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Spring Round II Exams > pharm exam 2 > Flashcards

pharm exam 2 Flashcards

1
Q

ASA

A

Salicylic asid

only one that does IRREVERSIBLE binding

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2
Q

ASA

A

pain
fever
swelling
anti-clot

(ALL 4 benefits)

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3
Q

ASA fatal dose

A

“Acute salicylic poisoning”
20 g of ASA

Reyes syndrome in kids (brain edema w/viral infection)

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4
Q

NSAIDs

A

pain
fever
swelling

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5
Q

NSAIDs

A 
Celocoxib (cox 2)
Indomethacin
Diclofenac 
Ketorolac (Toradol)
Ibuprofen (Motrin)
Naproxen
Piroxican and Meloxican
Phenylbutazone
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6
Q

Only NSAID that binds Cox2 specifically

A

Celecoxib

Really good for Anti-inflammatory, but CVD risk!

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7
Q

Indomethacin

A

Use for Patent Ductus Arteriosus

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8
Q

Diflofenac (voltaren)

A

Often combined w Misopristol to decrease GI side effects

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9
Q

Ketorolac (Toradol)

A

Post-operative pain

Often combined w Opiates

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10
Q

Ibuprofen (Motrin)

A

DOC bc of lowest side effects

Give every 6 hrs

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11
Q

Naproxen

A

known to LAST ALL DAY
but takes 1-2 hrs for effects to onset

CONTRA: pregnant

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12
Q

Piroxicam and Meloxicam

A

Inhibit PNM migration, lymphocyte fx

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13
Q

Phenylbutazone

A

not given in US

SE: GI stuff and Bone marrow!

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14
Q

Acetaminophen (Tylenol)

A

safe for kids!!

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15
Q

Acetaminophen (Tylenol)

A

pain
fever

no effect on Cox in the periphery
no anti-inflammatory effects

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16
Q

SE if overdose on Acetaminophen (Tylenol)

A

Liver toxicity

“Fatal liver death” but takes 2-3 days for this to happen, metabolites build up, person turns yellow

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17
Q

Acetaminophen (tylenol) can be used for

A

adjunct to Anti-inflammatory meds

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18
Q

Caution in these ppl when giving Acetaminophen (Tylenol)

A

Chronic Alcohol Drinkers

Toxicity d/t metabolite buildup

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19
Q

PUD considerations with these drugs

A

Hx of PUD but not active: Celecoxib or Some other NSAIDS + “Prazols”/ Misopristol

Active PUD: Acetaminophen (Tylenol) only!! possibly + Codeine

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20
Q

Acting on TNFa

A

Infliximab
Adalimumab
Certolizumab, Golimumab
Etanercept

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21
Q

Inhibit B cell diff and T cell activation

A

Rituximab

Abatacept

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22
Q

Inhibit nucleic acid synth

A

Leflunomide

Micophenolate

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23
Q

Interleukin receptor antag

A

Anakinra

Tocilizumab

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24
Q

JAK inhibitor

A

Tofacitinib

Baricitinib

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25
Q

Gold salts

rarely used now

A

Suppress cell immunity

SE: Bone marrow damage, Enterocolitis

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26
Q

Penicillamine (cuprimine)

A

Chelating drug

Use: RA, Wilson’s dz (Copper)

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27
Q

Downfall of Penicillamine (cuprimine)

A

TONS of SE

blood, protein, Lupus like, Goodpasture synd, myasth gravis

Pts >65YO higher risk of SE

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28
Q

Hydroxychloroquine (Plaquenil)

A

Many mechanisms

Toxicity: Hemolysis (G6PD), Ototoxic (ear), Retinopathy (eye), Periph Neuropathy

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29
Q

Sulfasalazine (Azulfidine)

A

Better tolerated than Gold salts and Hydroxychloroquine

An option for RA

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30
Q

The DOC for RA

A

Methotrexate

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31
Q

What must you monitor for when on Sulfasalazine?

