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LEIK FNP Review > Pharmacology review > Flashcards

Pharmacology review Flashcards

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1
Q

what hypertension medication class should not be given to those that have gout?

A

thiazide diuretics

a side effect patients can develop is hyperuricemia and hyperglycemia therefore its contraindicated.

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2
Q

what two labs need to monitored in patients that are taking an ACE inhibitor or an ARB?

when should it be monitored?

A

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.

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3
Q

what is the recommended INR goal for patients on anticoagulants with atrial fibrillation?

A

2 to 3 for atrial fibrillation

2.5 to 3.5 for prosthetic heart valves

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4
Q

The herbal supplement feverfew can be used for what purposes?

A

migraines, irregular menstrual periods, tinnitus, and other conditions

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5
Q

Drugs that acts an “inhibitors” do what?

A

they slow down drug clearance ( which increases drug concentration)–makes pt at risk for drug overdose and adverse effects.

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6
Q

what class of medication do these belong to?

Erythromycin
Clarithromycin
Telithromycin

A

Macrolides

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7
Q

what class of medication do these belong to?
Ketoconazole
fluconazole
itraconazole

A

Anti-fungals

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8
Q

Cimetidine is also known as what?

A

tagamet

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9
Q

Citalopram is also known as what?

A

Celexa

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10
Q

what class of medication do these belong to?

saquinavir
indinavir
nelfinavir

A

protease inhibitors

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11
Q

what drugs are adversely affected by grapefruit juice?

A

statins
erythromycin
calcium channel blockers (nifedipine, nisoldipine)
antivirals (indinavir, saquinavir)
amiodarone
benzodiazepines (diazepam, traizolam)
cisapride
carbamazepine
buspirone

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12
Q

The herbal supplement feverfew is used for what?

A

migraine, irregular menstrual periods, tinnitus, and other conditions

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13
Q

pharmacology

A

the study of the interaction between the body and the drugs

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14
Q

pharmacokinetics

A

the movement of drugs through the body (absorption, bioavailability, distribution, metabolism, and excretion)

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15
Q

pharmacodynamics

A

the study of the physiologic and biochemical effects of drugs ( what a drug does to the body)

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16
Q

pharmacogenomics

A

the study of how a person’s genes affect response to medications.

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17
Q

what is half life?

A

the amount of time in which drug concentration decreases by 50%

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18
Q

area under the curve means

A

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

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19
Q

maximum concentration is

A

the peak serum concentration of a drug

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20
Q

minimum inhibitory concentration

A

the lowest concentration of an antibiotic that will inhibit the growth of organisms (after overnight incubation)

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21
Q

maximum concentration

A

the highest concentration of a drug after a dose

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22
Q

trough

A

is the minimum concentration, the lowest concentration of a drug after a dose

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23
Q

do sublingual drugs go through a first pass metabolism?

A

no

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24
Q

what is responsible for the biotransformation (metabolism) of a drug?

A

the cytochrome P450 system

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25
Q

A drug being induced in the CYP450 system means what?

A

increases drug metabolism

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26
Q

a drug being inhibited in the CYP450 system means what?

A

slows down drug metabolism, increases drug concentrations…high risk for overdose

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27
Q

what is the organ responsible for biotransformation and what is the organ responsible for drug elimination?

A

liver is responsible for biotransformation

kidney is responsible for drug elimination

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28
Q

what are some pharmacokinetic age related changes?

A

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)

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29
Q

Warfarin (Coumadin) interacts with “G” herbs such as…

A

Garlic
Ginger
Ginkgo
Ginseng

also feverfew, green tea, and fish oil.

discontinue 7 days before surgery `

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30
Q

For people of chinese descent, what statin should they not be put on?

A

Simvastatin 40 mg/d or higher with niacin because of high risk myopathy or rhabdo

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31
Q

For bisphosphonate such as alendronate (Fosamax) and Risedronate (Actonel), what are the safety concerns?

A

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.

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32
Q

what are s/s of digoxin overdose?

A

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)

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33
Q

Mayonnaise, canola oil, and soybean oil have high levels of what?

A

vitamin K

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34
Q

phytonadione is also called what?

A

vitamin K

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35
Q

what are adverse effects of thiazide diuretics?
Hydrochlorothiazide, Indapamide (Lozol), Chlorthalidone

A

elevates plasma glucose/hyperglycemia, elevates cholesterol and LDL, elevates uric acid (gout atack), hypokalemia

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36
Q

what class of anti-hypertension medications should be given to a patient with both hypertension and osteoporosis?

A

Thiazide diuretics
because thiazide diuretics reduce calcium excretion by the kidneys and stimulate osteoblasts which help build bone.

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37
Q

what is important to know about beta blockers in diabetic patients?

