Pharmacology Exam 3 revised

Question 1

What are proton pump inhibitors ?

Answer 1

Drug of choice for PUD and GERD
But may cause vitamin B12 deficiency because of lack of intrinsic factor. PPIs reduce acid secretion by irreversibly binding to enzyme H+, and K+-ATpase.

Question 2

What are Chief cell?

parietal cells ?

Answer 2

Parietal cells secretes 1 to 3 L of hydrochloric acid each day.
• This strong acid helps break down food, activates pepsinogen, and kills microbes that may haw been ingested.
• Parietal cells also secrete intrinsic factor, which is essential for the absorption of vitamin B12.

Question 3

Causes of PUD (peptic ulcer disease)

Answer 3

caffeine, blood group O , smoking tobacco, drugs (corticosteroids & NSAIDs) stress, and H. pylori

Question 4

What are patients usually advised to do before initiating pharmacotherapy?

Answer 4

Change in lifestyle & o If no symptoms relieved : pharmacological interventions are used
medications to relieve PUD

Question 5

Prototype : Ranitidine (Zantac) H2 Receptor antagonist
Adverse effects !
Action ?
May reduce absorption ?

Answer 5

• Tachycardia, blurred vision, blood dyscrasias , musculoskeletal pain
blocks H2 receptors in stomach = decreased acid production

Question 6

Prototype : Ranitidine (Zantac) H2 Receptor antagonist
Herbal/food
May reduce absorption ?

Answer 6

 Herbal/Food: absorption of vitamin B12 depends on acidic environment; thus, deficiency may occur. Iron is also better absorbed in an acidic environment
Rantidine may reduce absorption of cefpodoxime, ketoconazole, itraconazole

Question 7

Prototype drug : proton pump inhibitor Omeprazole (Prilosec)
Administration alerts ?
Is it more effective ?

Answer 7

 More effective because it controls the acid better than the other proton pump inhibitors !
Do not crew, do not crush, take whole

Question 8

Prototype drug : proton pump inhibitor Omeprazole (Prilosec)
Duration?
Action?

Answer 8

It reduces acid secretion in the stomach by binding irreversibly to the enzyme H+, K+-ATPase
 Prevent movement of H2 out of parietal cell
 Longer duration than H2 blockers, more effective

Question 9

side effects for proton pump inhibitors ?

Answer 9

headache, dizziness, nausea, rash, diarrhea

Question 10

Cimetidine (Tagamet) : assessment of adverse effects ?
Class ?
Most common side effect ?

Answer 10

H2 receptor antagonist
Most common : headache,

Adverse effects
If adverse effect of drug : patient will come in with : confusion, anaphylaxis, skin reactions, or psychoses

Question 11

o	Prototype : Antacid : Aluminum hydroxide (alternaGEL, others)
Herbal/food?
Adverse effects?
Most common side effects ?
Administration alert?

Answer 11

Hearbal/food
• May inhibit the absorption of dietary iron
2 hours before or after medication to be administered because absorption could be affected
Adverse effects:
• Fecal impaction, hypophosphatemia
• Side effects : constipation , nausea, stomach cramps

Question 12

Ensuring therapeutic effects : patient’s receiving drug therapy for PUD and GERD

Answer 12

• ENCOURAGE APPROPRIATE LIFESTYLE CHANGES, INCLUDING AN INCREASED INTAKE OF YOGURT AND ACIDPHILUS-CONTAINING FOODS. HAVE THE PATIENT KEEP A FOOD DIARY NOTING CORRELATIONS BETWEEN DISCOMFORT OR PAIN AND MEALS OR ACTIVITIES. (SMOKING AND ALCOHOL USE INCREASE GASTRIC ACID AND IRRITATION AND SHOULD BE ELIMINATED. CORRELATING SYMPTOMS WITH DIETARY HABITS MAY HELP TO ELIMINATE A TRIGGERING FACTOR.)

Question 13

Magnesium hydroxide : adverse effect

Answer 13

hypermagnesemia and dysrhythmias

Question 14

o Sucralfate(Carafate) Cytoprotective agents
Action ?
disadvantage and administration alert ?

Answer 14

This drug produces a thick, gel-like substance that coats the ulcer, protecting it against further erosion and promoting healing
1 hour before meals , disadvantage : 4 x/day

Question 15

o Misoprstol (Cytotec)
inhibits ?
Why can’t pregnant woman take this drug?

Answer 15

Inhibits gastric acid secretion and stimulates the production of protective mucus
Causes uterine contractions : pregnancy Cat. C
• Can cause abortion

Question 16

What is constipation ?

Answer 16

decrease in frequency in bowel movements

Stools may become hard, dry , and difficult to evacuate from rectum without straining

Question 17

o Prototype drug : psyllium mucilloid (Metamucil)
Class ?
Action ?
Adverse effects ?

Answer 17

 Action : Bulk forming laxative
• When taken with a sufficient quantity of water, psyllium swells and increases the size of fecal mass
• The larger the size of fecal mass, the more defecation reflex will be stimulated, thus promoting the passage of stool
 Esophageal or GI obstruction if taken with insufficient fluid

Question 18

Prototype drug : psyllium mucilloid (Metamucil)

Administration alerts ?

Answer 18

 Administration alerts :
• Mix with at least 8 oz of water, fruit juice, or milk, and administer immedaitley. Follow each dose with an additional 8 oz of fluid

Question 19

 Saline and osmotic drugs

Most common ?

Answer 19

Miralax; magnesium hydroxide (Milk of magnesia)

adverse effects : hypermagnesemia, dysrhythmias

Question 20

Stimulant

Most common?

