Pharmacology Test 1 Flashcards
1
Q
Pharmacokinetics definition
A
what the body does to a drug involves ADME
2
Q
Pharmacodynamics definition
A
how a drug affects a body
3
Q
T/F: pharmacy and pharmacology mean the same thing?
A
False
4
Q
Pharmacotherapeutics definition
A
study of the therapeutic use and effects of drugs in the treatment or prevention of disease
5
Q
what does ADME stand for?
A
absorptiondistributionmetabolismexcretion
6
Q
what are the 3 steps in the FDA drug approval process?
A
identify new drug needFDA INDClinical trials
7
Q
what are the 4 phases of clinical trials?
A
- safety2. efficacy3. larger and longer RCT4. post marketing surveillance
8
Q
Off-label and Off-patent difference?
A
off-patent = not paying original develop, anyone can make it;
off-label = not original/FDA approved use for drug
9
Q
is off-label use illegal?
A
no (unless unethical)illegal to market off-label use though
10
Q
3 ways drugs are named
A
chemical, generic, brand/trade names
11
Q
define brand/trade name for drugs
A
drug marketed under a proprietary, trademark-protected name
12
Q
how are controlled substances classified?
A
into 5 schedules, schedule 1 has the highest abuse and dependence level and no medical purpose
13
Q
what are the 2 ways drugs are absorbed?
A
via enteral (GI tract) or parenteral route
14
Q
what are 3 drug types that are absorbed via enteral route?
A
oral,
sublingual,
rectal
15
Q
what are 5 drug types that are absorbed via parenteral route?
A
inhalation, injection, topical, transdermal, implant
16
Q
what are the 3 main pathways a drug gets to a target?
A
- passive diff thru lipid membrane2. passive diff thru aqueous channel3. carrier-mediated
17
Q
define bioavailability
A
% of drug that makes it into systemic circulation
18
Q
what is the first-pass effect/metabolim/elimination?
A
Oral medications that are taken will exit the stomach and can be absorbed up to the liver via the portal vein which can result in a large percentage of the drug being broken down and thus resulting in a decreased bioavailability of that drug.
19
Q
What does volume of distribution tell us?
A
how extensively a drug is distributed to the rest of the body compared to the plasma
20
Q
what does a higher Vd mean?
A
there is more drug in tissue than the blood
21
Q
what are CYP enzymes?
A
enzymes that catalyze reactions to break down drugs, mainly in the liver
22
Q
how are CYPs affected by drug-drug interactions?
A
some drugs induce or inhibit CYP which affects the bioavailability of other drugs
23
Q
what is the difference between first-order and zero order elimination?
A
first-order has a constant half-lifezero order has a constant elimination rate
24
Q
how many half-lives before a drug is considered “cleared”?
A
5
25
how many half-lives does it take to reach "steady state"?
4-5
26
define steady state as it pertains to dosing
amount of drug excreted in specific time frame = amount of drug administered often equal to time to reach therapeutic effect
27
define volume of distribution (Vd)
the ratio of the amount of drug in the total body to the concentration of drug in the plasma
28
define drug
articles intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease in man or other animals
29
what is toxicology?
the study of the harmful effects of chemicals, side effects or adverse effects
30
Schedule I substance
regarded as having the highest potential for abuse and addiction (THC, LSD, heroin, ecstasy)
31
Schedule II substance
approved for specific uses but still have a high potential for addiction (opioids/narcotics)
32
Schedule III substance
lower abuse potential but still might lead to dependence
33
Schedule IV substance
still lower potential for abuse
34
Schedule V substance
lowest relative abuse potential
35
define dose
the amount of drug given at any one time
36
define dosage
the frequency with which a drug dose is to be given
37
What are the 4 drug receptor types?
1. ligand-gated ion channels2. G-protein-coupled receptors3. Kinase-linked receptors4. Nuclear receptors (DNA coupled)
38
what is pharmacodynamics?
the study of the biochemical and physiological effects of drugs on the body and underlying pathologies
39
receptor info for ligand-gated ion channels?
nicotinic ACh receptorsvery quick (milliseconds)
40
receptor info for G-protein-coupled receptors?
Muscarinic ACh receptorsquick (seconds)
41
receptor info for Kinase-linked receptors?
Cytokine receptorslonger (hours)
42
receptor info for nuclear receptors?
estrogen receptors longer (hours)
43
what are 2 other drug targets?
enzymenon-human cells
44
define specificity
drug binds to only one type of receptor
45
define selectivity
can bind to a multiple subtypes of a receptor but it prefers one
46
what are the potential consequences of decreased specificity or selectivity?
less spec-selc = more AEless targeted approach
47
what is an agonist?
drugs that occupy receptors and activate them
48
what is an antagonist?
drugs that occupy receptors but don't activate themblock activation by agonist
49
what is competitive antagonist?
agonist vs antagonisthigher concentration wins
50
what is noncompetitive antagonist?
antagonist binds to secondary receptor, cannot leave, shuts down/blocks agonist effects
51
what is a partial agonist?
similar to agonist but not a perfect fitlower dose leads to some agonist effecthigher dose blocks agonist, leads to diminished effect
52
what is a partial agonist?
similar to agonist but not a perfect fitlower dose leads to some agonist effecthigher dose blocks agonist, leads to diminished effect
53
what is Emax?
maximal responsereceptors are saturatedmay cause toxicity
54
what is ED50?
effective dose to get 50% of expected response
55
how does ED50 relate to potency?
lower ED50 = more potentless drug required for effect
56
Other forms of antagonism?
chemical, physiologic, pharmacokinetic receptor changes
57
What is a quantal-dose response curve?
used to compare safety of a drugtracks % or # of population who has a particular reponse at a given dose
58
what can a quantal-dose response curve help us find?
the smallest effective dose among a population of people.
