Pharmacology review Flashcards
what hypertension medication class should not be given to those that have gout?
thiazide diuretics
a side effect patients can develop is hyperuricemia and hyperglycemia therefore its contraindicated.
what two labs need to monitored in patients that are taking an ACE inhibitor or an ARB?
when should it be monitored?
serum potassium and serum creatinine
It should be monitored at baseline, within the first month and periodically especially in elderly, diabetics, and those with CKD.
what is the recommended INR goal for patients on anticoagulants with atrial fibrillation?
2 to 3 for atrial fibrillation
2.5 to 3.5 for prosthetic heart valves
The herbal supplement feverfew can be used for what purposes?
migraines, irregular menstrual periods, tinnitus, and other conditions
Drugs that acts an “inhibitors” do what?
they slow down drug clearance ( which increases drug concentration)–makes pt at risk for drug overdose and adverse effects.
what class of medication do these belong to?
Erythromycin
Clarithromycin
Telithromycin
Macrolides
what class of medication do these belong to?
Ketoconazole
fluconazole
itraconazole
Anti-fungals
Cimetidine is also known as what?
tagamet
Citalopram is also known as what?
Celexa
what class of medication do these belong to?
saquinavir
indinavir
nelfinavir
protease inhibitors
what drugs are adversely affected by grapefruit juice?
statins
erythromycin
calcium channel blockers (nifedipine, nisoldipine)
antivirals (indinavir, saquinavir)
amiodarone
benzodiazepines (diazepam, traizolam)
cisapride
carbamazepine
buspirone
The herbal supplement feverfew is used for what?
migraine, irregular menstrual periods, tinnitus, and other conditions
pharmacology
the study of the interaction between the body and the drugs
pharmacokinetics
the movement of drugs through the body (absorption, bioavailability, distribution, metabolism, and excretion)
pharmacodynamics
the study of the physiologic and biochemical effects of drugs ( what a drug does to the body)
pharmacogenomics
the study of how a person’s genes affect response to medications.
what is half life?
the amount of time in which drug concentration decreases by 50%
area under the curve means
the average amount of a drug in the blood after a dose is given. it is a measure of the bioavailability of a drug after it is administered
maximum concentration is
the peak serum concentration of a drug
minimum inhibitory concentration
the lowest concentration of an antibiotic that will inhibit the growth of organisms (after overnight incubation)
maximum concentration
the highest concentration of a drug after a dose
trough
is the minimum concentration, the lowest concentration of a drug after a dose
do sublingual drugs go through a first pass metabolism?
no
what is responsible for the biotransformation (metabolism) of a drug?
the cytochrome P450 system
A drug being induced in the CYP450 system means what?
increases drug metabolism
a drug being inhibited in the CYP450 system means what?
slows down drug metabolism, increases drug concentrations…high risk for overdose
what is the organ responsible for biotransformation and what is the organ responsible for drug elimination?
liver is responsible for biotransformation
kidney is responsible for drug elimination
what are some pharmacokinetic age related changes?
increased fat to water ratio
decrease in albumin and plasma proteins
decrease in liver blood flow and size
decrease in some CYP450 enzyme pathways (decreased drug clearance)
decrease in glomerular filtration rate (GFR)
Warfarin (Coumadin) interacts with “G” herbs such as…
Garlic
Ginger
Ginkgo
Ginseng
also feverfew, green tea, and fish oil.
discontinue 7 days before surgery `
For people of chinese descent, what statin should they not be put on?
Simvastatin 40 mg/d or higher with niacin because of high risk myopathy or rhabdo
For bisphosphonate such as alendronate (Fosamax) and Risedronate (Actonel), what are the safety concerns?
Erosive esophagitis (chest pain while eating, dysphagia, heart burn), stop immediately if symptoms of esophagitis (chest pain, difficulty swallowing, burning midback) or jaw pain.
