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Adv Patho & Pharm 2018 > Pharm quiz 2 > Flashcards

Pharm quiz 2 Flashcards

1
Q

thyroid replacement contraindications

A

after acute MI, thyrotoxicosis

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2
Q

T3 vs. T4

A

both are iodine-contiaining derivatives of aa tyrosine

T3-much less produced but less protein bound and much more active

T4- much more produced, becomes T3 in tissues for activity; very protein bound, must measure free T4

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3
Q

inhibiting mechanism for coagulation cascade

A

antithrombin III (ATIII)

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4
Q

mimic endorphins

A

opiates

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5
Q

cholinergic medication considerations (3)

A
  1. don’t stop abruptly
  2. spread doses evenly, short half life
  3. beware of OD, can be lethal
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6
Q

pt on antipsychotics experienceing galactorrhea–must rule out

A

pituitary tumor; get pituitary MRI

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7
Q

DPP4 Inhibitors-action and what to watch

A

is like a PO GLP-1 inh (enzyme inactivates GLP-1 so this inhibits that enzyme); increases incretin hormone level

“gliptins”, Januvia

Caution in renal impairment, watch for pancreatitis

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8
Q

what to watch with ADHD Stimulant meds

methylphenidate (Ritalin) and

Amphetamines (Concerta, Adderall)

A

arrhythmias, tachycardia *get baseline EKG if any question of cardiac history

Hx sudden deaths

anxiety, weight loss, abuse, growth supression

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9
Q

Advantages (2) and Disadvantages (3) of metformin

A

rare hypoglycemia

wt loss, better lipid profile

GI side effects (often wane after a few weeks)

CI in renal insufficiency (Cr > 1.5)

can cause lactic acidosis

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10
Q

Foods to avoid with MAOIs

A

Tyramine-containing foods

anything fermented, aged cheeses, wine, chocolate

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11
Q

sulfonylureas-mechanism

A

2nd gen: glipizide, glyburide

Stimulate beta cells to release insulin

*effective monotherapy in lean pts/newer Dx bc they can still produce enough insulin

once beta cells are fatigues this isn’t as effective

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12
Q

AEs of MAOIs

A

The three Hs:

  1. hepatocellular jaundince
  2. hyperthermia
  3. hypertension
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13
Q

aspirin action and indications

A

binds COX enzyme on platelets and inhibits for life of plt, unable to produce thromboxane 2–can’t clot

stroke prevention, even better if used with plavix

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14
Q

lithium AEs

A

GI distress: anorexia, n/v/d

ADH antagonism->polyuria/polydipsia—>can cause renal fibrosis . *worry about kidneys with lithium

hair loss, acne, thyroid abn

CNS- reduced seizure threshold, slow cognition, intention tremor

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15
Q

baseline labs before starting lithium

A

BMP-creatinine, GFR

TSH

CBC (causes nonsignificant leukocytosis)

HCG- Pregnancy Category X

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16
Q

can count on these AEs with 2nd gen antipsychotics

A

stronger antiserotonergic effects–

weight gain

increased blood glucose

hyperlipidemia

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17
Q

phenobarbital-mechanism and effects

A

enhances GABA

sedating and addictive, multiple other AEs

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18
Q

major reason for lack of adherence with SSRIs

A

sexual dysfunction

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19
Q

this toxin is a nicotinic antagonist

A

botulinum toxin

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20
Q

danger with gabapentin, what to monitor for

A

depression, suicidal ideation

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21
Q

hydantoins (2)

A

antiseizure meds

phenytoin (Dilantin)

fosphenytoin (Cerebryx)

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22
Q

last ditch antipsychotic clozapine can cause

A

fatal agranulocytosis–freq monitoring of CBC

many other AEs

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23
Q

tricyclic AEs

A

anticholinergic AEs (block M1)

oHoTN (block alpha 1)

sedation (histaminergic)

weight gain

decreased libido

cardiac arrhythmia (block Na channels) –>

cardiotoxicity

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24
Q

enzyme that converts fibrinogen (loose, soft clot) to fibrin

A

thrombin

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25
Q

GLP-1 agonist-action and advantages/dis

A

mimic incretin GLP-1 (stimulates insulin and suppreses glucagon when glucose is high in GI tract)

