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Pharmacology > Pharmacology Exam 2 > Flashcards

Pharmacology Exam 2 Flashcards

1
Q

Liraglutide: Indication and distribution

A

Primarily - DM2

Also used as an anorexiant

highly bound to protein

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2
Q

Anorexiant MOA

A

Sympathomimetic amines → stimulate the satiety centers in the hypothalamus and limbic regions

  • noradrenergic, dopaminergic, or serotonergic pathways
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3
Q

Anorexiants: Contraindications

  • General
  • Liraglutide
  • Lorcaserin
A

DM - can cause hypoglycemia

Liraglutide - Pregnancy: due to wt loss

Lorcaserin -

  • Pregnancy due to category X
  • other drugs that increase serotonin
  • <18 yo
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4
Q

Anorexiants: ADRs

  • General
A

Hypoglycemia - decreaed intake

CNS overstimulation and agitation, confusion, insomnia, dizziness, hypertension, headache, palpitations, arrhythmias, dry mouth, mydriasis, dysuria, constipation, vomiting, diarrhea, and impotence

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5
Q

ADRs

Liraglutide

A

N/V/D

  • Hypoglycemia
  • Suicidal Ideation
  • Slowed gastric emptying – may alter other drug’s absorption
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6
Q

ADRs

Lorcaserin

A

Suicidal ideation

stimulate ADRs

euphoria/hallucinations

priapism/prolactin

CBC changes

hypoglycemia

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7
Q

Anticonvulsants (AEDs): Precautions

A
  • Increased risk for suicidal thoughts
  • Monitor seizure activity
  • associated with fetal defects
  • suicidal ideation
  • lactation
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8
Q

Anticonvulsants: Topiramate MOA

A

Inhibition of carbonic anhydrase → may lead to increased renal bicarb LOSS → metabolic acidosis

Inhibition of carbonic anhydrase can also lead to increased ammonia levels

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9
Q

Phenytoin (Hydantoin)

  • MOA
  • Blackbox Warning
  • Common Hypersensitivity
  • Newborn who have been exposed
A
  • blocks Na+ - decreased potential
  • IV < 50mg/min in adults and 1-3mg/kg in peds
  • Phenytoin-induced hepatitis is a common hypersensitivity
  • Newborns need Vit K
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10
Q

Phenytoin (Hydantoin): Common Drug Interaction

A

IBUPROFEN – increases dilantin lvls

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11
Q

Phenytoin monitoring

A

LFTs,CBC with diff, UA

Drug levels

Assess for phenytoin hypersensitivity syndrome → fever, rash, lymphadenopathy → typically weeks 3-8

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12
Q

Phenytoin (Hydantoin): Education

A

Good oral hygiene – tenderness

Urine may look pink, red, or reddish brown

DM - inhibits glucose stimulated insulin release - hyperglycemia

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13
Q

Phenytoin indication

A

Seizures, status epilepticus

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14
Q

Carbamazepine indications

A

epilepsy, bipolar disorder, trigeminal neuralgia, aggressive behavior

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15
Q

Carbamazepine: MOA - including additional

A

Decreases the amount of Na+ going into cortical neurons → decreases action potential → decreased seizure activity from interrupting the abnormal neuronal discharge

Alos: anticholinergic, antidiuretic, antidysrhythmic, and antidepressant activity

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16
Q

Carbamazepine: Metabolism

A

Self-induced – therapeutic ranges may fall

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17
Q

Carbamazepine: Precautions

-include Black Box Warning

A

Intraoccular pressure – due to anticholinergic affects

grapefruit juice increases drug levels

Decrease TSH

Black Box Warning: SJS - Screen asian patients for HLA-B*1202 gene

Black Box Warning: May cause blood dyskrasias – leukopenia, thrombocytopenia, agranulocytosis, and aplastic anemia

