Study Guide Flashcards
1
Q
Main SE of magnesium antacids
A
Diarrhea
2
Q
What med class stimulates receptors on osteoblasts - can lead to bone breakdown?
A
SERMS- Tamoxifen, Raloxifene (Evista) , and Clomiphene (clomid)
3
Q
What formulation of OCP has no androgenic activity?
Possible AE?
A
Drospirenone
- monitor for hyperkalemia
4
Q
Retain water to increase intraluminal pressure
A
Magnesium preps, NaPhos, lactulose, glycerin, sorbitol
osmotics
5
Q
Symptomatic treatment of hyperthyroidism
Blocks hyperadrenergic effects of thyroid excess
Blocks peripheral conversion of T4 to T3
A
β-blockers
6
Q
Tx for IBS
MOA: stimulates intestinal fluid secretion and transit
A
Linaclotide (Linzess)
7
Q
Main SE od calcium antacids
A
constipation
8
Q
GLP-1 receptor antagonist
avoid use in pts with medullary thyroid cancer
A
Liraglutide
9
Q
why can NSAIDS penetrate gastric cells
A
inhibit cox enzymes -> decrease in PGE2 -> increased gastric acid -> decreased bicarb, blood flow & mucus production
10
Q
TX of vasomotor sxs of menopause, SIgnificant 1st pass metabolism-> increased binding of globulins, TGs, HDL, clotting factors
A
Oral Estrogen
11
Q
Proposed uses of uterotonics
A
To empty Uterus- labor/ terminate pregnancy
Stop Bleeding- Immediately Postpartum/ late postpartum hemorrhage
Subinvolution- reduction of uterus to its normal size after childbirth
12
Q
Important teaching info for pt on a G-CSF like Filgrastim (Neupogen)
A
will reduce risk of infection but they can have significant bone pain (bone marrow is trying to make new cells)
13
Q
Phosphate binding to Ca
decreased GI absorption and plasma Ca level, increased PTH synthesis/ secretion is caused by what and then leads to what?
A
Hyperphosphatemia
… Hyperparathyroidism
When renal function is compromised either experimentally or by disease, there is a compensatory enlargement of the remaining nephrons and an increased rate of filtration per nephron. To remain in balance, the phosphate excretion per nephron must also increase.
As renal function progressively declines, increasingly higher levels of PTH are needed to maintain phosphate homeostasis
14
Q
H2 Antagonists - prevents activation of proton pump by inhibiting activation of H2 receptors in gut= suppression of gastric secretions
A
Cimetidine, Nizatidine, Ranidatinie, Famotidine
15
Q
Topical injury from NSAID use
A
Iron trapping- un-ionized goes to facilitation of transport across membrane in acid stomach lumen…
w/ in the cells ionized NSAIDs trap molecules = cellular damage (cant get out)
16
Q
Preferred in practice for hyperthyroidism
Longer ½ life, once daily dosing
More potent than PTU - less frequent serious AEs
A
Methimazole (Tapazole)
17
Q
Type of therapy that Targets a specific gene or protein on a cancerous cell
A
Targeted Therapy
18
Q
Tx for IBS.
MOA: locally active Cl- channel activator that enhances Cl- rich intestinal fluid secretion
A
Lubiprostone (amitiza)
19
Q
Why are hormone drug levels are less variable with the patch and vaginal ring?
A
more continuous absorption
20
Q
Docusate
A
Retains water to soften stools
21
Q
For hypothyroidism … Why not give T3 (Cytomel)?
A
Better to have a reservoir of T4 (prodrug) to normalize metabolism over a wide range of conditions.
Half-life of T3 is shorter (1 day).
22
Q
Potential benefits of Oral contraceptives
A
Potential benefits of Oral contraceptives
23
Q
used for colonoscopy preps
A
(osmotics) and saline laxatives
24
Q
How do Dilantin, Griseofulvin, and Rifampin interact with OCPs?
A
induce metabolism of OCP- need backup!