Adv: no inc CV risk, and less risk of hoGly than SUs

Dis: injectible only; pancreatitis, endocrine tumor risk

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26
Q

propanolol mechanism and indications

A

nonselective (beta 1 and beta 2) blocker

HTN (poor for this)

arrhythmias, angina

migraine

stage fright/performance anxiety

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27
Q

increase insulin sensitivity in muscle and fat cells and liver by regulating gene expression

A

TZDs (Actos, Avandia)

many dangerous AEs: HF, liver, bladder ca

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28
Q

how to switch antidepressants

A

b/t SSRIs-just switch

one med class to another-taper first med over two weeks, then start low and taper next med up

some meds need washout period (MAOIs)

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29
Q

s/s serotonin syndrome

A

akathasia (movement disorders)

AMS

tremors, muscle hypertonicity

hyperthermia

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30
Q

Myasthnia gravis treatment med

A

AChEI

pyridostigmine

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31
Q

goal of Alzheimer’s treatment

A

to increase activity of ACh (opposite of Parkinson’s)

treated with cholinesterase inhibitors (rivastigmine, donepezil-CNS specific AChEI)

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32
Q

T/F norepi is cholinergic

A

FALSE

norepi does not affect the PNS

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33
Q

first line partial and absence seizures, fairly sage

A

lamotrigine (Lamictal)

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34
Q

bisphosponates AEs

A

GI, eso ulcers, pathological Fx

caution with renal, liver, heart disease, GI problems

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35
Q

benzodiazepine withdrawal s/s

A

anxiety, insomnia

—> convulsions, death

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36
Q

atypical antidepressant-SSRI and 5HT1 agonist (mimics serotonin)

A

vortioxetine (Trintellix)

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37
Q

SU lite

tissue selective secreation of insulin

take with meals, good at reducting postprandial BG

A

meglitinides (Prandin, Starlix)

**Do not give with an SU!

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38
Q

inducer for intrinsic and extrinsic pathways

A

intrinsic induced by blood vessel injury

extrinsic induced by tissue injury

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39
Q

with antiseizure meds you need to monitor drug levels, even without dosage changes, because

A

many use the CYP 450 pathway and can have increased plasma levels (inducers)

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40
Q

metoprolol mechanism and indications

A

selective beta 1 blocker

HTN

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41
Q

second line for anxiety

A

buspirone

no QTc prolongation–can use for cardiac pts when want to avoid SSRI

minimal abuse potential

1-2 weeks for effect

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42
Q

sulfonylureas-considerations (5)

A
  1. risk of hypoglycemia, esp with EtOH/illness
  2. fatigues beta cells over time
  3. assoc with inc CV disease and mortality
  4. Cross allergy with sulfa drugs (Bactrim, thiazides)
  5. teratogenic (not glyburide)
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43
Q

first line mood stabilizer in bipolar disorder

mechanism

A

lithium

pre synapse-enables more serotonin to be released

post synapse- enables cells to take up serotonin

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44
Q

apixaban (Eliquis)

A

direct Xa inhibitor; Better outcomes than warfarin, can renally dose, fast onset (hours); no antidote, $$, AEs unknown-new

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45
Q

two common and dangerous AEs of antiseizure meds

A

Cardiac effects and skin reactions

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46
Q

1st line therapy DM

mechanism

A

metformin (Glucophage)

inhibits glucose production by the liver, decreases absorption of glucose by GI tract, and increases insulin sensitivity

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47
Q

1st line med for partial and generalized seizures (block Na movement) but not myoclonic; 2 black box warnings, and what you must monitor (2)

A

carbamazepine (Tegretol)

  1. Serious Derm reactions (asians at inc risk–polymorphism)
  2. aplastic anemia
  3. CBC
  4. drug levels-CYP 450 inducer
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48
Q

preterm labor can be slowed bu use of this beta 2 agonist

A

terbutaline-relaxes smooth muscle in uteral, GI, bladder, and bronchioles

uterus has smooth muscle with Beta 2 receptors not no ACh receptors

AEs: tachycardia, anxiety

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49
Q

tolerance vs. dependence

A

tolerance-you need to take more of the drug to get the same effect

dependence–physiological state in which you need to take the drug to prevent withdrawal

