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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
Metformin ADRs
- Metallic taste and GI upset (N/V/D) minimized by titrating - No weight gain - Lactic acidosis (major surgery, IV contrast)
26
Sulfonylureas (list) & MOA
1st gen = chlopromide (disulfiram like rxn) 2nd gen = glimepride, glipizide, glyburide=worst for hypoglycemia MOA = stimulation of insulin secretion
27
Sulfonylureas ADR
weight gain and hypoglycemia | disulfiram-like reaction w/ ETOH possible (chlorpropamide)
28
TZDs list and MOA
- pioglitazone, rosiglitazone - increase insulin sensitivity by acting on adipose, muscle and liver to increase glucose utilization and decrease glucose production **need insulin to work**
29
TZD ADR
-fluid retention -weight gain -heart failure = contraindication if NYHA III or IV (others)
30
Levothyroxine products ADRs
- s&s of hyperthyroidism - cardiac arrhtymias (afib, angina, ami) * *decrease bone mineral density**
31
M2 and M3 muscarinic antagonists
Tolerodine (used for incontinence)
32
"primarily" M3 selective muscarinic antagonists
Oxybutynin (used for incontinence)
33
MOA & indications of incontinence therapeutics
- mediates bladder contractions = increase bladder capacity and decreases uninhibited contractions, and delayed desire to void - Overactive bladder and urge incontinence
34
Incontinence Med Interactions & ADRs
- additive anticholinergic ADRs | - Anticholinergic effects (xerostomia most common)
35
Nonspecific alpha one antagonists
-zosins (improve voiding sumps)
36
Specific alpha one antagonists
-tamsulosin
37
ADRs of BPH therapeutics
selective = retrograde ejaculation
38
ED therapeutics
Sildenafil, vardenafil, vanafil (4.5hr 1/2 life) Tadalfil (18hr 1/2 life) ---these are also used for pulmonary htn
39
ED therapeutics ADRs and interactions
- Nonselective alpha antagonists & nitrates - ADR: headache, facial flushing, priapism - sildenafil may cause bluish vision
40
Triptan drugs MOA
selective serotonin agonist for receptors in cranial arteries
41
Triptan interactions & ADRs
``` Avoid concurrent ergots AMI symptoms (careful in vascular patients) ```
42
Cholinesterase inhibitors
increase cholinergic transmission! | DONEPEZIL, rivastigmine, galantamine, >> tacrine=hepatotoxic
43
1st line for Parkinsons
- Levodopa plus carbidopa +/- entacopone | - dopamine agonists (prmipexole, ropinirole)
44
2nd Line for Parkinsons
- Anticholinergics (trihexyphenidyl, benztropine) - Selective MAOB inhibitors ( selegiline, rasagiline) - NMDA antagonists (amantidine)
45
Levodopa, Carbidopa, Entacapone MOA
- Levodopa = crosses BBB and becomes dopamine - Carbidopa = blocks dopa decarboxylase (no metab in periph) - Entacapone = blocks COMT
46
Phenytoin clinical uses
-prevention of seizures following head trauma/ neurosurgery
47
Phenytoin Interactions
potent CYP INDUCER | monitor blood levels
48
Common Phenytoin ADRs
* *gingival hyperplasia * *teratogenicity - rash - vitamin D deficiency (osteomalacia)
49
Special Phenytoin ADRs
**nysatgmus leading to death because of high phenytoin levels
50
Clinical uses of Carbamazepine
- Treatment of bipolar | - Treatment of chronic pain syndromes
51
Carbamazepine Interactions
CYP INDUCER
52
Carbamazepine ADRs
- bone marrow suppression - drug fever * *rash (subtle to severe = SJS) - Vitamin D defiicency (osteomalacia) - Tearatogenicity***
53
Valproic Acid Clinical Uses
- Mania associated w/ bipolar | - Migraine prophylaxis
54
Valproic Acid ADRs
- Hepatotoxicity | * *Teratogenicity- NTD (avoid all together in women of childbearing age)
55
Fluoxetine and Paroxetine Interactions
- inhibitors of CYP2d6 (remember metoprolol) | * **can't degrade the metoprolol
56
SSRI interaction
SSRI plus serotonergic drug | linezolid, St. Johns Wort
57
Common SSRI ADRs
- Sexual (delayed ejaculation, anorgasmia, decreased libido) | - Long QT syndrome (mostly larger doses of citalopram/escitalopram)
58
Special SSRI ADRs
- 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
SNRIs =
- Venlafaxine | - Duloxetine (frequently used for pain)
60
SNRI ADRS
- similar to SSRIs | - Associated w/ dose dependent BP increase
61
TCAs =
- Amitriptyline | - Nortriptyline
62
TCA Interactions
- Anticholinergic agents - QTc prolonging agents - SSRI plus other sertonergic drugs (linezolid, st johns wort)
63
TCA ADRS
``` Common = anti-cholinergics Special = -Quinidine like cardiac effects **get baseline EKG** -Discontinuation syndrome **taper** -TCA overdaose ```
64
1st generation antipsychotics
- Haloperidol | - Chlorpromazine
65
2nd generation antipsychotics
- Risperidone - Olanzapine - Quetiapine - Ziprasidone - Aripiprazole
66
Antipsychotic Black Box warning
all have BB warning regarding mortality risk in dementia related psychosis and suicidality if indicated for depression
67
1st generation antipyschotic ADRs
- postural hypotension - sedation - EPS - NMS **think these + anesthesia** - QTc prolongation - Increase prolactin (lactation, gynecomastia, amenorrhea)
68
2nd Generation antipsychotic ADRs
- weight gain - diabetes - hyperlipidemia
69
Clozapine ADRS
(2nd generation used for very refractory) | -granulocytopenia
70
Isotretinoin Precautions
2 forms of contraception Need to monitor multiple labs Need to be on registry **only prescribed by derm**
71
Isotretinoin Interactions
- Avoid concomitant tetracycline (increased risk of pseudo tumor cerebri) - Vaoid concomitant ETOH intake
72
Isotretinoin ADRs
- alopecia - hepatitis/pancreatitis - pseudotumor cerebri - photosensitivity - TERATOGENICITY - psychosis/suicidal ideation

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