A

Beta blockers can blunt hypoglycemic response (warn diabetic patients to initially monitor blood sugars more often)

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38
Q

Direct renin inhibitors (Aliskiren/Tekturna) should not be used with which classes of anti-hypertension meds?

A

ACE inhibitors and ARBs

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39
Q

Alpha blockers, alpha 1 adrenergic antagonists have two functions what are they?

A

relaxes smooth muscles on the bladder neck and the prostate, and improves symptoms of BPH

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40
Q

what ending do the alpha 1 adrenergic antagonist have?

A

“osin”
examples;
terazosin
doxazosin
tamulosin
alfuzosin
silodosin

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41
Q

what are adverse effects of alpha 1 adrenergic blockers?

A

orthostatic hypotension (common in elderly)
dizziness, syncope
priapism (flomax)

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42
Q

ACE inhibitors (end in pril) give examples

A

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)

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43
Q

ARBs end in sartan, give examples

A

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)

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44
Q

what are adverse effects of ACE inhibitors and ARBs?

A

Hypotension

ACEI cough

Hyperkalemia

Angioedema and anaphylactoid reactions

Acute kidney injury (AKI)

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45
Q

ACE inhibitors induced cough and angioedema are caused by what?

A

inhibition of the metabolism of bradykinin and kallikrein system which are involved in the inflammatory process

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46
Q

Captopril is associated with what?

A

agranulocytosis, neutropenia, and leukopenia. Monitor CBC

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47
Q

calcium channel blockers have what functions?

A

causes vasodilation, decrease myocardial force generation, decreases heart rate, decreases conduction velocity

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48
Q

which meds are in the calcium channel blocker class?

A

Nondihydropyridines
Amlodipine (Norvasc)

Nifedipine (Procardia, Adalat CC)

Felodipine (Plendil)

Nicardipine (Cardene)

Isradipine (Dynacirc)

Nondihydrpyridines
verampil
diltiazem

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49
Q

what anti-hypertensive class should not be given to patients with chronic lung diseases such as asthma, copd, emphysema, chronic bronchitis?

A

beta blockers should not be given
(propranolol, atenolol, metoprolol, pindolol)

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50
Q

phosphodiesterase 5 inhibitors are what kind of medication?

A

They are for men to get an erection
Example: Sildenafil (viagara), tadalafil (Cialsis), and vardenafil (levitra)

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51
Q

what are 3 safety teaching to instruct patients on phosphodiesterase inhibitors?

A
  1. don’t mix with nitrates (nitroglycerine) and some alpha blockers
  2. erection lasting more than 4 hours, go to the ED
  3. Don’t give within 3-6 months of an MI or Stroke
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52
Q

what cardiac changes would you see on ekg with a patient on celexa?

A

prolonged QT interval, maximum dose for pts older than 60 is 20 mg/day

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53
Q

Bactericidal antibiotics do what?

A

kill bacteria

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54
Q

Bacteriostatic antibiotics do what?

A

limit bacterial growth and replication

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55
Q

tetracyclines are what kind of antibiotic?

A

bacteriostatic

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56
Q

Warfarin mixed with erythromycin or clarithromycin should not be used because

A

it can cause increase risk of bleeding

57
Q

which antibiotics belong to the class of macrolides?

A

Erythromycin
clarithromycin (Biaxin)
Azithromycin (zithromax, z-pack)

58
Q

what cephalosporin is the first line treatment for gonorrheal infections?

A

ceftriaxone (Rocephin) 500 mg IM
3rd generation cephalosporin

59
Q

For MRSA skin infections such as boils and abscess, what is the first line therapy?

A

Bactrim DS or clindamycin, treat for at least 5 to 10 days

60
Q

what is the treatment for mononucelosis?

A

penicillin VK

if penicillin allergy, use macrolide antibiotic

61
Q

Dicloxacillin is used for what?

A

staph skin infections such as mastitis and impetigo

62
Q

Cephalexin (keflex) po daily is used to treat what?
1st generation

A

uncomplicated skin and soft tissue infections (not caused by MRSA), impetigo.
can be used in pregnancy for urinary tract infections

63
Q

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

A

Cefdinir to treat AOM in children, acute rhinosinusitis

cefixime can treat pyelonephritis and CAP

Cefitraxone (Rocephin) IM treats gonorrheal infections

64
Q

Penicillin VK PO QID treats what?

A

strep throat

65
Q

Amoxicillin BID to TID treats what?

A

otitis media (first line), rhinosinusitis. Otitis media/rhinosinusitis (first to second line)

66
Q

Amoxicillin plus clavulanic acid) (Augmentin PO BID) treats what?

A

cystitis

67
Q

Benzathine penicillin G IM treats what?