Take medication alone upon awakening with 8 oz of water, not juice, before breakfast. do not lie down for 30 minutes afterward; don’t mix with other drugs.
what are s/s of digoxin overdose?
initial symptoms are GI (N/V), hyperkalemia, and bradydysrhythmias or tachydysrhythmias (v-fib, v-tach, a-fib, a-tac. also confusion and visual changes (yellowish-green tinged color vision)
Mayonnaise, canola oil, and soybean oil have high levels of what?
vitamin K
phytonadione is also called what?
vitamin K
what are adverse effects of thiazide diuretics?
Hydrochlorothiazide, Indapamide (Lozol), Chlorthalidone
elevates plasma glucose/hyperglycemia, elevates cholesterol and LDL, elevates uric acid (gout atack), hypokalemia
what class of anti-hypertension medications should be given to a patient with both hypertension and osteoporosis?
Thiazide diuretics
because thiazide diuretics reduce calcium excretion by the kidneys and stimulate osteoblasts which help build bone.
what is important to know about beta blockers in diabetic patients?
Beta blockers can blunt hypoglycemic response (warn diabetic patients to initially monitor blood sugars more often)
Direct renin inhibitors (Aliskiren/Tekturna) should not be used with which classes of anti-hypertension meds?
ACE inhibitors and ARBs
Alpha blockers, alpha 1 adrenergic antagonists have two functions what are they?
relaxes smooth muscles on the bladder neck and the prostate, and improves symptoms of BPH
what ending do the alpha 1 adrenergic antagonist have?
“osin”
examples;
terazosin
doxazosin
tamulosin
alfuzosin
silodosin
what are adverse effects of alpha 1 adrenergic blockers?
orthostatic hypotension (common in elderly)
dizziness, syncope
priapism (flomax)
ACE inhibitors (end in pril) give examples
Ramipril (Altace)
Lisinopril (Zestril, Prinivil)
Benazepril (Lotensin)
Captopril (Capoten)
Enalapril (Vasotec)
Fosinopril (Monopril)
Perindopril (Aceon)
Quinapril (Accupril)
Trandolapril (Mavik)
Combination: Lisinopril and HCTZ (Zestoretic), enalapril and HCTZ (Vaseretic), captopril and HCTZ (Capozide), benazepril and amlodipine (Lotrel)
ARBs end in sartan, give examples
Losartan (Cozaar)
Irbesartan (Avapro)
Valsartan (Diovan)
Candesartan (Atacand)
Telmisartan (Micardis)
Olmesartan (Benicar)
Eprosartan (Teveten)
Combination: Losartan and HCTZ (Hyzaar), valsartan and HCTZ (Diovan HCT), valsartan and amlodipine (Exforge)
what are adverse effects of ACE inhibitors and ARBs?
Hypotension
ACEI cough
Hyperkalemia
Angioedema and anaphylactoid reactions
Acute kidney injury (AKI)
ACE inhibitors induced cough and angioedema are caused by what?
inhibition of the metabolism of bradykinin and kallikrein system which are involved in the inflammatory process
Captopril is associated with what?
agranulocytosis, neutropenia, and leukopenia. Monitor CBC
calcium channel blockers have what functions?
causes vasodilation, decrease myocardial force generation, decreases heart rate, decreases conduction velocity
which meds are in the calcium channel blocker class?
Nondihydropyridines
Amlodipine (Norvasc)
Nifedipine (Procardia, Adalat CC)
Felodipine (Plendil)
Nicardipine (Cardene)
Isradipine (Dynacirc)
Nondihydrpyridines
verampil
diltiazem
what anti-hypertensive class should not be given to patients with chronic lung diseases such as asthma, copd, emphysema, chronic bronchitis?
beta blockers should not be given
(propranolol, atenolol, metoprolol, pindolol)
phosphodiesterase 5 inhibitors are what kind of medication?
They are for men to get an erection
Example: Sildenafil (viagara), tadalafil (Cialsis), and vardenafil (levitra)
what are 3 safety teaching to instruct patients on phosphodiesterase inhibitors?
