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Pharm 2 Jack > Test 1 > Flashcards

Test 1 Flashcards

1
Q

All drugs in the opiate category act by binding to specific opioid receptors in order to produce effects that mimic the actions of endogenous neurotransmitters, referred to as

A

the opiopeptins

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2
Q

The opiopeptins include peptides such as

A

endorphins and enkephalins

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3
Q

The analgesic properties of the opiates are primarily mediated by

A

mu receptors…mu 1 most commonly for pain

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4
Q

enkephalins interact more selectively with what receptors

A

delta receptors in the periphery

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5
Q

receptor possibly responsible for hallucinations and dysphoria often associated with opiate use

A

sigma receptor

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6
Q

class of Morphine/ MS Contin

A

opioid analgesic

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7
Q

ind. of Morphine/ MS Contin

A

pain relief

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8
Q

MOA of Morphine/ MS Contin

A

Potent opioid agonist. High affinity for μreceptors. Morphine relieves pain both by raising the pain threshold at the brain stem, thalamic and spinal cord level as well as by altering the brain’s perception of pain. Patients treated with morphine may still be aware of the presence of pain but perception of the actual sensation of pain is blocked.

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9
Q

Morphine/ MS Contin can also be used for what condition

A

acute myocardial infarction. It can potentially provide pain relief, decrease anxiety and also acts as a peripheral vasodilator.

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10
Q

side effects of Morphine/ MS Contin

A

Morphine causes respiratory depression by reducing the sensitivity of respiratory center neurons to carbon dioxide. Respiratory depression is the most common cause of death related to morphine. Miosis (pin point pupils) is due to enhanced parasympathetic stimulation to the occulomotor nerve. Itching is a common side effect due to the fact that the opiate drugs can stimulate histamine release.

Morphine often causes nausea and vomiting due to stimulation of the chemoreceptor trigger (nausea center) in the brain. Constipation due to reduced G.I. smooth muscle motility. PARALYTIC ILEUS is possible. Morphine crosses the placenta, thus potentially creating physical dependence in infants exposed to the drug.

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11
Q

class of Fentanyl/ Duragesic

A

opioid analgesic

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12
Q

indication of Fentanyl/ Duragesic

A

pain relief, anesthesia

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13
Q

MOA of Fentanyl/ Duragesic

A

similar to morphine with 80x the analgesic property of morphine. Used for anesthesia and for intractable pain

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14
Q

Drug often used as a transdermal patch or lollypop form

A

Fentanyl/ Duragesic

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15
Q

side effects of Fentanyl/ Duragesic

A

Respiratory depression with life threatening hypoventilation can occur. Patients using concomitant CYP 450 inhibitors may result in fatal blood levels of Fentanyl. Nausea/ vomiting. Constipation is a commonly occurring side effect and paralytic ileus can occur. Highly addictive.

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16
Q

class of Codeine

A

opioid analgesic

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17
Q

indication of Codeine

A

pain relief, antitussive

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18
Q

MOA of Codeine

A

Opioid agonist, is converted to morphine in the body but mg per mg, codeine is much weaker analgesic then morphine.

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19
Q

Can you cut a Fentanyl/Duragesic patch?

A

No, it will mess up the timed release of the patch.

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20
Q

Should you place a heating pad on a Fentanyl/Duragesic patch?

A

No, it will increase the dose

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21
Q

side effets of Codeine

A

Sedation, constipation, itching and increased potential for exaggerated response in certain individuals at risk due to genetic variability . The FDA has issued a Drug Safety Communication after reviewing reports of children who developed serious adverse effects, including death, after receiving codeine in the usual dosage range for pain relief following tonsillectomy and/or adenoidectomy for obstructive sleep apnea syndrome.

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22
Q

Which is better at controlling cough: Codeine, Morphine, or Fentanyl?

A

Codeine

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23
Q

Respiratory depression, a common side-effect of most opioids, is not clinically significant in normal doses of

A

Tramadol/ Ultram

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24
Q

Drug used in the controlled withdrawal of heroin and morphine in addicted patients

A

Methadone…Dependence can develop but the withdrawal syndrome is much milder then with heroin or morphine.

