pharm exam 2 Flashcards
1
Q
ASA
A
Salicylic asid
only one that does IRREVERSIBLE binding
2
Q
ASA
A
pain
fever
swelling
anti-clot
(ALL 4 benefits)
3
Q
ASA fatal dose
A
“Acute salicylic poisoning”
20 g of ASA
Reyes syndrome in kids (brain edema w/viral infection)
4
Q
NSAIDs
A
pain
fever
swelling
5
Q
NSAIDs
A
Celocoxib (cox 2) Indomethacin Diclofenac Ketorolac (Toradol) Ibuprofen (Motrin) Naproxen Piroxican and Meloxican Phenylbutazone
6
Q
Only NSAID that binds Cox2 specifically
A
Celecoxib
Really good for Anti-inflammatory, but CVD risk!
7
Q
Indomethacin
A
Use for Patent Ductus Arteriosus
8
Q
Diflofenac (voltaren)
A
Often combined w Misopristol to decrease GI side effects
9
Q
Ketorolac (Toradol)
A
Post-operative pain
Often combined w Opiates
10
Q
Ibuprofen (Motrin)
A
DOC bc of lowest side effects
Give every 6 hrs
11
Q
Naproxen
A
known to LAST ALL DAY
but takes 1-2 hrs for effects to onset
CONTRA: pregnant
12
Q
Piroxicam and Meloxicam
A
Inhibit PNM migration, lymphocyte fx
13
Q
Phenylbutazone
A
not given in US
SE: GI stuff and Bone marrow!
14
Q
Acetaminophen (Tylenol)
A
safe for kids!!
15
Q
Acetaminophen (Tylenol)
A
pain
fever
no effect on Cox in the periphery
no anti-inflammatory effects
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
17
Q
Acetaminophen (tylenol) can be used for
A
adjunct to Anti-inflammatory meds
18
Q
Caution in these ppl when giving Acetaminophen (Tylenol)
A
Chronic Alcohol Drinkers
Toxicity d/t metabolite buildup
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
20
Q
Acting on TNFa
A
Infliximab
Adalimumab
Certolizumab, Golimumab
Etanercept
21
Q
Inhibit B cell diff and T cell activation
A
Rituximab
Abatacept
22
Q
Inhibit nucleic acid synth
A
Leflunomide
Micophenolate
23
Q
Interleukin receptor antag
A
Anakinra
Tocilizumab
24
Q
JAK inhibitor
A
Tofacitinib
Baricitinib
25
Gold salts
| rarely used now
Suppress cell immunity
SE: Bone marrow damage, Enterocolitis
26
Penicillamine (cuprimine)
Chelating drug
| Use: RA, Wilson's dz (Copper)
27
Downfall of Penicillamine (cuprimine)
TONS of SE
blood, protein, Lupus like, Goodpasture synd, myasth gravis
Pts >65YO higher risk of SE
28
Hydroxychloroquine (Plaquenil)
Many mechanisms
Toxicity: Hemolysis (G6PD), Ototoxic (ear), Retinopathy (eye), Periph Neuropathy
29
Sulfasalazine (Azulfidine)
Better tolerated than Gold salts and Hydroxychloroquine
An option for RA
30
The DOC for RA
Methotrexate
31
What must you monitor for when on Sulfasalazine?
Hepatitis (LIVER) and
| Bone marrow Suppression (BONE)
32
Infliximab (Remicade)
TNFa
chimeric IgG1k monoclonal antibody
Human AND Murine
33
Infliximab (Remicade) use
Crohn's, RA
combined with MTX
34
Adalimumab (Humira)
ONLY Human monoclonal antibody, 100% human
35
Adalimumab (Humira)
Formally approved for MONOTHERAPY in tx of RA
36
"Copy cats" of Adalimumab (Humira)
Certrolizumab pegol,
| Golimumab
37
Etanercept (Enbrel)
a "FAKE" TNF receptor
| fusion protein produced by recombinant DNA technology
38
Etanercept (Enbrel) mechanism
TNF receptor, therefore the TNF binds to this and takes away the Pro-inflammatory effects that it would normally have
39
Etanercept (Enbrel) simple way to put mechanism
"FAKE" receptor
Inhibits TNF
40
Etanercept (Enbrel) CONTRA
The basic ones: pregnancy, breastfeeding, Infection, children + PLUS:
Bone marrow suppression, Diabetes mellitus, Sepsis, Vaccination, Varicella
41
Inhibitors of B cell diff and T cell activation
Rituximab and Abatacept
42
Rituximab (Rituxan)
Chimeric Murine/Human antibody
Binds CD20
43
Rituximab (Rituxan) use
Non-hodkin lymphoma
B cell CA
Chronic lymphocytic leukemia
44
Abatacept
Fully human fusion protein
| Blocker of T cell activation
45
Abatacept use
RA
46
All TNFa and Bcell/Tcell are administered
IV or SubQ
47
Drugs that are administered SubQ
Adalimumab (Humira)
| Etanercept (Enbrel)
48
B cell/T cell drugs:
Rituximab
Abatacept
both administered
IV
49
Leflunomide (Arava)
Inhibit Dihydro-orotate DH
key step in synth of Pyrimidine
50
Leflunomide (Arava)
Inhibits DHODH
Inhibit tyrosine kinase activity
AND
Inhibit COX-2
Use: RA
51
What drug do we give following Organ transplant?