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18
Q

Carbamazepine: screening

A

SJS and toxic epidermal necrolysis → particularly among asians

Screen asian patients for HLA-B*1202 gene

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19
Q

Carbamazepine: Contraindications

A

pregnancy: CATEGORY D

Hypersensitivity to Carbamazpines or TCAs,

hx of bone marrow suppression,

concurrent administration with MAOs

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20
Q

Carbamazepine can decrease levels of the following drugs:

A

Beta blockers, warfarin

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21
Q

Carbamazepine: Monitor

A

Baseline CBC, chemistry, LFT, Renal function, CMP, TSH/ T4 → then frequently → then every 3-4 mo if nrml

Carbamazepine → drug levels

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22
Q

Lamotrigine: Indications

A

seizure, bipolar disorder, mood

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23
Q

Lamotrigine: MOA

A

decraese sodium channels and inhibits the presynaptic release of glutamate and aspartate in the neuron

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24
Q

Carbamazepine: Side Effects

A

N/V, dizzy, drowsy, DRY MOUTH, feels like swollen tongue

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25
Q

Lamotrigine: Precautions

  • includingn Black Box Warning
A

Multi-organ failure - DIC → begin as fever or lymphadenopathy

BLACK BOX WARNING

Life-threatening rashes: SJS, TEN, and rash-related death → more likely in peds

Coadmininstration with valproate may increase risk of rash

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26
Q

Lamotrigine: Drug interactions

A

Many → due to CYP450

Estrogen → decrease Lamictal

Rifampin → decreases Lamictal

Valproate → increased chance of life threatening skin rash

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27
Q

Succinimides [ethosuximide (Zarontin)]:
- Indication
- Pregnancy

A

Indication: Seizures

Appears safe in pregnancy

Birth control → succinomides may decrease effectiveness of birthcontrol

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28
Q

Zosinamide:
- Indication
- Drug Interactions

A

Seizures

Used with other carbonic anhydrase inhibitors (topiramate, acetazolamide, dichlorphenamide) → may increase risk of metabolic acidosis

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29
Q

Zosinamide: Distribution

A

extensively bound to erythrocytes

  • 40% bound to proteins
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30
Q

Topiramate: Indication

Gabapentin: Indication

A

T - Seizures, migraine prophylaxis

G- Seizures, migraine prophylaxis

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31
Q

Gabapentin and Topiramate: Metabolism

A

G: Not metabolized – excreted unchanged in kidney

T: Isn’t metabolized a lot

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32
Q

Gabapentin : Side Effects

A

aggression/hostility

suicidal ideation (all AEDs)

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33
Q

Topiramate: Adverse effects

A

vision problems

oligohydramnios and hyperthermia

inhibition of carbonic anhydrase → may lead to increased renal bicarb LOSS → metabolic acidosis

Inhibition of carbonic anhydrase can also lead to increased ammonia levels

dizziness, drowsiness, fatigue

impaired concentration/memory

nervousness, speech problems

nausea, weight loss

ataxia

photosensitivity

behavioral problems, mood problems

anorexia

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34
Q

Topiramate: Monitoring

A

electrolytes (esp bicarbonate)

intraocular pressure

body temp/sweating

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35
Q

Perampanel:
- Indication
- MOA
- SE

A

Indication: Seizurs
MOA: AMPA antagonist

SE: Hosility, aggression, agitation, anger, homicidal

Dizziness and gait disturbances

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36
Q

Levetiracetam:
- Indication
- Metabolism
- SE

A

Indication: Seizures

Metabolism:
Less than 10% protein bound

Doesn’t use CYP450

SE: Alopecia –> reversible

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37
Q

What are the cardiac effects of TCA antidepressants?

A
  • tachycardia d2 inhibition of norepinephrine uptake and anticholinergic effects when TCAs block acetylcholine
  • slowing of depolarization contributes to a prolonged QRS and subsequent QT interval.
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38
Q

Which malignant neoplasm is carbidopa-levodopa known to activate?

A

Melanoma

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39
Q

How do you dc lorazepam (Ativan)?

