Test 3 Drugs Flashcards
1
Q
Somatropin indication
A
Hypotituitarism (dwarfism)
2
Q
Somatropin MOA
A
synthetic GH
has a role in bone, skeletal muscle, and organ growth.
Increases RBC mass, water transport, and electrolyte transport
3
Q
Somatropin AE
A
- fluid retention/edema
- muscle and joint pain
4
Q
Somatropin PT Specific Considerations
A
- drug accuracy is difficult
- altered hormone levels exceeding normal ranges
- report abnormal ailments to endocrinologist
- Low GH = low BMD = fracture risk
5
Q
What is DDAVP?
A
synthetic ADH (Vasopressin)
6
Q
Desmopressin (DDAVP) indication?
A
- hypopituitarism
- nocturia
7
Q
Desmopressin (DDAVP) MOA
A
decreases water exceretion, increasing urine concentration
8
Q
Desmopressin (DDAVP) AE
A
- dry mouth
- hyponatremia
9
Q
Drug class for spironolactone
A
Diuretic (K+ sparring)
10
Q
Spironolactone indication
A
- Hyperaldosteronism (mineralocorticoid excess)
- HTN
11
Q
Spironolactone MOA
A
nonselective for aldosterone receptors
12
Q
Spironolactone AE
A
- hyperkalemia
- lethargy
- mental confusion
- produces gynecomastia in males
- irregualrity in females
13
Q
Spironolactone notes
A
used in testosterone blockade for gender transition (male to female)
14
Q
Eplerenone drug class
A
Diuretic
15
Q
Eplerenone Indication
A
Hyperaldosteronism (mineralocorticoid excess)
16
Q
Eplerenone MOA
A
aldosterone receptor blocker
17
Q
Eplerenone AE
A
- hyperkalemia
- lethargy
- mental confusion
- produces gynecomastia in males
- irregualrity in females
18
Q
Eplerenone Notes
A
more selective than spironolactone
more sought out
more expensive
19
Q
Drug Classes that treat Muscle Spasticity
A
- Alpha 2 adrenergic agonist
- centrally acting antispasmodics
- DAA
20
Q
Muscle spasticity drugs
A
- Tizanidine (Zanaflex)
- cyclobenzaprine (Flexeril)
- baclofen
21
Q
Alpha 2 adrenergic agonist drug that treats muscle spasticity
A
tizanidine (Zanaflex)
22
Q
Centrally acting antispasmodic drug that treats muscle spasticity
A
cyclobenzaprine (Flexeril)
23
Q
DDA drug that treats muscle spasticity
A
baclofen
24
Q
tizanidine (Zanaglex) MOA
A
selectively binds to alpha 2 receptors in CNS to decrease release of excitatory NT from presynaptic terminals and decrease excitability of postsynaptic neurons
25
tizanidine (Zanaflex) AE
1. dizziness
2. drowsiness
3. asthenia
4. hypotension up to 33% within 1 hr,
* peaks 2-3 hrs after doses
26
tizanidine (Zanaflex) PK/PD considerations
sedation: within 30 minutes of dose
peak 1.5 hours after dose
may take with or w/o food but be consistent due to variable absorption
27
cyclobenzaprine (Flexeril) MOA
unknown
may inhibit polysnaptic reflex in SC
also possible GABA and serotonin effects, varies by drug
28
cyclobenzaprine (Flexeril) AE
1. sedation
2. dizziness
29
Notes on cyclobenzaprine (Flexeril)
1. Beer's list
2. increased risk of fractures
3. some anticholinergic effects
4. may have limited efficacy at tolerable doses
30
baclofen MOA
inhibitory effects on alpha motor neuron through inhibition of excitatory neurons (blocks Ca2+ influx into presynaptic terminal = decreases NT release)
31
baclofen AE
1. CNS depressant
* sedation, ataxia, cardiac/resp depression
2. Muscle weakness
3. In older adults and TBI -\> impaired memory and cognition
4. transient drowsiness usually disappears within a few days
32
baclofen PK/PD considerations
increased drug effectiveness with smaller doses
usually intrathecal method
