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AGACNP > Pharmacology 1 > Flashcards

Pharmacology 1 Flashcards

1
Q

Drugs known for drug-drug interactions (4)

A
  1. Macrolides (erythromycin, clarithromycin)
  2. Antifungals (ketoconazole, fluconazole)
  3. Cimetidine (Tagamet)
  4. Citalopram (Celexa)
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2
Q

Drugs affected by grapefuit juice (8)

A
  1. Statins
  2. Erythromycin
  3. CCB (nifedipine, nisolidipine)
  4. Antivirals
  5. Amiodarone
  6. Benzodiazepines (diazepam, triazolam)
  7. Carbamazepine
  8. Buspirone
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3
Q

Proton-pump inhibitors (PPIs) safety issues

A

Increased risk of fx (postmenopausal women), PNA, C diff, hypo-Mg, B12 & iron malabsorption, atorphic gastritis, kidney Dz

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4
Q

Omeprazole (Prilosec) safety issues

A

PPI: interacts w/ warfarin (Coumadin), diazepam (Valium), carbamazepine (Tegretol), phenytoin (Dilantin), ketoconazole (Nizoral)

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5
Q

Warfarin (Coumadin) safety issues

A

Interacts w/ “G” herbs (garlic, ginger, ginko, ginseng; other herbs/supplements (feverfew, green tea, fish oil); numerous drug interactions.
Discontinue 7 days prior to surgery

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6
Q

TZDs (thiazolidinediones) safety issues

A

Cause or exacerbate congestive HF in some Pts; do NOT use if NY Health Association Class III or IV HF

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7
Q

Pioglitazone (Actos) safety issues

A

TZD: Stop if causes dyspnea, wt gain, cough (HF)

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8
Q

Atypical antipsychotics safety issues:
Risperidone (Risperdal)
Olanzapine (Zyprexa)

A

High risk of wt gain (monitor wt q 3 mo.), metabolic syndrome, T2DM,
High mortality in elderly Pts

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9
Q

Atypical antipsychotics safety issues:

Quetiapine (Seroquel)

A

Monitor TSH, lipids, wt/body mass index

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10
Q

Bisphosphonates (osteoclast inhibitor) general safety issues

A

Erosive esophagitis, abdomin pain
Stop immediately when S/Sx of esophagitis or jaw pain
Take alone upon awakening w/ 8 oz water before breakfast; do not lie down for 30 min afterward; do not mix w/ other drugs; take first thing in the morning before breakfast

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11
Q

Bisphosphonates safety issues:
Alendronate (Fosamax)
Risedronate (Actonel)

A

Contraindications: Active GI Dz (GERD, PUD), CKD, esophageal stricture/varices

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12
Q

Statins safety issues

A

Do not mix w/ grapefruit juice; drug-induced hepatitis or rhabdomyolysis higher if mixed w/ azole antifungals

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13
Q

Simvastatin (Zocor) safety issues

A

High-dose (80 mg) has highest risk of rhabdomyolysis
Chinese decent: higher risk myopathy or rhabdomyolysis when taking > 40 mg/day with niacin
Increased lvl of creatine kinase

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14
Q

Clindamycin (Cleocin) safety issues

A

Higher risk of CDAD (C. diff associated diarrhea): Flagyl (PO TID x 10-14 days) + probiotics daily (BID x few wks)

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15
Q

Digoxin: Indication

A

Certain supraventricular tachyarrhythmias & HF 2/2 LV systolic dysfunction
* Not a first-line drug for controlling HR

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16
Q

Digoxin: Therapeutic range

A

0.5-2.0 ng/mL (i.e. narrow)

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17
Q

Digoxin: S/Sx of overdose

A
  • GI related (anorexia, N/V, abdomin pain)

- Arrhythmias, confusion, visual changes (yellowish green tinged-color vision, scotomas)

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18
Q

Digoxin toxicity: Lab tests

A
  • Digoxin level
  • Electrolytes (K, Mg, Ca)
  • Hyperkalemia is common in acute toxicity (Critical K vale < 2.5 or > 6.5 mEq/L)
  • Creatinine
  • Serial EKGs
19
Q

Warfarin (Coumadin): Pregnancy Cat. & class

A

Pregnancy Cat. X

Vitamin K agonist

20
Q

Warfarin (Coumadin): Indication

A

Prophylaxis & Tx thromboembolic events associated w/ A-fib or heart valve replacement (ie PE, DVT, stroke, thromboemboli)

