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AANP Study Cards > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Pharmacology is the

A

study of the interactions between the body and drugs

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2
Q

Pharmacokinetics is the

A

movement of drugs through the body (absorption, bioavailability, distribution, metabolism and excretion)

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3
Q

Pharmacodynamics is the

A

study of the physiologic and biochemical effects of drugs

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4
Q

Pharmacogenomics is the

A

study of how a person’s genes affect responses to medications

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5
Q

What drug classes are affected by kidney disease?/

A
  • NSAIDs: Reduction in blood flow will damage kidneys
  • ACEIs: Higher risk of hyperkalemia
  • Warfarin: Higher incidence of overcoagulation
  • Lithium: Increases risk of kidney injury
  • Contrast dyes: can injure kidneys
  • K+ sparring diuretics: Increased risk of hyperkalemia
  • Bowel prep (oral sodium phosphate) may result in sudden loss of kidney function
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6
Q

What drug classes are potent inhibitors of the CYP450 system

A
  • Macrolides (erythromycin, clarithromycin)
  • Antifungals (ketoconazole, fluconazole, phenytoin)
  • Cimetidine (Tagamet)
  • Citalopram (Celexa)
  • Protease inhibitors (saquinavir, indinavir, nelfinavir)
  • Grapefruit juice
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7
Q

What drugs are affected by grapefruit juice

A
  • statins
  • erythromycin
  • CCB
  • Antivirals
  • Amiodarone
  • Benzodiaepines
  • Cisapride
  • Carbamazepine
  • buspirone
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8
Q

What drugs have a narrow therapeutic index and require monitoring of levels

A
  • warfarin: monitor INR
  • digoxin: monitor dig levels, EKG, lytes
  • Theophylline: Monitor blood levels
  • Carbamazepine (tegretol) and phenytoin (dilantin): Monitor blood levels
  • Levothyroxine: Monitor TSH
  • Lithium: Monitor blood levels and TSH
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9
Q

What is a safety consideration with H2 antagonists

A

-mental status changes with kidney disease avoid if creatinine clearance is <50mL/min

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10
Q

What is a safety issue with proton pump inhibitors

A

increased risk of

  • fractures
  • pneumonia
  • c diff
  • hypomagnesium
  • B12
  • iron malabsorption
  • atrophic gastritis
  • kidney disease
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11
Q

What herbs does warfarin interact with

A

G herbs

  • garlic
  • ginger
  • gingko
  • ginseng

also feverfew, green tea, fish oil

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12
Q

What is the black box warning for Pioglitazone (Actos)

A

Can exacerbate CHF so do not use if NYHA Class III or IV

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13
Q

Aside from HF what other contraindications do you need to consider with Pioglitazone

A
  • hx of MI
  • hx of stroke
  • hx of bladder CA
  • T1DM
  • Eye or liver problems
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14
Q

What are examples of atypical antipsychotics

A
  • Risperidone (Risperdal)
  • Olanzapine (Zyprexa)
  • Quetiapine (Seroquel)
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15
Q

What are AE and drug safety considerations for atypical antipsychotics

A
  • weight gain
  • metabolic syndrome
  • T2DM
  • monitor weight q3 months
  • higher mortality on elderly patients
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16
Q

What labs should you consider in patients taking atypical antipsychotics

A
  • TSH
  • lipids
  • blood glucose
  • A1C
  • Weight
  • BMI
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17
Q

What is a consideration with bisphosphonates

A
  • erosive esophagitis (chest pain with eating, odonophagia, dysphagia; take with 8oz glass of water before breakfast and do not lie down for 30 minutes afterwards
  • CI: Active GI disease, esophageal strictures/varices
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18
Q

What are safety concerns of stains

A

-don’t mix with grapefruit juice will result in drug induced hepatitis, or rhabdomyolysis

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19
Q

What statin has the highest risk for rhabdo

A

-high dose zocor

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20
Q

What medication increases risk for c diff diarrhea

A

clindamycin

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21
Q

What is an AE with inhaled corticosteroids

A

-adrenal insufficiency (check if sx like hypoglycemia, hypotension, altered mental status, weakness)

