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Pharm Exam III > Study Guide Exam III > Flashcards

Study Guide Exam III Flashcards

1
Q

what are the first line drugs for PD treatment?

A

dopaminergics & dopamine agonists

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2
Q

what are the dopaminergics & dopamine agonists used to tx PD?

A 
Bromocriptine (Parlodel)
Pergolide (Permax)
Pramipexole (Mirapex)
Ropinirole (Requip)
*as symptoms worsen, introduce levodopa*
cholinergic blockers control tremor (relax smooth muscle)
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3
Q

how do anticonvulsants work?

A

stimulate influx of chloride ions (usually associated with GABA)
delay influx of sodium
delay influx of calcium

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4
Q

what are the most common ADRs of hydantoins?

A 
nystagmus
dizziness
pruritis
paresthesia
HA
somnolence
ataxia
confusion
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5
Q

what are the ADRs of iminostilbenes?

A 
bone marrow depression
liver damage 
impairs thyroid function
drowsiness
dizziness
blurred vision
N/V
dry mouth 
diplopia
HA
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6
Q

what are the ADRs of succinimides?

A 
GI most common
somnolence
fatigue
ataxia
agranulocytosis
aplastic anemia
granuloytopenia
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7
Q

what are the ADRs of GABA?

A

somnolence

CNS effects

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8
Q

what are the ADRs of lamotrigine?

A 
GI: mostly N/V
constipation
chest pain
peripheral edema
somnolence
fatigue
dizziness
anxiety
insomnia
HA
amblyopia
nystagmus
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9
Q

what are the goals of migraine therapy?

A

minimize impact on quality of life

avoid medication overuse

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10
Q

which medications are used in prophylactic treatment of migraines?

A

beta blockers
tricyclic antidepressants
antieleptic drugs

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11
Q

when is preventative migraine therapy initiated?

A

consider for pts with more than 2 migraines per months
goal: 50% reduction
Use HA diary
takes time to work (4 wks)

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12
Q

which beta blockers are FDA approved in preventative migraine therapy?

A

propranolol

timolol

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13
Q

which beta blockers should be used in pts who have asthma or respiratory concerns?

A

metoprolol

atenolol

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14
Q

what are the ADRs of beta blockers?

A

fatigue
lethargy
depression

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15
Q

which TCAs are used for migraine prevention?

A

Elavil

nortriptyline can be used

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16
Q

what are the ADRs of TCAs?

A

drowsiness
weight gain
constipation

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17
Q

which antieliptics are used for migraine prophylaxis?

A

depakote
neuronton
topamax

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18
Q

what are the miscellaneous drugs used for migraine prophylaxis?

A

NSAIDs (Naproxen for menstrual migraines)

CCBs (verapamil for pts with HTN who cannot tolerate beta blockers)

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19
Q

what are the medications used to treat Alzheimer’s disease?

A

Donepezil (Aricept)
Rivastigmine (Exelon)
Galantamine (Razadyne)
Memantine (Namenda)- *not a cholinesterase inhibitor

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20
Q

what are the ADRs of drugs used to tx Alzheimer’s disease?

A 
Constrict pupils 
Increased saliva
Bronchoconstriction 
Increased GI mucous 
Bladder fundus contraction
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21
Q

what is used to tx tension HAs?

A 
beta blockers
TCAs
*non-pharma therapy
-stress management
-biofeedback
-exercise
-acupuncture
-heat/cold
-massage therapy
-relaxation therapy
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22
Q

when is treatment for tension HAs considered?

A

if more than 1 or 2 per week

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23
Q

what do tension HAs NOT respond to?

A

triptans

ergots

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24
Q

what are the combination drugs used to tx tension HAs?

A

Fiorinal/Fioricet

Midrin

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25
Q

what are the SSRI medications?

A 
Fluoxetine (Prozac)
paroxetine (Paxil)
sertraline (Zoloft)
fluvoxamine (Luvox) 
citalopram (Celexa)
escitralopram (Lexapro)
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26
Q

what is the MOA of SSRIs?

A

have selective inhibitory effects on presynaptic serotonin reuptake and wqak effects on norepinephrine and dopamine neuronal uptake; more serotonin is available to bind with the postsynaptic receptors

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27
Q

explain the pharmacokinetics of SSRIs

A

slow absorption
half-life 21-26 hours
extensive first pass metabolism
*fluoxetine half-life of 1-3 days & first metabolite 4-16 days (why it can be given weekly)

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28
Q

what is the indication for prescribing SSRIs?

A

depressive d/o
anxiety
panic d/o
*fluvoxamine (Luvox) is approved for OCD

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29
Q

what are the ADRs of SSRIs?

