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Pharm Midterm Flashcards

1
Q

what medication should be added to an nsaid to prevent ulcers

A

PPI- azoles

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2
Q

how much acetaminophen to prescribe per day

A

No more than 4 grams of acetaminophen product per day

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3
Q

high doses of acetaminophen were concerned with

A

liver toxicity

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4
Q

NSAID side effects

A

gastric ulcers, GI bleeding- worried about giving w blood thinners

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5
Q
A
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6
Q

Know the advantage of sublingual medication vs regular release tabs

A

Sublingual release is faster than regular speed tablet- also sublingual doesnt rely on gi tract or liver

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7
Q

Know alternative medications to treat pain

A

PT, CBT, acupuncture etc

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8
Q

Mechanism of action of opioids

A

Acts primarily on spinal cord (dorsal gray matter), and brain (medial thalamus, hypothalamus); bind to specific receptors located on presynaptic nerve terminals & post synaptic neurons

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9
Q

opiod antagonists include

A

Naloxone and naltrexone

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10
Q

naloxone is used how

A

blocks the effects of opioids- reversal from opioid overdose

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11
Q

naltrexone used how

A

long-term treatment for opioid and alcohol use disorder (alcoholism)

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12
Q

Know which pain medications can be reversed fully with Narcan which cannot be fully reversed.

A

CAN REVERSE – opioids (OxyContin/oxycodone, fentanyl, methadone, Vicodin/hydrocodone, heroin, morphine, codeine, hydromorphone)
CAN NOT REVERSE – benzodiazepines, cocaine, alcohol

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13
Q

nsaids contraindications

A

kidney disease

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14
Q

Know the need for h pylori testing.

A

When pt has PUD and has flare up, test for h. Pylori.

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15
Q

Know when to order laxatives and when to not order laxatives ie perhaps root cause needs to be explored? ex contraindications

A

Abdominal pain, nausea, cramps, or other symptoms of appendicitis, regional enteritis, diverticulitis, or ulcerative colitis​
Acute surgical abdomen​
Fecal impaction or bowel obstruction​
Habitual use​
Use with caution in pregnancy and lactation

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16
Q

Safe laxative for pediatrics

A

Polyethylene glycol

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17
Q

Which conditions is magnesium hydroxide contraindicated in

A

Anyone with renal function problems- it can cause renal toxicity, and undiagnosed abd pain

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18
Q

Which laxative should be given to a patient who receives an opioid?

A

Docusate sodium/Colace

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19
Q

How is a Tylenol overdose reversed?

A

N-Acetylcysteine (Must be administered in appropriate amount of time, otherwise liver damage is permanent)

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20
Q

What should you do for an opioid patient who does not have relief after 6 months

A

Consider morphine extended release or Fentanyl patch

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21
Q

Why do we use combined pain medications for patients ie nsaids and opioids; think better pain control

A

↓DEC the dosage and/or side effects of opioids, while INC overall pain control

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22
Q

What to do for a patient who has failed 3 nitroglycerin tablets and still has chest pain

A

CALL 911

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23
Q

Be aware of what happens when a patient takes an enzyme inducer vs an inhibitor

A

Enzyme inducer - Increases enzyme activity, causing faster drug breakdown and potentially lower drug levels in the body
Enzyme inhibitor - Decreases enzyme activity, leading to slower drug breakdown and potentially higher drug levels in the body, which could lead to side effects.

