Pharm Quiz 7 Flashcards
1
Q
Diagnosis for COPD
A
Chronic bronchitis, Emphysema, and Forced Expiratory Volume in 1 second of less than .7
2
Q
MDI
A
Patient must begin breathing before administration.
Only 10% reaches the lungs.
When more than 1 breathe is needed, space by 1 minute.
Spacers increase delivery and contain a whistle that alarms when inhalation is too fast decreasing drug administration and increasing risk for bronchoconstriction.
3
Q
Dry-Powder Inhalers
A
Breath activated so do not require breath-hand coordination.
20% reaches the lungs.
4
Q
Why do glucocorticoids help asthma and COPD?
A
Reduce bronchial hyperreactivity
Decrease mucous production
Reduce bronchial beta receptors
5
Q
When are inhaled glucocorticoids used?
A
First-line for Persistent asthma
Exacerbations in COPD
6
Q
When are oral glucocorticoids used?
A
Only when first-line medications do not work. Use should be as brief as possible.
7
Q
Adverse effects of inhaled glucocorticoids:
A
Candidiasis and dysphonia
To minimize these effects gargle after every administration
8
Q
Adverse effects of oral glucocorticoids:
A
If taken for less than 10 days, adverse effects are minimal.
9
Q
Patient education Glucocorticoids
A
Used for preventative therapy not abortive therapy.
Use SABA before glucocorticoids
10
Q
Nebulized Budesonide
A
For children 1-8 years old.
Improvement should begin in 2 days.
Should be tapered off after a week.
11
Q
What are the preferred oral glucocorticoids?
A
Methylprednisolone, Prednisone ,and Prednisolone
12
Q
When should Leukotriene Receptor Antagonists be given?
A
Second-line when an inhaled glucocorticoid cannot be used.
Or when a glucocorticoid is not sufficient.
13
Q
Zileuton and Zafirlukast
A
Asthma prophylaxis for children 12 years and older.
Takes 1-2 hours to be effective.
Can damage the liver.
14
Q
Montelukast Indications:
A
Maintenance therapy for children >1.
Prevention of exercise-induced asthma >15.
Allergic rhinitis.
Maximal effects develop 24h after administration
15
Q
Adverse effects of Leukotriene Receptor Antagonists:
A
Neuropsychiatric effects –> depression and suicidal thoughts.
16
Q
Cromolyn
A
Inhalation agent that decreases inflammation.
Used as an alternative therapy to glucocorticoids.
Especially effective for prophylactic seasonal allergy triggers.
17
Q
Patient Education Cromolyn
A
Administer 15 minutes before working out.
Record peak expiratory flow, symptom frequency, night-time awakenings, etc.
18
Q
Omalizumab MOA
A
Antagonizes IgE antibodies
19
Q
Omalizumab Indications:
A
Moderate to severe asthma that is allergy related and cannot be controlled with a glucocorticoid.
20
Q
Problems with Omalizumab:
A
BB: Anaphylaxis
Must be administered in clinic
Expensive
Causes cancer, URIs
21
Q
Benralizumab, Mepolizumab, Reslizumab
A
Decrease eosinophils
22
Q
Dupilumab
A
Interleukin-Receptor Alpha Antagonist
Only for patients with eosinophilic asthma or dependence on oral glucocorticoids.
23
Q
Roflumilast
A
Phosphodieterase-4 Inhibitor only for patients with COPD with a chronic bronchitis component.
24
Q
When are LABAs indicated?
A
First-line for COPD
Second-line for asthma and must be combined with a glucocorticoid.
25
Oral Beta Agonists
Only used for preventative therapy
Second-line
26
Salmeterol, Formoterol, Arformoterol, Vilanterol (only combined with glucocorticoids)
LABAs
Administer BID
27
What are the two oral beta-agonists?
Albuterol and Terbutaline 3-4x/day
28
Theophylline
Bronchodilation
Used for chronic stable asthma.
Only used if anticholinergics and B-agonists are not available or if the patient cannot afford them.