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22
Q

What is an AE of systemic glucocorticoids

A
  • cataracts
  • osteoporosis
  • skin changes
  • emotional lability
  • weight gain
  • high BP
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23
Q

What medications should be avoid in older adults according to the beers criteria

A 
Anti-psychotics
Rivaroxaban and dabigatra
Tramadol
Antihistamines
Anticholinergics
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24
Q

What are life threatening effects of digoxin

A
  • severe bradycardia
  • heart block
  • ventricular tachycardia
  • ventricular fibrillation
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25
Q

What is a normal potassium level

A

3.5-5

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26
Q

In valvular disease or prosthetic heart valves the only anticoagulant you can use is

A

aWarfarin

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27
Q

In warfarin use the INR will increase __ to ___ days after first dose but full anticoagulation effect takes __ to ___ days

A

2-3

5-7

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28
Q

If a patient has a stable INR and has a single out of range INR 0.5 or less below or above therapeutic, advise

A

to continue current dose and recheck in 1-2 weeks

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29
Q

If INR is <5 with no signifcant bleeding you should

A

-omit 1 dose and or reduce the maintenance dose slightly

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30
Q

Beta blockers are contraindicated in

A

chronic lung disease (COPD, asthma)

-Do not discontinue because of severe rebound

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31
Q

_____ is the SSRI most likely to prolong QT interval

A

Celexa

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32
Q

What are adverse effects of thiazide diuretics

A
  • Hyperglycemia
  • Hyperuricemia
  • Hyperlipidemia
  • Hypokalemia
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33
Q

AE of spironolactone include

A
  • gynecomastia

- hyperkalemia

34
Q

People with both hypertension and osteoporosis receive extra benefit from this class of medication

A

Thiazides

35
Q

Patients with sulfa allergies should avoid what diuretics

A

thiazide and loop

36
Q

Adverse effects of ACEi and ARBS

A
  • Hypotension
  • Hyperkalemia
  • Angioedema
  • AKI

in ACEi only ACEi cough

37
Q

What are adverse effects of CCBs

A
  • hypotension
  • bradycardia
  • heartblock
  • headache
  • Reflex tachycardia
38
Q

What medication is 1st line for raynauds

A

CCBs

39
Q

What are adverse effects of beta blockers

A
  • bronchospams
  • bradycardia
  • depression
  • fatigue
  • erectile dysfunction
  • blunts the hypoglycemic response
40
Q

What are adverse effects of alpha blockers

A
  • Orthostatic hypotension
  • dizziness, syncope
  • priapism
41
Q

Tetracycline antibiotics are affective again gram ____ as well as

A

positive and negative and atypical bacteria/pathogens

42
Q

What are examples of Tetracyclines

A
  • Doxycycline
  • Minocycline
  • Tetracycline
43
Q

What are the adverse effects of tetracyclines

A
  • CI: in pregnancy or lactation, risk of neural tube defects, cleft palate, skeletal defects
  • teeth discoloration (can use after 8 years old)
44
Q

Doxycycline is indicated in the treatement of

A
  • STIs
  • Resp tract infect
  • anthrax
  • RMSF
  • ophthalmic infections
  • skin
  • malaria prophylaxis
  • specific bacterial infection
45
Q

Minocycline is indicated in

A
  • Acne
  • STIs
  • infective endocarditis
46
Q

What are the adverse effects of tetracyclines

A
  • photosensitivity reactions
  • esophageal irritation
  • Pseudotumor cerebri
47
Q

Macrolides cover what pathogens

A

gram positive

atypical bacteria

48
Q

What are examples of macrolides and are the CYP34A inhibitors?