59
what is TD50?
dose that is toxic for 50% of people
60
What is the Therapeutic Index?
a ratio of TD50 to ED50
61
which is safer: Narrow or Wide therapeutic index?
wide therapeutic index
62
define adverse drug reaction (ADR)
response to a medicine which is noxious and unintended
63
side effect
any unintended effect of a pharmaceutical product occurring at doses normally used by a patient which is related to the pharmacological properties of the drug
64
medication error
any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care pro, pt, or consumer
65
define side effect
any unintended effect of a pharmaceutical product occurring at doses normally used by a patient which is related to the pharmacological properties of the drug
66
define medication error
any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care pro, pt, or consumer
67
define adverse event/experience
any untoward medical occurrence that may present during treatment with a medicine but which does not necessarily have a causal relationship with this treatment
68
serious adverse event is any event that is:
1) . fatal/life threatening
2) .permanently/sig disabling
3) . requires/prolongs hospitalization
4) . causes congenital anomaly
5) . requires intervention
69
what are boxed warnings?
FDA designation added to labels, calls attention to serious/life threatening risk
70
What is the Naranjo Scale/
a questionnaire that helps to determine if a pt is suffering from AE
71
What could cause ADRs?
1) . patient specific factors
2) . drug-drug interactions
3) . HCP error
4) . Nonadherence
72
how to prevent ADRs
simplify med regimensassess adherenceevaluate changes in pt healthavoid polypharmacyuse ISMP recomendations
73
define synergistic interaction
produces a response \> sum of responses to both drugs
74
define antagonists interaction
produce effect \< response produced by each drug alone
75
What is pain?
an experience based on complex interactions of physical and psychological processes
76
what are the 3 types of pain?
nociceptiveneuropathicpsychogenic
77
What neural structures are involved with ascending pain pathways?
periphery sensory neurons, dorsal horn of spinal cord, brain stem, thalamus, somatosensory cortex
78
where would you find 1st order neurons in ascending pathways?
going from the injury site to the dorsal horn of the spinal cord
79
where would you find 2nd order neurons in ascending pathways?
going from the dorsal horn of the spinal cord, crossing over then ascending up to the thalamus
80
where would you find 3rd order neurons in ascending pathways?
going from the thalamus to the somatosensory cortex of the brain
81
Where does interpretation of pain occur?
somatosensory cortex (cerebral cortex)
82
What does the descending pathway do?
modulate/suppression pain signals
83
where does the descending pathway originate?
periaqueductal gray matter of the mid-brain
84
Name some neurotransmitters in the nociceptive pathways
GABA, glutamate, serotonin, norepinephrine, adenosin
85
what is the MOA for opioids?
bind to opioid receptor in CNS to inhibit ascending pain pathways
86
What are the 3 main opioid receptors?
mudeltakappa
87
AE of opioids on CNS
sedation, nausea, respiratory depression, cough suppression, miosis (pinpoint pupil), truncal rigidity
88
AE peripheral effects of opioids
constipationurinary retentionbronchospasmreduced GI motilityPruritus (itching)
89
what to notice for respiratory depression
labored breathing and decreased respiration rate
90
T/F: respiratory depression from opioid can occur even at usual doses
TRUE
91
most opioid drugs bind to which receptor?
mu
92
effects associated with Mu opioid receptors
analgesia, euphoria, respiratory depression, bradycardia, emesis, slowed GI motility, pruritis, high abuse/dependence potential
93
what is nociceptive pain?
produced by injurystabbing, aching, well-localized (exceptions)
94
when is nociceptive pain not localized?
when it originates from visera
95
what is neuropathic pain?
typically indicates nerve involvementburning, tingling sensation
96
what is psychogenic pain?
origin or relationship to pscyh d/o
97
T/F: the 3 types of pain are mutually exclusive and cannot have overlap?
FALSE
98
what are the 2 primary nociceptive afferent neurons?
unmyelinated C fibers finely myelinated A delta fibers
99
in the dorsal horn, what neurotransmitters inhibit pain signal propagation?