Therapeutic range: 5-20
29
Theophylline Toxicity:
S&S: Restlessness, Dysrhythmias, and Convulsions
Tx: Stop Theophylline, activated charcoal, lidocaine for dysrhythmias
30
Ipratroprium
Only approved for COPD bronchoconstriction but also used for asthma.
Effects begin quickly and are additive to B-agonists.
31
Tiotropium, Aclidinium, Umeclidinium
Long-Acting Anticholinergics
Used for maintenance therapy of COPD and Asthma
32
Fluticasone/Salmeterol (Advair)
Budesonide/Formoterol (Symbicort)
Mometasone/Formoterol (Dulera)
Long-term asthma
Combination Products
33
Albuterol/Ipratropium (Combivent)
Indacaterol/Glycopyrronium (Utibron)
Olodaterol/Tiotropium (Stiolto)
Vilanterol/Umeclidinium (Anoro)
Only approved for long-term COPD
34
FEV1
Max exhale in 1 second
35
FVC
Max exhale total
36
Treatment goals for reducing impairment
SABA use <2x/week
Preventing troublesome symptoms
Maintaining normal lung capacity
Maintaining normal activity levels
37
Treatment goals for reducing risk
Preventing recurrent exacerbations
Minimizing hospital visits
Preventing progressive loss of lung function
Providing maximum benefits with minimal adverse effects
38
Stepwise approach to managing asthma:
SABA
Long-term control (preferably glucocorticoid)
Increase long-term dose or include another medication
After a period of sustained-control, try moving down.
39
Tx for Acute Severe Exacerbations
Oxygen
Systemic glucocorticoid
Nebulized SABA
Nebulized Ipratropium
40
EIB Drugs
SABA immediately before
Cromolyn 15 minutes before
41
COPD Treatment Goals
Reduce symptoms
Improve health status
Improve exercise tolerance
Reduce risks and mortality
42
Management of Stable COPD
B-agonist or anticholinergics
Glucocorticoid with LABA
Roflumilast with LAMA, LABA, or inhaled glucocorticoid
*LABAs can be used alone for COPD but not asthma.
43
Management of COPD Exacerbation
LAMA
Systemic glucocorticoid
ATBs and Oxygen
44
Medication for Nasal decongestion:
Intranasal glucocorticoids
Oral decongestant
Combination therapy
Allergy testing
Anatomic block
Nonallergic inflammation
Immunotherapy
45
Intermittent nasal sneezing, nasal itching, and rhinorrhea
Oral antihistamine
Nasal antihistamine
Allergy testing
Avoidance
Immunotherapy
46
Moderate-Severe Allergy Symptoms
Intranasal glucocorticoids
Intranasal antihistamines
Combination therapy
Allergy testing
Aggressive environmental control
Immunotherapy
47
Budesonide, Fluticasone, Triamcinolone
Intranasal glucocorticoids are most effective.
Should be taken regularly for best effects.
Take highest dose at first and then reduce to lowest effective amount.
48
Antihistamines
Only used for sneezing, rhinorrhea, and nasal itching. They do not decrease congestion.
Best if taken regularly.
49
Azelastine and Olopatadine
Intranasal anti-histamines
50
Intranasal Cromolyn
Highly safe but slightly effective
Should be dosed regularly throughout the allergy season.
51
Phenylephrine
Pseudoephedrine
"Oline"
Topical or oral decreases congestion
52
Ephedrine Risks
Can be abused to achieve effects close to amphetamines.
Most products now contain phenylephrine.
53
How long should topical sympathomimetics be used for?
3-5 days to prevent rebound congestion.
54
Allegra
Fexofenadine/pseudoephedrine
55
Claritin
Loratidine/pseudoephedrine
56
Ipratropium for colds
Decreases rhinorrhea
57
Opioid antitussives
Hydrocodone and codeine
Codeine is taken at 1/10th the dose needed to relieve pain.