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25
Q

class of Naloxone/ Narcan

A

opioid antagonist

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26
Q

indication of Naloxone/ Narcan

A

Opioid overdose. Naloxone/ Narcan is used to reverse the coma and respiratory depression of opioid overdose.

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27
Q

MOA of Naloxone/ Narcan

A

Opioid antagonists bind with high affinity to opioid receptors but do not activate the receptor mediated response

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28
Q

isomer of codeine.

A

Dextromethorphan…effective antitussive and is commonly used in OTC cough meds. Generally has little to no analgesic, sedative or GI effects.

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29
Q

Pain relief agents you would not be expected to effect the GI

A

agents with DM aka dextromethorphan

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30
Q

The nonsteroidal anti-inflammatory drugs (NSAIDs) act by inhibiting the synthesis of

A

prostaglandins

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31
Q

Prostaglandins, thromboxanes and prostacyclins are all synthesized from the precursor fatty acid, arachadonic acid, via the

A

cyclooxygenase pathway

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32
Q

COX 1 and 2 inhibitors

A

aspirin and other salicylates, ibuprofen (motrin, advil), acetaminophen (tylenol)

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33
Q

isolated COX 2 inhibitor

A

Celecoxib (celebrex)

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34
Q

class of Aspirin/ Acetylsalicylic acid (ASA)

A

NSAID

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35
Q

indication of Aspirin/ Acetylsalicylic acid (ASA)

A

inflammation, pain, fever

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36
Q

MOA of Aspirin/ Acetylsalicylic acid (ASA)

A

Irreversible inhibition of COX-1 and COX-2 enzymes. Anti-inflammatory and analgesic effect largely due to blockade of prostaglandin synthesis at target tissues. Anti-pyretic effect due to blockade of prostaglandin synthesis at thermoregulatory centers in the hypothalamus.

Prostaglandin E2 (PGE2) is thought to sensitize nerve endings to the actions of bradykinins, histamines and other inflammatory mediators. Thus, aspirin serves to diminish pain by decreasing tissue sensitivity to the sensation of pain.

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37
Q

Drug that irreversibly inhibits COX-1 and COX-2 enzymes

A

Aspirin/ Acetylsalicylic acid (ASA)

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38
Q

side effects of Aspirin/ Acetylsalicylic acid (ASA)

A

Many potential side effects. Primarily G.I. irritation and peptic ulcer disease, nausea, and vomiting. Increased risk of bleeding. Renal insufficiency. Increased risk of Reye’s syndrome.

Salicylism involves dizziness, tinnitus, hyperventilation, mental status changes and potential for coma and death.

Treatment for salicylism involves I.V. hydration, alkalinization of urine and dialysis if renal insufficiency occurs.

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39
Q

class of Ibuprofen/ Motrin, Advil

A

NSAID

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40
Q

ind. of Ibuprofen/ Motrin, Advil

A

inflammation, pain, fever

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41
Q

MOA of Ibuprofen/ Motrin, Advil

A

Reversible inhibition of COX-1 and COX-2 enzymes. Anti-inflammatory and analgesic effect largely due to blockade of prostaglandin synthesis at target tissues.

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42
Q

class of Celecoxib/ Celebrex

A

NSAID

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43
Q

ind. of Celecoxib/ Celebrex

A

inflammation, pain, treatment of adenomatous polyps

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44
Q

MOA of Celecoxib/ Celebrex

A

reversible, selective COX-2 inhibition

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45
Q

side effects of Celecoxib/ Celebrex

A

presently unclear if a definite increased risk for cardiovascular disease exists with Celecoxib/ Celebrex

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46
Q

drug with reversible, selective COX-2 inhibition

A

Celecoxib/ Celebrex

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47
Q

2004, Merck & Co., Inc. announced a voluntary withdrawal of ___ from the U.S. and worldwide market due to safety concerns of an increased risk of cardiovascular events (including heart attack and stroke) in patients on

A

Rofecoxib/ Vioxx

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48
Q

class of Acetaminophen/ Tylenol

A

NSAID

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49
Q

indication of Acetaminophen/ Tylenol

A

pain, fever

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50
Q

MOA of Acetaminophen/ Tylenol

A

Not fully understood. Weak peripheral blockade of prostaglandin synthesis with stronger blockade of prostaglandin synthesis in hypothalamus

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51
Q

side effects of Acetaminophen/Tylenol

A

overdose (>7 gm/ 24 hrs) or when acetaminophen is taken with alcohol can lead to severe hepatic necrosis leading to liver failure, coma and death.

