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Pharmacology > Pharm Quiz 7 > Flashcards

Pharm Quiz 7 Flashcards

1
Q

Diagnosis for COPD

A

Chronic bronchitis, Emphysema, and Forced Expiratory Volume in 1 second of less than .7

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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.

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3
Q

Dry-Powder Inhalers

A

Breath activated so do not require breath-hand coordination.
20% reaches the lungs.

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4
Q

Why do glucocorticoids help asthma and COPD?

A

Reduce bronchial hyperreactivity
Decrease mucous production
Reduce bronchial beta receptors

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5
Q

When are inhaled glucocorticoids used?

A

First-line for Persistent asthma
Exacerbations in COPD

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6
Q

When are oral glucocorticoids used?

A

Only when first-line medications do not work. Use should be as brief as possible.

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7
Q

Adverse effects of inhaled glucocorticoids:

A

Candidiasis and dysphonia
To minimize these effects gargle after every administration

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8
Q

Adverse effects of oral glucocorticoids:

A

If taken for less than 10 days, adverse effects are minimal.

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9
Q

Patient education Glucocorticoids

A

Used for preventative therapy not abortive therapy.
Use SABA before glucocorticoids

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10
Q

Nebulized Budesonide

A

For children 1-8 years old.
Improvement should begin in 2 days.
Should be tapered off after a week.

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11
Q

What are the preferred oral glucocorticoids?

A

Methylprednisolone, Prednisone ,and Prednisolone

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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.

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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.

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14
Q

Montelukast Indications:

A

Maintenance therapy for children >1.
Prevention of exercise-induced asthma >15.
Allergic rhinitis.
Maximal effects develop 24h after administration

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15
Q

Adverse effects of Leukotriene Receptor Antagonists:

A

Neuropsychiatric effects –> depression and suicidal thoughts.

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16
Q

Cromolyn

A

Inhalation agent that decreases inflammation.
Used as an alternative therapy to glucocorticoids.
Especially effective for prophylactic seasonal allergy triggers.

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17
Q

Patient Education Cromolyn

A

Administer 15 minutes before working out.
Record peak expiratory flow, symptom frequency, night-time awakenings, etc.

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18
Q

Omalizumab MOA

A

Antagonizes IgE antibodies

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19
Q

Omalizumab Indications:

A

Moderate to severe asthma that is allergy related and cannot be controlled with a glucocorticoid.

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20
Q

Problems with Omalizumab:

A

BB: Anaphylaxis
Must be administered in clinic
Expensive
Causes cancer, URIs

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21
Q

Benralizumab, Mepolizumab, Reslizumab

A

Decrease eosinophils

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22
Q

Dupilumab

A

Interleukin-Receptor Alpha Antagonist
Only for patients with eosinophilic asthma or dependence on oral glucocorticoids.

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23
Q

Roflumilast

A

Phosphodieterase-4 Inhibitor only for patients with COPD with a chronic bronchitis component.

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24
Q

When are LABAs indicated?

A

First-line for COPD
Second-line for asthma and must be combined with a glucocorticoid.

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25
Q

Oral Beta Agonists

A

Only used for preventative therapy
Second-line

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26
Q

Salmeterol, Formoterol, Arformoterol, Vilanterol (only combined with glucocorticoids)

A

LABAs
Administer BID

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27
Q

What are the two oral beta-agonists?

A

Albuterol and Terbutaline 3-4x/day

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28
Q

Theophylline

A

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

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29
Q

Theophylline Toxicity:

A

S&S: Restlessness, Dysrhythmias, and Convulsions
Tx: Stop Theophylline, activated charcoal, lidocaine for dysrhythmias

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30
Q

Ipratroprium

A

Only approved for COPD bronchoconstriction but also used for asthma.
Effects begin quickly and are additive to B-agonists.

