Pharm2 Exam1 Flashcards
Reproductive Drugs (5)
Doxazosin Premarin Testoterone Tamoxifen Herceptin
Doxazosin CUSA (Class, Use, s/fx, and admin considerations)
Non-selective Alpha 1 (relaxes smooth muscle of bladder/prostate)
Benign Prostatic Hyperplasia and HTN
HypoTN and Ø ejaculation
Monitor BP and (care w/ nitro)
Premarin CUSA
Estrogen
Postmenopausal S/S
↑% embolytic event (MI, PE, DVT, CVA, CHF)
↑% endometrial/breast cancer
Ø Nicotine and monitor embolism
Testosterone CUSA
Androgen
Hypogonadism, delayed puberty, testicular failure
*anemia if Ørx to traditional therapy
Jaundice, ↑Cholesterol, ↑% prostate cancer
Monitor AST/ALT, BG levels, and PT/INR if on anti-coagulants
Tamoxifen CUSA
Hormone Regulator - Estrogen Receptor Blocker (for est. dependent cancers)
Advanced breast cancer/early (precocious) puberty
Menopausal S/S, N/V, ↑Ca, Vaginal Bleeding/Discharge
↑ Comfort against Menopausal S/S, report Chest pain or SOB
Herceptin CUSA
Immune Suppresant - Monoclonal Antibody (targets cancerous tissue)
Metastatic Breast Cancer
Toxicity, Tachycardia, HF, N/V
ECG/Monitor, SOB/Chest pain, Dyspnea, edema
Inflammation, Immune, Transplantation, and Rheumatoid Drugs (4)
Celebrex
Cyclosporoin
Aspirin/Ibuprofen
Acetaminophen
Celebrex CUSA
Anti-Rheumatic, NSAID
Osteoarthritis, rheumatoid arthritis, chest pain
MI, bleeding, stroke, thrombosis, edema
Notify if S/S toxicity (blackstool, rash, ↑ wieght, stroke, thrombosis, edema)
Cyclosporin CUSA
Anti-Rheumatic (DiseaseModifying ARD), immunosuppresant
Prevent transplant rejection (w/ corticosteroids) and rheumatoid arthritis
S/S infx Hepato/Nephrotoxicity HTN Bone marrow suppression **Hirsutism (abnormal hair growth)**
Monitor BUN, creatinine, I&Os, AST/ALT, CBC
Aspirin/Ibuprofen CUSA
Antipyretic, non-opiod Analgesic
Fever, pain, inflammation
♥ burn, bleeding, ↓ urine output (↑ BUN/creatinine), Salicylism
Reye Syndrome (rare swelling of liver/brain)
Take w/ food, milk to ↓ gastric d/comfort
Acetaminophen CUSA
Antipyretic, non-opiod Analgesic
Fever, pain
Hepatic failure, sweating, ↓K
Ø↑ 4g/day, if overdose counter w/ Mucomyst
The ONLY Chemotherapy Agent
Methotraxate CUSA
Antineoplastics (anti-tumor), anti-rheumatic, immunosuppresant
Leukemia, psoriasis, malignant cancer of placenta (choriocarcinomas)
Chills, fever, fatigue
Monitor CBC q3-6mo
↑ birth control
Anticoagulant & Thrombolytic Drugs (3)
Warfarin
Heparin/Lovenox
Streptokinase
Warfarin CUSA
Anticoagulant
Thrombosis, ♥ dz
Hemorrage, toxicity
Monitor for bleeding and CBC
If overdose counter w/ VitK
Heparin/Lovenox CUSA
Anticoagulant
embolisms, thrombosis, prophylaxis post-op venous thrombosis (like hip surgery)
Anticoagulant regulars (HypoTN, tachycardia, bruising, CBC) Overdose counter w/ protamine AVOID NSAIDS, aspirin, salicylates
Streptokinase CUSA
Thrombolytic (dissolves clots)
Acute MI, transient ischemia attack, restore catheter patency
GI, GU, cerebral, and superficial bleeding