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52
Q

Never mix Acetaminophen/Tylenol with

A

alcohol

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53
Q

maximum safe dose of Acetaminophen/Tylenol in the absence of alcohol use or underlying liver disease

A

4 grams/24 hours

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54
Q

Acetaminophen is oxidatively metabolized in the liver via the mixed function P450 system to a toxic metabolite

A

N-acetyl-p-benzoquinone-imine (NAPQI).

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55
Q

antidote for acetaminophen/tylenol

A

N-acetylcystein (NAC)

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56
Q

Serotonin 1 (5 HT-1) receptors appear to elicit

A

vascoconstriction

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57
Q

Serotonin 2 (5 HT-2) receptors appear to elicit

A

vasodilation

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58
Q

class of Propranolol/ Inderal

A

non-selective beta blocker

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59
Q

indication of Propranolol/ Inderal

A

HTN, angina, AMI, panic attacks and migraine headaches

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60
Q

what class of meds is best for prodromal phase of headaches

A

Triptans

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61
Q

whats classes of meds are used for actual headache phase

A

analgesics, anti-emetics

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62
Q

MOA of Propranolol/ Inderal

A

blocks adrenergic stimulation which serves to decrease heart rate and myocardial oxygen demand and also decreases renin release

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63
Q

side effects of Propranolol/ Inderal

A

Bronchoconstriction, hypotension, bradycardia, fatigue, impotence. Abrupt discontinuation may cause rebound hypertension and tachycardia with subsequent increase in myocardial oxygen demand. Abrupt discontinuation increases the risk of arrythmias, stroke, angina and M.I.

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64
Q

class of Amitriptyline/ Elavil

A

tricyclic antidepressant (TCA)

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65
Q

ind. of Amitriptyline/ Elavil

A

migraine/tension headache, chronic pain, bipolar disorder and depression

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66
Q

MOA of Amitriptyline/ Elavil

A

CNS modulation of both serotonin and norepinephrine

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67
Q

side effects of Amitriptyline/ Elavil

A

Dizziness and marked drowsiness. Anticholinergic effects such as dry mouth, constipation, urinary hesitancy and blurred vision. Do not use with monoamine oxidase (MAO) inhibitors. The full benefits of Amitriptyline may take days to several weeks to be observed whereas side effects are usually noted within first several days.

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68
Q

Topiramate/ Topamax class

A

anticonvulsant

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69
Q

ind. of Topiramate/ Topamax

A

anticonvulsant approved for use in treating epilepsy and prophylaxis of migraine headaches. Off-label use for bipolar disorder.

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70
Q

MOA of Topiramate/ Topamax

A

Block voltage-dependent sodium channels in the CNS, augmenting the activity of the neurotransmitter gamma-amino butyrate (GABA) at some subtypes of the GABA-A receptor. MOA as a migraine medication is not fully known.

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71
Q

side effects of Topiramate/ Topamax

A

fatigue, dizziness, vision, changes, acute angle glaucoma, nausea, constipation

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72
Q

class of Methysergide/ Sansert

A

Ergot derivative - serotonin 2 receptor antagonist

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73
Q

ind. of Methysergide/ Sansert

A

prophylaxis of migraine and cluster headache

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74
Q

MOA of Methysergide/ Sansert

A

MOA not fully known, yet it appears to be a serotonin 2 receptor antagonist which results in vasoconstrictor effect

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75
Q

caution w/ use of Methysergide/ Sansert

A

Should never be used beyond ~6 months without a drug free interval. Dosage must be tapered to avoid rebound. Do not use within 24 hrs of a triptan because of increased risk of vasoconstrictive spasm.