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31
Q

Tiotropium, Aclidinium, Umeclidinium

A

Long-Acting Anticholinergics
Used for maintenance therapy of COPD and Asthma

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32
Q

Fluticasone/Salmeterol (Advair)
Budesonide/Formoterol (Symbicort)
Mometasone/Formoterol (Dulera)

A

Long-term asthma
Combination Products

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33
Q

Albuterol/Ipratropium (Combivent)
Indacaterol/Glycopyrronium (Utibron)
Olodaterol/Tiotropium (Stiolto)
Vilanterol/Umeclidinium (Anoro)

A

Only approved for long-term COPD

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34
Q

FEV1

A

Max exhale in 1 second

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35
Q

FVC

A

Max exhale total

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36
Q

Treatment goals for reducing impairment

A

SABA use <2x/week
Preventing troublesome symptoms
Maintaining normal lung capacity
Maintaining normal activity levels

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37
Q

Treatment goals for reducing risk

A

Preventing recurrent exacerbations
Minimizing hospital visits
Preventing progressive loss of lung function
Providing maximum benefits with minimal adverse effects

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38
Q

Stepwise approach to managing asthma:

A

SABA
Long-term control (preferably glucocorticoid)
Increase long-term dose or include another medication
After a period of sustained-control, try moving down.

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39
Q

Tx for Acute Severe Exacerbations

A

Oxygen
Systemic glucocorticoid
Nebulized SABA
Nebulized Ipratropium

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40
Q

EIB Drugs

A

SABA immediately before
Cromolyn 15 minutes before

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41
Q

COPD Treatment Goals

A

Reduce symptoms
Improve health status
Improve exercise tolerance
Reduce risks and mortality

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42
Q

Management of Stable COPD

A

B-agonist or anticholinergics
Glucocorticoid with LABA
Roflumilast with LAMA, LABA, or inhaled glucocorticoid
*LABAs can be used alone for COPD but not asthma.

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43
Q

Management of COPD Exacerbation

A

LAMA
Systemic glucocorticoid
ATBs and Oxygen

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44
Q

Medication for Nasal decongestion:

A

Intranasal glucocorticoids
Oral decongestant
Combination therapy
Allergy testing
Anatomic block
Nonallergic inflammation
Immunotherapy

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45
Q

Intermittent nasal sneezing, nasal itching, and rhinorrhea

A

Oral antihistamine
Nasal antihistamine
Allergy testing
Avoidance
Immunotherapy

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46
Q

Moderate-Severe Allergy Symptoms

A

Intranasal glucocorticoids
Intranasal antihistamines
Combination therapy
Allergy testing
Aggressive environmental control
Immunotherapy

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47
Q

Budesonide, Fluticasone, Triamcinolone

A

Intranasal glucocorticoids are most effective.
Should be taken regularly for best effects.
Take highest dose at first and then reduce to lowest effective amount.

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48
Q

Antihistamines

A

Only used for sneezing, rhinorrhea, and nasal itching. They do not decrease congestion.
Best if taken regularly.

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49
Q

Azelastine and Olopatadine

A

Intranasal anti-histamines

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50
Q

Intranasal Cromolyn

A

Highly safe but slightly effective
Should be dosed regularly throughout the allergy season.

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51
Q

Phenylephrine
Pseudoephedrine
“Oline”

A

Topical or oral decreases congestion

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52
Q

Ephedrine Risks

A

Can be abused to achieve effects close to amphetamines.
Most products now contain phenylephrine.

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53
Q

How long should topical sympathomimetics be used for?

A

3-5 days to prevent rebound congestion.

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54
Q

Allegra

A

Fexofenadine/pseudoephedrine

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55
Q

Claritin

A

Loratidine/pseudoephedrine

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56
Q

Ipratropium for colds

A

Decreases rhinorrhea

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57
Q

Opioid antitussives

A

Hydrocodone and codeine
Codeine is taken at 1/10th the dose needed to relieve pain.

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58
Q

Dextromethorphan

A

OTC
Opioid-derivative that can only be abused at high doses

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59
Q

Nonopioid Antitussives

A

Diphenhydramine
Benzonatate -Lidocaine derivative that decreases respiratory tract receptor sensitivity

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60
Q

Expectorants

A

Not that effective except for guaifenesin

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61
Q

Mucolytics

A

Hypertonic Saline and Acetylcysteine decrease viscosity of mucous

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62
Q

Pediatric safety in cold medications

A

Do not give below 4-6 years
Avoid anti-histamine products to sedate children

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63
Q

How to safely manage colds in children:

A

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.

