Pharmacology 1 Flashcards
1
Q
what are the methods to prevent pregnancy?
A
hormonal, mechanical or barriers, intrauterine devices (IUD), abstinence and emergency contraception.
2
Q
what are mechaical and barrier methods of contraception?
A
condom, diaphragm, cervical cap, vaginal sponge or spermicide to kill sperm or to block sperm from entering the uterus
3
Q
how should a diaphragm be used?
A
must be inserted some time before sexual intercourse and remain in the vagina for 6-8 hours after a male’s last ejaculation
on removal it should be cleaned with warm soapy water before storage
must be removed for cleaning at least once every 24 hours
should be refitted after a weight change of 4/5kg or more or after any pregnancy
4
Q
what is a cervical cap?
A
placed over the cervix opening, is used with spermicide and has a high failure rate.
it comes in one size and does not need to be fitted. it is over the counter in canada
5
Q
what is a contraceptive sponge?
A
used with permicide and has a 9-28% failure rate. it provides protection immediately after insertion and should remain inserted for 6 hours after intercourse
6
Q
Vaginal contraceptive film? what is it?
A
thin film impregnated with a spermicide and placed over the cervix 15 minutes prior to intercourse
7
Q
what is the most widely used contraceptive device?
A
IUD
8
Q
how long is the IUD approved for?
A
5-10 years use and is more than 99% effective
9
Q
IUD are contraindicated in women who have?
A
pelvic inflammatory disease or who are pregnant
10
Q
Hormone-releasing brand name?
A
levonorgestrel
11
Q
T-shped IUD brand name?
A
Mirena
12
Q
Copper-releasing T-shaped IUD brand name?
A
Nova T
13
Q
Hormonal methods of contraception?
A
oral contraceptives, hormone-impregnated vaginal inserts, hormone injections, skin patches, surgical impants and some IUDs.
14
Q
Oral contraceptives contain what hormones?
A
estrogen and progestin combinations as well as progestin-only pills
15
Q
MOA of the pill?
A
work by initiating the negative feedback inhibition of follicle-stimulating hormone and luteinizing hormone secretion and as a result, mature follicles do not develop and LH does not reach the level reqiured to initiate ovulation
16
Q
what does the depo-provera injection do?
A
prevents ovulation and thickens cervical mucus, preventing the passage of sperm.
17
Q
what is evra?
A
is a transdermal patch containing a combination of estrogen and progestin.
One patch is applied each week for 3 weeks followed by 1 patch-free week (should not exceed 7 days)
18
Q
what is the NUva-ring?
A
is a hormonal vaginal ring inserted for 3 weeks and then removed for 1 week
19
Q
what is the most common emergency contraception?
A
Plan B (levonorgestrel)
20
Q
what is the EC protocol for plan B?
A
two tablets as a single dose or one tablet followed by a second tablet 12 hours later
EC may be used at any time during the menstrual cycle. If conception has alreasy occureed, EC will not terminal pregnancy
21
Q
what is classfied as menopause?
A
termination of menstrual cycle and is usually marked by the passage pf at least 1 full year without menstruation.
22
Q
Atrophic vaginitis?
A
is the postmenopausal thinning and dryness of the vaginal epithelium related to decreased estrogen levels.
symptoms: burning and pain during intercourse
23
Q
what the treatment of atrophic vaginitis?
A
hormone replacement therapy or application of topicalestrogen restores the integrity of the vaginal epithelium and relieves symtoms
24
Q
what is the purpose of hormone replacement therapy?
A
treat symtoms of menopause such as hot flashes, vaginaldryness, mood swings, sleep disorders and decreased sexual desire
contains one or more female hormones commonly estrogen plus progestin
25
what are the treatment protocols of HRT?
vary according to whether or not the women has a uterus or has a hysterectomy
-the dosage form may cary according to the symtoms to be treated
-
26
why HRT not used much?
due to study results showing an increase of developing breast cancer, heart attacks, strocks and blood clots
27
Premenstrual syndrome (PMS) what is it?
is a condition that invloves a collection of symptoms (headache, mood changes, fatigue, weight gain, sleep changes) that regularly occur in women prior to menstruation.
