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Pharmacy Foundations Flashcards

1
Q

Muscarinic receptor

A

Substrate acetylcholine
Agonist: paraympathetic ANS (wet) (pilocarpine, bethanechol)
Antagonist: sympathetic (dry) (atropine, oxybutynin)

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2
Q

Nicotinic receptor

A

Substrate: acetylcholine
Agonist: increase HR and BP (nicotine)
Antagonists: neuromuscular blockade (rocuronium etc)

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3
Q

Alpha-1 receptor

A

Substrate; epinephrine, norepinephrine
Mainly peripheral
Agonist: vasoconstriciton of smooth muscles and increased BP (phenylephrine, dopamine)
Antagonist: vasodilation of smooth muscles and decreased BP (doxazosin, carvedilol, phentolamine)

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4
Q

Alpha-2 receptor

A

Substrate; epinephrine, norepinephrine
Mainly central and brain
Agonist: inhibits release of Epi and NE, decreased BP and HR (clonidine, brimonidine)
Antagonist: increased BP and HR (ergot alkaloids, yohimbine)

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5
Q

Beta-1 receptor

A

Substrate; epinephrine, norepinephrine
Mainly heart
Agonist: increased contractility, CO, HR (dobutamine, isoproterenol, dopamine)
Antagonist: decreased CO and HR (metoprolol, propranolol, carvedilol)

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6
Q

Beta-2 receptor

A

Substrate: epinephrine
Mainly in lungs
Agonist: bronchodilator (albuterol, terbutaline, isoproterenol)
Antagonist: bronchoconstriction (propranolol, carvedilol)

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7
Q

Dopamine receptor

A

Substrate: dopamine
Agonist: renal, cardiac, and CNS effects (levodopa, pramipexole)
Antagonist: renal, cardiac, and CNS effects (haloperidol, metoclopermide)

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8
Q

Serotonin receptor

A

Substrate: serotonin
Agonist: platelet, GI, psychiatric (triptans)
Antagonist: platelet, GI, psychiatric (ondansetron, quetiapine)

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9
Q

Acetylcholinesterase

A

Breaks down acetylcholine
Inhibitors: donepezil, rivastigmine, galantamine
Results in increased ACh to treat Alzheimer’s

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10
Q

Angiotensin-converting enzyme

A

Converts angiotensin I to II that controls vasoconstriction
Inhibitors: lisinopril, ramipril
Resulting in decreased vasoconstriction and aldosterone secretion to treat hypertension, HF, and kidney disease

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11
Q

Catechol-O-methyltransferase

A

Breaks down levodopa
Inhibitor: entacapone
Blocks peripheral breakdown resulting in better duraiton of levodopa to treat Parkinson’s

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12
Q

Cyclooxygenase

A

Converst arachidonic acid to prostaglandins to cause inflammation, and thromboxane A2 to cause platelet aggregation
Inhibitors: aspirin, ibuprofen
Results in decreased inflammation, and platelet aggregation

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13
Q

Monoamine oxidase

A

Breaks down catecholamines (DA, NE, 5-HT)
Inhibitors: phenelzine, tranylcypromine, isocarboxazid, selegiline, rasagiline, methylene blue, linezolid
Results in increased catecholamine levels to treat depression
Overdose: hypertensive crisis, serotonin syndrome

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14
Q

Phosphodiesterase

A

Breaks down cGMP, which is a smooth muscle relaxant
Inhibitors (5): sildenafil, tadalafil
Competitively binds to cGMP active site on the PDE-5 enzyme resulting in smooth muscle relaxation to treat erectile dysfunction

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15
Q

Vitamin K epoxide reductase

A

Converts vitK to the active form to create clotting factors
Inhibitor: warfarin
Results in less clotting factors being produced such as II, VII, IX, X for blood clot prevention

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16
Q

Xanthine oxidase

A

Breaks down hypoxanthine and xanthine to uric acid
Inhibitor: allopurinol
Results in decreased uric acid production to treat gout

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17
Q

Neutral functional groups

A

Alcohol primary group, ketone, aldehyde, amide, nitrate, nitro, aromatic benzene ring, urea, carbonate, carbamate, ether, thioether

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18
Q

Acidic functional groups

A

Carboxyl, phenol, imide, sulfonamide

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19
Q

Basic functional groups

A

Amine primary group, amine tertiary group, imine, amidine

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20
Q

Essential drug structures

A

Amoxicillin, ceftriaxone, ertapenem, aztreonam, gentamicin, sulfamethoxazole, aspirin, ibuprofen, amphetamine, levothyroxine, amiodarone, fenofibrate, amitriptyline, chlorpromazine