A

Hepatitis (LIVER) and

Bone marrow Suppression (BONE)

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32
Q

Infliximab (Remicade)

A

TNFa

chimeric IgG1k monoclonal antibody

Human AND Murine

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33
Q

Infliximab (Remicade) use

A

Crohn’s, RA

combined with MTX

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34
Q

Adalimumab (Humira)

A

ONLY Human monoclonal antibody, 100% human

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35
Q

Adalimumab (Humira)

A

Formally approved for MONOTHERAPY in tx of RA

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36
Q

“Copy cats” of Adalimumab (Humira)

A

Certrolizumab pegol,

Golimumab

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37
Q

Etanercept (Enbrel)

A

a “FAKE” TNF receptor

fusion protein produced by recombinant DNA technology

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38
Q

Etanercept (Enbrel) mechanism

A

TNF receptor, therefore the TNF binds to this and takes away the Pro-inflammatory effects that it would normally have

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39
Q

Etanercept (Enbrel) simple way to put mechanism

A

“FAKE” receptor

Inhibits TNF

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40
Q

Etanercept (Enbrel) CONTRA

A

The basic ones: pregnancy, breastfeeding, Infection, children + PLUS:
Bone marrow suppression, Diabetes mellitus, Sepsis, Vaccination, Varicella

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41
Q

Inhibitors of B cell diff and T cell activation

A

Rituximab and Abatacept

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42
Q

Rituximab (Rituxan)

A

Chimeric Murine/Human antibody

Binds CD20

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43
Q

Rituximab (Rituxan) use

A

Non-hodkin lymphoma
B cell CA
Chronic lymphocytic leukemia

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44
Q

Abatacept

A

Fully human fusion protein

Blocker of T cell activation

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45
Q

Abatacept use

A

RA

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46
Q

All TNFa and Bcell/Tcell are administered

A

IV or SubQ

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47
Q

Drugs that are administered SubQ

A

Adalimumab (Humira)

Etanercept (Enbrel)

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48
Q

B cell/T cell drugs:

Rituximab
Abatacept

both administered

A

IV

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49
Q

Leflunomide (Arava)

A

Inhibit Dihydro-orotate DH

key step in synth of Pyrimidine

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50
Q

Leflunomide (Arava)

A

Inhibits DHODH
Inhibit tyrosine kinase activity
AND
Inhibit COX-2

Use: RA

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51
Q

What drug do we give following Organ transplant?

A

Mycophenolate Mofetil (cellcept)

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52
Q

Mycophenolate mofetil

A

Inhibit synth of Purine

by inhibiting enzyme: inosine monophosphate DH (IMPDH)

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53
Q

Inhibitors of Nucleic Acid synth

A

Leflunomide (use for RA, Pyrimidine)

Mycophenolate (use for organ transplant, Purine)

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54
Q

Anakinra (Kineret)

A

IL-1RA

Interleukin 1 receptor antag

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55
Q

Anakinra use

A

RA

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56
Q

Tocilizumab

A

Interleukin 6 receptor antag

IL-6RA

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57
Q

Tofacitinib (Xeljanz)

A

Inhibit JAK 1 and 3

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58
Q

Tofacitinib (Xeljanz) use

A

Pts with RA who have not responded to or cannot tolerate MTX

Use this med ALONE

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59
Q

Serious infections and CA may be precipitated by:

A

Tofacitinib

JAK 1 and 3

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60
Q

Baricitinib (olumiant)

A

JAK 1 and 2
Use for: RA

mono or combo with MTX

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61
Q

Box warnings for Baricitinib

JAK 1 and 2

A

Serious infection
CA
Thrombosis (clots)

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62
Q

NSAIDs used for acute mgmt of Gout

A

Naproxen
Indomethacin
Sulindac

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63
Q

NSAIDs that are contra-indicated in the treatment of Gout

A

ASA because acids make it worse

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64
Q

Colchicine mechanism

A

Inhibit Microtubule assembly

Anti-inflammatory bc it inhibits Leukocyte migration and Phagocytosis

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65
Q

Does Colchicine have any direct effect on pain?