58
Dextromethorphan
OTC
Opioid-derivative that can only be abused at high doses
59
Nonopioid Antitussives
Diphenhydramine
Benzonatate -Lidocaine derivative that decreases respiratory tract receptor sensitivity
60
Expectorants
Not that effective except for guaifenesin
61
Mucolytics
Hypertonic Saline and Acetylcysteine decrease viscosity of mucous
62
Pediatric safety in cold medications
Do not give below 4-6 years
Avoid anti-histamine products to sedate children
63
How to safely manage colds in children:
Use a bulb to remove secretions.
Use saline drops to decrease stuffiness.
>1 use honey to decrease cough.
>2 years mentholated chest rub to decrease cough.
64
Drugs for H-Pylori caused PUD:
ATBs with an antisecretory agent
65
Prophylaxis for older adults, NSAID use, and history of PUD:
First-Line: PPIs
Misoprostol
66
Treatment for NSAID induced PUD:
H2 receptor antagonists and PPIs are preferred.
67
Nondrug treatment for PUD:
Eating smaller and more meals can decrease fluctuations in gastric contents.
Decrease smoking.
68
ATBs used for PUD:
Clarithromycin
Amoxicillin
Bismuth
Metronidazole
Tetracycline
69
Preferred combination for H pylori:
Clarithromycin, Amoxicillin, and PPI
70
Cimetidine (Tagamet) Therapeutic Uses
H2 Receptor antagonist
Duodenal ulcers require 4-6 weeks
Gastric ulcers require 8-12 weeks
GERD symptoms
Zollinger-Ellson syndrome
71
PPI MOA
Reduces acid production but not as effective as H2 antagonists.
72
PPI Therapeutic Use
First-line: GERD For 6 weeks max unless GERD is severe.
Second-line: PUD for 6 weeks max
Hypersecretory states long-term.
73
PPI AE:
Pneumonia
Fractures
Rebound acid hypersecretion
74
Sucralfate
Creates a barrier between mucosa and pepsin.
Used for duodenal ulcers.
Minimal side effects.
75
Misoprostol
Gastric-ulcers caused by long-term NSAID ulcers.
Suppress secretion of gastric acid.
76
Antacids
Neutralize gastric acidity
Reduce pepsin activity
Enhance mucosal activity by activating prostaglandins
77
Bulk forming laxatives:
Psyllium
Methylcellulose
Polycarbophil
78
Indications for bulk forming laxatives:
Short-term constipation
Diverticulosis
IBS
79
Surfactant Laxatives
Docusate Calcium
Docusate Sodium
80
Surfactant Laxative MOA
Lower surface tension to allow water penetration into feces.
Inhibit fluid absorption.
Stimulate secretion of fluid and electrolytes into intestine.
81
Stimulant Laxatives
Bisacodyl
Senna
Castor Oils
82
Stimulant Laxative MOA
Stimulate intestinal motility
Increase secretion of water and electrolytes into the intestine
83
What are the legitimate indications for stimulant laxatives?
Opioid induced constipation
Constipation from slow intestinal transit
84
Bisacodyl
Oral or suppository
Swallow whole without milk
Proctitis develops from long-term use.
85
Castor Oil
Group 1
Only used when rapid evacuation is needed.
86
Osmotic Laxatives
Sodium Phosphate
Magnesium Hydroxide
Polyethylene Glycol
Lactulose
87
Osmotic Laxative Indications
High doses result in evacuation in 2-6 hours.
Diagnostic and surgical procedures
Removing toxins
Removing parasites after anthelmintic therapy
88
What laxative is preferred for chronic constipation?
Polyethylene Glyclol
89
Lubiprostone Indications:
Chronic idiopathic constipation
IBS-C in women
Opioid-induced constipation
90
Plecanatide Indications:
Chronic idiopathic constipation
91
Safest Laxative for Colonoscopy:
Polyethylene Glycol with electrolytes
Prevent electrolyte imbalances and dehydration but require large doses of water, which is not preferred by patients.
92
What products are used for colonoscopy?
Polyethylene Glycol
Sodium Phosphate
Sodium picosulfate, magnesium oxide, citric acid
93
Advising patients about laxative abuse
Stool quality is more important than amount.
