Pharmacology Flashcards
1
Q
List the Histamine 2 Blockers
A
1) Cimetidine
2) Ranitidine
3) Famotidine
4) Nizatidine
2
Q
Mechanism of H2 Blockers
A
Reversible block of histamine H2-reeptors –> Decreased H+ secretion via parietal cells
3
Q
Indications of H2 Blockers
A
1) Peptic Ulcer
2) Gastritis
3) Mild Esophageal Reflex
4
Q
H2 Blocker Relative Contraindication
A
Pregnancy
5
Q
Cimetidine is a ___ inhibitor and has ___ effects
A
P-450
Antiandrogenic Effects
6
Q
List the Antiandrogenic Effects of Cimetidine
A
1) Gynecomastia in Men
2) Galactorrhea in Women
7
Q
Ranitidine and Cimetidine have effects on kidneys by decreasing the secretion of _____,
A
Creatinine
8
Q
List the PPIs
A
Lansoprazole Dexlansoprazole Omeprazole Esomeprazole Pantoprazole Rabeprazole
9
Q
Mechanism of PPIs
A
Covalently binds sulfhydryl groups of H+/K+ ATPase of parietal cells
10
Q
Indications of PPIs
A
1) Peptic Ulcer
2) Gastritis
3) Zollinger-Ellison Syndrome
4) Component of H. Pylori Therapy
5) Stress Ulcer Prophylaxis
11
Q
Relative contraindication of PPI
A
Pregnancy
12
Q
Adverse Effects of PPI’s
A
1) Increased C. Difficle infection risk
2) Pneumonia
3) AKI
4) Vitamin B12 Malabsorption
5) Decreased Ca2+ and Mg2+ Absorption (Osteoporosis)
13
Q
Omeprazole is a ____ inhibitor and has many drug interactions
A
CYP450
14
Q
Sucralfate Indications
A
1) Increase Ulcer Healing
2) Duodenal Ulcer
15
Q
Contraindications of Sucralfate
A
1) Severe Renal Failure (due to aluminum) - pts should also avoid antacids
16
Q
Mechanism of Sucralfate
A
1) Provides physical protection
2) Allows HCO3- secretion to reestablish pH gradient in mucous layer
17
Q
Sucralfate should not be given with ___ and ___ because it requires an acidic enviroment.
A
1) PPI
2) H2 Blockers
18
Q
Adverse Effects of Sucralfate
A
1) Constipation (Aluminum Hydroxide)
19
Q
Since sucralfate has many drug interactions you’ll want to take this medication as well as Bismuth ___ after other medication.
A
2 hours
20
Q
Bismuth (Subsalicylate) Indications
A
1) Travelers Diarrhea
2) Combination Therapy for H. Pylori Gastritis
21
Q
Relative Contraindications of Bismuth
A
1) Antiplatelet and Anticoagulants
2) Severe Renal Failure
22
Q
Absolute Contraindications of Bismuth
A
1) GI bleeding
2) Salicylate Hypersensitivity
23
Q
Bismuth Mechanism
A
1) Prevent Microbial attachment to mucosa
2) Inactivation of Enterotoxins
3) Disruption of bacterial cell wall
24
Q
Adverse Effects of Bismuth
A
1) Constipation
2) Black/Dark (regularly-formed) stools
25
Misoprostol (PGE analog) Mechanism
1) Increase Production and Secretion of Gastric Mucous Barrier
2) Decrease Acid Production (Parietal Cell)
26
Indications of Misoprostol
Prevention of NSAID-induced peptic ulcers
27
Off-label usage of Misoprostol
1) Cervical Ripening
2) Post-partum Hemorrhaging
3) Pregnancy Termination
28
Contraindications of Misoprostol
1) Pregnancy
| 2) IBD (AVOID)
29
List the Serotonin (5-HT3) Receptor Antagonists
1) Dolasetron
2) Granisetron
3) Ondansetron
4) Palonosetron
30
Mechanism of action of 5-HT3 receptor antagonists
Blocks 5-HT3 Receptors at vagal nerve terminals and to CTZ
31
Ondansetron is most commonly used for ____
Mild N/V
32
Indications for 5-HT3 Blockers
1) CINV
2) RINV
3) PONV
4) NVP
5) Mild N/V
33
____ and ____ are 5-HT3 Blockers that are used for delayed CINV as a single dose
1) Palonosetron
| 2) Sustained-Release Formulation of Granisetron