NMDA blockersubstance P antagonistsinhibition of NO synthesis
100
what is the substantia gelatinosa?
a collection of gray cells (in dorsal horn) act like gate keeper to regulate pain signals from nociceptive fibers
101
what type of pain is usually created by unmyelinated C fibers?
diffuse pain sensation
102
what type of pain is usually created by finely myelinated A delta fibers?
localized, defined pain sensation
103
Ibuprofen trade name
Motrin Advil
104
Naproxen trade name
AleveNaprosyn
105
Indomethacin trade name
Indocin
106
Celecoxib trade name
Celebrex
107
Meloxicam trade name
Mobic
108
Diclofenac trade name
Voltaren
109
Trolamine salicylate trade name
Aspercreme
110
NSAID medications
IbuprofenNaproxenIndomethacinAspirinCelecoxibMeloxicamDiclofenacTrolamine salicylate
111
NSAID indications
analgesiaantipyreticanti-inflammatory
112
Aspirin indications
analgesiaantipyreticanti-inflammatoryantithrombotic
113
NSAID MOA
reversibly inhibits COX-1 and COX-2 enzymes to decrease prostaglandin formation
114
how is Aspirin's MOA different from other NSAIDS?
it irreversibly binds to COX enzymes, other NSAIDs reversibly bind
115
general NSAID's AE
GIN/VdyspepsiaulcersGI bleedingincreased BPnephrotoxicityCV risk
116
Rare Aspirin AE
skin rashphotosensitivitybronchospamsRaye Syndrome in Children
117
NSAIDs common routes
POtopical IMIV
118
Aspirin common routes
POrectal
119
Opioid drugs
CodeineHydrocodoneHydrocodone w/acetaminophenMorphineOxycodoneOxycodone w/acetminophenFentanylHydromorphoneMeperidineTramadol
120
Hydrocodone w/acetaminophen trade name
Vicodin
121
Morphine trade name
MS Contin
122
Oxycoden trade name
Oxycotin
123
Oxycodone w/acetaminophen trade name
Percocet
124
Fentanyl trade name
Duragesic
125
Hydromorphone trade name
Dilaudid
126
Meperidine trade name
Dermerol
127
what opioid can be perscribed as an antitussive?
codeine
128
Opioid Indication
analgesia
129
Opioid common routes
POrectalIVtopicalsubcutaneousintrathecalintranasaltransmucosaepidural
130
Opioid MOA
bind to opioid receptors in the CNS to inhibit ascending pain pathways
131
Opioid AE CNS effects
sedationnausearespiratory depressioncough suppressionmiosistruncal rigidity
132
Opioid Peripheral AE
constipationurinary retentionbronchospasmsreduced GI motilitypruitis
133
Acetaminophen trade name
Tylenol
134
Acetaminophen Indications
analgesiaantipyreticcombo with NSAID to reduce NSAID dose
135
Acetaminophen Common routes
POIVrectal
136
Acetaminophen MOA
inhibits prostaglandin synthesis in CNS
137
Acetaminophen AE
hepatotoxicity (esp w/alcohol)
138
Corticosteroids Drug List
Cortisone, Prednisone, Methylprednisolone, Prednisolone, Triamcinolone, Betamethasone
139
Corticosteroids Indication
RA, anti-inflammatory
140
Corticosteroids Common routes
PO, IV, intra-articular, topical
141
Corticosteroids MOA
decrease inflammation and suppress immune system
142
Short term corticosteroid AE
inc blood glucose, mood changes, fluid retention
143
Long term Corticosteroids AE
osteoporosis/ increased fracture risk, thin skin, muscle wasting, poor wound healing, adrenal suppression, Cushing's disease, increased risk of infection from immunosuppression
144
brand name Gabapentin
Neurontin
145
Gabapentin indication
neuropathic pain
146
Gabapentin drug class
GABA analog, anticonvulsant
147
Gabapentin common route
PO
148
Gabapentin MOA
bind to alpha 2-delta subunit of a calcium channel to block its effects
149
Gabapentin AE
dizziness, drowsiness
150
Azathioprine drug class
immunosuppresant
151
Azathioprine indication
SLE
152
Azathioprine common routes
PO, injectible
153
Azathioprine MOA
decreases the immune response so the body doesn't attack itself
154
Azathioprine AE
N/V
155
Hyaluronate trade name
Synvisc,Gel-One,Orthovisc
156
Hyaluronate indication
OA
157
Hyaluronate common route
injection
158
Hyaluronate MOA
viscoelastic solution to provide joint lubrication
159
Hyaluronate AE
injection site pain,swelling, rash
160
Lidocaine drug class
anesthetics
161
propofol drug class
anesthetics
162
anesthetic drugs
lidocaine, propofol
163
anasthetic drugs indications
patient controlled analgesia
164
general anasthetic common routes
IV, inhalation
165
regional anasthetic common routes
intrathecal, epidural, inflitration anesthesia, peripheral nerve block, IV, regional block
166
local anasthetic common routes
injection, topical
167
which antibiotic classes inhibit cell walls?
Penecillins, Cephalosporins Glycopeptides
168
which antibiotic classes inhibit protein synthesis?
Aminoglycides Tetracyclines Macrolides
169
which antibiotic classes inhibit DNA/RNA?
Fluoroquinolones, Nitroimidazole Antifolates
170
what pre/suffixes are associated with antibiotics that inhibit cell wall?
-cillin, ceph-, -vancin
171
what pre/suffixes are associated with antibiotics that inhibit protein synthesis?
-mycin -micin -cyclin
172
what pre/suffixes are associated with antibiotics that inhibit DNA/RNA?
-floxacin -idazole Sulfa-
173
Penecillins, Cephalosporins Glycopeptides
which antibiotic classes inhibit cell walls?
