Study Guide Flashcards
Main SE of magnesium antacids
Diarrhea
What med class stimulates receptors on osteoblasts - can lead to bone breakdown?
SERMS- Tamoxifen, Raloxifene (Evista) , and Clomiphene (clomid)
What formulation of OCP has no androgenic activity?
Possible AE?
Drospirenone
- monitor for hyperkalemia
Retain water to increase intraluminal pressure
Magnesium preps, NaPhos, lactulose, glycerin, sorbitol
osmotics
Symptomatic treatment of hyperthyroidism
Blocks hyperadrenergic effects of thyroid excess
Blocks peripheral conversion of T4 to T3
β-blockers
Tx for IBS
MOA: stimulates intestinal fluid secretion and transit
Linaclotide (Linzess)
Main SE od calcium antacids
constipation
GLP-1 receptor antagonist
avoid use in pts with medullary thyroid cancer
Liraglutide
why can NSAIDS penetrate gastric cells
inhibit cox enzymes -> decrease in PGE2 -> increased gastric acid -> decreased bicarb, blood flow & mucus production
TX of vasomotor sxs of menopause, SIgnificant 1st pass metabolism-> increased binding of globulins, TGs, HDL, clotting factors
Oral Estrogen
Proposed uses of uterotonics
To empty Uterus- labor/ terminate pregnancy
Stop Bleeding- Immediately Postpartum/ late postpartum hemorrhage
Subinvolution- reduction of uterus to its normal size after childbirth
Important teaching info for pt on a G-CSF like Filgrastim (Neupogen)
will reduce risk of infection but they can have significant bone pain (bone marrow is trying to make new cells)
Phosphate binding to Ca
decreased GI absorption and plasma Ca level, increased PTH synthesis/ secretion is caused by what and then leads to what?
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
H2 Antagonists - prevents activation of proton pump by inhibiting activation of H2 receptors in gut= suppression of gastric secretions
Cimetidine, Nizatidine, Ranidatinie, Famotidine
Topical injury from NSAID use
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)
Preferred in practice for hyperthyroidism
Longer ½ life, once daily dosing
More potent than PTU - less frequent serious AEs
Methimazole (Tapazole)
Type of therapy that Targets a specific gene or protein on a cancerous cell
Targeted Therapy
Tx for IBS.
MOA: locally active Cl- channel activator that enhances Cl- rich intestinal fluid secretion
Lubiprostone (amitiza)
Why are hormone drug levels are less variable with the patch and vaginal ring?
more continuous absorption
Docusate
Retains water to soften stools
For hypothyroidism … Why not give T3 (Cytomel)?
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).
Potential benefits of Oral contraceptives
Potential benefits of Oral contraceptives
used for colonoscopy preps
(osmotics) and saline laxatives
How do Dilantin, Griseofulvin, and Rifampin interact with OCPs?
induce metabolism of OCP- need backup!
Oral Phosphate Binder:
Binds to dietary phosphate, inhibiting its absorption
Not absorbed
Sevelamer (Renagel, Renvela)
What happens when SERMS activate receptors on osteoblasts ?
leads to bone anabolism
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
why can there be compliance issues with Sucracate
Large tablets and frequent administration
Oral Phosphate Binder: Binds to dietary phosphate, inhibiting its absorption
Dose with meals
Calcium carbonate/calcium Acetate
Contraindicated in Pregnancy - for prevention of NSAID induced ulcers
Misoprostol
This drug class can help to prevent and/or treat neutropenia associated with chemotherapy
Granulocyte-colony stimulating factors (G-CSF) ex. Filgrastim (Neupogen)
How do OCPs interact with corticosteroids?
OCPs potentiate corticosteroids - may need lower dose
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
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
Opium derivatives
ex. Paregoric/ tincture of opium
Inhibits peristalsis and diarrhea
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
Drugs That Alter Thyroid Status
Amiodarone
Lithium
Metoclopramide (Reglan)
AEs of Cimetidine (Tagamet) - H2 antagonists
potential for diarrhea, headache, muscle pain, constipation, fatigue, confusion
2nd most effective. inhibit CYP enzymes a
decrease elimination of some drugs
H2 Antagonists
Cimetidine, Nizatidine, Ranidatinie, Famotidine
SERM, Inhibits growth of estrogen dependent (ER+) breast tumors, agonist activity in bones can delay or prevent osteoporosis, does not stimulate endometrium
Raloxifene (Evista)
Not caused by H. Pylori, esophageal mucosa damaged by reflux of low PH material into lower esophagus
GERD
Uterotonic - Induces labor by promoting contractions, administered IV*, use w/ caution in cardiac/ renal disease, PIH
Oxytocin (pitocin)
why give colloidal bismuth to pt with H.Pylori and PUD?
coating agent used in PUD - inhibits growth of H. Pylori
increases release of norepi and dopamine from nerve terminals in addition to inhibiting their reuptake
avoid using with MAOIs
avoid abrupt withdrawal
Phentermine
Continue this drug for 1-2 weeks for GI to determine effectiveness
Esomeprazole (Nexium)
Lightheadedness, dizziness, sedation, nausea/ vomiting, euphoria, constipation,pruritus
drug dependence if used consistently
Side effects of tincture of opium
*Potential drug interactions via binding to drugs
AE: constipation
Sucralfate
How does Plan B work? AEs?
interferes with ovulation, fertilization, egg transport, and/ or implantation
ineffective after implantation
Nausea and vomiting
what is usually the culprit to acne?