25
Oral Phosphate Binder:
Binds to dietary phosphate, inhibiting its absorption
Not absorbed
Sevelamer (Renagel, Renvela)
26
What happens when SERMS activate receptors on osteoblasts ?
leads to bone anabolism
27
what's the goal range of Hgb for a pt on erythropoietin?
Don't try and get them in a normal range
- try for 10-12 -
if you push to high there is a greater risk of CV events
28
why can there be compliance issues with Sucracate
Large tablets and frequent administration
29
Oral Phosphate Binder: Binds to dietary phosphate, inhibiting its absorption
Dose with meals
Calcium carbonate/calcium Acetate
30
Contraindicated in Pregnancy - for prevention of NSAID induced ulcers
Misoprostol
31
This drug class can help to prevent and/or treat neutropenia associated with chemotherapy
Granulocyte-colony stimulating factors (G-CSF) ex. Filgrastim (Neupogen)
32
How do OCPs interact with corticosteroids?
OCPs potentiate corticosteroids - may need lower dose
33
Counseling pts for pts with GERD
```
avoid caffeine (increases acid secretion)
avoid alcohol (can have direct toxic effect on the mucosa)
stop smoking (decreased production of duodenal bicarb and decreased blood flow decrease ulcer healing)
avoid NSAIDs
```
34
What to counsel pts taking topical testosterone gel/ patch?
caution w/ transfer to children or pets - kids can develop premature pubic hair, increased libido, aggressive behavior
35
Opium derivatives
| ex. Paregoric/ tincture of opium
Inhibits peristalsis and diarrhea
36
Loperamide (imodium) AE/ CI
AE: abdominal pain, n/v, bloating, QT prolongation
CI: less than 2 years old-> fetal paralytic ileus, fever, ecoli, salmonella, campylobacter infections
37
Drugs That Alter Thyroid Status
Amiodarone
Lithium
Metoclopramide (Reglan)
38
AEs of Cimetidine (Tagamet) - H2 antagonists
potential for diarrhea, headache, muscle pain, constipation, fatigue, confusion
39
2nd most effective. inhibit CYP enzymes a
| decrease elimination of some drugs
H2 Antagonists
| Cimetidine, Nizatidine, Ranidatinie, Famotidine
40
SERM, Inhibits growth of estrogen dependent (ER+) breast tumors, agonist activity in bones can delay or prevent osteoporosis, does not stimulate endometrium
Raloxifene (Evista)
41
Not caused by H. Pylori, esophageal mucosa damaged by reflux of low PH material into lower esophagus
GERD
42
Uterotonic - Induces labor by promoting contractions, administered IV*, use w/ caution in cardiac/ renal disease, PIH
Oxytocin (pitocin)
43
why give colloidal bismuth to pt with H.Pylori and PUD?
coating agent used in PUD - inhibits growth of H. Pylori
44
increases release of norepi and dopamine from nerve terminals in addition to inhibiting their reuptake
avoid using with MAOIs
avoid abrupt withdrawal
Phentermine
45
Continue this drug for 1-2 weeks for GI to determine effectiveness
Esomeprazole (Nexium)
46
Lightheadedness, dizziness, sedation, nausea/ vomiting, euphoria, constipation,pruritus
drug dependence if used consistently
Side effects of tincture of opium
47
*Potential drug interactions via binding to drugs
| AE: constipation
Sucralfate
48
How does Plan B work? AEs?
interferes with ovulation, fertilization, egg transport, and/ or implantation
ineffective after implantation
Nausea and vomiting
49
what is usually the culprit to acne?
Progestin
50
Androgen Receptor Antagonist (2)
Flutamide, Bicalutamide
51
non-competitive irreversible antagonist. shuts down acid activity by working on potassium hydrogen ATPase pump
Omeprazole (prilosec)
52
TX of vasomotor sxs of menopause, caution w/ transfer to children/ pets
Topical Estrogen
53
Goal of chemo treatment
want to give the highest dose of chemo you can with least amount of side effects
54
Impedes growth of H. pylori,
| AE: constipation
Colloidal Bismuth
55
Treatment goals of PUD
decrease gastric acidity,
enhance mucosal defenses, eliminate H. Pylori,
Advise pt to quit smoking*
56
Who could benefit from progestin only contraceptives?