A

No, no analgesic direct effect

It affects inflammation, therefore secondarily improving pain when the swelling goes down

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66
Q

Uricosuric agents

A

Probenacid

Lesinurad (newer)

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67
Q

Uricosuric agents

A

increase excretion of Uric acid by blocking the active reabsorption of uric acid

Drink LOTS of water to decrease risk of kidney stone

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68
Q

When taking a Uricosuric agent (Probenacid) or Xanthine Oxidase Inhibitor (Allopurinol or Febuxostat), need to

A

take Colchicine prophylactically

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69
Q

Probenacid

Lesurinad

A

Uricosuric agents

Lesinurad (more specifically is a URAT1 inhibitor)

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70
Q

Xanthine Oxidase Inhibitors are known for

A

DRUG INTERACTIONS

Increase toxicity of 6MP (mercaptopurine)

Inhibit 5FU

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71
Q

Xanthine Oxidase Inhibitors

A

Allopurinol

Febuxostat

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72
Q

Serious SE including Agranulocytosis, Vasculitis, Hypersensitivity

A

Xanthine Oxidase Inhibitors

  • Allopurinol
  • Febuxostat
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73
Q

Meds that are enzymes that actually convert Uric Acid –> Allantoin which is then easily excreted

A

Rasburicase (fungal form of enzyme)

and

Peglioticase (similar to above, just a newer drug)

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74
Q

Rasburicase

A

Fungal enzyme

used in Children CAs

caution with Hypersensitivity rxns bc it’s a fungal enzyme

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75
Q

Migraine symptomatic tx

A

NSAIDs
Analgesics
Seretonin (5HT) Agonists

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76
Q

“Triptans” treatment for migraines

A

Seretonin 5HT agonist

given PO or SubQ

Vasoconstricting and decrease release of neuropeptides

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77
Q

SE of “Triptans” and Ergots

A

d/t Vasoconstricting properties!!

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78
Q

Ergotamine tantrate

A

5HT agonist AND
Alpha1 agonist

so the constricting SE are even worse

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79
Q

“triptans” have a short half life so often

A

required 2nd dose

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80
Q

“St Anthony Fire”

CNS side effects

A

Chronic Ergot use

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81
Q

Migraine prophylaxis

A 
Beta blocker (propranolol)
CCB (verapamil)
Antidepresssant (Amitriptyline, fluoxetine)
Anticonvulsant (Valproate, Topiramate)
Botox
ACE-I
ARBs
Erenumab (monoclonal antibody)
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82
Q

Valproic acid

A

CAUTION HEPATOTOXIC

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83
Q

Misoprostol

A

protective agent for stomach

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84
Q

Pepto bismu

A

Bismul subsalicylate

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85
Q

Magnesium

A

diarrhea

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86
Q

Aluminum

A

constipation

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87
Q

Sodium bicarb

alka seltzer (or even baking soda)

when you’ve eaten too much and need relief

A

fast acting
makes you belch
caution with Heart Failure (bc of the Na)

88
Q

Calcium bicarb

A

“milk alkali” synd if too much

NOT good for peptic ulcer, chronic stuff, GERD

acid rebound bc Ca stimulates acid production

89
Q

Calcium carbonate

A

Drug interactions

TUMS can make Digoxin not work as well

90
Q

Mg hydroxide

A

laxative

poorly absorbed but may accumulate if Renal (kidney fx) is poor

91
Q

Magnesium (diarrhea) and
Aluminum (constipation)

can decrease absorption of other drugs

A

usually poorly absorbed but CAUTION if Renal (kidney) fx is poor

92
Q

Sodium Bicarb

A

caution with HF

93
Q

if on Tetracycline

A

avoid Calcium

94
Q

H2 antagonist

A

“itidines”

block H2 receptor, inhibit cAMP
decrease GI acid formation

All are OTC

95
Q

H2 blockers most effective when?

A

at night

96
Q

PPI, use when?

A

morning

30 min b4 breakfast

97
Q

Cimetidine is unique, why?

A

Anti-testosterone effects

May be useful in women!

(but in men, chronic doses cause Gynecomastia, loss libido, impotence)

98
Q

Cimetidine other unique: DRUG INTXNS

A

inhibitor of CYP3A4

dangerous w drugs w narrow therap range:
Warfarin, Phenytoin, Thephylline, Digoxin

99
Q

PPI are activated where?

A

gastric parietal cells

in the STOMACH, only work here. covalently bind to the pump

100
Q

PPIs

A

“prazoles”

101
Q

PPI effects last

A

2-3 days

bind to the pump and effects last until new pumps are formed

102
Q

DOC for GERD

A

PPIs “prazoles”

103
Q

PPI SE

A

decrease Ca absorption (increase risk Osteoporosis)

decrease Mg- muscle spasm

B12- need supplement

104
Q

Omeprazole drug interaction w

may inhibit CYP..