A

CNS
GI
sexual dysfunction (up to 35%)
caution: pts with severe hepatic or renal impairment

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30
Q

what should you educate patients who are taking SSRIs on?

A

adherence (can take 3-4 wks)
suicide risk
avoid alcohol, OTC meds that stimulate, insomnia or dizziness, suicide ideology

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31
Q

SSRIs are pregnancy category what?

A

B/C
avoid in 1st and last trimester
*Sertraline been used w/o adverse consequences

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32
Q

what are the initial SE of SSRIs?

A 
nausea
light-headedness
sedation 
muscle restlessness
sleep disturbances
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33
Q

what should you monitor in elderly patients taking SSRIs?

A

electrolytes

*half dose recommended

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34
Q

higher doses of Celexa put the patient at risk for what?

A

QTc prolongation

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35
Q

Lexapro is the active metabolite of what?

A

citalopram (Celexa)

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36
Q

what are the indications for Prozac?

A

depression
OCD
bulimia
panic d/o

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37
Q

what are the indications for Luvox?

A

OCD
social anxiety d/o
depression (off-label)

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38
Q

what are the indications for Paxil?

A 
Depression
OCD
panic disorder
social phobia
PTSD
anxiety
PMDD (CR)
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39
Q

what are the indications for Zoloft?

A 
Depression
OCD
GAD
PMDD
PTSD
Social Anxiety disorder
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40
Q

when does serotonin syndrome happen?

A

in the presence of serotogenic activity

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41
Q

serotonin syndrome can be fatal. what are the symptoms?

A 
nausea
diarrhea
chills
sweating
hyperthermia
HTN
myoclonic jerking
tremor
agitation
ataxia
disorientation
confusion
delirium
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42
Q

what can be done to prevent serotonin syndrome?

A

Adhere to maximum recommended doses
Avoid adjunctive combinations of serotonergic agents
Adequate time for titration when changing agents (5 half lives per dose decrease)

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43
Q

what is withdrawal syndrome?

A

when shorter half life drugs can show withdrawal symptoms with just one missed dose

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44
Q

which medications have the potential for withdrawal syndrome?

A

paroxetine
sertraline
citalopram
escitalopram

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45
Q

what are the symptoms of withdrawal syndrome?

A

nausea
dizziness
paresthesias (electric shock sensations, visual tracers w/eye movements)

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46
Q

SSRIs require gradual slow tapering except…

A

fluoxetine (long half-life, active metabolites)

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47
Q

the black box warning on all antidepressants for increased risk of suicidal though and behavior affects which population?

A

children
adolescents
young adults to age 24
- during first two months of tx

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48
Q

what is the MOA of benzos?

A

all benzos work on chloride ion channels of GABA-A receptors; enhance GABA neurotransmission which lengthens hyperpolarization and slow down responses

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49
Q

benzos are:

A

anxiolytic
anticonvulsion
muscle relaxants
sedating

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50
Q

what is the non-benzo GABA agonist?

A

Buspar

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51
Q

what are the short-acting benzos?

A

Clorazepate (Tranxene)
Halazepam (Paxipam)
Prazepam (Centrex)

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52
Q

what are the intermediate-acting benzos?

A

Alprazolan (Xanax)
Lorazepam (Ativan)
Oxazepam (Serax)
Chlordiazepoxide (Librium)

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53
Q

what are the long-acting benzos?

A

Diazepam (Valium)

Clonazepam (Klonopin)

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54
Q

when are benzos used as anxiolytics?

A 
muscle relaxant
pre-anesthesia sedation
prevention and tx of panic attacks
acute agitation and dystonia
emergency tx of uncontrollable seizures
restless leg syndrome
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55
Q

which benzos are thought to be higher risk for dependence?

A

alprazolam
lorazepam
d/t high potency, and rapid, short-term action

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56
Q

when are benzos contraindicated?

A 
pregnancy
lactation
children < 6
hepatic & renal disease
*caution in elderly
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57
Q

when do the symptoms of benzo withdrawal usually occur?

A

1-2 days after last dose of short-acting

5-10 days after long-acting

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58
Q

what are the main ADRs of benzos?

A

excessive sedation
potential for cardiac & respiratory depression in combo with other CNS depressants
paradoxial anxiety, agitation & acute rage may occur

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59
Q

why should Buspar be taken with food?

A

reduces first pass affect, allowing for more active drug going directly into circulation

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60
Q

why is Buspar contraindicated with panic attacks?

A

one metabolite has noradrenergic effects

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61
Q

how long does it take for Buspar to take effect?

A

up to two weeks for onset

and up to six weeks for max effect

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62
Q

what is the half life of Buspar and why is that important?

A

1-10 hours

requires multiple dosing during the day

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63
Q

what are the positive symptoms in psych disorders?

