Test 1 Flashcards
What is the recommendation for the agent (Alendronate+D) used to treat osteoporosis?
Alendronate (Fosamax) is taken weekly.
Calcium is taken twice daily.
Risedronate (Actonel) is now available as a 75 mg tablet for monthly dosing, but patients have to take it on 2 consecutive days each month instead of 1 day a month, like ibandronate (Boniva).
Reclast (Zoledronic acid) is the first once-a-year bisphosphonate for treating postmenopausal osteoporosis. It can be given as a 15-minute infusion in a doctor’s office.
Formula that can be used to change the strength or quantity in Dilution and Concentration calculations
Q1XC1= Q2xC2
Q1 = old quantity C1 = old concentration Q2 = new quantity C2 = new concentration
Cardizem LA (diltiazem) increases the serum concentration of Zocor (simvastatin). Why?
Simvastatin (Zocor) and diltiazem (Cardizem) are substrates of 3A4; diltiazem is also an inhibitor of 3A4.
Patients should not exceed Zocor 10 mg daily if taking it with Cardizem LA.
PS PORCS {BIG INDUCERS)
Phenytoin Smoking Phenobarbital Oxcarbazepine Rifampin (and rifabutin, rifapentine) Carbamazepine (and is an auto-inducer) St. John's Wort
G PACMAN (BIG INHIBITORS)
Grapefruit
PIs Protease inhibitors (dont miss ritonavir) but check all Pls since many are potent inhibitors
Azole antifungals, the agents that are used oral and IV fluconazole, itraconazole, ketoconazole, posacoriazole, and voriconazole
C - cyclosporine and cimetidine, the H2RA that is the most difficult to use due to DIs and androgen-blocking effects (that can cause gynecomastia - swollen, or painful breast tissue or impotence)
Macrolides (clarithromycin and erythromycin), not azithromiycin, but DO include the related compound telithromycin
Amiodarone (and dronedarone)
Non-DHP CCBs diltiazem and verapamil
Important counseling point for Januvia (sitagliptin)
- Januvia (sitagliptin) may be taken without regard to meals at any time of the day as long as the time is generally consistent. It does not need to be taken with the first meal of the day.
- It should be stored in a cool dry place away from pets or small children.
- Blood sugars should also be monitored with the HbA1c rechecked in 3 months.
- There are no interactions with the other medications (Lipitor and Qsymia). Therefore, they do not need to be separated by 1 hour
What would be the effect of esomeprazole therapy in a CYP2C19 poor metabolizer when compared to an extensive metabolizer?
Even though there is a significant difference in systemic drug exposure between PM and EM of CYP2C19, both esomeprazole and omeprazole are well tolerated by the PM as the active enantiomer has a wide therapeutic index. The conversion of R- to S-enantiomer is mediated by CYP2C19, which exhibits genetic polymorphism. Therefore, the use of the pure isomer could in theory produce the same pharmacological effect in both PM and EM. The incidence of drug interaction is usually much higher in EM
What drug is the most appropriate for pulseless ventricular fibrillation resuscitation?
1 Digoxin 1mg IV
2 Atropine 1mg IV
3 Epinephrine 1mg IV
4 Amiodarone 300mg IV
- Digoxin is ineffective for terminating ventricular fibrillation and takes hours to exert its vagal effects.
- Atropine was considered as an alternative for non-shockable rhythms such as aystole or PEA but is no longer supported as later findings suggest vagal activity during PEA/asystole makes ROSC unlikely.
- Epinephrine has been considered the first choice agent for pulseless VT/VF and most benefits likely during the first two doses. When multiple doses of epinephrine are administered in attempts to restore spontaneous circulation, epinephrine may contribute to acidosis or be cardiotoxic, making return to spontaneous circulation more unlikely.
- Alternatively, vasopressin may be used once after the first two shocks are provided.
- Amiodarone would be selected following the administration of vasopression or epinephrine.
Should metoprolol be switched to sotalol to prevent Premature ventricular contractions (PVCs)?
Sotalol is reserved as a maintenance drug when electrolytes are repleted and the QRS is known to be regular and normal. SWORD discovered increased mortality when sotalol was used for treating PVCs teaching us that suppression of PVCs with antiarrhythmic drugs is associated with worse outcomes. Beta-blockers (without class III K+ channel blocking properties) are ideally suited for rate control without increasing mortality.
Galantamine (Razadyne) is indicated for?
mild to moderate Alzheimer’s disease
Niaspan side effect
Niaspan is a controlled release niacin compound that is used to treat high cholesterol. One of this drug’s most common and well-documented side effects is flushing. The flushing can also include itching, headache, and a heating sensation.
Which of the following Federal laws is related to approval of generic drugs?
Waxman-Hatch Act (1984)
Patient education for Fenofibrate (Tricor)
- follow up with regular blood work to check renal function.
- renal function should be assessed at baseline, within 3 months, then every 6 months thereafter.
- caution about the risk of allergic reaction to the medication (rash, swelling, hives) and advised to seek medical attention immediately if it happens.
Lorazepam (Ativan) side effects
Sedation, dizziness, weakness, and unsteadiness are the most frequent side effects of Ativan (Lorazepam). Memory impairment, confusion, depression, disinhibition, euphoria, suicidal ideation/attempt, ataxia, extrapyramidal symptoms, convulsions/seizures, vertigo, eye-function/visual disturbance, dysarthria/slurred speech, respiratory depression, jaundice, hypersensitivity reactions, alopecia, SIADH, and pancytopenia are some other recognized side effects of Ativan.
