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Pharmacology Test 3 > Test 3 Drugs > Flashcards

Test 3 Drugs Flashcards

1
Q

Somatropin indication

A

Hypotituitarism (dwarfism)

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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

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3
Q

Somatropin AE

A
  1. fluid retention/edema
  2. muscle and joint pain
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4
Q

Somatropin PT Specific Considerations

A
  1. drug accuracy is difficult
  2. altered hormone levels exceeding normal ranges
  3. report abnormal ailments to endocrinologist
  4. Low GH = low BMD = fracture risk
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5
Q

What is DDAVP?

A

synthetic ADH (Vasopressin)

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6
Q

Desmopressin (DDAVP) indication?

A
  1. hypopituitarism
  2. nocturia
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7
Q

Desmopressin (DDAVP) MOA

A

decreases water exceretion, increasing urine concentration

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8
Q

Desmopressin (DDAVP) AE

A
  1. dry mouth
  2. hyponatremia
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9
Q

Drug class for spironolactone

A

Diuretic (K+ sparring)

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10
Q

Spironolactone indication

A
  1. Hyperaldosteronism (mineralocorticoid excess)
  2. HTN
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11
Q

Spironolactone MOA

A

nonselective for aldosterone receptors

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12
Q

Spironolactone AE

A
  1. hyperkalemia
  2. lethargy
  3. mental confusion
  4. produces gynecomastia in males
  5. irregualrity in females
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13
Q

Spironolactone notes

A

used in testosterone blockade for gender transition (male to female)

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14
Q

Eplerenone drug class

A

Diuretic

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15
Q

Eplerenone Indication

A

Hyperaldosteronism (mineralocorticoid excess)

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16
Q

Eplerenone MOA

A

aldosterone receptor blocker

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17
Q

Eplerenone AE

A
  1. hyperkalemia
  2. lethargy
  3. mental confusion
  4. produces gynecomastia in males
  5. irregualrity in females
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18
Q

Eplerenone Notes

A

more selective than spironolactone

more sought out

more expensive

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19
Q

Drug Classes that treat Muscle Spasticity

A
  1. Alpha 2 adrenergic agonist
  2. centrally acting antispasmodics
  3. DAA
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20
Q

Muscle spasticity drugs

A
  1. Tizanidine (Zanaflex)
  2. cyclobenzaprine (Flexeril)
  3. baclofen
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21
Q

Alpha 2 adrenergic agonist drug that treats muscle spasticity

A

tizanidine (Zanaflex)

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22
Q

Centrally acting antispasmodic drug that treats muscle spasticity

A

cyclobenzaprine (Flexeril)

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23
Q

DDA drug that treats muscle spasticity

A

baclofen

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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

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25
Q

tizanidine (Zanaflex) AE

A
  1. dizziness
  2. drowsiness
  3. asthenia
  4. hypotension up to 33% within 1 hr,
    • peaks 2-3 hrs after doses
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26
Q

tizanidine (Zanaflex) PK/PD considerations

A

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

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27
Q

cyclobenzaprine (Flexeril) MOA

A

unknown

may inhibit polysnaptic reflex in SC

also possible GABA and serotonin effects, varies by drug

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28
Q

cyclobenzaprine (Flexeril) AE

A
  1. sedation
  2. dizziness
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29
Q

Notes on cyclobenzaprine (Flexeril)

A
  1. Beer’s list
  2. increased risk of fractures
  3. some anticholinergic effects
  4. may have limited efficacy at tolerable doses
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30
Q

baclofen MOA

A

inhibitory effects on alpha motor neuron through inhibition of excitatory neurons (blocks Ca2+ influx into presynaptic terminal = decreases NT release)

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31
Q

baclofen AE

A
  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
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32
Q

baclofen PK/PD considerations

A

increased drug effectiveness with smaller doses

usually intrathecal method

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33
Q

baclofen PT specific considerations

A

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
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34
Q

Testosterone Indication

A

Androgen deficiency

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35
Q

Testosterone administration route

A
  1. Topical
  2. subcutaneous
  3. patch
  4. gel
  5. nasal spray
  6. buccal
  7. NO PO option = hepatotoxicity
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36
Q

Testosterone AE

A
  1. increase risk of MI, stroke, CV death
  2. Prolonged use
    • hepatic toxicitiy
    • hepatitis
    • jaundice
  3. IM
    • hepatic adeomas
    • infertility with large doses
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37
Q