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24
Q

Class 1a antiarrhythmics include

A

quinidine, disopyramide, procainamide

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25
contraindications of class 1a antiarrythmics
DO not administer with fluoroquinolone antibiotics (inc risk of prolonged QT interval) (cipro, levo ) Contraindicated in 2nd and 3rd degree heart block** Congenital prolonged qt syndrome Cardiogenic shock
26
loop diuretics include
Furosemide, bumetanide, torsemide
27
thiazide diuretics
HCTZ, chlorthalidone, metolazone contraindicated w hypokalemia
28
k sparing diuretics
Spironolactone, amiloride, epelrenone contraindicated in pregnancy
29
Be familiar with the dosing frequency of Eliquis
Eliquis – BID medication. If initiating medications, you have to do a higher dose and then a maintenance dose Xarelto is once a day.
30
Be familiar with proper patient education for adherence ie diabetic patients
Schedule medications at the same time Watch for non-adherence, if pt is readmitted to the hospital Insulin based on blood glucose (before a meal, not after) not on how they feel; carb counting;
31
Know about monitoring parameters for therapeutic levels- warfarin, heparin, digoxin
warfarin- check INR daily heparin- check aptt digoxin- check dig levels
32
how grapefruit juice can interact with another medicine.
blocks the enzyme P450 which helps to metabolize- this can lead to inc drug levels
33
How can you monitor a drug with a narrow therapeutic index?
periodic lab testing
34
whats an inducer
An inducer will create more of the enzyme resulting in faster metabolism decreasing other drug levels (ie Carbamezapine, rifampin, phenytoin)​
35
inhibitor
An Inhibitor will block some of the enzyme resulting in higher drug levels. (ie -Isoniazid, ketoconazole, ciprofloxacin, omeprazole)​
36
Know how to correctly write a RX for a medication that is dosed once a day
“Take 1 (one) pill once a day.”write out one
37
Know the concept of tolerance vs dependence in an opioid patient.
Tolerance - need more drug to achieve effect but side effect profile gets worse​ Dependence - onset of withdrawal if drug is suddenly stopped
38
When is a pregnant patient at highest risk of teratogenicity from a medication?
1st trimester
39
What changes during a pregnant patients third trimester may affect drug clearance
Kidneys Renal blood flow is tripled by 3rd trimester GFR is increased so drugs are cleared by GF rapidly
40
What special considerations must be made for breastfeeding mothers/why are not many drugs studied in pregnant patients?
Effects on fetus are unknown. Research tends to focus on comparing women who did and women who did not take a medication during pregnancy Taking medications right AFTER breastfeeding so less medication will get to baby
41
How are medications dosed in neonates? Do they need higher doses or lower doses based on body surface area?
Lipid soluble drugs pass easily – higher effect on fetus Lower doses *– make sure you adjust for body surface area.
42
Tetracycline what can it do to pediatric patients?
stains teeth
43
What could be signs of non-adherence to medication?
multiple re admissions, therapeutic failure from under-dosing or toxicity from overdosing
44
Know medications that are indicated for nausea
Ondensatron [Zofran] Metoclopramide [Reglan] Glucocorticoids (off-label) Aprepitant [Emend] Lorazepam [Ativan]
45
motion sickness meds
Motion sickness Scopolamine - transdermal patch Meclizine [Bonine]/Dimenhydrinate [Dramamine]/cyclizine [Cyclivert, etc] (OTCs)
46
What medication can be used for overuse headaches from triptans
Topiramate/topamax
47
After 6 months of short acting opioid use and minimal relief what therapy is a good idea to start
fentanyl patch,
48
Metabolism occurs where
primarily in the liver
49
absorption occurs
primarily in the small intestine- GI tract
50
excretion occurs
primary in the kidneys
51
distribution
circulatory system
52
selective beta blockers
cardioselecctive- Atenolol, Bisoprolol, Metoprolol
53
non selective beta blockers
Natalol, Pindolol, Propranolol, Timolol Adverse effect: bronchoconstriction
54
agonist
Mimic regulatory molecules
55
antagonist
block endogenous regulator actions
56
Can Methadone be prescribed outpatient?
Not for addiction, but can be prescribed for pain control Monitor for prolonged QT intervals if pt is on methadone.
57
first pass effect
drug is broken down before it gets to the metabolism site (liver)- iv doesn't have a first pass effect bc it goes right into distribution system when taken orally- drug is broken down quickly
58