34
Adverse Effects of 5-HT3 Blockers
1) Serotonin Syndrome
| 2) Dose-dependent QT Prolongation (Torsade's)
35
5-HT3 Blockers Drug interaction
Antiarrhythmics/QT-prolonging agents
36
Which 5-HT3 blocker has the highest risk of death
Dolasetron
37
List the Neurokinin (NKI) Receptor Antagonists
1) Aprepitant
2) Fosaprepitant
3) Netupitant
4) Fosnetupitant
5) Rolapitant
38
MOA of Neurokinin (NK1) Receptor Antagonists
Blockade of NK1 (Substances P) receptors in CTZ/VC
39
Indications of NK1 receptors Blockers
CINV (most effective when used in combination)
40
Which of the NK1 Blockers have the longest half lives
1) Netupitant
| 2) Rolapitant
41
List the Histamine (H1) Receptor Antagonists
1) Diphenhydramine
2) Dimenhydrinate
3) Hydroxyzine
4) Meclizine
5) Cyclizine
6) Doxylamine
42
MOA of Histamine receptor antagonists
Block H1 receptors in VC and Vestibular System
43
Indications of H1 Blockers
1) PONV
2) NVP ( Doxylamine/B6)
3) Motion Sickness/Vertigo (Meclizine and Cyclizine)
4) CINV (Add on therapy)
5) RINV (Add on therapy)
6) Mild N/V
44
Adverse Effects of H1 Blockers
Anticholinergics Effects
- Drowsiness (CNS Depression)
- Dry Mouth
- Constipation
- Urinary Retention
- Blurred Vision
- Decreased BP
45
What is the initial therapy for NVP?
Doxylamine w/ Pyridoxine
46
List the Dopamine D2 Receptor Antagonists
1) Prochlorperazine
2) Olanzapine
3) Metoclopramide
4) Amisulpride
47
Primary MOA of D2 Receptor Blockers
1) D2 receptor blockade in CTZ
48
Metoclopramide is a ___ receptor blocker. What additional MOA does it have?
1) Stimulates ACh actions in GI
- Enhances GI motility (Dysmotility use)
- Increases Lower Esophageal Sphincter Tone
49
Indication for Amisulpride
PONV (IV FORM)
50
List the indications for D2 Receptor Blockers
1) PONV (Amisulpride)
2) NVP
3) Gastroparesis/Dysmotility (Metoclopramide)
4) CINV and RINV
51
General adverse effects of D2 Blockers
1) Drowsiness (All agents)
| 2) Hypotension (primarily from IV route)
52
Adverse Effects of Prochlorperazine
1) Drowsiness
2) Constipation
3) Urinary Retention
4) Blurred Vision
53
Amisulpride Adverse Effects
1) Hypokalemia
2) Hyperprolactinemia
3) Chills
54
List the Muscarinic Receptor Antagonists
Scopolamine
55
MOA of Scopolamine
Blocks ACh-stimulated muscarinic receptors from vestibular nuclei and reticular formation to VC
56
Indication of Scopolamine
1) Motion Sickness
| 2) End-of-life care for excessive secretions
57
Adverse Effects of Scopolamine
1) Drowsiness
2) Dry Mouth
3) Constipation
4) Urinary Retention
5) Blurred Vision
58
Scopolamine can be worn as a transdermal scope patch that lasts ____
72 hours
59
List the Cannabinoid Receptor Agonists
1) Dronabinol
| 2) Nabilone
60
MOA of cannabinoid Receptor Agonists
Stimulates CB1 (central) and CB2 (peripheral) cannabinoid receptors in VC/CTZ
- Decreases excitability of neurons
- Minimizes serotonin release from vagal afferent terminals
61
Indications of Cannabinoid Receptor Agonists
1) CINV (reserved for treatment-resistant scenarios) can be used as an add on
2) Appetite Stimulation
62
Describe H. Pylori Treatment
1) Triple therapy (14 days) - all agents 2x day
* ** Only for low Clarithromycin resistance areas and No prior exposure to Clarithromycin
- PPI
- Clarithromycin
- Amoxicillin or Metronidazole
63
Describe Quadruple Therapy of H. Pylori
1) PPI twice/day all other agents four times/day