Patient education for Ezetimibe (Zetia)
Common side effects associated with Zetia include diarrhea and arthralgia and elevated liver function tests, especially if used in combination with a statin. Zetia has a drug interaction with cholestyramine, leading to a reduction in Zetia absorption. Patients on concomitant therapy should be counseled to administer Zetia at least 2 hours before or 4 hours after cholestyramine.
Question Which of the following drugs should not be used together with neuromuscular blocking agents such as succinylcholine? Answer Choices 1 Penicillin 2 Aminoglycosides 3 Quinolones 4 Macrolides 5 Protease inhibitors
The available aminoglycosides produce varying degrees of neuromuscular blockade, with neomycin being the most potent. Although in general the effect is dose-related and self-limiting, the blockade can cause respiratory paralysis and is more likely in patients receiving concurrent neuromuscular blocking agent.
The drug AZT is effective against HIV because
it inhibits the DNA polymerase of HIV more effectively than the host cell polymerase. 3’-azido-3’-deoxythymidine (AZT) is a pyrimidine analog that is phosphorylated to AZT-triphosphate by cellular enzymes. This compound blocks HIV replication by inhibiting the RNA-dependent polymerase, HIV-DNA polymerase. The DNA polymerase from HIV is 100-fold more sensitive to AZT than the host polymerase.
What warnings/precaution regarding Diovan therapy must be communicated to the patient?
Serious warnings or precautions associated with Diovan use that must be communicated to the patient include the risk of angioedema, hypotension at the initiation of therapy or following dose increases, decreased renal function, and hyperkalemia. Diovan is commonly utilized in the treatment of heart failure, and therapy should be monitored closely due to the risk of hypotensive episodes
warfarin is highly protein bound; caution with other highly protein bound drugs that may displace warfarin e.g. ?
phenytoin, valproicacid, furosemide, bumetanide, spironolactone, metolazone, doxycycline, glipizide, glyburide, ibuprofen, naproxen, diphenhydramine, others)
2C9 Inducers that may decrease INR
including aprepitant, bosentan, carbamazepine, phenobarbital, phenytoin, primidone, rifampin (largei INR), licorice and St.John'sWort—
2C9 inhibitors may increase INR
including amiodarone, azole antifungals (e.g.,fluconazole,ketoconazole, voriconazole), capecitabine, etravirine, fluvastatin, fluvoxamine, macrolideantibiotics, metronidazole, tigecycline, TMP/SMX and zafirlukast
When starting amiodarone, decrease the dose of warfarin by
30-50%
What are the guidelines for the reduction of vasospastic angina?
Nitrates are not used for vasospastic angina. Verapamil, diltiazem, or dihydrypyridines (amlodipine and nifedipine) are effective and recommended in the most recent
How will you counsel this patient about nutrition when initiating methotrexate?
Patients receiving methotrexate must receive folic acid to reduce side effects of methotrexate. Most patients receive prescription strength folic acid but it is important to maintain a diet with adequate levels of folic acid during treatment.
the mechanism of action of calcium gluconate for muscle weakness, and decreased deep tendon reflexes. Electrocardiogram shows peaked T waves and a prolonged PR interval
In the setting of hyperkalemia, calcium acts to stabilize the cardiac myocyte membrane. In the setting of hyperkalemia, the resting membrane potential is shifted to a less negative value, that is, from 90 mV to 80 mV, which in turn moves the resting membrane potential closer to the normal threshold potential of 75 mV, resulting in increased myocyte excitability (1). When calcium is given, the threshold potential shifts to a less negative value (that is, from 75 mV to 65 mV), so that the initial difference between the resting and threshold potentials of 15 mV can be restored (1).
In the setting of hyperkalemia, calcium’s beneficial effects are not derived from enzyme activation, nuclear ceceptor activation, inhibition of protein synthesis, or increased gastrointestinal potassium excretion (which, however, is the mechanism of sodium polystyrene sulfonate and hence its use in this case of hyperkalemia).
How should the pharmacist instruct the patient to take Levothyroxine?
Levothyroxine is a thyroid replacement drug for hypothyroidism. Levothyroxine should be taken in the morning on an empty stomach. It should be taken at least 30 minutes before any food or nutritive drink. If it is taken with food or while food is in the stomach, this will impede its absorption. Therefore, taking it at bedtime, meal time, or anytime other than first thing in the morning on an empty stomach would be less than ideal for its proper absorption
Skelaxin
Metaxalone
Muscle relaxant
BuSpar®
Buspirone
Anxiety, Generalized anxiety disorder, Anxiety disorder, Intellectual disability, Depressive Disorder
Cogentin
Benztropine
Anticholinergic, H1 antagonist
Parkinson’s disease, Drug-Induced Abnormalities
Requip
Ropinirole
Nonergot Dopamine Agonist
Parkinson’s disease, Restless legs syndrome
Primidone
Mysoline
Anti-epileptic Agent
Epilepsy, Tremor
Pataday, Patanol, Patanas
olopatadine
Histamine-1 Receptor Inhibitor
Allergic conjunctivitis
Trexall, Rheumatrex
Methotrexate
Folate Analog Metabolic Inhibitor
Rheumatoid arthritis, Psoriasis, Leukemia
Raloxifene
Evista
Estrogen Agonist/Antagonist
May treat: Osteoporosis
May prevent: Postmenopausal osteoporosis
strong CYP3A4 inhibitors
including ketoconazole, atazanavir, clarithromycin, indinavir, itraconazole, nefazodone, nelfinavir, ritonavir, saquinavir and telithromycin.