A 
agitation/aggression
disorganized speech
hallucinations
delusions
paranoia
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64
Q

what are the negative symptoms in psych disorders?

A 
anhedonia (no pleasure)
flattening of affect
poverty of speech content
poor self care
social withdrawal
decreased motivation
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65
Q

what are the phenothiazines used to tx + symptoms in psych d/o?

A

Chlorpromazine (Thorazine) fluphenazine (Prolixin) Perphenazine (Trilafon) Thioridazine (Mellaril) Trifluoperazine (Stelazine)

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66
Q

what are the non-phenothiazines used to tx + symptoms in psych d/o?

A

Haloperidol (Haldol)
molindone (Moban) Thiothixene (Navane)
Loxapine (Loxitane)

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67
Q

what are the ADRs of the typical antipsychotics?

A 
*too much dopamine stimulation*
Shuffling
pill-rolling
cog-wheeling
tremors
drooling
akathisia (restlessness) dystonia (involuntary movements)
tardive dyskinesia (involuntary buccolongual movements)
--------------------------------------
sedation
weight gain
photosensitivity
reduction of seizure threshold
sexual dysfunction
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68
Q

what is given to counteract EPS?

A

antiparkinson
antihistamines
anticholinergics

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69
Q

what is neuroleptic malignant syndrome (NMS)?

A 
life threatening
fever up to 107
elevated pulse
diaphoresis
rigidity
stupor/coma
acute renal failure
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70
Q

what are the high-potency typical antipsychotics?

A

haloperidol

fluphenazine

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71
Q

what are the low-potency typical antipsychotics?

A

chlorpromazine

thioridazine

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72
Q

what are the contraindications for typical antipsychotics?

A

narrow-angle glaucoma
bone marrow depression
severe liver or cardiovascular disease

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73
Q

what are the atypical antipsychotics?

A 
Aripiprazole (Abilify)
Asenapine (Saphris)
Clozapine (Clozaril)
-Risk of fatal agranulocytosis – monitor CBCs
Iloperidone (Fanapt)
Olanzapine (Zyprexa, Zyprexa Zydis, IM, Relprevv)
Olanzapine-fluoxetine: Symbyax
Paliperidone (Invega, Invega Sustenna)
Quetiapine (Seroquel, Seroquel XR)
Risperidone (Risperdal, Risperdal Consta)
Ziprasidone (Geodon)
-Mild to moderate QTc prolongation
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74
Q

what kind of symptoms do atypical antipsychotics tx?

A

+ and -

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75
Q

what are the ADRs of atypical antipsychotics?

A 
weight gain- can lead to metabolic syndrome
seizures
hyperprolactinemia
dizziness
orthostatic hypotension
tachycardia
sleep disturbance
constipation
*caution: hepatic or renal dz
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76
Q

what makes clozapine unique?

A

risk of fatal agranulocytosis
reserved for tx of severe schizo refractory to complete trials of at least two different types of antipsychotics
available only through patient management system in which clinician and patient are both registered

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77
Q

clozapine should be monitored for how long after tx is discontinued?

A

4 wks

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78
Q

what are the indications for using atypical antipsychotics?

A 
schizophrenia
schizoaffective d/o
depression or mania with psychotic features
severe agitation
delusions with dementia
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79
Q

when changing from one atypical antipsychotic to another what should be done?

A

slowly titrating off the first and on to the second

washout period if possible

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80
Q

what are the pseudoparkinsonism extrapyramidal symptoms?

A

Tremor
muscle rigidity
stooped posture

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81
Q

what are the acute dystonia EPS?

A

Muscle spasms of face, tongue, neck or back

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82
Q

what are the akathisia EPS?

A

Inability to rest and relax; pacing

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83
Q

what are the tardive dyskinesia EPS?

A

Lip smacking
wormlike movements of the tongue
uncontrolled chewing and grimacing

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84
Q

schizophrenia & atypical APs increase the risk of what?

A

diabetes

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85
Q

what should be assessed before starting any atypical AP?

A 
waist circumference
BMI
blood pressure
fasting plasma glucose
lipid profile
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86
Q

what is lithium used to treat?

A

considered tx of choice for classic bipolar mood d/o

adjunct for tx of unipolar depression

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87
Q

what is the half-life of lithium?

A

15-36 hours

steady state: 5-7 days

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88
Q

what is the therapeutic index for lithium?

A

0.6-1.5 mEz/L

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89
Q

what are the signs of lithium toxicity?

A 
hand tremors
N/V
diarrhea
confusion
stupor
polydipsia/polyuria
muscle weakness
ataxia
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90
Q

lithium takes how long to reach max efficacy?

A

10-14 days (not for acute mania)

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91
Q

lithium is indicated for what?