Drugs can be equivalent in ingredients but not bioavailability- brand vs generic drug example
If pt is on synthroid they should stay on synthroid- can't switch to levothyroxine
59
Bioavailability
drugs are equal if they are absorbed at the same rate to the same degree- the percentage of the administred dose that appears in the blood stream
60
larger surface area means
faster absorption -
61
po med absorption is higher in
small intestine than in the stomach
62
key enzyme of digesting medications
P450 enzyme
63
excretion is dependent on what
on GFR- LOW GFR=low excretion
64
Drugs can be inducers or inhibitors of the p450 enzymes - an inducer will
Inducer- will create more of the enzyme resulting in faster metabolism , decreasing other drug levels
65
an inhibitor will
will block some of the enzyme , resulting in higher drug levels
66
lipid soluble drugs will have ___ effect on a fetus
more effect- they pass through more
67
Geriatric drugs- worried about
hepatic function and renal function- monitor creatinine clearance
68
Don't use abbreviations when writing prescriptions
69
pt with pitting edema and HF will give a
Furosemide diuretic
70
ACE inhibitor pt we should monitor
electrolytes
71
propranolol concerned for what pt
pt with asthma bc its non selective
72
Pt comes in after taking Nitroglycerin tablets- treatment should be
beta blockers and IV nitro
73
If pt takes too much warfarin or has signs of bleeding; monitor what labs
PTT nad INR*
74
INR is used to ____ in warfarin
adjust dosing in warfarin
75
Ca channel blockers- SUCH AS verapamil- used for what 3 indications
angina, arrhythmias, essential HTN
76
diabetic pt - prescribe
ace inhibitors are good for htn and they protect the kidneys
77
If pt comes in for htn- start with
dash diet, sodium restriction and exercise
78
ace inhibitors are contraindicated in pregnancy- pt can take what
pt can take methyldopa instead
79
initial treatment of htn is what diuretic
thiazide
80
furosemide we should monitor what levels
potassium- it is not potassium sparing
81
if pt is taking digoxin and verapamil monitor for
AV blockade
82
do not mix metronidazole with
ALCOHOL!
83
When controlling one arrhythmia you can cause
another arrythmia
84
How to prescribe controlled substances- class 2
- must have written rx with DEA number- NO refills allowed, can't call these in - only exception is hospice patients** cant be transferred btween pharmacies
85
FDA Medwatch form-
report adverse effects to the FDA
86
1a antiarrhythmics- block and bind to the
fast sodium channels in tissue! ex- Disopyramide, Quinidine, Procainamide
87
1a indications
sed for life threatening arrhythmias due to severity side effects- such as atrial arrhythmias, ventricular arrhythmias, WPW (Wolff parkinsons white), brugada syndrome (quinidine only)
88
contraindicaitons of 1a
DO not administer with fluoroquinolone antibiotics (inc risk of prolonged QT interval) (cipro, levo ) Contraindicated in 2nd and 3rd degree heart block*
89
1b anti arrhythmic include
Lidocaine, Mexiletine, Phenytoin MOA- quick dissociation, binding from gated sodium channels as well
90
Mexiletine and lidocaine- used for
ventricular arrhythmias, VF VT phenytoin rarely used- helpful for digoxin arrhythmias
91
1b contraindications
contraindicated in WPW (wollf parkinson white), severe liver dysfunction, 2nd and 3rd degree heart block
92
1c - flecainide, propafenone used for
Indications prevention of SVT Aflutter Afib Prevention of ventricular arrhythmias works on sodium channels as well
93
1c side effects-
mg and potassium levels can be disturbed which can lead to arrhythmias
94
Amiodarone (class 3 antiarrhythmic)
blocks k currents that are responsible for cardiac depolarizations
95
Amiodarone indications- used for
Afib with rapid ventricular response * amiodarone used to control ventricular rate A flutter svt vtach vfib
96
warfarin toxicity is determined by
INR- WHEN inr is greater than 5- risk is high
97
warfarin toxicity what do we do
stop med, administer vit k
98
eliquis and xarelto both have
starter pack- start with higher dose
99
statins MOA
prevents convention of hMG COA to mevalonic acid* its an inhibitor
100
quinidine AE
101
Therapeutic use of adenosine is used for
termination of paroxysmal svt
102
acetaminophen AE
elevated lft, liver failure, hepatotoxicity, stevens johnson syndrome, skin rash
103
opioid antagonists are prescribed for pt
who have addictions- reversal of cns and resp depression due to opioid use
104
ssris and opioids- be careful with
serotonin syndrome when giving both

Advanced Pharm (1 decks)

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