anyone who would benefit from avoiding estrogen- lupus sickle cell, cardiovascular disease, migraines, breastfeeding, VTE
57
considered the drug of choice for hypothyroidism because its converted to T3 over time
Levothyroxine
58
Work later on in the cycle- most effective- can take days or longer to take effect, non-competitive irreversible antagonist of potassium hydrogen ATPase pump to help decrease acid production
PPIs
| Lansoprazole (Prevacid), Pantoprazole, Esomeprazole (Nexium), Omeprazole (prilosec)
59
Non-specific forms of cytotoxic chemo
Radiation & Nitrosoureas
60
Potential Harm of Oral Contraceptives
Increase risk of MI/stroke/ VTE
| Relative CI if woman > 35 yrs and smokes due to increased risk of VTE and cardiovascular events*
61
Bulk Forming:
| stimulate stretch receptors
FiberCon, Metamucil, Citrucel, Metrolan
62
TX of vasomotor sxs of menopause, Tx vaginal atrophy, GU sxs of menopause
Vaginal Estrogen
63
Type of therapy that activates immune system to treat cancer
Immune-mediated toxicities (ex. vaccines, cytokines, immunomodulators...)
Immunotherapy
64
What do you need to monitor for pt on G-CSF?
Absolute neutrophil count
65
Type of therapy that Targets rapidly dividing cells - hair loss, bone marrow loss (affects RBCs, WBCs, platelets)
Cytotoxic
66
Targeted therapy drug class: intracellular target to shut down some cellular pathway
Tyrosine Kinase Inhibitors (TKIs)
67
Decrease T4 to T3 conversion
PTU, β-blockers, amiodarone, glucocorticoids
68
AE/ CI of Pepto-Bismol
AE: Black coating on tongue
CI: avoid in pts with renal failure
69
If pts don't loose a 5% of total body weight in 12 weeks consider removing them from this drug
Lorcaserin
70
What is tumor lysis syndrome? signs and symptoms?
caused by therapy working too fast that cell contents spill into the bloodstream
N/V/D
weakness, tingling, fatigue
71
Who derives the biggest benefit of hormone replacement therapy? *
Pts with most severe symptoms
72
Tx of CKD- secondary hyperparathyroidism
Phosphate binders
| calcimimetics
73
What to give pt if you want to stimulate their RBC count? Helps minimize length of time of anemia
Erythropoietin (Procrit)
| Darbepoetin (Aranesp)
74
Med used to treat BPH and alopecia*
Finasteride
75
Rank effectiveness of med classes that reduce gastric acid secretion
1. Proton Pump Inhibitors
2. H2 Antagonists
3. Anticholinergic Agents
76
```
Drug class that stimulates neutrophils and macrophages
- example?
```
GM- CSF - Granulocyte Macrophage Colony stimulating factor
Sargramostim (Leukine)
77
GI drug that does not alter the pH, but does provide symptomatic relief
Sucralfate
78
why is estrogen always administered with progesterone?
unopposed estrogen promotes endometrial growth = increased risk of endometrial cancer
79
anticholinergic- works on muscarinic acetylcholine receptors- decreases gastric acid secretion
Dicyclomine (bentyl)
80
MOA of OCPs (oral contraceptive pills)
Suppression of mid-cycle gonadotropin (FSH, LH) secretion = inhibiting ovulation*
81
```
Drug class of choice for GERD
what warning?
```
PPIs
| Warning for increased risk of C Diff.
82
TX of vasomotor sxs of menopause, as effective as oral estrogen for menopause and bone density but less AEs
Transdermal Estrogen
83
coats the lining of GI tract and soothes irritation, preventing stimulation of local refluxes that cause exc essive GI activity/ diarrhea
(Pepto-Bismol)
| Bismuth- subsalicylate
84
Uterotonic- Cervical ripening agent, naturally occurring PGE2, vaginal administration*
Dinoprostone (Cervidil)
85
what labs would you want to check for a pt with thyroid problems on Methimazole or PTU
Thyroid function panel - TSH and T4
LFTs
WBC and CBC (due to risk of agranulocytosis)
86
Most effective treatment of pts with Hypercalcemia and tumor lysis syndrome?