28
what is the more severe form of PMS?
premenstrual dysphoric disorder (PMDD)
29
what happens to symtoms of PMDD?
disappear a few days after the onset of the menses
symptoms worsen with age but go away with the onset of menopause
30
how is PMDD treated?
antidepressants such as selective serotonin reuptake inhibitors such as fluoxetine, sertraline, paroxetine
31
Fluoxetine brand name?
Prozac
32
Sertraline brand name?
Zoloft
33
Paroxetine brand name?
Paxil
34
Dysmenorrhea what is it?
painful menstruation is the term used to describe menstrual cramps.
-most common type in adolescents and young women
35
Symptoms of dysmenorrhea? why is it caused?
last from hours to days vary in severity from cycle to cycle, are caused by an abnormally increased concentration of certain prostaglandins produced by the uterine lining. High concentration of PGE2 and PGF2 cause painful spasms by decreasing blood flow and oxygen delivery to the uterine muscle.
36
what is amenorrhea?
is the adsence of normal menstruation
37
Abnormal uterine bleeding (AUB) what is it?
a condition that causes heavy menstrual bleeding, affects up to 1/3 of all women
38
what is the treatment of AUB?
treatment with NSAIDs and hormonal manipulation using low-dose birth control pills
39
what is hypogonadism?
is a condition in which the sex glands produce little or no hormones.
40
Treatment of infertility?
administration of selective estrogen receptor modulators SERMs: (clomiphene)
menotropins (menopur),
GnRH antagonists (Ganirelix)
recombinant human FSH (follitropin alfa)
41
Selective estrogen receptor modulator MOA?
it works by effectively tricking the pituitary gland into producing FSH and LH, necessary for ovulation
42
main SERM drug used to treat infertility?
Clomiphene
it competes with estrogen for estrogen-recetor binding sites
43
Clomiphene brand name?
Clomid
44
treatment of endometrosis?
-Danazol
-Gonadotropin-releasing hormone agonists
45
what is danazol?
is an androgenic steroid that is used to treatendometriosis and fibrocystic breast disease.
it reduces breast pain, tenderness and nodules
46
Danazol brand name?
Cyclomen
47
what is gonadotropin-releasing hormone agonists?
analogues used to treat prostate cancer, hypogonadism, endometriosis, advanced breast cancer, AUB, endometrial thinning
48
Goserelin brand name?
Zoladex
49
Leuprolide brand name?
Lupron
50
what is androgen?
is the male hormone testosterone and its derivatives are colletively called androgens
they are secreted by the anterior pituitary gland and are responsible for masculinization
51
what is androgen therapy?
used as replacement therapy for testosterone deficiency such as hypogonasism, select cases of deplayed puberty and postpuberty testosterone deficiency
52
what are the forms of androgens?
patches, gels, tablets , capsules, buccal, injections, transdermal patches, pellets
the mucoadhesive form produces twice the androgen activity of oral tablets
the transdermal patch is applied daily to the scrotum or other parts of the body
the gel is appled to the shoulder, upper arm, abdomen
testosterone patches are not substitutable
53
Androgen therapy drugs?
testosterone
androderm (patch)
androgel (gel)
delatestryl (injection)
54
Testosterone brand name?
Andriol
55
what are seizures?
by a sudden excessive, disorderly discharge of cerebral neurons
may be caused by injury or illness though half of all seizures have no known cause
the onset of a seizure may be preceded by an aura
56
what is a epilepsy?
a type of seizure disorder
persons must experience two or more seizures before a diagnosis of epilepsy is made
57
what are the two causes of seizures?
internal (birth defects, infection, perinatal injury, malignant tumors, lead poisoning, head trauma
external (metabolic disturbance, hypoglycemia, electrolyte imbalance, drug and alcohol withdrawal, drugs that lower seizure threshold
58
Generalized seizures are?
spread across both of cerebral hemispheres
-grand mal
-petit mal seizures aka absence seizures
59
what is grand mal seizures?
start with stiffening of the limbs and difficutly breathing, followed by jerking movements, loss bladder control, limbs become limp ad the person may be disoriented.
60
what is petit mal seizures?
associated with chracteristics vacant or absent state.
occur more commonly in children and are barely noticeable to onlookers as no major muscle twitching is exhibited
61
what is status epilepticus?