A

maintenance of mood stability

prevention of mania or hypomania

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92
Q

pts should be educated on what in regards to intake of lithium?

A

maintain adequate salt intake

take with food to minimize GI distress

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93
Q

lithium is contraindicated in which pt population?

A

children < 12

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94
Q

what are the ADRs of lithium?

A

Fine tremors
nausea
dry mouth
headache
drowsiness
Hypothyroidism and kidney failure may occur with long term administration
Sustained released – can minimize adverse effects associated with dosage peaks

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95
Q

lithium interacts with which medications?

A

Diuretics – increase sodium excretion and increase lithium levels
NSAIDs – reduce renal elimination and increase lithium levels

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96
Q

what are the most common pathogens that require anti-infectives?

A

staph aureus

strep pyogenes

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97
Q

what are the basic principles of topical anti-infectives?

A 
culture if unsure
treat empirically
follow progress & culture
watch for resistance
change med if appropriate
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98
Q

what are some of the common antibacterials used to treat skin d/o?

A

bacitracin
mupirocin
retapamulin
neomycin
polymyxin B
double antibiotic (polymyxin B, bacitracin)
triple antibiotic (polymyxin B, neomycin, bacitracin)

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99
Q

what are the indications for using bacitracin?

A

minor cuts
wound
impetigo (1-2 lesions only)

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100
Q

what are the indications for using mupirocin?

A

impetigo

nasal colonization with MRSA

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101
Q

what are the indications for using retapamulin?

A

impetigo

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102
Q

what are the indications for using neomycin?

A

minor cuts
wounds
impetigo (1-2 lesions only)

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103
Q

what are the indications for using polymyxin B?

A

minor cuts
wounds
impetigo (1-2 lesions only)

104
Q

what are the indications for using double antibiotic?

A

minor cuts
wounds
impetigo

105
Q

what are the indications for using triple antibiotic?

A

minor cuts
wounds
impetigo (1-2 lesions only)

106
Q

what are some of the common antifungals used to treat skin d/o?

A 
butenafine
ciclopirox olaminr
clotrimazole
econazole
gentian violet
ketoconazole
miconazole
naftifine
nystatin oral suspension
nystatin cream or ointment
oxiconazole
sertaconazole
terbinafine
tolnaftate
107
Q

what are the indications for using butenafine?

A 
tinea corporis (ringworm)
tinea cruris (jock itch)
108
Q

what are the indications for using ciclopirox olamine?

A 
tinea corporis (ringworm)
tinea cruris (jock itch)
109
Q

what are the indications for using clotrimazole?

A

oral candidiasis
fungal skin infections, including candidiasis
tinea pedis (athlete’s foot)

110
Q

what are the indications for using econazole?

A 
tinea corporis (ringworm)
tinea cruris (jock itch)
tinea pedis (athlete's foot)
111
Q

what are the indications for using gentian violet?

A

oral candidiasis

112
Q

what are the indications for using ketoconazole?

A 
tinea corporis (ringworm)
tinea cruris (jock itch)
tinea pedis (athlete's foot)
113
Q

what are the indications for using miconazole?

A 
fungal skin infections, including candidiasis
tinea pedis (athlete's foot)
114
Q

what are the indications for using naftifine?

A 
tinea corporis (ringworm)
tinea cruris (jock itch)
tinea pedis (athlete's foot)
115
Q

what are the indications for using nystatin oral suspension?

A

oral candidiasis

116
Q

what are the indications for using nystatin cream or ointment?

A

cutaneous candida infections

117
Q

what are the indications for using oxiconazole?

A 
tinea corporis (ringworm)
tinea capitis (ringworm of the scalp)
tinea pedis (athlete's foot)
118
Q

what are the indications for using sertaconazole?

A

interdigital tinea pedis in immunocompetent patients

119
Q

what are the indications for using sulconazole?

A 
tinea corporis (ringworm)
tinea cruris (jock itch)
tinea pedis (athlete's foot)
120
Q

what are the indications for using terbinafine?

A 
tinea corporis (ringworm)
tinea cruris (jock itch)
tinea pedis (athlete's foot)
121
Q

what are the indications for using tolnaftate?

A

tinea pedis (athlete’s foot)

122
Q

what are some of the common antivirals used to treat skin d/o?

A

acyclovir
docosanol
penciclovir

123
Q

what are the indications for using acyclovir?

A

initial herpes genitalis

mucocutaneous HSV infections in immunocompromised patients

124
Q

what are the indications for using docosanol?

A

recurrent oral-facial herpes simplex episodes

125
Q

what are the indications for using penciclovir?

A

recurrent herpes labialis (cold sores) on lips and face

126
Q

what are the low potency topical corticosteroids?

A

hydrocortisone 1% or 2.5%

triamcinolone acetonide 0.025%

127
Q

what are the intermediate potency topical corticosteroids?

