Pharmacology Unit 4 - Endocrine Pt. 4 Flashcards
there is some evidence to support efficacy of echinacea in the early treatment of _______________
colds
Echinacea should be avoided in individuals with _________________
immune deficiencies / autoimmune disorders
if Echinacea is used > 10-14 days it can lead to
immunosuppression & hepatic failure
adverse rxn of echinacea when used IV
flu like sx
adverse rxn of echinacea p.o.?
GI upset
rash
What are your common botanical supplements?
- Echinacea
- Garlic
- Ginkgo
- Ginseng
- Milk Thistle
- St. Johns Wort
- Saw Palmetto
if someone is taking a medication that has a disulfiram type reaction, which supplement should be avoided d/t the high alcohol content?
Echinacea
Garlic can be in the ____________, _____________, or ______________ form
dried; powdered; aged
uses of Garlic
- reduces total cholesterol and total triglycerides
- antiplt
- anti-htn
- cancer prevention
what is the biggest concern with a pt taking garlic supplements?
bleeding
Garlic should be cautioned in pts taking ____________________ meds
anticoagulant (warfarin, ASA, ibuprofen)
S/e with Garlic Supplements
- Nausea
- hypotension
- allergic rxn
- bleeding
- bad breath/body odor
Ginko uses
- improves PVD
- decreases oxidative stress in CABG pts through scavenging of free radicals
- possible antiplt effects
Ginko has been studied for what conditions? however, insufficient evidence to support clinical use at this time
- allergic and asthmatic bronchoconstriction
- short term memory in health non-demented adults
- ED
- tinnitus & hearing loss
- macular degeneration
There are over ____________ different types of Ginseng, but all are marketed as “Ginseng”
30
which herbal supplement claims to be an adaptogen?
ginseng
uses of Ginseng
- immune modulation (inc WBC)
- Increases ACh, Serotonin, NE, and Dopa
- antioxidant effects
- anti-inflammatory effects
- vasoregulatory effects
- cardioprotective activity
- improved glucose hemostasis
- anticancer properties
- antiplt meds
Ginseng supplementation should be cautioned in what patients?
- those taking psych meds
- those taking anticoagulants
- those with immunosuppression/taking immunosuppressants
Ginseng + psych meds –>
irritiability, sleeplessness, & manic behavior
Ginseng has the strongest support for its uses in ?
- cold prevention
- lowering post-prandial glucose
- non specific cancer prevention
what is milk thistle used for?
- liver disease
- chemotherapeutic effects
- lactation
in europe, milk thistle is given IV as a treatment for ___________________
mushroom poisoning
at high doses, > 1500 mg, milk thistle will have a _________________ effect
laxative
St. Johns Wort is used for
depression
MOA of St. Johns Wort
inhibits the reuptake of serotonin, NE ,and Dopa –> antidepressant effect
s/e of St. Johns Wort
- high level of photosensitivity
- hypomania and mania
- autonomic arousal
St. Johns Wort should bed avoided/used cautiously in pts taking _______________ or ________________
antidepressants; stimulants
which botanical supplement has been found to induce the CYP450 system?
St. Johns Wort
Which meds have been found to be at sub-therapeutic levels when used with St. Johns Wort, due to its CYP450 inducing effects?
- Digoxin
- Birth control meds
- cyclosporine
- HIV protease and nonnucleoside reverse transcriptase inhibitors
- Warfarin
- irinotecan
- Theophylline
- Anticonvulsants
Saw Palmetto supplements are used in the tx of
BPH
____________________ is a botanical supplement which produces similar effects to finasteride and tamulosin
saw palmetto
s/e with saw palmetto supplements
- ABD pain
- N/D
- fatigue
- HA
- decreased libido
- rhinitis
- liver damage
- pancreatitis
- increased bleeding
purified nutritional supplements are from _________________ or _____________ source, but they are not from ________________
human; non-human; plants
what are your purified nutritional supplements?
- Coenzyme Q10
- Glucosamine
- Melatonin
Coenzyme Q10 is found where?
in the mitochondria of organs
Conenzyme Q10 is used for
- HTN
- CHF
- ischemia - reduces reinfarction after acute MI
- statin induced myopathy
Conenzyme Q10 has little to no s/e in doses of ______________ mg/day
3000
s/e with coenzyme Q10
- N/D
- Heartburn
- anorexia
Coenzyme Q10’s structure is very similar to ________________; therefore, it should NOT be used in patients taking _____________________
vitamin K; warfarin
Glucosamine is commercially derived from ______________ & _______________
crabs; crustaceans
Glucosamine supplements are used for?