21
Q

Warfarin (Coumadin): Duration of action

A

2-5 days (single dose)

22
Q

Warfarin (Coumadin): Target value for A-fib

A

INR 2-3 (ideal INR 2.5)

23
Q

Warfarin (Coumadin): Initial dose

A

2-5 mg PO daily

24
Q

Warfarin (Coumadin): Contraindications

A

Pregnancy, large esophageal varices, thrombocytopenia, recent eye/brain/trauma surgery, within 72 hrs of major surgery, blood dyscrasias, careful if Hx of GI bleeding

25
Q

Drug classes that increase bleeding risk

A

Coumarins: Warfarin (Coumadin)
Direct thrombin inhibitors: Dabigatran (Pradaxa), Rivaroxaban (Xarelto)
Heparin: Heparin, LMW heparin (Lovenox)
Antiplatelet: Clopidogrel (Plavix)
Salicylate: Aspirin, magnesium salicylate, bismuth subsalicylate (Pepto-Bismol)
NSAIDs: Ketorolac (Toradol), naproxen (Aleve), ibuprofen, indomethacin
Cox-2 inhibitor: Celecoxib (Celebrex)

26
Q

Warfarin (Coumadin): reversal/antidote

A

Vitamin K

27
Q

Dabigatran (Pradaxa): reversal/antidote

A

Idarucizumab (Praxbind)

28
Q

LMW heparin (Lovenox): reversal/antidote

A

Protamine sulfate

29
Q

Clopidogrel (Plavix): reversal/antidote

A

No reversal agent, but FF plasma seem effective

30
Q

ACE inhibitors: Contraindications

A

Eg. Enalapril (Vasotec), Captopril (Capoten)
Avoid mixing w/ potassium supplements
Careful w/ K-sparing diuretics
Dry, hacking cough –> switch to ARB

31
Q

ARBs (angiotensin receptor blockers): Contraindications

A

Eg. Valsartan (Diovan), Losartan (Cozaar)

Avoid mixing w/ potassium supplements. Do not combine ARBs w/ ACEIs.

32
Q

K-sparing diuretics: Contraindications

A

Higher risk of hyperkalemia if combined w/ ACEI, ARB, or potassium and w/ severe renal Dz

33
Q

Potassium-sparing diuretics: Names (4)

A

Triameterene (Dyrenium)
Amiloride (Midamor)
Spironolactone (Aldactone)
Eplerenone (Inspra)

34
Q

Beta-blockers: Names (4)

A

Propranolol (Inderal)
Atenolol (Tenormin)
Metoprolol (Lopressor)
indolol (Visken)

35
Q

Beta-blockers: Contraindication

A

Pts w/ chronic lung Dz (asthma, COPD, emphysema, chronic bronchitis)
Do not discontinue beta-blockers abruptly 2/2 severe rebound (hypertensive crisis)

36
Q

Phosphodiesterase 5 (PDE5) inhibitors: Names (3)

A

Sildenafil (Viagra)
Vardenafil (Levitra)
Tadalafil (Cialis)

37
Q

Phosphodiesterase 5 (PDE5) inhibitors: Contraindications

A
  • Do not use w/ nitrates (nitroglycerine, isosorbide dinitrate) and some alpha-blockers
  • Within 3-6 mo. of MI or stroke
38
Q

Citalopram (Celexa): Drug Cat., warning

A

SSRI, antidepressant; doses > 40mg/day can cause QT prolongation

39
Q

Consistently stable INR within a range: Action

A

Check q 2-4 weeks

40
Q

Single out-of-range INR: Action

A

If out-of-range is equal or < 0.5 below or above therapeutic INR (2-3), continue current dose and check within 1-2 wks

41
Q

INR < 5 w/ no significant bleeding risk: Action

A

Omit one dose and/or reduce maintenance dose slightly; recheck INR

42
Q

One missed warfarin dose: Action

A

Take the dose ASAP on the same day. Do not double dose the next day

43
Q

Warfarin (Coumadin): Clinical pearls

A
  • Anticoagulant effects persist for 2-5 days after discontinuation of warfarin
  • Asian Pts may require lower starting and maintenence doses

AGACNP (21 decks)

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