A 
hydrocortisone valerate 0.2%
triamcinolone acetonide 0.1%
betamethasone valerate 0.12%
desoximetasone 0.05%
mometaxone furoate 0.1%
128
Q

what are the high potency topical corticosteroids?

A

betamethasone dipropionate augmented 0.05% (cream or lotion)
triamcinolone acetonide 0.5%
halcinonide 0.1%

129
Q

what are the super-high potency topical corticosteroids?

A

bethamethasone dipropionate augmented 0.05% (ointment or gel)
clobetasol propionate 0.05%
flurandrenolide 4-mcg/cm2 tape

130
Q

topical corticosteroids are pregnancy category what?

A

C

avoid use and/or limit amounts and duration

131
Q

who should not use high and super high potency topical corticosteroids?

A

children

132
Q

what is used to treat contact dermatitis?

A

topical corticosteroids
oral corticosteroids ( up to 2-3 wks of therapy)
wet dressings or baths: Al acetate solution (Burow’s, Domeboro) applied 30 mins 4x/day; colloidal oatmeal solids (Aveeno) or oils (Alpha Keri Bath Oil, Lubriderm Bath Oil)

133
Q

what is used to treat seborrheic dermatitis?

A 
topical anti-seborrheic shampoo (selenium sulfide, ketoconazole, pyrithione zinc)
topical corticosteroids (low potency, only if no response from shampoo)
134
Q

which medications are used to tx psoriasis?

A

topical intermediate to high potency corticosteroids

coal tar- creams, shampoos, ointments, lotions, gels, and oils 1-2x/daily (can cause photosensitivity)

135
Q

what should be used in the tx of scabies?

A

permethrin
lindane
topical corticosteroids for itching & inflammation (prolong healing phase)

136
Q

what are the topical retinoids used to tx acne?

A

tretinoin (Retin-A)
adapalene (Differin)
adapalene & benzoyl peroxide (Epiduo)

137
Q

what kind of acne do retinoids tx?

A

inflammatory & noninflammatory

  • can cause redness and peeling
  • can cause acne to initially worsen
138
Q

what are the topical antibiotics used to tx acne?

A 
benzoyl peroxide
benzoyl peroxide/clindamycin
erythromycin
benzoyl peroxide/erythromycin
clindamycin
tetracycline
metronidazole
139
Q

what are the oral antibiotics used to tx acne?

A

tetracycline
erythromycin- *take with food
minocyclin

140
Q

what is the only oral retinoid?

A

isotretinoin

141
Q

what does a pt need to be educated on when taking an oral retinoid?

A

pregnancy category X
reseved for severe recalcitrant cystic acne
requires iPledge
liver enzyme and lipid levels need to be monitored

142
Q

what is acne rosacea?

A

chronic inflammatory d/o of the blood vessels and pilosebaceous glands of the face

143
Q

what is used to tx acne rosacea?

A 
topical metronidazole (Metro-gel, Noritate)
tx for life
144
Q

how long does it take to determine of tx of acne rosacea is effective?

A

6-8 weeks

145
Q

what are the most common bacterial skin infection pathogens?

A

s. aureus

strep pyogenes

146
Q

what is used to tx worsening impetigo or > 5 lesions?

A 
oral medications:
cephalexin
amoxicillin/clavulanate
dicloxavillin
clindamycin
147
Q

if MRSA is suspected with an impetigo infection, which medication should be used?

A

clindamycin
TMP/SMZ
doxycycline

148
Q

which pathogen causes a furuncle?

A

s. aureus

149
Q

which medications are used to tx furuncles?

A

cephalexin
amoxicillin/clavulanate
dicloxacillin

150
Q

which medications are used to tx perianal strep infections?

A

penicillin

erythromycin

151
Q

which pathogen causes cellulitis?

A

strep pneumoniae
s. aureus
haemophilus influenzae (children only)

152
Q

which medications are used to tx oral candidiasis?

A

topical nystatin

oral fluconazole

153
Q

which pathogen causes tinea capitis?

A 
microsporum (present with broken hairs and fine gray scale)
trichophyton tonsurans (black dot tinea; presents with tiny black dots- remains of broken hair shafts)
154
Q

which medications are used to treat tinea capitis?

A

oral griseofulvin

biweekly shampoo with selenium sulfide or ketoconazole

155
Q

which pathogens cause tinea corporis & tinea cruris?

A

microsporum canis
t. tonsurans
epidermophyton floccosum

156
Q

which pathogen causes tinea pedis?

A

dermatophytes

e. floccosum
t. rubrum
t. mentagrophytes
c. albicans

157
Q

which pathogens cause tinea vesicolor?