Laxatives should only be used for the smallest amount of time.
Bowel training teaches the bowel to defecate at a specific time.
94
Serotonin Receptor Antagonists
"setron"
More effective when combined with glucocorticoids
95
What glucocorticoids are used as antiemetics?
Dexamethasone
Methylprenisolone
96
P/neurokinin-1
"pitant"
Used for CINV
Used for delayed and acute CINV
Must be used with setrons or glucocorticoids.
97
Dopamine Antagonist
Prochlorperazine/Promethazine
AE: extrapyramidal effects, respiratory depression, tissue death
98
Haldol and Droperidol
Block dopamine receptors
BB: May cause fatal dysrhythmias
99
Metoclopramide
Blocks dopamine receptors in the CTZ
100
Dronabinol
Nabilone
Cannabinoids
Used as second-line treatment for CINV
Used for weight gain in AIDS
101
When should antiemetics be given for CINV?
Before since they are more effective at preventing it than aborting it.
102
What antiemetics are used for pregnancy N/V?
Doxylamine and Vitamin B at bedtime
Second-line: prochlorperazine, metoclopramide, ondansetron
103
Motion Sickness
First-line: Scopolamine reduces nerve traffic from vestibular nerve
Second-line: Dramamine and Cyclizine (anti-histamines
104
Diphenoxylate (Lomotil)
Opioid for diarrhea given with Atropine to prevent abuse
105
Loperamide (Imodium)
Suppresses bowel motility and secretion of water into intestine.
Does not produce euphoria.
106
Treatment Traveler's Diarrhea:
Let the infection take its course unless severe.
Ciprofloxacin -Adults
Azithromycin -Children
107
Alosetron
Only for severe IBS-D in women.
Severe is classified as: severe discomfort, frequent urgency, or disability.
Takes 1-4 weeks to reach efficacy.
BB: ischemic colitis
108
Sulfasalazine
Reduces inflammation in the intestine for Crohn's and Ulcerative Colitis.
109
Budesonide
ER glucocorticoid with high local concentration in the intestine for IBD
110
Aziothioprine
Mercatoprine
Immunosuppressants for IBD that take up to 6 months. Because of toxicity, reserved for patients who have not responded to Sulfasalazine or glucocorticoids.
111
Cyclosporine
Immunosuppressant that rapidly removes IBD symptoms. Only occasionally long-term success.
112
Infliximab
Immunomodulator second-line for IBD.
Opportunistic infections and infusion reactions are common.
113
Metoclopamide
Prokinetic agent that increases upper GI motility for diabetic gastroparesis and GERD.
114
What is topical nitroglycerin used for?
chronic anal fissures
115
What is the primary hormone during the follicular phase?
Estrogen
116
What is the primary hormone during the luteal phase?
Progesterone
117
What pituitary hormones rise during ovulation?
FSH and LH
118
Where is estrogen emulsion applied?
Top of thighs and back of calves once a day
119
Where is the spray and gel applied?
Arm
120
Where are estrogen patches applied?
Trunk but not breasts
121
Benefits of transdermal estrogen
Dose is less since it bypasses the liver
Less N/V
Blood levels fluctuate less
Less risk for DVT
122
What is parenteral estrogen used for?
Heavy menstrual bleeding
123
Patient Education for Estrogen Transdermal Patch
Apply pressure for 10 seconds
If the patch falls off, apply the same one or if necessary a new one
Rotate the patch application site
124
How should the intravaginal estrogen ring be applied?
As deeply as possible for 3 weeks then 1 week break
If the old one falls out, wash with warm water and reapply
125
How often should the intravaginal insert be applied?
Once daily for 2 weeks
Then twice a week
126
Tamoxifen
Blocks cell growth in breasts, decreases osteoporosis
Causes hot flashes and uterine cancer
127
Raloxifene
Protects against osteoporosis and all cancer
128
What is progesterone used for?