- don’t mix with nitrates (nitroglycerine) and some alpha blockers
- erection lasting more than 4 hours, go to the ED
- Don’t give within 3-6 months of an MI or Stroke
what cardiac changes would you see on ekg with a patient on celexa?
prolonged QT interval, maximum dose for pts older than 60 is 20 mg/day
Bactericidal antibiotics do what?
kill bacteria
Bacteriostatic antibiotics do what?
limit bacterial growth and replication
tetracyclines are what kind of antibiotic?
bacteriostatic
Warfarin mixed with erythromycin or clarithromycin should not be used because
it can cause increase risk of bleeding
which antibiotics belong to the class of macrolides?
Erythromycin
clarithromycin (Biaxin)
Azithromycin (zithromax, z-pack)
what cephalosporin is the first line treatment for gonorrheal infections?
ceftriaxone (Rocephin) 500 mg IM
3rd generation cephalosporin
For MRSA skin infections such as boils and abscess, what is the first line therapy?
Bactrim DS or clindamycin, treat for at least 5 to 10 days
what is the treatment for mononucelosis?
penicillin VK
if penicillin allergy, use macrolide antibiotic
Dicloxacillin is used for what?
staph skin infections such as mastitis and impetigo
Cephalexin (keflex) po daily is used to treat what?
1st generation
uncomplicated skin and soft tissue infections (not caused by MRSA), impetigo.
can be used in pregnancy for urinary tract infections
Cefdinir (omnicef) daily to BID can be used to treat what?
Cefixime (Suprax) daily to bid can be used to treat what?
Ceftriaxone (Rocephin) treats what?
3rd generation cephalosporins
Cefdinir to treat AOM in children, acute rhinosinusitis
cefixime can treat pyelonephritis and CAP
Cefitraxone (Rocephin) IM treats gonorrheal infections
Penicillin VK PO QID treats what?
strep throat
Amoxicillin BID to TID treats what?
otitis media (first line), rhinosinusitis. Otitis media/rhinosinusitis (first to second line)
Amoxicillin plus clavulanic acid) (Augmentin PO BID) treats what?
cystitis
Benzathine penicillin G IM treats what?
syphilis
Dicloxacillin po QID treats what?
penicillinase-resistant penicillin; cellulitis (not caused by MRSA), impetigo, erysipelas
what do fluoroquinolones end in?
oxacin
examples of fluoroquinolones are?
ciprofloxacin
ofloxacin
levofloxacin
moxifloxacin
gemifoloxacin
what is the big adverse black box warning with fluoroquinolones?
increased risk of achilles tendon rupture. avoid strenous activity while on the drug. stop drug if tendon pain/swelling develops.
Ciprofloxacin (Cipro) BID treats what?
Anthrax infection, prophylaxis, treats pseudomonal pna in cystic fibrosis.
traveler’s diarrhea.
Ofloxacin (Floxin) BID treats what?
Urinary tract infections, pyelonephritis, epididymitis, and prostatitis.
BBW: risk of tendinitis and achilles tendinopathy/rupture
levofloxacin (levaquin) daily treats what?
community acquired penumonia, acute exacerbation of chronic bronchitis, pyelonephritis, epididymitis, prostatitis
increases risk of hypoglycemia
sulfonamide are they bacteriostatic or bactericidal?
bacteriostatic
what other drugs have sulfa in it?
Diuretics (furosemide, acetazolamide, HCTZ)
Sulfonylureas (e.g., glyburide, glipizide); glyburide may be used in gestational diabetes occurring beyond 25 weeks’ gestation
COX-2 inhibitor (celecoxib [Celebrex])
Dapsone (for HIV)
Sulfasalazine (for rheumatoid arthritis, Crohn’s disease, ulcerative colitis)
Sumatriptan (Imitrex)
Nitrofurantoin
Sulfites to preserve foods (wines, balsamic vinegar, beverages, deli meats)
Bactrim DS BID treats what?