A

pityrosporum orbiculare

158
Q

which medications are used to tx tinea vesicolor?

A 
selenium sulfide shampoo
topical antifungal (miconazole, clotrimazole, econazole)
159
Q

which medications are used to treat onychomycosis?

A 
griseofulvin
ketoconazole
itraconazole
terbinafine
ciclopirox nail lacquer
efinaconazole (Jublia)- for up to 48 wks
160
Q

which medications are used to treat superficial fungal infections?

A 
azoles
allylamines: naftifine (Naftin)
benzylamine: butenafine (Lotrimin Ultra)
ciclopirox olamine
tolnaftate (Tinactin)
nystatin
161
Q

what are the systemic antifungals used to tx fungal infections of the skin?

A 
griseofulvin
ketoconazole
itraconazole
fluconazole
terbinafine (Lamisil)
162
Q

what precautions are there with systemic antifungals?

A

used cautiously in pts with liver disease

griseofulvin has possible cross-sensitivity with penicillin

163
Q

what are the ADRs of topical antifungals?

A 
skin irritation
itching
burning
rash
gentian violet can cause staining of skin/clothing
164
Q

what are the drug interactions associated with topical antifungals?

A

theoretical interaction with azoles and amphotericin B

clotrimazole intravaginal should not be administered concurrently with nonoxynol-9 and octoxynol

165
Q

which medications are used to tx candidiasis infections?

A

Cutaneous Candida: OTC azoles, nystatin, prescription azoles
Gentian violet can be used for thrush refractory to azoles
Fluconazole may be used systemically for thrush or vaginal candidiasis

166
Q

which medications are used to tx tinea capitis infections?

A 
Griseofulvin
Terbinafine 
Use sporicidal shampoo 
-Selenium sulfide 
-Ketoconazole
167
Q

which medications are used to tx tinea corporis infections?

A

topical azoles
naftifine
ciclopirox olamine

168
Q

which medications are used to tx tinea cruris infections?

A

topical azoles

169
Q

which medications are used to tx tinea pedis infections?

A

topical azoles

170
Q

which medications are used to tx tinea vesicolor infections?

A

selenium sulfide shampoo

topical antifungal

171
Q

what should be monitored when taking griseofulvin?

A

renal
liver
CBC

172
Q

what should be monitored when taking ketoconazole?

A

liver function

173
Q

what should be monitored when taking itraconazole?

A

liver function

electrolytes

174
Q

what should be monitored when taking terbinafine?

A

liver enzymes

CBC

175
Q

which medications should be used to tx head lice?

A

pyrethrins
permethrin
benzoyl alcohol (Ulesfia)
2nd line- lindane & Ovide

176
Q

which medications should be used to tx body lice?

A

topical lindane & permethrin

177
Q

which medications should be used to tx pubic lice?

A

topical lindane, pyrethrin, & permethrin

178
Q

lindane should not be used in which population?

A

pregnancy

children

179
Q

which medication is safer to use in pregnancy for lice?

A

permetherin

180
Q

what are the anticholinergics?

A 
Darifenacin (Enablex)
Fesoterodine (Toviaz)
Oxybutynin (Ditropan, Ditropan XL)
Solifenacin (VESIcare)
Tolterodine (Detrol, Detrol LA)
Trospium (Sanctura)
181
Q

what are the anticholinergic ADRs?

A 
Dry mouth 
Dilate pupils
Increased contractility
Increased HR
Bronchodilation
Blurred vision
Constipation
Drowsiness/sedation
Hallucinations/delirium
Confusion
Decreased sweating
Decreased saliva
Bladder fundus relaxes, sphincter contracts (urinary incontinence)
182
Q

what are the alpha1 antagonists?

A 
Tamsulosin (Flomax)
-Use caution in hepatic impairment
Alfuzosin (Uroxatral)
-Dose not use with mild to moderate hepatic impairment
-Use caution with CrCl < 30 do not use
183
Q

what are the alpha1 antagonist ADRs?

A 
Orthostatic Hypotension – may result in syncope – tends to occur within 30-90 minutes of drug administration (decreased w/evening administration)
fluid retention
nasal congestion
blurred vision
dry mouth
constipation
impotence
urinary frequency
184
Q

what is testosterone replacement therapy used for?

A

muscle mass/strength

sexual desire, function, & performance

185
Q

TRT is contraindicated in which patients?

A

male breast or prostate cx
pregnancy & lactation
transdermal NOT used in women

186
Q

what are the ADRs of TRT?

A

hepatitis
hepatic neoplasm
cholestatic hepatitis
jaundice
hepatocellular carcinoma
Men: gynecomastia, reduced sperm levels, decreased libido, depression
Women: menstrual irregularities, virilization

187
Q

what are the PDE5 inhibitors?