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50
Q

levothyroxine directions/education

A

take with full glass of water at same time each day, preferably 1 hour before breakfast, 3 hrs after last meal

teach how to measure HR

don’t stop taking if feel better

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51
Q

serotonin syndrome results from

A

toxic increase in serotonin often caused by taking two meds that increase serotonin at the same time (ex SSRIs and MAOIs)

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52
Q

dopamine is used as adrenergic agonist-mechanism and used in treatment of

A

alpha and beta agonist

low BP:

hypovolemia

cardiogenic shock

53
Q

failing to taper SSRIs when discontinuing can cause

A

“withdrawal” of flu-like and/or GI symptoms

Taper over 2 weeks

54
Q

of the multiple AEs with hydantoins, these are the most concerning…(1)

and these should also be watched for…(3)

A

Cardiac (bradycardia, heart block)

skin rashes

gingival hyperplasia

CNS-nystagmus, cognitive slowing, lethargy

55
Q

adjunct seizure and neuropathic pain med without risk of SI; blocks Ca++ in CNS and blocks glutamate release

A

pregabalin (Lyrica)

56
Q

atypical antidepressants, no effect on serotonin

less weight gain and sexual AEs, no effect on serotonin

A

NDRIs

Wellbutrin

Zyban-smoking cessation

not good with comorbid anxiety

57
Q

indirect cholinergic agonists

A

AChEIs

58
Q

two cholinergic agonists used to treat glaucoma

A

pilocarpine (muscarinic agonist)

carbachol (nicotinic agonist)

59
Q

urinary retention is treated with

A

cholinergics

bethanechol-relaxes urinary sphincter and causes bladder contraction

60
Q

MAOIs

A

meds than inhibit MAO enzymes that break down neurotransmitters

Isoniazid

phenelzine (Nardil)

selegiline

rasagiline

61
Q

irreversible ACh inhibition is caused by these toxins

A

Sarin

Malathion

causes muscle weakness –> respiratory depression –> death

62
Q

how to beta one antagonists cause exercise intolerance ?

what other complication can they cause?

A

can’t inc HR and CO to meet demands

can also mask s/s of hypoglycemia–pt won’t know

63
Q

third line anxiety med

A

benzodiazepines-mimic GABA

okay short term, avoid long term

can cause daytime sedation

high abuse potential

choose based on onset and duration of action

64
Q

why use an SNRI instead of an SSRI

A

to treat more cognitive slowing and dec concentration

actually have a few more AEs than SSRIs

65
Q

alpha-glucosidase inhibitors-action and considerations

A

inhibits enzyme that breaks down starches; minimizes postprandial BG

take with meal; do not use dissacharides for hypoglycemia, monitor liver function

66
Q

three types of mood stabilizers

A
  1. lithium
  2. anticonvulsants
  3. antipsychotics
67
Q

AE cholinergics and anticholinergics have in common

A

erectile disfunction

PNS causes erection (pleasure)

SNS causes ejaculation (survival)

68
Q

if hyperlipidemia exists with hypothyroidism

A

treat thyroid first; dec thyroid activity will cause inc lipids

69
Q

First line in all seizure types, thought to increase GABA effects

A

valproic acid

70
Q

with an alpha 1 blocker like doxazosin, what education does the patient need?

A

rise from supine position slowly (compensatory mechanisms used in position change are inhibited)

71
Q

first line for anxiety

A

antidepressants

(takes weeks for effect, can use benzo short term)

72
Q

First line in partial and generalized seizures, blocks Na movement

A

hydantoins

73
Q

first line for absence seizures, a little safer than valproic acid but still many AEs, ex. SLE

A

ethosuximide (Zarontin)