Mycophenolate Mofetil (cellcept)
52
Mycophenolate mofetil
Inhibit synth of Purine
by inhibiting enzyme: inosine monophosphate DH (IMPDH)
53
Inhibitors of Nucleic Acid synth
Leflunomide (use for RA, Pyrimidine)
Mycophenolate (use for organ transplant, Purine)
54
Anakinra (Kineret)
IL-1RA
| Interleukin 1 receptor antag
55
Anakinra use
RA
56
Tocilizumab
Interleukin 6 receptor antag
IL-6RA
57
Tofacitinib (Xeljanz)
Inhibit JAK 1 and 3
58
Tofacitinib (Xeljanz) use
Pts with RA who have not responded to or cannot tolerate MTX
Use this med ALONE
59
Serious infections and CA may be precipitated by:
Tofacitinib
JAK 1 and 3
60
Baricitinib (olumiant)
JAK 1 and 2
Use for: RA
mono or combo with MTX
61
Box warnings for Baricitinib
JAK 1 and 2
Serious infection
CA
Thrombosis (clots)
62
NSAIDs used for acute mgmt of Gout
Naproxen
Indomethacin
Sulindac
63
NSAIDs that are contra-indicated in the treatment of Gout
ASA because acids make it worse
64
Colchicine mechanism
Inhibit Microtubule assembly
Anti-inflammatory bc it inhibits Leukocyte migration and Phagocytosis
65
Does Colchicine have any direct effect on pain?
No, no analgesic direct effect
It affects inflammation, therefore secondarily improving pain when the swelling goes down
66
Uricosuric agents
Probenacid
| Lesinurad (newer)
67
Uricosuric agents
increase excretion of Uric acid by blocking the active reabsorption of uric acid
Drink LOTS of water to decrease risk of kidney stone
68
When taking a Uricosuric agent (Probenacid) or Xanthine Oxidase Inhibitor (Allopurinol or Febuxostat), need to
take Colchicine prophylactically
69
Probenacid
| Lesurinad
Uricosuric agents
Lesinurad (more specifically is a URAT1 inhibitor)
70
Xanthine Oxidase Inhibitors are known for
DRUG INTERACTIONS
Increase toxicity of 6MP (mercaptopurine)
Inhibit 5FU
71
Xanthine Oxidase Inhibitors
Allopurinol
| Febuxostat
72
Serious SE including Agranulocytosis, Vasculitis, Hypersensitivity
Xanthine Oxidase Inhibitors
- Allopurinol
- Febuxostat
73
Meds that are enzymes that actually convert Uric Acid --> Allantoin which is then easily excreted
Rasburicase (fungal form of enzyme)
and
Peglioticase (similar to above, just a newer drug)
74
Rasburicase
Fungal enzyme
used in Children CAs
caution with Hypersensitivity rxns bc it's a fungal enzyme
75
Migraine symptomatic tx
NSAIDs
Analgesics
Seretonin (5HT) Agonists
76
"Triptans" treatment for migraines
Seretonin 5HT agonist
given PO or SubQ
Vasoconstricting and decrease release of neuropeptides
77
SE of "Triptans" and Ergots
d/t Vasoconstricting properties!!
