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PANCE > Pharmacology 2: Pulmonary, Pain, GI, thyroid, Psych > Flashcards

Pharmacology 2: Pulmonary, Pain, GI, thyroid, Psych Flashcards

1
Q

NSAID families

A

1) Carboxylic Acids (ASA)
2) Proprionic Acids (Ibu and naproxen)
3) Acetic Acid Deriv (Indomethacin, diclofenac, ketorolac)
4) Enorlic Acids (piroxicam, meloxicam)
* *pts may respond to one family and not another)
* *HAVE A REVERSIBLE PLATELET EFFECT**

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2
Q

Who shouldn’t get NSAIDs?

A
  • PREGOS

- pts w/ HTN< HF, CKD, asthma, PUD

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3
Q

NSAID interactions

A
  • use warfarin w/ great caution
  • increased risk of GI bleed w/ anti-platelet agents, ETOH, and corticosteroids
  • interferes w/ anti platelet effect of ASA (stop all NSAIDs indefinitely in AMI pts…except ASA)
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4
Q

NSAID ADR

A
  • GI effects

- Nephrotoxicity

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5
Q

Mild to Moderate Opiod Agonists

A

1) Phenanthrenes (codeine, hydrocodone)
2) Phenylheptylamines (removed from market)
3) Phenylpiperidines (diphenoxylate and loperamide = antidiarrheals)

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6
Q

Strong Opiod Agonists

A

1) Phenanthrenes (morphine, oxycodone, oxymorphone, hydromorphone)
2) Phenylheptylamines (methadone…stay away)

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7
Q

What are H2 blockers good for?

A

PRN use

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8
Q

H2 Class interactions

A
  • decrease absorption of iron, digoxin etc (these need acidic enviro to be absorbed)
  • cimetidine has many potential interactions
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9
Q

Cimetidine specific ADRs

A
  • Drug fever

* *Anti-androgen effects (ED, gynocomastia)

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10
Q

When to take PPI?

A

30-60 min before 1st meal of the day

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11
Q

PPI interactions

A
  • decrease absorption of iron, digoxin etc

- several inhibit CYP2C19 = clopidogrel interaction

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12
Q

PPI ADRs

A
  • anemia
  • fractures
  • C. dif
  • pneumonia
  • acid rebound w/ d/c = taper off
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13
Q

Promethazine MOA

A

-H1 receptor antagonist & D2 receptor antagonist

aka phenergan

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14
Q

Promethazine indications

A
  • antiemetic (not in kids <2y/o= fatal resp depression)

- pain management adjunct (ie migraine)

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15
Q

Promethazine interactions

A
  • Levodopa (may inhibit anti-parkinson effect)

- QTc prolongation w/ concomitant meds (Type IA & III antiarrhythmics, fluoroquinolones)

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16
Q

ADRs of promethazine

A
  • EPS

- may alter cardiac conduction

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17
Q

Dopamine receptor antagonists (list)

A
  • promethazine (also H1 blocker)
  • prochloperazine (compazine) same info as promethazine
  • metocloprmide (reglan)
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18
Q

Metocloperamide indications

A

-prevention and tx of chemo induced emesis, post op N/V
-diabetic gastroparesis
(interactions are the same as promethazine)

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19
Q

Metoclopramide ADRs

A

Acute dystonia (chronic use or high dose) = Black Box Warning (lots of lawsuits)

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20
Q

Serotonin Antagonists for anti-emesis indications

A

Ondansetron

  • Prevention of chemo induced emesis
  • nausea related to irradiation
  • prevention and treatment of post op N/V
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21
Q

Interaction of Ondansetron

A

-fairly clean but be careful w/ other QT PROLONGERS

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22
Q

Zofran in pregnancy

A

reserved for refractory symptoms or hyperemesis gravid

**1st trimester usel inked to 2x increase risk of congenital heart defects and cleft palate

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23
Q

Antihistamine w/ no sedation

A

Fexofenadine < loratadine < cetirizine

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24
Q

Metformin MOA

A

Decreases hepatic glucose production (needs insulin to work**)

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25
Q

Metformin ADRs

A
  • Metallic taste and GI upset (N/V/D) minimized by titrating
  • No weight gain
  • Lactic acidosis (major surgery, IV contrast)
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26
Q

Sulfonylureas (list) & MOA

A

1st gen = chlopromide (disulfiram like rxn)
2nd gen = glimepride, glipizide, glyburide=worst for hypoglycemia
MOA = stimulation of insulin secretion

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27
Q

Sulfonylureas ADR

A

weight gain and hypoglycemia

disulfiram-like reaction w/ ETOH possible (chlorpropamide)

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28
Q

TZDs list and MOA

A
  • pioglitazone, rosiglitazone
  • increase insulin sensitivity by acting on adipose, muscle and liver to increase glucose utilization and decrease glucose production need insulin to work
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29
Q

TZD ADR

A

-fluid retention
-weight gain
-heart failure = contraindication if NYHA III or IV
(others)

30
Q

Levothyroxine products ADRs

A
  • s&s of hyperthyroidism
  • cardiac arrhtymias (afib, angina, ami)
  • *decrease bone mineral density**
31
Q

M2 and M3 muscarinic antagonists

A

Tolerodine (used for incontinence)

32
Q

“primarily” M3 selective muscarinic antagonists

A

Oxybutynin (used for incontinence)

33
Q

MOA & indications of incontinence therapeutics

A
  • mediates bladder contractions = increase bladder capacity and decreases uninhibited contractions, and delayed desire to void
  • Overactive bladder and urge incontinence
34
Q

Incontinence Med Interactions & ADRs

A
  • additive anticholinergic ADRs

- Anticholinergic effects (xerostomia most common)