33
baclofen PT specific considerations
DO NOT abruptly stop meds = can lead to:
1. high fever
2. AMS
3. exaggerated rebound spasiticity and muscle rigidity
4. rhabdomyolysis
5. system failure
34
Testosterone Indication
Androgen deficiency
35
Testosterone administration route
1. Topical
2. subcutaneous
3. patch
4. gel
5. nasal spray
6. buccal
7. NO PO option = hepatotoxicity
36
Testosterone AE
1. increase risk of MI, stroke, CV death
2. Prolonged use
* hepatic toxicitiy
* hepatitis
* jaundice
3. IM
* hepatic adeomas
* infertility with large doses
37
Testosteron PK/PD considerations
IM --\> large swings from trough to peak = variable symptoms relief and mood changes
38
Testosterone PT specific considerations
1. avoid contact with path/gel areas
2. monitor BP
39
B3 adrenergic agonist drug
Mirabegron (Myrebetriq)
40
mirabegron (Myrbetriq) indication
Men's BPH (begnin prostatic hypertrophy)
41
mirabegron (Myrbetriq) MOA
relaxes detrusor muscle = decreases voiding symptoms
42
mirabegron (Myrbetriq) AE
increases BP
43
oxybutynin drug class
anticholinergic
44
oxybutynin indication
Men's BPH (benign prostatic hypertrophy)
45
oxybutynin MOA
antispasmodic effect on smooth musce = blocks acetylcholine on smooth muscle
46
oxybutynin AEs
ABCDs
47
levothyroxine (Synthroid) indication
hypothyroidism
48
levothyroxine MOA
synthetic thyroxine (T4), converted to T3, has usual effects
49
levothyroxine AE
well tolerated unless overtreated
1. sweating
2. heat sensitivity
3. tachycardia
4. dirrhea
5. nervousness
6. menstrual irregularities
7. increase BMR
50
levothyroxine PK/PD considerations
1. take on empty stomach
2. take 30-60 mins before meal or 3-4 hours after
3. do not take with Ca, Mg, Fe, and Al products
51
levothyroxine PT specific considerations
1. requires monitoring/close adjustments
2. monitor for cardiac symptoms
52
levothyroxine Notes
highest risk: baseline CAD, HF
53
methimazole indication
hyperthyroidism
54
methimazole MOA
used a monotherapy for 1st year to induce remission
blocks formation of T3, T4 by inhibiting oxidation of iodine
55
methimazole AE
Common
1. rash
2. GI upset
3. arthralgia (can develop into polyarthritis)
Rare AE
1. agranulocytosis
2. hepatotoxicitiy
3. can cause hypothyroidism
56
methimazole PT specific considerations
refer if pt develops fever, sore throat, mouth ulcers (possible agranulocytosis)
\*hepatotoxicity: increased risk with PTU
57
methimazole NOTES
can cause birth defects in 1st trimester of pregnancy
58
what is used to treat hypoparathyroidism?
calcium
vitamin D
59
MOA of vitamin D
stimualtes hematoporeisis
60
AE for calcium trx of of hypoparathyroidism
overtreatment can cause:
1. hypercalcemia
2. hypercalciuria = leading to nephrolithiasis
61
what class of drug is metformin (Glucophage)?
Biguanide
62
metformin (Glucophage) indication
Diabetes Type II
63
metformin (Glucophage) MOA
not fully known
1. inhibits production of glucose
2. inhibits intestinal absorption of glucose
3. increases insulin sensitivity to muscle and fat
64
metformin (Glucophage) AE
1. GI cramping
2. N/V/D
65
metformin (Glucophage) PT specific considerations
boxed warnings: lactic acidosis
more common if:
1. renal impairment
2. dehydration
3. elderly
4. acute decompensated HF
5. excess alcohol
66
metformin (Glucophage) Notes
Vitamin B12 deficiency can be misdiagnosed as peripheral neuropathy
67
what class of drug is glipizide?