78
Ergotamine tantrate
5HT agonist AND
Alpha1 agonist
so the constricting SE are even worse
79
"triptans" have a short half life so often
required 2nd dose
80
"St Anthony Fire"
CNS side effects
Chronic Ergot use
81
Migraine prophylaxis
```
Beta blocker (propranolol)
CCB (verapamil)
Antidepresssant (Amitriptyline, fluoxetine)
Anticonvulsant (Valproate, Topiramate)
Botox
ACE-I
ARBs
Erenumab (monoclonal antibody)
```
82
Valproic acid
CAUTION HEPATOTOXIC
83
Misoprostol
protective agent for stomach
84
Pepto bismu
Bismul subsalicylate
85
Magnesium
diarrhea
86
Aluminum
constipation
87
Sodium bicarb
alka seltzer (or even baking soda)
when you've eaten too much and need relief
fast acting
makes you belch
caution with Heart Failure (bc of the Na)
88
Calcium bicarb
"milk alkali" synd if too much
NOT good for peptic ulcer, chronic stuff, GERD
acid rebound bc Ca stimulates acid production
89
Calcium carbonate
Drug interactions
| TUMS can make Digoxin not work as well
90
Mg hydroxide
laxative
| poorly absorbed but may accumulate if Renal (kidney fx) is poor
91
Magnesium (diarrhea) and
Aluminum (constipation)
can decrease absorption of other drugs
usually poorly absorbed but CAUTION if Renal (kidney) fx is poor
92
Sodium Bicarb
caution with HF
93
if on Tetracycline
avoid Calcium
94
H2 antagonist
"itidines"
block H2 receptor, inhibit cAMP
decrease GI acid formation
All are OTC
95
H2 blockers most effective when?
at night
96
PPI, use when?
morning
| 30 min b4 breakfast
97
Cimetidine is unique, why?
Anti-testosterone effects
May be useful in women!
(but in men, chronic doses cause Gynecomastia, loss libido, impotence)
98
Cimetidine other unique: DRUG INTXNS
inhibitor of CYP3A4
dangerous w drugs w narrow therap range:
Warfarin, Phenytoin, Thephylline, Digoxin
99
PPI are activated where?
gastric parietal cells
in the STOMACH, only work here. covalently bind to the pump
100
PPIs
"prazoles"
101
PPI effects last
2-3 days
| bind to the pump and effects last until new pumps are formed
102
DOC for GERD
PPIs "prazoles"
103
PPI SE
decrease Ca absorption (increase risk Osteoporosis)
decrease Mg- muscle spasm
B12- need supplement
104
Omeprazole drug interaction w
may inhibit CYP..
Clopidogrel (making Plavix less effective)
switch to another "prazole" if using Clopidogrel (Plavix)
105
Misoprostol
Prostaglandin E1 analog
prevent NSAID induced damage
106
do NOT use Misoprostol in
Pregnancy!!
can induce contractions
107
Prokinetic agents
Metoclopramide
Bethanechol
Erythromycin
108
Metoclopramide
(prokinetic agent; get things moving)
D2 antagonist (acts on chemoreceptor trigger zone in CNS)
***PARKINSON LIKE SX SE***
109
Bethanechol
| prokinetic agent; get things moving
Muscarinic agonist
| Use: Post op ileus
110
Erythromycin
sometimes used in diabetic gastroparesis
acute situations, when other drugs haven't worked
111
GI system is too active
Antispasmodic
Muscarinic antagonist
Amtriptyline
Eluxadoline
112
Glycopyrolate
| Dicyclomine
commonly used to calm stomach down
They are Muscarinic antagonists; antispasmodic
SE: constipation, if slow it down tooo much!
113
Amitriptyline used for IBS is good in TWO ways
Muscarinic block, and
increased NE release stimulates a2 receptors- decrease pain
Block Musc: slow down bowel
NE in a2: decrease pain
TWO BENEFITS!
114
Eluxadoline
opioid agonist used to treat
IBS w diarrhea
115
Anti-nausea
5HT antagonist (seretonin)
"setrons"
116
"setrons" 5HT are good for
Chemo induced n/v, radiation, gastric dz, pre-op
NOT for motion sickness
117
What kind of block do we need to help w motion sickness?
Muscarinic block
118
Prochlorperazine
Promethazine
POST OP used often, gastroenteritis, chemo, motion sickness (not DOC tho) n/v
Block 3 types of receptors!