A

Clopidogrel (making Plavix less effective)

switch to another “prazole” if using Clopidogrel (Plavix)

105
Q

Misoprostol

A

Prostaglandin E1 analog

prevent NSAID induced damage

106
Q

do NOT use Misoprostol in

A

Pregnancy!!

can induce contractions

107
Q

Prokinetic agents

A

Metoclopramide
Bethanechol
Erythromycin

108
Q

Metoclopramide
(prokinetic agent; get things moving)

D2 antagonist (acts on chemoreceptor trigger zone in CNS)

A

PARKINSON LIKE SX SE

109
Q

Bethanechol

prokinetic agent; get things moving

A

Muscarinic agonist

Use: Post op ileus

110
Q

Erythromycin

A

sometimes used in diabetic gastroparesis

acute situations, when other drugs haven’t worked

111
Q

GI system is too active

Antispasmodic

A

Muscarinic antagonist
Amtriptyline
Eluxadoline

112
Q

Glycopyrolate

Dicyclomine

A

commonly used to calm stomach down

They are Muscarinic antagonists; antispasmodic

SE: constipation, if slow it down tooo much!

113
Q

Amitriptyline used for IBS is good in TWO ways

A

Muscarinic block, and
increased NE release stimulates a2 receptors- decrease pain

Block Musc: slow down bowel
NE in a2: decrease pain

TWO BENEFITS!

114
Q

Eluxadoline

opioid agonist used to treat

A

IBS w diarrhea

115
Q

Anti-nausea

A

5HT antagonist (seretonin)

“setrons”

116
Q

“setrons” 5HT are good for

A

Chemo induced n/v, radiation, gastric dz, pre-op

NOT for motion sickness

117
Q

What kind of block do we need to help w motion sickness?

A

Muscarinic block

118
Q

Prochlorperazine
Promethazine

POST OP used often, gastroenteritis, chemo, motion sickness (not DOC tho) n/v

A

Block 3 types of receptors!

Dopamine, Muscarinic, AND Histamine

HIGHLY sedating

119
Q

Bulk forming laxatives

A

Dietary
Methylcellulose
Psyllium
Polycarbophil

120
Q

Osmotic laxatives

A

Mg hydroxide
Sodium salts
Sorbitol, mannitol

121
Q

Polyethylene glycol

“Miralax”

A

Insoluble, holds water in intestine

Before Colonoscopy
In mild doses, for occasional constipation

122
Q

Lactulose

chronolac

A

Osmotic laxative
UNIQUE bc the only time an osmotic laxative is used CHRONICALLY

for pts with Cirrhosis: decreases ammonia buildup
(converts ammonia –> amonium)

123
Q

Lubiprostone and

Linaclotide

A

can be used for CHRONIC constipation

124
Q

Lubirprostone

A

Prostaglandin analog

Activate Cl- channels

125
Q

Linaclotide

A

Stimulate Cl- secretion

Cystic Fibrosis channel

126
Q

Loperamide (imodium)

A

Opioid analog

treat diarrhea

127
Q

Sulfasalazine is used for

A

Ulcerative Colitis (a type of Crohns)

128
Q

Simethicone

A

Gas X

129
Q

“Helidac” to treat H. Pylori consists of:

A

Bismuth sub (pepto bismol)
Metronidazole
Tetracycline

130
Q

“Tritec” to treat H. Pylori consists of:

A

Ranitidine
Bismuth citrate
Clarithromycin

131
Q

Eluxadoline and

Loperamide are similar how?

A

Eluxadoline: opioid
Loperamide: opioid analog

132
Q

Use of Eluxadoline and

Loperamide

A

Eluxadoline: IBS diarrhea
Loperamide: diarrhea

133
Q

Prochlorp
Promethazine

used post op n/v

A

block THREE receptor types:
histamine, dopamine, AND muscarinic

VERY sedating

134
Q

Lubiprostone and

Linaclotide

A

Cl- channels

Lubiprostone: prostaglandin analog
Linaclotide: Cystic Fibrosis channels

135
Q

What drug used to treat Ulcerative Colitis?