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76
Q

Side effects of Methysergide/ Sansert

A

Multiple potential side effects make methysergide a less attractive choice then newer treatment options. These side effects include but are not limited to hypertension, thrombophlebitis, nausea and vomiting. Pulmonary fibrosis and retroperitoneal fibrosis are severe and potentially life threatening occurrences.

Heart valve thickening has also been reported. Contraindicated in pregnancy (Category X) and in patients with peripheral vascular disease. Because of potential severe side effects.

Methysergide is usually reserved for cases refractive to other medications and treatment modalities.

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77
Q

Life threatening Side effects of Methysergide/ Sansert

A

Pulmonary fibrosis and retroperitoneal fibrosis are severe and potentially life threatening occurrences.

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78
Q

class of Sumatriptan/ Imitrex

A

serotonin agonist

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79
Q

ind. of Sumatriptan/ Imitrex

A

migraine and cluster headache

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80
Q

MOA of Sumatriptan/ Imitrex

A

Serotonin agonist at 5-HT 1D and 1B receptors, found in small, peripheral nerves that innervate the intracranial vasculature.

81
Q

side effects of Sumatriptan/ Imitrex

A

Dizziness, tingling, facial flushing, weakness, chest tightness or pain, arrythmias and hypertension. Use with caution in patients with high blood pressure and in patients with angina.

Serotonin syndrome is an uncommon potential side effect of all of the triptans. Symptoms of serotonin syndrome may include agitation, tremor, ataxia, fever, chills and diarrhea.

Frequent use of triptans (daily basis) can result in rebound headaches. Maximum dose generally 2 to 3 doses in a 24 hour period and no more then 12 to 18 doses per month.

82
Q

max dose of Sumatriptan/ Imitrex

A

Maximum of 2 doses in 24 hours

83
Q

uncommon potential side effect of all triptans

A

Serotonin syndrome is an uncommon potential side effect of all of the triptans. Symptoms of serotonin syndrome may include agitation, tremor, ataxia, fever, chills and diarrhea.

Frequent use of triptans (daily basis) can result in rebound headaches.

84
Q

The nonsteroidal anti-inflammatory drugs (NSAIDs) act by inhibiting the synthesis of

A

prostaglandins. Prostaglandins are also referred to as eicosanoids since “eicosa” refers to the 20 carbon atom structure.

85
Q

class of Butorphanol/ Stadol

A

opioid analgesic

86
Q

ind. of Butorphanol/ Stadol

A

migraine headache that is refractory to triptans and to other agents as well as less potent analgesics. Butorphanol/ Stadol may also be used in other acute pain conditions.

87
Q

MOA of Butorphanol/ Stadol

A

Mixed agonist-antagonist of opioid receptors

88
Q

side effects of Butorphanol/ Stadol

A

Nasal irritation, drowsiness, dysphoria, nausea and vomiting. Because of the mixed agonist-antagonist properties of Butorphanol, withdrawal symptoms can be precipitated in patients with underlying addiction to opiates.

89
Q

class of Prochlorperazine/ Compazine

A

typical neuroleptic

90
Q

ind. of Prochlorperazine/ Compazine

A

anti-emetic particularly when associated with migraine headaches, vertigo, anti-psychotic

91
Q

MOA of Prochlorperazine/ Compazine

A

primarily H1-histamine receptor antagonist. Also a D2 dopaminergic receptor antagonist and an alpha-adrenergic receptor antagonist.

92
Q

side effects of Prochlorperazine/ Compazine

A

Drowsiness, dry mouth, constipation and urinary retention. Lowers seizure threshold. Extrapyramidal side effects generally seen only when Prochlorperazine is given at high doses over long periods of time.

93
Q

class of Ondansetron/ Zofran

A

antiemetic

94
Q

MOA of Ondansetron/ Zofran

A

blockade of serotonin (5HT3) receptor sites results insignificant anti-nausea effect.

