Pharm Exam 3 Flashcards
What is the dose for colchicine?
1.2 mg (2 tablets) then 0.6 mg 1 hour later until symptoms subside
What is the biggest side effect with colchicine?
diarrhea
What lab values should be monitored with gout?
serum uric acid levels, CBC, renal and hepatic fx
allopurinol, febuxostat, and probenecid are __________ drugs for gout, not rescue meds
Maintenance
avoid _________ as it precipitates gout flares
alcohol
report any signs of _________ or _________ when taking colchicine
neuropathy or myopathy
What types of food should you avoid when taking colchicine?
oxalate rich foods; organ meats (liver, kidney), some fish such as sardines, trout
turkey, venison
What patient teaching will you provide when prescribing febuxostat (Uloric)
symptoms will get worse before they get better. Can take NSAIDs up to 6 months to help
These symptoms are all caused by what?
thinning of the skin, alopecia, acne, poor wound healing, myopathy, muscle wasting, osteoporosis, , skeletal fractures, peptic ulcer disease, HTN…
The use of corticosteroids for >6 months
What is steroid psychosis?
Caused by overuse of corticosteroids and causes: delirium, agitation, insomnia, mood swings, severe depression
Why is it important to taper the corticosteroid dose?
prevent adrenal insufficiency
avoid trigger of reoccurence of disease
What are the black box warnings for NSAIDs
increase risk for cardiovascular events (MI, stroke) and increased risk for GI adverse effects such as bleeding, ulceration, perforation
What are the recommendations in the treatment of pain?
First-choice: NSAIDs before opioids
What is the MOA of ibuprofen?
COX-2 inhibitor
decreases prostaglandin synthesis
What are the serious side effects associated with acetaminophen? /
acute toxicity –> liver failure
chronic toxicity –> renal failure
These symptoms describe what? decreased LOC, hunger, diaphoresis, weakness, dizziness, tachycardia
hypoglycemia
These symptoms describe what? Polyuria, polydipsia, polyphagia
Hyperglycemia
These symptoms describe what? Drowsiness, dim vision, Kussmaul’s respiration, cherry red lips, abdominal pain, ketone-odor breath
Ketoacidosis
What drug class is metformin?
Biguanide
How does metformin work?
It increase peripheral glucose uptake, decreases hepatic glucose production, and decreases intestinal absorption of glucose. it also decreases glycogenolysis by the liver.
What diagnostic testing is required before and throughout therapy with metformin?
renal function, liver function, CBC, serum electrolytes and ketones, BG
dipeptidyl peptidasase-4 inhibitors (DPP-4): “_____”
gliptins
sitagliptin, saxagliptin, linagliptin, alogliptin
How do gliptins work?
acts on the incretin hormone system to increase insulin production
Glucagon-like peptide (GLP-1) agonists (albiglutide, dulaglutide, exenatide, liraglutide, lixisenatide) MOA:
directly binds to the GLP-1 receptor in the beta cell and acts as an incretin mimetic
when should exenatide be administered? (GLP-1 Agonist)
60 minutes before a meal. Do not administer after a meal.
What are the adverse effects of propylthiouracil?
agranulocytosis and possible aplastic anemia
can cause drug-induced hepatitis
what is the BBW for propylthiouracil?
liver failure
What two drugs are used to treat toxic goiter?
methimazole and propylthiouracil
What are the doses of the two drugs used to treat toxic goiter?
methimazole: 60 mg/day TID
propylthiouracil 600-900 mg/day TID
What signs should a patient report while taking propylthiouracil?
fever, sore throat, abnormal bleeding/bruising
What is the MOA for alpha-glucosidase inhibitors?
block carbohydrates
What is the dosage for alpha-glucosidase inhibitors?
(Acarbose, Miglitol) AND when should this be taken?
25 mg x4 weeks with first bite of meal
increased by 25 mg up to 75 mg/day
If a patient is less than 60 kg, what dose of acarbose or miglitol should be prescribed?
50 mg TID
Describe the pharmakodynamics of meglitinides
stimulate insulin secretion to lower postprandial BG levels
what is the MOA of propylthiouracil?
blocks the conversion of T4 to T3 (INHIBITS THYROID HORMONES)
What are the contraindications for taking alpha-glucosidase inhibitors?
bowel diseases such as IBS. These drugs produce gas.
What patient education is important relative to the administration of levothyroxine?
should be taken 30 minutes before breakfast on an empty stomach. take in the morning to prevent insomnia.