A

Sulfasalazine

136
Q

Lactulose

SE: flatulence, diarrhea

A

Chronic use,

Used in Cirrhosis/ Liver dz to decrease blood Ammonia levels

137
Q

Bisacodyl and Senna

A

Mild irritants

Stimulate peristalsis, get GI tract going

138
Q

Docusate (colace)

A

Emulsifier, softens feces

usually an add-on, not very effective by itself

139
Q

Glycerin

A

lubricant, not v effective

used in Enema

140
Q

Linaclotide

A 
guanlyate cyclase
cGMP
Cystic Fibrosis membrane
Cl-
Use: IBS w constipation
141
Q

Always 1st thing to go for to treat Constipation

A

Bulk forming agents

142
Q

Contra to Laxative use

A 
N/v
Abd cramps
Undx abd pain
Appendicitis
Obstruction
143
Q

Diphenoxylate/Atropine (Lomotil)

to tx diarrhea

A

Opioid with Atropine (reduce abuse potential)

144
Q

Atropine

A

Anticholinergic

Antimuscarinic

145
Q

Atropine used to treat

A

pesticide poisoning

146
Q

Bismuth subsalicylate

treat diarrhea

A

Traveller’s diarrhea

Salicylate: anti-inflammatory properties

SE: black tongue, mouth, and stool!

147
Q

Contra to Bismuch subsalicylate “pepto-bismul”

A

Allergy to ASA
Children (reyes)
Caution Asthmatics “ASA asthma”

148
Q

Severe UC when others haven’t worked

A

Infliximab and
Adalumumab can be used (TNFa blockers)

have to make sure pt does NOT have TB!

149
Q

Cox 1

A

Vasoconstricting
Clot forming

Thromboxane

150
Q

Cox 2

A

Prostacyclin
vasodilating
inhibit clot

151
Q

“ximab”

A

chimeric

50/50 murine and human

152
Q

“cept”

A

fusion protein

153
Q

B cell

A

RituximaB

CD20

154
Q

AbaTacepT

A

T cell block

fully human fusion protein

155
Q

Anakrina

A

IL-1 RA

156
Q

Tocilizumab

A

IL-6 RA

157
Q

Jak 1,3

A

Tofacitinib

for those intolerant to MTX

Monotherapy

158
Q

Jak 1,2

A

Bari

159
Q

Xanthine Oxidase Inhibitor important properties

Allopurinol, Febuxostat

A

Increase toxicity of 6MP

Decrease effectiveness of 5FU

160
Q

Colchicine mechanism

A

microtubule

161
Q

Diclofenac (voltaren)

A

often combined w Misoprostol to decrease the GI effects

162
Q

Ketorolac (toradol)

A

post op pain

163
Q

Dont use ASA w GOUT pts because

A

at low (therapeutic doses), ASA decreases uric acid excretion and elevates Plasma urate concentration

164
Q

Cholinergic antagonist

A

COPD

Antimuscarinic

165
Q

Theophylline

A

Long lasting Bronchodilation but LAST CHOICE bc Low therapeutic index

Drug interaction w Cimetidine

166
Q

Theophylline mechanism

A

Blocks Adenosine

BUT good at preventing Diaphgragm fatigue

167
Q

Tx of COPD

A

LABA or

Anticholinergic

168
Q

Tx of COPD Exacerbation

A

Ipratropium

Albuterol

169
Q

B2 agonist mechanism

A

Activate adenylate cyclase,
increase CAMP
relax sm muscle
Stabilize mast cells

170
Q

Rapid and short action B2 agonists

SABA

1st line tx for Asthma

A

Albuterol

Levalbuterol

171
Q

LABA

prophylactic

A

Salmeterol
Formoterol
Vilanterol

172
Q

Combine beta agonist with steroid to

A

reduce the tolerance to the beta agonist

173
Q

Ipratropium and

Tiotropium

A

Muscarinic antagonist

SE: cough, dry mouth, nausea

174
Q

Tiotropium

A

longer duration of action than “Ipra”

once a day administration

175
Q

Theophylline

A

CNS stimulant

acts like caffeine, decreases fatigue and elevates mood

176
Q

Theophylline

A

Blockes adenosine
Phosphodiester inhibitor
increase cAMP

Very effective bronchoDILATOR

relaxes sm muscle, esp bronchioles

177
Q

Theophylline is indicated in use for

A

Don’t respond to b2 agonists alone and in Severe COPD

178
Q

SE of Theophylline

A

Nervous, Arrhythmia, weak diuretic

179
Q

Good thing about Theophylline?