Irregular bleeding
Amenorrhea
Endometrial hyperplasia
IVF, preventing preterm delivery
129
Benefits of menopausal hormone therapy:
Decreased vasomotor effects
Decreased urogenital atrophy
Prevention of fractures
130
Why is progesterone given to menopausal women?
Only to prevent endometrial cancer. Do not give to women who have had a hysterectomy.
131
What could be given alternatively to Estrogen for hot flashes?
Escitalopram or Desvenlafaxine
132
Estrogen Patient Education
Avoid nausea by taking at night with food.`
133
Estrogen and Progesterone BB
Increases risk for DVT
May increase risk of dementia for patients older than 65
134
Flibanserin
For low libido in women
CNS depression and dysrhythmias
Can only be given through REMS
135
Bremelanotide
Given SQ 45 minutes before sex.
Only 8x/month.
136
What are the most effective types of birth control?
Estonogesterol subdermal
Medroxyprogesterone Acetate intermuscular
Sterilization
IUDs
137
Combination OC MOA
Prevent ovulation
Thickening cervical mucous
Altering endometrium
138
Effectiveness of OC
.3% but realistically 8%
Decreases among obese women
139
What are some possible considerations against OC?
Smokers >35
Migraine
Seizures
Diabetes
140
AE of breast cancer
Promote but do not cause breast cancer
HTN
Abnormal uterine bleeding
Stroke in women with migraine
Glucose intolerance
141
What do OCs decrease risk for?
Ovarian and endometrial cancer
Pelvic Inflammatory Disease
Migraine
142
Preparations for OC
Ethinyl Estradiol with possible 8 other progestins
The lower the estrogen the better
143
Natazia
Employs a 4 cycle dosing schedule that decreasing menstrual bleeding.
144
Progesterone only OC
More safe
Less effective and more likely to cause bleeding
Increases cervical mucous
Must be taken exactly on tim
145
Nexplanon
Lasts for 3 years
Safe to use while breastfeeding
146
DMPA Depot
Lasts for 3 months
Takes 9 months to get pregnant
Causes reversible bone loss
147
How long do IUDs last for?
Copper: 10 years
Levonorgestrel: 3-7 years
148
Today Sponge
Soaked in Nonoxynol
Reapplied every 24 hours
16-32% effectiveness rate
149
Plan B One Step
Next Choice One Dose
Levonorgestrel
Recommended to take within 72 hours but also can be taken within 5 days.
No prescription required.
150
Ulipristal Acetate
Highly effective 5 days later.
Prescription required.
151
Considerations for Sidanefil:
A-adrenergic blockers
Vasodilators
Nitroglycerin
CVD, hypotn or HTN, HF, unstable angina
152
Phosphodiesterase 5 Education
Take 15-60 min before sex
Sex increases risk for MI
Seek help if an erection lasts more than 4 hours
153
Ending of Phosphodiesterase 5
"fil"
154
Alprostadil
Prostaglandin that promotes arterial blood flow into the penis.
Inserted into the urethra or intracavernous.
Starts in 5 minutes and lasts 60.
155
Papaverine plus Phentolamine
Promotes arterial blood flow.
Significant safety concerns.
156
Drugs for Premature Ejaculation:
SSRIs
Local anesthetics
157
5-alpha-reducterase inhibitors
Causes prostate to shrink by inhibiting active form of testosterone in the prostate for obstructive BPH. Takes 6-12 months to work.
158
5-alpha-reducterase inhibitors ending
"steride"
159
How is dutasteride different from finasteride?
Reduction in circulating DHT is more complete.
5 week half-life.
160
Selective alpha blockers
Relaxes smooth muscle near the bladder and urethra.
161
Selective alpha blockers ending
"osin"
162
Silodosin and Tamsulosin
Have no effect on BP since they are selective to the prostate.
163
What are Selective alpha blockers used for in women?
Urinary hesitancy or urinary retention
164
Combination of Selective alpha blockers and 5-alpha-reducterase inhibitors
Work synergistically
165
Tadalafil
For men with BPH or BPH with ED.
PDE-5 inhibitor