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64
Q

Drugs for H-Pylori caused PUD:

A

ATBs with an antisecretory agent

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65
Q

Prophylaxis for older adults, NSAID use, and history of PUD:

A

First-Line: PPIs
Misoprostol

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66
Q

Treatment for NSAID induced PUD:

A

H2 receptor antagonists and PPIs are preferred.

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67
Q

Nondrug treatment for PUD:

A

Eating smaller and more meals can decrease fluctuations in gastric contents.
Decrease smoking.

68
Q

ATBs used for PUD:

A

Clarithromycin
Amoxicillin
Bismuth
Metronidazole
Tetracycline

69
Q

Preferred combination for H pylori:

A

Clarithromycin, Amoxicillin, and PPI

70
Q

Cimetidine (Tagamet) Therapeutic Uses

A

H2 Receptor antagonist
Duodenal ulcers require 4-6 weeks
Gastric ulcers require 8-12 weeks
GERD symptoms
Zollinger-Ellson syndrome

71
Q

PPI MOA

A

Reduces acid production but not as effective as H2 antagonists.

72
Q

PPI Therapeutic Use

A

First-line: GERD For 6 weeks max unless GERD is severe.
Second-line: PUD for 6 weeks max
Hypersecretory states long-term.

73
Q

PPI AE:

A

Pneumonia
Fractures
Rebound acid hypersecretion

74
Q

Sucralfate

A

Creates a barrier between mucosa and pepsin.
Used for duodenal ulcers.
Minimal side effects.

75
Q

Misoprostol

A

Gastric-ulcers caused by long-term NSAID ulcers.
Suppress secretion of gastric acid.

76
Q

Antacids

A

Neutralize gastric acidity
Reduce pepsin activity
Enhance mucosal activity by activating prostaglandins

77
Q

Bulk forming laxatives:

A

Psyllium
Methylcellulose
Polycarbophil

78
Q

Indications for bulk forming laxatives:

A

Short-term constipation
Diverticulosis
IBS

79
Q

Surfactant Laxatives

A

Docusate Calcium
Docusate Sodium

80
Q

Surfactant Laxative MOA

A

Lower surface tension to allow water penetration into feces.
Inhibit fluid absorption.
Stimulate secretion of fluid and electrolytes into intestine.

81
Q

Stimulant Laxatives

A

Bisacodyl
Senna
Castor Oils

82
Q

Stimulant Laxative MOA

A

Stimulate intestinal motility
Increase secretion of water and electrolytes into the intestine

83
Q

What are the legitimate indications for stimulant laxatives?

A

Opioid induced constipation
Constipation from slow intestinal transit

84
Q

Bisacodyl

A

Oral or suppository
Swallow whole without milk
Proctitis develops from long-term use.

85
Q

Castor Oil

A

Group 1
Only used when rapid evacuation is needed.

86
Q

Osmotic Laxatives

A

Sodium Phosphate
Magnesium Hydroxide
Polyethylene Glycol
Lactulose

87
Q

Osmotic Laxative Indications

A

High doses result in evacuation in 2-6 hours.
Diagnostic and surgical procedures
Removing toxins
Removing parasites after anthelmintic therapy

88
Q

What laxative is preferred for chronic constipation?

A

Polyethylene Glyclol

89
Q

Lubiprostone Indications:

A

Chronic idiopathic constipation
IBS-C in women
Opioid-induced constipation

90
Q

Plecanatide Indications:

A

Chronic idiopathic constipation

91
Q

Safest Laxative for Colonoscopy:

A

Polyethylene Glycol with electrolytes
Prevent electrolyte imbalances and dehydration but require large doses of water, which is not preferred by patients.

92
Q

What products are used for colonoscopy?

A

Polyethylene Glycol
Sodium Phosphate
Sodium picosulfate, magnesium oxide, citric acid

93
Q

Advising patients about laxative abuse

A

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
Q

Serotonin Receptor Antagonists

A

“setron”
More effective when combined with glucocorticoids

95
Q

What glucocorticoids are used as antiemetics?