Progestin
Androgen Receptor Antagonist (2)
Flutamide, Bicalutamide
non-competitive irreversible antagonist. shuts down acid activity by working on potassium hydrogen ATPase pump
Omeprazole (prilosec)
TX of vasomotor sxs of menopause, caution w/ transfer to children/ pets
Topical Estrogen
Goal of chemo treatment
want to give the highest dose of chemo you can with least amount of side effects
Impedes growth of H. pylori,
AE: constipation
Colloidal Bismuth
Treatment goals of PUD
decrease gastric acidity,
enhance mucosal defenses, eliminate H. Pylori,
Advise pt to quit smoking*
Who could benefit from progestin only contraceptives?
anyone who would benefit from avoiding estrogen- lupus sickle cell, cardiovascular disease, migraines, breastfeeding, VTE
considered the drug of choice for hypothyroidism because its converted to T3 over time
Levothyroxine
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)
Non-specific forms of cytotoxic chemo
Radiation & Nitrosoureas
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*
Bulk Forming:
stimulate stretch receptors
FiberCon, Metamucil, Citrucel, Metrolan
TX of vasomotor sxs of menopause, Tx vaginal atrophy, GU sxs of menopause
Vaginal Estrogen
Type of therapy that activates immune system to treat cancer
Immune-mediated toxicities (ex. vaccines, cytokines, immunomodulators…)
Immunotherapy
What do you need to monitor for pt on G-CSF?
Absolute neutrophil count
Type of therapy that Targets rapidly dividing cells - hair loss, bone marrow loss (affects RBCs, WBCs, platelets)
Cytotoxic
Targeted therapy drug class: intracellular target to shut down some cellular pathway
Tyrosine Kinase Inhibitors (TKIs)
Decrease T4 to T3 conversion
PTU, β-blockers, amiodarone, glucocorticoids
AE/ CI of Pepto-Bismol
AE: Black coating on tongue
CI: avoid in pts with renal failure
If pts don’t loose a 5% of total body weight in 12 weeks consider removing them from this drug
Lorcaserin
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
Who derives the biggest benefit of hormone replacement therapy? *
Pts with most severe symptoms
Tx of CKD- secondary hyperparathyroidism
Phosphate binders
calcimimetics
What to give pt if you want to stimulate their RBC count? Helps minimize length of time of anemia
Erythropoietin (Procrit)
Darbepoetin (Aranesp)
Med used to treat BPH and alopecia*
Finasteride
Rank effectiveness of med classes that reduce gastric acid secretion
- Proton Pump Inhibitors
- H2 Antagonists
- Anticholinergic Agents
Drug class that stimulates neutrophils and macrophages - example?
GM- CSF - Granulocyte Macrophage Colony stimulating factor
Sargramostim (Leukine)
GI drug that does not alter the pH, but does provide symptomatic relief
Sucralfate
why is estrogen always administered with progesterone?
unopposed estrogen promotes endometrial growth = increased risk of endometrial cancer
anticholinergic- works on muscarinic acetylcholine receptors- decreases gastric acid secretion
Dicyclomine (bentyl)
MOA of OCPs (oral contraceptive pills)
Suppression of mid-cycle gonadotropin (FSH, LH) secretion = inhibiting ovulation*
Drug class of choice for GERD what warning?
PPIs
Warning for increased risk of C Diff.
TX of vasomotor sxs of menopause, as effective as oral estrogen for menopause and bone density but less AEs
Transdermal Estrogen
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
Uterotonic- Cervical ripening agent, naturally occurring PGE2, vaginal administration*
Dinoprostone (Cervidil)
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)
Most effective treatment of pts with Hypercalcemia and tumor lysis syndrome?
Oral and IV Hydration*
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
Drug that slows peristalsis and allows increase time for absorption of fluid/ electrolytes
Loperamide (imodium)
SERM, pro-estrogenic effect on endometrium, antagonistic estrogenic effects on breast tissue
Tamoxifen
Uterotonic, Synthetic form of PGE1, Pregnancy category X, Cervical ripening agent, vaginal administration*
Misoprostol (cytotec)
how to help a pt with anticipatory nausea/ vomiting from past chemo?
Benzodiazepine
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
stimulates myenteric plexus, alters water/ electrolyte secretion
Senna, Bisacodyl,
Oils
What to give pts who are allergic to PCN and have H. Pylori and PUD?