174
Aminoglycides Tetracyclines Macrolides
which antibiotic classes inhibit protein synthesis?
175
Fluoroguinolones, Nitroimidazole Antifolates
which antibiotic classes inhibit DNA/RNA?
176
-allinceph- -vancin
what pre/suffixes are associated with antibiotics that inhibit cell wall?
177
-mycin -micin -cyclin
what pre/suffixes are associated with antibiotics that inhibit protein synthesis?
178
-floxacin -idazole Sulfa-
what pre/suffixes are associated with antibiotics that inhibit DNA/RNA?
179
which antibiotic drug classes are gram +/-
Penecillins,
Tetracyclines
Macrolides
Antifolates
180
C-diff infection is treated using what antibiotic?
metronidazole
vancomycin
181
what antibiotic is used to treat respiratory infection?
macrolides
182
what antibiotic is used to treat community based pnemonia?
fluoroquinolones
183
what antibiotics are used to treat MRSA and Staph infections?
Linozolid
184
AE of antifolates
steven-johnson syndrome
allergies
185
AE of fluoroquinolones
Tendon rupure
hypoglycemia
186
AE of Penecillins
Allergies, GI distress
187
AE of cephalosporins
GI hypersentivity
188
AE of aminoglycides
ototoxicity
nephrotoxicity
photosensitivity
189
Macrolides AE
N/V/D
drug/drug interactions
190
AE Glycopeptides
hypotension (fall risk)
nephrotoxicity
redman syndrome
191
which antiobiotics can be administered as eye drops (opthalmic)?
Aminoglycocides
Fluoroquinolones
Macrolides
192
Nitroimidazole AE
GI
metallic taste
nausea
headache
193
which antiobiotics can rarely cause peripheral neuropathy?
Nitroimadzaole
194
How would aminoglycocides increase fall risk?
affects vestibular function (ototoxicity
195
potential AE of Linozolid
serotonin syndrome
thrombocytopenia
196
PT specific pertaining to TB trx
CN VIII damage - increases fall risk
197
tetracycline AE
GI distress, photosensitivity
198
what broad AE should you be concerned about concerning antibiotics?
GI distress (specifically diarrhea)
199
basic pathophysiology of cancer
uncontrolled cell growth
200
causes of cancer
1). extrinsic: carcinogens 2). Intrinsic: genetic mutations/DNA sequences, viral agents, chronic irritation, genetic predisposition, oncogenes
201
General stages of cell lifecycle
G0: cell at restG1: Pre-DNA S: DNA synthesisG2: pre-mitosisMitosis
202
cell-cycle-specific (CCS) agents do what?
target specific phase of cell cycle
203
what are CCS agents more effective on?
rapidly dividing tumors
204
dose frequency of CCS agents
continuous infusion or frequent doses
205
cell-cycle nonspecific (CCN) agents do what?
target the cell during it's entire life cycle (including G0)
206
What areas of the body are primarily adversely affected by chemotherapy?
bone marrow, GI, buccal mucosa, reproductive organs, hair follicles
207
what are CCN agents more effective on?
slow large growing tumors
208
dose frequency/timing of CCN agents
intermittently dose to reduce toxicities
209
what is Nadir?
10-28 days when WBC is at it's lowest, no trx given here
210
what stage of the cell life cycle is chemotherapy not effective?
G0: cell at rest
211
primary treatment (cure) for cancer
surgery, radiation, chemotherapy, biotherapy
212
when is adjuvant therapy used?
after primary trx
213
when is neoadjuvant therapy used?
before primary trx
214
goals/stages of treatment
cure, controlpalliative
215
what is palliative care?
decrease tumor burden, improve QOL, relieve pain
216
Types of cancer trx
radiation, surgery, pharmacotherapy,
217
what is used to treat almost every solid tumor?
radiation
218
Radiation trx AE
1). significant damage to all tissues2). can result in fibrosis of lungs (location dependent)3). fatigue
219
PT concerns for radiation
fatigue, location of tissue damage
220
Cancer trx used to maximize tumor eradication
surgery
221
PT considerations for surgery trx
wound complications, lymphedema, general post-op concerns
222
what are the 3 types of pharmacotherapy?
1). chemotherapy2). targeted therapy 3). immunotherapy
223
chemotherapy
drugs that inhibit growth and replication of cancer cells
224
targeted therapy
blocks genes/proteins, specific genetic mutations
225
immunotherapy
hormones and drugs that use the immune system to trx cancer
226
majority of immunotherapy drugs utilize what?
antibodies that end in -mab, interferon, interleukins (non-specific immunotherapy)
227
what cancer AE should we be most concerned with?
1). thrombocytopena2). neutropenia3). peripheral neuropathy4). pain5). infection6). mouth/throat
228
special precautions for oral chemotherapy
wear gloves when touching laundry or bodily fluids (specific to the oral med)
229
suffix associated with most antiviral drugs
-vir
230
AE influenza A & B
N/V/D, fever (the flu)
231
which forms of Hepatitis do not have a vaccine?
C, D, E
232
T/F: hepatitis D and E are common in the US
False
233
how is hepatitis B treated?
