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Pharma exam 2 Flashcards

1
Q
  1. Describe the “3 P’s” of diabetes
A
  • polydipsia: increase in thirst
  • polyuria: frequent urination
    polyphagia: rise in appetite
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2
Q

Differentiate between Type 1,Type 2 and gestational diabetes mellitus.

A
  1. Type 1: Body destroys cells in the pancreas that makes insulin. (strict diet, Insulin injections, exercise, monitors glucose)
  2. Type 2: Body is resistant to insulin produced. (obesity, older adults, sedentary, genetics)
  3. Gestational: During pregnancies (heavy babies, placenta produce hormone that blocks insulin.
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3
Q

List the long-term complications associated with poorly controlled diabetes

A
  1. cardiovascular disease
  2. Retinopathy
  3. nephropathy
  4. amputation
  5. Gastroparesis
  6. erectile dysfunction
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4
Q

Recognize common signs/symptoms of hypoglycemia.

A
  1. Tachycardia
  2. Palpitation
  3. Sweating
  4. Anxiety
  5. Shakiness
  6. Nervousness
  7. Headaches
  8. irritability
  9. confusion
  10. weakness
  11. fatigue
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5
Q

Discuss the “15-15 Rule”

A
  1. 15 grams of fast acting carbs (glucose tablets, juice, honey)
  2. wait 15 mins to check glucose again
  3. recheck, if glucose is still low and repeat steps
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6
Q

Know the blood glucose goals for patients with diabetes

A

Before meal: 70-130 mg/dl

after meal: <180 mg/dl (after 2 hours)

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7
Q

Describe the different types of blood glucose tests

A
  1. Fasting plasma glucose test: measure glucose concentration 8 hours of fasting
  2. Casual plasma glucose test: measures glucose anytime
  3. Oral glucose tolerance test: measures glucose before and after given a known amount of glucose
  4. Hgb Alc test: average glucose over 3 months
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8
Q

List which medications can be used in Type 1 vs Type 2 diabetes mellitus.

A

type 1: insulin and Amylin mimetics for both type 1 and 2

type 2: Metformin (Glucophage)
Glipizide (Glipizide)
Repaglinide (Prandin)
Pioglitazone (Actos)
Acarbose (Precose)
Canagliflozin (Invokana)
Sitagliptin (Januvia)
Exenatide (Byetta)
insulin
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9
Q

What is contraindicated in a persons with renal failure

A

metformin

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10
Q

Categorize insulins as to basal vs bolus (meal-time) insulin.

A

Basal insulin: controls glucose overnight and between meals 50% of insulin needed

Bolus insulin: meal time insulin (bowl-us) 10-20% of total insulin needed

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11
Q

Describe the pathophysiology of depression

A

it is still unknown and thought to be very complex, current theories all include monoamines norepinephrine, dopamine, and or/ serotonin.

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12
Q

Discuss why the TCA side effects differ from the SSRIs & why.

A

TCA are not selective compared to SSRI which are more selective, which makes them have less side effects

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13
Q

Discuss serotonin syndrome, its early warning signs, and drug causes.

A

too much serotonin, hypotension or hypertension, agitation, muscle tightness, and twitching.

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14
Q

Describe the food interactions associated with the MAO-Inhibitors.

A

Hypertensive crisis from Tyramine containing foods: cheese, liver, aged or smoked meats, soy sauce, figs, bananas, some imported wines and beers.

hypertensive crisis from foods containing vasopressors: chocolates, ginseng, caffeine

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15
Q

Describe the general onset of action for the antidepressants.

A

slow and takes 4-5 weeks for full effect

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16
Q

List the classes of antidepressants that are drugs of choice to treat depression.

A

SSRI, SNRI, bupropion, and mirtazapine

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17
Q

Discuss general patient education regarding insomnia & good sleep hygiene.

A
  1. establish a routine sleep schedule
  2. avoid day time. naps
  3. avoid CNS stimulants, heavy meals, alcohol, laxatives, and diuretics near bedtime.
  4. increase day time physical activity and sunlight
  5. make bedroom comfortable, quiet, and dark
  6. reserved bed room for sleep
  7. wind down before bedtime
  8. get up after 20 mins when not being able to sleep
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18
Q

List the antidote for benzodiazepine overdose.

A

Flumazenil (Romazicon)

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19
Q

Discuss general treatment of anxiety; list the medications that can be used and distinguish
between those used as preventative vs. for acute episodes (fast acting).

A
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20
Q

What is the most prescribe Hypnotics

A

zolpidem (Ambien)

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21
Q

Describe the pathophysiology of schizophrenia (i.e. the neurotransmitter theory of its cause).