A
  • Decrease the dose by 0.5 mg per week, then by 0.25 mg for the last few weeks.
  • Switching to a shorter-acting benzodiazepine, not a long-acting agent.
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40
Q

Benzodiazepines increase the levels of what two drugs?

A

TCAs and digitalis

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41
Q

TCA: adverse reactions

A
  • Histamine: drowsiness and weight gain
  • Tachycardia due to decreased norepinephrine reuptake and anticholinergic
  • Prolongation of QRS and PR/QT intervals
  • Anticholinergic adverse effects are common and can include dry mouth, constipation, urinary hesitancy or retention, blurred vision, sedation, orthostatic hypotension, weight gain, nausea and vomiting, gynecomastia, and changes in libido
  • older adults: anticholinergic and norepinephrine effects→ confusion, orthostatic hypotension, and falls
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42
Q

Why shouldn’t you use MAOIs when you are on TCAs?

A

can cause hyperpyrexia

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43
Q

TCA contraindications

A
  • Cardiac disorders: alpha-adrenergic blocking effect and quinidine-like effect on the myocardium
  • MAOIs → hyperpyrexia
  • High risk of suicide
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44
Q

TCA precautions

A
  • Overdose can be fatal - makes them less safe to use in patients who are a high risk for suicide
  • Glaucoma, prostatic hypertrophy, & urinary incontinence: d2 anticholinergic effects
  • Older adults: anticholinergic and norepinephrine effects→ confusion, orthostatic hypotension, and falls
  • Be alert for an energizing effect that precedes depressive symptom remission because this may contribute to sufficient neurocognitive activation to follow through with a suicidal plan
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45
Q

TCAs MOA

A
  • Inhibit reuptake of serotonin and norepinephrine
  • Histamine
  • Anticholinergic effects
46
Q

Common TCAs

A

Amitriptyline (Elavil)

Doxepin (Sinequan)

Imipramine (Tofranil)

nortriptyline (Pamelor, Aventyl)

trazodone

47
Q

4 MAOIs

A

Phenelzine (Nardil),

isocarboxazid (Marplan), tranylcypromine (Parnate), and selegiline (Emsam)

48
Q

MAOI MOA

A

Irreversibly inactivating the enzymes (MAOs) that metabolize norepinephrine, serotonin, and dopamine, thereby increasing the bioavailability of these neurotransmitters

Prevent breakdown of tyramine

49
Q

MAOI food resctrictions

A

No food with tyramine → cured foods, fermented foods, citrus

50
Q

Which SSRI is pregnancy category D?

A

paroxetine

51
Q

SSRI meds

A

fluoxetine

sertraline

paroxetine

fluvoxemine

citalopram

escitalopram

52
Q

Titrating off SSRIs

A

When stopping → titrate down → 5 half-lives per dose change

Fluoxetine does not need to taper down because very long half life.

A single dose of fluoxetine as the last step in tapering off other SSRIs is helpful in avoiding withdrawal symptoms

53
Q

Why is there an increased risk of suicide during the first 6-8 weeks of taking an SSRI?

A

Lag time in receiving the full therapeutic effect, while there is an increase in neurocognitive activation early in initiation of the drug.

Therefore, patients have greater energy to act on suicidal thoughts.

54
Q

SSRI adverse effects

A

Most common are nausea and sometimes vomiting, headache, light-headedness, dizziness, dry mouth, increased sweating, weight gain or loss, exacerbation of anxiety, and agitation. Sexual side effects

55
Q

SSRI drug interactions

A
  1. MOAIs - serotonin syndrome
  2. Lithium-Increased lithium levels, increased serotonergic effect
  3. Antipsychotics-Increased EPSEs
  4. Benzodiazepines -Increased benzodiazepine half-life
  5. TCAs -Increased TCA serum levels → toxicity -Displacement of TCAs from serum proteins → increased cardiac effects
  6. St. Johns wort → serotonin syndrome
  7. Betablockers → bradycardiaa, syncope, increased levels fo SSRI
56
Q

Bupropion (Wellbutrin) MOA

A

Norepinephrine and dopamine reuptake inhibitor

57
Q

Mirtazapine (Remeron) MOA

A

Central pre-synaptic alpha-2 antagonist.