- PPI
- Metronidazole
- Amoxicillin (Tetracycline; esp for PCN allergy)
- Bismuth Subsalicylate
64
Describe the substitutions for Quadruple Therapy of H. Pylori
1) Clarithromycin for Bismuth
| 2) Levofloxacin for failed eradication
65
Treatment for Clostridium Difficle
1) ORAL Vancomycin (Fidaxomicin = alternative)
| 2) I.V. Metronidazole (for severe disease + Oral Vancomycin)
66
Campylobacter Jejuni Treatment
Azithromycin (Ciprofloxacin = alternative)
67
Salmonella Spp. Treatment
Ciprofloxacin/Levofloxacin (Azithromycin (alternative)
68
Shigella Spp. Treatment
Ciprofloxacin/Levofloxacin (Azithromycin = Alternative)
69
MOA of Benzimidazoles
1) Inhibition of Microtubule polymerization via b-tubulin binding
2) Inhibition of mitochondrial fumarate reductase
70
List the GI Anthelmintic
1) Benzimidazoles
- Albendazole
- Mebendazole
71
List the GI Anti-Protozoal Agents
1) Paromomycin
2) Metronidazole
3) Tinidazole
72
MOA of Paromomycin
30S subunit inhibitor
73
Metronidazole and Tinidazole MOA
1) Disrupts Electron Transport Chain proteins --> Nitrogen free radicals
74
Treatment of Amebiasis: Entamoeba Histolytica
1) Metronidazole followed by paromomycin
75
Treatment for Hookworm: Ancylostoma Spp. and Necator Americanus
Albendazole (Mebendazole)
76
Roundworm Treatment: Ascaris Lumbricoides
Albendazole (Mebendazole)
77
Giardiasis Treatment: Giardia Spp.
Metronidazole (Tinidazole)
78
Tapeworm - Adult Forms: Taenia Spp. (Including T. solium, except cysticercosis)
Praziquantel
79
Tapeworm - Larval forms: Echinococcus Spp.
Albendazole + Praziquantel
80
Tapeworm - Larval Forms Taenia Solium (Cysticercosis)
Albendazole
81
Pinworm Treatment: Enterobius Vermicularis
Mebendazole (Albendazole)
82
Schistomiasis Treatment: Schictosoma Spp.
Praziquantel (+ steroids for neurological disease)
83
Whipworm Treatment: Trichuris Trichiura
Mebendazole (Albendazole)
84
Trichinellosis Treatment: Trichinella Spp.
Albendazole (Mebendazole) (+steroids for severe disease)
85
Cryptosporidium Spp. Treatment
Nitazoxanide
86
Ulcerative Colitis (U.C.) Treatment Classes
1) 5-ASA
2) Janus Kinase Inhibitors
3) IL-12/23 Inhibitors
4) TNF-a Inhibitors
5) a-4 Integrin Inhibitors
87
List the 5-ASA's
1) Sulfasalazine
2) Mesalamine
3) Olsalazine
4) Balsalazide
88
List the Janus Kinase (JAK) Inhibitors
Tofacitinib
89
List the IL-12/23 inhibitors
Ustekinumab
90
List the U.C. TNF-a inhibitors
1) Adalimumab
2) Golimumab
3) Infliximab
91
List the U.C. a-4 integrin inhibitors
Vedolizumab
92
List the General Classes for Chrons Disease
1) IL-12/23 Inhibitors
2) TNF-a Inhibitors
3) a-4 integrin inhibitors
93
List the Chron Disease TNF-a Inhibitors
Adalimumab
Certolizumab
Infliximab
94
List the C.D. a-4 Integrin Inhibitors
Natalizumab
| Vedolizumab
95
MOA of 5-ASA agents
1) Inhibition of PG and LT production via arachidonic acid pathway
- COX and LIPOX
2) Reduction in PMN and Macrophage chemotaxis
96
Contraindications of 5-ASA compounds
1) ASA-allergic pts
| 2) Sulfasalazine contraindicated in sulfonamide allergic pts
97
MOA of TNF-a
blocks leukocyte migration to site of inflammation
98
Which of the TNF-a inhibitors is supplied via IV
Infliximab
99
Side Effects of TNF-a inhibitors
1) Infections (TB testing pre-therapy)
100
Indications of Adalimumab
Moderate-to-severe U.C. and C.D.
101
Indications for Infliximab
1) Moderate-to-Severe C.D.
| 2) Severe U.C.