1). Interferon (weekly injection)2). Nucleoside/Nucleotide analog (better, PO)
234
AE of Interferon
flu-like symptoms
235
common AE for DAAs
fatigue, weakness, headache, nausea
236
PT concern with DAAs + corticosteroids
Bradycardia
237
what does HIV target?
immune system -\> CD4 T cells
238
result of HIV progression?
decreased CD4 count leading to AIDS
239
how is HIV treated?
HAART (Highly Active Antiretroviral Treatment)
240
what is HAART?
combo therapy to increase efficacy and decrease resistance
241
patient specific factor in successful management of HIV
ADHERENCE
242
MOA of antivirals
target different points in lifecycle
243
Rehab concerns specific to HIV
1). opportunistic infections2). Neuromuscular problems (myopathy, peripheral neuropathy)3). pt trx include pain management
244
types of fungal infections
1). superficial2). systemic
245
patients at risk for fungal infections
immunosuppression, antibacterial, diabetics, burn victims
246
\*antifungal drugs basic MOA
alter cell membrane permeability
247
2 antifungal classes
1). polyenes, 2). azoles
248
which antifungal drug class is broad spectrum
azoles
249
PD implications of azoles
common CYP interactions
250
which antifungals commonly have DDI?
Azoles
251
Polyene drugs
Nystatin, Amphotericin B
252
Nystatin AE
N/V/D, cramps (PO), rash, urticaria (topical)
253
Azole drugs
Fluconazole, ketoconazole
254
Azole drugs AE
N/V, photophobia, cardiac arrhythmia, menstrual irregularities,
255
primary concern with antifungals
liver damage, elevated serum transaminasekidney damage
256
What are the types of vaccines?
1). inactivated2). subunit/conjugated3). attenuated4). toxoid
257
what is in an inactivated vaccine?
killed pathogen
258
what is in a conjugated vaccine?
piece of the pathogen
259
what is in a live attenuated vaccine?
weakened pathogen
260
what is in a toxoid vaccine?
pathogen toxin instead of actual pathogen
261
which vaccine is good for life?
life attenuated
262
which vaccine should be avoided in immunocompromised populations?
life attenuated
263
areas of virus lifecycle that a virus can impact
1). going into and out of cell (binding/budding)2). movement in cell (uncoating)3). replication (translation/transcription/assembly)
264
what is used to treat Hepatitis C?
DAA
265
What is a therapeutic concern when treating a patient with hepatitis C?
bradycardia
266
for an acute infection of of Hepatitis A what is recommended?
rest, hyrdate, antipyretic drugs, AVOID acetaminophen, typically takes 2-6 months to recover
267
name all the categories of antiviral drugs
antiherpes, anti-influenza, antihepatitis, miscellanis
268
Opioid drugs
Codeine, Hydrocodone, Hydrocodone w/acetaminophen, Morphine, Oxycodone, Oxycodone w/acetminophen, Fentanyl, Hydromorphone, Meperidine, Tramadol, Methadone
269
Hydrocodone w/acetaminophen trade name
Vicodin
270
Morphine trade name
MS Contin
271
Oxycoden trade name
Oxycotin
272
Oxycodone w/acetaminophen trade name
Percocet
273
Fentanyl trade name
Duragesic
274
Hydromorphone trade name
Dilaudid
275
Meperidine trade name
Dermerol
276
what opioid can be perscribed as an antitussive?
codeine
277
Opioid Indication
analgesia
278
Opioid common routes
PO, rectal, IV, topical, subcutaneous, intrathecal, intranasal, transmucosa, epidural
279
Opioid MOA
bind to opioid receptors in the CNS to inhibit ascending pain pathways
280
Opioid AE CNS effects
sedation
nausea
respiratory depression
cough suppression
miosis
truncal rigidity
281
Opioid Peripheral AE
constipation
urinary retention
bronchospasms
reduced GI motility
pruitis
282
Which opioid drugs do not have trade names?
Codeine, Hydrocodone, Tamadol, Methadone
283
DMARD drug list
Methotrexate, Sulfasalazine, Adalimumab, Etanercept, Rituximab Hydroxyhloroquine
284
Non-biologic DMARDs
Methotrexate,SulfasalazineHydroxychloroquine
285
DMARD (biologic TNF Inhibitor)
Adalimumab,Etanercept
286
DMARD (biologic Non-TNF Inhibitor)
Rituximab
287
Adalimumab trade name
Humira
288
Etanercept trade
Enbrel
289
Rituximab trade name
Rituxan
290
DMARD indications
RA
291
what else is methotrexate indicated for?
lupus
292
Hydroxychloroquine Drug Class
DMARD (non-biologic)antimalarial
293
Hydroxychloroquine trade name
Plaquenil
294
Other indications for hydroxychloroquine?
lupus malaria
295
What DMARDs are indicated for lupus?
methotrexatehydroxychloroquine
296
DMARDs common routes
PO, IV, sub cutan
297
which DMARDs have only the PO route?
methotrexate,sulfasalazinehydroxychloroquine
298
which DMARDs are administered IV, or sub cut?