Oral and IV Hydration*
87
What is first line choice for pt with H. Pylori and PUD? When there is not a concern w/ resistance
triple therapy
amoxicillin,
clarithromycin, PPI
88
Drug that slows peristalsis and allows increase time for absorption of fluid/ electrolytes
Loperamide (imodium)
89
SERM, pro-estrogenic effect on endometrium, antagonistic estrogenic effects on breast tissue
Tamoxifen
90
Uterotonic, Synthetic form of PGE1, Pregnancy category X, Cervical ripening agent, vaginal administration*
Misoprostol (cytotec)
91
how to help a pt with anticipatory nausea/ vomiting from past chemo?
Benzodiazepine
92
What kind of hormonal contraceptives would be useful for breastfeeding mother? Route of admin, AE, CI
Progestin Only- Oral/ IM/ Intrauterine
| must take at same time everyday, more breakthrough bleeding, less effective than combo pills
93
stimulates myenteric plexus, alters water/ electrolyte secretion
Senna, Bisacodyl,
| Oils
94
What to give pts who are allergic to PCN and have H. Pylori and PUD?
Quadruple Therapy
tetracycline, Metronidazole, PPI
Bismuth
95
Counseling for pts with PUD
stop NSAIDS and smoking
96
most useful for myxedema coma (an acute hypothyroid state)- because it is not a prodrug
Cytomel
97
Potential drug interactions via CYP inhibition
| AE: headache, GI disturbances
H2 Antagonists and PPIs
98
mimics iodide and can cause hypothyroidism
Lithium
99
Can increase plasma iodide levels causing hyperthyroidism and increase thyroid hormone synthesis causing hypothyroidism
Amiodarone
100
Decreased phosphate excretion
| no activation of vit D
CKD
101
what meds could be prescribed for symptomatic tx for pt with goiter
Beta Blocker, Iodide, Corticosteroids
102
How should you treat rashes caused by immunotherapy agents?
High dose steroid pack for at least 2 weeks
103
What are PDE-5 inhibitors contraindicated to take with?
Nitrates (will have too much smooth muscle relaxation)
104
Why can't you use benadryl to treat GERD?
Benadryl is a H1 antihistamine, Tagamet is a H2 antagonist- so they work on different receptors in different areas of the body
105
Converted to active thyroid hormone T3 in the body
T4
106
gold standard anticoagulant for cancer pts?
Low molecular weight heparin
107
GI problem caused by H.Plylori
PUD
108
Estrogen receptor antagonist, inhibits growth of estrogen dependent (ER+) breast tumors
Fulvestrant
109
Phenobarbital, phenytoin, rifampin, and carbamazepine can reduce levels of what thyroxine ? How?
levothyroxine - by inducing its metabolism
110
Targeted therapy: target protein on outside of the cell
Monoclonal Antibodies
111
Finasteride
| Dutasteride
5A Reductase Inhibitors
(Competitive Synthesis Inhibitors)
prevent conversion of testosterone toi DHT
FIn used for alopecia and BPH
112
Pentanoic Acid ester that inhibits gastric and pancreatic lipases
take with a multivitamin
Orlistat
113
What drug do you also need to stop when you get Hgb in range of 10-12?
Darbepoetin (Aranesp)
114
SERM and ER antagonist in hypothalamus gland anterior pituitary gland = increased GnRH , Induces ovulation via partial agonism in ovaries
Clomiphene (clomid)
115
Selectively activates 5HT 2c
avoid in pts with heart failure
avoid with SSRIs, SNRIs, MAOIs
Lorcaserin
116
Classic symptom of GERD?