Limit INJ, monitor LoC, Monitor PT, PTT, HH
Neurological Drugs (3)
Levodopa
Dantrolene
Phenytoin
Levodopa CUSA
Anti-Parkinson
Parkinsons DZ
Dyskinesias (bobbing, tics, grimacing)
Orthostatic HypoHTN
d/colored sweat/urine
Ø High protein, MAOI, HypoTN S/S
Dantrolene CUSA
Skeletal Muscle Relaxant
Spinal injur, CVA, cerebral palsy, malignant hyperthermia
drowsiness, fatigue, ↑ urinatipon
Avoid other CNS depressants and driving
Phenytoin CUSA
Anti-Epileptic/Arrhythmic
clonic/psychomotor siezures
↓ CNS (dpliopia, slurred speech, dizziness)
Ø Alcohol
ONLY mix with NSS
Ø↑ 50g/min
Testicular CA R/F and Pharm Intervention
Cryptorchidism, FamHx
Anti-neoplastics
Prostate CA R/F and Pharm Intervention
Race (Black > White > Asian), Diet, and FamHx
HEAVY METAL, STDs and Vasectomy
Anti-androgens
Androgen Fx and Indication
↑ electrolyte retention, protein, RBC
Delayed puberty and to delay ovulation for endometriosis (uterine skin painful overgrowth)
Androgen ↑ levels of…?
Warfarin, Glucocorticoids, and Oral Hypoglycemis
Androgen Monitor for…?
Bleeding, ↓Glycemia, S/S infx
Names of Androgens and what for..?
SOUNDS TRADE NAMES?
Testosterone and Fluoxymesterone - Hypgonad/boob cancer
Testolactone - boob cancer
Danazol - blocks FSH/LH release in ♀
SOUNDS - Tes/Testo/Testin and Danocrine
Anabolic Steroids Fx and Indications
↑ tissues, RBC, and HH
Anemia, cancer, ↑ protein
Names of Anabolic Steroids and what for…?
SOUNDS TRADE NAMES?
Oxandrolone - ↑ weight, prtoein, ↓ cancer
Oxymetholone - anemia
Stanozol - Hx angioedema
Oxa and Drol/Strol
Adfx Androgens/Anabolic Steroids and things to monitor
Gender trait switches
↓ LDL ↑ HDL
Monitor liver, ♥, LDL/HDL
Prostate-Specific Antigen (PSA) Testing
Class, 2 tests, ↑ levels =?
Single-Chain Glycoprotein test with finger up butthole and Blood labs for antigen
↑ levels indicate prostate CA
Herceptin
Binds to HER2 tumor cells and MARKS FOR DESTRUCTTIION
BRCA genetic markers and CA
BRCA1 and 2 help repair mutated DNA.
If they are mutated… ↑% CA
Pros and Cons of HRT of Menopausal S/S
Pros
↓ S/S, ↓% CV dz, dementia, and osteoporosis
Cons
↑% breast/cervical CA, ↑ %CVdz, clots, and gallstones
Organ Preservation
Date/time of death with consent form.
Infuse organ w/ preservation solution
Package in preservative, triple bagged on ice
Histocompatibility
Ability of cells and tissue to live w/out interference from the immune system (MHC I and II are key)
More likely with family members/twins
Immunosuppresant Drug therapy
Immunosuppresants + Corticosteroids blcok inflam/immune fx to ↓ dmg to transplant
Macrolide Antibiotics
Tacrolimus FK506 (Prograf) From soil fungus, ↓ T lymphs
Sfx ↑ BP/BG levels
Monitor BP/BG
Antimeabolites
Azathioprine or AZA (Imuran)
Cytotoxic Agents
USED to be drug of choice for Øgraft rejection but is TOXIC
↓ DNA/RNA synthesis, Targets T lymphs and some B lymphs
Replaced by Mycophenolate Mofetil (MMF)
Take MMF after or before meals?
