
57
Chemo drug- Alkylating AgentsCyclophosphamide
- Causes abnormal crosslinks in DNA strand causing the body to kill the defective cell.
- Alopecia, hemorrhagic cystitis (damages bladder wall / bleeds possible blood clot in urethra )
-Hyperkalemia, hyponatremia
Orally without food
58
Platinum Compounds Cisplatin * TOXIC CHEMO*
Heavy metal that causes abnormal cross links in DNA
Severe GI symptoms can happen quickly, 1 hour after infusion
Nadir 18-23 days
Nephrotoxic and ototoxic
Neuropathy
Anaphylaxis, epinephrine on standby
IV only
59
Anti-tumor AntibioticsAnthracyclines-Doxyrubicin
Intercalation of DNA, prevention of enzyme repair
Nadir 10-14 days
Alopecia
Red urine and tears for 1-2 days after infusion
Cardiac toxicity (even years later) Need prophylactic ACEi
Hepatotoxicity
Vesicant
Supra-infections
60
Anti-MitoticsTaxanes-Paclitaxel
Stops mitosis, nonfunctional microtubules
Nadir 11 days
Allergy
Bradycardia during infusion
Neuropathy
IV, 3 hour infusion, special filter/tubing
Pretreat with anti-histamine and steroids