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21
Q

Common prodrugs

A

Capecitabine; fluorouracil
Clopidogrel; metabolites active
Codeine; morphine
Colistimethate; colistin
Famciclovir; penciclovir
Fosphenytoin; phenytoin
Isavuconazonium sulfate; isavuconazole
Levodopa; dopamine
Lisdexamfetamine; dextroamphetamine
Prednisone; prednisolone
Primidone; phenobarbital
Tramadol; metabolites active
Valacyclovir; acyclovir
Valganciclovir; ganciclovir

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22
Q

Common CYP inhibitors

A

GPACMAN
Grapefruit juice
Protease inhibitors, especially ritonavir
Azole antifungals
Cyclosporine, cobiscistat
Macrolides, except azithromycin
Amiodarone, dronedarone
Non-DHP CCB

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23
Q

Common CYP inducers

A

PS PORCS
Phenytoin
Smoking
Phenobarbital
Oxcarbazepine
Rifampin, rifabutin, rifapentine
Carbamazepine
St. John’s Wort

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24
Q

Common p-gp substrates, inhibitors, inducers

A

Substrates: anticoagulants (esp riva and api), cardiovascular (esp digoxin, verapamil, diltiazem), immunosuppressants (esp cyclosporine, tacrolimus), HCV drugs, and colchicine
Inducers: same as CYP inducers plus dexamethasone, and tipranavir
Inhibitors: Anti-infectives, cardiovascular drugs (esp amiodarone, diltiazem, verapamil), HIV drugs (esp cobiscistat, ritonavir), cyclosporine