A medical emergency and results from repeated , generalized seizures that deprive the brain of oxygen
reqiures IV anti-seizure medications
62
Focal (partial) seizures?
confined to single hemisphere and classfied as simple or complex
simple focal seizures: may cause arms, face or legs to twitch and visual, olfactory or auditory hallucinations may occur
complex focal seizures: begin with a blank state, person becomes disoriented and engages in repetitive actions during the seizure
-person has no recollection when seizure is over
63
what causes seizures?
caused by an abnormaility in nerve signlaing by neurotransmitters
**excess neuronal firing results from a combination of
- abnormally high level of excitatory neurotransmitters
- low-level inhibitory neurotransmitters
64
what is GABA?
is an inhibitory NT that plays an important role in epilepsy
65
what is an excitatory NT?
Glutamate
66
Seizures are suppressed by drugs that?
-inhibit neuronal firing by deplay inflow of sodium ions
-bind to T-type calcium channels, reducing initiaition seizure activity
-stimulate GABA receptors and inhibit the formation of action and neuronal hyperactivity
67
What drugs inhibit neuronal firing by deplaying the inflow of Na, K and Ca ions?
-Phenytoin
-Carbamazepine
-Oxocarbazepine
-Esilcarbazine
-Lamotrigine
-gabapentin
-pregablin
-levetricatam
-lacosamide
-ethosuximide
68
Things about phenytoin?
can alter rate of metabolism of other drugs
-Must periodically have blood levels checked (narrow therpaeutic index)
-Drug interactions: can occur between phenytoin and erythromycin, isoniazid and warfarin as well as OC
-important to use product from same manufactuere
69
Gabpentin and pregabalin? what are they used to treat? and how?
-act on ion channels instead
-effective in treating partial and generalized seizures
-used in management of neuropathic pain
70
what is carbamazepine used for?
generalized and complex focal seizures
71
Common adverse reactions of drugs that modulate ion channels?
Nausea and vomiting
sedation
dizziness
ataxia
72
common adverse reaction of phenytoin?
Hirsutism, gingival hyperplasia, cleft palate, decreased folic acid, calcium and vitamin B absorption
73
adverse reactions of carbamazepine?
may cause double vision
bruising
jaundice
74
can phenytoin be used in pregancy?
no is a known teratogen
75
GABA is what?
is an inhibitory neurotransmitter and its receptor regulates the movement of choride ion into the neuron
76
Drugs that potentiate GABA?
-Valproates
-Barbiturates
-Tiagabine
-Benzodiazepines
-Topiramate
-Felbamate
-Vigabatrin
77
MOA of drugs that potentiate GABA
Chloride ions are nagatively charged so their influx creates an inhibitory neuronal response to suppress seizures
78
what is phenobarbital used for?
used to treat seizures (1st)
generalized tonic-clonic and partial seizures
given to children to control febrile seizures
invloved in many interactions
Absorption is slow (widely distributed throughtout the CNS due to high lipid solubility)
79
Valproic acid and divalproex sodium?
broad spectrum drug for seizures
few indicated for absence seizures
-passed into breastmilk so not recommended while breatfeeding
-many drug interactions (especially when given with other antiseizure medications)
80
what is benzodiazepines used for?
status epilepticus, absence seizures, myoclonic seizures and partial seizures
81
MOA of valproates?
enhance the inhibitory actions of GABA
may also include actions on potassium channels that result in membrane stabilization
82
Drugs that inhibit glutamate? drug name?
Perampanel (Fycompa) : treat partial-onset seizures with ot without secondary gernalized seizures
83
Adverse reactions drugs that inhibit glutamate?
dizziness, fatigue, falls, nausea, balane disorder,ataxia, vertigo and weight gain
life-threathening psychiatric and behavioural changes
84
Risk factors of Schizophrenia & Psychoses?
-substance abuse: highter rates of suubstance abuse/dependence disorders are found in indiciduals with schizophrenia
-Cannabis use is risk factor for psychosis and apprears to be a dose-response between amount of use and risk of psychosis.
-Patients with psychotic disorders more likely to be heavy smokers and 2-3 times more likely to abuse other substances
-Family history of mental illness
85
therapeutic choices for schizophrenia?
-antipsychotics considered most effective treatment
-must be integrated with psychosocial interventions to optimize outcomes
-Both pharmacologic and psychocsocial interventions should be tailored to the individual.