35
Q

Nonspecific alpha one antagonists

A

-zosins (improve voiding sumps)

36
Q

Specific alpha one antagonists

A

-tamsulosin

37
Q

ADRs of BPH therapeutics

A

selective = retrograde ejaculation

38
Q

ED therapeutics

A

Sildenafil, vardenafil, vanafil (4.5hr 1/2 life)
Tadalfil (18hr 1/2 life)
—these are also used for pulmonary htn

39
Q

ED therapeutics ADRs and interactions

A
  • Nonselective alpha antagonists & nitrates
  • ADR: headache, facial flushing, priapism
  • sildenafil may cause bluish vision
40
Q

Triptan drugs MOA

A

selective serotonin agonist for receptors in cranial arteries

41
Q

Triptan interactions & ADRs

A 
Avoid concurrent ergots
AMI symptoms (careful in vascular patients)
42
Q

Cholinesterase inhibitors

A

increase cholinergic transmission!

DONEPEZIL, rivastigmine, galantamine,&raquo_space; tacrine=hepatotoxic

43
Q

1st line for Parkinsons

A
  • Levodopa plus carbidopa +/- entacopone

- dopamine agonists (prmipexole, ropinirole)

44
Q

2nd Line for Parkinsons

A
  • Anticholinergics (trihexyphenidyl, benztropine)
  • Selective MAOB inhibitors ( selegiline, rasagiline)
  • NMDA antagonists (amantidine)
45
Q

Levodopa, Carbidopa, Entacapone MOA

A
  • Levodopa = crosses BBB and becomes dopamine
  • Carbidopa = blocks dopa decarboxylase (no metab in periph)
  • Entacapone = blocks COMT
46
Q

Phenytoin clinical uses

A

-prevention of seizures following head trauma/ neurosurgery

47
Q

Phenytoin Interactions

A

potent CYP INDUCER

monitor blood levels

48
Q

Common Phenytoin ADRs

A
  • *gingival hyperplasia
  • *teratogenicity
  • rash
  • vitamin D deficiency (osteomalacia)
49
Q

Special Phenytoin ADRs

A

**nysatgmus leading to death because of high phenytoin levels

50
Q

Clinical uses of Carbamazepine

A
  • Treatment of bipolar

- Treatment of chronic pain syndromes

51
Q

Carbamazepine Interactions

A

CYP INDUCER

52
Q

Carbamazepine ADRs

A
  • bone marrow suppression
  • drug fever
  • *rash (subtle to severe = SJS)
  • Vitamin D defiicency (osteomalacia)
  • Tearatogenicity***
53
Q

Valproic Acid Clinical Uses

A
  • Mania associated w/ bipolar

- Migraine prophylaxis

54
Q

Valproic Acid ADRs

A
  • Hepatotoxicity

* *Teratogenicity- NTD (avoid all together in women of childbearing age)

55
Q

Fluoxetine and Paroxetine Interactions

A
  • inhibitors of CYP2d6 (remember metoprolol)

* **can’t degrade the metoprolol

56
Q

SSRI interaction

A

SSRI plus serotonergic drug

linezolid, St. Johns Wort

57
Q

Common SSRI ADRs

A
  • Sexual (delayed ejaculation, anorgasmia, decreased libido)

- Long QT syndrome (mostly larger doses of citalopram/escitalopram)

58
Q

Special SSRI ADRs

A
  • FDA warning about antidepressants and suicide
  • Discontinuation Syndrome (N,V,D, HA, anxiety, anorexia, insomnia, flu-like illness) need to taper off
  • Serotonin Syndrome (agitation, altered mental status, fever, resting tremor, myoclonic jerks, hyperreflexia, ataxia)
59
Q

SNRIs =

A
  • Venlafaxine

- Duloxetine (frequently used for pain)

60
Q

SNRI ADRS

A
  • similar to SSRIs

- Associated w/ dose dependent BP increase

61
Q

TCAs =

A
  • Amitriptyline

- Nortriptyline

62
Q

TCA Interactions

A
  • Anticholinergic agents
  • QTc prolonging agents
  • SSRI plus other sertonergic drugs (linezolid, st johns wort)
63
Q

TCA ADRS

A 
Common = anti-cholinergics
Special =
-Quinidine like cardiac effects **get baseline EKG**
-Discontinuation syndrome **taper**
-TCA overdaose
64
Q

1st generation antipsychotics

A
  • Haloperidol

- Chlorpromazine

65
Q

2nd generation antipsychotics

A
  • Risperidone
  • Olanzapine
  • Quetiapine
  • Ziprasidone
  • Aripiprazole
66
Q

Antipsychotic Black Box warning

A

all have BB warning regarding mortality risk in dementia related psychosis and suicidality if indicated for depression

67
Q

1st generation antipyschotic ADRs

A
  • postural hypotension
  • sedation
  • EPS
  • NMS think these + anesthesia
  • QTc prolongation
  • Increase prolactin (lactation, gynecomastia, amenorrhea)
68
Q

2nd Generation antipsychotic ADRs

A
  • weight gain
  • diabetes
  • hyperlipidemia
69
Q

Clozapine ADRS

A

(2nd generation used for very refractory)

-granulocytopenia

70
Q

Isotretinoin Precautions

A

2 forms of contraception
Need to monitor multiple labs
Need to be on registry
only prescribed by derm

71
Q

Isotretinoin Interactions

A
  • Avoid concomitant tetracycline (increased risk of pseudo tumor cerebri)
  • Vaoid concomitant ETOH intake
72
Q

Isotretinoin ADRs

A
  • alopecia
  • hepatitis/pancreatitis
  • pseudotumor cerebri
  • photosensitivity
  • TERATOGENICITY
  • psychosis/suicidal ideation

PANCE (18 decks)

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