95
Q

Ind. of Ondansetron/ Zofran

A

severe nausea

96
Q

Side effects of Ondansetron/ Zofran

A

dizziness, headache. Generally well tolerated.

97
Q

non-pharm treatment options for migraines

A

Riboflavin (vitamin B2) 400 mg/ day

Magnesium 600 mg to 2000 mg/ day

Biofeedback

Acupuncture

Botulinum toxin (Botox) injection has shown promise as a therapeutic agent.

98
Q

Treatment of acute gouty attack includes

A

NSAIDs, Steroids, Colchicine

99
Q

Prophylactic treatment options for gout include

A

colchicine, allopurinol, probenecid

100
Q

first line treatment for gout is

A

NSAIDs

101
Q

class of Indomethacin/ Indocin

A

NSAID

102
Q

ind. of Indomethacin/ Indocin

A

gout, arthritis, bursitis, migraine, hemicrania, pain and swelling

103
Q

MOA of Indomethacin/ Indocin

A

COX-1 and COX-2 inhibition

104
Q

side effects of Indomethacin/ Indocin

A

bleeding, gastritis, PUD, may exacerbate hypertension or CHF. Use with caution in patients with preexisting renal and/or liver disease.

105
Q

Avoid use of Indomethacin/ Indocin in patients with

A

asthma and nasal or sinus polyps

106
Q

class of Cortisone injection

A

steroid

107
Q

ind. of Cortisone injection

A

cortisone injection are used to give short term pain relief and reduce the swelling from inflammation of a joint, tendon or bursa as well as for marked allergic reaction or post-epinephrine treatment of anaphylaxis

108
Q

MOA of cortisone injection

A

decreases inflammation by inhibiting pro-inflammatory proteins

109
Q

side effects of Cortisone injection

A

Use of cortisone has a number of potential systemic side effects: hyperglycemia, insulin resistance, diabetes mellitus, osteoporosis, anxiety, depression, amenorrhea, cataracts and glaucoma, among other problems.

110
Q

class of Colchicine

A

mitotic inhibitor

111
Q

ind. of Colchicine

A

Gout, both for acute flares and for prophylaxis

112
Q

MOA of Colchicine

A

Colchicine inhibits microtubule polymerization by binding to tubulin, one of the main constituents of microtubules. The availability of tubulin is essential to mitosis therefore mitosis is inhibited the process in affected cells.

Colchicine also inhibits neutrophil motility and neutrophil activity, resulting in an anti-inflammatory effect.

113
Q

side effects of Colchicine

A

GI upset, anemia, neutropenia, hair loss, hair loss, PERIPHERAL NEUROPATHY. Colchicine overdose symptoms include: vomiting, diarrhea, acute renal failure and possible hypovolemic shock. No specific antidotes are known.

114
Q

primary side effect of Colchicine

A

peripheral neuropathy

115
Q

class of Allopurinol/ Zyloprim

A

Purine analog

116
Q

indication of Allopurinol/ Zyloprim

A

hyperuricemia, gout, prophylaxis against tumor lysis syndrome

117
Q

MOA of Allopurinol/ Zyloprim

A

xanthine oxidase inhibitor

118
Q

side effects of Allopurinol/ Zyloprim

A

Nausea, vomiting, skin rash, SJS, Hypersensitivity syndrome consists of fever, skin rash, eosinophilia, hepatitis and decreased renal function.

119
Q

what are Uricosurics?

A

Uricosuric medications are substances that increase the excretion of uric acid in the urine, thus reducing the concentration of uric acid in blood plasma. In general, this effect is achieved by action on the proximal tubule of the kidney. By decreasing plasma uric acid levels, uricosurics help to dissolve these crystals, while limiting the formation of new ones. However, the increased uric acid levels in urine can contribute to kidney stones.

120
Q

class of Probenecid/Probalan

A

Uricosuric

121
Q

ind. of Probenecid/Probalan

A

hyperuricemia, gout

122
Q

MOA of Probenecid/Probalan

A

Probenecid works by interfering with the kidneys’ organic anion transporter (OAT), which reclaims uric acid from the urine and returns it to the plasma. Thus, the tubular reabsorption of uric acid is decreased which serves to increase the urinary excretion of uric acid.