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25
Common CYP substrates
3A4: Analgesics, anticoagulants, immunosuppressants, statins, HIV (esp NNRTI), PDE-5 inhibitors, ethinyl estradiol 1A2: theophylline, warfarin 2C8: amiodarone, pioglitazone, repaglinide 2C9: warfarin 2C19; clopidegrel 2D6: analgesics, antipsychotics, antidepressants, tamoxifen
26
Normal BMP
Na: 135-145mEq/mL K: 3.5-5mEq/mL Cl: 95-106mEq/mL Ca: 8.5-10.5mg/dL Ca, ion: 4.5-5.1mg/dL Mg: 1.3-2.1mEq/mL PO4: 2.3-4.7mg/dL HCO3 venous: 24-30mEq/mL HCO3 arterial: 22-26mEq/mL BUN: 7-20mg/dL SCr: 0.6-1.3mg/dL Glu: 70-110mg/dL AG: 5-12mEq/mL
27
Normal CBC
WBC: 4-11 thousand cells/mm3 Neut: 45-73% Bands: 3-5% Eos: 0-5% Baso: 0-1% Lymph: 20-40% Mono: 2-8% RBCm: 4.5-5.5 thousand cells/mcL RBCfe: 4.1-4.9 thousand cells/mcL HGBm: 13.5-18g/dL HGBfe: 12-16g/dL HCTm: 38-50% HCTfe: 36-46% MCV: 80-100fL Folate: 5-25mcg/L B12: >200pg/mL Reticulocyte: 0.5-2.5% G6PD: 5-14Units/g
28
Normal anticoagulants
Anti-XaLMWH: 1-2IU/mL peak Anti-XaHep: 0.3-0.7IU/mL peak PT: 10-13sec INR: <1.2 aPTT: 22-38sec PLT: 150-450 thousand cells/mm3
29
Normal liver and GI tests
Alb: 3.5-5g/dL AST: 10-40units/L ALT: 10-40units/L TBili: 0.1-1.2mg/dL Amylase: 60-180units/L Lipase: 5-160units/L
30
Normal cardiovascular
CK/CPKm: 55-170IU/L CK/CPKfe: 30-135IU/L TnT: <0.1ng/mL TnI: <0.5ng/mL BNP: <100pg/mL NT-proBNPm: <61pg/mL NT-proBNPfe: 12-151pg/mL LDL: <100mg/dL HDL: >60mg/dL TG: <150mg/dL TChol: <200mg/dL CRP: <0.5mg/dL
31
Normal diabetes
FPG: <100mg/dL, >126mg/dL diabetic A1c: <7% C-peptide fasting: 0.78-1.89ng/mL UAE: <30mg/d
32
Normal thyroid, gout, and inflammation
TSH: 0.3-3mIU/L Uric acidM: 3.5-7.2mg/dL Uric acidFe: 2-6.5mg/dL RF: <20IU/L ESRm: <20mm/H ESRfe: <30mm/H
33
Normal HIV
CD4: >200cells/mm3 HIV RNA: 0copies/mL
34
Normal acid-base
pH: 7.35-7.45
35
Normal hormones
PSA: <4ng/mL
36
Normal other;
Lactic acid: 0.5-2.2mEq/L TPMT: >15units/mL VitD: >30ng/mL
37
Common therapeutic drug levels
Carbamazepine: 4-12mcg/mL Digoxin AF: 0.8-2ng/mL Digoxin HF: 0.5-0.9ng/mL Genta/Tobra P: 5-10mcg/mL Genta/Tobra Tr: <2mcg/mL Li: 0.6-1.2mEq/L Phenytoin: 10-20mcg/mL Free phenytoin: 1-2.5mcg/mL Procainamide: 4-10mcg/mL NAPA (metabolites): 15-25mcg/mL Both: 10-30mcg/mL Theophylline: 5-15mcg/mL Valproic acid: 50-100mcg/mL Vanco Bad: 15-20mcg/mL Vanco Fine: 10-15mcg/mL Warfarin: 2-3 INR Warfarin mechanical: 2.5-3.5 INR
38
FDA colored books
Orange: interchangeable Brand/generic Pink: epidemiology and vaccine preventable diseases Pink Sheet: news reports on regulatory, legislature, legal, and business development Purple: Biologics and biosimilars Red Phar: pricing Red Peds: peds ID's, tx, and vaccines Yellow: international traveler's Green: animal drugs
39
Common drugs with diluent requirements; NS or dextrose only
NS only, no dextrose: A DIAbetic Can't Eat Pie Ampicillin, daptomycin, infliximab, ampicillin/sulbactam, caspofungin, ertapenem, phenytoin Dextrose only, no NS: Outrageous Bakers Avoid Salt Oxaliplatin, Bactrim, Amphotericin B, Synercid
40
Common drugs with leaking in PVC and filters
Issues with PVC: Leach Absorbs To Take In Nutrients Lorazepam, amiodarone, tacrolimus, taxanes, insulin, nitroglycerin Filter requirements (5 microns): GAL Is PAT who has a MaP Golimumab, Amphotericin B lipid, Lipids (1.2 microns), Isavuconazonium, pheytoin, amiodarone, taxanes, Mannitol, parenteral nutrition (1.2 micron)
41
Common drugs that cannot be refrigerated
Dear Sweet Pharmacist Freezing Makes Me Edgy Dexedetomidine Sulfamethoxazole/trimethoprim Phenytoin Furosemide Metronidazole Moxifloxacin Enoxaparin
42
Common drugs that must be protected from light
Protect Every Necessary Med from Daylight Phytonadione (vitK) Epoprostenol Nitroprusside Micafungin Doxycycline
43
Colored IV solutions
Red: anthracyclines, rifampin Blue: mitoxantrone Yellow: methotrexate, multivitamins Orange: tigecycline Brown: IV iron
44
Medication problems
Untreated medical treatment No indications Improper drug selection for indication Dose is too high or low Therapeutic duplication Patient does not know about it Drug allergies Drug interactions Improper use Failure to receive meds Adverse drug reactions Nonadherence
45
High alert medications
IV or inhaled anesthesias, IV antiarrythmias, anticoagulants, antiplatelets, chemotherapeutics, epidurals or intrathecal, hypertonic saline, immunosuppressants, inotropics, insulins, magnesium sulfate inj, neuromuscular blockers, opioids, hypoglycemic, parenteral nutrition, KCl and PO4 inj, sterile water.