After
Antibodies r/t Acute Organ Rjx
OKT# (Monoclonal)
Atgam (Polyclonal)
HyperAcute Rjx
Immediately via Antibodies (min - hrs)
Adhere to blood vessels and clot, r/in necrosis/inflammation of organ
Acute Rjx
1 - 3 weeks
Includes 2 fx:
HyperAcute+ Cellular Response
Can be tx with medication
Cellular Response
T and NK penetrate organ and r/in inflammatory resp. and lysis of organ
TYPE4 T lymphs and macrophages attack and destroy
Chronic Rjx
Humoral, antibodies slowly attack graft over years
Similar to HyperAcute but at lower lvl
Blood Labs and what they monitor (5)
CBC - most common, RBC, HH, platelets, WBCs
Chemistry/Metabolis - Glucose, electrolytes, and Kidney fx
Enzyme - ♥ troponin, creatine kinase
Lipoprotein - Cholestrol, L/HDL, Triglyercides
Blood Clotting - PT, PTT, INR
4 Types of Immunity
Primary - macrophage consumes antigen, r/in TH cells which activate B cells
Secondary - B cells respond to antigens and ↑ plasma antibody levels
Vaccination - simulates primary
Booster Shot - simulates secondary
Vascular vs. Cellular Stage of Acute Inflammation
Vasc - prostaglandin/leukotrienes ↑permeability r/in warmth and WBC access Cellular - WBC↑ Granuloytes Monocytes Leukocytes and Liver fx together to destroy
Granulocyte FX Neutro Eosino Baso Mast
arrive w/in 90 min
↑ blood
release histamine/mediators
release histamine but in CT
Monocyte and Leukocyte FX
Mono - macrophage stuff
Leuko - adhesive proteins clot and mediate ↑ response
Liver Fx in immune resp.
↑ fibrinogen and CRP
Chronic Inflammation vs Acute
Macrophages and Lymphocytes replace NEUTOPHILS which r/in Granulomatous Inflammation
Fibroblasts replace EXUDATES
Granulomatous Inflammation
- distinctive s/s to chronic inflammation where macrophages and CT surround foreign bodies (like in TB)
4 Types of Hypersensitivity
1 - allergic rx and anaphylactic
IgE r/in degranulation which dominos inflammation response
2 - Cytotoxic, IgG and IgM’s attack antigens of surfaces (RBC transfusion) which domino
3 - IgM’s clump around vessel walls and r/in tissue dmg
4 - TH improperly attack wrong antigens
IgA IgD IgE IgG IgM
in mucous, blocks entrance in B cells, rx to antigens in mast cells, c/ inflammation in fluids, attacks antigens in fluids, clumps antigens
Antibodies and complement proteins
Antibodies couple and Compliment proteins rx to antigen and DESTROY cell
NK cells (Natural Killers)
Don’t need MHC or antibodies to kill
CD4 (T-Helpers)
Attach to MHC 2 proteins and c/ immune response
CD8 (T Cytotoxic)
Attach to MHC 1 and KILL
B Lymphocites (CD4 followup)
Only attacks cells w/ T-helpers on… then r/in…
Memory B - remain and fight against
Plasma - produce antibodies against
Exudate Types serous Sanguinous/Hemorrhagic Fibrinous Membranous Purulent
water plasma RBC's ind. vessel dmg thick whitish r/t necrotic cell collection pus, malodorous, ind. infx ↑ swelling and pain
Anti-Inflammation Drugs (5)
Corticosteroids Antihistamines Salicylates NSAIDS Anti-Arthritics
Salicylates like aspirin!
Block prostaglandins and thromboxane A.
Ø w/ NSAIDS and tatazine
Salicylism is when ↑ levels r/in ear issues, confusion, and diarrhea
NSAIDS like Tylenol!
5 Types
Block prostaglandins and COX1-2
Ø w/ salicylates, sulfonamindes, and GI issues
5 Types of NSAIDS
Proprionic Acids Acetic Acids Fenamates Oxicam Derivatives COX-2 Inhibitors
Anti-Arthritics (GOOOLD!!!)
gold salt tx where gold is consumed by macrophages and blocks phagocytosis. Used if traditional therapy Øfx
CAN BE VERY TOXIC.