123
Q

side effects of Probenecid/Probalan

A

GI upset, gastritis, nausea, vomiting. Anemia, leukopenia and possible hemolytic anemia, particularly in patients with glucose -6- phosphate dehydrogenase deficiency. Possible drug induced hepatitis, dizziness.

124
Q

key side effects of Probenecid/Probalan

A

May cause the formation of uric acid renal stones, particularly in patients with renal insufficiency

Exacerbation of gout following therapy with Probenecid may occur.

125
Q

common MOA of cytotoxic drugs

A

prevent clonal expansion of both B and T lymphocytes

126
Q

class of Methotrexate/ MTX

A

anti-metabolite and anti-folate

127
Q

ind. of Methotrexate/ MTX

A

Cancer, autoimmune diseases, including rheumatoid arthritis, psoriasis, psoriatic arthritis, lupus and Crohn’s disease as well as an abortifacient. MTX has also been used for multiple sclerosis but is not yet FDA approved for this indication.

128
Q

MOA of Methotrexate/ MTX

A

anti-metabolite and anti-folate drug

129
Q

when taking Methotrexate/ MTX, assessment of what is necessary

A

creatinine levels at least every 2 months

130
Q

side effects of Methotrexate/ MTX

A

The most common adverse effects include: nausea, abdominal pain, fatigue, fever, dizziness, ulcerative stomatitis, low white blood cell count and thus predisposition to infection. Other adverse effects include acute pneumonitis and rarely, pulmonary fibrosis.

Methotrexate is a highly teratogenic drug and is considered category X by the FDA. Women must not take the drug during pregnancy, if there is a risk of becoming pregnant, or if they are breastfeeding. To engage in any of these activities (after discontinuing the drug), women must wait until the end of a full ovulation cycle.

131
Q

While using Methotrexate/ MTX for cancer, the use of what is contraindicated

A

folic acid, because Methotrexate/ MTX is a folate inhibitor

132
Q

class of Azathioprine/ Imuran

A

purine anti-metabolite immuno-suppressant

133
Q

ind. of Azathioprine/ Imuran

A

Prevention of transplant rejection, inflammatory bowel disease, SLE and rheumatoid arthritis.

134
Q

MOA of Azathioprine/ Imuran

A

Metabolic breakdown products of Azathioprine act to inhibit purine synthesis which will block protein synthesis, particularly in cells that experience rapid turnover.

135
Q

side effects of Azathioprine/ Imuran

A

Rapidly growing cells are most readily affected, leading to hair loss, bone marrow suppression, GI toxicity, leukopenia, and thrombocytopenia. Decreased ability to fight infection. Can cause pancreatitis. Known to cause birth defects.

136
Q

class of Cyclosporine/ Sandimmune (Restasis)

A

an immunosuppressant drug derived from a soil fungus

137
Q

ind. of Cyclosporine/ Sandimmune (Restasis)

A

Prevent rejection of kidney, liver and heart transplants as well as for treatment of RA and other autoimmune diseases such as severe psoriasis.

138
Q

MOA of Cyclosporine/ Sandimmune (Restasis)

A

T-cell inhibition. Blocks the signal to lymphocytes to produce IL-1, IL-2, IL-3, IL-4, and interferon gamma

139
Q

side effects of Cyclosporine/ Sandimmune (Restasis)

A

Nausea, vomiting, diarrhea, loss of appetite, high blood pressure, kidney damage, tremors, headaches, seizures, excessive hair growth, excessive gum growth, confusion, coma, and gout.

As is the case with all immunosuppressive drugs, there is increased risk for infection leading to sepsis for any patient taking Cyclosporine.

140
Q

blood levels of Cyclosporine/ Sandimmune (Restasis) are increased when patients consume

A

grapefruit juice

141
Q

class of Tacrolimus/ Prograf

A

An immunosuppressant drug related to the macrolide class of antibiotics extracted from soil microorganism.