MRSA cellulitis and UTIs, pyelonephritis
pregnant women with a UTI can be treated with what antibiotics?
beta lactams, nitrofuratonin, and fosfomycin.
what antibiotic is an alternative for a patient who has strep throat but is allergic to penicillins?
clindamycin
Penicillin-Allergic Patient With Strep Throat
An 18-year-old female patient has a positive throat culture and sensitivity (C&S) for S. pyogenes (group A beta streptococci). The patient reports a history of an allergic reaction to penicillin with “swollen lips” accompanied by itchy hives. Which of the following is the most appropriate treatment?
a.Clarithromycin (Biaxin) 250 mg PO twice a day × 10 days
b.Gargle with salt water three times a day
c. Cephalexin (Keflex) 250 mg PO four times a day × 10 days
d. Doxycycline 100 mg PO twice a day × 10 days
Correct answer is option A: Clarithromycin (Biaxin) 250 mg PO twice a day × 10 days
also can be: Azithromycin x5 days (z-pack)
A 16-year-old high school athlete is returning for follow-up for a severe sore throat. During the physical exam, purulent exudate is noted on both tonsils. Tender lymph nodes that are 1 cm in diameter are palpable on the posterior cervical chains. The lungs are clear. The rapid strep antigen test is positive for group A beta hemolytic Streptococcus. The Monospot test (heterophile antibody test) is positive. What is the best initial clinical management of this patient?
A. Initiate a prescription of amoxicillin 500 mg PO twice a day × 10 days.
B.Initiate a penicillin V 250 mg PO prescription three times a day × 10 days.
C. Order an Epstein–Barr virus titer to determine whether the patient has acute or a reactivated mononucleosis infection.
D. Write a prescription for an abdominal ultrasound to determine the size of the patient’s liver and spleen
B: Initiate a penicillin V 250 mg PO prescription three times a day × 10 days.
what are examples of decongestants? what should you advise pts?
pseudoephedrine (sudafed) and phenylephrine.
they are a stimulant, and contraindicated in pts with hypertension and CAD
what is the first line drug for osteoarthritis/degenerative joint disease?
acetaminophen (Tylenol)
Capsaicin cream is used to treat what?
trigeminal neuralgia and postherpetic neuralgia
Clinical pearls about a severe case of poison ivy or poison oak rash may requires how many days of an oral steroid to cear?
14 to 21 days
what are some drugs in the DEA category schedule I?
heroin, ectasy/MDMA, PCP
illegal to presribe, no currently accepted for medical use
DEA schedule II drugs include?
Demerol, diaudid, oxycontin, cocaine, fentanyl
only the original prescription with the prescriber’s signature is acceptable
expires in 6 months of date written on script
if reguarly taken, then a new prescription is written every month because it can’t be refilled on the same script.
DEA schedule III drugs include?
Tylenol with codeine, Vicodin, anabolic steroids, testosterone
DEA schedule IV (4) drugs include?
benzos, ambien, lunesta, soma
DEA schedule V drugs include?
cough medicines with less than 200 mg of codeine, lomotil, lyrica
which scheduled drug classes can be called over the phone?
scheduled III to V medications can be prescribed over the phone, by paper prescription, or by electronic prescribing of controlled substances.
for all controlled substances, you must have:
the prescriber’s DEA number, clinic address on the pad, it can’t be predated or postdated.
What is the maximum number of refills for schedule III to V drugs?
5 with a limit of 90 pills per refill.
Echinachea (purple coneflower): is used for what?
Used to shorten duration of common cold or flu; avoid if history of autoimmune disease or allergic to ragweed (may cause anaphylaxis)
feverfew or butterbur is used for what?
migraine headache
cinnamon is used for what?
improves blood sugar (diabetes) and cholsterol
Glucosamine is used for what?
osteoarthritis
ginkgo biloba is used for what?
Dementia, memory problems, tinnitus; affects blood-clotting; stop taking 2 weeks before surgery (including dental procedures); NSAIDs will increase risk of bleeding.
Natural progesterone cream or sublingual capsules (from Mexican wild yam or soybeans) is used for what?
Premenstrual symptoms and menopausal symptoms such as hot flashes; no research on safety with long-term use
Isoflavones (from soybeans) is used for what?
estrogen like effects
Saw palmetto is used for what?
urinary symptoms of BPH
Kava kava, valerian root: is used for what?
Anxiety and insomnia; do not mix kava kava with CNS drugs, since it will worsen the sedative effect.
St. John’s wort is used for what?
Mild depression; do not use with SSRIs, sumatriptan, HIV protease inhibitors (indinavir), others.