Antagonist of 5HT2 and 5HT3 receptors.

Inhibitor of histamine H1 receptors and alpha 1 and muscarinic receptors.

58
Q

Bupoprion (Wellbutrin) contraindications

Mirtazapine (Remeron) contraindications

A

W: seizures or risk of developing seizures

M: 14 days of taking MAOIs

59
Q

Bupoprion (Wellbutrin) adverse effects

A

insomnia (up to 40%), headache, agitation, dizziness, diaphoresis, nausea and vomiting, xerostomia, and constipation. Tachycardia and cardiac arrhythmias may occur

60
Q

Mirtazapine (Remeron) adverse effects

A

sedation, dry mouth, increased appetite, constipation

61
Q

Antipsychotic drugs:

A

Haloperidol, Thioridazine, Chlorpromazine

62
Q

Typical antipsychotics MOA

A

block dopamine D2 receptors

inhibit histamine, cholinergic, and alpha adrenergic receptors

63
Q

Typical Antipsychotics adverse effects

A

EPS- akathesia, dystonic reactions, parkinsonism;

Hyperprolactinemia;

sedation; weight gain; anticholinergic side effects; orthostatic hypertension;

decreased seizure threshold (low potency); sexual dysfunction;

photosensitivity.

64
Q

Dopamanerigics Indication and MOA

A

Parkinsons

Increases dopamine or dopamine like activity

65
Q

Atypical antipsychotic drugs

A

Aripiprazole (Abilify), cariprazine (Vraylar), lurasidone (Latuda),

olanzapine (Zyprexa, Zyprexa Zydis IM), quetiapine (Seroquel),

risperidone (Risperdal, Risperdal M-Tabs, Risperdal Consta)

66
Q

Atypical antipsychotics: MOA

A

Block serotonin receptors in the cortex, which blocks the usual ability of serotonin to inhibit the release of dopamine. Thus, more dopamine is released to the prefrontal cortex, which reduces the negative symptoms of schizophrenia

Block D2 receptors → less so than typical antipsychotics

Variously affect adrenergic, histaminic, and cholinergic receptors

67
Q

Cloazapine:
- Drug class
- Used for
- Major SE
- Monitor

A

Antipsychotic - severe granulocytosis → reserved for severe refractory schizophrenia

Falling WBC count (fever, lethargy, bruising, sore throat, flu-like symptoms) → can be fatal within 24 to 72 hours → IDENTIFY EARLY

weekly CBC before 1 weeks worth of meds are picked up

68
Q

Atypical antipsychotics: adverse effects

A

Weight gain → metabolic syndrome

Seizures, dry mouth, weight gain, diabetes,

hyperprolactinemia, dizziness, orthostatic hypotension, tachycardia, sleep disturbance, constipation, and rhinitis

Less risk of developing EPS, TD, and NMS compared to typical antipsychotics

69
Q

Dopamanergics: Amantadine

A

Contraindicated: Kidney issues → bc excreted unchanged in the kidney

70
Q

5 Basic Pathogen Types

A

Gram+ Cocci: SSE

Gram- Cocci: H flu, Neisseria, Moraxella

Gram- Bacilli: EKP, ESP, Salmonella, and Shigella

Pseudomonas Aeruginosa

Anaerobes - Bacteriodes

71
Q

5 Basic Pathogen Types AND their clinical associations

A

Gram+ Cocci: SSE
Infection –> skin, soft tissue, respiratory, GI/GU

Gram- Cocci: H flu, Neisseria, Moraxella
Infection –> AOM, sinusitis, bronchitis, Neisseria–meningitis, GU

Gram- Bacilli: EKP, ESP, Salmonella, and Shigella
Infection –> EKP–UTI and GI, ESP, Salmonella, and Shigella–GI