46
Types of drug allergies
Type I: IgE mediated immediate reaction; urticaria, bronchospasms, angioedema, anaphylaxis Type II: antibody mediated delayed 5-8 days after; hemolytic anemia, thrombocytopenia Type III: immune complex delayed 7 day reaction; serum sickness Type IV: T cell mediated delayed 2-7 days after; Stevens-Johnson syndrome
47
Meds associated with phototoxicity
Amiodarone, thiazide and loop diuretics, methotrexate, retinoids, quinolones, St. John's Wort, sulfa drugs, tacrolimus, tetracyclines, voriconazole
48
Meds associated with severe cutaneous side effects
Allopurinol, amoxicillin, ampicillin, carbamazepine, ethosuximide, lamotrigine, nevirapine, phenytoin, sulfamethoxazole, sulfasalazine, vancomycin
49
Meds that follow Michaelis-Menten kinetics
Phenytoin, theophylline, voriconazole Do not double dose to adjust, use smaller increments and based on levels or toxicity
50
HLA pharmacogenomics
HLA-B*5701 positive should avoid abacavir due to hypersensitivity risk. HLA-B*5801 positive should avoid allopurinol due to SJS. HLA-B*1502 positive should avoid carbamazepine, oxcarbazepine, phenytoin, and fosphenytoin due to SJS and TEN. Testing is needed for carbamazepine in Asian patients and is recommended for all others.
51
CYP pharmacogenomics
2C19: *1 fully functional. *2 and *3 are poor metabolizers and should not use clopidogrel due to lack of conversion to active prodrug. 2D6: ultra-rapid metabolizers should avoid codeine due to increased conversion to morphine. Nursing mothers should also avoid due to infant deaths. Poor metabolizers should also not be used. 2C9: *2 and *3 should start at a lower dose of warfarin due to increased risk for bleeding. VKORC1 G>A variant: start at a lower dose of warfarin.
52
Other pharmacokinetics
HER2 negative cannot use HER2 inhibitors (trastuzumab) due to lack of efficacy. KRAS positive (aka wild type) should avoid EGFR inhibitors (cetuximab) due to lack of efficacy Low TPMT activity should start at a low dose of azathioprine due to the risk of myelosuppression. DPD deficiency do not use fluorouracil or capecitabine due to high risk for severity.
53
Avoid drugs in these positive screenings
HLA and KRAS
54
Avoid drugs in these negative screenings
HER2
55
Testing recommended or strongly encouraged for these drugs
Abacavir and combinations, azathioprine, carbamazepine, EGFR inhibitors (cetuximab), and HER2 inhibitors (trastuzumab). May consider also testing for allopurinol, capecitabine, fluorouracil, clopidogrel, codeine, phenytoin, fosphenytoin, and warfarin.
56
Commonly used supplements in disease states: Anxiety, ADHD, cold sores, cold and flu, dementia, depression, diabetes, dyslipidemia, dyspepsia, energy/weight loss, heart health, erectile dysfunction, hypertension, GI health, inflammation, insomnia, liver disease, menopause, migraine, motion sickness, osteoarthritis, osteoporosis, prostate health, skin conditions, UTI, and weight loss.
Anxiety: valerian, passionflower, kava, St. Johns Wort, chamomile, 5-HTP (hydroxytryptophan). ADHD: omega-3 fatty acids. Cold sores: L-lysine. Cold/flu: echinacea, zinc, vitamin C, eucalyptus oil, probiotics. Dementia: ginkgo, vitamin E, vitamin D, acetyl-L-carnitine, vinpocetine. Depression: St. John's Wort, SAMe, valerian, 5-HTP. Diabetes: Alpha lipoic acid, chromium, cassia cinnamon, magnesium, American ginseng, Panax ginseng. Dyslipidemia: Red yeast rice, omega-3 fatty acids, garlic, plant sterol, fibers, artichoke extract. Dyspepsia: calcium, magnesium, peppermint, chamomile. Energy: bitter orange, caffeine, guarana. Erectile dysfunction: ginseng, L-arginine, yohimbine. Heart health: Coenzyme Q10, hawthorn, omega-3 fatty acids. Hypertension: omega-3 fatty acids, L-arginine, coenzyme Q10, garlic, fiber, potassium. GI health: fibers, chamomile, probiotics, peppermint, horehound, wheatgrass. Inflammation: omega-3 fatty acids, flax seeds, turmeric. Insomnia: melatonin, valerian, chamomile, lemon balm, passionflower, coenzyme Q10, 5-HTP, L-tryptophan. Liver disease: milk thistle. Menopause: black cohosh, dong quai, evening primrose oil, red clover, soy, Panas ginseng. Migraine: feverfew, butterbur, magnesium, vitamin B2 (riboflavin), coenzyme Q10, guarana, caffeine. Motion sickness: ginger, peppermint. Osteoarthritis: glucosamine, chondroitin, SAMe, turmeric. Osteoporosis: calcium, vitamin D, soy, ipriflavone. Prostate: saw palmetto, lycopene, pygeum, pumpkin seed. Skin: tea tree oil, aloe vera, vitamin D, biotin. UTI: cranberry, yogurt, probiotics. Weight loss: garvinia cambogia.