142
Q

ind. of Tacrolimus/ Prograf

A

Protection against rejection of organ transplantation. Topical treatment for severe eczema.

143
Q

MOA of Tacrolimus/ Prograf

A

T-cell inhibition similar to that of Cyclosporine. Tacrolimus is approximately 100x more potent in its immunosuppressive effects then an equal volume of Cyclosporine.

144
Q

side effects of Tacrolimus/ Prograf

A

Also very similar to Cyclosporine in side effect profile with nausea, vomiting, diarrhea, loss of appetite, high blood pressure, kidney damage and increased risk for infection.

145
Q

DMARDs stands for

A

Disease-modifying anti-rheumatic drugs

146
Q

class of Etanercept/ Enbrel

A

DMARD, recombinant-DNA drug

147
Q

ind. of Etanercept/ Enbrel

A

Moderate to severe rheumatoid arthritis, moderate to severe polyarticular juvenile arthritis, psoriatic arthritis, ankylosing spondylitis and moderate to severe plaque psoriasis.

148
Q

MOA of Etanercept/ Enbrel

A

Reduction of inflammatory response via anti-TNF alpha therapy.

149
Q

side effects of Etanercept/ Enbrel

A

Very broad side effect profile with notable decreased resistance to infection. Increasing number of reports of potential for increased risk for leukemia, lymphoma and solid tumors, as well as increasing number of reports of serious liver injury, congestive heart failure and demyelinating central nervous system disorders.

150
Q

Eye drop to increase tear production

A

Cyclosporine/ Sandimmune (Restasis)

151
Q

class of Infliximab/ Remicade

A

DMARD, recombinant-DNA drug

152
Q

ind. of Infliximab/ Remicade

A

RA, Crohn’s disease, U.C.

153
Q

MOA of Infliximab/ Remicade

A

According to product labeling, Infliximab neutralizes the biological activity of TNFα by binding with high affinity to the soluble (free floating in the blood) TNFα and the trans-membrane (located on the outer membranes of T cells and similar immune cells) forms of TNFα, thus preventing the effective binding of TNFα with its receptors.

154
Q

difference between Etanercept/ Enbrel and Infliximab/ Remicade

A

Infliximab/ Remicade causes programmed cell death of TNFalpha expressing activated T cells but Etanercept/ Enbrel does not

155
Q

when you see a drug ending in “-imab” you can generally assume

A

its a recombinant drug

156
Q

Etanercept/ Enbrel is not used for

A

Crohn’s or UC, Infliximab/ Remicade is used for them.

157
Q

which drug used for RA or Lupus is also used to treat Malaria

A

Hydroxychloroquine/ Plaquenil

158
Q

class of Hydroxychloroquine/ Plaquenil

A

Immunosuppressant and anti-malarial

159
Q

ind. of Hydroxychloroquine/ Plaquenil

A

RA, SLE, Sjogren’s as well as malaria in area of the world in which there is low rick for Hydroxychloroquine/ Plaquenil resistant malaria

160
Q

MOA of Hydroxychloroquine/ Plaquenil

A

blocks activation of TLRs on plasmacytoid dendritic cells. May involve an anti-spirochete activity as well as an anti-inflammatory activity

161
Q

higher does of this drug requires frequent eye-dilated exams because it can cause the cornea to become opaque

A

Hydroxychloroquine/ Plaquenil

162
Q

2 big side effects of Hydroxychloroquine/ Plaquenil

A

Effects on the cornea and patients with G6PD enzyme deficiency who take Hydroxychloroquine can develop a severe anemia and should be closely monitored if the drug is not stopped.

163
Q

which drug is most likely the last drug of choice to treat RA

A

Gold Salt: Auranofin/Ridaura

164
Q

Side effects of Gold Salts

A

decreased appetite, nausea, hair thinning and diarrhea, rash, and thrombocytopenia. Renal toxicity is generally the most severe complication.