Sulfonylureas
68
glipizide indication
Diabetes Type II
69
glipizide MOA
binds sulfonurea receptor in pancreas --\> depolarization causes insulin release
70
glipizide AE
1. hypoglycemia (especially in elder and renal dysfunction)
2. weight gain
71
glipizide PK/PD considerations
take before breakfast
immediate release must be 30 mins before meal
72
glipizide PT specific considerations
if not taken correctly can increase hypoglycemia risk
73
glipizide Notes
on ther Beer's List
74
Stimulant drugs
1. mixed amphetamine salts (Adderall)
2. methyphenidate (Concerta, Ritalin)
75
mixed amphetamine salts drug class
Stimulants
76
Mixed amphetamine salts brand name
Adderall
77
Adderall indication
ADHD
78
Adderall MOA
block dopamine and NE reuptake, increase dopamine and NE release
79
AE for:
Adderall
methylphenidate (Concerta, Ritalin)
1. decrease appetite
2. wt. loss
3. stomach ache
4. insomnia
5. HA
6. irritabililty/jitteriness
80
Rare AE for:
Adderall
methylphenidate (Concerta, Ritalin)
1. dysphoria
2. spacey state
3. Tics
4. HTN and HR fluctuations
5. hallucinations
6. chemical leukoderma (white skin from patch)
81
PK/PD considerations for:
mixed amphetamine salts (Adderall)
methylphenidate (Concerta, Ritalin)
if taken with food, slower onset and may decrease absorption and some AE
82
PT Specific considerations for:
mixed amphetamine salts (Adderall)
methylphenidate (Concerta, Ritalin)
report concerns about dependence or non therapeutic use
83
Boxed warnings for:
mixed amphetamine salts (Adderall)
methylphenidate (Concerta, Ritalin)
1. CV risk -- misuse can cause death or CV AE
2. use w/caution w/CV disease present
3. abuse potential (especially illictly)
84
atomoxetine (Strattera) indication
ADHD
85
atomoxetine (Strattera) MOA
selective NE reuptake ihibitor (SNRI)
86
atomoxetine (Stratter) AE
similar to other stimulants but more fatigue, sedation, and dizziness
87
atomextine (Strattera) PK/PD considerations
1. onset: 2-4 weeks
2. 6-12 weeks when reaching full benefit (must build up)
88
PT specific considerations atomoxetine (Strattera)
Boxed warnings:
monitor for suicidal ideation in adolescents/children
monitor mood changes
89
T/F: atomoxetine (Strattera) can be used as a monotherapy +/- stimulant
TRUE
90
Drug classes used to in treatment of Parkinson's Disease
1. Dopamine replacement therapy
2. Dopamine agonist therapy
91
levodopa-carbidopa (Sinemet) drug class
dopamine replacement therapy
92
levodopa-carbidopa (Sinemet) MOA
1. L-dopa is a precursor to dopamine that can cross the BBB and be converted to have CNS action
2. carbidopa stops the breakdown of l-dopa to dopamine in periphery so that more l-dopa crosses BBB
93
levodopa-carbidopa (Sinemet) AE
1. motor disturbances
2. end of dose "wearing off"
3. delayed or "no on" effect
4. freezing
5. "on" perioid dyskinesia
94
levodopa-carbidopa (Sinemet)
"wearing off" AE
stiffness returns (short 1/2 life of l-dopa)
95
what is freezing from levodopa-carbidopa (Sinemet)?
sudden inhibition of LE function
96
what is levodopa-carbidopa (Sinemet) "on" period dyskinesia?
involuntary mvmt of neck, trunk, extremities
due to peak drug levels causing increase dopamine response
97
PK/PD considerations of levodopa-carbidopa (Sinemet)
L-dopa has a short 1/2 life.
have consistent meal routine (high protein meal decreases absorption)
98
PT specific considerations for levodopa-carbidopa (Sinemet)?
ask them if they are taking the med regularly
99
ropinirole (Requip) drug class
Dopamine Agonist Therapy
100
what is ropinirole (Requip) indicated for?
PD
101
ropinirole (Requip) MOA
Binds to and agonizes dopamine receptors - helps with restless leg syndrome
102
ropinirole (Requip) AE
1. Nausea
2. drowsiness
3. dizziness
4. syncope
5. light headedness
6. postural hypotension
7. hallucinations
8. lower extremity edema
103
less common AE for ropinirole (Requip)
1. impulsive behavior
2. sleep attacks
104
when would ropinirole (Requip) be used as a monotherapy?
in younger pts.
normally be used as adjunct to reduce end of dose wearing off of l-dopa
105
Drugs used to treat MS
1. Interferon beta
2. glatiramer acetate
3. fingolimod (Gilenya)
4. dimethyl fumarate (Tecfidera)
5. natalizumab (Tysabri)
6. ocrelizumab (Ocrevus)
106
Drug class of interferon Beta
Interferon
107
interferon beta MOA
exact is unknown in MS
IFN-B is a protein produced by fibroblasts and has impact on immune function
108
interferon beta AE
1. \>50% -- flu like symptoms
2. \>20%
1. fatigue
2. depression
3. pain
4. abdominal pain
5. nausea
6. leukopenia
7. increased LFTs
8. myalgia
9. back pain
10. weakness
11. fever
109
PT specific considerations fo interferon B?