Answer 20

bisacodyl (Dolculax)

Adverse effects : • Fluid and electrolyte loss

Question 21

Stool softeners, surfactant

Answer 21

docusate (Colace)

Adverse effects: no serious, side effects include abdominal cramping and diarrhea

Question 22

herbal agent

Most common?

Answer 22

Ex-lax

No serious adverse effects, side effects : abdominal cramping and diarrhea

Question 23

Misc. Agents

Most common ?

Answer 23

Mineral oil

Adverse effects : nutritional deficiencies, aspiration pneumonia

Question 24

Prototype drug : diphenoxylate with atropine
Drug-drug interaction ?
Action?

Answer 24

 Drug-drug interaction
• Interacts with other CNS depressants including alcohol, to produce additive sedation. When taken with MAO inhibitors, diphenoxylate may cause hypertensive crisis
Action :
• Slows peristalsis, allowing time for additional water reabsorption from the colon and more solid stools

Question 25

Prototype drug : diphenoxylate with atropine

other information he told us in class !

Answer 25

comination of 2 drugs

opioid without analgesic property, so it will not help with pain

Question 26

 Prototype drug : prochloperazine (Compazine)
Class ?
Adverse effects ? Treatment of overdose?

Answer 26

antiemetics, phenothiazines
agranulocytosis & neuroletpic malignant syndrome (muscle tremors, fever, rigidity, stiffness : extrapyramidal symptoms !)
Treatment of overdose : antiparkinson’s durg or Cogentin

Question 27

 Prototype drug : prochloperazine (Compazine)
Drug-drug interaction ?
administration alert ?

Answer 27

• When taken with Phenobarbital, metabolism of prochlorperazine is increased
Administer 2 hours before or after antacids and antidiarrheals

Question 28

: prototype drug : sibutramine (Meridia)
Class & action ?
Contraindications ?

Answer 28

Anorexiant, SSRI, antiobesity agent, appetite suppressant
• Able to produce 5%-10% loss of body weight within 6-12 months of treatment
contraindicated for patients with eating disorders (anorexia and bulemia) and patients taking MAOIs because it can cause serotonin syndrome)
(agitation/restlessness, diarrhea, confusion, heavy sweating, etc)

Question 29

prototype drug : sibutramine (Meridia)

Drug-drug interaction

Answer 29

• Use with decongestants, cough, and allergy medications may cause elevated blood pressure

Question 30

prototype drug: pancrelipase (Cotazym, Pancrease)
If used in high dose what will it cause ?
Action?
Class

Answer 30

hyperuricemia –> GOUT (high levels of uric acid in blood or urine)
• Used as a replacement therapy for patients with insufficient pancreatic, exocrine, secretions, including those with pancreatitis and cystic fibrosis
pancreatic enzyme *

Question 31

Which lipid is most prevalent ?

Answer 31

Triglycerides are most common which are neutral fats

Question 32

Steroids & atherosclerosis ?

Answer 32

cholesterol is the most widely know of the steroids, and its role in promoting athersclerosis has been clearly demonstrated

Question 33

normal values for total cholesterol, LDL, HDL, triglycerides

Answer 33

• Total cholesterol : 60 md/dL

* Triglycerides : <150 md/dL

Question 34

atorvastatin (Lipitor)
Class ?
Adverse effects ?
Labs?

Answer 34

	Class : HMG-CoA reductase inhibitor
•	Adverse effects
o	Rhabdomylosis, severe myositis
Muscle pain/ache, cannot walk, etc
you will see high CPK levels 
Labs : decreased I&O (urine output) less than 30 GFR renal failure …
•	I&O and BUN, creatinine

Question 35

atorvastatin (Lipitor)
Action & use
decrease synthesis of ?

Answer 35

• Acts by inhibiting HMG-CoA reductase
• As the liver makes less cholesterol, it responds by making more LDL receptors on surface of liver cells
• The greater the number of LDL receptors in liver results in increased removal of LDL from the blood thus reducing blood levels of LDL and cholesterol
• Statins also decrease synthesis of coenzyme Q10 (CoQ10), patients may benefit from CoQ10 supplements
o Manifestations of CoQ10 deficiency include high BP, CHF, and low energy

Question 36

atorvastatin (Lipitor)
drug-drug interaction?
risk of ?

Answer 36

• Erythromycin may increase atorvastatin levels 40%
• Risk of rhadomylosis increases with concurrent administration of atorvastatin with macrolide antibiotics, cyclosporine, azole antifungals, and niacin. (don’t get distracted metroniadzole ? )

Question 37

prototype : Cholistyramine (Questran)
Class ?
administration alert ?

Answer 37

(Bile acid resin, antihyperlipidemic)
 Administration alert
• Give other drugs more than 2 hours before or 4 hours after the patient take cholestyramine

Question 38

Prototype : Gemfibrozil (Lopid)
Class ?
Action ?
Administration alert ?

Answer 38

 Antihyperlipidemic, Fibric acid agent
 Action :
• Effects include up to 50% reduction in VLDL with an increase in HDL
 Administration alert
• Administer with meals to reduce GI distress

Question 39

minimizing adverse effects patients receiving lipid lowering drug therapy

Answer 39

 Continue to monitor periodic liver function tests, and CPK levels
• Abnormal liver function tests and increased CPK levels may indicate drug-induced adverse hepatic effects or myopathy and should be reported
 Continue to assess for drug-related symptoms, which may indicate adverse effects are occurring
• Lipid-lowering drugs often adversely effect the liver but may also cause-drug specific adverse effects
 Assess for possibility of increased adverse effects when a combination of lipid-lowering agents are used
• Lipid-lowering agents may be combined for better effects but this increases the risk of adverse effects