A
  • erythromycin
  • Clarithromycin
  • Azithromycin

*Only erythromycin and Clarithromycin are CYP34A inhibitors

49
Q

What are adverse effects of macrolides

A
  • GI distress
  • Hepatotoxicity
  • QT prolongation
  • May exacerbate myasthemia Gravis
50
Q

Rocephin (Ceftriaxone) 250mg IM is 1st line for

A

gonorrheal infections

51
Q

First generation cephalosporins work agains

A

-gram +

52
Q

What are adverse effects of cephalosporins

A
  • hypersensitivity reactions
  • C Diff
  • Leukopenia
  • Thrombocytopenia
53
Q

3rd generation cephalosporins are indicated in

A
  • meningitis
  • genitourinary tract infections
  • CAP
  • Bone and joint infections
  • skin and soft tissue infections
54
Q

Example of a 1st generation cephalosporin

A

Keflex or Cephalexin

55
Q

What are adverse effects of penicillins

A
  • diarrhea
  • C diff
  • vaginitis
  • Steven Johnson syndrome
56
Q

You should avoid ____ in patients with concurrent mono because

A

amoxicillin; produces a morbilliform rash

macular or maculopapular lesion

57
Q

Gram-Positive Bugs

A
  • Staph
  • Strep
  • Enterococcus

Plus listeria, diptheria, clostridium, bacillus anthracis. p. acne,

Everything else is gram negative

58
Q

What medications are beta-lactams

A
  • penicillins

- cephalosporins

59
Q

Never give a cephalosporin if the pt had the following reactions to penicillins

A
  • PCN reaction was anaphylaxis

- if PCN reaction was Hives

60
Q

You can give a cephalosporin if the patient had penicillin and had a

A

morbiliform rash

61
Q

Morbiliform rashes occur with

A
  • Sulfa drugs and HIV

- Pencillins and Mono

62
Q

Penicillins are used to treat

A
  • Gram + (not staph)
  • Strep A, B, C, G
  • Enterococcus
  • Strep pneuo
  • SRSP
  • Botulism (wound)
63
Q

Amoxicllin/Clavulanic acid is used to treat

A
  • gram positive
  • Gram negatives
  • Beta lactamase (not MRSA)
  • strep
  • enterococcus
  • strep pneumo
  • DRSP
  • H influenza
  • M catarrhalis
  • E coli
  • Neisseria
  • Diptheria
64
Q

You assume a bug produces beta-lactamase if the patient has had

A

antibiotics in last 3 months

65
Q

Sulfonamides are used for

A

Gram negatives and MRSA

*now have high resistance for E. Coli

66
Q

Tetracyclines are used for

A

Gram negatives, atypicals, MRSA

  • Minocycline is a good choice for MSSA and CA-MRSA
  • Doxycycline good for atypical pathogens and lower resp tract pathogens
67
Q

1st generation cephalosporins are used to treat

A

Staph: MSSA

Strep

68
Q

2nd generation cephalosporins are used to treat

A
  • gram + (staph, strep)
  • gram negatives

H.Flu
E.coli
Proteus mirabillis

*Not beta lactamase

69
Q

3rd generation cephalosporin are used to treat

A

Strep groups, gram negatives, Beta-lactamase, H. flu, M. cat, E. coli, Klebsiella, shigella

70
Q

Extended spectrum 3rd generation are used to treat

A

-gram +, gram -, beta lactamase

71
Q

What do macrolide treat

A

-atypical pathogens

72
Q

Ciprofloxacin is used to kill

A

Gram negatives and atypical pathogen (3rd choice)

73
Q

Respiratory quinolones is used to treat

A

-gram positive, negative (above the belt), atypical pathogens, DRSP, aerobes, anaerobes

74
Q

Nitrofurantoin treats

A

urinary pathogens

75
Q

Flagyl is used to treat

A
  • anaerobes

- clostridium

76
Q

Clindamycin is used to treat

A

-gram +, aerobes, anaerobes

77
Q

Vancomycin is used to treat

A

-gram +, anaerobes

78
Q

Fluoroquinolones are effective agains

A

Gram negative and atypical bacteria

4th gen (levo, moxi) have great gram + coverage

79
Q

What is the black box warning for quinolones

A

Achilles tendon ruputre

80
Q

What are CI of quinolones

A
  • Children (<18)
  • Myasthenia gravis
  • Pregnancy
  • Breastfeeding
  • Hx of CVD, aneurysms and hypertension
81
Q

What are adverse effects of quinolones

A
  • hypoglycemia
  • CNS effects
  • QT prolongation
  • Peripheral neuropathy
  • Phototoxicity
  • Double vision
  • Tendinopathy
  • Hepatotoxicity

AANP Study Cards (20 decks)

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