1. monitorr for neuropyschic changes
2. drug induced hyperthyroidism
3. worsening cardiac function in HF
110
glatiramer acetate MOA
reduce autoimmune response to myelin by reducing T cell response against myelin
111
glatiramer acetate common AE
1. \*\*\*injection site rxns (most common)
2. rash
3. dyspnea
4. chest pain
112
S1P receptor modulator drug
fingolimod (gilenya)
113
fingolimod (Gilenya) MOA
converted to active metabolites which blocks release of lymphocytes into CNS = reduces inflammation
114
fingolimod (Gilenya) AE
1. \>15% = HA, increased LFTs
2. rare = macular edema, infection
115
dimethyl fumarate brand name
Tecfidera
116
dimethyl fumarate (Tecfidera) MOA
may have anti-inflammatory properties
117
dimethyl fumarate (Tecfidera) AE
1. GI (N/V/D, abdominal pain in 12-18%)
2. flushing (40%)
3. \*\*\*Rare = hepatoxicity
118
monoclonal antibodies AE
1. infusion related rxns
2. HA
3. fatigue
4. arthalgia
5. monitor for infection (respiratory, skin, herpes related)
119
donepezil (Atricept) drug class
acetylcholinesterase inhibitor
120
donepezil (Atricept) indication
AD
121
donepezil (Atricept) MOA
inhibit acetylcholinesterase which breaks down ACh = increased ACh, corrects for ACh deficiency in AD
122
donepezil (Atricept) AE
SLUDGE
DUMBELLS
123
donepezil (Atricept) PK/PD considerations
taper if discontinuing and monitor for worsening cognitive function
124
donepezil (Atricept) Other
1. Beer's list for bradycardia
2. avoid if history of syncope that may be related to bradycardia
125
memantine (Namenda) drug class
NMDA antagonist
126
memantine (Namenda) indication
AD
127
memantine (Nameda) MOA
antagonised NMDA receptor = stops excessive receptor activation by glutamate = decreases excitation and neuronal death
128
memantine (Namenda) AE
usually well tolerated
monitor for falls
129
tizanidine brand name
Zanaflex
130
tizanidine (Zanaflex) drug class
Alpha 2 adrenergic agonist
131
tizanidine (Zanaflex) MOA
selectively bind to alpha 2 receptors in CNS to decrease release of excitatory NTs from presynaptic terminals = decreased excitability of postsynaptic neurons
132
tizanidine (Zanaflex) AE
1. dizziness
2. drowsiness
3. asthenia
4. HTN up to 33% within 1 hr (peaks 2-3 hrs after dose)
133
tizanidine (Zanaflex) PK/PD Considerations
sedation can occur within 30 minutes of dose
peaks ~1.5 hrs after dose
may take with or w/o food but be consistent due to variable absorption
134
cyclobenzaprine brand name
Flexeril
135
cyclobenzaprine (Flexeril) drug class
Centrally Acting Antispasmodics
136
cyclobenzaprine (Flexeril) MOA
unclear
may inhibit polysnaptic reflex in spinal cord
also possible GABA and serotonin effects
137
cyclobenzaprine (Flexeril) AE
1. sedation
2. dizziness
138
cyclobenzaprine (Flexeril) Notes
on Beer's list = increased risk for
1. fractures
2. some anticholinergic effects
3. may have limited efficacy at tolerable doses
139
baclofen drug class
DAA
140
baclofen MOA
inhibitory effect on alpha motor neuron through inhibition of excitatory neurons (blocks Ca influx into presynaptic terminal) = decreases NT release
141
baclofen AE
1. CNS depression
2. muscle weakness
3. impaired memory and cognition in older adults and TBI
142
baclofen PK/PD Considerations
increased drug effectiveness with smaller doses using intrathecal method (ITB)
143
baclofen specific concerns
Do not abruptly stop med \>\> can lead to:
1. altered mental state (AMS)
2. fever
3. exaggerated rebound spasticity
4. rhabdomylosis
5. organ failure
144