Adalimumab,etanerceptrituximab
299
sulfasalazine and hydroxychloroquine MOA
impacts mediators of inflammatory response
300
methotrexate MOA
possibly impacting IL-1, TNF-alpha, and leukotriene levels
301
DMARD biologic TNF inhibitor MOA
bind TNF-alpha receptors to modulate downstream effects on inflammatory processes
302
Rituximab MOA
basic MOA impacts inflammation process
303
methotrexate common AE
N/V/D, alopecia, malaise
304
methotrexate less common AE
increased liver function tests, heptatoxicity, nephrotoxicity, thrombocytopenia, bone marrow suppression
305
sulfasalazine AE
Nausea, rash, hepatitis, pneumonitis, bone marrow suppression
306
hydroxychloroquine AE
dyspepsia, nausea, abdominal pain, rashes, nightmares and visual disturbances
307
rituximab AE
injection/infusion reactions, increased LFTs, antibody development
308
DMARD (biologic TNF Inh) common AE
headache, infection, antibody development, IV infusion reactions (fever, hypotension, urticaria)
309
DMARD (biologic TNF In) Boxed warnings
serious infections, secondary malignancies like lymphoma
310
what are the three subtypes of DMARDs?
Non-biologic, Biologic (TNF/Non-TNF inhibitor)
311
What 3 drugs are Non-biologic DMARDs?
Methotrexate, Sulfasalazine, Hydroxychloroquine
312
What 2 drugs are TNF Inhibitors?
Adalimumab, Etanercept
313
What drug is a Non-TNF inhibitor?
Tituximab
314
How are biologic DMARDs usually administered?
IV, subcut.
315
How are Non-biologic DMARDs usually administered?
PO
316
What is the basic MOA for DMARDs?
impacts mediators of inflammatory response
317
What is the MOA of Methrotrexate?
unknown, but possibly impacts IL-1, TNF-alpha, leukotreine levels
318
AE of hydroxychloroquine
nightmares, visual disturbances, GI (N, dyspepsia), skin rash
319
which DMARDs have boxed warnings?
Adalimumab, Etanercept
320
AE TNF inhibitors
headache, antibody development, infection, IV reactions
321
common AE Methotrexate
N/V/D, malaise, alopecia,
322
AE Rituximab
increased LFTs, antibody development, injection infusion reaction
323
rare AE Methotrexate
hepatotoxicity, nephrotoxicity, thrombocytopenia, bone marrow suppression
324
MTX PT concerns
hydration, photo-sensitivity, caution: strengthening, stretching, deep tissue work, infection risk
325
brand name Gabapentin
Neurontin
326
Gabapentin indication
neuropathic pain
327
Gabapentin drug class
GABA analog, anticonvulsant
328
Gabapentin common route
PO
329
Gabapentin MOA
bind to alpha 2-delta subunit of a calcium channel to block its effects
330
Gabapentin AE
dizziness, drowsiness
331
Azathioprine drug class
immunosuppresant
332
Azathioprine indication
SLE
333
Azathioprine common routes
PO, injectible
334
Azathioprine MOA
decreases the immune response so the body doesn't attack itself
335
Azathioprine AE
N/V
336
Hyaluronate trade name
Synvisc,Gel-One,Orthovisc
337
Hyaluronate indication
OA
338
Hyaluronate common route
injection
339
Hyaluronate MOA
viscoelastic solution to provide joint lubrication
340
Hyaluronate AE
injection site pain,swelling, rash
341
Lidocaine drug class
anesthetics
342
propofol drug class
anesthetics
343
anesthetic drugs
lidocaine, propofol
344
anasthetic drugs indications
patient controlled analgesia
345
general anasthetic common routes
IV, inhalation
346
regional anasthetic common routes
intrathecal, epidural, inflitration anesthesia, peripheral nerve block, IV, regional block
347
local anasthetic common routes
injection, topical
348
NSAID PT considerations
impacts muscle repair, injury recovery, and cartilage repair. caution against overuse and during Resistance training
349
Opioid PT specific considerations
maximize PT scheduling to maximize pain relief, be aware of fall risk
350
Fentanyl PT specific considerations
w/patches avoid using heat/hot pack
351
Hydromorphone PT specific considerations
develop tolerance to all except constipation, miosis. Generally taken with a laxative
352
Gabapentin PT specific considerations
higher chance of experiencing fall (due to dizziness)
353
Corticosteroids PT specific considerations
diabetic pts can experience massive changes in blood sugar
354
PT specific consideration for all DMARDs
keep pt hydrated
355
methotrexate PT specific consideration
careful w/strengthening, stretching, deep tissue work. Lupus infection control (wash hands, etc.) Photo-sensitivity
356
methotrexate PK/PD considerations
combo MTX w/another DMARD increase efficacy (but also toxicity). Give folic acid to reduce GI, hepatic and hematology toxicity
357
Sulfasalazine PK/PD considerations
DMARDS + high-dose steroids = catabolic effect
358
Azathioprine PT specific considerations
lupus infection control: wash hands, clean equipment, etx. Photosensitivity
359
Hyaluronate PT specific considerations
mindful of swelling, rash following injections
360
Anesthesia PT specific considerations
NM weakness, prolonged drowsiness, potential fall risk, impaired airway clearance
361
what drug is usually safer than NSAIDs or elderly?
Acetaminophen
362
what drug class would be prescribed for short-term RA treatment?
corticosteroids
363
what is the gold standard treatment for RA?
methotrexate
364
which drugs on our list have boxed warnings?