A

syphilis

68
Q

Dicloxacillin po QID treats what?

A

penicillinase-resistant penicillin; cellulitis (not caused by MRSA), impetigo, erysipelas

69
Q

what do fluoroquinolones end in?

A

oxacin

70
Q

examples of fluoroquinolones are?

A

ciprofloxacin
ofloxacin
levofloxacin
moxifloxacin
gemifoloxacin

71
Q

what is the big adverse black box warning with fluoroquinolones?

A

increased risk of achilles tendon rupture. avoid strenous activity while on the drug. stop drug if tendon pain/swelling develops.

72
Q

Ciprofloxacin (Cipro) BID treats what?

A

Anthrax infection, prophylaxis, treats pseudomonal pna in cystic fibrosis.

traveler’s diarrhea.

73
Q

Ofloxacin (Floxin) BID treats what?

A

Urinary tract infections, pyelonephritis, epididymitis, and prostatitis.

BBW: risk of tendinitis and achilles tendinopathy/rupture

74
Q

levofloxacin (levaquin) daily treats what?

A

community acquired penumonia, acute exacerbation of chronic bronchitis, pyelonephritis, epididymitis, prostatitis

increases risk of hypoglycemia

75
Q

sulfonamide are they bacteriostatic or bactericidal?

A

bacteriostatic

76
Q

what other drugs have sulfa in it?

A

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)

77
Q

Bactrim DS BID treats what?

A

MRSA cellulitis and UTIs, pyelonephritis

78
Q

pregnant women with a UTI can be treated with what antibiotics?

A

beta lactams, nitrofuratonin, and fosfomycin.

79
Q

what antibiotic is an alternative for a patient who has strep throat but is allergic to penicillins?

A

clindamycin

80
Q

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

A

Correct answer is option A: Clarithromycin (Biaxin) 250 mg PO twice a day × 10 days

also can be: Azithromycin x5 days (z-pack)

81
Q

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

A

B: Initiate a penicillin V 250 mg PO prescription three times a day × 10 days.

82
Q

what are examples of decongestants? what should you advise pts?

A

pseudoephedrine (sudafed) and phenylephrine.
they are a stimulant, and contraindicated in pts with hypertension and CAD

83
Q

what is the first line drug for osteoarthritis/degenerative joint disease?

A

acetaminophen (Tylenol)

84
Q

Capsaicin cream is used to treat what?

A

trigeminal neuralgia and postherpetic neuralgia

85
Q

Clinical pearls about a severe case of poison ivy or poison oak rash may requires how many days of an oral steroid to cear?

A

14 to 21 days

86
Q

what are some drugs in the DEA category schedule I?

A

heroin, ectasy/MDMA, PCP

illegal to presribe, no currently accepted for medical use

87
Q

DEA schedule II drugs include?

A

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.

88
Q

DEA schedule III drugs include?

A

Tylenol with codeine, Vicodin, anabolic steroids, testosterone

89
Q

DEA schedule IV (4) drugs include?

A

benzos, ambien, lunesta, soma

90
Q

DEA schedule V drugs include?

A

cough medicines with less than 200 mg of codeine, lomotil, lyrica

91
Q

which scheduled drug classes can be called over the phone?

A

scheduled III to V medications can be prescribed over the phone, by paper prescription, or by electronic prescribing of controlled substances.

92
Q

for all controlled substances, you must have:

A

the prescriber’s DEA number, clinic address on the pad, it can’t be predated or postdated.

93
Q

What is the maximum number of refills for schedule III to V drugs?

A

5 with a limit of 90 pills per refill.

94
Q

Echinachea (purple coneflower): is used for what?

A

Used to shorten duration of common cold or flu; avoid if history of autoimmune disease or allergic to ragweed (may cause anaphylaxis)

95
Q

feverfew or butterbur is used for what?

A

migraine headache

96
Q

cinnamon is used for what?

A

improves blood sugar (diabetes) and cholsterol

97
Q

Glucosamine is used for what?

A

osteoarthritis

98
Q

ginkgo biloba is used for what?

A

Dementia, memory problems, tinnitus; affects blood-clotting; stop taking 2 weeks before surgery (including dental procedures); NSAIDs will increase risk of bleeding.

99
Q

Natural progesterone cream or sublingual capsules (from Mexican wild yam or soybeans) is used for what?

A

Premenstrual symptoms and menopausal symptoms such as hot flashes; no research on safety with long-term use

100
Q

Isoflavones (from soybeans) is used for what?

A

estrogen like effects

101
Q

Saw palmetto is used for what?

A

urinary symptoms of BPH

102
Q

Kava kava, valerian root: is used for what?

A

Anxiety and insomnia; do not mix kava kava with CNS drugs, since it will worsen the sedative effect.