A 
Sildenafil citrate (Viagra)
Tadalafil (Cialis)
Can be given 2.5-5mg once daily instead of prn
Vardenafil (Levitra)
Avanafil (Stendra)
188
Q

what are the PDE5 inhibitor contraindications?

A

food decreases absorption
cannot use concurrently with nitrates
alpha blockers have additive hypotension

189
Q

what are the ADRs of PDE5 inhibitors?

A 
HA
flushing
dyspepsia
blue hue vision change
tadalafil- low back pain & < visual disturbances
190
Q

what is priapism?

A

erection > 4 hours

191
Q

diflucan doesn’t reach steady state for how many days?

A

5-10

192
Q

what is diflucan used for?

A

vaginal candidiasis

oropharyngeal candidiasis

193
Q

UTIs can be treated empirically with which medication?

A

bactrim 1st line when no complicating factors

194
Q

UTIs should be treated with what kind of medications?

A

gram -

195
Q

which pathogen is the primary culprit for UTIs?

A

E. coli

196
Q

what is the alternative first-line treatment for UTIs?

A

ciprofloxacin

can also use levofloxacin

197
Q

which medication should not be used to treat UTIs?

A

moxifloxacin (poor concentration in urine)

198
Q

which medication should be used in children when treating a UTI?

A

ciprofloxacin

199
Q

what is second line therapy in treatment of UTIs?

A

amoxicillin

or cephalosporins

200
Q

which medications should be used to treat UTI in pregnancy?

A

2nd line drugs

nitrofurantion

201
Q

when is nitrofurnation contraindicated?

A

Contraindicated in CrCl<60- no harm to the patient but not effective; UTI won’t go away

202
Q

what are the antibiotics used to tx UTIs?

A 
Trimethoprim/sulfamethoxazole (TMP/SMX, Bactrim)
Nitrofurantoin (Furadantin, Macrodantin)
Fluoroquinolones
-Ciprofloxacin (Cipro)
-Levofloxacin (Levaquin)
Cephalosporins
-Cephalexin (Keflex)
-Cefpodoxime (Vantin)
-Cefixime (Suprax)
Penicillins
-Amoxicillin (Amoxil)
-Amoxicillin/clavulante
203
Q

when is estrogen only contraindicated?

A 
women with an intact uterus
Pregnancy (category X)
Breast cancer
Estrogen-dependent cancers
Active DVT or PE 
Hx in past year of stroke or MI
Liver dysfunction
Smokers
204
Q

what are the ADRs of estrogen?

A

can interfere w/lab tests (endocrine, LFTs, thyroid, & PT)
impaired glucose tolerance
increased triglycerides
thromboembolic phenomena (leg pain, visual disturbances, severe HA- smoker s& diabetics are at increased risk)

205
Q

what are the common drug interactions with estrogen?

A

anticoagulants
anti-TB drugs
corticosteroids
anti-seizure

206
Q

what are the delivery methods of contraception?

A 
oral
topical
vaginal ring
subdermal implants
IM
IUDs
207
Q

when choosing a contraceptive, what should be done first?

A

start with absolute contraindications- estrogen contraindications

208
Q

what are the common oral contraception formulations?

A 
progestin only
ultra low dose (20m mcg EE)
monophasic COC
multiphasic COC
non-daily administration
209
Q

what are the two formulations of estrogen that are available in contraceptive preparations?

A 
ethinyl estradiol (EE)
mestranol (rarely seen)
210
Q

when there is an increased dose of estrogen, what kind of symptoms does the patient have?

A

more pregnancy symptoms

211
Q

when there is a low dose of estrogen, what kind of symptoms does the patient have?

A

less cycle control

212
Q

what are the first generation progesterones?

A

Norethindrone norethindrone acetate ethynodiol diacetate

213
Q

what are the SE of first generation progesterones?

A

highest chance of spotting & breakthrough bleeding

least risk of androgen SE

214
Q

what are the second generation progesterones?

A

norgestrl

levonorgestrel

215
Q

what are the SE of second generation progesterones?

A

lowest risk of breakthrough bleeding

increased risk of androgen SE (acne, hirsutism, dyslipidemia)

216
Q

what are the third generation progesterones?

A

desogestrel

norgestimate

217
Q

what are the SE of third generation progesterones?

A

balance between 1st & 2nd gen

reduce SE on carbohydrate and lipid metabolism; acne; hirsutism

218
Q

which generation of progesterones are first line for contraception?

A

third

219
Q

what are the goals of OC treatment?

A

tolerance
-current OCs has less estrogen (less pregnancy like symptoms)
-newer gen progestins have fewer weight changes, reduced mood swings
effectiveness
-N/V decrease effectiveness (decreased absorption), backup method x7 days

220
Q

what are the dosing regimens for OCs?

