Pharmacology Group 2 Flashcards
Which pharmaceutical should be used for the following conditions?
Hypertriglyceridemia and coronary heart disease risk
Gemfibrozil (similar agent is Fenofibrate)
Which pharmaceutical activates lipoprotein lipase which reduces triglycerides and VLDL cholesterol, modestly reduces LDL, and increases HDL cholesterol?
Gemfibrozil
What are 6 adverse effects associated with Gemfibrozil use?
- Drowsiness
- Dyspepsia
- Abdominal pain
- Diarrhea
- Fatigue
- Mildly decreased WBC, hematocrit, and hemoglobin levels
What is the pregnancy class of Gemfibrozil?
Preg C
What are 2 contradictions for use of Gemfibrozil?
- Cholelithiasis
2. Renal insufficiency
T/F: There is an increase in rhabdomyolysis with concomitant lovastatin use
True
There is an increase in toxicity with concomitant use of Gemfibrozil with which 2 other medications?
- Repaglinide
2. Thiazolidinedione
What are 3 monitoring parameters associated with Gemfibrozil use?
- Lipid levels (test every 3 months)
- CBC
- Liver panel
How is Gemfibrozil administered? Usual dose?
Oral; 300-600mg
Which pharmaceutical should be used for the following conditions?
Mild to severe heart failure, left ventricular dysfunction
Carvedilol
Which pharmaceutical is a non-selective beta-adrenoreceptor and has alpha-adrenergic blocking activity?
Carvedilol
What are 8 adverse effects associated with Carvedilol use?
- Hypotension
- Dizziness
- Fatigue
- Hyperglycemia
- Weight gain
- Diarrhea
- Weakness
- Bradycardia
What are 6 contraindications for use of Carvedilol?
- Bronchial asthma
- AV block
- Sick sinus syndrome
- Severe bradycardia
- Cardiogenic shock
- Severe hepatic impairment
What is the pregnancy class of Carvedilol?
Preg C
Which 5 drugs/drug types is Carvedilol inhibited by?
- Delavirdine
- Fluconazole
- Ketoconazole
- NSAIDS
- Sulfonamides
Serum levels of Carvedilol are increased by which 2 drugs?
- Clonidine
2. Cimetidine
What are 5 monitoring parameters associated with Carvedilol use?
- HR
- BP
- Renal studies
- BUN
- Liver function
How is Carvedilol administered?
Orally
Which pharmaceutical should be used for the following conditions?
CHF, A-fib/flutter
Digoxin
Which pharmaceutical is a cardiac glycoside that inhibits cardiac Na+/K+-ATPase, it is positively inotropic (increases contractility), negatively chronotropic (decreases HR), and makes heart beat more efficiently (reduces O2 demand)?
Digoxin
What are 8 adverse effects with use of Digoxin?
- Anorexia
- Fatigue
- Nausea/vomiting
- Yellow-green halo around objects (visual disturbances)
- Bradycardia
- Arrhythmias
- Gynecomastia
- Loss of libido
T/F: Digoxin has a narrow therapeutic window
True: OD can be lethal and will recirculates in the enterohepatic cycle (toxicity cumulative)
What are 2 antidotes for Digoxin?
- Potassium
2. Digoxin antibodies
What are 6 contraindications associated with using Digoxin?
- Hypokalemia
- Hypo- or hypercalcemia
- Hypomagnesemia
- Ventricular arrhythmia
- Kidney failure (renal excretion)
- Severe carditis
T/F: Digoxin can cause false positives on ECG
True
Digoxin toxicity is potentiated by ___ and/or _____ depleting substances. Examples?
K+ and/or Mg2+
Examples: Diuretics, steroids, Glycyrrhiza
What are 10 drug/drug types that INCREASE Digoxin effects/toxicity?
- Alprazolam
- Antibiotics
- Anticholinergics
- Benzodiazepines
- Calcium channel blockers
- Ibuprofen
- Indomethacin
- Omeprazole
- Quinine
- Quinidine
What are 12 drug/drug types that DECREASE Digoxin effects/toxicity?
- Aminoglycosides
- Antacids
- Antihistamines
- Barbituates
- Chemotherapy drugs
- Cholestyramine
- Dietary fiber
- Oral hypoglycemics
- Penicillamine
- Phenytoin
- Rifampin
- Sucralfate
What are 4 monitoring parameters associated with Digoxin use?
- Monitor serum levels of drug
- Monitor electrolytes
- Renal function
- ECG
How is Digoxin administered? What consideration should be taken for elderly?
Oral or IV
Must use lower doses for elderly
Digoxin doses need to be adjusted to reflect metabolism, how does the dose need to be adjusted for hypo- hyperthyroidism or high fever?
Hypothyroidism: Decrease dose
Hyperthyroidism or high fever: Increase dose
Which pharmaceutical should be used for the following conditions?
Bradycardia, iridocyclitis, heart block (Mobitz type 1 second-degree and third-degree), hyperhidrosis, organophosphate poisoning, PUD
Atropine
Which pharmaceutical is antimuscarinic (anticholinergic) and increases AV and SA node activity?
Atropine
What are 9 adverse effects associated with use of Atropine?
- Dry mouth
- Dry eyes
- Blurred vision
- Mydriasis
- Photophobia
- Confusion
- Hallucinations
- Tachycardia
- V-fib
What are 2 antidotes for Atropine?
- Physostigmine
2. Pilocarpine
What are 2 contraindication for use of Atropine? In which population should caution be used?
- Narrow-angle glaucoma
- Ischemic heart block
Use caution in elderly
T/F: Atropine has synergistic toxicity with other anticholinergic drugs
True
T/F: Atropine potentiates the effects of bradycardia drugs (e.g. beta-blockers)
FALSE: Atropine counteracts effects of bradycardia drugs
What are 3 routs of administration of Atropine?
- Oral
- IV
- IM
Which pharmaceutical should be used for the following conditions?
Serious ventricular arrhythmias, chemical cardioversion of A-fib, NOT a first-line antiarrhythmic because of significant (potentially fatal) toxicity
Amiodarone
Which pharmaceutical is a class III antiarrhythmic agent and is a sodium channel blocker w/ affinity for inactivated channels, in contrast to quinidine?
Amiodarone
What are 10 adverse effects associated with use of Amiodarone? Which populations should caution be used when administering this medication?
- Hypotension
- Neurological adverse events
- Nausea/Vomiting
- CHF
- Arrhythmias
- Fever
- Fatigue
- Photosensitivity
- Involuntary movement
- Muscle weakness
Use caution in surgical patients and elderly
What are 5 contraindications for use of Amiodarone?
- Serious sinus-node dysfunction
- Second or Third degree AV block
- Bradycardia causing syncope
- Pregnancy
- Breast-feeding
Note: Safety in pediatric patients is not established
There are many interactions with use of Amiodarone and they tend to be quite serious. Why does it take more >1 week for drug interactions to show up with this medication?
Long half-life
What are 6 monitoring parameters associated with use of Amiodarone?
- Monitor thyroid levels closely
- HR
- ECG
- Lethargy
- Edema
- Pulmonary function tests
What is the oral Amiodarone used to manage? When is this medication switched to IV treatment and prophylaxis?
Life-threatening V-fib and V-tach; recurring V-fib and unstable V-tach use when oral treatment is indicated but not tolerated