A

Dexamethasone
Methylprenisolone

96
Q

P/neurokinin-1

A

“pitant”
Used for CINV
Used for delayed and acute CINV
Must be used with setrons or glucocorticoids.

97
Q

Dopamine Antagonist

A

Prochlorperazine/Promethazine
AE: extrapyramidal effects, respiratory depression, tissue death

98
Q

Haldol and Droperidol

A

Block dopamine receptors
BB: May cause fatal dysrhythmias

99
Q

Metoclopramide

A

Blocks dopamine receptors in the CTZ

100
Q

Dronabinol
Nabilone

A

Cannabinoids
Used as second-line treatment for CINV
Used for weight gain in AIDS

101
Q

When should antiemetics be given for CINV?

A

Before since they are more effective at preventing it than aborting it.

102
Q

What antiemetics are used for pregnancy N/V?

A

Doxylamine and Vitamin B at bedtime
Second-line: prochlorperazine, metoclopramide, ondansetron

103
Q

Motion Sickness

A

First-line: Scopolamine reduces nerve traffic from vestibular nerve
Second-line: Dramamine and Cyclizine (anti-histamines

104
Q

Diphenoxylate (Lomotil)

A

Opioid for diarrhea given with Atropine to prevent abuse

105
Q

Loperamide (Imodium)

A

Suppresses bowel motility and secretion of water into intestine.
Does not produce euphoria.

106
Q

Treatment Traveler’s Diarrhea:

A

Let the infection take its course unless severe.
Ciprofloxacin -Adults
Azithromycin -Children

107
Q

Alosetron

A

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
Q

Sulfasalazine

A

Reduces inflammation in the intestine for Crohn’s and Ulcerative Colitis.

109
Q

Budesonide

A

ER glucocorticoid with high local concentration in the intestine for IBD

110
Q

Aziothioprine
Mercatoprine

A

Immunosuppressants for IBD that take up to 6 months. Because of toxicity, reserved for patients who have not responded to Sulfasalazine or glucocorticoids.

111
Q

Cyclosporine

A

Immunosuppressant that rapidly removes IBD symptoms. Only occasionally long-term success.

112
Q

Infliximab

A

Immunomodulator second-line for IBD.
Opportunistic infections and infusion reactions are common.

113
Q

Metoclopamide

A

Prokinetic agent that increases upper GI motility for diabetic gastroparesis and GERD.

114
Q

What is topical nitroglycerin used for?

A

chronic anal fissures

115
Q

What is the primary hormone during the follicular phase?

A

Estrogen

116
Q

What is the primary hormone during the luteal phase?

A

Progesterone

117
Q

What pituitary hormones rise during ovulation?

A

FSH and LH

118
Q

Where is estrogen emulsion applied?

A

Top of thighs and back of calves once a day

119
Q

Where is the spray and gel applied?

A

Arm

120
Q

Where are estrogen patches applied?

A

Trunk but not breasts

121
Q

Benefits of transdermal estrogen

A

Dose is less since it bypasses the liver
Less N/V
Blood levels fluctuate less
Less risk for DVT

122
Q

What is parenteral estrogen used for?

A

Heavy menstrual bleeding

123
Q

Patient Education for Estrogen Transdermal Patch

A

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
Q

How should the intravaginal estrogen ring be applied?

A

As deeply as possible for 3 weeks then 1 week break
If the old one falls out, wash with warm water and reapply

125
Q

How often should the intravaginal insert be applied?

A

Once daily for 2 weeks
Then twice a week

126
Q

Tamoxifen

A

Blocks cell growth in breasts, decreases osteoporosis
Causes hot flashes and uterine cancer

127
Q

Raloxifene

A

Protects against osteoporosis and all cancer

128
Q

What is progesterone used for?

A

Irregular bleeding
Amenorrhea
Endometrial hyperplasia
IVF, preventing preterm delivery

129
Q

Benefits of menopausal hormone therapy:

A

Decreased vasomotor effects
Decreased urogenital atrophy
Prevention of fractures

130
Q

Why is progesterone given to menopausal women?

A

Only to prevent endometrial cancer. Do not give to women who have had a hysterectomy.

131
Q

What could be given alternatively to Estrogen for hot flashes?