A

traditional- 21 days active drug, 7 inactive
extended cycle: 84 days of active, 7 days off
monophasic: same dose of estrogen & progestin for full cycle
biphasic: vary dose of progestin (rare)
triphasic: vary estrogen, progestin or both (more popular)

221
Q

what are the extended cycle dosing medications?

A

seasonique
loSeasonique
lybrel

222
Q

what is the difference of new monophasics?

A

24 active and 4 non-active pills per cycle

-goal lighter & shorter withdrawal bleeds & to decrease breakthrough spotting

223
Q

when are progestin-only pills used?

A

when estrogen is contraindicated

224
Q

what are the common ADRs of progestin-only pills?

A

changing bleeding patterns

breast tenderness

225
Q

what should pts taking progestin-only be educated on?

A

dose MUST be taken at the same time daily

if a pill is taken even a few hours late, backup method is recommended for 48 hours

226
Q

how do progestin-only pills work?

A

thickening of cervical mucus and prevention of sperm penetration

227
Q

what are the injectable progestins?

A

depo-provera

228
Q

what are the advantages of the injectable progestin?

A

once every 12 week dosing

effective

229
Q

what are the disadvantages of the injectable progestin?

A

spotting and then amenorrhea
weight gain
depression
decreased bone-density with long-term use

230
Q

how do intrauterine progestins work?

A

releases 20 mcg of levonorgestrel daily

231
Q

how long can IUDs be left in place?

A

5 yrs

232
Q

what is an advantage of IUDs?

A

only small levels of systemic circulating hormone
minimal SE
can cause changes in menstrual bleeding, amenorrhea

233
Q

what are the progestin implants?

A

implanon/nexplanon; contains 68 mg of etonogestrel

234
Q

how long do progestin implants provide contraception?

A

up to 3 yrs

235
Q

when is hormone replacement therapy used?

A

any time there is a loss of the body’s ability to produce estrogen and progestin (removal of ovaries, menopause)

236
Q

what are the goals of HRT treatment?

A

provide relief from symptoms associated with menopause
used to tx moderate to severe menopausal symptoms
used to tx/prevent other chronic illness not encouraged
lowest dose & shortest duration recommended

237
Q

what are the symptoms of decreased hormones?

A

vasomotor symptoms
vaginal atrophy
osteoporosis

238
Q

what are the “rules” for rational HRT drug selection?

A

use lowest dose that relieves symptoms for shortest time (up to 5 yrs)
individualize the drug choice and dose on woman’s risk profile
monitor women annually for changes in risk profile, development of AE, & cont. need for therapy

239
Q

when is HRT not recommended?

A

to prevent CHD

women with h/o breast cx or 1st degree family memeber

240
Q

when is HRT indicated?

A

can decrease r/o colon cancer
reduces r/o osteoporosis
will improve symptoms of vasomotor symptoms & vaginal atrophy

241
Q

what is estrogen therapy used for?

A

relief of perimenopausal/postmenopausal symptoms
vulvovaginal atrophy/dryness
reduction in colon and rectal cancers

242
Q

when treating vulvovaginal atrophy & dryness what is the preferred route?

A

topical d/t lower overall estrogen dose

oral estrogen improves symptoms

243
Q

what are some of the alternative “medications” used to treat perimenopausal/postmenopausal symptoms?

A 
phytoestrogens
-red clover
-soy
-black cohosh
botanicals/herbals
-black cohos
-chaste tree fruit
244
Q

there is an increased risk of what type of cancer with estrogen therapy?

A

endometrial with unopposed estrogen

245
Q

the risk of what increases with estrogen therapy?

A

CHD
stroke
thromboembolic events

246
Q

estrogen therapy is correlated with reduction of what?

A

colon and rectal cancers

247
Q

what is progestin alone used for?

A

contraception

menorrhagia

248
Q

progestin is combined with estrogen to treat peri & postmenopausal women for what reason?

A

prevent endometrial hyperplasia (increases risk for endometrial cx)

249
Q

combo of estrogen & progestin are used when what is intact?

A

uterus

250
Q

what are the combo medications available?

A

prempro

premphase

251
Q

what is the outcome of continuous regimens?

A

eliminate monthly withdrawal bleeding

have higher rate of breakthrough bleeding esp. first 6 mths

252
Q

what is the outcome of cyclical/sequential therapy?

A

given when problem with breakthrough bleeding
estrogen taken daily
medroxyprogesterone taken part of the cycle

253
Q

when is testosterone therapy used?

A

when hot flashes don’t improve with HRT/ERT

254
Q

testosterone is combined with what?

A

estrogen

255
Q

testosterone alone an lead to what?

A

masculinization

Pharm Exam III (4 decks)

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