Azathioprine, Adalimumab, Etanercept, Methotrexate,
365
NSAID medications
IbuprofenNaproxenIndomethacinAspirinCelecoxibMeloxicamDiclofenacTrolamine salicylate
366
NSAID indications
analgesiaantipyreticanti-inflammatory
367
Aspirin indications
analgesiaantipyreticanti-inflammatoryantithrombotic
368
NSAID MOA
reversibly inhibits COX-1 and COX-2 enzymes to decrease prostaglandin formation
369
how is Aspirin's MOA different from other NSAIDS?
it irreversibly binds to COX enzymes, other NSAIDs reversibly bind
370
general NSAID's AE
N/V, dyspepsia, ulcers, GI bleeding, increased BP, nephrotoxicity, CV risk
371
Rare Aspirin AE
skin rash, bleed and bruising,
photosensitivity,
bronchospams,
Raye Syndrome in Children
372
NSAIDs common routes
PO
topical
IM
IV
373
Aspirin common routes
POrectal
374
what NSAIDs are antithrombotic?
Aspirin
Celecoxib
Diclofenac
Trolamine Salicylate
Meloxicam
375
If you have GI risk which NSAID is the safest to take?
Ibuprofen (motrin, Advil)
376
If you are at CV risk what is the safest NSAID to take?
Naproxen
377
When should you avoid taking Celecoxib?
If you are at CV risk
378
If you hae CV risk what NSAID should you avoid?
Celexocib
379
If you have CV risk which NSAID is safest to take?
Naproxen
380
If you have GI risk which NSAIDs are safe for you to take?
Celecoxib, Ibuprofen
381
NSAIDs administered by what route give the lowest dose and for the shortest duration?
Topical
382
T/F: someone with CHF shouldn't take NSAIDs because it will increase their fluid retention
TRUE
383
T/F: NSAIDs blunt the action of cardiovascular drugs?
TRUE
384
If a patient is taking Ibuprofen, what should you watch out for?
Elderly, poor kidney function, history of GI bleed, any CV issues
385
what else is methotrexate indicated for?
lupus
386
Hydroxychloroquine trade name
Plaquenil
387
Other indications for hydroxychloroquine?
lupus malaria
388
What DMARDs are indicated for lupus?
methotrexatehydroxychloroquine
389
DMARDs common routes
PO, IV, sub cutan
390
which DMARDs have only the PO route?
methotrexate,sulfasalazinehydroxychloroquine
391
which DMARDs are administered IV, or sub cut?
Adalimumab,etanerceptrituximab
392
methotrexate common AE
N/V/D, alopecia, malaise
393
methotrexate less common AE
increased liver function tests, heptatoxicity, nephrotoxicity, thrombocytopenia, bone marrow suppression
394
sulfasalazine AE
Nausea, rash, hepatitis, pneumonitis, bone marrow suppression
395
hydroxychloroquine AE
dyspepsia, nausea, abdominal pain, rashes, nightmares and visual disturbances
396
rituximab AE
injection/infusion reactions, increased LFTs, antibody development
397
DMARD (biologic TNF Inh) common AE
headache, infection, antibody development, IV infusion reactions (fever, hypotension, urticaria)
398
DMARD (biologic TNF In) Boxed warnings
serious infections, secondary malignancies like lymphoma
399
what are the three subtypes of DMARDs?
Non-biologic, Biologic (TNF/Non-TNF inhibitor)
400
What 3 drugs are Non-biologic DMARDs?
Methotrexate, Sulfasalazine, Hydroxychloroquine
401
What 2 drugs are TNF Inhibitors?
Adalimumab, Etanercept
402
What drug is a Non-TNF inhibitor?
Rituximab
403
How are biologic DMARDs usually administered?
IV, subcut.
404
How are Non-biologic DMARDs usually administered?
PO
405
What is the basic MOA for DMARDs?
impacts mediators of inflammatory response
406
What is the MOA of Methrotrexate?
unknown, but possibly impacts IL-1, TNF-alpha, leukotreine levels
407
AE of hydroxychloroquine
nightmares, visual disturbances, GI (N, dyspepsia), skin rash
408
which DMARDs have boxed warnings?
Adalimumab, Etanercept
409
AE TNF inhibitors
headache, antibody development, infection, IV reactions
410
common AE Methotrexate
N/V/D, malaise, alopecia,
411
AE Rituximab
increased LFTs, antibody development, injection infusion reaction
412
rare AE Methotrexate
hepatotoxicity, nephrotoxicity, thrombocytopenia, bone marrow suppression
413
MTX PT concerns
hydration, photo-sensitivity, caution: strengthening, stretching, deep tissue work, infection risk
414
basic pathophysiology of cancer
uncontrolled cell growth
415
causes of cancer
1). extrinsic: carcinogens 2). Intrinsic: genetic mutations/DNA sequences, viral agents, chronic irritation, genetic predisposition, oncogenes
416
General stages of cell lifecycle
G0: cell at restG1: Pre-DNA S: DNA synthesisG2: pre-mitosisMitosis
417
cell-cycle-specific (CCS) agents do what?
target specific phase of cell cycle
418
what are CCS agents more effective on?
rapidly dividing tumors
419
dose frequency of CCS agents
continuous infusion or frequent doses
420
cell-cycle nonspecific (CCN) agents do what?
target the cell during it's entire life cycle (including G0)
421
What areas of the body are primarily adversely affected by chemotherapy?
bone marrow, GI, buccal mucosa, reproductive organs, hair follicles
422
what are CCN agents more effective on?
slow large growing tumors
423
dose frequency/timing of CCN agents
intermittently dose to reduce toxicities
424
what is Nadir?