A

Escitalopram or Desvenlafaxine

132
Q

Estrogen Patient Education

A

Avoid nausea by taking at night with food.`

133
Q

Estrogen and Progesterone BB

A

Increases risk for DVT
May increase risk of dementia for patients older than 65

134
Q

Flibanserin

A

For low libido in women
CNS depression and dysrhythmias
Can only be given through REMS

135
Q

Bremelanotide

A

Given SQ 45 minutes before sex.
Only 8x/month.

136
Q

What are the most effective types of birth control?

A

Estonogesterol subdermal
Medroxyprogesterone Acetate intermuscular
Sterilization
IUDs

137
Q

Combination OC MOA

A

Prevent ovulation
Thickening cervical mucous
Altering endometrium

138
Q

Effectiveness of OC

A

.3% but realistically 8%
Decreases among obese women

139
Q

What are some possible considerations against OC?

A

Smokers >35
Migraine
Seizures
Diabetes

140
Q

AE of breast cancer

A

Promote but do not cause breast cancer
HTN
Abnormal uterine bleeding
Stroke in women with migraine
Glucose intolerance

141
Q

What do OCs decrease risk for?

A

Ovarian and endometrial cancer
Pelvic Inflammatory Disease
Migraine

142
Q

Preparations for OC

A

Ethinyl Estradiol with possible 8 other progestins
The lower the estrogen the better

143
Q

Natazia

A

Employs a 4 cycle dosing schedule that decreasing menstrual bleeding.

144
Q

Progesterone only OC

A

More safe
Less effective and more likely to cause bleeding
Increases cervical mucous
Must be taken exactly on tim

145
Q

Nexplanon

A

Lasts for 3 years
Safe to use while breastfeeding

146
Q

DMPA Depot

A

Lasts for 3 months
Takes 9 months to get pregnant
Causes reversible bone loss

147
Q

How long do IUDs last for?

A

Copper: 10 years
Levonorgestrel: 3-7 years

148
Q

Today Sponge

A

Soaked in Nonoxynol
Reapplied every 24 hours
16-32% effectiveness rate

149
Q

Plan B One Step
Next Choice One Dose

A

Levonorgestrel
Recommended to take within 72 hours but also can be taken within 5 days.
No prescription required.

150
Q

Ulipristal Acetate

A

Highly effective 5 days later.
Prescription required.

151
Q

Considerations for Sidanefil:

A

A-adrenergic blockers
Vasodilators
Nitroglycerin
CVD, hypotn or HTN, HF, unstable angina

152
Q

Phosphodiesterase 5 Education

A

Take 15-60 min before sex
Sex increases risk for MI
Seek help if an erection lasts more than 4 hours

153
Q

Ending of Phosphodiesterase 5

A

“fil”

154
Q

Alprostadil

A

Prostaglandin that promotes arterial blood flow into the penis.
Inserted into the urethra or intracavernous.
Starts in 5 minutes and lasts 60.

155
Q

Papaverine plus Phentolamine

A

Promotes arterial blood flow.
Significant safety concerns.

156
Q

Drugs for Premature Ejaculation:

A

SSRIs
Local anesthetics

157
Q

5-alpha-reducterase inhibitors

A

Causes prostate to shrink by inhibiting active form of testosterone in the prostate for obstructive BPH. Takes 6-12 months to work.

158
Q

5-alpha-reducterase inhibitors ending

A

“steride”

159
Q

How is dutasteride different from finasteride?

A

Reduction in circulating DHT is more complete.
5 week half-life.

160
Q

Selective alpha blockers

A

Relaxes smooth muscle near the bladder and urethra.

161
Q

Selective alpha blockers ending

A

“osin”

162
Q

Silodosin and Tamsulosin

A

Have no effect on BP since they are selective to the prostate.

163
Q

What are Selective alpha blockers used for in women?

A

Urinary hesitancy or urinary retention

164
Q

Combination of Selective alpha blockers and 5-alpha-reducterase inhibitors

A

Work synergistically

165
Q

Tadalafil

A

For men with BPH or BPH with ED.
PDE-5 inhibitor

Pharmacology (7 decks)

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