OA
which supplement has the potential for cross contamination with shellfish allergies
glucosamine
melatonin is used for
- jet lag
- insomina
melatonin is best used for jet lag when travelling > ___________ time zones
4
which supplement will increase heart rate and blood pressure through direct and indirect sympathomimetic effects?
ephedra
what are the perioperative concerns with the supplement ephedra?
- MI
- stroke
- ventricular arrhythmias with halothane
- intraoperative hemodynamic instability
- life threatening interaction with MAOIs
ephedra should be d/c’d at least _______________ before surgery
24 hours
Garlic supplements should be D/C’d at least _________________ before surgery
7 days
perioperative concerns in pt taking Ginseng supplements
- hypoglycemia
- bleeding risk
- decreased anticoagulation effects of warfarin
Ginkgo supplements should be d/c’d ________________ before surgery
36 hours
Ginseng should be D/c’d _____________________ before surgery
7 days
Kava should be d/c’d at least __________________ before surgery
24 hours
St. John’s Wort should be d/c’d at least _____________________ before surgery
5 days
perioperative concerns with Kava supplementation
- increases sedative effects of anesthetics
perioperative concerns of pt taking valerian supplements
- potential to increase sedative effects of anesthetics
- benzodiazepine like acute withdrawal
- potential to increase anesthetic requirements with long term use
anything classified as a ______________________ drug is determined to be a medication about which directions for safe use by the public can be written
over the counter (OTC)
T/F: OTC meds are regulated by the FDA
true
with OTC meds, there is a approximately 1000 ingredients in a variety of forms and combinations, this increases the risk for what?
drug-drug interactions
there are over _______________ systemic pain relievers advertised and available to the public as OTC drugs,
100
of large number of OTC pain relievers, most all contain _____________, ______________, _______________ or some combination of these primary ingredients
asprin; acetaminophen; ibuprofen
T/F: in general the less expensive generic OTC is equally effective as the propriety product (ex: Tylenol vs walmart brand acetaminophen)
true
due to lack of information of generic equivalents of many brand name OTC’s, the general public generally chooses which OTC meds?
the ones that are the most heavily advertised
what are some examples of drugs that are inappropripriate for consumer self diagnosis and treatment, thus are not available OTC ?
- statins
- oral acyclovir
what are 2 of the actions the FDA has made to OTC drugs over the past 45 years?
- ingredients designated as ineffective or unsafe for their claimed therapeutic use are being eliminated from OTC product formulations
- agents previously only available by prescription are now available for OTC use
T/F: there are OTCs available in low dose that are also available in a prescription strenght
true
why have classification switches from prescription only to OTC declined significantly over the past decade?
reclassification processes is costly and rigorous
FDA 2008 FDA advisory alert on OTC meds?
- there is limited data on efficacy of OTC cold remedies in children under 12
- OTC cold and cough agents should not be used in infants and children less than 2 years of age
- pharmaceutical co. changed labels of cold and cough meds to say “do not use in children under 4”
OTC 2008 FDA advisory alert on cold and cough meds for pediatrics included which types of meds?
- antitussives
- expectorants
- decongestants
- antihistamines
T/F: insurance companies will pay for a prescription med even when a similar OTC preparation is available
false; they will not pay for the prescription med
Why do providers need to know/be informed of OTC meds?
- OTC can tx common aliments, and providers can help pts in selecting appropriate med
- there are inactive ingredients in OTCs that can worsen existing medical conditions, and/or interact with prescription drugs
- misuse/abuse of OTCs can cause significant medical problems
- due to pt condition or pt meds it is sometimes important that one OTC is chosen over another
what is the OTC med phenylpropanolamine? why was it removed from US shelves?
a sympathomimetic in cold, allergy, and weight control products ; increases the risk of hemorrhagic stroke
what common OTC antitussive is abused by adolescents as a hallucinogen by them taking 5-10x the recommended cough suppressing dose
dextromethorphan (found in mucinex DM and robitussin)
___________________ is an OTC med that is often combined with acetaminophen, antihistamines, and/or sympathomimetics, and can be fatal when taken at 5-10x the normal dose
dextromethorphan
____________________ is a common decongestant found in cold remedies that has been used in the illicit manufacturing of methamphetatmines
pseudoephedrine
meds that contain ________________, ______________, or _______________, must be purchased from behind the counter with an ID, and can only be purchased once per month
pseduoephedrine; ephedrine; phenylpropanolamine
what is the max dose of acetaminophen that should not be exceeded within 24 hours
4000 mg
cumulative dosage of tylenol exceeding 4000mg in 24 hours, plus chronic alcoholism significantly potentiates the risk of acetaminophen toxicity due to the unintentional depletion of ____________________
glutathione
OTC recommendation guidelines
- single ingredient; simplest form preferred
- select a product that contains a therapeutically effective dose
- encourage pts to read the drug facts label
- recommend a generic product if one is available
- be wary of advertising claims of specific superiority over similar products
- dose, dosage form, and palatability of med are important things to consider.