86
what is the nonpharmacologic choices for first epiode/recurrent acute episode?
Appropriate treatment setting (least restrictive, ensure safety, reduce environmental stressors and stimuli)
Seeing patient frequently: promote medication, adherence, monitor response, practical advice
Acutely agitated or imminent risk of harm to self or others will reqiure hospitalization
87
Nonpharmacologic choices for stabilization/stable phases?
-focus on medication adherence, stress management, assessment of depression and suicidality
-assessment of substance use and education about early warning signs of relapse
-Conselling regarding healthy diet and exercise helpful in preventing and or managing antipsychotic side effects
-Exercise may reduce symtoms and improve corrdination/memory
88
Two major classes of antipsychotics? treatment?
-First-gen antipsychotics
-Second-gen antipsychotics
All FGA's and SGA's with exception of clozapine have similar efficacy in treating the positive (psychotic) symtoms of schizophrenia and may be considered as initial treatment options
89
what are FGA's known for?
typical or conventional antipsychotics
90
how are FGA classified?
by chemical structure or potency as determined by dopamine D2-receptor binding affinity
Differences in side effects of low and high potency agents
91
What drugs are low-potency agents of FGA?
Chlorpromazine, methotrimeprazine
92
Side effects of low-potency agents of FGA?
More sedation, cardiovascular effects, anticholinergic effects and weight gain
93
High-potency agents drugs?
Fluphenazine, haloperidol
94
what side effects do high-potency agents of FGA have?
More extrapyramindal side effects (parkinsonism, tardive movement disorders such as tardive dyskinesia), neuroleptic malignant syndeome and elevated prolactin levels.
95
SGA are also known as?
atypical antipsychotics
96
what drugs are SGA?
Aripiprazole, asenapine, brexpiprazole, clozapine, lurasidone, olanzapine, paliperidone, quetiapine, risperidone, ziprasidone
97
what may account for clinical differences in dosing reqiurements and side effects proflies among SGAs?
Duration of binding to D2 receptor and differences in binding affinity to other neurotransmitters (serotonergic, muscarinic, histaminic, alpha-adrenergic)
98
What SGA drugs have different binding affinitis compared with other SGAs?
Aripiprazole, asenapine, brexpiprazole, lurasidone, paliperidone and ziprasidone
99
types of receptors?
Dopamine, histaminic, muscarinic, noradrenergic, serotonin,
100
Side effects of histaminic?
Sadation, appetite, stimulation, weight gain
101
Muscarinic side effects?
Anticholinergic effects (dry mouth, constipation)
102
Noradrenergic side effects?
Orthostatic hypotension
103
Serotonin side effects?
increase doapminergic activity in the mesocortical pathway (improving negative symtoms of schizophrenia) and the nigrostriatal pathway
104
treatment of acute phase?
-Haloperidol IM
-Olanzapine IM appears to have efficacy similar to haloperidol and causes less EPS
-Rapid-dissolving oral formulations of olanzapine and riseperisone are as effective as haloperidol IM
-In the first episode, antipsychotic medication should be contiuned for at least 2 weeks unless there are significant tolerability issues
105
Treatment for stabilization/ stable phases?
-patients are vulnerable to relapse.
-avoid changes in antipsychotic medication unless there are intolerable side effects or persistent residual symptoms that are distressing and or disabling to the patient
-continue maintenance pharmacotherapy for at least 1-2 years, longer treatment may be reqiured. may patients will reqiure antipsychotic treatment indefinitely
-poor medication adherence is common
106
what is long-acting injectable antipsychotics treatment?
-long-acting injectable antipsychotics such as aripiprazole, paliperidone palmitate or risperidone should be offered as an option in all phases of illness, including the first episode after first establishing tolerability with oral formulations
-promoting adherence, LAIs may improve rates of remission and decrease the risk of hospitalization and relapse
107
Antipsychotic polypharmacy treatment?
-can lead to increased risk of drug-drug interactions that can be life-threatening, decreased efficacy, increased side effects and decreased adherence to treatment
-recommended that antipsychotic polypharmacy be used only in exceptional circumstances under the care of a psychiatrist
108
what drug is the only antipsychotic with proven effiacy in treatment-resistant schizophrenia?
Clozapine