Heartburn- pain in center of chest
117
Also inhibits conversion of T4 to T3 in the periphery
Short half-life requires TID dosing
Can deplete levels of prothrombin leading to increased bleeding tendency
Preferred agent in pregnancy and thyroid storm
PTU
118
AE of Dicyclomine (Bentyl)
dry mouth, constipation, blurred vision, heart arrhythmias, urinary retention
119
Noncompetitive synthesis Inhibitors
Exemestane
| Formestane
120
Precursor to androgen and estrogen synthesis
Progestin
121
What group of drugs inhibits absorption of drugs that need acid in the stomach?
PPIs
| Lansoprazole (Prevacid)
122
Infusion reactions are biggest concern
Titrate slowly
More human=less reaction
Premedicated with
Acetaminophen (+/-)
Diphenhydramine (+/-)
Glucocorticoid (+/-)
Monoclonal Antibody Toxicity
123
How to treat SE from immunotherapy?
**TREATED WITH HIGH DOSE STEROIDS***
```
SE (LEGS)
L: liver (increased LFTs)
E: endocrine (hypothyroidism)
G: gastrointestinal (diarrhea and colitis)
S: skin (rash)
```
More serious SE include cytokine release syndrome and infusion reactions
124
What to give pts with minimal or low emetic risk?
minimal= No prophylaxis
Low= Dexamethasone 8 mg -or- first-generation 5HT3 antagonist (Zofran)
125
What to give pts with moderate emetic risk?
5HT3 antagonist and dexamethasone
Add NK1 antagonist if severe/refractory emesis develops
If risk of delayed emesis:
Continue dexamethasone for a few days
-or-
Use palonosetron as 5HT3 antagonist
126
What to give pts with severe emetic risk?
NK1 antagonist + 5HT3 antagonist + dexamethasone
127
how to tx breakthrough chemo nausea?
Use a drug with a different MOA
| EX: Olanzapine, prochlorperazine, promethazine, metoclopramide, dronabinol
128
PPI that can prevent the conversion of Clopidogrel (plavix) to its active form
Omeprazole
129
H2 antagonist that inhibits CYP3A4, 2D6, 1A2
| Benzos and warfarin
Cimetidine
130
Drugs that work to neutralize gastric acid? used for pain relief, fast onset- short acting
```
Aluminum hydroxide
Mag. Hydroxide
Sodium bicarb.
Calcium Carbonate
(antacids)
```
131
Antibiotic that interferes with OCP?
Rifampin (for TB tx)
132
What to do if no response to thioamines in 6-12 months?
Radioactive iodine-thyroid gland ablation
Surgical removal of thyroid, then, thyroid hormone replacement therapy
133
Not a thyroid drug that Increases TSH production and release?
Reglan
134
Actively concentrated in thyroid gland
Body recognizes it as iodine
Can inhibit synthesis of thyroid hormone causing hypothyroidism
Lithium
135
Acts like thyroid hormone, structural resemblance
Contains large amounts of iodine
Can cause hypo- or hyperthyroidism
Amiodarone
136
lowers serum bicarb, may cause metabolic acidosis
Useful in pts with hypercalcemia
Renagel (phosphate binder)
137
buffered form of Sevelamer, avoids acidosis
Useful in pts with hypercalcemia
Renvela (phosphate binder)
138
Used with calcium for osteoporosis treatment and prevention to increase calcium levels
Cholecalciferol= ______
Ergocalciferol= ________
Doxercalcifero= _______
Cholecalciferol (vitamin D3)
Ergocalciferol (vitamin D2)
Doxercalciferol (vitamin D2)
139
activated vitamin D?
Where?
Better for CKD, bypasses synthesis by kidneys
Calcitonin
| Liver
140
Paricalcitol (Zemplar)
Synthetic analogue of vitamin D
141
Binds to calcium sensing receptors, increasing sensitivity to calcium
Suppresses PTH
Treatment of secondary hyperparathyroidism
Treatment of hypercalcemia associated with parathyroid carcinoma
Cinacalcet (Sensipar) [Calcimimetic]
142
For Severe HYPOcalcemia (IV)
HYPOparathyroidism and osteoporosis (PO)
Calcium
(Calcium gluconate, calcium chloride)[IV]
(Calcium citrate, calcium carbonate, calcium phosphate, calcium lactate)[PO]