alcohol (% ethanol) is hidden in what type of OTC drugs
- cough syrups
- cold preparations
- mouthwashes
antihistamines are hidden in what type of OTC drugs
- analgesics
- menstrual products
- sleep aids
aspirin/salicyclates are often hidden in what OTC drugs
- anti-diarrheals
- antacids
- menstrual products
- cold/allergy preparations
caffeine is often hidden in what OTC drugs
- analgesics
- menstrual products
- stimulants
local anesthetics, usually benzocaine; are hidden in what OTC drugs
- antitussives/lozenges
- dermatologic preparations
- hemrrhoidal products
- toothache/teething products
- cold sore products
sodium is hidden in what OTC drugs
- analgesics
- antacids
- cough/cold preparations
- laxatives
sympathomimetics are hidden in what OTC drugs
- analgesics
- asthma products
- cold/cough remedies
- allergy preparations
- hemorrhoidal products
sympathomimetic containing agents should be avoided or used cautiously in pts with which conditions?
- T1DM
- HTN
- angina
- hyperthyroidism
________________________ should not be used in children or adolescents for the tx of viral illnesses due to the risk of reyes syndrome
asprin
asprin should be avoided in whom?
- peds
- PUD
- Plt disorders
- pts on anti-coagulants
why should NSAIDs be avoided in pts with PUD
it decreases COX1 in the GI tract –> decreased prostaglandins –> decreased protective mucosal layer
why should NSAIDs be avoided in pts with plt disorders and those on anti-coagulants
blocks cyclooxygenase (COX) –> block in the formation of Thromboxane A2 –> impaired plt aggregation and increased bleeding time
_____________________ is often hidden in OTC drugs, and they may cause sedation/drowsiness especially when taking with other sedating agents, CNS depressants, or alcohol
antihistamines
long term use of OTC antacids can cause _____________ and ______________ in the elderly, and possibly __________________
constipation; impaction; hypophosphatemia
OTC laxative use/abuse can cause _________________ and ______________
abdominal cramping; fluid and electrolyte imblances
caffeine containing analgesics, like excedrin, can result in ____________________ when stopped
rebound HA
long term use of analgesics (OTC) can cause ________________________
interstitial nephritis
ASA and NSAID containing OTC analgesics can cause __________________ and _______________ in those consuming more than 3 etoh beverages per day
hepatotoxicity; GI hemorrhage
in a preop hx, when asking about medications, one should specifically ask about _____________________ because not all patients consider them to be “medications”
non-prescription drugs (OTC)
insulin is released at a rate of ______________ microunits/L; but peaks with meals at a rate of _______________ microunits/L
5-15; 60-90
MOA of insulin
- binds to insulin receptor on most tissues
- increases glucose uptake
- increases glycogen synthase activity
- increases glycogen formation
- enhances DNA synthesis
- effects on protein synthesis, lipolysis, and lipogenesis
which glucocorticoids have NO Nacl retaining activity
long acting glucocorticoids: betamethasone and dexmethasone
place the glucocorticoids in order starting with the one that has the greatest anti-inflammatory effects, down to the least anti-inflammatory effects
dexmethasone > betamethasone > fludrocortisone > methylprednisolone > prednisone > hydrocortisone
place the glucocorticoids in order starting with the one that has the greatest NaCl retaining activity to the least
fludrocortisone > hydrocortisone > prednisone > methylprednisolone > betamethasone and dexmethasone
drug facts label must contain what items (in order)
- active ingredients (including amount in dosage units)
- purpose of product (pharmacologic action)
- uses for the product - indications for use
- specific warnings to include pregnancy information
- notice of when the patient should seek medical attn
- side effect/contraindications
- dosage instructions
- inactive ingredients
if someone consumes 3+ etoh beverages per day, ASA and NSAID containing analgesics can cause ________________ and/or _______________
GI hemorrhage; hepatotoxicity
what is the most comprehensive source for information about OTC drugs
handbook of nonprescription drugs
toxicity of ginko will cause
seizures
s/e of ginko
- nausea
- GI upset
- HA
- bleeding
- allergy
- anxiety
- insomnia
- toxicity = seizure
s/e of ginseng with high doses
- vaginal bleeding/mastalgia
- insomnia
- nervousness
- HTN
which herbals cause bleeding
- garlic
- ginko
- ginseng
- glucosamine
which herbal should a patient taking warfarin be educated to avoid due to it being similar in structure to vitamin K thus will cause sub-therapeutic levels?
coenzyme Q10
perioperatively blood pressure is low 2ndary to pt taking ephedra, how should you treat it?
with direct vasoconstrictor like phenylephrine