Quadruple Therapy
tetracycline, Metronidazole, PPI
Bismuth
Counseling for pts with PUD
stop NSAIDS and smoking
most useful for myxedema coma (an acute hypothyroid state)- because it is not a prodrug
Cytomel
Potential drug interactions via CYP inhibition
AE: headache, GI disturbances
H2 Antagonists and PPIs
mimics iodide and can cause hypothyroidism
Lithium
Can increase plasma iodide levels causing hyperthyroidism and increase thyroid hormone synthesis causing hypothyroidism
Amiodarone
Decreased phosphate excretion
no activation of vit D
CKD
what meds could be prescribed for symptomatic tx for pt with goiter
Beta Blocker, Iodide, Corticosteroids
How should you treat rashes caused by immunotherapy agents?
High dose steroid pack for at least 2 weeks
What are PDE-5 inhibitors contraindicated to take with?
Nitrates (will have too much smooth muscle relaxation)
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
Converted to active thyroid hormone T3 in the body
T4
gold standard anticoagulant for cancer pts?
Low molecular weight heparin
GI problem caused by H.Plylori
PUD
Estrogen receptor antagonist, inhibits growth of estrogen dependent (ER+) breast tumors
Fulvestrant
Phenobarbital, phenytoin, rifampin, and carbamazepine can reduce levels of what thyroxine ? How?
levothyroxine - by inducing its metabolism
Targeted therapy: target protein on outside of the cell
Monoclonal Antibodies
Finasteride
Dutasteride
5A Reductase Inhibitors
(Competitive Synthesis Inhibitors)
prevent conversion of testosterone toi DHT
FIn used for alopecia and BPH
Pentanoic Acid ester that inhibits gastric and pancreatic lipases
take with a multivitamin
Orlistat
What drug do you also need to stop when you get Hgb in range of 10-12?
Darbepoetin (Aranesp)
SERM and ER antagonist in hypothalamus gland anterior pituitary gland = increased GnRH , Induces ovulation via partial agonism in ovaries
Clomiphene (clomid)
Selectively activates 5HT 2c
avoid in pts with heart failure
avoid with SSRIs, SNRIs, MAOIs
Lorcaserin
Classic symptom of GERD?
Heartburn- pain in center of chest
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
AE of Dicyclomine (Bentyl)
dry mouth, constipation, blurred vision, heart arrhythmias, urinary retention
Noncompetitive synthesis Inhibitors
Exemestane
Formestane
Precursor to androgen and estrogen synthesis
Progestin
What group of drugs inhibits absorption of drugs that need acid in the stomach?
PPIs
Lansoprazole (Prevacid)
Infusion reactions are biggest concern
Titrate slowly
More human=less reaction
Premedicated with
Acetaminophen (+/-)
Diphenhydramine (+/-)
Glucocorticoid (+/-)
Monoclonal Antibody Toxicity
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
What to give pts with minimal or low emetic risk?
minimal= No prophylaxis
Low= Dexamethasone 8 mg -or- first-generation 5HT3 antagonist (Zofran)
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
What to give pts with severe emetic risk?
NK1 antagonist + 5HT3 antagonist + dexamethasone
how to tx breakthrough chemo nausea?
Use a drug with a different MOA
EX: Olanzapine, prochlorperazine, promethazine, metoclopramide, dronabinol
PPI that can prevent the conversion of Clopidogrel (plavix) to its active form
Omeprazole
H2 antagonist that inhibits CYP3A4, 2D6, 1A2
Benzos and warfarin
Cimetidine
Drugs that work to neutralize gastric acid? used for pain relief, fast onset- short acting
Aluminum hydroxide Mag. Hydroxide Sodium bicarb. Calcium Carbonate (antacids)
Antibiotic that interferes with OCP?
Rifampin (for TB tx)
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
Not a thyroid drug that Increases TSH production and release?
Reglan
Actively concentrated in thyroid gland
Body recognizes it as iodine
Can inhibit synthesis of thyroid hormone causing hypothyroidism
Lithium
Acts like thyroid hormone, structural resemblance
Contains large amounts of iodine
Can cause hypo- or hyperthyroidism
Amiodarone
lowers serum bicarb, may cause metabolic acidosis
Useful in pts with hypercalcemia
Renagel (phosphate binder)
buffered form of Sevelamer, avoids acidosis
Useful in pts with hypercalcemia
Renvela (phosphate binder)
Used with calcium for osteoporosis treatment and prevention to increase calcium levels
Cholecalciferol= ______
Ergocalciferol= ________
Doxercalcifero= _______
Cholecalciferol (vitamin D3)
Ergocalciferol (vitamin D2)
Doxercalciferol (vitamin D2)
activated vitamin D?
Where?
Better for CKD, bypasses synthesis by kidneys
Calcitonin
Liver
Paricalcitol (Zemplar)
Synthetic analogue of vitamin D
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]
For Severe HYPOcalcemia (IV)
HYPOparathyroidism and osteoporosis (PO)
Calcium
(Calcium gluconate, calcium chloride)[IV]
(Calcium citrate, calcium carbonate, calcium phosphate, calcium lactate)[PO]
