Pharm Final

Question 1

These drugs can cause histamine release

Answer 1

Atracurium, dilaudid and morphine

Question 2

Giving reglan with this medication can cause dysrhythmias

Answer 2

Zofran

Question 3

For who is reglan contraindicated?

Answer 3

Bowel obstruction
Parkinson’s
Seizure disorders

Question 4

What can we give to reverse gastric cramping from reglan

Answer 4

An anticholinergic (glycopyrrolate)

Question 5

Rapid administration of reglan can cause ____ while rapid admin of zofran can cause

Answer 5

Cramping

HA

Question 6

This medication may cause out of body experiences

Answer 6

Droperidol

Question 7

Thioamines take 1-2 weeks to take effect due to thyroid stores in the body. We can take these meds in the meantime to decrease symptoms

Answer 7

Beta blockers.

These block the hyper-adrenergic effects of hyperthyroidism.
Also, these block the peripheral conversion of T4 to T3.

Question 8

We use this med in thyroid storm

Answer 8

Esmolol

Question 9

How do corticosteroids work in treating hyperthyroidism?

Answer 9

1) Suppresses TSIs in Grave’s disease (remember steroids are immunosuppressants!). Also decreases inflammation.
2) Blocks the peripheral conversion of T4 to T3

We use prednisone or methylprednisolone

Question 10

Drugs that can alter thyroid status

Answer 10

Amiodarone (resembles thyroid hormone and contains iodine– can cause hypo or hyperthyroidism)

Lithium (body can mistake it for iodine–> hypothyroidism)

Reglan (can increase TSH production and release)

Question 11

Why choose methimazole over PTU?

Answer 11

More potent than PTU, longer half-life allows for QD dosing (PTU is TID), and has fewer SE than PTU

Question 12

How does lugol’s solution treat hyperthyroidism?

Answer 12

1) Blocks peripheral T4 to T3 conversion
2) Decreases the vascularity of the thyroid
3) Temporary block of T4 release (the thyroid is so busy taking up iodine that it doesn’t have time to focus on releasing hormone. This effect is only temporary!!!)

This is a short-term solution to decrease thyroid activity before thyroid surgery

Question 13

IV T3 is called ____ and can be given emergently for _____

Answer 13

Cytomel

Myxedema coma

Question 14

How are sulfonylureas metabolized?

Answer 14

Via the liver! They are 99% protein-bound, so the liver is gonna have to deal with those before they can be excreted via the kidneys. Avoid in ESLD.

Question 15

These sulfonylureas should be used if the pt has renal disease

Answer 15

Glipizide or Tolbutamine (because these will be completely metabolized to inactive or weakly active products)

Question 16

sulfonylureas should be avoided in these patients

Answer 16

ESLD and those with sulfa allergies

Question 17

How do sulfonylureas work?

Answer 17

1) block the ATP sensitive K+ pump

2) Increases sensitivity of the tissues to insulin

Question 18

How to biguinides like Metformin work?

Answer 18

1) Shifts into anaerobic metabolism, decreasing glucose production in the liver and kidneys (less gluconeogenesis and glycogenolysis)*******

Also:

a) Enhances insulin binding (decreases insulin resistance)
b) Increases glucose utilization

Question 19

Who are biguanides contraindicated in

Answer 19

ESRD, ESLD, CHF, pulm disease, shock

All related to buildup of anaerobic metabolites

Question 20

These two oral hypoglycemic meds require insulin to work

Answer 20

Biguanides (like metformin)

Thiazolidinediones (TZDs like Pioglitazone)

Question 21

These antiepileptics are CP450 inducers

Answer 21

Phenytoin
Barbiturates (phenobarb)
Carbamazepime (tegretol)

Question 22

These antiepileptics are CP450 inhibitors

Answer 22

Valproic acid

Felbamate

Question 23

Many anti-epileptics are associated with these life-threatening complications

Answer 23

Hepatotoxicity
Bone marrow suppression

We want to test for LFTs and get a CBC

Question 24

These are the major considerations with phenytoin (Dilantin)

Answer 24

1) Infuse no faster than 50mg/min!! Could cause cardiac collapse
2) Enzyme inducer
3) CNS toxicity (nystagmus, double vision, vertigo, peripheral neuropathies)
4) Stevens Johnson Syndrome
5) Precipitates in solutions with a pH<7.8

Question 25

What is fosphenytoin?

Answer 25

Pro-drug of phenytoin

Question 26

Reasons nitrates are good for the heart

Answer 26

1) Preferentially dilate collateral vessels service ischemic areas
2) Decrease preload
3) SLIGHT decrease of afterload
4) Attenuates coronary vasospasm
5) Increases rate of relaxation during diastole**

Question 27

Why aren’t nitrates used for chronic BP control?

Answer 27

Because people develop tolerance to them

Question 28

How do we prevent tolerance with nitrates?

Answer 28

Tell people to remove their patches at night

Question 29

What would we use to treat the profound hypotension caused by taking nitrates with a PDE?

Answer 29

Phenylephrine

Question 30

Main SE of nitrates

Answer 30

HA

Orthostatin hypotension/fainting

Question 31

These medications have been shown to reduce M&M in patients with CHF

Answer 31

Aldosterone antagonists
ACE Inhibitors
ARBs
BBs

Question 32

These medications have NOT been shown to reduce M&M in patients with CHF

Answer 32

Thiazide or loop diuretics (symptom relief only)

Digoxin (again-symptom relief only–> may worsen long-term outcomes)

Question 33

Do we hold ACEIs and ARBs before surgery?

Answer 33

Yes, or else the patient will be too dry

Question 34

A patient with CHF should be on these 3 meds

Answer 34

Spironolactone, BB, and ACEI

Question 35

All ACEIs have this suffix

Answer 35

pril

As in “captopril”

Question 36

ARBS have this suffix

Answer 36

artan

Ex- Losartan or Valsartan

Question 37

Weuse this med for BP control in pregnancy

Answer 37

Methyldopa

Question 38

How do CCBs help fight HTN?

Answer 38

1) Reducing heart rate and contractility

2) Reducing SVR (arteriodilation)