Ø w/ DM1-2 and CV r/t issues (♥, vessels, blood)
Salicylates prototype and -suffixes
Aspirin
-ide, -ine, -late
NSAIDS prototype and -suffixes
Ibuprofen
-profen, -rozin
Acedtic Acid -suffixes
-ac, -cin, -ton, -tin
Fenamates buzzwords
Long Meclo/Mef names
OxiCAM derivative -suffixes
-cam
COX2 Inhibitor -suffix
-coxib
Benign vs. Malignant Neoplasms/Tumors
Benign - non-cancerous (moles, uterine fibroids, lipomas)
Malignant - metastasizes and SPREADS!!! (aka CA)
Secondary Neoplasm
- metastatic offshoot of primary tumor or an unr/t tumor that ↑ in freq w/ chemo and radiotherapy
Herceptin in Biological Therapy
tx with drugs that stop cancer cells from communicating to divide.
It’s called Trastuuzumab and is used against early breast cancer. Also ↓% of cancer coming back post-op
Methotrexate Class and Use
Prototype Antimetabolite Agent
Interferes w/ cells that reproduce quickly. Counters CA, bone marrow, and skin cells.
Good against ALL CA, psoriasis, and rheumatoid arthritis
Acute Coronoary Syndrome/Acute Myocardial Infarction
Atherosclerosis of coronary arteries c/b plaque growth
Two types of plaque growth and fx
Stable - rich lipid core inflames b/c it attracts platelets/thrombus formation
Unstable - r/in unstable angina’s and MI’s
ACS/AMI Key S/S
ACS
Chest pain >20 min @ rest (sitting on chest)
More severe per episode
Radiates to LUE and jaw
AMI
Many are ASYMPTOMATIC
2 Types of MI classifications
Transmural - full thickness of vent. wall
Sub-endocardial - 1/3 vent wall.
Anticoagulant Fx
Ø clotting/thrombin formation
r/in bleeding, GI upset, etc.
Overdose counter w/ VitK or Coumadin (Warfarin)
Heparin rx (drug 2 drug) with…? (5)
Overdose counter?
Oral anti-coags, salicylates, PCN, cephalosporins, and nitroglycerin
Protamine Sulfate
Warfarin rx (drug 2 drug) with…?
Basically everything…
Warfarin (Coumadin)
Maintains state of anti-coagulation if pt is in danger of clot formation
Heparin (Generic)
Ø prothrombin to thrombin
Argatroban (Acova)
Tx thrombosis r/t Heparin induced thrombocytopenia
Bivalirudin (AngioMax)
w/ aspirin prevents ischemic events
Antiplatelets Use and adfx
↓ platelet aggregation by blocking receptor site of platelet membrane (with Anagrelide)
Ø use with recurrent ♥ issues
Bleeding
Thrombolytic Drugs Fx, route, adfx
Activates plasminogen to plasmin, which breaks fibrin threats in clots
INJ, metabolized by liver
Bleeding, HypoTN
Drug r/t PT/INR, PTT, and Platelet therapy?
PT/INR = Warfarin (Coumadin)
PTT = Heparin
Platelet - Antiplatelet Drugs
Myoglobin
Troponin I & T
Creatine Kinase and MB
Onset of Myocardial Dmg and Markers
1 hour / 4 - 8 hours
3 hours / 7 - 10 days
4 - 8 hrs/ 2 - 3 days
Preload
Afterload
Cardiac Tamponade
Degree of stretch @ end of diastole
Resistance on ventricles c/b resistance via vessels
Pressure on ♥ c/b fluid between myocardium (♥ muscle) and outer covering (pericardium)
Zones of Myocardial Dmg
Ischemic - recovers if flow is re-established (Time is Myocardium)
Injury - some can be salvaged, some die
Necrotic - dead and will never come back
Outside
V
Inside
Digoxin Positive and Negative Fx?
Contraindications? and OD counter?