10-28 days when WBC is at it's lowest, no trx given here
425
what stage of the cell life cycle is chemotherapy not effective?
G0: cell at rest
426
primary treatment (cure) for cancer
surgery, radiation, chemotherapy, biotherapy
427
when is adjuvant therapy used?
after primary trx
428
when is neoadjuvant therapy used?
before primary trx
429
goals/stages of treatment
cure, controlpalliative
430
what is palliative care?
decrease tumor burden, improve QOL, relieve pain
431
Types of cancer trx
radiation, surgery, pharmacotherapy,
432
what is used to treat almost every solid tumor?
radiation
433
Radiation trx AE
1). significant damage to all tissues2). can result in fibrosis of lungs (location dependent)3). fatigue
434
PT concerns for radiation
fatigue, location of tissue damage
435
Cancer trx used to maximize tumor eradication
surgery
436
PT considerations for surgery trx
wound complications, lymphedema, general post-op concerns
437
what are the 3 types of pharmacotherapy?
1). chemotherapy2). targeted therapy 3). immunotherapy
438
chemotherapy
drugs that inhibit growth and replication of cancer cells
439
targeted therapy
blocks genes/proteins, specific genetic mutations
440
immunotherapy
hormones and drugs that use the immune system to trx cancer
441
majority of immunotherapy drugs utilize what?
antibodies that end in -mab, interferon, interleukins (non-specific immunotherapy)
442
what cancer AE should we be most concerned with?
1). thrombocytopena2). neutropenia3). peripheral neuropathy4). pain5). infection6). mouth/throat
443
special precautions for oral chemotherapy
wear gloves when touching laundry or bodily fluids (specific to the oral med)
444
suffix associated with most antiviral drugs
-vir
445
AE influenza A & B
N/V/D, fever (the flu)
446
which forms of Hepatitis do not have a vaccine?
C, D, E
447
T/F: hepatitis D and E are common in the US
False
448
how is hepatitis B treated?
1). Interferon (weekly injection)2). Nucleoside/Nucleotide analog (better, PO)
449
AE of Interferon
flu-like symptoms
450
common AE for DAAs
fatigue, weakness, headache, nausea
451
PT concern with DAAs + corticosteroids
Bradycardia
452
what does HIV target?
immune system -\> CD4 T cells
453
result of HIV progression?
decreased CD4 count leading to AIDS
454
how is HIV treated?
HAART (Highly Active Antiretroviral Treatment)
455
what is HAART?
combo therapy to increase efficacy and decrease resistance
456
patient specific factor in successful management of HIV
ADHERENCE
457
MOA of antivirals
target different points in lifecycle
458
Rehab concerns specific to HIV
1). opportunistic infections2). Neuromuscular problems (myopathy, peripheral neuropathy)3). pt trx include pain management
459
types of fungal infections
1). superficial2). systemic
460
patients at risk for fungal infections
immunosuppression, antibacterial, diabetics, burn victims
461
\*antifungal drugs basic MOA
alter cell membrane permeability
462
2 antifungal classes
1). polyenes, 2). azoles
463
which antifungal drug class is broad spectrum
azoles
464
PD implications of azoles
common CYP interactions
465
which antifungals commonly have DDI?
Azoles
466
Polyene drugs
Nystatin, Amphotericin B
467
Nystatin AE
N/V/D, cramps (PO), rash, urticaria (topical)
468
Azole drugs
Fluconazole, ketoconazole
469
Azole drugs AE
N/V, photophobia, cardiac arrhythmia, menstrual irregularities,
470
primary concern with antifungals
liver damage, elevated serum transaminasekidney damage
471
What are the types of vaccines?
1). inactivated2). subunit/conjugated3). attenuated4). toxoid
472
what is in an inactivated vaccine?
killed pathogen
473
what is in a conjugated vaccine?
piece of the pathogen
474
what is in a live attenuated vaccine?
weakened pathogen
475
what is in a toxoid vaccine?
pathogen toxin instead of actual pathogen
476
which vaccine is good for life?
life attenuated
477
which vaccine should be avoided in immunocompromised populations?
life attenuated
478
areas of virus lifecycle that a virus can impact
1). going into and out of cell (binding/budding)2). movement in cell (uncoating)3). replication (translation/transcription/assembly)
479
what is used to treat Hepatitis C?
DAA
480
What is a therapeutic concern when treating a patient with hepatitis C?
bradycardia
481
for an acute infection of of Hepatitis A what is recommended?
rest, hyrdate, antipyretic drugs, AVOID acetaminophen, typically takes 2-6 months to recover
482
name all the categories of antiviral drugs
antiherpes, anti-influenza, antihepatitis, miscellanis