What is the BBW for the administration of thiazolidinediones (TZDs)
heart failure and bladder cancer
What symptoms may indicate that a patient is taking too much thyroid replacement drug?
symptoms of hyperthyroidism
tachycardia, arrhthmias, angina, tremors, insomnia, irratabillity, V/D, Weight loss, menstrual irregularities, heat intolerance
What is the MOA of metformin?
increases insulin sensitivity, decreases hepatic glucose production, and decreases intestinal absorption of glucose
What lab values will be used to monitor a patient who is on levothyroxine?
TSH and free T4
Two rapid acting insulins:
aspart and glulisine
two short-acting insulins
regular insulin and R U-500
What is the intermediate insulin?
NPH
Name three long-acting insulins
glargine, detemir, degludec
When changing from NPH insulin, how will you adjust the patient’s dose?
Add total daily dose then decrease by 20% and make adjustments by the patient’s response
What are the side effects of insulin therapy?
hypoglycemia, hypokalemia, weight gain
What assessment should be made before prescribing anti-hypertensive agents?
baseline BP and pulse, diet, sodium intake, electrolytes (especially potassium d/t diuretic therapy)
weight and other fluid status indicators
What should you monitor when prescribing ACE-I, ARBs, and DRI (direct rennin inhibitors)
RENAL FUNCTION and potassium levels
Why are ACE inhibitors the drug of choice in a diabetic patients with HTN?
They delay progression of diabetic neuropathy
What is the MOA for ACE-I
decreased production of both angiotensin II and aldosterone
What is the most common adverse effect of an ACE inhibitor?
dry, hacking cough
What is the MOA for ARBS
block angiotensin II receptors
do not produce dry, hacking cough
What is the MOA for CCB?
Block calcium channels resulting in decrease in trans-membrane calcium and prolonged vascular smooth muscle relaxation
What are the two types of CCBs?
dihydropyridine type “PINE” or non-dihydropyridine type (verapamil)
side effects of CCB?
dizziness, hypotension, tachycardia, increase proteinuria which causes edema
What are the adverse effects of statins?
risk of myopathy and the resulting rhabdomyolysis
What patient education will you provide for patients taking statins?
report any muscle weakness
avoid alcohol
do not take if pregnant
What lipid disorders do fibric acid derivatives treat?
hypertriglyceridemia
What disorders do bile acid sequestrants treat?
hyperlipidemia
What is the MOA for fibric acid derivatives?
promotes secretion of LDL which is then cleared by a receptor-mediated mechanism (so lower overall LDL)
What is the MOA for bile acid sequestrants?
reduce plasma low-density lipoprotein (LDL) by interrupting the enterohepatic circulation of bile acids, with consequent diversion of hepatic cholesterol toward the synthesis of new bile acids
What would you recommend to a patient who is experiencing flushing while taking niacin?
gradually increase the dose over a few weeks
pre-treat with ASA 30 minutes before, and take the extended release form (Niaspan)
What type of drug is amlodipine?
dihydropyridine CCB
How is amlodipine metabolized?
CYP3A4 system in the liver
avoid grapefruit
What are the side effects of amlodipine?
dizziness, hypotensin, edema (which can exacerbate HF)
What patient teaching will you provide when taking amiodorone?
take as prescribed. Don’t double doses, it has a very long half life. Abrupt withdrawal can cause life-threatening arrythmias, MI, or stroke. Can also cause pulmonary toxicity. Change positions slowly d/t hypotension
What are the drug interactions with digoxin?
any drug that cause hypokalemia, hypercalcemia, or hypomagnesemia
What is the purpose of a thyroid panel while taking amiodarone?
amiodarone (structurally similar to thyoxine) inhibits the thyroid gland and results in inflammation causing either hyperthyroidiism or hypothyroidism
What is nitrate intolerance?
continuous exposure to nitates cause them to lose effect. Need to be free for 10-12 hours before regaining their effects.
What are the contraindications to warfarin?
any type of bleeding issues or pregnancy
What classes of medication are used in the treatment of HF?
ACE inhibitors are the first-line of treatment
What are the adverse effects of procanimide (anti-arrhythmic agent) and what patient teaching will you provide?
hypotension–change positions slowly
take caution while driving d/t sedative effects
report fever, chills, sore throat, or unusual bleeding (agranulocytosis)
What lab monitoring will be completed for a patient taking statins?
cholesterol, liver fx
3 contraindications for ACE-I and ARBs?
bilateral renal artery stenosis
angioedema
pregnancy
What patient education will be provided when taking thiazolidiediones (TZDs)
don’t use with patients with bladder CA or HF
may need to increase BC dose or choose alternative treatment for BC
What is the daily maximum dose of APAP?
4 gm/day
Can schedule 2 drugs be refilled?
NO
Can schedule 3 drugs be refilled?
prescription must be rewritten after 6 months or 5 refills (narcotics with codeine, stimulants, depressants