Testosteron PK/PD considerations

A

IM –> large swings from trough to peak = variable symptoms relief and mood changes

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38
Q

Testosterone PT specific considerations

A
  1. avoid contact with path/gel areas
  2. monitor BP
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39
Q

B3 adrenergic agonist drug

A

Mirabegron (Myrebetriq)

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40
Q

mirabegron (Myrbetriq) indication

A

Men’s BPH (begnin prostatic hypertrophy)

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41
Q

mirabegron (Myrbetriq) MOA

A

relaxes detrusor muscle = decreases voiding symptoms

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42
Q

mirabegron (Myrbetriq) AE

A

increases BP

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43
Q

oxybutynin drug class

A

anticholinergic

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44
Q

oxybutynin indication

A

Men’s BPH (benign prostatic hypertrophy)

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45
Q

oxybutynin MOA

A

antispasmodic effect on smooth musce = blocks acetylcholine on smooth muscle

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46
Q

oxybutynin AEs

A

ABCDs

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47
Q

levothyroxine (Synthroid) indication

A

hypothyroidism

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48
Q

levothyroxine MOA

A

synthetic thyroxine (T4), converted to T3, has usual effects

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49
Q

levothyroxine AE

A

well tolerated unless overtreated

  1. sweating
  2. heat sensitivity
  3. tachycardia
  4. dirrhea
  5. nervousness
  6. menstrual irregularities
  7. increase BMR
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50
Q

levothyroxine PK/PD considerations

A
  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
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51
Q

levothyroxine PT specific considerations

A
  1. requires monitoring/close adjustments
  2. monitor for cardiac symptoms
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52
Q

levothyroxine Notes

A

highest risk: baseline CAD, HF

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53
Q

methimazole indication

A

hyperthyroidism

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54
Q

methimazole MOA

A

used a monotherapy for 1st year to induce remission

blocks formation of T3, T4 by inhibiting oxidation of iodine

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55
Q

methimazole AE

A

Common

  1. rash
  2. GI upset
  3. arthralgia (can develop into polyarthritis)

Rare AE

  1. agranulocytosis
  2. hepatotoxicitiy
  3. can cause hypothyroidism
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56
Q

methimazole PT specific considerations

A

refer if pt develops fever, sore throat, mouth ulcers (possible agranulocytosis)

*hepatotoxicity: increased risk with PTU

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57
Q

methimazole NOTES

A

can cause birth defects in 1st trimester of pregnancy

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58
Q

what is used to treat hypoparathyroidism?

A

calcium

vitamin D

59
Q

MOA of vitamin D

A

stimualtes hematoporeisis

60
Q

AE for calcium trx of of hypoparathyroidism

A

overtreatment can cause:

  1. hypercalcemia
  2. hypercalciuria = leading to nephrolithiasis
61
Q

what class of drug is metformin (Glucophage)?

A

Biguanide

62
Q

metformin (Glucophage) indication

A

Diabetes Type II

63
Q

metformin (Glucophage) MOA

A

not fully known

  1. inhibits production of glucose
  2. inhibits intestinal absorption of glucose
  3. increases insulin sensitivity to muscle and fat
64
Q

metformin (Glucophage) AE

A
  1. GI cramping
  2. N/V/D
65
Q

metformin (Glucophage) PT specific considerations

A

boxed warnings: lactic acidosis

more common if:

  1. renal impairment
  2. dehydration
  3. elderly
  4. acute decompensated HF
  5. excess alcohol
66
Q

metformin (Glucophage) Notes

A

Vitamin B12 deficiency can be misdiagnosed as peripheral neuropathy

67
Q

what class of drug is glipizide?

A

Sulfonylureas

68
Q

glipizide indication

A

Diabetes Type II

69
Q

glipizide MOA

A

binds sulfonurea receptor in pancreas –> depolarization causes insulin release

70
Q

glipizide AE

A
  1. hypoglycemia (especially in elder and renal dysfunction)
  2. weight gain
71
Q

glipizide PK/PD considerations

A

take before breakfast

immediate release must be 30 mins before meal

72
Q

glipizide PT specific considerations

A

if not taken correctly can increase hypoglycemia risk

73
Q

glipizide Notes

A

on ther Beer’s List

74
Q

Stimulant drugs

A
  1. mixed amphetamine salts (Adderall)
  2. methyphenidate (Concerta, Ritalin)
75
Q

mixed amphetamine salts drug class

A

Stimulants

76
Q

Mixed amphetamine salts brand name

A

Adderall

77
Q

Adderall indication

A

ADHD

78
Q

Adderall MOA

A

block dopamine and NE reuptake, increase dopamine and NE release

79
Q

AE for:

Adderall

methylphenidate (Concerta, Ritalin)

A
  1. decrease appetite
  2. wt. loss
  3. stomach ache
  4. insomnia
  5. HA
  6. irritabililty/jitteriness
80
Q

Rare AE for:

Adderall

methylphenidate (Concerta, Ritalin)

A
  1. dysphoria
  2. spacey state
  3. Tics
  4. HTN and HR fluctuations
  5. hallucinations
  6. chemical leukoderma (white skin from patch)
81
Q

PK/PD considerations for:

mixed amphetamine salts (Adderall)

methylphenidate (Concerta, Ritalin)

A

if taken with food, slower onset and may decrease absorption and some AE

82
Q

PT Specific considerations for:

mixed amphetamine salts (Adderall)

methylphenidate (Concerta, Ritalin)

A

report concerns about dependence or non therapeutic use

83
Q

Boxed warnings for:

mixed amphetamine salts (Adderall)

methylphenidate (Concerta, Ritalin)

A
  1. CV risk – misuse can cause death or CV AE
  2. use w/caution w/CV disease present
  3. abuse potential (especially illictly)
84
Q

atomoxetine (Strattera) indication

A

ADHD

85
Q

atomoxetine (Strattera) MOA

A

selective NE reuptake ihibitor (SNRI)

86
Q

atomoxetine (Stratter) AE

A

similar to other stimulants but more fatigue, sedation, and dizziness

87
Q

atomextine (Strattera) PK/PD considerations

A
  1. onset: 2-4 weeks
  2. 6-12 weeks when reaching full benefit (must build up)
88
Q

PT specific considerations atomoxetine (Strattera)

A

Boxed warnings:

monitor for suicidal ideation in adolescents/children

monitor mood changes

89
Q

T/F: atomoxetine (Strattera) can be used as a monotherapy +/- stimulant

A

TRUE

90
Q

Drug classes used to in treatment of Parkinson’s Disease

A
  1. Dopamine replacement therapy
  2. Dopamine agonist therapy
91
Q

levodopa-carbidopa (Sinemet) drug class

A

dopamine replacement therapy

92
Q

levodopa-carbidopa (Sinemet) MOA

A
  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
Q

levodopa-carbidopa (Sinemet) AE

A
  1. motor disturbances
  2. end of dose “wearing off”
  3. delayed or “no on” effect
  4. freezing
  5. “on” perioid dyskinesia
94
Q

levodopa-carbidopa (Sinemet)

“wearing off” AE

A

stiffness returns (short 1/2 life of l-dopa)

95
Q

what is freezing from levodopa-carbidopa (Sinemet)?

A

sudden inhibition of LE function

96
Q

what is levodopa-carbidopa (Sinemet) “on” period dyskinesia?

A

involuntary mvmt of neck, trunk, extremities

due to peak drug levels causing increase dopamine response

97
Q

PK/PD considerations of levodopa-carbidopa (Sinemet)

A

L-dopa has a short 1/2 life.

have consistent meal routine (high protein meal decreases absorption)

98
Q

PT specific considerations for levodopa-carbidopa (Sinemet)?

A

ask them if they are taking the med regularly

99
Q

ropinirole (Requip) drug class

A

Dopamine Agonist Therapy

100
Q

what is ropinirole (Requip) indicated for?

A

PD

101
Q

ropinirole (Requip) MOA

A

Binds to and agonizes dopamine receptors - helps with restless leg syndrome

102
Q

ropinirole (Requip) AE

A
  1. Nausea
  2. drowsiness
  3. dizziness
  4. syncope
  5. light headedness
  6. postural hypotension
  7. hallucinations
  8. lower extremity edema
103
Q

less common AE for ropinirole (Requip)

A
  1. impulsive behavior
  2. sleep attacks
104
Q

when would ropinirole (Requip) be used as a monotherapy?

A

in younger pts.

normally be used as adjunct to reduce end of dose wearing off of l-dopa

105
Q

Drugs used to treat MS

A
  1. Interferon beta
  2. glatiramer acetate
  3. fingolimod (Gilenya)
  4. dimethyl fumarate (Tecfidera)
  5. natalizumab (Tysabri)
  6. ocrelizumab (Ocrevus)
106
Q

Drug class of interferon Beta

A

Interferon

107
Q

interferon beta MOA

A

exact is unknown in MS

IFN-B is a protein produced by fibroblasts and has impact on immune function

108
Q

interferon beta AE

A
  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
Q

PT specific considerations fo interferon B?