102
Indications for Golimumab
Moderate-to-Severe U.C. only
103
Indications for Certolizumab
Moderate-to-Severe C.D. only
104
Indications for 5-ASA Agents
1) Mild-to-Moderate U.C.
- Except Olsalazine (only for maintenance of remission)
- Except Balsalazide (only for active disease)
105
What are the exceptions for 5-ASA Agents
All treat Mild-to-Moderate U.C. Except:
1) Olsalazine = maintenance of remission
2) Balsalazide = Active Disease only
106
When should you consider TNF-a inhibitors as a treatment option?
After inadequate response to conventional or immunosuppressant therapy
107
MOA of a-4 integrin inhibitors
1) Prevents trans-endothelial migration of leukocytes (decrease leukocyte traffic)
108
Indications of a-4 Integrin Inhibitors: Natalizumab
Moderate-to-severe C.D.
109
Indications for a-4 Integrin inhibitors: Vedolizumab
Moderate-severe C.D. and U.C.
110
Side Effects of a-4 Integrin Inhibitors: Natalizumab ***cases for only Natalizumab at this time
Infections:
| - PML (Progressive Multifocal Leukoencephalopathy) associated w/ John Cunningham Virus (JCV))
111
3 Risk Factors for PML associated Natalizumab
1) Treatment > 2 yrs
2) Prior Immunosuppressant Treatment
3) Anti-JC virus (JCV) antibodies
112
When should you consider a-4 integrin inhibitors
** After inadequate response to conventional or TNF-a therapy
113
MOA of Ustekinumab (Interleukin IL-12 and IL-23 Inhibitors)
Bind P40-subunit of IL-12 and IL-23
1) Decrease activation and differentiation of naïve T Cells
2) Decrease activation of NK cells
114
Side Effects of IL-12 and IL-23 Inhibitors
Infections:
| - TB testing pre-therapy recommended
115
Indications for Ustekinumab
Moderate-to-Severe UC and CD
116
When should you consider Interleukin inhibitors as a treatment?
After:
1) Conventional
2) Immune Modulators
3) Steroids or TNF-a therapy
117
MOA of JAK Kinase Inhibitors
Bind JAK1 and JAK3 --> inhibition of gene transcription and cytokine release
118
Tofacitinib (oral) is used for U.C., __, ___
Psoriatic
| RA
119
Indications for JAK's Inhibitors
Moderate to Severe U.C.
120
______: concomitant use of Biologic Therapies or immunosuppressant's not recommended
JAK's Inhibitors
121
Indications for Glucocorticosteroids
Acute and/or Severe U.C. and C.D. uncontrolled by other conventional medications
*** Not for maintenance of remission unless absolutely required
122
List the general classes for Diarrhea
1) Prostaglandin Inhibitors
2) Opioid Agonists
3) Serotonin Antagonists
4) Chloride Channel Inhibitors
123
Loperamide is an ___ used for diarrhea
Opioid agonist
124
Loperamide causes ___ toxicities leading to death
Cardiac
125
Side efecft of loperamide
Anticholinergic
126
Diphenoxylate is an ___ and is used for diarrhea
Opioid agonist
127
List the Nucleoside Analogue Reverse Transcriptase Inhibitors that Treat HBV
1) Entecavir
2) Lamivudine
3) Telbivudine
128
Entecavir Indication
Chronic Hep B Infection
129
Lamivudine Indication
Chronic Hep B w/ HIV-1 Infection
130
Contraindication of Lamivudine
Hypersensitivity Reaction to Lamivudine
131
Telbivudine Indication
Chronic Hepatitis B in Adult Population
132
Contraindication of Telbivudine
Can't use w/ PEGylated Interferon alfa-2a
133
If Telbivudine is used with PEGylated interferon alfa-2a it increases risk of....