74
Q

cholinergic crisis antidote

A

atropine

muscarinic antagonist

also used for bradycardia

75
Q

how long to use antidpressents before you see effects

A

4-6 weeks

76
Q

dobutamine-mechanism and indication

A

beta one agonist

cardiac stimulation in cardiogenic shock

77
Q

advantages of LMW heparins (Fragmin, Lovenox) over unfractionated

A

more predictibe pharmokinetics, less monitoring needed, lower incidence of HIT

Monitor with renal/hepatic disease

78
Q

doxazosin and silodosin- mechanism and indication

A

alpha one blockers-vasodilators

last ditch treatment for HTN

BPH-relaxes smooth muscles to decrease size of prostate

79
Q

SGLT-2 Inhibitors-action

Pros and Cons

A

sodium glucose transport inhibitors (Invokana)

increase excretion of glucose in urine by inhibiting resorption

Better reduction in HgA1C than others

lower CV mortality, BP, low risk of HoGly

Cons: UTIs/pyelo, candida, need good renal function

80
Q

antipsychotic AEs Summary (6)

A
  1. EPS, tardive dyskinesia can be permanent
  2. hyperprolactinemia (dec inh of prolactin) gynecomastia, galactorrhea, *osteoporosis
  3. Sexual dysfunction, priapism
  4. Cardiac arrhythmia, prol QTc–>torsades; sudden cardia death risk inc 2x
  5. Seizures-all lower threshold
  6. Metabolic syndrome-weight gain, bad glycemic control, hyperlipidemia
81
Q

aspirin AEs

A

GI bleed/ulcer

bronchospasm

renal damage

reye’s syndrome

dangerous OD

82
Q

2nd line seizures and commonly used for status epilepticus, febrile seizures

A

phenobarbital

83
Q

donepezil and rivastigmine are used in AD treatment because

A

they are cholinergic (AChEIs)

increase ACh in brain which supports memory

affects are temporary and take six weeks for effect

84
Q

albuterol mecahnism and indications

A

beta 2 agonist-cause bronchodilation in asthma, allergy

AE: tachycardia

85
Q

MAOS Alzheimer’s adjunct

A

selegiline

also used for smoking cessation, ADHD

86
Q

muscarinic antagonists have a similar effect as

A

beta agonists

87
Q

anti-thyroid meds

A

block incorporation of iodine into hormone

methimazole, PTU

*do not miss dose, don’t make up if you do; teach hypothyroid symptoms, reduce dietary iodine

88
Q

adrenergic agonists that are not broken down by MAOx, can be taken PO and are nonpolar-cross BBB

A

non-catecholamines

89
Q

rivoraxaban (Xarelto)

action and considerations

A

direct factor Xa inhibitor-prevents conversion of prothrombin to thrombin

similar to warfarin in effects, less ICH

fast onset (2-4h) and can renally dose

no antidote, $$, unknown AEs-new

90
Q

intrinsic and extrinsic pathways both lead to

A

activated factor X= Xa

converts prothrombin to thrombin

(the common pathway from then on)

91
Q

use this in valvular AFib

A

warfarin

Do not use dabigatran (Pradaxa)

92
Q

black box warning on many antidepressants

A

4% inc risk of SI <25 years old

93
Q

Pt education-bisphosphonates

A

take with full glass of water in am

remain upright for 30 minutes after dose

good dietary Ca and Vit D

avoid use with antacids, EtOH

94
Q

1st gen antipsychotics vs 2nd

mechanism of both and AEs

A

1st gen treats positive but not negative symptoms, 2nd treats both; less AEs with 2nd, varies

Block dopamine receptors–>cause extrapyrimidal side effects

parkisonian syndrome, tardive dyskinesia, neuroleptic malignant syndrome (can start any time during treatment)

95
Q

mimic GABA

A

benzodiazepines

96
Q

antiplatelet agents, can use with ASA in ACS and post MI but not preventative for stroke

A

clopidrogel (Plavix)

ticlodipine (Ticlid)

block platelet activation

97
Q

warfarin-action and indications

A

antagonizes vitamin K

PO

prophylaxis/Tx of DVT, PE, Afib clot, post MI, hypercoagubility disorders

98
Q

long term use of levothyroxine associated with

A

dec bone density in hip/spine in post-menopausal women–monitor

99
Q

common AEs SSRIs

A

sexual dysfunction (dec libido)

weight gain

insomnia/sedation

GI effects

prolonged QTc

100
Q

bladder spasms are due to overactive PNS activity so treat with

A

anticholinergics

101
Q

adjunct antiseizure med often also commonly used for neuropathic pain; mimics GABA