+Inotropic - ↑ force of conraction
-Chronotropic - ↓ HR
Ø if HR
Thrombolytic vs. Anticoagulant
Thromos - plasminogen -> plasmin which break clots
Anticoags - interfere with clotting process
Multiple Sclerosis
Immune-mediated destruction of myelin
Stage 1 - inflammatory lesions
Stage 2 - r/in demylenation and ↓ conduction
Myasthenia Gravis
Bacteria in nerves r/in ptosis/diplopia.
↓Neurological fx apply
Myasthenia Crisis = respirations compromised
Acetylcholine Øfx
Tx for MG
Anticholinesterase
Corticosteroids
Cyclosportine
Antibiotics
Pyrido/Neostigmine for long term tx
Parkinsons, Alzheimers, and Siezures
Rigid
Forget
Involuntary
Provoked vs. Unprovoked Siezures
Provoked are caused by fever, ↓BG, CNS infx, etc.
Unprovoked cause unknown
Absence Atonic Myoclonic Tonic-Clonic Generalized Siezures
↓ consciousness
↓ muscle tone
muscle contraction/stiffening
muscle contraction + LoC
^ starts Tonic Phase - rigid/LoC then Clonic - rhythmic jerking
Siezures w/out recovery (involves both hemispheres of brain)
Complex
vs Simple Focal/Local Siezures
Syncope for 1-3 min f/b amnesia (temporal)
Conscious but exp. smell or pain
Cluster
Tension
Migraine Headaches
Episodic, 1-8 a day b/c vasorx and hypothalamus,
Pain in forhead, temporal, and eyes.
Caused by stress or oromandiublar d/fx
Pain in neck and shoulders
R/t arterial inflammatory process
Common - 85% no aura, throbbing, visual disturbance
Classic - aura -> pain with S/S similar to Common (5 - 20 minutes before pain)
Cluster
Tension
Migrane Headaches S/S
Sharp, steady pain
Dull band around head
Severe throbbing
Ergot Derivatives and Triptans
Block alpha-adrenergic/serotonin receptors and reduce headaches
Rx w/ betablockers
Binds to serotonin sites and tx acute migrane (not prevent)
Rx w/ ergots and MAOIS ↑ fx
Preventative Migrane Therapy (5)
Anti-inflammatory NSAIDS Smooth Muscle Relaxants Beta-Blockers CaChnl blockers
Tx for Alzheimers Dz (5)
Donepezil (Aricept) = prototype Galantamine (Razadyne) Rivastigmine (Exelon) Tacrine (Cognex) Memantine (Namendia) = newest
Tx Multiple Sclerosis with…?
Dantrolene
Huntington’s Dz r/in…?
Loss of nerves in brain and brain cells
Tx Parkinsons w/…? (2)
Anticholinergics and Dopaminergics
Anticholinergic Fx
Block ACh in CNS to normalize dopamine imbalance
Tx Parkinsons
Ø w/ GI/GU obs
Dopaminergic Tx (Levodopa) Fx
MAINSTAY TX Parkinsonism
Always given with Carbidopa (Sinemet) which counters levels
Rx with MAOS and VitB
Seizure Drugs (5)
Hydantoins Barbiturates Gabapentin Succinimides Benzos
Hydantoins (Dilantin and Fosphenytoin)
Tx tonic-clonic seizures
Ø use with absence seizures (will ↑% frequency)
Ø mix with NSS or give >50mg/min
Controls short term seizures
Barbituates (3)
Phenobarbital - emergency control
Primdone - partial control
Mephobaribital - absence seizures
Ø give is RR
Gabapentin Tx
Partial seizures
Ø give w/in 2 hrs of antacids
Succinimides (2)
Valporic Acid - absence seizures
Ethosuximide - DRUG OF CHOICE for absence seizures
Benzodiazepines (2)
Diazepam - prototype, relieves anxiety/spasms
Clonazepam - absence and myoclonic seizures
R/F for Seizure activity (6)
Fever Electroimbas ↓BG CNS infx/dmg Alcohol withdrawal Stroke
OD Counters for Benzos and Opiods
Benzo counter w/ Romazicon (Flumazenil)
Opiods counter w/ Naloxone (Ø PO)