Peripheral neuropathy
134
BB warning for Entecavir
1) Severe Acute Exacerbations of Hep B
2) Pts co-infected w/ HIV and HBV
3) Lactic Acidosis
4) Hepatomegaly
135
BB Warning of Lamivudine
1) Lactic Acidosis
2) Severe Hepatomegaly
3) Exacerbations of Hep B
136
BB Warning of Telbivudine
1) Lactic Acidosis
2) Severe Hepatomegaly w/ Steatosis
3) Severe Acute Exacerbations of Hepatitis B
137
List the Nucleotide Analogues that Treat Chronic HBV
1) Tenofovir disoproxil
| 2) Adefovir Pipivoxil
138
Indications of Tenofovir
1) HIV-1 Treatment in Adults and Peds Pts
| 2) Chronic HBV (12yrs or older)
139
Adverse Effects of Tenofovir
1) Nephrotoxicity:
- Acute Renal Failure
- Fanconi Syndrome
2) Nausea (most Common)
140
BB Warning of Tenofovir
1) Lactic Acidosis
2) Severe Hepatomegaly w. Steatosis
3) Post Treatment exacerbation of Hepatitis
141
Indications of Adefovir
1) Chronic Hep B (12yrs and older)
142
Contraindications of Adefovir
Hypersensitivity to any components
143
Adverse Effects of Adefovir
Nephrotoxicity
Asthenia
Increased Creatinine
144
Adefovir should not be used with other drugs that ____ or ___ because it increases risk of increased serum Adefovir
1) Reduce renal function
| 2) Compete for active tubular secretion
145
List the Drugs that Treat HCV
1) PEG-Interferon Alfa-2a
2) Elbasvir/Grazoprevir
3) Ledipasvir/Sofosbuvir
4) Velpatasvir/Sofosbuvir
5) Ribavirin
6) Boceprevir
146
MOA of PEG-Interferon Alfa-2a
Anti-viral and Immunomodulatory Effects
147
Indications of PEG-Interferon Alfa-2a
1) Chronic Hep C (18yr or older)
148
Contraindications of PEG-Interferon Alfa-2a
1) Hypersenstivity to INF-a
2) Autoimmune Hepatitis
3) Decompensated Liver Disease
149
Adverse Effects of PEG-Interferon Alfa-2a
Flu-Like Sx
150
BB Warning for PEG-Interferon Alfa-2a
1) Aggravate Fatal or Life-Threatening Neuropsychatric, Autoimmune, Ischemic and Infectious Disorders
151
-Asvir MOA
NS5A Polymerase Inhibitor
152
- Previr MOA
NS3/4A Protease Inhibitor
153
- Buvir MOA
NS5B Polymerase Inhibitor
154
indication for Elbasvir/Grazoprevir
Chronic Hep C
155
Elbasvir/Grazoprevir shouldn't be Co-administered with a ___.
CYP3A Inducer (will Decrease its concentration)
156
Ledipasvir/Sofosbuvir Indication
Chronic Hep. C
157
Drugs interactions of Ledipasvir/Sofosbuvir
1) Poly glycoprotein Inducers
- Rifampin
- St. John's Wort
158
Velpatasvir/Sofosbuvir Indication
1) Chronic Hep C.
| - W/o Cirrhosis or w/ Compensated Cirrhosis
159
If a Pt has Decompensated Cirrhosis what should be used in combination with Velpatasvir/Sofosbuvir.
Ribavirin
160
Indication for Ribavirin
1) Chronic Hep C in combination w/ Interferon alfa-2a
| 2) CHC pts co-infected with HIV
161
Contraindications of Velpatasvir/Sofosbuvir
1) Pregnant Women and Men whose female partners are pregnant
2) Hemoglobinopathies
162
BB Warning for Velpatasvir
1) Potentiates Bradycardia w/ amiodarone co-administration
| 2) Caution w/ Beta Blockers, Cardiac Comorbidities and/or advanced liver disease
163
Indications of Ribavirin
1) Chronic Hep C infection in combination w/ interferon alfa-2a
2) CHC pts co-infected with HIV
164
BB Warning of Ribavirin
1) Birth Defects and Fetal Death
| 2) Don't use in pregnancy and for 6mo after treatment
165
Contraindications of Ribavirin
1) Pregnant Women and Men whose female partners are pregnant
2) Hemoglobinopathies
166
Boceprevir MOA
NS3/4A Protease Inhibitor
167
Indication of Boceprevir
Chronic Hep. C Infection in combination with peginterferon alfa and ribavirin
168
Contraindication of Boceprevir
1) Contraindications of Peginterferon
- Hypersensitivity to INF-a
- Autoimmune Hepatitis
- Decompensated Liver Disease
2) Contraindications of Ribavirin
- Pregnant women and men whose female partners are pregnant
- Hemoglobinopathies
169
Pt who has decompensated cirrhosis needs treatment. How would you treat this pt.
1) Velpastasvir/Sofosbuvir + Ribavirin
170
Pt has Autoimmune Hepatitis what Drug that treats Hep C would you not want to use?
PEG-Interferon Alfa-2a