A

involves excessive dopamine and possibly serotonin in the brain

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22
Q

Describe the positive, negative, and cognitive symptoms of schizophrenia

A

(+): hallucination (auditory&raquo_space; visual), delusion, agitation, tension, paranoia, hostility, excitement.

(-): lack of motivation, uncooperativeness, blunted affect, poor-self cared, social withdrawal, little speech, poor abstract thinking

cognitive: impaired attention, impaired short term memory, impaired executive function, impaired verbal fluency.

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23
Q

Describe the side effect term “extrapyramidal side effects” and the different types

A

movement disorder due to blockade of dopamine, D2-receptors, acute dystonia, Parkinsonism-like movement disorder, akathisia, tardive dyskinesia

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24
Q

Describe the main differences between the first-generation antipsychotics and the second-
generation antipsychotics

A

1st: are d2 antagonist that targets d2 receptors in the limbic system, also blocks dopamine receptors in nigrostriatal pathway
2nd: higher affinity for serotonin receptors and lower affinity for d2 receptors.

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25
Q

Discuss general patient education regarding schizophrenia & the antipsychotics.

A

discuss importance of compliance with patients and family members. discuss management of orthostatic hypotension, anticholinergic side effects, sedation

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26
Q

Discuss the monitoring requirements for a patient on clozapine.

A

1-2% to cause life threatening adverse effects of agranulocytosis. weekly monitors CBC is required. WBC falls too much the drug should be stopped. warn patients of infections like fever, sore throat, and fatigue.

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27
Q

Describe the pathophysiology of Parkinson’s disease (i.e. the neurotransmitter theory of its
cause).

A

it is a progressive neurological disorder of muscle movement

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28
Q

List the cardinal symptoms of Parkinson’s disease

A

Tremors, muscle rigidity, bradykinesia, and postural instability

29
Q

List the general side effects of medications used to treat Parkinson’s disease

A

Peripheral dopaminergic
AE: nausea, vomiting, constipation, orthostatic hypotension, dizziness

Central dopaminergic
AE: psychiatric disturbances (hallucination, and delusion) insomnia

30
Q

What is the gold standard for treatment for Parkinson’s Disease

A

Levodopa and carbidopa

31
Q

What can dopamine agonist cause?

A

compulsive behaviors

32
Q

Describe why some anti-Parkinson’s agents may cause psychiatric disturbances.

A

by blocking dopamine receptors

33
Q

Describe why dopamine blockers can worsen symptoms of Parkinson’s.

A

correlated to a decrease of inhibitory dopaminergic neurons in the substantia nigra. imbalance of acetylcholine imbalance is responsible for the symptoms of Parkinson’s

34
Q

What are the side effects for Phenytoin

A

Gingival Hyperplasia

35
Q

What are the side effects for Carbamazepine

A

Bone marrow suppression

36
Q

What are the side effects for Valproic Acids

A

Highly teratogenic (Preg catego X)

37
Q

What are the side effects for Lamotrigine

A

Life threatening rashes

38
Q

List the anti-seizure medications used to treat status epilepticus.

A

Diazepam, lorazepam, phenytoin

39
Q

Know that the vast majority of anti-seizure medications have

A

p450 drug interaction, narrow therapeutic windows, side effects even at therapeutic dosage.

40
Q

AED are…

A

Teratogenic and casue fetal harm

41
Q

Describe how these drugs are used differently in treating asthma vs COPD.

A

COPD: need bronchodilators

Asthma: primary is anti-flammatories and bronchodilator prn

42
Q

List the key class of drugs in controlling asthma inflammation / preventing attacks.

A

Corticosteroid inhalers, then long acting bronchodilators

43
Q

Distinguish between the drugs used to quickly relieve acute asthma attacks (rescue inhalers) and
those used for prophylaxis.

A

Acute: fast acting b2 agonist
Alubuterol (muscarinic antagonists), inhaled steroids (emergency), systemic steroids

Prophylaxis: long acting b2 agonist
Leukotriene modifiers, masst cell stablizers, inhaled steroids, systemic steroids

44
Q

Distinguish between the bronchodilators and the anti-inflammatory drugs

A

anti-inflammatory: suppresses inflammation by suppressing pro-inflammatory cytokines and reducing inflammatory cell activation
Corticosteroids/ Mast Cell Stabilizer/ Leukotriene Modifiers

Bronchodilator: : activates B2 receptors causing smooth muscle relaxation= bronchodilation
Muscarinic antagonist/ B2 agonists/ Theophylline

45
Q

. Distinguish between the therapeutic uses of the fast acting & slow acting β2 agonist.