Pseudomonas Aeruginosa
Infection –> pneumonia, skin, various

Anaerobes - Bacteriodes
Infection –> GI, aspiration pneumonia

72
Q

Gram+ Cocci: SSE
- associated with what infections

A

skin, soft tissue, respiratory, GI/GU

73
Q

Gram- Cocci: H flu, Neisseria, Moraxella
- associated with what infections

A

AOM, sinusitis, bronchitis, Neisseria–meningitis, GU

74
Q

Gram- Bacilli: EKP, ESP, Salmonella, and Shigella
- associated with what infections

A

EKP–UTI and GI, ESP, Salmonella, and Shigella–GI

75
Q

Pseudomonas Aeruginosa
- associated with what infections

A

pneumonia, skin, various

76
Q

Anaerobes - Bacteriodes
- associated with what infections

A

GI, aspiration pneumonia

77
Q

PCNs cover what types of bacteria?

A

Gram+ (SSE) (Skin, soft tissue, resp)

78
Q

PCNs extended spectrum cover what types of bacteria?

A

Less Gram +, More Gram - EKP, ESP (GU/GI)

B lactamase Gram+ (skin, soft tissue, Resp)

79
Q

Tetracyclines cover what types of bacteria?

A

Gram- (SKIN, GU/GI)

Atypicals - chlamydiae, mycoplasma, protozoan parasites;

MRSA

Gram+ step pneumonia

80
Q

Sulfonamides cover what types of bacteria?

A

Gram- EKP (GU)

Gram+ MRSA (SKIN)

81
Q

Which antibiotics attack the cell wall of bacteria?

A

B-lactams
- PCNs
- Cephalosporins
- Monobactams
- Carbapenems

Glycopeptides
- Vacomycin

Bacitracin

82
Q

Which antibiotics attack DNA or RNA synthesis?

A

Fluoroquinolons
- Cipro
- Levoflaxacin
- Moxifloxacin

Rifamycins
- Rifampin

83
Q

Which antibiotics attack bacterial plasma membrane?

A

Polymyxins
Lipopeptide

84
Q

Which antibiotics attack the ribosomes of bacteria?

A
  • Aminoglycosides
  • Tetracyclines
  • Macrolides
  • lincosamides
85
Q

Which antibiotics attack the folic acid pathway?

A
  • Sufonamides
  • trimethoprim
86
Q

Which antibiotics attack Mycolic acid synthesis?

A

Izoniazid

87
Q

1st Generation cephalosporins
- Drug Names
- Bacteria Type

A

Cefazolin (Ancef),

cephalexin (Keflex), cefadroxil

Bacteria: Gram+ (SSE)
very little Gram-

88
Q

2nd Generation cephalosporins
- Drug Names
- Bacteria Type

A

Cefotetan (Cefoten), cefoxitin (Mefoxin)

Cefaclor (Ceclor), cefprozil, cefuroxime (Ceftin)

Bacteria: Gram+ (SSE)
weak Gram-

89
Q

3rd Generation cephalosporins
- Drug Names
- Bacteria Type

A

Cefotaxime (Claforan), ceftazidime (Fortaz) , ceftriaxone (Cipro)

cefdinir (Omnicef), cefditoren (Scpectracef), cefpodoxime proxetil (Vantin), ceftibuten (Cedax), cefixime (Suprax)

Bacteria: Weak gram+, Strong Gram -
EKP, ESP, H flu, Neisseria, some enterobacteriacceae
B-lactamase

90
Q

4th Generation cephalosporins
- Drug Names
- Bacteria Type

A

cefepime (Maxipime)

Bacteria: Enhanced Gram-, polymicrobial,
ESP, EKP, SSE, H flu, Neisseria, P. Aueroginosa

91
Q

5th Generation cephalosporins
- Drug Names
- Bacteria Type

A

Ceftaroline (Teflaro)