A

Decreases diaphragm fatigue

180
Q

Leukotriene inhibitors

  • Zafirlukast
  • Montelukast (singulair)
  • Zyflo
A

Decrease asthmatic response to EXERCISE or COLD AIR

decrease need for steroids

181
Q

Benralizumab

A

Severe asthma w EISINOPHILIC type

182
Q

What to add for Asthma if you’re taking B2 and ICS and still having exacerbations?

A

Leukotriene inhibitor

Montelukast

183
Q

Theophylline

A

PDE5 inhibitor

COPD

184
Q

Sedation and dry mouth SE

A

Benadryl

185
Q

Pre surgery for colon

A

Polyethylene glycol “Miralax”

186
Q

Cimetidine

A

inhibits Hepatic enzymes and decreases metabolism of many drugs

187
Q

Diphenoxylate (Lomotil)

A

Opioid + Atropine

188
Q

Probenacid

A

A uricosuric agent in tx of Gout that interferes/competes wtih elimination of Acids

189
Q

Probenacid competes w elimination of the following drugs (bc they are Acids)

A 
ASA
Pen G
Vit C
Furosemide
MTX
Clofibrate
NSAIDs
190
Q

DES given to pregnant mothers was linked to what in their female daughters once they reached age 20s?

A

Adenocarcinoma

191
Q

Toradol

A

Post op pain

192
Q

Levothyroxine

A

safe in pregnancy

193
Q

Mg

A

Diarrhea

“mega diarrhea”

194
Q

Sumatriptan (Imitrex) properties

used for migraines

A

Produce vasoconstriction
produce coronary vasospasm
CONTRA in seizures

SE: abd pain and bloody diarrhea

195
Q

ASA

A

low dose: respiraotry alkalosis

high dose: Acidosis (both types)

196
Q

ASA is excreted more easily if the urine is

A

Alkaline

197
Q

Ergot

A

5HT (seretonin) AND alpha 1 agonist

therefore it has more constricting side effects

198
Q

5HT3 blockers that do NOT cause daytime sleepiness

used for N/V

A

Ondansetron
“setrons” are 5HT (seretonin) antagonists

safe for pregnancy

199
Q

Ondansetron brand name is what

A

“Zofran”

can give to pregnant mommas

200
Q

Probenacid and Lesinurad are what

A

Uricosuric agents used in the tx of Gout

201
Q

Allopurinol and Febuxostat are what

A

Xanthine Oxidase Inhibitors used in the tx of Gout

202
Q

Important considerations with XOIs (gout tx)

A

Increase toxicity of 6MP and decrease effectiveness of 5FU

203
Q

Cetirizine (zyrtec) is excreted

A

SOLELY by kidney

204
Q

Cromolyn
Cetirizine
Azelastine

A

All inhibit Histamine release from mast cells

205
Q

Inhibits Histamine release AND blocks receptors

A

Azelastine

206
Q

PROchlorperazine

PROmethazone

A

blocks 3 types of receptors and thus HIGHLY sedating

Dopamine
Muscarinic
Histamine

207
Q

Amitriptyline is special why?

it does TWO beneficial things

A 
Muscarinic antagonist
A2 sitmulation (helps w pain)

anti-spasmodic

208
Q

Senna

A

irritant laxative

209
Q

Lubriprostone

Linaclotide

A

Chronic constipation

210
Q

Lubiprostone

A

Females w IBS and constipation

Prostaglandin analog

211
Q

Linaclotide

A

Cystic fibrosis

Cl-

212
Q

Sulfasalazine

A

Ulcerative Colitis

213
Q

Loperamide

A

Opioid analog

OTC for diarrhea

214
Q

Benadryl mechanism

A

Competes w histamine

Blocks musc receptors

215
Q

Severe allergic asthma

A

Omalizumab injection

216
Q

Rebound acid productiion

A

Ca carbonate (Tums)

217
Q

Can reduce oral absorption rate of ASA

A

Ca carbonate (Tums)

Spring Round II Exams (10 decks)

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