Turmeric is used for what?
Alzheimer’s disease, arthritis, cancer
Fish or krill oil, omega-3 oil is used for what?
Heart disease, high cholesterol, arthritis/joint pain (reduces inflammation)
ayureveda is what?
an ancient healing system from india. foods, spices, herbs, yoga, and lifestyle are believed to prevent and treat disease.
The INR goal of a stroke patient is what?
2 to 3
the INR goal for a patient with a prosthetic valve replacement is what?
2.5 to 3.5
Paroxetine (Paxil) is an SSRI that can cause what?
erectile dysfunction
why is erythromycin and telithromycin contraindicated in patients with myasthenia gravis?
because of potential respiratory collapse
Side effects of nifedinpine (Procardia XL) are what?
edema of the ankle and headache, dizziness, flushing, and weakness.
ACE inhibitors tend to have what side effects?
angioedema and a dry hacking cough
Diuretics can cause what side effects?
hypoglycemia and hyperuricemia
Bell’s palsy is caused by inflammation of what cranial nerve?
cranial nerve 7, facial nerve
Pioglitazone (Actos) is contraindicated in which patients?
Heart failure class III or IV
it causes water retention, should also be avoided in those with hx of bladder cancer.
Patients with sulfa allergies may be sensitive to what medications?
thiazides, loop diuretics, and some protease inhibitors (Darunavair, fosamprenavir) which are used in the treatment of HIV.
are potassium sparing diuretics a safe alternative for patients with severe sulfa allergy?
Yes
what are symptoms of reye’s syndrome?
Severe vomiting, diarrhea, lethargy, stupor, elevated ALT and AST. Personality changes, irritability, aggression, hyperactive reflexes, confusion, delirium, cerebral edema, coma, seizures, and death.
side effects of thiazide diuretics such as hydrochlorothiazide are what?
hyperglycemia, hyperuricemia, hypertriglyceridemia, and hypercholesteremia
patients should be monitored for hypokalemia, hyponatremia, and hypomagnesemia
what is the treatment for chlamydia trachomatis?
Azithromycin 1 g PO in a single dose
or
doxycycline 100 mg po BID x 7 days
what medication causes nausea, vomiting, confusion, and yellowish-green halos in their vision?
digoxin (lanoxin)
digoxin toxicity causes hypokalemia and hypercalcemia ?
true
lithium toxicity causes what?
seizures, slurred speech, increased urination, and increased thirst
Dilantin (phenytoin) toxicity symptoms include what?
nystagmus, ataxia, and confusion
carbamazepine (tegretol) toxicity will present as what ?
skin rash and jaundice
terazosin (Hytrin) is used to treat symptoms of what?
BPH and HTN
Silodosin (Rapaflo)is used to manage the s/s of what?
BPH
what is the first line therapy for a child with impetigo?
1 Mupirocin
what hormone will a NP prescribe to a 28 yr old female with hypothyroidism?
levothyroxine T4
what is the frist line treatment for a patient with a dog/cat bite?
amoxicillin-clavulanate (Augmentin)
`
if penicillin allergy, do Bactrim DS
which class of antibiotic is the first line treatment for an unvaccinated infant diagnosed with pertussis?
Macrolides (azithromycin, erythromycin, or clarithromycin )
what effect does finasteride (Proscar) have on prostate-specific antigen (PSA) levels in patients with prostate cancer?
the chronic effect of finasteride is the stabilization of the PSA
it is used to treat prostate cancer, has a gradual decline of the patient’s PSA.
What effect does ASA have on platelet function?
the effect on platelet function is irreversible and lasts 10 days
what is a major side effect of medroxyprogesterone (Depo-provera)?
increases risk of bone loss
what is the first line treatment for patients iwth osteoporosis?
bisphosphonates
what is the osteopenia range?
-1.5 to -2.4
what is a potential adverse effect of long-term haloperidol therapy?
tardive dyskinesia
it is an extrapyramidal side eff`ect involving involuntary rhythmic movements.
what benzodiazepine has the shortest half life?
Triazolam (Halcion)