Bacteria: Gram+, Gram-
MRSA, DRSP

92
Q

Cephalosporin + B lactamase inhibitor

A

Ceftazidime - avibactam

Ceftolozane-tazobactam

93
Q

Gram+ Cocci:
- bacteria
- location of infections

A

SSE

Skin, soft tissue, respiratory, GI/GU

94
Q

Gram- Cocci:
- bacteria
- location of infections

A

H flu, Neisseria, Moraxella

AOM, Sinusitis, bronch

Neisseria - meningitis, GU

95
Q

Gram- Bacilli:
- bacteria
- location of infections

A

EKP, ESP, Salmonella, and Shigella

Infection –> EKP–UTI and GI, ESP,

Salmonella, and Shigella–GI

96
Q

Pseudomonas Aeruginosa: Location

A

Infection –> pneumonia, skin, various

97
Q

Anaerobes - Bacteroides: Location

A

Infection –> GI, aspiration pneumonia

98
Q

What treats SSE?

A

Gram+
PCNs, carbapenenms, macrolides, clindamycin, cephalosporins, fluoroquinolones

99
Q

What treats H. Influenzae, Neisseria, Moraxella

A

Gram-
Macrolides, carbapenems, fluoroquinolones, Ceph 3&4

100
Q

EKP
ESP
Salmonella
Shigella

A

Gram-
Ceph 2, 3, & 4
TMP-SMX &Fluoroquinolones

Stronger Gram-
carbapenems, fluroquinolones, Aminoglycosides

101
Q

Pseudomonas: which meds treat

A

Fluoroquinolones, aminoglycosides

102
Q

Bacteroides: which meds treat

A

Carbapenems, Clindamycin, Tetracyclines

103
Q

Carbapenems: which bacteria

A

Listeria
Gram+ → many
Gram- → most
Anaerobic bacteria → most

104
Q

Carbapenems: adverse reactions

A

n/v/d, rash, drug fever

SEIZURES

105
Q

Vacomycin:
- MOA
- Which bacteria

A

Large molecule → can’t use porins

Prevent cell wall synthesis

Binds to d-alanyl-dalanine portin of the peptide side chain precursor or peptidoglycan subunits → units can’t access PBPs

Bacteria:
Gram+ due to molecule size –> can’t use porins of Gram-

MRSA,VRSA
Cdiff

106
Q

Vancomycin: Toxicity and Adverse Reaction

A

Toxicity
Nephrotoxicity and hearing loss

Adverse
Red man’s syndrome → red, itchy, rash → slow down infusion

107
Q

Daptomycin:
MOA
Bacteria
Adverse

A

MOA
Binds to bacterial cytoplasmic membrane → effects enzymes needed for cell wall synthesis

Gram+
MRSA, PCN resistant S. Pneumoniae,VRE
POOR in lungs → not for pneumonia

Adverse
Reversible myopathy
Phlebitis, rash, eosinophilic pneumonia, GI upset

108
Q

Colistin
MOA
Bacteria
Adverse

A

MOA
Cationic → + charge allows drug to bind to negatively charged lipopolysaccharide molecules in the outer membrane → displaces Ca++ and Mg++ → increased permeability of cell wall

Gram-
P aeruginosa
E coli, Klebsiella
H flu

Toxicity
Associate with nephrotoxicity and neurotoxicity

109
Q

Rifampin:
Important
MOA
Bacteria
Adverse

A

Usually use in a combo
Or prophylaxis of Neisseria and H Flu
NOT MONOTHERAPY because easy to develop resistance

MOA
Inhibit RNA polymerase

Gram
Mycobacteria and staphylococci
Adverse
CYP450 inducers

GI
Causes orange/red color of tears, urine, and other body fluids

110
Q

Tetracyclines mainly used to treat:

A

Atypical: rickettsiae, chlamydiae, and mycoplasmas

Tetracyclines are broad spectrum: Gram+/-, anaerobic and aerobic

Pharmacology (2 decks)

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