A
  1. monitorr for neuropyschic changes
  2. drug induced hyperthyroidism
  3. worsening cardiac function in HF
110
Q

glatiramer acetate MOA

A

reduce autoimmune response to myelin by reducing T cell response against myelin

111
Q

glatiramer acetate common AE

A
  1. ***injection site rxns (most common)
  2. rash
  3. dyspnea
  4. chest pain
112
Q

S1P receptor modulator drug

A

fingolimod (gilenya)

113
Q

fingolimod (Gilenya) MOA

A

converted to active metabolites which blocks release of lymphocytes into CNS = reduces inflammation

114
Q

fingolimod (Gilenya) AE

A
  1. >15% = HA, increased LFTs
  2. rare = macular edema, infection
115
Q

dimethyl fumarate brand name

A

Tecfidera

116
Q

dimethyl fumarate (Tecfidera) MOA

A

may have anti-inflammatory properties

117
Q

dimethyl fumarate (Tecfidera) AE

A
  1. GI (N/V/D, abdominal pain in 12-18%)
  2. flushing (40%)
  3. ***Rare = hepatoxicity
118
Q

monoclonal antibodies AE

A
  1. infusion related rxns
  2. HA
  3. fatigue
  4. arthalgia
  5. monitor for infection (respiratory, skin, herpes related)
119
Q

donepezil (Atricept) drug class

A

acetylcholinesterase inhibitor

120
Q

donepezil (Atricept) indication

A

AD

121
Q

donepezil (Atricept) MOA

A

inhibit acetylcholinesterase which breaks down ACh = increased ACh, corrects for ACh deficiency in AD

122
Q

donepezil (Atricept) AE

A

SLUDGE

DUMBELLS

123
Q

donepezil (Atricept) PK/PD considerations

A

taper if discontinuing and monitor for worsening cognitive function

124
Q

donepezil (Atricept) Other

A
  1. Beer’s list for bradycardia
  2. avoid if history of syncope that may be related to bradycardia
125
Q

memantine (Namenda) drug class

A

NMDA antagonist

126
Q

memantine (Namenda) indication

A

AD

127
Q

memantine (Nameda) MOA

A

antagonised NMDA receptor = stops excessive receptor activation by glutamate = decreases excitation and neuronal death

128
Q

memantine (Namenda) AE

A

usually well tolerated

monitor for falls

129
Q

tizanidine brand name

A

Zanaflex

130
Q

tizanidine (Zanaflex) drug class

A

Alpha 2 adrenergic agonist

131
Q

tizanidine (Zanaflex) MOA

A

selectively bind to alpha 2 receptors in CNS to decrease release of excitatory NTs from presynaptic terminals = decreased excitability of postsynaptic neurons

132
Q

tizanidine (Zanaflex) AE

A
  1. dizziness
  2. drowsiness
  3. asthenia
  4. HTN up to 33% within 1 hr (peaks 2-3 hrs after dose)
133
Q

tizanidine (Zanaflex) PK/PD Considerations

A

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
Q

cyclobenzaprine brand name

A

Flexeril

135
Q

cyclobenzaprine (Flexeril) drug class

A

Centrally Acting Antispasmodics

136
Q

cyclobenzaprine (Flexeril) MOA

A

unclear

may inhibit polysnaptic reflex in spinal cord

also possible GABA and serotonin effects

137
Q

cyclobenzaprine (Flexeril) AE

A
  1. sedation
  2. dizziness
138
Q

cyclobenzaprine (Flexeril) Notes

A

on Beer’s list = increased risk for

  1. fractures
  2. some anticholinergic effects
  3. may have limited efficacy at tolerable doses
139
Q

baclofen drug class

A

DAA

140
Q

baclofen MOA

A

inhibitory effect on alpha motor neuron through inhibition of excitatory neurons (blocks Ca influx into presynaptic terminal) = decreases NT release

141
Q

baclofen AE

A
  1. CNS depression
  2. muscle weakness
  3. impaired memory and cognition in older adults and TBI
142
Q

baclofen PK/PD Considerations

A

increased drug effectiveness with smaller doses using intrathecal method (ITB)

143
Q

baclofen specific concerns

A

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
Q
A

Pharmacology Test 3 (10 decks)

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