165
Q

disease that requires glucocorticoid for survival

A

addison’s disease

166
Q

patients using inhaled steroids are at increased risk of

A

thrush

167
Q

for steroids, the greater the anti-inflammatory effect, the ___ the mineral corticoid effect

A

the less the mineral corticoid effect

168
Q

what is tachyphylaxis

A

a rapid decrease in the response to a drug over a relatively short time period

169
Q

what can be used to prevent tachyphylaxis

A

topical corticosteroids

170
Q

the active ingredient in some Preparation H products is

A

Phenylephrine in a 0.25% concentration, a drug which constricts blood vessels

171
Q

Short acting (8-12 hours) steroids

A

Hydrocortisone

172
Q

Intermediate acting (18-36 hours) steroids

A

Prednisone

173
Q

Long acting (24-72+ hours) steroids

A

Dexamethasone, Betamethasone

174
Q

Rate these steroids in terms of anti-inflammatory effect: Dexamethasone, Hydrocortisone, Betamethasone, Prenisone

A

Lowest to Highest: hydrocortisone, prednisone, dexamethasone, betamethasone

175
Q

abrupt withdrawal of glucocorticoids can lead to exacerbation of the underlying disease as well as

A

acute adrenal infusfficiency syndrome aka Addisonian crisis, which can be a lethal event

176
Q

class of Hydrocortisone/ Cortef

A

glucocorticoid/corticosteroid

177
Q

ind. of Hydrocortisone/ Cortef

A

Preferred drug for cortisol replacement therapy.

178
Q

MOA of Hydrocortisone/ Cortef

A

affects gene transcription to either stimulate or repress protein production

179
Q

class of Prednisone/ Deltasone

A

glucocorticoid/corticosteroid

180
Q

ind. of Prednisone/ Deltasone

A

Preferred drug for reactive airways disease or moderate to severe allergic reaction. Important drug for leukemia reaction.

181
Q

MOA of Prednisone/ Deltasone

A

Affects gene transcription to either stimulate or repress protein production

182
Q

class of Dexamethasone/ Decadron

A

fluorinated corticosteriod

183
Q

Ind. of Dexamethasone/ Decadron

A

Extremely potent anti-inflammatory. Useful in IV form for reducing intracranial pressure.

184
Q

MOA of Dexamethasone/ Decadron

A

Affects gene transcription to either stimulate or repress protein production

185
Q

class of Triamcinolone inhaler/Azmacort

A

corticosteroid

186
Q

ind. of Triamcinolone inhaler/Azmacort

A

asthma, COPD. Not indicated for treating an acute asthma attack once it has already began.

187
Q

MOA of Triamcinolone inhaler/Azmacort

A

Diminished inflammation of bronchial wall. Affects gene transcription and alters protein production.

188
Q

Side effects of Triamcinolone inhaler/Azmacort

A

Thrush, sore throat, nosebleeds, increased coughing, headache, runny nose and other side effects as noted in prior slides.

189
Q

class of Fludrocortisone/ Florinef

A

Halogenated glucocorticoid/Mineralcorticoid agonist

190
Q

ind. of Fludrocortisone/ Florinef

A

mineralcorticoid replacement for patients with Addison’s disease and in other cases of hyponatremia

191
Q

MOA of Fludrocortisone/ Florinef

A

sodium retention. Main effect is via reduction of sodium loss to the urine at the renal tubular cells.

192
Q

drug not indicated as an anti-inflammatory agent

A

Fludrocortisone/ Florinef

193
Q

Side effects of Fludrocortisone/ Florinef

A

Salt retention, edema, hypertension, rash, nausea and vomiting, as well as the potential side effects that are attributable to glucocorticoids.

194
Q

Key Addisonian crisis symptom and additional symptoms

A

Key: Hyponatremia and hypoglycemia

Additional: severe lethargy, severe vomiting/diarrhea, hypotension, confusion, LOC, convulsions, fatal if untreated

195
Q

Schedule I

A

no currently accepted medical use and high potential for abuse

196
Q

schedule II

A

potential for abuse less than schedule I but still high

197
Q

schedule III

A

moderate to low potential for dependence

198
Q

schedule IV

A

low potential for abuse/dependence

199
Q

schedule V

A

lowest potential for abuse

Pharm 2 Jack (7 decks)

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