A

gabapentin (Neurontin)–

works like a benzo without the addiction risk

102
Q

AChEIs used to treat MG

A

edrophonium- short acting, used for Dx

neostigmine and physostigmine (also used for AD and delayed gastric emptying)

103
Q

succinylcholine mechanism for skeletal muscle paralysis

A

anticholinergic

nicotinic antagonist

104
Q

warfarin-considerations

A

highly protein bound

metabolized in liver using CYP450 pathway

many drug interactions (any broad spectrum abx can dec absorption)

AEs: bleeding; teratogenic; warfarin-induced skin necrosis

Food interations: inh by Vit K and EtOH

and herbal interactions

105
Q

mechanism of action of ipratropium (Atrovent) and tiotropium (Spiriva)

A

anticholinergic muscarinic antagonists that block PNS bronchoconstriction

1st line for COPD

106
Q

if you need cardiac stimulation with vasoconstriction, use …

if you don’t need vasoconstriction, use …

A

dopamine

dobutamine

107
Q

considerations-metformin (3)

A
  1. decrease/hold in dehydration
  2. hold 48 hrs before and after radiocontrast
  3. discourage EtOH
108
Q

…is the precursor of norepi

norepi is the precursor of …

A

dopamine

epinephrine

109
Q

dangers

opiates vs. benzos

A

opiate withdrawal is not fatal, benzo withdrawal can be

easier to OK with opiates, need 2nd depressant to OK with benzos.

110
Q

adrenergic agonists that are destroyed by MAO; can’t take PO, don’t cross BBB

A

catecholamines (epi and norepi)

111
Q

anticholinergic used for bowel spasm treatment to relax smooth muscle and dec GI motility

A

dicyclomine

112
Q

better than warfarin in prevention of CVAs with reduced risk of bleeding; pros and cons

A

direct thrombin inhibitors (pradaxa)

Pros: no lab monitoring, no drug/food interactions

Cons: no antidote, $$

113
Q

atypical antidepressants given for sleep

A

mirtazapine (Remeron)

trazadone (Desryel)

114
Q

prazosin, mechanism and indications

A

alpha one antagonist/blocker

antihypertensive

115
Q

goal of Parkinson’s disease treatment

A

increase effect of dopamine

dopamine agonists (Ex Requip) + Levodopa/Carbidopa

116
Q

cholinergic medications that inhibit ACh breakdown

A

Acetylcholinesterase inhibitors (AChEIs)

117
Q

baseline labs before starting metformin and to monitor during use

A

CMP (renal and hepatic function)

HgA1C

118
Q

INR management

A

therapeutic 2-3

<8 no significant bleeding: hold dose(s) until <5 then resume doses

>8 no bleeding; hold until <5, maybe hospitalize

Any inc INR with serious bleeding–>hospitalize

119
Q

MAOI used for Parkinson’s treatment

A

rasagiline (Azilect)

120
Q
A
121
Q

this med (type/name) is used to constrict the pupil in glaucoma treatment

A

cholinergic

carbachol

122
Q

do not use propanolol in patients with

A

asthma, COPD

nonselective–will block beta 2

123
Q

phenylephrine-mechanism and indications

A

alpha one agonist–vasoconstrictor

decongestant and hypotension

124
Q

heparin action

A

increase the action of antithrombin III up to 1000x

inc inh of Xa on factor II-dec formation of fibrin

125
Q

benzodiazepine reversal agent

A

flumazenil

126
Q

heparin indications and AEs

A

immediate anticoagulation in which quick reversal may be needed-DVT, PE, ACS, can be used in pregnancy

AEs: bleeding, HIT, osteoporosis long term high dose use

*requires regular monitoring of aPTT

127
Q

why are beta blockers useful in patients post MI?

A

decrease myocardial oxygen consumption and cardiac workload

128
Q

muscarinic antagonist used to treat parkinson’s dyskinesia

A

benztropine

129
Q

what type of med is contraindicated in a patient with bowel obstruction

A

an anticholinergic medication like hyoscimine

Adv Patho & Pharm 2018 (5 decks)

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