A

Fast; acute severe asthma/ exercise/ COPD/ acute COPD exacerbations/ carry for chronic patients
Long: Chronic asthma/ prior to exercise (NOT RESCUE)/ COPD

46
Q

. List the signs & symptoms of theophylline toxicity

A

Diarrhea, insomnia, anxiety, shaking/twitching, tachycardia, ventricular fibrillation, hypoglycemia, seizure

47
Q

What has a narrow therapeutic window and multiple drug interaction in the respiratory system

A

theophylline

48
Q

Discuss general patient education regarding proper inhaler technique

A

delivers a measure amount of meds
shake before use
breath slow and deep
spacers: helps increase delivery into lungs
nebulizer: makes it a fine mist for inhalation

hold breath for 10 sec wait 60 sec between puffs

49
Q
  1. Discuss potential risks vs. benefits of giving a medication OTC status.
A 
Increased access to effective drugs
Decreased visits to Dr. (less cost)
Improved education of consumers.
Increased autonomy of patients
Decreased costs to 3rd-party payers.
50
Q

Classify the OTC agents as expectorants

A

Guaifenesin

51
Q

Classify the OTC agents as antitussives

A

Codiene

Dextromethorphan

52
Q

Classify the OTC agents as decongestants

A

Pseudoephedrine (Sudafed)
Phenylepherine (Sudafed PE)

Oxymetazoline (Long acting)
Phenylephrine (Short acting)

53
Q

Classify the OTC agents as antihistamines

A

1st gen sedating: *Diphenhydramine (Benadryl)

2nd gen non sedating:

  • Fexofenadine (Allegra)
  • Loratadine (Claritin)
  • Cetirizine (Zyrtec)
54
Q

Classify the OTC agents as antidiarrheal

A

opioid:
Loperamide (Imodium)
Diphenoxylate/atropine(Lomotil)

non opioid:
Metamucil, Citrucel, Fibercon

55
Q

Classify the OTC agents as bulk-forming laxatives

A

prevent constipation
Psyllium (Metamucil)
Methylcellulose (Citrucel)
Calcium polycarbophil ( FiberCon)

56
Q

Classify the OTC agents as stool softeners

A

prevent constipation

*Docusate

57
Q

Classify the OTC agents as stimulant laxatives

A

prevent constipation

*Senna (Senokot); senna/docusate (Senokot-S), Bisacodyl (Dulcolax)

58
Q

Classify the OTC agents as osmotic laxatives.

A

*Magnesium Hydroxide (Phillips Milk Of Magnesia), Magnesium Citrate, Magnesium Oxide Magnesium Sulfate (Epsom Salts), Sodium Phosphate

59
Q

Discuss the role / therapeutic uses of an antitussive vs. an expectorant, a decongestant, or an
antihistamine.

A

decongestant reduces (stuffy)swelling, pressure, and congestion/ vasoconstrictor; where as a antihistamine reduces a runny nose and block H1 receptors

60
Q
  1. Discuss side effects and patient instructions for decongestants (intranasal & systemic).
A

Intranasal: Do not use for more than 3-5 days or you can get rebound congestion

Systemic: you can only purchase sudafed behind the ocunter because it is used for meth also *use caution in diabetes, HTN, heart disease, and hyperthyroidism

61
Q
  1. Discuss side effects for the antihistamines.
A

Sedation, dizziness, confusion, uncoordination, loss of balance, Anticholinergic side effects, Paradoxical excitation

62
Q

what is a very sedating antihistamine.

A

diphenhydramine

63
Q
  1. List the products preferred for treatment vs. prevention of constipation.
A

Prevent: Docusate, psyllium

Treatment: senna, bisacodyl, polyethylene glycol,

64
Q
  1. List the 2 common causes of peptic ulcer disease
A

H. plyori and NSAID use

65
Q
  1. Discuss the treatment of peptic ulcer disease.
A

Eradicating H. Pyrlori, reducing secretion of gastric acid, providing agents that protect the gastric mucosa

66
Q

4.What prevent NSAID induced peptic ulcers

A

Misoprostil
Mechanism of Action: replace prostaglandins that are diminished during NSAID therapy.
Therapeutic Indications: prevent NSAID induced gastric ulcers.
Adverse Effects: nausea & diarrhea. Pregnancy category X

67
Q
  1. List the class of agents that will provide the fastest relief of heartburn.
A

Antacids

68
Q
  1. List the neurotransmitters involved in vomiting.
A

acetylcholine, serotonin, dopamine, & histamine

69
Q
  1. Recognize which medications can be used for motion sickness.
A

Scopolamine, Meclizine (Antivert) *Dimenhydrinate (Dramamine)

Pharma (2 decks)

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