57
Safety issues with common supplements
St. John's Wort: induces CYP 3A4, 2C19, 2C9, 1A2, is serotonergic, photosensitivity, and lowers the seizure threshold. Increased bleeding risk: 5 G's; garlic, ginger, ginkgo, ginseng, glucosamine, fish oils, vitamin E, dong quai, willow bark, feverfew, Liver toxicity; black cohosh, kava, chaparral, comfrey, green tea extracts. Cardiac toxicity; bitter orange, DMAAlicorice, yohimbe. Serotonergic; 5-HTP, SAMe. Allergic reactions: artichoke extract, chamomile, echinacea. Other heart: Qt prolongation with passionflower, positive inotrope with hawthorn (interacts with digoxin).
58
Iron recommendations and levels
0-4 months: not required 4-6 months: 1mg/kg/d 6-12 months: 11mg/d 12-36 months: 7mg/d
59
Meds that cause nutrient depletions
Acetazolamide: Ca, K Antiepileptics: Ca Amphotericin B: Mg, K Isoniazid: B6 Loops: K Metformin: B12 Methotrexate: B9 Orlistat: B-carotene, fat soluble vitamins PPI: Mg, B12 Sulfamethoxazole: B9
60
Vitamin names
A; retinol B1; thiamine B2; riboflavin B3; niacin B6; pyridoxine B9; folic acid B12; cobalamin C; ascorbic acid D2; ergocalciferol D3; cholecalciferol E; alpha-tocopherol
61
Diseases with recommended supplements
Alcohol use disorder; B1, B9 Goiter; iodine Microcytic anemia; ferrous sulfate Macrocytic anemia; B12, B9 Pregnancy; B6, B9, Ca, D Osteopenia; Ca, D CKD; D Scurvy; C Crohn's; iron, zinc, B, D, Ca Bariatric surgery; patient-specific
62
Drug overdose symptoms and management
Acetaminophen: N/V, hepatotoxicity 24-48h, hepatic failure 48-96h. NAC using Rumack-Matthew monogram. Anticholinergics (atropine, Benadryl, dimenhydrinate, belladonna, jimson weed): Dry as a bone, red as a beet, blind as a bat etc. Physostigmine rarely. Anticoagulants: bleeding. Andexanet alfa for apixaban/rivaroxaban, idarucizumab for dabigatran, phytonadione or Kcentra for warfarin, protamine for LMWH or heparin, Kcentra for Xa inhibitors. Antipsychotics; benztropine or bicarbonate. Benzos; flumazenil. BB; glucagon, insulin, lipi emulsion. CCB: glucagon, insulin, lipid emulsion, Ca. Cyanide (nitroprusside); hydroxocobalamin (Cyanokit, Na thiosulfate with Na nitrite (Nithiodote). Digoxin, oleander, foxglove; digoxin immune Fab. 40mg vials bind 0.5mg digoxin. Heavy metals: dimercaprol for arsenic, gold, Hg, penicillamine for copper, ferric hexacyanoferrate (Prussian blue) for thallium, and for lead either dimercaprol with Ca Na2 EDTA edetate, or succimer with DMSA dimercaptosuccinic acid. Hydrocarbons; do not induce vomiting. Insulin; dextrose, glucagon, and octreotide for sulfonylureas. isoniazid; vitamin B6, benzos, barbiturates. Iron, Al: deferoxamine. Iron overload: deferiprone, deferasirox. Local anesthetics: IV lipid emulsion 20% Methotrexate; leucovorin (folinic acid), levoleucovorin (Fusilev), glucarpidase (Voraxaze) Methemoglobinemia (benzocaine, dapsone, nitrates, sulfonamide); methylene blue except in G6PD, SSRI, and SNRI. Amatoxin mushrooms; atropine. Naphthalene mothballs; methylene blue. Neostigmine, pyridostigmine; pralidoxime, atropine, glycopyrrolate. Nicotine; early sx abdominal pain and nausea, late sx bradycardia. Atropine and benzos. Paralytics; neostigmine methylsulfate for Roc, Vec, and Pan, or sugammadex for Roc or Vec. Salicylates; bicarb. Stimulants; benzos. Alcohols; fomepizole or ethanol. TCA: bicarb, benzos, vasopressors. Valproate (hyperammonia); levocarnitine.
63
Organophosphate overdose and treatment
SLUDD: salivation, lacrimation, urination, diarrhea, defecation. Atropine blocks ACh. Pralidoxime reactivates cholinesterase. Combo is called DuoDote. Usually caused by pesticides.
64
Antidotes to bites and stings
Animal bites generally: Rabies vaccine (RabAvert, Imovax) or human immune globulin (HyperRAB S/D, Imogam Rabies HT). Black widow spider: Antivenin for Latrodectus mactans. Scorpion stings: Antivenin immune FAB Centruroides (Anascorp). Snake bites: Crotalidae polyvalent immune FAB (CroFab) for copperheads and rattlesnakes, and Crotalidae immune Fab2 (Anavip) for rattlesnakes.

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