Dopamine, Muscarinic, AND Histamine
HIGHLY sedating
119
Bulk forming laxatives
Dietary
Methylcellulose
Psyllium
Polycarbophil
120
Osmotic laxatives
Mg hydroxide
Sodium salts
Sorbitol, mannitol
121
Polyethylene glycol
"Miralax"
Insoluble, holds water in intestine
Before Colonoscopy
In mild doses, for occasional constipation
122
Lactulose
| chronolac
Osmotic laxative
UNIQUE bc the only time an osmotic laxative is used CHRONICALLY
for pts with Cirrhosis: decreases ammonia buildup
(converts ammonia --> amonium)
123
Lubiprostone and
| Linaclotide
can be used for CHRONIC constipation
124
Lubirprostone
Prostaglandin analog
| Activate Cl- channels
125
Linaclotide
Stimulate Cl- secretion
Cystic Fibrosis channel
126
Loperamide (imodium)
Opioid analog
treat diarrhea
127
Sulfasalazine is used for
Ulcerative Colitis (a type of Crohns)
128
Simethicone
Gas X
129
"Helidac" to treat H. Pylori consists of:
Bismuth sub (pepto bismol)
Metronidazole
Tetracycline
130
"Tritec" to treat H. Pylori consists of:
Ranitidine
Bismuth citrate
Clarithromycin
131
Eluxadoline and
| Loperamide are similar how?
Eluxadoline: opioid
Loperamide: opioid analog
132
Use of Eluxadoline and
| Loperamide
Eluxadoline: IBS diarrhea
Loperamide: diarrhea
133
Prochlorp
Promethazine
used post op n/v
block THREE receptor types:
histamine, dopamine, AND muscarinic
VERY sedating
134
Lubiprostone and
| Linaclotide
Cl- channels
Lubiprostone: prostaglandin analog
Linaclotide: Cystic Fibrosis channels
135
What drug used to treat Ulcerative Colitis?
Sulfasalazine
136
Lactulose
SE: flatulence, diarrhea
Chronic use,
Used in Cirrhosis/ Liver dz to decrease blood Ammonia levels
137
Bisacodyl and Senna
Mild irritants
| Stimulate peristalsis, get GI tract going
138
Docusate (colace)
Emulsifier, softens feces
usually an add-on, not very effective by itself
139
Glycerin
lubricant, not v effective
| used in Enema
140
Linaclotide
```
guanlyate cyclase
cGMP
Cystic Fibrosis membrane
Cl-
Use: IBS w constipation
```
141
Always 1st thing to go for to treat Constipation
Bulk forming agents
142
Contra to Laxative use
```
N/v
Abd cramps
Undx abd pain
Appendicitis
Obstruction
```
143
Diphenoxylate/Atropine (Lomotil)
to tx diarrhea
Opioid with Atropine (reduce abuse potential)
144
Atropine
Anticholinergic
| Antimuscarinic
145
Atropine used to treat
pesticide poisoning
146
Bismuth subsalicylate
treat diarrhea
Traveller's diarrhea
Salicylate: anti-inflammatory properties
SE: black tongue, mouth, and stool!
147
Contra to Bismuch subsalicylate "pepto-bismul"
Allergy to ASA
Children (reyes)
Caution Asthmatics "ASA asthma"
148
Severe UC when others haven't worked
Infliximab and
Adalumumab can be used (TNFa blockers)
have to make sure pt does NOT have TB!
149
Cox 1
Vasoconstricting
Clot forming
Thromboxane
150
Cox 2
Prostacyclin
vasodilating
inhibit clot
151
"ximab"
chimeric
50/50 murine and human
152
"cept"
fusion protein
153
B cell
RituximaB
CD20
154
AbaTacepT
T cell block
| fully human fusion protein
155
Anakrina
IL-1 RA
156
Tocilizumab
IL-6 RA
157
Jak 1,3
Tofacitinib
for those intolerant to MTX
Monotherapy
158
Jak 1,2
Bari
159
Xanthine Oxidase Inhibitor important properties
| Allopurinol, Febuxostat
Increase toxicity of 6MP
Decrease effectiveness of 5FU
160
Colchicine mechanism
microtubule
161
Diclofenac (voltaren)
often combined w Misoprostol to decrease the GI effects
162
Ketorolac (toradol)
post op pain
163
Dont use ASA w GOUT pts because
at low (therapeutic doses), ASA decreases uric acid excretion and elevates Plasma urate concentration
164
Cholinergic antagonist
COPD
| Antimuscarinic
165
Theophylline
Long lasting Bronchodilation but LAST CHOICE bc Low therapeutic index
Drug interaction w Cimetidine
166
Theophylline mechanism
Blocks Adenosine
BUT good at preventing Diaphgragm fatigue
167
Tx of COPD
LABA or
| Anticholinergic
168
Tx of COPD Exacerbation
Ipratropium
| Albuterol
169
B2 agonist mechanism
Activate adenylate cyclase,
increase CAMP
relax sm muscle
Stabilize mast cells
170
Rapid and short action B2 agonists
SABA
1st line tx for Asthma
Albuterol
| Levalbuterol
171
LABA
prophylactic
Salmeterol
Formoterol
Vilanterol
172
Combine beta agonist with steroid to
reduce the tolerance to the beta agonist
173
Ipratropium and
| Tiotropium
Muscarinic antagonist
SE: cough, dry mouth, nausea
174
Tiotropium
longer duration of action than "Ipra"
once a day administration
175
Theophylline
CNS stimulant
| acts like caffeine, decreases fatigue and elevates mood
176
Theophylline
Blockes adenosine
Phosphodiester inhibitor
increase cAMP
Very effective bronchoDILATOR
relaxes sm muscle, esp bronchioles
177
Theophylline is indicated in use for
Don't respond to b2 agonists alone and in Severe COPD
178
SE of Theophylline
Nervous, Arrhythmia, weak diuretic
179
Good thing about Theophylline?