103
Q

St. John’s wort is used for what?

A

Mild depression; do not use with SSRIs, sumatriptan, HIV protease inhibitors (indinavir), others.

104
Q

Turmeric is used for what?

A

Alzheimer’s disease, arthritis, cancer

105
Q

Fish or krill oil, omega-3 oil is used for what?

A

Heart disease, high cholesterol, arthritis/joint pain (reduces inflammation)

106
Q

ayureveda is what?

A

an ancient healing system from india. foods, spices, herbs, yoga, and lifestyle are believed to prevent and treat disease.

107
Q

The INR goal of a stroke patient is what?

A

2 to 3

108
Q

the INR goal for a patient with a prosthetic valve replacement is what?

A

2.5 to 3.5

109
Q

Paroxetine (Paxil) is an SSRI that can cause what?

A

erectile dysfunction

110
Q

why is erythromycin and telithromycin contraindicated in patients with myasthenia gravis?

A

because of potential respiratory collapse

111
Q

Side effects of nifedinpine (Procardia XL) are what?

A

edema of the ankle and headache, dizziness, flushing, and weakness.

112
Q

ACE inhibitors tend to have what side effects?

A

angioedema and a dry hacking cough

113
Q

Diuretics can cause what side effects?

A

hypoglycemia and hyperuricemia

114
Q

Bell’s palsy is caused by inflammation of what cranial nerve?

A

cranial nerve 7, facial nerve

115
Q

Pioglitazone (Actos) is contraindicated in which patients?

A

Heart failure class III or IV
it causes water retention, should also be avoided in those with hx of bladder cancer.

116
Q

Patients with sulfa allergies may be sensitive to what medications?

A

thiazides, loop diuretics, and some protease inhibitors (Darunavair, fosamprenavir) which are used in the treatment of HIV.

117
Q

are potassium sparing diuretics a safe alternative for patients with severe sulfa allergy?

A

Yes

118
Q

what are symptoms of reye’s syndrome?

A

Severe vomiting, diarrhea, lethargy, stupor, elevated ALT and AST. Personality changes, irritability, aggression, hyperactive reflexes, confusion, delirium, cerebral edema, coma, seizures, and death.

119
Q

side effects of thiazide diuretics such as hydrochlorothiazide are what?

A

hyperglycemia, hyperuricemia, hypertriglyceridemia, and hypercholesteremia
patients should be monitored for hypokalemia, hyponatremia, and hypomagnesemia

120
Q

what is the treatment for chlamydia trachomatis?

A

Azithromycin 1 g PO in a single dose

or

doxycycline 100 mg po BID x 7 days

121
Q

what medication causes nausea, vomiting, confusion, and yellowish-green halos in their vision?

A

digoxin (lanoxin)

122
Q

digoxin toxicity causes hypokalemia and hypercalcemia ?

A

true

123
Q

lithium toxicity causes what?

A

seizures, slurred speech, increased urination, and increased thirst

124
Q

Dilantin (phenytoin) toxicity symptoms include what?

A

nystagmus, ataxia, and confusion

125
Q

carbamazepine (tegretol) toxicity will present as what ?

A

skin rash and jaundice

126
Q

terazosin (Hytrin) is used to treat symptoms of what?

A

BPH and HTN

127
Q

Silodosin (Rapaflo)is used to manage the s/s of what?

A

BPH

128
Q

what is the first line therapy for a child with impetigo?

A

1 Mupirocin

129
Q

what hormone will a NP prescribe to a 28 yr old female with hypothyroidism?

A

levothyroxine T4

130
Q

what is the frist line treatment for a patient with a dog/cat bite?

A

amoxicillin-clavulanate (Augmentin)
`
if penicillin allergy, do Bactrim DS

131
Q

which class of antibiotic is the first line treatment for an unvaccinated infant diagnosed with pertussis?

A

Macrolides (azithromycin, erythromycin, or clarithromycin )

132
Q

what effect does finasteride (Proscar) have on prostate-specific antigen (PSA) levels in patients with prostate cancer?

A

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.

133
Q

What effect does ASA have on platelet function?

A

the effect on platelet function is irreversible and lasts 10 days

134
Q

what is a major side effect of medroxyprogesterone (Depo-provera)?

A

increases risk of bone loss

135
Q

what is the first line treatment for patients iwth osteoporosis?

A

bisphosphonates

136
Q

what is the osteopenia range?

A

-1.5 to -2.4

137
Q

what is a potential adverse effect of long-term haloperidol therapy?

A

tardive dyskinesia
it is an extrapyramidal side eff`ect involving involuntary rhythmic movements.

138
Q

what benzodiazepine has the shortest half life?

A

Triazolam (Halcion)

LEIK FNP Review (19 decks)

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