Decreases diaphragm fatigue
180
Leukotriene inhibitors
- Zafirlukast
- Montelukast (singulair)
- Zyflo
Decrease asthmatic response to EXERCISE or COLD AIR
decrease need for steroids
181
Benralizumab
Severe asthma w EISINOPHILIC type
182
What to add for Asthma if you're taking B2 and ICS and still having exacerbations?
Leukotriene inhibitor
| Montelukast
183
Theophylline
PDE5 inhibitor
COPD
184
Sedation and dry mouth SE
Benadryl
185
Pre surgery for colon
Polyethylene glycol "Miralax"
186
Cimetidine
inhibits Hepatic enzymes and decreases metabolism of many drugs
187
Diphenoxylate (Lomotil)
Opioid + Atropine
188
Probenacid
A uricosuric agent in tx of Gout that interferes/competes wtih elimination of Acids
189
Probenacid competes w elimination of the following drugs (bc they are Acids)
```
ASA
Pen G
Vit C
Furosemide
MTX
Clofibrate
NSAIDs
```
190
DES given to pregnant mothers was linked to what in their female daughters once they reached age 20s?
Adenocarcinoma
191
Toradol
Post op pain
192
Levothyroxine
safe in pregnancy
193
Mg
Diarrhea
"mega diarrhea"
194
Sumatriptan (Imitrex) properties
used for migraines
Produce vasoconstriction
produce coronary vasospasm
CONTRA in seizures
SE: abd pain and bloody diarrhea
195
ASA
low dose: respiraotry alkalosis
high dose: Acidosis (both types)
196
ASA is excreted more easily if the urine is
Alkaline
197
Ergot
5HT (seretonin) AND alpha 1 agonist
therefore it has more constricting side effects
198
5HT3 blockers that do NOT cause daytime sleepiness
used for N/V
Ondansetron
"setrons" are 5HT (seretonin) antagonists
safe for pregnancy
199
Ondansetron brand name is what
"Zofran"
can give to pregnant mommas
200
Probenacid and Lesinurad are what
Uricosuric agents used in the tx of Gout
201
Allopurinol and Febuxostat are what
Xanthine Oxidase Inhibitors used in the tx of Gout
202
Important considerations with XOIs (gout tx)
Increase toxicity of 6MP and decrease effectiveness of 5FU
203
Cetirizine (zyrtec) is excreted
SOLELY by kidney
204
Cromolyn
Cetirizine
Azelastine
All inhibit Histamine release from mast cells
205
Inhibits Histamine release AND blocks receptors
Azelastine
206
PROchlorperazine
| PROmethazone
blocks 3 types of receptors and thus HIGHLY sedating
Dopamine
Muscarinic
Histamine
207
Amitriptyline is special why?
it does TWO beneficial things
```
Muscarinic antagonist
A2 sitmulation (helps w pain)
```
anti-spasmodic
208
Senna
irritant laxative
209
Lubriprostone
| Linaclotide
Chronic constipation
210
Lubiprostone
Females w IBS and constipation
Prostaglandin analog
211
Linaclotide
Cystic fibrosis
| Cl-
212
Sulfasalazine
Ulcerative Colitis
213
Loperamide
Opioid analog
OTC for diarrhea
214
Benadryl mechanism
Competes w histamine
| Blocks musc receptors
215
Severe allergic asthma
Omalizumab injection
216
Rebound acid productiion
Ca carbonate (Tums)
217
Can reduce oral absorption rate of ASA
Ca carbonate (Tums)
